Left-sided heart failure treatment in 112 Cardiac surgery clinics in Asia with additional parameter

Recently I had to admit my mother here in an emergency. The staff is very rude and they didn’t allow me to be with mom as a primary caregiver. In fact they didn’t inform me anything about my mom’s health condition what treatment was going on etc. they treated us all as if my mom was put in a jail. There was no emergency help staff who could guide and explain us through all the protocols. We were restlessly waiting in panic until the morning to wait until doctors consult. The staff didn’t even give the basic information like her BP stats and what food she had eaten. I believe we have the right to information and doctors are supposed to give us the periodic updates on the medical conditions. They kept everything under the wraps in the name of hospital protocol which we were never informed before admission. We had to forcefully take discharge and move her to another hospital where her health improved significantly

Doctors of course were good, nurses n ward boys r also nice. Main is d rooms n hospital maintenence as compared to what they are charging per patient is in absolutely pathetic condition. I wonder in our country we never get quality as compared to what one is paying for.

My mom was admitted to this hospital on 16th May for AVR & Ascending Aorta surgery. Surgery was successfully done by Dr. Ramakanta Panda. Best part of the hospital is Dr. Panda and the nursing staffs. The nurses took care of my mother like their own family member. Sister Sape, Pranita & Pallavi are few names that I remember. All others were equally good. Sape is missing from the photos but I will always remember her. Hoping for the best.

The hospital staff needs to improve their compassion and empathy towards patients and their families. The customer service and facilities are below par. A dignified and respectful treatment should be provided to every individual, regardless of their social status. The families of ICU patients should be given a proper place to rest while waiting for updates. The hospital should convert dead spaces into lounges or waiting areas for families. Despite the high fees, the services, facilities, and staff attitudes do not meet the expectations.

I had a terrible experience with the gay cashier and fat male bodyguard who were assigned at that time. The guard shouted at me because I asked him for the second time the cashier's office since his instruction at first was unclear. When I went upstairs, that gay cashier was soo rude! He got annoyed because I did not tell him right away that I would be using GLs. He insulted me by saying "Di lahat ng patients dito GL ang binabayad". I apologized patiently and told him that IT WAS MY FIRST TIME THERE. Yet, he was still frowning. HOW COME THIS HOSPITAL HIRED THOSE AGRESSIVE STAFF? I just controlled my anger and emotions since my father had to undergo a surgery at that time. I didn't want to stress him and my mother. On the other hand, the doctors were kind and approachable. I hope this concern will be raised, anyway.

Pretty much go there monthly to buy my maintenance medicines from their pharmacy. Waiting times can be long with their new July 2023 procedures where the 4th floor pharmacy only takes cash and card sales. The 1st floor only takes GL transaxtions and only entertains cash transactions at 4pm daily. Senior discounts are applied for 30day supplies only. 😑

About a year ago, I underwent heart valve replacement surgery.The doctor gave thorough explanations and the nurses, even though they were all young, treated me with great care. Even patients who complained due to stress were treated with sincerity. When I was in the ICU, the assistant doctor had to take me to the bathroom every hour in the middle of the night because of the diuretics I was in. When I apologized, she said with a smile, "Don't worry about it, it's fine!" I was able to spend my time with peace of mind. I am very glad that I had the surgery at this hospital. Even though the food is low in salt, there are about 3 side dishes, so I think it's satisfying.

Thank you everyone for your kind response! It's clear to see that he puts his patients first. My illness, which had not been detected even though it had become serious at a major local hospital, was immediately discovered here, and I was given very detailed care, arranging for surgery and the prognosis. I believe that it is the best hospital in the world in terms of technology, service, and everything else.

Three years ago, I had a blood vessel transplant and catheter surgery for coronary artery stenosis and angina pectoris here, and since then I've been going to the hospital regularly.It's a clean hospital, I feel comfortable, and it's conveniently located near JR Kishibe Station, which is helpful.

