scholarly journals Unmet need of essential treatments for critical illness in Malawi

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256361
Author(s):  
Raphael Kazidule Kayambankadzanja ◽  
Carl Otto Schell ◽  
Isaac Mbingwani ◽  
Samson Kwazizira Mndolo ◽  
Markus Castegren ◽  
...  
Keyword(s):  
Critical Illness ◽  
Low Cost ◽  
A Priori ◽  
Unmet Need ◽  
Vital Signs ◽  
Lateral Position ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Pharyngeal Airway ◽  
Conscious Level

Background Critical illness is common throughout the world and has been the focus of a dramatic increase in attention during the COVID-19 pandemic. Severely deranged vital signs such as hypoxia, hypotension and low conscious level can identify critical illness. These vital signs are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of such essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi. Methods We conducted a point prevalence cross-sectional study of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened. Patients with hypoxia (oxygen saturation <90%), hypotension (systolic blood pressure <90mmHg) and reduced conscious level (Glasgow Coma Scale <9) were included in the study. The a-priori defined essential treatments were oxygen therapy for hypoxia, intravenous fluid for hypotension and an action to protect the airway for reduced consciousness (placing the patient in the lateral position, insertion of an oro-pharyngeal airway or endo-tracheal tube or manual airway protection). Results Of the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%). Conclusion There was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.

scholarly journals Unmet need of essential treatments for critical illness in Malawi

2021 ◽  
Author(s):  
Raphael Kazidule Kayambankadzanja ◽  
Carl Otto Schell ◽  
Isaac Mbingwani ◽  
Samson Kwazizira Mndolo ◽  
Markus Castegren ◽  
...  
Keyword(s):  
Critical Illness ◽  
Low Cost ◽  
A Priori ◽  
Unmet Need ◽  
Vital Signs ◽  
Lateral Position ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Oropharyngeal Airway ◽  
Conscious Level

AbstractBackgroundCritical illness is common throughout the world and has been the focus of a dramatic increase in attention in the COVID-19 pandemic. Severely deranged vital signs can identify critical illness, are simple to check and treatments that aim to correct derangements are established, basic and low-cost. The aim of the study was to estimate the unmet need of essential treatments for severely deranged vital signs in all adults admitted to hospitals in Malawi.MethodsWe conducted a cross-sectional study with follow-up of adult hospitalized patients in Malawi. All in-patients aged ≥18 on single days Queen Elizabeth Central Hospital (QECH) and Chiradzulu District Hospital (CDH) were screened.. Patients with hypoxia (oxygen saturation <90%), hypotension (systolic blood pressure <90mmHg) and reduced conscious level (Glasgow Coma Score <9) were included in the study. The a-priori defined essential treatments were oxygen therapy for hypoxia, intravenous fluid for hypotension and an action to protect the airway for reduced consciousness (placing the patient in the lateral position, insertion of an oropharyngeal airway or endo-tracheal tube or manual airway protection).ResultsOf the 1135 hospital in-patients screened, 45 (4.0%) had hypoxia, 103 (9.1%) had hypotension, and 17 (1.5%) had a reduced conscious level. Of those with hypoxia, 40 were not receiving oxygen (88.9%). Of those with hypotension, 94 were not receiving intravenous fluids (91.3%). Of those with a reduced conscious level, nine were not receiving an action to protect the airway (53.0%).ConclusionThere was a large unmet need of essential treatments for critical illness in two hospitals in Malawi.

scholarly journals Socioeconomic determinants of unmet need for outpatient healthcare services in Iran: a national cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sajad Vahedi ◽  
Amin Torabipour ◽  
Amirhossein Takian ◽  
Saeed Mohammadpur ◽  
Alireza Olyaeemanesh ◽  
...  
Keyword(s):  
Health System ◽  
Age Groups ◽  
Unmet Need ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Outpatient Services ◽  
Self Medication ◽  
Cross Sectional ◽  
Organizational Policies ◽  
Utilization Of Healthcare

