scholarly journals Termination of wanted pregnancy and suicidal ideation in hyperemesis gravidarum: A mixed methods study

2021 ◽  
pp. 1753495X2110409
Author(s):  
Melanie Nana ◽  
Florence Tydeman ◽  
Georgie Bevan ◽  
Harriet Boulding ◽  
Kimberley Kavanagh ◽  
...  

Background Difficulty accessing medication and poor patient experience have been implicated as risk factors for termination of pregnancy and suicidal ideation in women with hyperemesis gravidarum. We aimed to gain further insight into these factors in order to further inform and improve patient care. Methods We performed a sub-analysis on quantitative data generated through a UK-wide survey of 5071 participants. A qualitative analysis of free text comments was performed using an inductive thematic approach. Results 41.2% % of women taking prescribed medications had to actively request them. ‘Extremely poor’ or ‘poor’ experiences were described in 39.4% and 30.0% of participants in primary and secondary care respectively. Protective factors for termination of pregnancy and suicidal ideation include holistic support from family, friends and healthcare providers. Conclusion Optimal care in hyperemesis gravidarum should incorporate timely access to pharmacotherapy, assessment of mental health, consideration of referral to specialist services and care being delivered in a compassionate manner.

2017 ◽  
Vol 23 (1) ◽  
pp. 104-122 ◽  
Author(s):  
Guillermina Noël ◽  
Janet Joy ◽  
Carmen Dyck

Improving the quality of patient care, generally referred to as Quality Improvement (QI), is a constant mission of healthcare. Although QI initiatives take many forms, these typically involve collecting data to measure whether changes to procedures have been made as planned, and whether those changes have achieved the expected outcomes. In principle, such data are used to measure the success of a QI initiative and make further changes if needed. In practice, however, many QI data reports provide only limited insight into changes that could improve patient care. Redesigning standard approaches to QI data can help close the gap between current norms and the potential of QI data to improve patient care. This paper describes our study of QI data needs among healthcare providers and managers at Vancouver Coastal Health, a regional health system in Canada. We present an overview of challenges faced by healthcare providers around QI data collection and visualization, and illustrate the advantages and disadvantages of different visualizations. At present, user– centred and evidence–based design is practically unknown in healthcare QI, and thus offers an important new contribution.


2021 ◽  
Vol 9 ◽  
Author(s):  
Elham Hatef ◽  
Gurmehar Singh Deol ◽  
Masoud Rouhizadeh ◽  
Ashley Li ◽  
Katyusha Eibensteiner ◽  
...  

Introduction: Despite the growing efforts to standardize coding for social determinants of health (SDOH), they are infrequently captured in electronic health records (EHRs). Most SDOH variables are still captured in the unstructured fields (i.e., free-text) of EHRs. In this study we attempt to evaluate a practical text mining approach (i.e., advanced pattern matching techniques) in identifying phrases referring to housing issues, an important SDOH domain affecting value-based healthcare providers, using EHR of a large multispecialty medical group in the New England region, United States. To present how this approach would help the health systems to address the SDOH challenges of their patients we assess the demographic and clinical characteristics of patients with and without housing issues and briefly look into the patterns of healthcare utilization among the study population and for those with and without housing challenges.Methods: We identified five categories of housing issues [i.e., homelessness current (HC), homelessness history (HH), homelessness addressed (HA), housing instability (HI), and building quality (BQ)] and developed several phrases addressing each one through collaboration with SDOH experts, consulting the literature, and reviewing existing coding standards. We developed pattern-matching algorithms (i.e., advanced regular expressions), and then applied them in the selected EHR. We assessed the text mining approach for recall (sensitivity) and precision (positive predictive value) after comparing the identified phrases with manually annotated free-text for different housing issues.Results: The study dataset included EHR structured data for a total of 20,342 patients and 2,564,344 free-text clinical notes. The mean (SD) age in the study population was 75.96 (7.51). Additionally, 58.78% of the cohort were female. BQ and HI were the most frequent housing issues documented in EHR free-text notes and HH was the least frequent one. The regular expression methodology, when compared to manual annotation, had a high level of precision (positive predictive value) at phrase, note, and patient levels (96.36, 95.00, and 94.44%, respectively) across different categories of housing issues, but the recall (sensitivity) rate was relatively low (30.11, 32.20, and 41.46%, respectively).Conclusion: Results of this study can be used to advance the research in this domain, to assess the potential value of EHR's free-text in identifying patients with a high risk of housing issues, to improve patient care and outcomes, and to eventually mitigate socioeconomic disparities across individuals and communities.


