scholarly journals Impact of Free Newborn Care Service package on Out of Pocket Expenditure-Evidence from a multicentric study in Nepal.

2021 ◽  
Author(s):  
Avinash K Sunny ◽  
Omkar Basnet ◽  
Ankit Acharya ◽  
Prajwal Paudel ◽  
Mats Målqvist ◽  
...  
Keyword(s):  
Care Service ◽  
Newborn Care ◽  
Public Hospitals ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Health Coverage ◽  
Multicentric Study ◽  
Sick Newborn ◽  
The Cost

Abstract Background: Sustainable Development Goal ( SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal. Methods: Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for all sick newborns admitted in public hospitals in Nepal from November 2017. We conducted this pre-post quasi-experimental study with four months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period. Results: A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17% of mothers paid for sick newborn care while after implementation 15.3% mothers (p-value=0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean±SD: US dollar 14.3+12.1 and after implementation was Mean±SD: USD 13.0±9.6 (p-value=0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value<0.001) while the cost for medicine increased (p-value=0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value=0.04) and neonatal sepsis (p-value<0.001) after the FNC program was implemented. Conclusion: We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such programs in hospitals of Nepal.

scholarly journals Impact of Free Newborn Care Service package on Out of Pocket Expenditure-Evidence from a multicentric study in Nepal.

2020 ◽  
Author(s):  
Avinash K Sunny ◽  
Omkar Basnet ◽  
Ankit Acharya ◽  
Prajwal Paudel ◽  
Mats Målqvist ◽  
...  
Keyword(s):  
Care Service ◽  
Newborn Care ◽  
Public Hospitals ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Health Coverage ◽  
Multicentric Study ◽  
Sick Newborn ◽  
The Cost

Abstract Background: Sustainable Development Goal (SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal. Methods: Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for all sick newborns admitted in public hospitals in Nepal from November 2017. We conducted this pre-post quasi-experimental study with four months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period. Results: A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17% of mothers paid for sick newborn care while after implementation 15.3% mothers (p-value=0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean±SD: US dollar 14.3+12.1 and after implementation was Mean±SD: USD 13.0±9.6 (p-value=0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value<0.001) while the cost for medicine increased (p-value=0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value=0.04) and neonatal sepsis (p-value<0.001) after the FNC program was implemented.Conclusion: We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such programs in hospitals of Nepal.

scholarly journals Impact of Free Newborn Care Service package on Out of Pocket Expenditure-Evidence from a multicentric study in Nepal.

2020 ◽  
Author(s):  
Avinash K Sunny ◽  
Omkar Basnet ◽  
Ankit Acharya ◽  
Prajwal Paudel ◽  
Mats Målqvist ◽  
...  
Keyword(s):  
Care Service ◽  
Newborn Care ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Health Coverage ◽  
Post Intervention ◽  
Multicentric Study ◽  
Sick Newborn ◽  
The Cost

Abstract Background Sustainable Development Goal (SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal. Methods Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for sick newborns admitted in public referral hospitals in Nepal after October 2017. We conducted this study with three months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period. Results A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17% of mothers paid for sick newborn care while after implementation 15.3% mothers (p-value = 0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean ± SD: US dollar 14.3 + 12.1 and after implementation was Mean ± SD: USD 13.0 ± 9.6 (p-value = 0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value < 0.001) while the cost for medicine increased (p-value = 0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value = 0.04) and neonatal sepsis (p-value < 0.001) after the FNC program was implemented. Conclusion We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such a financing strategy in hospitals of Nepal.

scholarly journals Impact of free newborn care service package on out of pocket expenditure‐evidence from a multicentric study in Nepal

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Avinash K Sunny ◽  
Omkar Basnet ◽  
Ankit Acharya ◽  
Prajwal Poudel ◽  
Mats Malqvist ◽  
...  
Keyword(s):  
Care Service ◽  
Newborn Care ◽  
Public Hospitals ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Health Coverage ◽  
Post Intervention ◽  
Multicentric Study ◽  
Sick Newborn ◽  
The Cost

