scholarly journals Protecting brains and saving futures guidelines: A prospective, multicenter, and observational study on the use of telemedicine for neonatal neurocritical care in Brazil

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262581
Author(s):  
Gabriel Fernando Todeschi Variane ◽  
Maurício Magalhães ◽  
Rafaela Fabri Rodrigues Pietrobom ◽  
Alexandre Netto ◽  
Daniela Pereira Rodrigues ◽  
...  
Keyword(s):  
Observational Study ◽  
Clinical Outcomes ◽  
Neonatal Intensive Care ◽  
Near Infrared ◽  
Neurocritical Care ◽  
Length Of Hospital Stay ◽  
Primary Objective ◽  
Large Country ◽  
Link Type ◽  
Care Assessment

Background Management of high-risk newborns should involve the use of standardized protocols and training, continuous and specialized brain monitoring with electroencephalography (EEG), amplitude integrated EEG, Near Infrared Spectroscopy, and neuroimaging. Brazil is a large country with disparities in health care assessment and some neonatal intensive care units (NICUs) are not well structured with trained personnel able to provide adequate neurocritical care. To reduce this existing gap, an advanced telemedicine model of neurocritical care called Protecting Brains and Saving Futures (PBSF) Guidelines was developed and implemented in a group of Brazilian NICUs. Methods A prospective, multicenter, and observational study will be conducted in all 20 Brazilian NICUs using the PBSF Guidelines as standard-of-care. All infants treated accordingly to the guidelines during Dec 2021 to Nov 2024 will be eligible. Ethical approval was obtained from participating centers. The primary objective is to describe adherence to the PBSF Guidelines and clinical outcomes, by center and over a 3-year period. Adherence will be measured by quantification of neuromonitoring, neuroimaging exams, sub-specialties consultation, and clinical case discussions and videoconference meetings. Clinical outcomes of interest are detection of seizures during hospitalization, use of anticonvulsants, inotropes, and fluid resuscitation, death before hospital discharge, length of hospital stay, and referral of patients to specialized follow-up. Discussion The study will provide evaluation of PBSF Guidelines adherence and its impact on clinical outcomes. Thus, data from this large prospective, multicenter, and observational study will help determine whether neonatal neurocritical care via telemedicine can be effective. Ultimately, it may offer the necessary framework for larger scale implementation and development of research projects using remote neuromonitoring. Trial registration NCT03786497, Registered 26 December 2018, https://www.clinicaltrials.gov/ct2/show/NCT03786497?term=protecting+brains+and+saving+futures&draw=2&rank=1.

scholarly journals Epidemiological and clinical features of 291 cases with coronavirus disease 2019 in areas adjacent to Hubei, China: a double-center observational study

2020 ◽  
Author(s):  
Xu Chen ◽  
Fang Zheng ◽  
Yanhua Qing ◽  
Shuizi Ding ◽  
Danhui Yang ◽  
...  
Keyword(s):  
Observational Study ◽  
Clinical Outcomes ◽  
Clinical Characteristics ◽  
Imaging Finding ◽  
Length Of Hospital Stay ◽  
Ground Glass Opacity ◽  
Antibody Test ◽  
Critical Group ◽  
Hunan Province ◽  
Mycoplasma Pneumonia

AbstractBackgroundThe clinical outcomes of COVID-19 patients in Hubei and other areas are different. We aim to investigate the epidemiological and clinical characteristics of patient with COVID-19 in Hunan which is adjacent to Hubei.MethodsIn this double-center, observational study, we recruited all consecutive patients with laboratory confirmed COVID-19 from January 23 to February 14, 2020 in two designated hospitals in Hunan province, China. Epidemiological and clinical data from patients’ electronic medical records were collected and compared between mild, moderate and severe/critical group in detail. Clinical outcomes were followed up to February 20, 2020.Findings291 patients with COVID-19 were categorized into mild group (10.0%), moderate group (72.8%) and severe/critical group (17.2%). The median age of all patients was 46 years (49.8% were male). 86.6% patients had an indirect exposure history. The proportion of patients that had been to Wuhan in severe/critical group (48.0% vs 17.2%, p=0.006) and moderate group (43.4% vs 17.2%, p=0.007) were higher than mild group. Fever (68.7%), cough (60.5%), and fatigue (31.6%) were common symptoms especially for severe and critical patients. Typical lung imaging finding were bilateral and unilateral ground glass opacity or consolidation. Leukopenia, lymphopenia and eosinopenia occurred in 36.1%, 22.7% and 50.2% patients respectively. Increased fibrinogen was detected in 45 of 58 (77.6%) patients with available results. 29 of 44 (65.9%) or 22 of 40 (55.0%) patients were positive in Mycoplasma pneumonia or Chlamydia pneumonia antibody test respectively. Compared with mild or moderate group, severe/critical group had a relative higher level of neutrophil, Neutrophil-to-Lymphocyte Ratio, h-CRP, ESR, CK, CK–MB, LDH, D-dimer, and a lower level of lymphocyte, eosinophils, platelet, HDL and sodium (all p<0.01). Most patients received antiviral therapy and Chinese Medicine therapy. As of February 20, 2020, 159 (54.6%) patients were discharged and 2 (0.7%) patients died during hospitalization. The median length of hospital stay in discharged patients was 12 days (IQR: 10-15).InterpretationThe epidemiological and clinical characteristics of COVID-19 patients in Hunan is different from patients in Wuhan. The proportion of patients that had been to Wuhan in severe/critical group and moderate group were higher than mild group. Laboratory and imaging examination can assist in the diagnosis and classification of COVID-19 patients.

