scholarly journals Labour Induction with Misoprostol in German Obstetric Clinics: What Are the Facts on Such Use?

2021 ◽  
Vol 81 (08) ◽  
pp. 955-965
Author(s):  
Sven Kehl ◽  
Christel Weiss ◽  
Werner Rath ◽  
Michael Schneider ◽  
Florian Stumpfe ◽  
...  
Keyword(s):  
Prostaglandin E2 ◽  
Management Practices ◽  
Cross Sectional Study ◽  
Labour Induction ◽  
Induction Agent ◽  
Cross Sectional ◽  
Before And After ◽  
The Media ◽  
Level I ◽  
The Impact

Abstract Subject While the synthetic prostaglandin E1 analogue misoprostol is the most effect labour induction agent, its use is off-label for the most part. For this reason, and in view of its potential adverse effects and varying approaches to its administration, the drug has recently once again become a focus of critical attention. The objective of this survey was thus to establish a record of labour induction with misoprostol in German clinics and determine the impact of the negative reporting on everyday obstetric practice. Material and Methods In this cross-sectional study, 635 obstetrics and gynaecology departments in Germany were requested by email to participate in our survey in February/March 2020. Online responses to 19 questions were requested regarding the clinic, use of misoprostol before and after the critical reporting, use of misoprostol (sourcing, method of administration, dosage, monitoring) and other labour induction methods. Results A total of 262 (41.3%) of the clinics solicited for the survey completed the questionnaire. There were no differences regarding the care level (Perinatal Centre Level I, Perinatal Centre Level II, Clinic with Perinatal Focus or Obstetric/Private Clinic; p = 0.2104) or birth counts (p = 0.1845). In most cases, misoprostol was prepared in the clinicʼs own pharmacy (54%) or imported from another country (46%) and administered orally in tablet form (95%). Misoprostol dosage levels varied (25 µg [48%], 50 µg [83%], 75 µg [6%], 100 µg [47%] and > 100 µg [5%]). Most of the clinics used premanufactured tablets/capsules (59%), although Cytotec tablets were also divided (35%) or dissolved in water (5%). Misoprostol administration intervals were mainly every 4 hours (64%) or every 6 hours (30%). CTG checks were run in most cases before and after administration of a dose of misoprostol (78% and 76%) and before and after administration of a dose of prostaglandin E2 (both 88%). Presence of contractions led to no misoprostol (59%) or no prostaglandin E2 (64%) being administered in most cases. The critical reporting resulted in discontinuation of use of misoprostol in 17% of the clinics – mainly smaller obstetric/private clinics with fewer than 1000 births. Labour cocktails were used mainly in obstetric and private clinics (61%). Conclusion Misoprostol is an established agent for labour induction in German clinics. The dosing schemes used vary. Improvements of currently common management practices are required, especially in the area of labour induction (CTG checks before and after administration of labour-inducing medication, no administration of prostaglandin if contractions are ongoing). The discussion of use of misoprostol in the media resulted in stoppage of its use mainly in smaller clinics.

scholarly journals The Impact of Bariatric Surgery on Menstrual Abnormalities—a Cross-Sectional Study

2020 ◽  
Vol 30 (11) ◽  
pp. 4505-4509
Author(s):  
Anna Różańska-Walędziak ◽  
Paweł Bartnik ◽  
Joanna Kacperczyk-Bartnik ◽  
Krzysztof Czajkowski ◽  
Maciej Walędziak
Keyword(s):  
Bariatric Surgery ◽  
Menstrual Cycle ◽  
Cross Sectional Study ◽  
Reproductive Age ◽  
Obese Women ◽  
Sectional Study ◽  
Cross Sectional ◽  
Contraception Use ◽  
Before And After ◽  
The Impact

