Hospital-based System Research Articles

Paediatric Active Enhanced Disease Surveillance (PAEDS) 2017 and 2018: Prospective hospital-based surveillance for serious paediatric conditions.

The Paediatric Active Enhanced Disease Surveillance (PAEDS) network is a hospital-based active surveillance system employing prospective case ascertainment for selected serious childhood conditions, particularly vaccine-preventable diseases and potential adverse events following immunisation (AEFI). This report presents surveillance data for 2017 and 2018. Specialist nurses screened hospital admissions, emergency department (ED) records, laboratory and other data on a daily basis in seven paediatric tertiary referral hospitals across Australia to identify children with the conditions under surveillance. In 2017 and 2018 these included acute flaccid paralysis (AFP; a syndrome associated with poliovirus infection), acute childhood encephalitis (ACE), influenza, intussusception (IS; a potential AEFI with rotavirus vaccines), pertussis, varicella-zoster virus infection (varicella and herpes zoster), invasive meningococcal, and invasive Group A streptococcus diseases. An additional social research component was added to evaluate parental attitudes to vaccination. PAEDS captured 1,580 and 925 cases for 2017 and 2018, respectively, across all conditions under surveillance. Key outcomes of PAEDS included: contribution to national AFP surveillance to reach the World Health Organization reporting targets; identification of a third human parechovirus outbreak among other infectious diseases linked to ACE; demonstration of variable influenza activity between 2017 and 2018, with vaccine effectiveness (VE) analysis demonstrating that the protection offered through vaccination is season-dependent. All IS cases associated with vaccine receipt were reported to the relevant state health department. Varicella and herpes zoster case numbers remained unchanged, with vaccine uptake found to be suboptimal among eligible children under the NIP. Enhanced pertussis surveillance continues to capture controls for VE estimation. Surveillance for invasive meningococcal disease showed predominance for serotype B at 57% over 2 years among 77 cases where serotyping was available, and surveillance for invasive group A streptococcus captured severe disease in children. PAEDS continues to provide unique policy-relevant data on serious paediatric conditions using hospital-based sentinel surveillance.

Establishing injury surveillance in emergency departments in Nepal: protocol for mixed methods prospective study

BackgroundGlobally, injuries cause more than 5 million deaths annually, a similar number to those from HIV, Tuberculosis and Malaria combined. In people aged between 5 and 44 years of age trauma is the leading cause of death and disability and the burden is highest in low- and middle-income countries (LMICs). Like other LMICs, injuries represent a significant burden in Nepal and data suggest that the number is increasing with high morbidity and mortality. In the last 20 years there have been significant improvements in injury outcomes in high income countries as a result of organised systems for collecting injury data and using this surveillance to inform developments in policy and practice. Meanwhile, in most LMICs, including Nepal, systems for routinely collecting injury data are limited and the establishment of injury surveillance systems and trauma registries have been proposed as ways to improve data quality and availability.MethodsThis study will implement an injury surveillance system for use in emergency departments in Nepal to collect data on patients presenting with injuries. The surveillance system will be introduced in two hospitals and data collection will take place 24 h a day over a 12-month period using trained data collectors. Prospective data collection will enable the description of the epidemiology of hospital injury presentations and associated risk factors. Qualitative interviews with stakeholders will inform understanding of the perceived benefits of the data and the barriers and facilitators to embedding a sustainable hospital-based injury surveillance system into routine practice.DiscussionThe effective use of injury surveillance data in Nepal could support the reduction in morbidity and mortality from adult and childhood injury through improved prevention, care and policy development, as well as providing evidence to inform health resource allocation. This study seeks to test a model of injury surveillance based in emergency departments and explore factors that have the potential to influence extension to additional settings.

