scholarly journals Functional Outcomes and Morbidity in Pediatric Sepsis Survivors: A Tanzanian Experience

2022 ◽  
Vol 9 ◽  
Author(s):  
Sarah A. Lau-Braunhut ◽  
Audrey M. Smith ◽  
Martina A. Steurer ◽  
Brittany L. Murray ◽  
Hendry Sawe ◽  
...  
Keyword(s):  
Functional Status ◽  
Functional Outcomes ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Childhood Morbidity ◽  
Septic Episode ◽  
Scale Scores ◽  
Sepsis Survivors ◽  
Pediatric Sepsis

Pediatric sepsis remains a significant cause of childhood morbidity and mortality, disproportionately affecting resource-limited settings. As more patients survive, it is paramount that we improve our understanding of post-sepsis morbidity and its impact on functional outcomes. The functional status scale (FSS) is a pediatric validated outcome measure quantifying functional impairment, previously demonstrating decreased function following critical illnesses, including sepsis, in resource-rich settings. However, functional outcomes utilizing the FSS in pediatric sepsis survivors have never been studied in resource-limited settings or in non-critically ill septic children. In a Tanzanian cohort of pediatric sepsis patients, we aimed to evaluate morbidity associated with an acute septic episode using the FSS modified for resource-limited settings. This was a prospective cohort study at an urban referral hospital in Tanzania, including children with sepsis aged 28 days to 14 years old over a 12-month period. The FSS was adapted to the site's available resources. Functional status scale scores were obtained by interviewing guardians both at the time of presentation to determine the child's baseline and at 28-day follow-up. The primary outcome was “decline in functional status,” as defined by a change in FSS score of at least 3. In this cohort, 4.3% of the 1,359 surviving children completing 28-day follow-up had a “decline in functional status.” Conversely, 13.8% of guardians reported that their child was not yet back to their pre-illness state. Three-quarters of children reported as not fully recovered were not identified via the FSS as having a decline in functional status. In our cohort of pediatric sepsis patients, we identified a low rate of decline in functional status when using the FSS adapted for resource-limited settings. A higher proportion of children were subjectively identified as not being recovered to baseline. This suggests that the FSS has limitations in this population, despite being adapted for resource-limited settings. Next steps include developing and validating a further revised FSS to better capture patients identified as not recovered but missed by the current FSS.

scholarly journals Stereotactic radiosurgery at a low marginal dose for the treatment of pediatric arteriovenous malformations: obliteration, complications, and functional outcomes

2014 ◽  
Vol 14 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Matthew B. Potts ◽  
Sunil A. Sheth ◽  
Jonathan Louie ◽  
Matthew D. Smyth ◽  
Penny K. Sneed ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Functional Outcomes ◽  
Arteriovenous Malformations ◽  
Target Volume ◽  
Neurological Deficits ◽  
Single Institution ◽  
Risks And Benefits ◽  
Scale Scores ◽  
Time Of Presentation

Object Stereotactic radiosurgery (SRS) is an established treatment modality for brain arteriovenous malformations (AVMs) in children, but the optimal treatment parameters and associated treatment-related complications are not fully understood. The authors present their single-institution experience of using SRS, at a relatively low marginal dose, to treat AVMs in children for nearly 20 years; they report angiographic outcomes, posttreatment hemorrhage rates, adverse treatment-related events, and functional outcomes. Methods The authors conducted a retrospective review of 2 cohorts of children (18 years of age or younger) with AVMs treated from 1991 to 1998 and from 2000 to 2010. Results A total of 80 patients with follow-up data after SRS were identified. Mean age at SRS was 12.7 years, and 56% of patients had hemorrhage at the time of presentation. Median target volume was 3.1 cm3 (range 0.09–62.3 cm3), and median prescription marginal dose used was 17.5 Gy (range 12–20 Gy). Angiograms acquired 3 years after treatment were available for 47% of patients; AVM obliteration was achieved in 52% of patients who received a dose of 18–20 Gy and in 16% who received less than 18 Gy. At 5 years after SRS, the cumulative incidence of hemorrhage was 25% (95% CI 16%–37%). No permanent neurological deficits occurred in patients who did not experience posttreatment hemorrhage. Overall, good functional outcomes (modified Rankin Scale Scores 0–2) were observed for 78% of patients; for 66% of patients, functional status improved or remained the same as before treatment. Conclusions A low marginal dose minimizes SRS-related neurological deficits but leads to low rates of obliteration and high rates of hemorrhage. To maximize AVM obliteration and minimize posttreatment hemorrhage, the authors recommend a prescription marginal dose of 18 Gy or more. In addition, SRS-related symptoms such as headache and seizures should be considered when discussing risks and benefits of SRS for treating AVMs in children.

