On the effectiveness of inpatient treatment of children with comorbid pathology

Introduction. A comprehensive approach in providing of medical aid to a child with comorbid pathology is intended to mean that child receives high-quality diagnostics, treatment, rehabilitation and informational support in the full extent in regard to all the diseases child has. The main problems of this category of patients are need of expanding treatment and diagnostic activities, attracting of consultants and also increasing of resource costs and breakdown of response to treatment. The goal of research is to study the efficiency of hospital treatment of children with comorbidities in complex examination and treatment. Material and methods. It was examined 616 children aged 7-14 years, hospitalized for asthma. At the same time, 368 children had comorbidities. One half of patients with comorbid pathology received a comprehensive examination and taking into account comorbidities, the other half - a standard set of examination and treatment of the main disease. The survey of parents and catamnestic observation of patients for 1 year was carried out. Results. The presence of comorbidities in children with bronchial asthma, in particular the obesity and gastroenterological diseases, has a significant negative impact on the course of asthma, the efficiency of its therapy and the need for medical aid. The results of the study showed that children with high levels of comorbidity have more frequent and prolonged hospitalizations. Comprehensive screening and early treatment of comorbidities reduces the incidence of exacerbations, the risk of emergency hospitalizations and improves asthma control. Discussion. An increase in the duration of hospitalization of patients with comorbid pathology may be associated with a severity of the main illness and a lower rate of response to therapy, possibly with reduced compliance. Although the presence of comorbidities contributes to the lengthening of hospitalization, a comprehensive examination and treatment does not increase the duration of the child’s stay in the hospital. Conclision. The expansion of diagnostic and therapeutic actions in relation to concomitant diseases in a patient with bronchial asthma within the framework of hospitalization increases the clinical and economic efficiency of treatment measures, reduces the subsequent burden on the hospital and out-patient hospital, increases the assessment of medical care by parents and their adherence to the prescribed treatment.

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Perceptions of mothers having children with bronchial asthma regarding inhaler therapy: a qualitative study

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20175573 ◽

2017 ◽

Vol 5 (1) ◽

pp. 129

Author(s):

Kanai Barik Barik ◽

Uttam Kumar Paul

Keyword(s):

Bronchial Asthma ◽

Response To Therapy ◽

Response To Treatment ◽

Adherence To Treatment ◽

Medical College ◽

Paediatric Department ◽

Depth Interview ◽

Qualitative Descriptive ◽

Excessive Crying ◽

In Parenthesis

Background: Bronchial asthma imposes a significant health burden on the children. Multiple inflammatory mediators are recruited in bronchial asthma. Inhaled corticosteroid therapy is the mainstay of bronchial asthma treatment which is most effective to suppress the inflammatory changes in bronchial airways. The principal issue in proper control of bronchial asthma is adherence to treatment. The objective of the study is to find out the causes of non-adherence to treatment and perceptions of mothers having child with bronchial asthma through a qualitative in-depth interview method. Methods: The study was conducted in the Paediatric Department of Burdwan Medical College, Burdwan, West Bengal. The study was one of qualitative descriptive types involving in depth interviews (IDI) of 27 mothers having children with bronchial asthma. The interviews were translated into English transcripts which were then analyzed to find out suitable codes and categories. Results: From the transcripts we found out eight categories each of which is further divided into several codes. The categories are given here with codes in parenthesis. Initial repercussion (disagreement, habit forming, harmful, future problems), non-willingness to treatment (discontinuation, avoidance and oral medication), hazards during treatment (cost, availability, remote places, lack of time and family crisis), technical difficulties (demonstration, lack of knowledge, and cleaning the device), problem of the baby (irritability, vomiting, and excessive crying), attitude of mother/caregiver (misconception, non-motivation, and worriedness), other modalities of treatment (homeopathy, and ayurvedic medicines), and response to treatment (better feeling, decreased frequency, reduced recurrences, and total cure). Conclusions: Most of the studies dealing with the various factors of non-adherence of treatment of bronchial asthma is not a qualitative approach. In the present study we have applied qualitative in-depth interview approach and able to find out different causes of non-adherence to inhaler therapy of bronchial asthma. In the category "response to therapy", a few of the comments is quite encouraging and fully support the modern views of the management of bronchial asthma.

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Dependence of Anterior Active Rhinomanometry Indices on Nasal Obstructive Disorders in Children with Atopic Bronchial Asthma Complicated by Nasal Symptoms

BioMed Research International ◽

10.1155/2018/1869613 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10

Author(s):

Tatyana I. Eliseeva ◽

Svetlana V. Krasilnikova ◽

Sergey Yu. Babaev ◽

Alexey A. Novozhilov ◽

Dmitry Yu. Ovsyannikov ◽

...

