scholarly journals Air, Air, Air: a champion midwife programme in Tanzania using HOT neonatal resuscitation—lessons learned

2021 ◽  
Author(s):  
Jan Becker ◽  
Chiung-Jung (Jo) Wu ◽  
Chase Becker ◽  
James Moir ◽  
Marion Gray ◽  
...  
Keyword(s):  
Real Life ◽  
Neonatal Resuscitation ◽  
Lessons Learned ◽  
First Line ◽  
Neonatal Deaths ◽  
Helping Babies Breathe ◽  
Hands On ◽  
Effective Ventilation ◽  
Guided Instruction ◽  
Bag And Mask Ventilation

Abstract Background Tanzania has approximately 40 000 newborn deaths per year, with >25% of these linked to intrapartum-related hypoxia. The Helping Babies Breathe© and Golden minute© (HBB©) programme was developed to teach skilled intervention for non-breathing neonates at birth. While Helping Babies Breathe© and Golden minute©, providing training in simulated bag and mask ventilation, is theoretically successful in the classroom, it often fails to transfer to clinical practice without further support. Furthermore, the proclivity of midwives to suction excessively as a first-line intervention is an ingrained behaviour that delays ventilation, contributing to very early neonatal deaths. Methods The ‘champion’ programme provided guided instruction during a real-life resuscitation. The site was Amana Hospital, Tanzania. The labour ward conducts 13 500 deliveries annually, most of which are managed by midwives. Brief mannikin simulation practice was held two to three times a week followed by bedside hands-on training (HOT) of bag and mask skills and problem solving while reinforcing the mantra of ‘air, air, air’ as the first-line intervention during a real-life emergency. Results Champion midwives (trainers) guided instructions given during a real emergency at the bedside caused learners beliefs to change. Trainees observed changes in baby skin colour and the onset of spontaneous breathing after effective ventilation. Conclusions Visible success during an actual real-life emergency created confidence, mastery and collective self-efficacy.

scholarly journals Teaching Helping Babies Breathe via Telehealth: A New Application in Rural Guatemala

2019 ◽  
Vol 4 (3) ◽  
pp. 1-6
Author(s):  
Caitlin Jones-Bamman ◽  
Susan Niermeyer ◽  
Kelly McConnell ◽  
John F. Thomas ◽  
Christina Olson
Keyword(s):  
Nursing Students ◽  
Neonatal Resuscitation ◽  
Cost Effective ◽  
Helping Babies Breathe ◽  
Life Saving ◽  
Percent Improvement ◽  
Hands On ◽  
Post Test ◽  
Course Material ◽  
Passing Scores

Background: Helping Babies Breathe (HBB) is a neonatal resuscitation curriculum that teaches life-saving interventions utilized in the first minutes after birth, reducing morbidity and mortality. Traditionally, it requires in-person facilitators for didactic and hands-on training. Objectives: The aim of this study was to offer HBB to nurses and nursing students in Guatemala, with the lead facilitator presenting concepts via telehealth and in-person facilitators providing hands-on demonstration. Methods: Learners completed pre- and post-tests that included the standard HBB knowledge check, as well as an assessment of the course teaching model. Learners also completed the standard Objective Structured Clinical Evaluations (OSCEs). Results: Eighteen learners were included in the analysis. All but one learner (94%) passed the course, and the average percent improvement from the pre- to post-test was 12%. All learners achieved passing scores on the OSCEs. Learners responded positively to questions regarding the technology, connection with the instructor, and ability to ask questions. Ninety-four percent of the learners agreed with the statement “this lecture was as good via telehealth as in person.” A cost analysis demonstrated approximately USD 3,979.00 in savings using telehealth compared to a standard in-person course. Conclusions: The telehealth model was successful in delivering course material to the learners and was well received. This model represents a cost-effective way to improve access to HBB. This study may not be generalizable to other populations, and the ability to use telehealth requires reliable internet connectivity, which may not be available in all settings. Further study and expansion of this pilot are needed to assess success in other settings.

scholarly journals Tractable targets for meropenem-sparing antimicrobial stewardship interventions

