Use of the expanded Apgar score for the assessment of intraventricular and intraparenchymal haemorrhage risk in neonates

2020 ◽  
Author(s):  
Góralska Agnieszka ◽  
Joanna Puskarz-Gąsowska ◽  
Paweł Bujnowski ◽  
Renata Bokiniec
Keyword(s):  
Apgar Score ◽  
Chi Square ◽  
Intensive Care Department ◽  
Interaction Detection ◽  
Haemorrhage Risk ◽  
Key Factor ◽  
Intraparenchymal Haemorrhage ◽  
Fraction Of Inspired Oxygen ◽  
Medical University ◽  
Inspired Oxygen

Abstract Background Preterm birth is a key factor contributing to haemorrhage incidence in neonates. This study focused on defining relevant parameters for the assessment of intraventricular and intraparenchymal haemorrhage risks in neonates. Methods Chi-square automatic interaction detection was used to analyse the Apgar score (AS), the Apgar max score, and the course of resuscitation documented according to the expanded AS in 696 infants born between 2009 and 2011 in the Neonatal and Intensive Care Department of the Medical University of Warsaw. Results Gestational age was the most relevant discriminating variable for the prediction of intraventricular and intraparenchymal haemorrhage incidences. Infants born before the 31st week of pregnancy made up 80% of the intraventricular or intraparenchymal haemorrhage cases. Additionally, a fraction of inspired oxygen > 0.8 at ten minutes after birth was a better discriminating variable in the youngest neonates than an Apgar max score ≤ 5, identifying 31.6% and 20.6% of infants with intraventricular and intraparenchymal haemorrhage, respectively. Conclusions Consideration of the oxygen concentration supplied during resuscitation significantly improves the prognosis of intraventricular and intraparenchymal haemorrhages in preemies compared to the use of the classical AS.

Pronation Technique in ARDS Patients

ABOUTOPEN ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. 21-23
Author(s):  
Raffaele Di Fenza ◽  
Hedwige Gay ◽  
Martina Favarato ◽  
Isabella Fontana ◽  
Roberto Fumagalli
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Distress Syndrome ◽  
Daily Practice ◽  
Volume Distribution ◽  
Intensive Care Unit Staff ◽  
Safe Technique ◽  
Fraction Of Inspired Oxygen ◽  
And Diffusion ◽  
Inspired Oxygen

In severe acute respiratory distress syndrome (ARDS), characterized by the ratio of arterial partial pressure of oxygen over fraction of inspired oxygen (P/F) less than 150 mm Hg, pronation cycles are the only intervention that showed improved survival, in combination with protective ventilation. The physiological advantages of performing pronation cycles, such as the improvement of oxygenation, better tidal volume distribution with increased involvement of dorsal regions, and easier drainage of secretions, overcome the possible complications, that is, endotracheal tube occlusion or misplacement, pressure ulcers, and brachial plexus injury. However, the incidence of complications is dramatically lower in intensive care units with expertise, adopting prone positioning in daily practice. In this video we are proposing step by step an easy and ergonomic technique to perform pronation maneuvers in patients with severe ARDS. Recent literature suggests that a high percentage of these patients are treated without undergoing pronation cycles. The main purpose of this video is to help increase the number of intensive care units worldwide commonly performing pronation cycles in patients that have indications to be pronated, in order to decrease healthcare burden and costs directly caused by ARDS. Proper intensive care unit staff training is fundamental in minimizing the risks associated with the maneuver for both patients and operators; and diffusion of a safe technique encouraging the operators is the second main purpose of this video.

PENERAPAN CHAID DENGAN PENDEKATAN SMOTE PADA KEMATIAN BALITA DI KAWASAN TIMUR INDONESIA TAHUN 2017

2020 ◽  
Vol 2019 (1) ◽  
pp. 357-367
Author(s):  
Isti Samrotul Hidayati ◽  
I Made Arcana
Keyword(s):  
Sampling Technique ◽  
Chi Square ◽  
Interaction Detection ◽  
Chi Squared

