Variable Outcome in Quintuplets Pregnancy Based on Obstetric Care

The incidence of multiple pregnancies has increased dramatically over the last few years in developed countries, largely attributed to delayed childbearing and the increasing use of assisted reproduction technologies and ovulation inducing hormones. Relatively few countries have population-based statistics covering birth statistics. Of those that do, the numbers of quintuplet pregnancies rose sharply in the nineties while, at the same time, their delivery rates decreased greatly because of the use of fetal reduction. Fetal reduction is not possible or legal in some countries, Poland being one of them, and therefore obstetricians are faced with the challenges of quintuplet deliveries. Conservative treatment and management is difficult, and outcomes often vary greatly. Despite this, expert care provided at tertiary care centers can positively influence outcomes. The objective of this article is to present different care options and their consequences in two illustrative cases, as well as to establish a set of obstetric care and management goals that would allow prolongation of the gestation time. Quintuplet pregnancy is rare but poses relevant clinical problems to both the obstetrician and the neonatologist. It should be managed with close cooperation between all concerned. Due to the extreme and invariable risk of premature delivery associated with quintuplet pregnancies, we recommend early diagnosis, adequate prenatal care at one tertiary medical center, routine hospitalization and bed rest, repeated ante partum ultrasound surveillance with tests of fetal well-being, tocolytic therapy at first signs of the risk of premature labor, and specialized neonatology care after delivery.

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Institutional Audit of Pediatric and Adolescent Malignancy in Nepal

Nepalese Journal of Cancer ◽

10.3126/njc.v4i1.31847 ◽

2020 ◽

Vol 4 (1) ◽

pp. 78-83

Author(s):

Krishna Sagar Sharma ◽

Sabita Panthi ◽

Kishor Pradhananga ◽

Bhaktaman Shrestha

Keyword(s):

Geographical Distribution ◽

Cancer Registry ◽

Relative Frequency ◽

Bone Tumors ◽

Tertiary Care ◽

Developed Countries ◽

Population Based ◽

Pediatric Malignancy ◽

Pediatric Malignancies ◽

Childhood Malignancies

Background: There have been no records of the incidence of pediatric malignancy recorded in Nepal until recently. The aim of this study is to analyze the cases of pediatric malignancy reported in 2006 in order to find out the relative frequency and geographical distribution of childhood malignancy throughout Nepal. Methods: All the data for 2006 were collected from the Hospital-based Cancer Registry of Nepal (B P Koirala Memorial Cancer Hospital Registry Programme). All the cases included in the report were analyzed for geographical distribution, age, sex and relative frequency of the various types of childhood malignancies. The cancers were all classified according to the International Classification of Childhood Cancer (ICCC) and separated into 12 major groupings. Result: A total 343 children and adolescents from seven tertiary care hospitals located in the western, middle and eastern regions of Nepal were registered in the Hospital-based Cancer Registry Program of Nepal. A majority of the patients were from the eastern and mid-eastern regions. The others were from the western, far-western and mid-western regions. Very few of them were from the far-western and mid-western regions. The males had a higher reported rate of malignancies than the females, 60% vs. 40%. The adolescent population (13-19 years old) had 43% of the malignancies: a significant number. Leukemia (33%), lymphoma (18%) and bone tumors (13%) were the first, second and third most common cancers among the 12 groups. The number of reported cases has increased each year from 2003 to 2006. Discussion: The Hospital-based Cancer Registry was started in 2003. At that time not much attention was given during the collection of data to making note of the different variables. The incidence of pediatric malignancies has not been known till now. This study shows that the relative frequencies of pediatric malignancies and leukemiaare the same as in western countries. Knowledge of the national incidence is necessary in order to make proper policies for the treatment of children with cancer and for research in the field of pediatric oncology. Brain tumors are the second most common cancer in developed countries but in our study it is the fifth most common malignancy: 20% Vs 5%. We have a higher percentage of bone tumors 10% vs. 5% unlike other developed countries where population based registry data are available.

