scholarly journals Impact of Prone Position on 12-Lead Electrocardiogram in Healthy Adults: A Comparison Study with Standard Electrocardiogram

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yunis Daralammouri ◽  
Murad Azamtta ◽  
Hamza Hamayel ◽  
Amro Adas ◽  
Osama Sawalmeh ◽  
...  
Keyword(s):  
Heart Rate ◽  
Prone Position ◽  
Management Strategies ◽  
Healthy Adults ◽  
P Wave ◽  
Cross Sectional ◽  
Supine Posture ◽  
The Mean ◽  
The Impact ◽  
Prone Posture

Background. The standard electrocardiogram (ECG) is commonly performed in the supine posture. It may be difficult to report ECG in a supine posture for those who are unable to adopt the supine posture because of certain circumstances such as acute respiratory distress syndrome—patients who are placed in a prone position for long periods to improve oxygenation. Few data are available on the impact of the prone position on the ECG recording with electrodes on the posterior chest. Examining and analyzing the type and extent of changes observed in the prone ECG in healthy adults have become vitally valuable. Methods. A cross-sectional observational study enrolled forty healthy adults (24 males and 16 females) aged between 18 and 40 years. The ECG was performed in two different body positions, supine and prone. Influence of prone position on the heart rate, mean QRS axis, amplitude, morphology, duration, mean T wave axis and polarity, mean P wave axis, PR, and mean QTc duration was evaluated. Results. The mean heart rate was higher in the prone position (73.2 ± 12.4 bpm) compared with the supine position (69.5 ± 11.5 bpm, p = 0.03). The QRS duration decreased considerably from supine (92.8 ± 12.6 ms) to prone (84.9 ± 11.9 ms, p < 0.001 ). The mean QRS axis moved to the left in the prone posture (40.5° ± 32°) relative to the supine (49° ± 28°, p = 0.015 ). The QRS amplitude in the precordial leads was significantly decreased from supine (7.42 ± 3.1 mV) to prone (3.68 ± 1.7 mV, p < 0.001 ). In addition, changes in the QRS morphology in leads V1–V3 with the appearance of new Q waves were noted. A notable variation in the mean corrected QT (QTc) period with decrease in duration in prone posture ECG (385 ± 64.8) relative to supine (406 ± 18.8, p = 0.05 ). Conclusions. Prone position ECG resulted in significant changes in healthy adults that should be aware of this as this can affect diagnosis and management strategies. Further studies are needed to investigate the impact of prone position on ECG recording in patients with cardiovascular diseases.

Heart Rate and Neurological Outcomes in Patients Undergoing Targeted Temperature Management

2020 ◽  
pp. 088506662098250
Author(s):  
Chad M. Conner ◽  
William H. Perucki ◽  
Andre Gabriel ◽  
David M. O’Sullivan ◽  
Antonio B. Fernandez
Keyword(s):  
Heart Rate ◽  
Positive Association ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Neurological Outcomes ◽  
Neurologic Outcomes ◽  
Resuscitation Guidelines ◽  
The Mean ◽  
The Impact ◽  
The Relationship

Introduction: There is a paucity of data evaluating the impact of heart rate (HR) during Targeted Temperature Management (TTM) and neurologic outcomes. Current resuscitation guidelines do not specify a HR goal during TTM. We sought to determine the relationship between HR and neurologic outcomes in a single-center registry dataset. Methods: We retrospectively studied 432 consecutive patients who completed TTM (33°C) after cardiac arrest from 2008 to 2017. We evaluated the relationship between neurologic outcomes and HR during TTM. Pittsburgh Cerebral Performance Categories (CPC) at discharge were used to determine neurological recovery. Statistical analysis included chi square, Student’s t-test and Mann-Whitney U. A logistic regression model was created to evaluate the strength of contribution of selected variables on the outcome of interest. Results: Approximately 94,000 HR data points from 432 patients were retrospectively analyzed; the mean HR was 82.17 bpm over the duration of TTM. Favorable neurological outcomes were seen in 160 (37%) patients. The mean HR in the patients with a favorable outcome was lower than the mean HR of those with an unfavorable outcome (79.98 bpm vs 85.67 bpm p < 0.001). Patients with an average HR of 60-91 bpm were 2.4 times more likely to have a favorable neurological outcome compared to than HR’s < 60 or > 91 (odds ratio [OR] = 2.36, 95% confidence interval [CI] 1.61-3.46, p < 0.001). Specifically, mean HR’s in the 73-82 bpm range had the greatest rate of favorable outcomes (OR 3.56, 95% CI 1.95-6.50), p < 0.001. Administration of epinephrine, a history of diabetes mellitus and hypertension all were associated with worse neurological outcomes independent of HR. Conclusion: During TTM, mean HRs between 60-91 showed a positive association with favorable outcomes. It is unclear whether a specific HR should be targeted during TTM or if heart rates between 60-91 bpm might be a sign of less neurological damage.