Biomarkers to Stratify Risk Groups among Children with Malnutrition in Resource-Limited Settings and to Monitor Response to Intervention

2017 ◽  
Vol 88 (1) ◽  
pp. 111-117 ◽  
Author(s):  
Christine J. McGrath ◽  
Michael B. Arndt ◽  
Judd L. Walson
Keyword(s):  
At Risk ◽  
Risk Groups ◽  
Response To Therapy ◽  
Children At Risk ◽  
Resource Limited Settings ◽  
Targeted Interventions ◽  
Growth Faltering ◽  
Resource Limited ◽  
Childhood Morbidity ◽  
Novel Biomarkers

Despite global efforts to reduce childhood undernutrition, current interventions have had little impact on stunting and wasting, and the mechanisms underlying growth faltering are poorly understood. There is a clear need to distinguish populations of children most likely to benefit from any given intervention and to develop tools to monitor response to therapy prior to the development of morbid sequelae. In resource-limited settings, environmental enteric dysfunction (EED) is common among children, contributing to malnutrition and increasing childhood morbidity and mortality risk. In addition to EED, early alterations in the gut microbiota can adversely affect growth through nutrient malabsorption, altered metabolism, gut inflammation, and dysregulation of the growth hormone axis. We examined the evidence linking EED and the gut microbiome to growth faltering and explored novel biomarkers to identify subgroups of children at risk of malnutrition due to underlying pathology. These and other biomarkers could be used to identify specific groups of children at risk of malnutrition and monitor response to targeted interventions.

Pediatric sepsis and septic shock management in resource-limited settings

2016 ◽  
Vol 42 (12) ◽  
pp. 2037-2039 ◽  
Author(s):  
Ndidiamaka Musa ◽  
Srinivas Murthy ◽  
Niranjan Kissoon
Keyword(s):  
Septic Shock ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Pediatric Sepsis ◽  
Sepsis And Septic Shock

scholarly journals Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

2013 ◽  
Vol 04 (03) ◽  
pp. 250-256 ◽  
Author(s):  
Patrick Mulligan ◽  
Bethwel Raore ◽  
Shuling Liu ◽  
Jeffrey J Olson
Keyword(s):  
Functional Status ◽  
Subdural Hematoma ◽  
Functional Outcomes ◽  
The Elderly ◽  
Neurological Status ◽  
Common Disease ◽  
Before And After ◽  
Grading Scale ◽  
Burr Holes

ABSTRACT Background: Subdural hematoma (SDH) is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005), yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44%) were discharged home, 16 (36%) discharged to nursing home or rehab, 6 (13%) to hospice and 3 (7%) died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

scholarly journals A Mobile Health App for the Collection of Functional Outcomes After Inpatient Stroke Rehabilitation: Pilot Randomized Controlled Trial

10.2196/17219 ◽  
2020 ◽  
Vol 8 (5) ◽  
pp. e17219
Author(s):  
Li Li ◽  
Jia Huang ◽  
Jingsong Wu ◽  
Cai Jiang ◽  
Shanjia Chen ◽  
...  
Keyword(s):  
Functional Status ◽  
Functional Outcomes ◽  
Home Visit ◽  
Controlled Trial ◽  
Completion Rates ◽  
Validity And Reliability ◽  
Randomized Controlled ◽  
Group Completion ◽  
Functional Assessments

