Changes in care in the fourth trimester in Ireland: 2010–2020

2021 ◽  
Vol 29 (12) ◽  
pp. 683-691
Author(s):  
Jean Doherty ◽  
Mary Brosnan ◽  
Lucille Sheehy
Keyword(s):  
Negative Impact ◽  
Maternity Hospital ◽  
Care Needs ◽  
High Quality ◽  
Midwifery Care ◽  
Hospital Stays ◽  
Current Context ◽  
Discharge From Hospital ◽  
The Impact

Background There has been a shift in maternity care over the past decade. The changes encountered by postnatal ward staff and the impact of these changes on women postnatally requires exploration. This study aimed to ascertain midwives' and healthcare assistants' perspectives of the changes in postnatal care and challenges to providing care in the current context. Methods This was a qualitative study involving two focus groups of 15 midwives and healthcare assistants from an Irish urban maternity hospital. The participants' responses were analysed thematically. Results Changes in women's clinical characteristics, including increased comorbidities and caesarean section rates, were highlighted as creating additional care needs. Furthermore, additional midwifery tasks and clinical protocols as well as shorter hospital stays leave little time for high-quality, woman-centred care. Participants highlighted a negative impact on maternal health from limited follow-up midwifery care in the community. Conclusions With additional midwifery duties and a reduction in time to complete them, additional community midwifery care is key to providing high-quality follow-on care after postnatal discharge from hospital.

scholarly journals Cannabis and breastfeeding

2020 ◽  
Vol 25 (Supplement_1) ◽  
pp. S26-S28 ◽  
Author(s):  
Lisa Graves
Keyword(s):  
Health Care Providers ◽  
Small Sample ◽  
Adverse Outcomes ◽  
Care Providers ◽  
High Quality ◽  
High Quality Evidence ◽  
Small Sample Sizes ◽  
The Impact ◽  
Quality Evidence

Abstract Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting use in 2019. There is emerging evidence that cannabis is linked to an impact on the developing brain in utero and adverse outcomes in infants, children, and adolescents. The impact of cannabis during breastfeeding has been limited by studies with small sample sizes, follow-up limited to 1 year and the challenge of separating prenatal exposure from that during breastfeeding. In the absence of high-quality evidence, health care providers need to continue to engage women in conversation about the potential concerns related to breastfeeding and cannabis use.

scholarly journals Venous and Lung Thromboembolism in the Context of Lung Cancer: Clinical Manifestations, Risk Factors and Prognosis

2019 ◽  
Vol 32 (10) ◽  
pp. 647 ◽  
Author(s):  
Rosana Maia ◽  
Inês Neves ◽  
António Morais ◽  
Henrique Queiroga
Keyword(s):  
Lung Cancer ◽  
Venous Thromboembolism ◽  
Cancer Diagnosis ◽  
Negative Impact ◽  
Clinical Manifestations ◽  
Research Subjects ◽  
Lung Cancer Diagnosis ◽  
The Impact ◽  
The Relationship

Introduction: The relationship between cancer and thromboembolic events has been known for a long time. Lung and venous thromboembolism are frequent complications of lung cancer and its treatment, being a great cause of morbidity and mortality. We pretend to establish the relationship between lung and venous thromboembolism and lung cancer, describe patient characteristics and analyze the impact in the survival and prognosis.Material and Methods: It was a retrospective study. All research subjects were selected from lung cancer patients with a newly diagnosed lung and venous thromboembolism event admitted to Hospital S. João, between January 2008 and December 2013 and were followed until December 2014. Statistical analysis was performed with SPSS.Results: From the search, we obtained 113 patients. The majority was male, smokers or ex-smokers, and adenocarcinoma was the most frequent histologic type, being diagnosed mostly in advanced stages. We noticed that the median time between lung cancer diagnosis and lung venous thromboembolism was 2.9 months. In 24 patients (21.4%), the lung cancer diagnosis occurred after the lung and venous thromboembolism event and in 86 patients (76.8%), it occurred before the event. After a median follow up of 1.4 months, 107 (94.7%) patients died, 1 (0.9%) was lost to follow-up and 5 (4.4%) were still alive. The median survival rate was 1.5 months.Discussion: The diagnosis of lung and venous thromboembolism in patients with lung cancer is associated with bad prognosis. It occurs most frequently in patients with advanced disease, in the first months after lung cancer diagnosis and after beginning chemotherapy.Conclusion: Disease progression is an independent predictor with negative impact in overall survival.