Establishment of the Bangabandhu Sheikh Mujib Medical University was an upgrade of the Institute of Postgraduate Medicine and Research (IPGMR). IPGMR was established in December 1965, as a Government-controlled postgraduate institute for medical research and studies. It was housed in the now defunct Hotel Shahbag, once the biggest hotel in Dhaka. The hotel got its name Shahbag from the name of the neighborhood. From 2010, many of the medical and public health colleges/institutes have become affiliated to BSMMU. For example BIRDEM, BIHS, DMC, SSMC, NICVD, NITOR and others. It was renamed as Bangabandhu Sheikh Mujib Medical University by the Act 1, 1998 of Jatiyo Sangshad after the first President of Bangladesh, Bangabandhu Sheikh Mujibur Rahman BSMMU has an academic library known as BSMMU Central Library, and a digital library. The university publishes a peer-reviewed medical journal, Bangabandhu Sheikh Mujib Medical University. It publishes 4 issue per year. The institution's top leadership, the vice-chancellor, has had ten individuals since it began in 1998: M. A. Quadery (30 Apr 1998 - 9 Jan 2001) Md. Tahir (10 Jan 2001 - 17 May 2001) Mahmud Hasan (18 May 2001 - 23 Nov 2001) M. A. Mishu (24 Nov 2001 - 21 Dec 2006) Md. Tahir (21 Dec 2006 - 4 Nov 2008) Md. Nazrul Islam (5 Nov 2008 - 24 Mar 2009) Pran Gopal Datta (25 Mar 2009 – 24 Mar 2012) Pran Gopal Datta (25 Mar 2012 – 24 Mar 2015) Kamrul Hasan Khan (24 March 2015 – 23 Mar 2018) Kanak Kanti Barua (24 March 2018 –23 March 2021) Md. Sharfuddin Ahmed (29 March 2021–present) List of affiliated colleges/institutes under BSMMU:[8] Armed Forces Medical Institute (AFMI), Dhaka Bangabandhu Sheikh Mujib Medical College, Faridpur Bangladesh Institute of Child Health (BICH), Dhaka Bangladesh Institute of Health Sciences Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders (BIRDEM Academy), Dhaka Center for Medical Education (CME), Dhaka Dhaka Dental College, Dhaka Dhaka Medical College, Dhaka Enam Nursing College, Savar, Dhaka Bangabandhu Sheikh Mujib Medical College, Faridpur Ibrahim Cardiac Hospital & Research Institute Institute of Child & Mother Health (ICMH), Dhaka Institute of Child Health & Shishu Sasthya Foundation Hospital, Dhaka Institute of Community Ophthalmology, Chittagong Ispahani Islamia Eye Institute and Hospital, Dhaka Kumudini Welfare Trust, Mirzapur, Tangail Lions Eye Institute & Hospital, Dhaka Mymensingh Medical College, Mymensingh National Institute of Advanced Nursing Education and Research, Dhaka National Heart Foundation Hospital & Research Institute, Dhaka National Institute of Cardiovascular Diseases (NICVD), Dhaka National Institute of Cancer Research & Hospital, Dhaka National Institute of Diseases of the Chest and Hospital (NIDCH), Dhaka National Institute of Kidney Diseases & Urology (NIKDU), Dhaka National Institute of Mental Health (NIMH), Dhaka National Institute of Neurosciences & Hospital National Institute of Nuclear Medicine & Allied Science, Dhaka National Institute of Ophthalmology (NIO), Dhaka National Institute of Preventive and Social Medicine (NIPSOM), Dhaka National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Dhaka National Institute of ENT, Tejgaon, Dhaka Shaheed Suhrawardy Medical College, Dhaka Sheikh Hasina National Institute of Burn and Plastic Surgery Sir Salimullah Medical College, Dhaka.

Bangabandhu Sheikh Mujib Medical University (BSMMU) is the premier Postgraduate Medical Institution of the country. It bears the heritage to Institute of Postgraduate Medical Research (IPGMR) which was established in December 1965. In the year 1998 the Government converted IPGMR into a Medical University for expanding the facilities for higher medical education and research in the country. It has an enviable reputation for providing high quality postgraduate education in different specialties. The university has strong link with other professional bodies at home and abroad. The university is expanding rapidly and at present, the university has many departments equipped with modern technology for service, teaching and research. Besides education, the university plays the vital role of promoting research activities in various discipline of medicine. Since its inception, the university has also been delivering general and specialized clinical service as a tertiary level healthcare center. There service is very good

