Adverse obstetric outcomes in two Brazilian maternity hospitals

PurposeObstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals.Design/methodology/approachA one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index.FindingsA significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year.Originality/valueHigh AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.

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GAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF INCIDENT DISABILITY IN MEXICAN OLDER ADULTS

Journal of Frailty & Aging ◽

10.14283/jfa.2014.10 ◽

2014 ◽

pp. 1-4

Author(s):

T. LOPEZ-TEROS ◽

L.M. GUTIERREZ-ROBLEDO ◽

M.U. PEREZ-ZEPEDA

Keyword(s):

Older Adults ◽

Gait Speed ◽

Daily Living ◽

Handgrip Strength ◽

Statistical Significance ◽

Adverse Outcomes ◽

Community Dwelling ◽

Performance Tests ◽

One Year

Physical performance tests are associated with different adverse outcomes in older people. Theobjective of this study was to test the association between handgrip strength and gait speed with incidentdisability in community-dwelling, well-functioning, Mexican older adults (age ≥70 years). Incident disability wasdefined as the onset of any difficulty in basic or instrumental activities of daily living. Of a total of 133participants, 52.6% (n=70) experienced incident disability during one year of follow-up. Significant associationsof handgrip strength (odds ratio [OR] 0.96, 95% confidence interval [95%CI] 0.93-0.99) and gait speed (OR0.27, 95%CI 0.07-0.99) with incident disability were reported. The inclusion of covariates in the models reducedthe statistical significance of the associations without substantially modifying the magnitude of them. Handgripstrength and gait speed are independently associated with incident disability in Mexican older adults.

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Transoral Endoscopic Adenoidectomy

International Journal of Otolaryngology ◽

10.1155/2009/949315 ◽

2009 ◽

Vol 2009 ◽

pp. 1-4 ◽

Cited By ~ 8

Author(s):

Amr El-Badrawy ◽

Mosaad Abdel-Aziz

Keyword(s):

High Risk ◽

Nasal Allergy ◽

Nasal Endoscope ◽

Experienced Surgeon ◽

Nasal Symptoms ◽

Recent Advancement ◽

Long Time ◽

One Year ◽

Telephone Questionnaire

Objective. Adenoid curette guided by an indirect transoral mirror and a headlight is a simple and quick procedure that has already been in use for a long time, but this method carries a high risk of recurrence unless done by a well-experienced surgeon. The purpose of this paper was to evaluate the efficacy of transoral endoscopic adenoidectomy in relieving the obstructive nasal symptoms.Methods. 300 children underwent transoral endoscopic adenoidectomy using the classic adenoid curette and St Claire Thomson forceps with a Hopkins 4-mm nasal endoscope introduced through the mouth and the view was projected on a monitor. Telephone questionnaire was used to follow-up the children for one year. Flexible nasopharyngoscopy was carried out for children with recurrent obstructive nasal symptoms to detect adenoid rehypertrophy.Results. No cases presented with postoperative complications. Only one case developed recurrent obstructive nasal symptoms due to adenoid regrowth and investigations showed that he had nasal allergy which may be the cause of recurrence.Conclusion. Transoral endoscopic adenoidectomy is the recent advancement of classic curettage adenoidectomy with direct vision of the nasopharynx that enables the surgeon to avoid injury of important structures as Eustachian tube orifices, and also it gives him the chance to completely remove the adenoidal tissues.

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Neurodevelopmental Outcome of High Risk Babies at One Year of Age Born in a Tertiary Centre

Journal of Nepal Paediatric Society ◽

10.3126/jnps.v37i1.16242 ◽

2017 ◽

Vol 37 (1) ◽

pp. 45-50

Author(s):

Merina Shrestha ◽

Luna Bajracharya ◽

Laxman Shrestha

Keyword(s):

High Risk ◽

Congenital Anomalies ◽

Neonatal Period ◽

Neurodevelopmental Outcome ◽

Single Item ◽

Tertiary Centre ◽

Developmental Domains ◽

One Year ◽

High Risk Clinic

Introduction: With increasing survival of high risk babies, children with different developmental disabilities have emerged as a challenge for the baby, family as well as for physicians. With limited awareness and resources, follow-up and interventions for these babies are difficult. The study was carried out to find out the development of high risk babies in different developmental domains at one year of age.Material and Methods: NICU graduates who visited high risk clinic at one year of age were assessed. ASQ-3 was used to screen development. Children with major congenital anomalies and syndromes were excluded from the study.Results: Out of 28 high risk babies, about 29% had global delay. Those babies who had seizure during neonatal period could not score even in single item of ASQ-3. Conclusion: All high risk babies are at risk of developing delay hence should be followed up regularly. Timely early intervention needs to be started to minimize delay.