Untapped Potential: A Qualitative Study of a Hospital-Based Dengue Surveillance System

.The incidence and geographical distribution of dengue fever has increased in recent decades. The actual disease burden is unknown owing to frequent underreporting and misclassification of cases. A well-functioning system for diagnosing, treating, and reporting cases is of prime importance as disease statistics is the foundation for decisions aiming to control the disease. This study aimed to explore the hospital-based disease surveillance system in Yogyakarta, a dengue-endemic region on Java, Indonesia. Semi-structured interviews were performed with 16 informants from four hospitals, including five general practitioners, three internists, four pediatricians, and four administrative staff working with administration relating to dengue diagnostics and reporting. Data were analyzed using content analysis. A theme arose from the analysis “Dengue surveillance stands and falls by the rigor of the health system.” The theme, and underlying categories and subcategories, describes a surveillance system that in the best-case scenario works well and is likely to produce reliable dengue case data. However, there is a lack of synchronization between regulations and guidelines in different hospitals and some friction between regulatory bodies and the care provider. Knowledge among the staff appears to vary, and many clinical and financial decisions are made rather arbitrarily, which ultimately might lead to unequal health service delivery. In conclusion, the dengue surveillance system under study could improve further, particularly by ensuring that all regulations and recommended procedures are standardized and that all staff are given the best opportunity to stay updated on dengue-related matters, clinical as well as regulatory, on a regular basis.

A Framework to Monitor Changes in Transmission and Epidemiology of Emerging Pathogens: Lessons From Nipah Virus

It is of uttermost importance that the global health community develops the surveillance capability to effectively monitor emerging zoonotic pathogens that constitute a major and evolving threat for human health. In this study, we propose a comprehensive framework to measure changes in (1) spillover risk, (2) interhuman transmission, and (3) morbidity/mortality associated with infections based on 6 epidemiological key indicators derived from routine surveillance. We demonstrate the indicators' value for the retrospective or real-time assessment of changes in transmission and epidemiological characteristics using data collected through a long-standing, systematic, hospital-based surveillance system for Nipah virus in Bangladesh. We show that although interhuman transmission and morbidity/mortality indicators were stable, the number and geographic extent of spillovers varied significantly over time. This combination of systematic surveillance and active tracking of transmission and epidemiological indicators should be applied to other high-risk emerging pathogens to prevent public health emergencies.

A Combined Approach to Priorities of Surgical Oncology During the COVID-19 Epidemic

A Combined Approach to Priorities of Surgical Oncology During the COVID-19 Epidemic

Analysis on the birth situation different fertility policy periods in monitoring area of birth defect population in Zhejiang Province

Objective: To explore the impacts on birth situation associated with birth policy adaption in monitoring area of birth defect population in Zhejiang province. Methods: Data were obtained from hospital-based birth defect surveillance system in Zhejiang Province. The surveillance population was childbearing women living in Nanhu of Jiaxing and Fenghua of Ningbo no less than 1 year. We divided data into three groups as "only child" (Jan, 2012-Sep, 2013), "privileged second child" (Jan, 2015-Sep, 2016) and "universal second child" (Jan, 2017-Sep, 2018) according to birth policy adaption. The differences of maternal age distribution in different birth policy periods were compared by using Kruskal-Wallis test. The changing trend of the proportion of parturient in different birth policy periods was analyzed by using Trend χ(2) test. Unconditional logistic regression model was used to analyze the relationship between birth policy and adverse perinatal outcomes. Results: During "only child" , " privileged second child" and "universal second child" period, the number of childbearing women was 12 557, 14 097 and 15 509, respectively, with an increase of 12.3% and 10.0% over previous periods. Maternal ages [M (P(25), P(75))] were [27 (25, 30)], [28 (26, 31)] and [28 (26, 32)] years old. The proportion of multipara in each period was 19.5%, 35.7% and 45.8%, showing an increased trend (P<0.001). The incidence of adverse perinatal outcomes was lowest in the "only child" period (8.7%) and highest in the "universal second child" period (11.1%). Unconditional logistic regression model showed that after adjusting for age, compared with the "only child" period, the risk of premature birth [OR values (95%CI) were 1.20(1.08-1.33) and 1.08 (1.02-1.13), respectively] and birth defects [OR values (95%CI) were 1.33(1.13-1.55) and 1.29 (1.20-1.39), respectively] increased in "privileged second child" and "universal second child" period. The risk of macro infants decreased significantly [OR values(95%CI) were 0.87 (0.80-0.96) and 0.91 (0.87-0.95), respectively], and the risk of perinatal death changed insignificantly [OR values (95%CI) were 0.78 (0.53-1.15) and 0.84 (0.69-1.02), respectively]. Conclusion: According to population based surveillance in two regions in Zhejiang, the proportion of women with advanced age, the proportion of multipara , the risks of birth defects increased with birth policy adaption.

