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Sample records for hospital maternity records

  1. Recording of Neonatal Seizures in Birth Certificates, Maternal Interviews, and Hospital Discharge Abstracts in a Cerebral Palsy Case-Control Study in Michigan.

    PubMed

    Li, Qing; Lenski, Madeleine; Copeland, Glenn; Kinsman, Stephen L; Francis, Matthew; Kirby, Russell S; Paneth, Nigel

    2016-06-01

    We evaluated the recording of neonatal seizures in birth certificates, hospital discharge abstracts, and maternal interviews in 372 children, 198 of them with cerebral palsy, born in Michigan hospitals from 1993 to 2010. In birth certificates, we examined checkbox items "seizures" or "seizure or serious neurologic dysfunction"; in hospital discharge abstracts ICD-9-CM codes 779.0, 345.X, and 780.3; and in maternal interviews a history of seizures or convulsions on day 1 of life recalled 2-16 years later. In 27 neonates, 38 neonatal seizures were recorded in 1 or more sources, 17 in discharge abstracts, 20 in maternal interviews, but just 1 on a birth certificate. The kappa coefficient (κ) between interviews and discharge abstracts was moderate (κ = 0.55), and substantial (κ = 0.63) if mothers noted use of antiepileptics. Agreement was higher (κ = 0.71 vs κ = 0.29) in term births than in preterm births. Birth certificates significantly underreported neonatal seizures. PMID:26668053

  2. Maternity records in Edinburgh and Aberdeen in 1936: a comparison.

    PubMed

    Nuttall, A M; Ayaz, E; Sherlock, L; Shenkin, S D

    2015-03-01

    Historians have long used maternity records to understand the evolution of maternity services. More recently, epidemiologists have become interested in obstetric hospital records as a source of data (e.g. birth weight, social class), to study the influence of early life on future health and disease: life course epidemiology. Edinburgh and Aberdeen are unusual in holding detailed records from several maternity institutions. The records of 1936 are of particular interest because all children born in this year and at school in Scotland at age 11 sat a cognitive ability test, the Scottish Mental Survey 1947. This study aims to describe the maternity services in Edinburgh and Aberdeen in 1936, between the First and Second World Wars. Understanding the richness of data in birth records, the manner in which they were recorded, and the context of the institutions in their community is essential for interpreting life course epidemiology studies. PMID:25874836

  3. Influence of the support offered to breastfeeding by maternity hospitals

    PubMed Central

    Passanha, Adriana; Benício, Maria Helena D’Aquino; Venâncio, Sônia Isoyama; dos Reis, Márcia Cristina Guerreiro

    2015-01-01

    ABSTRACT OBJECTIVE To evaluate whether the support offered by maternity hospitals is associated with higher prevalences of exclusive and predominant breastfeeding. METHODS This is a cross-sectional study including a representative sample of 916 infants less than six months who were born in maternity hospitals, in Ribeirao Preto, Sao Paulo, Southeastern Brazil, 2011. The maternity hospitals were evaluated in relation to their fulfillment of the Ten Steps to Successful Breastfeeding. Data were collected regarding breastfeeding patterns, the birth hospital and other characteristics. The individualized effect of the study factor on exclusive and predominant breastfeeding was analyzed using Poisson multiple regression with robust variance. RESULTS Predominant breastfeeding tended to be more prevalent when the number of fulfilled steps was higher (p of linear trend = 0.057). The step related to not offering artificial teats or pacifiers to breastfed infants and that related to encouraging the establishment of breastfeeding support groups were associated, respectively, to a higher prevalence of exclusive (PR = 1.26; 95%CI 1.04;1.54) and predominant breastfeeding (PR = 1.55; 95%CI 1.01;2.39), after an adjustment was performed for confounding variables. CONCLUSIONS We observed a positive association between support offered by maternity hospitals and prevalences of exclusive and predominant breastfeeding. These results can be useful to other locations with similar characteristics (cities with hospitals that fulfill the Ten Steps to Successful Breastfeeding) to provide incentive to breastfeeding, by means of promoting, protecting and supporting breastfeeding in maternity hospitals. PMID:26759966

  4. Informal patient payments in maternity hospitals in Kiev, Ukraine.

    PubMed

    Stepurko, Tetiana; Pavlova, Milena; Levenets, Olena; Gryga, Irena; Groot, Wim

    2013-01-01

    Maternity care in Ukraine is a government priority. However, it has not undergone substantial changes since the collapse of the Soviet Union. Similar to the entire health care sector in Ukraine, maternity care suffers from inefficient funding, which results in low quality and poor access to services. The objective of this paper is to explore the practice of informal payments for maternity care in Ukraine, specifically in cases of childbirth in Kiev maternity hospitals. The paper provides an ethnographic study on the consumers' and providers' experiences with informal payments. The results suggest that informal payments for childbirth are an established practice in Kiev maternity hospitals. The bargaining process between the pregnant woman (incl. her partner) and the obstetrician is an important part of the predelivery arrangement, including the informal payment. To deal with informal payments in Kiev maternity hospitals, there is a need for the following: (i) regulation of the "quasi-official" patient payments at the health care facility level; and (ii) improvement of professional ethics through staff training. These strategies should be coupled with improved governance of the health care sector in general, and maternity care in particular in order to attain international quality standards and adequate access to facilities. PMID:23239082

  5. Erratum: maternal mortality in Cameroon: a university teaching hospital report.

    PubMed

    2015-01-01

    This erratum corrects article: "Maternal mortality in Cameroon: a university teaching hospital report." The Pan African Medical Journal. 2015;21:16. doi:10.11604/pamj.2015.21.16.3912[This corrects the article on p. 16 in vol. 21, PMID: 26401210.]. PMID:26816561

  6. Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania

    PubMed Central

    2010-01-01

    Background Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved. Methods A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed. Results Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed. Conclusions Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions. PMID

  7. Association of Maternal Smoking during Pregnancy with Infant Hospitalization and Mortality Due to Infectious Diseases

    PubMed Central

    Metzger, Michael J.; Halperin, Abigail C.; Manhart, Lisa E.; Hawes, Stephen E.

    2012-01-01

    Background Maternal smoking is associated with infant respiratory infections and with increased risk of low birthweight (LBW) infants and preterm birth. This study assesses the association of maternal smoking during pregnancy with both respiratory and non-respiratory infectious disease (ID) morbidity and mortality in infants. Methods We conducted two retrospective case-control analyses of infants born in Washington State from 1987–2004 using linked birth certificate, death certificate, and hospital discharge records. One assessed morbidity—infants hospitalized due to ID within one year of birth (47,404 cases/48,233 controls). The second assessed mortality—infants who died within one year due to ID (627 cases/2,730 controls). Results Maternal smoking was associated with both hospitalization (Adjusted Odds Ratio (AOR)=1.52; 95%CI: 1.46, 1.58) and mortality (AOR=1.51; 95%CI: 1.17, 1.96) due to any ID. In subgroup analyses, maternal smoking was associated with hospitalization due to a broad range of ID including both respiratory (AOR=1.69; 95%CI: 1.63, 1.76) and non-respiratory ID (AOR=1.27; 95%CI: 1.20, 1.34). Further stratification by birthweight and gestational age did not appreciably change these estimates. In contrast, there was no association of maternal smoking with ID infant mortality when only LBW infants were considered. Conclusions Maternal smoking was associated with a broad range of both respiratory and non-respiratory ID outcomes. Despite attenuation of the mortality association among LBW infants, ID hospitalization was found to be independent of both birthweight and gestational age. These findings suggest that full-term infants of normal weight whose mothers smoked may suffer an increased risk of serious ID morbidity and mortality. PMID:22929173

  8. Maternal mortality in a district hospital in West Bengal.

    PubMed

    Gun, K M

    1970-06-01

    To ascertain the causes of high maternal mortality in West Bengal, the author examined maternal mortality between 1964-68. It was intended that measures to improve the situation in rural areas could be suggested. Women in labor often arrive at the hospital very late and few antenatal care facilities are available in rural areas. High risk cases often are delivered at home, a situation which often results in fetal complications. Maternal deaths have declined, but not dramatically. Of the 24,265 deliveries at the Burdwan district hospital, there were 333 maternal deaths for an incidence of 13.7/1000, along with another 42 cases where death was due to pregnancy-associated causes. In contrast, the maternal mortality rate in a district hospital in Calcutta was 4/1000 in 1968. Eclampsia accounted for 42.34% (141) of maternal deaths making it the major cause of death. In Calcutta this cause of death is receding gradually but in the districts it still accounts for a heavy loss of life (an incidence of 1 in 38). Adequate antenatal care would reduce this high mortality. 2 factors which have contributed to the high mortality are the hours lost in transporting a patient from a rural area and inadequate hospital staff. Postpartum hemorrhage and/or retained placenta was responsible for 39 deaths and none of the cases admitted from outside had received antenatal care. A shortage of blood was also a contributory factor. Severe anemia was responsible for 34 deaths and abortions resulted in another 29 deaths (16 because of severe sepsis; 13 due to hemorrhage or shock). An emergency service would help reduce the number of deaths but at present such a service does not even exist in the urban areas. Ruptured uterus resulted in 29 deaths and obstructed labor in 27 deaths. Placenta previa brought about 14 deaths and the remaining 20 deaths were due to such causes as accidental hemorrhage (10), hydatidiform mole (4), puerperal sepsis (3), ectopic pregnancy (2), and uterine inversion (1

  9. Maternal satisfaction with organized perinatal care in Serbian public hospitals

    PubMed Central

    2014-01-01

    Background Understanding the experiences and expectations of women across the continuum of antenatal, perinatal, and postnatal care is important to assess the quality of maternal care and to determine problematic areas which could be improved. The objective of this study was to identify the factors associated with maternal satisfaction with hospital-based perinatal care in Serbia. Methods Our survey was conducted from January 2009 to January 2010 using a 28-item, self-administered questionnaire. The sample consisted of 50% of women who expected childbirths during the study period from all 76 public institutions with obstetric departments in Serbia. The following three composite outcome variables were constructed: satisfaction with technical and professional aspects of care; communication and interpersonal aspects of care; and environmental factors. Results We analyzed 34,431 completed questionnaires (84.2% of the study sample). The highest and lowest average satisfaction scores (4.43 and 3.25, respectively) referred to the overall participation of midwives during delivery and the quality of food served in the hospital, respectively. Younger mothers and multiparas were less concerned with the environmental conditions (OR = 0.55, p = 0.006; OR = 1.82, p = 0.004). Final model indicated that mothers informed of patients’ rights, pregnancy and delivery through the Maternal Counseling Service were more likely to be satisfied with all three outcome variables. The highest value of the Pearson’s coefficient of correlation was between the overall satisfaction score and satisfaction with communication and interpersonal aspects of care. Conclusions Our study illuminated the importance of interpersonal aspects of care and education for maternal satisfaction. Improvement of the environmental conditions in hospitals, the WHO program, Baby-friendly Hospital, and above all providing all pregnant women with antenatal education, are recommendations which would

  10. Information for managers in hospitals: representing maternity unit statistics graphically.

    PubMed Central

    Szczepura, A; Mugford, M; Stilwell, J A

    1987-01-01

    Staff who organise and run maternity units contribute many statistics to their health authority but do not find it easy to obtain information about their unit from these statistics. Data that are collected routinely, however, can be used to provide each unit with a graphical profile of its activity and resources. The method described here was derived from the personality profiles used by psychologists and allows staff in one unit to assess the outcome, activity, and use of resources in their unit in relation to similar units, to explain some of the differences when these occur, or to highlight potential problems. Examples are taken from a study of maternity units in the West Midlands. It is concluded that the technique can indicate potential problems and usefully be adopted by those who monitor maternity care in districts or hospitals. PMID:3105784

  11. Self-efficacy as a mediator between maternal depression and child hospitalizations in low-income urban families.

    PubMed

    Holland, Margaret L; Yoo, Byung-Kwang; Kitzman, Harriet; Chaudron, Linda; Szilagyi, Peter G; Temkin-Greener, Helena

    2011-10-01

    The objective of this study is to examine the role of maternal self-efficacy as a potential mediator between maternal depression and child hospitalizations in low-income families. We analyzed data from 432 mother-child pairs who were part of the control-group for the Nurse-Family Partnership trial in Memphis, TN. Low-income urban, mostly minority women were interviewed 12 and 24 months after their first child's birth and their child's medical records were collected from birth to 24 months. We fit linear and ordered logistic regression models to test for mediation. We also tested non-linear relationships between the dependent variable (child hospitalization) and covariates (depressive symptoms and self-efficacy). Elevated depressive symptoms (OR: 1.70; 90% CI: 1.05, 2.74) and lower maternal self-efficacy (OR: 0.674; 90% CI: 0.469, 0.970) were each associated with increased child hospitalizations. When both maternal self-efficacy and depressive symptoms were included in a single model, the depressive symptoms coefficient decreased significantly (OR decreased by 0.13, P = 0.069), supporting the hypothesis that self-efficacy serves as a mediator. A non-linear, inverse-U shaped relationship between maternal self-efficacy and child hospitalizations was supported: lower compared to higher self-efficacy was associated with more child hospitalizations (P = 0.039), but very low self-efficacy was associated with fewer hospitalizations than low self-efficacy (P = 0.028). In this study, maternal self-efficacy appears to be a mediator between maternal depression and child hospitalizations. Further research is needed to determine if interventions specifically targeting self-efficacy in depressed mothers might decrease child hospitalizations. PMID:20706866

  12. Maternal Clinical Diagnoses and Hospital Variation in the Risk of Cesarean Delivery: Analyses of a National US Hospital Discharge Database

    PubMed Central

    Kozhimannil, Katy B.; Arcaya, Mariana C.; Subramanian, S. V.

    2014-01-01

    Background Cesarean delivery is the most common inpatient surgery in the United States, where 1.3 million cesarean sections occur annually, and rates vary widely by hospital. Identifying sources of variation in cesarean use is crucial to improving the consistency and quality of obstetric care. We used hospital discharge records to examine the extent to which variability in the likelihood of cesarean section across US hospitals was attributable to individual women's clinical diagnoses. Methods and Findings Using data from the 2009 and 2010 Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project—a 20% sample of US hospitals—we analyzed data for 1,475,457 births in 1,373 hospitals. We fitted multilevel logistic regression models (patients nested in hospitals). The outcome was cesarean (versus vaginal) delivery. Covariates included diagnosis of diabetes in pregnancy, hypertension in pregnancy, hemorrhage during pregnancy or placental complications, fetal distress, and fetal disproportion or obstructed labor; maternal age, race/ethnicity, and insurance status; and hospital size and location/teaching status. The cesarean section prevalence was 22.0% (95% confidence interval 22.0% to 22.1%) among women with no prior cesareans. In unadjusted models, the between-hospital variation in the individual risk of primary cesarean section was 0.14 (95% credible interval 0.12 to 0.15). The difference in the probability of having a cesarean delivery between hospitals was 25 percentage points. Hospital variability did not decrease after adjusting for patient diagnoses, socio-demographics, and hospital characteristics (0.16 [95% credible interval 0.14 to 0.18]). A limitation is that these data, while nationally representative, did not contain information on parity or gestational age. Conclusions Variability across hospitals in the individual risk of cesarean section is not decreased by accounting for differences in maternal diagnoses. These findings highlight

  13. ‘Because of Poverty brought into Hospital: . . .’A Casenote-Based Analysis of the Changing Role of the Edinburgh Royal Maternity Hospital, 1850-1912

    PubMed Central

    Nuttall, Alison

    2008-01-01

    Summary Although the shift from a social to a medical function which occurred in nineteenth-century general hospitals has been explored, the occurrence of such a change in maternity hospitals has not been considered. Recent analyses of such institutions have examined particular aspects only, and thus give a somewhat static picture. This paper uses analysis of patient records (themselves an under-exploited resource) to explore the changing function of the Edinburgh Royal Maternity Hospital from a provider of shelter during childbirth to the destitute to a source of skilled medical care. It concludes that, although the Hospital had adopted the outward features of a medical institution by 1890, its casebooks suggest that its purpose only truly changed in the early twentieth century, and thus can perhaps be more appropriately linked with national anxiety regarding the health of babies and their mothers. PMID:18605328

  14. Records and record-keeping for the hospital compounding pharmacist.

    PubMed

    McElhiney, Linda F

    2007-01-01

    The United States Pharmacopeial Convention, Inc., is recognized by federal law and by most state boards of pharmacy as the official group for setting the standards for pharmaceuticals and pharmacy practice, including compounding. The standards of United States Pharmacopeia Chapter 795 require that a pharmacy maintain records on a compounded preparation, including the formulation record, and a Material Safety Data Sheets file. The American Society of Health-Systems Pharmacists' guidelines require that hospital pharmacy departments maintain at least four sets of records in the compounding area: (1) compounding formulas and procedures, (2) compounding logs of all compounded preparations, including batch records and sample batch labels, (3) equipment maintenance records, and (4) a record of ingredients purchased, including cerificates of analysis and Material Saftey Data Sheets. Hospital compounding records may be inspected by any of several outside organizations, including state boards of pharmacy, third-party payers, the Joint Commission on Accreditaion of Healthcare Organizations, the Drug Enforcement Agency, and attorneys. With the existing standards and guidelines in place and the importance of documentation unquestionable, a record of pharmacy activites should be maintained in a compounding pharmacy so that preparations can be replicated consistently, the history of each ingredient traced, equipment maintenance and calibration verified, and compounding procedures evaluated easily. PMID:23974620

