scholarly journals Pregnancy, childbirth and neonatal outcomes in women with inherited bleeding disorders: a retrospective analysis.

2021 ◽  
Author(s):  
Lisa Clarke ◽  
Jennifer Curnow ◽  
Briony Cutts ◽  
Bryony Ross ◽  
Giselle Kidson-Gerber
Keyword(s):  
Post Partum ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
Bleeding Disorders ◽  
Neuraxial Analgesia ◽  
The Many ◽  
Definition Of ◽  
Tertiary Care Hospitals ◽  
Pregnancy And Birth

Objective To describe the characteristics and outcomes of women with inherited bleeding disorder during pregnancy and birth. Design Retrospective cohort study. Setting Tertiary care hospitals, NSW and Victoria Australia. Population 100 women with inherited bleeding disorders, who birthed 134 live infants from 132 pregnancies. Methods Data was retrospectively obtained from the patient and neonatal medical records. Descriptive analysis was used to report maternal and pregnancy characteristics, birth and neonatal outcomes. Main outcome measures Factor replacement, neuraxial analgesia use and complications, post-partum haemorrhage and neonatal complications. Results PPH occurred in 22% of deliveries with primary PPH occurring in 20% and secondary PPH in 4% of births. 48% of PPHs were classified as major. PPHs occurred across the spectrum of IBD and was evenly distributed between women who had “normalised” their factor levels in pregnancy compared to those requiring factor at the time of birth. An obstetric cause was identified in more than half of PPHs. Conclusions Women with inherited bleeding disorders can deliver safely and receive neuraxial analgesia without complication when best practices are adhered to. PPH appears to occur at higher rates than the general population despite adequate factor levels or planned replacement. Whilst an obstetric cause was demonstrable in the many cases, these findings raise concern over the current definition of “adequate” factor levels at the time of birth.

REFERRAL PATTERN AND OUTCOMES OF NEONATES FROM SECONDARY CARE SETTING OF AGA KHAN UNIVERSITY HOSPITAL TO TERTIARY CARE CENTERS IN PAKISTAN

2021 ◽  
pp. 1-13
Author(s):  
Suneeta khemani ◽  
Nazia Shamim ◽  
Adnan Mirza ◽  
Nadia Muhammad ◽  
Safdar Kagazwala ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Neonatal Mortality ◽  
Secondary Care ◽  
Surgical Intervention ◽  
Tertiary Care ◽  
Neonatal Outcomes ◽  
University Hospital ◽  
P Value ◽  
Tertiary Care Centers ◽  
Tertiary Care Hospitals

ABSTRACT:Objective: To determine the reasons of neonatal referrals from secondary care settings of Aga Khan University Hospital (AKUH) to tertiary care centers of Karachi, Pakistan and to assess the neonatal outcomes for referred cases. Methodology: This retrospective observational study was conducted at AKUH from July 2015 tjune 2019. All neonates born after 32 weeks of gestation at AKUH secondary care(Kharadar, Garden & Karimabad)and referred to tertiary care hospitals were consecutively enrolled. The reason for referral, i.e. surgical intervention, respiratory support, care of prematurity; need of mechanical ventilation, referral place and neonatal outcomes like discharge in stable condition, left against medical advice (LAMA) and mortality, were noted. Results: Of 348 referred cases, 306 (87.9%)were reported alive. neonatal mortality was reported in 42 (12.1%) of the cases. Of these 306 alive participants, 284 (92.81%) were discharged from the hospital whereas 22 (7.18%) LAMA. Of 348 patients, the referral place of most of the patients was outside AKU,i.e.189(56.3%).The need of mechanical ventilation was reported in, 63 (18.1%) patients. A significant association of mechanical ventilation in tertiary centers was observed in neonates born with low APGAR score at 1 and 5 min (p-value <0.001), shorter duration of stay at secondary care(p-value 0.007),and aggressive resuscitation requirement at birth (p-value <0.001). Conclusion: Most common reasons for referral of newborns to tertiary care hospital was respiratory diseases requiring respiratory support and surgical intervention. Neonatal mortality noted for referrals made to AKUH were much less as compared to cases referred to other tertiary care hospitals. Continuous...  