Bangabandhu Sheikh Mujib Medical University popularly known as PG Hospital, is the first medical university in Bangladesh. Before becoming a university, its name was Institute of Post Graduate Medicine and Research. It is located in Shahbagh, Dhaka. Right next to it there are two another institution these are 'Bangladesh National Meuseum' and 'Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BARDEM)'. The Institute of Post Graduate Medicine and Research (IPGMR) was established in Dhaka in 1965 to provide postgraduate courses in medical education. Although responsible for post-graduate teaching and research, this institution did not have degree-granting powers. It was entrusted to Dhaka University. Dhaka University used to offer MBBS degree in many medical colleges including IPGMR program. On April 30, 1998, it was converted into a full-fledged medical university through a parliamentary ordinance. Although the MBBS course was introduced, the institution earlier offered only post-graduate education. The new university was named after Bangabandhu Sheikh Mujibur Rahman. This university has a hospital which is equipped to provide quality treatment. The university has a total of five multi-storied buildings; Block A, B, C, D and Cabin Block. Education, research and treatment run parallel in this medical university.

Such a great hospital with a great service too. The existence of this hospital are really helpfull. With good facilities and complete doctors, hopefully it can help more people.

Overally good hospital in Pku, just need to expand the parking area inside..

the best hospital in Pekanbaru that i ever known.

MCU - Today, 5 Dec 2023. Thank you very much to Suster Ria, Suster Dwi, Suster Fenti, Suster Putri dan Suster Wulan who help us in serving and guiding during the MCU process. We are satisfy with the service and all paramedics support for our heath check up.

I am recovering from Bell's Palsy and require therapy treatments. I am very happy with the services and treatment from the staff here. Nurul and Ben provide excellent services. They are friendly and motivating too. Very well done!

Good service as always, the schedule is always in time. Thank you Drg Rahma Natalia, nurse Utari n nurse Kiki for your kindness and good service to my kiddos.

Ok best in batam

Very fraudulent behaviour for a hospital. The prices for vaccinations are not clear and they don't have a transparent and upfront price chart for them. The first time i asked to get an MMR vaccination, they said it was total cost for 2 injections ALL TOGETHER. When i came back for my 2nd injection, they told me to pay the same price once more. They cheat you without giving you correct details of the price and without a clear price chart on each vaccine. Even on the invoice thats given, the breakdown of the total price is NOT THERE. This is a complaint towards the head of the Medical Check Up unit, Dr Anna Maria Marlina. Maam, tell you're staff and nurses to be transparent and honest about prices because this is unprofessional. Otherwise, you're scamming your own patients.

Patients Hospitalize with broken bones and breathing problems. I thought, Awal Bros Hospital is the best choice in Batam. instead its the worsts of the worst. We paid with deluxe room. (Not insurance) feel like, no nurses are working to take care of the patient.not even helping with the poop and washing not even care in checking to change the infused tube. Nurse service worst than government hospitals. absolutely need to train more humanly nurse not just to receive monthly pay check.. Doctor come in after 2days patients hospitalized. Even the Doctor came in just for info. not a single finger touched the patient to check heart beat or breathing problem....what kind of hospital is this. Thank you for your worst service. Hope for your wonderful future.

May Allah bless all workers and the Government may Allah make us grateful

It supposed to be the best Hospital in the Sultanate. Despite all the expertise and the best facilities as well as state of the art equipments. Still the outcome is not as good as it supposed to be. In order to ensure that the best services are provided the management should spend more time in the field rather than sitting in the offices.

We booked a private room for 20 rial a day and 100 rial deposit. The room is around 18m2 (6*3). Contains a bathroom a fridge and a small extra bed. Its located just beside the normal admission beds. The price is a bit high for the room but there was no other options.

Our experience with BIMC was exceptional. Highly caring and skilled staff led by Dr. Priangga who provided great care and follow up the following day. Many thanks to all at BIMC.

Very good hospital. I had a triple ankle fracture in September. Everybody is speaking English. Surgery was done perfect! Medication was very good, i felt nearly no pain! Recovery is really good, i can go cycling again.

