Provider Perspectives on the Acceptability, Appropriateness, and Feasibility of Teleneonatology

2021 ◽  
Author(s):  
Jennifer L. Fang ◽  
Rachel Umoren ◽  
Hilary Whyte ◽  
Jamie Limjoco ◽  
Abhishek Makkar ◽  
...  
Keyword(s):  
Rural Communities ◽  
Neonatal Intensive Care ◽  
Linear Models ◽  
Neonatal Care ◽  
Community Hospitals ◽  
Provider Perspectives ◽  
Level Ii ◽  
Survey Results ◽  
Level I ◽  
Strongly Agree

Objective We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICUs) and community hospitals. Study Design Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the 12 statements, scale values ranged from 1 to 5 (1 = strongly disagree; 5 = strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. Results The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6 to 99.0%, with mean scores of 4.4 to 4.7 and median scores of 4.0 to 5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. Conclusion Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable. Key Points

Provider Perspectives on the Acceptability, Appropriateness, and Feasibility of Teleneonatology

2021 ◽  
Author(s):  
Jennifer L. Fang ◽  
Rachel A Umoren ◽  
Hilary Whyte ◽  
Jamie Limjoco ◽  
Abhishek Makkar ◽  
...  
Keyword(s):  
Rural Communities ◽  
Neonatal Intensive Care ◽  
Linear Models ◽  
Neonatal Care ◽  
Community Hospitals ◽  
Provider Perspectives ◽  
Level Ii ◽  
Survey Results ◽  
Level I ◽  
Strongly Agree

Objective: We aimed to measure provider perspectives on the acceptability, appropriateness, and feasibility of teleneonatology in neonatal intensive care units (NICU) and community hospitals. Study Design: Providers from five academic tertiary NICUs and 27 community hospitals were surveyed using validated implementation measures to assess the acceptability, appropriateness, and feasibility of teleneonatology. For each of the twelve statements, scale values ranged from 1 to 5 (1=strongly disagree; 5=strongly agree), with higher scores indicating greater positive perceptions. Survey results were summarized, and differences across respondents assessed using generalized linear models. Results: The survey response rate was 56% (203/365). Respondents found teleneonatology to be acceptable, appropriate, and feasible. The percent of respondents who agreed with each of the twelve statements ranged from 88.6-99.0%, with mean scores of 4.4-4.7 and median scores of 4.0-5.0. There was no difference in the acceptability, appropriateness, and feasibility of teleneonatology when analyzed by professional role, years of experience in neonatal care, or years of teleneonatology experience. Respondents from Level I well newborn nurseries had greater positive perceptions of teleneonatology than those from Level II special care nurseries. Conclusion: Providers in tertiary NICUs and community hospitals perceive teleneonatology to be highly acceptable, appropriate, and feasible for their practices. The wide acceptance by providers of all roles and levels of experience likely demonstrates a broad receptiveness to telemedicine as a tool to deliver neonatal care, particularly in rural communities where specialists are unavailable.

Back Transport of Neonates: Improved Efficiency of Tertiary Nursery Bed Utilization

PEDIATRICS ◽  
1983 ◽  
Vol 71 (6) ◽  
pp. 918-922 ◽  
Author(s):  
August L. Jung ◽  
Carl L. Bose
Keyword(s):  
Intensive Care ◽  
Community Hospitals ◽  
Oxygen Supplementation ◽  
Newborn Intensive Care Unit ◽  
Level Ii ◽  
Hospital Beds ◽  
Critically Ill Neonates ◽  
Newborn Intensive Care ◽  
Level I ◽  
Full Occupancy

Neonatal back transport is defined as the return of previously critically ill neonates from Level III newborn intensive care units to Level II and Level I nurseries for intermediate and/or convalescing care. During 1980, 172 infants (65% of eligible infants) were back transported from a Level III nursery to both Level I and Level II community hospitals. Infants who were returned to Level II hospitals tended to be smaller at the time of transfer, were less frequently nipple fed, and more frequently required oxygen supplementation compared with infants returned to Level I hospitals. Back transport permitted physicians to defer 3,892 days of hospitalization for these infants to community hospitals, an equivalent savings of approximately ten hospital beds at full occupancy. This resulted in a 44% reduction in the need for services in the newborn intensive care unit. Back transport is an efficient means of dealing with overcrowding of Level III nurseries.