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Pregnancy Outcomes and Associated Factors for Uterine Rupture: An 8 Years Population-based Retrospective Study

10.21203/rs.3.rs-558866/v1 ◽

2021 ◽

Author(s):

Sheng Wan ◽

Mengnan Yang ◽

Jindan Pei ◽

Xiaobo Zhao ◽

Chenchen Zhou ◽

...

Keyword(s):

Retrospective Study ◽

Uterine Rupture ◽

Obstetric Care ◽

Developed Countries ◽

Population Based ◽

Fetal Heart Rate Monitoring ◽

Fetal Complications ◽

History Of ◽

Scarred Uterus ◽

Obstetrical Emergency

Abstract Background: Uterine rupture is an obstetrical emergency with serious undesired complications for laboring mothers resulting in fatal maternal and neonatal outcomes. The aim of this study was to assess the incidence of uterine rupture, its association with previous uterine surgery and vaginal birth after caesarean section (VBAC), and the maternal and perinatal implications. Methods: This is a population-based retrospective study. All pregnant women treated for ruptured uterus in one center between 2013 and 2020 were included. Their information retrieved from the medical records department were retrospectively reviewed.Results: A total of 209,112 deliveries were included and 41 cases of uterine rupture were identified. The incidence of uterine rupture was 1.96/10 000 births. 16 (39.0%) had maternal and fetal complications. There were no maternal deaths secondary to uterine rupture, while perinatal fatality related to uterine rupture was 7.3%. Among all case, 38 (92.7%) were scarred uterus and 3 (7.3%) were unscarred uterus. The most common cause of uterine rupture was previous cesarean section, while cases with a history of laparoscopic myomectomy were more likely to have serious adverse outcome. 24 (59%) of the ruptures occurred in anterior lower uterine segment. Fetal heart rate monitoring changes were the most reliable signs for rupture.Conclusions: Incidence of uterine rupture in the study area was consistent with developed countries. Further improvement in obstetric care and strong collaboration with referring health facilities was needed to ensure maternal and perinatal safety.

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Prevalence of Nosocomial Infection and Antibiotic Use at a University Medical Center in Malaysia

Infection Control and Hospital Epidemiology ◽

10.1086/502494 ◽

2005 ◽

Vol 26 (1) ◽

pp. 100-104 ◽

Cited By ~ 42

Author(s):

Andrew J. Hughes ◽

Norliza Ariffin ◽

Tan Lien Huat ◽

Habibah Abdul Molok ◽

Salbiah Hashim ◽

...

Keyword(s):

Nosocomial Infection ◽

Infection Control ◽

Medical Center ◽

Tertiary Care ◽

Bloodstream Infections ◽

Antibiotic Use ◽

Developed Countries ◽

High Rate ◽

Antibiotic Prescribing ◽

Tract Infections

AbstractBackground and Objective:Most reports of nosocomial infection (NI) prevalence have come from developed countries with established infection control programs. In developing countries, infection control is often not as well established due to lack of staff and resources. We exMnined the rate of N1 in our institution.Methods:A point-prevalence study of N1 and antibiotic prescribing was conducted. On July 16 and 17, 2001, all inpatients were surveyed for N1, risk factors, pathogens isolated, and antibiotics prescribed and their indication. NIs were diagnosed according to CDC criteria. Cost of antibiotic acquisition was calculated by treatment indication.Setting:Tertiary-care referral center in Malaysia.Patients:All inpatients during the time of the study.Results:Five hundred thirty-eight patients were surveyed. Seventy-five had 103 NIs for a prevalence of 13.9%. The most common NIs were urinary tract infections (12.29-6), pneumonia (21.4%), laboratory-confirmed bloodstream infections (12.2%), deep surgical wound infections (11.2%), and clinical sepsis (22.4%).Pseudomonas aeruginosa, MRSA, and MSSA were the most common pathogens. Two hundred thirty-seven patients were taking 347 courses of antibiotics, for an overall prevalence of antibiotic use of 44%. N1 treatment accounted for 36% of antibiotic courses prescribed but 47% of antibiotic cost. Cost of antibiotic acquisition for N1 treatment was estimated to be approximately 2 million per year (Malaysian dollars).Conclusion:Whereas the rate of N1 is relatively high at our center compared with rates from previous reports, antibiotic use is among the highest reported in any study of this kind. Further research into this high rate of antibiotic use is urgently required.

