Transfusion Reactions in Sickle Cell Disease (SCD) Patients Receiving Multiple Blood Transfusions.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 946-946
Author(s):  
Vishwas S. Sakhalkar ◽  
Diana M. Veillon ◽  
James D. Cotelingam ◽  
Linda M. Hawthorne ◽  
Gloria C. Caldito ◽  
...  
Keyword(s):  
Medical Center ◽  
Blood Type ◽  
P Value ◽  
Transfusion Reaction ◽  
Chi Square ◽  
Exact Test ◽  
Number Of Patients ◽  
Before And After ◽  
Patient Groups ◽  
Transfusion Reactions

Abstract Aim: To study transfusion reactions in our SCD patients before and after instituting the practice of transfusing C, E, K blood type negative (CEKneg) packed red blood cell (pRBC) units. Material and Methods: We retrospectively reviewed blood bank records of all SCD patients transfused pRBCs since 1990. Statistical analysis was performed using the Chi square test and Fischer’s exact test. Results: During 1990–2004, 500 SCD patients received pRBCs in our medical center. Of these, 387 received pRBC units crossmatched only for ABO and Rh blood types and suffered 37 transfusion reactions. Table I: General data of various patient groups Major patient groups Number of patients Median age in yrs # of pRBCs Tx Total (%) Sex (m/f) (range) Total units Median (range) Grand total of all patients 500 240/260 22 (0.7–79) 16617 14 (1–524) CEK (&ABO) matched transfusion patients 113 62/51 8 (0.5–35) 2354 10 (1–143) Regular (only ABORh) matched Tx patients 387 (100) 178/209 26 (0.7–79) 14263 18 (1–524) AlloAB forming patients 121 (31.3) 56/65 29 (5–70) 7338 26 (1–500) Non-alloAB forming pts 266 (68.7) 122/144 25 (0.7–79) 6925 12 (1–524) Table 2: Transfusion reactions in various patient groups Major patient groups Total # of pts Total # of pRBCs Transfusion reactions (% of pts) [Incidence/1000 Tx] Total Febrile Allergic dHTR CEK matched pts 113 2354 0 0 0 0 Regular (ABORh) Tx pts 387 14263 37 (10%)[2.594] 10 23 (6%)[1.61] 4 (1%)[0.28] AlloAB forming pts 121 7338 23 (19%)[3.134] 4 (3%)[0.55] 15 (12%)[2.04] 4 (3%)[0.55] Non-alloAB forming pts 266 6925 14 (5%)[2.0] 6(2%)[0.87] 8 (3%)[1.16] 0 P value (alloAB vs non-alloAB) # of pts 0.25 0.684 0.266 - P value (alloAB vs non-alloAB) # of Tx <0.001 0.809 0.002 - 121 developed alloantibodies (alloABs). 113 patients always received CEKneg pRBCs (from 1997). The technologist required 30 more minutes and $153 extra in reagent costs for this extended CEK match. Most Rh negative pRBC units were also CEKneg. 90% of our donors are Caucasian. Discussion: ’Non-alloAB forming’ patients who received ABORh matched transfusions were 4 times less likely (and twice less likely when number of transfusions was considered) to develop allergic transfusion reaction (p=0.002), compared with ’alloAB forming’ counterparts. Similar finding is seen in patients receiving CEK matched pRBCs. It would be interesting to know if ’slow/rapid/non alloAB producer patients had any genetic predisposition accounting for early/slow/non-development of ABs and transfusion reactions or if alloAB formation transforms the immune system to a hyper-reactive state leading to autoAB formation/allergic reaction. Conclusions: This study showed that utilizing extended antigen (C, E, K) matching for pRBC transfusion ↓↓ alloAB(p<0.01) and autoAB(p=0.005) formation in our SCD patients and eliminated transfusion reactions. Universal availability of leukopoor pRBCs may have eliminated febrile reactions. AlloAB forming patients were more prone to develop allergic transfusion reaction (p=0.002). AutoAB formation was more common in patients with alloABs and did not cause complications. dHTRs were rare and mild. CEK matching made it easier to find and transfuse blood due to less formation of ABs and reactions. However, it resulted in marked overuse of Rh negative pRBCs, extra cost and additional effort to find CEKneg pRBCs for every transfusion.

