Search results for: care pathways

Authors: Sahar Shams

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Coeliac disease (CD) is a widely reported disease particularly in countries with predominant Caucasian populations. It presents with many signs and symptoms including iron deficiency (ID) and iron deficiency anaemia/anaemia (IDA/A). The exact association between ID, IDA/A and CD and how accurate these signs are in diagnosing CD is not fully known. This systematic review was conducted to investigate the accuracy of both ID & IDA/A as a diagnostic indicator for CD and whether it warrants point of care testing. A systematic review was performed looking at studies published in MEDLINE, Embase, Cochrane Library, and Web of Science. QUADAS-2 tool was used to assess risk of bias in each study. ROC curve and forest plots were generated as part of the meta-analysis after data extraction. 16 studies were identified in total, 13 of which were IDA/A studies and 3 ID studies. The prevalence of CD regardless of diagnostic indicator was assumed as 1%. The QUADAS-2 tool indicated most of studies as having high risk of bias. The PPV for CD was higher in those with ID than for those with IDA/A. Meta-analysis showed the overall odds of having CD is 5 times higher in individuals with ID & IDA/A. The ROC curve showed that there is definitely an association between both diagnostic indicators and CD, the association is not a particularly strong one due to great heterogeneity between studies. Whilst an association between IDA/A & ID and coeliac disease was evident, the results were not deemed significant enough to prompt coeliac disease testing in those with IDA/A & ID.

Keywords: anemia, iron deficiency anemia, coeliac disease, point of care testing

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Authors: Enkelejda Shkurti, Diamant Shtiza

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Background: Health-related quality of life (HRQoL) is a significant consequence in health care. The objective of our study was to recognize features related to lower HRQoL scores in children with anorectal malformation (ARM) and Hirschsprung disease (HD). Methods: Children younger than 18 years, with HD or ARM, that were assessed at our private clinic in Tirana, Albania, from December 2018 to October 2019, were acknowledged. The outcomes of broad questionnaires concerning diagnosis, symptoms, and preceding health/surgical history and authenticated tools to measure urinary status, stooling grade, and HRQoL were appraised. Results: In patients aged 0-6 years, vomiting and abdominal enlargement were allied with a substantial decrease in total HRQoL scores. In children > 6 years of age, vomiting, abdominal swelling, and abdominal discomfort were also linked to a considerably lower HRQoL. The main indicator of lower HRQoL scores on regression tree analysis in all age clusters was the occurrence of psychosomatic, behavioral, or progressive comorbidity. Conclusion: Children with both HD or ARM that have a psychosomatic, behavioral, or growing problem experience considerably lower HRQoL than patients deprived of such problems, proposing that establishment of behavioral/growing sustenance as part of the care of these patients may have a considerable influence on their HRQoL.

Keywords: anorectal malformation, Hirsch Sprung disease, quality of life, Albania

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Authors: Nicole Selvi Hill, Archchana Radhakrishnan

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Introduction: Traumatic brain injury (TBI) is a leading cause of mortality among trauma patients. In the management of TBI, the main principle is avoiding cerebral ischemia, as this is a strong determiner of neurological outcomes. The use of vasoactive drugs, such as vasopressin, has an important role in maintaining cerebral perfusion pressure to prevent secondary brain injury. Current guidelines do not suggest a preferred vasoactive drug to administer in the management of TBI, and there is a paucity of information on the therapeutic potential of vasopressin following TBI. Vasopressin is also an endogenous anti-diuretic hormone (AVP), and pathways mediated by AVP play a large role in the underlying pathological processes of TBI. This creates an overlap of discussion regarding the therapeutic potential of vasopressin following TBI. Currently, its popularity lies in vasodilatory and cardiogenic shock in the intensive care setting, with increasing support for its use in haemorrhagic and septic shock. Methodology: This is a review article based on a literature review. An electronic search was conducted via PubMed, Cochrane, EMBASE, and Google Scholar. The aim was to identify clinical studies looking at the therapeutic administration of vasopressin in severe traumatic brain injury. The primary aim was to look at the neurological outcome of patients. The secondary aim was to look at surrogate markers of cerebral perfusion measurements, such as cerebral perfusion pressure, cerebral oxygenation, and cerebral blood flow. Results: Eight papers were included in the final number. Three were animal studies; five were human studies, comprised of three case reports, one retrospective review of data, and one randomised control trial. All animal studies demonstrated the benefits of vasopressors in TBI management. One animal study showed the superiority of vasopressin in reducing intracranial pressure and increasing cerebral oxygenation over a catecholaminergic vasopressor, phenylephrine. All three human case reports were supportive of vasopressin as a rescue therapy in catecholaminergic-resistant hypotension. The retrospective review found vasopressin did not increase cerebral oedema in TBI patients compared to catecholaminergic vasopressors; and demonstrated a significant reduction in the requirements of hyperosmolar therapy in patients that received vasopressin. The randomised control trial results showed no significant differences in primary and secondary outcomes between TBI patients receiving vasopressin versus those receiving catecholaminergic vasopressors. Apart from the randomised control trial, the studies included are of low-level evidence. Conclusion: Studies favour vasopressin within certain parameters of cerebral function compared to control groups. However, the neurological outcomes of patient groups are not known, and animal study results are difficult to extrapolate to humans. It cannot be said with certainty whether vasopressin’s benefits stand above usage of other vasoactive drugs due to the weaknesses of the evidence. Further randomised control trials, which are larger, standardised, and rigorous, are required to improve knowledge in this field.

Keywords: catecholamines, cerebral perfusion pressure, traumatic brain injury, vasopressin, vasopressors

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Authors: Aneena Suresh, C. S. Sidharth

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Drug related problems (DRPs) are common in chronic kidney disease (CKD) patients and end stage patients undergoing hemodialysis. To treat the co-morbid conditions of the patients, more complex therapeutic regimen is required, and it leads to development of DRPs. So, this calls for frequent monitoring of the patients. Due to the busy work schedules, physicians are unable to deliver optimal care to these patients. Addition of a clinical pharmacist in the team will improve the standard of care offered to CKD patients by minimizing DRPs. In India, the role of clinical pharmacists in the improving the health outcomes in CKD patients is poorly recognized. Therefore, this study is conducted to put an insight on the role of clinical pharmacist in improving Drug Related Problems in patients with chronic kidney disease, thereby helping them to achieve desired therapeutic outcomes in the patients. A prospective interventional study was conducted for a year in a 620 bedded tertiary care hospital in India. Data was collected using an unstructured questionnaire, medication charts, etc. DRPs were categorized using Hepler and Strand classification. Relationships between the age, weight, GFR, average no of medication taken, average no of comorbidities, and average length of hospital days with the DRPs were identified using Mann Whitney U test. The study population primarily constituted of patients above the age of 50 years with a mean age of 59.91±13.59. Our study showed that 25% of the population presented with DRPs. On an average, CKD patients are prescribed at least 8 medications for the treatment in our study. This explains the high incidence of drug interactions in patients suffering from CKD (45.65%). The least common DRPs in our study were found to be sub therapeutic dose (2%) and adverse drug reactions (2%). Out of this, 60 % of the DRPs were addressed successfully. In our study, there is an association between the DRPs with the average number of medications prescribed, the average number of comorbidities, and the length of the hospital days with p value of 0.022, 0.004, and 0.000, respectively. In the current study, 86% of the proposed interventions were accepted, and 41 % were implemented by the physician, and only 14% were rejected. Hence, it is evident that clinical pharmacist interventions will contribute significantly to diminish the DRPs in CKD patients, thereby decreasing the economic burden of healthcare costs and improving patient’s quality of life.

