scholarly journals Home-Based Monitoring and Telemonitoring of Complicated Pregnancies: Nationwide Cross-Sectional Survey of Current Practice in the Netherlands (Preprint)

2020 ◽  
Author(s):  
Josephus F M van den Heuvel ◽  
Samira Ayubi ◽  
Arie Franx ◽  
Mireille N Bekker
Keyword(s):  
The Netherlands ◽  
Hospital Admission ◽  
Pregnant Women ◽  
Pregnancy Complications ◽  
Current Practice ◽  
Home Visits ◽  
Cross Sectional ◽  
Advantages And Disadvantages ◽  
Home Based ◽  
Wide Range

BACKGROUND Daily monitoring of fetal and maternal conditions in complicated pregnancies leads to recurrent outpatient visits or (prolonged) hospitalization. Alternatives for hospital admissions include home-based monitoring with home visits by professionals or telemonitoring with self-measurements performed by pregnant women and uploaded for in-clinic assessment. For both alternatives, cardiotocography and blood pressure measurement can be performed at home. It is unknown to what extent, for which reasons, and for which pregnancy complications these strategies are used. OBJECTIVE This study aims to assess the current practice and attitudes concerning home-based monitoring (with daily home visits by professionals) and telemonitoring (using devices and the internet for daily self-recorded measurements) in high-risk pregnancies requiring maternal and fetal monitoring in the Netherlands. METHODS This nationwide cross-sectional study involved sending a web-based survey to the obstetrics departments of all 73 hospitals in the Netherlands to be answered by 1 representative dedicated to pregnancy monitoring per hospital. The primary outcome was the provision of home-based monitoring or telemonitoring using cardiotocography between 1995 and 2018. The survey further addressed perspectives regarding the use of home-based monitoring and telemonitoring, including (contra)indications, advantages, and disadvantages for pregnant women and clinicians. RESULTS The response rate for the provision of either home-based monitoring or telemonitoring was 100%. In 2018, 38% (28/73) of centers in the Netherlands offered either home-based monitoring or telemonitoring or both to pregnant women with complications. Home-based monitoring was offered in 26% (19/73) of the centers; telemonitoring, in 23% (17/73); and both in 11% (8/73). Telemonitoring was first offered in 2009, increasing from 4% (3/73) of hospitals in 2014 to 23% (17/73) in 2018. Responses were received from 78% (57/73) of the invited hospitals and analyzed. Of all 17 centers using telemonitoring, 59% (10/17) did not investigate perinatal outcomes, safety, and patient satisfaction prior to implementation. Other (6/17, 35%) telemonitoring centers are participating in an ongoing multicenter randomized clinical trial comparing patient safety, satisfaction, and costs of telemonitoring with standard hospital admission. Home-based monitoring and telemonitoring are provided for a wide range of complications, such as fetal growth restriction, pre-eclampsia, and preterm rupture of membranes. The respondents reported advantages of monitoring from home, such as reduced stress and increased rest for patients, and reduction of admission and possible reduction of costs. The stated barriers included lack of insurance reimbursement and possible technical issues. CONCLUSIONS Home-based monitoring is provided in 26% (19/73) and telemonitoring, in 23% (17/73) of hospitals in the Netherlands to women with pregnancy complications. Altogether, 38% (28/73) of hospitals offer either home-based monitoring or telemonitoring or both as an alternative to hospital admission. Future research is warranted to assess safety and reimbursement issues before more widespread implementation of this practice.

scholarly journals Home-Based Monitoring and Telemonitoring of Complicated Pregnancies: Nationwide Cross-Sectional Survey of Current Practice in the Netherlands

10.2196/18966 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e18966
Author(s):  
Josephus F M van den Heuvel ◽  
Samira Ayubi ◽  
Arie Franx ◽  
Mireille N Bekker
Keyword(s):  
The Netherlands ◽  
Hospital Admission ◽  
Pregnant Women ◽  
Pregnancy Complications ◽  
Current Practice ◽  
Home Visits ◽  
Cross Sectional ◽  
Advantages And Disadvantages ◽  
Home Based ◽  
Wide Range