Abstract Introduction Obesity is associated with hyperestrogenism along with other hormonal abnormalities affecting the menstrual cycle. The most effective and decisive method of obesity treatment is bariatric surgery. The aim of this study was to analyze the impact of bariatric surgery on menstrual cycle, the incidence of menstrual abnormalities, hyperandrogenism manifestation, and contraception use. Materials and Methods It was a cross-sectional study of 515 pre-menopausal women who had undergone bariatric surgery between 1999 and 2017 in a bariatric center. Data was collected via anonymous questionnaire, and the questions covered a 1-year period before the surgery and the last year before questionnaire completion. Results Before the surgery, 38.6% of the patients reported irregular menstruations in comparison with 25.0% after bariatric surgery (RR = 0.65; 95%CI 0.53–0.79). The mean number of menstruations per year did not differ before and after surgery (10.2 ± 3.9 vs 10.4 ± 3.3; p < .45). There were no statistically significant differences in terms of prolonged menstruations, acne, and hirsutism prevalence. A total of 14.4% of patients before surgery reported estrogen-based contraception use in comparison with 15.0% after the surgery (p < .95). There were no significant differences in the frequency of OC use (11.0% before surgery vs 13.6% 12 months after the surgery vs 11.5% at the moment of survey administration; p < 0.46). Conclusion Bariatric surgery improves the regularity of the menstrual cycle in obese women in reproductive age. The lack of any changes in the combined hormonal contraception (CHC) use, especially OC, before and after bariatric surgery may be a result of a possibly low level of contraception counseling.

What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

2020 ◽  
pp. 019459982096963
Author(s):  
Vanessa F. Torrecillas ◽  
Kaden Neuberger ◽  
Alexander Ramirez ◽  
Paul Krakovitz ◽  
Jeremy D. Meier
Keyword(s):  
Elective Surgery ◽  
Lag Time ◽  
Cross Sectional Study ◽  
Health Claims ◽  
Third Party ◽  
Prior Authorization ◽  
Cross Sectional ◽  
Before And After ◽  
The Mean ◽  
The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

Impact of bladder cancer (BC) on health-related quality of life (HRQL) in 1,476 older Americans.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 9549-9549
Author(s):  
Chunkit Fung ◽  
Chintan Pandya ◽  
Katia Noyes ◽  
Emelian Scosyrev ◽  
Deepak M. Sahasrabudhe ◽  
...  
Keyword(s):  
Smoking Status ◽  
Cross Sectional Study ◽  
Older Age ◽  
Future Research ◽  
Cross Sectional ◽  
Older Americans ◽  
Comorbidity Score ◽  
Before And After ◽  
Related Quality ◽  
The Impact

9549 Background: The impact of BC on HRQL is poorly understood. To our knowledge, this is the first and largest cross-sectional study that compares HRQL of patients before and after BC diagnosis (DX). Methods: Our sample included 1,476 BC patients (≥ age 65) within the SEER-Medicare Health Outcomes Survey linkage database (1998-2007). We assessed differences in HRQL as measured by SF-36 physical (PCS) and mental (MCS) summary scores in patients who had a survey >1 yr before BC DX (n=620) and those who had a survey after BC DX (n=856). We compared groups by year from BC DX using regression analyses and results were adjusted for cancer stage, race, gender, age at BC DX, marital status, education, income, smoking status, activity of daily living (ADLs), and non-cancer comorbidities. Results: Patients who had a survey after BC DX were diagnosed with BC at an older age than those with a survey before BC DX (55.9% at age ≥75 yr vs. 36.8%; P<0.01). Other baseline demographic and socioeconomic characteristics were similar. Baseline HRQL were poor in patients before DX (PCS mean=40.1; MCS mean=51.1) with 50.6% and 31.9% of them having comorbidity score ≥2 and impairment of ≥1 ADLs, respectively. After BC DX, significant decreases in PCS (-2.7; 95% CI -3.8,-1.7) and MCS (-1.4; 95% CI -2.6, -0.3) were observed, with HRQL being lowest in those who had BC DX within 1 yr (PCS mean= 36.6; MCS mean=49.7). Declines in PCS during the <1, 1-3, 3-5, 5-10, and 10+ yr periods after BC DX compared to before BC DX were -3.8 (P<0.01), -2.5 (P<0.01), -2.2 (P=0.01), -1.1 (P=0.19) and -0.8 (P=0.57) whereas decreases in MCS were -2.0 (P=0.01), -2.2 (P<0.01), -1.2 (P=0.21), -0.1 (P=0.92), -0.8 (P=0.62) respectively. More advanced BC, lower educational level, higher comorbidity score, and impaired ADLs were significantly associated with both worse PCS and MCS after BC DX (P<0.05). Lower income and older age at BC DX showed significant association with low PCS (P<0.05). Conclusions: Older BC patients are a vulnerable population with poor baseline HRQL. HRQL of patients after BC DX is significantly worse than HRQL of patients before DX, possibly due to therapy and/or disease progression. Future research that evaluates interventions to improve HRQL in older patients with BC is critical.