2021 ◽  
pp. 186-193
Author(s):  
Meda Venkatasubbaiah ◽  
P Dwarakanadha Reddy ◽  
Suggala V Satyanarayana

Introduction: Lack of awareness about pharmacovigilance (PV) is one of the most important causes of under-reporting, which is widespread and poses a daunting challenge in India. The aim of this study is to assess and to document the knowledge, attitude, and practices (KAP) of Doctor of Pharmacy (Pharm.D) interns who practicing in hospitals with regards to PV and adverse drug reaction (ADR) reporting and to identify the causes of under reporting. Methods: This cross-sectional descriptive study was conducted for a period of six months across ten hospitals in Andhra Pradesh, India. Results: Overall, 578 responses were analysed, 78% of the participants had good knowledge on reporting ADR, 82% were aware that patient will be benefited from the ADR reporting, and the majority of the participants had a positive attitude towards reporting ADR. Fifty-nine percentage of the participants had reported the ADRs through different ADR reporting procedures, 52% were advised the awareness programmes for improving the reporting culture, and 34% had the difficulty in deciding or diagnosing the ADR. Conclusion: The KAP of the Pharm.D interns is appreciable and may reduce the burden on the other healthcare providers and improve patient care.


Author(s):  
Masara Laginaf ◽  
Harry Costello ◽  
Gary Price

Abstract Background/aims Functional visual symptoms are relatively common symptoms seen by ophthalmologists. However, there are no consensus guidelines on ophthalmological management of this condition, and there is a paucity of knowledge about the collective challenges experienced in treating patients with functional visual symptoms. In order to establish an ophthalmological perspective on this condition, we undertook the first national survey of experience, knowledge and management of functional visual symptoms amongst ophthalmologists. Methods An online survey was disseminated to ophthalmologists in the UK via all Royal College of Ophthalmology college tutors. Results One hundred nineteen ophthalmologists completed the survey. Functional visual symptoms accounted for 3% of all new referrals. Forty per cent of respondents felt they had a good understanding of functional visual symptoms. Two-thirds reported a need for further training in this area. Respondents estimated two-thirds of patients’ symptoms improved, but a third experienced severe or extreme disability. Following diagnosis, a minority of patients were referred to mental health or neurology services. The majority of respondents described difficulty discussing psychological factors, with a lack of time or space in a clinic preventing a holistic approach. Free text comments highlighted a lack of access to dedicated psychological support for patients. Conclusion Functional visual symptoms are disabling and are seen relatively frequently by ophthalmologists. This preliminary survey suggests that care pathways for patients with functional visual symptoms could be optimised. Fostering links between ophthalmology and existing services with expertise in functional disorders could improve patient care and clinician education and ultimately encourage research in this area.


Author(s):  
Victoria López ◽  
Diego Urgelés ◽  
Óscar Sánchez ◽  
Gabriel Valverde

Healthcare providers and payers are increasingly turning to Big Data and analytics, to help them understand their patients and the context of their illnesses in more detail. Industry leaders are exploring/using Big Data to reduce costs, increase efficiency and improve patient care. The next future is an innovative approach to improving patient access using lean methods and predictive analytics. Social sciences are very much related to healthcare and both areas develop in a parallel way. In this article, we introduce one example of application: Bip4cast (a bipolar disorder CAD system). This paper shows how Bip4cast deals with different data sources to enrich the knowledge and improve predictive analysis.


