Outcome In Hospital Research Articles

Clinical and Neuroimaging Profile of Neonates With Moderate-to-Severe Encephalopathy Treated With Therapeutic Hypothermia

Objective: To demonstrate the clinical and neuroimaging profile of infants with moderate-to-severe encephalopathy after therapeutic hypothermia (TH) in the Indian setting. The secondary objective was to determine the logistics involved in performing neuroimaging in these infants. Design and Setting: A retrospective descriptive study in 2 tertiary centers. Methods: All infants who underwent cooling in both centers from January 2019 to December 2019 were included. Demographic data, details of cooling, clinical and neuroimaging profile (magnetic resonance imaging [MRI] and magnetic resonance spectroscopy [MRS]), and details of the logistics involved in performing the imaging (sedation, neonatal transport, personnel, distance traveled, and time taken) were collected and analyzed. Results: A total of 44 infants were enrolled of which 37 (84.0%) underwent both TH and neuroimaging (MRI and MRS). A total of 33 (75.0%) of infants were outborn, 20 (45.5%) of them had sentinel events before delivery and 17 (38.6%) were intubated at birth. Apgar score <5 min was seen in 8 (18.2%) and seizures in 23 (52.3%) of infants. A total of 37 (84.1%) survived until discharge and underwent neuroimaging. Neuroimaging was performed between 5 and 14 days after birth. The most common abnormal finding on MRI brain was the signal changes in watershed areas of brain 8 (18.2%) and on MRS was low N-acetyl aspartate and high lactate 13 (29.5%). Midazolam (68.2%) and Triclofos (15.2%) were the sedatives used during neuroimaging these infants. Conclusion: TH for infants with neonatal encephalopathy resulted in excellent survival outcomes in tertiary private sector hospitals.

SURFACTANT THERAPY IN MECONIUM ASPIRATION SYNDROME AND ITS OUTCOME IN TERTIARY CARE HOSPITAL

Aims: To study the role of surfactant therapy in meconium aspiration syndrome and its outcome in tertiary care hospital. Objectives: To evaluate the efcacy of surfactant in the treatment of term and near term infants with meconium aspiration syndrome and their outcome in terms of duration and outcome of ventilation, duration of oxygen requirement,complications associated with meconium aspiration syndrome. Material and methods: 64 neonates admitted in NICU, King George Hospital, Visakhapatnam with symptoms of MAS were enrolled in the study, of them 32 were given surfactant and were taken as cases,32 were not given surfactant and enrolled as controls. Data on APGAR, need for resuscitation, baby weight, gestational age and laboratory prole were recorded. Those babies with downe's score >7 were given high dose(4ml/kg) of surfactant and were followed up. Results: There was a rapid fall in oxygenation index in 24hrs after administration of surfactant and improvement in PaO2/PAO2. In surfactant group mean duration of ventilation, oxygen supplementation after extubation and length of hospital stay were all signicantly low as compared to control groups. Conclusion: Surfactant administration improved PaO2/PAO2 signicantly in comparison to the control group with in 24 hours after delivery, indicating that surfactant aids in improving gaseous exchange at the alveolar capillary barrier in lungs.

Investigating the Association Between a Risk-Directed Prophylaxis Protocol and Postoperative Nausea and Vomiting: Validation in a Low-Income Setting.