Evolution of emergency medical services in the Kingdom of Bahrain

Emergency medical services (EMS) is crucial to any healthcare system, especially in urban countries. The Kingdom of Bahrain has always strived to develop healthcare services throughout the Kingdom including EMS. Like any other country, the Kingdom has gone through several stages in the provision of EMS. This article will focus on the development of EMS in the Kingdom and its evolution from a scattered hospital-based system to a unified system, which ensures ease of access for the population and speed of delivery to the healthcare facilities. The major focus will be the most recent national project which is the National Ambulance.

Implementation and validation of ASL perfusion measurements for population imaging.

PurposePseudocontinuous arterial spin labeling (pCASL) allows for noninvasive measurement of regional cerebral blood flow (CBF), which has the potential to serve as biomarker for neurodegenerative and cardiovascular diseases. This work aimed to implement and validate pCASL on the dedicated MRI system within the population‐based Rotterdam Study, which was installed in 2005 and for which software and hardware configurations have remained fixed.MethodsImaging was performed on two 1.5T MRI systems (General Electric); (I) the Rotterdam Study system, and (II) a hospital‐based system with a product pCASL sequence. An in‐house implementation of pCASL was created on scanner I. A flow phantom and three healthy volunteers (<27 years) were scanned on both systems for validation purposes. The data of the first 30 participants (86 ± 4 years) of the Rotterdam Study undergoing pCASL scans on scanner I only were analyzed with and without partial volume correction for gray matter.ResultsThe validation study showed a difference in blood flow velocity, sensitivity, and spatial coefficient of variation of the perfusion‐weighted signal between the two scanners, which was accounted for during post‐processing. Gray matter CBF for the Rotterdam Study participants was 52.4 ± 8.2 ml/100 g/min, uncorrected for partial volume effects of gray matter. In this elderly cohort, partial volume correction for gray matter had a variable effect on measured CBF in a range of cortical and sub‐cortical regions of interest.ConclusionRegional CBF measurements are now included to investigate novel biomarkers in the Rotterdam Study. This work highlights that when it is not feasible to purchase a novel ASL sequence, an in‐house implementation is valuable.

An epidemiological study of suspected rabies exposures and adherence to rabies post-exposure prophylaxis in Eastern Thailand, 2015.

BackgroundHuman rabies is a notifiable condition in Thailand, and 46 confirmed and probable cases were reported from 2010–2015; eleven were reported from Eastern Thailand. Although rabies is vaccine preventable, more than 90% of persons who died of rabies in Thailand either did not receive or inappropriately discontinued post-exposure prophylaxis (PEP). In 2012 Thailand launched a national animal rabies elimination program with the goal of elimination by 2020. One of the policies of this national program is to improve detection of animal rabies exposures, access to PEP, and adherence to vaccine schedules. To achieve this goal, several hospital-based electronic PEP surveillance systems have been instituted throughout Thailand.MethodData from a voluntary, electronic hospital-based, rabies exposure and PEP surveillance system was analyzed from eight provinces in Eastern Thailand for the time period January 1 –December 31, 2015. The surveillance system collects data from all persons who present to an R36-integrated healthcare facility with a suspected rabies exposure, including characteristics of the biting animals, categorization of the rabies exposure, and adherence to PEP recommendations. The crude rate of healthcare seeking for a suspected rabies exposure was assessed by province, and a multivariable linear regression model was developed to determine the potential extent of undetected rabies exposures due to bite treatment at healthcare facilities that do not utilize the R36 system. Suspected rabies exposures were described by patient demographics, location of wound, and disposition of the offending animal. A comparison of adherence to intramuscular and intradermal vaccination regimens was performed and odds ratios were calculated for factors related to unadvised PEP discontinuation.Result6,204 suspected rabies exposures were reported from eight Eastern Thailand provinces, yielding a crude exposure rate of 106 reported rabies exposures per 100,000 population. When adjusted for under-detection due to non-participating hospitals and province-level demographic differences, the estimated suspected rabies exposure rate was 204/100,000. Dogs were the main source of exposure (77.8%) and children age <15 years and elderly age >60 years had the highest overall reported exposure rate (189.7 and 189.2/100,000). Adherence to either the intramuscular 5-dose or the intradermal 4-dose PEP regimen was low (15.8% and 46.5%, respectively); rabies immunoglobulin was received by only 15% of persons for whom it was indicated. Persons with rabies exposures were more likely to discontinue the vaccination series against medical advice if they were male, aged 16–45, if they received immunoglobulin, or if received the intramuscular regimen.ConclusionWhen adjusting for number of reporting hospitals, province population density, number of hospitals per population and average family income, the expected report rate increased 1.9-fold, indicating that there is likely a high level of under-detection of persons seeking medical care for suspected rabies exposures. Expanded implementation of electronic surveillance systems will likely improve reporting and the epidemiologic knowledge of rabies exposures. Analysis of data collected from this system revealed very low rates of adherence to rabies vaccination recommendations. PEP adherence was better by the intradermal route, which provides more support for its use in situations where it is economically feasible.

