scholarly journals Daily weekday audit and feedback to clinicians for an inpatient intervention in obstetrics: is there sustained impact over the weekend? A secondary analysis of a prospective cohort study

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Rebecca F. Hamm ◽  
Lisa D. Levine ◽  
Meghan Lane-Fall ◽  
Rinad Beidas
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Secondary Analysis ◽  
Audit And Feedback ◽  
Evidence Based ◽  
Risk Calculator ◽  
Significant Difference ◽  
Obstetric Intervention ◽  
The Impact

Abstract Background Audit and feedback as an implementation strategy leads to small, but potentially important improvements in practice. Yet, audit and feedback is time and personnel intensive. Many interventions designed for inpatient care are meant to be utilized by care teams all days of the week, including weekends when research staff are at a minimum. We aimed to determine if audit and feedback regarding use of an evidence-based inpatient obstetric intervention performed only on weekdays could have a sustained impact over the weekend. Methods This study was performed as a secondary analysis of a prospective cohort study examining the impact of implementation of a validated calculator that predicts the likelihood of cesarean delivery during labor induction. During the 1 year postimplementation period, Monday through Friday, a member of the study team contacted clinicians daily to provide verbal feedback. While the same clinician pool worked weekend shifts, audit and feedback did not occur on Saturdays or Sundays. The primary outcome was intervention use, defined as documentation of counseling around the cesarean risk calculator result, in the electronic health record. Intervention use was compared between those with (weekdays) and without (weekends) audit and feedback. Results Of the 822 women meeting eligibility criteria during the postimplementation period (July 1, 2018–June 30, 2019), 651 (79.2%) were admitted on weekdays when audit and feedback was occurring and 171 (20.8%) on weekends without audit and feedback. The use of the cesarean risk calculator was recorded in 676 of 822 (82.2%) of eligible patient charts. There was no significant difference in cesarean risk calculator use overall by days when audit and feedback occurred versus days without audit and feedback (weekday admissions 82.0% vs. weekend admissions 83.0%, aOR 0.90 95% CI [0.57–1.40], p = 0.76). There was no significant trend in the relationship between calculator use and weekday versus weekend admission by month across the study period (p = 0.21). Conclusions Daily weekday audit and feedback for implementation of an evidence-based inpatient obstetric intervention had sustained impact over the weekends. This finding may have implications for both research staffing, as well as sustainability efforts. Further research should determine the lowest effective frequency of audit and feedback to produce implementation success.

scholarly journals P130 Timing of nasogastric tube insertion and risk of postoperative pneumonia: international, prospective cohort study

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
◽  
Keyword(s):  
Cohort Study ◽  
Colorectal Surgery ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Secondary Analysis ◽  
Primary Outcome Measure ◽  
Elective Colorectal Surgery ◽  
Significant Difference ◽  
Multivariable Regression ◽  
Nasogastric Tube Insertion

Abstract Introduction This study aims to assess whether Prophylactic NGT insertion was associated with reduced rates of pneumonia, in comparison to Reactive NGT after colorectal surgery. Methods Pre-planned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January and April 2018 were included. Those receiving NGT were divided into three groups, based on the timing of the placement: Routine (at the time of surgery); Prophylactic (after surgery, before vomiting); and Reactive (after surgery, after vomiting). Pneumonia within 30 postoperative days was considered as primary outcome measure and it was compared between the three groups using multivariable regression analysis. Results 4,715 patients were included in the analysis. 1,536 (32.6%) received an NGT corresponding to 926 (60.3%) Routine, 461 (30%) Reactive and 149 (9.7%) Prophylactic. 200 patients (4.2%) developed pneumonia (No NGT: 2.7%; Routine NGT: 5.2%; Reactive NGT: 10.6%; Prophylactic NGT: 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the Prophylactic and Reactive NGT groups (OR: 1.03, 95% CI: 0.56 – 1.87, p = 0.932). Conclusion In patients who required NGT insertion after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery in comparison to reactive insertion.

scholarly journals Impact of the SARS-CoV-2 pandemic on access to contraception and pregnancy intentions: a national prospective cohort study of the UK population

2021 ◽  
pp. bmjsrh-2021-201164
Author(s):  
Neerujah Balachandren ◽  
Geraldine Barrett ◽  
Judith M Stephenson ◽  
Ephia Yasmin ◽  
Dimitrios Mavrelos ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Unplanned Pregnancy ◽  
Pregnancy Intentions ◽  
Significant Difference ◽  
Unplanned Pregnancies ◽  
The Uk ◽  
The Impact ◽  
Access To Contraception