The efficacy of postoperative nausea and vomiting (PONV) prevention protocols in low-income countries is not well known. Different surgical procedures, available medications, and co-occurring diseases imply that existing protocols may need validation in these settings. We assessed the association of a risk-directed PONV prevention protocol on the incidence of PONV and short-term surgical outcomes in a teaching hospital in Rwanda. We compared the incidence of PONV during the first 48 hours postoperatively before (April 1, 2019-June 30, 2019; preintervention) and immediately after (July 1, 2019-September 30, 2019; postintervention) implementing an Apfel score-based PONV prevention strategy in 116 adult patients undergoing elective open abdominal surgery at Kigali University Teaching Hospital in Rwanda. Secondary outcomes included time to first oral intake, hospital length of stay, and rate of wound dehiscence. Interrupted time series analyses were performed to assess the associated temporal slopes of the outcome before and immediately after implementation of the risk-directed PONV prevention protocol. Compared to just before the intervention, there was no change in the odds of PONV at the beginning of the postintervention period (odds ratio [OR], 0.23; 95% confidence interval [CI], 0.05-1.01). There was a decreasing trend in the odds of nausea (OR, 0.60; 95% CI, 0.36-0.97) per month. However, there was no difference in the incidence of nausea immediately after implementation of the protocol (OR, 0.96; 95% CI, 0.25-3.72) or in the slope between preintervention and postintervention periods (OR, 1.48; 95% CI, 0.60-3.65). In contrast, there was no change in the odds of vomiting during the preintervention period (OR, 1.01; 95% CI, 0.61-1.67) per month. The odds of vomiting decreased at the beginning of the postintervention period compared to just before (OR, 0.10; 95% CI, 0.02-0.47; P = .004). Finally, there was a significant decrease in the average time to first oral intake (estimated 14 hours less; 95% CI, -25 to -3) when the protocol was first implemented, after adjusting for confounders; however, there was no difference in the slope of the average time to first oral intake between the 2 periods ( P = .44). A risk-directed PONV prophylaxis protocol was associated with reduced vomiting and time to first oral intake after implementation. There was no substantial difference in the slopes of vomiting incidence and time to first oral intake before and after implementation.

An assessment of the quality of antenatal care and pregnancy outcomes in a tertiary hospital in Ghana.

Antenatal care (ANC) is imperative to decreasing adverse pregnancy outcomes and their related maternal mortality. However, in sub-Saharan Africa, increases in ANC coverage have not correlated well with improved maternal and fetal outcomes suggesting the quality of ANC received could be the missing link. This study assessed ANC quality and its effect on adverse pregnancy outcomes among women who delivered at Komfo Anokye Teaching Hospital. A cross-sectional study was conducted among women who delivered at Komfo Anokye Teaching Hospital within the study period. Women were selected through systematic sampling and interviewed using a pretested structured questionnaire as well as review of their medical records. Data were collected on their sociodemographic and reproductive characteristics, care provided during ANC and delivery outcomes. Categorical variables were compared using the χ2 test. Factors associated with quality of ANC and adverse pregnancy outcomes were assessed using univariate and multivariate logistic regression to generate crude and adjusted odds ratios (ORs) with 95% confidence intervals (CIs). Statistical analyses were performed using SPSS and GraphPad Prism. P-values of < 0.05 were considered statistically significant. 950 women were recruited into the study with mean age of 30.39±5.57 years. Less than one-tenth (7.6%) of the women received good quality ANC, 63.4% had average quality ANC, and 29.0% received poor quality ANC. Increasing educational level and initiating ANC in the first trimester [aOR 0.2; 95%CI 0.08-0.68; p<0.001] increased the odds of receiving good quality ANC while being unemployed decreased the odds of receiving good quality ANC [aOR 0.3; 95% CI 0.12-0.65; p = 0.003]. Receiving poor and average quality of ANC were significantly associated with increased likelihood of developing anaemia during pregnancy, preeclampsia with severe features or delivering a low birth weight baby. Most women did not receive good quality ANC. High quality ANC should be provided while the women are encouraged to comply with the recommendations during ANC.

A balanced approach involving hard and soft factors for internalizing Lean Management and Six Sigma in hospitals

