scholarly journals The French implementation study PARENTHESE to improve prenatal care of immigrant women

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Azria ◽  
F Eboue ◽  
M Fallon ◽  
O Khomry ◽  
P Sauvegrain ◽  
...  
Keyword(s):  
Pilot Study ◽  
Prenatal Care ◽  
Immigrant Women ◽  
Group Model ◽  
Group Prenatal Care ◽  
Migrant Women ◽  
Optimal Care ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
The Impact

Abstract Numerous studies have shown that non-Western immigrant women have higher maternal and perinatal mortality and morbidity than women and children from host countries. This increased risk is partly explained by less access to quality antenatal care and more sub-optimal care. The organisation and provision of prenatal care in France remain unchanged on a model that is not very sensitive and adaptable to the specific needs of certain groups such as non-Western migrant women. Group prenatal care, an alternative and innovative model, can theoretically be rigorously implemented within the framework of the recommendations for prenatal care set by the French Haute Autorité de Santé and thus meet the objectives assigned to it. This alternative method of monitoring, implemented in different US settings, seems to increase access and adherence to prenatal monitoring, as well as women's involvement in its monitoring. Some studies also suggest that this type of prenatal monitoring could also reduce maternal and perinatal risk. Such intervention has never been tested in France and moving away from a prenatal monitoring model based on individual monitoring towards a group model requires overcoming significant cultural barriers. Before being able to test the impact of a complex intervention such as group prenatal care for migrant women and wider deployment, we set up a pilot study with the aim of precisely defining the intervention and preparing and documenting its implementation process in three different sites using qualitative and quantitative approaches. It is also to evaluate its acceptability for women who participate in these groups as well as for professionals. In addition to presenting this pilot study at this workshop, the objective of this presentation is also to highlight the importance of contextual considerations in the design of the intervention or its implementation in the particular context of intervention aimed at improving migrant populations' health.

scholarly journals Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

2011 ◽  
Vol 114 (2) ◽  
pp. 283-292 ◽  
Author(s):  
Laurent G. Glance ◽  
Andrew W. Dick ◽  
Dana B. Mukamel ◽  
Fergal J. Fleming ◽  
Raymond A. Zollo ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Noncardiac Surgery ◽  
Pulmonary Complications ◽  
Wound Complications ◽  
Severe Anemia ◽  
Thromboembolic Complications ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Increased Risk ◽  
The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

scholarly journals Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

2006 ◽  
Vol 124 (4) ◽  
pp. 186-191 ◽  
Author(s):  
Afonso Celso Pereira ◽  
Roberto Alexandre Franken ◽  
Sandra Regina Schwarzwälder Sprovieri ◽  
Valdir Golin
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Hospital Death ◽  
Inferior Wall ◽  
Mortality And Morbidity ◽  
Killip Class ◽  
Increased Risk ◽  
The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

scholarly journals The Impact of Diabetes on Hippocampus

2021 ◽  
Author(s):  
Saeed Vafaei-Nezhad ◽  
Masood Vafaei-Nezhad ◽  
Mehri Shadi ◽  
Samira Ezi
Keyword(s):  
Central Nervous System ◽  
Developing Countries ◽  
Nervous System ◽  
Child Mortality ◽  
Maternal Diabetes ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
The Impact ◽  
Diabetic Mothers ◽  
Lines Of Evidence

Maternal Diabetes is one of the most common metabolic disorders resulting an increased risk of abnormalities in the developing fetus and offspring. It is estimated that the prevalence of diabetes during pregnancy among women in developing countries is approximately 4.5 percent and this range varies between 1 to 14 percent in different societies. According to earlier studies, diabetes during pregnancy is associated with an increased risk of maternal and child mortality and morbidity as well as major congenital anomalies including central nervous system (CNS) in their offspring. Multiple lines of evidence have suggested that infants of diabetic women are at risk of having neurodevelopmental sequelae. Previous studies reveal that the offspring of diabetic mothers exhibit disturbances in behavioral and intellectual functioning. In the examination of cognitive functioning, a poorer performance was observed in the children born to diabetic mothers when compared with the children of non-diabetic mothers. Therefore, it is important to study the possible effects of maternal diabetes on the hippocampus of these infants.

