scholarly journals Early essential newborn care is associated with improved newborn outcomes following caesarean section births in a tertiary hospital in Da Nang, Vietnam: a pre/post-intervention study

2021 ◽  
Vol 10 (3) ◽  
pp. e001089
Author(s):  
Hoang Thi Tran ◽  
John Charles Scott Murray ◽  
Howard Lawrence Sobel ◽  
Priya Mannava ◽  
Le Thi Huynh ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Relative Risk ◽  
Caesarean Section ◽  
Environmental Changes ◽  
Newborn Care ◽  
Adverse Outcomes ◽  
National Guidelines ◽  
Post Intervention ◽  
Essential Newborn Care ◽  
Newborn Outcomes

BackgroundTo improve maternal and neonatal outcomes, Vietnam implemented early essential newborn care (EENC) using clinical coaching and quality improvement self-assessments in hospitals to introduce policy, practice and environmental changes. Da Nang Hospital for Women and Children began EENC with caesarean section births to inform development of national guidelines. This study compared newborn outcomes after caesarean sections pre/post-EENC introduction.MethodsMaternity records of all live in-born hospital caesarean births and separate case records of the subpopulation admitted to the neonatal intensive care unit (NICU) were reviewed pre-EENC (November 2013–October 2014) and post-EENC (November 2014–October 2015) implementation. NICU admissions and adverse outcomes on NICU admission were compared using descriptive statistics.FindingsA total of 16 927 newborns were delivered by caesarean section: 7928 (46.8%) pre-EENC and 8999 post-EENC (53.2%). Total NICU admissions decreased from 16.7% to 11.8% (relative risk 0.71; 95% CI 0.66 to 0.76) after introduction of EENC. Compared with the pre-EENC period, babies with hypothermia on admission to the NICU declined from 5.0% to 3.7% (relative risk 0.73; 95% CI 0.63 to 0.84) and cases of sepsis from 3.2% to 0.8% (relative risk 0.26; 95% CI 0.20 to 0.33) post-EENC implementation. While more than half of all newborns in the NICU were fed something other than breastmilk pre-EENC introduction, 85.8% were exclusively breast fed post-EENC (relative risk 1.86; 95% CI 1.75 to 1.98). Preterm newborns <2000 g receiving kangaroo mother care (KMC) increased from 50% to 67% (relative risk 1.33; 95% CI 1.12 to 1.59).ConclusionThe EENC quality improvement approach with caesarean section births was associated with reduced NICU admissions, admissions with hypothermia and sepsis, and increased rates of exclusive breast feeding and KMC in the NICU.

scholarly journals Quality of Early Essential Newborn Care in hospitals in Gaza: a pre-intervention and post-intervention study

The Lancet ◽  
2021 ◽  
Vol 398 ◽  
pp. S2
Author(s):  
Shireen N Abed ◽  
Sireen Al Attar ◽  
Bothaina Shaikh Khalil ◽  
Laila Al Masharfa ◽  
Nashwa Skaik ◽  
...  
Keyword(s):  
Intervention Study ◽  
Newborn Care ◽  
Post Intervention ◽  
Essential Newborn Care

scholarly journals Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254781
Author(s):  
Manoja Kumar Das ◽  
Narendra Kumar Arora ◽  
Suresh Kumar Dalpath ◽  
Saket Kumar ◽  
Amneet P. Kumar ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Newborn Care ◽  
Lessons Learned ◽  
Essential Newborn Care ◽  
Case Record ◽  
District Hospitals ◽  
Maternal And Newborn

Introduction Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts. Methods This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider’s knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact. Results The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19–42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC. Conclusion This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.

