Severe hypocalcemia and seizures after normalization of pCO2 in a patient with severe bronchopulmonary dysplasia and permissive hypercapnia

Abstract Objectives To describe the association between the rapid normalization of pCO2 after intubation in a patient with severe bronchopulmonary dysplasia managed with permissive hypercapnia, with the risk of developing hypocalcemia and seizures, and to make health care providers aware of this risk in similar cases. Case presentation An extreme premature infant, born at 25 weeks of gestational age (GA), developed a severe bronchopulmonary dysplasia (BPD) and, after several extubation failures could be managed with non-invasive ventilation and permissive hypercapnia, with capillary pCO2 of up to 80 mmHg and pH >7.20. At 46 postmenstrual age (PMA) he was intubated because of severe hypercapnia and compensating metabolic alkalosis. About 20 h after intubation, after normalization of pH and pCO2, he developed hypocalcemia and seizures, that remitted after iCa normalization. A comparison between arterial and capillary blood gases showed a significantly greater correlation between pH and iCa in arterial than in capillary samples. Conclusions Our findings emphasize the importance of avoiding the abrupt reduction of pCO2 and the close monitoring of acute metabolic changes after its correction in chronic patients with permissive hypercapnia, as well as the potential superiority of arterial samples over capillaries to improve the precision of this control.

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0907 Implementation Of Pathway For Severe Obstructive Sleep Apnea Management In Children

SLEEP ◽

10.1093/sleep/zsaa056.903 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A345-A345

Author(s):

S Gehring ◽

L Auricchio ◽

S Kidwell ◽

K Oppy ◽

S Smallwood ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Health Care Providers ◽

Therapeutic Option ◽

Sleep Medicine ◽

Close Monitoring ◽

Severe Obstructive Sleep Apnea ◽

Care Providers ◽

Oxygen Supplementation ◽

Obstructive Sleep

Abstract Introduction Obstructive Sleep Apnea (OSA) is associated with neuro-cognitive, cardiovascular and metabolic morbidity in children. Adeno-tonsillectomy is the first line of treatment for OSA with PAP therapy and Oxygen supplementation being alternative therapeutic options in select cases. Severe Obstructive Sleep Apnea is a known risk factor for postoperative respiratory complications after adenotonsillectomy. Therefore, inpatient adenotonsillectomy with close monitoring is recommended for this group of children. Challenges to safe and timely care for this high risk group of children can be overcome with effective coordination of care between different locations and health care providers. Methods All children seeking treatment at Dayton Children’s Division of Sleep Medicine were managed through a pathway developed by a multi-disciplinary team involving sleep medicine, otolaryngology and clinical logistics. Severe OSA was defined as AHI ≥15 events/hr (children <2 year old), AHI ≥15 events/hr with three or more Oxygen desaturations <80% (children ≥2 to <6 years old), AHI ≥ 30 events/hr with three or more Oxygen desaturations <80% (Children ≥6 to 18 years old). Results A total of 78 children were diagnosed with severe OSA in 2019. All children were successfully triaged to appropriate therapeutic option (Adenonotonsillectomy, PAP, O2) within 24 hours of diagnosis. Urgent adenotonsillectomy was performed on the same day in 4 children and within 2 weeks on 12 children. There was no postoperative respiratory complication after urgent adenotonsillectomy. Thirteen children had adenotonsillectomy after 2 weeks. PAP therapy was started in 28 children (34%). Therapy was initiated on the same day in 10 children and the next day on one child. Oxygen supplementation was started in 21 children (27%). Conclusion A multidisciplinary collaborative approach can result in delivery of timely and safe care for severe OSA in children. Support NA

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Health Care, Medical Education and National Medical Commission Bill

LAW REVIEW ◽

10.29320/jnpglr.38.1.3 ◽

2018 ◽

Vol 38 (1) ◽

Author(s):

Dr. R. K. Verma

Keyword(s):

Health Care ◽

Health Care Providers ◽

Medical Profession ◽

Care Providers ◽

Indian States ◽

National Medical ◽

Government Hospitals ◽

Make Health Care ◽

Care Development ◽

Medical Colleges

Health and health care development has not been a priority of the Indian States and it is a wellknown fact that all these facilities, policies and systems of healthcare are an eyewash and restricted to sheer papers. The worst aspect of this situation is that private medical colleges and institutions have become money making machine and in turn they take admissions of even the incompetent and unworthy students in consideration of inordinate fees and donations and as a result the doctors who get their degrees from these incompetent and unethical institutions are authorized to practice who are mostly inept, unskilled and unworthy thereby putting to risk lives of many of their patients. Over the years, the IMA and the MCI have been alleged to be deviating from its motto, thereafter doing little to control the rampant corruption in medical profession and medical colleges/government hospitals etc. Moreover, there is no transparency in their working or accountability for deeds. Medical care is not just a matter of accessibility and affordability but also quality as India prepares to fight the emerging problems of health care. To provide best health care at the lowest possible cost and make health care providers accountable for cost and quality, it is a high time for critical analysis regarding views and perspective of National Medical Commission Bill, 2017.