The impact of new universal child influenza programs in Australia: Vaccine coverage, effectiveness and disease epidemiology in hospitalised children in 2018

BackgroundNew jurisdictionally-based vaccination programs were established providing free quadrivalent influenza vaccine (QIV) for preschool Australian children in 2018. This was in addition to the National Immunisation Program (NIP) funded QIV for Indigenous children and children with comorbid medical conditions. We assessed the impact of this policy change on influenza disease burden and vaccine coverage, as well as report on 2018 vaccine effectiveness in a hospital-based surveillance system. MethodsSubjects were recruited prospectively from twelve PAEDS-FluCAN sentinel hospital sites (April until October 2018). Children aged ≤16 years hospitalised with an acute respiratory illness (ARI) and laboratory-confirmed influenza were considered cases. Hospitalised children with ARI who tested negative for influenza were considered controls. VE estimates were calculated from the adjusted odds ratio of vaccination in cases and controls. ResultsA total of 458 children were hospitalised with influenza: 31.7% were <2 years, 5.0% were Indigenous, and 40.6% had medical comorbidities predisposing to severe influenza. Influenza A was detected in 90.6% of children (A/H1N1: 38.0%; A/H3N2: 3.1%; A/unsubtyped 48.6%). The median length of stay was 2 days (IQR: 1,3) and 8.1% were admitted to ICU. Oseltamivir use was infrequent (16.6%). Two in-hospital deaths occurred (0.45%). 12.0% of influenza cases were vaccinated compared with 36.0% of test-negative controls. Vaccine effectiveness of QIV for preventing influenza hospitalisation was estimated at 78.8% (95%CI: 66.9; 86.4). ConclusionsCompared with 2017 (n = 1268 cases), a significant reduction in severe influenza was observed in Australian children, possibly contributed to by improved vaccine coverage and high vaccine effectiveness. Despite introduction of jurisdictionally-funded preschool programs and NIP-funded vaccine for children with risk factors for severe disease, improved coverage is required to ensure adequate protection against paediatric influenza morbidity and mortality.

Influenza Vaccine Effectiveness Against Influenza-Related Mortality in Australian Hospitalized Patients: A Propensity Score Analysis.

Data on influenza vaccine effectiveness (IVE) against mortality are limited, with no Australian data to guide vaccine uptake. We aimed to assess IVE against influenza-related mortality in Australian hospitalized patients, assess residual confounding in the association between influenza vaccination and mortality, and assess whether influenza vaccination reduces the severity of influenza illness. Data were collected between 2010 and 2017 from a national Australian hospital-based sentinel surveillance system using a case-control design. Adults and children admitted to the 17 study hospitals with acute respiratory symptoms were tested for influenza using nucleic acid testing; all eligible test-positive cases, and a subset of test-negative controls, were included. Propensity score analysis and multivariable logistic regression were used to determine the adjusted odds ratio (aOR) of vaccination, with IVE = 1 - aOR × 100%. Residual confounding was assessed by examining mortality in controls. Over 8 seasons, 14038 patients were admitted with laboratory-confirmed influenza. The primary analysis included 9298 cases and 6451 controls, with 194 cases and 136 controls dying during hospitalization. Vaccination was associated with a 31% (95% confidence interval [CI], 3%-51%; P = .033) reduction in influenza-related mortality, with similar estimates in the National Immunisation Program target group. Residual confounding was identified in patients ≥65 years old (aOR, 1.92 [95% CI, 1.06-3.46]; P = .031). There was no evidence that vaccination reduced the severity of influenza illness (aOR, 1.07 [95% CI, .76-1.50]; P = .713). Influenza vaccination is associated with a moderate reduction in influenza-related mortality. This finding reinforces the utility of the Australian vaccination program in protecting those most at risk of influenza-related deaths.