Abstract 123: Door To Needle 60, Creative Solutions in Academia

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ilana M Ruff ◽  
Ava L Liberman ◽  
Fan Z Caprio ◽  
Kapil Sachdeva ◽  
Deborah L Bergman ◽  
...  
Keyword(s):  
Boot Camp ◽  
Adverse Outcomes ◽  
National Guidelines ◽  
Medication History ◽  
Post Intervention ◽  
Exclusion Criteria ◽  
Unique Challenge ◽  
Intravenous Tissue Plasminogen Activator ◽  
Creative Solutions ◽  
Iv Tpa

Introduction: National guidelines endorse that eligible acute ischemic stroke (AIS) patients should be treated with intravenous tissue plasminogen activator (IV tPA) within 60 minutes of arrival to an emergency department (ED). We participated in the American Heart Association’s Target: Stroke program which successfully reduced door to needle (DTN) times through 10 best practices, but academic hospitals face a unique challenge as junior residents evaluate and manage AIS patients. We hypothesized that a “stroke boot camp” could improve resident efficiency during stroke codes and shorten DTN times through faster stroke code to tPA times. Methods: A neurology resident educational protocol was developed and implemented in April 2013 using a Socratic case-based discussion to emphasize focused history and exam, medication history, and tPA exclusion criteria. We distributed cards with IV tPA risks/benefits and a checklist for tPA exclusion criteria. We compared pre-intervention (January 2010-April 2013) to post-intervention (April 2013-April 2014) patient demographics, comorbidities, resident level, relevant times, and outcomes using appropriate tests. Results: We analyzed 122 consecutive AIS patients treated with IV tPA in our ED during the study period. Pre and post intervention groups did not differ by demographics except gender (p = 0.005). There were no difference in comorbidities, baseline NIHSS, or resident post graduate year (PGY). After the intervention, stroke-code-to-tPA was significantly reduced (75 min vs. 45 min; p < 0.001), whereas door-to-stroke-code (7 min vs. 6 min, p = 0.56) and door-to-CT (18 min vs. 19 min, p = 0.44) did not change. The proportion of patients treated within 60 minutes increased (16.4% vs. 51.4%, P < 0.001) and median DTN time decreased (81 min vs. 60 min P < 0.001) significantly after the intervention. Time reductions were consistent across PGY levels without increased adverse outcomes. Conclusion: Reduction in stroke code-to-tPA times after implementation of a “stroke boot camp” led to a significant reduction in DTN time. Focused neurology resident acute stroke education should be implemented at academic institutions to improve rapid IV tPA administration

Effectiveness of Early Essential Newborn Care Implementation In Four Provinces of Western China

2021 ◽  
Author(s):  
Chenran Wang ◽  
Yun Lin ◽  
Hanxiyue Zhang ◽  
Ge Yang ◽  
Kun Tang ◽  
...  
Keyword(s):  
Intervention Group ◽  
Newborn Care ◽  
Western China ◽  
World Health ◽  
Health Concern ◽  
Control Group ◽  
Neonatal Health ◽  
Post Intervention ◽  
Essential Newborn Care ◽  
Postpartum Mothers

Abstract Introduction: Neonatal survival remains a public health concern globally. Early Essential Newborn Care (EENC) recommended by World Health Organization is a package of cost-effective interventions to improve neonatal health and development outcomes. In this study we aimed to explore the effectiveness of EENC implementation in four provinces of western China.Methods: A pre- and post-intervention investigations were conducted in 4 selected EENC intervention counties and 4 control counties of four western provinces of China, during June to August 2017 and December 2020 to April 2021 respectively. A mixed quantitative and qualitative approach was used for data collection and analysis. Data on the coverage of EENC practices were collected through post-intervention face-to-face questionnaire interview with postpartum mothers before hospital discharge. Hospital-reported data on neonatal health outcomes were obtained through mail surveys in both investigations. We also performed semi-structured interviews with stakeholders of policymakers, health staff, and postpartum mothers to learn their perceived usefulness of EENC implementation. Results: 599 mother-newborn pairs in the intervention group and 699 pairs in the control group participated in the post-intervention survey. With the confounding factor of province being controlled for, proportions of newborns receiving any skin to skin contact (99.50% vs. 49.07%), exclusive breastfeeding before discharge (92.57% vs. 63.80%), no applied medicine to the umbilical cord (98.50% vs. 9.73%), routine eye care (93.16% vs. 8.73%), and vitamin K1 administration (98.33% vs. 88.98%) were higher in the intervention group compared with the control group (P<0.05). Lower incidences of neonatal diarrhea (0.07% vs. 0.22%) and eye infection (0.04% vs. 0.29%) were reported in the intervention group than the control group (P<0.05). The enhanced satisfaction of stakeholders primarily manifests in belief acknowledgement, policy promotion, emotional support, health improvement, widely-acknowledged sustainability, and work support. Conclusion: EEEC-recommended core practices have been successfully introduced in pilot hospitals. The efficacy of EENC implementation should be highly recognized to accelerate the progress towards its national rolling out.