scholarly journals Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clare Shakespeare ◽  
Handsome Dube ◽  
Sikhangezile Moyo ◽  
Solwayo Ngwenya
Keyword(s):  
Perinatal Outcomes ◽  
Control Measures ◽  
Central Hospital ◽  
Cross Sectional ◽  
Maternity Services ◽  
Before And After ◽  
The Mean ◽  
Significant Change ◽  
The Impact ◽  
Mpilo Central Hospital

Abstract Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

What Is the Impact of Prior Authorization on the Incidence of Pediatric Tonsillectomy?

2020 ◽  
pp. 019459982096963
Author(s):  
Vanessa F. Torrecillas ◽  
Kaden Neuberger ◽  
Alexander Ramirez ◽  
Paul Krakovitz ◽  
Jeremy D. Meier
Keyword(s):  
Elective Surgery ◽  
Lag Time ◽  
Cross Sectional Study ◽  
Health Claims ◽  
Third Party ◽  
Prior Authorization ◽  
Cross Sectional ◽  
Before And After ◽  
The Mean ◽  
The Impact

Objective Third-party payers advocate for prior authorization (PA) to reduce overutilization of health care resources. The impact of PA in elective surgery is understudied, especially in cases where evidence-based clinical practice guidelines define operative candidacy. The objective of this study is to investigate the impact of PA on the incidence of pediatric tonsillectomy. Study Design Cross-sectional study. Setting Health claims database from a third-party payer. Methods Any pediatric patient who had evaluation for tonsillectomy from 2016 to 2019 was eligible for inclusion. A time series analysis was used to evaluate the change in incidence of tonsillectomy before and after PA. Lag time from consultation to surgery before and after PA was compared with segmented regression. Results A total of 10,047 tonsillectomy claims met inclusion and exclusion criteria. Female patients made up 51% of claims, and the mean age was 7.9 years. Just 1.5% of claims were denied after PA implementation. There was no change in the incidence of tonsillectomy for all plan types ( P = .1). Increased lag time from consultation to surgery was noted immediately after PA implementation by 2.38 days (95% CI, 0.23-4.54; P = .030); otherwise, there was no significant change over time ( P = .98). Conclusion A modest number of tonsillectomy claims were denied approval after implementation of PA. The value of PA for pediatric tonsillectomy is questionable, as it did not result in decreased incidence of tonsillectomy in this cohort.

scholarly journals Management Models in SMEs, Strategic Tool in Business Management

2021 ◽  
Author(s):  
L. R. Fiallos Ortega ◽  
F. F. Esparza Paz ◽  
A. G. Castelo Salazar
Keyword(s):  
Information And Communication Technologies ◽  
Small And Medium Enterprises ◽  
Management Strategies ◽  
Business Management ◽  
Field Investigation ◽  
Corporate Management ◽  
Total Quality ◽  
Cross Sectional ◽  
Management Models ◽  
The Impact

