scholarly journals Risk classification in a pediatric service: evaluation of the structure, process, and outcome

2022 ◽  
Vol 75 (1) ◽  
Author(s):  
Karynne Borges Cabral ◽  
Cristiane Chagas Teixeira ◽  
Julianna Malagoni Cavalcante Oliveira ◽  
Jacqueline Andreia Bernardes Leão Cordeiro ◽  
Keila Cristianne Trindade da Cruz ◽  
...  

ABSTRACT Objectives: to evaluate a pediatric risk evaluation and classification service in the aspects of structure, process, and outcome. Methods: a cross-sectional, descriptive, and exploratory study in which qualitative data complement the results. Data collection by non-participant observation, interview, and consultation of medical records. Results: we observed two hundred and four visits. The service works in a makeshift room and without privacy. The nurses did not use various materials/equipment available for evaluation, rarely performed a physical examination, used the interview most of the time, and did not consult the protocol. Parents/companions received no information, and medical records showed incomplete records. Nurses classified 69.1% of the children as non-emergency. The most frequent outcome of the visits was discharge. Conclusions: the service showed weaknesses in the physical structure, in the risk classification process, and the outcomes, but it presents a good resolution in the assistance. We recommend a revision in the protocol used and sensitize nurses about the work process and communication with parents/companions.

2018 ◽  
Vol 18 (4) ◽  
pp. 735-743
Author(s):  
Vanessa Dela Justina ◽  
Jéssica Silva Gonçalves ◽  
Flávia Lúcia David ◽  
Fernanda Regina Giachini ◽  
Victor Vitorino Lima

Abstract Objectives: to evaluate the drug prescriptions for pregnant women in the Legal Amazon during prenatal care. Methods: this is a pharmacoepidemiological, descriptive, retrospective and cross-sectional study. Medical records included sociodemographic variables, prenatal care, most frequent pharmacological classes prescribed, risk classification of drugs and possible drug-drug interactions among pregnant women. Results: a total of 159 records from pregnant women, enrolled in the Unified Health System were used. Most pregnant women began prenatal consultations in the first trimester of pregnancy (53.3%) whereas most of the drugs were prescribed in the second gestational trimester (55.5%). The most used pharmacological classes, classified according to the National List of Essential Drugs were: antianemic preparations (52.9%), vitamins (12.5%) and analgesic (10.6%). According to the risk classification, the highest prevalence of prescribed drugs belongs to category A (46.8%), followed by category C (28.9%), category B (20.0%) and category D (4.3%). Eight possible drug-drug interactions were found, being considered with mild severity, and six classified with moderate risk. Conclusions: the results demonstrate a lack of information regarding prescription drugs for pregnant women and this may endanger maternal and fetal health. It is essential that medical records be an effective therapeutic tool, which should be read, analyzed and reviewed in order to ensure effective and safe medical treatment.


