Preventing cesareans with peanut ball use

The Association of Women's Health Obstetrical and Neonatal Nurses (AWHONN) has launched a Peanut Ball campaign to help curb the high rate of cesarean births in the United States. Cesarean births are especially likely in women who receive epidural anesthesia due to immobility and pelvic laxity. The peanut ball (PB) is a birthing ball that when placed between the mother's legs can increase pelvic dimensions and facilitate fetal descent and birth. For PB to increase vaginal deliveries (VDs), nurses on obstetrical wards need to “buy in” to using this innovation. Having “innovator” nurses on the shift helped disseminate the PB intervention and increased the rate of VDs. Using a retrospective study design that uses data collected for non-research purposes saves time and cost. Our retrospective study examined the difference in VDs with patient controlled epidural anesthesia (PCEA) in the first five months of 2016 prior to PB use compared with the same months in 2017 post intervention. Using a paired t-test we found a significant difference of successful PCEA vaginal births in 2016 compared to 2017 (p = .008). This relatively inexpensive and easy survey can be done by most obstetrical services and help AWHONN in their campaign to decrease the rate of cesarean sections.

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Influence of preoperative corticosteroid treatment on rate of diagnostic surgeries in primary central nervous system lymphoma: a multicenter retrospective study

BMC Cancer ◽

10.1186/s12885-021-08515-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Florian Scheichel ◽

Franz Marhold ◽

Daniel Pinggera ◽

Barbara Kiesel ◽

Tobias Rossmann ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Retrospective Study ◽

Diagnostic Delay ◽

Central Nervous System Lymphoma ◽

Corticosteroid Treatment ◽

Histopathological Diagnosis ◽

Significant Difference ◽

The Difference ◽

Immunocompetent Patients

Abstract Background Corticosteroid therapy (CST) prior to biopsy may hinder histopathological diagnosis in primary central nervous system lymphoma (PCNSL). Therefore, preoperative CST in patients with suspected PCNSL should be avoided if clinically possible. The aim of this study was thus to analyze the difference in the rate of diagnostic surgeries in PCNSL patients with and without preoperative CST. Methods A multicenter retrospective study including all immunocompetent patients diagnosed with PCNSL between 1/2004 and 9/2018 at four neurosurgical centers in Austria was conducted and the results were compared to literature. Results A total of 143 patients were included in this study. All patients showed visible contrast enhancement on preoperative MRI. There was no statistically significant difference in the rate of diagnostic surgeries with and without preoperative CST with 97.1% (68/70) and 97.3% (71/73), respectively (p = 1.0). Tapering and pause of CST did not influence the diagnostic rate. Including our study, there are 788 PCNSL patients described in literature with an odds ratio for inconclusive surgeries after CST of 3.3 (CI 1.7–6.4). Conclusions Preoperative CST should be avoided as it seems to diminish the diagnostic rate of biopsy in PCNSL patients. Yet, if CST has been administered preoperatively and there is still a contrast enhancing lesion to target for biopsy, surgeons should try to keep the diagnostic delay to a minimum as the likelihood for acquiring diagnostic tissue seems sufficiently high.

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1476. Impact of an Educational Campaign on Rates of Sputum Culture Acquisition as an Opportunity for Antibiotic De-escalation

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1657 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S739-S739

Author(s):