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An App Developed for Detecting Nurse Burnouts Using the Convolutional Neural Networks in Microsoft Excel: Population-Based Questionnaire Study (Preprint)

10.2196/preprints.16528 ◽

2019 ◽

Author(s):

Yi-Lien Lee ◽

Willy Chou ◽

Tsair-Wei Chien ◽

Po-Hsin Chou ◽

Yu-Tsen Yeh ◽

...

Keyword(s):

Predictive Accuracy ◽

Early Stage ◽

Medical Center ◽

Characteristic Curve ◽

Area Under The Curve ◽

Maslach Burnout Inventory ◽

Well Being ◽

Population Based ◽

Psychological Status ◽

Sensitivity Specificity

BACKGROUND Burnout (BO), a critical syndrome particularly for nurses in health care settings, substantially affects their physical and psychological status, the institute’s well-being, and indirectly, patient outcomes. However, objectively classifying BO levels has not been defined and noticed in the literature. OBJECTIVE The aim of this study is to build a model using the convolutional neural network (CNN) to develop an app for automatic detection and classification of nurse BO using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS) to help assess nurse BO at an earlier stage. METHODS We recruited 1002 nurses working in a medical center in Taiwan to complete the Chinese version of the 20-item MBI-HSS in August 2016. The k-mean and CNN were used as unsupervised and supervised learnings for dividing nurses into two classes (n=531 and n=471 of suspicious BO+ and BO−, respectively) and building a BO predictive model to estimate 38 parameters. Data were separated into training and testing sets in a proportion 70%:30%, and the former was used to predict the latter. We calculated the sensitivity, specificity, and receiver operating characteristic curve (area under the curve) across studies for comparison. An app predicting respondent BO was developed involving the model’s 38 estimated parameters for a website assessment. RESULTS We observed that (1) the 20-item model yields a higher accuracy rate (0.95) with an area under the curve of 0.97 (95% CI 0.94-0.95) based on the 1002 cases, (2) the scheme named matching personal response to adapt for the correct classification in model drives the prior model’s predictive accuracy at 100%, (3) the 700-case training set with 0.96 accuracy predicts the 302-case testing set reaching an accuracy of 0.91, and (4) an available MBI-HSS app for nurses predicting BO was successfully developed and demonstrated in this study. CONCLUSIONS The 20-item model with the 38 parameters estimated by using CNN for improving the accuracy of nurse BO has been particularly demonstrated in Excel (Microsoft Corp). An app developed for helping nurses to self-assess job BO at an early stage is required for application in the future.

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Exploring healthcare providers’ perceptions of mental health amid COVID-19 pandemic in obstetrics and gynaecology department of a tertiary care public sector hospital of Karachi, Pakistan: an exploratory qualitative study protocol

BMJ Open ◽

10.1136/bmjopen-2021-054010 ◽

2021 ◽

Vol 11 (12) ◽

pp. e054010

Author(s):

Haleema Yasmin ◽

Afreen Sadia ◽

Areesha Qamar ◽

Anam Shahil Feroz

Keyword(s):