Keywords: chronic kidney disease, clinical pharmacist, drug related problem, intervention

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Authors: Rose Chapman Rodriguez

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Problem: Evidence-based practice (EBP) attributes are significantly associated with EBP implementation science, which improves patient care outcomes. Nurses influence EBP, yet little is known of the specific EBP attributes of pediatric nurses in their clinical sub-specialties. Aim: This study aims to investigate the relationship between nursing academic degree, years of experience, and clinical specialty, with mean survey scores on EBP belief, organizational culture, and implementation scales across all levels of nursing in a Children’s Hospital. Methods: A convenience sample of nurses (n=185) participated in a descriptive, cross-sectional, correlational study in May 2023. The electronic surveys comprised 11 demographic questions and nine survey items from the short-version EBP Beliefs Scale (Cronbach α = 0.81), Organizational Culture and Readiness Scale for System-wide Integration Scale (Cronbach α = 0.87), and EBP Implementation Scale (Cronbach α = 0.89). Findings: EBP belief scores were notably higher in nurses working in neonatology (m=4.33), critical care (m=4.47), and among nurse leaders (m=4.50). There was a statistically significant difference in EBP organizational culture among nurse leaders (m = 3.95, p=0.039) compared to clinical nurses (m = 3.34) and advanced practice nurses (m = 3.34). EBP implementation was favorable in neonatology (m=4.20), acute care (m=4.05), and nurse leaders (m=4.33). No significant difference or correlation was found in EBP belief, organizational culture, or implementation mean scores related to nurses' age, academic nursing degree, or years of experience in our cohort (EBP beliefs (r = -.06, p = .400), organizational readiness (r = .02, p = .770), and implementation scales (r = .01, p = .867). Conclusions: This study identified nurse’s EBP attributes in a Children’s Hospital using key variables studied in EBP social cognitive theory and learning theory. Magnet status, shared governance structure, specialty certification, and nurse leaders play a significant role in favorable EBP culture and implementation. Nurses’ unit level ‘group culture’ may vary depending on the EBP attributes and collaborative efforts of local teams. Opportunities for mentoring were identified, which may continue to enhance EBP implementation science across all nursing roles in our pediatric organization.

Keywords: evidence-based practice, peditrics, nursing roles, implementation

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Authors: Ibrahim A. Alkali

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There is no reservation on the outstanding contribution of patient families in restoration of hospitalised patients, hence their consideration as essential component of hospital ward regimen. The psychological and emotional support a patient requires has been found to be solely provided by the patient’s family. However, consideration of their presence as one of the major functional requirements of an inpatient setting design have always been a source of disquiet, especially in developing countries where policies, norms and protocols of healthcare administration have no consideration for the patients’ family. This have been a major challenge to the hospital ward facilities, a concern for the hospital administration and patient management. The study therefore is aimed at obtaining a consensus opinion on the best approach for family integration in the design of an inpatient setting.  A one day visioning charrette involving Architects, Nurses, Medical Doctors, Healthcare assistants and representatives from the Patient families was conducted with the aim of arriving at a consensus opinion on practical design approach for sustainable family integration. Patient’s family are found to be decisive character of hospital ward regimen that cannot be undermined. However, several challenges that impede family integration were identified and subsequently a recommendation for an ideal approach. This will serve as a guide to both architects and hospital management in implementing much desired Patient and Family Centred Care.

Keywords: patient's family, inpatient setting, care giving, integration

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Authors: Fernanda Ludmilla Rossi Rocha, Thamiris Cavazzani Vegro, Silvia Helena Henriques Camelo, Carmen Silvia Gabriel, Andrea Bernardes

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Introduction: Organizations are cultural, symbolic and imaginary systems composed by values and norms. These values and norms represent the organizational culture, which determines the behavior of the workers, guides the work practices and impacts the quality of care and the safety culture of health services worldwide. Objective: To analyze the organizational culture of a public and a private hospital in Brazil. Method: Descriptive study with quantitative approach developed in a public and in a private hospital of Brazil. Sample was composed by 281 nursing workers, of which 73 nurses and 208 nursing auxiliaries and technicians. The data collection instrument comprised the Brazilian Instrument for Assessing Organizational Culture. Data were collected from March to December 2013. Results: At the public hospital, the results showed an average score of 2.85 for the values concerning cooperative professionalism (CP); 3.02 for values related to hierarchical rigidity and the centralization of power (HR); 2.23 for individualistic professionalism and competition at work (IP); 2.22 for values related to satisfaction, well-being and motivation of workers (SW); 3.47 for external integration (EI); 2.03 for rewarding and training practices (RT); 2.75 for practices related to the promotion of interpersonal relationships (IR) About the private hospital, the results showed an average score of 3.24 for the CP; 2.83 for HR; 2.69 for IP; 2.71 for SW; 3.73 for EI; 2.56 for RT; 2.83 for IR at the hospital. Discussion: The analysis of organizational values of the studied hospitals shows that workers find the existence of hierarchical rigidity and the centralization of power in the institutions; believed there was cooperation at workplace, though they perceived individualism and competition; believed that values associated with the workers’ well-being, satisfaction and motivation were seldom acknowledged by the hospital; believed in the adoption of strategic planning actions within the institution, but considered interpersonal relationship promotion, continuous education and the rewarding of workers to be little valued by the institution. Conclusion: This work context can lead to professional dissatisfaction, compromising the quality of care and contributing to the occurrence of occupational diseases.