Background Daily monitoring of fetal and maternal conditions in complicated pregnancies leads to recurrent outpatient visits or (prolonged) hospitalization. Alternatives for hospital admissions include home-based monitoring with home visits by professionals or telemonitoring with self-measurements performed by pregnant women and uploaded for in-clinic assessment. For both alternatives, cardiotocography and blood pressure measurement can be performed at home. It is unknown to what extent, for which reasons, and for which pregnancy complications these strategies are used. Objective This study aims to assess the current practice and attitudes concerning home-based monitoring (with daily home visits by professionals) and telemonitoring (using devices and the internet for daily self-recorded measurements) in high-risk pregnancies requiring maternal and fetal monitoring in the Netherlands. Methods This nationwide cross-sectional study involved sending a web-based survey to the obstetrics departments of all 73 hospitals in the Netherlands to be answered by 1 representative dedicated to pregnancy monitoring per hospital. The primary outcome was the provision of home-based monitoring or telemonitoring using cardiotocography between 1995 and 2018. The survey further addressed perspectives regarding the use of home-based monitoring and telemonitoring, including (contra)indications, advantages, and disadvantages for pregnant women and clinicians. Results The response rate for the provision of either home-based monitoring or telemonitoring was 100%. In 2018, 38% (28/73) of centers in the Netherlands offered either home-based monitoring or telemonitoring or both to pregnant women with complications. Home-based monitoring was offered in 26% (19/73) of the centers; telemonitoring, in 23% (17/73); and both in 11% (8/73). Telemonitoring was first offered in 2009, increasing from 4% (3/73) of hospitals in 2014 to 23% (17/73) in 2018. Responses were received from 78% (57/73) of the invited hospitals and analyzed. Of all 17 centers using telemonitoring, 59% (10/17) did not investigate perinatal outcomes, safety, and patient satisfaction prior to implementation. Other (6/17, 35%) telemonitoring centers are participating in an ongoing multicenter randomized clinical trial comparing patient safety, satisfaction, and costs of telemonitoring with standard hospital admission. Home-based monitoring and telemonitoring are provided for a wide range of complications, such as fetal growth restriction, pre-eclampsia, and preterm rupture of membranes. The respondents reported advantages of monitoring from home, such as reduced stress and increased rest for patients, and reduction of admission and possible reduction of costs. The stated barriers included lack of insurance reimbursement and possible technical issues. Conclusions Home-based monitoring is provided in 26% (19/73) and telemonitoring, in 23% (17/73) of hospitals in the Netherlands to women with pregnancy complications. Altogether, 38% (28/73) of hospitals offer either home-based monitoring or telemonitoring or both as an alternative to hospital admission. Future research is warranted to assess safety and reimbursement issues before more widespread implementation of this practice.

scholarly journals A Cross-sectional Survey of the North American Skull Base Society: Current Practice Patterns of Vestibular Schwannoma Evaluation and Management in North America

2017 ◽  
Vol 79 (03) ◽  
pp. 289-296 ◽  
Author(s):  
Jamie Van Gompel ◽  
R. Wiet ◽  
Nicole Tombers ◽  
Anand Devaiah ◽  
Devyani Lal ◽  
...  
Keyword(s):  
North America ◽  
Skull Base ◽  
Vestibular Schwannoma ◽  
North American ◽  
Management Practices ◽  
Current Practice ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Wide Range

Background Very few studies have examined vestibular schwannoma (VS) management trends across centers and between providers. The objective of this study is to examine current practice trends, variance in treatment philosophies, and nuanced or controversial aspects of VS care across North America. Methods This is a cross-sectional survey of North American Skull Base Society (NASBS) members who report regular involvement in VS care. Results A total of 57 completed surveys were returned. Most respondents claimed to have over 20 years of experience and the majority reported working in an academic practice with an affiliated otolaryngology and/or neurosurgery residency program. Sixty-three percent of respondents claimed to evaluate VS patients in clinic with both an otolaryngologist and neurosurgeon involved. Eighty-six percent of respondents claimed to operate on VS with both an otolaryngologist and neurosurgeon involved, while only 18% of neurosurgeons and 9% of otolaryngologists performed surgery alone. There was a wide range in the number of cases evaluated at each center annually. Similarly, there was wide variation in the number of patients treated with microsurgery and radiation at each center. Additional details regarding management preferences for microsurgery, stereotactic radiosurgery, stereotactic radiotherapy, and conservative observation are presented. Conclusion VS management practices vary between providers and centers. Overall, most centers employ a multidisciplinary approach to management with collaboration between otolaryngology and neurosurgery. Overall, survey responses concur with previous studies suggesting a shift toward conservatism in management.