Background Monitoring the functional status of poststroke patients after they transition home is significant for rehabilitation. Mobile health (mHealth) technologies may provide an opportunity to reach and follow patients post discharge. However, the feasibility and validity of functional assessments administered by mHealth technologies are unknown. Objective This study aimed to evaluate the feasibility, validity, and reliability of functional assessments administered through the videoconference function of a mobile phone–based app compared with administration through the telephone function in poststroke patients after rehabilitation hospitalization. Methods A randomized controlled trial was conducted in a rehabilitation hospital in Southeast China. Participants were randomly assigned to either a videoconference follow-up (n=60) or a telephone follow-up (n=60) group. We measured the functional status of participants in each group at 2-week and 3-month follow-up periods. Half the participants in each group were followed by face-to-face home visit assessments as the gold standard. Validity was assessed by comparing any score differences between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Reliability was assessed by computing agreements between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Feasibility was evaluated by the levels of completion, satisfaction, comfort, and confidence in the 2 groups. Results Scores obtained from the videoconference follow-up were similar to those of the home visit assessment. However, most scores collected from telephone administration were higher than those of the home visit assessment. The agreement between videoconference follow-up and home visit assessments was higher than that between telephone follow-up and home visit assessments at all follow-up periods. In the telephone follow-up group, completion rates were 95% and 82% at 2-week and 3-month follow-up points, respectively. In the videoconference follow-up group, completion rates were 95% and 80% at 2-week and 3-month follow-up points, respectively. There were no differences in the completion rates between the 2 groups at all follow-up periods (X21=1.6, P=.21 for 2-week follow-up; X21=1.9, P=.17 for 3-month follow-up). Patients in the videoconference follow-up group perceived higher confidence than those in the telephone follow-up group at both 2-week and 3-month follow-up periods (X23=6.7, P=.04 for 2-week follow-up; X23=8.0, P=.04 for 3-month follow-up). The videoconference follow-up group demonstrated higher satisfaction than the telephone follow-up group at 3-month follow-up (X23=13.9; P=.03). Conclusions The videoconference follow-up assessment of functional status demonstrates higher validity and reliability, as well as higher confidence and satisfaction perceived by patients, than the telephone assessment. The videoconference assessment provides an efficient means of assessing functional outcomes of patients after hospital discharge. This method provides a novel solution for clinical trials requiring longitudinal assessments. Trial Registration chictr.org.cn: ChiCTR1900027626; http://www.chictr.org.cn/edit.aspx?pid=44831&htm=4.

scholarly journals A Mobile Health App for the Collection of Functional Outcomes After Inpatient Stroke Rehabilitation: Pilot Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Li Li ◽  
Jia Huang ◽  
Jingsong Wu ◽  
Cai Jiang ◽  
Shanjia Chen ◽  
...  
Keyword(s):  
Functional Status ◽  
Functional Outcomes ◽  
Home Visit ◽  
Controlled Trial ◽  
Completion Rates ◽  
Validity And Reliability ◽  
Randomized Controlled ◽  
Group Completion ◽  
Functional Assessments