Keywords: nursing management, organizational culture, quality of care, interpersonal relationships

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Authors: Mokgadi Malatji, Tebogo Mothiba, Rambelani Malema

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Absenteeism is a global problem in the working force and this is no exception in the nursing profession. A lot of attention has been drawn to factors that contribute to absenteeism however little attention has been placed on the effects of absenteeism on the remaining workers/nurses being left behind in the workplace by their colleagues. Nurses absent themselves leaving behind their colleagues to do their work. Nurses who are committed to their work often find themselves working under strenuous conditions due to inadequate staff. These may lead to poor patient care provision, nurses feeling overworked and sick due to the increased workload. The purpose of this study was to investigate the effects of absenteeism on nurses that remained at work at Mankweng Hospital in the Capricorn District, Limpopo Province. A descriptive cross-sectional quantitative research design was conducted to determine if there were any effects of absenteeism on nurses remaining at work. Data collection was done using structured questionnaires. The respondents (n=107), consisted of different categories of registered nurses (professional nurses (n=43), auxiliary nurses (n=40) and staff nurses (n=24)) who participated in this study. The findings indicated that most nurses (76, 6%) are demotivated and they struggle with completion of duties when their colleagues are absent. Patient care that nurses provided when their colleagues were absent was of poor quality as set standards and principles were not adhered to. Individualized patient care was not being implemented due to absenteeism. This simply implies that routine work is being done to cover basic duties. Most nurses (74, 8%) believed that favoritism and lack of appreciation of nurse’s skills and capabilities are being displayed by managers and that this contributes to absenteeism. Nurses who are loyal sacrifice their time and work overtime for absent colleagues and this led to fatigue and stress. From the study findings, it is recommended that nurses be trained frequently to upgrade their studies to motivate them to work. The government can provide this training to improve their skills as this will motivate nurses to work harder and be committed to their work. Training can be offered after a stipulated period. For example, after every five years, a nurse can be provided with a new skill. Team building events must be encouraged for the whole hospital to motivate staff. In conclusion, the study revealed that absenteeism poses detrimental effects on nurses, the hospital and patients. More and more nurses end up changing workplace due to these effects.

Keywords: absenteeism, effects, nurses, remaining at work

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Authors: F. DelGaudio, H. Gill

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Resuscitation during cardiopulmonary (CPA) arrest is dynamic, high stress, high acuity situation, which can easily lead to communication breakdown, and errors. The care of these high acuity patients has also been shown to increase physiologic stress and task saturation of providers, which can negatively impact the care being provided. These difficulties are further complicated during a global pandemic and pose a significant safety risk to bedside providers. Nurse-led codes are a relatively new concept that may be a potential solution for alleviating some of these difficulties. An experienced nurse who has completed advanced cardiac life support (ACLS), and additional training, assumed the responsibility of directing the mechanics of the appropriate ACLS algorithm. This was done in conjunction with a physician who also acted as a physician leader. The additional nurse-led code training included a multi-disciplinary in situ simulation of a CPA on a suspected COVID-19 patient. During the CPA, the nurse leader’s responsibilities include: ensuring adequate compression depth and rate, minimizing interruptions in chest compressions, the timing of rhythm/pulse checks, and appropriate medication administration. In addition, the nurse leader also functions as a last line safety check for appropriate personal protective equipment and limiting exposure of staff. The use of nurse-led codes for CPA has shown to decrease the cognitive overload and task saturation for the physician, as well as limiting the number of staff being exposed to a potentially infectious patient. The real-world application has allowed physicians to perform and oversee high-risk procedures such as intubation, line placement, and point of care ultrasound, without sacrificing the integrity of the resuscitation. Nurse-led codes have also given the physician the bandwidth to review pertinent medical history, advanced directives, determine reversible causes, and have the end of life conversations with family. While there is a paucity of research on the effectiveness of nurse-led codes, there are many potentially significant benefits. In addition to its value during a pandemic, it may also be beneficial during complex circumstances such as extracorporeal cardiopulmonary resuscitation.

Keywords: cardiopulmonary arrest, COVID-19, nurse-led code, task saturation

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Authors: Kim Toyer, Belinda Thompson, Louise Koelmeyer

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Lymphoedema is a chronic condition caused by dysfunction of the lymphatic system, which limits the drainage of fluid and tissue waste from the interstitial space of the affected body part. The normal physiological changes in pregnancy cause an increased load on a normal lymphatic system which can result in a transient lymphatic overload (oedema). The interaction between lymphoedema and pregnancy oedema is unclear. Women with pre-existing lymphoedema require accurate information and additional strategies to manage their lymphoedema during pregnancy. Currently, no resources are available to guide women or their healthcare providers with accurate advice and additional management strategies for coping with lymphoedema during pregnancy until they have recovered postnatally. This study explored the experiences of Australian women with pre-existing lymphoedema during recent pregnancy and the early postnatal period to determine how their usual lymphoedema management strategies were adapted and what were their additional or unmet needs. Interactions with their obstetric care providers, the hospital maternity services, and usual lymphoedema therapy services were detailed. Participants were sourced from several Australian lymphoedema community groups, including therapist networks. Opportunistic sampling is appropriate to explore this topic in a small target population as lymphoedema in women of childbearing age is uncommon, with prevalence data unavailable. Inclusion criteria were aged over 18 years, diagnosed with primary or secondary lymphoedema of the arm or leg, pregnant within the preceding ten years (since 2012), and had their pregnancy and postnatal care in Australia. Exclusion criteria were a diagnosis of lipedema and if unable to read or understand a reasonable level of English. A mixed-method qualitative design was used in two phases. This involved an online survey (REDCap platform) of the participants followed by online semi-structured interviews or focus groups to provide the transcript data for inductive thematic analysis to gain an in-depth understanding of issues raised. Women with well-managed pre-existing lymphoedema coped well with the additional oedema load of pregnancy; however, those with limited access to quality conservative care prior to pregnancy were found to be significantly impacted by pregnancy, including many reporting deterioration of their chronic lymphoedema. Misinformation and a lack of support increased fear and apprehension in planning and enjoying their pregnancy experience. Collaboration between maternity and lymphoedema therapy services did not happen despite study participants suggesting it. Helpful resources and unmet needs were identified in the recent Australian context to inform further research and the development of resources to assist women with lymphoedema who are considering or are pregnant and their supporters, including health care providers.

Keywords: lymphoedema, management strategies, pregnancy, qualitative

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Authors: Rubaiyea Uddin, Rebecca Taylor, Emily Levesque

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The hippocampus, located in the limbic system, is most commonly known for its role in memory and spatial navigation (as cited in Brain Reward and Pathways). It maintains an especially important role in specifically episodic and declarative memory. The hippocampus has also recently been linked to dopamine, the reward pathway’s primary neurotransmitter. Since research has found that dopamine also contributes to memory consolidation and hippocampal plasticity, this neurotransmitter is potentially responsible for contributing to the hippocampus’s role in memory formation. In this experiment we tested to see the effect of tactile cues on spatial navigation for eight different mice. We used a radial arm that had one designated “reward” arm containing sucrose. The presence or absence of bedding was our tactile cue. We attempted to see if the memory of that cue would enhance the mice’s memory of having received the reward in that arm. The results from our study showed there was no significant response from the use of tactile cues on spatial navigation on our 129 mice. Tactile cues therefore do not influence spatial navigation.