Clinical and Economic Issues in Multiply Transfused Sickle Cell Disease (SCD) Patients.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1889-1889
Author(s):  
Vishwas S. Sakhalkar ◽  
Diana M. Veillon ◽  
James D. Cotelingam ◽  
Linda M. Hawthorne ◽  
Gloria C. Caldito ◽  
...  
Keyword(s):  
Subsequent Development ◽  
Blood Type ◽  
P Value ◽  
Blood Group Antigens ◽  
Chi Square ◽  
Exact Test ◽  
Number Of Patients ◽  
Before And After ◽  
Patient Groups ◽  
Transfusion Reactions

Abstract Aim: To study alloantibody (alloAB)/autoAB formation and transfusion reactions in SCD patients before and after instituting the practice of transfusing C, E, K blood type negative (CEKneg) packed red blood cell (pRBC) units. Material and Methods: We retrospectively reviewed blood bank records of all SCD patients transfused pRBCs. Statistical analysis was performed using the Chi square test and Fischer’s exact test. Results: During 1990–2004, 500 SCD patients received 16,617 pRBCs in our hospital. 387 received pRBCs crossmatched for ABO and Rh only; 121 (31.3%) developed alloantibodies (alloABs). Table 1: Transfusion characteristics of patients forming alloABs Data on pts forming alloABs CEK matched patients CEK unmatched pRBC Transfusion (Tn) patients (387) ≥ 1 ABs ≥ 2 ABs ≥ 3 ABs ≥ 4 ABs ≥ 5 ABs Number of patients (% of total) 6/113 (5%) 121/387(31%) 57/121 (47%) 29/57 (51%) 16/29 (55%) 11/29 (69%) # of Tn before AB-Median (range) 9.5 (0-106) 7(0-270) 2 (0-106) 0 (0-89) 0 (0-180) 0 (0-16) # of pts with > 5 Tn before AB 4/6 (67%) 68/121(56%) 21/57 (37%) 5/29 (17%) 4/16 (25%) 1/11 (9%) # of pts with >30 Tn before AB 1 12 4 2 1 0 There were 37 transfusion reactions: 9 febrile, 24 allergic and 4 dHTRs, none was life-threatening. 21 pts developed multiple alloABs simultaneously after a single transfusion; 15 additionally developed warm autoABs. >13% patients transfused CEK unmatched units developed ABs to C, E, K and other antigens. Once allosensitized, there was an ↑ chance of subsequent development of multiple alloABs with fewer transfusions. Table 2: Incidence of antibody formation in patient groups Major patient groups Total # of pts Total # of transfusions Number of allo ABs (%of pts) [Incidence/1000 pRBCs] Number of autoABs (%of pts) [Incidence/1000 pRBCs] All Non-CEK Total Warm P value (CEK vs Regular) - # of pts <0.001 0.03 0.005 0.02 CEKmatched 113 2354 6 (5%)[2.55] 5(4%)[2.12] 1 (0.88%)[0.425] 1 (1%)[0.46] Regular (ABORh) 387 14263 240(31%)[16.8] 76 (13%)[5.33] 39 (10%)[2.73] 30 (8%)[2.1] alloAB forming pts 121 7338 240[32.71] 76[10.36] 34 (28%)[4.63] 30 (25%)[4.1] No alloAB pts 266 6925 N/A N/A 5 (2%)[0.7] 0 P value(alloAB vs non-alloAB) - # of pts N/A N/A <0.001 <0.001 Of 266 patients who did not develop any alloABs, 5 had cold and no warm autoABs. 113 patients received 2354 CEKneg pRBCs only (from 1997), 6 (p<0.01) had one alloAB each, 1 warm autoAB and no reactions. Technologists required 30 more minutes and $153 extra in reagent costs for extended CEK match. 90% of our donors are Caucasian. Conclusions: Utilizing CEK negative pRBCs ↓↓ alloAB(p<0.01), autoAB (p<0.001) formation and eliminated transfusion reactions in our multiply transfused SCD patients. Universal availability of leukopoor pRBCs (from 1997) may have eliminated febrile reactions. There was ↓ alloAB formation for C, E, K and other blood group antigens. Though unlikely, Rh neg and CEKneg pRBCs may also be negative for other minor antigens. AutoAB formation (and allergic reactions)especially ↑ in patients with multiple and simultaneous alloAB formation. CEK matching made it easier to find pRBCs due to less formation of alloABs. However, it resulted in marked overuse of Rh neg pRBCs and extra cost and effort to find CEKneg pRBCs for every transfusion. For cost efficacy, one might consider CEKneg pRBCs after first alloAB.

