scholarly journals Increases in diagnosis and management of obstetric and neonatal complications in district hospitals during a high intensity nurse-mentoring program in Bihar, India

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0247260
Author(s):  
Ammar Joudeh ◽  
Rakesh Ghosh ◽  
Hilary Spindler ◽  
Seema Handu ◽  
Sunil Sonthalia ◽  
...  
Keyword(s):  
Birth Asphyxia ◽  
Supplemental Oxygen ◽  
Significant Trend ◽  
Positive Pressure ◽  
Positive Trend ◽  
Management Support ◽  
Chi Square ◽  
Hypertensive Disorders ◽  
District Hospitals ◽  
Number Of Patients

Maternal and neonatal mortality in Bihar, India was far higher than the aspirational levels set out by the Sustainable Development Goals. Provider training programs have been implemented in many low-resource settings to improve obstetric and neonatal outcomes. This longitudinal investigation assessed diagnoses and management of postpartum hemorrhage (PPH), hypertensive disorders of pregnancy, birth asphyxia (BA), and low birth weight (LBW), as part of the CARE’s AMANAT program in 22 District Hospitals in Bihar, between 2015 and 2017. Physicians and nurse mentors conducted clinical instruction, simulations and teamwork and communication activities, infrastructure and management support, and data collection for 6 consecutive months. Analysis of diagnosis included 11,259 non-referred and management included 11,800 total (non-referred and referred) admissions that were observed. Data were analyzed using the chi-square test for trend. PPH was diagnosed in 3.7% with no significant trend but diagnosis of hypertensive disorders increased from 1.0% to 1.7%, (ptrend = 0.04), over the 6 months. BA was diagnosed in 5.8% with no significant trend but LBW diagnoses increased from 11% to 16% (ptrend<0.01). Among PPH patients, 96% received fluids, 85% received uterotonics and 11% received Tranexamic Acid (TXA). There was a significant positive trend in the number of patients receiving TXA for PPH (6% to 13.8%, ptrend = 0.03). Of all neonates with BA, there were statistically significant increases in the proportion who were initially warmed, dried, and stimulated (78% to 94%, ptrend = 0.02), received airway suction (80% to 93%, ptrend = 0.03), and supplemental oxygen without positive pressure ventilation (73% to 86%, ptrend = 0.05). Diagnoses of hypertensive disorders and LBW as well as initial management of BA increased during the AMANAT program. However, underdiagnoses of PPH and hypertensive disorders relative to population levels remain critical barriers to improving maternal morbidity and mortality.

scholarly journals RELATIONSHIP BETWEEN WORKLOAD AND MOTIVATION WITH HEALTH WORKER’S PERFORMANCE IN COMMUNICABLE DISEASE PROGRAM IN PRIMARY HEALTH CENTRE IN EAST KOLAKA DISTRICT

2020 ◽  
Vol 2 (2) ◽  
pp. 53-57
Author(s):  
Muhamad Said ◽  
La Ode Saafi ◽  
Sunarsih Sunarsih
Keyword(s):  
Health Service ◽  
Infectious Diseases ◽  
Diarrheal Disease ◽  
Communicable Disease ◽  
Health Centre ◽  
Birth Asphyxia ◽  
Sampling Technique ◽  
Chi Square ◽  
Cross Sectional ◽  
Number Of Patients

Background: The incidence of infectious diseases in the world, Indonesia and provinces is still relatively high. Based on WHO data (2017), the top ten diseases that cause death are under 5 years of age, including HIV / AIDS 4%, diarrhea 18%, measles 1%, malaria 8%, pneumonia 16%, premature 12%, birth asphyxia 9%. , neonatal sepsis 6%, congenital abnormalities 4%, and accident 3%. In Indonesia, the incidence of infectious diseases is still high and some have experienced an increase in cases from the previous year. The data from the East Kolaka Health Service Profile shows that Accute Respiratory Infection (ARI) has increased by 55%, the number of sufferers is 84, while diarrheal disease has increased by 24%, the number of sufferers is 839, and TB disease has increased by 65% The number of patients 129. Methods: This type of research is a cross sectional study. The population of this study were all programmers in the working area of ??the East Kolaka Health Service as many as 48 programmers. The sampling technique was carried out by simple random sampling using the Lemeshow formula. Data were collected through a questionnaire and then analyzed using the Chi Square test. Result: The results showed that chi square of motivation = 5.773 and workload = 8,644. They chi squar etable is 3,841 at ? = 5% and df = 1. It means that chi square value> chi square table. Conclusion: There was a relationship between motivation, and workload with performance of officers in East Kolaka Regency.

