Standardization of rounds on a general paediatric ward: Implementation of a checklist to improve efficiency, quality of rounds, and family satisfaction

2021 ◽  
Author(s):  
Camille Trahan ◽  
Angela Y Hui ◽  
Navneet Binepal
Keyword(s):  
Parent Satisfaction ◽  
Family Satisfaction ◽  
Quality Score ◽  
P Value ◽  
Paediatric Ward ◽  
Post Intervention ◽  
External Observer ◽  
Observational Methodology ◽  
Checklist Implementation

Abstract Objective The purpose of this study was to develop a standardized rounding tool for use on the general paediatric ward and to determine if its use can improve quality of rounds as well as patient and parent satisfaction. Methodology The study used a pre- and post-intervention prospective observational methodology. The intervention consisted of the implementation of a Checklist Rounding Tool (CRT) entitled the ‘Paediatric Inpatient Rounding Checklist (PIRC)’ which outlined items deemed essential to discuss during rounds for all patients admitted to the paediatric ward. The PIRC was created by the research team after reviewing the literature and it was peer reviewed by a panel of expert paediatricians. Performance on rounds based on discussion of checklist items as well as patient and parent satisfaction were evaluated by an external observer both pre- and post-PIRC implementation. Results Four of the five less frequently addressed checklist items were discussed significantly more post-intervention. The Rounds Quality Score was significantly improved after checklist implementation, the pre- and post-intervention scores being 8.24 and 9.61/10, respectively (P-value <0.001). Patient and parent satisfaction were rated higher with the use of the checklist. There was no difference in the duration of rounds between the pre- and post-implementation phases. Conclusion In summary, utilization of a standardized rounding tool on an inpatient paediatric ward led to improvement in quality of rounds as well as patient and parent satisfaction.

scholarly journals Quality of the documentation of the Nursing process in clinical decision support systems

2021 ◽  
Vol 29 ◽  
Author(s):  
Neurilene Batista de Oliveira ◽  
Heloísa Helena Ciqueto Peres
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
P Value ◽  
Nursing Process ◽  
Post Intervention ◽  
Quasi Experimental ◽  
Process Documentation

Objective: to compare the quality of the Nursing process documentation in two versions of a clinical decision support system. Method: a quantitative and quasi-experimental study of the before-and-after type. The instrument used to measure the quality of the records was the Brazilian version of the Quality of Diagnoses, Interventions and Outcomes, which has four domains and a maximum score of 58 points. A total of 81 records were evaluated in version I (pre-intervention), as well as 58 records in version II (post-intervention), and the scores obtained in the two applications were compared. The interventions consisted of planning, pilot implementation of version II of the system, training and monitoring of users. The data were analyzed in the R software, using descriptive and inferential statistics. Results: the mean obtained at the pre-intervention moment was 38.24 and, after the intervention, 46.35 points. There was evidence of statistical difference between the means of the pre- and post-intervention groups, since the p-value was below 0.001 in the four domains evaluated. Conclusion: the quality of the documentation of the Nursing process in version II of the system was superior to version I. The efficacy of the system and the effectiveness of the interventions were verified. This study can contribute to the quality of documentation, care management, visibility of nursing actions and patient safety.

scholarly journals PENGARUH LATIHAN JALAN KAKI TERHADAP KUALITAS TIDUR PADA PASIEN KANKER PAYUDARA YANG MENJALANI KEMOTERAPI DI RSUP DR. M DJAMIL PADANG

2020 ◽  
Vol 3 (1) ◽  
pp. Page16-27
Author(s):  
Weny Amelia ◽  
Mira Andika ◽  
Diana Yulanda
Keyword(s):  
Breast Cancer ◽  
Sleep Quality ◽  
Cancer Patients ◽  
Quality Index ◽  
Quality Score ◽  
P Value ◽  
Breast Cancer Patients ◽  
Quality Of Sleep ◽  
Walking Exercise