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Clark D Russell ◽  
Ian F Laurenson ◽  
Morgan H Evans ◽  
Claire L Mackintosh
Keyword(s):  
Clinical Practice ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Real Life ◽  
Lessons Learned ◽  
Source Control ◽  
First Line ◽  
Escalation Therapy ◽  
Clinical Records

Abstract Background As meropenem is a restricted antimicrobial, lessons learned from its real-life usage will be applicable to antimicrobial stewardship (AMS) more generally. Objectives To retrospectively evaluate meropenem usage at our institution to identify targets for AMS interventions. Methods Patients receiving meropenem documented with an ‘alert antimicrobial’ form at two tertiary care UK hospitals were identified retrospectively. Clinical records and microbiology results were reviewed. Results A total of 107 adult inpatients receiving meropenem were identified. This was first-line in 47% and escalation therapy in 53%. Source control was required in 28% of cases after escalation, for predictable reasons. Those ultimately requiring source control had received more prior antimicrobial agents than those who did not (P = 0.03). Meropenem was rationalized in 24% of cases (after median 4 days). Positive microbiology enabled rationalization (OR 12.3, 95% CI 2.7–55.5, P = 0.001) but rates of appropriate sampling varied. In cases with positive microbiology where meropenem was not rationalized, continuation was retrospectively considered clinically and microbiologically necessary in 8/40 cases (0/17 empirical first-line usage). Rationalization was more likely when meropenem susceptibility was not released on the microbiology report (OR 5.2, 95% CI 1.3–20.2, P = 0.02). Input from an infection specialist was associated with a reduced duration of meropenem therapy (P < 0.0001). Early review by an infection specialist has the potential to further facilitate rationalization. Conclusions In real-life clinical practice, core aspects of infection management remain tractable targets for AMS interventions: microbiological sampling, source control and infection specialist input. Further targets include supporting rationalization to less familiar carbapenem-sparing antimicrobials, restricting first-line meropenem usage and selectively reporting meropenem susceptibility.

scholarly journals Chest Compressions for Bradycardia during Neonatal Resuscitation—Do We Have Evidence?

Children ◽  
2019 ◽  
Vol 6 (11) ◽  
pp. 119 ◽  
Author(s):  
Agrawal ◽  
Lakshminrusimha ◽  
Chandrasekharan
Keyword(s):  
Gas Exchange ◽  
Hospital Setting ◽  
Neonatal Resuscitation ◽  
Cardiac Activity ◽  
Intrathoracic Pressure ◽  
Chest Compressions ◽  
Helping Babies Breathe ◽  
Liaison Committee ◽  
Pediatric Study ◽  
Effective Ventilation

The International Liaison Committee on Resuscitation (ILCOR) recommends the initiation of chest compressions (CC) during neonatal resuscitation after 30 s of effective ventilation if the infant remains bradycardic (defined as a heart rate less than 60 bpm). The CC are performed during bradycardia to optimize organ perfusion, especially to the heart and brain. Among adults and children undergoing cardiopulmonary resuscitation (CPR), CC is indicated only for pulselessness or poor perfusion. Neonates have a healthy heart that attempts to preserve coronary and cerebral perfusion during bradycardia secondary to asphyxia. Ventilation of the lungs is the key step during neonatal resuscitation, improving gas exchange and enhancing cerebral and cardiac blood flow by changes in intrathoracic pressure. Compressing the chest 90 times per minute without synchrony with innate cardiac activity during neonatal bradycardia is not based on evidence and could potentially be harmful. Although there are no studies evaluating outcomes in neonates, a recent pediatric study in a hospital setting showed that when CC were initiated during pulseless bradycardia, a third of the patients went into complete arrest, with poor survival at discharge. Ventilation-only protocols such as helping babies breathe are effective in reducing mortality and stillbirths in low-resource settings. In a situation of complete cardiac arrest, CC reinitiates pulmonary flow and supports gas exchange. However, the benefit/harm of performing asynchronous CC during bradycardia as part of neonatal resuscitation remains unknown.

scholarly journals Effect of skill drills on neonatal ventilation performance in a simulated setting- observation study in Nepal