Adult CHD patients under clinical follow-up have a similar quality of life to the general population in Malta

2016 ◽  
Vol 27 (6) ◽  
pp. 1051-1059
Author(s):  
Maryanne Caruana ◽  
Victor Grech
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
General Population ◽  
Negative Impact ◽  
Adult Survivors ◽  
Cardiac Medication ◽  
Self Reporting Questionnaire ◽  
The Impact

AbstractBackgroundThe improved survival of patients born with CHD has led to increasing interest in research on quality of life of adult survivors. We report the findings of the first study in Malta carried out to investigate quality of life in adults with CHD under follow-up.MethodsA self-reporting questionnaire modelled on the basis of the European Health Interview Survey 2008, including questions on mental health and vitality, was administered to consecutive adult CHD outpatients, aged 16 years and over, between May, 2013 and May, 2014. Foreigners and patients with learning difficulties or cognitive impairment were excluded. Quality-of-life data were compared with that from 371 age- and sex-matched 2008 survey responders – general population cohort. The impact of congenital lesion complexity, hospitalisation in the preceding 12 months, arrhythmias, co-morbidities, and cardiac medication use on quality of life of the CHD cohort was also investigated.ResultsThere were a total of 120 patient responders (63 males; mean age 30.53, SD 12.77 years). Overall, there were no significant differences in mental health and vitality between patient and general population cohorts, although older patients had better mental health scores compared with age-matched controls. Within the adult CHD cohort, hospitalisation in the preceding 12 months was the only factor associated with a poorer quality of life.ConclusionsOverall, CHD has no negative impact on mental health and vitality in Maltese adult patients under follow-up. Patients needing frequent hospitalisations might warrant closer attention by clinical psychologists.

scholarly journals Conservative management of CIN2p16 positive lesions in women with multiple HPV infection

2020 ◽  
Author(s):  
Maria Teresa Bruno ◽  
Guido Scalia ◽  
Nazario Cassaro ◽  
Maria Costanzo ◽  
Sara Boemi
Keyword(s):  
Laser Therapy ◽  
Conservative Management ◽  
Negative Impact ◽  
Hpv Infection ◽  
Multiple Infection ◽  
Multiple Infections ◽  
Hpv Test ◽  
American Society ◽  
The Impact

Abstract BackgroundAccording to the 2006 American Society for Colposcopy and Cervical Pathology guidelines, positive CIN2 p16 in women over the age of 25 should be managed with excisional treatment. However, excisional treatment is associated with physical, psychological and obstetric morbidity and can have a negative impact on sexual function. In our study we sought to identify a clear management strategy, addressing the impact of routine use of p16 immunohistochemistry in this population and identify appropriate criteria for patient selection with the aim of reducing over-treatment.MethodWe studied the medical records of 130 patients who had undergone laser therapy for CIN2. Each patient underwent colposcopy, biopsy and HPV test and were tested for p16 protein,. Patients were divided based on HPV infection into: single infections, multiple infections. All patients underwent ZTA laser therapy with follow-up (2-year follow-up ). Statistical analysis Contingency tables were created to evaluate the correlation between single, multiple and CIN2+ infections. Values with p <0.05 were considered statistically significant.ResultsSingle infections had a histological regression of 61.8% (21/34) and a histological persistence rate of 35.3% (12/34), which was greater than the multiple infection rate. The common characteristic that the women with persistence and progression had was the dimension of the lesion and the genotype 16. Ten cases of histological persistence and the only case of progression had one lesion greater than three quarters of the cervix.ConclusionsWith the progress of our understanding of the natural history of infection from human papillomavirus and the increasing use of colposcopy, thanks to the addition of HPV genotyping and the technique of immunohistochemistry, conservative management of these lesions is now possible