Abstrak Kemoterapi merupakan salah satu modalitas pengobatan kanker untuk mengatasi stadium lokal maupun metastase. Masalah yang sering muncul pada pasien kanker payudara yang menjalani kemoterapi adalah gangguan tidur sehingga berpengaruh terhadap kualitas tidur pasien. Penurunan kualitas tidur yang dialami oleh pasien kanker payudara yang menjalani kemoterapi dapat diatasi dengan latihan jalan kaki. Latihan jalan kaki merupakan kegiatan atau aktivitas yang dilakukan dengan menggunakan kedua kaki yang diikuti dengan ayunan tangan atau bagian anggota tubuh secara sinergis. Tujuan penelitian ini adalah untuk melihat pengaruh latihan jalan kaki terhadap kualitas tidur padapasien kanker payudara yang menjalani kemoterapi.                    . Penelitian ini dilakukan di RSUP Dr. M.Djamil Padang. Waktu penelitian ini dimulai pada tanggal 4-9 September 2019. Penelitian ini menggunakan pre eksperimet design dengan rancangan one group pretest-posttest design. Pengumpulan data dilakukan dengan menggunakan kuesioner PSQI (Pittsburgh Quality Index) untuk mengetahui kualitas tidur pasien berupa latihan jalan kaki selama 30 menit dilakukan 3 kali dalam 3 hari. .                       Hasil penelitian dengan uji statistik uji paired sampel t-test didapatkan bahwa rata-rata skor kualitas tidur sebelum intervensi 12.16 dan rata-rata skor kualitas tidur setelah intervensi 7.16. Penelitian ini menemukan perbedaan bermakna peningkatan kualitas tidur sebelum dan setelah intervensi p value = 0,000 ( p< 0.05) sehingga dapat disimpulkan bahwa terdapat pengaruh latihan jalan kaki terhadap kualitas tidur pasien kanker payudara yang menjalani kemoterapi.                                       .                                                       Disarankan kepada perawat untuk memberikan edukasi latihan jalan kaki kepada pasien kanker payudara yang menjalani kemoterapi untuk meningkatkan kualitas tidur pasien, sehingga dapat meningkatkan kondisi kesehatan pasien secara umum yang nantinya dapat memperbaiki dan meningkatkan kualitas hidup pasien kanker payudara. Kata Kunci : Latihan Jalan kaki, Kualitas Tidur,  Kanker Payudara, Kemoterapi Abstract                     Chemotherapy is one of the modalities of cancer treatment to overcome the local stage and metastasis. The problem that often arises in breast cancer patients undergoing chemotherapy is sleep disorders that affect the patient's sleep quality. Decreased sleep quality experienced by breast cancer patients undergoing chemotherapy can be overcome by walking exercises. Walking exercises are activities or activities carried out using both legs followed by swinging hands or parts of the body synergistically. The purpose of this study was to look at the effect of walking training on sleep quality in breast cancer patients undergoing chemotherapy. .                     This research was conducted at the Dr. M.Djamil Padang. When this study began on September 4-9, 2019. This study used a pre-experimental design with one group pretest-posttest design. Data collection was carried out using a PSQI (Pittsburgh Quality Index) questionnaire to determine the quality of sleep of patients in the form of 30 minutes of walking exercises performed 3 times in 3 days. .                     The results of the study with the statistical test paired sample t-test found that the average sleep quality score before the intervention was 12.16 and the average sleep quality score after the intervention was 7.16. This study found a significant difference in the improvement of sleep quality before and after the intervention p value = 0,000 (p <0.05) so that it can be concluded that there is an effect of walking exercise on the sleep quality of breast cancer patients undergoing chemotherapy. .                     It is recommended to nurses to provide education on walking exercises to breast cancer patients undergoing chemotherapy to improve the quality of sleep of patients, so as to improve the general health condition of patients who can later improve and improve the quality of life for breast cancer patients. Keywords: Breast Cancer, Chemotherapy, Sleep Quality, Walking Exercise

scholarly journals A case study: Applying quality improvement methods to reduce pre-operative length of stay in a resource-constrained setting in Rwanda

2015 ◽  
Vol 5 (1) ◽  
pp. 41 ◽  
Author(s):  
Ssebuufu Robinson ◽  
Victor Pawelzik ◽  
Abraham Megentta ◽  
Oswald Benimana ◽  
Damascene Mazimpaka ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Problem Solving ◽  
Length Of Stay ◽  
Work Group ◽  
Surgical Patients ◽  
P Value ◽  
Post Intervention ◽  
Quality Of Surgery ◽  
The Impact