The business sector constitutes an engine for the Ecuadorian economy through the generation of employment and redistribution of wealth. Therefore, given the current economic dynamics of high competition, globalization of markets, and use of information and communication technologies, business managers need to use different tools such as management models to achieve acceptable levels of utility, profitability, customer satisfaction and permanence in the consumer market. This research involved an analysis of the impact on corporate management of applying different management models of Small and Medium Enterprises (SMEs) in the city of Riobamba, province of Chimborazo (Ecuador). The study was descriptive, cross-sectional, exploratory and non-experimental and it was conducted in the first half of 2019. Data were collected through field investigation and the application of a structured survey with a sample composed of 136 managers, owners and administrators, from a population of 440 entrepreneurs. The results showed that 93% of entrepreneurs knew about the existence of management models, and 41% recorded that total quality is the most applied model followed by continuous improvement (18%) and re-engineering (13%). We conclude that entrepreneurs consider management models to be crucial in the management of their company. Keywords: management model, business management, strategies, competitiveness, SMEs. Resumen El sector empresarial en todos sus niveles constituye un motor para la economía ecuatoriana, por la generación de empleo y redistribución de la riqueza; por ello los gerentes de las empresas dada la actual dinámica económica por la alta competencia, globalización de los mercados, uso de las tecnologías de información y comunicación, entre otras variables, necesita utilizar diferentes herramientas como son los modelos gerenciales para lograr niveles aceptables de utilidad, rentabilidad, satisfacción de los clientes y permanencia en el mercado consumidor. La investigación tiene como objetivo efectuar un análisis de la aplicación e incidencia en la gestión corporativa, de diferentes modelos gerenciales de las Pequeñas y Medianas empresas (Pymes) de la ciudad de Riobamba, provincia de Chimborazo (Ecuador). El estudio es descriptivo, transversal, exploratorio y no experimental efectuado en el primer semestre del año 2019, realizado mediante una investigación de campo, a través de la aplicación de una encuesta estructurada, seleccionando una muestra compuesta por 136 gerentes, propietarios y administradores, de una población de 440 empresarios. Los resultados obtenidos evidenciaron que el 93% de los empresarios conocen de la existencia de modelos gerenciales, el 41% registra que la calidad total es el modelo más aplicado seguido del mejoramiento continuo (18%) y Reingeniería (13%). Se concluye que los empresarios y emprendedores consideran a los modelos gerenciales de mucha importancia en la dirección de su empresa. Palabras clave: modelo gerencial, gestión empresarial, estrategias, competitividad, pymes.

scholarly journals The Physiological Effects of IPAD Digital Games on Children with Autism

2017 ◽  
Vol 5 (2) ◽  
Author(s):  
Nur Zakiah Mohd Saat ◽  
Najwa Suhaili Md Zin ◽  
Sazlina Kamaralzaman
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Children With Autism ◽  
Cross Sectional Study ◽  
Breathing Rate ◽  
Blood Pressure Monitor ◽  
Pressure Monitor ◽  
Cross Sectional ◽  
Strategy Games ◽  
The Mean

Background: Previous studies found that the use of an iPad® in intervention programmes benefited the skills of daily living of children with autism. The purpose of the study was to determine the physiological changes in children while playing action and strategy games on an iPad. Methodology: A cross-sectional study was conducted using Powerlab 24/6T, a blood pressure monitor, respiratory belt, and finger pulse transducer. The children were asked to play two types of game. The duration for each game was 10 minutes. The measurement of blood pressure - both systolic and diastolic, heart rate and breathing rate were taken at three consecutive times (before, during and after each game). The inclusion criteria are children aged 7 to 12 years old who have been diagnosed with a mild type of autism (Pervasive developmental disorder). The exclusion criteria were children who had co-morbidities such as epilepsy, migraine, heart, and lung problems, depression, physical disabilities and visual impairments.  Results: Nineteen children with autism participated in this study. The result indicated that the mean systolic and diastolic blood pressures increased before and after playing strategy games and action games. However, compared to pre-play values, the mean heart rate and breathing rate decreased both during and after playing both types of game. Meanwhile, there was significant mean difference for breathing rate for both types of game (p<0.05). Conclusion: Playing strategy and action games did not affect the measured physiological parameters of children with autism. 

The Social and Psychological Impact of Superficial Dermatophytic Infection using Dlqi and Ghq-12: A Cross-Sectional Study in 174 Patients at a Tertiary Care Centre in Southern-East Rajasthan

2021 ◽  
pp. 1-6
Author(s):  
Shivani Saini ◽  
◽  
Agarwal Shail ◽  
Jain Manish ◽  
Yadav Devendra ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Impact ◽  
Cross Sectional Study ◽  
World Population ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Patients ◽  
The Mean ◽  
The Impact

