scholarly journals A neonatal ward strengthening program improves survival for neonates treated with CPAP at district hospitals in Malawi

2021 ◽  
Author(s):  
Jennifer Carns ◽  
Sara Liaghati-Mobarhan ◽  
Aba Asibon ◽  
Samuel Ngwala ◽  
Elizabeth Molyneux ◽  
...  
Keyword(s):  
Health Facility ◽  
Rural Hospitals ◽  
Improvement Program ◽  
Healthcare Facilities ◽  
Improved Outcomes ◽  
District Hospitals ◽  
Suitable Space ◽  
Rural Sites ◽  
One Year ◽  
The Impact

Introduction: From 2013-2015, a CPAP quality improvement program (QIP) was implemented to introduce and monitor CPAP usage and outcomes in the neonatal wards at all government district and central hospitals in Malawi. In 2016 the CPAP QIP was extended into healthcare facilities operated by the Christian Health Association of Malawi. Although clinical outcomes improved, ward assessments indicated that many rural sites lacked other essential equipment and a suitable space to adequately treat sick neonates, which likely limited the impact of improved respiratory care. The aim of this study was to determine if a ward strengthening program improved outcomes for neonates treated with CPAP. Methods: To address the needs identified from ward assessments, a ward strengthening program was implemented from 2017-2018 at rural hospitals in Malawi to improve the care of sick neonates. The ward strengthening program included the distribution of a bundle of equipment, supplemental training, and, in some cases, health facility renovations. Survival to discharge was compared for neonates treated with CPAP at 12 rural hospitals for one year before and for one year immediately after implementation of the ward strengthening program. Results: In the year prior to ward strengthening, 189 neonates were treated with CPAP; in the year after, 232 neonates received CPAP. The overall rate of survival for those treated with CPAP improved from 46.6% to 57.3% after ward strengthening (p=0.03). For the subset of neonates with admission weights between 1.00-2.49 kg diagnosed with respiratory distress syndrome, survival increased from 39.4% to 60.3% after ward strengthening (p=0.001). Conclusion: A ward strengthening program including the distribution of a bundle of equipment, supplemental training, and some health facility renovations, further improved survival among neonates treated with CPAP at district-level hospitals in Malawi.

The impact of the TelEmergency program on rural emergency care: An implementation study

2016 ◽  
Vol 23 (6) ◽  
pp. 588-594 ◽  
Author(s):  
Sarah A Sterling ◽  
Samantha R Seals ◽  
Alan E Jones ◽  
Melissa H King ◽  
Robert L Galli ◽  
...  
Keyword(s):  
Emergency Care ◽  
Rural Areas ◽  
Patient Discharge ◽  
Rural Hospitals ◽  
Rural Hospital ◽  
P Value ◽  
Discharge Rates ◽  
Before And After ◽  
One Year ◽  
The Impact

Introduction Timely, appropriate intervention is key to improving outcomes in many emergent conditions. In rural areas, it is particularly challenging to assure quality, timely emergency care. The TelEmergency (TE) program, which utilizes a dual nurse practitioner and emergency medicine-trained, board-certified physician model, has the potential to improve access to quality emergency care in rural areas. The objective of this study was to examine how the implementation of the TE program impacts rural hospital Emergency Department (ED) operations. Methods Methods included a before and after study of the effect of the TE program on participating rural hospitals between January 2007 and December 2008. Data on ED and hospital operations were collected one year prior to and one year following the implementation of TE. Data from participating hospitals were combined and compared for the two time periods. Results Nine hospitals met criteria for inclusion and participated in the study. Total ED volumes did not significantly change with TE implementation, but ED admissions to the same rural hospital significantly increased following TE implementation (6.7% to 8.1%, p-value = 0.02). Likewise, discharge rates from the ED declined post-initiation (87.1% to 80.0%, p-value = 0.003). ED deaths and transfer rates showed no significant change, while the rate of patient discharge against medical advice significantly increased with TE use. Discussion In this analysis, we found a significant increase in the rate of ED admissions to rural hospitals with TE use. These findings may have important implications for the quality of emergency care in rural areas and the sustainability of rural hospitals’ EDs.