Autoantibody Formation in Sickle Cell Disease Patients Receiving Multiple Blood Transfusions.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3186-3186
Author(s):  
Vishwas S. Sakhalkar ◽  
Diana M. Veillon ◽  
James D. Cotelingam ◽  
Deborah M. McCaskill ◽  
Gloria C. Caldito ◽  
...  
Keyword(s):  
Immune System ◽  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Medical Center ◽  
Blood Type ◽  
P Value ◽  
Cell Disease ◽  
Exact Test ◽  
Patient Groups ◽  
Autoantibody Formation

Abstract Aim: To study autoantibody (autoAB) formation in our sickle cell disease (SCD) patients before and after instituting the practice of transfusing C, E, K blood type negative (CEKneg) packed red blood cell (pRBC) units. Material and Methods: We retrospectively reviewed blood bank records of all SCD patients that were transfused pRBCs since 1990 to date. Statistical analysis was performed using the Chi square test and Fischer’s exact test. Results: During 1990–2004, a total 500 SCD patients (240 male, 260 female) received 16,617 pRBCs in our medical center. Of these, 387 (178m, 209f) received 7338 sickle negative ‘regular’ pRBC units crossmatched only for ABO and Rh blood types. 121 (31.3%, 56m, 65f) patients received 7338 pRBCs and developed alloantibodies (alloABs), and those patients developed 4 cold and 30 warm autoABs. 266 patients (68.7%, m, f; 6925 transfusions) never developed alloABs, but 5 patients developed cold and no warm autoABs. 16 patients developed autoABs (15 warm) simultaneously in addition to the multiple alloABs after a single pRBC transfusion. 113 patients (62m, 51f) always received 2354 CEKneg pRBCs (from 1997), 6 patients (4m, 2f; p&lt;0.01) developed one alloAB each and only 1 warm autoAB.Patients receiving CEK matched pRBCS developed autoABs at 6 times↓frequency. It was found that the technologist required 30 more minutes and $153 extra in reagent costs for this extended CEK match. It was found that most Rh negative pRBC units were also CEKneg. 90% of our donors are Caucasian. The patients who received only ABORh matched transfusions and yet did not develop alloABs, also did not develop any warm autoABs compared to 30 warm autoABs encountered in corresponding patients that developed alloABs (p&lt;0.001). Extended antigen matching (by an additional C,E,K antigen match) ↓ alloAB and autoAB formation. In some patients, allosensitization possibly activates the immune system into a hyperactive state leading to further, earlier, multiple and simultaneous alloAB and autoAB formation. Conclusions: This study showed that utilizing CEK negative pRBCs dramatically ↓ autoAB formation in our SCD patients. Patients that did not develop alloABs also did not develop any warm autoABs (p&lt;0.001). AutoAB formation was more common in patients that developed multiple alloABs simultaneously, but did not result in any significant complications. These patients were also more prone to develop allergic reactions (p&lt;0.002), prompting speculation whether allosensitization possibly activates the immune system into a hyperactive state or if certain patients are gentically more predisposed to allosensitization or both. In our population, extended antigen matching made it easier to transfuse blood units due to less formation of alloABs and autoABs. However, it resulted in a significant overuse of Rh negative pRBCs and extra cost and effort to find CEKneg pRBCs for every transfusion. Table: Incidence of autoantibody formation in patient groups Major patient groups # of pts # of pRBCs Number of autoABs (% of patients)[Incidence/1000 Tx ] Total Warm P value (CEK vs Regular) 0.005 0.02 CEKmatched Tn pts 113 2354 1 (0.88%)[0.425] 1 (1%)[0.46] Regular (ABORh) 387 14263 39 (10%)[2.73] 30 (8%)[2.1] alloAB forming pts 121 7338 34 (28%)[4.63 ] 30 (25%)[4.1] No alloAB forming pts 266 6925 5 (2%)[0.7] 0 P value(alloAB vs non-alloAB) &lt;0.001 &lt;0.001