scholarly journals Long-Term Oxygen Therapy in COPD: evidences and open questions of current indications

2016 ◽  
Vol 73 (1) ◽  
Author(s):  
A. Corrado ◽  
T. Renda ◽  
S. Bertini
Keyword(s):  
Oxygen Therapy ◽  
Supplemental Oxygen ◽  
Future Research ◽  
Chronic Obstructive ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Copd Patients ◽  
Number Of Patients ◽  
Long Term Oxygen Therapy

Long term oxygen therapy (LTOT) has been shown to improve the survival rate in Chronic Obstructive Pulmonary Disease (COPD) patients with severe resting hypoxemia by NOTT and MRC studies, published more than 25 years ago. The improved survival was found in patients who received oxygen for more than 15 hours/day. The effectiveness of LTOT has been documented only in stable COPD patients with severe chronic hypoxemia at rest (PaO255%. In fact no evidence supports the use of LTOT in COPD patients with moderate hypoxemia (55&lt;PaO2&lt;65 mmHg), and in those with decreased oxygen saturation (SO2&lt;90%) during exercise or sleep. Furthermore, it is generally accepted without evidence that LTOT in clinical practice is warranted in other forms of chronic respiratory failure not due to COPD when arterial blood gas criteria match those established for COPD patients. The prescription of oxygen in these circumstances, as for unstable patients, increases the number of patients receiving supplemental oxygen and the related costs. Comorbidities are likely to affect both prognosis and health outcomes in COPD patients, but at the moment we do not know if LTOT in these patients with complex chronic diseases and mild-moderate hypoxemia could be of any use. For these reasons a critical revision of the actual guide lines indications for LTOT in order to optimise effectiveness and costs, and future research in the areas that have not previously been addressed by NOTT and MRC studies, are mandatory.

Kangaroo Mother Care Reduces Noninvasive Ventilation and Total Oxygen Support Duration in Extremely Low Birth Weight Infants

2019 ◽  
Author(s):  
Xiaohua Xie ◽  
Xueyu Chen ◽  
Panpan Sun ◽  
Aifen Cao ◽  
Yanzhu Zhuang ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Supplemental Oxygen ◽  
Kangaroo Mother Care ◽  
Extremely Low Birth Weight ◽  
Positive Pressure ◽  
Low Birth Weight Infants ◽  
Cpap Ventilation ◽  
Objective Evidence ◽  
Tertiary Center

Abstract Objective Evidence on the safety and influence of kangaroo mother care (KMC) in extremely low birth weight infants (ELBWIs) on ventilation is lacking. Study Design This is a retrospective cohort study performed in 145 ELBWIs on noninvasive mechanical ventilation from a tertiary center. Results The duration of nasal intermittent positive pressure ventilation (nIPPV) and continuous positive airway pressure (CPAP) ventilation was significantly shorter in infants with KMC compared with infants without (21 vs. 13.5 days, p = 0.001 and 29.5 days vs. 20.5 days, p = 0.001, respectively). The frequency of apnea during hospital stay was fewer in KMC infants, compared with no KMC (23 vs. 20 times, p = 0.002). Multiple linear regression analysis showed that KMC was an independent protective factor for shortening nIPPV/CPAP duration (β = −9.90, 95% confidence interval [CI] [−13.20, −6.60], p < 0.001), total supplemental oxygen support (β = −10.52, 95% CI [−16.73, −4.30], p = 0.001), and reducing times of apneas (β = −5.88, 95% CI [−8.56, −3.21], p < 0.001). Conclusion KMC benefits ELBWIs by shortening nIPPV/CPAP ventilation duration and total supplemental oxygen support, and reducing the frequency of apneas.

scholarly journals A retrospective study of predisposing factors and outcome of persistant pulmonary hypertension among newborns at rural tertiary care centre