Mental Health ◽

Public Sector ◽

Medical Center ◽

Tertiary Care ◽

Healthcare Providers ◽

Well Being ◽

Care Hospital ◽

Obstetrics And Gynaecology ◽

Study Results ◽

Qualitative Descriptive

IntroductionIn the wake of the unprecedented public health challenge of the COVID-19 pandemic, it is highly significant to recognise the mental health impact of this mounting threat on healthcare providers (HCPs) working in the obstetrics and gynaecology department. Experience from epidemics and emerging literature around COVID-19 show that the unparalleled amount of stress that HCPs are dealing with is linked with the increased burden of mental health conditions. We aim to conduct an exploratory qualitative descriptive study to assess HCPs’ perceptions of mental health amid the COVID-19 pandemic in the obstetrics and gynaecology department of a public sector tertiary care hospital of Karachi, Pakistan.Methods and analysisThis study will use a qualitative descriptive approach where approximately 20–25 HCPs from the obstetrics and gynaecology department will be recruited using a purposive sampling approach. Data will be collected through semistructured interviews and it will be analysed thematically using NVivo V.12 Plus software.Ethics and disseminationEthical approval for this study has been obtained from the Institutional Review Board Committee of Jinnah Postgraduate Medical Center hospital. The study results will be disseminated to the scientific community and the HCPs participating in the study. The findings will help us to explore the doctor’s perceptions of mental health during the current pandemic of COVID-19 and its impact on their daily lives and mental well-being.

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The Trend of Cleft Care at a Children’s Referral Center in Thailand

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620922103 ◽

2020 ◽

Vol 57 (9) ◽

pp. 1100-1104

Author(s):

Dhave Setabutr ◽

Thanakrit Sathavornmanee ◽

Polpatt Jitpakdee ◽

Songphon Nudchawong ◽

Penpak Krergmatukorn

Keyword(s):

Cleft Lip ◽

Medical Center ◽

Tertiary Care ◽

Developed Countries ◽

Senior Author ◽

Timing Of Surgery ◽

Referral Center ◽

Tertiary Care Medical Center ◽

Significant Difference ◽

The Impact

Objective: To investigate the trend in cleft care at a major children’s referral center in Bangkok, Thailand. Study Design: Retrospective chart review. Patients and Methods: A review of 129 patients under 18 years of age who had underwent care by the senior author for cleft treatment between January 2015 and October 2017 was done. The impact of varying factors on patient care was analyzed. We compare our demographics and treatment timeline to that of previously published literature in more developed countries. Setting: Tertiary care medical center. Results: One hundred and two patient charts were reviewed with 53% male patients. Most patients had both cleft lip and cleft palate, 44%. Cleft lips most commonly were complete and occurred on the left side. In all, 77.4% of clefts were nonsyndromic. On average, primary cleft lip surgery was delayed being performed about 11 months of age. Sixteen percent of patients were treated with an obturator, while 11 patients had nasoalveolar molding use. Hearing screenings occurred on average at around 6 months of age. Abnormal tympanograms were evident in 32% of individuals. There was a significant difference in timing of surgery for patients who lived a distance greater than 30 kilometers from the hospital versus those from the Bangkok metropolis ( P < .05). Conclusion: Reviewing data from a high-volume referral center in Thailand reveals mild variance with regard to cleft care timing compared to published literature from the developed world. Distance traveled was found to impact timing of surgery.

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SARS-CoV-2 Infection in Healthcare Personnel and Their Household Contacts at a Tertiary Academic Medical Center: Protocol for a Longitudinal Cohort Study (Preprint)

10.2196/preprints.25410 ◽

2020 ◽

Author(s):

Emily J Ciccone ◽

Paul N Zivich ◽

Evans K Lodge ◽

Deanna Zhu ◽

Elle Law ◽

...

Keyword(s):

Risk Factors ◽

Personal Protective Equipment ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Well Being ◽