scholarly journals Impact of non-cystic fibrosis bronchiectasis on critically ill patients in Korea: a retrospective observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Youngmok Park ◽  
Seung Hyun Yong ◽  
Ah Young Leem ◽  
Song Yee Kim ◽  
Sang Hoon Lee ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Odds Ratio ◽  
Negative Impact ◽  
Icu Mortality ◽  
Chest Computed Tomography ◽  
Lower Survival Rate ◽  
All Cause Mortality ◽  
Hospital Stays ◽  
The Mean ◽  
The Impact

AbstractThis study investigated the impact of bronchiectasis on patients admitted to the intensive care unit (ICU) at a hospital in Korea. Patients with bronchiectasis were diagnosed using results of chest computed tomography performed before ICU admission. The severity of bronchiectasis was based on the number of affected lobes, and patients with ≥ 3 bronchiectatic lobes were classified into the severe bronchiectasis group. Overall, 823 patients were enrolled. The mean age was 66.0 ± 13.9 years, and 63.4% were men. Bronchiectasis and severe bronchiectasis were present in 148 (18.0%) and 108 (13.1%) patients, respectively. The increase in the number of bronchiectatic lobes was related to the rise in ICU mortality (P for trend = 0.012) and in-hospital mortality (P for trend = 0.004). Patients with severe bronchiectasis had higher odds for 28-day mortality [odds ratio (OR) 1.122, 95% confidence interval (CI) 1.024–1.230], ICU mortality (OR 1.119, 95% CI 1.023–1.223), and in-hospital mortality (OR 1.208, 95% CI 1.092–1.337). The severe bronchiectasis group showed lower overall survival (log-rank P < 0.001), and the adjusted hazard ratio was 1.535 (95% CI 1.178–2.001). Severe bronchiectasis had a negative impact on all-cause mortality during ICU and hospital stays, resulting in a lower survival rate.

scholarly journals Environmental regulations, capacity utilization, and high-quality development of manufacturing: an analysis based on Chinese provincial panel data

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hongyang Wang ◽  
Baizhou Li
Keyword(s):  
Environmental Regulation ◽  
Manufacturing Industry ◽  
Negative Impact ◽  
Environmental Regulations ◽  
Rapid Development ◽  
Capacity Utilization ◽  
Utilization Rate ◽  
Quality Development ◽  
High Quality ◽  
The Impact

AbstractThe high-quality development of the manufacturing industry is an important strategic task for Chinese economic development. The rapid development of the manufacturing industry is also accompanied by problems such as overcapacity and environmental pollution. This paper analyzes the impact of capacity utilization on the high-quality development of manufacturing and establishes a nonlinear threshold regression model on this basis, and studies and analyzes environmental regulations as a threshold variable under the influence of capacity utilization rate on the high-quality development of the manufacturing industry. The research results show that: capacity utilization, profitability, foreign direct investment, and government participation all have a significant positive impact on the high-quality development of the manufacturing industry; environmental regulations have a significant negative impact on the high-quality development of the manufacturing industry. And in the model of the effect of capacity utilization on the high-quality development of the manufacturing industry, environmental regulation has a single threshold effect. With the increase in the intensity of environmental regulation, the coefficient and significance of the effect of capacity utilization on the high-quality development of the manufacturing industry have changed. Finally, this article puts forward corresponding policies and suggestions based on the results of data analysis.

scholarly journals The Impact of Center-Based Childcare Attendance on Early Child Development: Evidence From the French Elfe Cohort