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P6237Clinical utility of echocardiographic left-ventricular ejection fraction monitoring for cardiotoxicity risk assessment in patients with HER2+ early breast cancer undergoing trastuzumab-based therapy

European Heart Journal ◽

10.1093/eurheartj/ehz746.0838 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

F Posch ◽

T Glantschnig ◽

S Firla ◽

M Smolle ◽

M Balic ◽

...

Keyword(s):

Breast Cancer ◽

High Risk ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

One Year ◽

Over Time

Abstract Background Monitoring left-ventricular ejection fraction (LVEF) is a routinely-practiced strategy to survey patients with breast cancer (BC) towards cardiotoxic treatment effects. However, whether the LVEF as a single measurement or as a trajectory over time is truly sufficient to identify patients at high risk for cardiotoxicity is currently debated. Purpose To quantify the prognostic impact of LVEF and its change over time for predicting cardiotoxicity in women with HER2+ early BC. Methods We analyzed 1,136 echocardiography reports from 185 HER2+ early BC patients treated with trastuzumab ± chemoimmunoendocrine therapy in the neoadjuvant/adjuvant setting (Table 1). Cardiotoxicity was defined as a 10% decline in LVEF below 50%. Results Median baseline LVEF was 64% (25th-75th percentile: 60–69). Nineteen patients (10%) experienced cardiotoxicity (asymptomatic n=12, symptomatic n=7, during treatment n=19, treatment modification/termination n=14), Median time to cardiotoxicity was 6.7 months, and median LVEF decline in patients with cardiotoxicity was 18%. One-year cardiotoxicity risk was 7.6% in the 35 patients with a baseline LVEF≥60% and 24.5% in the 150 patients with a baseline LVEF<60% (Hazard Ratio (HR)=3.45, 95% CI: 1.35–8.75, Figure 1). During treatment, LVEF declined significantly faster in patients who developed cardiotoxicity than in patients without cardiotoxicity (1.3%/month vs. 0.1%/month, p<0.0001). A higher rate of LVEF decrease predicted for higher cardiotoxicity risk (HR per 0.1%/month higher LVEF decrease/month=2.50, 95% CI: 1.31–4.76, p=0.005), and cardiotoxicity risk increased by a factor of 1.7 per 5% absolute LVEF decline from baseline to first follow-up (HR=1.70, 95% CI: 1.30–2.38, p<0.0001). Thirty-six patients (19%) developed an LVEF decline of at least 5% from baseline to first follow-up (“early LVEF decline”). One-year cardiotoxicity risk was 6.8% in those without early LVEF decline and a baseline LVEF≥60% (n=117), 15.7% in those without an early LVEF decline and a baseline LVEF<60% (n=65), and 66.7% in those with an early LVEF decline and a baseline LVEF<60% (n=3), respectively (log-rank p<0.0001). Table 1. Baseline characteristics Age (years, median [IQR]) 55 [49–65] Estrogen receptor positive (n, %) 124 (67%) Neoadjuvant setting (n, %) 103 (56%) Figure 1. Risk of Cardiotoxicity. Conclusion Both a single LVEF measurement and the rate of LVEF decrease strongly predict cardiotoxicity in early BC patients undergoing HER2-targeted therapy. Routine LVEF monitoring identifies individuals at high risk of cardiotoxicity that may benefit from more sensitive screening techniques such as strain imaging.

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P5021Hypoperfusion markers identify patients with acute pulmonary embolism at highest risk for an adverse outcome

European Heart Journal ◽

10.1093/eurheartj/ehz746.0199 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Ebner ◽

C Sentler ◽

V P Harjola ◽

H Bueno ◽

K Keller ◽

...