scholarly journals The Difference of Cadre Knowledge Before and After Handwashing Tele-Education in COVID-19 Outbreak at Burangrang Village, Bandung

2020 ◽  
Vol 8 (2) ◽  
pp. 36-41
Author(s):  
Fachreza Aryo Damara
Keyword(s):  
Cross Sectional Study ◽  
Cross Sectional ◽  
The People ◽  
Before And After ◽  
The Media ◽  
The Subject ◽  
Transmission Prevention ◽  
The Difference ◽  
Prevention Method ◽  
The Given

Background: Health prevention and promotion are both important in making better public health. In order to actualize both aspects, Posyandu cadre play major role. Cadre have bigger chance and impact to educate the people who are living around them. However, doing a direct education has become more difficult since physical contacts were minimalized during this COVID-19 outbreak. Therefore, an effective tele-education is needed as an effort to prevent COVID-19 transmission. The study aims to evaluate the effect of tele-education through Youtube and Whatsapp to enhance people's understanding on COVID-19 transmission prevention Method: The study was a cross-sectional study with observational descriptive-analytical methods and quantitatively approach. Subject of the study was Posyandu cadre in Burangrang Village, Lengkong District, Bandung with the subject total was 19. Results: After given a tele-education, there was an increase in total score means between pretest and posttest with p=0.000 (p<0.001). Moreover, there were increases in both social media’s impression and engagement on educational video which was uploaded on Youtube. Discussion: In doing tele education to Posyandu cadre, video as a media to deliver the content was more preferred. Sharing the knowledge through video along with evaluating participants' understanding of the given topics could enhance cadre knowledge about handwashing as a prevention in the middle of COVID-19 outbreak. Conclusion: Tele education using video could enhance cadre’s understanding about handwashing. The media that has been used was able to deliver the content based on impression and engagement evaluations.

scholarly journals Influence of workshop attendance on management of pediatric fecal incontinence in Nigeria

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Taiwo Akeem Lawal
Keyword(s):  
Fecal Incontinence ◽  
Management Practices ◽  
Postgraduate Training ◽  
Surgical Care ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Past ◽  
The Impact ◽  
Training Opportunities ◽  
And Training

Abstract Background The care of children with fecal incontinence is suboptimal with inadequate support and training opportunities. The postgraduate training of pediatric surgeons on the management of fecal incontinence is inadequate since each training center is not likely to see enough number of cases yearly. Supplemental training through workshops on fecal incontinence may help to bridge the gap. The aim of this cross sectional study was to evaluate the impact of previous attendance of a workshop on fecal incontinence management practices among pediatric surgeons. Results A total of 41 respondents participated. Eleven (26.8%) respondents had attended a workshop in the past and seven (17.1%) had done a Malone antegrade continent enema (MACE) on patients. A higher proportion of respondents who had practiced for over 15 years had attended a workshop on fecal incontinence compared to those who had not attended one (90.9% vs. 33.3%, p = 0.001). The proportion of respondents who had attended a workshop on fecal incontinence and had performed a MACE (18.2%) was higher than the proportion of those who had not attended a workshop and had performed a similar procedure on patients (3.3%), p = 0.047. Conclusions One quarter of pediatric surgeons in the country surveyed had attended a workshop on fecal incontinence. Prior attendance of a workshop on fecal incontinence is significantly related to experience and significantly influenced the performance of a MACE procedure. Supplementation of the training of pediatric surgeons through workshops on fecal incontinence will help to improve capacity in pediatric colorectal surgical care.

scholarly journals The Use of Exergames in the Neurorehabilitation of People with Parkinson Disease: The Impact on Daily Life

2020 ◽  
Author(s):  
Bianca Simone Zeigelboim ◽  
Maria Renata José ◽  
Maria Izabel Rodrigues Severiano ◽  
Geslaine Janaína Bueno dos Santos ◽  
Helio Afonso Ghizoni Teive ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Cross Sectional Study ◽  
Daily Activities ◽  
Cross Sectional ◽  
Balance Confidence ◽  
Progressive Degeneration ◽  
Before And After ◽  
Vestibular Assessment ◽  
The Impact

