scholarly journals Neonatal Intra-Ventricular-Hemorrhage Prevention in Premature at < 30 Weeks Gestational Age

2021 ◽  
Author(s):  
Angela Hoyos ◽  
Pablo Vasquez-Hoyos
Keyword(s):  
Bivariate Analysis ◽  
Post Intervention ◽  
Multicenter Studies ◽  
Improvement Project ◽  
Vaginal Deliveries ◽  
Antenatal Steroid ◽  
High Incidence ◽  
Before And After ◽  
Prevention Project ◽  
Ventricular Hemorrhage

Introduction: Intraventricular Hemorrhage (IVH) is a devastating condition mostly in preterm infants at &lt; 30 weeks GA with large morbidities and mortality usually in the first 72 hours after birth. Prevention seems to be the only way to completely deal with this problem. The IVH prevention in this age group has been studied and includes some strategies such as prenatal corticosteroids, cesarean delivery, careful extraction among others, but still, it has an unacceptably high incidence in this population.Objective: To measure the application of a quality improvement project develop from the "Drive to Zero IVH Prevention Project" presented in a Epiclatino lecture in our unit.Material and method: We design a before and after observational study and measured the incidence of IVH before and after October 2017 when a minimum manipulation protocol was implemented at the Cl&iacute;nica del Country (CDC) unit. We also compare these findings to those of other units in the EpicLatino network. All patients born &lt;30 weeks GA with less than 2 days of age, who survived at least 3 days, and had a neuroimaging taken were included. We compared demographics, diagnosis, and frequency of IVH cases, before Nov 2017 and after from CDC and the from 2018-2019 EpicLatino registry using a bivariate analysis. Results: We collected data from 46 cases before, 40 after implementation, and 203 cases from the EpicLatino registry. Demographic characteristics were very similar in the post-intervention with few statistically significant differences in antenatal steroid use (97.5% post, 96% before and 79.3% Epilatino, p=0.016), prolonged rupture of membranes (15% post, 4% before and 15% EpicLatino, p &lt;0.001), vaginal deliveries (7.5% post, 10.9% before and 24.1% Epilatino, p=0.01), suspended chorioamnionitis (12.5% post, 6% before and 20.2% Epiclatino). We found a significant reduction in IVH after the protocol was implemented with only 5 (7.5%) cases post-intervention compared to 19 (29.4%) case before, and when compared to the 81 (39.1%) cases in the registry, p&lt; 0.001. Most of the cases that occurred in the post-intervention occurred before admission to the unit due to obstetric trauma.Discussion: If a well-controlled delivery minimizing obstetric trauma is achieved, a minimal manipulation protocol appears to significantly decrease the incidence of HIV. Controlled, multicenter studies are still required to confirm these findings.

scholarly journals Penyuluhan garam beryodium terhadap perubahan pengetahuan ibu rumah tangga dalam penggunaan garam yodium

2021 ◽  
Vol 2 (2) ◽  
pp. 178
Author(s):  
Nurhayati Nurhayati ◽  
Irwan Irwan ◽  
Ampera Miko
Keyword(s):  
Iodized Salt ◽  
Primary Data ◽  
Bivariate Analysis ◽  
A Value ◽  
High Incidence ◽  
Before And After ◽  
Post Test ◽  
Quasi Experimental ◽  
Level Of Knowledge ◽  
Food And Drink