2020 ◽  
Vol 8 (1) ◽  
pp. 92
Author(s):  
B. C. Yelamali ◽  
Gangadhar S. Mirji ◽  
Mirnalini Rajput
Keyword(s):  
Risk Factors ◽  
Pulmonary Hypertension ◽  
Retrospective Study ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Birth Asphyxia ◽  
Male Gender ◽  
Predisposing Factors ◽  
Positive Pressure ◽  
Increased Risk

Background: Persistent pulmonary hypertension in newborns (PPHN) remains a significant cause of perinatal morbidity and mortality. Early recognition of factors that increase the risk of PPHN is of great importance in either to prevent or to treat PPHN optimally. Aim was to study the neonatal predisposing factors, profile and outcome of PPHN.Methods: This retrospective study was conducted in level III neonatal care unit, a rural referral centre of North Karnataka, India from January 2018 to April 2020.Results: During the study period a total of 50 infants with PPHN were identified with the incidence of 5.43/1000 live births. Mean gestation age (±SD) was 38.28±2.49 weeks and mean birth weight (±SD) was 2624±512 gm. The most noted risk factors were meconium aspiration syndrome (42%), birth asphyxia (16%), RDS (10%), positive pressure ventilation at birth (52%) and male gender (62%). Out of 50 infants with PPHN, high mortality was seen in low birth weight babies (66.6%). Use of sildenafil showed increased mortality (56.2%) whereas use of surfactant scored better with decreased mortality of 42.8%.Conclusions: Major risk factors for PPHN are MAS, birth asphyxia, RDS and low birth weight. Poor prognosis is seen in male gender, prematurity and CDH with increased risk of mortality. The use of systemic pulmonary vasodilators can be considered with caution and use of surfactant has a role in management of PPHN.

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 Clinical and Electroencephalographic Profile Of Children

2015 ◽  
Vol 11 (2) ◽  
pp. 110-116
Author(s):  
N Limbu ◽  
BH Paudel ◽  
D Thakur
Keyword(s):  
Cerebral Palsy ◽  
Febrile Seizure ◽  
Pediatric Patients ◽  
Birth Asphyxia ◽  
Seizure Disorder ◽  
Chi Square ◽  
Demographic Profiles ◽  
Epileptiform Discharges ◽  
Chi Square Test ◽  
The Relationship

Background Reports on pediatric electroencephalogram of Nepalese patients are rare. Objective We aimed to study the relationship between provisional clinical and electrophysiological diagnoses of pediatric patients with documentation of demographic profiles, and type and frequency of the disorders/diseases. Methods Electroencephalographic reports of 634 children from 2006 to 2009 were analyzed at neurophysiology laboratory, department of Basic and Clinical Physiology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal, retrospectively. Chi-Square test was applied after detail descriptive statistics. Results Male and female were 72.2 % (n=458/634) and 27.76 % (n=176/634) respectively. Most frequent EEG abnormality was seizure disorder (n=370, 59.39%), then febrile seizure (n= 94, 15.08%) and birth asphyxia with hypoxic-induced encephalopathy (n=68, 10.91%). Electroencephalogram showed significant epileptiform discharges in seizure disorder (p=0.001, OR= 2.26, 95 % CI= 1.61 to 3.18) and in cerebral palsy (p=0.049, OR=6.88, 95 % CI=0.89 to 145.95), specifically in 6 to 12 (p=0.001, OR=2.94, 95 % CI=1.43 to 6.06) and one to five (p=0.019) years, respectively. Electroencephalogram detected significantly less epileptiform discharges (p=0.001, OR=0.25, 95 % CI= 0.15 to 0.42) in febrile seizure specifically in 1 to 5 years (p=0.003, OR=0.16, 95 % CI= 0.04 to 0.63). Conclusion Predominant Electroencephalographic abnormality was seizure disorder, followed by febrile seizure and birth asphyxia with hypoxic-induced encephalopathy respectively. Electroencephalographic abnormality was highly associated with seizure disorder and cerebral palsy but was not associated with febrile seizure. DOI: http://dx.doi.org/10.3126/kumj.v11i2.12484 Kathmandu University Medical Journal Vol.11(2) 2013: 110-116

scholarly journals The Use of Milrinone Versus Conventional Treatment for the Management of Life-Threatening Bronchial Asthma