A Pilot Study of a Sleep Intervention Delivered through Group Prenatal Care to Overweight and Obese Women

2019 ◽  
Vol 18 (4) ◽  
pp. 477-487 ◽  
Author(s):  
Mary Ashley Cain ◽  
Jessica Brumley ◽  
Adetola Louis-Jacques ◽  
Michelle Drerup ◽  
Marilyn Stern ◽  
...  
Keyword(s):  
Pilot Study ◽  
Prenatal Care ◽  
Group Prenatal Care ◽  
Obese Women

The impact of Centering Pregnancy Group Prenatal Care on postpartum family planning

2014 ◽  
Vol 210 (1) ◽  
pp. 50.e1-50.e7 ◽  
Author(s):  
Nathan Hale ◽  
Amy H. Picklesimer ◽  
Deborah L. Billings ◽  
Sarah Covington-Kolb
Keyword(s):  
Family Planning ◽  
Prenatal Care ◽  
Group Prenatal Care ◽  
Centering Pregnancy ◽  
Postpartum Family Planning ◽  
The Impact

scholarly journals Optimizing Pharmacokinetics-Pharmacodynamics of Antimicrobial Management in Patients with Sepsis: A Review

2020 ◽  
Vol 222 (Supplement_2) ◽  
pp. S132-S141 ◽  
Author(s):  
Kady Phe ◽  
Emily L Heil ◽  
Vincent H Tam
Keyword(s):  
Therapeutic Drug ◽  
Optimal Care ◽  
Risk Of Death ◽  
Physiological Alterations ◽  
Increased Risk ◽  
Individualized Dosing ◽  
Antimicrobial Management ◽  
Diagnostic Technology ◽  
Aggressive Interventions ◽  
The Impact

Abstract Critically ill patients with sepsis or septic shock are at an increased risk of death. Early and aggressive interventions are essential for improving clinical outcomes. There are a number of therapeutic and practical challenges in the management of antimicrobials in patients with sepsis. These include the timely selection and administration of appropriate antimicrobials, significant physiological alterations that can influence antimicrobial pharmacokinetics, and significant interpatient variability of antimicrobial concentrations using standard dosing approaches. Understanding the impact of these factors on the probability of attaining pharmacokinetic-pharmacodynamic target goals is essential to guide optimal therapy. Using rapid diagnostic technology could facilitate timely selection of antimicrobials, and therapeutic drug monitoring would provide a more individualized dosing approach. Using an interdisciplinary sepsis team would also be beneficial in coordinating efforts to overcome the challenges encountered during this critical period to ensure optimal care.

scholarly journals Enhancing Accessibility of Physical Activity During Pregnancy: A Pilot Study on Women’s Experiences With Integrating Yoga Into Group Prenatal Care

2019 ◽  
Vol 6 ◽  
pp. 233339281983488
Author(s):  
Patricia Kinser ◽  
Nancy Jallo ◽  
Leroy Thacker ◽  
Christine Aubry ◽  
Saba Masho
Keyword(s):  
Physical Activity ◽  
Pilot Study ◽  
Prenatal Care ◽  
Pregnant Women ◽  
Lived Experience ◽  
Self Efficacy ◽  
The United States ◽  
Group Prenatal Care ◽  
Hospital System ◽  
Over Time

Introduction: Health guidelines suggest that pregnant women should participate in daily physical activity, yet rarely do they meet these guidelines. Means to enhance accessibility of physical activity for pregnant women are required, and yoga has been suggested as a possible method to enhance women’s sense of confidence and competence with physical activity. In this pilot study, our primary aim is to evaluate pregnant women’s perceptions about their lived experience of an intervention which integrates a low-intensity form of physical activity, yoga, into prenatal care; our secondary aim is to evaluate changes in participants’ self-efficacy for physical activity and time spent in physical activity over time. Methods: Held in an outpatient obstetrics department of an urban hospital system in the United States, this pilot study enrolled 16 pregnant women to participate in the intervention throughout their pregnancy. We explored participants’ lived experience of the intervention using qualitative methods (phenomenology). Means, variances, and covariances were calculated for the 2 measures (self-efficacy and time spent in physical activity) over the intervention period. Results: Qualitative findings from focus groups suggest that it is acceptable for prenatal yoga to be integrated into group prenatal care classes and women reported increased confidence with physical activity during pregnancy. Participants did not consider the intervention to fit within the traditional definition of exercise. Women reported increased amounts of time spent in physical activity from baseline to the end of pregnancy, but there were no statistically significant changes in self-efficacy over time. Discussion: The integration of gentle physical activity into the group prenatal care model warrants further attention for potential benefits with regard to maternal physical and mental wellness.

