scholarly journals Impact of COVID-19 on Antenatal, Natal, and Postnatal Care of pregnant females at Akbar Niazi Teaching Hospital

2021 ◽  
Vol 25 (1) ◽  
pp. 60-65
Author(s):  
Nadia Jabeen ◽  
Fareeha Zaheer ◽  
Kinza Ali ◽  
Amna Faruqi ◽  
Irfan Afzal Mughal ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Postnatal Care ◽  
Preventive Measures ◽  
Care Delivery ◽  
P Value ◽  
Pregnant Females ◽  
Number Of Patients ◽  
The Impact ◽  
Middle Class Families ◽  
Source Of Information

Objective: To determine the perception of pregnant patients regarding the COVID pandemic, preventive measures taken by the patients during the pandemic, and the impact of COVID on their Natal, Intrapartum, and Postpartum Care.Materials and Methods: This study included 850 patients presenting in the Obstetrics and Gynaecology department for antenatal care, inpatient care (delivery and caesarean section), and postpartum complications. Percentages were calculated for descriptive variables like demographic factors, source of information, and opinion of patients about COVID-19, preventive measures are taken by the patients, their Antenatal, Natal, and Postnatal fears. An independent t-test was applied and a p-value of ˂0.05 was taken as statistically significant.Results: We enrolled 850 patients in this study with a mean age of +28 years,mean gravidity of +3, 50% were matriculated and 75% of our patients belonged to middle-class families.. Among our patients, 96% were in fear of getting infected along with their fetus, if they visited the hospital for antenatal care, which is why a majority of them did not visit the hospital for antenatal care and a statistically significant percentage (80%) of them missed antenatal care for 5 months. While the same number of patients (96%, p-value ˂0.05) shared their fear regarding contracting the infection from the hospital during delivery and postnatal care in the hospital, and the same percentage were of the opinion that the baby would get infected during and after delivery in a hospital.Conclusion: Antenatal care is a basic right of every pregnant female. During emergencies like pandemics ways and means should be devised, not only to provide care but, also, to address the fears of pregnant females to prevent complications during this important phase of life.

scholarly journals NCDB Analysis of Melanoma 2004–2015: Epidemiology and Outcomes by Subtype, Sociodemographic Factors Impacting Clinical Presentation, and Real-World Survival Benefit of Immunotherapy Approval

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1455
Author(s):  
Sunny R. K. Singh ◽  
Sindhu J. Malapati ◽  
Rohit Kumar ◽  
Christopher Willner ◽  
Ding Wang
Keyword(s):  
Metastatic Melanoma ◽  
Metastatic Disease ◽  
Real World ◽  
Care Delivery ◽  
Sociodemographic Factors ◽  
P Value ◽  
Real World Data ◽  
Factors Associated ◽  
Improvement In Survival ◽  
The Impact

Background: The incidence of invasive melanoma is rising, and approval for the first immune checkpoint inhibitor (ICI) to treat metastatic melanoma occurred in 2011. We aim to describe the epidemiology and outcomes in recent years, sociodemographic factors associated with the presence of metastasis at diagnosis, and the real‐world impact of ICI approval on survival based on melanoma subtype and race. Methods: This is a retrospective analysis of the National Cancer Database (NCDB) from the years 2004–2015. The primary outcome was the overall survival of metastatic melanoma by subtype. Secondary outcomes included sociodemographic factors associated with the presence of metastasis at diagnosis and the impact of treatment facility type and ICI approval on the survival of metastatic melanoma. Results: Of the 419,773 invasive melanoma cases, 93.80% were cutaneous, and 4.92% were metastatic at presentation. The odds of presenting with metastatic disease were higher in African Americans (AA) compared to Caucasians (OR 2.37; 95% CI 2.11–2.66, p < 0.001). Treatment of metastatic melanoma at an academic/research facility was associated with lower mortality versus community cancer programs (OR 0.75, 95 % CI 0.69–0.81, p-value<0.001). Improvement in survival of metastatic melanoma was noted for Caucasians after the introduction of ICI (adjusted HR 0.80, 95% CI 0.78–0.83, p < 0.001); however, this was not statistically significant for AA (adjusted HR 0.80, 95% CI 0.62–1.02, p‐value = 0.073) or ocular cases (HR 1.03, 95% CI 0.81–1.31, p‐value 0.797). Conclusion: Real‐world data suggest a 20% improvement in survival of metastatic melanoma since the introduction of ICI. The disproportionately high odds of metastatic disease at presentation in AA patients with melanoma suggest the need for a better understanding of the disease and improvement in care delivery.