Objective: While several studies have focused on improving the quality of surgery, less attention has been paid to reducing pre-operative delays in care. We undertook a hospital quality improvement (QI) effort to reduce pre-operative delays in a teaching hospital in Rwanda. Without a coordinated admission schedule, many surgical patients arriving at the hospital for admissions were turned away because of unavailable beds. For those admitted for surgery, the pre-operative waits were long.Methods: A pre- and post-intervention study was conducted to examine the impact of a QI effort on two metrics: 1) pre-operative length-of-stay (LOS) for elective surgical patients, and 2) the number of elective surgical patients who were turned away on the scheduled admission date. Intervention: A multi-disciplinary work group utilized a Strategic Problem Solving Approach and implemented a centralized patient wait list and new schedule process utilizing the existing resources available at the hospital.Results: The percentage of elective surgical patients with a pre-operative LOS of more than two days was significantly lower in the post-intervention compared with the pre-intervention period (80% versus 26.8%, p-value < .001). The percentage of scheduled patients who were turned away due unavailable inpatient beds significantly decreased from 63.4% to 5.3%, p-value < .001.Conclusions: By following a methodical strategic problem solving approach, the pre-operative LOS was reduced, elective surgical patients turned away due to unavailable beds was decreased at very low financial cost.

scholarly journals IMPLEMENTASI PANGGILAN GEREJA MELALUI PELAYANAN DALAM HOSPITALISASI KRISTEN

2021 ◽  
Author(s):  
Thresia Ampulembang
Keyword(s):  
Family Satisfaction ◽  
Observational Research ◽  
P Value ◽  
Pediatric Nurses ◽  
Validity And Reliability ◽  
Chi Square ◽  
Cross Sectional ◽  
Patient Will ◽  
Nurses Role

Family satisfaction survey is important to measur e the quality of pediatric nursing care. The dimensions of the quality of nursing services are divided into five part. They are reliability, responsiveness, assurance, emphaty, and tangibles. The purpose of this research was analyzed the relation between pediatric nurses role and family satisfactory level during the hospitalization process at the child care spaces at Balung regional hospital Jember . This research use d an analytical observational research with cross sectional approach. The m ethod collected the sample used quota sampling. The research sample in this study were 35 respondents. Validity and reliability test used the Pearson Product Moment and Cronbach Alpha test . Data were analyzed using nonparametric Chi Square. The result showed that there were correlation between pediatric nurses role with family satisfactory with p value: 0,027 less than α: 0.05. Pediatric nurse at the hospital is expected to carry out its role in a professional manner so as to improve patient andfamilysatisfaction.Highfamilysatisfactory gives a positive experience and loyalty to hospital services, so the patient will return to the hospital and using health services again in the future.

scholarly journals QUALITY OF LIFE AMONGST BENZODIAZEPINE USERS PRE AND POST DEPRESCRIBING

2019 ◽  
pp. 91-92
Author(s):  
SHILPA SHREE H. S. ◽  
NAVEEN KUMAR N. ◽  
MAHESWARI E. ◽  
VIRUPAKSHA H. S.
Keyword(s):  
Quality Of Life ◽  
Social Relationships ◽  
Psychological Health ◽  
Decision Model ◽  
Statistical Significance ◽  
P Value ◽  
Inclusion Criteria ◽  
Test Statistic ◽  
Post Intervention

Objective: The study aimed to analyze the Quality of Life (QoL) of patients utilizing benzodiazepines (BZDs). Methods: A prospective interventional study was conducted among 109 patients who met the inclusion criteria. The patients consuming BZDs more than the prescribed duration were identified and deprescribed. Deprescribing plan was advised after discussing with the prescribing psychiatrist and inappropriate BZD users. The QoL of patient’s pre and post-intervention amongst both the continuing and deprescribed groups was evaluated by WHO-QoL BREF questionnaire. Results: Mean scores in the domains of physical health (71.48), psychological health (68.74), social relationships (65.15) and environmental health (68) among the deprescribed group was higher compared to the maintenance group. Independent t-test statistic for QoL showed a statistical significance in all 4 domains with p value<0.05. Conclusion: The current study emphasizes that deprescribing of BZDs as shared decision model involving the physician, pharmacist and patients improves the QoL of the patient.