Keywords: mice, radial arm maze, memory, spatial navigation, tactile cues, hippocampus, reward, sensory skills, Alzheimer's, neuro-degenerative diseases

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Authors: Ola A. Nassr, Ali M. Abd Alridha, Rua A. Naser, Rasha S. Abbas

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Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Keywords: Acute care, Antibiotic misuse, Iraq, Prescribing

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Authors: Francis Gyapong, Denis Yar

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The use of cell phones has become an indispensable tool in the hospital's settings. Cell phones are used in hospitals without restrictions regardless of their unknown microbial load. However, the indiscriminate use of mobile devices, especially at health facilities, can act as a vehicle for transmitting pathogenic bacteria and other microorganisms. These potential pathogens become exogenous sources of infection for the patients and are also a potential health hazard for self and as well as family members. These are a growing problem in many health care institutions. Innovations in mobile communication have led to better patient care in diabetes, asthma, and increased in vaccine uptake via SMS. Notwithstanding, the use of cell phones can be a great potential source for nosocomial infections. Many studies reported heavy microbial contamination of cell phones among healthcare workers and communities. However, limited studies have been reported in our region on bacterial contamination on cell phones among healthcare workers. This study assessed microbial contamination of cell phones of health care workers (HCWs) at the Mampong Municipal Government Hospital (MMGH), Ghana. A cross-sectional design was used to characterize bacterial microflora on cell phones of HCWs at the MMGH. A total of thirty-five (35) swab samples of cell phones of HCWs at the Laboratory, Dental Unit, Children’s Ward, Theater and Male ward were randomly collected for laboratory examinations. A suspension of the swab samples was each streak on blood and MacConkey agar and incubated at 37℃ for 48 hours. Bacterial isolates were identified using appropriate laboratory and biochemical tests. Kirby-Bauer disc diffusion method was used to determine the antimicrobial sensitivity tests of the isolates. Data analysis was performed using SPSS version 16. All mobile phones sampled were contaminated with one or more bacterial isolates. Cell phones from the Male ward, Dental Unit, Laboratory, Theatre and Children’s ward had at least three different bacterial isolates; 85.7%, 71.4%, 57.1% and 28.6% for both Theater and Children’s ward respectively. Bacterial contaminants identified were Staphylococcus epidermidis (37%), Staphylococcus aureus (26%), E. coli (20%), Bacillus spp. (11%) and Klebsiella spp. (6 %). Except for the Children ward, E. coli was isolated at all study sites and predominant (42.9%) at the Dental Unit while Klebsiella spp. (28.6%) was only isolated at the Children’s ward. Antibiotic sensitivity testing of Staphylococcus aureus indicated that they were highly sensitive to cephalexin (89%) tetracycline (80%), gentamycin (75%), lincomycin (70%), ciprofloxacin (67%) and highly resistant to ampicillin (75%). Some of these bacteria isolated are potential pathogens and their presence on cell phones of HCWs could be transmitted to patients and their families. Hence strict hand washing before and after every contact with patient and phone be enforced to reduce the risk of nosocomial infections.

Keywords: mobile phones, bacterial contamination, patients, MMGH

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Authors: Maha Salah Abdullah Ismail, Mahmoud M. Alsagheir, Mohammed Salah Abd Allah

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Acute respiratory distress syndrome (ARDS) is characterized by permeability pulmonary edema and refractory hypoxemia. Lung-protective ventilation is still the key of better outcome in ARDS. Prone position reduces the trans-pulmonary pressure gradient, recruiting collapsed regions of the lung without increasing airway pressure or hyperinflation. Prone ventilation showed improved oxygenation and improved outcomes in severe hypoxemic patients with ARDS. This study evaluates the effect of prone positioning on mechanically ventilated patients with ARDS. A quasi-experimental design was carried out at Critical Care Units, on 60 patients. Two tools were utilized to collect data; Socio demographic, medical and clinical outcomes data sheet. Results of the present study indicated that prone position improves oxygenation in patients with severe respiratory distress syndrome. The study recommended that use prone position in patients with severe ARDS, as early as possible and for long sessions. Also, replication of this study on larger probability sample at the different geographical location is highly recommended.

Keywords: acute respiratory distress syndrome, critical care, mechanical ventilation, prone position

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Authors: Tero Huhtala, Minna Pikkarainen, Saila Saraniemi

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Information technology has long been used as an enabler of exchange for goods and services. Services are evolving from generic to personalized, and the reverse use of customer data has been discussed in both academia and industry for the past few years. This article presents the results of an empirical case study in the area of preventive health care services. The primary data were gathered in workshops, in which future personal data-based services were conceptualized by analyzing future scenarios from a business perspective. The aim of this study is to understand business model transformation in emerging personal data ecosystems. The work was done as a case study in the context of occupational healthcare. The results have implications to theory and practice, indicating that adopting personal data management principles requires transformation of the business model, which, if successfully managed, may provide access to more resources, potential to offer better value, and additional customer channels. These advantages correlate with the broadening of the business ecosystem. Expanding the scope of this study to include more actors would improve the validity of the research. The results draw from existing literature and are based on findings from a case study and the economic properties of the healthcare industry in Finland.

Keywords: ecosystem, business model, personal data, preventive healthcare

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Authors: Merav Ben Natan, David Maman, Milana Avramov, Galina Shamilov, Yaron Berkovich

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Introduction: Patient satisfaction and the willingness to recommend a hospital are vital for improving healthcare quality. This study examines orthopedic patients to identify factors influencing their willingness to recommend the hospital. Aim: This study to explore the demographic and clinical variables affecting orthopedic patients' willingness to recommend the hospital and to understand the role of patient satisfaction in this context. Methods: A cross-sectional survey was conducted with 200 orthopedic patients hospitalized between July and December 2023 in north-central Israel. Data were analyzed to assess the impact of various factors on the willingness to recommend the hospital. Results: Age was positively associated with the willingness to recommend (OR=2.44), while the length of stay in the Emergency Department negatively impacted this willingness (OR=0.58). Satisfaction with hospital care had a positive effect on willingness to recommend (OR=1.96). Gender, comorbidities, and total hospital stay length did not significantly influence willingness to recommend. Conclusions: Satisfaction with hospital care and the length of Emergency Department stays are crucial factors affecting orthopedic patients' willingness to recommend the hospital. This underscores the need for strategies to improve patient experiences and address delays in the Emergency Department. The findings offer valuable insights for healthcare providers and policymakers.