Author(s):  
Y. Widyastuti Y. Widyastuti

  ABSTRACT [In advanced countries the number of permanent contraception option ( kontap ) approximately 10 % of all national family planning methods , while in Indonesia reached approximately 5.7 % . Based on data obtained from medical records Bhayangkara Hospital Palembang in 2010 the number of achievement when seen from the percentage of contraceptive use is only 9.10 % The purpose of this study is known age and parity relationship with the selection of contraceptive methods Surgery Women ( MOW ) in Palembang RS.Bhayangkara obstetrics clinic in 2012 . This study uses the analytic survey with cross sectional approach . The population in this study were women who become new acceptors were recorded in medical records at the hospital . Palembang Bhayangkara Hospitals January 1, 2012 to December 31 in 2012 . The sample in this study is part of a whole number of new acceptors ( either using contraception methods MOW and other family planning methods ) were registered in the hospital . Palembang Police Hospitals of January 1, 2012 to December 31 years of data 2012.Analisa univariate and bivariate statistical Chi - Square test with significance level α = 0.05 . The results showed there were 80 respondents ( 46.3 % ) who became MOW contraceptive acceptors , acceptors who have old age by 45 respondents ( 56.3 % ) and who has a young age by 35 respondents ( 43.8 % ) . acceptors which have high parity were 44 respondents ( 55 % ) who had low parity and a total of 36 respondents ( 45 % ) . From the results of Chi-square test value obtained ρ = 0.00 is smaller than α = 0.05 . There is a significant correlation between age and the selection of MOW Chi square test results obtained ρ value = 0.00 and there was a significant association between parity with the election MOW Chi square test results obtained ρ value = 0 , . From these results , it is expected to power health, especially family planning services at the hospital . Palembang Police Hospitals in order to improve the quality of family planning services in an effective, efficient , and safe are considered particularly suitable for users of contraception OperatingMethodWomen(MOW).                                      ABSTRAK Di negara sudah maju jumlah pilihan kontrasepsi mantap (kontap) sekitar 10% dari semua metode KB nasional, sedangkan di Indonesia baru mencapai sekitar 5,7 %. Berdasarkan data yang diperoleh dari Rekam medik  Rumah Sakit Bhayangkara Palembang tahun 2010 Jumlah pencapain tersebut jika dilihat dari persentasi penggunaan kontrasepsi MOW hanya  9,10% Tujuan penelitian ini adalah diketahuinya hubungan umur dan paritas dengan pemilihan alat kontrasepsi Metode Operasi Wanita (MOW) di poliklinik kebidanan RS.Bhayangkara Palembang Tahun 2012. Penelitian ini menggunakan metode survey analitik dengan pendekatan cross sectional. Populasi dalam penelitian ini adalah wanita yang menjadi akseptor KB Baru yang tercatat di rekam medik  di RS. Bhayangkara Palembang tanggal 1 januari 2012 sampai dengan 31 Desember  tahun 2012. Sampel dalam penelitian ini adalah sebagian dari seluruh jumlah akseptor KB Baru (baik yang menggunakan alat kontrasepsi Metode MOW maupun Metode KB lain) yang teregister di RS. Bhayangkara Palembang dari tanggal 1 januari 2012 sampai dengan 31 Desember  tahun 2012.Analisa data dilakukan secara univariat dan bivariat dengan uji statistik Chi-Square dengan tingkat kemaknaan α = 0,05. Hasil penelitian menunjukkan dari 80 responden terdapat (46,3%) yang menjadi akseptor kontrasepsi MOW, akseptor yang memiliki umur tua sebanyak 45 responden (56,3%) dan yang memiliki  umur muda sebanyak 35 responden (43,8%). akseptor yang memiliki paritas tinggi sebanyak 44 responden  (55%) dan yang memiliki  paritas rendah sebanyak 36 responden (45%). Dari hasil uji Chi square didapatkan ρ value = 0,00 lebih kecil dari α = 0,05. Ada hubungan yang bermakna antara umur dengan pemilihan MOW dari hasil uji Chi square didapatkan ρ value = 0,00 dan ada hubungan yang bermakna antara paritas dengan pemilihan MOW hasil uji Chi square didapatkan ρ value = 0,.Dari hasil penelitian ini, diharapkan kepada tenaga kesehatan khususnya pelayanan KB  di RS. Bhayangkara Palembang  agar dapat meningkatkan kualitas pelayanan KB secara efektif, efisien, dan aman yang dianggap cocok bagi penggunanya khususnya mengenai kontrasepsi Metode Operasi Wanita (MOW).    


2020 ◽  
Vol 2 (1) ◽  
pp. 53-59
Author(s):  
Josimara A. de Araújo Varela ◽  
Tatiana F.T. Palitot ◽  
Smyrna L.X. de Souza ◽  
Alidianne F.C. Cavalcanti ◽  
Alessandro L. Cavalcanti

Objective: This study aimed to analyze the presence of lesions in the skull and face and the associated factors in pedestrian victims of traffic accidents. Methods: A cross-sectional, descriptive-analytical study carried out through the analysis of medical records of pedestrian victims of traffic accidents in an emergency service in the city of Campina Grande, Brazil, during the year of 2016. Information was collected regarding gender, age group, day of the week, time of the accident, type of vehicle involved, presence of trauma to the skull and face, and outcomes. The Chi-square and Fisher's Exact tests were used, with a significance level of 5%. Results: A total of 1,884 medical records were evaluated, out of which 7.1% (n = 133) involved pedestrians. Men were the most frequent victims (68.4%), and victims of age 60 years old or over (30.5%) predominated. Almost one-third of the cases were recorded during the weekends (30.5%), and the most prevalent time was at night (52.7%). Regarding the type of vehicle involved, motorcycles predominated (47.4%). Head trauma was present in 37.6% of victims, while facial injuries corresponded to 8.2%. In 12% of cases, the victims died. The variables of gender, age group, occurrence on weekends, and trauma to the face showed a statistically significant association with the occurrence of traffic accidents (Chi-square test; p<0.05). Conclusion: Among pedestrian victims of traffic accidents, there is a predominance of men aged 65 years or over. Accidents are frequent at night, and motorcycles are the main vehicles involved. The presence of trauma to the skull and face regions is high.