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The Measurements and an Elaborated Understanding of Chinese eHealth Literacy (C-eHEALS) in Chronic Patients in China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15071553 ◽

2018 ◽

Vol 15 (7) ◽

pp. 1553 ◽

Cited By ~ 16

Author(s):

Angela Chang ◽

Peter Schulz

Keyword(s):

Health Literacy ◽

Health Information ◽

Health Care Providers ◽

Computer Literacy ◽

Strong Association ◽

Care Providers ◽

Chronic Patients ◽

Online Questionnaire ◽

Ehealth Literacy ◽

Electronic Health

The rapid rise of Internet-based technologies to disseminate health information and services has been shown to enhance online health information acquisition. A Chinese version of the electronic health literacy scale (C-eHEALS) was developed to measure patients’ combined knowledge and perceived skills at finding and applying electronic health information to health problems. A valid sample of 352 interviewees responded to the online questionnaire, and their responses were analyzed. The C-eHEALS, by showing high internal consistency and predictive validity, is an effective screening tool for detecting levels of health literacy in clinical settings. Individuals’ sociodemographic status, perceived health status, and level of health literacy were identified for describing technology users’ characteristics. A strong association between eHealth literacy level, media information use, and computer literacy was found. The emphasis of face-to-face inquiry for obtaining health information was important in the low eHealth literacy group while Internet-based technologies crucially affected decision-making skills in the high eHealth literacy group. This information is timely because it implies that health care providers can use the C-eHEALS to screen eHealth literacy skills and empower patients with chronic diseases with online resources.

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Patient with a History of Active Substance Abuse Requesting Opioids for Chronic Pain

10.2310/pm.15051 ◽

2021 ◽

Author(s):

Alan D. Kaye ◽

Martin J Carney ◽

Mark R. Jones ◽

Harold J. Campbell ◽

Burton R. Beakley

Keyword(s):

Substance Abuse ◽

Chronic Pain ◽

Health Care Providers ◽

Active Substance ◽

Ethical Issues ◽

Clinical Manifestations ◽

Prescription Opioid ◽

Close Monitoring ◽

Care Providers ◽

History Of

Health care providers face a considerable challenge when treating chronic pain patients with prescription opioid medications. Although indications exist for the use of these drugs, their addictive nature and street value render them high-risk targets for abuse, misuse, and diversion. All patients receiving opioids should, therefore, be screened for abuse potential before beginning opioid therapy, be required to sign an opioid agreement, and receive close monitoring throughout the course of their treatment. Patients who present with a history of active substance abuse are at higher risk for iatrogenic dependence and necessitate more frequent monitoring. Herein arise several ethical issues, such as the principle of justice, which mediates equitable treatment for all patients. This review discusses the disease underlying substance abuse and clinical manifestations thereof, as well as relevant pathophysiology, ethical issues, and guidelines for the safe treatment with opioids. This review contains 3 tables and 43 references. Key Words: addiction, ethics, opioids, safety, substance abuse

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Management of perinatal HPP during critical illness/ECMO

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0187 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Neetu Krishnan ◽

Nancy Dunbar

Keyword(s):

Critical Illness ◽

Respiratory Distress ◽

Health Care Providers ◽

Influenza A ◽

Bone Mineralization ◽

Close Monitoring ◽

Care Providers ◽

Enzyme Replacement ◽

Life Saving ◽

Chest X Ray

Abstract Objectives With the advent of asfotase alfa, the enzyme replacement therapy (ERT) approved for hypophosphatasia (HPP), health care providers need to navigate management of ERT during critical illness. Case presentation We present the case of a young girl, treated with ERT for severe perinatal HPP, who had cardiorespiratory arrest in the setting of influenza A. Her life-saving treatment involving extra corporeal membrane oxygenation (ECMO) required a two-week interruption of ERT leading to persistent hypercalcemia and hyperphosphatemia. A three year old female presented with respiratory distress and blood tinged secretions. She was influenza A positive with bilateral opacities on chest X-ray (CXR). Worsening respiratory distress and bradycardic arrest required intubation, CPR and venoarterial ECMO cannulation. She remained on ECMO for 10 days with anticoagulation restrictions requiring her thrice-weekly subcutaneous ERT to be held. Hypercalcemia (12.3 mg/dL) and hyperphosphatemia (7.6 mg/dL) developed two weeks after restarting ERT and resolved six weeks later. Conclusions We highlight that the obligatory cessation of ERT while on ECMO led to the loss of functional TNSALP with a profound decrease in bone mineralization leading to excess circulating calcium and phosphorus. In cases where it is necessary to interrupt ERT, we advise close monitoring of calcium and phosphorous levels.