Alloantibody Formation in Sickle Cell Disease Patients Receiving Multiple Transfusions.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3795-3795
Author(s):  
Vishwas S. Sakhalkar ◽  
Diana M. Veillon ◽  
James D. Cotelingam ◽  
Gloria C. Caldito ◽  
Deborah M. McCaskill ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Blood Type ◽  
Blood Group Antigens ◽  
Adult Males ◽  
Cell Disease ◽  
Chi Square ◽  
Exact Test ◽  
Number Of Patients ◽  
Patient Groups

Abstract Aim: To study allosensitization in our sickle cell disease (SCD) patients before and after instituting the practice of transfusing C, E, K blood type negative (CEKneg) packed red blood cell (pRBC) units. Material and Methods: We retrospectively reviewed blood bank records of all SCD patients that were transfused pRBCs since 1990 to date. Statistical analysis was performed using the Chi square test and Fischer’s exact test. Results: See table 1. Table I: General data of various patient groups Major patient groups Total pt # (%) Sex (m/f) Pt age in yrs, Median (range) Total pRBC units Median Tn #/pt(range) 121 (31.3%, 56m, 65f) developed alloantibodies (alloABs). Grand total of all patients 500 240/260 22 (0.7–79) 16617 14 (1–524) CEK (& ABO) matched tn pts 113 62/51 8 (0.5–35) 2354 10 (1–143) Regular (ABORh) matched Tn pts 387 (100) 178/209 26 (0.7–79) 14263 18 (1–524) AlloAB forming patients 121 (31.3) 56/65 29 (5–70) 7338 26 (1–500) Non-alloAB forming pts 266 (68.7) 122/144 25 (0.7–79) 6925 12 (1–524) Table II: Transfusion characteristics of patients forming alloantibodies Data on pts forming alloantibodies CEK matched patients CEK unmatched pRBC Transfusion (Tn) patients(387) &gt;0 ABs &gt;1 ABs &gt;2 ABs &gt;3 ABs &gt;4 ABs Number of patients 6/113 121/387(31%) 57/121 (47%) 29/57 (51%) 16/29 (55%) 11/29 # of Transfusions before AB formation 9.5 (0–106) 7 (0–270) 2 (0–106) 0 (0–89) 0 (0–180) 0 (0–16) # of pts with &gt; 5 Tn before alloAB formed 4/6(67%) 68/121(56%) 21/57(37%) 5/29(17%) 4/16(25%) 1/11(9%) # of pts with &gt;30 Tn before AB formed 1 12 4 2 1 0 There were 33 patients with anti-C, 74 with anti-E, and 57 with anti-K ABs (a total of 164, incidence of 2.235 CEK alloABs/100 transfusions{Tn}). 266 patients (6925 Tn, 68%) did not develop any alloABs. 21 patients developed multiple alloABs simultaneously after a single transfusion. pRBC Tn was 1½ times more likely to lead to alloAB formation in adult females (p=0.006) and children (p=0.011) over adult males. &gt;13% patients transfused with CEK unmatched units developed ABs to C, E, K and other antigens. 2/3 patients never developed ABs. Once allosensitized, there was an sustained ↑ chance of developing a 2nd (& later) AB (50% Vs 31% for first timers) with fewer Tn (usually &lt;5). A small number of patients developed alloABs later (&gt;30 pRBCs). Patients receiving CEK matched pRBCs developed non-CEK ABs at 2½ times lower frequency than the corresponding group of patients. It was found that the technologist required 30 more minutes and $153 extra in reagent costs for this extended CEK match. Most Rh negative pRBC units were also CEKneg. 90% of our donors are Caucasian. Conclusions: This study showed that utilizing CEK negative pRBCs dramatically ↓ alloAB(p&lt;0.01) formation in our SCD patients, including C, E, and K and other minor blood group antigens. Patients transfused without C, E, K antigen match developed ABs to C, E, K, and other antigens. In some patients, allosensitization possibly activates the immune system into a hyperactive state leading to further, earlier, multiple and simultaneous alloAB and autoAB formation. Though unlikely, Rh negative and CEKneg pRBCs may also be negative for other minor antigens. Extended antigen matching made it easier to find proper blood units due to less formation of alloABs. However, it resulted in overuse of Rh negative pRBCs and effort to find CEKneg pRBCs for every transfusion.