scholarly journals Optimising neonatal service provision for preterm babies born between 27 and 31 weeks gestation in England (OPTI-PREM), using national data, qualitative research and economic analysis: a study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029421
Author(s):  
Thillagavathie Pillay ◽  
Neena Modi ◽  
Oliver Rivero-Arias ◽  
Brad Manktelow ◽  
Sarah E Seaton ◽  
...  
Keyword(s):  
Neonatal Intensive Care ◽  
Clinical Decision Making ◽  
Point Of Care ◽  
Preterm Births ◽  
Clinical Decision ◽  
Primary Objective ◽  
Neonatal Unit ◽  
Advisory Panel ◽  
Research Database ◽  
Link Type

IntroductionIn England, for babies born at 23–26 weeks gestation, care in a neonatal intensive care unit (NICU) as opposed to a local neonatal unit (LNU) improves survival to discharge. This evidence is shaping neonatal health services. In contrast, there is no evidence to guide location of care for the next most vulnerable group (born at 27–31 weeks gestation) whose care is currently spread between 45 NICU and 84 LNU in England. This group represents 12% of preterm births in England and over onr-third of all neonatal unit care days. Compared with those born at 23–26 weeks gestation, they account for four times more admissions and twice as many National Health Service bed days/year.MethodsIn this mixed-methods study, our primary objective is to assess, for babies born at 27–31 weeks gestation and admitted to a neonatal unit in England, whether care in an NICU vs an LNU impacts on survival and key morbidities (up to age 1 year), at each gestational age in weeks. Routinely recorded data extracted from real-time, point-of-care patient management systems held in the National Neonatal Research Database, Hospital Episode Statistics and Office for National Statistics, for January 2014 to December 2018, will be analysed. Secondary objectives are to assess (1) whether differences in care provided, rather than a focus on LNU/NICU designation, drives gestation-specific outcomes, (2) where care is most cost-effective and (3) what parents’ and clinicians' perspectives are on place of care, and how these could guide clinical decision-making. Our findings will be used to develop recommendations, in collaboration with national bodies, to inform clinical practice, commissioning and policy-making. The project is supported by a parent advisory panel and a study steering committee.Ethics and disseminationResearch ethics approval has been obtained (IRAS 212304). Dissemination will be through publication of findings and development of recommendations for care.Trial registration numberNCT02994849 and ISRCTN74230187.

Urban energetics applications and Geomatic technologies in a Smart City perspective

2015 ◽  
Vol 6 (1) ◽  
pp. 19-29 ◽  
Author(s):  
G. Bitelli ◽  
P. Conte ◽  
T. Csoknyai ◽  
E. Mandanici
Keyword(s):  
Smart City ◽  
Laser Scanning ◽  
Near Infrared ◽  
Three Dimensional ◽  
Energy Sector ◽  
Primary Objective ◽  
Airborne Lidar ◽  
City Management ◽  
Urban Context ◽  
Research Areas