scholarly journals Violência doméstica contra a mulher gestante

2017 ◽  
Vol 11 (12) ◽  
pp. 4999
Author(s):  
Naiany Monise Gomes Ramalho ◽  
Josefa Danielma Lopes Ferreira ◽  
Carla Lidiane Jácome de Lima ◽  
Thalys Maynnard Costa Ferreira ◽  
Sayonara Lays Umbelino Souto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Domestic Violence ◽  
Pregnant Women ◽  
Violence Against Women ◽  
Exclusion Criteria ◽  
Scientific Publications ◽  
Cross Sectional ◽  
Wide Range ◽  
Factores De Riesgo ◽  
Violencia Domestica

RESUMOObjetivo: analisar as publicações científicas sobre a violência doméstica contra a mulher gestante. Método: revisão integrativa, com buscas nas bases de dados MEDLINE, SCOPUS, LILACS e BDENF, usando os descritores em português e inglês violência doméstica, mulher grávida e Enfermagem. Foram identificados 536 artigos. Após critérios de inclusão e exclusão, obtiveram-se 16 estudos que compuseram a amostra. A apresentação dos resultados e a discussão final foram feitas de forma descritiva, além de estatística simples por porcentagem e apresentados sob a forma de figuras. Resultados: dos estudos incluídos na revisão, 18,8% foram publicados em 2007. Quanto ao tipo de estudo, 56,3% foram estudos de corte transversal. Os tipos de violência mais retratados foram o sexual, o físico e o psicológico. Todos os estudos relatavam os fatores de risco para a violência contra a mulher gestante. Conclusão: analisando os estudos, foi possível identificar uma ampla gama de fatores de risco encontrados na literatura e a falta de registros sobre a assistência de saúde à mulher grávida em situação de violência. Descritores: Enfermagem; Violência Doméstica; Mulher Grávida; Violência Contra a Mulher; Cuidados De Enfermagem; Fatores de Risco.ABSTRACTObjective: to analyze the scientific publications on domestic violence against pregnant women. Method: integrative review, with searches in the MEDLINE, SCOPUS, LILACS and BDENF databases, using the descriptors in Portuguese and English, domestic violence, pregnant women and Nursing. A total of 536 articles were identified. After inclusion and exclusion criteria, we obtained 16 studies that composed the sample. The presentation of the results and final discussion was done in a descriptive way, in addition to simple statistics by percentage and presented in the form of figures. Results: of the studies included in the review, 18.8% were published in 2007. Regarding the type of study, 56.3% were cross-sectional studies. The types of violence most portrayed were sexual, physical and psychological. All studies reported the risk factors for violence against pregnant women. Conclusion: analyzing the studies, it was possible to identify a wide range of risk factors found in the literature and the lack of records on health care for pregnant women in situations of violence. Descriptors: Nursing; Domestic Violence; Pregnant Woman; Violence Against Women; Nursing Care; Risk Factors.RESUMENObjetivo: analizar las publicaciones científicas sobre la violencia doméstica contra la mujer gestante. Método: revisión integrativa, con búsquedas en las bases de datos MEDLINE, SCOPUS, LILACS y BDENF, usando los descriptores en portugués e inglés violencia doméstica, mujer embarazada y Enfermería. Se identificaron 536 artículos. Después de criterios de inclusión y exclusión, se obtuvieron 16 estudios que compusieron la muestra. La presentación de los resultados y la discusión final fueron hechas de forma descriptiva, además de estadística simple por porcentaje y presentados bajo la forma de figuras. Resultados: de los estudios incluidos en la revisión, el 18,8% fueron publicados en 2007. En cuanto al tipo de estudio, el 56,3%, fueron estudios de corte transversal. Los tipos de violencia más retratados fueron el sexual, el físico y el psicológico. Todos los estudios relataban los factores de riesgo para la violencia contra la mujer embarazada. Conclusión: analizando los estudios, fue posible identificar una amplia gama de factores de riesgo encontrados en la literatura y la falta de registros sobre la asistencia de salud a la mujer embarazada en situación de violencia. Descriptores: Enfermería; La Violencia Doméstica; Mujer Embarazada; Violencia Contra la Mujer; Atención de Enfermería; Factores de Riesgo.