PurposeThis study examines the theoretical and empirical relationships between LM&SS, human resource management (HRM), climate for LM&SS and outcomes (employee well-being and performance) in hospitals. As part of this research, the authors examine the interplay between “hard” and “soft” practices for LM&SS and “soft” HR practices.Design/methodology/approachA cross-sectional, multisite survey study covering all internal service units at all eight Dutch university hospitals was conducted (42 units, N = 218 supervisors, N = 1,668 employees), and multivariate multilevel regression analyses were performed.FindingsA systems approach involving “soft” LM&SS practices that are specifically HR-related has a positive effect (β is 0.46) on a climate for LM&SS. A climate for LM&SS is not related to perceived performance or employee health. It is, however, positively related to employee happiness and trusting relationships (both βs are 0.33). We did not find that a climate for LM&SS had a mediating effect.Research limitations/implicationsThis study shows that a balanced approach involving both “hard” and “soft” factors is crucial to achieving the desired breadth and depth of LM&SS adoption at the macro, meso, and micro levels. The authors found that a climate for LM&SS positively affects employee well-being in hospitals.Practical implicationsIn their attempt to create mutual gains for both their organization and their employees, hospitals that adopt LM&SS should foster a climate for LM&SS by embracing a balanced approach consisting of both “hard” and “soft” practices, thereby internalizing LM&SS at the macro, meso, and micro levels.Originality/valueThis is one of the first studies to examine in-depth the impact of “hard” and “soft” LM&SS on both employee well-being (subdivided into different components) and performance in healthcare, as well as the role of “soft” HRM in this relationship. Linking LM&SS, HRM and outcomes to a climate for LM&SS is relatively a new approach and has led to a deeper understanding of the mechanisms underpinning the internalization of LM&SS in healthcare.

Texture analysis of sonographic image of placenta in pregnancies with normal and adverse outcomes, a pilot study

IntroductionMany maternal and fetal morbidity and mortality from complications of pregnancy have been attributed to placenta abnormality. Placenta assessment in developing countries is mainly through ultrasonography which is subjective and prone to error. Objective assessment of placental abnormalities through texture analysis has been frequently done using magnetic resonance images with little done on ultrasound generated images, thus, the need for this study. The study is aimed at using statistical texture analysis in characterizing placenta tissue into normal and abnormal placenta as well as testing the accuracy of different texture analysis algorithms in differentiating placenta into normal and abnormal placental tissues. MethodsThis longitudinal study involved 500 ultrasound-generated placenta images from patients screened for adverse pregnancy outcomes in a private hospital in Enugu. These images were loaded onto an HP laptop for viewing. Two regions of interest were selected from the placenta tissue where texture features were extracted and were classified into normal and abnormal placentas using MaZda® software version 47 while the accuracy of the classification descriptors was assessed using WEKA classification algorithms. ResultsCo-occurrence matrix, run length matrix and histogram parameters differentiated normal placenta tissue from abnormal placental tissues (p-value <0.05) while variance is the only absolute gradient parameter that can differentiate normal placenta tissue from abnormal placenta tissues. All feature descriptors show high classification accuracy using KNN and ANN algorithms. ConclusionTexture analysis can differentiate normal placenta tissues from abnormal placenta tissue which will reduce the errors associated with subjective assessment of the placenta echogenicity. Implications for practiceIntegrating these computer-aided algorithms into our ultrasound machines will lead to early detection of abnormal placenta tissues as early management results in better pregnancy outcomes.

Screening and Risk Factors for Retinopathy of Prematurity in a Tertiary Care Hospital in Cairo, Egypt.

PurposeTo evaluate the retinopathy of prematurity (ROP) prevalence, risk factors and screening outcome in a tertiary hospital in Cairo, Egypt.MethodsA prospective observational study was done in Neonatal Intensive Care Unit in Ain Shams University Hospital. A total of 159 premature infants were screened for ROP based on the most inclusive criteria reported to date. Screening included premature infants with gestational age (GA) of ≤34 weeks or birth weight (BW) of ≤2000 grams, or GA >34 weeks or BW >2000 grams, with multiple co-morbidities. The prevalence of ROP, plus disease and their correlation with risk factors of interest were studied.ResultsThe GA of the included infants ranged from 27 to 36 weeks, mean (SD) 31.87 (± 1.81) weeks. The BW ranged from 640 to 3900 grams, mean (SD) 1784.71 (± 560.30) grams. The prevalence of ROP more than stage 0 was 25.8% (41 infants), 7.3% of the cases (11 infants) showed plus disease and 6.3% (10 infants) showed severe ROP requiring treatment. Of those, 2 cases (20%) fell outside the British Guideline’s criteria for Screening. There was a highly significant (p < 0.0001) correlation between ROP more than stage 0 and low GA, low BW, mechanical ventilation, respiratory distress syndrome, necrotizing enterocolitis, intraventricular haemorrhage, and blood transfusion. No significant correlation was found between appearance of ROP more than stage 0 and gender (p = 0.911), patent ductus arteriosus (p =0.187), or sepsis (p =0.998).ConclusionROP is a significant problem in the premature infants in Egypt. Extremely premature infants with lower BW are more prone to develop ROP. However, cases with higher GA and BW than mentioned in the British guidelines screening criteria especially with multiple comorbidities showed severe ROP requiring intervention, which implies the need to develop a screening guideline for the Egyptian population.