Frequency and outcomes of melanoma subtypes in a diverse population: The Los Angeles County – University of Southern California (LAC-USC) Medical Center experience.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e21063-e21063
Author(s):  
Gino Kim In ◽  
Dongyun Yang ◽  
Jacob Stephen Thomas ◽  
Anthony Pham ◽  
Arnab Basu ◽  
...  
Keyword(s):  
African Americans ◽  
Los Angeles ◽  
Medical Center ◽  
Prior History ◽  
P Value ◽  
Superficial Spreading ◽  
Braf Mutations ◽  
Exact Test ◽  
Number Of Patients ◽  
Melanoma Patients

e21063 Background: Melanoma is a biologically heterogeneous disease that varies by ethnicity and histology. While superficial spreading (SSM) histology is the most common subtype in non-Hispanic whites (NHW), acral lentiginous (ALM) and other subtypes occur more frequently in Hispanics, Asians and African Americans. There are no known risk factors for ALM, and further investigation is warranted. Methods: We retrospectively reviewed a database of melanoma patients diagnosed between 2001-2016 at LAC-USC. Overall survival (OS) was estimated using Kaplan-Meier methodology, and comparisons performed using log-rank testing. Fisher’s exact test was used to evaluate associations between relevant clinicopathological variables. A p-value < 0.05 was considered statistically significant. Results: Among 272 melanoma patients, there were 140 Hispanics (51.5%), 105 NHW (38.6%), 14 Asians, and 4 African Americans. The most frequent histology among Hispanics was ALM (30.7%), while SSM was the most frequent among NHW (33.3%). BRAF V600 mutations were found in 34.5% (10/29) and 58.8% (10/17) of Hispanics and NHW, respectively. A total of 52 patients with ALM were identified, including 43 Hispanics (82.7%). There was a significant association between no prior history of non-melanoma skin cancer (NMSC) and ALM (p < .0001). Median Breslow thickness for ALM was 4.2 mm, and 32.7% were ulcerated. The rate of BRAF V600 mutations among 13 ALM patients tested was 0%. NRAS mutations were found in 3 ALM patients; KIT amplification/mutations were found in 2 ALM patients. Conclusions: We identified a population enriched for Hispanic patients with ALM. We found an association between no prior NMSC and ALM, suggesting that UV exposure is not a causative risk factor. BRAF mutations are less common amongst Hispanics, and nearly absent in ALM. Survival differences were not statistically significant, but cannot be ruled out due to low number of patients in this early study. [Table: see text]

scholarly journals Acceptability, tolerability, and effects on symptoms and signs of vulvovaginitis of a non-soap, herbal-based intimate hygiene solution (Zelesse®)