Development of a Medically Tailored Hospital-based Food Pantry System.

Fifty-six percent of high-needs NYC cancer patients are food insecure, at times choosing between medical treatment and food. We describe FOOD (Food to Overcome Outcome Disparities), an innovative intervention, which has established eleven medically tailored food pantries in NYC cancer centers and distributed the equivalent of 307,080 meals since 2011.

Congenital heart disease in neonates with external congenital anomalies in Jos, Nigeria

Background: Congenital heart disease (CHD) has been found to be more common in neonates with other congenital anomalies and may worsen prognosis. Early diagnosis and treatment of internal congenital anomalies including CHD will improve outcome and decrease neonatal mortality. This study determined the prevalence of CHD among neonates seen with external congenital anomalies in Jos, Nigeria. Materials and Methods: We performed complete physical examinations on 2,340 neonates delivered in two tertiary hospitals in Jos, Nigeria. We identified neonates with external congenital anomalies and determined the prevalence of congenital heart defects in them using echocardiography. Data were analysed using STATA 14.0. Results: External congenital anomalies were present in 49 of the 2,340 neonates recruited − prevalence of 20.9 per 1,000, with a male to female ratio of 1.1:1. Fourteen (28.6%) neonates were syndromic. CHD was present in 15 of 49 (30.6%) neonates studied– prevalence 30.6 per 100. The mean age of the parents with neonates who had external congenital anomalies and CHD was significantly higher than those without CHD. Conclusion: CHD frequently co-exists with external congenital anomalies especially in syndromic neonates. Hospital-based surveillance systems are needed to capture accurately both internal and external congenital anomalies to improve outcome in these group of neonates.

Early clinical exposure during medical school: Omani medical students and interns experience

<br><b>Introduction:</b> Early clinical exposure (ECE) is a teaching learning methodology, which fosters the exposure of the medical students to the patients as early as the 1^st year of medical college. A hospital-based educational system provides the exposure to the clinical environment by direct contact with patients, including bedside teaching and applying skills and knowledge. <b>Aim:</b> evaluate the impact of ECE of Omani medical students on their attitude, knowledge, and skills. <b>Methods:</b> A cross-sectional study. A designed questionnaire was sent to more than 500 Omani medical students in Sultan Qaboos University (SQU) and National University (NU). The questionnaire consists two sections. The first section included personal demographic information. The second part included questions to evaluate the quantity and quality of ECE and questions directed toward knowing the current perception of Omani students toward the importance of ECE in terms of developing knowledge and skills. Fifteen questions were asked in the questionnaire. <b>Results:</b> There were a total number of 191 students who participated in this study with a response rate of 44%. The vast majority of them were females represented 73.8. Nearly 63.4% were from SQU and 31.8% were from NU. Sixty-eight percent of the participants are in their 5^th, 6^th, 7^th year, intern, and postintern academic status. There is a significant relationship between getting clinical exposure during preclinical years and fast adaptation in early clinical years with <i>P</i> < 0.05. <b>Conclusion:</b> ECE is a vital part of the preclinical curriculum and should be further enhanced by creating more opportunities to receive clinical and practical training in hospitals.<br>

The influence of time-management on medical resident's perceived stress scale and overtime: A tertiary care hospital experience from Switzerland

Background and Aim: Many physicians express challenges in managing time demands during clinical practice. Effective time-management skills may counter the negative effects of high workload and time pressures, and subsequently improve productivity as well as professional and personal wellness. The objective is to determine the impact of time-management training on medical residents' overtime hours and self-reported stress scores. Materials and Methods: The present study employed a within-subjects, single group pretest-posttest design. Convenience sampling was used to recruit 27 medical residents from a tertiary care hospital in Saint Gall, Switzerland. Each resident participated in a single, 2-h interactive time-management workshop. Each resident completed the Perceived Stress Scale-10 (PSS-10) 1-week before and 8-week after the time-management intervention. Overtime of every resident was documented during the same time intervals using a hospital-based computer system. Finally, we recorded whether residents experienced any stressful life events during this 8-week study. Results: Residents worked significantly fewer overtime hours after the time-management intervention than before the intervention (P = 0.01). There was also a significant reduction in mean PSS scores following the intervention, but only for residents who reported experiencing stressful life events during the study (P = 0.028). The intervention had no effect on mean PSS scores for residents who did not report a stressful life event (P = 0.36). Conclusion: The present study reported an effect of time-management training on overtime and perceived stress in residents. We argue that time-management can help residents cope with external stressors, and that individuals who experience stressful life events may especially benefit from time-management training.

