scholarly journals P-OGC40 Enhanced recovery after oesophagectomy at Oxford University Hospitals: the benefit of having a discharge target

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Nainaka Menon ◽  
Stefan Antonowicz ◽  
Antonio Matarangelo ◽  
Stephen Ash ◽  
Richard Owen ◽  
...  
Keyword(s):  
Enhanced Recovery ◽  
Economic Status ◽  
Clinical Care ◽  
Cell Cancer ◽  
Binary Logistic Regression ◽  
Major Surgery ◽  
University Hospitals ◽  
Specific Patient ◽  
Chi Squared ◽  
Cancer Experience

Abstract Background Enhanced recovery after surgery (ERAS) is a multimodal approach to decreasing morbidity and accelerating return-of-function after major surgery. However, the majority of patients undergoing oesophagectomy for cancer experience some kind of complication, which extends their admission and causes pathway deviation. Thus, the value of having a discharge target (Day 8 at our institution) could be challenged. In this study we reviewed our experience using this pathway, with a focus on: (i) whether length of stay and morbidity has improved since pathway implementation (ii) describing the medical and non-medical reasons for extended admission (iii) identifying pre-operative predictors of pathway deviation. Methods A retrospective review of a prospectively maintained database was performed. Complications are recorded during routine clinical care using standardised definitions set out by the Esophageal Complications Consensus group,  and are updated in the database at a weekly departmental meeting. Median and interquartile range were used for descriptors and differences tested with Mann-Whitney U test or Chi squared tests, using SPSS ver 26. Multivariable models were fitted to establish independent predictors of pathway deviation, using a binary logistic regression approach with bootstrapping. Results 150 of 448 patients met the 8-day target. Patients treated since 2018 were significantly more likely meet their discharge date (OR 1.28, P = 0.041) compared to 2015-2017, and have less complications. Surgical quality was unchanged. Thirty-day mortality increased but was still low (0.9% vs 1.8%, P = 0.067).  Aside from having a complication (OR 4.15,  P < 0.001), independent predictor of delayed discharge was female sex (OR 2.6, P = 0.003), squamous cell cancer histology (OR 2.8, P = 0.014) and low socio-economic status (OR 1.33, P = 0.014), but not age, smoking, BMI, co-morbidities and other baseline variables. Conclusions Enhanced recovery after oesophagectomy provides clear goals for the patient and multi-disciplinary team, however the target is often not met owing to the frequent nature of post-operative complications. Nonetheless these targets provide a culture for accelerated recovery, with steady improvement in short-term outcomes over time.  A number of specific patient-groups are more likely to have extended admissions independent of complications, which has implications for optimising prehabilitation services. Overall , these findings suggest that having a discharge target is valuable,  even though it often is not met.

scholarly journals Determinants of safe delivery utilization among Indonesian women in eastern part of Indonesia

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 332
Author(s):  
Ferry Efendi ◽  
Susy Katikana Sebayang ◽  
Erni Astutik ◽  
Setho Hadisuyatmana ◽  
Eka Mishbahatul Mar'ah Has ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Economic Status ◽  
Full Range ◽  
Unwanted Pregnancy ◽  
Secondary Data ◽  
Binary Logistic Regression ◽  
Wealth Quintile ◽  
Cross Sectional ◽  
Safe Delivery ◽  
Chi Squared