Abstract Background Sustainable Development Goal (SDG) aspires to improve universal health coverage through reduction of Out of Pocket Expenditure (OOPE) and improving the quality of care. In the last two decades, there have been several efforts to reduce the OOPE for maternal and newborn care. In this paper, we evaluate the change in the OOPE for treatment of sick newborn at hospital before and after implementation of a free newborn care (FNC) program in hospitals of Nepal. Methods Ministry of Health and Population implemented a free newborn care program which reimbursed the cost of treatment for all sick newborns admitted in public hospitals in Nepal from November 2017. We conducted this pre-post quasi-experimental study with four months of pre-implementation and 12 months of post-implementation of the program in 12 hospitals of Nepal. Logistic regression analysis was conducted for categorical variables and Mann-Whitney test was applied for continuous variables to determine statistically significant differences between pre- and post- intervention period. Results A total of 353 sick newborns were admitted into these hospitals before implementation of the FNC program while 1122 sick newborns were admitted after the implementation. Before implementation, 17 % of mothers paid for sick newborn care while after implementation 15.3 % mothers (p-value = 0.59) paid for care. The OOPE for treatment of sick newborn at hospital before implementation was Mean ± SD: US dollar 14.3 + 12.1 and after implementation was Mean ± SD: USD 13.0 ± 9.6 (p-value = 0.71). There were no significant differences in neonatal morbidity after the implementation of the FNC program. The stay in a hospital bed (in days) decreased after the implementation of FNC program (p-value < 0.001) while the cost for medicine increased (p-value = 0.02). The duration of hospital stay (in days) of sick newborns significantly decreased for Hypoxic Ischemic Encephalopathy (HIE) (p-value = 0.04) and neonatal sepsis (p-value < 0.001) after the FNC program was implemented. Conclusions We found no change in the OOPE for sick newborn care following implementation of the FNC Program. There is a need to revisit the FNC program by the type of morbidity and duration of stay. Further studies will be required to explore the health system adequacy to implement such programs in hospitals of Nepal. Trial registration ISRCTN- 30829654, Registered on May 02, 2017.

617 Who Benefits the Most from Burn Camps?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S162-S163
Author(s):  
Jennifer B Radics-Johnson ◽  
Daniel W Chacon ◽  
Li Zhang
Keyword(s):  
Retrospective Review ◽  
Burn Injury ◽  
Statistical Significance ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Self Evaluation ◽  
Significant Difference ◽  
Return Home ◽  
The Impact

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value&lt; 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

scholarly journals POS0942 THE NEGATIVE IMPACT OF UNDIAGNOSED DEPRESSION IN AXIAL SPONDYLOARTHROPARTHY: RESULTS OF A SCREENING STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 734.1-734
Author(s):  
S. Maguire ◽  
F. B. O’shea
Keyword(s):  
Disease Activity ◽  
Negative Impact ◽  
Depression Scale ◽  
Clinic Visit ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Numerical Result ◽  
Co Morbidity ◽  
Patient Reported

Background:Previous research in axial spondyloarthropathy(axSpA) has shown this population to have a high prevalence of depression. This co-morbidity has been previously shown to impact disease activity in patients with rheumatic disease.Objectives:The purpose of this study was to screen for early signs of depression using two validated tools, the Patient Health Questionaire-9 (PHQ-9) and the Hospital Anxiety and Depression Scale for depression (HADs-D) in patients with known axSpA.Methods:AxSpA patients attending the Rheumatology department in St James’ Hospital between February and October 2020 were invited to take a self-administered survey which included the PHQ-9 and the HADs-D. Scores from the HADs-D yielded a numerical result which was then categorised as normal, borderline or abnormal. PHQ-9 numerical results were categorised as normal, mild, moderate, moderate/severe or severe. Patients with a known diagnosis of depression were excluded. In addition to baseline demographics, patient reported outcomes from the clinic visit were also recorded.Data analysis was performed using IBM SPSS version 26. Continuous variables were recorded as means, categorical variables as frequencies with percentages. A one-way analysis of variance analysis (ANOVA) was used to determine significance of variation in outcomes between patient outcomes as determined by the HADs-D and PHQ-9. A p-value of <0.05 was deemed significant. Consent was obtained prior to participation. Approval was received from the St James’/Tallaght Hospital Joint Ethics Committee.Results:In total 71 axSpA patients took part in the survey. The population was 70.4%(50) males and 29.5%(21) female, with an average age 47.9 years and mean disease duration 19.7 years (mean outcomes: BASDAI 4.08, BASFI 3.62, BASMI 3.54, ASQoL 6.79). Overall, 7 (9.9%) participants recorded abnormal HADs-D scores, while 17 (23.9%) recorded moderate to severe PHQ-9 scores indicative of underlying depression. AxSpA females had higher mean HADs-D scores (7.5 vs 4.8, p=0.01) than males, with abnormal scores in 19%(4) of females and 6% (3) of males. No significant differences were found in PHQ-9 scores between genders.Analysis revealed significantly worse BASDAI (6.27 vs 3.42, p<0.01) and AQoL scores (12.57 vs 5.26, p<0.01) in axSpA patients with abnormal compared to normal HADs-D scores. No significant differences were noted in BASFI, BASMI or baseline demographics. A similar pattern was noted on analysis of PHQ-9 scores, with significantly worse BASDAI (7.9 vs 2.55, p<0.01), BASFI (8.05 vs 2.33, p<0.01) and ASQoL (19.5 vs 2.62, p<0.01) noted in those scoring as severe compared to normal. No significant differences were detected in BASMI scores or baseline demographics.Conclusion:A high percentage of axSpA patients recorded high HADs-D and PHQ-9 scores concerning for undiagnosed depression. These patients were noted to have significantly worse disease activity and quality of life as compared to patients with normal scores. Clinicians treating axSpA should consider screening for depression in this population.Disclosure of Interests:Sinead Maguire Speakers bureau: Speaker fee from Jassen, Grant/research support from: Recipient of the Gilead Inflammation Fellowship Grant, Finbar Barry O’Shea: None declared