Keyword(s):

Bronchial Asthma ◽

Negative Impact ◽

Nasal Airflow ◽

Clinical Tests ◽

Anthropometric Parameters ◽

Upper Airways ◽

Atopic Bronchial Asthma ◽

Nasal Symptoms ◽

Significant Negative Impact ◽

Pharyngeal Tonsil

Background. Atopic bronchial asthma (BA) in children is associated with upper airways pathology (UAP). Among them, a combination of allergic rhinitis (AR) and nasal obstructive disorders (NOD), including hypertrophy of the pharyngeal tonsil (HPT) and anomalies of the intranasal structures (AINS), is abundant. In such patients, anterior active rhinomanometry (AARM) is an important method of examining nasal patency. However, NOD can influence the AARM parameters in children with BA and nasal symptoms, and this effect must be taken into account in clinical practice. Study goal was to elucidate the effect of NOD on rhinomanometric parameters in this group of patients. Methods. Total of 66 children with BA and AR were examined with AARM, rhinovideoendoscopy, spirometry, and standard clinical tests allowing revealing the structure of comorbid pathologies. In order to avoid the influence of anthropometric parameters of children and their age on AARM parameters, a special index of reduced total nasal airflow was used. Results. It has been established that NOD, especially HPT, have a significant negative impact on the indices of anterior active rhinomanometry during the periods of both AR remission and AR exacerbation. The effect of AINS is much weaker and was remarkable only in combination with HPT.

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Comparison of Time spent between an electronic and a paper-based laboratory information system by laboratorians at a polyclinic in Greater Accra, Ghana: A time-motion study

10.31124/advance.12917756.v1 ◽

2020 ◽

Author(s):

Philip Boakye

Keyword(s):

Information System ◽

Negative Impact ◽

Laboratory Information System ◽

Time Motion ◽

Accessible Information ◽

Motion Study ◽

Significant Difference ◽

Significant Negative Impact ◽

Key Issues ◽

Motion Studies

The acceptance of electronic laboratory information system (LIS) is gradually increasing in developing countries. However, the issue of time effectiveness due to computerization is less clear as there is fewer accessible information. One of the key issues for laboratorians is their indecision with LISs’ would-be effect of time on their work. A polyclinic in Ghana was in the process of implementing electronic LIS. Several of the laboratorians did not have knowledge and skill in computing and there were disagreeing views on the time effectiveness of the LIS after implementation. The management of the polyclinic laboratory was concerned to assess time advantageousness of recording data when using the electronic LIS compared with paper-based LIS. <div><br></div><div>Five randomly selected laboratorians were provided two sheets of paper with tables to document the time they spent for both paper-based and electronic LIS. Data were collected for a total of 230 records,115 electronic LIS and 115 paper-based LIS. The t-test (mean-comparison test) was computed to compare the means of both electronic and paperbased LIS times. </div><div><br></div><div>There was a statistical significant difference in the time spent between electronic and paper-based LIS. The time spent between paper-based and electronic LIS was 0.41 minutes (95% CI 0.15 to 0.66) longer than in electronic LIS. </div><div><br></div><div>LIS can be adopted in polyclinics without having significant negative impact on time spent between electronic and paper-based LIS. More time–motion studies that include laboratorians are however necessary in order to get a more complete picture of time spent between electronic and paper-based LIS. </div>

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ASSESSMENT OF THE SPATIOTEMPORAL DYNAMICS OF THE MACROPHYTE THICKET ECOSYSTEMS IN THE NEVA BAY AND THE ADJACENT WATERS OF THE EASTERN GULF OF FINLAND

Proceedings of International Conference "Managinag risks to coastal regions and communities in a changinag world" (EMECS'11 - SeaCoasts XXVI) ◽

10.31519/conferencearticle_5b1b93849b8ce5.05692343 ◽

2017 ◽

Author(s):

Ekaterina Maksimova ◽

Vladimir Zhigulsky ◽

Vladimir Shuisky ◽

...