scholarly journals Faktor – factor yang Berhubungan dengan Kepuasan Keluarga Pasien di Instalasi Gawat Darurat Rumah Sakit Panti Rapih Yogyakarta

2021 ◽  
Vol 2 (2) ◽  
pp. 140-155
Author(s):  
Yohana Sugiyatmi ◽  
Eva Marti ◽  
Sri Oktri Hastuti
Keyword(s):  
Patient Satisfaction ◽  
Emergency Room ◽  
Positive Relationship ◽  
Family Satisfaction ◽  
Visual Design ◽  
P Value ◽  
Location Factor ◽  
Significant Positive Relationship ◽  
Performance Factors

ABSTRACT Background : Patient satisfaction is a feeling of pleasure or satisfaction that the services received have met or exceeded the patient's expectations (Nursalam, 2016). Emergency Room (ER) is a part that serves patients with emergency conditions, the action must be effective and efficient according to the quality of service. Satisfaction of patients and their families needs to be measured to improve the quality of services in the Emergency Room   Purpose : This study aims to find out relations between the factors related to family satisfaction of patients in the Emergency Room at Panti Rapih Hospital, Yogyakarta.   Methods : This research is a quantitative study with a correlational descriptive method using a cross sectional approach. The instrument used was the Patient satisfaction questionnaire  format 10 compiled by the previous researcher and the questionnaire about factors related to satisfaction compiled by the researcher. The sample in this study used a non probability sampling with accidental sampling method. The number of respondents is 75 people. The study was conducted on January 13, 2021 to January 28, 2021, Univariate analysis using percentage analysis and bivariate analysis using Spearman correlation to determine the factors associated with satisfaction.   Result :There is a significant positive relationship between performance factors and patient family satisfaction (p value = 0.000) rho value = 0.533, there is a significant positive relationship between the facility factor and patient family satisfaction (p value = 0.000) rho value = 0.474, there is a significant positive relationship between service factors and patient family satisfaction (p value = 0.000) rho value = 0.550, there is a significant positive relationship between communication factors and patient family satisfaction (p value = 0.000) rho value = 0.471, there is a significant positive relationship between the atmosphere factor and patient's family satisfaction (p value = 0.000) rho value = 0.513, there is a significant positive relationship between the location factor and patient's family satisfaction (p value = 0.000) rho value = 0474, there is a significant positive relationship between visual design and patient family satisfaction ( p value = 0.000) rho value = 0.435.   Conclusion : There is a significant, positive relationship between performance factors, facilities, services, communication, atmosphere, location and visual design on the patient's family satisfaction. This research can be used as a reference in an effort to increase patient and family satisfaction in the hospital.

Communication Disordered: Program Implementation in Long-Term Care

2016 ◽  
Vol 1 (15) ◽  
pp. 64-67
Author(s):  
George Barnes ◽  
Joseph Salemi
Keyword(s):  
Program Implementation ◽  
Long Term Care ◽  
Family Satisfaction ◽  
Regulatory Compliance ◽  
Care Staff ◽  
Term Care ◽  
Staff Members ◽  
Change Policy

The organizational structure of long-term care (LTC) facilities often removes the rehab department from the interdisciplinary work culture, inhibiting the speech-language pathologist's (SLP's) communication with the facility administration and limiting the SLP's influence when implementing clinical programs. The SLP then is unable to change policy or monitor the actions of the care staff. When the SLP asks staff members to follow protocols not yet accepted by facility policy, staff may be unable to respond due to confusing or conflicting protocol. The SLP needs to involve members of the facility administration in the policy-making process in order to create successful clinical programs. The SLP must overcome communication barriers by understanding the needs of the administration to explain how staff compliance with clinical goals improves quality of care, regulatory compliance, and patient-family satisfaction, and has the potential to enhance revenue for the facility. By taking this approach, the SLP has a greater opportunity to increase safety, independence, and quality of life for patients who otherwise may not receive access to the appropriate services.