Background: Disorders Due to Iodine Deficiency (IDD) is one of the main nutritional problems that cannot be eliminated due to an environment that is poor in iodine sources. Residents who live in areas with an iodine deficit and only consume available food and drink. Lack of knowledge about the causes of IDD is the driving force for the high incidence of health problems.Objectives: This study aims to determine whether there is an effect before and after the counseling is carried out on changes in the knowledge of housewives and the use of iodized salt.Methods: This type of research is a quasi-experimental research with pre-test and post-test. This research was conducted in Trienggadeng District, Pidie Jaya Regency, which was conducted in 2019. The sample size in this study was the entire population as a sample, namely all 39 housewives. Data collection includes primary data and maternal data. Data processing in this study with 4 stages, including stages namely; editing, coding, entry, processing, and cleaning data. Data analysis was carried out univariate and bivariate. The statistical test for bivariate analysis was using the T-dependent statistical test.Results: The results showed that the level of knowledge and use of iodized salt in housewives in Trienggadeng District, Pidie Jaya Regency. There is an effect of counseling the benefits of iodized salt before and after on increasing the knowledge of housewives, with a value of p = 0.001 (p < 0.05). There is an effect of counseling the benefits of iodized salt between before and after the use of iodized salt to housewives, with a value of p = 0.000 (p < 0.05). Conclusion: There is the influence of education on the benefits of iodized salt to increase knowledge of housewives, but it is also significant in household use.

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p&lt; 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

scholarly journals Daily Bathing with Chlorhexidine-Based Soap and the Prevention of Staphylococcus aureus Transmission and Infection

2014 ◽  
Vol 35 (3) ◽  
pp. 243-250 ◽  
Author(s):  
Melissa A. Viray ◽  
James C. Morley ◽  
Craig M. Coopersmith ◽  
Marin H. Kollef ◽  
Victoria J. Fraser ◽  
...  
Keyword(s):  
At Risk ◽  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Control Unit ◽  
Post Intervention ◽  
Icu Patients ◽  
Chlorhexidine Bathing ◽  
Before And After ◽  
Surgical Icu ◽  
Time Series Methodology

Objective.Determine whether daily bathing with chlorhexidine-based soap decreased methicillin-resistant Staphylococcus aureus (MRSA) transmission and intensive care unit (ICU)-acquired S. aureus infection among ICU patients.Design.Prospective pre-post-intervention study with control unit.Setting.A 1,250-bed tertiary care teaching hospital.Patients.Medical and surgical ICU patients.Methods.Active surveillance for MRSA colonization was performed in both ICUs. In June 2005, a chlorhexidine bathing protocol was implemented in the surgical ICU. Changes in S. aureus transmission and infection rate before and after implementation were analyzed using time-series methodology.Results.The intervention unit had a 20.68% decrease in MRSA acquisition after institution of the bathing protocol (12.64 cases per 1,000 patient-days at risk before the intervention vs 10.03 cases per 1,000 patient-days at risk after the intervention; β, −2.62 [95% confidence interval (CI), −5.19 to −0.04]; P = .046). There was no significant change in MRSA acquisition in the control ICU during the study period (10.97 cases per 1,000 patient-days at risk before June 2005 vs 11.33 cases per 1,000 patient-days at risk after June 2005; β, −11.10 [95% CI, −37.40 to 15.19]; P = .40). There was a 20.77% decrease in all S. aureus (including MRSA) acquisition in the intervention ICU from 2002 through 2007 (19.73 cases per 1,000 patient-days at risk before the intervention to 15.63 cases per 1,000 patient-days at risk after the intervention [95% CI, −7.25 to −0.95]; P = .012)]. The incidence of ICU-acquired MRSA infections decreased by 41.37% in the intervention ICU (1.96 infections per 1,000 patient-days at risk before the intervention vs 1.15 infections per 1,000 patient-days at risk after the intervention; P = .001).Conclusions.Institution of daily chlorhexidine bathing in an ICU resulted in a decrease in the transmission of S. aureus, including MRSA. These data support the use of routine daily chlorhexidine baths to decrease rates of S. aureus transmission and infection.