scholarly journals The impact of antenatal care on under‐five mortality in Ethiopia: a difference‐in‐differences analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Samuel Oduse ◽  
Temesgen Zewotir ◽  
Delia North
Keyword(s):  
Antenatal Care ◽  
Child Survival ◽  
First Trimester ◽  
Sub Saharan Africa ◽  
P Value ◽  
Difference In Differences ◽  
Under Five ◽  
Care Services ◽  
Sub Saharan ◽  
The Impact

Abstract Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

scholarly journals The Impact of Scientific and Technical Training on Improving Routine Collection of Antenatal Care Data for Maternal and Foetal Risk Assessment: A Case Study in the Province of South Kalimantan, Indonesia

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Dewi Anggraini ◽  
Mali Abdollahian ◽  
Kaye Marion ◽  
Supri Nuryani ◽  
Fadly Ramadhan ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antenatal Care ◽  
Technical Training ◽  
P Value ◽  
Factors Affecting ◽  
High Workload ◽  
Data Provision ◽  
Data Documentation ◽  
Evidence Based Guideline ◽  
The Impact

Objectives. First, to assess the impact of scientific and technical training on midwives’ abilities in collecting and recording the results of routine antenatal care examinations. Second, to explore midwives’ views with regard to factors affecting their abilities to successfully complete the data documentation tasks. Methods. The study was conducted in South Kalimantan, Indonesia (April 2016-October 2017). Nineteen urban and rural midwives were selected. Access to antenatal care information on 4,946 women (retrospective cohort study) and 381 women (prospective cohort study) was granted. A descriptive and exploratory design was used to describe midwives’ abilities and challenges pertaining to timely collection and recording of results concerning antenatal care examinations. Results. Scientific and technical training has significantly improved the average amount of recorded antenatal care data (from 17.5% to 62.1%, p-value < 0.0005). Lack of awareness, high workload, and insufficient skills and facilities are the main reasons for the database gaps. Conclusions. The training has equipped midwives with scientific knowledge and technical abilities to allow routine collection of antenatal care data. Provision and adequate use of this information during different stages of pregnancy is crucial as an evidence-based guideline to assess maternal and foetal risk factors to ending preventable mortality.

scholarly journals F.E.M. Stress-Investigation of Scolios Apex

2018 ◽  
Vol 12 (1) ◽  
pp. 51-71 ◽  
Author(s):  
A. Daghighi ◽  
H. Tropp ◽  
N. Dahlström ◽  
A. Klarbring
Keyword(s):  
Vertebral Column ◽  
Parameter Extraction ◽  
Surrounding Tissue ◽  
P Value ◽  
Shear Stresses ◽  
Response Variable ◽  
Geometric Models ◽  
Number Of Patients ◽  
Distortion Energy ◽  
The Impact

Background:In scoliosis, kypholordos and wedge properties of the vertebrae should be involved in determining how stress is distributed in the vertebral column. The impact is logically expected to be maximal at the apex.Aim:To introduce an algorithm for constructing artificial geometric models of the vertebral column from DICOM stacks, with the ultimate aim to obtain a formalized way to create simplistic models, which enhance and focus on wedge properties and relative tilting.Material/Methods:Our procedure requires parameter extraction from DICOM image-stacks (with PACS,IDS-7), mechanical FEM-modelling (with Matlab and Comsol). As a test implementation, models were constructed for five patients with thoracal idiopathic scoliosis with varying apex rotation. For a selection of load states, we calculated a response variable which is based upon distortion energy.Results:For the test implementation, pairwise t-tests show that our response variable is non-trivial and that it is chiefly sensitive to the transversal stresses (transversal stresses where of main interest to us, as opposed to the case of additional shear stresses, due to the lack of explicit surrounding tissue and ligaments in our model). Also, a pairwise t-test did not show a difference (n = 25, p-value≈0.084) between the cases of isotropic and orthotropic material modeling.Conclusion:A step-by-step description is given for a procedure of constructing artificial geometric models from chest CT DICOM-stacks, such that the models are appropriate for semi-global stress-analysis, where the focus is on the wedge properties and relative tilting. The method is inappropriate for analyses where the local roughness and irregularities of surfaces are wanted features. A test application hints that one particular load state possibly has a high correlation to a certain response variable (based upon distortion energy distribution on a surface of the apex), however, the number of patients is too small to draw any statistical conclusions.

scholarly journals A Cross-Sectional Survey Exploring the Impact of the COVID-19 Pandemic on the Cancer Care of Adolescents and Young Adults

