scholarly journals Enteric Function as a Determinant of Nutritional and Clinical Recovery from Acute Illness Among Children in Kenya and Pakistan

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 916-916
Author(s):  
Kirkby Tickell ◽  
Donna Denno ◽  
Ali Saleem ◽  
Zaubina Kazi ◽  
Barbra Richardson ◽  
...  
Keyword(s):  
High Performance ◽  
A Priori ◽  
Infection Prevalence ◽  
Hiv Status ◽  
Post Discharge ◽  
Middle Income ◽  
Funding Sources ◽  
Gates Foundation ◽  
Poor Outcomes ◽  
Discharge From Hospital

Abstract Objectives In low- and middle-income countries (LMICs), acutely ill undernourished children remain at high risk of mortality for months following discharge from hospital. Community-based studies suggest that enteric dysfunction (ED), including permeability and impaired absorption, is associated with poor outcomes. We used the lactulose rhamnose ratio (L: R) test, which provides a functional assessment of gut integrity, to determine if ED influences clinical and nutritional recovery in the post-discharge period. Methods Children aged 2–24 months without diarrhea were recruited from Civil Hospital Karachi, Pakistan and Migori County Referral Hospital, Kenya. L: R tests were administered after children were clinically stable (oral feeds, not dehydrated, no oxygen needs) and pre-discharge. Similarly aged children were pseudo-randomly selected from homes near those of children being discharged and were also tested. Prior to administration of sugars, urine was collected to detect background levels, followed by a two-hour collection. Samples were analyzed by high-performance chromatography mass spectroscopy. Crude L: R distributions were compared using the Mann-Whitney test. A priori determined confounders (age, mid-upper arm circumference [MUAC], HIV status, site) were adjusted for in linear regression of log-transformed L: R. Results 156 hospitalized and 91 community children were recruited. Median age was nine months in each group. Hospitalized children had lower median MUAC (12.4 vs 13.5 cm) and higher HIV infection prevalence (5% vs 1%). Both sugars were largely undetectable in pre-dose samples. Urinary median L: R among children being discharged (0.36 (interquartile range [IQR] 0.20–0.87)) was significantly higher compared to community peers (0.30 (IQR: 0.17–0.48, P = 0.038)). This difference remained significant in the adjusted model (p: 0.008). Conclusions Children at discharge from hospital in LMICs appear to have worse enteric function than community peers, and this difference does not appear to be attributable to young age or nutritional or HIV status. This analysis will be expanded to include L: R association with mortality, morbidity and growth outcomes prior to the conference. Funding Sources Thrasher Research Foundation 14,466, the Bill & Melinda Gates Foundation OPP 1,131,320.

scholarly journals Stakeholder Engagement Strategies for Policy and Programmatic Uptake: Lessons from the Drivers of Food Choice Competitive Grants Program

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 920-920
Author(s):  
Andrea Warren ◽  
Shilpa Constantinides ◽  
Edward Frongillo ◽  
Christine Blake
Keyword(s):  
International Development ◽  
Stakeholder Engagement ◽  
Food Choice ◽  
A Priori ◽  
Lead Author ◽  
Structured Interviews ◽  
Middle Income ◽  
Engagement Strategies ◽  
Stakeholder Identification ◽  
Gates Foundation

Abstract Objectives This study drew upon experiences of stakeholder engagement in food choice research to advance knowledge about best practices. Methods The Drivers of Food Choice Competitive Grants Program aimed to understand food choice in low- and middle-income-countries. All funded proposals included stakeholder engagement strategies. Data were from document review of proposals and reports and semi-structured interviews with the principal investigators of the 15 projects. Interviews were transcribed and uploaded into NVIVO 12. The lead author analyzed interviews thematically using an a priori code list and led discussion of themes and patterns through peer review with co-authors. Results Grantees developed and implemented a range of strategies. “Uni-directional” strategies were researcher-driven and informational, did not seek input from the target stakeholder, and included one-way communication such as emails, newsletters, meetings, press releases, technical briefs, newspaper articles, and public engagement efforts. “Bi-directional” strategies sought collaboration with stakeholders. Examples were workshops which sought feedback on stakeholder identification, research questions, methods, results, and recommendations. Grantees used unidirectional strategies to increase buy-in and generate demand for results, which helped promote the use of evidence for decision-making. Bi-directional strategies were integral to knowledge production. Grantees thought that bi-directional engagement enhanced the immediate applicability of the research. Grantees developed more- and less-intensive strategies that involved both bi-and uni-directional engagement, depending on goals for uptake. Conclusions This research sheds light on the role of stakeholder engagement strategies in advancing multisectoral nutrition. The current landscape of research and practice is fast-paced and complex; ensuring relevance of research via diverse stakeholder engagement strategies should remain a priority for researchers and funders. Our findings may aid researchers in constructing strategies that are responsive to diverse research programs and goals within complex multisectoral nutrition landscapes. Funding Sources UK Government's Department for International Development and Bill & Melinda Gates Foundation.