scholarly journals 1096. Reducing Unnecessary Postoperative Antibiotic Prophylaxis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S389-S390
Author(s):  
Talene A Metjian ◽  
Jeffrey Gerber ◽  
Adam Watson ◽  
Caroline Burlingame ◽  
Heuer Gregory ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Antibiotic Prophylaxis ◽  
Adverse Drug Events ◽  
Tethered Cord ◽  
Surgical Site Infections ◽  
Antibiotic Use ◽  
Quality Improvement Initiative ◽  
National Guidelines ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background National guidelines for the prevention of surgical site infections (SSI) recommend against antibiotic prophylaxis following wound closure for clean and clean-contaminated surgical procedures. Prolonged antibiotic prophylaxis can lead to antibiotic resistance and adverse drug events without reducing SSI rates. The objective was to reduce the rate of antibiotic prophylaxis following surgical incision closure for specified procedures in the Divisions of Neurosurgery (NRS), Otolaryngology (OTO), and General Surgery (GS) at Children’s Hospital of Philadelphia (CHOP). Methods We identified all NRS, OTO, and GS procedures conducted at CHOP from July 1, 2016 to June 20, 2017. Collaborative meetings between surgical quality improvement team leads and the antimicrobial stewardship program (ASP) were convened to identify procedures most suitable for the intervention, including Chiari decompressions and tethered cord repair (NRS); tympanoplasty and tracheostomy (OTO); and laparoscopic and thoracoscopic procedures (GS). The intervention, started in March 2018, included (1) education of surgeons on perioperative prescribing guidelines, (2) order set modification, and (3) individualized monthly audit with feedback reports of inappropriate postoperative prescribing (via email copying all surgeons within the division). We monitored rates utilizing SPC charts of postoperative antibiotic use (defined as administration within 24 hours of procedure end) and evaluated SSI rates pre and post-intervention with a Poisson regression. Results Following the intervention, postoperative antibiotic use reached special cause resulting in a mean decline for laparoscopy (19.6% to 11.7%), thoracoscopy (35.6% to 17.9%), tympanoplasty (90.5% to 11.4%), tethered cord repair (95% to 25.5%), and Chiari decompression (97% to 45.9%). There was no mean shift in postoperative antibiotic use for tracheostomy (25.5%). 30-day SSI rates did not change pre- and post-intervention (P = 0.36). Conclusion A quality improvement initiative conducted to implement national guidelines recommending against postoperative antibiotic prophylaxis showed a significant reduction in postoperative antibiotic prophylaxis without a concomitant rise in SSI rates. Disclosures All authors: No reported disclosures.

scholarly journals Risk of major labour-related complications for pregnancies progressing to 42 weeks or beyond

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Anthea C. Lindquist ◽  
Roxanne M. Hastie ◽  
Richard J. Hiscock ◽  
Natasha L. Pritchard ◽  
Susan P. Walker ◽  
...  
Keyword(s):  
Relative Risk ◽  
Caesarean Section ◽  
Post Partum ◽  
Shoulder Dystocia ◽  
Adverse Outcomes ◽  
Study Cohort ◽  
Adjusted Relative Risk ◽  
Perineal Tear ◽  
Nulliparous Women ◽  
Post Partum Haemorrhage