Jessica Snawerdt ◽

Derek N Bremmer ◽

Dustin R Carr ◽

Thomas L Walsh ◽

Tamara Trienski ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Mortality ◽

Community Acquired Pneumonia ◽

Sputum Culture ◽

Post Intervention ◽

Significant Difference ◽

Educational Campaign ◽

The Difference ◽

Hospital Acquired ◽

Culture Acquisition

Abstract Background The 2019 community-acquired pneumonia (CAP) guidelines recommend obtaining a sputum culture in patients who are empirically treated for methicillin-resistant Staphylococcus aureus (MRSA) or Pseudomonas aeruginosa to assist clinicians in optimizing antimicrobial therapy. A previous study at our institution found respiratory cultures were rarely obtained in patients with CAP. As a result of these findings, an educational campaign was implemented to promote the use of an induced sputum protocol. Methods This was a multicenter, retrospective cohort study that included patients who were ≥18 years of age, had a diagnosis of CAP, and received ≥48 hours of anti-pseudomonal antibiotics. Patients were excluded if mechanically ventilated within 48 hours of admission or diagnosed with hospital-acquired or ventilator-associated pneumonia. Patients were grouped into pre- and post-intervention time periods. The intervention involved education on obtaining respiratory cultures including technique on induced sputums and updates to CAP order sets. The primary outcome was the rate of sputum culture acquisition. Secondary outcomes included duration of anti-pseudomonal and anti-MRSA therapy, in-hospital mortality, and length of stay. Results A total of 143 patients met inclusion criteria, 72 in the pre-implementation group and 71 in the post-implementation group. Baseline characteristics were similar between the two groups. More patients in the post-implementation group had a sputum culture obtained but the difference was not statistically significant (38.9% vs 53.5%; p=0.08). Anti-pseudomonal therapy was continued for an average of 5.6 days pre-implementation and 5.2 days post-implementation (p=0.499). There was also not a significant difference in anti-MRSA duration between the two groups (3.4 days vs 3.2 days; p=0.606). In-hospital mortality and length of stay were similar between the two groups. Conclusion An educational campaign focusing on the acquisition of induced sputums led to an increase in rates of sputum cultures collected. However, this did not correlate with a decrease in duration of anti-MRSA or anti-pseudomonal therapy. Further interventions should be made to optimize de-escalation of broad spectrum antibiotics based on sputum culture results. Disclosures All Authors: No reported disclosures

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Effects of Orthokeratology Lens On Axial Length Elongation in Myopia With Anisometropia Children

10.21203/rs.3.rs-741927/v1 ◽

2021 ◽

Author(s):

Ziyang Chen ◽

Kai-Ming Chen ◽

Ying Shi ◽

Zhao-Da Ye ◽

Sheng Chen ◽

...

Keyword(s):

Retrospective Study ◽

Axial Length ◽

Statistical Significance ◽

Spherical Equivalent ◽

Significant Difference ◽

The Mean ◽

The Difference ◽

Better Than ◽

Group 1

Abstract AimTo investigate the effect of orthokeratology (OK) lens on axial length (AL) elongation in myopia with anisometropia children.MethodsThirty-seven unilateral myopia (group 1) and fifty-nine bilateral myopia with anisometropia children were involved in this 1-year retrospective study. And bilateral myopia with anisometropia children were divided into group 2A (diopter of the lower SER eye under − 2.00D) and group 2B(diopter of the lower SER eye is equal or greater than − 2.00D). The change in AL were observed.The datas were analysed using SPSS 21.0.Results(1) In group 1, the mean baseline AL of the H eyes and L eye were 24.70 ± 0.89 mm and 23.55 ± 0.69 mm, respectively. In group 2A, the mean baseline AL of the H eyes and L eyes were 24.61 ± 0.84 mm and 24.00 ± 0.70 mm respectively. In group 2B, the mean baseline AL of the H eyes and L eyes were 25.28 ± 0.72 mm and 24.70 ± 0.74 mm. After 1 year, the change in AL of the L eyes was faster than the H eyes in group 1 and group 2A (all P<0.001).While the AL of the H eyes and L eyes had the same increased rate in group 2B. (2) The effect of controlling AL elongation of H eyes is consistent in three groups (P = 0.559).The effect of controlling AL elongation of L eyes in group 2B was better than that in group 1 and group 2A (P < 0.001). And the difference between group 1 and group 2A has no statistical significance. (3) The AL difference in H eyes and L eyes decreased from baseline 1.16 ± 0.55mm to 0.88 ± 0.68mm after 1 year in group 1.And in group 2A, the AL difference in H eyes and L eyes decreased from baseline 0.61 ± 0.34mm to 0.48 ± 0.28mm. There was statistically significant difference (all P<0.001). In group 2B, the baseline AL difference in H eyes and L eyes has no significant difference from that after 1 year (P = 0.069).ConclusionsMonocular OK lens is effective on suppression AL growth of the myopic eyes and reduce anisometropia value in unilateral myopic children. Binocular OK lenses only reduce anisometropia with the diopter of the low eye under − 2.00D. Binocular OK lenses cannot reduce anisometropia with the diopter of the low eye equal or greater than − 2.00D. Whether OK lens can reduce refractive anisometropia value is related to the spherical equivalent refractive of low refractive eye in bilateral myopia with anisometropia children after 1-year follow-up.