2021 ◽  
Vol 28 (4) ◽  
pp. 3201-3213
Author(s):  
Kaitlyn Howden ◽  
Camille Glidden ◽  
Razvan G. Romanescu ◽  
Andrew Hatala ◽  
Ian Scott ◽  
...  
Keyword(s):  
Young Adults ◽  
Cancer Treatment ◽  
Cancer Care ◽  
Negative Impact ◽  
Positive Impact ◽  
Care Delivery ◽  
Adolescents And Young Adults ◽  
P Value ◽  
Cross Sectional Survey ◽  
The Impact

We aimed to describe the negative and positive impacts of changes in cancer care delivery due to COVID-19 pandemic for adolescents and young adults (AYAs) in Canada, as well as the correlates of negative impact and their perspectives on optimization of cancer care. We conducted an online, self-administered survey of AYAs with cancer living in Canada between January and February 2021. Multiple logistic regression was used to identify factors associated with a negative impact on cancer care. Of the 805 participants, 173 (21.5%) experienced a negative impact on their cancer care including delays in diagnostic tests (11.9%), cancer treatment (11.4%), and appointments (11.1%). A prior diagnosis of mental or chronic physical health condition, an annual income of <20,000 CAD, ongoing cancer treatment, and province of residence were independently associated with a negative cancer care impact (p-value < 0.05). The majority (n = 767, 95.2%) stated a positive impact of the changes to cancer care delivery, including the implementation of virtual healthcare visits (n = 601, 74.6%). Pandemic-related changes in cancer care delivery have unfavorably and favorably influenced AYAs with cancer. Interventions to support AYAs who are more vulnerable to the adverse effects of the pandemic, and the thoughtful integration of virtual care into cancer care delivery models is essential.

scholarly journals Evaluation of a novel approach to community health care delivery in Ifanadiana District, Madagascar

2020 ◽  
Author(s):  
Bénédicte Razafinjato ◽  
Luc Rakotonirina ◽  
Jafeta Benony Andriantahina ◽  
Laura F. Cordier ◽  
Randrianambinina Andriamihaja ◽  
...  
Keyword(s):  
Health Care ◽  
Quality Of Care ◽  
Community Health ◽  
Access To Health Care ◽  
Care Delivery ◽  
Local Level ◽  
Scale Up ◽  
P Value ◽  
The Impact

AbstractDespite the widespread global adoption of community health (CH) systems, there are evidence gaps in how to best deliver community-based care aligned with global best practice in remote settings where access to health care is limited and community health workers (CHWs) may be the only available providers. PIVOT partnered with the Ministry of Public Health to pilot a new two-pronged approach for care delivery in rural Madagascar: one CHW provided care at a stationary CH site while 2-5 additional CHWs provided care via proactive household visits. The pilot included professionalization of the CHW workforce (i.e. recruitment, training, financial incentive) and twice monthly supervision of CHWs. We evaluated the impact of the CH pilot on utilization and quality of integrated community case management (iCCM) in the first six months of implementation (October 2019-March 2020).We compared utilization and proxy measures of quality of care (defined as adherence to the iCCM protocol for diagnosis, classification of disease severity, treatment) in the intervention commune and five comparison communes, using a quasi-experimental study design and relying on routinely collected programmatic data. Average per capita monthly under-five visits were 0.28 in the intervention commune and 0.22 in the comparison communes. In the intervention commune, 40.0% of visits were completed at the household via proactive care. CHWs completed all steps of the iCCM protocol in 77.8% of observed visits in the intervention commune (vs 49.5% in the comparison communes, p-value=<0.001). A two-pronged approach to CH delivery and professionalization of the CHW workforce increased utilization and demonstrated satisfactory quality of care. National stakeholders and program managers should evaluate program re-design at a local level prior to national or district-wide scale-up.

Impact of COVID-19 Lockdown on Ocular Trauma in Benghazi, Libya

2021 ◽  
pp. 53-57
Author(s):  
Mariam Gebril ◽  
Bahjah Esehiyb ◽  
Suliman Masoud
Keyword(s):  
Statistical Difference ◽  
Surgical Intervention ◽  
Ocular Trauma ◽  
Public Health Problem ◽  
P Value ◽  
Eye Trauma ◽  
Number Of Patients ◽  
The World ◽  
The Impact ◽  
Similar Incidence