Abstract Background Post-term gestation beyond 41+6 completed weeks of gestation is known to be associated with a sharp increase in the risk of stillbirth and perinatal mortality. However, the risk of common adverse outcomes related to labour, such as shoulder dystocia and post-partum haemorrhage for those delivering at this advanced gestation, remains poorly characterised. The objective of this study was to examine the risk of adverse, labour-related outcomes for women progressing to 42 weeks gestation or beyond, compared with those giving birth at 39 completed weeks. Methods We performed a state-wide cohort study using routinely collected perinatal data in Australia. Comparing the two gestation cohorts, we examined the adjusted relative risk of clinically significant labour-related adverse outcomes, including macrosomia (≥ 4500 at birth), post-partum haemorrhage (≥1000 ml), shoulder dystocia, 3rd or 4th degree perineal tear and unplanned caesarean section. Parity, maternal age and mode of birth were adjusted for using logistic regression. Results The study cohort included 91,314 women who birthed at 39 completed weeks and 4317 at ≥42 completed weeks. Compared to 39 weeks gestation, those giving birth ≥42 weeks gestation had an adjusted relative risk (aRR) of 1.85 (95% CI 1.55–2.20) for post-partum haemorrhage following vaginal birth, 2.29 (95% CI 1.89–2.78) following instrumental birth and 1.44 (95% CI 1.17–1.78) following emergency caesarean section; 1.43 (95% CI 1.16–1.77) for shoulder dystocia (for non-macrosomic babies); and 1.22 (95% CI 1.03–1.45) for 3rd or 4th degree perineal tear (all women). The adjusted relative risk of giving birth to a macrosomic baby was 10.19 (95% CI 8.26–12.57) among nulliparous women and 4.71 (95% CI 3.90–5.68) among multiparous women. The risk of unplanned caesarean section was 1.96 (95% CI 1.86–2.06) following any labour and 1.47 (95% CI 1.38–1.56) following induction of labour. Conclusions Giving birth at ≥42 weeks gestation may be an under-recognised risk factor for several important, labour-related adverse outcomes. Clinicians should be aware that labour at this advanced gestation incurs a higher risk of adverse outcomes. In addition to known perinatal risks, the risk of obstetric complications should be considered in the counselling of women labouring at post-term gestation.

Relative risk of cardiovascular disease is higher in women with type 2 diabetes, but not in those with prediabetes, as compared with men

2020 ◽  
Author(s):  
Elena Succurro ◽  
Teresa Vanessa Fiorentino ◽  
Sofia Miceli ◽  
Maria Perticone ◽  
Angela Sciacqua ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Longitudinal Study ◽  
Relative Risk ◽  
Hdl Cholesterol ◽  
Cross Sectional Study ◽  
Adverse Outcomes ◽  
Cross Sectional ◽  
Normal Glucose

<b>Objective</b>: Most, but not all studies suggested that women with type 2 diabetes have higher relative risk (RR) for cardiovascular disease (CVD) than men. More uncertainty exists on whether the RR for CVD is higher in prediabetic women compared to men. <p><b>Research Design and Methods</b>: In a cross-sectional study, in 3540 normal glucose tolerant (NGT), prediabetic, and diabetic adults, we compared the RR for prevalent non-fatal CVD between men and women. In a longitudinal study including 1658 NGT, prediabetic, and diabetic adults, we compared the RR for incident major adverse outcomes, including all-cause death, coronary heart disease, and cerebrovascular disease events after 5.6 years follow-up. </p> <p><b>Results:</b> Women with prediabetes and diabetes exhibited greater relative differences in BMI, waist circumference, blood pressure, total, LDL and HDL cholesterol, triglycerides, fasting glucose, hsCRP, and white blood cell count than men with prediabetes and diabetes when compared with their NGT counterparts. We found a higher RR for prevalent CVD in diabetic women (RR 9.29; 95% CI 4.73-18.25; <i>P</i><0.0001) than in men (RR 4.56; 95% CI 3.07-6.77; <i>P</i><0.0001), but no difference in RR for CVD was observed comparing prediabetic women and men. In the longitudinal study, we found that diabetic, but not prediabetic women have higher RR (RR 5.25; 95% CI 3.22-8.56; <i>P</i><0.0001) of incident major adverse outcomes than their male counterparts (RR 2.72; 95% CI 1.81-4.08; <i>P</i><0.0001).</p> <p><b>Conclusions:</b> This study suggests that diabetic, but not prediabetic, women have higher RR for prevalent and incident major adverse outcomes than men. </p>

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