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EFFECTIVENESS OF CHLORHEXIDINE BATH, SALINE BATH, AND STANDARD BATH ON BACTERIAL COLONIZATION ON THE SKIN

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i10.25893 ◽

2018 ◽

Vol 11 (10) ◽

pp. 330

Author(s):

Divya Abraham ◽

Vinitha Ravindran ◽

Vinsley Rose ◽

Joy Sarojini Michael

Keyword(s):

Bacterial Colonization ◽

Cost Effective ◽

Colony Count ◽

Coagulase Negative Staphylococcus ◽

Invasive Procedures ◽

Post Intervention ◽

Bacterial Colony ◽

Medical College ◽

Significant Difference ◽

The Difference

Objective: The main objective of the study was to determine whether bathing with 2% chlorhexidine or 0.9% saline or standard soap and water will reduce the bacterial colony count on skin effectively.Methods: Quantitative approach with experimental design and consecutive sampling was used. The study was conducted among 102 children admitted in pediatric wards of Christian Medical College, Vellore. Swabs from axilla and groin were collected at 0 h, 2 h, and 24 h of intervention to determine the bacterial colony count in subjects.Results: The results showed that, of 102 children, 73 (71.56%) of them had high axillary colony count and 69 (67.64%) of them had high groin colony count during admission. Majority 88.2% and 78% of them had colonization with coagulase-negative staphylococcus in the axilla and groin, respectively. There was no significant difference in the bacterial colony count in axilla at 2 and 24 h in all three groups. There was a significant difference in the bacterial colony count in groin at 2 h after the intervention in the chlorhexidine group, and the difference was not significant at 24 h. The colony count was not significantly different at 2 h post-intervention in saline and standard soap and water group but was statistically different in these groups at 24 h after the intervention.Conclusion: Chlorhexidine has shown to be effective for a shorter duration and it can be adopted for children who are undergoing invasive procedures and preoperatively in surgical wards while continuing routine standard bath for all children which is considered to be cost effective too.

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Evolution of clinical outcomes of metastatic pancreatic adenocarcinoma: A 10-year single-institution retrospective study.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e16760 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e16760-e16760

Author(s):

Moataz Ellithi ◽

Mohamed A. Abdallah ◽

Mahum Shahid ◽

Isaak Ailts ◽

Kate Waligoske ◽

...

Keyword(s):

Retrospective Study ◽

Clinical Outcomes ◽

Pancreatic Adenocarcinoma ◽

Cox Regression ◽

The United States ◽

Wilcoxon Test ◽

Cox Regression Analysis ◽

Metastatic Pancreatic Adenocarcinoma ◽

Significant Difference ◽

Before And After

e16760 Background: Pancreatic adenocarcinoma represents the fourth leading cause of cancer-related death in the United States. A majority of patients have locally advanced or metastatic disease at the time of diagnosis. For many years, gemcitabine monotherapy was the standard of care for advanced disease, until recent studies demonstrated survival benefits for FOLFIRINOX (5-FU, leucovorin, irinotecan, and oxaliplatin) and Gem/nab-P (gemcitabine/nab-paclitaxel). In this study, we evaluated the clinical outcomes in patients with metastatic pancreatic adenocarcinoma in a single health system before and after the incorporation of these newer treatments into practice. Methods: A retrospective study of metastatic pancreatic adenocarcinoma patients diagnosed between January 2009 to December 2018 with follow up until December 2019. Overall survival (OS) and progression-free survival (PFS) were calculated using Kaplan-Meier survival analysis. Univariate and multivariable Cox regression analyses were used to explore predictors of survival. Results: 394 patients were diagnosed with metastatic pancreatic adenocarcinoma at Sanford Health hospitals during the study period. There was no statistically significant difference in OS between the cohort diagnosed between 2009-2013 compared to 2014-2018, with median OS of 4.7 and 3.6 months respectively; in those receiving at least one line of chemotherapy, the median OS was 6.7 and 7.3 months. While subgroup analysis of all study population based on the type of first-line chemotherapy showed improved survival with FOLFIRINOX and Gem/nabP as compared to gemcitabine monotherapy [10.7, 6.9, 4 months respectively] (Wilcoxon Test of Homogeneity of Survival Curves p = 0.0002). Univariate and multivariate Cox regression analysis of all study data revealed that at the time of the diagnosis, age (HR: 1.021, p = 0.0013), ECOG performance status > 1 (HR: 3.47, p = 0.0001), serum albumin (HR: 0.708, p = 0.0002), Neutrophil-to-Lymphocytes ratio (HR: 1.076, p≤0.0001) and platelets-to-lymphocyte ratio (HR: 0.998, p = 0.0031) were predictors of survival. Conclusions: Although newer treatments appear to offer improved survival for eligible patients, overall outcomes for metastatic pancreatic adenocarcinoma in this cohort were similar before and after the incorporation of newer treatment regimens. Further advances in the treatment and early detection of pancreatic cancer are needed to improve clinical outcomes.