scholarly journals Effects of Full-Moon Definition on Psychiatric Emergency Department Presentations

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Varinder S. Parmar ◽  
Ewa Talikowska-Szymczak ◽  
Emily Downs ◽  
Peter Szymczak ◽  
Erin Meiklejohn ◽  
...  
Keyword(s):  
Emergency Department ◽  
Mental Health Professionals ◽  
Full Moon ◽  
Tertiary Care ◽  
Lunar Cycle ◽  
Future Research ◽  
Before And After ◽  
Definition Of ◽  
Tertiary Care Hospitals ◽  
The Impact

Objectives. The lunar cycle is believed to be related to psychiatric episodes and emergency department (ED) admissions. This belief is held by both mental health professionals and the general population. Previous studies analyzing the lunar effect have yielded inconsistent results. Methods. ED records from two tertiary care hospitals were used to assess the impact of three different definitions of the full-moon period, commonly found in the literature. The full-moon definitions used in this study were 6 hours before and 6 hours after the full moon (a 12-hour model); 12 hours before and 12 hours after the full moon (a 24-hour model); and 24 hours before and after the day of the full moon (a 3-day model). Results. Different significant results were found for each full-moon model. Significantly fewer patients with anxiety disorders presented during the 12-hour and 24-hour models; however, this was not true of the 3-day model. For the 24-hour model, significantly, more patients presented with a diagnosis of personality disorders. Patients also presented with more urgent triage scores during this period. In the 3-day model, no significant differences were found between the full-moon presentations and the non-full-moon presentations. Conclusions. The discrepancies in the findings of full moon studies may relate to different definitions of “full moon.” The definition of the “full moon” should be standardized for future research.

scholarly journals A questionnaire based study to evaluate the knowledge, attitude and perception towards pharmacovigilance among doctors in rural hospital, Jammu, India

2018 ◽  
Vol 7 (11) ◽  
pp. 2247
Author(s):  
Shallini Gupta ◽  
Kanika Khajuria ◽  
Vijay Khajuria ◽  
Niraj Kumar
Keyword(s):  
Health Care Professionals ◽  
Health Workers ◽  
District Hospital ◽  
Tertiary Care ◽  
Adr Reporting ◽  
Validated Questionnaire ◽  
Pharmacovigilance Center ◽  
Knowledge And Attitude ◽  
Definition Of ◽  
Tertiary Care Hospitals

Background: Monitoring and reporting of adverse drug reactions (ADRs) is very important to minimize or prevent drug caused harm. Thus, pharmacovigilance deals with it and ensures the patient safety. However, most of pharmacovigilance centers are concentrated in the urban tertiary care hospitals and contributes the maximum reports of ADRs. Participation of the rural health workers is equally important towards the success of pharmacovigilance.Methods: The study was conducted using a pre-validated questionnaire among forty doctors in rural Sub district hospital Akhnoor, Jammu after approval of the institutional ethical committee of Government Medical Jammu. The questionnaire consisted of 16 questions (7 related to knowledge, 4 related to attitude, and 4 related to practice and one question pertained to under reporting). The responses were recorded, and data obtained was analysed and presented as number and percentage.Results: Total 66.6% doctors gave correct response regarding the definition of pharmacovigilance and purpose of pharmacovigilance was given by 76.6% of doctors. 70% agreed that ADR reporting is a professional obligation for them. 80% responded that health care professionals are responsible for reporting ADRs. 63.3% of them were aware of a pharmacovigilance programme of India. A total of 96.6% doctors agreed that reporting of ADR is necessary and 93.3% were of the view that pharmacovigilance should be taught in detail. Majority of doctors have experienced ADRs in patients and 36.6% have seen the ADR reporting form. However, only 10% have ever reported ADR to a pharmacovigilance center. No remuneration (50%), lack of time to report ADR (30%), belief that a single unreported case may not affect ADR database (10%), and difficulty to decide whether ADR has occurred or not (10%) were important causes for under reporting of ADRs.Conclusions: Current study has shown that majority of the doctors have good knowledge and attitude about pharmacovigilance. However, under reporting is still a major concern among rural doctors and efforts are needed to address this problem of under reporting by conducting CMEs on regular basis.