Keywords: orthopedic patients, patient satisfaction, willingness to recommend, hospital recommendation

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Authors: Wanvipa Thongborisute, Punyaphat Sirithanabadeekul, Pichit Suvanprakorn, Anan Jiraviroon

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Background: Acne vulgaris is one of the most common dermatologic problems, and can have a significant psychological and physical effect on patients. Propionibacterium acnes' roles in acne vulgaris involve the activation of toll-like receptor 4 (TLR4), and toll-like receptor 2 (TLR2) pathways. By activating these pathways, inflammatory events of acne lesions, comedogenesis and sebaceous lipogenesis can occur. Currently, there are several topical agents commonly use in treating acne vulgaris that are known to have an effect on TLRs, such as retinoic acid and adapalene, but these drugs still have some irritating effects. At present, there is an alarming increase in rate of bacterial resistance due to irrational used of antibiotics both orally and topically. For this reason, acne treatments should contain bioactive molecules targeting at the site of action for the most effective therapeutic effect with the least side effects. Sparganium stoloniferumis a Chinese aquatic herb containing a compound called Sparstolonin B (SsnB), which has been reported to selectively blocks Toll-like receptor 2 (TLR2) and Toll-like receptor 4 (TLR4)-mediated inflammatory signals. Therefore, this topical TLR2 and TLR4 antagonist, in a form of Sparganium stoloniferum-derived compound containing SsnB, should give a benefit in reducing inflammation of acne vulgaris lesions and providing an alternative treatments for patients with this condition. Materials and Methods: The objectives of this randomized double blinded split faced placebo controlled trial is to study the safety and efficacy of the Sparganium stoloniferum-derived compound. 32 volunteered patients with mild to moderate degree of acne vulgaris according to global acne grading system were included in the study. After being informed and consented the subjects were given 2 topical treatments for acne vulgaris, one being topical 2.40% Sparganium stoloniferum extraction (containing Sparstolonin B) and the other, placebo. The subjects were asked to apply each treatment to either half of the face daily morning and night by randomization for 8 weeks, and come in for a weekly follow up. For each visit, the patients went through a procedure of lesion counting, including comedones, papules, nodules, pustules, and cystic lesions. Results: During 8 weeks of experimentation, the result shows a reduction in total lesions number between the placebo and the treatment side show statistical significance starting at week 4, where the 95% confidence interval begin to no longer overlap, and shows a trend of continuing to be further apart. The decrease in the amount of total lesions between week 0 and week 8 of the placebo side shows no statistical significant at P value >0.05. While the decrease in the amount of total lesions of acne vulgaris of the treatment side comparing between week 0 and week 8 shows statistical significant at P value <0.001. Conclusion: The data demonstrates that 2.40% Sparganium stoloniferum extraction (containing Sparstolonin B) is more effective in treating acne vulgaris comparing to topical placebo in treating acne vulgaris, by showing significant reduction in the total numbers of acne lesions. Therefore, this topical Sparganium stoloniferum extraction could become a potential alternative treatment for acne vulgaris.

Keywords: acne vulgaris, sparganium stoloniferum, sparstolonin B, toll-like receptor 2, toll-like receptor 4

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Authors: Susan Evans, Janna Gordon-Elliott, Katarzyna Wyka, Virginia Mutch

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During the rise of the COVID-19 pandemic, healthcare workers needed an intervention that could address their profound acute stress. Mindfulness-based stress reduction (MBSR) is a program that has long established effectiveness for mental and physical health outcomes. In recent years, MBSR has been modified such that the duration of both class time and number of sessions has been abbreviated, and its delivery has been adapted for online dissemination, thus increasing the likelihood that individuals who could most benefit from the program would do so. We sought to investigate whether a brief, online version of MBSR could be feasible and acceptable for health care workers (HCW) in acute stress in response to the COVID-19 pandemic. Participants were recruited via an email sent to all hospital employees, which spans residents, physicians, nurses, housekeeping, lab technicians, administrators, and others. Participating HCW were asked about their previous experience with mindfulness and asked to commit to a minimum of 3 sessions. They were then provided with four weekly 1-hour sessions online that included the major mindfulness exercises taught during traditional MBSR programs (i.e., body scan, sitting meditation, mindful eating, and yoga). Participants were provided with supporting slides, videos, demonstrations and asked to track their practice. Hospital staff enrolled in the program; by the end of the first day of recruitment, 40 had applied; by the start date, about 100 were enrolled, and n attended a minimum of 3 sessions, supporting feasibility. Hospital staff also participated and practiced the mindfulness exercises (n=42), thus supporting acceptability. Participants reported that the program was logical, successful, and worth recommending both before starting the program and after completing it (M= 22.02 and M=21.76, respectively, possible range 0-27). There was a slight decline in the belief in improvement in health and well-being due to the program (ES=.37, p=.021). Secondary hypotheses regarding participants’ self-reported stress and levels of mindfulness were also supported, such that participants reported improvements in perceived stress (ES=.45, p=.006), compassion satisfaction, burnout, and secondary traumatic stress (ES=.41, ES=.31, ES=.35, respectively, p<.05). Participants reported significant improvements in the describing facet of mindfulness (ES=.49, p=.004), while all other facets (observing, acting with awareness, nonjudging of inner experience, nonreactivity to inner experience) remained unchanged pre- to post-program. Results from this study suggest that an abridged, online version of MBSR is feasible and accessible to health care workers in acute stress and provides benefits expected from traditional MBSR programs. The lack of a randomized control group limits generalizability. We intend to provide a structure, framework, and lessons learned to hospital administrators and clinical staff seeking to support their employees in acute stress.

Keywords: acute stress, health care workers, mindfulness, online interventions

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Authors: Fatma Abdel Moneim Al Tawil

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Low back pain (LBP) among nurses has been the subject of research studies worldwide. However, evidence of the influence of patients lifting behaviors and LBP among nurses in Saudi Arabia remains scarce. The purpose of this study was to investigate the relationship between LBP and nurses lifting behaviors. LBP questionnaire was distributed to 100 nurses working in Alsadairy Hospital distributed as Emergency unit(9),Coronary Care unit (9), Intensive Care Unit (7), Dialysis unit (30), Burn unit (5), surgical unit (11), Medical (14) and, X-ray unit (15). The questionnaire included demographic data, attitude scale, Team work scale, Back pain history and Knowledge scale. Regarding to emergency unit, there is appositive significant relation between teamwork scale and Knowledge as r = (0.807) and P =0.05. Regarding to ICU unit, there is a positive significant relation between teamwork scale and attitude scale as r= (0.781) and P =0.05. Regarding to Dialysis unit, there is a positive significant relation between attitude scale and teamwork scale as r=(0.443) and P =0.05. The findings suggest enhanced awareness of occupational safety with safe patient handling practices among nursing students must be emphasized and integrated into their educational curriculum. Moreover, back pain prevention program should incorporate the promotion of an active lifestyle and fitness training the implementation of institutional patient handling policies.