scholarly journals Assessment of Vitamin A (VA) Total Body Stores (TBS) Using Dried Derum Spots (DSS)

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 861-861
Author(s):  
Georg Lietz ◽  
Anthony Oxley ◽  
Reina Engle-Stone ◽  
Jody Miller ◽  
Dolly Reario ◽  
...  
Keyword(s):  
Current Method ◽  
Cold Chain ◽  
Isotope Dilution Method ◽  
Dilution Method ◽  
Serum Samples ◽  
Retinyl Acetate ◽  
Middle Income ◽  
Funding Sources ◽  
Filipino Children ◽  
Gates Foundation

Abstract Objectives The retinol isotope dilution method has been successfully applied to assess the efficacy of VA interventions in low and middle-income countries. However, the current method is limited in its applicability because it relies on keeping serum samples in the cold chain. To overcome that limitation, we assessed the feasibility of using DSS for assessing TBS in Filipino children 12–18 months of age. Methods Serum (40 µL) from Filipino children, who had received an oral dose of [,13C10]-retinyl acetate was spotted and dried on Whatman 903 cards then stored at −20°C before shipment at room temperature; aliquots of liquid serum were kept frozen at −80°C until analysis. DSS and liquid serum were extracted by established methods and then analysed by LC-MS/MS to quantify the [,13C]/[,12C] retinol ratio and TBS. Results Mean ± SD TBS of 57 Filipino infants aged 12–18 mo were 507.6 ± 185.8 µmol and 495.5 ± 170.1 µmol from either serum or DSS samples, respectively. Comparison of methods using Bland-Altman analysis indicated agreement between both methods with an intra-individual mean difference for TBS of 22.1 µmol (4.5%). Conclusions TBS can be determined using serum spot samples in field settings, thus reducing the costs and limitations of shipping serum samples on dry ice and reducing the need for −80C storage in field stations. Funding Sources Medical Research Council UK; Bill and Melinda Gates Foundation.

scholarly journals Household Food-Related Assessment Using an Innovative Passive Dietary Assessment Device in Ghana

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1157-1157
Author(s):  
Alex Anderson ◽  
Megan McCrory ◽  
Matilda Steiner-Asiedu ◽  
Richard Ansong ◽  
Clara Lewis ◽  
...  
Keyword(s):  
Formal Education ◽  
Dietary Assessment ◽  
Primary Caregivers ◽  
Older Children ◽  
Middle Income ◽  
Funding Sources ◽  
Dietary Assessment Methods ◽  
Household Food ◽  
Low Middle Income Countries ◽  
Gates Foundation