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Age is A Critical Factor In Wrist Function After Surgical Therapy of Patients Suffering From A-Type Distal Radius Fracture: A PROM Study

10.21203/rs.3.rs-1195686/v1 ◽

2021 ◽

Author(s):

F Von Matthey ◽

Johannes Weber ◽

Michael Müller ◽

Peter Biberthaler ◽

Helen Abel

Keyword(s):

Retrospective Study ◽

Distal Radius ◽

Patient Group ◽

Study Design ◽

Type A ◽

Control Group ◽

Age Group ◽

Significant Difference ◽

Retrospective Study Design ◽

Wrist Function

Abstract Background: Although distal radius fractures (DRF) are the most common fractures of the human body there is still no consensus concerning the best treatment option, especially for type A fractures. Moreover, studies concerning other anatomic regions could prove that patient age is of high impact on therapy and outcome. Therefore, we have quantified wrist function within a retrospective study design using PROM and we have analysed the influence of age between control and patient collective and young versus old, respectively.Patients and Methods: The retrospective study included all patients with a surgically treated DRF type A and a control group of healthy patients, age and gender matched. The function of the wrist was examined with a self-assessment questionnaire the Munich Wrist Questionnaire (MWQ) according to the patient related outcome measurements (PROM). Results: PROM was answered by 110 patients with DRF type A. The average follow-up was 66 months. 110 healthy wrists were the control group and subgroup matching induced similar age group distribution. Hence, 7 individuals < 30 years, 67 between 31 and 64 years, 29 control individuals between 65 and 79 years and 7 control individuals > 80 years, respectively. Women were significantly older than the men (59±15 vs. 47±17).In overall analysis, there was no significant difference between control and patient group (96±6 vs. 95±7). Function was significantly different between control and patient group < 30 years (100±1 vs. 98±2). In the control group the function was significantly decreasing with advanced aging whereas in the patient group this influence was absent. The difference between age group <30 and 65-79 and >80 and between 30-64 and 65-79 and >80 was significantly different with increasing age. Conclusion: PROM is a suitable tool for a retrospective study design as numerous patients can be analysed. The influence of age is critical for wrist function. Hence, we therefore strongly suggest that this information should be taken into consideration for future study plans.

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Influence of Community-Based Interventions on Routine Immunization Uptake among Children Under Five Years in Ntungamo District-Uganda

TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH ◽

10.21522/tijph.2013.09.04.art006 ◽

2021 ◽

Vol 9 (4) ◽

pp. 62-83

Author(s):

Byamukama Topher

Keyword(s):

Immunization Coverage ◽

Control Groups ◽

Community Based Interventions ◽

Post Intervention ◽

Community Based ◽

Significant Difference ◽

Immunization Services ◽

Level Of Knowledge ◽

The Difference ◽

And Control

Evidence of the effectiveness of community-based interventions in improving immunization coverage in populations of low coverage is limited. Vaccine-preventable diseases is a major public health challenge in low-income countries where Uganda lies, and immunization is the only reliable strategy for child survival. The study's objective was to assess the influence of a community-based intervention on the uptake of immunization services to recommend strategies to health stakeholders to improve immunization coverage. A quasi-experimental study was conducted in three phases. Structured and key informant interviews were used as data collection tools. Phase one provided baseline data before the intervention, the second phase was a community-based intervention, and the third phase was post-intervention evaluation. There was no significant difference on the uptake of BCG, POLIO-0, POLIO-1, POLIO-2, DPTHeP-Hib1, DPTHeP-Hib2, PCV1 and PCV2 immunizations between the intervention and control group post-intervention (P= 1.00, α =0.5). The level of knowledge on immunization was 68.8% and 29.6% in the intervention and control groups, respectively. The difference between the two was statistically significant (P=0.00 = α= 0.5). There was a significant association between the level of knowledge of the caregivers on immunization and the uptake of immunization services (P=0.00, α=0.5). There was also a statistically significant difference in immunization coverage between the intervention and control groups (97.5%) and (75.1%) for the intervention and control groups, respectively. The difference was statistically associated with the community-based intervention (P =0.00, α=0.5). Community-based interventions influenced the uptake of routine immunization services.