2019 ◽  
Vol 47 (6) ◽  
pp. 2626-2636 ◽  
Author(s):  
Misericordia Guinot ◽  
Jose Eliseo Blanco ◽  
Juan Luis Delgado ◽  
Raquel Oliva ◽  
Luis Manuel San Frutos ◽  
...  
Keyword(s):  
Symptomatic Relief ◽  
Signs And Symptoms ◽  
Categorical Variables ◽  
Adult Women ◽  
Chi Square ◽  
Exact Test ◽  
Before And After ◽  
Effective Option ◽  
Patient Groups ◽  
Symptoms And Signs

Objective To evaluate the acceptability, tolerability, and effects on vulvovaginitis symptoms and signs of a non-soap, herbal-based intimate solution (Zelesse®). Methods We conducted a prospective, observational, multicenter study including adult women with symptoms and signs of vulvovaginitis with various etiologies, including candidiasis, trichomoniasis, bacterial vaginosis, and atrophic and irritative vaginitis. The presence and intensity of signs (edema, erythema, vaginal discharge) and symptoms (pruritus) of vulvovaginitis were evaluated before and after 5–15 days of daily use of Zelesse® alone or as a coadjuvant in antimicrobial therapy. Variables following a normal distribution and categorical variables were analyzed using the Student t-test and chi-square or Fisher’s exact test, respectively. Results A total 137 women were enrolled in the study; 87 (63.5%) women received concomitant antimicrobials and 50 (36.5%) used Zelesse® only. Global symptom scores and frequency of patients with vulvovaginitis signs and symptoms, and their mean intensity, decreased after treatment in both patient groups. Vaginal pH and (in the Zelesse®-only group) vaginal flora remained unaltered. The product was safe, well tolerated, and highly accepted by patients. Conclusions Zelesse®, the non-soap herbal-based solution in this study, may represent a safe and effective option for symptomatic relief of vulvovaginitis.

Venous Thromboembolism and High Grade Gliomas

1993 ◽  
Vol 70 (03) ◽  
pp. 393-396 ◽  
Author(s):  
Mandeep S Dhami ◽  
Robert D Bona ◽  
John A Calogero ◽  
Richard M Hellman
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
Medical Center ◽  
Significant Risk ◽  
Bleeding Complications ◽  
Fisher Exact Test ◽  
High Grade ◽  
Chi Square ◽  
Exact Test ◽  
High Grade Gliomas

SummaryA retrospective study was done to determine the incidence of and the risk factors predisposing to clinical venous thromboembolism (VTE) in patients treated for high grade gliomas. Medical records of 68 consecutive patients diagnosed and treated at Saint Francis Hospital and Medical Center from January 1986 to June 1991 were reviewed. The follow up was to time of death or at least 6 months (up to December 1991). All clinically suspected episodes of VTE were confirmed by objective tests. Sixteen episodes of VTE were detected in 13 patients for an overall episode rate of 23.5%. Administration of chemotherapy (p = 0.027, two tailed Fisher exact test) and presence of paresis (p = 0.031, two tailed Fisher exact test) were statistically significant risk factors for the development of VTE. Thrombotic events were more likely to occur in the paretic limb and this difference was statistically significant (p = 0.00049, chi square test, with Yates correction). No major bleeding complications were seen in the nine episodes treated with long term anticoagulation.We conclude that venous thromboembolic complications are frequently encountered in patients being treated for high grade gliomas and the presence of paresis and the administration of chemotherapy increases the risk of such complications.

scholarly journals HUBUNGAN METODE PELAKSANAAN EPEEP (EXPLAIN, PAIN, ELIMINATION, ENVIRONMENT AND PLAN OF RETURN) DENGAN KEPUASAN PASIEN DIRUANG RAWAT INAP PANDORIA RUMAH