Keywords: low back pain, lifting behaviors, nurses, team work

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Authors: Endalew Fufa Kufi

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Every married person aspires to be a parent regardless of the situation in which s/he lives. Such aspiration meets with reality when the destined parent is able to give adequate supports and services to his/her children, whether the latter are got by birth or through adoption. The adequacy of services parents provide their children is both enriched and tempted by the work on which they involve. On the one hand, parents need to work and earn a living in order to support their family. On the other hand, they must spend most of their time outside home to do the work, which shortens the time and might they spare to care for their children. Where the sufficiency of services parents owe their children could be ascertained by in terms of life skills, physical care and related provisions, the role of working fathers and mothers in providing such supports could be diverse across cultures and work traditions. Hence, this research deals with the investigation of working mothers’ parental practices, challenges they face in providing parental services and the implication for the future progress of the parents and their children. Target of the study will be Arsi University in Oromia Regional State of Ethiopia. Descriptive survey design in holding the research, and data for the research will be collected in the form of experiential self-report from 150 working mothers selected from the entire working women population of Colleges of Agriculture and Environmental Studies and College of Health Sciences through stratified random-sampling. Instruments of data collection will be closed and open-ended questionnaire. Complementary data will also be collected from purposively selected samples through semi-structured interview. Data for the research will be collected through questionnaire first and then through interview. Data analysis will also follow the same procedure. The collected data will systematically be organized and statistically and thematically analyzed in order to come up with indicative findings. The overarching thesis is that, working mothers in the study area bear a lot of responsibilities both at home and at work place which leave them very little time for parenting services. Unless due attention is given to the way they can spare time for their children, they are more likely to be tense between work-life and family care services, which tempt them in different directions.

Keywords: challenges, mothers, practices, university, working

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Authors: MD. Kamruzzaman

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As a developing country, Bangladesh has seen an increase in total GDP in recent years. But it can be further improved by developing “Health-Care” (HC) services because it has enormous infrastructure problems all over the country. Bangladesh's HC system is now clearly poised to undergo reform at any process level, including prevention, diagnosis, and treatment. Although the Bangladeshi government is trying to develop the HC sector, due to health corruption in this sector, the improvement has not accelerated yet. For this reason, lots of Bangladeshi people are facing acute diseases. Regarding the prevention, diagnosis, and treatment of disease, this research will illustrate the law relating to health and HC to ensure excellent health and well-being. Firstly, this paper investigates health under Bangladeshi law from different perspectives related to the HC system. A massive gap has been investigated in this research after comparing Bangladeshi and international health law (HL). Secondly, a practical scenario is investigated and compared with international HC law. It is evident that the Bangladeshi HC system did not achieve a satisfactory standard level concerning international law. A staggering 70% of Bangladesh's population lives in rural areas, with no restrictions on access to hospitals and clinics. However, it is clear that proper HC infrastructure and some new medical practices are urgently needed to ensure HC quality. Finally, this research provides suggestions for developing a HC system to ensure the health of all Bangladeshi people that needs to be immediately implemented by the Bangladeshi government. This research has practical implications in the HC system for any developing country to maintain their citizen's safety.

Keywords: HC system, law relating, bangladeshi HL, international HL, human HC suggestions

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Authors: Ellen Dahl Gundersen, Berit Johannessen

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Introduction: Dementia and depression are common mental disorders of nursing home residents. The care of these residents consists of providing both physical, social and mental care. Too often, the physical needs are given priority, and municipal health services are urged to focus more on the patients mental and social needs. The presence of dogs may have positive impact on the mental health of nursing home residents by improving mood, social interaction and enjoyment of the visits. The voluntary organization Red Cross, has given priority to this subject by training and certifying dogs and owners (equipages), committed for regular visits at local nursing homes. Focus of this study: How do the dog owners and employees experience the presence of a dog equipage concerning the mental health of nursing home residents? Method: Individual interviews with 8-10 certified dog owners who are volunteers from Red Cross, contributing with regular visits at local nursing homes. Focus group interviews with 10 employees working in two different nursing homes. Preliminary results: Five to seven residents and one or two employees attended weekly dog equipage visits during a period of six months. The presence of an equipage seems to have made the residents calm and more social orientated with a lighter mood and better verbal expression. Some of the residents with dementia remembered the name of the dog from one week to another. The informants also reported positive outcome for the residents by their opportunity to give and get close through physical contact with a dog. Further, the presence of an equipage affected the atmosphere at the nursing home positively by promoting joy and initiating conversations about dogs. A conscious approach by the dog owners towards the residents seems to be of significance to this matter. The positive attitude and support from employees also seem to be of crucial importance for the maintenance of these visits. Conclusion: The presence of trained dog equipages in nursing homes seems to have had an overall positive impact on the mental health of residents. A conscious approach from the dog owners as well as positive support from employees seems to have a crucial impact on the success and maintenance of the visits. These findings correspond well to former research and can thereby give implications for more extended use of dogs as a mental health promoting initiative towards geriatric consumers of municipal health care services. Further research through larger studies is needed.

Keywords: animal assisted intervention, geriatric mental health, nursing home, resident

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Authors: Thomas P. Jones

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Overview: Drowning is an important cause of accidental death, particularly in children and young people. Although many survive drowning incidents, it is a relatively rare presenting complaint in Emergency Departments. When cases do present, they can be complex and unpredictable. For patients to receive the best care, it is important that their management is standardized and evidence based, however this can be difficult in a topic area with limited studies and inconsistencies in case reporting. Objectives: To review recent cases to assess the performance of Manchester Royal Infirmary Emergency Department in the management of near drowning. To produce evidence based guideline on the management of drowning victims in the ED. Methods: Emergency department records were searched for patients with the diagnosis of ‘fatal drowning’ or ‘nearly drowning’ and two relevant case notes reviewed. To produce the guideline a literature review was conducted and a series of structured short cut systematic reviews known as Best BETs carried out. This information was used to produce a clear treatment pathway. Results: The case studies emphasized the variety in presentation of drowning victims whilst highlighting inconsistencies in management and documentation. An evidence-based guideline is presented as a flowchart, which illustrates the relevant investigations and treatment that victims of a drowning incident should receive, based on the best available evidence. Conclusion: It is hoped that when put into practice, the guideline will improve and standardize patient care in cases of near drowning. An audit is recommended to assess its effectiveness.

Keywords: drowning, near drowning, non fatal drowning, fatal drowning

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Authors: Fagner Luiz P. Salles, Janaina C. Oliveira, Ivair P. Cesar

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Statement of the Problem: Auriculotherapy (AT) is a TCM technique, which uses seeds instead of needles, based physiologically on the mechanical stimulation of the cranial nerves. In the context of understanding the new concept of health of the WHO, the AT is an integrative approach for achieving Global Health Care so as to achieve the global health care concerns. This study aimed to evaluate the effect of auriculotherapy on pain and sleep quality in patients with chronic pain. Methodology and Theoretical Orientation: This study was performed between February and March 2017 at the Faculdade Estácio de Sá de Vitória, Brazil. The pain evaluation was through VAS in 4 periods: maximum, minimum, average and at the time of evaluation; the evaluation of sleep quality was used the Pittsburgh Sleep Quality Index. Socio-demographic data included: gender, age, use of medication and BMI. All data are presented as mean (standard deviation), Teste Mann-Whitney and T-student with P-values < 0.05 were regarded as significant. Findings: Participated in this study thirty-two individuals with age (M = 43.18, SD = 17.86), the time with pain in years (M = 3.67, SD = 3.68), 81.7% were female, 75% of the individuals used medication and BMI (M = 26.67; SD = 6.20). The pain presented improvement in the maximum level and the average of the pain and sleep quality before did not have statistically significant results. Conclusion and Significance: This study showed that TA is efficacy for reduction levels of pain. However, AT was not effective in improving sleep quality.