Abstract 14565: Simultaneous Heart-Kidney Transplant - Does Hospital Experience With Heart Transplant or Kidney Transplant Have a Greater Impact on Patient Outcomes?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael A Catalano ◽  
Stevan Pupovac ◽  
Brian Lima ◽  
Gerin R Stevens ◽  
Alan R Hartman ◽  
...  
Keyword(s):  
Kidney Transplant ◽  
Heart Transplant ◽  
Multivariable Analysis ◽  
High Volume ◽  
Patient Demographics ◽  
Improved Outcomes ◽  
Institutional Experience ◽  
One Year ◽  
Mortality Table ◽  
The Impact

Objective: High institutional transplant volume is known to be associated with improved outcomes in heart transplant and kidney transplant. However, little is known regarding the impact of institutional experience on outcomes in simultaneous heart-kidney transplant (SHKT). The aim of this study was to assess trends and outcomes of SHKT nationally, as well as the impact of institutional heart and kidney transplant volume on mortality for SHKT patients. Methods: All adult patients (age ≥18) who underwent SHKT between 2005 - 2019 were identified using the United Network for Organ Sharing (UNOS) database. Annual institutional volume in heart transplant and kidney transplant were determined. Univariate and multivariable analyses were conducted to assess the impact of patient demographics, comorbidities, and institutional transplant volumes on 1-year mortality. Results: There were 1564 SHKT identified in the sample, increasing fourfold from 54 in 2005 to 221 in 2019 (p < .001). Median annual institutional heart transplant volume among centers performing SHKT was 35 (IQR 24 - 56); median annual kidney transplant volume was 166 (IQR 89 - 224). One-year mortality was 11.8%. In multivariable analysis, increasing annual institutional heart transplant volume was associated with reduced 1-year-month mortality. Contrarily, annual institutional kidney transplant volume was not associated with mortality. Increasing body mass index, dialysis, requirement for extracorporeal membrane oxygenator support (ECMO) at time of transplant, ischemic times, and total bilirubin levels were independently associated with increased 1-year mortality (Table 1). Conclusion: Increased institutional heart transplant volume is associated with reduced mortality in SHKT. A similar association was not identified between institutional kidney transplant volume and mortality. Thus, emphasis should be placed on high-volume heart transplant centers to manage SHKT patients.

scholarly journals The Impact of COVID-19 Era on Pulmonary Embolism Patients: Increased Incidence of Hospitalizations and Higher Mortality—What Can Be Done?

COVID ◽  
2021 ◽  
Vol 1 (1) ◽  
pp. 357-365
Author(s):  
Aura Vîjîiac ◽  
Diana Irena Stănciulescu ◽  
Alexandru Emil Băetu ◽  
Iulia-Adelina Grigore ◽  
Denisa Vintilă ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Weight Control ◽  
Positive Impact ◽  
Pulmonary Angiography ◽  
Future Research ◽  
Healthcare Facilities ◽  
The Social ◽  
Significant Burden ◽  
One Year ◽  
The Impact

The coronavirus disease outbreak in 2019 (COVID-19) reached devastating pandemic proportions, still representing a challenge for all healthcare workers. Furthermore, the social environment underwent significant changes and healthcare facilities were overwhelmed by COVID-19 patients. The purpose of our study was to compare the prevalence, characteristics and outcomes of 234 patients presenting with pulmonary embolism diagnosed by computed tomography pulmonary angiography (CTPA) during the COVID-19 pandemic, to patients presenting with PE one year before, aiming to assess differences and similarities between these patients. Or main findings were: patients with PE had worse survival during the pandemic, there was an increased incidence of PE among hospitalizations in our cardiology unit during the COVID-19 pandemic, and patients hospitalized with PE during the pandemic were more likely to be obese, allowing us to infer that weight control can have a positive impact on preventing PE. Future research should establish optimal therapeutic, epidemiological and economical strategies for non-COVID patients, as the pandemic continues to put significant burden on the healthcare systems worldwide.