Staff is super slow. You may book an appointment and then wait for hours. And every time they Will day that you is a next one. For payment l, minum half an hour waiting for then to make up an invoice. Very dissapointing service, but specialist doctors are generally good

Welcome to PMCH - Parkview Medical College & Hospital Bangladesh is rapidly becoming a role model for different aspect of health care development among developing countries. It is not possible for a government alone to develop health manpower to cater the increasingly complex, diverse and expensive public health care needs of a developing country like Bangladesh. In addition to Government Medical Colleges, Private Medical Colleges in Bangladesh are performing very significant role in producing skilled medical health professionals and providing specialized health care facilities at reasonable cost to ailing people of the country. To develop a new Medical College, location is a significant factor. 

We came for an endoscopy test scheduled at 11:30 am but had to wait for over 50 minutes. The delayed doctor appointment was a frustrating experience for us and other patients

A decent medical facility is taken into account a basic would like for all. there's AN imperative would like for moderate to glorious health care facilities within the town of Chattogram. In Chattogram, there are not any well-equipped hospital compared to the hospital in Dhaka. They wanted to modify these health care facilities and revolution to established a well-facilitated and fashionable hospital within the town of port.

I recently found myself admitted to Mahkota Hospital due to a severe migraine, and I must express my gratitude for the exceptional care and support I received during my stay, particularly in Ward 9.Nurse Linda and the entire team in Ward 9 went above and beyond to ensure my well-being. Nurse Litta, in particular, demonstrated unwavering dedication and compassion in her care. Her attentiveness, professionalism, and genuine concern for patients like me were truly remarkable. She not only attended to my medical needs promptly but also provided much-needed emotional support, creating a comforting environment during a challenging time.The overall atmosphere of Ward 9 was remarkable—clean, organized, and conducive to healing. The staff's collective effort in maintaining a high standard of care while fostering a supportive atmosphere did not go unnoticed.My experience at Mahkota Hospital, especially in Ward 9, was reassuring and comforting, largely due to Nurse Linda's exceptional care. I wholeheartedly recommend this hospital and Ward 9 for their outstanding healthcare and the compassionate approach they bring to patient well-being.Heartfelt thanks to Nurse Linda and the entire team in Ward 9 for their dedication and unwavering commitment to patient care.

I would like to thank Dr Chan and his team for the successful TKR surgery. He is very proficient, professional and yet humble! I don't encounter much pain after the surgery and I am recovering well. Thank you very much Dr Chan! Highly recommended him !! Would like also to thank the staff of ward 7B who are friendly and helpful. However noted that there is insufficient walking frame during my stay. I've limited mobility and this creates inconvenience for me as I have to share with other patients. This should not be happening! Overall the rooms are newly refurbished and very comfortable. Thank you!

5 star service by Dr Wan ( Gynecologist ) and Dr Loo ( Pediatrician ). Baby delivery went on smooth, special thanks to all the lovely staff at Level 2 ward for their utmost kindness and pleasant hospitality throughout the 2 days there. Dr’s were very professional from the very start till the end. Thank you again and highly recommended

I lived most of my life suffering from pain and discomfort that kept getting worse. I was diagnosed with endometriosis 2 month ago and underwent a surgery with Dr Gul Rana. From the initial consultation to the surgery and follow-up care, the entire process was smooth. She made me feel comfortable every step of the way. The surgical procedure was success, I walked out with a set date for laparoscopic surgery. After 7 days of my surgery, I walk out of her clinic but this time pain-free, healthier and feel more confident. Thank you, Dr. Gul e Rana and her assistant Ms Manju for being so so nice and helpful. Thank you once again for your exceptional care and I immensely more grateful for the care I received from CSH staff and Specially nurses. I highly recommend Dr. Gul e Rana to anyone seeking top-notch gynecological care. If I had the option, I would give Dr. Gul e Rana a perfect 10-star rating! Her compassion, understanding, calm demeanor, and genuine care for her patients are truly remarkable. Her extensive knowledge allows her to explain complex matters in a way that anyone can easily grasp. She is the best...❤️❤️❤️

I was referred by a friend to see one of your specialists, but I'm experiencing difficulties with the booking system. The staff handling the process lacks in customer service and marketing skills. Instead of retaining customers, they seem to be pushing them away. I suggest implementing more engaging scheduling options to keep patients interested.