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Older Cancer Patients during the COVID-19 Epidemic: Practice Proposal of the International Geriatric Radiotherapy Group

Cancers ◽

10.3390/cancers12051287 ◽

2020 ◽

Vol 12 (5) ◽

pp. 1287 ◽

Cited By ~ 3

Author(s):

Nam P. Nguyen ◽

Vincent Vinh-Hung ◽

Brigitta G. Baumert ◽

Alice Zamagni ◽

Meritxell Arenas ◽

...

Keyword(s):

Health Care ◽

Clinical Trials ◽

Cancer Patients ◽

Social Services ◽

Health Care Providers ◽

Close Monitoring ◽

Care Providers ◽

Phone Calls ◽

Short Period ◽

Older Cancer Patients

The coronavirus disease 19 (COVID-19) pandemic is unprecedented as it reached all countries in the world within a record short period of time. Even though COVID-19 infection may be just severe in any adults, older adults (65-year-old or older) may experience a higher mortality rate. Among those affected, cancer patients may have a worse outcome compared to the general population because of their depressed immune status. As the health resources of most countries are limited, clinicians may face painful decisions about which patients to save if they require artificial ventilation. Cancer patients, especially the older ones, may be denied supportive care because of their shorter life expectancy. Thus, special considerations should be taken to prevent infection of older cancer patients and to provide them with adequate social support during their cancer treatment. The following proposal was reached: (1) Education of health care providers about the special needs of older cancer patients and their risks of infection. (2) Special consideration such as surgical masks and separate scheduling should be made to protect them from being infected. (3) Social services such as patient navigators should be provided to ensure adequate medical supply, food, and daily transportation to cancer centers. (4) Close monitoring through phone calls, telecommunication to ensure social distancing and psychological support from patient family to prevent anxiety and depression. (5) Shorter course of radiotherapy by use of hypofractionation where possible to decrease the needs for daily transportation and exposure to infection. (6) Enrollment of older cancer patients in clinical trials for potential antiviral medications if infection does occur. (7) Home health care telemedicine may be an effective strategy for older cancer patients with COVID-19 infection to avoid hospital admission when health care resources become restricted. (8) For selected patients, immunotherapy and targeted therapy may become the systemic therapy of choice for older cancer patients and need to be tested in clinical trials.

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Medication Adherence and the Role of Pictograms in Medication Counselling of Chronic Patients: a Review

Frontiers in Pharmacology ◽

10.3389/fphar.2021.582200 ◽

2021 ◽

Vol 12 ◽

Author(s):

Piotr Merks ◽

Jameason Cameron ◽

Krzysztof Bilmin ◽

Damian Świeczkowski ◽

Tomira Chmielewska-Ignatowicz ◽

...

Keyword(s):

Health Care ◽

Medication Adherence ◽

Health Care Providers ◽

Economic Status ◽

Care Providers ◽

Low Literacy ◽

Chronic Patients ◽

Improve Medication Adherence ◽

Related Information ◽

Medication Counselling

Pharmaceutical care requires a patient-centered approach, focusing on the ability of patients to understand drug-related information and follow the instructions delivered by pharmacists as well as other health-care providers included in the circle of care. With the goal of ensuring the prescribed use of medications, called medication adherence, health-care providers have to consider many risk factors such as geography (culture), social economic status, age, and low literacy that may predispose patients to non-adherence, and considerations have to be made for chronic patients living with life-long disease states. The aim of this review is to provide a balanced and comprehensive review outlining a number of different medication counselling and education approaches that have been used to try to improve medication adherence and health outcomes with the use of clear and concise graphic illustrations—called pictograms. By highlighting the current landscape of the general use and efficacy of pharmaceutical pictograms to aid in the knowledge and recall of drug-related information, as well as outlining specific medication adherence outcomes with pharmaceutical pictograms in chronic patients, the current review describes the need for health-care providers to move beyond the traditional didactic methods of oral and verbal communication with patients regarding medication-taking behavior.