Keyword(s):

Aquatic Vegetation ◽

Temporal Dynamics ◽

Negative Impact ◽

Spatiotemporal Dynamics ◽

Gulf Of Finland ◽

Active Growth ◽

Nesting Sites ◽

Significant Negative Impact ◽

And Migration ◽

Neva Bay

The macrophyte thicket ecosystems of higher aquatic vegetation in the Neva Bay (NB) and Eastern Gulf of Finland (EGoF) perform many important roles, including acting as the habitats, nesting sites and migration sites for aquatic and semi-aquatic birds, creating the specific conditions necessary for the spawning and growth of many species of fish, and taking part in the self-purification of the aquatic ecosystems. Many anthropogenic disturbances, hydraulic works in particular, have a significant negative impact on these macrophyte thicket ecosystems. In recent years, the active growth of a new type of macrophyte thicket has been observed in the NB. This is due to the aftereffects of the construction of the Saint Petersburg Flood Prevention Facility Complex (FPFC). It is quite likely that the total macrophyte thicket area in these waters is currently increasing. In the future, it will be necessary to assess the environmental impacts of the hydraulic works on the macrophyte thicket of the NB and EGoF, taking into account the background processes of the spatiotemporal dynamics of the reed beds in the waters in question. To do this, it will be necessary to carry out a comprehensive study of these ecosystems and identify patterns in their spatial and temporal dynamics. The program of the study has been developed and is currently being implemented by Eco-Express-Service, a St. Petersburg eco-design company.

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On the Major Differences between the Banking Systems of the EAEU States

Economics and Management ◽

10.35854/1998-1627-2020-4-397-406 ◽

2020 ◽

Vol 26 (4) ◽

pp. 397-406

Author(s):

T. E. Chekanova

Keyword(s):

Financial Stability ◽

Systems Approach ◽

Negative Impact ◽

Banking Regulation ◽

Member States ◽

Banking Systems ◽

Significant Negative Impact ◽

The Difference ◽

The Government ◽

Major Factors

The presented study examines the problems of integration of the national banking systems of the member states of the Eurasian Economic Union (EAEU).Aim. The study aims to examine the major differences in various aspects of functioning of banking systems in the EAEU member states in terms of their impact on integration processes.Tasks. The author identifies the most prominent features of the banking systems of the EAEU states; reveals the depth of the existing differences through a comparative analysis of various indicators of national banking systems; outlines ways of overcoming integration problems associated with differences in the banking sectors of the Union states.Methods. This study is based on universal general scientific methods and elements of comparative, functional, and economic analysis within the framework of a systems approach. The author uses regulatory documents and banking reports of the EAEU states, statistical and analytical materials of the Eurasian Economic Commission (EEC), and data of Moody’s international rating agency.Results. The study identifies a number of aspects that contain the major differences in the functioning of banking systems in the EAEU member states; highlights the disproportions in the scale, level of development, financial stability, and risks of the banking spheres of the Union states; comparatively analyzes the proportion of banking and non-banking structures in the system and the share of the government and non-resident companies in the capital of banks; marks the difference in the pricing of banking services; determines differences in the existing approaches to banking regulation and the established standards; analyzes the major differences in the legislative acts of the central banks and governments of the EAEU member states and in the terms and definitions used. According to the results of the study, the major factors hindering the development of integration processes between the banking systems of the EAEU states are identified.Conclusions. The existing differences between the banking systems of the EAEU countries are diverse and multifaceted. The author states that the aspects addressed in this study have a significant negative impact on the further development of integration processes, describing the major directions and actions of the member states aimed at minimizing the exiting differences, which are required to facilitate the convergence of the states and the transition towards a common financial market.

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Melanoma: Prognostic Factors and Factors Predictive of Response to Therapy

Current Medicinal Chemistry ◽

10.2174/0929867326666191205160007 ◽

2020 ◽

Vol 27 (17) ◽

pp. 2792-2813

Author(s):

Martina Strudel ◽

Lucia Festino ◽

Vito Vanella ◽

Massimiliano Beretta ◽

Francesco M. Marincola ◽

...

Keyword(s):