2019 ◽  
Vol 13 (1) ◽  
pp. 12-17 ◽  
Author(s):  
Amr Sobhy ◽  
Doaa M. K. Eldin ◽  
Hany V. Zaki
Keyword(s):  
Bronchial Asthma ◽  
Conventional Treatment ◽  
Controlled Trial ◽  
Blood Gases ◽  
Categorical Variables ◽  
Chi Square ◽  
Arterial Blood ◽  
Number Of Patients ◽  
Significant Difference ◽  
Life Threatening

Background and Aims: In our study, we investigated the effectiveness of intravenous milrinone in life-threatening bronchial asthma as compared to conventional treatment. Methods: Fifty patients aged 18-50 years, presenting with life-threatening asthma were enrolled in a Randomised Controlled Trial (RCT). They were randomly allocated into Group C (25 patients): who received the standard pharmacotherapy and placebo, and Group M (25 patients): who in addition to the standard therapy, received 25 μg milrinone as an initial slow IV bolus diluted in 10 ml of normal saline. The following data were recorded: PEFR (Peak Expiratory Flow Rate) expressed as a percentage of the patient’s previous value, Respiratory Rate (RR), MABP (Mean Arterial Blood Pressure), arterial blood gases, and the number of patients requiring mechanical ventilation. Differences between groups were tested using Analysis of Variance (ANOVA) for quantitative variables with post hoc using the Least Significant Difference (LSD) test, and Chi square test for categorical variables. Results: Group M showed marked improvement in PEFR that was highly significant (P < 0.001) 10 min after injection and significant after one hour from the start of treatment in comparison to Group C. There was also an improvement in RR and PO2 that was significant in group M. Milrinone was associated with a reduction in MABP only after 10 min from injection, and showed a statistically significant decrease in the number of patients requiring mechanical ventilator support (P ˂ 0.05). Conclusion: Milronine is a promising agent as a rescue drug in the treatment of life-threatening bronchial asthma.

scholarly journals The Relationship between Smoking and Sublingual Varices in the Elderly

2021 ◽  
Vol 36 (4) ◽  
pp. e288-e288
Author(s):  
Niusha Barzideh ◽  
Arezoo Alaee ◽  
Arash Azizi
Keyword(s):  
Older Adults ◽  
Cigarette Smoking ◽  
Elderly Patients ◽  
Varicose Veins ◽  
The Elderly ◽  
Control Group ◽  
Case Group ◽  
Chi Square ◽  
Number Of Patients ◽  
And Control

Objectives: We investigated the existence of any connection between smoking and sublingual varices (SLV) in the older population. Methods: This case-control study was conducted in 2019 on adults > 65 years old at Kahrizak Charity Nursing Home, Alborz, Iran. We conducted clinical examination and inspection of 222 elderly patients. Both the case group and control group contained the same number of patients (n = 111). SLV were classified as grade 0 (few or none visible) and grade 1 (moderate or severe). The case group included patients with SLV and the control group consisted of those older adults without SLV and who were matched with the case group based on age, gender, blood pressure, denture wearing, and varicose veins in their legs. Cigarette smoking habits were investigated in both groups. Smokers were considered those who smoked at least one cigarette per day for more than six months. Chi-square and odds ratio (OR) were used to statistically analyze the exposure of participants to smoking in both groups. Results: Among 222 participants, 21.6% and 5.4% were smokers in the case and control groups, respectively. The results of our data analysis revealed that SLV were significantly associated with smoking (p < 0.001, OR = 4). Conclusions: Elderly patients with SLV are more likely to be cigarette smokers. Therefore, cigarette smoking cessation programs are recommended for older adults in society.

scholarly journals An epidemiological study of socio-demographic characteristics and pattern of use of personal protective equipments amongst agricultural workers in rural India

2018 ◽  
Vol 5 (10) ◽  
pp. 4292
Author(s):  
Vijay Kumar Manwani
Keyword(s):  
Cross Sectional Study ◽  
Agricultural Workers ◽  
Sectional Study ◽  
Lower Socioeconomic Status ◽  
Chi Square ◽  
Cross Sectional ◽  
Protective Measures ◽  
Lower Socioeconomic ◽  
Number Of Patients ◽  
Demographic Distribution