Implementation of a Nurse-Driven Burn Resuscitation Protocol: A Quality Improvement Project

2013 ◽  
Vol 33 (1) ◽  
pp. 25-35 ◽  
Author(s):  
Kyra Fahlstrom ◽  
Cameron Boyle ◽  
Mary Beth Flynn Makic
Keyword(s):  
Serum Level ◽  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Distress Syndrome ◽  
Venous Pressure ◽  
Improvement Project ◽  
Fluid Status ◽  
Before And After ◽  
Abdominal Compartment ◽  
Burn Resuscitation

Background Burn resuscitation, including titration of fluids and administration of colloids, is often driven by physicians’ orders. Inconsistencies in burn resuscitation cause overresuscitation, which has adverse consequences. Methods Retrospective chart reviews were completed to evaluate fluid resuscitation and complications for 12 months before and after development and implementation of a nurse-driven burn resuscitation protocol. Results Before implementation of the protocol, results at 24 hours after injury indicated that 58% of patients were overresuscitated, had a serum level of lactate of at least 2 mmol/L (100%), and had complications (pulmonary edema 20%, abdominal compartment syndrome 7%, acute lung injury/acute respiratory distress syndrome 30%) within the first 5 days. Two outcomes differed from before to after implementation of the protocol: serum level of lactate at 24 hours (t37.8 =2.38, P =.007) and central venous pressure at 48 hours (t31 =2.27, P =.03). After implementation of the protocol, no patients had abdominal compartment syndrome develop. Conclusions Implementation of the nurse-driven burn resuscitation protocol improved nurses’ awareness and assessment of fluid status during resuscitation and improved patients’ outcomes.

scholarly journals Impact of a blended curriculum on nursing handover quality: a quality improvement project

2021 ◽  
Vol 10 (1) ◽  
pp. e001024
Author(s):  
Xavier Losfeld ◽  
Laure Istas ◽  
Quentin Schoonvaere ◽  
Michel Vergnion ◽  
Jochen Bergs
Keyword(s):  
Educational Intervention ◽  
Patient Information ◽  
Professional Communication ◽  
Fit Indices ◽  
Negative Consequences ◽  
Improvement Project ◽  
Face To Face ◽  
Before And After ◽  
Post Test ◽  
E Learning

Context and objectiveThe negative consequences of inadequate nursing handovers on patient safety are widely acknowledged, both within the literature as in practice. Evidence regarding strategies to improve nursing handover is, however, lacking. This study investigates the effect of a tailored, blended curriculum on nurses’ perception of handover quality.MethodsWe used a pre-test/post-test design within four units of a Belgian general hospital. Our educational intervention consisted of an e-learning module on professional communication and a face-to-face session on the use of a structured method for handovers. All nurses completed this blended curriculum (n=87). We used the Handover Evaluation Scale (HES) to evaluate nurses’ perception of handover quality before and after the intervention. The HES was answered by 87.4% of the nurses (n=76 of 87) before and 50.6% (n=44 of 87) after the intervention. Confirmatory factor analysis was used to assess the validity of the HES.ResultsThe original factor structure did not fit with our data. We identified a new HES structure with acceptable or good fit indices. The overall internal consistency of our HES structure was considered adequate. Perception of nurses on Relevance of information showed a significant improvement (M=53.19±4.33 vs M=61.03±6.01; p=0.04). Nurses also felt that the timely provision of patient information improved significantly (M=4.50±0.34 vs M=5.16±0.40; p=0.01).ConclusionThe applied intervention resulted in an improved awareness on the importance of Relevance of information during handovers. After our intervention, the nurses’ perception of the HES item ‘Patient information is provided in a timely manner’ also improved significantly. We are aware that the educational intervention is only the first step to achieve the long-term implementation of a culture of professional communication based on mutual support.