Demography ◽  
2021 ◽  
Author(s):  
Lawrence M. Berger ◽  
Lidia Panico ◽  
Anne Solaz
Keyword(s):  
Child Development ◽  
Motor Skills ◽  
Negative Impact ◽  
Positive Impact ◽  
Language Skills ◽  
The United States ◽  
Small Scale ◽  
High Quality ◽  
Disadvantaged Children ◽  
The Impact

Abstract Proponents of early childhood education and care programs cite evidence that high-quality center-based childcare has positive impacts on child development, particularly for disadvantaged children. However, much of this evidence stems from randomized evaluations of small-scale intensive programs based in the United States and other Anglo/English-speaking countries. Evidence is more mixed with respect to widespread or universal center-based childcare provision. In addition, most evidence is based on childcare experiences of 3- to 5-year-old children; less is known about the impact of center-based care in earlier childhood. The French context is particularly suited to such interrogation because the majority of French children who attend center-based care do so in high-quality, state-funded, state-regulated centers, known as crèches, and before age 3. We use data from a large, nationally representative French birth cohort, the Étude Longitudinale Français depuis l'Enfance (Elfe), and an instrumental variables strategy that leverages exogenous variation in both birth quarter and local crèche supply to estimate whether crèche attendance at age 1 has an impact on language, motor skills, and child behavior at age 2. Results indicate that crèche attendance has a positive impact on language skills, no impact on motor skills, and a negative impact on behavior. Moreover, the positive impact on language skills is particularly concentrated among disadvantaged children. This implies that facilitating increased crèche access among disadvantaged families may hold potential for decreasing early socioeconomic disparities in language development and, given the importance of early development for later-life outcomes, thereby have an impact on long-term population inequalities.

scholarly journals The Impact of a Nanocellulose-Based Wound Dressing in the Management of Thermal Injuries in Children: Results of a Retrospective Evaluation

Life ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. 212
Author(s):  
Julia Cattelaens ◽  
Laura Turco ◽  
Luc M. Berclaz ◽  
Birgit Huelsse ◽  
Wolfgang Hitzl ◽  
...  
Keyword(s):  
Wound Dressing ◽  
Pediatric Patients ◽  
Wound Dressings ◽  
Retrospective Evaluation ◽  
Thermal Injuries ◽  
Hospital Stays ◽  
The Mean ◽  
The Impact ◽  
First Time

The aim of this retrospective study is to evaluate for the first time the impact of a nanocellulose-based wound dressing in the treatment of pediatric patients with both partial- and deep-thickness burns. Usability and effectiveness were defined based on parameters such as frequency of dressing changes under narcosis, duration of hospital stay, onset of complications, need for additional treatments, and follow up scar formation assessment. Fifty-six children who sustained burns in the year 2018 and were treated with a nanocellulose-based wound dressing were included in the trial. The mean stay in hospital was 6.7 days. Patients underwent dressing changes under narcosis 2.4 times on average, and none had wound-associated infection. In all, 82% of the patients were treated only with nanocellulose-based wound dressings, and reepithelialization occurred after ten days. The majority of patients had scars with normal pigmentation (98%), vascularization (91%), height (92%), and pliability (92%). In conclusion, using a nanocellulose-based wound dressing for the treatment of both superficial, partial-thickness and deep, full-thickness burns has several advantages. Compared with the results published in literature on other wound dressings, it requires a moderate number of dressing changes under narcosis and results in short hospital stays. Additionally, it has a low associated infection rate and promotes wound healing.