Background: Improving maternal health and reducing maternal mortality are part of the United Nations global Sustainable Development Goals for 2030. Ensuring every woman’s right to safe delivery is critical for reducing the maternal mortality rate. Our study aimed to identify determinants of safe delivery utilization among women in the eastern Indonesia. Methods: This study was cross-sectional and used a secondary data from the 2017 Indonesian Demographic and Health Survey (IDHS). A total of 2,162 women who had their last child in the five years preceding the survey and lived in the eastern part of Indonesia were selected as the respondents. Chi-squared test and binary logistic regression were used to understand the determinants of safe delivery. Results: Higher child rank and interval ≤2 years (OR: 0.30, 95% CI: 0.19-0.47), unwanted pregnancy at time of becoming pregnant (OR: 1.48, 95% CI: 1.05-2.08), richest wealth quintile (OR: 5.59, 95% CI: 3.37-9.30), more than four antenatal care visits (OR: 3.62, 95% CI: 2.73-4.79), rural residence, good composite labor force participation, and a good attitude towards domestic violence were found to be significantly associated with delivery at health facility. Higher child rank and interval ≤2 years (OR: 0.49, 95% CI: 0.29-0.83), husband/partner having completed secondary or higher education (OR: 2.18, 95% CI: 1.48-3.22), being in the richest wealth quintile, and four other factors were found to be significantly associated with the assistance of skilled birth attendants. Conclusions: This research extends our knowledge on the determinants of safe delivery among women in the eastern part of Indonesia. This study revealed that the economic status of household remains an important issue in improving safe delivery among women in eastern part of Indonesia. An open innovation and partnership process to improve safe delivery program that engages the full range of stakeholders should be developed based on economic situation.

scholarly journals Patient Experience in Home Respiratory Therapies: Where We Are and Where to Go

2019 ◽  
Vol 8 (4) ◽  
pp. 555 ◽  
Author(s):  
Cátia Caneiras ◽  
Cristina Jácome ◽  
Sagrario Mayoralas-Alises ◽  
José Ramon Calvo ◽  
João Almeida Fonseca ◽  
...  
Keyword(s):  
Clinical Research ◽  
Patient Experience ◽  
Clinical Care ◽  
Research Priorities ◽  
Specific Patient ◽  
Quality Healthcare ◽  
Body Of Knowledge ◽  
Number Of Patients ◽  
Patient Reported ◽  
System Sustainability

The increasing number of patients receiving home respiratory therapy (HRT) is imposing a major impact on routine clinical care and healthcare system sustainability. The current challenge is to continue to guarantee access to HRT while maintaining the quality of care. The patient experience is a cornerstone of high-quality healthcare and an emergent area of clinical research. This review approaches the assessment of the patient experience in the context of HRT while highlighting the European contribution to this body of knowledge. This review demonstrates that research in this area is still limited, with no example of a prescription model that incorporates the patient experience as an outcome and no specific patient-reported experience measures (PREMs) available. This work also shows that Europe is leading the research on HRT provision. The development of a specific PREM and the integration of PREMs into the assessment of prescription models should be clinical research priorities in the next several years.

scholarly journals Characteristics of visits and predictors of admission from a paediatric emergency room in Saudi Arabia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mohammad H. Al-Qahtani ◽  
Abdullah A. Yousef ◽  
Bassam H. Awary ◽  
Waleed H. Albuali ◽  
Mohammed A. Al Ghamdi ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Binary Logistic Regression ◽  
Total Sample ◽  
Age Group ◽  
Chi Squared ◽  
Improper Use ◽  
Level Shifts ◽  
The Impact

Abstract Background The Emergency Repartment (ER) is one of the most used areas in healthcare institutions. Problems with over utilisation and overcrowding have been reported worldwide. This study aims at examining the characteristics of paediatric ER visits, the rate of hospital admissions and its associated predictors at King Fahd Hospital of the University in the Eastern Province of Saudi Arabia. Methods This is a retrospective, medical record-based study. Variables included gender, age group, nationality, complaints, Triage level, shifts and seasons. Descriptive statistics were reported as frequencies/percentages. P-values were obtained through a Chi-Squared test while unadjusted and adjusted odds ratios were estimated by binary logistic regression, where admission was considered as the outcome. Results The total number of paediatric patients included was 46,374, and only 2.5% were admitted. Males comprised 55.4% while females comprised 44.6%. The most common age group were toddlers, and 92.4% of the total sample were Saudis. The most common complaint was fever (26.9%) followed by respiratory symptoms (24.9%). Only 7 patients (0.02%) were classified as triage I (Resuscitation), and most were triage IV (Less urgent) (71.0%). Most visits occurred during the winter months. Adjusted ORs showed that neonates had higher odds of admission (OR = 3.85, 95%CI = 2.57–5.76). Moreover, those presenting with haematological conditions showed an OR of 65.49 (95%CI = 47.85–89.64), followed by endocrine conditions showing an OR of 34.89 (95%CI = 23.65–51.47). Triage I had a very high odds of admission (OR = 19.02, 95%CI = 2.70–133.76), whereas triage V was associated with a very low odds of admission (OR = 0.30, 95%CI = 0.23–0.38). Conclusions A low rate of hospital admission was found in comparison with other rates worldwide. This was mostly attributed to an alarmingly high number of non-urgent ER visits. This further emphasises the problem with improper use of ER services, as these cases should be more appropriately directed towards primary healthcare centres. Further studies to examine the impact of prioritising patients in the ER based on the identified predictors of hospital admission, in addition to the standard triage system, are suggested.