Thank you so much Dr Sarah Alam Endocrinologist for the difference you make in the lives of your patients. Your kindness, sincere caring, and concern make everything better and are a great encouragement. I am a diabetic since 2018 and visited many doctors. They just prescribed medicines and I couldn’t control my sugar level at all. I wanted to give a try at the Canadian Hospital and I went there in August. When I visited Dr Sarah Alam Endocrinologist my Hba1c level was at 9.9 and yesterday after the test it was down at 6. Such a vast improvement. Dr Sarah’s aim was to control my sugar level. She is so skilled at what she does. I had a lot of health complications when I went to her and now I feel a lot better in every aspect. I never thought I could get better, but she put me on the right medications and gave me the proper treatment. She is keen to know about everything that affects the patient, and treats even the slightest problem they have. Also, she respects your phone calls and messages and replies timely. She calls personally to check up on you. I had the best experience with her, I recommend her to all diabetics who are with uncontrolled sugar levels and others who need to visit an endocrinologist. She’s the best in Dubai. She’s a remarkable doctor and a professional I can trust.

The Signature hospital is well connected and easy to access, making it a great option for those seeking quality healthcare. Overall treatment is good. The services were good and the staff and doctors were excellent in all ways. Everything was good. Very good treatment and the doctors are very friendly. I would definitely recommend this hospital to family and friends!

In this hospital where I had my appendicitis operation provided excellent care. The medical staff was attentive and professional throughout my stay. The surgery went smoothly, and the recovery process was well-managed. I felt confident in their expertise, making a stressful situation more manageable. Overall, a top-notch healthcare experience...!✌🏻😄

I recently had an exceptional experience at Signature Advanced Specialty Hospital. From the moment I walked in, the staff was incredibly welcoming and attentive. The doctors displayed a high level of expertise and took the time to thoroughly explain the treatment plan, putting me at ease. The hospital's state-of-the-art facilities and advanced technology were impressive. I also appreciated the cleanliness and organization throughout the hospital.

We visited this hospital for outpatient treatment. They have refurbished the interior and looks better than our last visit some years ago. Counter staff were courteous. Doctor was helpful in explanation of the condition and the MRI scan was done efficiently at comparatively reasonable cost.

The staff nurses here are very friendly and jovial, ever ready to help. Old building but well-refurbished. Services are excellent with affordable price. Nursery staff nurse came to ask for suggestions or feedback but can't think of anything that they should improve 🤣

A revisit to Dr Lam since year 2019. Arrived about 7:50am on Saturday and the registration counter alread full of people. Waited about 30 mins for my turn. Direct went into Cardiolgy Unit, reception was friendly. Dr Lam, as before very patience to explain in details for the things I need to know. Done my Stress Test (level 6 in 17 mins) and Echo. Report is very good, according to Dr Lam and need to go back only after 2 years :) . The chief nurse (I guess, based on the color of the uniform), did not ask for her name, is very efficient and friendly to handle the reception area. Thank you Dr Lam and the nurses.

I recently delivered my baby boy at Kings College Dubai Hills. I had a memorable and an amazing experience and felt so at home. My husband and I were so humbled and couldn’t have asked for more private care. All the staff and nurses were excellent and I was in good hands. However, Leanne my midwife was exceptionally helpful and was like a second Mum to me. She went above and beyond all the time to make sure I was ok. She assisted me with everything I had to learn and know as a new Mum and always made me feel at ease. She is always so hardworking, professional and passionate about what she does. I’ve never met someone who loves what they do so much! Leanne has provided so much care post my delivery as well and she has become a very close friend of mine. I can confidently recommend Leanne as she deserves it. I am convinced that having her as a member of staff will be a valuable asset.

I delivered my baby with King's in July 2022. I highly recommend the hospital and stuff working there, everyone was very supportive and kind. I am sincerely grateful to Dr. Esra for my delivery. On a separate note, I sincerely want to thank Mary Grace for her kind support. As a first time mother, even whilst I was attending Antenatal classes, I lacked practical experience of how to take care of baby. Mary Grace was very attentive and showed us how to bath and change the baby, explaining many interesting life hacks. Her support and explanation how to breastfeed the baby was indispensable, without her I would not be that lucky to establish breastfeeding which I continue to date.

