Safety and efficacy of a home nasogastric monitoring program for premature infants

BACKGROUND: A novel home monitoring program, in which premature infants are cared for at home with a nasogastric tube in place prior to achievement of full oral feeding, was evaluated. The program combines a digital, fully EMR-integrated, virtual daily rounding platform with direct provider video and telephone contact. METHODS: A case-control study was performed evaluating infants < 34 weeks’ gestation who were followed in our program. A historical control group, was created by matching 2 : 1 based on gestational age±6 days, retroactively. RESULT: 15 patients discharged in the program were compared with 30 controls. The home cohort gained an average of 30 g/day compared with the in-hospital group at 27g/day (p = 0.325). The home group required a mean of 5.9±2.9 days to full oral feeding once discharged, not different from the control group at 5.4±3.7 days (p = 0.606). The percentage of oral feeds for the home cohort, however, increased at a rate of 12.2%before discharge compared to rising 57%at home (p < 0.001). The control group spent an additional 8.1±3.9 days in the hospital after reaching criteria. There were no reported adverse events or readmissions. CONCLUSION: Premature infants can safely advance oral feeds using a home monitoring program. While at home, infants gained weight similarly to their inpatient controls inpatient, yet gained full oral skills at a significantly faster rate compared to when they were in the hospital.

Feasibility of home and hospital colorectal irrigation with continuous tube placement for Hirschsprung’s disease in neonates and infants: a comparative retrospective study

Background Since the length of the affected colon widely varies, the preoperative management of Hirschsprung’s disease varies from one hospital to another. For our cases in which the length of the aganglionic colon cannot be managed by enema, anal bougienage, or rectal irrigation, colorectal irrigation is used along with the placement of a transanal catheter for these patients as home or hospital management, until one-stage definitive surgery can be performed. No comparative studies have been conducted on the continuous tube placement method, and no study has utilized this method as home management. Thus, this study aimed to analyze the efficacy and feasibility of our proposed continuous tube placement management for patients with Hirschsprung’s disease in the hospital or even at home. Results We included 22 infants with Hirschsprung’s disease between 2008 and 2018. The patients were divided into two groups: those who were managed with enema, bougienage, and rectal irrigation (n = 6), and those who were managed with the placement of a continuous transanal tube and colorectal irrigation (n = 16). The group with continuous transanal tube placement was further divided into two groups: those who were preoperatively managed with a continuous anorectal tube at home (n = 7), and those at a hospital (n = 9). Preoperative demographic information and clinical details were retrospectively examined and compared between the two groups. Univariate analysis showed no significant differences in the backgrounds and clinical status between the enema, bougienage, and rectal irrigation group and the colorectal irrigation group. The patients in the home group were older and weighed more at the time of radical surgery than those in the hospital group (p = 0.0267, p = 0.0377, respectively). The total duration of hospitalization until radical surgery was significantly decreased in the home group (p = 0.0315). Conclusions The total duration of hospitalization was significantly reduced in patients undergoing home colorectal irrigation which was as effective as the conventional method, with no impact on the preoperative condition or postoperative outcomes. Hence, our home-based preoperative management for patients with Hirschsprung’s disease may be effective and potentially feasible for the management of patients with Hirschsprung’s disease.

ECLS supported transport of ICU patients: does out-of -house implantation impact survival?

