scholarly journals A cohort study of survival following discharge from hospital in rural Tanzanian children using linked data of admissions with community-based demographic surveillance

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Oscar Mukasa ◽  
Honorati Masanja ◽  
Don DeSavigny ◽  
Joanna Schellenberg
Keyword(s):  
Linked Data ◽  
Cox Regression ◽  
District Hospital ◽  
Rural Setting ◽  
Post Discharge ◽  
Community Based ◽  
Related Data ◽  
Clinical Surveillance ◽  
Additional Support ◽  
Discharge From Hospital

Abstract Background To illustrate the public health potential of linking individual bedside data with community-based household data in a poor rural setting, we estimated excess pediatric mortality risk after discharge from St Francis Designated District Hospital in Ifakara, Tanzania. Methods Linked data from demographic and clinical surveillance were used to describe post-discharge mortality and survival probability in children aged < 5 years, by age group and cause of admission. Cox regression models were developed to identify risk factors. Results Between March 2003 and March 2007, demographic surveillance included 28,910 children aged 0 to 5 years and among them 831 (3%) were admitted at least once to the district hospital. From all the children under the demographic surveillance 57,880 person years and 1381 deaths were observed in 24 months of follow up. Survivors of hospital discharge aged 0–5 years were almost two times more likely to die than children of the same age in the community who had not been admitted (RR = 1.9, P < 0.01, 95% CI 1.6, 2.4). Amongst children who had been admitted, mortality rate within a year was highest in infants (93 per 1000 person years) and amongst those admitted due to pneumonia and diarrhoea (97 and 85 per 1000 person years respectively). Those who lived 75 km or further from the district hospital, amongst children who were admitted and survived discharge from hospital, had a three times greater chance of dying within one year compared to those living within 25 km (adjusted HR 3.23, 95% CI 1.54,6.75). The probability of surviving the first 30 days post hospitalization was 94.4% [95% CI 94.4, 94.9], compared to 98.8% [95% CI 97.199.5] in non-hospitalized children of the same age in the commuity. Conclusion This study illustrates the potential of linking health related data from facility and household levels. Our results suggest that families may need additional support post hospitalization.

Information and Support Needs of Parents With Premature Infants: An Integrative Review

2020 ◽  
pp. 105381512095773 ◽  
Author(s):  
Susan L. Davis-Strauss ◽  
Ensa Johnson ◽  
Welma Lubbe
Keyword(s):  
Premature Infants ◽  
Integrative Review ◽  
Initial Time ◽  
Future Research ◽  
Support Needs ◽  
Post Discharge ◽  
Community Based ◽  
Additional Information ◽  
Time Period ◽  
Discharge From Hospital

International research, while mostly conducted in high-income countries, repeatedly states that parents of premature infants have increased needs and require additional information and varied support channels after the infant’s initial discharge from hospital. However, the perceived self-reported needs of parents concerned with the caregiving of premature infants during the initial time period at home after discharge are not well known. This integrative review explores all extant literature that embodies self-reported or parent-quoted perceptions, experiences, and parent testimonials related to post-discharge infant caregiving information and support needs published from January 1990 to April 2019. Generated findings from the review that reveal parents, regardless of country, consistently reported unmet information and support needs, coupled with a lack of adequate community-based and health care professional support. Current gaps in literature are identified and recommendations for future research are also addressed.

scholarly journals A Successful Model of Cancer Screening in Low Resource Settings: Findings of an Integrated Cancer Screening Camp from a Rural Setting of North India

2020 ◽  
Vol 5 (2) ◽  
pp. 83-86
Author(s):  
Bashar MD Abu ◽  
Aggarwal Arun K
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Oral Cavity ◽  
Diagnostic Tests ◽  
District Hospital ◽  
North India ◽  
Rural Setting ◽  
Community Based ◽  
Low Resource Settings ◽  
Low Resource