S73 Effect of Substance Abuse on Cholangiocarcinoma Outcomes and Screening in a Large Urban Safety-Net Hospital

Introduction: Patients with substance use disorders are at an increased risk of viral hepatitis and alcohol-related liver disease and, consequently, at higher risk of developing cholangiocarcinoma (CCA). Further, patients with substance abuse are often less compliant with healthcare screening strategies. We performed a retrospective study to evaluate the association of substance use disorders with CCA screening and outcomes. Methods: A manual chart review was performed for all patients diagnosed with CCA at a large urban safety-net hospital from 2010-2019. Patients were divided into two cohorts, CCA patients with and without a history of substance abuse. Patient characteristics, liver disease etiology, and radiologic screening intervals were recorded. CCA outcomes such as mortality rate, disease metastasis, and treatment decision at tumor board were noted. Statistical analyses were performed using Statistical Product and Service Solutions version 26.9 (SPSS, Inc., Chicago, Illinois). Qualitative and quantitative differences between groups were analyzed by Chi-squared or Fisher’s exact tests for categorical variables and t-test for continuous variables. Results: A total of 46 patients were identified with CCA. Among them, 11 patients (23.9%) had a history of substance abuse, while 35 patients (76.1%) did not have a history of substance abuse. CCA patients with a history of substance abuse were significantly younger (mean age 60 vs. 65) at diagnosis (Table). There were no significant differences in the adequacy of screening in CCA patients with or without a history of substance abuse. While not statistically significant, compared to those without substance abuse, patients with CCA and substance abuse trended toward a higher mortality rate (72.7% vs. 54.3%) and were more likely to be recommended a palliative approach at tumor board (72.7% vs. 57.1%) (Figure). Conclusion: Notably, those patients with substance abuse were diagnosed with CCA at a significantly younger age. Therefore, cirrhotic patients with substance abuse may benefit from earlier referral to specialist care with hopes of more adherence to screening exams. There is suggestion of worse outcomes in those with substance abuse, as they had higher deaths in follow up and higher likelihood of referral to palliative care upon diagnosis. Overall, this study emphasizes the need for more multidisciplinary linkage to care for this vulnerable patient population.Figure 1.: Screening adequacy and disease outcome in Cholangiocarcinoma patients with and without substance abuse. Legend: 1Therapeutic treatment options include resection, transplantation, ablation, or Transarterial chemoembolization. 2 Palliative treatment options include chemotherapy and hospice. Table 1. - Baseline characteristics of Cholangiocarcinoma patients with and without substance abuse CCA Total (n=46) Substance Abuse (n=11) No substance abuse (n=35) P-value Age (mean +/- sd) 64.4 +/- 11.1 60.9 +/- 5.4 65.5 +/- 12.2 0.0278 Gender Male 22 (47.8%) 8 (72.7%) 14 (40.0%) 0.0485 Female 24 (52.2%) 3 (27.7%) 21 (60.0%) Race African Americans 14 (30.4%) 2 (18.2%) 12 (34.3%) 0.2064 White 25 (54.3%) 7 (63.6%) 18 (51.4%) Asian 1 (2.2%) 0 (0%) 1 (2.9%) Ethnicity Hispanic 5 (10.9%) 2 (18.2%) 3 (8.6%) 0.2626 Non-Hispanic 41 (89.1%) 9 (81.8%) 32 (91.4%) Insurance Medicaid 14 (30.4%) 4 (36.4%) 10 (28.6%) 0.8376 Medicare 15 (32.6%) 4 (36.4%) 11 (31.4%) Financial Assistance 1 (2.2%) 0 (0%) 1 (2.9%) Private 9 (19.6%) 1 (9.1%) 8 (22.9%) No insurance 7 (15.2%) 2 (18.2%) 5 (14.3%) Liver disease HCV 11 (23.9%) 6 (54.5%) 5 (14.3%) 0.3049 Alcohol 7 (15.2%) 5 (45.5%) 2 (5.7%) NASH 3 (6.5%) 0 (0%) 3 (8.6%) HCV treatment HCV treated 1 (9.1%) 1 (16.7%) 0 (0%) 0.5455 HCV not treated 10 (90.9%) 5 (83.3%) 5 (100%) Abbreviations: HCV hepatitis C virus, NASH = Non-alcoholic steatohepatitis