Abstract Background Unmet need is a critical indicator of access to healthcare services. Despite concrete evidence about unmet need in Iran’s health system, no recent evidence of this negative outcome is available. This study aimed to measure the subjective unmet need (SUN), the factors associated with it and various reasons behind it in Iran. Methods We used the data of 13,005 respondents over the age of 15 from the Iranian Utilization of Healthcare Services Survey in 2016. SUN was defined as citizens whose needs were not sought through formal healthcare services, while they did not show a history of self-medication. The reasons for SUN were categorized into availability, accessibility, responsibility and acceptability of the health system. The multivariable logistic regression was used to determine significant predictors of SUN and associated major reasons. Results About 17% of the respondents (N = 2217) had unmet need for outpatient services. Nearly 40% of the respondents chose only accessibility, 4% selected only availability, 78% chose only responsibility, and 13% selected only acceptability as the main reasons for their unmet need. Higher outpatient needs was the only factor that significantly increased SUN, responsibility-related SUN and acceptability-related SUN. Low education was associated with higher SUN and responsibility-related SUN, while it could also reduce acceptability-related SUN. While SUN and responsibility-related SUN were prevalent among lower economic quintiles, having a complementary insurance was associated with decreased SUN and responsibility-related SUN. The people with basic insurance had lower chances to face with responsibility-related SUN, while employed individuals were at risk to experience SUN. Although the middle-aged group had higher odds to experience SUN, the responsibility-related SUN were prevalent among elderly, while higher age groups had significant chance to be exposed to acceptability-related SUN. Conclusion It seems that Iran is still suffering from unmet need for outpatient services, most of which emerges from its health system performance. The majority of the unmet health needs could be addressed through improving financial as well as organizational policies. Special attention is needed to address the unmet need among individuals with poor health status.

scholarly journals Methodological quality of systematic reviews on treatments for depression: a cross-sectional study

2017 ◽  
Vol 27 (6) ◽  
pp. 619-627 ◽  
Author(s):  
V. C. H. Chung ◽  
X. Y. Wu ◽  
Y. Feng ◽  
R. S. T. Ho ◽  
S. Y. S. Wong ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Methodological Quality ◽  
A Priori ◽  
Cross Sectional Study ◽  
Risk Of Bias ◽  
Sectional Study ◽  
Pharmacological Treatments ◽  
Cross Sectional ◽  
Depression Treatments

Aims.Depression is one of the most common mental disorders and identifying effective treatment strategies is crucial for the control of depression. Well-conducted systematic reviews (SRs) and meta-analyses can provide the best evidence for supporting treatment decision-making. Nevertheless, the trustworthiness of conclusions can be limited by lack of methodological rigour. This study aims to assess the methodological quality of a representative sample of SRs on depression treatments.Methods.A cross-sectional study on the bibliographical and methodological characteristics of SRs published on depression treatments trials was conducted. Two electronic databases (the Cochrane Database of Systematic Reviews and the Database of Abstracts of Reviews of Effects) were searched for potential SRs. SRs with at least one meta-analysis on the effects of depression treatments were considered eligible. The methodological quality of included SRs was assessed using the validated AMSTAR (Assessing the Methodological Quality of Systematic Reviews) tool. The associations between bibliographical characteristics and scoring on AMSTAR items were analysed using logistic regression analysis.Results.A total of 358 SRs were included and appraised. Over half of included SRs (n = 195) focused on non-pharmacological treatments and harms were reported in 45.5% (n = 163) of all studies. Studies varied in methods and reporting practices: only 112 (31.3%) took the risk of bias among primary studies into account when formulating conclusions; 245 (68.4%) did not fully declare conflict of interests; 93 (26.0%) reported an ‘a priori’ design and 104 (29.1%) provided lists of both included and excluded studies. Results from regression analyses showed: more recent publications were more likely to report ‘a priori’ designs [adjusted odds ratio (AOR) 1.31, 95% confidence interval (CI) 1.09–1.57], to describe study characteristics fully (AOR 1.16, 95% CI 1.06–1.28), and to assess presence of publication bias (AOR 1.13, 95% CI 1.06–1.19), but were less likely to list both included and excluded studies (AOR 0.86, 95% CI 0.81–0.92). SRs published in journals with higher impact factor (AOR 1.14, 95% CI 1.04–1.25), completed by more review authors (AOR 1.12, 95% CI 1.01–1.24) and SRs on non-pharmacological treatments (AOR 1.62, 95% CI 1.01–2.59) were associated with better performance in publication bias assessment.Conclusion.The methodological quality of included SRs is disappointing. Future SRs should strive to improve rigour by considering of risk of bias when formulating conclusions, reporting conflict of interests and authors should explicitly describe harms. SR authors should also use appropriate methods to combine the results, prevent language and publication biases, and ensure timely updates.