Background: Cancers of cervix, breast and oral cavity claims millions of deaths each year globally and are the three most common cancers in India. There is need to develop and test models for organizing integrated cancer screening camps in low resource settings with inter-sectorial co-ordination between different stakeholders. Methods: A community based integrated cancer screening camp was organized in a rural setting of north India in co-ordination with district health administration and local governing body (Panchayati Raj Institution). Screening methods included Clinical Breast Examination (CBE) for breast cancer, visual inspection under 5% acetic acid (VIA) for cervical cancer and oral visual examination (OVE) for oral cavity cancer. Men and women found to be screen positive in the camp were referred to the district hospital and a tertiary care center for further diagnostic tests and were followed up. Results: A total of 90 individuals (40 men and 50 women) above 30 years of age attended the screening camp. Of them, one (2.5%) male was screened positive for precancerous lesion of oral cavity. Out of the 50 women attending the camp, two were detected with suspected breast lumps, which on further diagnostic tests at district hospital were diagnosed as benign tumors. Only half (52.0%) of the women consented for cervical cancer screening, out of which one (3.9%) was screened positive on VIA which on colposcopy examination and biopsy at referral center was confirmed as early stage cancerous lesion of cervix and was instituted on treatment. Conclusion: The screening camp sets a successful example of community based cancer control activity for early detection and management of three common cancers through inter-sectoral co-ordination in low resource settings.

Paediatric post-discharge pain and parent perceptions of support from an Australian nurse practitioner led acute pain service

2021 ◽  
pp. 136749352110147
Author(s):  
Elizabeth M. Forster ◽  
Catherine Kotzur ◽  
Julianne Richards ◽  
John Gilmour
Keyword(s):  
Pain Management ◽  
Acute Pain ◽  
Nurse Practitioner ◽  
Parental Support ◽  
Transition Period ◽  
Short Form ◽  
Acute Pain Service ◽  
Cross Sectional Survey ◽  
Post Discharge ◽  
Discharge From Hospital

Poorly managed post-operative pain remains an issue for paediatric patients. Post-discharge telephone follow-up is used by an Australian Nurse Practitioner Acute Pain Service (NpAPS) to provide access to effective pain management post-discharge from hospital. This cross-sectional survey design study aimed to determine the pain levels of children following discharge and parent views on participation in their child’s pain management and perceptions of support from the NpAPS. Parents completed the Parents’ Postoperative Pain Measure–Short Form (PPPM-SF) and factors affecting parents’ participation in children’s pain management questionnaire (FPMQ). Results indicated that pain score was high, especially on the day of discharge and 24 hours post-discharge. Parents, despite feeling supported by the NpAPS, experienced uncertainty, emotional responses and expressed concerns about communication and coordination of care. The clinically significant pain levels of the majority of children on the day of discharge and day post-discharge from hospital are a concern. Worry and uncertainty among parents, particularly on the day and first night of discharge, suggest this transition period where responsibility of clinical management of pain is handed over to parents may require greater focus for parental support.

scholarly journals Improving the management and care of refugees in Australian hospitals: a descriptive study

2016 ◽  
Vol 40 (6) ◽  
pp. 679 ◽  
Author(s):  
Lindsey Ross ◽  
Catherine Harding ◽  
Alexa Seal ◽  
Geraldine Duncan
Keyword(s):  
Healthcare Professionals ◽  
Barriers To Care ◽  
Psychological Needs ◽  
Public Hospitals ◽  
Health Needs ◽  
Cultural Barriers ◽  
Rural Setting ◽  
Provider Perceptions ◽  
Additional Support ◽  
The Impact