2015 ◽  
Vol 8s1 ◽  
pp. NMI.S29523 ◽  
Author(s):  
Iris J. Grooten ◽  
Tessa J. Roseboom ◽  
Rebecca C. Painter

Nausea and occasional vomiting in early pregnancy (NVP) are common. When vomiting is severe or protracted, it is referred to as hyperemesis gravidarum (HG). HG affects up to 3% of pregnancies and is characterized by weight loss, dehydration, electrolyte imbalance, and the need for hospital admission. HG has significant consequences for maternal well-being, is associated with adverse birth outcomes, and leads to major health care costs. Treatment options are symptomatic, hampered by the lack of evidence-based options including studies on nutritional interventions. One of the reasons for this lack of evidence is the use of a broad range of definitions and outcome measures. An internationally accepted definition and the formulation of core outcomes would facilitate meta-analysis of trial results and implementation of evidence in guidelines to ultimately improve patient care.


2017 ◽  
Vol 4 (2) ◽  
pp. 637 ◽  
Author(s):  
Sanjay Marwah ◽  
Priyanka Singla ◽  
Mahavir Singh ◽  
Himanshu Sharma

Background: Unforeseen re-admissions are a consequence of natural course of patient’s disease or results from sub-optimal care during first admission. Apart from causing increased expenditure, readmission immensely adds to the distress of the patient as well as his relatives. The aim of the study was to assess the incidence and risk factors for 30-day unplanned readmission following emergency laparotomy for perforation peritonitis.Methods: This prospective observational study was conducted on 145 patients undergoing laparotomy for perforation peritonitis in over a period of two years. Various pre-operative, intra-operative and post-operative parameters were studied to identify the risk factors for readmission.Results: Overall readmission rate was 8.96% and in majority of the cases it was due to post-surgical complications. Various factors found significant for readmission were American Society of Anaesthesiology (ASA) grade (p = 0.014) hypoproteinemia (p<0.001), diabetes mellitus (p = 0.001), immuno compromised status (p<0.001), stoma creation (p<0.001), blood transfusion (p = 0.022), renal complications and UTI (p = 0.027 each). On multivariate analysis, hypoproteinemia and stoma creation were found to be significant.Conclusions: Risk factors for readmission among surgical patients are multi-factorial. Taking appropriate steps can reduce the burden of readmission. Moreover decreasing the rate of surgical readmission represents an opportunity to improve patient care.


Web Services ◽  
2019 ◽  
pp. 842-858
Author(s):  
Victoria López ◽  
Diego Urgelés ◽  
Óscar Sánchez ◽  
Gabriel Valverde

Healthcare providers and payers are increasingly turning to Big Data and analytics, to help them understand their patients and the context of their illnesses in more detail. Industry leaders are exploring/using Big Data to reduce costs, increase efficiency and improve patient care. The next future is an innovative approach to improving patient access using lean methods and predictive analytics. Social sciences are very much related to healthcare and both areas develop in a parallel way. In this article, we introduce one example of application: Bip4cast (a bipolar disorder CAD system). This paper shows how Bip4cast deals with different data sources to enrich the knowledge and improve predictive analysis.


2016 ◽  
Vol 23 (11) ◽  
pp. 1298-1304
Author(s):  
Huma Ali ◽  
Farya Zafar ◽  
Hina Hasnain ◽  
Sana Ahmed ◽  
Neelam Mallick ◽  
...  

The solution for safe and rational medication use to improve patient care aswell as to enhance public health status is Pharmacovigilance (PV). Optimal care of patientand appropriate medication utilization in secure way with respect to various conditions is animperative function of pharmacovigilance system. PV mainly involves in the adverse drugreactions (ADRs) identification, system of reporting, scrutinizes the effectiveness of treatment,reduces the adverse consequences to utmost level and guarantees the patient wellbeing.The safety of drug is highly essential factor when it comes from the healthcare provider to thepatient. For a drug to be successful in market, it is crucial for it to be efficacious as well as safeand secure for the patients. Hence, adherence toward pharmacovigilance activities and systemis now based on a paradigm change from care to safety.


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