Consumer Wearables for Patient Monitoring in Otolaryngology: A State of the Art Review

2021 ◽  
pp. 019459982110616
Author(s):  
Shaan N. Somani ◽  
Katherine M. Yu ◽  
Alexander G. Chiu ◽  
Kevin J. Sykes ◽  
Jennifer A. Villwock
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
Behavioral Interventions ◽  
Early Recognition ◽  
Clinical Care ◽  
The United States ◽  
Major Surgery ◽  
Inpatient Setting ◽  
Biometric Data ◽  
Pubmed Search

Objective Consumer wearables, such as the Apple Watch or Fitbit devices, have become increasingly commonplace over the past decade. The application of these devices to health care remains an area of significant yet ill-defined promise. This review aims to identify the potential role of consumer wearables for the monitoring of otolaryngology patients. Data Sources PubMed. Review Methods A PubMed search was conducted to identify the use of consumer wearables for the assessment of clinical outcomes relevant to otolaryngology. Articles were included if they described the use of wearables that were designed for continuous wear and were available for consumer purchase in the United States. Articles meeting inclusion criteria were synthesized into a final narrative review. Conclusions In the perioperative setting, consumer wearables could facilitate prehabilitation before major surgery and prediction of clinical outcomes. The use of consumer wearables in the inpatient setting could allow for early recognition of parameters suggestive of poor or declining health. The real-time feedback provided by these devices in the remote setting could be incorporated into behavioral interventions to promote patients’ engagement with healthy behaviors. Various concerns surrounding the privacy, ownership, and validity of wearable-derived data must be addressed before their widespread adoption in health care. Implications for Practice Understanding how to leverage the wealth of biometric data collected by consumer wearables to improve health outcomes will become a high-impact area of research and clinical care. Well-designed comparative studies that elucidate the value and clinical applicability of these data are needed.

Deciphering Links Between Sexual Violence and Castes in India

2021 ◽  
pp. 2455328X2110325
Author(s):  
Yogendra Musahar
Keyword(s):  
Regression Model ◽  
Sexual Violence ◽  
Economic Status ◽  
Family Health ◽  
Uttar Pradesh ◽  
Binary Logistic Regression ◽  
Wealth Index ◽  
Bivariate Analysis ◽  
Binary Logistic Regression Model ◽  
Explanatory Variables

The recent incident, the gang rape and murder of a 19-year-old woman in Hathras, a small village in Uttar Pradesh of India, once again sparks a debate on links between sexual violence and castes in India. This article aims to examine the links between sexual violence and castes in India. This study utilizes the national representative National Family Health Survey 4 (NFHS-4, 2015–16) data. A bivariate analysis was carried out to analyse the data. A binary logistic regression model was applied to predict the effect of explanatory variables, viz. type of place of residence, years of schooling complete, economic status in terms of wealth index and finally castes on predicted variable, i.e. sexual violence. The binary regression model indicates that there were links between sexual violence and castes. For secured and dignified life of women, caste-based sexual violence must be annihilated.