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Rejina Gurung ◽  
Abhishek Gurung ◽  
Avinash K. Sunny ◽  
Omkar Basnet ◽  
Shree Krishna Shrestha ◽  
...  
Keyword(s):  
Clinical Case ◽  
Neonatal Resuscitation ◽  
Ventilation Rate ◽  
High Fidelity ◽  
Mask Ventilation ◽  
Observation Study ◽  
Adequate Ventilation ◽  
Effective Ventilation ◽  
Ventilation Performance ◽  
Bag And Mask Ventilation

Abstract Aim Maintaining neonatal resuscitation skills among health workers in low resource settings will require continuous quality improvement efforts. We aimed to evaluate the effect of skill drills and feedback on neonatal resuscitation and the optimal number of skill drills required to maintain the ventilation skill in a simulated setting. Methods An observational study was conducted for a period of 3 months in a referral hospital of Nepal. Sixty nursing staffs were trained on Helping Babies Breathe (HBB) 2.0 and daily skill drills using a high-fidelity manikin. The high-fidelity manikin had different clinical case scenarios and provided feedback as “well done” or “improvement required” based on the ventilation performance. Adequate ventilation was defined as bag-and-mask ventilation at the rate of 40–60 breaths per minute. The effective ventilation was defined as adequate ventilation with a “well done” feedback. We assessed the correlation of number skill drills and clinical case scenario with adequate ventilation rate using pearson’s correlation. We assessed the correlation of number of skill dills performed by each participant with effective ventilation using Mann Whitney test. Results Among the total of 60 nursing staffs, all of them were competent with an average score of 12.73 ± 1.09 out of 14 (p < 0.001) on bag-and-mask ventilation skill checklist. Among the trained staff, 47 staffs participated in daily skill drills who performed a total of 331 skill drills and 68.9% of the ventilations were done adequately. Among the 47 nursing staffs who performed the skill drills, 228 (68.9%) drills were conducted at a ventilation rate of 40–60 breathes per minute. There was no correlation of the adequate ventilation with skill drill category (p = 0.88) and the level of skill performed (p = 0.28). Out of 47 participants performing the skill drills, 74.5% of them had done effective ventilation with a mean average of 8 skill drills (SD ± 4.78) (p-value- 0.032). Conclusion In a simulated setting, participants who had an average skill drill of 8 in 3 months had effective ventilation. We demonstrated optimal skill drill sessions for maintain the neonatal resuscitation competency. Further evaluation will be required to validate the findings in a scale up setting.

Political Science Research in the Middle East and North Africa

2018 ◽  
Keyword(s):  
Middle East ◽  
Research Methods ◽  
North Africa ◽  
Quantitative Research ◽  
Real Life ◽  
Field Research ◽  
Science Research ◽  
Lessons Learned ◽  
Conducting Research ◽  
Personal Accounts

Based on personal accounts of their experiences conducting qualitative and quantitative research in the countries of the Middle East and North Africa, the contributors to this volume share the real-life obstacles they have encountered in applying research methods in practice and the possible solutions to overcome them. The volume is an important companion book to more standard methods books, which focus on the “how to” of methods but are often devoid of any real discussion of the practicalities, challenges, and common mistakes of fieldwork. The volume is divided into three parts, highlighting the challenges of (1) specific contexts, including conducting research in areas of violence; (2) a range of research methods, including interviewing, process-tracing, ethnography, experimental research, and the use of online media; and (3) the ethics of field research. In sharing their lessons learned, the contributors raise issues of concern to both junior and experienced researchers, particularly those of the Global South but also to those researching the Global North.

scholarly journals Hands‐on horticulture: Lessons learned teaching online experiential horticulture during COVID‐19

2021 ◽  
Author(s):  
Claire Luby ◽  
Emily Tepe ◽  
Laura Irish ◽  
Thomas Michaels ◽  
Emily Hoover
Keyword(s):  
Lessons Learned ◽  
Teaching Online ◽  
Hands On

scholarly journals Deploying triple artemisinin-based combination therapy (TACT) for malaria treatment in Africa: ethical and practical considerations