Abstract 302: Pediatric CPR Performance During One Year of RQI in a Pediatric Emergency Department

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Aaron Donoghue ◽  
Mary Kate Abbadessa ◽  
Shannon Gaines ◽  
Ichiro Watanabe ◽  
Richard Hanna ◽  
...  
Keyword(s):  
High Frequency ◽  
Fixed Effects ◽  
Pediatric Emergency ◽  
Future Research ◽  
Improvement Program ◽  
Mixed Effect ◽  
Video Review ◽  
Improved Performance ◽  
One Year ◽  
The Impact

The Resuscitation Quality Improvement Program is a low-dose high-frequency training method for CPR skills. Evidence linking high-frequency training to improved performance during actual CPR is lacking. We have previously reported on the simultaneous use of video review and chest compression (CC) monitoring devices to describe CC quality at the level of individual providers. We sought to evaluate CC quality in pediatric CPR over a one year period following RQI implementation. Methods: Observational study in a pediatric ED where codes are videorecorded and where all providers were enrolled in RQI in October 2017. Video review is used to identify CPR providers and measure the duration of CC segments they perform. A monitor device is used to record CC depth and rate, allowing summarization of CC parameters for those individual time segments (i.e. CC performance by individual providers). CCs were analyzed by ‘compressor segment’, defined as the period of time where a single provider performed chest compressions until replaced by another. Data was summarized by quarter; change over time was analyzed by mixed effect logistic regression modeling adjusting for quarter and segment duration as fixed effects. Results: 159 providers enrolled in RQI. Data for 18 events totaling 206 CC segments were analyzed. 52 providers performed CC at some point during the study period. CC segments are graphed per quarter in Figure 1. There were no significant differences in proportion of CC segments meeting guidelines during the study period. Conclusions: CPR events in our ED are infrequent and a minority of providers perform CPR in routine clinical practice. Over a 15 month period following the implementation of RQI in a pediatric ED, CC quality during CPR events in children did not improve with time, although our analysis was limited by sample size constraints. Future research should expand this method to examine the impact of varied retraining intervals and varied participant groups on CC quality.

Chasing the phantom: biogeography and conservation of Vipera latastei-monticola in the Maghreb (North Africa)

2018 ◽  
Vol 39 (2) ◽  
pp. 145-161 ◽  
Author(s):  
Inês Freitas ◽  
Soumia Fahd ◽  
Guillermo Velo-Antón ◽  
Fernando Martínez-Freiría
Keyword(s):  
North Africa ◽  
Habitat Degradation ◽  
Conservation Status ◽  
Western Mediterranean ◽  
Niche Modelling ◽  
Habitat Transformation ◽  
Mountain Ranges ◽  
Management Actions ◽  
Suitable Space ◽  
The Impact

Abstract The Maghreb region (North Africa) constitutes a major component of the Mediterranean Basin biodiversity hotspot. During the last centuries, a consistent human population growth has led to an unprecedented rate of habitat transformation and loss in the region and thus, threatening its biodiversity. The Western Mediterranean viper Vipera latastei-monticola inhabits humid and subhumid areas in the main mountain ranges of the Maghreb, facing such threatening factors; however, its elusive character and rarity hindered data collection for distinct biological purposes. Here, we study the biogeographical patterns and conservation status of the Maghrebian V. latastei-monticola resulting from recent sampling campaigns in Morocco and Tunisia. We update species distribution, and integrate phylogeographic and ecological niche modelling analyses at both species and lineage level to identify suitable areas, and to evaluate the impact of anthropogenic transformation and level of protection of their suitable space. We identified four highly divergent mitochondrial lineages, including a new lineage endemic to the Western High Atlas, with allopatric distributions and restricted to mountain ranges, supporting the role of mountains as past climatic refugia. Despite the remoteness of suitable areas, we report widespread habitat degradation and identify the low effectiveness of the current protected areas system in preserving the species and lineages range. Our study shows the urgent need to apply management actions for the long-term conservation of this vulnerable species and suggests a revaluation of the specific status of V. monticola, as these populations likely represent an ecotype of V. latastei.