Analysis of cataract referrals from community optometrists and general practitioners and subsequent clinic visit outcomes in a university hospital in the west of Ireland.

Studies published from hospitals in other countries have reported rates of between 69 and 90% of cataract referrals being listed for surgery(1-3). This potentially represents unnecessary outpatient appointments, time off work and transport costs for patients and carers(2). Our first primary endpoint was to assess the number of cataract referrals listed for surgery. Our second primary endpoint was to assess the number of cataract referrals which included the following: (i) that visual loss from the cataract resulted in a detrimental effect on the patient's lifestyle, (ii) that the patient was willing to have surgery and (iii) that the patient was symptomatic from their cataract. This project followed the Declaration of Helsinki. This was a retrospective study. Between February 2021 and February 2022, 198 patients were seen in Mr. PM's cataract clinic. Overall, 129 patients (67.5%) were listed for cataract surgery. Forty-seven referrals (23.7%) reported that the cataract was having a detrimental effect on the patient's life and these patients were more likely to be listed for surgery (93.6% vs. 59.2%, p = 0.00). Twenty-five referrals (12.6%) reported that the patient was willing to undergo surgery and these patients were more likely to be listed for surgery (88% vs. 64.8%, p = 0.02). A total of 130 referrals (65.7%) reported that the patient was symptomatic from their cataract and these patients were more likely to be listed for surgery (81.5% vs. 38.3%, p = 0.00). It is possible that an appropriately focussed referral form will aid in triaging cataract referrals and potentially reduce unnecessary appointments.

Determinants of immediate adverse pregnancy outcomes: A hospital based study

Adverse pregnancy outcomes are a major public health problem which can lead to serious short and long- term health effect to the mother and the newborn. Hence, the objective of this study is to find out the determinants of immediate adverse pregnancy outcomes in tertiary care hospital in South India. The study comprised of antenatal mothers admitted for delivery in selected tertiary care hospital in Belgaum, Karnataka, India from 10th November, 2021 to 20th January 2022. All registered deliveries in the study period have been included, comprises of 101. Bivariate logistic regression was used to determine the factors associated with outcome variables. A significance level of 5% was used to decide the significance of statistical tests. The mean age in years (± SD) of the mother was 24.6 (± 3.9). The average cost invested for a family health check-up in a year was Rupees 18,099. The average birth weight of the newborn was 2.7 kg, while the minimum weight of the newborn was 1.4 kg, and the maximum weight was 3.8 kg. The average week of gestation for the first-time with respect to antenatal care visit of pregnant women was 9.6 weeks. The average weight of the women was 47.6 kg during first antenatal care visit and 61.5 kg during last antenatal care visit. Adverse outcomes reported were post-partum hemorrhage was 7.9%, low birth weight 26.7%, preterm delivery 28.7%, anemia 53.5%, neonatal physiological and jaundice 15.8%. However, use of mode of transportation during antenatal care visit was found to be significant factor for preterm delivery. Every fourth baby was low birth weight, and every fourth women have preterm delivery and every second woman was anemic. Socioeconomic, demographic and chronic illness was associated with immediate adverse pregnancy outcomes.

Impact of ischaemic aetiology on the efficacy of intravenous ferric carboxymaltose in patients with iron deficiency and acute heart failure: insights from the AFFIRM-AHF trial.