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Paulina Tindana ◽  
Freek de Haan ◽  
Chanaki Amaratunga ◽  
Mehul Dhorda ◽  
Rob W. van der Pluijm ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Combination Therapy ◽  
Southeast Asia ◽  
Malaria Control ◽  
Lessons Learned ◽  
Line Treatment ◽  
African Continent ◽  
First Line ◽  
First Line Treatment ◽  
Made In

AbstractMalaria remains a major cause of morbidity and mortality in Africa, particularly in children under five years of age. Availability of effective anti-malarial drug treatment is a cornerstone for malaria control and eventual malaria elimination. Artemisinin-based combination therapy (ACT) is worldwide the first-line treatment for uncomplicated falciparum malaria, but the ACT drugs are starting to fail in Southeast Asia because of drug resistance. Resistance to artemisinins and their partner drugs could spread from Southeast Asia to Africa or emerge locally, jeopardizing the progress made in malaria control with the increasing deployment of ACT in Africa. The development of triple artemisinin-based combination therapy (TACT) could contribute to mitigating the risks of artemisinin and partner drug resistance on the African continent. However, there are pertinent ethical and practical issues that ought to be taken into consideration. In this paper, the most important ethical tensions, some implementation practicalities and preliminary thoughts on addressing them are discussed. The discussion draws upon data from randomized clinical studies using TACT combined with ethical principles, published literature and lessons learned from the introduction of artemisinin-based combinations in African markets.

scholarly journals OP0288 ANTI-IL1 TREATMENT IN COLCHICINE RESISTANT PEDIATRIC FMF PATIENTS-REAL LIFE DATA FROM THE HELIOS REGISTRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 179.1-180
Author(s):  
E. Sag ◽  
F. Akal ◽  
E. Atalay ◽  
U. Kaya Akca ◽  
S. Demir ◽  
...  
Keyword(s):  
Age At Onset ◽  
Real Life ◽  
First Line ◽  
Research Support ◽  
Skin Reactions ◽  
Local Skin ◽  
Extreme Stress ◽  
On Demand ◽  
Drug Registry ◽  
Treatment Onset

Background:FMF is a prototype of autoinflammatory diseases associated with excess IL1 production. Anti-IL1 treatments are the first-line alternatives in colchicine resistant/intolerant FMF patients.Objectives:We aimed to investigate the efficacy and safety of anti-IL1 treatment in pediatric FMF patients in our local (HELIOS) registry.Methods:HELIOS (Hacettepe univErsity eLectronIc research fOrmS) is a web-based biological drug registry for pediatric rheumatology patients (helios.hacettepe.edu.tr). Data were recorded at biological treatment onset (month 0), at month 6 and yearly thereafter in patients. We have analysed the clinical features, disease activity parameters, treatment responses and safety outcomes in FMF patients treated with anti-IL1 agent.Results:Forty pediatric FMF patients were included to the study group (67% female).Thirty-four patients received continous anti-IL1 treatment. The mean age at the start of the colchicine was 5.55±3.87 years. Age at onset of the anti-IL1 treatment was 11.47±5.41 with a mean follow-up duration of 3.87±1.96 years. Apart from two patients, all of them had biallelic exon-10 mutations.We have also given anti-IL1 treatment on an on-demand basis in six adolescent patients. Five of them were having very severe attacks during menstrual periods and one was having attacks during extreme stress periods along with very high CRP levels. The quality of life has markedly improved and these patients no longer reveal any CRP elevation.Anakinra was used as the first-line anti-IL1 treatment. During the last visit, six patients were treated with anakinra and 28 patients were treated with canakinumab. Anti-IL1 treatment decreased the CRP levels, number and severity of the attacks. (Figure 1.) There were three hospitalizations reported due to mild infections. Eleven patients had local skin reactions, two patients had leukopenia with anakinra and one patient had thrombocytopenia with canakinumab. We have discontinued anti-IL1 treatment until the cytopenia subsided. We have switched to on-demand therapy in one patient, started the same treatment and gradually increased the dose in the other two patients. There were no malignancy or other severe adverse reactions.Figure 1.Conclusion:Anakinra and canakinumab are efficient and safe alternatives in colchicine resistant and intolerant pediatric FMF patients. We also for the first time, report on-demand use of anti-IL1 in pediatric FMF patients. We suggest that on-demand treatment should be considered under certain circumstances where the trigger is known and short-lasting (such as menstruation and periods of extreme stress)Acknowledgments:Authors would like to thank Elif Arslanoglu Aydin, Armagan Keskin, Kubra Yuksel and Emil Aliyev for their contribution to the HELIOS registryDisclosure of Interests:Erdal Sag Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Fuat Akal Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Erdal Atalay Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Ummusen Kaya Akca Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Selcan Demir Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Dilara Demirel Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Ezgi Deniz Batu Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Yelda Bilginer Grant/research support from: Novartis and SOBI financially supported the HELIOS registry during the establishment of infrastructure, Seza Özen Consultant of: Novartis, Pfizer, Speakers bureau: SOBI, Novartis