  15. Neonatal respiratory distress in Omdurman Maternity Hospital, Sudan

    PubMed Central

    Hamed, Selma MA; Nasr, Abdelhaleem

    2014-01-01

    Neonatal respiratory distress (NRD) is a common neonatal problem, which is responsible for high morbidity and mortality. There are few published studies in developing countries addressing neonatal respiratory distress. There is no previously published study in Sudan on this problem. The objective of the study is to determine the frequency, different causes, immediate outcome. It was a prospective, descriptive, cross sectional hospital-based study which was carried out in neonatal intensive care unit (NICU) of Omdurman Maternity Hospital, between February-March 2013. The study enrolled all Sudanese newborns from 0-28 days including normal, low and high birth weight of different gestational ages admitted to the neonatal intensive care unit and diagnosed as neonatal respiratory distress. The frequency of NRD was calculated, the causes and immediate outcome were determined. Results showed that the frequency rate of NRD was (4.83%) among the total number of hospital (2071) live births during the period of the study. The commonest causes were transient tachypnoea of the newborn (TTN) in 28% of cases, sepsis in 24% of cases and hyaline membrane disease (HMD) in 15% of cases. The outcome of NRD was: cure in 56% of cases, death in 36% of cases, and patients discharged with complications in 8% of cases. In conclusion, the study confirmed the importance of NRD with a frequency rate of 4.83%, morbidity of 8% and mortality of 36% of cases. The causes and immediate outcome were determined and discussed. Some recommendations were suggested in order to reduce its frequency, morbidity and mortality. PMID:27493392

  16. Quality of Care: A Review of Maternal Deaths in a Regional Hospital in Ghana.

    PubMed

    Adusi-Poku, Yaw; Antwil, Edward; Osei-Kwakye, Kingsley; Tetteh, Chris; Detoh, Eric Kwame; Antwi, Phyllis

    2015-09-01

    The government of Ghana and key stakeholders have put into place several interventions aimed at reducing maternal deaths. At the institutional level, the conduct of maternal deaths audit has been instituted. This also contributes to reducing maternal deaths as shortcomings that may have contributed to such deaths could be identified to inform best practice and forestall such occurrences in the future. The objective of this study was to review the quality of maternal care in a regional hospital. A review of maternal deaths using Quality of Care Evaluation Form adapted from the Komfo Anokye Teaching Hospital (KATH) Maternal Death Audit Evaluation Committee was used. About fifty-five percent, 18 (55%) of cases were deemed to have received adequate documentation, senior clinicians were involved in 26(85%) of cases. Poor documentation, non-involvement of senior clinicians in the management of cases, laboratory related issues particularly in relation to blood and blood products as well as promptness of care and adequacy of intensive care facilities and specialists in the hospital were contributory factors to maternal deaths . These are common themes contributing to maternal deaths in developing countries which need to be urgently tackled. Maternal death review with emphasis on quality of care, coupled with facility gap assessment, is a useful tool to address the adequacy of emergency obstetric care services to prevent further maternal deaths. PMID:26897915

  17. Maternal mortality in a subdivisional hospital of eastern Himalayan region.

    PubMed

    Ray, A

    1992-05-01

    This study was conducted in a subdivisional hospital of eastern Himalayan region among 5,273 pregnant women over a period of 8 years. There were 29 deaths, the maternal mortality rate was 55 per 10,000. Septic abortion was encountered in 4 among them. Direct obstetric cause was responsible in 72.41% of cases and indirect cause in 27.59% cases. Sepsis, both puerperal and postabortal resulted in 24.14% followed by postpartum haemorrhage in 20.69%. Two of these cases were associated with inversion of the uterus. Preeclampsia caused 10.34% and eclampsia 6.9% of the deaths. Among the indirect causes severe anaemia and pulmonary tuberculosis accounted for 10.34% and 6.9% respectively. Infective hepatitis was the cause in 6.9% cases. Only 17% of the cases were booked and the rest were unbooked. Majority of the cases (62.07%) belonged to the age group of 20-30 years. Primigravida constituted 41.38% of the cases. PMID:1517613

  18. Trends in Maternal Mortality Ratio in a Tertiary Referral Hospital and the Effects of Various Maternity Schemes on It

    PubMed Central

    Kaur, Harpreet; Kaur, Sharanjit; Singh, Sukhwinderjit

    2015-01-01

    Objective: To analyze the trend in maternal mortality ratio in a tertiary care centre and the effect of various maternity schemes on it. Materials and methods: Retrospective analysis of all maternal deaths occurring in the Guru Gobind Singh Medical College & Hospital, Faridkot, Punjab, India was done from Jan 2010 to Dec 2012. Every maternal death was scrutinized from various aspects like direct cause of death, age, locality, antenatal care and gestational age. Results: The total number of deliveries has risen from 957 in 2010 to 1063 in 2012 at the same time the maternal mortality ratio has increased from 835.94 in 2010 to 2054.55 per one live birth in 2012. Haemorrhage (24.12%) and sepsis (18.9%) were the most common causes of death followed closely by pregnancy induced hypertension including eclampsia (15.5%). Anemia (12.06%) contributed to the most common indirect cause of death. Conclusion: Implementation of the various maternity schemes has had no significant impact on the profile of dying mothers. There is a need to stress the importance of good antenatal care in reducing Maternal Mortality Ratio. PMID:26175763

  19. Maternity patients' access to their electronic medical records: use and perspectives of a patient portal.

    PubMed

    Megan Forster, Megan; Dennison, Kerrie; Callen, Joanne; Andrew, Andrew; Westbrook, Johanna I

    2015-01-01

    Patients have been able to access clinical information from their paper-based health records for a number of years. With the advent of Electronic Medical Records (EMRs) access to this information can now be achieved online using a secure electronic patient portal. The purpose of this study was to investigate maternity patients' use and perceptions of a patient portal developed at the Mater Mothers' Hospital in Brisbane, Australia. A web-based patient portal, one of the first developed and deployed in Australia, was introduced on 26 June 2012. The portal was designed for maternity patients booked at Mater Mothers' Hospital, as an alternative to the paper-based Pregnancy Health Record. Through the portal, maternity patients are able to complete their hospital registration form online and obtain current health information about their pregnancy (via their EMR), as well as access a variety of support tools to use during their pregnancy such as tailored public health advice. A retrospective cross-sectional study design was employed. Usage statistics were extracted from the system for a one year period (1 July 2012 to 30 June 2013). Patients' perceptions of the portal were obtained using an online survey, accessible by maternity patients for two weeks in February 2013 (n=80). Descriptive statistics were employed to analyse the data. Between July 2012 and June 2013, 10,892 maternity patients were offered a patient portal account and access to their EMR. Of those 6,518 created one (60%; 6,518/10,892) and 3,104 went on to request access to their EMR (48%; 3,104/6,518). Of these, 1,751 had their access application granted by 30 June 2013. The majority of maternity patients submitted registration forms online via the patient portal (56.7%). Patients could view their EMR multiple times: there were 671 views of the EMR, 2,781 views of appointment schedules and 135 birth preferences submitted via the EMR. Eighty survey responses were received from EMR account holders, (response

  20. Maternal mortality in Cameroon: a university teaching hospital report.

    PubMed

    Tebeu, Pierre-Marie; Pierre-Marie, Tebeu; Halle-Ekane, Gregory; Gregory, Halle-Ekane; Da Itambi, Maxwell; Maxwell, Da Itambi; Enow Mbu, Robinson; Robinson, Enow Mbu; Mawamba, Yvette; Yvette, Mawamba; Fomulu, Joseph Nelson; Nelson, Fomulu Joseph

    2015-01-01

    More than 550,000 women die yearly from pregnancy-related causes. Fifty percent (50%) of the world estimate of maternal deaths occur in sub-Saharan Africa alone. There is insufficient information on the risk factors of maternal mortality in Cameroon. This study aimed at establishing causes and risk factors of maternal mortality. This was a case-control study from 1st January, 2006 to 31st December, 2010 after National Ethical Committee Approval. Cases were maternal deaths; controls were women who delivered normally. Maternal deaths were obtained from the delivery room registers and in-patient registers. Controls for each case were two normal deliveries following identified maternal deaths on the same day. Variables considered were socio-demographic and reproductive health characteristics. Epi Info 3.5.1 was used for analysis. The mean MMR was 287.5/100,000 live births. Causes of deaths were: postpartum hemorrhage (229.2%), unsafe abortion (25%), ectopic pregnancy (12.5%), hypertension in pregnancy (8.3%), malaria (8.3%), anemia (8.3%), heart disease (4.2%), and pneumonia (4.2%), and placenta praevia (4.2%). Ages ranged from 18 to 41 years, with a mean of 27.7 ± 5.14 years. Lack of antenatal care was a risk factor for maternal death (OR=78.33; CI: (8.66- 1802.51)). The mean MMR from 2006 to 2010 was 287.5/100,000 live births. Most of the causes of maternal deaths were preventable. Lack of antenatal care was a risk factor for maternal mortality. Key words: Maternal mortality, causes, risk factors, Cameroon. PMID:26401210

  1. Maternal mortality in a teaching hospital in southern India. A 13-year study.

    PubMed

    Rao, K B

    1975-10-01

    During the 13 years 1960-1972, in a teaching hospital that serves a predominantly rural and semiurban population in southern India, there were 74,384 deliveries and 1245 maternal deaths, a maternal mortality rate of 16.7 per 1000 births. Direct obstetric factors caused 854 (65.5%) of these deaths. The leading indirect or associated causes of maternal deaths were anemia, cerebrovascular accidents, and infectious hepatitis. During the past 13 years, monthly maternal mortality meetings have helped to reduce the incidence of avoidable factors in maternal deaths among patients from the city but not among those brought from the surrounding countryside. The important causes of maternal deaths in this developing country, and their prevention, are individually discussed. PMID:1080844

  2. Evaluation of maternal and neonatal hospital care: quality index of completeness

    PubMed Central

    da Silva, Ana Lúcia Andrade; Mendes, Antonio da Cruz Gouveia; Miranda, Gabriella Morais Duarte; de Sá, Domicio Aurélio; de Souza, Wayner Vieira; Lyra, Tereza Maciel

    2014-01-01

    OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System. METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country. RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country. CONCLUSIONS The index of completeness proved to be of great value for monitoring the

  3. Are urban safety-net hospitals losing low-risk Medicaid maternity patients?

    PubMed Central

    Gaskin, D J; Hadley, J; Freeman, V G

    2001-01-01

    OBJECTIVE: To examine data on Medicaid and self-pay/charity maternity cases to address four questions: (1) Did safety-net hospitals' share of Medicaid patients decline while their shares of self-pay/charity-care patients increased from 1991 to 1994? (2) Did Medicaid patients' propensity to use safety-net hospitals decline during 1991-94? (3) Did self-pay/charity patients' propensity to use safety-net hospitals increase during 1991-94? (4) Did the change in Medicaid patients' use of safety-net hospitals differ for low- and high-risk patients? STUDY DESIGN: We use hospital discharge data to estimate logistic regression models of hospital choice for low-risk and high-risk Medicaid and self-pay/charity maternity patients for 25 metropolitan statistical areas (MSAs) in five states for the years 1991 and 1994. We define low-risk patients as discharges without comorbidities and high-risk patients as discharges with comorbidities that may substantially increase hospital costs, length of stay, or morbidity. The five states are California, Florida, Massachusetts, New Jersey, and New York. The MSAs in the analysis are those with at least one safety-net hospital and a population of 500,000 or more. This study also uses data from the 1990 Census and AHA Annual Survey of Hospitals. The regression analysis estimates the change between 1991 and 1994 in the relative odds of a Medicaid or self-pay/charity patient using a safety-net hospital. We explore whether this change in the relative odds is related to the risk status of the patient. PRINCIPAL FINDINGS: The findings suggest that competition for Medicaid patients increased from 1991 to 1994. Over time, safety-net hospitals lost low-risk maternity Medicaid patients while services to high-risk maternity Medicaid patients and self-pay/charity maternity patients remained concentrated in safety-net hospitals. IMPLICATIONS FOR POLICY: Safety-net hospitals use Medicaid patient revenues and public subsidies that are based on Medicaid

  4. Shallow medication extraction from hospital patient records.

    PubMed

    Boytcheva, Svetla

    2011-01-01

    This paper presents methods for shallow Information Extraction (IE) from the free text zones of hospital Patient Records (PRs) in Bulgarian language in the Patient Safety through Intelligent Procedures in medication (PSIP) project. We extract automatically information about drug names, dosage, modes and frequency and assign the corresponding ATC code to each medication event. Using various modules for rule-based text analysis, our IE components in PSIP perform a significant amount of symbolic computations. We try to address negative statements, elliptical constructions, typical conjunctive phrases, and simple inferences concerning temporal constraints and finally aim at the assignment of the drug ACT code to the extracted medication events, which additionally complicates the extraction algorithm. The prototype of the system was used for experiments with a training corpus containing 1,300 PRs and the evaluation results are obtained using a test corpus containing 6,200 PRs. The extraction accuracy (f-score) for drug names is 98.42% and for dose 93.85%. PMID:21685617

  5. The Relationship Between Self-Rated Health and Hospital Records.

    PubMed

    Nielsen, Torben Heien

    2016-04-01

    This paper investigates whether self-rated health (SRH) covaries with individual hospital records. By linking the Danish Longitudinal Survey on Ageing with individual hospital records covering all hospital admissions from 1995 to 2006, I show that SRH is correlated to historical, current, and future hospital records. I use both measures separately to control for health in a regression of mortality on wealth. Using only historical and current hospitalization controls for health yields the common result that SRH is a stronger predictor of mortality than objective health measures. The addition of future hospitalizations as controls shows that the estimated gradient on wealth is similar to one in which SRH is the control. The results suggest that with a sufficiently long time series of individual records, objective health measures can predict mortality to the same extent as global self-rated measures. PMID:25702929

  6. Maternal Infection Requiring Hospitalization during Pregnancy and Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Atladottir, Hjordis O.; Thorsen, Poul; Ostergaard, Lars; Schendel, Diana E.; Lemcke, Sanne; Abdallah, Morsi; Parner, Erik T.

    2010-01-01

    Exposure to prenatal infection has been suggested to cause deficiencies in fetal neurodevelopment. In this study we included all children born in Denmark from 1980, through 2005. Diagnoses of autism spectrum disorders (ASDs) and maternal infection were obtained through nationwide registers. Data was analyzed using Cox proportional hazards…

  7. Community hospital successfully implements eRecord and CPOE.

    PubMed

    Wolf, Debra M; Greenhouse, Pamela K; Diamond, Joel N; Fera, William; McCormick, Donna L

    2006-01-01

    Despite media attention on converting the nation's paper-based medical record systems to electronic systems, few hospitals, and even fewer community hospitals, have done so. University of Pittsburgh Medical Center St. Margaret has converted to a comprehensive electronic health record system, known as eRecord, in a short time. The authors describe key factors that were critical to the success of the conversion, along with positive results on quality of care. PMID:17108749

  8. Wide Variation Found In Hospital Facility Costs For Maternity Stays Involving Low-Risk Childbirth.

    PubMed

    Xu, Xiao; Gariepy, Aileen; Lundsberg, Lisbet S; Sheth, Sangini S; Pettker, Christian M; Krumholz, Harlan M; Illuzzi, Jessica L

    2015-07-01

    Childbirth is the leading cause of hospital admission in the United States, yet there has been little research on variation in hospital costs associated with childbirth. Using data from the 2011 Nationwide Inpatient Sample, we characterized the variation in estimated facility costs of hospitalizations for low-risk childbirth across US hospitals. We found that the average estimated facility cost per maternity stay ranged from $1,189 to $11,986 (median: $4,215), with a 2.2-fold difference between the 10th and 90th percentiles. Estimated facility costs were higher at hospitals with higher rates of cesarean delivery or serious maternal morbidity. Hospitals having government or nonprofit ownership; being a rural hospital; and having relatively low volumes of childbirths, low proportions of childbirths covered by Medicaid, and long stays also had significantly higher costs. The large variation in estimated facility cost for low-risk childbirths among hospitals suggests that hospital practices might be an important contributor to variation in cost and that there may be opportunities for cost reduction. The safe reduction of cesarean deliveries, increasing the coordination of care, and emphasizing value of care through new payment and delivery systems reforms may help reduce hospital costs and cost variation associated with childbirth in the United States. PMID:26153317

  9. Comparison of maternal and fetal outcomes of IVF and spontaneously conceived twin pregnancies: three year experience of a tertiary hospital

    PubMed Central

    Göçmen, Ahmet; Güven, Şirin; Bağci, Simge; Çekmez, Yasemin; Şanlıkan, Fatih

    2015-01-01

    Objectives: The aim of this study was to compare maternal and fetal outcomes of spontaneously conceived and in-vitro fertilization (IVF) twin pregnancies that were admitted to our obstetric clinic and delivered between January 1, 2011 to November 1, 2014. Material method: A total of 84 twin pregnancies were enrolled for the study and divided into two groups: group 1 as IVF (n = 19) and group 2 as spontaneously conceived (n = 65) twin pregnancies. Data of neonatal various morbidities needs neonatal intensive care unit (NICU) such as necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), sepsis, retinopathy of prematurity (ROP), and intraventricular hemorrhage (IVH) and maternal morbidities such as preeclampsia, eclampsia, postpartum bleeding, gestational diabetes mellitus(GDM) were collected by hospital records. Results: There were no statistical difference between two groups regarding hypertension related to pregnancy, intrauterine growth retardation, Apgar scores, NICU needs, birth weight and height (P > 0.05). The rate of premature rupture of membranes, maternal age, antenatal anemia and premature birth were detected higher in IVF group when compared with the other group (P < 0.05). Conclusion: Although twin pregnancies, regardless of conception method are high risk pregnancies in terms of obstetric and perinatal outcomes, premature rupture of membranes, maternal age, antenatal anemia and premature birth risks are higher in IVF twin pregnancies. PMID:26131238

  10. Major Placenta Previa: Rate, Maternal and Neonatal Outcomes Experience at a Tertiary Maternity Hospital, Sohag, Egypt: A Prospective Study

    PubMed Central

    Ahmed, Salah Roshdy; Aitallah, Abdusaeed; Abdelghafar, Hazem M.