Healthcare Personnel ◽

Protective Equipment ◽

Household Contacts ◽

Tertiary Care Medical Center

BACKGROUND Healthcare personnel are at high risk for exposure to the SARS-CoV-2 virus. While personal protective equipment may mitigate this risk, prospective data collection on its use and other risk factors for seroconversion in this population is needed. OBJECTIVE The primary objectives of this study are to (1) determine the incidence of and risk factors for SARS-CoV-2 infection among healthcare personnel at a tertiary medical center and (2) actively monitor personal protective equipment use, interactions between study participants via electronic sensors, secondary cases in households, and participant mental health and well-being. METHODS To achieve these objectives, we designed a prospective, observational study of SARS-CoV-2 infection among healthcare personnel and their household contacts at an academic tertiary care medical center. Enrolled healthcare personnel completed frequent surveys on symptoms and work activities and provided serum and nasal samples for SARS-CoV-2 testing every two weeks. Additionally, interactions between participants and their movement within the clinical environment were captured with a smartphone app and Bluetooth sensors. Finally, a subset of participants' households was randomly selected every two weeks for further investigation, and enrolled households provided serum and nasal samples via at-home collection kits. RESULTS As of September 30, 2020, 164 healthcare personnel and 33 household participants have been enrolled. Recruitment and follow-up are ongoing and expected to continue until March 2021. CONCLUSIONS Much remains to be learned regarding risk of SARS-CoV-2 infection among healthcare personnel and their household contacts. Through use of a multi-faceted study design enrolling a well-characterized cohort, we will collect critical information regarding SARS-CoV-2 transmission in the healthcare setting and its linkage to the community.

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A Retroprospective Study of an Antimicrobial Stewardship Program on Antimicrobial Utilization at a Tertiary Care Medical Center in Kolkata

International Journal of Pharmaceutical Sciences Review and Research ◽

10.47583/ijpsrr.2021.v70i02.013 ◽

2021 ◽

Vol 70 (2) ◽

Author(s):

Sujay Ranjan Deb ◽

Sourav Maiti ◽

Arpan Dutta Roy ◽

Prolay Paul ◽

Dipankar Maiti ◽

...

Keyword(s):

Medical Center ◽

Tertiary Care ◽

Cost Savings ◽

Population Based ◽

Defined Daily Dose ◽

Stewardship Program ◽

Tertiary Care Medical Center ◽

Antimicrobial Utilization ◽

Daily Dose ◽

Clinically Significant

The WHO has set Defined Daily Dose which represent the average daily dose of an antibiotic in a standard patient. The DDD mainly focuses on population-based parameters & assumes that patients as well as hospitals are homogenous entities. DOTs are very useful in order to classify antibiotic days based on patient-level exposure. DOTs merely mean the number of days that a patient is on an antibiotic, irrespective of dose. DOTs signifies that the underlying assumptions about antibiotic dosing was appropriate. Additionally, when patients receive more than one antibiotic, supplementary DOT may be counted. The 300-bed tertiary care medical center serves adults and paediatrics. An all-time Microbiology Consultant and a Clinical Pharmacology trainee used to go for round daily and used to collect data for ASP for the period of 3 months that is April to June,2021. In this study we have compared DOT of some important antibiotics for a specific period of time for both COVID and NON COVID patient. ASP-focused antibiotics were antibiotics routinely evaluated by the ASP team for appropriateness during therapy and the potential to optimize their appropriate use through policies, protocols, formulary restrictions, or clinician education. ASP-focused antibiotics included meropenem, linezolid, pip-taz, poly b, colistin, teicoplanin. In this study we have compared the DDD for 2 specific period of time for better understanding the consumption of those antibiotics. In conclusion, following the initiation of an ASP, significant decreases in utilization, increases in cost savings occurred. In our study we have reduced the consumption and DDD of linezolid which is clinically significant. When it comes to DOTs; We have reduced the DOTs of piptaz and teicoplanin for covid patient And Reduced the DOTs of meropenem and teicoplanin for noncovid patient which is clinically and statistically significant.

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Sheehan's syndrome in modern times: a nationwide retrospective study in Iceland

Acta Endocrinologica ◽

10.1530/eje-10-1004 ◽

2011 ◽

Vol 164 (3) ◽

pp. 349-354 ◽

Cited By ~ 19

Author(s):

Hallgerdur Lind Kristjansdottir ◽

Sigrun Perla Bodvarsdottir ◽

Helga Agusta Sigurjonsdottir

Keyword(s):