Dr. May Ali has been an incredible support throughout my twin pregnancy journey. Her professionalism and unwavering support guided me every step of the way. Her expertise and care during the C-section brought my beautiful baby girls into the world safely. I'm immensely grateful for her dedication and expertise. Additionally, her assistant Princy was always attentive and supportive, making the entire experience even more reassuring. I'm definitely continuing as Dr. May's patient for any future needs🙂

Everything was perfect The doctors and staff are very caring, efficient and handle everything with great deal of understanding and patience. There is no time wasted or any waiting during any off the procedures. Highly recommend this top hospital and their doctors, thanks Dr. Arneja .

Better than any other hospitals i can think of. Admission and treatment is very good . staff is good. They will take good care of your patient . they take great and immediate care of the patient . Special thanks Dr Arneja sir

"I recently had the excellent experience of having my father undergo bypass surgery at Arneja hospital. I can't praise the hospital staff enough for their friendliness and cooperation. They took care of everything exceptionally well, and all the services provided were spot on. Any doubts or concerns we had were promptly addressed. I highly recommend this hospital for the exceptional care and support they offer."

TERRIBLY SLOW!! 1 hour in a queue for payment and medicine collection. I’ve been using this hospital for several years and the service is significantly getting worse. There’s no SMS or any notifications to let you know when your queue is coming up, so you have no choice but to wait patiently in the waiting area. Staffs were nice and friendly but there must be something totally wrong with the system or process. Please take this as a feedback to improve your service.

I prebooked my consultation and surgey from New Zealand at Sikarin Hospital, Their International team made everything so easy for me, beautiful hospital, very clean and all the staff i encounted were fantastic, My Doctor in urology dept was excellent as was his team. I am happy to recommend this hospital to all travelers and of coarse the lovely Thai people. Thank you.

The service usual great but now just dropped below acceptable. Loud construction noise in waiting area, long wait time. Very disappointed

AVOID THEIR ER. They will give you test and procedures that has nothing to do with what you came for. Pregnancy Test and CT Scan for cough and sore throat?! Come on! Stop scamming people! If you really must visit them, always ask and check first what they want to do. If it's irrelevant, just SAY NO! YOU'VE BEEN WARNED!

My relative was confined in this hospital for four days. In those four days, her doctor only visited her twice but charged us P8,000 as PF. Nurses only came in when called--via phone because the nurse call button was cut. We were monitoring our patient's fever ourselves. I've reviewed the bill and there were questionable charges as well like gloves, tape etc. It's not as if the nurses finished all of those supplies but we were charged for the whole amount nonetheless. This would have been okay if the excess supplies were given to the patient upon discharge. ER charges were unreasonable as well. There were only three patients when we came in yet the whole process of admitting the patient took 2 hours, meanwhile incurring more and more charges in the ER. But the worst part of the experience was requiring the patient to have a companion for the purpose of having someone actually take care of the patient. Doesn't that negate the purpose of going to the hospital? You go to a hospital to get medical treatment and care. But it seemed like we were only there for the convenience of having labs done and having IV fluids--which to be honest can be done at home--because the actual care of the patient came from the companion. In effect, companions need to miss work to take care of the patient. For as long as the patient is confined, they miss the opportunity to earn money--which they need in the first place to be able to pay for the high hospital bill. It's an oppressive system. This set-up would have been forgivable if companions had a comfortable bed if they are required to be with the patient 24/7. But no, they are only given a plastic chair. And even if we get the private room, a companion is still required. People go to private hospitals for better service, but it seems like the only difference between DLSMC and a public hospital is that this hospital has aircon. What a waste of hard-earned money.

Amazing and professional Doctors, Nurses, and Staff. They really value their patient's well-being. Kudos to everyone. Godbless you all! Special thanks to Dra. Mary Grace B. Rojas. Very compassionate and responsive to my queries.

Very good service, the staff is so polite and good attitude. One of the best hospitals in bekasi👍🏻

In my first two visits, I was impressed with their quite efficient system. But not today, looong wait for my medicine. Apparently, after certain time ( 8.30 or 9 pm ?) Pharmacy service for BPJS and non BPJS was combined with only one staff delivering the medicine. Kindly revisit this. People deserve what they pay for.

your procedure for KIS patient treatment sucks btw. you have that bunch of patients, so u know what u should do to reduce it. also the service of the staff to inform the schedule for surgery especially for cardiac specialist, plin plan gak jelas infonya. big evaluation for the KIS patient procedure is needed.