Rheumatology ◽  
2021 ◽  
Vol 60 (Supplement_1) ◽  
Author(s):  
Chan Ning Lee ◽  
Mrinalini Dey ◽  
Mooikhin Hng ◽  
Simon Peterson ◽  
Imna Rahiman ◽  
...  

Abstract Background/Aims  Hydroxychloroquine (HCQ), a frequently-used therapy in rheumatology, can be associated with retinal toxicity. More stringent screening and monitoring guidelines for HCQ-related retinopathy were published by the Royal College of Ophthalmologists (RCOphth) in 2018. Recommendations include: 1) baseline retinal screening within six-twelve months of commencing HCQ; 2) subsequent annual monitoring for at-risk patients, specifically: concurrent tamoxifen-use, estimated glomerular filtration rate (eGFR) &lt;60ml/min/1.73m2, HCQ dose &gt;5mg/kg/day; 3) annual monitoring for all other patients after five years continuous treatment; 4) patient education on HCQ retinopathy. We quantified the rheumatology HCQ exposure and estimated burden on ophthalmology, to inform the development of HCQ retinal screening services. Methods  Cross-sectional data were extracted for patients established on HCQ between 1995-2020 including: weight; eGFR; concomitant retino-toxic medication; concomitant retinal pathology; HCQ dose and duration; documentation of patient education on retinal side-effects. Documentation of relevant ophthalmic testing at baseline (i.e. at time of starting HCQ) were recorded, specifically colour fundus photography, spectral domain optical coherence tomography (SD-OCT) and 10-2 Humphrey visual field (HVF) testing as necessary. Subsequent monitoring with 10-2 HVFs, SD-OCT, autofluorescence (AF) and electrodiagnostic tests (EDTs) as appropriate annually from baseline and from 5 years was recorded. Results  150 patients were included, 84% female, with a mean baseline age of 50.7 years (SD 14.8) and mean weight of 76.4kg (SD 17.6). 63% were on HCQ &gt;5 years (mean duration 7.0 years, SD 5.1). At time of auditing, 50% (75/150) patients had permanently ceased HCQ (62% due to treatment &gt;5 years). 60% patients had documented evidence of education regarding HCQ retinopathy. Of the 150 patients, 39% had baseline risks for retinopathy. 6% had a baseline eGFR &lt;60ml/min/1.73m2. 32% were commenced on HCQ dose greater than 5mg/kg/day. No patients were on concomitant tamoxifen; one patient was on a known retino-toxic drug (quinine). 4% of patients had pre-existing retinal pathology. Of the 75 patients still taking HCQ at time of auditing, 27 (36%) had baseline risk factors warranting yearly retinal screening and 44 (58%) had been on treatment &gt;5years. Most ophthalmology reviews were put on hold until a screening service was established. Of the small number (5.3%) that had baseline ophthalmic screening, 12.5% had colour photography and 75% had SD-OCT. No patients required HVF testing or EDTs. Annual screening revealed 50% of patients had 10-2 HVFs; 75% had SD-OCT; 75% had AF. Only one patient developed maculopathy, not attributed to HCQ. Conclusion  Our results demonstrate the need for service development to facilitate adherence to RCOphth guidance. Up to 40% of patients started on HCQ have baseline risks for retinopathy, most due to dosing &gt;5mg/kg/day warranting yearly screening. Our findings will inform development of a rheumatology HCQ retinal screening pathway and services, to ensure safe long-term use of HCQ. Disclosure  C. Lee*: None. M. Dey*: None. M. Hng: None. S. Peterson: None. I. Rahiman: None. M. Elshafei: None. C. Estrach: None. N.J. Goodson: None.


BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e040238
Author(s):  
Belayneh Kefale ◽  
Amien Ewunetei ◽  
Mulugeta Molla ◽  
Gobezie Temesgen Tegegne ◽  
Amsalu Degu

ObjectivesThis study aimed to assess the clinical pattern and predictors of stroke treatment outcomes among hospitalised patients in Felege Hiwot comprehensive specialised hospital (FHCSH) in northwest Ethiopia.DesignA retrospective cross-sectional study.SettingThe study was conducted medical ward of FHCSH.ParticipantsThe medical records of 597 adult patients who had a stroke were included in the study. All adult (≥18 years) patients who had a stroke had been admitted to the medical ward of FHSCH during 2015–2019 were included in the study. However, patients with incomplete medical records (ie, incomplete treatment regimen and the status of the patients after treatment) were excluded in the study.ResultsIn the present study, 317 (53.1%) were males, and the mean age of the study participants was 61.08±13.76 years. About two-thirds of patients (392, 65.7%) were diagnosed with ischaemic stroke. Regarding clinical pattern, about 203 (34.0%) of patients complained of right-side body weakness and the major comorbid condition identified was hypertension (216, 64.9%). Overall, 276 (46.2%) of them had poor treatment outcomes, and 101 (16.9%) of them died. Patients who cannot read and write (AOR=42.89, 95% CI 13.23 to 111.28, p<0.001), attend primary school (AOR=22.11, 95% CI 6.98 to 55.99, p<0.001) and secondary school (AOR=4.20, 95% CI 1.42 to 12.51, p<0.001), diagnosed with haemorrhagic stroke (AOR=2.68, 95% CI 1.62 to 4.43, p<0.001) and delayed hospital arrival more than 24 hours (AOR=2.92, 95% CI 1.83 to 4.66, p=0.001) were the independent predictors of poor treatment outcome.ConclusionsApproximately half of the patients who had a stroke had poor treatment outcomes. Ischaemic stroke was the most predominantly diagnosed stroke type. Education status, types of stroke and the median time from onset of symptoms to hospitalisation were the predictors of treatment outcome. Health education should be given to patients regarding clinical symptoms of stroke. In addition, local healthcare providers need to consider the above risk factors while managing stroke.


Author(s):  
Moon-Sook Kim ◽  
Hyun-Myung Jung ◽  
Hyo-Yeon Lee ◽  
Jinhyun Kim

The purpose of this study was to identify the risk factors of serious fall-related injuries by analyzing the differences between two fall groups: one with serious fall-related injuries and one without such injuries. Applying a retrospective, descriptive investigation study design, we analyzed the degree of fall-related injury and the risk factors related to serious falls by conducting a complete survey of the medical records of fall patients reported throughout one full year, 2017, at a tertiary hospital in Seoul, Korea. Among the patients with reported falls, 188 sustained no injury (63.1%), 72 sustained minor injury (24.2%), and 38 patients sustained serious injury (12.8%). The serious fall-related injuries included eight lacerations requiring suture (2.7%), 23 fractures (7.7%), five brain injuries (1.7%), and two deaths (0.7%). Analysis results indicated that taking anticoagulants/antiplatelet drugs (p = 0.016) and having a fall history (p = 0.038) were statistically significant in the differences between the group with serious injury related to falls and the group without serious injury. Logistic regression revealed that taking anticoagulant/antiplatelet drugs was the factor most significantly correlated with serious injuries related to falls (OR = 2.299, p = 0.022). Results show that it is necessary to develop a patient-tailored fall prevention activity program.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Alex F. Martin ◽  
Sarah Denford ◽  
Nicola Love ◽  
Derren Ready ◽  
Isabel Oliver ◽  
...  

