scholarly journals Wireless versus routine physiologic monitoring after cesarean delivery to reduce maternal morbidity and mortality in a resource-limited setting: protocol of type 2 hybrid effectiveness-implementation study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adeline A. Boatin ◽  
Joseph Ngonzi ◽  
Blair J. Wylie ◽  
Henry M. Lugobe ◽  
Lisa M. Bebell ◽  
...  
Keyword(s):  
Cesarean Delivery ◽  
Monitoring System ◽  
Morbidity And Mortality ◽  
World Health ◽  
Physiologic Monitoring ◽  
Implementation Study ◽  
Wireless Monitoring ◽  
Link Type ◽  
Physiologic Data

Abstract Background Women in sub-Saharan Africa have the highest rates of morbidity and mortality during childbirth globally. Despite increases in facility-based childbirth, gaps in quality of care at facilities have limited reductions in maternal deaths. Infrequent physiologic monitoring of women around childbirth is a major gap in care that leads to delays in life-saving interventions for women experiencing complications. Methods We will conduct a type-2 hybrid effectiveness-implementation study over 12 months to evaluate using a wireless physiologic monitoring system to detect and alert clinicians of abnormal vital signs in women for 24 h after undergoing emergency cesarean delivery at a tertiary care facility in Uganda. We will provide physiologic data (heart rate, respiratory rate, temperature and blood pressure) to clinicians via a smartphone-based application with alert notifications if monitored women develop predefined abnormalities in monitored physiologic signs. We will alternate two-week intervention and control time periods where women and clinicians use the wireless monitoring system during intervention periods and current standard of care (i.e., manual vital sign measurement when clinically indicated) during control periods. Our primary outcome for effectiveness is a composite of severe maternal outcomes per World Health Organization criteria (e.g. death, cardiac arrest, jaundice, shock, prolonged unconsciousness, paralysis, hysterectomy). Secondary outcomes include maternal mortality rate, and case fatality rates for postpartum hemorrhage, hypertensive disorders, and sepsis. We will use the RE-AIM implementation framework to measure implementation metrics of the wireless physiologic system including Reach (proportion of eligible women monitored, length of time women monitored), Efficacy (proportion of women with monitoring according to Uganda Ministry of Health guidelines, number of appropriate alerts sent), Adoption (proportion of clinicians utilizing physiologic data per shift, clinical actions in response to alerts), Implementation (fidelity to monitoring protocol), Maintenance (sustainability of implementation over time). We will also perform in-depth qualitative interviews with up to 30 women and 30 clinicians participating in the study. Discussion This is the first hybrid-effectiveness study of wireless physiologic monitoring in an obstetric population. This study offers insights into use of wireless monitoring systems in low resource-settings, as well as normal and abnormal physiologic parameters among women delivering by cesarean. Trial registration ClinicalTrials.gov, NCT04060667. Registered on 08/01/2019.

Perancangan Sistem Informasi “DIAMONS” (Diabetes Monitoring System) Berbasis Internet of Things (IoT)

2019 ◽  
Vol 6 (1) ◽  
pp. 39-51
Author(s):  
Endang Sri Rahayu ◽  
Nurul Amalia
Keyword(s):  
Internet Of Things ◽  
World Health Organization ◽  
Real Time ◽  
Monitoring System ◽  
World Health ◽  
Health Organization ◽  
Diabetes Monitoring