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Yulianti Wulandari ◽  
Siska Afri Nofita
Keyword(s):  
Patient Satisfaction ◽  
Daily Activity ◽  
Client Satisfaction ◽  
Sampling Technique ◽  
Satisfaction Survey ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Implementation Method

In health service, nurses are at the forefront of providing health care, if the nurses don’t provide the care and not accompanied by EPEEP implementation (Explain, Pain, Elimination, Environment and Plan Of Return) it will have an impact on decreasing client satisfaction. From the results of the preliminary survey the nurses have not done EPEEP implementation method (Explain, Pain, Elimination, Environment and Plan Of Return) properly. And the achievement of patient satisfaction in the pandoria room of Awal Bros Batam Hospital from the results of satisfaction survey in September 2018, very satisfied category was 46%, satisfied category was 54% and less satisfied category was 2%. Therefore , it is necessary to implement EPEEP (Explain, Pain, Elimination, Environment and Plan Of Return) in providing services to clients. This study aimed to determine the Relation between EPEEP Implementation Methods (Explain, Pain, Elimination, Environment and Plan Of Return) With Patient Satisfaction at Pandoria Inpatient Awa Bros Batam in 2019. This type of research was descriptive correlation with cross sectional approach, 129 respondents selected using purposive sampling technique. Data were obtained by observation sheets on nurses about EPEEP implementation (Explain, Pain, Elimination, Environment and Plan Of Return) and provide satisfaction questionnaires to clients. The study was conducted in February until March 2019 in the Pandoria room. Analysis of the data used Chi square. There was a relationship between EPEEP implementation method (Explain, Pain, Elimination, Environment and Plan Of Return) with patient satisfaction and with nurses inpatient at Pandoria Awal Bros Batam Hospital, and the p-value was 0.00 (p <0.05). It can be concluded that the implementation of EPEEP (Explain, Pain, Elimination, Environment and Plan Of Return) can affect client satisfaction. Suggestions for future researchers can conduct research related to how long the nurse responds if there are patients who call or press the bell (Patient Calls) and for the Home Pain as an input to perform research related to nurse daily activity, because Pandoria Room compared to other inpatient rooms was the room with the highest number of patients and the highest mobile patients.

scholarly journals Relationship Between Hand-washing Habit and Toilet Use with Diarrhea Incidence in Children Under Five Years

2017 ◽  
Vol 5 (1) ◽  
pp. 95
Author(s):  
Nikmatur Rohmah ◽  
Fariani Syahrul
Keyword(s):  
Public Health ◽  
Public Health Problem ◽  
Cross Sectional Study ◽  
Hand Washing ◽  
Chi Square ◽  
Cross Sectional ◽  
Exact Test ◽  
Children Under Five ◽  
Under Five ◽  
Before And After

Diarrhea is still a public health problem in the world and the mostly occur in children under five years. At the moment the number of diarrhea-caused mortality was 3.8 per 1000 per year by 3.2 episodes per year in children under five years. This research aims to analyze the association between hand-washing habits and toilet use with the incidence of diarrhea in children under five years. This is an observational analytic with cross sectional study. Population of the research was a children's mother took her children to the public health center of Sekardangan Sidoarjo Subdistrict. The number of samples taken as many as 58 mother of children under five years. Data collection was done with interviews to parents of children and the observations of the toilets. Technique of data analysis using chi-square test or Fisher's exact test. On the results of the research there is a significant association the habit of hand washing (p = 0.006) and toilet use(p = 0.014) with the incidenceof diarrhea in children under five years. Conclusions of the research is the habit of hand washing and toilet use had a significant association with the incidenceof diarrhea in children under five years. Advice that can be given to the mother of a children under five years is to wash the hands before and after defecating and before preparing food for children. Keywords: diarrhea, hand washing, toilet use, observational, children under five years

scholarly journals End-of-Life Decision-Making in Intensive Care Ten Years after a Law on Advance Directives in Germany