ObjectiveEvaluate the impact of the COVID-19 pandemic on access to contraception and pregnancy intentions.DesignNationwide prospective cohort study.SettingUnited Kingdom.ParticipantsWomen in the UK who were pregnant between 24 May and 31 December 2020.Main outcome measuresAccess to contraception and level of pregnancy intentions, using the London Measure of Unplanned Pregnancy (LMUP) in women whose last menstrual period was before or after 1 April 2020. While the official date of the first UK lockdown was 23 March, we used 1 April to ensure that those in the post-lockdown group would have faced restrictions in the month that they conceived.ResultsA total of 9784 women enrolled in the cohort: 4114 (42.0%) conceived pre-lockdown and 5670 (58.0%) conceived post-lockdown. The proportion of women reporting difficulties accessing contraception was higher in those who conceived after lockdown (n=366, 6.5% vs n=25, 0.6%, p<0.001) and continued to rise from March to September 2020. After adjusting for confounders, women were nine times more likely to report difficulty accessing contraception after lockdown (adjusted odds ratio (aOR) 8.96, 95% CI 5.89 to 13.63, p<0.001). There is a significant difference in the levels of pregnancy planning, with higher proportions of unplanned (n=119, 2.1% vs n=55, 1.3%) and ambivalent pregnancies (n=1163, 20.5% vs n=663, 16.1%) and lower proportions of planned pregnancies (n=4388, 77.4% vs n=3396, 82.5%) in the post-lockdown group (p<0.001). After adjusting for confounders, women who conceived after lockdown were still significantly less likely to have a planned pregnancy (aOR 0.88, 95% CI 0.79 to 0.98, p=0.025).ConclusionsAccess to contraception in the UK has become harder during the COVID-19 pandemic and the proportion of unplanned pregnancies has almost doubled.

scholarly journals The Impact of Breastfeeding on Neurocognitive Outcome at Twelve Years – Secondary Analysis of a Prospective Cohort Study

2021 ◽  
Author(s):  
Kelly Reilly ◽  
Barbara McConnell ◽  
Andrew Thompson ◽  
Peter Hepper ◽  
Moira Stewart ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Linear Regression Analysis ◽  
Secondary Analysis ◽  
Group Score ◽  
Townsend Score ◽  
Umbilical Artery Doppler ◽  
Observed Behaviour ◽  
The Impact

Abstract BackgroundThe objectives of this secondary analysis were to compare the; (i) cognitive and (ii) behavioural outcomes in children born congenitally normal, non-preterm, and non-growth restricted that were breastfed beyond one month of age with those that were not breastfed or breastfed for <1-month. MethodsAn original prospective cohort study conducted on n=2097 fetuses compared children with normal fetal UAD PI (Umbilical Artery Doppler Pulsatility Index) against those with an elevated UAD PI and assessed neurocognitive development at twelve years of age using British Ability Scale Version II (BAS II) and the Achenbach Behavioural Checklist Parent Rated Version (CBCL). This secondary analysis included children where maternal breastfeeding status was known (n=252). Childhood cognitive and behavioural scores were analysed and compared for the breastfed versus the non-breastfed group. Linear regression analysis was performed, controlling for confounders including gender, age at assessment, Townsend Score, and UAD PI. Results Excluding congenitally abnormal, preterm and growth restricted babies, n=206 were included. The mean age at follow-up was 12.2 years (±0.6 SD) for both groups with 43.5% (n=20) and 50.3% (n=81) of male gender in both groups respectively. When comparing those children who were breastfed against those who were not or for <1-month, the breastfed group score higher in spelling (p<0.001) and reading (p<0.001) assessments. As was also the case in verbal (p<0.001), reasoning (p<0.001) and spatial ability scores (p<0.001). In relation to behavioural assessments, there was no difference between groups. Conclusion Term babies who are breastfed for >1-month have more optimal scores in neurocognition when analysed at 12-years with no differences in parent observed behaviour compared to non-breastfed/breastfed for <1-month counterparts. These findings must be interpreted with caution due to the presence of confounders with further research into the biological and physiological mechanisms by which breastfeeding may optimise brain development.

scholarly journals Health literacy, health status and health behaviors of German students– study protocol for the “Healthy Habits” cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Martin Lange ◽  
Alexandra Löwe ◽  
Gerrit Stassen ◽  
Andrea Schaller
Keyword(s):  
Cohort Study ◽  
Health Status ◽  
Health Literacy ◽  
Health Behavior ◽  
Health Behaviors ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
The State ◽  
The Impact ◽  
Study Format

Abstract Background The emerging adulthood is traditionally viewed as a time of optimal health, but also as a critical life span, characterized by changing life circumstances and the establishment of an individual lifestyle. Especially university life seems to hold several challenges impeding the manifestation of a health supporting manner, as many students tend to show a poorer health behavior and a higher amount of health-related problems than comparable age groups. This, along with a steady growth of the higher education sector, brings increased attention to the university setting in the context of prevention. To date, there are few empirical longitudinal and coherent cross-sectional data on the status of students’ health literacy, health status, and health behaviors, and on the impact of the study format on students’ health. The aim of this prospective cohort study is to reduce this research gap. Methods Starting during winter semester 2020/21, the prospective cohort study collects data on health literacy, health status and health behavior on a semester-by-semester basis. All enrolled students of the IST University of Applied Sciences, regardless of study format and discipline, can participate in the study at the beginning of their first semester. The data are collected digitally via a specifically programmed app. A total of 103 items assess the subjectively perceived health status, life and study satisfaction, sleep quality, perceived stress, physical activity, diet, smoking, alcohol consumption, drug addiction and health literacy. Statistical analysis uses (1) multivariate methods to look at changes within the three health dimensions over time and (2) the association between the three health dimensions using multiple regression methods and correlations. Discussion This cohort study collects comprehensive health data from students on the course of study. It is assumed that gathered data will provide information on how the state of health develops over the study period. Also, different degrees of correlations of health behavior and health literacy will reveal different impacts on the state of students’ health. Furthermore, this study will contribute to empirically justified development of target group-specific interventions. Trial registration German Clinical Trials Register: DRKS00023397 (registered on October 26, 2020).

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