Metode Chi-squared Automatic Interaction Detection (CHAID) merupakan metode segmentasi berdasarkan hubungan variabel respon dan penjelas menggunakan uji chi-square, yang dalam penerapannya perlu memperhatikan keseimbangan data untuk meminimalkan kesalahan dalam klasifikasi. Salah satu pendekatan yang dapat digunakan pada data yang tidak seimbang adalah metode Synthetic Minority Over-sampling Technique (SMOTE). Dalam penelitian ini, metode CHAID dengan pendekatan SMOTE diterapkan pada Angka Kematian Balita (AKBa) di Kawasan Timur Indonesia (KTI). Tujuannya adalah untuk mengetahui variabel-variabel yang mencirikan kematian balita berdasarkan metode analisis CHAID yang diterapkan dan membandingkannya dengan pendekatan SMOTE. Hasil perbandingan menunjukkan bahwa pendekatan SMOTE lebih baik digunakan dengan nilai sensitivitas sebesar 48,3% dan nilai presisi sebesar 75,9%. Variabel yang signifikan mencirikan kematian balita di KTI adalah berat badan saat lahir, jenis kelahiran, status bekerja ibu dan kekayaan rumah tangga, dengan karakteristik utama adalah balita yang memiliki berat badan lahir rendah dan terlahir kembar.

scholarly journals Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: a case series

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Andrew G. Weber ◽  
Alice S. Chau ◽  
Mikala Egeblad ◽  
Betsy J. Barnes ◽  
Tobias Janowitz
Keyword(s):  
Case Series ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Dornase Alfa ◽  
Extracellular Traps ◽  
Dnase 1 ◽  
Fraction Of Inspired Oxygen ◽  
Oxygen Requirements ◽  
Inspired Oxygen ◽  
Ventilated Patients

Abstract Background Mechanically ventilated patients with COVID-19 have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation. DNA from neutrophil extracellular traps (NETs) contribute to the viscosity of mucopurulent secretions and NETs are found in the serum of COVID-19 patients. Dornase alfa is recombinant human DNase 1 and is used to digest DNA in mucoid sputum. Here, we report a single-center case series where dornase alfa was co-administered with albuterol through an in-line nebulizer system. Methods Demographic and clinical data were collected from the electronic medical records of five mechanically ventilated patients with COVID-19—including three requiring veno-venous extracorporeal membrane oxygenation—treated with nebulized in-line endotracheal dornase alfa and albuterol, between March 31 and April 24, 2020. Data on tolerability and response were analyzed. Results The fraction of inspired oxygen requirements was reduced for all five patients after initiating dornase alfa administration. All patients were successfully extubated, discharged from hospital and remain alive. No drug-associated toxicities were identified. Conclusions Results suggest that dornase alfa will be well-tolerated by patients with severe COVID-19. Clinical trials are required to formally test the dosing, safety, and efficacy of dornase alfa in COVID-19, and several have been recently registered.

scholarly journals Inhaled Epoprostenol for Pulmonary Hypertension Treatment in Neonates: A 12-Year Experience

2018 ◽  
Vol 36 (11) ◽  
pp. 1142-1149 ◽  
Author(s):  
Frédérique Berger-Caron ◽  
Bruno Piedboeuf ◽  
Geneviève Morissette ◽  
David Simonyan ◽  
Philippe Chétaille ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Side Effects ◽  
Retrospective Cohort ◽  
Rebound Effect ◽  
Oxygenation Index ◽  
Pediatric Intensive Care ◽  
Primary Objective ◽  
Hypertension Treatment ◽  
Fraction Of Inspired Oxygen ◽  
Inspired Oxygen

Background Persistent pulmonary hypertension of the newborn (PPHN) occurs in 10% of neonatal respiratory insufficiency. To selectively reduce pulmonary vascular resistance, several treatments have been tried. Inhaled epoprostenol (iPGI2) has been used for 12 years in our institution for the management of refractory PPHN despite the gaps in the literature to support this use. Objectives The primary objective was to evaluate the efficacy of iPGI2 for PPHN. The secondary objectives were to describe its use in neonates and assess side effects. Study Design This retrospective cohort study included infants < 28 days with PPHN treated with iPGI2 in the neonatal or pediatric intensive care units of our institution between 2004 and 2016. Results We reviewed 43 patient' care episodes (mean gestational age of 36 weeks). This was an extremely ill population with 54% mortality rate. Oxygenation index improved significantly after 12-hour treatment (p = 0.047), with a rebound effect when discontinuing nebulization. By the end of the therapy, the fraction of inspired oxygen had significantly dropped (p = 0.0018). Echocardiographic markers tended to normalize during treatment. No potential side effects were reported. Conclusion In these sick newborns, we observed an improvement in PPHN under iPGI2 without significant adverse effects. To our knowledge, this is the largest neonatal cohort reported to have received iPGI2 for PPHN.