scholarly journals An Effectiveness Trial of STEADI in an Outpatient, Primary Care Practice

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 774-774
Author(s):  
David Rein ◽  
Madeleine Hackney ◽  
Michele Dougherty ◽  
Camille Vaughan ◽  
Laurie Imhof ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Review ◽  
Primary Care Practice ◽  
Controlled Trial ◽  
Care Practice ◽  
Strength Assessment ◽  
Randomized Controlled ◽  
Study Team ◽  
One Year ◽  
The Impact

Abstract The STEADI Options trial uses a randomized, controlled-trial design to assess the effectiveness and cost-effectiveness of the STEADI Initiative . Beginning March, 2020, we will randomize 3,000 adults ≥ 65 years of age at risk for falls seen in an Emory Clinic primary care practice to: (1) full STEADI; (2) a STEADI-derived gait, balance, and strength assessment with physical therapy referrals; (3) a STEADI-derived medication review and management; or (4) usual care. This presentation will discuss decisions made by the study team to facilitate implementation of STEADI including electronically conducting screening prior to the date of encounter, the use of dedicated nursing staff to conduct assessments, implementation of strength, balance, orthostatic hypotension, and vision testing, methods to facilitate medication review, and communication of assessment information to providers. The results from this study will be used to estimate the impact of STEADI on falls, service utilization, and costs over one year.

scholarly journals Ventricular arrhythmias in patients with functional mitral regurgitation and implantable cardiac devices: implications of mitral valve repair with Mitraclip

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Benito Gonzalez ◽  
X Freixa ◽  
C Godino ◽  
M Taramasso ◽  
R Estevez-Loureiro ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Mitral Regurgitation ◽  
Valve Repair ◽  
One Year ◽  
The Impact

Abstract Background Limited information has been reported regarding the impact of percutaneous mitral valve repair (PMVR) on ventricular arrhythmic (VA) burden. The aim of this study was to address the incidence of VA and appropriate antitachycardia implantable cardiac defibrillator (ICD) therapies before and after PMVR. Methods We retrospectively analyzed all consecutive patients with heart failure with reduce left ventricular ejection fraction, functional mitral regurgitation grade 3+ or 4+ and an active ICD or cardiac resynchronizer who underwent PMVR in any of the eleven recruiting centers. Only patients with complete available device VA monitoring from one-year before to one year after PMVR were included. Baseline clinical and echocardiographic characteristics were collected before PMVR and at 12-months follow-up. Results 93 patients (68.2±10.9 years old, male 88.2%) were enrolled. PMVR was successfully performed in all patients and device success at discharge was 91.4%. At 12-months follow-up, we observed a significant reduction in mitral regurgitation severity, NT-proBNP and prevalence of severe pulmonary hypertension and severe kidney disease. Patients also referred a significant improvement in NYHA functional class and showed a non-significant trend to reserve left ventricular remodeling. After PMVR a significant decrease in the incidence of non-sustained ventricular tachycardia (VT) (5.0–17.8 vs 2.7–13.5, p=0.002), sustained VT or ventricular fibrillation (0.9–2.5 vs 0.5–2.9, p=0.012) and ICD antitachycardia therapies (2.5–12.0 vs 0.9–5.0, p=0.033) were observed. Conclusion PMVR was related to a reduction in arrhythmic burden and ICD therapies in our cohort. Proportion of patients who presented ven Funding Acknowledgement Type of funding source: None

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