scholarly journals Prevalence of food insecurity in pregnant women and its association with gestational weight gain pattern, neonatal birth weight, and pregnancy complications in Hamadan County, Iran, in 2018

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Farideh Kazemi ◽  
Seyedeh Zahra Masoumi ◽  
Arezoo Shayan ◽  
Seyedeh Zahra Shahidi Yasaghi
Keyword(s):  
Weight Gain ◽  
Birth Weight ◽  
Food Insecurity ◽  
Pregnant Women ◽  
Pregnancy Outcomes ◽  
Pregnancy Complications ◽  
Maternal Weight ◽  
Cross Sectional ◽  
Significance Level ◽  
Adverse Pregnancy

Abstract Background The results of some studies have indicated the association between food insecurity and certain adverse pregnancy outcomes. The present study aimed to investigate the prevalence of food insecurity in pregnant women and its association with pregnancy outcomes and complications. Methods The present cross-sectional study was conducted on 772 mothers who visited comprehensive health service centers during the first 10 days after delivery in 2018. The tools included the demographic and midwifery information questionnaire and an 18-item questionnaire devised by the U.S. Department of Agriculture. The significance level was considered to be 0.05. Results 67.5% of pregnant women had food insecurity. The multivariate analysis showed that birth weight decreased with the increase in the severity of food insecurity, but the reduction was not statistically significant. Based on the results, food insecurity had no statistically significant impact on the mothers’ weight gain pattern (p = 0.13). The risk of hypertension/preeclampsia and anemia was not related to food insecurity. Compared with the food-secure group, the probability of gestational diabetes was 56% lower in the food-insecure group without hunger and 61% lower in the food-insecure group with moderate hunger; however, in the food-insecure group with severe hunger, this probability was 1.5 times more than the food-secure group, which is not statistically significant. Conclusions The prevalence of food insecurity was high in pregnant women. Maternal weight gains during pregnancy and birth weight (despite being statistically insignificant) were affected by this condition; therefore, it is necessary to identify women with food insecurity on their first pregnancy visit; it is also crucial to take steps towards improving their health through allocating a family food basket and nutritional support for these women at least during pregnancy. Due to the limited sample size and inability to control the potential confounders, the association between food insecurity during pregnancy and the incidence of pregnancy complications could not be reached, hence the need for more studies.

scholarly journals Surgical treatment of pulmonary metastases in the Netherlands: data from the Dutch Lung Cancer Audit for Surgery

2020 ◽  
Vol 58 (4) ◽  
pp. 768-774 ◽  
Author(s):  
Martijn van Dorp ◽  
Naomi Beck ◽  
Willem Hans Steup ◽  
Wilhelmina Hendrika Schreurs
Keyword(s):  
Lung Cancer ◽  
Surgical Treatment ◽  
The Netherlands ◽  
Current Practice ◽  
Pulmonary Metastases ◽  
Primary Lung Cancer ◽  
Postoperative Mortality ◽  
Hospital Variation ◽  
Wide Range ◽  
Complicated Course