System intervention in community pharmacy setting: Leading to better patient care through reducing harm associated with coprescribing benzodiazepines and opioids

2021 ◽  
Vol 17 (6) ◽  
pp. 445-453
Author(s):  
Angelina Vascimini, PharmD ◽  
Kevin Duane, PharmD ◽  
Stacey Curtis, PharmD
Keyword(s):  
Chart Review ◽  
Primary Outcome ◽  
Community Pharmacists ◽  
Retrospective Chart Review ◽  
Secondary Outcome ◽  
Post Intervention ◽  
Improvement Project ◽  
System Intervention ◽  
Secondary Outcomes ◽  
Pharmacy Setting

Objective: The opioid epidemic is frequently discussed including the staggering numbers involved with coprescribing opioids and benzodiazepines associated with death. Community pharmacists, with the help of a system intervention, have a unique opportunity to help reduce the coprescribing of benzodiazepines and opioids and reduce the associated risk of death.Design: A single center retrospective chart review was conducted after a system intervention was placed, as a quality improvement project, from November 2019 to May 2020.Setting: Independent community pharmacy.Patients/participants: Data included demographics, dosing of each medication pre- and post-intervention, and naloxone status.Main outcome(s) measures: The primary outcome evaluated was reduction in dose/discontinuation of these prescriptions. The secondary outcome evaluated was the number of naloxone prescriptions ordered per protocol and picked up.Results: The primary outcome did not show statistical difference; however, the secondary outcomes showed statistical significance.Conclusion: In conclusion, community pharmacists, with the help of evolving technologies, can reduce harm associated with the coprescribing of benzodiazepines and opioids.

Influence Counseling with Smart Calendar Media (Kalpin) to Knowledge and Attitude of Pregnant Women about First 1000 Days of Life

2019 ◽  
Vol 1 (1) ◽  
pp. 11-15
Author(s):  
Yanik Muyassaroh ◽  
Ana Afifah
Keyword(s):  
Pregnant Women ◽  
Bivariate Analysis ◽  
Control Group ◽  
Nutrition Counseling ◽  
Lecture Method ◽  
Before And After ◽  
Post Test ◽  
Good Nutrition ◽  
Knowledge And Attitude ◽  
Analytic Design

Malnutrition in pregnant women has an impact on the health of the next generation. Therefore, nutrition counseling first 1000 days of life needs to be given. Good nutrition during the period of 1000 days starting from early pregnancy until the child’s second birthday. This study aims to determine the effect of counseling with “Kalpin” or Smart Calendar on knowledge and attitude of pregnant women about the first 1000 days of life. This type of research is a comparative analytic design with pre-test and post-test control group. Nutrition counseling activities carried out by the lecture method using a smart calendar. Measurement of knowledge and attitude of pregnant women perfomed twice: before and after the extension granted. Analysis of the data used were bivariate analysis test Independent T-Test and Mann Whitney. The result shows influence of counseling about first 1000 days of life with Kalpin to knowledge (p = 0,000) and attitude of pregnant woman (p = 0,000) about first 1000 days of life. For health service can be a new input in efforts to improve the quality of service with realization the Program Healthy Indonesia that include first 1000 days of life.

Needle-free connectors to prevent central venous catheter occlusion at a tertiary cardiac center: A prospective before and after intervention study

2021 ◽  
pp. 112972982110396
Author(s):  
Andrea Sansalone ◽  
Raffaello Vicari ◽  
Fabio Orlando ◽  
Alessandro Dell’Avo ◽  
Silvia Giuffrida ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Intervention Study ◽  
Absolute Risk ◽  
Phase 1 ◽  
Venous Catheter ◽  
Care Staff ◽  
Infusion Therapy ◽  
Central Venous ◽  
Post Intervention ◽  
Before And After

Objectives: To evaluate the effectiveness of needle-free connectors to maintain Central Venous Catheter—CVC patency. Background: Loss of patency is a common complication associated with CVC. For patients, this can be stressful and painful, and can result in a delay in infusion therapy. Pressure-activated anti-reflux needle-free connectors are one of the most modern devices; however, no studies have compared this connector with the open-system three-way stopcock in terms of the incidence of CVC occlusion. Methods: This study is a prospective before and after intervention study. From March to August 2018, an observation phase was conducted with the three-way stopcock as the standard central venous catheter hub and closure system (phase 1). After implementation of needle-free connectors (phase 2), post-intervention observations were made from September 2019 to January 2020 (phase 3). Results: Of 199 CVCs analyzed, 41.2% (40/97) occluded in at least one lumen in the first phase, and 13.7% (14/102) occluded after introducing the technological device, absolute risk reduction 27.5% (95% confidence interval 15.6%–39.4%). The lumens supported by needle-free connectors showed a higher probability of maintaining patency compared with three-way stopcocks. No differences were observed in the rate of infection. Conclusions: Pressure-activated anti-reflux needle-free connectors are effective and safe devices suitable for the management of vascular access in cardiac patient care. Staff training, even on apparently simple devices, is essential to avoid the risk of infection.