scholarly journals Management of Fraud: Case of an Indian Insurance Company

2018 ◽  
Vol 7 (3) ◽  
pp. 18
Author(s):  
Sunita Mall ◽  
Prasun Ghosh ◽  
Parita Shah
Keyword(s):  
Claims Data ◽  
Confusion Matrix ◽  
Statistical Techniques ◽  
Insurance Company ◽  
Chi Square ◽  
Interaction Detection ◽  
Time Period ◽  
Prime Objective ◽  
Level Of Significance ◽  
Indian Insurance

Frauds in insurance are typically where a fraudster tries to gain undue benefit from the insurance contract by ignorance or wilful manipulation. Using the claims data in motor insurance obtained from a Mumbai based insurance company for the time period of 2010-2016, this study focuses on studying the pattern exhibited by those claims which have been rejected and accepted as well. The prime objective of the study is to identify the important or the significant triggers of fraud and predicting the fraudulent behaviour of the customers using the identified triggers in an existing algorithm. This study makes use of statistical techniques like logistic regression & CHAID (Chi Square Automatic Interaction Detection) technique to identify the significant fraud triggers and to determine the probability of rejection & acceptance of each claim coming in future respectively. Data mining techniques like decision tree and confusion matrix are used on the important parameters to find all possible combinations of these significant variables and the bucket for each combination.This study finds that variables like Seats/Tonnage, No Claim Bonus, Type of Vehicle, Gross Written Premium, Sum Insured, Discounts, State Similarity and Previous Insurance details are found to be significant at 1% level of significance. The variables like Branch Code and Risk Types are found to be significant at 5% level of signify cance. The Gain chart depicts that our model is a fairly good model. This research would help the insurance company in settling the legitimate claims within less time and less cost and would also help in identifying the fraudulent claims.

scholarly journals Knobmanship: Dialing Up Understanding of VAE Triggers

2021 ◽  
Vol 1 (S1) ◽  
pp. s80-s81
Author(s):  
Kelly Cawcutt ◽  
Mark Rupp ◽  
Lauren Musil
Keyword(s):  
Chart Review ◽  
Clinical Care ◽  
Trigger Points ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Review Period ◽  
Fraction Of Inspired Oxygen ◽  
Provider Bias ◽  
Inspired Oxygen ◽  
Ventilated Patients

Background: Mechanical ventilation is a lifesaving therapy for critically ill patients. Hospitals perform surveillance for the NHSN for ventilator-associated events (VAE) by monitoring mechanically ventilated patients for metrics that are generally thought to be objective and preventable and that lead to poor patient outcomes. The VAE definition is met in a stepwise manner; initially, a ventilator-associated condition (VAC) is triggered with an increase in positive end-expiratory pressure (PEEP, >3 cm H2O) or fraction of inspired oxygen (FIO2, 0.20 or 20 points) after a period of stability or improvement on the ventilator. We believe that many reported VAEs could be avoided by provider and respiratory therapy attention to “knobmanship.” We define knobmanship as knowledge of the VAE definition and trigger points combined with appropriate clinical care for mechanically ventilated patients while avoiding unnecessary triggering of the VAE definition by avoiding small unneeded changes in PEEP or FIO2. Methods: We performed a chart review of 283 patients who had a reported VAE to the NHSN between January 1, 2019, and December 31, 2020. We collected data including type of VAE, VAE triggering criteria, and clinical course. Results: Of the 283 VAEs, 59 were triggered by a PEEP increase from 5 to 8 with stable or decreasing FIO2. Of the 59 VAEs, 33 were VACs, 18 were infection-related ventilator- associated complications (IVACs), and 8 were possible ventilator-associated pneumonia (PVAP). Most of these transient changes in PEEP were deemed clinically unnecessary. A 21% reduction of VAEs reported to the NSHN over the 2-year review period could have been avoided by knobmanship. Conclusions: The VAE definition may often be triggered by provider bias to the ventilator settings rather than what the patient’s clinical-condition requires. Attention to knobmanship may result in substantial decrease in reported VAE.Funding: NoDisclosures: None

scholarly journals Pengaruh Kualitas Produk Terhadap Kepuasan, Reputasi Merek Dan Loyalitas Konsumen Jamu Tolak Angin Pt. Sido Muncul