Abstract Introduction Parkinson disease (PD) is a progressive degeneration characterized by motor disorders, such as tremor, bradykinesia, stiffness and postural instability. Objective To evaluate the independence, confidence and balance in the development of daily activities in patients with PD before and after rehabilitation. Methods A descriptive, retrospective cross-sectional study was carried out with 16 patients (mean 57.6 ± 18.7 years), submitted to anamnesis, otolaryngological evaluation and vestibular assessment. The Vestibular Disorders Activities of Daily Living (VADL) and the Activities-Specific Balance Confidence (ABC) scales were applied before and after rehabilitation with virtual reality. Results a) The instrumental subscale of the questionnaire showed statistically significant result (p = 0.022; 95% CI 1.21; 2.21) between the first and second assessments; b) The correlation between the questionnaires showed statistically significant result in the ambulation subscale (p = 0.011; 95% CI −0.85; −0.17) first and (p = 0.002, 95% CI −0.88; −0.31) second assessments, and the functional subscale was only verified in the second assessment (p = 0.011, 95% CI −0.85; −0.17); and c) The patients presented clinical improvement in the final assessment after rehabilitation with significant result for the tightrope walk (p = 0.034, 95% CI −12.5; −0.3) and ski slalom games (p = 0.005, 95% CI −34.8; −6.6). Conclusions Our results showed that the VADL and ABC questionnaires, applied before and after rehabilitation, were important tools to measure the independence, confidence and balance while developing daily activities. The VADL and ABC questionnaires may effectively contribute to quantify the effect of the applied therapeutics and, consequently, its impact on the quality of life of patients with PD.

The Impact of Visualization Dashboards on Patient Care in the Emergency Room (Preprint)

2020 ◽  
Author(s):  
Doaa Alhabib ◽  
Arwa Alumran ◽  
Saja Alrayes
Keyword(s):  
Emergency Room ◽  
Patient Care ◽  
Cross Sectional Study ◽  
Royal Commission ◽  
Quality And Safety ◽  
Cross Sectional ◽  
Future Studies ◽  
Before And After ◽  
Artery Disease ◽  
The Impact

UNSTRUCTURED Displaying patients’ data on electronic dashboards in the emergency room provides emergency room employees continuous visual monitoring. With this study, we aimed to measure the effects of displaying data on electronic dashboards on the quality and safety of the patient care provided in the emergency room (ER). We used a cross-sectional study design to compare the results of specific quality and safety indicators before and after the implementation of the dashboards in the ER of the Royal Commission Hospital, Jubail, Saudi Arabia. Our results showed statistically significant improvements on the waiting time for all ER patients, the total length of stay in the ER, and the time from arrival until an electrocardiogram test was performed for patients who came to the ER with symptoms suggesting coronary artery disease. Future studies might be conducted to evaluate the end-users’ utilization and satisfaction of the ER dashboards.

scholarly journals Glycaemic Control Impact on Renal Endpoints in Diabetic Patients on Haemodialysis

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Danielle Creme ◽  
Kieran McCafferty
Keyword(s):  
Glycaemic Control ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Poor Glycaemic Control ◽  
Number Of Patients ◽  
Weight Gains ◽  
Before And After ◽  
Patients With Diabetes ◽  
The Impact

Objective. To identify the number of haemodialysis patients with diabetes in a large NHS Trust, their current glycaemic control, and the impact on other renal specific outcomes.Design. Retrospective, observational, cross-sectional study.Methods. Data was collected from an electronic patient management system. Glycaemic control was assessed from HbA1c results that were then further adjusted for albumin (Alb) and haemoglobin (Hb). Interdialytic weight gains were analysed from weights recorded before and after dialysis, 2 weeks before and after the most recent HbA1c date. Amputations were identified from electronic records.Results. 39% of patients had poor glycaemic control (HbA1c > 8%). Adjusted HbA1c resulted in a greater number of patients with poor control (55%). Significant correlations were found with interdialytic weight gains (P<0.02,r=0.14), predialysis sodium (P<0.0001,r=-1.9), and predialysis bicarbonate (P<0.02,r=0.12). Trends were observed with albumin and C-reactive protein. Patients with diabetes had more amputations (24 versus 2).Conclusion. Large number of diabetic patients on haemdialysis have poor glycaemic control. This may lead to higher interdialytic weight gains, larger sodium and bicarbonate shifts, increased number of amputations, and possibly increased inflammation and decreased nutritional status. Comprehensive guidelines and more accurate long-term tests for glycaemic control are needed.