Prognostic Factors ◽

Lactate Dehydrogenase ◽

Checkpoint Inhibitors ◽

Survival Rates ◽

Elevated Serum ◽

Predictive Biomarkers ◽

Response To Therapy ◽

Response To Treatment ◽

Prognostic Features ◽

Programmed Death

Background: A better understanding of prognostic factors and biomarkers that predict response to treatment is required in order to further improve survival rates in patients with melanoma. Predictive Biomarkers: The most important histopathological factors prognostic of worse outcomes in melanoma are sentinel lymph node involvement, increased tumor thickness, ulceration and higher mitotic rate. Poorer survival may also be related to several clinical factors, including male gender, older age, axial location of the melanoma, elevated serum levels of lactate dehydrogenase and S100B. Predictive Biomarkers: Several biomarkers have been investigated as being predictive of response to melanoma therapies. For anti-Programmed Death-1(PD-1)/Programmed Death-Ligand 1 (PD-L1) checkpoint inhibitors, PD-L1 tumor expression was initially proposed to have a predictive role in response to anti-PD-1/PD-L1 treatment. However, patients without PD-L1 expression also have a survival benefit with anti-PD-1/PD-L1 therapy, meaning it cannot be used alone to select patients for treatment, in order to affirm that it could be considered a correlative, but not a predictive marker. A range of other factors have shown an association with treatment outcomes and offer potential as predictive biomarkers for immunotherapy, including immune infiltration, chemokine signatures, and tumor mutational load. However, none of these have been clinically validated as a factor for patient selection. For combined targeted therapy (BRAF and MEK inhibition), lactate dehydrogenase level and tumor burden seem to have a role in patient outcomes. Conclusions: With increasing knowledge, the understanding of melanoma stage-specific prognostic features should further improve. Moreover, ongoing trials should provide increasing evidence on the best use of biomarkers to help select the most appropriate patients for tailored treatment with immunotherapies and targeted therapies.

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Reserved Bed Program Reduces Neurosciences Intensive Care Unit Capacity Strain: An Implementation Study

Neurosurgery ◽

10.1093/neuros/nyz024 ◽

2019 ◽

Vol 86 (1) ◽

pp. 132-138

Author(s):

Christopher D Shank ◽

Nicholas J Erickson ◽

David W Miller ◽

Brittany F Lindsey ◽

Beverly C Walters

Keyword(s):

Intensive Care ◽

Economies Of Scale ◽

Negative Impact ◽

The United States ◽

Fiscal Year ◽

Implementation Study ◽

Service Line ◽

Hospital Units ◽

Significant Negative Impact ◽

Operational Issues

Abstract BACKGROUND Neurosciences intensive care units (NICUs) provide institutional centers for specialized care. Despite a demonstrable reduction in morbidity and mortality, NICUs may experience significant capacity strain with resulting supraoptimal utilization and diseconomies of scale. We present an implementation study in the recognition and management of capacity strain within a large NICU in the United States. Excessive resource demand in an NICU creates significant operational issues. OBJECTIVE To evaluate the efficacy of a Reserved Bed Pilot Program (RBPP), implemented to maximize economies of scale, to reduce transfer declines due to lack of capacity, and to increase transfer volume for the neurosciences service-line. METHODS Key performance indicators (KPIs) were created to evaluate RBPP efficacy with respect to primary (strategic) objectives. Operational KPIs were established to evaluate changes in operational throughput for the neurosciences and other service-lines. For each KPI, pilot-period data were compared to the previous fiscal year. RESULTS RBPP implementation resulted in a significant increase in accepted transfer volume to the neurosciences service-line (P = .02). Transfer declines due to capacity decreased significantly (P = .01). Unit utilization significantly improved across service-line units relative to theoretical optima (P < .03). Care regionalization was achieved through a significant reduction in “off-service” patient placement (P = .01). Negative externalities were minimized, with no significant negative impact in the operational KPIs of other evaluated service-lines (P = .11). CONCLUSION Capacity strain is a significant issue for hospital units. Reducing capacity strain can increase unit efficiency, improve resource utilization, and augment service-line throughput. RBPP implementation resulted in a significant improvement in service-line operations, regional access to care, and resource efficiency, with minimal externalities at the institutional level.

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The Influence of Urban Sprawl on Air Pollution and the Mediating Effect of Vehicle Ownership

Processes ◽

10.3390/pr9081261 ◽

2021 ◽

Vol 9 (8) ◽

pp. 1261

Author(s):

Aiping Tao ◽

Qun Liang ◽

Peng Kuai ◽

Tao Ding

Keyword(s):

Air Pollution ◽

Urban Sprawl ◽

Negative Impact ◽

Empirical Support ◽

Mediating Effect ◽

Vehicle Ownership ◽

Mediating Role ◽

Effect Model ◽

Significant Negative Impact ◽

The Impact

Based on the panel data of 224 prefecture-level and above cities in China from 2003 to 2016, this paper empirically studies the impact of urban sprawl on air pollution and introduces a mediating effect model to test the mediating role of vehicle ownership concerning the impact of urban sprawl on air pollution. The research in this paper arrives at three conclusions. First, urban sprawl has a significant positive effect on air pollution, and this conclusion is still valid after solving the endogeneity problem and conducting a robustness test. Second, the results of mediating effect test show that urban sprawl indirectly affects air pollution through the partial mediating effect of vehicle ownership. By removing the mediating effect, urban sprawl has a significant negative impact on air pollution, indicating that the mediating effect of vehicle ownership is higher concerning the impact of urban sprawl on air pollution. Third, further panel quantile regression results show that the higher the level of air pollution, the weaker the mediating effect of vehicle ownership and the stronger the direct effect of urban sprawl on air pollution. These conclusions can provide some empirical support for solving the air pollution problems caused by urban sprawl in China.