Objectives The aim of the present study was to investigate healthcare provider perceptions of the impact of refugee patients at two public hospitals, one rural and one urban, in designated refugee resettlement areas. Healthcare professionals’ views regarding improvements that could be made in this area were also sought. Methods Two-page anonymous questionnaires containing demographic, quantitative and open-ended questions were distributed to 150 healthcare providers at each research site. Results Response rates at the rural and urban sites were 50% and 49%, respectively. Refugees were seen at least monthly by 40% of respondents. Additional support was requested by 70% of respondents. Confidence was associated with being born overseas (P = 0.029) and increased time working with refugees (rs = 0.418, P < 0.001). Only 47% of respondents felt confident managing social and psychological needs of refugees. Midwives saw refugees more than nursing and allied healthcare staff combined, and this was significant at the rural hospital (P < 0.001). Rural respondents reported that working with refugees enhanced their practice (P = 0.025), although felt significantly less confident (P < 0.001) than urban respondents. Themes that arose regarding barriers to care included language and cultural barriers, paucity of knowledge and issues accessing available services, including appropriate interpreters, Medicare eligibility and patient factors, including lack of patient trust in government systems. Desire for support was more pronounced in the rural setting (P = 0.001). Conclusions Refugees were seen frequently in both settings and most respondents requested additional support, highlighting that caring for refugees in Australian hospitals is a significant challenge. Additional support and education should be targeted to those caring for refugees most frequently, particularly midwifery services, to reduce barriers to care. What is known about the topic? Refugees are a vulnerable group, often with complex health needs. These needs are often unmet because of issues including language and cultural barriers. What does this paper add? Refugees were seen frequently in the two public hospital settings involved in the present study and most often by midwifery services. Healthcare professionals require more support, more information about available services and better access to interpreter services. These issues were more pronounced in the rural setting where very limited research exists. What are the implications for practitioners? Implementing additional support and education regarding refugee health needs could increase knowledge and confidence when managing refugees, reducing barriers to care and improving quality of care.

Introduction of a modified analgesic ladder in the emergency department: Effect on oxycodone use for back pain

2021 ◽  
Vol 17 (1) ◽  
pp. 55-61
Author(s):  
Jenny Ly, BPharm, GradCertPharmPrac ◽  
Cristina P. Roman, BPharm (Hons), MPP ◽  
Carl Luckhoff, MB, ChB, FACEM ◽  
Peter A. Cameron, MBBS, MD, FACEM, FCEM (Hon) ◽  
Michael J. BPharm, GradDipHospPharm, PhD, AdvPracPharm, FSHP, FISOPP ◽  
...  
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Outcome Measure ◽  
Interquartile Range ◽  
Post Intervention ◽  
Community Based ◽  
Analgesic Ladder ◽  
Multifaceted Interventions ◽  
Discharge From Hospital ◽  
Modest Reduction

Objective: The aim of this study was to assess the introduction of an analgesic ladder and targeted education on oxycodone use for patients presenting to the emergency department (ED).Design: A retrospective pre-post implementation study was conducted. Data were extracted for patients presenting from June to July 2016 (preintervention) and June to July 2017 (post-intervention).Setting: The EDs of a major metropolitan health service and an affiliated community-based hospital.Participants: Patients with back pain where nonpharmacological interventions such as mobilization and physiotherapy are recommended as the mainstay of treatment.Interventions: A modified analgesic ladder introduced in May 2017. The ladder promoted the use of simple analgesics such as paracetamol and nonsteroidal anti-inflammatory drug (NSAIDs) prior to opioids and tramadol in preference to oxycodone in selected patients.Main outcome measure(s): The proportion of patients prescribed oxycodone and total doses administered.Results: There were 107 patients pre and 107 post-intervention included in this study. After implementation of the analgesic ladder, 78 (72.9 percent) preintervention patients and 55 (51.4 percent) post-intervention patients received oxycodone in ED (p = 0.001). The median oxycodone doses administered in the ED was 14 mg (interquartile range: 5-20 mg) and 5 mg (interquartile range: 5-10 mg; p 0.001), respectively. On discharge from hospital, a prescription for oxycodone was issued for 36 (33.6 percent) patients preintervention and 26 (24.3 percent) patients post-intervention (p = 0.13). Conclusions: Among patients with back pain, implementation of a modified analgesic ladder was associated with a statistically significant but modest reduction in oxycodone prescription. Consideration of multifaceted interventions to produce major and sustained changes in opioid prescribing is required.