TeleNICU: Extending the reach of level IV care and optimizing the triage of patient transfers

2021 ◽  
pp. 1357633X2110381
Author(s):  
Jawahar Jagarapu ◽  
Vishal Kapadia ◽  
Imran Mir ◽  
Venkat Kakkilaya ◽  
Kristin Carlton ◽  
...  
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Neonatal Intensive Care ◽  
Medical Center ◽  
Demographic Data ◽  
Newborn Infants ◽  
Cost Savings ◽  
Neonatal Care ◽  
Transport Cost ◽  
Medical Diagnoses

Background The use of telemedicine to provide care for critically ill newborn infants has significantly evolved over the last two decades. Children's Health System of Texas and University of Texas Southwestern Medical Center established TeleNICU, the first teleneonatology program in Texas. Objective To evaluate the effectiveness of Tele Neonatal Intensive Care Unit (TeleNICU) in extending quaternary neonatal care to more rural areas of Texas. Materials and methods We conducted a retrospective review of TeleNICU consultations from September 2013 to October 2018. Charts were reviewed for demographic data, reasons for consultation, and consultation outcomes. Diagnoses were classified as medical, surgical, or combined. Consultation outcomes were categorized into transferred or retained. Transport cost savings were estimated based on the distance from the hub site and the costs for ground transportation. Results TeleNICU had one hub (Level IV) and nine spokes (Levels I–III) during the study period. A total of 132 direct consultations were completed during the study period. Most consultations were conducted with Level III units (81%) followed by level I (13%) and level II (6%) units. Some common diagnoses included prematurity (57%), respiratory distress (36%), congenital anomalies (25%), and neonatal surgical emergencies (13%). For all encounters, 54% of the patients were retained at the spoke sites, resulting in an estimated cost savings of USD0.9 million in transport costs alone. The likelihood of retention at spoke sites was significantly higher for medical diagnoses compared to surgical diagnoses (89% vs. 11%). Conclusion Telemedicine effectively expands access to quaternary neonatal care for more rural communities, helps in the triage of neonatal transfers, promotes family centered care, and significantly reduces health care costs.

scholarly journals Perinatal Regionalization and Implications for Long-Term Health Outcomes in Cerebral Palsy

2016 ◽  
Vol 43 (2) ◽  
pp. 248-253 ◽  
Author(s):  
Corneliu Bolbocean ◽  
Pia Wintermark ◽  
Michael I. Shevell ◽  
Maryam Oskoui
Keyword(s):  
Cerebral Palsy ◽  
Propensity Score ◽  
Neonatal Care ◽  
Outcome Variable ◽  
Level Of Care ◽  
Level Ii ◽  
Versus Level ◽  
Perinatal Regionalization ◽  
Level I

AbstractBackground: Perinatal regionalization is linked to improved neonatal outcomes; however, the effects on long-term outcomes in cerebral palsy (CP) are not known. We estimate the effect of highest levels of neonatal care available at delivery on the risk of developing a nonambulatory CP status. Methods: Children with CP born in Quebec from the Canadian CP Registry excluding postneonatal causes were included (N=360). We estimate the effect of level of care available at delivery on risk of nonambulatory status among children with CP using propensity score matching and instrumental variables methods to adjust for differences in case mix among the three groups of hospitals. The outcome variable is an indicator for CP nonambulation assigned according to Gross Motor Function Classification System (levels IV and V). This study used data that predated therapeutic hypothermia in Quebec. Results: Propensity score estimates of change in the adjusted risk of having a nonambulatory CP status because of birth at level II versus level I is −0.081, 95% confidence interval (CI; −0.2182 to 0.0562); level III versus level I is −0.072 95% CI (−0.225 to 0.08), and level III versus level II is 0.157 95% CI (0.027 to 0.286). Conclusions: Differences in levels of neonatal care available at hospital where the delivery was carried out are not associated with the risk of a nonambulatory CP phenotype. This suggests that level of care and associated medical technology within the Quebec regionalized neonatal-perinatal system is used efficiently because it does not offer any further marginal benefit in the reduction of severe CP outcomes. The system works well as it is, which is supportive of the perinatal regionalization. The success of the neonatal resuscitation program and referral of high-risk births to regional hospitals with sufficient obstetric and perinatal competence and resources may contribute to this lack of variability.

scholarly journals Analysis of the Referral Rates of Newborn Hearing Screening Test According to Childbirth Delivery Methods in Neonatal Care Units

2021 ◽  
Vol 10 (13) ◽  
pp. 2923
Author(s):  
Ganghyeon Seo ◽  
Hyo Geun Choi ◽  
Sookyung Jang ◽  
Sun Choi ◽  
Sa Ra Lee ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Neonatal Care ◽  
Referral Rate ◽  
Hearing Screening ◽  
Neonatal Intensive Care Units ◽  
Parental Anxiety ◽  
Delivery Methods ◽  
Referral Rates ◽  
Newborn Hearing ◽  
Level I