CIScoSI Study [Children Immunization Status and cases of Systemic Illness]

2018 ◽  
Vol 3 (3) ◽  
Keyword(s):  
Infectious Diseases ◽  
East Asia ◽  
Pediatric Patients ◽  
Severe Disease ◽  
Tertiary Care ◽  
Immunization Coverage ◽  
South East Asia ◽  
Immunization Status ◽  
Tertiary Care Hospitals ◽  
Total Coverage

To determine the immunization status of pediatric patients under age of 5 years visiting pediatric department of tertiary care hospitals in South East Asia. The aim of this study was to appreciate the awareness and implementation of vaccination in pediatric patients who came into pediatric outpatient Department with presenting complain other than routine vaccination. we can also know the count of patients who do not complete their vaccination after birth. we can differentiate between vaccinated and unvaccinated patients and incidence of severe disease in both groups. Immunization is a protective process which makes a person resistant to the harmful diseases prevailing in the community, typically by vaccine administration either orally or intravenously. It is proven for controlling and eliminating many threatening diseases from the community. WHO report that licensed vaccines are available for the prevention of many infectious diseases. After the implementation of effective immunization the rate of many infectious diseases have declined in many countries of the world. South-East Asia is far behind in the immunization coverage. An estimated total coverage is 56%-88% for a fully immunized child, which is variable between countries. Also the coverage is highest for BCG and lowest for Polio.

Religious Narrative

2013 ◽  
Vol 42 (4) ◽  
pp. 3-9
Author(s):  
Armin Geertz
Keyword(s):  
Special Issue ◽  
Human Communication ◽  
Religious Narrative ◽  
The Many ◽  
Definition Of

This introduction to the special issue on narrative discusses various ways of approaching religious narrative. It looks at various evolutionary hypotheses and distinguishes between three fundamental aspects of narrative: 1. the neurobiological, psychological, social and cultural mechanisms and processes, 2. the many media and methods used in human communication, and 3. the variety of expressive genres. The introduction ends with a definition of narrative.

Study of Mortality Patterns among Hospitalized Patients in Public Sector Tertiary Care Hospitals Faisalabad, Pakistan

2017 ◽  
Vol 11 (3) ◽  
pp. 238-242
Author(s):  
Muhammad Arif Ali ◽  
Ayesha Arif ◽  
Tehreem Fatima ◽  
Muhammad Moaaz Arif
Keyword(s):  
Public Sector ◽  
Tertiary Care ◽  
Hospitalized Patients ◽  
Tertiary Care Hospitals

COMPARISON OF EFFECTIVENESS OF MOBILIZATION AND SELF-EXERCISES IN ADHESIVE CAPSULITIS OF SHOULDER

2018 ◽  
Vol 7 (1) ◽  
pp. 35-41
Author(s):  
Muhammad Usman Khan ◽  
Ghazala Noor Nizami ◽  
Ali Farhad
Keyword(s):  
Pain Intensity ◽  
Adhesive Capsulitis ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Sampling Technique ◽  
Simple Random Sampling ◽  
T Test ◽  
P Value ◽  
Group A ◽  
Group B

OBJECTIVE To compare the effectiveness of mobilization and self-exercises in the management of adhesive capsulitis of shoulder STUDY DESIGN Randomized Control Trial SAMPLE SELECTION 30 patients of adhesive capsulitis of shoulder from physiotherapy department of tertiary care hospitals of Karachi were selected through simple random sampling technique. PROCEDURE Treatment was continued for 5 days per week for the period of 3 weeks followed by assessment. Patients were randomly divided into two equal groups. Group A was treated with midrange mobilization while group B performed self-exercises. Both groups received TENS and hot pack prior to the exercises. Mean ± SD, frequencies and percentages were used for descriptive analysis. ROM via goniometry and pain intensity through VAS was analyzed by paired t-test within the groups and by independent t-test between the groups, using SPSS. P-value of less than 0.05 was considered significant. RESULTS 60% were females (n=18) and 40% were males (n=12) with mean age of 50.17±6.37 years. Significant improvement (p-value <0.05) in pain and shoulder ROM was observed among patients of Group A as compared to Group B. Pain intensity was decreased to 1.67 ± 0.62 in group A, whereas ROMs in these patients were also better than other group.

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