scholarly journals Clinical Outcomes of Trans-caesarean and Vaginal Post-placental CuT380A IUCD Insertions: A Comparative Study

2021 ◽  
pp. 46-57
Author(s):  
C. P. Okoye ◽  
D. N. Onwusulu ◽  
C. P. Nnamani
Keyword(s):  
Clinical Outcomes ◽  
Post Partum ◽  
Sampling Technique ◽  
Categorical Variables ◽  
P Value ◽  
Contraceptive Device ◽  
Continuous Variables ◽  
Expulsion Rate ◽  
Post Placental ◽  
Pregnant Mothers

Background: Immediate postpartum CuT380A intrauterine contraceptive device (PPIUCD) insertion provides a novel approach in reducing the unmet contraceptive needs of family planning. The insertion can be trans-caesarean or vaginal following delivery of the placenta. The clinical outcomes of the different routes of insertion have not been adequately studied. Aim: The study aimed at comparing the clinical outcomes following trans-caesarean and vaginal post-placental insertions of CuT380A IUCD. Methodology: The study was a prospective cohort study of 81 pregnant mothers managed at a tertiary health institution in southern Nigeria. They were recruited into two groups using a convenient sampling technique; 27 and 54 mothers in the caesarean and vaginal delivery groups respectively. The pregnant mothers were followed up till delivery and at the six weeks postnatal visit. Information on their socio-demographic characteristics, Obstetrics and Gynecology history were obtained with the aid of a proforma. The proforma was updated with the clinical outcomes of immediate PPIUCD insertions in the two groups, at the six weeks visit. Data obtained were analyzed using statistical package of social sciences version 21. Continuous variables were expressed as means and standard deviations. The Chi square test was used for dichotomous or categorical variables. A p-value of less than 0.05 was considered statistically significant. Results: The study showed that PPIUCD is a safe practice in both vaginal and caesarean deliveries with no significant differences in clinical outcomes. However, incidence of missing string was higher in the caesarean group compared to vaginal group (81.5% vs 51.9%; p value-0.01); and expulsion rate was also high in the vaginal group but not significant. (13.0% vs 7.4%; p value 0.45). Conclusion: Immediate postpartum CuT380A contraception, irrespective of route of insertion, is convenient, effective, and safe. Although there is a relatively higher incidence of missing strings, including expulsions after vaginal PPIUCD insertions, immediate post-partum contraception should be encouraged. This will help to reduce high unmet contraceptive needs in our environment and loss to follow up irrespective of route of delivery. Recommendation: Immediate PPIUCD, irrespective of the route, should be encouraged and integrated into the existing Maternal and Child Health Programme. Awareness should be created to promote acceptance in our environment.

scholarly journals Noncommunicable Disease Service Utilization among Expatriate Patients in Thailand: An Analysis of Hospital Service Data, 2014–2018