Background: Dermatophytosis is a common fungal infection affecting 20-25% of the world population. Aims: Our study was aimed to assess its impact on health-related quality of life(QoL), mental health, and various variables. Materials and Methods: A cross-sectional study was done from April 2019 to September 2019 on 174 patients of dermatophytosis of aged more than 16 years with their informed consent. The impact of infection on the quality of life was assessed by using the Dermatology life quality index questionnaire and General health questionnaire-12 was used to assess psychological impact. A visual analogue scale was used to assess the severity of pruritus. Appropriate statistical tests were applied. Results: Males to females ratio was 1.4:1. The age group of 21-30 was having the highest number of patients with the mean age of 27.8±9.97. Most patients had BSA under 10%. The mean value of DLQI and GHQ-12 were found 15.989±7.407 and 2.8563±2.8964, respectively. We found that dermatophytosis had a very large effect on the quality of life as the maximum number of patients(39%) were within this category. The “work and school” part in the questionnaire gained maximum importance(52.8%). The mean VAS score was 6±2.733 with most patients(32.7%) had moderate itching. We found a positive correlation between VAS and DLQI, VAS and GHQ-12, DLQI, and GHQ-12 with the statistical significance. Conclusion: In our study dermatophytosis affected the quality of life as well as the psychological health of patients. Therefore proper treatment of superficial dermatophtytosis is essential to prevent it from further complications

Electrocardiographic Predictors of Cognitive Decline and Dementia: A Systematic Review

2021 ◽  
pp. 1-20
Author(s):  
Yume Imahori ◽  
Davide L. Vetrano ◽  
Petter Ljungman ◽  
Chengxuan Qiu
Keyword(s):  
Systematic Review ◽  
Heart Rate ◽  
Cognitive Decline ◽  
Prospective Studies ◽  
Left Ventricular ◽  
Qt Prolongation ◽  
P Wave ◽  
Cross Sectional ◽  
Incident Dementia ◽  
Electrocardiogram Ecg

Background: Markers of altered cardiac function might predict cognitive decline and dementia. Objective: This systematic review aims to review the literature that examines the associations of various electrocardiogram (ECG) markers with cognitive decline and dementia in middle-aged and elderly populations. Methods: We searched PubMed, Embase, and Web of Science through 1 July 2020 for literature and conducted a systematic literature review. We included studies examining the associations of ECG markers (e.g., left ventricular hypertrophy [LVH], spatial QRS-T angle, and QT prolongation) with cognitive function and dementia in adult populations regardless of study setting and design, but excluded studies examining atrial fibrillation and heart rate variability. Results: Fourteen community-based cross-sectional and longitudinal studies were identified. ECG markers were investigated in association with dementia in four prospective studies, and with cognitive decline in ten prospective studies. ECG-assessed LVH was associated with dementia in one study while five heterogeneous prospective studies yielded inconsistent associations with cognitive decline. Regarding ventricular repolarization markers, spatial QRS-T angle was associated with cognitive decline in one study while another study found no association between QT prolongation and cognitive decline. High resting heart rate was associated with both dementia and cognitive decline in one study but not associated with dementia in another study. P-wave abnormality was significantly associated with incident dementia and cognitive decline in one prospective study. Conclusion: Some ECG markers were associated with incident dementia and cognitive decline. However, limited number of heterogeneous studies did not allow us to make firm conclusions. Further studies are needed.

scholarly journals Family size and marital age

2019 ◽  
Vol 25 (5-6) ◽  
pp. 107-11
Author(s):  
Helena Siregar ◽  
Azwin Lubis ◽  
M. Arif Nasution ◽  
Indra Kesuma Nasution ◽  
Thamrin Tanjung
Keyword(s):  
Family Planning ◽  
Family Size ◽  
Occupational Status ◽  
Married Couples ◽  
Simple Random Sampling ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
The Mean ◽  
Age Of Marriage ◽  
The Impact

A cross sectional study about the relationships between family size and marital age and the impact of educatimt, occupation and family planning programme was conducted in the region of South Tapanuli North Sumatera. The study was performed on 246 married couples by simple random sampling of households in the villages Pakantea, Tamiang, Muarasoro and Sumuran, during the period of September 25 up to October 3, 1982. The eariiest age of marriage for women was 14 years, ancl the latest 20 years. Most of the women (68%) married at 15-20 year. The main education of responders were primary school (67%). The occupational status was mostly (90%) farmer. The mean family size under 20 years old was 6.3 and over 20 years, 5.3. Fertility rate under 20 years was still high. Family Planning was not yet widely accepted in this area.