Diabetes merupakan penyakit “silent killer” yang ditandai dengan peningkatan kadar glukosa darahdan kegagalan sekresi insulin. World Health Organization (WHO) pada tahun 2016 menyatakanbahwa diabetes menduduki urutan ke-6 sebagai penyakit mematikan di Indonesia. Sehingga upayapencegahan dan penanganan diabetes perlu mendapat perhatian yang serius. Internet of Things (IoT)dapat dijadikan sarana penunjang dalam penanganan penyakit diabetes. Inovasi ini memungkinkanperangkat perawatan kesehatan terhubung dengan jaringan internet, sehingga data pasien dapatdiperbaharui dan diakses secara real-time. Selain mempermudah akses, penggunaan IoT juga akanmemberikan nilai tambah pada efisiensi biaya pelayanan kesehatan. Penelitian ini bertujuan untukmerancang software sistem monitoring gula darah berbasis web yang terintegrasi dengan IoT,sehingga pasien dapat melakukan pemeriksaan, konsultasi dengan dokter dan melihat data rekammedis dari jarak jauh. Data hasil pemeriksaan akan disimpan didalam cloud dan ditampilkan secaraonline. Penelitian ini menggunakan Node MCU ESP8266 sebagai mikrokontroller yang telahdilengkapi dengan modul WiFi, Thingspeak sebagai cloud, aplikasi online dengan “Diamons” sebagaidashboard yang mampu menampilkan presentasi data grafis, dibangun dengan bahasa HypertextPreprocessor (PHP) sebagai bahasa pemogramannya. Penelitian ini akan melibatkan pihak medisdalam pengambilan keputusan. Umpan balik yang diberikan kepada pasien berupa anjuran sepertiresep obat, pola makan, dan kegiatan fisik yang harus dilakukan oleh pasien.

Type 1 Diabetes Mellitus - Risk Factor for Cardiovascular Disease Morbidity and Mortality

2020 ◽  
Vol 17 (1) ◽  
pp. 37-54
Author(s):  
Tatyana Chalakova ◽  
Yoto Yotov ◽  
Kaloyan Tzotchev ◽  
Sonya Galcheva ◽  
Boyan Balev ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Diabetic Control ◽  
Macrovascular Complications ◽  
Morbidity And Mortality ◽  
Diabetes Mellitus Risk

: Type 1 diabetes mellitus (T1DM) is a chronic disease that starts early in life and often leads to micro- and macrovascular complications. The incidence of the disease is lower than that of type 2 DM and varies in different countries and ethnic groups, and the etiological and pathogenetic factors are different from T2DM. The aim of this overview is to investigate the effect of T1DM on all-cause mortality and CVD morbidity and mortality. During the last decades, the treatment of T1DM has improved the prognosis of the patients. Still, the mortality rates are higher than those of the age- and sex-matched general population. With the prolonged survival, the macrovascular complications and cardiovascular diseases (CVD) appear as major health problems in the management of patients with T1DM. The studies on the CVD morbidity and mortality in this disease group are sparse, but they reveal that T1DM is associated with at least 30% higher mortality. In comparison to healthy people, CVDs are more common in T1DM patients and they occur earlier in life. : Furthermore, they are a major cause for death and impaired quality of life in T1DM patients. The correlation between diabetic control and the duration of T1DM is not always present or is insignificant. Nevertheless, the early detection of the preclinical stages of the diseases and the risk factors for their development is important; similarly, the efforts to improve glycemic and metabolic control are of paramount importance.

scholarly journals The impact of nationwide lockdown on acute coronary syndromes hospitalization rate in the Western Macedonia regional hospital of Greece

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
I Kanellos ◽  
V Vasilakopoulos ◽  
S Daios ◽  
S Lampropoulos ◽  
M Petridou ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Hospitalization Rate ◽  
Regional Hospital ◽  
Morbidity And Mortality ◽  
World Health ◽  
Cardiology Department ◽  
Number Of Patients ◽  
Significant Difference ◽  
Coronary Syndromes ◽  
Pandemic Wave