Background Extracorporeal life support (ECLS) is an established tool to stabilize severely ill patients with therapy-refractory hemodynamic or respiratory failure. Recently, we established a mobile ECLS retrieval service at our institution. However, data on the outcome of patients receiving ECLS at outside hospitals for transportation into tertiary hospitals is still sparse. Methods We have analyzed all patients receiving ECLS in outside hospitals (Transport group, TG) prior to transportation to our institution and compared the outcome to our in-house ECLS experience (Home Group, HG). Results Between 2012 and 2018, we performed 978 ECLS implantations, 243 of which were performed on-site in tertiary hospitals for ECLS supported transportation. Significantly more veno-venous systems were implanted in TG (n = 129 (53%) vs. n = 327 (45%), p = 0.012). Indication for ECLS support differed between the groups, with more pneumonia; acute respiratory distress syndromes in the TG group and of course, more postcardiotomy patients in HG. Mean age was 47 (± 20) (HG) vs. 48 (± 18) (TG) years, p = 0.477 with no change over time. No differences were seen in ECLS support time (8.03 days ±8.19 days HG vs 7.81 days ±6.71 days TG, p = 0.675). 30-day mortality (n = 379 (52%) (HG) vs. n = 119 (49%) (TG) p = 0.265) and death on ECLS support (n = 322 (44%) (HG) vs. n = 97 (40%) TG, p = 0.162) were comparable between the two groups, despite a more severe SAVE score in the v-a TG (HG: − 1.56 (± 4.73) vs. TG -3.93 (± 4.22) p < 0.001). Mortality rates did not change significantly over the years. Multivariate risk analysis revealed Influenza, Peak Insp. Pressure at implantation, pO2/FiO2 ratio and ECLS Score (SAVE/RESP) as well as ECLS support time to be independent risk factors for mortality. Conclusion Mobile ECLS support is a tremendous challenge. However, it is justified to offer 24 h/7d ECLS standby for secondary and primary hospitals as a tertiary hospital. Increasing indications and total numbers for ECLS support raise the need for further studies to evaluate outcome in these patients.

Jigsaw On Line Model as the Improvization of Learning Methods in the Covid-19 Pandemic

Jigsaw cooperative learning is a learning model that encourages active students and helps each other in mastering the subject matter by dividing it into groups of origin and groups of experts in teaching and learning activities. Each group of experts is responsible for a material or subject. After the expert group has finished studying one topic of their expertise, each student returns to their home group to teach their expertise material to their friends in a discussion group. The aim of the study was to test whether the online Jigsaw method was effective for college students. The jigsaw method is done online, so it's done using zoom software, and goegle meet. The research subjects were 98 students in the 5th semester. The data analysis technique used the Independent sample T-test inferential statistics. The result of the analysis shows that there are significant differences between students who get online learning using the jigsaw method and the conventional method.

Kelas Gitar Akustik Berbasis Pembelajaran Kooperatif

This article examines learning acoustic guitar in formal schools employing cooperative learning design. The problem is focused on students’ perceptions of the difficulty of interpreting theory, teacher mastery of music theory, and the learning methods used. This study aims to describe the cooperative learning method implemented in acoustic guitar classes at schools (N = 30). Data were collected through observation, interviews, and documentation to be analyzed qualitatively using an interactive model (Miles et al., 2014). The guitar learning process is carried out in groups by breaking the home group and the expert group. Music material in group interaction is in the form of theory and practice. Based on observations of students’ musical abilities, there is an increase in knowledge of music theory and practice in guitar classes. Students receive the highest score on the aspects of sound accuracy, chord progression to the song, and the time expended learning the song. This study concludes that learning acoustic guitar applying cooperative learning methods is effective in enhancing students’ musical understanding through appreciation and creation. Appreciative attitude turns out as a manifestation of a positive response affective.

Projection of the Number of Elderly in Different Health States in Thailand in the Next Ten Years, 2020–2030

The objective of this study is to predict the volume of the elderly in different health status categories in Thailand in the next ten years (2020–2030). Multistate modelling was performed. We defined four states of elderly patients (aged ≥ 60 years) according to four different levels of Activities of Daily Living (ADL): social group; home group; bedridden group; and dead group. The volume of newcomers was projected by trend extrapolation methods with exponential growth. The transition probabilities from one state to another was obtained by literature review and model optimization. The mortality rate was obtained by literature review. Sensitivity analysis was conducted. By 2030, the number of social, home, and bedridden groups was 15,593,054, 321,511, and 152,749, respectively. The model prediction error was 1.75%. Sensitivity analysis with the change of transition probabilities by 20% caused the number of bedridden patients to vary from between 150,249 and 155,596. In conclusion, the number of bedridden elders will reach 153,000 in the next decade (3 times larger than the status quo). Policy makers may consider using this finding as an input for future resource planning and allocation. Further studies should be conducted to identify the parameters that better reflect the transition of people from one health state to another.