In AFFIRM-AHF, intravenous ferric carboxymaltose (FCM) reduced heart failure (HF) hospitalisations and improved quality of life versus placebo in iron-deficient patients stabilised after an acute HF episode. This analysis explored the effects of FCM versus placebo in patients with ischaemic and non-ischaemic HF aetiology. We included 1082 patients from AFFIRM-AHF: 590 with ischaemic HF (defined as investigator-reported ischaemic HF aetiology and/or prior acute myocardial infarction and/or prior coronary revascularisation) and 492 with non-ischaemic HF. The prevalences of male sex, comorbidities, and history of HF were higher in the ischaemic versus non-ischaemic HF subgroup. Annualised event rates for the primary composite outcome of total HF hospitalisations and cardiovascular death with FCM versus placebo were 65.3 versus 100.6 per 100 patient-years in the ischaemic HF subgroup (rate ratio [RR] 0.65, 95% confidence interval [CI] 0.47-0.89, p=0.007) and 58.3 versus 52.5 in the non-ischaemic HF subgroup (RR 1.11, 95% CI 0.75-1.66, p=0.60) (pinteraction =0.039). An interaction between HF aetiology and treatment effect was also observed for the secondary outcome of total HF hospitalisations (pinteraction =0.038). A nominal increase in quality of life, assessed using the 12-item Kansas City Cardiomyopathy Questionnaire, was observed with FCM versus placebo, within each subgroup. Heart failure hospitalisations and cardiovascular deaths occurred at a higher rate in patients with ishaemic versus those with non-ischaemic HF and were reduced by FCM versus placebo only in ischaemic patients. Further studies are needed to assess the role of aetiology in FCM efficacy.

Diagnostic ability of a computer algorithm to identify prehospital STEMI

Background: Acute myocardial infarction (AMI) accounts for 43% of deaths related to ischaemic heart disease, with ST-segment elevation myocardial infarction (STEMI) accounting for 25%–40% of all AMI presentations. Given the impact of these diseases, there is a strong prehospital focus on early identification, treatment and transport of patients with acute coronary syndrome. The main aim of the STEMI system of care is to reduce the time to reperfusion of the myocardium, thereby improving morbidity and mortality rates. Therefore, the identification of STEMI by paramedics can have a dramatic effect on patients' long-term health outcomes. Ambulance Victoria paramedics play a crucial role in the care provided to AMI patients across the state, with the assistance of a computer-automated interpretation of 12-lead electrocardiograms (ECGs) to aid STEMI identification. Objectives: This study's objective is to analyse the diagnostic capability of the computer-automated interpretation to diagnose STEMI in the out-of-hospital setting. Methods: Quantitative data from January 2018 to December 2019 was sourced from the Victorian Ambulance STEMI Quality Initiative. These data were periodically matched with hospital outcome and diagnosis data from the Victorian Cardiac Outcomes Registry to compare provisional paramedic diagnoses with the final hospital diagnoses. Results: Of the 5269 cases of suspected STEMI, 765 (14.5%) could be matched with outcome data. Of these 765 cases, 88.9% were correctly identified as STEMI. The remaining 10% were categorised as either non-STEMI or unstable angina. No data were available for 1.1%. Conclusions: The diagnostic capability of the Zoll Inovise 12L interpretive algorithm to diagnose STEMI in the out-of-hospital setting appears safe and feasible. However, because of limited data matching paramedic findings with patient outcomes in hospital, no hard conclusions can be drawn. Furthermore, there is no way to ascertain how many false positives the Zoll monitor is interpreting. Further investigation is required to assess the true diagnostic capability of the Zoll Inovise 12L interpretive algorithm.

Amphetamine-related care in the USA, 2003–2014: cross-sectional analyses examining inpatient trends and factors associated with hospitalisation outcomes

ObjectivesAlthough amphetamine use is a growing health problem in the USA, there are limited data on amphetamine-related hospitalisations. The primary objective of our study was to examine trends in amphetamine-related...