2021 ◽  
Vol 18 (18) ◽  
pp. 9721
Author(s):  
Anon Khunakorncharatphong ◽  
Nareerut Pudpong ◽  
Rapeepong Suphanchaimat ◽  
Sataporn Julchoo ◽  
Mathudara Phaiyarom ◽  
...  
Keyword(s):  
Public Health ◽  
Service Utilization ◽  
Well Being ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Noncommunicable Disease ◽  
Noncommunicable Diseases ◽  
P Value ◽  
Health Coverage ◽  
Cross Sectional

Global morbidity associated with noncommunicable diseases (NCDs) has increased over the years. In Thailand, NCDs are among the most prevalent of all health problems, and affect both Thai citizens and non-Thai residents, such as expatriates. Key barriers to NCD health service utilization among expatriates include cultural and language differences. This study aimed to describe the situation and factors associated with NCD service utilizations among expatriate patients in Thailand. We employed a cross-sectional study design and used the service records of public hospitals from the Ministry of Public Health (MOPH) during the fiscal years 2014–2018. The focus of this study was on expatriates or those who had stayed in Thailand for at least three months. The results showed that, after 2014, there was an increasing trend in NCD service utilizations among expatriate patients for both outpatient (OP) and inpatient (IP) care. For OP care, Cambodia, Laos PDR, Myanmar, and Vietnam (CLMV) expatriates had fewer odds of NCD service utilization, relative to non-CLMV expatriates (p-value < 0.001). For IP care, males tended to have greater odds of NCD service utilization compared with females (AdjOR = 1.35, 95% CI = 1.05–1.74, p-value = 0.019). Increasing age showed a significant association with NCD service utilization. In addition, there was a growing trend of the NCD prevalence amongst expatriate patients. This issue points to a need for prompt public health actions if Thailand aims to have all people on its soil protected with universal health coverage for their well-being, as stipulated in the Sustainable Development Goals. Future studies that aim to collect primary evidence of expatriates at the household level should be conducted. Additional research on other societal factors that may help provide a better insight into access to healthcare for NCDs, such as socioeconomic status, beliefs, and attitudes, should be conducted.

scholarly journals Leptospira spp. seroprevalence in humans involved in a cross-sectional study in Garissa and Tana River Counties, Kenya

2020 ◽  
Author(s):  
Arithi Mutembei ◽  
Festus K. Mutai ◽  
Damaris Mwololo ◽  
John Muriuki ◽  
Mark Obonyo ◽  
...  
Keyword(s):  
Case Fatality ◽  
Cross Sectional Study ◽  
Wilcoxon Test ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Sectional Study ◽  
Test Statistic ◽  
Cross Sectional ◽  
Tana River

AbstractIntroductionLeptospirosis is a neglected bacterial zoonotic infection caused by spirochetes of Leptospira genus. Humans get infected through direct or indirect contact with urine of infected animals or environment. It accounts for more than 300,000 severe cases annually worldwide with case fatality rates of over 30%. Costs of diagnosis and treatment for human and animals, disruption of international trade of animals and products, reduced productivity and reproductivity in animals constitute economic importance. In Kenya, leptospirosis burden is significant but under-diagnosis and under-reporting affects the awareness of the disease. This study aimed to determine and compare the sero-prevalence and factors associated with Leptospira spp. in the two counties.MethodsWe conducted a cross-sectional study that involved apparently healthy people of at least 5 years of age in randomly selected households in Garissa and Tana River Counties. Blood samples were collected and tested for Leptospira spp antibodies using IgM ELISA. Standardized structured questionnaires were administered to collect socio-demographic and exposure information. We calculated frequencies and proportions for categorical variables and odds ratios (OR) and 95% confidence interval (CI) to evaluate association between sero-positivity and exposure factors. We used Wilcoxon test to evaluate statistical difference in sero-positivity for continuous variables and calculated test statistic (H) and p-value.ResultsA total of 952 subjects were recruited into the study – these included 482 persons from Garissa and 470 from Tana River. The overall sero-prevalence was 26% [(244/952); (CI: 23% to 29%)]. Garissa County had significantly higher Leptospira spp. seroprevalence (31%, n = 147; CI: 27% to 35%) compared to Tana River County (21 %, n = 97; CI: 17% to 25%). Being a female (OR=1.6, CI: 1.2-2.2) and engaging in pastoralism (OR=2.7, CI: 1.8-3.9) were significantly associated with higher odds of Leptospira spp. seropositivity compared to being a male or working in irrigated areas. The mean altitude of residence of sero-positive patients was 73m ± 21 SD (standard deviation) above sea level and that for sero-negative was 80m ± 22 SD (H=35, p-value = 0.00).ConclusionThis study determined the seroprevalence and risk factors for Leptospira spp. exposure in Garissa and Tana River Counties, Kenya. Females in pastoral communities experience high burden of the disease. Enhanced surveillance in humans and animals and further research is required to understand the complex and multifactorial drivers of leptospirosis transmission in the two Counties.