The management of an urban context in a Smart City perspective requires the development of innovative projects, with new applications in multidisciplinary research areas. They can be related to many aspects of city life and urban management: fuel consumption monitoring, energy efficiency issues, environment, social organization, traffic, urban transformations, etc. Geomatics, the modern discipline of gathering, storing, processing, and delivering digital spatially referenced information, can play a fundamental role in many of these areas, providing new efficient and productive methods for a precise mapping of different phenomena by traditional cartographic representation or by new methods of data visualization and manipulation (e.g. three-dimensional modelling, data fusion, etc.). The technologies involved are based on airborne or satellite remote sensing (in visible, near infrared, thermal bands), laser scanning, digital photogrammetry, satellite positioning and, first of all, appropriate sensor integration (online or offline). The aim of this work is to present and analyse some new opportunities offered by Geomatics technologies for a Smart City management, with a specific interest towards the energy sector related to buildings. Reducing consumption and CO2 emissions is a primary objective to be pursued for a sustainable development and, in this direction, an accurate knowledge of energy consumptions and waste for heating of single houses, blocks or districts is needed. A synoptic information regarding a city or a portion of a city can be acquired through sensors on board of airplanes or satellite platforms, operating in the thermal band. A problem to be investigated at the scale A problem to be investigated at the scale of the whole urban context is the Urban Heat Island (UHI), a phenomenon known and studied in the last decades. UHI is related not only to sensible heat released by anthropic activities, but also to land use variations and evapotranspiration reduction. The availability of thermal satellite sensors is fundamental to carry out multi-temporal studies in order to evaluate the dynamic behaviour of the UHI for a city. Working with a greater detail, districts or single buildings can be analysed by specifically designed airborne surveys. The activity has been recently carried out in the EnergyCity project, developed in the framework of the Central Europe programme established by UE. As demonstrated by the project, such data can be successfully integrated in a GIS storing all relevant data about buildings and energy supply, in order to create a powerful geospatial database for a Decision Support System assisting to reduce energy losses and CO2 emissions. Today, aerial thermal mapping could be furthermore integrated by terrestrial 3D surveys realized with Mobile Mapping Systems through multisensor platforms comprising thermal camera/s, laser scanning, GPS, inertial systems, etc. In this way the product can be a true 3D thermal model with good geometric properties, enlarging the possibilities in respect to conventional qualitative 2D images with simple colour palettes. Finally, some applications in the energy sector could benefit from the availability of a true 3D City Model, where the buildings are carefully described through three-dimensional elements. The processing of airborne LiDAR datasets for automated and semi-automated extraction of 3D buildings can provide such new generation of 3D city models.

Frequency and Severity of Chlorothiazide-Induced Hyponatremia in the Neonatal Intensive Care Unit

2021 ◽  
Author(s):  
Maura Harkin ◽  
Peter N. Johnson ◽  
Stephen B. Neely ◽  
Lauren White ◽  
Jamie L. Miller
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Serum Sodium ◽  
Neonatal Intensive Care ◽  
Primary Objective ◽  
Severe Hyponatremia ◽  
Days Of Therapy ◽  
Neonates And Infants ◽  
Sodium Supplementation

Objective Although thiazide diuretics are commonly used in the neonatal intensive care unit (NICU), the risk of thiazide-induced hyponatremia in infants has not been well documented. The primary objective of this study was to determine the frequency and severity of hyponatremia in neonates and infants receiving enteral chlorothiazide. Secondary objectives included identifying: (1) percent change in serum sodium from before chlorothiazide initiation to nadir, (2) time to reach nadir serum sodium concentration, and (3) percentage of patients on chlorothiazide receiving sodium supplementation. Study Design This was a retrospective cohort study of NICU patients admitted between July 1, 2014 and July 31, 2019 who received ≥1 dose of enteral chlorothiazide. Mild, moderate, and severe hyponatremia were defined as serum sodium of 130 to 134 mEq/L, 120 to 129 mEq/L, and less than 120 mEq/L, respectively. Data including serum electrolytes, chlorothiazide dosing, and sodium supplementation were collected for the first 2 weeks of therapy. Descriptive and inferential statistics were performed in SAS software, Version 9.4. Results One hundred and seven patients, receiving 127 chlorothiazide courses, were included. The median gestational age at birth and postmenstrual age at initiation were 26.0 and 35.9 weeks, respectively. The overall frequency of hyponatremia was 35.4% (45/127 courses). Mild, moderate, and severe hyponatremia were reported in 27 (21.3%), 16 (12.6%), and 2 (1.6%) courses. The median percent decrease in serum sodium from baseline to nadir was 2.9%, and the median time to nadir sodium was 5 days. Enteral sodium supplements were administered in 52 (40.9%) courses. Sixteen courses (12.6%) were discontinued within the first 14 days of therapy due to hyponatremia. Conclusion Hyponatremia occurred in over 35% of courses of enteral chlorothiazide in neonates and infants. Given the high frequency of hyponatremia, serum sodium should be monitored closely in infants receiving chlorothiazide. Providers should consider early initiation of sodium supplements if warranted. Key Points

scholarly journals TCT-372 The Impact of CHA2DS2-VASc and HAS-BLED Scores on Clinical Outcomes in the Amplatzer Amulet Observational Study

2019 ◽  
Vol 74 (13) ◽  
pp. B369
Author(s):  
Giuseppe Tarantini ◽  
Gianpiero D'Amico ◽  
Boris Schmidt ◽  
Patrizio Mazzone ◽  
Sergio Berti ◽  
...  
Keyword(s):  
Observational Study ◽  
Clinical Outcomes ◽  
The Impact

scholarly journals Effects of early corticosteroid use in patients with severe coronavirus disease 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong Hoon Hyun ◽  
Moo Hyun Kim ◽  
Yujin Sohn ◽  
Yunsuk Cho ◽  
Yae Jee Baek ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Corticosteroid Treatment ◽  
Threshold Value ◽  
Steroid Use ◽  
Corticosteroid Administration ◽  
Significant Difference ◽  
Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

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