COVID-19 Infection in Parturients: Comparative Neonatal and Maternal Outcomes in a Single-Institute Regional Hospital in Thailand

Objective: Chonburi province is ranked fourth in Thailand in terms of COVID-19 cases. The objective was to compare neonatal and maternal outcomes among pregnant women with and without COVID-19 infection delivered in Chonburi hospital. Materials and Methods: The present study was a retrospective matched cohort study that included all pregnant women who delivered between January 1 and August 31, 2021, at Chonburi Hospital, Thailand. The exposure group comprised women with a current or previous positive COVID-19 PCR test, while the comparators were the PCR negative group. The matching ratio was 1:4, based on gestational and maternal age, parity, and the closest delivery date. Clinical data were obtained from medical records. Results: Forty-six pregnant women had a positive COVID-19 PCR, 24 (52.17%) were Thai and 22 (47.83%) were of other ethnicities. Most (60.87%) were asymptomatic or required no medical assistance. Three (6.52%) had severe pneumonia and required respiratory support. Neither maternal death nor vertical transmission was detected. Compared with 184 COVID-19-negative pregnant women, no significant differences in low APGAR score of less than 7, and preeclampsia in the 46 COVID-19-positive pregnant women were observed. However, COVID-19-positive pregnant women showed an increased rate of neonatal respiratory distress (RD) (relative risk [RR] 2.55; 95% confidence interval [CI] 1.04 to 6.21] and clinical early-onset neonatal sepsis (RR 3.60; 1.55 to 8.36). Additionally, a higher cesarean section rate was observed in the COVID-19 positive group (RR 1.45, 1.11 to 1.85). Conclusion: There were no significant differences in neonates with APGAR of less than 7 between the cohort of 46 pregnant women who tested positive for COVID-19 and those who tested negative. However, a higher rate of cesarean delivery, presumed early-onset neonatal septicemia, and RD in the COVID-19 positive group were noted and should be monitored. Keywords: COVID-19; Pregnancy; Neonatal outcome; Birth asphyxia

Comparison of clinical characteristics and short-term outcomes among COVID-19 patients in a tertiary care center during second wave pandemic in Nepal: a cross-sectional study

Background: Coronavirus disease 2019 (COVID-19) emerged as a challenging pandemic globally. The clinical manifestations range from asymptomatic infection to severe respiratory failure. In-hospital mortality varies from 18.9% to 20.3%. Old age, male gender, co-morbidities, lower oxygen saturation, lymphopenia, raised C-reactive protein, and d-dimer levels increase the risk of critical illness and death. The objective of this study was to compare the clinical characteristics of COVID-19 patients and associated outcomes in a tertiary level hospital in Nepal. Methods: An analytical cross-sectional study was conducted in laboratory-confirmed COVID-19 patients admitted in a tertiary center of Nepal during the peak of the second wave of the pandemic. A non-probabilistic consecutive sampling technique was adopted. Data were analyzed using Statistical Package for the Social Sciences (IBM-SPSS), version-23. Mortality (yes/no) was the primary outcome of interest, and accordingly, the cases were divided into two groups, survivors and non-survivors. Bivariate and multivariate analyses were performed. Results: The overall in-hospital mortality was 84 (19.58%), and Intensive Care Unit (ICU) mortality was 36 (58.06%). The death rate was higher in cases presenting with shortness of breath and anorexia. Hypoxemic respiratory failure (16.08%) and acute respiratory distress syndrome (8.62%) were the most common complications associated with higher mortality. Patients with older age had higher odds of mortality (adjusted OR, 1.077; p&lt;0.001). The risk of mortality was higher in severe to critically ill patients (adjusted OR, 5.861; p=0.001), and those who were under mechanical ventilation (adjusted OR, 39.059; p&lt;0.001). Likewise, the duration of hospital stay was significantly associated with mortality (adjusted OR, 0.795; p&lt;0.001). Conclusions: The non-survivors of COVID-19 tended to be of older age, severe to critically ill at presentation, require mechanical ventilation, and have a shorter duration of hospital stay, compared to survivors. So, these groups of patients need special care and support during hospital admission.