Effect of maintaining supervised gym- and home-based exercises on the seasonal variations of metabolic outcomes in overweight and obese Japanese adults

ObjectivesThis study aimed to examine whether maintaining supervised gym- and home-based exercises for an extended time of period could decrease seasonal variations of metabolic outcomes in overweight and obese Japanese adults.MethodsThis retrospective study recruited 54 overweight and obese outpatients who started exercising in 2006–2010 and analysed their metabolic outcomes for 5 years from March 2011 to February 2016. In this group, 26 participants performed moderate-intensity aerobic exercise (MIAE) for 30–40 min/day for at least 2 days/week, supervised by physical therapists at a hospital gym (GYM) during the observation period. Conversely, 28 participants were asked to perform MIAE by themselves at or around their homes (HOME) for the same duration.ResultsThe body mass index (BMI), waist circumference and homoeostasis model assessment of insulin resistance (HOMA-IR) values in winter were higher than those in other seasons in the HOME group but not in the GYM group. The annual ranges of BMI, waist circumference, fasting plasma glucose and HOMA-IR in the GYM group were smaller than those in the HOME group.ConclusionMaintaining supervised gym-based exercise, as opposed to home-based exercise, may decrease seasonal variations of some metabolic outcomes in overweight and obese Japanese adults.

Case study: WhatsApp support through the COVID-19 pandemic

As care homes seek innovative ways to support their residents through the lockdown, one care home group has turned to WhatsApp to connect and inspire its staff. Beth Britton reports on the establishment of the group and how the sharing of ideas has benefited both residents and staff

Cost-effectiveness of postoperative rehabilitation after surgery for lumbar disc herniation: an analysis based on a randomized controlled trial

OBJECTIVEThe aim of this study was to examine whether routine referral to municipal postoperative rehabilitation is cost-effective in comparison to no referral after surgery for lumbar disc herniation (LDH).METHODSOne hundred forty-six patients scheduled for primary discectomy due to LDH were included. This secondary analysis, based on data from a previous randomized controlled trial, compared costs and quality-adjusted life years (QALYs) between two groups of patients recovering from LDH surgery: one group of patients received a referral for municipal physical rehabilitation (REHAB) and the other group was sent home without a referral to any postoperative rehabilitation (HOME). Primary outcomes were QALYs calculated from the EQ-5D utility score, societal costs, and incremental cost-effectiveness ratios (ICERs). The main cost-effectiveness analysis used intention-to-treat data, whereas sensitivity analyses included as-treated data. Questionnaires were collected after 1, 3, 6, 12, and 24 months postoperatively.RESULTSThe main cost-effectiveness analysis showed a small, insignificant incremental QALY of 0.021 and an incremental cost of €211.8 for the REHAB group compared to the HOME group, resulting in an ICER of €10,085. In the as-treated sensitivity analysis, the REHAB group had poorer outcomes and higher costs compared to the HOME group.CONCLUSIONSRoutine referral to municipal physical rehabilitation in patients recovering from LDH surgery was not cost-effective compared to no referral.Clinical trial registration no.: NCT03505918 (clinicaltrials.gov)

Psalm 133: Ancient Wisdom Interpreted by Contemporary South Africans

This short psalm is generally regarded as a wisdom psalm, celebrating family and community. In biblical times it may have served to encourage fellowship among pilgrims travelling to Jerusalem for the feasts, or as a call for unity among the northern and southern tribes. But how is it interpreted today? Does it speak to our social relations? For this article, three groups of contemporary South Africans study the psalm and share their perceptions as to its meaning for them. The groups include women in a township who are part of a church “home-group”, teenagers from various backgrounds who attend a weekly “youth meeting” at a local church, and performance artists who are members of the same church. Each group shows imaginative ideas and significant engagement with the psalm. The study contributes by showing that the ancient wisdom in the psalm is meaningful today although the imagery and media may need to be adjusted to the particular audience. It is thus a stimulus to those who work with young people to encourage them to “re-translate” biblical texts (particularly poems) and thus to make them their own.