scholarly journals Trends and patterns of family planning methods used among women attending family planning clinic in a rural setting in sub-Sahara Africa: the case of Mbalmayo District Hospital, Cameroon

2018 ◽  
Vol 11 (1) ◽  
Author(s):  
Paul Nkemtendong Tolefac ◽  
Theophile Njamen Nana ◽  
Eugene Vernyuy Yeika ◽  
Nkemnji Stanley Awungafac ◽  
Yolande Ntsama ◽  
...  
Keyword(s):  
Family Planning ◽  
District Hospital ◽  
Rural Setting ◽  
Family Planning Clinic ◽  
Planning Methods ◽  
Family Planning Methods

scholarly journals Neutrophil-Lymphocyte Ratio and Circulating Tumor Cells Counts Predict Prognosis in Gastrointestinal Cancer Patients

2021 ◽  
Vol 11 ◽  
Author(s):  
Chengcheng Qian ◽  
Renjie Cai ◽  
Wenying Zhang ◽  
Jiongyi Wang ◽  
Xiaohua Hu ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Gastrointestinal Cancer ◽  
Cox Regression ◽  
Disease Free Survival ◽  
Tumor Location ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Related Data

PurposeThe purpose of this study is to explore the prognostic value of associating pre-treatment neutrophil–lymphocyte ratio (NLR) with circulating tumor cells counts (CTCs) in patients with gastrointestinal cancer.Materials and MethodsWe collected the related data of 72 patients with gastric cancer (GC) and colorectal cancer (CRC) who received different therapies from August 2016 to October 2020, including age, gender, primary tumor location, TNM stage, tumor-differentiation, NLR, CTCs, disease-free survival (DFS) and overall survival (OS). We chose the optimal cut-off value of NLR &gt;3.21 or NLR ≤3.21 and CTC &gt;1 or CTC ≤1 by obtaining receiver operating characteristic (ROC) curve. The Kaplan–Meier survival analysis and Cox regression analysis were used to analyze DFS and OS. To clarify the role of the combination of NLR and CTCs counts in predicting the prognosis, we analyzed the DFS and OS when associated NLR and CTCs counts.ResultsA high NLR (&gt;3.21) was associated with shorter DFS (P &lt;0.0001) and OS (P &lt;0.0001). Patients with high CTCs level (&gt;1) had shorter DFS (P = 0.001) and OS (P = 0.0007) than patients with low CTCs level. Furthermore, patients who had both higher NLR and higher CTCs counts had obvious shorter DFS (P &lt;0.0001) and OS (P &lt;0.0001).ConclusionsPatients with higher NLR and more CTCs respectively tended to have poor prognosis with shorter DFS and OS, which might be regarded as predictors of gastrointestinal cancer. In particular, associating NLR and CTCs counts might be a reliable predictor in patients with gastrointestinal cancer.

scholarly journals Coverage Assessment For Community-Based Management Of Acute Malnutrition In Rural And Urban Ghana: A Comparative Cross-Sectional Study. 

2021 ◽  
Author(s):  
Joana Apenkwa ◽  
Sam K Newton ◽  
Samuel Kofi Amponsah ◽  
Reuben Osei-Antwi ◽  
Emmanuel Nakua ◽  
...  
Keyword(s):  
Severe Acute Malnutrition ◽  
Qualitative Approach ◽  
Rural District ◽  
Urban Setting ◽  
Acute Malnutrition ◽  
Rural Setting ◽  
Community Based ◽  
Cross Sectional ◽  
Study District ◽  
Point Coverage