Factors contributing to oligohydramnios in third trimester of pregnancy and its impact on maternal and perinatal outcome in a tertiary hospital of rural Vadodara

Factors contributing to oligohydramnios in third trimester of pregnancy and its impact on maternal and perinatal outcome in a tertiary hospital of rural Vadodara

A study of abnormal liver function in pregnancy and its correlation with fetomaternal outcome in a teaching hospital of Kolkata in Eastern India

Background: Liver is a vital organ to maintain physiology of the body and supports every organ of the body. Its proper functioning during pregnancy is essential for a good maternal and fetal outcome. The study analyzes the causes and fetomaternal outcome in pregnancies and suggests measures to reduce morbidity and mortality. Aims and Objectives: This study aims to analyze the maternal and fetal outcome in pregnancy complicated with abnormal liver function test. Materials and Methods: This was hospital-based observational prospective study conducted at NRS Medical College and Hospital from March 2020 to August 2021. Total 144 pregnant women with abnormal liver function were included in the study. Template was generated and analysis was done on SPSS software. Results: Among 144 pregnant women 44.4% patients were 21–25 years of age. About 79.2% patients had &lt;2 serum bilirubin, 13.9% patients had 2–5 serum bilirubin, 2.8% patients had abruption, 11.8% patients had convulsion, and 9.3% patients had fetal bradycardia. About 13.9% patients had acute kidney injury, 22.2% patients had BT, 9.7% patients had hemolysis, elevated liver enzymes and low platelets, 15.3% patients had postpartum hemorrhage, and 3.8% patients had maternal death. In our study, 34.7% patients had pre-eclampsia and 11.8% patients had eclampsia. Conclusion: Abnormal liver function during pregnancy is associated with adverse events for both the mother and the fetus. Regular antenatal check-up, screening, and diagnosing liver disorder can save the lives of many mothers and fetus.

Embedding pharmacists in residential aged care: Why it's important to integrate resident‐ and system‐level services

Embedding pharmacists in residential aged care: Why it's important to integrate resident‐ and system‐level services

Disease Course and Patient’s Characteristics in a Regional First Level Hospital in Western-Germany During the First Three Covid-19 Surges from March 2020 to July 2021

The worldwide spread of SARS-CoV-2 profoundly affected almost all aspects of public life and challenged international and national health institutions of all different medical care levels including Europe up from the very beginning in 2020 until today. Public and press perception might have been weighed somehow towards third level health care providers offering treatment options like ECMO therapy for Covid-19 patients with the worst disease course, the majority of patients who needed hospital care were treated in hospitals of the first level. These hospitals provided about 50% of intensive care treatments in the federal state of Rhineland Palatinate (RLP) in Germany, too [1]. According to the Destatis [2] about 71000 additional deaths were registered in Germany during the first 12 months (02/2020 – 02/2021) of pandemic of which about 50000 could be attributed to Covid-19 as given in the medical death reports. However, only few data has been published on the concrete disease course and patient´s outcome on the scale of a single treatment site. Thus, this analysis provides routine data on patient´s characteristics, treatment modalities and outcome in a single first level hospital in RLP during the first three Covid-19 surges during 03/2020 – 07/2021.

A Decade of Pediatric Intensive Care Outreach and the Deteriorating Child—The Relationship between Dose and Outcomes in a Tertiary Children's Hospital

AbstractThe aim of this study is to evaluate the amalgamation and maturation of a Pediatric Intensive Care Outreach Service (PICOS) with a rapid response system (RRS) and associated outcomes over a 10-year period. It is a single-center retrospective study analyzing patient outcomes within the context of significant organizational changes introducing a track and trigger RRS called Between the Flags (BTF) and evolution of this system to electronic observation charting and alerts (eBTF) in a tertiary metropolitan children's hospital. Children on inpatient wards who required urgent activation of the RRS and admission to the pediatric intensive care unit (PICU) between 2009 and 2018 were included. Three cohorts were identified according to the system changes—pre-BTF (2009–2011), BTF (2012–2017), and eBTF (2017–2018). The PICOS dose (number of activations per 1000 hospital admissions) increased with the introduction of BTF and the RRS and this trend continued following eBTF. The number of PICU admissions via the PICOS did not vary across the decade. When comparing the pre-BTF to the BTF group, PICU mortality decreased (p &lt; 0.05), Pediatric Index of Mortality 2 Risk of Death scores improved, and hospital length of stay decreased (p &lt; 0.05) in the BTF group. Introduction of a track and trigger RRS and electronic charting augmenting an existing PICOS is associated with increasing dose and workload, with no significant impact on PICU admission rates or length of stay. PICOS patient mortality has notably decreased with the introduction of an RRS; however, this impact was not sustained with the addition of electronic charting and alerts in the patient medical record.