The impact of a guideline to prevent inappropriate albumin administration in a hospital in Iran

2020 ◽  
Vol 26 (10) ◽  
pp. 1-7
Author(s):  
Javad Javan-Noughabi ◽  
Elahe Parnian ◽  
Mohammadreza Hajiesmaeili ◽  
Hamid Salehiniya ◽  
Fatemeh Setoodehzadeh
Keyword(s):  
Hospital Setting ◽  
Clinical Information ◽  
Cross Sectional Study ◽  
Descriptive Statistics ◽  
Sectional Study ◽  
National Guidelines ◽  
Cross Sectional ◽  
Standard Guideline ◽  
Before And After ◽  
The Impact

Background/Aims In Iran, there are no specific national guidelines for the prescription or administration of albumin. Since March 2017, a standard guideline for albumin prescription has been implemented at a hospital in Tehran, Iran. The objective of this study was to compare the use of albumin and its related costs before and after implementation of this guideline. Methods A cross-sectional study was performed at the hospital in 2018. Data regarding albumin prescription were collected using a census method. Collected data included the demographic and clinical information of patients, duration of hospitalisation and the costs of tests and pharmacotherapy consultations before albumin was prescribed. Albumin consumption costs were also collected before and after the implementation of the guideline. Data were analysed using SPSS 21 software and descriptive statistics. Results Albumin consumption was significantly reduced after the guideline was implemented, decreasing from an average of 28 vials (289g) to an average of 6 vials (67g) per patient. The average cost of albumin use also fell from the equivalent of $1218 before the guideline was implemented, to an average of $281 per patient. Conclusions The implementation of a guideline for albumin prescription and administration in a hospital setting resulted in a significant reduction of inappropriate albumin use and the associated costs.

A Statewide Survey of General Practitioners in NSW, Australia, about Immunisation and Strategies to Increase Childhood Immunisation Rates

1999 ◽  
Vol 11 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Maria Victoria C Guevarra ◽  
Leena Gupta ◽  
Timothy C Heath ◽  
Margaret A Burgess
Keyword(s):  
Response Rate ◽  
New South ◽  
Cross Sectional Study ◽  
Childhood Immunisation ◽  
Parental Concern ◽  
Cross Sectional ◽  
South Wales ◽  
The Media ◽  
The Impact ◽  
Self Administered Questionnaire

A statewide survey was conducted to ascertain GPs' views in New South Wales (NSW), Australia, about the potential usefulness of strategies to increase immunisation rates and to facilitate providing childhood immunisation in their practice. The survey also explored the usefulness of information sources about immunisation. From September 1997-January 1998, a cross-sectional study using a four page self-administered questionnaire was undertaken. Four hundred GPs practising in NSW, Australia were randomly selected and 343 were eligible to participate. Of these, 281 returned a completed questionnaire (82% response rate). Ninety-one percent and 88% of GPs, respectively, agreed that television campaigns or registering children with the national Australian Childhood Immunisation Register (ACIR) w ere likely to increase immunisation rates. Sixty-two percent of respondents considered that the media created unwarranted parental concern about immunisation. GPs most commonly rated availability of an ACIR list of children overdue for immunisation, better parent educational material and better access to vaccines as strategies which would make immunisation easier. Sixty percent of respondents felt that increased GP payments would be successful in increasing immunisation rates. Only 51% indicated that they had used the “Australian Immunisation Procedures Handbook 6th edition” (a national clinical practice guideline) in the previous month. This study identified GP support for many initiatives aimed at increasing immunisation rates in Australia although GPs were sceptical about the benefits of some programmes. Studies to monitor the impact of GP incentives on immunisation rates in populations and individual practices are underway. These will be useful in determining whether GPs' opinions found in our study correlate with practice in this regard.

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