HUBUNGAN KUALITAS KEHIDUPAN KERJA TERHADAP KINERJA PERAWAT PELAKSANA

2019 ◽  
Vol 9 (4) ◽  
pp. 413-420
Author(s):  
Amella Gusty ◽  
Dachriyanus Dachriyanus ◽  
Leni Merdawati
Keyword(s):  
District Hospital ◽  
Simple Random Sampling ◽  
Work Life ◽  
Quality Of Work Life ◽  
P Value ◽  
Work Context ◽  
Cross Sectional ◽  
Quality Of Work ◽  
The Relationship

Kinerja perawat merupakan hasil yang dicapai dalam melaksanakan asuhan keperawatan di rumah sakit. Terciptanya asuhan keperawatan yang optimal sangat diperlukan dukungan dari pihak rumah sakit salah satunya adalah menciptakan kualitas kehidupan kerja baik bagi perawat. Penelitian ini bertujuan untuk mengetahui hubungan antara kualitas kehidupan kerja terhadap kinerja perawat pelaksana di RSUD Teluk Kuantan. Jenis penelitian kuantitatif dengan pendekatan cross sectional. Jumlah sampel 120 responden yang diperoleh melalui proportionate simple random sampling. Hasil penelitian menunjukkan kualitas kehidupan kerja perawat RSUD Teluk Kuantan berada pada kategori sedang, kinerja perawat berada pada kategori kurang baik. Berdasarkan analisis kedua variabel teridentifikasi bahwa tidak ada hubungan antara kualitas kehidupan kerja dengan kinerja perawat pelaksana dengan  p value 0,817. Dimensi work context merupakan komponen yang memiliki hubungan dengan kinerja perawat pelaksana dengan p value 0,008, dimensi work life  tidak berhubungan secara signifikan dengan kinerja perawat. Kesimpulan penelitian diketahui tidak ada hubungan antara kualitas kehidupan kerja dengan kinerja perawat pelaksana. Ada hubungan dimensi work context dengan kinerja perawat pelaksana. Tidak ada hubungan dimensi work life dengan kinerja perawat.   Kata kunci: kualitas kehidupan kerja, kinerja, perawat pelaksana   THE RELATIONSHIP BETWEEN THE QUALITY OF WORK LIFE AND THE PERFORMANCE OF IMPLEMENTERS NURSES   ABSTRACT Nurse performance is the result achieved in implementing nursing care in a hospital. The creation of optimal nursing care is very much needed support from the hospital, one of which is to create a good quality of work life for nurses. This study aims to determine the relationship between the quality of work life and the performance of nurses at the Kuantan District Hospital. This type of quantitative research with cross sectional approach. The number of samples of 120 respondents obtained through proportionate simple random sampling. The results showed that the quality of work life of nurses at the Kuantan District Hospital was in the medium category, the nurses' performance was in the unfavorable category. Based on the analysis of the two variables, it was identified that there was no relationship between the quality of work life with the performance of implementing nurses with a p value of 0.817. The work context dimension is a component that has a relationship with the performance of nurses implementing with p value 0.008, the dimension of work life does not significantly correlate with nurse performance. The conclusion of the research is that there is no relationship between the quality of work life and the performance of the implementing nurses. There is a relationship between the dimensions of the work context and the performance of the nurses. There is no relationship between the dimensions of work life and nurse performance.   Keywords: quality of work life, performance, implementers nurse

PENINGKATAN KUALITAS HIDUP MELALUI LOGOTERAPI PADA KLIEN YANG MENJALANI HEMODIALISIS

2019 ◽  
Vol 11 (1) ◽  
pp. 9-18
Author(s):  
Abdul Wakhid ◽  
Ana Puji Astuti ◽  
Maya Kurnia Dewi
Keyword(s):  
Quality Of Life ◽  
Renal Failure ◽  
Test Group ◽  
Sampling Technique ◽  
T Test ◽  
P Value ◽  
Number Of Patients ◽  
Post Test ◽  
The Mean