2011 ◽  
Vol 4 (2) ◽  
Author(s):  
Budi Hermawan
Keyword(s):  
Customer Satisfaction ◽  
Product Quality ◽  
Customer Loyalty ◽  
Structural Equation ◽  
Equation Model ◽  
Chi Square ◽  
Brand Reputation ◽  
Key Factor ◽  
Good Reputation ◽  
Loyal Customers

One of the key factor that PT Sido Muncul concerns about its Jamu Tolak Angin is the customer loyalty. The increase number of loyal customers can be considered as the success of the company’s product amidst the competition. This research is conducted to find out whether the product’s quality influences the customer loyalty through customer satisfaction and brand reputation of the PT Sido Muncul’s Jamu Tolak Angin brand. This research is conducted to retest the model proposed by Fred Selnes (1993), by using the Structural Equation Model (SEM). The sample of this research is 200 persons, collected by judgment sampling. The result of this research shows that customer loyalty is influenced by product quality, customer satisfaction, and brand reputation. Product quality influences customer loyalty through customer satisfaction and brand reputation. The model’s test of this research shows Chi-Square=65.81 (P=0.00026), RMSEA=0.071, GFI=0.94, dan AGFI=0.90. Product quality influences customer loyalty through customer satisfaction and brand reputation by 0.26 and it influences customer loyalty through brand reputation by 0.46. This research shows that good quality product will lead to the increase of customer loyalty and brand reputation of the PT Sido Muncul’s Jamu Tolak Angin brand. Loyal customers are directly influenced by PT Sido Muncul’s Jamu brand, while customer satisfaction doesn’t directly influence customer loyalty. When choosing which jamu product to consume, the customers don’t necessarily choose the product based on the satisfaction of past use but on the brand reputation. Customers think that the jamu brand that has good reputation is suitable for continuous use. This is because customers view jamu as traditional medicine, so the selection should be based on those products who have reliable brand reputation. This result shows that the PT Sido Muncul’s Jamu Tolak Angin brand reputation that has been formed may strengthen the product quality’s influence on creating customer loyalty.

scholarly journals Aplikasi Data Mining Dengan Metode CHAID Dalam Menentukan Status Kredit

2020 ◽  
Vol 18 (1) ◽  
pp. 29
Author(s):  
Muhammad Rizki ◽  
Muhammad Isnaini Hadiyul Umam ◽  
Muhammad Luthfi Hamzah
Keyword(s):  
Data Mining ◽  
Chi Square ◽  
Interaction Detection ◽  
Detection Analysis

Seiring dengan digalakkannya Industrial 4.0, data mining menjadi topik yang hangat untuk bahas dikalangan peneliti. Perkembangan teknologi yang begitu cepat memaksa kita untuk dapat mengambil keputusan dengan cepat pula. Kredit macet menjadi salah satu resiko terbesar lembaga keuangan. Resiko kredit macet ini wajib diminimalisir dengan menganalisa faktor status nasabah berdasarkan data personalnya, sehingga dapat dilakukan klasifikasi berdasarkan  hubungan antar faktor tersebut. Salah satu kunci utama memenangkan persaingan pasar yaitu dengan menentukan target pasar. Data mining menyediakan banyak alat bantu untuk klasifikasi, salah satunya dengan menggunakan metode analisis CHAID (Chi-square Automatic Interaction Detection Analysis). Diagram pohon keputusan yang dihasilan dari Analisis CHAID dapat memberikan informasi tentang derajat hubungan antara variable independent dan dependent, serta informasi tentang karakteristik masing-masing kategori. Dalam hal ini, analisis CHAID digunakan untuk menentukan klasifikasi nasabah berdasarkan status kredit nasabah sebagai variable terikat dan data pribadi nasabah sebagai variable bebas. Dengan menggunakan uji Chi-square, dari total 7 variables independent, hanya 5 variable yang signifikan dengan variable dependent. Variable-variable tersebut adalah variable independent usia, pekerjaan, pendidikan, jangka waktu dan jumlah pinjaman. Berdasarkan hasil analisis CHAID didapatkan empat kelas. Kelas nasabah dengan pekerjaan sebagai (Aparatur Sipil Negara) ASN merupakan kelas yang memiliki resiko kredit macet yang paling minimal.

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