Background. COVID-19 is a new pandemic that spread over the world in 2020, for which most countries imposed rigorous lockdown to reduce its upsurge and thus its socioeconomics’ sever effects. Global measures include isolation, social distancing, lockdown any nonemergency facilities, local and international travelling restrictions. But these rules are implacable in case of trauma in general and more with ocular trauma, which represents a serious public health problem and leading cause of visual impairment. The aim of this study was to evaluate the impact of COVID -19 lock down on number of ocular traumas acquiring surgery. Methods. A retrospective study in Aljala trauma hospital in the period from 18 March to 18 April 2020 on patients who underwent surgical intervention for non-war eye trauma. Results. A total number of patients seen in emergency department were 350 patients in 2020 with four patients needed hospital admission and surgical intervention making a 1.14% of total number. While number of patients seen at the same time in 2019 were 965 patients and three patients needed surgical intervention (0.31%). There was no statistical difference in the amount of patient acquiring surgical intervention in the two periods with the P value of >0.05 Conclusion. Although total emergency eye visits decreased during the covid-19 lockdown period, similar incidence of surgery needed ocular trauma persisted.

scholarly journals Evidence on the effect of gender of newborn, antenatal care and postnatal care on breastfeeding practices in Ethiopia: a meta-analysis andmeta-regression analysis of observational studies

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e023956 ◽  
Author(s):  
Tesfa Dejenie Habtewold ◽  
Nigussie Tadesse Sharew ◽  
Sisay Mulugeta Alemu
Keyword(s):  
Systematic Review ◽  
Regression Analysis ◽  
Antenatal Care ◽  
Breast Feeding ◽  
Postnatal Care ◽  
Observational Studies ◽  
Meta Analysis ◽  
P Value ◽  
Timely Initiation ◽  
Breastfeeding Practices

ObjectivesThe aim of this systematic review and meta-analysis was to investigate the association of gender of newborn, antenatal care (ANC) and postnatal care (PNC) with timely initiation of breast feeding (TIBF) and exclusive breastfeeding (EBF) practices in Ethiopia.DesignSystematic review and meta-analysis.Data sourcesTo retrieve all available literature, PubMed, EMBASE, CINAHL, WHO Global Health Library, Web of Science and SCOPUS databases were systematically searched and complemented by manual searches. The search was done from August 2017 to September 2018.Eligibility criteriaAll observational studies including cross-sectional, case-control, cohort studies conducted in Ethiopia from 2000 to 2018 were included. Newcastle-Ottawa Scale was used for quality assessment of included studies.Data extraction and synthesisStudy area, design, population, number of mothers (calculated sample size and participated in the study) and observed frequency data were extracted using Joanna Briggs Institute tool. To obtain the pooled effect size, a meta-analysis using weighted inverse variance random-effects model was performed. Cochran’s Q X2test, τ2and I2statistics were used to test heterogeneity, estimate amount of total/residual heterogeneity and measure variability attributed to heterogeneity, respectively. Mixed-effects meta-regression analysis was done to identify possible sources of heterogeneity. Egger’s regression test at p value threshold ≤0.01 was used to examine publication bias. Furthermore, the trend of evidence over time was examined by performing a cumulative meta-analysis.ResultsOf 523 articles retrieved, 17 studies (n=26 146 mothers) on TIBF and 24 studies (n=17 819 mothers) on EBF were included in the final analysis. ANC (OR=2.24, 95% CI 1.65 to 3.04, p<0.001, I2=90.9%), PNC (OR=1.86, 95% CI 1.41 to 2.47, p<0.001, I2=63.4%) and gender of newborn (OR=1.31, 95% CI 1.01 to 1.68, p=0.04, I2=81.7%) significantly associated with EBF. ANC (OR=1.70, 95% CI 1.10 to 2.65, p=0.02, I2=93.1%) was also significantly associated with TIBF but not with gender of newborn (OR=1.02, 95% CI 0.86 to 1.21, p=0.82, I2=66.2%).ConclusionsIn line with our hypothesis, gender of newborn, ANC and PNC were significantly associated with EBF. Likewise, ANC was significantly associated with TIBF. Optimal care during pregnancy and after birth is important to ensure adequate breast feeding. This meta-analysis study provided up-to-date evidence on breastfeeding practices and its associated factors, which could be useful for breastfeeding improvement initiative in Ethiopia and cross-country and cross-cultural comparison.Trial registration numberCRD42017056768