    2015-01-01

    Introduction Major degree placenta is a serious health issue and is associated with high fetal-maternal morbidity and mortality. Literature from developing countries is scant. Aim To determine the prevalence and maternal and neonatal outcomes among women with major placenta previa (PP). Materials and Methods A prospective descriptive study of 52 singleton pregnancies with PP was evaluated in this study. The study was conducted at Sohag University Hospital, Egypt from January through June 2014. Outcome measures, including the prevalence of PP, maternal and neonatal outcomes, and case-fatality rate. Results The total number of deliveries performed during the study period was 3841, of them, 52 cases were placenta previa. Thus, the prevalence of PP was 1.3%. The mean of previous cesarean scars was 2.2±1.4. Of women with PP, 26.4% (n=14) had placenta accreta. In total, 15.1% (n=8) of women underwent an obstetric hysterectomy. From the total no. of babies, 13.2% (n=7) were delivered fresh stillborn babies. Of the surviving babies (n=45), 20% (n=9) required admission to NICU. The frequencies of bowel and bladder injuries were 3.8% (n=2) and 13.2% (n=7) respectively. There was no maternal death in this study. Conclusion The rate of PP is comparable to previous studies, however, the rate of placenta accreta is high. Also, there are high rates of neonatal mortality and intraoperative complications which can be explained by accreta. The study highlights the need to revise maternity and child health services. PMID:26674539

  11. Association between Short Maternal Height and Low Birth Weight: a Hospital-based Study in Japan

    PubMed Central

    2016-01-01

    Anthropometry measurements, such as height and weight, have recently been used to predict poorer birth outcomes. However, the relationship between maternal height and birth outcomes remains unclear. We examined the effect of shorter maternal height on low birth weight (LBW) among 17,150 pairs of Japanese mothers and newborns. Data for this analysis were collected from newborns who were delivered at a large hospital in Japan. Maternal height was the exposure variable, and LBW and admission to the neonatal intensive care unit were the outcome variables. Logistic regression models were used to estimate the associations. The shortest maternal height quartile (131.0–151.9 cm) was related to LBW (OR 1.91 [95% CI 1.64, 2.22]). The groups with the second (152.0–157.9 cm) and the third shortest maternal height quartiles (158.0–160.9 cm) were also related to LBW. A P trend with one quartile change also showed a significant relationship. The relationship between maternal height and NICU admission disappeared when the statistical model was adjusted for LBW. A newborn’s small size was one factor in the relationship between shorter maternal height and NICU admission. In developed countries, shorter mothers provide a useful prenatal target to anticipate and plan for LBW newborns and NICU admission. PMID:26955234

  12. [The Hospital Information System of the Brazilian Unified National Health System: a performance evaluation for auditing maternal near miss].

    PubMed

    Nakamura-Pereira, Marcos; Mendes-Silva, Wallace; Dias, Marcos Augusto Bastos; Reichenheim, Michael E; Lobato, Gustavo

    2013-07-01

    This study aimed to investigate the performance of the Hospital Information System of the Brazilian Unified National Health System (SIH-SUS) in identifying cases of maternal near miss in a hospital in Rio de Janeiro, Brazil, in 2008. Cases were identified by reviewing medical records of pregnant and postpartum women admitted to the hospital. The search for potential near miss events in the SIH-SUS database relied on a list of procedures and codes from the International Classification of Diseases, 10th revision (ICD-10) that were consistent with this diagnosis. The patient chart review identified 27 cases, while 70 potential occurrences of near miss were detected in the SIH-SUS database. However, only 5 of 70 were "true cases" of near miss according to the chart review, which corresponds to a sensitivity of 18.5% (95%CI: 6.3-38.1), specificity of 94.3% (95%CI: 92.8-95.6), area under the ROC of 0.56 (95%CI: 0.48-0.63), and positive predictive value of 10.1% (IC95%: 4.7-20.3). These findings suggest that SIH-SUS does not appear appropriate for monitoring maternal near miss. PMID:23843001

  13. Maternal mortality at government maternity hospital. Hyderabad, Andhra Pradesh (a review of 431 cases).

    PubMed

    Durgamba, K K; Qureshi, S

    1970-01-01

    This reviews 431 maternal deaths over 3 periods of 3-4 years each from January 1958 to December 1968. Trends in mortality are noted. A steady decline was noted. Associated diseases increased maternal mortality but age and parity had no significant influence. 47% of the deaths were intrapartum, 35% postpartum, and 18% antenatal. Major causes were hemorrhage, preeclampsia, eclampsia, sepsis, and anemia, in that order. Deaths due to infection diminished markedly during the period. 58.2% of the deaths were considered avoidable. Delay by patient or doctor and lack of facilities in rural areas were principle avoidable factors. Extension of obstetrical service to villages, emergency mobile squads, and periodic review of mortality statistics are recommended. PMID:12304876

  14. Observations from a maternal and infant hospital in Kabul, Afghanistan--2003.

    PubMed

    Williams, Jennifer L; McCarthy, Brian

    2005-01-01

    Afghanistan is believed to have one of the highest infant and maternal mortality rates in the world. As a result of decades of war and civil unrest, Afghan women and children suffer from poor access to health services, harsh living conditions, and insufficient food and micronutrient security. To address the disproportionately high infant and maternal mortality rates in Afghanistan, the US Department of Health and Human Services pledged support to establish a maternal health facility and training center. Rabia Balkhi Hospital in Kabul, Afghanistan, was selected because this hospital admits approximately 36,000 patients and delivers more than 14,000 babies annually. This article reports the initial observations at Rabia Balkhi Hospital and describes factors that influenced women's access, the quality of care, and the evaluation health care services. This observational investigation examined areas of obstetric, laboratory and pharmacy, and ancillary services. The investigators concluded that profound changes were needed in the hospital's health care delivery system to make the hospital a safe and effective health care facility for Afghan women and children and an appropriate facility in which to establish an Afghan provider training program for updating obstetric skills and knowledge. PMID:15973254

  15. [Maternal mortality at the Hospital Center of Libreville (1984-1987)].

    PubMed

    Picaud, A; Nlome-Nze, R A; Faye, A; Ogowet Igumu, N

    1989-01-01

    Maternal mortality at the University Hospital of Libreville was 152.5 for every 100,000 live births. There were 48 maternal deaths out of 31,799 deliveries carried out between 1984 and 1987. The principal causes were: haemorrhage in 45.8%, infections in 20.8%, intercurrent diseases in 20.8%, vasculo-renal syndromes in 10.4% and thromboses in 2%. The main differences between this country and developed countries were the large number of haemorrhages and the rarity of thrombosis. Poor prognostic factors were SS sickle-cell disease in 10.4% of the cases who died and in deaths due to anaemias, of which 25% were due to haemorrhage connected with the afterbirth. Complications occurring in the 1st trimester of pregnancy caused nearly a third of all maternal deaths. Complications of abortion occurred in 16.6% and of extra-uterine pregnancies in 14.6%. If the maternal mortality rate is to be reduced it is important to have a proper blood bank. The risks of caesarean section are ten times greater than of vaginal delivery, although it is a good way out for difficult situations. The indications for the operation have to be carefully considered. Comparing the statistics reported from Cotonou, the University Hospital in Libreville has a lower incidence of maternal mortality but it is too high and requires real progress to be made. PMID:2778279

  16. Applicability of initial optimal maternal and fetal electrocardiogram combination vectors to subsequent recordings

    NASA Astrophysics Data System (ADS)

    Yan, Hua-Wen; Huang, Xiao-Lin; Zhao, Ying; Si, Jun-Feng; Liu, Tie-Bing; Liu, Hong-Xing

    2014-11-01

    A series of experiments are conducted to confirm whether the vectors calculated for an early section of a continuous non-invasive fetal electrocardiogram (fECG) recording can be directly applied to subsequent sections in order to reduce the computation required for real-time monitoring. Our results suggest that it is generally feasible to apply the initial optimal maternal and fetal ECG combination vectors to extract the fECG and maternal ECG in subsequent recorded sections.

  17. Maternal mortality -- aetiological factors: analytic study from a teaching hospital of Punjab.

    PubMed

    Sarin, A R; Singla, P; Kaur, H

    1992-01-01

    A review of maternal deaths at Rajendra Hospital, Punjab, from January 1978 to December 1991 yielded important data for the planning of maternal health services in this area of India, During the 14 year study period, there were 33,160 births and 339 deaths, for a maternal mortality rate of 1002/100,000 live births. Women who had received no prenatal care accounted for 47.4% of deliveries but 92.8% of maternal deaths. In addition, a disproportionate number of deaths involved rural women (74.6%) and poor women (76.4%). 57.8% of maternal deaths involved women 21-30 years of age; 37.1% occurred among primigravidas. Direct obstetrical causes were considered the etiologic factor in 83.1% of these deaths. Primary among these causes were sepsis (37.1%), obstetric hemorrhage (26.2%), hypertensive disorders of pregnancy (21.4%), and obstructed labor (15.3%). 30.6% of deaths occurred during pregnancy, 50.3% during labor, and 19.1% in the postpartum period. Indirect obstetrical causes, notably severe anemia and anesthesia complications, were implicated in 15.3% of the maternal deaths. Critical analysis of the maternal deaths in this series suggested that 89.6% were totally preventable, 9.6% were probably preventable, and only 0.8% were not avoidable. Factors that would reduce the high rate of maternal mortality in this region include more widespread use of prenatal care, training of traditional birth attendants in asepsis, referral of high-risk pregnancies, and improved transportation in rural areas. PMID:12288813

  18. A Retrospective Audit of Clinically Significant Maternal Bacteraemia in a Specialist Maternity Hospital from 2001 to 2014

    PubMed Central

    Drew, Richard John; Fonseca-Kelly, Zara; Eogan, Maeve

    2015-01-01

    Maternal sepsis is a significant problem in obstetrics, with almost one in four maternal deaths related to severe sepsis. We carried out a retrospective review of clinically significant bacteraemia in obstetric patients attending Rotunda Hospital over 14 years. From 2001 to 2014, there were 252 clinically significant positive blood culture episodes in obstetric patients. There were 112,361 live births >500 g during the study period giving an overall rate of 2.24 clinically significant positive maternal blood culture episodes per 1000 live births >500 g. The median rate over the 14 years was 2.12 episodes per 1000 live births >500 g, with an interquartile range of 1.74–2.43 per 1000 live births >500 g. There was no discernable increasing or decreasing trend over the 14 years. E. coli was the most commonly isolated organism (n = 92/252, 37%), followed by group B Streptococcus (n = 64/252, 25%), Staphylococcus aureus (n = 28/252, 11%), and anaerobes (n = 11/252, 4%). These top four organisms represented three-quarters of all positive blood culture episodes (n = 195/252, 77.3%). Of note, there were only five cases of listeriosis, representing a rate of 4.4 cases per 100,000 live births >500 g. The rate of invasive group A streptococcal infection was also very low at 5.3 cases per 100,000 live births >500 g. PMID:26494975

  19. Dental status of pregnant women attending a Brisbane maternity hospital.

    PubMed

    Jago, J D; Chapman, P J; Aitken, J F; McEniery, T M

    1984-12-01

    A sample of 314 consecutive women attending for their first antenatal visit at a public hospital were examined according to the WHO survey procedure. The women's age ranged from 16 to 42 yr with a mean of 23.5 yr. Only 3% were edentulous in both jaws, but 13% had some form of denture. A quarter had pocketing in at least one sextant and only 16% were free of gingivitis. The average number of DMF teeth was 15.8, comprising 2.7 decayed, 4.5 missing and 8.6 filled teeth; 70% had teeth needing restoration and 10% had at least one tooth needing extraction. There were significant relationships between DMF score and age (positive) and between number of teeth needing restoration and age, educational level, and the woman's own perception of her dental health (all inverse). Some form of dental attention was needed by 86% of the women; 12% had conditions needing immediate attention. By comparison with a 1971 study of pregnant women in Brisbane, there has been a marked decline in DMFT score (from 19.1 to 15.8). PMID:6597062

  20. [Hospital readmission after postpartum discharge of term newborns in two maternity wards in Stockholm and Marseille].

    PubMed

    Boubred, F; Herlenius, E; Andres, V; des Robert, C; Marchini, G

    2016-03-01

    The consequences of early postpartum discharge (EPPD, within 2days after birth) on newborn health remain debated. Early discharge has been associated with increased neonatal morbidity. However, neonatal re-hospitalization can be prevented by careful follow-up during the 1st week after birth. We compared the early neonatal hospitalization of term newborns over 2years in two hospitals: Karolinska University Hospital in Stockholm (n=7300births), which allowed early discharge from 6h after birth with specific neonatal follow-up, and Marseille University Hospital (AP-HM) (n=4385) where postpartum discharge was more conventional after 72h. During the study period, the EPPD rate was 41% vs. 2% in Stockholm and Marseille, respectively (P<0.001). Hospital readmission was comparable (5.6‰ vs. 7‰, P=0.2). The leading cause associated with hospitalization was icterus in Stockholm (76% vs. 26%, P<0.001) and feeding difficulties in Marseille (17% vs. 48%, P<0.001). In conclusion, close neonatal follow-up during the 1st week of life associated with restricted maternal and neonatal eligibility criteria for EPPD are required to prevent early neonatal re-hospitalization. PMID:26899902

  1. Availability and quality of emergency obstetric care, an alternative strategy to reduce maternal mortality: experience of Tongji Hospital, Wuhan, China.

    PubMed

    Bangoura, Ismael Fatou; Hu, Jian; Gong, Xun; Wang, Xuanxuan; Wei, Jingjing; Zhang, Wenbin; Zhang, Xiang; Fang, Pengqian

    2012-04-01

    The burden of maternal mortality (MM) and morbidity is especially high in Asia. However, China has made significant progress in reducing MM over the past two decades, and hence maternal death rate has declined considerably in last decade. To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital, Wuhan, China, this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009. Two baseline periods of equal length were used for the comparison of variables. A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations, either 71.35% of all activities. No maternal death was recorded. Mean age of women was 29.31 years with a wide range of 14-52 years. About 96.26% of women had higher levels of schooling, university degrees and above and received the education of secondary school or college. About 3.74% received primary education at period two (P2) from 2005 to 2009, which was significantly higher than that of period one (P1) from 2000 to 2004 (P<0.05) (OR: 0.586; 95% CI: 0.442 to 0.776). About 65.69% were employed as skilled or professional workers at P2, which was significantly higher than that of P1 (P<0.05). About 34.31% were unskilled workers at P2, which was significantly higher than that of P1 (P<0.05). Caesarean section was performed for 9,930 women (88.48%) and the percentage of the procedure increased significantly from 19.25% at P1 to 69.23% at P2 (P<0.05). We were led to conclude that, despite the progress, significant gaps in the performance of maternal health services between rural and urban areas remain. However, MM reduction can be achieved in China. Priorities must include, but not limited to the following: secondary healthcare development, health policy and management, strengthening primary healthcare services. PMID:22528213

  2. Nutritional anemia in pregnancy: a study at the maternity hospital, Kuala Lumpur.

    PubMed

    Tee E Siong; Kandiah, M; Ali, J; Kandiah, V; Zahari, M R; Kuladevan, R; Hamzah, Z

    1984-06-01

    The study presents recent data on the prevalence and pattern of nutritional anemia in the Maternity Hospital, Kuala Lumpur. A total of 309 pregnant women in their 3rd trimester, of Malay, Chinese and Indian origin from the lower socio-economic strata were randomly selected for the study. Hematological indices (including Hb, PCV, MCHC, and TRBC), serum iron, transferrin saturation and ferritin, serum folate as well as protein and albumin were determined. Based on Hb and PCV values, 30-40% of the women could be considered anemic; approximately 50% of them presented with unsatisfactory serum iron, transferrin saturation and ferritin values; 60.9% had low serum folate levels; and about 30% may be considered to be of poor protein nutriture. Anemia in the study population was seen to be related mostly to iron and to a lesser extent, folate deficiency. Hematological, iron, folate and protein status was observed to be the poorest amongst the Indian women, better in the Malay group and generally the best amongst the Chinese women. Birth records of 169 of these women revealed that all of them had live births. Nearly all the infants were delivered by normal vaginal delivery (NVD). The mean gestational age was 38.6 weeks. One of the infants had a birth weight of 2.0 kg; incidence of low birth weight, 2.5 kg, was 8.3%. Although there was a trend of deteriorating hematological, iron and protein status of women from the 0, 1-3 and 4 parity groups, these differences were not statistically significant. PMID:12267519

  3. Case Study: Clinical Governance as an Approach to Improve Maternal and Newborn Health in 22 Hospitals in Indonesia.

    PubMed

    Amelia, Dwirani; Suhowatsky, Stephanie; Baharuddin, Mohammad; Tholandi, Maya; Hyre, Anne; Sethi, Reena

    2015-01-01

    Clinical governance is a concept used to improve management, accountability and the provision of quality healthcare. An approach to strengthen clinical governance as a means to improve the quality of maternal and newborn care in Indonesia was developed by the Expanding Maternal and Neonatal Survival (EMAS) Program. This case study presents findings and lessons learned from EMAS program experience in 22 hospitals where peer-to-peer mentoring supported staff in strengthening clinical governance from 2012-2015. Efforts resulted in improved hospital preparedness and significantly increased the odds of facility-level coverage for three evidence-based maternal and newborn healthcare interventions. PMID:26860759

  4. Public versus private hospital maternity length of stay: a gamma mixture modelling approach.

    PubMed

    Lee, A H; Xiao, J; Codde, J P; Ng, A S K

    2002-02-01

    Application of a gamma mixture model to obstetrical diagnosis-related groups (DRGs) revealed heterogeneity of maternity length of stay (LOS). The proportion of long-stay subgroups identified, which can account for 30% of admissions, varied between DRGs. The burden of long-stay patients borne was estimated to be much higher in private hospitals than public hospitals for normal delivery, but vice versa for Caesarean section. Such differences highlights the impact of DRG-based casemix funding on inpatient LOS and have significant implications for health insurance companies to integrate casemix funding across the public and private sectors. The analysis also benefits hospital administrators and managers to budget expenditures accordingly. PMID:11854995

  5. Maternal mortality and its relationship to emergency obstetric care (EmOC) in a tertiary care hospital in South India

    PubMed Central

    2015-01-01

    Objective: To determine the trends in maternal mortality ratio over 5 years at JIPMER Hospital and to find out the proportion of maternal deaths in relation to emergency admissions. Methods: A retrospective analysis of maternal deaths from 2008 to 2012 with respect to type of admission, referral and ICU care and cause of death according to WHO classification of maternal deaths. Results: Of the 104 maternal deaths 90% were emergency admissions and 59% of them were referrals. Thirty two percent of them died within 24 hours of admission. Forty four percent could be admitted to ICU and few patients could not get ICU bed. The trend in cause of death was increasing proportion of indirect causes from 2008 to 2012. Conclusion: The trend in MMR was increasing proportion of indirect deaths. Ninety percent of maternal deaths were emergency admissions with complications requiring ICU care. Hence comprehensive EmOC facilities should incorporate Obstetric ICU care. PMID:27512460

  6. Poor standards of care in small, private hospitals in Maharashtra, India: implications for public-private partnerships for maternity care.