Keyword(s):

Pulmonary Embolism ◽

Cardiac Arrest ◽

High Risk ◽

Predictive Value ◽

Odds Ratio ◽

Adverse Outcome ◽

A Priori ◽

Positive Likelihood Ratio ◽

Adverse Outcomes ◽

Prognostic Information

Abstract Background/Introduction According to the European Society of Cardiology (ESC) 2014 guideline, systemic hypotension (HT) is the critical variable defining high-risk in patients with pulmonary embolism (PE). However, signs of organ hypoperfusion might more adequately identify PE patients with cardiogenic shock due to right ventricular (RV) failure. Purpose We investigated whether hypoperfusion markers provide superior prognostic information for identifying PE patients at highest risk of early adverse outcomes. Methods Consecutive PE patients enrolled in a prospective single-centre registry between 09/2008 and 03/2018 were included. We analysed the predictive value of symptoms and findings suggesting hypoperfusion for in-hospital adverse outcome (catecholamine treatment, resuscitation or PE-related death) and in-hospital all-cause mortality. Results We analysed 814 patients, including 83 (10.2%) ESC 2014 high-risk patients. Patients presenting with cardiac arrest (CA, 4.5%) were a priori defined as high risk. Markers suggesting hypoperfusion of the brain (altered metal status, odds ratio [OR] 8.2 [95% CI, 4.2–16.0]), lung (respiratory insufficiency, 25.0 [9.4–66.7]) and tissue (venous lactate ≥2.2 mmol/l, 6.4 [3.2–12.9]) as well as HT (13.5 [6.7–27.2]) predicted an adverse outcome. The risk for an adverse outcome increased with the number of positive markers (AUC 0.86 [0.80–0.93]). Patients with ≥3 positive hypoperfusion markers had an OR of 42.9 (11.0–167.3) and patients defined as high-risk by the ESC 2014 an OR of 17.2 (8.8–33.3) with regard to an adverse outcome (Figure 1; Table 1). A new definition of high-risk (CA or ≥3 hypoperfusion markers) was associated with an OR of 73.2 (31.3–171.1) for an in-hospital adverse outcome and 26.2 (12.1–56.7) for in-hospital mortality. Table 1. Prognostic performance of hypoperfusion markers Adverse outcome (if negative) Adverse outcome (if positive) Sensitivity Specificity LR+ OR (95% CI) ≥1 hypoperfusion marker 1.1% 21.0% 91.9% 68.2% 2.9 24.4 (7.3–80.8) ≥2 hypoperfusion markers 4.7% 50.0% 48.6% 95.5% 10.9 20.3 (9.1–45.1) ≥3 hypoperfusion markers 6.5% 75.0% 24.3% 99.3% 32.7 42.9 (11.0–167.3) ESC 2014 high-risk 5.7% 51.1% 35.0% 96.9% 11.4 17.2 (8.8–33.3) Cardiac arrest 8.4% 86.5% 33.0% 99.3% 47.3 70.1 (26.4–186.1) Abbreviations: LR+, positive likelihood ratio; OR, odds ratio; CI, confidence interval. Figure 1. Frequency of adverse outcome Conclusions Markers of organ hypoperfusion have high predictive value for early adverse outcomes in acute PE. Risk increases with the number of positive markers and is critically elevated in patients presenting with CA or ≥3 markers. Acknowledgement/Funding This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503).

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Pre-irradiation chemotherapy for infants and children with medulloblastoma: a preliminary report

Journal of Neurosurgery ◽

10.3171/jns.1989.71.6.0820 ◽

1989 ◽

Vol 71 (6) ◽

pp. 820-826 ◽

Cited By ~ 31

Author(s):

Cynthia S. Kretschmar ◽

Nancy J. Tarbell ◽

William Kupsky ◽

Beverly L. Lavally ◽

Jay S. Loeffler ◽

...

Keyword(s):

Radiation Therapy ◽

High Risk ◽

Complete Response ◽

Drug Regimen ◽

Direct Evaluation ◽

Term Survival ◽

Content Type ◽

Disease Free

✓ From March, 1984, through June, 1987, 21 newly diagnosed children with high-risk medulloblastoma (Chang Stage T3 to T4) were treated on a 9-week postoperative, pre-irradiation chemotherapy regimen consisting of vincristine and cisplatin. The children over 2 years old then received radiation therapy. Six infants (aged 6 to 18 months) were maintained on chemotherapy consisting of MOP (nitrogen mustard, vincristine, and procarbazine) until the age of 2 years, at which time they were referred for irradiation. Of 13 children with measurable disease following surgery, five showed a definite response on computerized tomography scans to vincristine and cisplatin (one complete response and four partial responses) and five others showed clear marginal responses. Four of the six infants were disease-free at 19, 32, 35, and 57 months from diagnosis. One infant developed progressive disease at the completion of the vincristine and cisplatin course, and a second infant had progression during MOP administration. Three of the 21 children developed hearing loss within the speech frequencies during cisplatin treatments, but there were no other major toxicities. Fifteen children remained disease-free with a median follow-up period of 35 months (range 19 to 57 months). Chemotherapy given between surgery and radiotherapy may allow for the direct evaluation of a specific drug regimen and permit the postponement of radiation therapy in infants. Pre-irradiation vincristine and cisplatin was well tolerated and effective in shrinking the tumor in most children with medulloblastoma. Such chemotherapy regimens have the potential for extending long-term survival in high-risk children.