Keywords: auriculotherapy, chronic pain, sleep quality, integrative approach

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Authors: C. Fortin, D. Tokmeninova, O. Ushakova

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Among 500 Russian universities Skolkovo Institute of Science and Technology (Skoltech) is one of the youngest (established in 2011), quite small and vastly international, comprising 20 percent of international students and 70 percent of faculty with significant academic experience at top-100 universities (QS, THE). The institute has emerged from close collaboration with MIT and leading Russian universities. Skoltech is an entirely English speaking environment. Skoltech curriculum plans of ten Master programs are based on the CDIO learning outcomes model. However, despite the Institute’s unique focus on industrial innovations and startups, one of the main challenges has become an evident large proportion of nearly half of MSc graduates entering PhD programs at Skoltech or other universities rather than industry or entrepreneurship. In order to increase the share of students joining the industrial sector after graduation, Skoltech started implementing a number of unique practices with a focus on employers’ expectations incorporated into the curriculum redesign. In this sense, extended knowledge exchange with industrial partners via collaboration in learning activities, industrial projects and assessments became essential for students’ headway into industrial and entrepreneurship pathways. Current academic curriculum includes the following types of components based on extended knowledge exchange with industrial partners: innovation workshop, industrial immersion, special industrial tracks, MSc defenses. Innovation workshop is a 4 week full time diving into the Skoltech vibrant ecosystem designed to foster innovators, focuses on teamwork, group projects, and sparks entrepreneurial instincts from the very first days of study. From 2019 the number of mentors from industry and startups significantly increased to guide students across these sectors’ demands. Industrial immersion is an exclusive part of Skoltech curriculum where students after the first year of study spend 8 weeks in an industrial company carrying out an individual or team project and are guided jointly by both Skoltech and company supervisors. The aim of the industrial immersion is to familiarize students with relevant needs of Russian industry and to prepare graduates for job placement. During the immersion a company plays the role of a challenge provider for students. Skoltech has started a special industrial track comprising deep collaboration with IPG Photonics – a leading R&D company and manufacturer of high-performance fiber lasers and amplifiers for diverse applications. The track is aimed to train a new cohort of engineers and includes a variety of activities for students within the “Photonics” MSc program. It is expected to be a successful story and used as an example for similar initiatives with other Russian high-tech companies. One of the pathways of extended knowledge exchange with industrial partners is an active involvement of potential employers in MSc Defense Committees to review and assess MSc thesis projects and to participate in defense procedures. The paper will evaluate the effect and results of the above undertaken measures.

Keywords: Curriculum redesign, knowledge exchange model, learning outcomes framework, stakeholder engagement

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Authors: Delies L. Alejo

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This study explores the psychosocial influences of Spinal Cord Injury (SCI) on patients in the Philippine Orthopedic Center Hospital in the Philippines, examining their social functioning and proposing interventions for reintegration. Quantitative data were collected through surveys using a concurrent triangulation research design, while qualitative insights were obtained via interviews. Findings revealed significant psychosocial challenges among SCI patients, impacting relationships, family dynamics, work, friendships, parenting, education, and self-care. Demographic profiles indicated variations in psychosocial functioning. The study underscores the importance of tailored interventions for SCI patients based on age, marital status, gender, education, and occupation. Triangulation of data enhanced understanding, revealing four themes: ‘Resilient Navigation of Intimacy and Connection,’ ‘Family Dynamics and Care Challenges,’ ‘Occupational Hurdles and Work Engagement,’ and ‘Social and Community Integration Obstacles.’ The study proposes a holistic intervention plan, addressing emotional challenges, creating support networks, implementing vocational rehabilitation, promoting community engagement, and sustaining collaboration with healthcare professionals.

Keywords: spinal cord injury, psychosocial influences, social functioning, concurrent triangulation, intervention plan

Procedia PDF Downloads 46

Authors: E. Steen, B. Dewulf, N. Müller, C. Vandycke, Y. Vandekerckhove

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Introduction: The care for a ST-elevation myocardial infarction (STEMI) patient is time-critical. Reperfusion therapy within 90 minutes of initial medical contact is mandatory in the improvement of the outcome. Primary percutaneous coronary intervention (PCI) without previous fibrinolytic treatment, is the preferred reperfusion strategy in patients with STEMI, provided it can be performed within guideline-mandated times. Aim of the study: During a one year period (January 2013 to December 2013) the files of all consecutive STEMI patients with urgent referral from non-PCI facilities for primary PCI were reviewed. Special attention was given to a subgroup of patients with prior out-of-hospital medical contact generated by the 112-system. In an effort to reduce out-of-hospital system delay to definitive care a change in pre-hospital 112 dispatch strategies is proposed for these time-critical patients. Actual time recordings were compared with travel time simulations for two suggested scenarios. A first scenario (SC1) involves the decision by the on scene ground EMS (GEMS) team to transport the out-of-hospital diagnosed STEMI patient straight forward to a PCI centre bypassing the nearest non-PCI hospital. Another strategy (SC2) explored the potential role of helicopter EMS (HEMS) where the on scene GEMS team requests a PCI-centre based HEMS team for immediate medical transfer to the PCI centre. Methods and Results: 49 (29,1% of all) STEMI patients were referred to our hospital for emergency PCI by a non-PCI facility. 1 file was excluded because of insufficient data collection. Within this analysed group of 48 secondary referrals 21 patients had an out-of-hospital medical contact generated by the 112-system. The other 27 patients presented at the referring emergency department without prior contact with the 112-system. The table below shows the actual time data from first medical contact to definitive care as well as the simulated possible gain of time for both suggested strategies. The PCI-team was always alarmed upon departure from the referring centre excluding further in-hospital delay. Time simulation tools were similar to those used by the 112-dispatch centre. Conclusion: Our data analysis confirms prolonged reperfusion times in case of secondary emergency referrals for STEMI patients even with the use of HEMS. In our setting there was no statistical difference in gain of time between the two suggested strategies, both reducing the secondary referral generated delay with about one hour and by this offering all patients PCI within the guidelines mandated time. However, immediate HEMS activation by the on scene ground EMS team for transport purposes is preferred. This ensures a faster availability of the local GEMS-team for its community. In case these options are not available and the guideline-mandated times for primary PCI are expected to be exceeded, primary fibrinolysis should be considered in a non-PCI centre.