    PubMed

    Bhate-Deosthali, Padma; Khatri, Ritu; Wagle, Suchitra

    2011-05-01

    The private health sector in India is generally unregulated. Maharashtra is among the few states which require registration of private hospitals. This paper reports on a study of standards of care in small, private hospitals (less than 30 beds) in Maharashtra state, India, with a focus on maternity care, based on interviews with the hospitals' owners or senior staff, and observation. In the absence of reliable information on the number of private hospitals in the state, a physical listing was carried out in 11 districts and an estimate drawn up; 10% of hospitals found in each location were included in the study sample. We found poor standards of care in many cases, and few or no qualified nurses or a duty medical officer in attendance. Of the 261 hospitals visited, 146 provided maternity services yet 137 did not have a qualified midwife, and though most claimed they provided emergency care, including caesarean section, only three had a blood bank and eight had an ambulance. Government plans to promote public-private partnerships with such hospitals, including for maternity services, create concern, given our findings. The need to enforce existing regulations and collect information on health outcomes and quality of care before the state involves these hospitals further in provision of maternity care is called for. PMID:21555084

  7. Major clonal lineages in impetigo Staphylococcus aureus strains isolated in Czech and Slovak maternity hospitals.

    PubMed

    Růžičková, Vladislava; Pantůček, Roman; Petráš, Petr; Machová, Ivana; Kostýlková, Karla; Doškař, Jiří

    2012-11-01

    One hundred and twenty-seven exfoliative toxin-producing (ET-positive) strains of Staphylococcus aureus collected in 23 Czech and one Slovak maternity hospitals from 1998 to 2011 were genotypically characterized by multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) profiling, spa gene polymorphism analysis, and ETA-converting prophage carriage, which resulted in the identification of 21 genotypes grouped into 4 clonal complexes (CC). Ninety-one isolates carried the eta gene alone whilst 12 isolates harboured only the etb gene. Two new, to date not defined, spa types (t6644 and t6645) and 2 novel sequence types (ST2194 and ST2195) were identified in the set of strains under study. The predominant CC121 occurred in 13 Czech hospitals. CC15, CC9, and ST88 (CC88) exclusively included eta gene-positive strains while the strains belonging to ST121 harboured the eta and/or etb genes. This study highlights not only significant genomic diversity among impetigo strains and the distribution of major genotypes disseminated in the Czech and Slovak maternity hospitals, but also reveals their impact in epidermolytic infections. PMID:22664376

  8. Is baby-friendly breastfeeding support in maternity hospitals associated with breastfeeding satisfaction among Japanese mothers?

    PubMed

    Hongo, Hiroko; Nanishi, Keiko; Shibanuma, Akira; Jimba, Masamine

    2015-06-01

    While the World Health Organization's Baby-Friendly Hospital Initiative has increased breastfeeding duration and exclusivity, a survey found that only 8.5 % of maternity hospitals in 31 developed countries could be designated baby-friendly. Baby-friendly breastfeeding support is sometimes criticized as mother unfriendly. This study examined whether baby-friendly breastfeeding support was associated with breastfeeding satisfaction, duration, and exclusivity among Japanese mothers. In this cross-sectional study, 601 breastfeeding Japanese mothers completed questionnaires at their infants' 4-month health checkups at two wards in Yokohama, Japan; 363 were included in the analysis. Baby-friendly breastfeeding support was measured based on the WHO's "Ten Steps to Successful Breastfeeding." We measured satisfaction using two subscales of the Japanese version of the Maternal Breastfeeding Evaluation Scale. The association of baby-friendly support with maternal satisfaction was assessed using multiple linear regression, while the prevalence ratios (PRs) for breastfeeding were estimated using Poisson regression. Mothers were stratified by prepartum exclusive breastfeeding intention (yes, n = 256; no, n = 107). Mothers who experienced early skin-to-skin contact with their infants were more likely to report breastfeeding satisfaction than those who did not. Among mothers without exclusive breastfeeding intention, those who were encouraged to feed on demand were more likely to be breastfeeding without formula at 1 month (PR 2.66 [95 % CI 1.32, 5.36]) and to perceive breastfeeding as beneficial for their baby (regression coefficient = 3.14 [95 % CI 0.11, 6.17]) than those who were not so encouraged. Breastfeeding satisfaction was a useful measure of breastfeeding outcome. Early skin-to-skin contact and encouragement to feed on demand in the hospital facilitate breastfeeding satisfaction. PMID:25366103

  9. Investment in home-based maternal, newborn and child health records improves immunization coverage in Indonesia.

    PubMed

    Osaki, K; Hattori, T; Kosen, Soewarta; Singgih, Budihardja

    2009-08-01

    Indonesia Demographic and Health Surveys show that the ownership of home-based immunization records among children aged 12-23 months increased from 30.8% in 1997 and 30.7% in 2002-3 to 37% in 2007. In 2002-3, 70.9% of children who owned records had received all vaccines by the time of the survey, whereas 42.9% of children who did not own records had been fully immunized. An Indonesian ministerial decree of 2004 stated that the Maternal and Child Health Handbook (MCH handbook) was to be the only home-based record of maternal, newborn and child health. The increased immunization coverage seen would be a reflection of MCH handbook implementation, through raising awareness of immunization among community and health personnel and children's parents or guardians and allowing more accurate measurement of immunization coverage. PMID:19375141

  10. Lessons premier hospitals learned about implementing electronic health records.

    PubMed

    DeVore, Susan D; Figlioli, Keith

    2010-04-01

    Implementing health information technology (IT) is a major strategic objective for providers. To pinpoint considerations that tie to success, the Premier health care alliance surveyed hospitals to develop an electronic health record best-practices library. Compiled from diverse health care organizations, the library outlines considerations to support "meaningful use" in the areas of computerized physician order entry, medication management, clinical documentation, reporting of measures, privacy, information exchange, management of populations' health, and personal health records. Best practices also uncovered strategies for securing executive leadership, culture change, communication, and support for clinicians. This paper summarizes lessons from the library, providing recommendations to speed up health IT implementation. PMID:20368596

  11. Incidence of maternal near miss in hospital childbirth and postpartum: data from the Birth in Brazil study.

    PubMed

    Dias, Marcos Augusto Bastos; Domingues, Rosa Maria Soares Madeira; Schilithz, Arthur Orlando Corrêa; Nakamura-Pereira, Marcos; Diniz, Carmen Simone Grilo; Brum, Ione Rodrigues; Martins, Alaerte Leandro; Theme Filha, Mariza Miranda; Gama, Silvana Granado Nogueira da; Carmo Leal, Maria do

    2014-08-01

    This study evaluated data on the incidence of maternal near miss identified on World Health Organization (WHO) criteria from the Birth in Brazil survey. The study was conducted between February 2011 and October 2012. The results presented are estimates for the study population (2,337,476 births), based on a sample of 23,894 women interviewed. The results showed an incidence of maternal near miss of 10.21 per 1,000 live births and a near-miss-to-mortality ratio of 30.8 maternal near miss to every maternal death. Maternal near miss was identified most prevalently by clinical criteria, at incidence of 5.2 per 1,000 live births. Maternal near miss was associated with maternal age 35 or more years (RR=1.6; 95%CI: 1.1-2.5), a history of previous cesarean delivery (RR=1.9; 95%CI: 1.1-3.4) and high-risk pregnancy (RR=4.5; 95%CI: 2.8-7.0). incidence of maternal near miss was also higher at hospitals in capital cities (RR=2.2; 95%CI: 1.3-3.8) and those belonging to Brazil's national health service, the Brazilian Unified National Health System (SUS) (RR=3.2; 95%CI: 1.6-6.6). Improved quality of childbirth care services can help reduce maternal mortality in Brazil. PMID:25167176

  12. [Microflora formation in the newborn in maternity hospitals and neonatal abnormality units].

    PubMed

    Shilova, V P; Rozanova, S M; Kyrf, M V; Beĭkin, Ia B; Kuznetsova, L S; Turintseva, E G; Usova, O P; Chernykh, N G; Iagafarova, I S

    2007-10-01

    The basic sources of pyoseptic infection pathogens are infected and colonized neonatal infants in maternity hospitals. Microbiological monitoring revealed the specific features of biocenosis formation in the newborn in the "Mother and Baby" units, resuscitative departments (RD), intensive care units, and neonatal abnormality departments (NAD). Irrespective of the conditions of hospital stay, methicillin-resistant S. epidermis (MRSE) and Enterococcus faecium were prevalent in the neonatal microbial landscape. Colonization with the normal flora in the newborn actively treated with antibiotics is difficult in RD, at the same time there is a significant infection with the mycotic flora. Broad-spectrum beta-lactamase producing Klebsiela pneumonia strains have received wide acceptance in NAD. PMID:18154133

  13. Association between Hospital Birth Volume and Maternal Morbidity among Low-Risk Pregnancies in Rural, Urban, and Teaching Hospitals in the United States.

    PubMed

    Kozhimannil, Katy B; Thao, Viengneesee; Hung, Peiyin; Tilden, Ellen; Caughey, Aaron B; Snowden, Jonathan M

    2016-05-01

    Objectives This study aims to examine the relationship between hospital birth volume and multiple maternal morbidities among low-risk pregnancies in rural hospitals, urban non-teaching hospitals, and urban teaching hospitals, using a representative sample of U.S. hospitals. Study Design Using the 2011 Nationwide Inpatient Sample from 607 hospitals, we identified 508,146 obstetric deliveries meeting low-risk criteria and compared outcomes across hospital volume categories. Outcomes include postpartum hemorrhage (PPH), chorioamnionitis, endometritis, blood transfusion, severe perineal laceration, and wound infection. Results Hospital birth volume was more consistently related to PPH than to other maternal outcomes. Lowest-volume rural (< 200 births) and non-teaching (< 650 births) hospitals had 80% higher odds (adjusted odds ratio [AOR] = 1.80; 95% CI = 1.56-2.08) and 39% higher odds (AOR = 1.39; 95% CI = 1.26-1.53) of PPH respectively, than those in corresponding high-volume hospitals. However, in urban teaching hospitals, delivering in a lower-volume hospital was associated with 14% lower odds of PPH (AOR = 0.86; 95% CI = 0.80-0.93). Deliveries in rural hospitals had 31% higher odds of PPH than urban teaching hospitals (AOR = 1.31; 95% CI = 1.13-1.53). Conclusions Low birth volume was a risk factor for PPH in both rural and urban non-teaching hospitals, but not in urban teaching hospitals, where higher volume was associated with greater odds of PPH. PMID:26731180

  14. Causes of Trauma in Pregnant Women Referred to Shabih-Khani Maternity Hospital in Kashan

    PubMed Central

    Mesdaghinia, Elaheh; Sooky, Zahra; Mesdaghinia, Azam

    2012-01-01

    Background Trauma occurs in 7% of pregnancies and is a major cause of morbidity and mortality in the mother and fetus. Objectives The present study was conducted in Kashan in 2009–2010 to evaluate the causes of trauma in pregnancy. Patients and Methods This descriptive study analyzed data from 32 pregnant women with trauma who were referred to the maternity hospital from 2009 to 2010. Data included age, gestational age, mother’s occupation, cause of trauma, maternal-fetal complications, gravidity, and parity. The diagnosis of maternal and fetal complications was based on clinical examinations by a gynecologist and results of blood tests, urine analysis tests, and sonography. Data were analyzed as frequency distributions. Results the causes of trauma included falling (9 cases (28.1%)), abdominal trauma (8 cases ( 25%)), spousal feud (3 cases (9.4%)), motorcycle accident (2 cases (6.25%)), car accident (2 cases (6.25%)), falling from a motorcycle (2 cases (6.25%)), falling or fainting resulting in head trauma (1 case (3.1%)), pain from crossing over a bump in the car (1 cases (3.1%)), and unspecified causes (4 cases (12.55%)). The causes of traumas occurred between 5 and 40 weeks of gestation. In 17.2% of the cases, trauma occurred prior to 20 weeks of gestation. However, there was no significant relationship between the cause of trauma and maternal age or gestational age. Vaginal bleeding and retroplacental clots were reported in 2 (6.25%) cases and 1 (3.1%) case, respectively. Conclusions Nearly half of the women presenting with trauma had experienced spousal feud or domestic violence; therefore, it is necessary to recognize spousal abuse and provide adequate support to traumatized pregnant women. PMID:24719837

  15. Fetal outcome in emergency versus elective cesarean sections at Souissi Maternity Hospital, Rabat, Morocco

    PubMed Central

    Benzouina, Soukayna; Boubkraoui, Mohamed El-mahdi; Mrabet, Mustapha; Chahid, Naima; Kharbach, Aicha; El-hassani, Amine; Barkat, Amina

    2016-01-01

    Introduction Perinatal mortality rates have come down in cesarean sections, but fetal morbidity is still high in comparison to vaginal delivery and the complications are more commonly seen in emergency than in elective cesarean sections. The objective of the study was to compare the fetal outcome and the indications in elective versus emergency cesarean section performed in a tertiary maternity hospital. Methods This comparative cross-sectional prospective study of all the cases undergoing elective and emergency cesarean section for any indication at Souissi maternity hospital of Rabat, Morocco, was carried from January 1, to February 28, 2014. Data were analyzed with emphasis on fetal outcome and cesarean sections indications. Mothers who had definite antenatal complications that would adversely affect fetal outcome were excluded from the study. Results There was 588 (17.83%) cesarean sections among 3297 births of which emergency cesarean section accounted for 446 (75.85%) and elective cesarean section for 142 cases (24.15%). Of the various factors analyzed in relation to the two types of cesarean sections, statistically significant associations were found between emergency cesarean section and younger mothers (P < 0.001), maternal illiteracy (P = 0.049), primiparity (P = 0.005), insufficient prenatal care (P < 0.001), referral from other institution for pregnancy complications or delivery (P < 0.001), cesarean section performed under general anesthesia (P < 0.001), lower birth weight (P < 0.016), neonatal morbidity and early mortality (P < 0.001), and admission in neonatal intensive care unit (P = 0.024). The commonest indication of emergency cesarean section was fetal distress (30.49%), while the most frequent indication in elective cesarean section was previous cesarean delivery (47.18%). Conclusion The overall fetal complications rate was higher in emergency cesarean section than in elective cesarean section. Early recognition and referral of mothers who are

  16. Establishing a National Maternal Morbidity Outcome Indicator in England: A Population-Based Study Using Routine Hospital Data

    PubMed Central

    Nair, Manisha; Kurinczuk, Jennnifer J.; Knight, Marian

    2016-01-01

    Introduction As maternal deaths become rarer, monitoring near-miss or severe maternal morbidity becomes important as a tool to measure changes in care quality. Many calls have been made to use routinely available hospital administration data to monitor the quality of maternity care. We investigated 1) the feasibility of developing an English Maternal Morbidity Outcome Indicator (EMMOI) by reproducing an Australian indicator using routinely available hospital data, 2) the impact of modifications to the indicator to address potential data quality issues, 3) the reliability of the indicator. Methods We used data from 6,389,066 women giving birth in England from April 2003 to March 2013 available in the Hospital Episode Statistics (HES) database of the Health and Social care Information centre (HSCIC). A composite indicator, EMMOI, was generated from the diagnoses and procedure codes. Rates of individual morbid events included in the EMMOI were compared with the rates in the UK reported by population-based studies. Results EMMOI included 26 morbid events (17 diagnosis and 9 procedures). Selection of the individual morbid events was guided by the Australian indicator and published literature for conditions associated with maternal morbidity and mortality in the UK, but was mainly driven by the quality of the routine hospital data. Comparing the rates of individual morbid events of the indicator with figures from population-based studies showed that the possibility of false positive and false negative cases cannot be ruled out. Conclusion While routine English hospital data can be used to generate a composite indicator to monitor trends in maternal morbidity during childbirth, the quality and reliability of this monitoring indicator depends on the quality of the hospital data, which is currently inadequate. PMID:27054761