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Assessment of Medication Adherence Among Diabetic Mellitus Patients in a Tertiary Care Hospital

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.4430 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 2124-2127

Author(s):

Kaavya S ◽

Srinivasan V

Keyword(s):

Medication Adherence ◽

Health Care Providers ◽

Tertiary Care ◽

Care Hospital ◽

Care Providers ◽

Diabetic Mellitus ◽

Chronic Patients ◽

Patient Counselling ◽

Medical College

Diabetic Mellitus is a commonly known disease referred to as diabetics, needs to follow medication consistently without a break to keep the blood sugar level in control. Consistent medication deals with a measure of how patients adhere to their medications and is done by health care providers. This is very important because it ensures that the patient follows the doctors order correctly and also ensure that the treatment is not just based on a therapeutic contract between doctor and patient. This monitoring is very high, with patients having serious problems with diabetics and is reported low for chronic patients. The aim of this study is to assess medication adherence in type 2 diabetes patients. The study was carried out at Saveetha Medical College. Data was collected using a standardized questionnaire. Data entered in MS Excel and analyzed using Weka 3.8.3 and results interpreted. The best way health professionals can tackle the adherence problem is through quality patient counselling, as done in this study.

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Etiology, Detection, Diagnosis, and Clinical Management of Gestational Diabetes Mellitus

Journal of Pharmacy Practice ◽

10.1177/089719009901200108 ◽

1999 ◽

Vol 12 (1) ◽

pp. 65-71

Author(s):

Beverly A. Sullivan ◽

Scott T. Henderson ◽

Julie M. Davis ◽

Martin B. Steffenson

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Health Care Providers ◽

Close Monitoring ◽

Care Providers ◽

Treatment Interventions ◽

Increased Risk ◽

Mother And Child

Healthy outcomes for both mother and child are expected and fortunately seen in most pregnancies. In some cases, serious or potentially serious problems arise during the pregnancy that mandate a need for both close monitoring and treatment interventions by health care providers. Gestational diabetes mellitus (GDM) is such a condition that may evolve during pregnancy. Women who experienced gestational diabetes during pregnancy are at increased risk of developing Type 2 diabetes as are their offspring. As defined, GDM is a type of diabetes restricted to pregnant women in whom the recognition of glucose intolerance first occurs during pregnancy.1 Physicians and pharmacists who are trained in the management of diabetes can help guide the patient with GDM through the pregnancy and after delivery, monitor her and the infant. This article reviews the current concepts pertaining to the basic pathophysiology, detection, diagnosis, and management of gestational diabetes mellitus.

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Perception of pregnant women on maternity care services at the Volta Regional Hospital, Ghana

International Journal of Community Medicine and Public Health ◽

10.18203/2394-6040.ijcmph20182602 ◽

2018 ◽

Vol 5 (7) ◽

pp. 2699 ◽

Cited By ~ 2

Author(s):

Kennedy Diema Konlan ◽

Joseph M. Kombat ◽

Milipaak Japiong ◽

Kennedy Dodam Konlan

Keyword(s):

Health Care ◽

Pregnant Women ◽

Sample Size ◽

Health Care Providers ◽

Maternity Care ◽

Sample Size Calculation ◽

The Body ◽

Close Monitoring ◽

Care Providers ◽

Care Services

Background: Maternity period is crucial and sensitive in the life of women due to various physiological changes that take place in the body during pregnancy and after. These changes need close monitoring to help optimize maternal and foetal health. This study explored pregnant women’s perceptions of maternity care services in the Volta Regional Hospital.Methods: Multiparous women (170) in the Ante Natal Clinic responded to a pretested questionnaire. The sample size was determined using Fischer’s formula for sample size calculation. Respondents were chosen using the convenient sampling method. The data was analysed using Statistical Package for Social Sciences version 20 in to descriptive statistics.Results: This study identified that women (42.5%) were never encouraged by health care providers to bring their partners during antenatal visits. Pregnant women (62.9%) reported that health care professionals did not allow their support persons including their husbands to be with them during labour. Women (34.1%) during labour were sometimes assaulted while 2.9% were always assaulted. Majority (74.2%) of the women received this five cardinal services that included vitamin K, eye care, cord care, bathing and immunization during the post natal period as 60.7% were introduced to family planning by midwives.Conclusions: Partner involvement in maternal health care needs to be encouraged by midwives to improve support from partners during pregnancy, labour and the post natal period. Support persons should be allowed to stay with women during labour to give the necessary support and encouragement and also take part in decision making concerning women’s care.

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