28 Assessment of Pain and Provision of Non-Pharmacologic Analgesia to Children by Prehospital Providers in Southwestern Ontario: A Cross-Sectional Study

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e21-e21
Author(s):  
Karina Burke ◽  
Branka Vujcic ◽  
Jonathan Hamilton ◽  
Charlotte Mace ◽  
John Teefy ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Rating Scale ◽  
A Priori ◽  
Numeric Rating Scale ◽  
Cross Sectional Study ◽  
Subject Area ◽  
Stepwise Logistic Regression ◽  
Tertiary Referral Centre ◽  
Cross Sectional ◽  
Pain Scores

Abstract Primary Subject area Emergency Medicine - Paediatric Background There is abundant evidence that provision of pharmacologic analgesia by prehospital providers to children is suboptimal. Most paediatric calls are performed by primary care paramedics (PCPs) who are unable to administer pharmacologic analgesia to children but can administer non-pharmacologic therapies. Objectives Our objective was to describe the provision of non-pharmacologic analgesia to children by prehospital providers. Design/Methods We reviewed all ambulance call reports (ACRs) of children 0-17 years with acutely painful conditions (headache, abdominal pain, injury, head/ears/eyes/nose/throat pain, and back pain) who were transported to a paediatric tertiary referral centre serving a catchment of &gt; 1 million from 2017-2019. Data collection was recorded by two blinded assessors using a study-specific Excel™ sheet. The primary outcome was the proportion of children offered non-pharmacologic analgesia. We performed a stepwise logistic regression on the primary outcome using covariates defined a priori: age, sex, visible deformity, type of crew, complaint, pain score, call time, and prior analgesia. Results All 11,084 ACRs from January 1, 2017 to December 31, 2019 were reviewed. The sample included 5887/11084 (53.1%) males, ranging from 1 month to 17 years, with a mean (SD) age of 10.5 (5.6) years. Calls involved mainly PCPs [8576/11084 (77.4%)]. Non-trauma-related musculoskeletal injuries were most common, comprising 2743/11,084 (24.7%) of calls. Pain scores were documented in 6947/11084 (62.7%) of calls. The verbal numeric rating scale (0-10) was used in 5022/6947 (72.3%) of calls, with a mean (SD) score of 5.2 (3.2). Non-pharmacologic analgesia was provided in 2926/11084 (26.4%) of calls, most commonly splint (1115/2926, 38.1%) and ice (931/2926, 31.8%). Pharmacologic analgesia was provided in 458/11084 (4.1%) of calls. In the multivariate model, mild (OR: 3.2; 95% CI 2.3-4.4; p &lt; 0 .001) and moderate pain (OR: 1.7; 95% CI 1.3-2.2) (versus no pain) were significant predictors of non-pharmacologic analgesia, whereas visible deformity (OR: 0.5; 95% CI 0.3-0.6; p &lt; 0 .001) was a significant negative predictor. Conclusion The provision of non-pharmacologic analgesia to children in Southwestern Ontario by prehospital providers is suboptimal, despite moderate to severe pain. There is a clear need for education surrounding approaches to non-pharmacologic analgesia in children among prehospital providers.

A - 28 Mastering Concussion Reporting: Does Previous Injury and Education Play a Role in Reporting Skill?