Abstract Objectives Traditional dietary assessment methods in low-middle income countries (LMICs) have considerable limitations. the objective of this study was to test the feasibility of using the Automatic Ingestion Monitor (AIM), an eyeglasses-mounted wearable chewing sensor and micro-camera, to monitor food acquisition, preparation and consumption of households in a LMIC setting. Methods Data from households in Mampong-Akuapem (n = 5), a semi-rural community, and Kweiman (n = 7), a peri-urban community, in the Eastern and Greater Accra Regions of Ghana, respectively, were evaluated. The AIM was used to monitor household activities for one day. Within each household, the primary caregiver (mother) wore the AIM during waking hours on the chosen day as she went about her daily activities, except any activities where she wanted to preserve privacy. Mothers also responded to a socio-demographic questionnaire and evaluated their perceived burden of wearing the AIM. Images captured by the AIM were processed and annotated in custom-designed software. Time spent in major household related activities around food are described. Results Households had 1.9 ± 0.3 adults and 2.8 ± 1.6 children (mean ± SD). Primary caregivers were 30.5 ± 5.2 years of age, all were married (1 separated), and had a median of 9 years of formal education. Two mothers were breastfeeding at data collection, but only 1 household had an infant <1 year. Total AIM wear time was 8 h, 19 min ± 2 h, 11 min, representing 58% of waking hours. All members of each household consumed the same prepared meals, and all meals were captured by the AIM. Among mothers, time spent cooking varied widely (2 h, 19 min ± 1 h, 42 min), ranging from 0.5 to 6 h. Time spent eating and drinking was 41 ± 15 min. Most of the mothers (n = 10) spent time feeding children (17 ± 23 min, including breastfeeding), with 6 mothers feeding younger children (11 ± 10 min), 5 feeding older children (7 ± 4 min), and 2 breastfeeding (53 ± 25 min). The AIM was generally accepted by the primary caregivers and household members although they would prefer a smaller size version. Conclusions In this pilot study, the AIM successfully captured household food related activities and practices that are associated with dietary intake and nutritional health in LMIC. Funding Sources The Bill and Melinda Gates Foundation.

Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service

2021 ◽  
pp. 136749352110147
Author(s):  
Elizabeth M. Forster ◽  
Catherine Kotzur ◽  
Julianne Richards ◽  
John Gilmour
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Nurse Practitioner ◽  
Parental Support ◽  
Transition Period ◽  
Short Form ◽  
Acute Pain Service ◽  
Cross Sectional Survey ◽  
Post Discharge ◽  
Discharge From Hospital

Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child’s pain management and perceptions of support from the NpAPS. Parents completed the Parents’ Postoperative Pain Measure–Short Form (PPPM-SF) and factors affecting parents’ participation in children’s pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24 hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.

565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
R Khaw ◽  
S Munro ◽  
J Sturrock ◽  
H Jaretzke ◽  
S Kamarajah ◽  
...  
Keyword(s):  
Weight Loss ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Failure To Thrive ◽  
Post Discharge ◽  
Postoperative Weight Loss ◽  
Poor Outcomes ◽  
The Impact

Abstract   Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss. Methods Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes. Results 594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases. Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge. Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%. Conclusion Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.

scholarly journals A cohort study of survival following discharge from hospital in rural Tanzanian children using linked data of admissions with community-based demographic surveillance

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Oscar Mukasa ◽  
Honorati Masanja ◽  
Don DeSavigny ◽  
Joanna Schellenberg
Keyword(s):  
Linked Data ◽  
Cox Regression ◽  
District Hospital ◽  
Rural Setting ◽  
Post Discharge ◽  
Community Based ◽  
Related Data ◽  
Clinical Surveillance ◽  
Additional Support ◽  
Discharge From Hospital

Abstract Background To illustrate the public health potential of linking individual bedside data with community-based household data in a poor rural setting, we estimated excess pediatric mortality risk after discharge from St Francis Designated District Hospital in Ifakara, Tanzania. Methods Linked data from demographic and clinical surveillance were used to describe post-discharge mortality and survival probability in children aged < 5 years, by age group and cause of admission. Cox regression models were developed to identify risk factors. Results Between March 2003 and March 2007, demographic surveillance included 28,910 children aged 0 to 5 years and among them 831 (3%) were admitted at least once to the district hospital. From all the children under the demographic surveillance 57,880 person years and 1381 deaths were observed in 24 months of follow up. Survivors of hospital discharge aged 0–5 years were almost two times more likely to die than children of the same age in the community who had not been admitted (RR = 1.9, P < 0.01, 95% CI 1.6, 2.4). Amongst children who had been admitted, mortality rate within a year was highest in infants (93 per 1000 person years) and amongst those admitted due to pneumonia and diarrhoea (97 and 85 per 1000 person years respectively). Those who lived 75 km or further from the district hospital, amongst children who were admitted and survived discharge from hospital, had a three times greater chance of dying within one year compared to those living within 25 km (adjusted HR 3.23, 95% CI 1.54,6.75). The probability of surviving the first 30 days post hospitalization was 94.4% [95% CI 94.4, 94.9], compared to 98.8% [95% CI 97.199.5] in non-hospitalized children of the same age in the commuity. Conclusion This study illustrates the potential of linking health related data from facility and household levels. Our results suggest that families may need additional support post hospitalization.