GRID-FORMING INVERTERS-REAL-LIFE IMPLEMENTATION EXPERIENCE AND LESSONS LEARNED

2021 ◽  
Author(s):  
S.D. Rao ◽  
S. Dutta ◽  
M. Lwin ◽  
D. Howard ◽  
R. Konopinski ◽  
...  
Keyword(s):  
Real Life ◽  
Lessons Learned ◽  
Implementation Experience

Real-world clinical outcomes study of sequential novel antihormonal therapy (NAH) or radium-223 (Ra-223) treatment of metastatic castration-resistant prostate cancer (mCRPC) that progressed after first-line NAH.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 48-48
Author(s):  
Oliver A. Sartor ◽  
Daniel J. George ◽  
Bertrand Tombal ◽  
Celestia S. Higano ◽  
Cora N. Sternberg ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Real Life ◽  
Patient Characteristics ◽  
Castration Resistant Prostate Cancer ◽  
First Line ◽  
Highly Active ◽  
Radium 223 ◽  
Alpha Emitter ◽  
Antihormonal Therapy ◽  
The Usa

48 Background: We assessed real-life clinical outcomes in patients with mCRPC treated in the USA who received sequential first-line (1L)/second-line (2L) NAH (abiraterone/enzalutamide or enzalutamide/abiraterone) or switched to a different mechanism of action (alpha-emitter Ra-223) after progression on 1L NAH. Methods: This was a retrospective study (PHENIX, NCT03896984) of the Flatiron electronic health record database in patients with mCRPC that progressed on 1L NAH and started 2L monotherapy with Ra-223 (n=120) or NAH (n=226) between Jan 2013 and Dec 2018. Patient characteristics, overall survival (OS) from 2L start, and symptomatic skeletal events (SSEs) were analyzed descriptively. Results: The two cohorts were generally similar at 2L start, including similar rates of bone-health agent (BHA) use, but the Ra-223 cohort had a higher incidence of bone-only metastases, shorter duration of 1L NAH, and higher rate of prior SSEs than the 2L NAH cohort (Table). Median treatment duration was 5.6 mo (median 4.5 doses) for Ra-223 and 4.7 mo for 2L NAH. Median OS from 2L start was 10.8 mo for Ra-223 and 11.2 mo for 2L NAH, with 49% and 39%, respectively, receiving subsequent therapy. Among those who received subsequent therapy, the proportion who received subsequent taxane was lower in the Ra-223 cohort (47%) than in the 2L NAH cohort (76%). SSEs were observed after 2L start in 32 patients (27%) on Ra-223 and 49 (22%) on 2L NAH. Conclusions: OS from start of 2L mCRPC treatment was similar for patients who received Ra-223 or alternative NAH in 2L. Slightly more patients received subsequent therapy in the Ra-223 cohort than in the 2L NAH cohort. Patients who received subsequent therapy were more likely to receive chemotherapy in the 2L NAH cohort, which is unsurprising as 2L NAH after 1L NAH is not highly active. Although the prior SSE rate before 2L start was higher in the Ra-223 cohort than in the 2L NAH cohort, and the two cohorts had similar rates of BHA use at 2L start, the rate of SSEs after 2L start was similar in both cohorts. Clinical trial information: NCT03896984. [Table: see text]

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