  17. Complications of childbirth and maternal deaths in Kinshasa hospitals: testimonies from women and their families

    PubMed Central

    2011-01-01

    Background Maternal mortality in Kinshasa is high despite near universal availability of antenatal care and hospital delivery. Possible explanations are poor-quality care and by delays in the uptake of care. There is, however, little information on the circumstances surrounding maternal deaths. This study describes and compares the circumstances of survivors and non survivors of severe obstetric complications. Method Semi structured interviews with 208 women who survived their obstetric complication and with the families of 110 women who died were conducted at home by three experienced nurses under the supervision of EK. All the cases were identified from twelve referral hospitals in Kinshasa after admission for a serious acute obstetric complication. Transcriptions of interviews were analysed with N-Vivo 2.0 and some categories were exported to SPSS 14.0 for further quantitative analysis. Results Testimonies showed that despite attendance at antenatal care, some women were not aware of or minimized danger signs and did not seek appropriate care. Cost was a problem; 5 deceased and 4 surviving women tried to avoid an expensive caesarean section by delivering in a health centre, although they knew the risk. The majority of surviving mothers (for whom the length of stay was known) had the caesarean section on the day of admission while only about a third of those who died did so. Ten women died before the required caesarean section or blood transfusion could take place because they did not bring the money in time. Negligence and lack of staff competence contributed to the poor quality of care. Interviews revealed that patients and their families were aware of the problem, but often powerless to do anything about it. Conclusion Our findings suggest that women with serious obstetric complications have a greater chance of survival in Kinshasa if they have cash, go directly to a functioning referral hospital and have some leverage when dealing with health care staff PMID

  18. Human immunodeficiency virus and AIDS and other important predictors of maternal mortality in Mulago Hospital Complex Kampala Uganda

    PubMed Central

    2011-01-01

    Background Women with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda. Methods This was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care. Results Severe pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39), maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1. The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8), non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2), non use of oxytocics (OR 4.0, 95% CI 1.7-9.7), lack of essential drugs (OR 3.6, 95% CI 1.1-11.3) and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9) and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1). Conclusion The predictors of progression from severe maternal morbidity to mortalitywere: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS. There is need to improve on the referral system, economic

  19. Hospital financial position and the adoption of electronic health records.

    PubMed

    Ginn, Gregory O; Shen, Jay J; Moseley, Charles B

    2011-01-01

    The objective of this study was to examine the relationship between financial position and adoption of electronic health records (EHRs) in 2442 acute care hospitals. The study was cross-sectional and utilized a general linear mixed model with the multinomial distribution specification for data analysis. We verified the results by also running a multinomial logistic regression model. To measure our variables, we used data from (1) the 2007 American Hospital Association (AHA) electronic health record implementation survey, (2) the 2006 Centers for Medicare and Medicaid Cost Reports, and (3) the 2006 AHA Annual Survey containing organizational and operational data. Our dependent variable was an ordinal variable with three levels used to indicate the extent of EHR adoption by hospitals. Our independent variables were five financial ratios: (1) net days revenue in accounts receivable, (2) total margin, (3) the equity multiplier, (4) total asset turnover, and (5) the ratio of total payroll to total expenses. For control variables, we used (1) bed size, (2) ownership type, (3) teaching affiliation, (4) system membership, (5) network participation, (6) fulltime equivalent nurses per adjusted average daily census, (7) average daily census per staffed bed, (8) Medicare patients percentage, (9) Medicaid patients percentage, (10) capitation-based reimbursement, and (11) nonconcentrated market. Only liquidity was significant and positively associated with EHR adoption. Asset turnover ratio was significant but, unexpectedly, was negatively associated with EHR adoption. However, many control variables, most notably bed size, showed significant positive associations with EHR adoption. Thus, it seems that hospitals adopt EHRs as a strategic move to better align themselves with their environment. PMID:21991681

  20. Maternal metabolic risk factors for autism spectrum disorder-An analysis of electronic medical records and linked birth data.

    PubMed

    Connolly, Natalia; Anixt, Julia; Manning, Patty; Ping-I Lin, Daniel; Marsolo, Keith A; Bowers, Katherine

    2016-08-01

    Past studies have suggested that conditions experienced by women during pregnancy (e.g. obesity and gestational diabetes mellitus (GDM)) may be associated with having a child with autism spectrum disorder (ASD). Our objective was to compare mothers who had a child diagnosed with ASD to mothers of children with a non-ASD developmental disorder (DD) or without any reported DD (controls). To accomplish the objective we collected medical record data from patients who resided in the Cincinnati Children's Hospital Medical Center's (CCHMC) primary catchment area and linked those data to data from birth certificates (to identify risk factors). Two comparison groups were analyzed; one with DD; and the other, controls without a reported ASD or DD. Descriptive statistics and regression analyses evaluated differences. Differences were greater comparing mothers of ASD to controls than comparing ASD to DD. Maternal obesity and GDM were associated with a statistically significant approximately 1.5-fold increased odds of having a child with an ASD. For mothers with both GDM and obesity, the association was twofold for having a child with ASD compared with controls. Maternal obesity and GDM might be associated with an increased risk of ASD in the offspring; however, no difference in risk of ASD according to BMI and GDM was seen when comparing to DD. Autism Res 2016, 9: 829-837,. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. PMID:26824581

  1. Maternal and fetal outcome in pre-eclampsia in a secondary care hospital in South India

    PubMed Central

    Aabidha, Parveen M.; Cherian, Anne G.; Paul, Emmanuel; Helan, Jasmin

    2015-01-01

    Background: Hypertensive disorders in pregnancy are one of the common causes for perinatal and maternal morbidity and mortality in developing countries. Pre-eclampsia is a condition which typically occurs after 20 weeks of gestation and has high blood pressure as the main contributing factor. The aim was to study the effects of pre-eclampsia on the mother and the fetus in rural South Indian population. Materials and Methods: This was a descriptive study conducted in a secondary level hospital in rural South India. A total of 1900 antenatal women were screened for pre-eclampsia during the period August 2010 to July 2011 to study the effects on the mother and fetus. Results: Of the 1900 women screened 93 were detected with pre-eclampsia in the study. Among these, 46.23% were primigravida, 30.1% belonged to socio-economic class 4 and 48.8% were among those with BMI 26–30. The incidence of severe pre-eclampsia was higher in the unregistered women. The most common maternal complication was antepartum hemorrhage (13.9%) and the most common neonatal complication was prematurity (23.65%). Conclusions: Treating anemia and improving socioeconomic status will improve maternal and neonatal outcome in pre-eclampsia. Antenatal care and educating women on significance of symptoms will markedly improve perinatal morbidity and mortality. Prematurity, growth restriction and low birth weight are neonatal complications to be anticipated and dealt with when the mother has pre-eclampsia. A good neonatal intensive care unit will help improve neonatal outcomes. PMID:25949977

  2. Assessment of client satisfaction in labor and delivery services at a maternity referral hospital in Ethiopia

    PubMed Central

    Melese, Tadele; Gebrehiwot, Yirgu; Bisetegne, Daniel; Habte, Dereje

    2014-01-01

    Introduction Patients perception about service quality shapes their confidence with regard to use of the available health care facility. This study is aimed to assess the client`s satisfaction in a maternal health care setting. Methods This is an institution based cross sectional descriptive study. A total of 423 postpartum women were interviewed. Data was analyzed using SPSS version 20 statistical package. Results The proportion of mothers who are completely satisfied with health care ranges between 2.4 to 21%. Pain control was the poorest source of satisfaction with 82% reporting dissatisfaction. Provider's communication with clients yielded complete satisfaction rates ranging between 0.7 to 26%. Inadequate information about the drug prescribed and explanation of procedures to be done to the client were found to be major causes of dissatisfaction. The complete satisfaction rate with environmental factor of the hospital was between 3.3 to 40.2%. Age of the client, educational status, income of the client and client's address away from Addis Ababa were found to be the predictors of client satisfaction. Provider's attitude and communication, as well as longer duration of stay in the ward were independent predictors of client satisfaction. Conclusion Pain management, client privacy and client provider communication need to be addressed to ensure the satisfaction of maternity clients. The clients need to be involved in the management of their own health problems. PMID:25018826

  3. FURTHER MAPPING OF THE NATALITY CHRONOME IN TODA CITY (JAPAN) MATERNITY HOSPITAL

    PubMed Central

    YAMANAKA, T.; CORNÉLISSEN, G.; KAZUMA, M.; KAZUMA, N.; MURAKAMI, S.; OTSUKA, K.; SIEGELOVÁ, J.; DUŠEK, J.; SOSÍKOVÁ, M.; HALBERG, F.

    2008-01-01

    In order to investigate any circannual and/or circaseptan variations in birth incidence and birth weight in Toda City (Japan), data on 4,411 consecutive births were obtained from the city’s Maternity Hospital between 1 Jan 1999 and 31 Dec 2001. Data were analysed by cosinor separately for babies with birth weights in given ranges, and separately for boys and girls born at different gestational ages. A circannual rhythm was detected with statistical significance (P=0.047) for birth incidence of all vaginal deliveries, with an acrophase in the fall. A similar result for caesarean sections was of borderline statistical significance. A circaseptan component with a relatively consistent acrophase around midweek was of borderline statistical significance for birth incidence in some of the groups investigated. About-yearly and about-weekly variations were also found to characterize birth weight in some of the groups investigated. PMID:18978949

  4. Becoming Baby-Friendly and Transforming Maternity Care in a Safety-Net Hospital on the Texas-Mexico Border.

    PubMed

    Eganhouse, Deborah J; Gutierrez, Leticia; Cuellar, Lorena; Velasquez, Cecilia

    2016-01-01

    Nurse leaders used the Centers for Disease Control and Prevention's survey on Maternity Practices in Infant Nutrition and Care, as well as Baby-Friendly Hospital Initiative guidelines, to transform maternity care in a safety-net hospital with more than 3,500 births annually. Implementing evidence-based guidelines to support breastfeeding was essential for a vulnerable population characterized by minimal prenatal care and high rates of diabetes, hypertension, obesity, and poverty. Research showing the importance of breastfeeding in protecting against these factors guided extensive changes in our maternity care model. The nursing and medical teams changed long-held practices that separated women from their newborns and observed substantial improvements in breastfeeding initiation and exclusive breastfeeding rates at discharge. PMID:27520602

  5. Infant and maternal characteristics in neonatal abstinence syndrome--selected hospitals in Florida, 2010-2011.

    PubMed

    Lind, Jennifer N; Petersen, Emily E; Lederer, Philip A; Phillips-Bell, Ghasi S; Perrine, Cria G; Li, Ruowei; Hudak, Mark; Correia, Jane A; Creanga, Andreea A; Sappenfield, William M; Curran, John; Blackmore, Carina; Watkins, Sharon M; Anjohrin, Suzanne

    2015-03-01

    Neonatal abstinence syndrome (NAS) is a constellation of physiologic and neurobehavioral signs exhibited by newborns exposed to addictive prescription or illicit drugs taken by a mother during pregnancy. The number of hospital discharges of newborns diagnosed with NAS has increased more than 10-fold (from 0.4 to 4.4 discharges per 1,000 live births) in Florida since 1995, far exceeding the three-fold increase observed nationally. In February 2014, the Florida Department of Health requested the assistance of CDC to 1) assess the accuracy and validity of using Florida's hospital inpatient discharge data, linked to birth and infant death certificates, as a means of NAS surveillance and 2) describe the characteristics of infants with NAS and their mothers. This report focuses only on objective two, describing maternal and infant characteristics in the 242 confirmed NAS cases identified in three Florida hospitals during a 2-year period (2010-2011). Infants with NAS experienced serious medical complications, with 97.1% being admitted to an intensive care unit, and had prolonged hospital stays, with a mean duration of 26.1 days. The findings of this investigation underscore the important public health problem of NAS and add to current knowledge on the characteristics of these mothers and infants. Effective June 2014, NAS is now a mandatory reportable condition in Florida. Interventions are also needed to 1) increase the number and use of community resources available to drug-abusing and drug-dependent women of reproductive age, 2) improve drug addiction counseling and rehabilitation referral and documentation policies, and 3) link women to these resources before or earlier in pregnancy. PMID:25742381

  6. Fragmented implementation of maternal and child health home-based records in Vietnam: need for integration

    PubMed Central

    Aiga, Hirotsugu; Nguyen, Vinh Duc; Nguyen, Cuong Dinh; Nguyen, Tho Thi Thi; Nguyen, Lien Thi Phuong

    2016-01-01

    Background Home-based records (HBRs) are globally implemented as the effective tools that encourage pregnant women and mothers to timely and adequately utilise maternal and child health (MCH) services. While availability and utilisation of nationally representative HBRs have been assessed in several earlier studies, the reality of a number of HBRs subnationally implemented in a less coordinated manner has been neither reported nor analysed. Objectives This study is aimed at estimating the prevalence of HBRs for MCH and the level of fragmentation of and overlapping between different HBRs for MCH in Vietnam. The study further attempts to identify health workers’ and mothers’ perceptions towards HBR operations and utilisations. Design A self-administered questionnaire was sent to the provincial health departments of 28 selected provinces. A copy of each HBR available was collected from them. A total of 20 semi-structured interviews with health workers and mothers were conducted at rural communities in four of 28 selected provinces. Results Whereas HBRs developed exclusively for maternal health and exclusively for child health were available in four provinces (14%) and in 28 provinces (100%), respectively, those for both maternal health and child health were available in nine provinces (32%). The mean number of HBRs in 28 provinces (=5.75) indicates over-availability of HBRs. All 119 minimum required items for recording found in three different HBRs under nationwide scale-up were also included in the Maternal and Child Health Handbook being piloted for nationwide scaling-up. Implementation of multiple HBRs is likely to confuse not only health workers by requiring them to record the same data on several HBRs but also mothers about which HBR they should refer to and rely on at home. Conclusions To enable both health workers and pregnant women to focus on only one type of HBR, province-specific HBRs for maternal and/or child health need to be nationally standardised

  7. Relevance of the electronic computer to hospital medical records*

    PubMed Central

    Mitchell, J. H.

    1969-01-01

    During the past 30 years an “information explosion” has completely changed patterns of illness. Unit files of individual patients have become so large that they are increasingly difficult both to store physically and to assimilate mentally. We have reached a communications barriers which poses a major threat to the efficient practice of clinical medicine. At the same time a new kind of machine, the electronic digital computer, which was invented only 26 years ago, has already come to dominate large areas of military, scientific, commercial, and industrial activity. Its supremacy rests on its ability to perform any data procedure automatically and incredibly quickly. Computers are being employed in clinical medicine in hospitals for various purposes. They can act as arithmetic calculators, they can process and analyse output from recording devices, and they can make possible the automation of various machine systems. However, in the field of case records their role is much less well defined, for here the organization of data as a preliminary to computer input is the real stumbling-block. Data banks of retrospective selected clinical information have been in operation in some centres for a number of years. Attempts are now being made to design computerized “total information systems” to replace conventional paper records, and the possibility of automated diagnosis is being seriously discussed. In my view, however, the medical profession is in danger of being dazzled by optimistic claims about the usefulness of computers in case record processing. The solution to the present problems of record storage and handling is very simple, and does not involve computerization. PMID:4898564

  8. High rates of burnout among maternal health staff at a referral hospital in Malawi: A cross-sectional study

    PubMed Central

    2011-01-01

    Background Burnout among maternal healthcare workers in sub-Saharan Africa may have a negative effect on services provided and efforts to mitigate high maternal mortality rates. In Malawi, research on burnout is limited and no empirical research has been conducted specifically among maternal health staff. Therefore, the aims of the study were to examine the prevalence and degree of burnout reported by healthcare workers who provide antenatal, intrapartum, and postnatal services in a district referral hospital in Malawi; and, to explore factors that may influence the level of burnout healthcare workers experience. Methods In the current cross-sectional study, levels of burnout among staff working in obstetrics and gynaecology at a referral hospital in Malawi were examined, in addition to individual and job characteristics that may be associated with burnout. Results In terms of the three dimensions of burnout, of the 101 participants, nearly three quarters (72%) reported emotional exhaustion, over one third (43%) reported depersonalization while almost three quarters (74%) experienced reduced personal accomplishment. Conclusions Based on these findings, burnout appears to be common among participating maternal health staff and they experienced more burnout than their colleagues working in other medical settings and countries. Further research is needed to identify factors specific to Malawi that contribute to burnout in order to inform the development of prevention and treatment within the maternal health setting. PMID:21605379

  9. Syphilis serology in pregnancy: an eight-year study (2005-2012) in a large teaching maternity hospital in Dublin, Ireland.