Abstract OBJECTIVES Surgical resection is widely employed as a potential curative treatment option for patients with limited lung metastases originating from a wide range of primary tumours. However, there are no clear national or international practice guidelines and, thereby, the risk for potential practice variation exists. This study aims to define the current practice for the surgical treatment of pulmonary metastases in the Netherlands by using data from the Dutch Lung Cancer Audit for Surgery (DLCA-S). METHODS Data from the DLCA-S were used to analyse patients undergoing a parenchymal lung resection for the treatment of pulmonary metastases between 2012 and 2017. Volume of metastasectomies per hospital was calculated as a proportion of the volume of primary lung cancer resection. Studied outcomes were overall complications and postoperative mortality and complicated course. For the latter, both the national average and between-hospital variation were calculated. RESULTS A total of 2090 patients, distributed over 45 Dutch hospitals, were included for analysis. The most common primary cancer was colorectal carcinoma (N = 1087, 52.0%) followed by the urogenital carcinoma (N = 296, 14.2%). The most common type of parenchymal resection was a wedge resection (N = 1477, 70.7%) followed by a lobectomy (N = 424, 20.3%). Resection was performed minimally invasively in 1548 patients (74.1%) with a conversion rate of 3.8%. Resection of a solitary metastasis was performed in 1663 patients (79.6%). In 40 patients (1.9%), 4 or more metastases were resected. A postoperative complicated course was noted in 3.6%, and the 30-day mortality rate was 0.7%. The variety between hospitals in the volume of metastasectomies in proportion to the volume of primary lung cancer resections was 3.4–41.5%. CONCLUSIONS This analysis of the DLCA-S registry provides a unique insight into current practice on pulmonary metastasectomies in the Netherlands over a 6-year period. The rate of postoperative adverse outcome was limited, and the morbidity and mortality were lower compared to primary lung cancer resections in the DLCA-S database.

scholarly journals Vestibular Schwannoma Management: Current Practice Amongst UK Otolaryngologists – Time for a National Prospective Audit

2006 ◽  
Vol 88 (5) ◽  
pp. 490-495 ◽  
Author(s):  
Shakeel R Saeed ◽  
Ranga Suryanarayanan ◽  
Attila Dezso ◽  
Richard T Ramsden
Keyword(s):  
Vestibular Schwannoma ◽  
Current Practice ◽  
Manpower Planning ◽  
Postal Questionnaire ◽  
Cross Sectional ◽  
Number Of Patients ◽  
Wide Range ◽  
Collaborative Working ◽  
Computer Based ◽  
The Uk

INTRODUCTION It is generally agreed that the successful management of a vestibular schwannoma (VS) usually involves close collaboration between a neuro-otologist and neurosurgeon. In addition, it is accepted that the experience of the team managing such tumours is one of the key determinants of outcome after surgical intervention. The aim of this study was to identify current practice in the management of such tumours amongst otolaryngologists in the UK and to observe whether such collaborative working practices exist. MATERIALS AND METHODS A cross sectional postal questionnaire survey of consultant members of the British Association of Otorhinolaryngologists – Head and Neck Surgeons (n = 542). RESULTS A total of 336 replies were received (62%). Of respondents, 299 consultants referred their patients to another surgeon for further management; 242 referred to another ENT surgeon (80.9%), 29 to a neurosurgeon (9.7%) and 28 to a combined team (9.4%). Twenty-eight of the responding otolaryngologists (8.6%) managed the tumours themselves, of whom 22 worked with a neurosurgeon. Of these 28 neuro-otologists, nearly two-thirds (64%) had been undertaking VS surgery for more than 10 years. The total number of patients with a VS referred to these 28 consultants during 2001 was 775, with a mean caseload of 29.8, median 23 and a range of 4 to 102 per surgeon. Seven of the 28 otolaryngologists chose their surgical approach entirely based on the size of the tumour. Eight consultants preferred the sub-occipital (SO) approach, 10 the trans-labyrinthine (TL) approach, three chose between SO and TL approaches. The majority of surgeons had a prospective, computer-based data collection and were willing to give further information about their outcomes and complications. CONCLUSIONS Amongst the otolaryngologists surveyed in the UK, we have identified 28 neuro-otologists who undertake VS surgery. The majority work with neurosurgical colleagues, confirming collaborative practice. The wide range in caseload raises the issue of training and maintaining standards and in the first instance we recommend a prospective national audit of VS management and outcomes with our neurosurgical colleagues. This would also be of value in manpower planning particularly if a minimum caseload could be identified below which results were seen to be less good.