It is known that neonates born by cesarean delivery (CD) may have higher referral rates than those born by vaginal delivery (VD) for newborn hearing screening (NHS). False-positive NHS results can increase costs and parental anxiety. This study analyzed the differences in NHS referral rates according to delivery methods in Level I, II, and III neonatal care units. A retrospective chart review was done for 2322 infants (4644 ears) with delivery records who underwent NHS between 2004 and 2017. The first NHS was performed immediately before discharge when the infant was in good condition via the automated auditory brainstem response (AABR) or automated otoacoustic emissions (AOAE). There were 98 neonates (196 ears) who underwent both AABR and AOAE simultaneously as the first NHS, 30 of which failed. We used a total of 4810 ears in this analysis. Of all enrolled ears, 2075 ears were of neonates born by CD, and 2735 ears were of neonates born by VD. A total of 2460 ears were from patients in Level III neonatal intensive care units (NICU) and 2350 ears were from Level I and II neonatal care units. The overall referral rate was higher in infants born via CD (4.5%) than VD (3.2%). In Level I and II neonatal intensive care units, the referral rate was significantly higher in those born via CD (3.0%) than via VD (1.4%). Further, based on the screening method, AABR (75.8%) was more frequently used than AOAE (24.2%), thereby revealing AABR’s higher referral rate in CD (2.9%) than in VD (1.2%). The referral rate of infants who underwent the NHS within three days of birth was higher in the CD group (3.0%) than in the VD group (1.3%). There was no significant difference in the referral rate depending on the delivery method when infants were hospitalized for more than four days or hospitalized in the NICU. The referral rate according to the delivery methods was significantly higher when the NHS test was performed for healthy newborns in the Level I and II neonatal care units born by CD within 72 h using AABR. Therefore, we recommend that the hearing screening test for newborns delivered by cesarean section be performed after 72 h of age. The results of this study may reduce the false-positive NHS results, unnecessary further tests, and parental anxiety.

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

scholarly journals Secondary prevention medication persistence and prognosis of acute ischaemic stroke or transient ischaemic attack

2021 ◽  
pp. svn-2020-000471
Author(s):  
Lei Zhang ◽  
Junfeng Shi ◽  
Yuesong Pan ◽  
Zixiao Li ◽  
Hongyi Yan ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Recurrent Stroke ◽  
Medication Persistence ◽  
Level Ii ◽  
Composite Events ◽  
Ischaemic Attack ◽  
Level I

IntroductionThe risk of disability and mortality is high among recurrent stroke, which highlights the importance of secondary prevention measures. We aim to evaluate medication persistence for secondary prevention and the prognosis of acute ischaemic stroke or transient ischaemic attack (TIA) in China.MethodsPatients with acute ischaemic stroke or TIA from the China National Stroke Registry II were divided into 3 groups based on the percentage of persistence in secondary prevention medication classes from discharge to 3 months after onset (level I: persistence=0%, level II: 0%<persistence<100%, level III: persistence=100%). The primary outcome was recurrent stroke. The secondary outcomes included composite events (stroke, myocardial infarction or death from cardiovascular cause), all-cause death and disability (modified Rankin Scale score=3–5) from 3 months to 1 year after onset. Recurrent stroke, composite events and all-cause death were performed using Cox regression model, and disability was identified through logistic regression model using the generalised estimating equation method.Results18 344 patients with acute ischaemic stroke or TIA were included, 315 (1.7%) of whom experienced recurrent strokes. Compared with level I, the adjusted HR of recurrent stroke for level II was 0.41 (95% CI 0.31 to 0.54) and level III 0.37 (0.28 to 0.48); composite events for level II 0.41 (0.32 to 0.53) and level III 0.38 (0.30 to 0.49); all-cause death for level II 0.28 (0.23 to 0.35) and level III 0.20 (0.16–0.24). Compared with level I, the adjusted OR of disability for level II was 0.89 (0.77 to 1.03) and level III 0.82 (0.72 to 0.93).ConclusionsPersistence in secondary prevention medications, especially in all classes of medications prescribed by the physician, was associated with lower hazard of recurrent stroke, composite events, all-cause death and lower odds of disability in patients with acute ischaemic stroke or TIA.

Source depth estimation using multi-station waveform data

1984 ◽  
Vol 74 (5) ◽  
pp. 1623-1643
Author(s):  
Falguni Roy
Keyword(s):  
Depth Estimation ◽  
The United States ◽  
Digital Data ◽  
United States Geological Survey ◽  
Travel Times ◽  
Source Depth ◽  
Time Data ◽  
Waveform Data ◽  
Level Ii ◽  
Level I

Abstract A depth estimation procedure has been described which essentially attempts to identify depth phases by analyzing multi-station waveform data (hereafter called level II data) in various ways including deconvolution, prediction error filtering, and spectral analysis of the signals. In the absence of such observable phases, other methods based on S-P, ScS-P, and SKS-P travel times are tried to get an estimate of the source depth. The procedure was applied to waveform data collected from 31 globally distributed stations for the period between 1 and 15 October 1980. The digital data were analyzed at the temporary data center facilities of the National Defense Research Institute, Stockholm, Sweden. During this period, a total number of 162 events in the magnitude range 3.5 to 6.2 were defined by analyzing first arrival time data (hereafter called level I data) alone. For 120 of these events, it was possible to estimate depths using the present procedure. The applicability of the procedure was found to be 100 per cent for the events with mb &gt; 4.8 and 88 per cent for the events with mb &gt; 4. A comparison of level I depths and level II depths (the depths as obtained from level I and level II data, respectively) with that of the United States Geological Survey estimates indicated that it will be necessary to have at least one local station (Δ &lt; 10°) among the level I data to obtain reasonable depth estimates from such data alone. Further, it has been shown that S wave travel times could be successfully utilized for the estimation of source depth.

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