Background: India being a country of agriculture, very little attention has been given to the occupational health problems of the agricultural workers; though the need of investigation and intervention towards their problems has repeatedly been mentioned. The objectives of the study were to find out the socio-demographic distribution of agricultural health hazards, to find out the personal protective measures being used by the agricultural workers and to give the necessary recommendations for the prevention of health hazards.Methods: It was a cross-sectional study conducted from September 2009 to December 2011. A pilot study was conducted on 50 patients. Data collection was done through asking questionnaire from the patients/relatives. Data was analyzed in the form of percentage (%) and presented in the tabular form. Chi- square (χ2) test was applied as a test of significance.Results: Out of total 926 cases maximum number of patients were males (549, 59.29%), followed by females (377, 40.71%). Majority of the respondents were primary educated (31.87%) followed by illiterate (29.48%). majority (44.60%) of the respondents belong to Class-IV (lower) socioeconomic status. Males (53.35%) were more addicted than females (10.26%). It was revealed that maximum number of the cases was not using (85.53%) PPE and only 14.47% were using any kind of PPE.Conclusions: Out of the total 926 cases, 549 (59.29%) were males, followed by females (377, 40.71%). Majority (63.61%) of the respondents have some kind of addiction. It was revealed that maximum number of the cases were not using (83.02%) any kind of PPE.

Visual Outcome after Microsurgical removal of Craniopharyngioma via Pterional Craniotomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Adnan Khaliq ◽  
Farooq Azam ◽  
Mumtaz Ali ◽  
Asadullah , ◽  
Akramullah , ◽  
...  
Keyword(s):  
Benign Tumor ◽  
Case Series ◽  
Visual Outcome ◽  
Bimodal Distribution ◽  
Visual Disturbance ◽  
Surgical Removal ◽  
Paired Data ◽  
Chi Square ◽  
Female Ratio ◽  
Number Of Patients

Background: Craniopharyngioma is a benign tumor of sellar & Suprasellar area with bimodal distribution. Visual disturbance isone of the common clinical presentation. Early surgical intervention results in favourable results.Objective: To analyze visual outcome after surgical removal of craniopharyngioma via pterional craniotomy.Material and Methods: This observational descriptive case series was conducted at department of neurosurgery,LRH/Peshawar. Duration of study was 18 months from Jan 2017 to June 2018. The study included patients withcraniopharyngioma, who underwent surgery in elective setup, newly diagnosed cases and patients operated via pterionalapproach. All those patients who presented in crisis like acute hydrocephalus, operated via other approaches and recurrent caseswere excluded from this study. The changes of visual function (visual acuity and field) of the patients were assessed preoperativelyand postoperatively, documented by a predesigned proforma and paired data of this change were compared. Visual assessmentwas done on follow up visits on 2 weeks,1 month,3 months and 6 months. Chi square test was applied as statistical test. Data wasanalysed through SPSS version 17.Results: Total number of patients were (30) with Male to female ratio was 1.5:1.Age of patients were Ranging from 4 year to 62years (mean 35 years).There were 23 Children (76.6%) and 7 Adults (23.3%).Out of 30 patients, 21 patients(70%) presented withvisual disturbance and 9 patients (30%) had non opthalmogical symptoms. Optic atrophy was seen in 6 patients (20%) preoperatively.Per operatively tumor was found in suprasellar area in 24 patients(80%) and in both supra+infrasellar area in 6patients(20%). Tumor size was less than 3cm in 19 patients(63.3%) and more than 3cm in 11 patients(36.6%). Morphology peroperatively was cystic in 19 patients(63.3%), solid in 5 patients(16.6%) and both solid and cystic in 6 patients(20%). Calcification intumor was seen in 16 patients(53.3%). Gross total resection(GTR) of tumor was done in only 21 patients(70%). Post-operativefollow up assessment of visual status showed that (50%) of patients improved.Conclusion: Craniopharyngioma is a benign tumor with malignant behaviour so timely intervention give favourable results.

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