Abstract Funding Acknowledgements Type of funding sources: None. Introduction  World Health Organization declared the Covid-19 outbreak a global pandemic on March 11, 2020. The pandemic is associated with more than 75 million cases and more than 1.5 million deaths worldwide. Greece implemented a nationwide lockdown on March 23, 2020, to control the pandemic wave and prevent reducing morbidity and mortality due to Covid-19. During this period, acute coronary syndromes (ACS) hospitalization in the cardiology department was reduced. In addition, the second pandemic wave also led to a new national lockdown on November 7, 2020, although it was implemented 15 days earlier in the relative regional hospital area due to high viral load. Purpose  Our study evaluated the number of hospitalized patients with ACS during the nationwide lockdown period, comparing them with the previous years (period 2018 and 2019). Material and Methods  Data recordings regarding ACS (unstable angina, NSTEMI, STEMI) hospitalization rates in the Cardiology department were collected from the hospital"s register. Each year"s data analysis interval included the periods of the nationwide lockdown of 2020; March 23 to May 3 and October 14 to December 10. Statistical analysis was performed between periodic groups using the chi-square test (IBM SPSS Statistics software, version 23.0). Results  During 2018, the number of patients hospitalized for ACS was 81 and consisted of 39,1% of the total hospitalizations in the Cardiology Department. In 2019 the number of patients hospitalized for ACS was 62 and consisted the 48,8% of the total hospitalizations, while in 2020, the number of patients hospitalized for ACS was 30 and consisted the 27,5% of the total hospitalizations. Furthermore, there was a statistically significant difference (p < 0,05) regarding ACS event hospitalization rate between the period of lockdown (March to May and October-December 2020) and the COVID-19-free period of the previous year (March to May and October to December 2019). There was no statistically significant difference (p > 0,05) regarding ACS event hospitalization rate between the period of lockdown (March to May and October to December 2020) and the COVID-19-free period of the year 2018 (March to May and October to December). Finally, there was no statistically significant difference (p > 0,05) in ACS event hospitalization rate between March to May and October to December regarding the years 2018 and 2019. Conclusion  Our results are in compliance with the ESC"s comparative survey regarding the observed worldwide reduction of hospitalizations for ACS during the COVID-19 lockdown era, suggesting a potential impact of lockdown in both non-environmental and environmental risk factors for cardiovascular disease. Factors of the relative epidemiological reduction are complexed and puzzled, while morbidity and mortality of ACS remained relatively stable even after the lockdown, so future studies are necessary to further investigate them.

scholarly journals Bilateral posterior Quadratus Lumborum block for pain relief after cesarean delivery: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Pawinee Pangthipampai ◽  
Sukanya Dejarkom ◽  
Suppachai Poolsuppasit ◽  
Choopong Luansritisakul ◽  
Suwida Tangchittam
Keyword(s):  
Side Effects ◽  
Cesarean Delivery ◽  
Pain Control ◽  
Spinal Block ◽  
Side Group ◽  
Link Type ◽  
Quadratus Lumborum Block ◽  
Analgesic Regimen ◽  
Quadratus Lumborum ◽  
Median Pain

Abstract Background Achieving optimal analgesia with few side effects is the goal of pain management after cesarean delivery. Intrathecal (IT) morphine is the current standard but ultrasound-guided quadratus lumborum block (QLB) may offer superior pain control with fewer side effects. This study compared the pain-free period after cesarean delivery among parturients who received spinal block with IT morphine, with IT morphine and bilateral QLB, or only bilateral QLB. Methods Parturients having elective cesarean delivery under spinal block were randomized and allocated into IT morphine 0.2 mg with sham QLB (Group IT), IT morphine 0.2 mg and bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group IT+QLB), or bilateral QLB with 0.25% bupivacaine 25 ml in each side (Group QLB). A PCA pump was connected after completion of the QLB or sham block. The first time to PCA morphine requirement was recorded and compared. Results Eighty parturients were included. Analysis of Group QLB was terminated early because at the second interim analysis, median pain-free period was significantly shorter in Group QLB [hours (95%CI): 2.50 (1.04–3.96) in Group IT vs. 7.75 (5.67–9.83) in IT+QLB vs. 1.75 (0.75–2.75) in QLB (p < 0.001)]. The median (min, max) amount of morphine required during 24 h was 5.5 (0–25) in Group IT vs. 5.0 (0–36) in IT+QLB vs. 17.5 (1–40) mg in Group QLB (p < 0.001). In the final analysis the median pain-free period was 2.50 (1.23–3.77) hours (95%CI) in Group IT (n = 27) vs. 8.02 (5.96–10.07) in IT+QLB (n = 28). (p = 0.027). Conclusion US-QLB used in conjunction with IT morphine yielded a statistically significant longer median pain-free period compared with standard IT morphine alone. However, QLB alone provided inferior pain control compared with standard IT morphine. When combined with IT morphine, QLB could provide additional analgesic benefit as a part of multimodal analgesic regimen, especially during the early postoperative period. Trial registration ClinicalTrials.gov no. NCT03199170 Date registered on June 22, 2017. Prospectively registered.