Keywords: STEMI, system delay, HEMS, emergency medicine

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Authors: J. Niyitegeka, G. Nshimirimana, A. Silverstein, J. Odhiambo, Y. Lin, T. Nkurunziza, R. Riviello, S. Rulisa, P. Banguti, H. Magge, M. Macharia, J. P. Dushime, R. Habimana, B. Hedt-Gauthier

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In low-resource settings, women needing an emergency cesarean section experiences various delays in both reaching and receiving care that is often linked to poor neonatal outcomes. In this study, we quantified different measures of delays and assessed the association between these delays and neonatal outcomes at three rural district hospitals in Rwanda. This retrospective study included 441 neonates and their mothers who underwent emergency cesarean sections in 2015 at Butaro, Kirehe and Rwinkwavu District Hospitals. Four possible delays were measured: Time from start of labor to district hospital admission, travel time from a health center to the district hospital, time from admission to surgical incision, and time from the decision for the emergency cesarean section to surgical incision. Neonatal outcomes were categorized as unfavorable (APGAR < 7 or death) and favorable (APGAR ≥ 7). We assessed the relationship between each type of delay and neonatal outcomes using multivariate logistic regression. In our study, 38.7% (108 out of 279) of neonates’ mothers labored for 12 to 24 hours before hospital admission and 44.7% (159 of 356) of mothers were transferred from health centers that required 30 to 60 minutes of travel time to reach the district hospital. 48.1% (178 of 370) of caesarean sections started within five hours after admission and 85.2% (288 of 338) started more than thirty minutes after the decision for the emergency cesarean section was made. Neonatal outcomes were significantly worse among mothers with more than 90 minutes of travel time from the health center to the district hospital compared to health centers attached to the hospital (OR = 5.12, p = 0.02). Neonatal outcomes were also significantly different depending on decision to incision intervals; neonates with cesarean deliveries starting more than thirty minutes after decision had better outcomes than those started immediately (OR = 0.32, p = 0.04). Interventions that decrease barriers to access to maternal health care services can improve neonatal outcome after emergency cesarean section. Triaging could explain the inverse relationship between time from decision to incision and neonatal outcome; this must be studied more in the future.

Keywords: Africa, emergency obstetric care, rural health delivery, maternal and child health

Procedia PDF Downloads 223

Authors: Ammar Asma, Bouafia Nabiha, Ben Cheikh Asma, Ezzi Olfa, Mahjoub Mohamed, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Ventilator-associated pneumonia (VAP) is currently recognized as one of the most relevant causes of morbidity and mortality among intensive care unit (ICU) patients worldwide. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP. The purposes of this study were to determine the incidence and risk factors for VAP in in a Tunisian medical ICU. Materials / Methods: A retrospective case-control study design based on the prospective database collected over a 14-month period from September 15th, 2015 through November 15th, 2016 in an 8-bed medical ICU. Patients under ventilation for over 48 h were included. The number of cases was estimated by Epi-info Software with the power of statistical test equal to 90 %. Each case patient was successfully matched to two controls according to the length of mechanical ventilation (MV) before VAP for cases and the total length of MV in controls. VAP in the ICU was defined according to American Thoracic Society; Infectious Diseases Society of America guidelines. Early onset or late-onset VAP were defined whether the infectious process occurred within or after 96 h of ICU admission. Patients’ risk factors, causes of admission, comorbidities and respiratory specimens collected were reviewed. Univariate and multivariate analyses were performed to determine variables associated with VAP with a p-value < 0.05. Results: During the period study, a total of 169 patients under mechanical ventilation were considered, 34 patients (20.11%) developed at least one episode of VAP in the ICU. The incidence rate for VAP was 14.88/1000 ventilation days. Among these cases, 9 (26.5 %) were early-onset VAP and 25 (73.5 %) were late-onset VAP. It was a certain diagnosis in 66.7% of cases. Tracheal aspiration was positive in 80% of cases. Multi-drug resistant Acinerobacter baumanii was the most common species detected in cases; 67.64% (n=23). The rate of mortality out of cases was 88.23% (n= 30). In univariate analysis, the patients with VAP were statistically more likely to suffer from cardiovascular diseases (p=0.035) and prolonged duration of sedation (p=0.009) and tracheostomy (p=0.001), they also had a higher number of re-intubation (p=0.017) and a longer total time of intubation (p=0.012). Multivariate analysis showed that cardiovascular diseases (OR= 4.44; 95% IC= [1.3 - 14]; p=0.016), tracheostomy (OR= 4.2; 95% IC= [1.16 -15.12]; p= 0.028) and prolonged duration of sedation (OR=1.21; 95% IC= [1.07, 1.36]; p=0.002) were independent risk factors for the development of VAP. Conclusion: VAP constitutes a therapeutic challenge in an ICU setting, therefore; strategies that effectively prevent VAP are needed. An infection control-training program intended to all professional heath care in this unit insisting on bundles and elaboration of procedures are planned to reduce effectively incidence rate of VAP.

Keywords: case control study, intensive care unit, risk factors, ventilator associated pneumonia

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Authors: Lundqvist M., Alwin J., Levin L-A.

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Background: Assistance dogs are dogs trained to assist persons with functional impairment or chronic diseases. The assistance dog concept includes different types: guide dogs, hearing dogs, and service dogs. The service dog can further be divided into subgroups of physical services dogs, diabetes alert dogs, and seizure alert dogs. To examine the long-term effects of health care interventions, both in terms of resource use and health outcomes, cost-effectiveness analyses can be conducted. This analysis can provide important input to decision-makers when setting priorities. Little is known when it comes to the cost-effectiveness of assistance dogs. The study aimed to assess the cost-effectiveness of certified service or hearing dogs in comparison to regular companion dogs. Methods: The main data source for the analysis was the “service and hearing dog project”. It was a longitudinal interventional study with a pre-post design that incorporated fifty-five owners and their dogs. Data on all relevant costs affected by the use of a service dog such as; municipal services, health care costs, costs of sick leave, and costs of informal care were collected. Health-related quality of life was measured with the standardized instrument EQ-5D-3L. A decision-analytic Markov model was constructed to conduct the cost-effectiveness analysis. Outcomes were estimated over a 10-year time horizon. The incremental cost-effectiveness ratio expressed as cost per gained quality-adjusted life year was the primary outcome. The analysis employed a societal perspective. Results: The result of the cost-effectiveness analysis showed that compared to a regular companion dog, a certified dog is cost-effective with both lower total costs [-32,000 USD] and more quality-adjusted life-years [0.17]. Also, we will present subgroup results analyzing the cost-effectiveness of physicals service dogs and diabetes alert dogs. Conclusions: The study shows that a certified dog is cost-effective in comparison with a regular companion dog for individuals with functional impairments or chronic diseases. Analyses of uncertainty imply that further studies are needed.

Keywords: service dogs, hearing dogs, health economics, Markov model, quality-adjusted, life years

Procedia PDF Downloads 149