Use of Synchronous Digital Health Technologies for the Care of Children With Special Health Care Needs and Their Families: Scoping Review.

BackgroundUse of synchronous digital health technologies for care delivery to children with special health care needs (having a chronic physical, behavioral, developmental, or emotional condition in combination with high resource use) and their families at home has shown promise for improving outcomes and increasing access to care for this medically fragile and resource-intensive population. However, a comprehensive description of the various models of synchronous home digital health interventions does not exist, nor has the impact of such interventions been summarized to date.ObjectiveWe aim to describe the various models of synchronous home digital health that have been used in pediatric populations with special health care needs, their outcomes, and implementation barriers.MethodsA systematic scoping review of the literature was conducted, guided by the Arksey and O’Malley Scoping Review Framework. MEDLINE, CINAHL, and EMBASE databases were searched from inception to June 2018, and the reference lists of the included systematic reviews and high-impact journals were hand-searched.ResultsA total of 38 articles were included in this review. Interventional articles are described as feasibility studies, studies that aim to provide direct care to children with special health care needs, and studies that aim to support family members to deliver care to children with special health care needs. End-user involvement in the design and implementation of studies is evaluated using a human-centered design framework, and factors affecting the implementation of digital health programs are discussed in relation to technological, human, and systems factors.ConclusionsThe use of digital health to care for children with special health care needs presents an opportunity to leverage the capacity of technology to connect patients and their families to much-needed care from expert health care providers while avoiding the expenses and potential harms of the hospital-based care system. Strategies to scale and spread pilot studies, such as involving end users in the co-design techniques, are needed to optimize digital health programs for children with special health care needs.

Implementation of surveillance systems to determine the burden of communicable diseases in a facility in Qatar.

Hospital-based surveillance has proved useful in determining the incidence of infectious diseases. This study aimed to describe the epidemiological characteristics of reported cases and specific performance indicators of the surveillance system. A descriptive study of reported communicable diseases was carried out in The Cuban Hospital (Qatar) during January 2012 to December 2013. A multidimensional communicable diseases surveillance approach was used. Information of epidemiological variables, laboratory confirmation and notification date were collected. We calculated the proportion of cases with laboratory confirmation and time between the report by the physician and notification to the Supreme Council of Health. A total of 1065 patients were reported; 802 (75.3%) male with a mean age of 33.2 (standard deviation 15.4) years. There was a predominance of cases from Southeast Asia (41.5%) and Eastern Mediterranean Region (16.7%). There were 539 cases of influenza-like illness, 186 of skin infectious diseases, 66 of scabies, 48 with multidrug-resistant organisms, and 39 cases of diarrhoea of presumed infectious etiology. A steady increase in laboratory confirmation was observed (mean 59.3%). Timing for notification to the Supreme Council of Health was 1.88 (2.9) days. The implemented hospital-based surveillance system was feasible and delivered important insights into the epidemiological characteristic of communicable diseases in a western community in Qatar.

The national maternal near miss surveillance in China: A facility-based surveillance system covered 30 provinces.