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 930
Author(s):  
Jan A. Graw ◽  
Fanny Marsch ◽  
Claudia D. Spies ◽  
Roland C. E. Francis
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
End Of Life ◽  
Advance Directives ◽  
Advance Directive ◽  
Medical Center ◽  
Relevant Information ◽  
Number Of Patients ◽  
Before And After ◽  
Ethical Approval

Background and Objectives: Mortality on Intensive Care Units (ICUs) is high and death frequently occurs after decisions to limit life-sustaining therapies. An advance directive is a tool meant to preserve patient autonomy by guiding anticipated future treatment decisions once decision-making capacity is lost. Since September 2009, advance directives are legally binding for the caregiver team and the patients’ surrogate decision-maker in Germany. The change in frequencies of end-of-life decisions (EOLDs) and completed advance directives among deceased ICU patients ten years after the enactment of a law on advance directives in Germany is unknown. Materials and Methods: Retrospective analysis on all deceased patients of surgical ICUs of a German university medical center from 08/2008 to 09/2009 and from 01/2019 to 09/2019. Frequency of EOLDs and advance directives and the process of EOLDs were compared between patients admitted before and after the change in legislation. (No. of ethical approval EA2/308/20) Results: Significantly more EOLDs occurred in the 2019 cohort compared to the 2009 cohort (85.8% vs. 70.7% of deceased patients, p = 0.006). The number of patients possessing an advance directive to express a living or therapeutic will was higher in the 2019 cohort compared to the 2009 cohort (26.4% vs. 8.9%; difference: 17.5%, p < 0.001). Participation of the patients’ family in the EOLD process (74.7% vs. 60.9%; difference: 13.8%, p = 0.048) and the frequency of documentation of EOLD-relevant information (50.0% vs. 18.7%; difference: 31.3%, p < 0.001) increased from 2009 to 2019. Discussion: During a ten-year period from 2009 to 2019, the frequency of EOLDs and the completion rate of advance directives have increased considerably. In addition, EOLD-associated communication and documentation have further improved.

scholarly journals The Effect of the Covid-19 Free Operation Path Protocol on the Incidence of Lung Complications in Postoperative Elective Patients at dr. Moewardi Hospital Surakarta

2021 ◽  
Vol 5 (11) ◽  
pp. 1030-1036
Author(s):  
Galih Aktama ◽  
Henky Agung Nugroho ◽  
Muhammad David Perdana Putra
Keyword(s):  
Cancer Patients ◽  
Elective Surgery ◽  
Pulmonary Complications ◽  
P Value ◽  
Chi Square ◽  
Elective Surgical Procedures ◽  
Significant Difference ◽  
Before And After ◽  
Chi Square Test ◽  
Elective Patients

The pandemic that began in late 2019, COVID-19, affects all patients, including cancer patients. Patients with cancer that continues to spread and  there is no other effective alternative treatment must undergo surgery so that cancer does not get worse. Given this problem, many health care centers have developed a protocol system in the form of a COVID-19-free surgical route. This study is a retrospective cohort study comparing the incidence of pulmonary complications in patients undergoing elective cancer surgery at dr. Moewardi Surakarta before and during the COVID-19 pandemic. The study sample was adult patients  aged ≥ 18 years which underwent elective surgical procedures with the aim of curative cancer starting before COVID-19 (March 2019-February 2020) until the time the COVID-19 pandemic emerged (March 2020 - February 2021). The data obtained were 768 patients. Of these patients, 384 were classified as having a COVID19-free operation route during the pandemic, and 384 others underwent elective surgery in the pre-pandemic period. Based on the Chi-Square test, a p-value of 0.850 was obtained (P>0.05) which shows that there is significant difference between cases of pulmonary complications in surgical patients before and after the pandemic who were carried out through the COVID-19-free protocol route. In conclusion, there is no significant change in effect of the covid-19 free operation path protocol on the incidence of lung complications in postoperative elective patients at dr. Moewardi Hospital Surakarta, although this patented and mandatory protocol can reduce cancer patients’ morbidity and mortality who undergoing elective surgery during a pandemic.

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