Logoterapi merupakan terapi untuk menemukan makna positif dibalik sebuah kejadian yang tidak diharapkan. Logoterapi dilaksanakan secara individu maupun berkelompok dalam bentuk konseling dan berorientasi pada pencarian makna hidup individu. Tujuan logoterapi meningkatkan makna pengalaman hidup individu yang diarahkan kepada pengambilan keputusan yang bertanggung jawab. Penelitian ini dilakukan dengan menggunakan rancangan pre-experiment dengan metode pre and post test group, artinya pengumpulan data dilakukan terhadap responden untuk membandingkan kualitas hidup sebelum dan sesudah dilakukan intervensi. Teknik pengambilan sampel dilakukan dengan metode total sampling yaitu pengambilan seluruh sampel dengan tetap memperhatikan kriteria yang telah ditetapkan. Jumlah pasien yang menjalani hemodialisis di RSUD Ungaran sebanyak 21 orang dan di RSUD Ambarawa sebanyak 25 pasien. Analisis data dilakukan dengan menggunakan uji t test dependent. Hasil penelitian didapatkan bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 60.22 dengan skor terrendah 55 dan skor tertinggi 69. Bahwa dari 46 responden didapatkan rata-rata skor kualitas hidup pasien yang mejalani hemodialisis sebesar 88.72 dengan skor terrendah 79 dan skor tertinggi 103. Hasil uji statistik dengan uji t test dependent diketahui ada pengaruh logoterapi terhadap kemampuan memaknai hidup pada klien yang menjalani hemodialisis di RSUD Kabupaten Semarang (p value: 0,0001). Saran perlunya peningkatan kemampuan perawat dalam memberikan layanan kesehatan termasuk pemberian atau pemanduan penemuan makna hidup bagi pasien hemodialysis, agar selain dengan hemodialysis, ada faktor internal dari pasien yang dapat dijadikan sebagai motivasi untuk sembuh dari penyakit.   Kata Kunci: Logoterapi, kualitas hidup   IMPROVE THE QUALITY OF LIFE OF PATIENTS WITH RENAL FAILURE WHO UNDERWENT HEMODIALYSIS   ABSTRACT Logotherapy is a therapy to discover the positive meaning behind an unexpected event. Logotherapy is carried out individually or in groups in the form of counseling and oriented to the search for the meaning of individual life. This study aims to improve the quality of life of patients with renal failure who underwent hemodialysis. This research was conducted by using pre-experiment with pre-post test study. The sampling technique was done by the convenience sampling. The number of patients undergoing hemodialysis as many as 46 respondents. Data analysis was done by using test t test dependent. The result showed that from 46 respondents got the mean of quality of life of patients who had hemodialysis 60.22 with lowest score 55 and highest score 69. Whereas from 46 respondents got the mean score of life quality of patients who had hemodialysis 88.72 with score the lowest score 79 and the highest score 103. The result of statistical test with t test dependent is known there is influence of logoterapi to the ability of meaningful life on client who undergo hemodialysis at Semarang Regency hospitals (p value: 0.0001). Advice on the need to improve the nurse's ability to provide health services, including the provision or guidance of the discovery of the meaning of life for hemodialysis patients, in addition to hemodialysis, there are internal factors of the patient that can be used as a motivation to recover from illness.   Keywords: Logotherapy, quality of life, kidney failure.  

Penatalaksanaan IMD pada Ibu Postpartum Sectio Caesarea Mempengaruhi Status Gizi dan Kecepatan Produksi ASI

2020 ◽  
Vol 2 (2) ◽  
pp. 112-120
Author(s):  
Nursari Abdul Syukur ◽  
Susi Purwanti
Keyword(s):  
Breast Milk ◽  
Nutritional Status ◽  
Milk Production ◽  
Quantitative Research ◽  
Milk Protein ◽  
Sectio Caesarea ◽  
Control Group ◽  
P Value ◽  
Study Results

Many mothers who give birth to Sectio Caesarea (SC) do not Initiate Early Breastfeeding (IMD), which fails exclusive breastfeeding. This study aimed to determine the effect of IMD management in postpartum SC mothers on nutritional status, speed of milk production, and quality of breast milk protein. Method: quantitative research with quasi approach experiment. The research design used was a pre-post-test control non-equivalent control group. A sampling of this study used the Consecutive method sampling with a sample of 20 mothers who gave birth by cesarean section (SC). Hypothesis testing uses the independent t-test and the Mann-Whitney test. The study results showed an influence on the management of IMD in postpartum SC mothers on the speed of ASI production (p-value=0.004) and nutritional status (p-value=0.028). There was no effect of IMD management on postpartum SC mothers on the quality of breast milk protein (p-value = 0.543). This study recommends that the hospital implement an IMD promotion program before the abdominal wall is closed as a form of intervention to increase milk production and maternal nutritional status

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