Abstract Background In December 2020, Public Health England with NHS Test and Trace initiated a pilot study in which close contacts of people with confirmed COVID-19 were given the option to carryout lateral flow device antigen tests at home, as an alternative to self-isolation for 10–14 days. In this study, we evaluated engagement with daily testing, and assessed levels of adherence to the rules relating to behaviour following positive or negative test results. Methods We conducted a service evaluation of the pilot study, examining survey responses from a subset of those who responded to an evaluation questionnaire. We used an online cross-sectional survey offered to adult contacts of confirmed COVID-19 cases who consented to daily testing. We used a comparison group of contacts who were not offered testing and instead self-isolated. Results Acceptability of daily testing was lower among survey respondents who were not offered the option of testing and among people from ethnic minority groups. Overall, 52% of respondents reported being more likely to share details of people that they had been in contact with following a positive test result, if they knew that their contacts would be offered the option of daily testing. Only 2% reported that they would be less likely to provide details of their contacts. On the days that they were trying to self-isolate, 19% of participants reported that they left the house, with no significant group differences. Following a negative test, 13% of respondents reported that they increased their contacts, but most (58%) reported having fewer risky contacts. Conclusions Our data suggest that daily testing is potentially acceptable, may facilitate sharing contact details of close contacts among those who test positive for COVID-19, and promote adherence to self-isolation. A better understanding is needed of how to make this option more acceptable for all households. The impact of receiving a negative test on behaviour remains a risk that needs to be monitored and mitigated by appropriate messaging. Future research should examine attitudes and behaviour in a context where infection levels are lower, testing is more familiar, and restrictions on activity have been reduced.


Author(s):  
Muliana Edi ◽  
Yit Chin ◽  
Fui Woon ◽  
Geeta Appannah ◽  
Poh Lim ◽  
...  

Despite the advancement of the healthcare system, low birth weight (LBW) remains as one of the leading causes of under-five mortality. This cross-sectional study aimed to determine the prevalence of LBW and its associated factors among 483 third trimester pregnant women recruited from six selected public health clinics in the Federal Territory of Kuala Lumpur and the state of Selangor, Malaysia. Pregnant women were interviewed for information on socio-demographic characteristics, smoking behaviour, and second-hand smoke (SHS) exposure at home and in the workplace. Information on the obstetrical history and prenatal care visits history were retrieved from the maternal medical records, while infant’s birth outcomes were retrieved from infant medical records. The prevalence of LBW (<2.5 kg) in infants was 10.4%, with a mean birth weight of 3.0 [standard deviation (SD) 0.4] kg. Results from the multivariable logistic regression model showed that inadequate weight gained during pregnancy [odds ratio (OR) = 2.41, 95% confidence interval (CI) = 1.18–4.90] and exposure to SHS at home (OR = 1.92, 95% CI = 1.03–3.55) were significantly associated with LBW. In conclusion, pregnant women should monitor their rate of weight gain throughout pregnancy and avoid SHS exposure at home to reduce the risk of delivering LBW infants.


BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e016546 ◽  
Author(s):  
Jesus Maria Aranaz Andrés ◽  
Ramon Limón Ramírez ◽  
Carlos Aibar Remón ◽  
Maria Teresa Gea-Velázquez de Castro ◽  
Francisco Bolúmar ◽  
...  

BackgroundAdverse events (AEs) epidemiology is the first step to improve practice in the healthcare system. Usually, the preferred method used to estimate the magnitude of the problem is the retrospective cohort study design, with retrospective reviews of the medical records. However this data collection involves a sophisticated sampling plan, and a process of intensive review of sometimes very heavy and complex medical records. Cross-sectional survey is also a valid and feasible methodology to study AEs.ObjectivesThe aim of this study is to compare AEs detection using two different methodologies: cross-sectional versus retrospective cohort design.SettingSecondary and tertiary hospitals in five countries: Argentina, Colombia, Costa Rica, Mexico and Peru.ParticipantsThe IBEAS Study is a cross-sectional survey with a sample size of 11 379 patients. The retrospective cohort study was obtained from a 10% random sample proportional to hospital size from the entire IBEAS Study population.MethodsThis study compares the 1-day prevalence of the AEs obtained in the IBEAS Study with the incidence obtained through the retrospective cohort study.ResultsThe prevalence of patients with AEs was 10.47% (95% CI 9.90 to 11.03) (1191/11 379), while the cumulative incidence of the retrospective cohort study was 19.76% (95% CI 17.35% to 22.17%) (215/1088). In both studies the highest risk of suffering AEs was seen in Intensive Care Unit (ICU) patients. Comorbid patients and patients with medical devices showed higher risk.ConclusionThe retrospective cohort design, although requires more resources, allows to detect more AEs than the cross-sectional design.


Sign in / Sign up

Export Citation Format

Share Document