scholarly journals Attendance at an outpatient follow-up clinic by HIV-positive psychiatric patients initiated on ART as inpatients

2015 ◽  
Vol 21 (3) ◽  
pp. 5
Author(s):  
Yvette M Nel ◽  
Gregory Jonsson
Keyword(s):  
Psychiatric Patients ◽  
Mental Healthcare ◽  
Limited Resource ◽  
Primary Objective ◽  
Hiv Treatment ◽  
Hiv Positive ◽  
Hiv Status ◽  
Post Discharge ◽  
Resource Setting

<p><strong>Background.</strong> Evidence suggests that the presence of mental illness may be associated with poorer adherence to antiretroviral therapy (ART). There is also a general understanding that patients initiated on ART as inpatients have poorer outcomes than those initiated as outpatients. Negative perceptions regarding future adherence may affect the clinical decision to initiate ART in hospitalised psychiatric patients. Attendance at clinic appointments is an indicator of medication adherence, and is easily measurable in a limited-resource setting. </p><p><strong>Objectives.</strong> The primary objective of this study was to examine the rate of attendance at the first clinic appointment post discharge from a period of psychiatric hospitalisation in HIV-positive psychiatric patients initiated on ART as inpatients. A secondary objective was to determine which factors, if any, were associated with clinic attendance. </p><p><strong>Methods.</strong> This study was a retrospective record review, conducted at the Luthando Neuropsychiatric HIV Clinic in Soweto, which is an integrated mental healthcare and ART clinic. Patients who were initiated on ART as psychiatric inpatients from 1 July 2009 to 31 December 2010, and subsequently discharged for outpatient follow-up at Luthando Clinic were included in the sample.  </p><p><strong>Results.</strong> There were 98 patients included in the analysis. The sample was predominantly female. The rate of attendance was 80%. The attendant and non-attendant groups were similar in terms of demographic and clinical data.  Significantly fewer non-attendant patients had disclosed their HIV status to their treatment supporter (<em>p</em>=0.01). </p><p><strong>Conclusion.</strong> Non-disclosure of HIV status needs to be further addressed in integrated psychiatric HIV treatment facilities in order to improve attendance. Female predominance in this setting should also be further investigated.</p>

scholarly journals Out of hospital cardiac arrest in Western Sydney - an analysis of outcomes and estimation of future eCPR eligibility

2021 ◽  
Author(s):  
Pramod Chandru ◽  
Tatum Priyambada Mitra ◽  
Nitesh Dutt Dhanekula ◽  
Mark Dennis ◽  
Adam Eslick ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Rescue Therapy ◽  
A Priori ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Eligibility Criteria ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Poor Outcomes ◽  
Hospital Cardiac Arrest

Abstract Background Refractory out of hospital cardiac arrest (OHCA) is associated with extremely poor outcomes. However, in selected patients extracorporeal cardiopulmonary resuscitation (eCPR) may be an effective rescue therapy, allowing time treat reversible causes. The primary goal was to estimate the potential future caseload of eCPR at historically 'low-volume' extracorporeal membrane oxygenation (ECMO) centres. Methods A 3-year observational study of OHCA presenting to the Emergency Department (ED of an urban referral centre without historical protocolised use of eCPR. Demographics and standard Utstein outcomes are reported. Further, an a priori analysis of each case for potential eCPR eligibility was conducted. A current eCPR selection criteria (from the 2-CHEER study) was used to determine eligibly. Results In the study window 248 eligible cardiac arrest cases were included in the OHCA registry. 30-day survival was 23.4% (n=58). The mean age of survivors was 55.4 years. 17 (6.8%) cases were deemed true refractory arrests and fulfilled the 2-CHEER eligibility criteria. The majority of these cases presented within “office hours” and no case obtained a return of spontaneous circulation standard advanced life support. Conclusions In this contemporary OHCA registry a significant number of refractory cases were deemed potential eCPR candidates reflecting a need for future interdisciplinary work to support delivery of this therapy.

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