2021 ◽  
Vol 36 (4) ◽  
pp. 668-668
Author(s):  
Tomczyk CP ◽  
Covassin T
Keyword(s):  
Linear Regression ◽  
A Priori ◽  
Collegiate Athletes ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Previous Injury ◽  
Demographic Questionnaire ◽  
Predictor Model ◽  
Study Participants ◽  
Score Range

Abstract Objective The purpose of this study was to determine whether previous injury (PI) and/or concussion education (ce) significantly predicted collegiate athlete reporting skill (RS). It was hypothesized that both PI and ce would be significant predictors of RS. Methods A cross-sectional study design was implemented, and collegiate athletes (n = 105; age = 19.77 ± 1.23; sex = 53% female) from two institutions were included in the study. Participants were administered a demographic questionnaire to determine PI and ce prior to enrollment, and the Reporting Skill Scale (5-items) was administered to measure RS. A composite score (range: 1–5) was calculated where higher values indicated greater RS. A stepwise multivariable linear regression was used to determine the predictive value of PI and ce on RS (a priori p &lt; 0.05). Results A high percentage of the sample reported PI (n = 52, 49%), received ce (n = 83, 78%), and had high levels of RS (4.27 ± 0.68). The stepwise multivariable linear regression generated a one predictor model where ce significantly predicted RS (F(1,105) = 4.804, p = 0.03, R2 = 0.05, β = 0.35, 90% CI [0.33, 0.67]), whereas PI did not significantly predict RS (p = 0.83, β = −0.22). Conclusions The study revealed that ce partially predicts RS in collegiate athletes. Although the predicted variance was small, this highlights that educating athletes on the steps needed to report an injury is better suited for influencing the psychomotor domain of concussion reporting than simply experiencing a PI. Determining an athlete’s RS, including the factors that influence it, can aid clinicians in identifying athletes that may not fully understand how to report a concussion following injury.

Giving when it costs

2017 ◽  
Vol 35 (5) ◽  
pp. 722-742 ◽  
Author(s):  
Lisa C. Day ◽  
Emily A. Impett
Keyword(s):  
Romantic Relationships ◽  
Low Cost ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Daily Experience ◽  
Self Construal ◽  
Interdependent Self ◽  
The Face ◽  
Willingness To Sacrifice

Do some people exhibit a greater willingness to sacrifice in romantic relationships and derive more satisfaction from doing so, even in the face of high costs? In a cross-sectional study and a daily experience study, we show that people low in interdependent self-construal were less willing to sacrifice when the costs were relatively high, whereas people high in interdependent self-construal were equally willing to make high- and low-cost sacrifices. Further, when people low in interdependent self-construal chose to sacrifice, they felt less authentic when the costs were high, which in turn, detracted from their satisfaction with sacrifice. In contrast, people high in interdependent self-construal did not feel less authentic and were buffered against feeling less satisfied when making more costly sacrifices. The findings identify a set of individuals who are more willing to sacrifice, even in the face of high costs, and who feel more satisfied and authentic when doing so.

scholarly journals Internet addiction among engineering students in Belagavi city: cross sectional study

2019 ◽  
Vol 6 (4) ◽  
pp. 1488
Author(s):  
Ravikiran Kamate ◽  
Sulakshna Baliga ◽  
M. D. Mallapur
Keyword(s):  
Internet Addiction ◽  
Internet Use ◽  
Engineering Students ◽  
Low Cost ◽  
Cross Sectional Study ◽  
Behavioral Pattern ◽  
Easy Access ◽  
The Internet ◽  
Sectional Study ◽  
Cross Sectional

Background: Internet addiction is not clinical diagnosis, but a potentially pathological behavioral pattern with symptoms: a loss of control over the behavior, preoccupation with the Internet, using the Internet to modify mood, and withdrawal symptoms. Easy access and low cost of Internet packs- are main cause of development of increased internet use in India. Internet addiction – factors like gender, environmental factors, socioeconomic status, etc. have effect on internet use.Methods: Cross-sectional study conducted during January 2016 to February 2016. Data was collected among 500 engineering students of four engineering colleges of Belagavi city using young's questionnaire. Analysis was performed using SPS 20. Chi-square applied as statistical test of significance for the association between age, sex, residence, SES and schooling. P<0.01 was considered to be statistically significant.Results: The present study revealed that 16.2 and 6.2% of participants had moderate and severe form of internet addiction respectively. With increase in age prevalence of addiction increased. Internet addiction was more among Males when compared to females. Addiction was seen more in students whose both parents were working.Conclusions: Internet addiction is an emerging form of addiction among students with males more than females mostly among engineering students who are dependent on internet for their work, carrier and completion of course Hence it's time to develop comprehensive intervention approach to promote healthy and safe internet use from family, college and peers.

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