Abstract P165: Comparing Grip Strength, Weakness, And Frailty Based On Comorbidity And Laboratory Data Among Patients With Cardiovascular Disease

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Gloria Kim ◽  
Arati A Gangadharan ◽  
Matthew A Corriere
Keyword(s):  
Grip Strength ◽  
Frailty Index ◽  
Laboratory Data ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Chi Square ◽  
Mean Values ◽  
Multivariable Models ◽  
And Gender

Introduction: Some approaches to frailty screening use diagnostic or laboratory data that may be incomplete. Grip strength can identify weakness, a component of phenotype-based frailty assessment. We compared grip strength as a reductionist, phenotype-based approach to frailty screening with comorbidity and laboratory-based alternatives. Hypothesis: Grip strength and categorical weakness are correlated with the modified frailty index-5 (mFI-5) and lab values associated with frailty. Methods: Weakness based on grip, BMI, and gender was compared with mFI-5 comorbidities and lab values. Patients with at least 3/5 mFI-5 comorbidities were considered frail. Lab data collected within 6 months of grip measurement was assessed. Associations were evaluated using multivariable models and kappa. Methods: 2,597 patients had grip strength measured over 5 months. Mean age was 64.4±14.6, mean BMI was 29.5±6.9;46% were women, and 87% white. Prevalent comorbidities included hypertension (28%), CHF (22%), diabetes (29%), and COPD (26%); 9% were functionally dependent. 34% were weak, but only 13% were frail based on mFI-5. Hemoglobin, creatinine, and CRP differed significantly based on weakness ( Table ). Laboratory data were missing for 36%- 95% of patients. Multivariable models identified significant associations between weakness, hemoglobin, and all MFI-5 comorbidities. Categorical agreement between weakness and frailty was limited (kappa =0.09; 95% CL 0.0641-0.1232). Conclusion: Weakness based on grip strength provides a practical, inexpensive approach to risk assessment, especially when incomplete data excludes other approaches. Comorbidity-based assessment categorizes many weak patients as non-frail. Table. Demographic, laboratory values, and comorbidities by categorical weakness based on grip 20 th percentile. Mean values for continuous variables by weakness adjusted for gender and BMI, p-value for T-test; frequency and total percent for categorical variables, p-value represents chi-square test.

VOMITING

2018 ◽  
Vol 25 (12) ◽  
pp. 1887-1891
Author(s):  
Malik Jamil Ahmed ◽  
Muhammad Nasir ◽  
Aamir Furqan
Keyword(s):  
Computer Software ◽  
Outcome Variable ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Postoperative Vomiting ◽  
Hospital Data ◽  
Chi Square ◽  
Oral Ketamine ◽  
The Difference

Objectives: To investigate whether the addition of dexamethasone and chloropheniramine to oral ketamine premedication affects the incidence of postoperative vomiting. Study Design: Randomized control trail. Setting: Department of Anesthesia and Intensive Care Nishtar Hospital, Multan. Period: March 2016 to March 2017. Methodology: After obtaining ethical approval ethical and review board of hospital. Data was entered in a computer software SPSS version 23.1 and analyzed for possible variables. Continuous variables were presented as mean and standard deviation like age, weight, sedation time, anesthesia time, admission time and PACU time. Categorical variables were presented as gender, ASA statusand postoperative vomiting. Student test and chi square test was applied to see association of outcome variable. P value of 0.05 was taken as significant. Results: Overall, 100% (n=80) patients were included in this study, both genders. The study group was further divided into twoequal groups, 50% (n=40) in each, i.e. Group K (Ketamine) group and group KD (Ketamine-Dexamethasone). The main outcome variable of this study was postoperative vomiting. In this study, Postoperative vomiting observed in 35% (n=10) and 10% (n=4) patients, for group K and group KD respectively. The difference was statistically significant (p=0.007). Conclusion: Addition of dexamethasone and chloropheniramine with ketamine as premedication reduce the incidence of postoperative vomiting.

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