Residual chemosensitivity to ventilatory challenges in genotyped congenital central hypoventilation syndrome

2014 ◽  
Vol 116 (4) ◽  
pp. 439-450 ◽  
Author(s):  
Michael S. Carroll ◽  
Pallavi P. Patwari ◽  
Anna S. Kenny ◽  
Cindy D. Brogadir ◽  
Tracey M. Stewart ◽  
...  
Keyword(s):  
Young Adults ◽  
Clinical Care ◽  
Neurodevelopmental Disorder ◽  
Control Group ◽  
Congenital Central Hypoventilation Syndrome ◽  
Specific Patient ◽  
Cerebrovascular Function ◽  
Central Hypoventilation ◽  
Hypoventilation Syndrome ◽  
Chemosensory Function

Congenital central hypoventilation syndrome (CCHS) is a neurodevelopmental disorder characterized by life-threatening hypoventilation, possibly resulting from disruption of central chemosensory integration. However, animal models suggest the possibility of residual chemosensory function in the human disease. Cardioventilatory function in a large cohort with CCHS and verified paired-like homeobox 2B ( PHOX2B) mutations was assessed to determine the extent and genotype dependence of any residual chemosensory function in these patients. As part of inpatient clinical care and evaluation, 64 distinct studies from 32 infants, children, and young adults with the disorder were evaluated for physiological response to three different inspired steady-state gas exposures of 3 min each: hyperoxia [100% oxygen (O2)]; hyperoxic hypercapnia [95% O2 and 5% carbon dioxide (CO2)]; and hypoxic hypercapnia [14% O2 and 7% CO2 balanced with nitrogen (N2)]. These were followed by a hypoxia challenge consisting of five or seven breaths of N2 (100% N2). In addition, a control group of 15 young adults was exposed to all but the hypoxic challenge. Comprehensive monitoring was used to derive breath-to-breath and beat-to-beat measures of ventilatory, cardiovascular, and cerebrovascular function. On average, patients showed a residual awake ventilatory response to chemosensory challenge, independent of the specific patient PHOX2B genotype. Graded dysfunction in cardiovascular regulation was found to associate with genotype, suggesting differential effects on different autonomic subsystems. In addition, differences between cases and controls in the cerebrovascular response to chemosensory challenge may indicate alterations in cerebral autoregulation. Thus residual cardiorespiratory responses suggest partial preservation of central nervous system networks that could provide a fulcrum for potential pharmacological interventions.

scholarly journals Mobile Floriculture Operators in Southern Sri Lanka: Challenges and Solutions

2020 ◽  
pp. 32-39
Author(s):  
H. I. G. K. Anuruddi ◽  
D. L. C. K. Fonseka ◽  
W. W. U. I. Wickramaarachchi
Keyword(s):  
Sri Lanka ◽  
Economic Status ◽  
Ornamental Plants ◽  
Binary Logistic Regression ◽  
Product Diversification ◽  
Export Market ◽  
Full Time ◽  
Willingness To Adopt ◽  
Coir Dust ◽  
Full Time Employment

Floriculture is a flourishing industry in Sri Lanka with a great potential in both domestic and export market. Street and mobile flower vending is a micro enterprise which is not a negligible portion of floriculture sector in the country. Present study was conducted to investigate the constraints faced by street and mobile flower vendors and to understand their willingness to adopt those challenges. Randomly selected 40 flower vendors from Galle, Matara and Hambantota districts were interviewed using a semi structured questionnaire by visiting them at their marketing sites such as streets, week fairs and “Kaprukawaruna” exhibitions conducted by Coconut Cultivation Board, Matara. According to the findings, majority of the respondents engage in the business as a full time employment and 43.3% of the vendors sell plants grown in their own nurseries. Apart from the flowering and ornamental plants, they sell fertilizers, coir dust and coconut husk pieces and product diversification has a significant impact (p=0.016) on their monthly income. Average nursery size was found to be 500ft2 where average income was noted as 200 USD. Among the vendors 70% use their own money to refinance the business. Majority of the respondents (60%) were members of different flower grower societies. Vendors (87.5%) sell their products targeting week fairs and (62.5%) sell their products beside the streets in temporary fixed huts. Not having an authorized place to market their goods was identified as the major problem by 85% of the respondents. Majority of the vendors (62.5%) were willing to expand the business while 42.5% identified this as a profitable venture to invest. According to the binary logistic regression results, age (p=0.000), education level (p=0.001), economic status (p=0.057), nursery size (p=0.004) and credit accessibility (p=0.024) were positively related with their willingness to adopt for the challenges they face. It is concluded that following key actions must be taken to strengthen the street and mobile flower vendors for their further empowerment: Provision of proper authorized sites of operation, improve the market credit and other infrastructure facilities and more training opportunities.