To introduce the National Maternal Near Miss Surveillance System (NMNMSS) in detail and to report the composition of maternal near miss (MNM) in China.The NMNMSS was established by the National Health Commission at the end of 2010, covered over 400 health facilities from 30 provinces in China. The NMNMSS was designed to collect individual information for every pregnant woman admitted to obstetric department in the sampled health facilities. Cross tabulations and correlations were used to describe the distribution of population and sampled facilities in the NMNMSS, and to calculate the MNM mortality ratio for different complications and organ dysfunctions.The individual survey forms of 9,051,638 pregnant women were collected in the NMNMSS between 2012 and 2017. Compared with urban areas, there are very few well-quality medical resources in rural areas. Most women with pregnancy complications in rural areas can only be treated in Level 2 and lower hospitals. MNM in women with indirect obstetric complications received treatment more frequently in Level 3 hospital. The most common maternal complications in severe maternal outcomes (including maternal near miss and maternal death) are obstetrics hemorrhage (58.7%), hypertension disorder (28.0%), and severe anemia (20.6%). The overall MNM mortality ratio is 38:1. The MNM mortality ratios are lowest in amniotic fluid embolism, HIV/AIDS, heart disease, thrombophlebitis, and sepsis. For different organ dysfunctions, the ranks of the MNM mortality ratio from low to high are renal dysfunction, respiratory dysfunction, cardiovascular dysfunction, hepatic dysfunction, neurologic dysfunction, uterine dysfunction, coagulation dysfunction.The NMNMSS is a well-established hospital-based surveillance system for maternal complications in China. It can identify the maternal complications that need to improve health care immediately in China through a powerful longitudinal real-world evidence.

A hospital-based birth defects surveillance system in Kampala, Uganda

BackgroundIn 2010, the World Health Assembly passed a resolution calling upon countries to prevent birth defects where possible. Though birth defects surveillance programs are an important source of information to guide implementation and evaluation of preventive interventions, many countries that shoulder the largest burden of birth defects do not have surveillance programs. This paper shares the results of a hospital-based birth defects surveillance program in Uganda which, can be adopted by similar resource-limited countries.MethodsAll informative births, including live births, stillbirths and spontaneous abortions; regardless of gestational age, delivered at four selected hospitals in Kampala from August 2015 to December 2017 were examined for birth defects. Demographic data were obtained by midwives through maternal interviews and review of hospital patient notes and entered in an electronic data collection tool. Identified birth defects were confirmed through bedside examination by a physician and review of photographs and a narrative description by a birth defects expert. Informative births (live, still and spontaneous abortions) with a confirmed birth defect were included in the numerator, while the total informative births (live, still and spontaneous abortions) were included in the denominator to estimate the prevalence of birth defects per 10,000 births.ResultsThe overall prevalence of birth defects was 66.2/10,000 births (95% CI 60.5–72.5). The most prevalent birth defects (per 10,000 births) were: Hypospadias, 23.4/10,000 (95% CI 18.9–28.9); Talipes equinovarus, 14.0/10,000 (95% CI 11.5–17.1) and Neural tube defects, 10.3/10,000 (95% CI 8.2–13.0). The least prevalent were: Microcephaly, 1.6/10,000 (95% CI 0.9–2.8); Microtia and Anotia, 1.6/10,000 (95% CI 0.9–2.8) and Imperforate anus, 2.0/10,000 (95% CI 1.2–3.4).ConclusionA hospital-based surveillance project with active case ascertainment can generate reliable epidemiologic data about birth defects prevalence and can inform prevention policies and service provision needs in low and middle-income countries.

Toward Wearable Healthcare: A Miniaturized 3D Imager With Coherent Frequency-Domain Photoacoustics.

Medical monitoring is undergoing a translation from the hospital-based system to the personalized home-based system. With the aim of wearable application of photoacoustic technique, we propose a miniaturized photoacoustic 3D imager for superficial medical imaging. By employing the compact continuous-wave laser diode based optical irradiation and an ultrathin 2D matrix array based photoacoustic detection in the coherent frequency domain, a wearable imaging probe with a size of about 80 × 25 × 24mm3 and a weight of 21 g is developed. At the backend, an FPGA controlled Howland current source drives the laser diodes to excite linear frequency modulated optical irradiation. Recorded by a portable multichannel data acquisition system, the generated photoacoustic responses are firstly compressed with the coherent frequency domain photoacoustic method and then extrapolated in the wavenumber-frequency domain for fast image reconstruction. With three-wavelength (450nm, 638nm, and 808nm) laser irradiation, photoacoustic imaging can be operated multispectrally, endowing the developed imager with functional imaging capability in 3D space. With the imager worn on the human forearm, hemoglobin oxygen saturation level in superficial arm vasculature can be long-term monitored with high stability. When the imager is applied for imaging in a relatively large area (e.g., early melanoma detection in the human breast), flexible scanning in a handheld manner can be performed. This work opens the application potential of photoacoustic technique in a broad range of areas, including personalized healthcare, home health monitoring, and long-term physiologic monitoring.