scholarly journals The transverse diameter of right common femoral vein by ultrasound in the supine position for predicting post-spinal hypotension during cesarean delivery

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shi-Fa Yao ◽  
Yan-Hong Zhao ◽  
Jing Zheng ◽  
Jie-Yan Qian ◽  
Chen Zhang ◽  
...  
Keyword(s):  
Spinal Anesthesia ◽  
Cesarean Delivery ◽  
Femoral Vein ◽  
Elective Cesarean Section ◽  
Gravid Uterus ◽  
Transverse Diameter ◽  
Common Femoral Vein ◽  
Link Type ◽  
Spinal Hypotension ◽  
Receiver Operating

Abstract Background Post-spinal anesthesia hypotension during cesarean delivery is caused by decreased systemic vascular resistance due to the blockage of the autonomic nerves, which is further worsened by inferior vena cava (IVC) compression by the gravid uterus. This study aimed to assess whether peak velocity and diameter of the IVC below the xiphoid or right common femoral vein (RCFV) in the inguinal region, as measured on ultrasound, could reflect the degree of IVC compression and further identify parturients at risk of post-spinal hypotension. Methods Fifty-six parturients who underwent elective cesarean section with spinal anesthesia were included in this study; peak velocities and anteroposterior diameters of the IVC and peak velocities and transverse diameters of the RCFV were measured using ultrasound before anesthesia. The primary outcome was the ultrasound measurements of IVC and RCFV acquired before spinal anesthesia and their association with post-spinal hypotension. Hypotension was defined as a drop in systolic arterial pressure by > 20% from the baseline. Multinomial logistic regression analysis was used to identify the association between the measurements of IVC, RCFV, and post-spinal hypotension during cesarean delivery. Receiver operating characteristic curves were used to test the abilities of the identified parameters to predict post-spinal hypotension; the areas under the curve and optimum cut-off values for the predictive parameters were calculated. Results A longer transverse diameter of the RCFV was associated with the occurrence of post-spinal hypotension (odds ratio = 2.022, 95% confidence interval [CI] 1.261–3.243). The area under the receiver operating characteristics curve for the prediction of post-spinal hypotension was 0.759 (95% CI 0.628–0.890, P = 0.001). A transverse diameter of > 12.2 mm of the RCFV could predict post-spinal hypotension during cesarean delivery. Conclusions A longer transverse diameter of RCFV was associated with hypotension and could predict parturients at a major risk of hypotension before anesthesia. Trial registration This study was registered at http://www.chictr.org.cn on 16, May, 2018. No. ChiCTR1800016163.

Design and Implementation of Wireless Voltage Monitoring System Based on Zigbee

2017 ◽  
Vol 12 (3) ◽  
pp. 83-96 ◽  
Author(s):  
Luo Xiaohui
Keyword(s):  
Monitoring System ◽  
Single Phase ◽  
Low Cost ◽  
Moving Average ◽  
Voltage Sensor ◽  
Wireless Transmission ◽  
Phase Voltage ◽  
Medium Voltage ◽  
Wireless Monitoring ◽  
Three Phase

This paper proposed a low cost wireless monitoring system based on ZigBee wireless transmission, and designed a new floating voltage sensor which is suitable for the monitoring of medium voltage and high voltage(MV/HV) public equipment. The system used TI-CC2530 as the controller, proposed a new moving average voltage sensing(MAVS) algorithm by reasonable assumptions, and adopted algorithms to perform the theoretical analysis for the single phase and three-phase voltage. At last, the author carried out a practical experiment on the wireless floating voltage sensor under the voltage up to 30kV, the experimental results showed that the proposed low cost wireless sensor can achieve a good voltage monitoring function, and the error is less than 3%.

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