    PubMed

    McGettrick, Padraig; Ferguson, Wendy; Jackson, Valerie; Eogan, Maeve; Lawless, Mairead; Ciprike, Vaneta; Varughese, Alan; Coulter-Smith, Sam; Lambert, John S

    2016-03-01

    All cases of positive syphilis serology detected in antenatal and peripartum screening in a large teaching maternity hospital in inner city Dublin, Ireland over an eight-year period (2005-2012 inclusive) were reviewed and included in our study. Demographic, antenatal registration, laboratory (including co-infections), partner serology, treatment and delivery data were recorded in our database. Infant follow-up, treatment and outcome data were also collected. During this period, 194 women had positive syphilis serology, of which 182 completed their pregnancies at the institution. This accounts for 0.28% of the total number of women completing their pregnancies during this time (N = 66038); 79 had no previous diagnosis of infection. There was one case of re-infection during pregnancy. Thirty-two women were co-infected with human immunodeficiency virus, hepatitis B or hepatitis C. There was one case suggestive of congenital syphilis infection. Our study is a comprehensive analysis of the diagnosis, management and clinical outcomes of women testing positive for syphilis infection in pregnancy. It reveals the relatively high prevalence of syphilis infection in the population utilising the maternity services in north inner-city Dublin. It re-enforces the importance of continued active surveillance to prevent morbidity and mortality associated with maternal syphilis infection. It also highlights the importance of strategies such as re-testing high-risk groups and definitive screening of spouse serology. PMID:25829517

  10. Diffusion of Electronic Medical Record Based Public Hospital Information Systems

    PubMed Central

    Cho, Kyoung Won; Kim, Seong Min; An, Chang-Ho

    2015-01-01

    Objectives This study was conducted to evaluate the adoption behavior of a newly developed Electronic Medical Record (EMR)-based information system (IS) at three public hospitals in Korea with a focus on doctors and nurses. Methods User satisfaction scores from four performance layers were analyzed before and two times after the newly develop system was introduced to evaluate the adoption process of the IS with Rogers' diffusion theory. Results The 'intention to use' scores, the most important indicator for determining whether or not to adopt the IS in Rogers' confirmation stage for doctors, were very high in the third survey (4.21). In addition, the scores for 'reduced medication errors', which is the key indicator for evaluating the success of the IS, increased in the third survey for both doctors and nurses. The factors influencing 'intention to use' with a high odds ratio (>1.5) were the 'frequency of attendance of user training sessions', 'mandatory use of system', 'reduced medication errors', and 'reduced medical record documentation time' for both doctors and nurses. Conclusions These findings show that the new EMR-based IS was well accepted by doctors. Both doctors and nurses also positively considered the effects of the new IS on their clinical environments. PMID:26279954

  11. Early breast-feeding patterns in a Malaysian maternity hospital, 1980-1983.

    PubMed

    Kader, H A

    1984-12-01

    The promotion of commercial infant formulas in hospitals making such formulas freely available to new mothers has been prohibited by a set of rules 1st enforced in Malaysia in 1981. This report studies the influence this development has had on infant feeding patterns among health mothers over 3 different time periods: the period before this code of ethics was enforced in 1980-1981 (29,401 cases); the period immediately after from June to December of 1982 (7,833 cases); and the last phase from January to April of 1983 (4,380 cases). Over the 3 phases of the study, choice of breastfeeding increased consecutively from 4.1% to 10.5% and finally 31.7%. Formula feeding increased also, from 1.5% to 2.0% and 2.4%. While mixed feeding was the most popular choice, its incidence declined from 94.4% in 1981 to 65.9% in 1983. Differences among ethnic groups were not statistically significant in the early studies, while in 1983 the incidence of breastfeeding among Chinese, Indians and Malays was 33.1%, 32.1% and 31.0%, respectively. For maternal age groups studied, the increase in breastfeeding was greater for the at-risk groups (mothers less than 20 years and over 35 years of age). This same trend was seen among parity groups, with at-risk groups being parity 1 and parity 5. When socioeconomic status was compared, all classes showed an increase in breastfeeding, but the largest increase was among the highest socioeconomic class. Although mixed feeding is still favored, there is a definitive trend toward breastfeeding, perhaps partly helped by the introduction of the code of ethics against free formula distribution in hospitals. PMID:12280340

  12. [Birth weight and factors associated with the prenatal period: a cross-sectional study in a maternity hospital of reference].

    PubMed

    Capelli, Jane de Carlos Santana; Pontes, Juliana Silva; Pereira, Silvia Eliza Almeida; Silva, Alexandra Anastácio Monteiro; do Carmo, Cleber Nascimento; Boccolini, Cristiano Siqueira; de Almeida, Maria Fernanda Larcher

    2014-07-01

    This study examined factors related to birth weight in a maternity hospital in the city of Rio de Janeiro. It is a descriptive, sectional study conducted in the Herculano Pinheiro Maternity Hospital (HMHP) in Rio de Janeiro between December 2008 and February 2009, with postpartum mothers between 20 and 34 years of age. The chi-square test, the Student's t test and the logistical regression model were applied. 14.6% of the infants had low birth weight (less than 2500 g). There was a negative correlation between birth weight and smoking habits of the mother. The pre-pregnancy weight, maternal pre-pregnancy body mass index and number of pre-natal visit variables were positively associated with birth weight. Multiple regression analysis indicated maternal age as being a risk factor for low birth weight. The conclusion reached is that the marital status situation, where this was perceived as an important variable, as well as the number of prenatal visits, which in group analysis showed no statistical significance, deserve further investigation together with other studies. PMID:25014286

  13. Assessment of maternal risk factors associated with low birth weight neonates at a tertiary hospital, Nanded, Maharashtra

    PubMed Central

    Domple, Vijay Kishanrao; Doibale, Mohan K.; Nair, Abhilasha; Rajput, Pinkesh S.

    2016-01-01

    Background: To assess the maternal risk factors associated with low birth weight (LBW) neonates at a tertiary hospital, Nanded, Maharashtra. Materials and Methods: This study was carried out in a tertiary care hospital in Nanded city of Maharashtra between January 2014 and July 2014 among 160 cases (LBW-birth weight ≤2499 g) and 160 controls (normal birth weight-birth weight >2499. Data collection was done by using predesigned questionnaire and also related health documents were checked and collected the expected information during the interview after obtaining informed consent from mothers. The data were analyzed by Epi Info 7 Version. Results: The present study found the significant association among gestational age, sex of baby, type of delivery, maternal age, religion, education of mother and husband, occupation of mother and husband, type of family, maternal height, weight gain, hemoglobin level, planned/unplanned delivery, bad obstetric history, interval between pregnancies, previous history of LBW, underlying disease, tobacco chewing, timing of first antenatal care (ANC) visit, total number of ANC visit, and iron and folic acid (IFA) tablets consumption with LBW. No significant association was found among maternal age, residence, caste, consanguinity of marriage, socioeconomic status, gravida, birth order, multiple pregnancy, and smoking with LBW in our study. Conclusion: It was concluded that hemoglobin level, weight gain during pregnancy, gestational age, planned/unplanned delivery, bad obstetric history, and IFA tablets consumption during pregnancy were independent risk factors for LBW. PMID:27185977

  14. Factors affecting the outcome of maternity care. II. Neonatal outcomes and resources beyond the hospital of birth.

    PubMed Central

    Mugford, M; Szczepura, A; Lodwick, A; Stilwell, J

    1988-01-01

    Analysis of data about perinatal mortality and indicators of resources at maternity hospitals in the West Midlands region between 1977 and 1983 showed that paediatric staff ratios were inversely related to in-house mortality rates. In this paper, the outcomes for and resources used by transferred babies are added to those of the hospital of birth for three of the study years--1978, 1980, and 1982. Patterns of transfer differ between units and over time in the region, and a regional neonatal intensive care policy was introduced in 1980. Analysis of the new variables showed that in 1978 paediatric staffing was significantly inversely related to neonatal mortality. In later years, neonatal mortality of births at maternity units is explained entirely by the proportion of low or very low weight births. PMID:3221167

  15. Abdominal computed tomography during pregnancy for suspected appendicitis: a 5-year experience at a maternity hospital.

    PubMed

    Shetty, Mahesh K; Garrett, Nan M; Carpenter, Wendy S; Shah, Yogesh P; Roberts, Candace

    2010-02-01

    The objective of this article is to evaluate the role of computed tomography (CT) in a pregnant patient with right lower quadrant pain in whom there was a clinical suspicion of acute appendicitis. During a 5-year period the clinical records of all pregnant women who underwent imaging examination for clinically suspected appendicitis were reviewed. The imaging findings were correlated with patient management and final outcome. Thirty-nine pregnant patients were referred for imaging, of which 35 underwent initial evaluation with sonography, 23 of these women underwent a computed tomographic examination, and an additional 4 patients were directly imaged with CT without earlier sonographic assessment. Surgery confirmed appendicitis in all 5 patients who were operated on on the basis of findings of appendicitis on a CT scan. Two patients underwent surgery based on an alternate diagnosis suggested preoperatively (tubal torsion = 1, ovarian torsion = 1). All patients with negative findings at CT had an uneventful clinical course. In those patients who were evaluated only with ultrasound, a diagnosis of appendicitis was missed in 5 patients. The sensitivity of CT in the diagnosis of appendicitis in our study group was 100%, compared with a sensitivity of 46.1% for ultrasound. CT provides an accurate diagnosis in patients suspected to have acute appendicitis and is of value in avoiding false negative exploratory laparatomy with its consequent risk of maternal and fetal mortality and morbidity. Although sonography is the preferred initial imaging modality as its lack of ionizing radiation, CT is more accurate in providing a timely diagnosis and its use is justified to reduce maternal mortality and mortality in patients with appendicitis. PMID:20102691

  16. Socioeconomic and physical distance to the maternity hospital as predictors for place of delivery: an observation study from Nepal

    PubMed Central

    Wagle, Rajendra Raj; Sabroe, Svend; Nielsen, Birgitte Bruun

    2004-01-01

    Background Although the debate on the safety and women's right of choice to a home delivery vs. hospital delivery continues in the developed countries, an undesirable outcome of home delivery, such as high maternal and perinatal mortality, is documented in developing countries. The objective was to study whether socio-economic factors, distance to maternity hospital, ethnicity, type and size of family, obstetric history and antenatal care received in present pregnancy affected the choice between home and hospital delivery in a developing country. Methods This cross-sectional study was done during June, 2001 to January 2002 in an administratively and geographically well-defined territory with a population of 88,547, stretching from urban to adjacent rural part of Kathmandu and Dhading Districts of Nepal with maximum of 5 hrs of distance from Maternity hospital. There were no intermediate level of private or government hospital or maternity homes in the study area. Interviews were carried out on 308 women who delivered within 45 days of the date of the interview with a pre-tested structured questionnaire. Results A distance of more than one hour to the maternity hospital (OR = 7.9), low amenity score status (OR = 4.4), low education (OR = 2.9), multi-parity (OR = 2.4), and not seeking antenatal care in the present pregnancy (OR = 4.6) were statistically significantly associated with an increased risk of home delivery. Ethnicity, obstetric history, age of mother, ritual observance of menarche, type and size of family and who is head of household were not statistically significantly associated with the place of delivery. Conclusions The socio-economic standing of the household was a stronger predictor of place of delivery compared to ethnicity, the internal family structure such as type and size of family, head of household, or observation of ritual days by the mother of an important event like menarche. The results suggested that mothers, who were in the low

  17. Factors affecting the outcome of maternity care. 1. Relationship between staffing and perinatal deaths at the hospital of birth.

    PubMed Central

    Stilwell, J; Szczepura, A; Mugford, M

    1988-01-01

    This is the first of two papers describing a retrospective study of maternity hospitals in an English health region using data for the years 1977-83. The research was designed to investigate the relationship between resources (such as staff and equipment) and the outcomes of births at maternity units. Considerable variation in medical and nursing staffing levels in the units in the study was observed. Regression analysis suggests that, after taking account of differences in very low weight births at each unit, the level of paediatric staffing at a maternity unit is a significant factor in explaining differences in "in house" mortality. There was no identifiable relationship between staff categories other than paediatricians and the rate of perinatal death at the hospital of delivery. As selective referral and transfers between hospitals may affect the interpretation of these findings, a second paper follows presenting the results of a further analysis that adjusts both resources and outcomes to take account of neonatal transfers. PMID:3221166

  18. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Condition of participation: Special medical record... PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.61 Condition of participation: Special... stated by the patient and/or others significantly involved. (4) The social service records,...

  19. Prenatal lead exposure and relationship with maternal exposure determinants in a public maternity hospital of La Plata, Argentina.

    PubMed

    Martins, Enrique; Varea, Ana; Apezteguía, María; González, Horacio F; Girardelli, Ana; Caro, Laura Sanchez; Lobisuto, Mario; Delgado, Griselda; Disalvo, Liliana

    2014-03-01

    Prenatal lead exposure is a health hazard that may cause cognitive development impairments and other adverse effects in children. We conducted a cross sectional study analyzing cord blood lead levels (CBLL) of newborns and their relationship with maternal determinants of lead exposure. Mothers answered a questionnaire about socio-demographic, lifestyle habits and environmental characteristics. We used Mann-Whitney's test to compare CBLL geometrical means (GM) corresponding to the presence or absence of each lead exposure determinant, and Chi square test to study the relationship between CBLL and maternal lead exposure determinants. A total of 159 newborns participated in the study. CBLL GM was 2.1 μg/dL; and 25% of the participants had a measurable CBLL (LOQ=3.3 μg/dl). Although the participants had several determinants of lead exposure, we only found a significant relationship with inside household determinants, such as presence of lead piping (p=0.026), unplastered walls (p=0.046) and peeling paint (p=0.048). Our results show that CBLL GM was similar to that reported in several studies conducted around the world. However, 25% of the participants might have some degree of risk for lead poisoning. PMID:24361446

  20. An IBCLC in the Maternity Ward of a Mother and Child Hospital: A Pre- and Post-Intervention Study.

    PubMed

    Chiurco, Antonella; Montico, Marcella; Brovedani, Pierpaolo; Monasta, Lorenzo; Davanzo, Riccardo

    2015-08-01

    Published evidence on the impact of the integration of International Board Certified Lactation Consultants (IBCLCs) for breastfeeding promotion is growing, but still relatively limited. Our study aims at evaluating the effects of adding an IBCLC for breastfeeding support in a mother and child hospital environment. We conducted a prospective study in the maternity ward of our maternal and child health Institute, recruiting 402 mothers of healthy term newborns soon after birth. The 18-month intervention of the IBCLC (Phase II) was preceded (Phase I) by data collection on breastfeeding rates and factors related to breastfeeding, both at hospital discharge and two weeks later. Data collection was replicated just before the end of the intervention (Phase III). In Phase III, a significantly higher percentage of mothers: (a) received help to breastfeed, and also received correct information on breastfeeding and community support, (b) started breastfeeding within two hours from delivery, (c) reported a good experience with the hospital staff. Moreover, the frequency of sore and/or cracked nipples was significantly lower in Phase III. However, no difference was found in exclusive breastfeeding rates at hospital discharge or at two weeks after birth. PMID:26308018

  1. An IBCLC in the Maternity Ward of a Mother and Child Hospital: A Pre- and Post-Intervention Study

    PubMed Central

    Chiurco, Antonella; Montico, Marcella; Brovedani, Pierpaolo; Monasta, Lorenzo; Davanzo, Riccardo

    2015-01-01

    Published evidence on the impact of the integration of International Board Certified Lactation Consultants (IBCLCs) for breastfeeding promotion is growing, but still relatively limited. Our study aims at evaluating the effects of adding an IBCLC for breastfeeding support in a mother and child hospital environment. We conducted a prospective study in the maternity ward of our maternal and child health Institute, recruiting 402 mothers of healthy term newborns soon after birth. The 18-month intervention of the IBCLC (Phase II) was preceded (Phase I) by data collection on breastfeeding rates and factors related to breastfeeding, both at hospital discharge and two weeks later. Data collection was replicated just before the end of the intervention (Phase III). In Phase III, a significantly higher percentage of mothers: (a) received help to breastfeed, and also received correct information on breastfeeding and community support, (b) started breastfeeding within two hours from delivery, (c) reported a good experience with the hospital staff. Moreover, the frequency of sore and/or cracked nipples was significantly lower in Phase III. However, no difference was found in exclusive breastfeeding rates at hospital discharge or at two weeks after birth. PMID:26308018

  2. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care.