Disturbed Appetite Patterns and Nutrient Intake in Peritoneal Dialysis Patients

2003 ◽  
Vol 23 (6) ◽  
pp. 550-556 ◽  
Author(s):  
Mark Wright ◽  
Graham Woodrow ◽  
Siobahn O'Brien ◽  
Neil King ◽  
Louise Dye ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Food Intake ◽  
Nutrient Intake ◽  
Cross Sectional ◽  
Dialysis Unit ◽  
Diurnal Variability ◽  
Patient Reported ◽  
Dietary Records ◽  
The Mean ◽  
The Impact

Objective Malnutrition is common among peritoneal dialysis (PD) patients. Reduced nutrient intake contributes to this. It has long been assumed that this reflects disturbed appetite. We set out to define the appetite profiles of a group of PD patients using a novel technique. Design Prospective, cross-sectional comparison of PD patients versus controls. Setting Teaching hospital dialysis unit. Patients 39 PD patients and 42 healthy controls. Intervention Visual analog ratings were recorded at hourly intervals to generate daily profiles for hunger and fullness. Summary statistics were generated to compare the groups. Food intake was measured using 3-day dietary records. Main Outcome Measures Hunger and fullness profiles. Derived hunger and fullness scores. Results Controls demonstrated peaks of hunger before mealtimes, with fullness scores peaking after meals. The PD profiles had much reduced premeal hunger peaks. A postmeal reduction in hunger was evident, but the rest of the trace was flat. The PD fullness profile was also flatter than in the controls. Mean scores were similar despite the marked discrepancy in the profiles. The PD group had lower peak hunger and less diurnal variability in their hunger scores. They also demonstrated much less change in fullness rating around mealtimes, while the mean and peak fullness scores were little different. The reported nutrient intake was significantly lower for PD. Conclusion The data suggest that PD patients normalize their mean appetite perception at a lower level of nutrient intake than controls, suggesting that patient-reported appetite may be misleading in clinical practice. There is a loss of the usual daily variation for the PD group, which may contribute to their reduced food intake. The technique described here could be used to assess the impact of interventions upon the abnormal PD appetite profile.

scholarly journals The impact of stroke on people living in central Uganda: A descriptive study

2018 ◽  
Vol 7 ◽  
Author(s):  
Julius T. Kamwesiga ◽  
Lena K. Von Kock ◽  
Gunilla M. Eriksson ◽  
Susanne G.E. Guidetti
Keyword(s):  
Everyday Life ◽  
Urban Areas ◽  
Clinical Characteristics ◽  
Hand Function ◽  
Chronic Phase ◽  
Mulago Hospital ◽  
Stroke Severity ◽  
Cross Sectional ◽  
The Mean ◽  
The Impact

Background: Knowledge about perceived impact of stroke on everyday life as well as rehabilitation needs after stroke in Uganda is necessary to identify and develop rehabilitation interventions.Objectives: To explore and describe clinical characteristics and functioning during the acute or subacute phase and chronic phase, as well as the impact of stroke on everyday life during the chronic phase in stroke survivors in central Uganda.Method: A cross-sectional observational study was conducted on a consecutively included acute or subacute (n = 58) sample and a chronic (n = 62) sample. Face-to-face interviews were conducted to collect demographic information and clinical characteristics. The Scandinavian Stroke Scale (SSS) was used to collect clinical characteristics, assess neurological impairment and define stroke severity. The Barthel Index was used to assess the level of dependence in activities of daily living. In addition, the Stroke Impact Scale (SIS) 3.0 Uganda version was used to assess the impact of stroke in everyday life as perceived by the individuals in the chronic sample receiving rehabilitation.Results: The mean age of the acute/subacute sample was 49 years and 81% had moderate or severe stroke. The mean age of the chronic rehabilitation group was 53 years and 58% had mild stroke. Time since onset in the acute sample was between 2 days and 3 weeks, and time since onset for the chronic sample varied between 3 months and 3 years. Strength, hand function and participation were the most impacted SIS domains in the chronic sample.Conclusion: People with severe and moderate stroke were more likely to be admitted to Mulago Hospital. The mean age in the study sample was lower than that in high-income countries. Further knowledge is needed regarding the impact of stroke to develop guidelines for stroke rehabilitation interventions feasible in the Ugandan healthcare context in both rural and urban areas.

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