scholarly journals Changes in contraceptive and sexual behaviours among unmarried young people in Nigeria: Evidence from nationally representative surveys

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246309
Author(s):  
Sunday A. Adedini ◽  
Jacob Wale Mobolaji ◽  
Matthew Alabi ◽  
Adesegun O. Fatusi
Keyword(s):  
Young People ◽  
Associated Factors ◽  
Sexual Debut ◽  
Economic Status ◽  
Binary Logistic Regression ◽  
Demographic And Health Surveys ◽  
Inconsistent Condom ◽  
Sexual Behaviours ◽  
Nationally Representative ◽  
Multiple Sexual Partnership

Context Nigeria is a high-burden country in terms of young people’s health. Understanding changes in young people’s sexual and reproductive health (SRH) behaviours and the associated factors is important for framing appropriate interventions. Objective This study assessed changes in SRH behaviours of unmarried young people aged 15–24 and associated factors over a ten-year period in Nigeria. Data and method We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours. Results Over four-fifths of unmarried young people (15–24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20–24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves. Conclusion Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH.

scholarly journals Data mining untuk memprediksi prestasi siswa berdasarkan sosial ekonomi, motivasi, kedisiplinan dan prestasi masa lalu

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Heri Susanto ◽  
Sudiyatno Sudiyatno
Keyword(s):  
Data Mining ◽  
Decision Tree ◽  
Multiple Regression ◽  
Economic Status ◽  
Predictive Analysis ◽  
Research Approach ◽  
Significance Level ◽  
Achievement Prediction ◽  
Interaction Detection ◽  
Chi Squared

Penelitian ini bertujuan untuk membuat prediksi prestasi belajar siswa berdasarkan status sosial ekonomi orang tua, motivasi, kedisiplinan siswa dan prestasi masa lalu menggunakan metode data mining dengan algoritma J48. Sebagai perbandingan, data penelitian dianalisis juga dengan CHAID (Chi Squared Automatic Interaction Detection) dan regresi ganda. Pendekatan penelitian yang digunakan adalah kuantitatif. Subyek penelitian ini adalah siswa tingkat X SMK Negeri 4 Surakarta berjumlah 416 siswa. Teknik pengumpulan data yang digunakan adalah dokumentasi dan angket. Hasil penelitian menunjukkan bahwa analisis prediksi menggunakan decision tree algoritma J48 memiliki akurasi sebesar 95,7%, sedangkan analisis prediksi menggunakan CHAID memiliki tingat akurasi 82,1% dan analisis regresi ganda menghasilkan tingkat signifikansi sebesar 90,6%. Berdasarkan hasil tersebut bisa disimpulkan bahwa metode J48 lebih baik dibandingkan dengan metode CHAID dan regresi ganda. DATA MINING TO PREDICT STUDENT’S ACHIEVEMENT BASED ON SOCIO-ECONOMIC, MOTIVATION, DISCIPLINE AND ACHIEVEMENT OF THE PASTAbstractThis study aims to make student achievement prediction based on socio-economic status of parents, motivation, discipline students and past achievements using data mining methods with the J48 algorithm. For comparison, the data were analyzed also with CHAID (Chi Squared Automatic Interaction Detection) and multiple regression. The research approach is quantitative. The subjects of this study were student-first level at SMK Negeri 4 Surakarta totaled 416 students. Data collection techniques used are documentation and questionnaires. The results showed that the predictive analysis using J48 decision tree algorithm has an accuracy of 95.7%, while the predictive analysis using CHAID has the rank of an accuracy of 82.1% and a multiple regression analysis resulted in a significance level of 90.6%. Based on these results it can be concluded that the J48 method is better than the CHAID and multiple regression methods.

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