scholarly journals Rhetorical, Metacognitive, and Cognitive Strategies in Teacher Candidates’ Essay Writing

2017 ◽  
Vol 19 (2) ◽  
pp. 87-100
Author(s):  
Claudio Díaz Larenas ◽  
Lucía Ramos Leiva ◽  
Mabel Ortiz Navarrete
Keyword(s):  
Foreign Language ◽  
Teacher Candidates ◽  
Cognitive Strategies ◽  
Think Aloud ◽  
Writing Intervention ◽  
Writing Program ◽  
Post Intervention ◽  
Essay Writing ◽  
Think Aloud Protocols ◽  
Before And After

This paper reports on a study about the rhetoric, metacognitive, and cognitive strategies pre-service teachers use before and after a process-based writing intervention when completing an argumentative essay. The data were collected through two think-aloud protocols while 21 Chilean English as a foreign language pre-service teachers completed an essay task. The findings show that strategies such as summarizing, reaffirming, and selecting ideas were only evidenced during the post intervention essay, without the use of communication and socio-affective strategies in either of the two essays. All in all, a process-based writing intervention does not only influence the number of times a strategy is used, but also the number of students who employs strategies when writing an essay—two key considerations for the devising of any writing program.

scholarly journals Impact of educational intervention regarding anaemia and its preventive measures among pregnant women: an interventional study

2017 ◽  
Vol 6 (12) ◽  
pp. 5317 ◽  
Author(s):  
Pankajkumar B. Nimbalkar ◽  
Jaldhara N. Patel ◽  
Nilesh Thakor ◽  
Mansi Patni
Keyword(s):  
Pregnant Women ◽  
Preventive Measures ◽  
Signs And Symptoms ◽  
Contributory Factor ◽  
Interventional Study ◽  
Post Intervention ◽  
Medical College ◽  
Maternal Morbidity And Mortality ◽  
Before And After ◽  
Baseline Knowledge

Background: Iron deficiency anaemia (IDA) is the most common nutritional deficiency in pregnancy and major contributory factor to maternal morbidity and mortality. Objective of present study was to assess knowledge of pregnant women regarding anaemia and its preventive measures before and after educational interventional training.Methods: The present study was an interventional study undertaken in purposively selected pregnant women attending the out patient Department of Obstetrics and Gynecology Department of GMERS Medical College, Gandhinagar During the month of October 2017. Total 100 pregnant women were included after written informed consent. Baseline knowledge of pregnant women regarding anaemia and its preventive measures was assessed by pre-designed, pre-tested and semi structured questionnaire. Single educational interventional training for 45 minutes was given to selected pregnant women. Post– intervention knowledge of pregnant women for the same was assessed after training. Thus, collected data was analyzed /using Epi info 7.Results: Baseline knowledge of the pregnant women regarding causes, signs and symptoms of anemia and dietary sources of iron was 21%, 23% and 40% respectively which was significantly increased to 64%, 66% and 72% respectively after the intervention. Baseline knowledge of the pregnant women regarding factors which inhibit and increase iron absorption was 25% and 4% respectively which was significantly increased to 55% and 41 % respectively after the intervention. Baseline knowledge of the pregnant women regarding treatment of anaemia was 30% which was significantly increased to 79 % after the intervention.Conclusions: There was significant improvement in the knowledge regarding anaemia and its preventive measures among pregnant women after our single educational session.

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