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Pregnancies past the estimated date of confinement: labour and delivery outcome

Eastern Mediterranean Health Journal ◽

10.26719/2003.9.5-6.955 ◽

2003 ◽

Vol 9 (5-6) ◽

pp. 955-960

Author(s):

M. Al Taani

Keyword(s):

Caesarean Section Rate ◽

Adverse Outcomes ◽

Mortality And Morbidity ◽

Delivery Outcome ◽

Vaginal Deliveries ◽

Significant Difference ◽

The Difference ◽

A Prospective Study ◽

Onset Group ◽

Spontaneous Onset

To compare labour and delivery outcomes in women undergoing induction and those having spontaneous onset for pregnancies past the estimated date of delivery, a prospective study of 395 singleton, uncomplicated pregnancies was performed. Labour was induced in 175 women. Overall caesarean section rate was 9.4%, with no significant difference between the 2 groups. Overall rate of assisted vaginal deliveries was 7%, higher in the induction group than the spontaneous onset group but the difference was not significant. There was no significant difference in occurrence of intrapartum meconium, nor for maternal morbidity. No neonate needed intubation. No perinatal deaths occurred. Perinatal mortality and morbidity are preventable, and induction of labour before 42 weeks is justifiable to prevent adverse outcomes

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A study on effect of strain-counterstrain in plantar fasciitis

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20171059 ◽

2017 ◽

Vol 4 (2) ◽

pp. 551

Author(s):

Pournima A. Pawar ◽

Ruchi U. Tople ◽

Ujwal L. Yeole ◽

Gaurai M. Gharote ◽

Rasika B. Panse ◽

...

Keyword(s):

Manual Therapy ◽

Plantar Fasciitis ◽

Plantar Fascia ◽

Maximum Pressure ◽

Human Beings ◽

Post Intervention ◽

Equal Distribution ◽

Disability Scale ◽

Significant Difference ◽

The Difference

Background: Bipedal locomotion is a unique feature of human beings and has the advantage of upright mobility. Hence, foot becomes the most important weight loading structure and gets the maximum pressure per unit area. Plantar fasciitis is a painful inflammatory process of the plantar fascia, the connective tissue on the sole of the foot. Thus a study was conducted to determine the effect of strain-counterstrain in plantar fasciitis.Methods: 30 individuals aged between 18-35 years both male and female with plantar fasciitis were recruited for the study. The patients were treated for a period of 7 days using the technique of strain-counterstrain. Pre-intervention and post-intervention scores of Plantar Fasciitis Pain and Disability scale were assessed and were analysed using unpaired t-test and repeated ANOVA.Results: There was equal distribution of occurrence of plantar fasciitis among both the genders out of the population of study. A significant difference was noted between the pre and post interventional measure of a type of manual therapy called strain-counterstrain (p<0.0001). The difference between pre intervention and after third day intervention did not show much of a difference. However after fifth day a considerable difference was noted (p <0.0001). It was noted that limited dorsiflexion improved after one week of interventional measure of strain-counterstrain (p <0.0001).Conclusions: The technique of strain-counterstrain which is a type of manual therapy is effective in patients affected by plantar fasciitis. It also showed an improvement in the limited ankle dorsiflexion range.

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The defensive behavior of Indiana mite biting honeybees against Varroa destructor and the structure of mandibles

10.1101/2020.12.07.403147 ◽

2020 ◽

Author(s):

Jada Smith ◽

Xaryn L Cleare ◽

Krispn Given ◽

Hongmei Li-Byarlay

Keyword(s):

United States ◽

Varroa Destructor ◽

Scientific Evidence ◽

The United States ◽

Micro Computed Tomography ◽

Colony Losses ◽

Significant Difference ◽

The Difference ◽

States Experience ◽

Biting Behavior

The honeybees (Apis mellifera) are the most important managed pollinator for sustainable agriculture and our ecosystem. However, the managed honeybee colonies in the United States experience 30-40% of losses annually. Among all the biotic stressors, the parasitic mite Varroa destructor is considered as one of the main pests for colony losses. The mite biting behavior as a Varroa tolerant or resistant trait has been selected in the State of Indiana for a decade. A survey of damaged mites from the bottom of a colony can be used as an extended phenotype of the mite biting behavior to evaluate a colony. On average 37% of mites sampled were damaged or mutilated from the breeding stocks of 59 colonies of mite biters of Indiana, which is significantly higher than 19% of damaged mites in commercial colonies from the Southern United States. No significant difference was detected between the damage of missing legs between breeding stocks and commercial colonies. In addition, the morphology of pollen forager worker mandibles were compared between two populations via X-ray micro-computed tomography using six parameters, and the difference was detected in one parameter. Our results showed the novel scientific evidence to explain the potential defensive mechanism against Varroa mites via mandibles providing a significant knowledge of a defensive behavioral trait for mite resistance.

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