Cost Comparison of Psychogeriatric Consultations: Outpatient Versus Home-Based Consultations

1994 ◽  
Vol 6 (2) ◽  
pp. 179-184 ◽  
Author(s):  
Ajit Shah
Keyword(s):  
Home Visits ◽  
Cost Comparison ◽  
Comparison Study ◽  
Advantages And Disadvantages ◽  
Home Based ◽  
The Many ◽  
The Cost ◽  
Methodological Difficulties ◽  
At Home

In this article a cost-comparison study of psychogeriatric outpatient and home consultations (if all outpatients are seen at home) is reported. The cost of home visits was estimated to be less than that for outpatient consultations. The results are discussed in the context of methodological difficulties and the advantages and disadvantages of home and outpatient consultations. In view of the many advantages of home-based consultations, including lower costs, it is concluded that we should be developing and evaluating services with greater emphasis on home-based consultations.

scholarly journals Socio-demographic, clinical, hospital admission and oxygen requirement characteristics of COVID-19 patients of Bangladesh

2020 ◽  
Author(s):  
Ratindra Nath Mondal ◽  
Md. Abdur Razzak Sarker ◽  
Anupom Das ◽  
M. Ahsanul Kabir Ahsan ◽  
Shah Md Sarwer Jahan ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Family Members ◽  
Disease Symptom ◽  
Rt Pcr ◽  
Cross Sectional Survey ◽  
General Physician ◽  
Cross Sectional ◽  
Male Predominance ◽  
Study Results ◽  
Wide Range

Abstract Background: Clinical presentation hospital admission and outcome of COVID-19 pandemic are different from one country to another. So every country should have their own data regarding COVID-19. Subjects and Methods: This was an online cross-sectional survey carried out in RT-PCR positive COVID-19 adult patient. A preformed questionnaire adapted in Google form and circulated through online to collect data. Informed consent was ensured before participation in this study. Results: We have studied of 305 RT-PCR positive COVID-19 patients mean age was 36.32(+/-12.369) years with male predominance and majority were doctor 46.9%. 48.8% of the patients family members affected along with them. After COVID-19 pandemic 31.7% did not go out of their house. For prevention (72.4%)of the patients used mask and 38.8% used hand gloves during outing. 28.7% reported to be affected while working in hospital 21.8%were affected in their office. Fever (80.1%) cough (57.7%) pain in throat (50.8%) rhinitis (45.9%) and loss of smell (45%) and taste sensation (45.6%) were the most common symptoms. Sample was given average 3 (+/- 3.384) days after onset of the symptoms and report was delivered average 4.57 days after giving sample. After getting result 32.1% of the patients seek treatment in telemedicine and 23% directly consulted in Government hospital only 2% reported to be treated by the Government designated telephone number. 73.1% of the patient took both steam inhalation and warm water gargling. Paracetamol and antihistamine was the most commonly use drugs 69.8% and 71.5% respectively besides 47.5% took ivermectin 41.6% took azithromycin 35.1% steroid 34.8% took doxycyclin and 21.6% hydroxychloroquine. Among the patients only 20.3% needed hospital admission. The patients admitted in hospital average 5 (+/-3.922) days after onset of symptoms and hospital staying was 9.2 days (average). Breathless (54.83%) was the major cause of hospital admission and 19.35% patients admitted due to fear. 14% patients needed oxygen and average duration of oxygen was 4.84 days. 81.3% patients has taken oxygen in hospital and 18.8% at their home. Among the patient 2.2% needed ICU and artificial ventilation needed for 1.1% patients. The patients recovered after 17.74 days (average) from the onset of symptom. COVID-19 became negative (RT-PCR) at15th day from onset of symptom. 91.8%) were in mental stress to become the cause of infection spread to other family members 20.7%) reported that they were anxious that they would not get oxygen or ICU if required and 27.9% were suffering from fear of death. Weakness was the most common post disease symptom in 57.4% cases. Average time required for coming back to normal life was 21.59 days (+/-7.901) ranging a wide range from 5 to 60 days. Conclusion: COVID-19 patients were mostly male health worker. Fever cough pain in throat were most common symptoms. Hospital admission required in only one-fifth cases and ICU required for only 2% patients. Weakness was the most common post disease symptom. Keywords: COVID Bangladesh oxygen ivermectin Correspondence Dr. Ratindra Nath Mondal President Society of General Physician Founder-Daktarkhana (GP center) Rangpur Bangladesh Email [email protected].

Sign in / Sign up

Export Citation Format

Share Document