196: The impact of centeringpregnancy group prenatal care on preterm birth

2018 ◽  
Vol 218 (1) ◽  
pp. S130-S131
Author(s):  
Misty L. McDowell ◽  
Chelsea Abshire ◽  
Amy H. Crockett ◽  
Nancy L. Fleischer
Keyword(s):  
Preterm Birth ◽  
Prenatal Care ◽  
Group Prenatal Care ◽  
The Impact

scholarly journals A Pilot Study of the Clinical Frailty Scale to Predict Frailty Transition and Readmission in Older Patients in Vietnam

2020 ◽  
Vol 17 (5) ◽  
pp. 1582
Author(s):  
Tan Van Nguyen ◽  
Thuy Thanh Ly ◽  
Tu Ngoc Nguyen
Keyword(s):  
Pilot Study ◽  
Older Patients ◽  
Rural And Remote ◽  
Clinical Frailty Scale ◽  
Frailty Status ◽  
Phone Calls ◽  
Increased Risk ◽  
Rural And Remote Areas ◽  
The Impact

Background. The Clinical Frailty Scale (CFS) is gaining increasing acceptance due to its simplicity and applicability. Aims. This pilot study aims to examine the role of CFS in identifying the prevalence of frailty, frailty transition, and the impact of frailty on readmission after discharge in older hospitalized patients. Methods. Patients aged ≥60 admitted to the geriatric ward of a hospital in Vietnam were recruited from 9/2018–3/2019 and followed for three months. Frailty was assessed before discharge and after three months, using the CFS (robust: score 1–2, pre-frail: 3–4, and frail: ≥5). Multivariate logistic regression was applied to investigate the associated factors of frailty transition and the impact of frailty on readmission. Results. There were 364 participants, mean age 74.9, 58.2% female. At discharge, 4 were robust, 160 pre-frail, 200 frail. Among the 160 pre-frail participants at discharge, 124 (77.5%) remained pre-frail, and 36 (22.5%) became frail after 3 months. Age (adjusted OR1.09, 95% CI 1.03–1.16), number of chronic diseases (adjusted OR 1.37, 95% CI 1.03–1.82), and polypharmacy at discharge (adjusted OR 3.68, 95% CI 1.15–11.76) were significant predictors for frailty after 3 months. A frailty status at discharge was significantly associated with increased risk of readmission (adjusted OR2.87, 95% CI 1.71–4.82). Conclusions. Frailty was present in half of the participants and associated with increased risk of readmission. This study suggests further studies to explore the use of the CFS via phone calls for monitoring patients’ frailty status after discharge, which may be helpful for older patients living in rural and remote areas.

The Impact of Group Prenatal Care on Interpregnancy Interval

2021 ◽  
Author(s):  
Justine M. Keller ◽  
Jessica A. Norton ◽  
Fan Zhang ◽  
Rachel Paul ◽  
Tessa Madden ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Prenatal Care ◽  
Maternal Education ◽  
Stepwise Logistic Regression ◽  
Group Prenatal Care ◽  
Interpregnancy Interval ◽  
Inclusion Criteria ◽  
Postpartum Contraception ◽  
Infant Birth ◽  
The Impact

Objective To evaluate whether participation in CenteringPregnancy group prenatal care is associated with decreased risk of an interpregnancy interval (IPI) ≤6 months. Study Design We conducted a retrospective cohort study of women enrolled in Missouri Medicaid from 2007 to 2014 using maternal Medicaid data linked to infant birth certificate records. Inclusion criteria were women ≥11 years old, ≥1 viable singleton delivery during the study period, residency in St. Louis city or county, and ≥2 prenatal visits. The primary outcome was an IPI ≤6 months. Secondary outcomes included IPI ≤12 months, IPI ≤18 months, postpartum long-acting reversible contraception (LARC) uptake, and postpartum LARC or depot medroxyprogesterone acetate (DMPA) uptake. Data were analyzed using descriptive statistics and logistic regression. Backward stepwise logistic regression was used to adjust for potential confounders including maternal age, race, obesity, nulliparity, marital status, diabetes, hypertension, prior preterm birth, and maternal education. Results Of the 54,968 pregnancies meeting inclusion criteria, 1,550 (3%) participated in CenteringPregnancy. CenteringPregnancy participants were less likely to have an IPI ≤6 months (adjusted odds ratio [aOR]: 0.61; 95% confidence interval [CI]: 0.47–0.79) and an IPI ≤12 months (aOR: 0.74; 95% CI: 0.62–0.87). However, there was no difference for an IPI ≤18 months (aOR: 0.89; 95% CI: 0.77–1.13). Women in CenteringPregnancy were more likely to use LARC for postpartum contraception (aOR: 1.37; 95% CI: 1.20–1.57). Conclusion Participation in CenteringPregnancy is associated with a significant decrease in an IPI ≤6 and ≤12 months and a significant increase in postpartum LARC uptake among women enrolled in Missouri Medicaid compared with women in traditional prenatal care. Key Points

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