Effect of impaired cardiac conduction after alcohol septal ablation on clinical outcomes: insights from the Euro-ASA registry

2018 ◽  
Vol 5 (3) ◽  
pp. 252-258 ◽  
Author(s):  
Morten Kvistholm Jensen ◽  
Lothar Faber ◽  
Max Liebregts ◽  
Jaroslav Januska ◽  
Jan Krejci ◽  
...  
Keyword(s):  
New York ◽  
Negative Impact ◽  
Nyha Class ◽  
Heart Association ◽  
Cardiac Conduction ◽  
Alcohol Septal Ablation ◽  
New York Heart Association ◽  
Symptomatic Outcome ◽  
The Impact

Abstract Aims We analysed the impact of bundle branch block (BBB) and pacemaker (PM) implantation on symptoms and survival after alcohol septal ablation (ASA) in patients with hypertrophic cardiomyopathy (HCM). Methods and results Among 1416 HCM patients from the Euro-ASA registry, 58 (4%) patients had a PM and 64 (5%) patients had an implantable cardioverter-defibrillator (ICD) before ASA. At latest follow-up (5.0 ± 4.0 years) after ASA, 118 (8%) patients had an ICD and 229 (16%) patients had a PM. In patients without an implantable device prior to ASA 13% had a PM and 5% had an ICD implanted following ASA. New onset BBB was present in 44% (right BBB in 31%) of patients without previous BBB. At latest follow-up, we found no associations between BBB and New York Heart Association (NYHA) Class 3–4 [odds ratio (OR) 0.98, 95% confidence interval (CI) 0.63–1.51; P = 0.91] or Canadian Cardiovascular Society (CCS) Class 3–4 (OR 1.5, CI 0.32–6.7; P = 0.62), respectively, and no associations between PM and NYHA Class 3–4 (OR 1.2, CI 0.70–2.0; P = 0.52) or CCS 3–4 (OR 1.3, CI 0.24–6.6; P = 0.79), respectively. The survival after ASA was not reduced in patients with BBB [hazard ratio (HR) 0.73, CI 0.53–1.01; P = 0.06] or PM (HR 0.78, CI 0.52–1.17; P = 0.24). Conclusions Development of BBB or need for a PM after ASA in patients with obstructive HCM was not associated with inferior symptomatic outcome or reduced survival, thus concerns for the negative impact of impaired cardiac conduction on the clinical outcome after ASA were not confirmed.

The Impact of Standing Orders on Medication and Skill Selection, Paramedic Assessment, and Hospital Outcome: A Follow-up Report

1991 ◽  
Vol 6 (3) ◽  
pp. 303-308 ◽  
Author(s):  
James E. Pointer ◽  
Michael Osur ◽  
Colleen Campbell ◽  
Ben H. Mathews ◽  
Chet McCall
Keyword(s):  
Negative Impact ◽  
Time Study ◽  
Alameda County ◽  
Hospital Outcome ◽  
Medical Control ◽  
Standing Order ◽  
The Impact ◽  
Order Intervals ◽  
Different Levels

AbstractIntroduction:A prior report demonstrated a five-minute decrement in scene and total prehospital times in the standing order and limited standing order intervals as compared to control.Methods:The Alameda County Emergency Medical Service (EMS) District studied the impact of standing orders on field times, comparison of paramedic assessments with emergency department diagnoses, field drug use and procedures, and hospital outcome. These variables were studied over three discrete, six-week, time-study intervals, which represented three different levels of base-hospital medical control (control, standing order, and limited standing order).Results:There were no statistically significant differences between the three time-study intervals for the following variables: 1) incidence of prehospital administration of three cardiac arrest drugs; 2) incidence of prehospital administration of no drugs; 3) incidence of performance of endotracheal intubation; 4) incidence of performance of defibrillation; 5) assessment comparison; and 6) hospital outcome. There were statistically significant differences between intervals for incidence of: 1) administration of naloxone; 2) administration of 50% dextrose; 3) intravenous (IV) starts; and 4) paramedic performance of no procedures.Conclusion:Although there are several potential flaws in method, the data suggest that standing orders result in decreased incidence of drug administration and IV starts in non-critical situations without a negative impact on paramedic assessments or hospital outcome.

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