    PubMed

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries.To create a major change in Haiti's health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic "community care grids" to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis.We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti's health care system will be among the leaders in that region. PMID:26934625

  3. Addressing the Child and Maternal Mortality Crisis in Haiti through a Central Referral Hospital Providing Countrywide Care

    PubMed Central

    Jacobs, Lee D; Judd, Thomas M; Bhutta, Zulfiqar A

    2016-01-01

    The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere, with rates similar to those found in Afghanistan and several African countries. We identify several factors that have perpetuated this health care crisis and summarize the literature highlighting the most cost-effective, evidence-based interventions proved to decrease these mortality rates in low- and middle-income countries. To create a major change in Haiti’s health care infrastructure, we are implementing two strategies that are unique for low-income countries: development of a countrywide network of geographic “community care grids” to facilitate implementation of frontline interventions, and the construction of a centrally located referral and teaching hospital to provide specialty care for communities throughout the country. This hospital strategy will leverage the proximity of Haiti to North America by mobilizing large numbers of North American medical volunteers to provide one-on-one mentoring for the Haitian medical staff. The first phase of this strategy will address the child and maternal health crisis. We have begun implementation of these evidence-based strategies that we believe will fast-track improvement in the child and maternal mortality rates throughout the country. We anticipate that, as we partner with private and public groups already working in Haiti, one day Haiti’s health care system will be among the leaders in that region. PMID:26934625

  4. Understanding Afghan healthcare providers: a qualitative study of the culture of care in a Kabul maternity hospital

    PubMed Central

    Arnold, R; van Teijlingen, E; Ryan, K; Holloway, I

    2015-01-01

    Objective To analyse the culture of a Kabul maternity hospital to understand the perspectives of healthcare providers on their roles, experiences, values and motivations and the impact of these determinants on the care of perinatal women and their babies. Design Qualitative ethnographic study. Setting A maternity hospital, Afghanistan. Population Doctors, midwives and care assistants. Methods Six weeks of observation followed by 22 semi-structured interviews and four informal group discussions with staff, two focus group discussions with women and 41 background interviews with Afghan and non-Afghan medical and cultural experts. Main outcome measures The culture of care in an Afghan maternity hospital. Results A large workload, high proportion of complicated cases and poor staff organisation affected the quality of care. Cultural values, social and family pressures influenced the motivation and priorities of healthcare providers. Nepotism and cronyism created inequality in clinical training and support and undermined the authority of management to improve standards of care. Staff without powerful connections were vulnerable in a punitive inequitable environment—fearing humiliation, blame and the loss of employment. Conclusions Suboptimal care put the lives of women and babies at risk and was, in part, the result of conflicting priorities. The underlying motivation of staff appeared to be the socio-economic survival of their own families. The hospital culture closely mirrored the culture and core values of Afghan society. In setting priorities for women's health post-2015 Millennium Development Goals, understanding the context-specific pressures on staff is key to more effective programme interventions and sustainability. PMID:25394518

  5. Medical record validation of maternal recall of pregnancy and birth events from a twin cohort.

    PubMed

    Liu, Jianghong; Tuvblad, Catherine; Li, Linda; Raine, Adrian; Baker, Laura A

    2013-08-01

    This study aims to assess the validity of maternal recall for several perinatal variables 8-10 years after pregnancy in a twin sample. Retrospective information was collected 8-10 years after the delivery event in a cohort of mothers from the University of Southern California Twin Study (N = 611) and compared with medical records for validity analysis. Recall of most variables showed substantial to perfect agreement (κ = 0.60-1.00), with notable exceptions for specific medical problems during pregnancy (κ ≤ 0.40) and substance use when mothers provided continuous data (e.g., number of cigarettes per day; r ≤ 0.24). With the exception of delivery method, neonatal intensive care unit admission, birth weight, neonatal information, and post-delivery complications were also recalled with low accuracy. For mothers of twins, maternal recall is generally a valid measure for perinatal variables 10 years after pregnancy. However, caution should be taken regarding variables such as substance use, medical problems, birth length, and post-delivery complications. PMID:23725849

  6. Postpartum posttraumatic stress disorder in a fetal high-risk maternity hospital in the city of Rio de Janeiro, Brazil.

    PubMed

    Henriques, Tatiana; Moraes, Claudia Leite de; Reichenheim, Michael E; Azevedo, Gustavo Lobato de; Coutinho, Evandro Silva Freire; Figueira, Ivan Luiz de Vasconcellos

    2015-12-01

    The objectives of this study were to estimate the prevalence of postpartum posttraumatic stress disorder (PTSD) in a maternity hospital for fetal high-risk pregnancies and to identify vulnerable subgroups. This was a cross-sectional study at a fetal high-risk maternity hospital in Rio de Janeiro, Brazil, with a sample of 456 women who had given birth at this hospital. The Trauma History Questionnaire and Post-Traumatic Stress Disorder Checklist were used to screen for lifetime traumatic events and PTSD symptoms, respectively. Overall prevalence of PTSD was 9.4%. Higher PTSD prevalence was associated with three or more births, a newborn with a 1-minute Apgar score of seven or less, history of mental disorder prior to or during the index pregnancy, postpartum depression, physical or psychological intimate partner violence during the pregnancy, a history of unwanted sexual experience, and lifetime exposure to five or more traumas. Rapid diagnosis and treatment of PTSD are essential to improve the mother's quality of life and the infant's health. PMID:26872229

  7. Medico-social and socio-demographic factors associated with maternal mortality at Kenyatta National Hospital, Nairobi, Kenya.

    PubMed

    Makokha, A E

    1991-01-01

    To identify the most significant determinants of maternal mortality in Kenya, a prospective study involving 49,335 deliveries occurring at Kenyatta National Hospital from January 1978-87 was conducted. There were 156 maternal deaths in this series, for a maternal mortality rate of 3.2/1000 deliveries. The 5 most frequent causes of death were abortion (24%), hypertensive disease of pregnancy (13%), sepsis (13%), anemia (10%), and cardiac disease (7%). 24% of women who died were age 19 years or under, 27% were 20-24 years, 23% were 25-29 years, and 11% were 30-34 years. The largest percentage (24%) of deaths involved nulliparous women; 16% were to women of parity 5 and above. 28% of the women who died were single, and single women contributed the majority of deaths from abortion. 66% of the women who died had received no prenatal care. The proportion of avoidable deaths was 19% among clinic attenders compared to 29% among non-attenders. Overall, age, parity, and marital status--traditionally regarded as the key factors associated with maternal mortality--vary in their impact, given the cause of death and medical services received. The assumption that high parity is associated with maternal mortality was not confirmed in this study due to the significant number of deaths from abortion that involved single, nulliparous women. In addition, many women who died were in the optimum age group for childbearing, but were more prone to suffer from anemia, hypertension, ectopic pregnancy, and cardiac disease than women over 30 years old. Overall, 126 deaths were considered avoidable. Contributory factors were slowness of surgical management of emergencies, prolonged confinement of women with cardiac disease, and a lack of emergency supplies of blood and drugs for complicated deliveries. PMID:12316813

  8. Conditions triggering local incident reviews in UK hospital maternity units: A national survey

    PubMed Central

    Mohamed-Ahmed, Olaa; McClymont, Charlotte; Knight, Marian

    2014-01-01

    Objectives In countries, such as the UK, where maternal deaths are rare, reviews of other severe complications of pregnancy and the puerperium can provide an additional perspective to help learn lessons to improve future care. The objective of this survey was to identify the types of incidents which triggered local reviews in the UK, in order to inform national safety reporting guidance. Design A national descriptive survey. Setting UK. Participants Consultant-led maternity units. Main outcome measure Seventy-one per cent of maternity units provided an incident review trigger list. The conditions included were classified by two assessors. Incidents that were listed by at least 5% of maternity units were reported and compared with incidents recommended for review by the Royal College of Obstetricians and Gynaecologists (RCOG). Results The conditions covered were highly variable, although those recommended by the RCOG were most highly represented. The most commonly listed conditions that had not been recommended for review by the RCOG included inadequate staffing levels (70%), cardiac arrest (69%) and maternal sepsis (64%). Conclusions Substantial variation exists in the types of incident listed for review by maternity units in the UK. Importantly, some units are not reviewing cases of severe infective complications even though this is a current major concern. Future guidance concerning local serious incident review processes should include how the list of conditions triggering a review should be managed in the light of changing clinical and safety priorities. PMID:25057407

  9. Characteristics of Hospitals Associated with Complete and Partial Implementation of Electronic Health Records

    PubMed Central

    Bhounsule, Prajakta; Peterson, Andrew M.

    2016-01-01

    Objectives (1) To determine the proportion of hospitals with and without implementation of electronic health records (EHRs). (2) To examine characteristics of hospitals that report implementation of EHRs partially or completely versus those that report no implementation. (3) To identify hospital characteristics associated with nonimplementation to help devise future policy initiatives. Methods This was a retrospective cross-sectional study using the 2012 American Hospital Association Annual Survey Database. The outcome variable was the implementation of EHRs completely or partially. Independent variables were hospital characteristics, such as staffing, organization structure, accreditations, ownership, and services and facilities provided at the hospitals. Descriptive frequencies were determined, and multinomial logistic regression was used to determine variables independently associated with complete or partial implementation of EHRs. Results In this study, 12.6 percent of hospitals reported no implementation of EHRs, while 43.9 percent of hospitals implemented EHRs partially and 43.5 percent implemented EHRs completely. Overall characteristics of hospitals with complete and partial implementation were similar. The multinomial regression model revealed a positive association between the number of licensed beds and complete implementation of EHRs. A positive association was found between children's general medical, surgical, and heart hospitals and complete implementation of EHRs. Conversely, psychiatric and rehabilitation hospitals, limited service hospitals, hospitals participating in a network, service hospitals, government nonfederal hospitals, and nongovernment not-for-profit hospitals showed less likelihood of complete implementation of EHRs. Conclusion Study findings suggest a disparity of EHR implementation between larger, for-profit hospitals and smaller, not-for-profit hospitals. Low rates of implementation were observed with psychiatric and

  10. Maternal recall versus medical records of metabolic conditions from the prenatal period: A validation study

    PubMed Central

    Krakowiak, Paula; Walker, Cheryl K.; Tancredi, Daniel J.; Hertz-Picciotto, Irva

    2015-01-01

    Objectives To assess validity of maternally-reported diabetes and hypertensive disorders, and reliability of BMI measurements during periconception and pregnancy compared with medical records when mothers are interviewed 2-5 years after delivery. To investigate whether reporting accuracy differed by child's case status (autism, delays, typical development). Methods Participants were mothers of 2-5 year old children with and without neurodevelopmental disorders from the CHARGE (CHildhood Autism Risks from Genetics and the Environment) Study who had both prenatal/delivery records and telephone interviews. Sensitivity and specificity of self-report in telephone interview was assessed by comparison with medical records; agreement was evaluated by kappa statistics. Deviations in reported BMI were evaluated with Bland-Altman plots and concordance correlation coefficient (CCC). Results Mothers of children with neurodevelopmental disorders (autism or developmental delay) reported metabolic conditions slightly more accurately than control mothers. For diabetes, sensitivity ranged from 73% to 87% and specificity was ≥98% across groups. For hypertensive disorders, sensitivity ranged from 57% to 77% and specificity from 93% to 98%. Reliability of BMI was high (CCC=0.930); when grouped into BMI categories, a higher proportion of mothers of delayed children were correctly classified (κwt=0.93) compared with the autism group and controls (κwt=0.85 and κwt=0.84, respectively; P=0.05). Multiparity was associated with higher discrepancies in BMI and misreporting of hypertensive disorders. Conclusions For purposes of etiologic studies, self-reported diabetes and hypertensive disorders during periconception and pregnancy show high validity among mothers irrespective of child's case status. Recall of pre-pregnancy BMI is reliable compared with self-reported values in medical records. PMID:25656730

  11. Maternal Recall Versus Medical Records of Metabolic Conditions from the Prenatal Period: A Validation Study.

    PubMed

    Krakowiak, Paula; Walker, Cheryl K; Tancredi, Daniel J; Hertz-Picciotto, Irva

    2015-09-01

    To assess validity of maternally-reported diabetes and hypertensive disorders, and reliability of BMI measurements during periconception and pregnancy compared with medical records when mothers are interviewed 2-5 years after delivery. To investigate whether reporting accuracy differed by child's case status (autism, delays, typical development). Participants were mothers of 2-5 year old children with and without neurodevelopmental disorders from the CHARGE (CHildhood Autism Risks from Genetics and the Environment) Study who had both prenatal/delivery records and telephone interviews. Sensitivity and specificity of self-report in telephone interview was assessed by comparison with medical records; agreement was evaluated by kappa statistics. Deviations in reported BMI were evaluated with Bland-Altman plots and concordance correlation coefficient (CCC). Mothers of children with neurodevelopmental disorders (autism or developmental delay) reported metabolic conditions slightly more accurately than control mothers. For diabetes, sensitivity ranged from 73 to 87% and specificity was ≥98% across groups. For hypertensive disorders, sensitivity ranged from 57 to 77% and specificity from 93 to 98%. Reliability of BMI was high (CCC = 0.930); when grouped into BMI categories, a higher proportion of mothers of delayed children were correctly classified (κ(wt) = 0.93) compared with the autism group and controls (κ(wt) = 0.85 and κ(wt) = 0.84, respectively; P = 0.05). Multiparity was associated with higher discrepancies in BMI and misreporting of hypertensive disorders. For purposes of etiologic studies, self-reported diabetes and hypertensive disorders during periconception and pregnancy show high validity among mothers irrespective of child's case status. Recall of pre-pregnancy BMI is reliable compared with self-reported values in medical records. PMID:25656730

  12. Constructing a Population-Based Research Database from Routine Maternal Screening Records: A Resource for Studying Alloimmunization in Pregnant Women

    PubMed Central

    Zhang, Zhongxing; Gryfelt, Gunilla; Wikman, Agneta; Reilly, Marie

    2011-01-01

    Background Although screening for maternal red blood cell antibodies during pregnancy is a standard procedure, the prevalence and clinical consequences of non-anti-D immunization are poorly understood. The objective was to create a national database of maternal antibody screening results that can be linked with population health registers to create a research resource for investigating these issues. Study Design and Methods Each birth in the Swedish Medical Birth Register was uniquely identified and linked to the text stored in routine maternal antibody screening records in the time window from 9 months prior to 2 weeks after the delivery date. These text records were subjected to a computerized search for specific antibodies using regular expressions. To illustrate the research potential of the resulting database, selected antibody prevalence rates are presented as tables and figures, and the complete data (from more than 60 specific antibodies) presented as online moving graphical displays. Results More than one million (1,191,761) births with valid screening information from 1982–2002 constitute the study population. Computerized coverage of screening increased steadily over time and varied by region as electronic records were adopted. To ensure data quality, we restricted analysis to birth records in areas and years with a sustained coverage of at least 80%, representing 920,903 births from 572,626 mothers in 17 of the 24 counties in Sweden. During the study period, non-anti-D and anti-D antibodies occurred in 76.8/10,000 and 14.1/10,000 pregnancies respectively, with marked differences between specific antibodies over time. Conclusion This work demonstrates the feasibility of creating a nationally representative research database from the routine maternal antibody screening records from an extended calendar period. By linkage with population registers of maternal and child health, such data are a valuable resource for addressing important clinical questions

  13. Incidence and Variation of Discrepancies in Recording Chronic Conditions in Australian Hospital Administrative Data

    PubMed Central

    Assareh, Hassan; Achat, Helen M.; Stubbs, Joanne M.; Guevarra, Veth M.; Hill, Kim

    2016-01-01

    Diagnostic data routinely collected for hospital admitted patients and used for case-mix adjustment in care provider comparisons and reimbursement are prone to biases. We aim to measure discrepancies, variations and associated factors in recorded chronic morbidities for hospital admitted patients in New South Wales (NSW), Australia. Of all admissions between July 2010 and June 2014 in all NSW public and private acute hospitals, admissions with over 24 hours stay and one or more of the chronic conditions of diabetes, smoking, hepatitis, HIV, and hypertension were included. The incidence of a non-recorded chronic condition in an admission occurring after the first admission with a recorded chronic condition (index admission) was considered as a discrepancy. Poisson models were employed to (i) derive adjusted discrepancy incidence rates (IR) and rate ratios (IRR) accounting for patient, admission, comorbidity and hospital characteristics and (ii) quantify variation in rates among hospitals. The discrepancy incidence rate was highest for hypertension (51% of 262,664 admissions), followed by hepatitis (37% of 12,107), smoking (33% of 548,965), HIV (27% of 1500) and diabetes (19% of 228,687). Adjusted rates for all conditions declined over the four-year period; with the sharpest drop of over 80% for diabetes (47.7% in 2010 vs. 7.3% in 2014), and 20% to 55% for the other conditions. Discrepancies were more common in private hospitals and smaller public hospitals. Inter-hospital differences were responsible for 1% (HIV) to 9.4% (smoking) of variation in adjusted discrepancy incidences, with an increasing trend for diabetes and HIV. Chronic conditions are recorded inconsistently in hospital administrative datasets, and hospitals contribute to the discrepancies. Adjustment for patterns and stratification in risk adjustments; and furthermore longitudinal accumulation of clinical data at patient level, refinement of clinical coding systems and standardisation of comorbidity

  14. Incidence and Variation of Discrepancies in Recording Chronic Conditions in Australian Hospital Administrative Data.

    PubMed

    Assareh, Hassan; Achat, Helen M; Stubbs, Joanne M; Guevarra, Veth M; Hill, Kim

    2016-01-01

    Diagnostic data routinely collected for hospital admitted patients and used for case-mix adjustment in care provider comparisons and reimbursement are prone to biases. We aim to measure discrepancies, variations and associated factors in recorded chronic morbidities for hospital admitted patients in New South Wales (NSW), Australia. Of all admissions between July 2010 and June 2014 in all NSW public and private acute hospitals, admissions with over 24 hours stay and one or more of the chronic conditions of diabetes, smoking, hepatitis, HIV, and hypertension were included. The incidence of a non-recorded chronic condition in an admission occurring after the first admission with a recorded chronic condition (index admission) was considered as a discrepancy. Poisson models were employed to (i) derive adjusted discrepancy incidence rates (IR) and rate ratios (IRR) accounting for patient, admission, comorbidity and hospital characteristics and (ii) quantify variation in rates among hospitals. The discrepancy incidence rate was highest for hypertension (51% of 262,664 admissions), followed by hepatitis (37% of 12,107), smoking (33% of 548,965), HIV (27% of 1500) and diabetes (19% of 228,687). Adjusted rates for all conditions declined over the four-year period; with the sharpest drop of over 80% for diabetes (47.7% in 2010 vs. 7.3% in 2014), and 20% to 55% for the other conditions. Discrepancies were more common in private hospitals and smaller public hospitals. Inter-hospital differences were responsible for 1% (HIV) to 9.4% (smoking) of variation in adjusted discrepancy incidences, with an increasing trend for diabetes and HIV. Chronic conditions are recorded inconsistently in hospital administrative datasets, and hospitals contribute to the discrepancies. Adjustment for patterns and stratification in risk adjustments; and furthermore longitudinal accumulation of clinical data at patient level, refinement of clinical coding systems and standardisation of comorbidity

  15. Graphical electrocardiogram waveforms as part of an integrated hospital system's patient record.

    PubMed Central

    Enison, E. J.; Dayhoff, R.; Fletcher, R. D.