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Principals’ experiences of changes in relationships with newly qualified teachers resulting from a teacher registration reform

International Journal of Educational Management ◽

10.1108/ijem-02-2018-0076 ◽

2019 ◽

Vol 33 (4) ◽

pp. 556-568

Author(s):

Anneli Frelin ◽

Göran Fransson

Keyword(s):

Instructional Leaders ◽

Small Scale ◽

Structured Interviews ◽

Content Type ◽

Qualified Teachers ◽

One Year ◽

Teachers Perspectives ◽

Academic Year ◽

Newly Qualified Teachers

Purpose The purpose of this paper is to understand, from principals’ points of view, how a teacher registration reform is enacted by examining the potential changes in the relationships between principals and newly qualified teachers (NQTs). The reform entailed principals performing an aptitude assessment of new teachers in their probationary year. Design/methodology/approach Semi-structured interviews were conducted with five principals from two Swedish municipalities on three occasions in one academic year. A third follow-up interview was conducted one year later with four of the principals, the fifth no longer being in post. Findings The assessment appears to be downplayed by the principals, whereas the supportive dimension and the facilitation of NQTs’ professional development seem to be acknowledged and made explicit. For some of the principals, their creative translation of the reform’s intentions transformed these relations and strengthened their leadership. Research limitations/implications The study is small-scale and was carried out in a specific period of policy implementation from the principals’ perspectives. Future studies would benefit from involving both principals’ and teachers’ perspectives. Practical implications Policymakers appear to have underestimated the structural aspects of the reform, even though in general the reform enactments had some kind of positive effect on these relations. Social implications For some principals, their creative translation of the reform’s intentions transformed relations and strengthened their leadership. Originality/value The data are from a unique period when a reform was implemented and later partly withdrawn. The study deepens the understanding on how principals tries to enact and balance their roles as evaluators of NQTs and pedagogical and instructional leaders.

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One-year follow-up of a remotely delivered epilepsy self-management program in high-risk people with epilepsy

Epilepsy & Behavior ◽

10.1016/j.yebeh.2019.04.034 ◽

2019 ◽

Vol 96 ◽

pp. 237-243 ◽

Cited By ~ 2

Author(s):

Martha Sajatovic ◽

Kari Colon-Zimmermann ◽

Mustafa Kahriman ◽

Edna Fuentes-Casiano ◽

Christopher Burant ◽

...

Keyword(s):

High Risk ◽

Management Program ◽

Self Management ◽

One Year

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Comparison of Risk-Adjusted Outcomes in Medicare Open versus Laparoscopic Cholecystectomy

The American Surgeon ◽

10.1177/000313481808400108 ◽

2018 ◽

Vol 84 (1) ◽

pp. 12-19 ◽

Cited By ~ 1

Author(s):

Donald E. Fry ◽

Michael Pine ◽

Susan M. Nedza ◽

Agnes M. Reband ◽

Chun-Jung Huang ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

High Risk ◽

Length Of Stay ◽

Adverse Outcome ◽

Adverse Outcomes ◽

High Risk Population ◽

Hospital Level ◽

Prolonged Length ◽

Medicare Patients ◽

Open Versus

More than 90 per cent of cholecystectomies are performed laparoscopically and this has resulted in concern that surgeons will not have sufficient experience to perform open procedures when clinical circumstances require it. We reviewed the open cholecystectomies (OCs) of Medicare patients from 2010 to 2012 in hospitals with 20 or more cases, created risk-adjusted models for adverse outcomes which were evaluated for 90-days after discharge, and compared the hospital-level outcomes with laparoscopic cholecystectomy performed in the same hospitals for the same period of time. Results demonstrated that inpatient deaths, inpatient prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day readmissions were statistically the same with an overall adverse outcome rate of 21.6 per cent in OC versus 20.9 per cent in laparoscopic cholecystectomy. Conversion of laparoscopic to open procedures was not associated with increased adverse outcomes. Laparoscopic cholecystectomy provides patients with many advantages, but when clinical circumstances are necessary, OC continues to be performed with the same overall adverse outcome rates, and the conversion process is not associated with poorer results in this high-risk population of patients.

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