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Risk Factors, Pattern and Outcome of Motorcycle-associated Head Injury in Sokoto: An Analysis of 184 Cases

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1722553 ◽

2021 ◽

Author(s):

Henry Olayere Obanife ◽

Nasiru Jinjiri Ismail ◽

Ali Lasseini ◽

Bello B. Shehu ◽

Ega J. Otorkpa

Keyword(s):

Developing Countries ◽

Head Injury ◽

Road Traffic ◽

Negative Impact ◽

Cross Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Incidence And Mortality ◽

Male Female Ratio ◽

Significant Negative Impact

Abstract Background Road traffic accident (RTA) is the eighth leading cause of death worldwide. Motorcycle-associated head injury is the leading cause of road traffic associated morbidity and mortality in developing countries. Even though the incidence and mortality of head injury from motor cycle crash is on the increase in developing countries, especially in the African continent, most of the studies published in the literature on this subject matter took place in the developed Western countries. Methods This is a retrospective cross-sectional study of data from patients managed in our institution between December 2014 and November 2016. Results One hundred and eighty-four patients were analyzed. None of the patients used safety helmet for protection. The mean age was 27.6 ± 17.2 years with male female ratio of 6.7:1. Lone crash by cyclists and collisions accounted for 66.8% and 33.1% of the cases, respectively. Passengers and riders comprised 75% of the patients, while 25% were vulnerable pedestrians. The most frequently abused substance by the patients was tramadol (65.52%). Severe head injury and pupillary abnormality were found in 23.9% and 45.5% of the patients, respectively. Cranial CT scan showed abnormalities in 40.2% of the patients. Surgery was done in 28.3% of the patients with mortality rate of 20.7%. Conclusions The use of motorcycle as a mean of transportation has caused significant negative impact on the society. Young people, who constitute the workforce, are majorly affected, and this invariably leads to a serious economic burden on the concerned families and communities.

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Implementing Personalized Medicine in COVID-19 in Andalusia: An Opportunity to Transform the Healthcare System

Journal of Personalized Medicine ◽

10.3390/jpm11060475 ◽

2021 ◽

Vol 11 (6) ◽

pp. 475

Author(s):

Joaquín Dopazo ◽

Douglas Maya-Miles ◽

Federico García ◽

Nicola Lorusso ◽

Miguel Ángel Calleja ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Clinical Practice ◽

Personalized Medicine ◽

Local Level ◽

Individual Variability ◽

Response To Therapy ◽

Control Measures ◽

Response To Treatment ◽

Specific Patient

The COVID-19 pandemic represents an unprecedented opportunity to exploit the advantages of personalized medicine for the prevention, diagnosis, treatment, surveillance and management of a new challenge in public health. COVID-19 infection is highly variable, ranging from asymptomatic infections to severe, life-threatening manifestations. Personalized medicine can play a key role in elucidating individual susceptibility to the infection as well as inter-individual variability in clinical course, prognosis and response to treatment. Integrating personalized medicine into clinical practice can also transform health care by enabling the design of preventive and therapeutic strategies tailored to individual profiles, improving the detection of outbreaks or defining transmission patterns at an increasingly local level. SARS-CoV2 genome sequencing, together with the assessment of specific patient genetic variants, will support clinical decision-makers and ultimately better ways to fight this disease. Additionally, it would facilitate a better stratification and selection of patients for clinical trials, thus increasing the likelihood of obtaining positive results. Lastly, defining a national strategy to implement in clinical practice all available tools of personalized medicine in COVID-19 could be challenging but linked to a positive transformation of the health care system. In this review, we provide an update of the achievements, promises, and challenges of personalized medicine in the fight against COVID-19 from susceptibility to natural history and response to therapy, as well as from surveillance to control measures and vaccination. We also discuss strategies to facilitate the adoption of this new paradigm for medical and public health measures during and after the pandemic in health care systems.

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