Overall survival (OS) in metastatic melanoma since the introduction of immunotherapy: A National Cancer Database analysis.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19333-e19333
Author(s):  
Sunny R K Singh ◽  
Sindhu Janarthanam Malapati ◽  
Rohit Kumar ◽  
Ding Wang
Keyword(s):  
African Americans ◽  
Metastatic Melanoma ◽  
Metastatic Disease ◽  
Real World ◽  
Proportional Hazards Model ◽  
Care Delivery ◽  
Mucosal Melanoma ◽  
Cox Proportional Hazards Model ◽  
P Value ◽  
The Impact

e19333 Background: Metastatic melanoma historically had a very poor prognosis and survival until the utilization of immunotherapy. Ipilimumab, the first immune checkpoint (ICP) inhibitor was approved in March 2011, followed soon after by the approval of PD-1 and PD-L1 inhibitors. We aim to conduct a real-world analysis of survival outcomes before and after 2011 in metastatic melanoma and its subtypes. We will also explore the impact of race on the clinical presentation and outcomes of melanoma. Methods: Adults with metastatic melanoma were identified from the NCDB (2004-2015). Kaplan Meier method was used to estimate survival and Cox proportional hazards model was used to determine hazard ratio (HR) for death after adjusting for age, race, sex, comorbidity index, melanoma type, education, income, insurance, facility type and geographical location. Odds of having metastatic disease at diagnosis were estimated using multivariate log regression analysis. Results: Of the 20,691 metastatic melanoma cases, 19,492 (94.2%) were cutaneous, 326 (1.6%) were ocular and 873 (4.2%) were mucosal. The effect of immunotherapy use on survival in metastatic melanoma was assessed by comparing years 2011-2015 versus 2004-2010. After the introduction of immunotherapy in 2011, the adjusted survival for metastatic melanoma had improved in Caucasians (HR 0.80, p < 0.001, CI 0.77-0.83) but not in African Americans (HR 0.80, p value = 0.08, CI 0.62-1.03). Although, AA constituted a minority in each melanoma group (1.7% cases of cutaneous, 1.5% of ocular and 8.1% of mucosal melanoma), their odds of having metastatic disease at onset was higher in both cutaneous (OR 2.60, p < 0.001 CI 2.28-2.95) and mucosal melanoma (OR 1.85, p < 0.001 CI 1.39-2.47) compared to Caucasians. Conclusions: Real-world data suggested a 20% improvement in survival of metastatic melanoma since the introduction of ICP inhibitors except in the subgroups of ocular melanoma and African Americans. The disproportionately high odds of metastatic disease at presentation in African American patients with melanoma suggests the need for improvement in care delivery, specifically in terms of early detection. [Table: see text]

scholarly journals Using Quality Improvement Methods and Time-Driven Activity-Based Costing to Improve Value-Based Cancer Care Delivery at a Cancer Genetics Clinic

2016 ◽  
Vol 12 (3) ◽  
pp. e320-e331 ◽  
Author(s):  
Ryan Y.C. Tan ◽  
Marie Met-Domestici ◽  
Ke Zhou ◽  
Alexis B. Guzman ◽  
Soon Thye Lim ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cancer Care ◽  
Cancer Genetics ◽  
Care Delivery ◽  
Genetic Counselor ◽  
Activity Based Costing ◽  
Improvement Project ◽  
Personnel Costs ◽  
Number Of Patients ◽  
The Impact

Purpose: To meet increasing demand for cancer genetic testing and improve value-based cancer care delivery, National Cancer Centre Singapore restructured the Cancer Genetics Service in 2014. Care delivery processes were redesigned. We sought to improve access by increasing the clinic capacity of the Cancer Genetics Service by 100% within 1 year without increasing direct personnel costs. Methods: Process mapping and plan-do-study-act (PDSA) cycles were used in a quality improvement project for the Cancer Genetics Service clinic. The impact of interventions was evaluated by tracking the weekly number of patient consultations and access times for appointments between April 2014 and May 2015. The cost impact of implemented process changes was calculated using the time-driven activity-based costing method. Results: Our study completed two PDSA cycles. An important outcome was achieved after the first cycle: The inclusion of a genetic counselor increased clinic capacity by 350%. The number of patients seen per week increased from two in April 2014 (range, zero to four patients) to seven in November 2014 (range, four to 10 patients). Our second PDSA cycle showed that manual preappointment reminder calls reduced the variation in the nonattendance rate and contributed to a further increase in patients seen per week to 10 in May 2015 (range, seven to 13 patients). There was a concomitant decrease in costs of the patient care cycle by 18% after both PDSA cycles. Conclusion: This study shows how quality improvement methods can be combined with time-driven activity-based costing to increase value. In this paper, we demonstrate how we improved access while reducing costs of care delivery.

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