Abstract Background: Ghana for years has implemented the Community-based Management of Acute Malnutrition (CMAM) among children in order to reduce malnutrition prevalence. However, the prevalence of malnutrition remains high. This study aimed to determine CMAM coverage levels in the Ahafo Ano South (AAS), a rural district, and Kumasi Subin sub-metropolis (KSSM), an urban district. Methods: The study was a cross-sectional comparative study with a mixed-methods approach. In all, 497 mother/caregiver and child under-five pairs were surveyed using a quantitative approach while qualitative methods were used to study 25 service providers and 40 mother/ caregivers who did not participate in the quantitative survey. Four types of coverage indicators were assessed: point coverage (defined as the number of Severe Acute Malnutrition cases [SAM] in treatment divided by total number of Severe Acute Malnutrition cases in the study district), geographical coverage (defined as total number of health facilities delivering treatment for SAM divided by total number of healthcare facilities in the study district), and treatment coverage (defined as children with SAM receiving therapeutic care divided by total number of SAM children in the study district) and program coverage (defined as number of SAM cases in the CMAM programme ÷ Number of SAM cases that should be in the programme). The qualitative approach was used to support the assessment of the coverage indicators. Data were analyzed using STATA version 14, and Atlas.ti, version 7.5 for the quantitative and qualitative data respectivelyResults: Geographically, only 6% of the facilities in the urban communities were participating in the CMAM programme as against 29% of rural district facilities. The districts had point coverage of 41% and 10% for the urban and rural districts respectively. The urban setting recorded a SAM prevalence of 52% as against 36% in the rural setting. The proportion of SAM children enrolled in CMAM was higher in KSSM when compared with AAS; 41% and 33% respectively. In both districts, the most likely factors to attract mothers/caregivers to utilize the CMAM services were: ‘free services’ and ‘a cured child.’ The qualitative approach showed that coverage improvement in both districts is hampered by barriers such: distance, transportation cost, lack of trained personnel in the communities for community mobilization and home visits, and insufficient feeds. Conclusion: To improve CMAM coverage, there is the need to train health workers to embark on aggressive health education strategies to encourage mothers/caregivers of malnourished children to utilize CMAM while ensuring that services reach those who need them. Trial registration: This study is approved and registered with The Kwame Nkrumah University of Science and Technology Committee on Human Research, Ethics and Publications (CHRPE/AP/314/15)

scholarly journals Becoming a Carer for an Elderly Person after Discharge from an Acute Hospital Admission :

2004 ◽  
Author(s):  
Karen Grimmer ◽  
John Moss ◽  
Julie Falco
Keyword(s):  
Independent Living ◽  
Discharge Planning ◽  
Elderly Person ◽  
Community Setting ◽  
Community Services ◽  
Post Discharge ◽  
Acute Hospitals ◽  
Planning Processes ◽  
Discharge From Hospital ◽  
Patient Relationships

Objective: To describe the perceptions of people taking on a new or expanded caring role for an elderly patient recently hospitalised with a new or intensified health problem. Design: Observational study collecting qualitative data monthly for six months following patients’ discharge from hospital and attempted return to independent living in the community. Setting: Four South Australian acute hospitals (one metropolitan, three country). Subjects: 34 unpaid carers were nominated by 100 patients. 24 carers participated (17 elderly spouses, 3 younger family members, 4 neighbours and/ or friends). Results: The study highlighted carers’ perceptions of being unprepared for their new tasks, and their frustrations at the long-term and frequently significant changes to their lives brought about by assuming a caring role. Many carers felt their role had been imposed upon them without real choice, and that their own physical and emotional fitness for their new role had not been considered during discharge planning. Carers claimed to have been provided with little information about how to care for the patient, particularly when community services were seldom provided in the first week after discharge. Stresses developed in many of the carer-patient relationships, and patient and carer morale was often low for months post-discharge. Discussion: Carers indicated that their tasks could have been made easier by more timely, targeted education about their patient’s condition and their role in managing it. They would have liked greater inclusion in discharge planning processes whilst the patient was in hospital, and more timely and appropriate provision of post-discharge services that were patient- and carer-focused, and which addressed their ability to live independently in the community. Conclusion: Discharge planning systems should take greater account of the motivation and needs of carers, especially when this role is new or becoming expanded, and of the barriers they face in undertaking their role.

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