BACKGROUND Monitoring the functional status of poststroke patients after they transition home is significant for rehabilitation. Mobile health (mHealth) technologies may provide an opportunity to reach and follow patients post discharge. However, the feasibility and validity of functional assessments administered by mHealth technologies are unknown. OBJECTIVE This study aimed to evaluate the feasibility, validity, and reliability of functional assessments administered through the videoconference function of a mobile phone–based app compared with administration through the telephone function in poststroke patients after rehabilitation hospitalization. METHODS A randomized controlled trial was conducted in a rehabilitation hospital in Southeast China. Participants were randomly assigned to either a videoconference follow-up (n=60) or a telephone follow-up (n=60) group. We measured the functional status of participants in each group at 2-week and 3-month follow-up periods. Half the participants in each group were followed by face-to-face home visit assessments as the gold standard. Validity was assessed by comparing any score differences between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Reliability was assessed by computing agreements between videoconference follow-up and home visit assessments, as well as telephone follow-up and home visit assessments. Feasibility was evaluated by the levels of completion, satisfaction, comfort, and confidence in the 2 groups. RESULTS Scores obtained from the videoconference follow-up were similar to those of the home visit assessment. However, most scores collected from telephone administration were higher than those of the home visit assessment. The agreement between videoconference follow-up and home visit assessments was higher than that between telephone follow-up and home visit assessments at all follow-up periods. In the telephone follow-up group, completion rates were 95% and 82% at 2-week and 3-month follow-up points, respectively. In the videoconference follow-up group, completion rates were 95% and 80% at 2-week and 3-month follow-up points, respectively. There were no differences in the completion rates between the 2 groups at all follow-up periods (<i>X</i><sup>2</sup><sub>1</sub>=1.6, <i>P</i>=.21 for 2-week follow-up; <i>X</i><sup>2</sup><sub>1</sub>=1.9, <i>P</i>=.17 for 3-month follow-up). Patients in the videoconference follow-up group perceived higher confidence than those in the telephone follow-up group at both 2-week and 3-month follow-up periods (<i>X</i><sup>2</sup><sub>3</sub>=6.7, <i>P</i>=.04 for 2-week follow-up; <i>X</i><sup>2</sup><sub>3</sub>=8.0, <i>P</i>=.04 for 3-month follow-up). The videoconference follow-up group demonstrated higher satisfaction than the telephone follow-up group at 3-month follow-up (<i>X</i><sup>2</sup><sub>3</sub>=13.9; <i>P</i>=.03). CONCLUSIONS The videoconference follow-up assessment of functional status demonstrates higher validity and reliability, as well as higher confidence and satisfaction perceived by patients, than the telephone assessment. The videoconference assessment provides an efficient means of assessing functional outcomes of patients after hospital discharge. This method provides a novel solution for clinical trials requiring longitudinal assessments. CLINICALTRIAL chictr.org.cn: ChiCTR1900027626; http://www.chictr.org.cn/edit.aspx?pid=44831&amp;htm=4.

scholarly journals Pediatric Sepsis and Septic Shock Management in Resource-Limited Settings

2019 ◽  
pp. 197-216 ◽  
Author(s):  
Ndidiamaka Musa ◽  
Srinivas Murthy ◽  
Niranjan Kissoon ◽  
Rakesh Lodha ◽  
Suchitra Ranjit
Keyword(s):  
Septic Shock ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Pediatric Sepsis ◽  
Sepsis And Septic Shock

Interventions for smoking cessation with supporting of health staff in low - and middle-income countries: a systematic review and meta-analysis study

2021 ◽  
Vol 30 (9) ◽  
pp. 68-82
Author(s):  
Do Thi Thanh Toan ◽  
Chun Huang- Erick Wan ◽  
Nguyen Thu Anh ◽  
Pham Ngoc Yen ◽  
Luu Ngoc Minh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Smoking Cessation ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Resource Limited Settings ◽  
Middle Income ◽  
Middle Income Countries ◽  
Randomized Controlled ◽  
Resource Limited

The level of smoking cessation support in hospitals are low, especially in resource limited settings. Current healthcare systems are not well organized to address the issue. This review aimed to evaluate the effectiveness of smoking cessation interventions initiated in health facilities in resource-limited settings. A systematic review using meta-analysis techniques was applied. Bibliographic databases included PubMed, Medline, LILACS, the United States Clinical Trials and the Cochrane Collaboration Library. Eligibility criteria included smoking cessation intervention studies were published in English or Vietnamese, from the year 1990 to 2018. Study designs were randomized controlled trials, quasi-randomized controlled trials, cohort studies and before and after studies. Populations were limited to those in low and middle-income countries. Interventions were limited smoking cessation programs conducted in health facilities. 17 studies had included for the reviewing. 12 studies had been assessed to the meta-analysis. The proportion of successful smoking cessation in 6 months follow-up were range from 11.7% to 62.2% for the intervention group. In 12 months, follow-up, the abstinence rate ranges from 13.6% to 73%. The popularly of medical staff support the intervention was the physicians (8/17, 47.1%) and doctor (5/17, 29.4%). The evidence from our study suggests that the abstinence rate can be affected by the supporting of medical staff follow the smoking cessation (SC) program.

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