Clinical Presentation ◽

Correct Diagnosis ◽

Diagnostic Delay ◽

Obstetric Care ◽

Developed Countries ◽

Population Based ◽

Sheehan’S Syndrome ◽

Significance Level ◽

Modern Times ◽

Sheehan's Syndrome

Background and objectiveHalf a century ago the prevalence of Sheehan's syndrome (SS) was 10–20 per 100 000 women. With better obstetric help the prevalence is assumed to have decreased, especially in developed countries. The aim of this study is to estimate the prevalence of SS in modern times in Iceland.DesignWe studied the prevalence of SS in 2009 in a nationwide retrospective population-based study.MethodsAll patients with diagnosed SS were identified, and information regarding obstetric care, clinical presentation and hormonal assays was collected. Correlation was calculated with Kendall's tau-b. Significance level: P<0.05.ResultsEight women were identified with SS; thus, the prevalence of SS in 2009 was 5.1 per 100 000 women. The mean age at delivery and diagnosis was 33.0 and 36.6 respectively, resulting in a diagnostic delay (DD) of 1–240 months. Four women had low blood pressure during delivery, and five had massive blood loss (>1000 ml). Six had complicated deliveries. The most common clinical presentation was failure to lactate and failure to resume menstruation. The patients had three to five failing pituitary axis. There was no correlation between bleeding at delivery or the number of hormonal axes affected and DD.ConclusionThe prevalence of SS in Iceland was higher than we expected in a country with modern obstetric care. Long DD and incidental diagnosis indicate that women might be lacking correct diagnosis and treatment, and thus the prevalence of SS is even higher. As SS is easily diagnosed and treatable, but can be life-threatening if unrecognised, doctors need to be aware of the disease.

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An App Developed for Detecting Nurse Burnouts Using the Convolutional Neural Networks in Microsoft Excel: Population-Based Questionnaire Study

JMIR Medical Informatics ◽

10.2196/16528 ◽

2020 ◽

Vol 8 (5) ◽

pp. e16528 ◽

Cited By ~ 1

Author(s):

Yi-Lien Lee ◽

Willy Chou ◽

Tsair-Wei Chien ◽

Po-Hsin Chou ◽

Yu-Tsen Yeh ◽

...

Keyword(s):

Predictive Accuracy ◽

Early Stage ◽

Medical Center ◽

Characteristic Curve ◽

Area Under The Curve ◽

Maslach Burnout Inventory ◽

Well Being ◽

Population Based ◽

Psychological Status ◽

Sensitivity Specificity

Background Burnout (BO), a critical syndrome particularly for nurses in health care settings, substantially affects their physical and psychological status, the institute’s well-being, and indirectly, patient outcomes. However, objectively classifying BO levels has not been defined and noticed in the literature. Objective The aim of this study is to build a model using the convolutional neural network (CNN) to develop an app for automatic detection and classification of nurse BO using the Maslach Burnout Inventory–Human Services Survey (MBI-HSS) to help assess nurse BO at an earlier stage. Methods We recruited 1002 nurses working in a medical center in Taiwan to complete the Chinese version of the 20-item MBI-HSS in August 2016. The k-mean and CNN were used as unsupervised and supervised learnings for dividing nurses into two classes (n=531 and n=471 of suspicious BO+ and BO−, respectively) and building a BO predictive model to estimate 38 parameters. Data were separated into training and testing sets in a proportion 70%:30%, and the former was used to predict the latter. We calculated the sensitivity, specificity, and receiver operating characteristic curve (area under the curve) across studies for comparison. An app predicting respondent BO was developed involving the model’s 38 estimated parameters for a website assessment. Results We observed that (1) the 20-item model yields a higher accuracy rate (0.95) with an area under the curve of 0.97 (95% CI 0.94-0.95) based on the 1002 cases, (2) the scheme named matching personal response to adapt for the correct classification in model drives the prior model’s predictive accuracy at 100%, (3) the 700-case training set with 0.96 accuracy predicts the 302-case testing set reaching an accuracy of 0.91, and (4) an available MBI-HSS app for nurses predicting BO was successfully developed and demonstrated in this study. Conclusions The 20-item model with the 38 parameters estimated by using CNN for improving the accuracy of nurse BO has been particularly demonstrated in Excel (Microsoft Corp). An app developed for helping nurses to self-assess job BO at an early stage is required for application in the future.

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