    1993-01-01

    The U.S. Department of Veterans Affairs (VA) has an ongoing project to integrate diagnostic images into its existing text-based hospital information system. High-quality images from cardiology, pulmonary medicine, gastroenterology, endoscopy, pathology, radiology, hematology and nuclear medicine can be displayed for clinicians quickly and conveniently on workstations throughout the hospital. As a part of this endeavor, diagnostic-quality computer generated 12-lead electrocardiograms, including both median and rhythm data, can be viewed as a part of the on-line patient record of an integrated hospital information system. Now computer generated graphics can be included in the longitudinal patient record. Incorporating generated graphics and images into a text based patient record is another step towards the next generation of integrated hospital information system with multimedia patient records. PMID:8130498

  16. The development of medical record services in Hong Kong public hospitals.

    PubMed

    Fung, V

    1994-12-01

    Medical record service in Hong Kong public hospitals have been developing at different levels. Since 1992, various improvements in medical record services have been carried out in public hospitals, e.g. professional management, record storage, organized medical records, computerization, completion of discharge summaries, and the introduction of a more precise coding system. The aim of the reform is to provide timely, accurate, organized and meaningful clinical information for end-users. Evolving from this reform, work has been started on developing Patient Related Groups and Specialty Clinical Information Systems. PMID:10142476

  17. An audit to review the characteristics and management of placenta praevia at Aberdeen Maternity Hospital, 2009-2011.

    PubMed

    Pande, B; Shetty, A

    2014-07-01

    Placenta praevia (PP) is an important cause of maternal and fetal morbidity. We reviewed the characteristics and management of PP at the Aberdeen Maternity Hospital (AMH) to evaluate performance. In the years 2009-2011, a total of 60 cases with confirmed PP underwent caesarean section (CS) at the AMH. Two-fifths of cases had previous CS and two-thirds were posterior praevias. Four-fifths were major praevias. Diagnosis was mostly by trans-abdominal scanning (TAS). A little less than two-thirds underwent hospital admission (half of them for antepartum haemorrhage). Most received steroid and ferrous sulphate as appropriate. The majority were delivered at greater than 36 weeks' gestation. There was good support in theatre by senior obstetricians and anaesthetists. Cell salvage was used in theatre. Overall, the outcomes were good. Improvements could be made on documentation of counselling preoperatively and practice of trans-vaginal scans (TVS) to confirm low lying placentae even at the 20-week scan for better diagnosis, as per the RCOG guidelines. PMID:24702527

  18. [Cocooning strategy: Effectiveness of a pertussis vaccination program for parents in the maternity unit of a university hospital].

    PubMed

    Decréquy, A; de Vienne, C; Bellot, A; Guillois, B; Dreyfus, M; Brouard, J

    2016-08-01

    The aim of this study was to evaluate the impact on vaccination coverage of a protocol in which promotion and administration of pertussis vaccine in the maternity ward were proposed upon discharge from a French university hospital. Pertussis is a potentially fatal bacterial respiratory infection, especially in young infants. Since 2004 the High Council of Public Health has recommended vaccinating adults who may become parents. This recommendation is not widely applied in France. The study, organized as a professional practice evaluation (EPP) was conducted by a multidisciplinary team at Caen University Hospital. Thirty couples were included for each period. The primary endpoint was the rate of vaccination coverage for both parents at hospital discharge. Before the information campaign (first period, January 2012), immunization coverage of mothers and fathers was 20% and 13%, respectively. No couple had received a prescription for vaccines. During the second period (June 2013), vaccination coverage was 77% at hospital discharge for mothers and 57% for fathers. Parental immunization coverage against pertussis was multiplied by four to five during the study, which is very encouraging, and it is important to continue this campaign at the region and national levels. PMID:27345559

  19. Afraid of Delivering at the Hospital or Afraid of Delivering at Home: A Qualitative Study of Thai Hmong Families' Decision-Making About Maternity Services.

    PubMed

    Culhane-Pera, Kathleen A; Sriphetcharawut, Sarinya; Thawsirichuchai, Rasamee; Yangyuenkun, Wirachon; Kunstadter, Peter

    2015-11-01

    Thailand has high rates of maternity services; both antenatal care (ANC) and hospital delivery are widely used by its citizens. A recent Northern Thailand survey showed that Hmong women used maternity services at lower rates. Our objectives were to identify Hmong families' socio-cultural reasons for using and not using maternity services, and suggest ways to improve Hmong women's use of maternity services. In one Hmong village, we classified all 98 pregnancies in the previous 5 years into four categories: no ANC/home birth, ANC/home, no ANC/hospital, ANC/hospital. We conducted life-history case studies of 4 women from each category plus their 12 husbands, and 17 elders. We used grounded theory to guide qualitative analysis. Families not using maternity services considered pregnancy a normal process that only needed traditional home support. In addition, they disliked institutional processes that interfered with cultural birth practices, distrusted discriminatory personnel, and detested invasive, involuntary hospital procedures. Families using services perceived physical needs or potential delivery risks that could benefit from obstetrical assistance not available at home. While they disliked aspects of hospital births, they tolerated these conditions for access to obstetrical care they might need. Families also considered cost, travel distance, and time as structural issues. The families ultimately balanced their fear of delivering at home with their fear of delivering at the hospital. Providing health education about pregnancy risks, and changing healthcare practices to accommodate Hmong people's desires for culturally-appropriate family-centered care, which are consistent with evidence-based obstetrics, might improve Hmong women's use of maternity services. PMID:26138321

  20. Medical Record Clerk Training Program, Course of Study; Student Manual: For Medical Record Personnel in Small Rural Hospitals in Colorado.

    ERIC Educational Resources Information Center

    Community Health Service (DHEW/PHS), Arlington, VA. Div. of Health Resources.

    The manual provides major topics, objectives, activities and, procedures, references and materials, and assignments for the training program. The topics covered are hospital organization and community role, organization and management of a medical records department, international classification of diseases and operations, medical terminology,…

  1. Record-keeping in a state hospital: a modification of the Weed system.

    PubMed

    Fahrner, B G; Ellis, N C; Stark, S L; Spencer, J A

    1977-12-01

    The Weed problem-oriented medical record has been modified for use in a state psychiatric hospital that has a large proportion of long-term patients and uses an interdisciplinary team approach to treatment. Three new record forms were developed during a pilot study at the hospital: the processed-problem list, the problem card, and the unprocessed-problem list. The modified problem-oriented record system is being used in 28 wards providing both short- and long-term psychiatric care. PMID:304437

  2. Outcome of very low birthweight neonates in a developing country: experience from a large Malaysian maternity hospital.

    PubMed

    Boo, N Y

    1992-02-01

    Between January 1989 to April 1990 (16 months), a prospective observational study was carried out on 329 consecutive very low birthweight (VLBW) less than or equal to 1500 grams) Malaysian neonates born in the Maternity Hospital, Kuala Lumpur before their first discharge from the hospital. The objectives of the study were to determine the common causes of early morbidity and mortality of this group of Malaysian neonates. The study shows that the incidence of Malaysian VLBW neonates was 9.9 per 1000 livebirths (95% confidence intervals 9.0 to 10.8). The mean duration of stay in the hospital was 19.3 days (SD = 21.4). One hundred and ninety-six (59.6 percent) of the VLBW neonates died. They accounted for 60 percent (196/334) of all neonatal deaths in the hospital during the study period. Mortality was significantly higher in neonates of birthweight less than 1000 grams (p less than 0.01) and of gestation of less than 33 weeks (p less than 0.001). The three most common clinical problems were respiratory distress syndrome (RDS) (72.6 percent), septicemia (28.0 percent) and intraventricular haemorrhage (IVH) (21.9 percent). Death occurred in 71.1 percent of the septicemic patients. The most common causative organisms of septicemia were multiresistant klebsiella (52.3 percent) and multiresistant acinetobacter (14.7 percent). RDS (33.2 percent), septicemia (29.6%) and IVH (17.9 percent) were the three most common causes of death. Improvement in the nursing staff situation and basic neonatal care facilities in this hospital and prevention of premature delivery could help to decrease morbidity and mortality in this group of neonates. PMID:1598605

  3. Evaluation of Maternal Complications in Severe Preeclampsia in a University Hospital in Tirana

    PubMed Central

    Ndoni, Eriseida; Hoxhallari, Redi; Bimbashi, Astrit

    2016-01-01

    BACKGROUND: Preeclampsia is a hypertensive multisystem disorder of pregnancy that complicates up to 10% of pregnancies worldwide and is one of the leading causes of maternal and perinatal morbidity and mortality. AIM: To evaluate maternal complications associated with severe preeclampsia. METHODS: This is a retrospective cross-sectional study conducted in the UHOG “Koço Gliozheni”, in Tirana. Primary outcomes evaluated: maternal death, eclampsia, stroke, HELLP syndrome, and pulmonary edema. Secondary outcomes: renal failure, admission in ICU, caesarean section, placental abruption, and postpartum hemorrhage. Fisher’s exact test and Chi-squared test were used as statistical methods. RESULTS: In women with severe preeclampsia we found higher rates of complications comparing to the group with preeclampsia. Eclampsia (1.5% vs. 7.1%, P < 0.001), HELLP syndrome (2.4% vs. 11.0%; P < 0.001), stroke (0.5% vs 1.9%, P = 0.105) pulmonary edema (0.25% vs. 1.3%, P = 0.0035), renal failure (0.9% vs. 2.6%, P = 0.107), admission in ICU (19.5% vs. 71.4%, P = 0.007), caesarean section rates (55.5% vs. 77%, P = 0.508), placental abruption (4.3% vs. 7.8%, P = 0.103) and severe postpartum hemorrhage (3.2% vs. 3.9%, P = 0.628). CONCLUSION: Severe preeclampsia is associated with high rates of maternal severe morbidity and early diagnosis and timely intervention can prevent life treating complications. PMID:27275340

  4. A model approach to sharing electronic medical records between and within the state hospitals in Turkey.

    PubMed

    Güler, I; Müldür, S

    2001-11-01

    It has always been a research interest to solve hospital management problems with systematic approach by using modern management tools. Almost all the Hospital Information System (HIS) software packages in Turkey keep track of local transactions in administrative activities and material flow. In state hospitals in Turkey, very little medical information is processed and most of the records are still kept manually and archived on papers. In this paper, a cost-effective, flexible and easy-to-use Hospital Information System model is proposed in order to give better diagnostic and treatment services. It is also demonstrated that this model makes it possible to exchange information between and within the hospitals over Transmission Control Protocol/Internet Protocol (TCP/IP) network. User needs are taken into consideration during model development and the benefits of model implementation to the hospital administration are stated. According to the model proposed in this paper, only a single health care record number (HCRN) is required for a patient to access all her/his medical records stored in different locations, from any state hospital in Turkey. PMID:11604155

  5. An evaluation of hospital discharge records as a tool for serious work related injury surveillance

    PubMed Central

    Alamgir, H; Koehoorn, M; Ostry, A; Tompa, E; Demers, P

    2006-01-01

    Objectives To identify and describe work related serious injuries among sawmill workers in British Columbia, Canada using hospital discharge records, and compare the agreement and capturing patterns of the work related indicators available in the hospital discharge records. Methods Hospital discharge records were extracted from 1989 to 1998 for a cohort of sawmill workers. Work related injuries were identified from these records using International Classification of Disease (ICD‐9) external cause of injury codes, which have a fifth digit, and sometimes a fourth digit, indicating place of occurrence, and the responsibility of payment schedule, which identifies workers' compensation as being responsible for payment. Results The most frequent causes of work related hospitalisations were falls, machinery related, overexertion, struck against, cutting or piercing, and struck by falling objects. Almost all cases of machinery related, struck by falling object, and caught in or between injuries were found to be work related. Overall, there was good agreement between the two indicators (ICD‐9 code and payment schedule) for identifying work relatedness of injury hospitalisations (kappa = 0.75, p < 0.01). There was better concordance between them for injuries, such as struck against, drowning/suffocation/foreign body, fire/flame/natural/environmental, and explosions/firearms/hot substance/electric current/radiation, and poor concordance for injuries, such as machinery related, struck by falling object, overexertion, cutting or piercing, and caught in or between. Conclusions Hospital discharge records are collected for administrative reasons, and thus are readily available. Depending on the coding reliability and validity, hospital discharge records represent an alternative and independent source of information for serious work related injuries. The study findings support the use of hospital discharge records as a potential surveillance system for such injuries

  6. Serum Retinol Concentrations in Mothers and Newborns at Delivery in a Public Maternity Hospital in Recife, Northeast Brazil

    PubMed Central

    Andreto, Luciana Marques; Vieira, Carmina Silva dos Santos; de Arruda, Ilma Kruze Grande; Diniz, Alcides da Silva

    2014-01-01

    Serum retinol concentrations were compared in a consecutive series of 65 mother-newborn pairs at delivery in a public maternity hospital in Recife, Brazil, from January to August 2008 and examined their association with biological, socioeconomic, environmental and obstetrical characteristics. Serum retinol concentrations of the newborns (umbilical cord) and mothers (brachial venipuncture) were analyzed by high-performance liquid chromatography. Prevalence of low (<0.70 µmol/L) and inadequate (<1.05 µmol/L) serum retinol concentrations were observed in 23.1% (95% CI 13.9-35.5) and 23.0% (95% CI 13.5-35.8) among newborns and mothers respectively. The serum retinol distribution was lower in male than female infants (-0.4 µmol/L, p=0.01) and, across both sexes, concentrations in paired newborn and mother were correlated (r=0.27, p=0.04). Further, maternal status explains only 7% of the variance in retinol concentrations in newborn's cord plasma. Among mothers delivering in public facilities in Recife, hypovitaminosis may exist. PMID:24847590

  7. Electronic Health Record Adoption In US Hospitals: Progress Continues, But Challenges Persist.

    PubMed

    Adler-Milstein, Julia; DesRoches, Catherine M; Kralovec, Peter; Foster, Gregory; Worzala, Chantal; Charles, Dustin; Searcy, Talisha; Jha, Ashish K

    2015-12-01

    Achieving nationwide adoption of electronic health records (EHRs) remains an important policy priority. While EHR adoption has increased steadily since 2010, it is unclear how providers that have not yet adopted will fare now that federal incentives have converted to penalties. We used 2008-14 national data, which includes the most recently available, to examine hospital EHR trends. We found large gains in adoption, with 75 percent of US hospitals now having adopted at least a basic EHR system--up from 59 percent in 2013. However, small and rural hospitals continue to lag behind. Among hospitals without a basic EHR system, the function most often not yet adopted (in 61 percent of hospitals) was physician notes. We also saw large increases in the ability to meet core stage 2 meaningful-use criteria (40.5 percent of hospitals, up from 5.8 percent in 2013); much of this progress resulted from increased ability to meet criteria related to exchange of health information with patients and with other physicians during care transitions. Finally, hospitals most often reported up-front and ongoing costs, physician cooperation, and complexity of meeting meaningful-use criteria as challenges. Our findings suggest that nationwide hospital EHR adoption is in reach but will require attention to small and rural hospitals and strategies to address financial challenges, particularly now that penalties for lack of adoption have begun. PMID:26561387

  8. Hysterectomy use: the correspondence between self-reports and hospital records.

    PubMed Central

    Brett, K M; Madans, J H

    1994-01-01

    Studies of the relationship between hysterectomy use and sociodemographic factors tend to use self-reported data. In the current study, data were collected from a representative sample of US women who have been prospectively followed since 1971. Hysterectomy status was obtained by self-report and from hospital records. Although these two measures of hysterectomy were highly related, more women reported hysterectomy than could be confirmed by hospital records. The two measures showed similar associations between several obstetric and demographic characteristics and hysterectomy status, suggesting that the use of self-reported hysterectomy data does not bias analyses of potentially associated factors. PMID:7943489

  9. Analysis of 572 Cases of Adolescent Pregnancy in Z.H. Maternity Hospital, Ankara, Turkey.

    ERIC Educational Resources Information Center

    Coskun, Aydin; And Others

    1993-01-01

    Compared records of 572 adolescents who delivered babies in 1 obstetric service with records of 978 older patients. Found no significant differences between groups regarding spontaneous and operative delivery rates or regarding neonatal risk. Findings support view that obstetric outcomes of adolescents are no worse than outcomes for older…

  10. Cystic Echinococcosis Epidemiology in Spain Based on Hospitalization Records, 1997-2012

    PubMed Central

    Siles-Lucas, Mar; Aparicio, Pilar; Lopez-Velez, Rogelio; Gherasim, Alin; Garate, Teresa; Benito, Agustín

    2016-01-01

    Background Cystic echinococcosis (CE) is a parasitic disease caused by the tapeworm Echinococcus granulosus. Although present throughout Europe, deficiencies in the official reporting of CE result in under-reporting and misreporting of this disease, which in turn is reflected in the wrong opinion that CE is not an important health problem. By using an alternative data source, this study aimed at describing the clinical and temporal-spatial characteristics of CE hospitalizations in Spain between 1997 and 2012. Methodology/Principal Findings We performed a retrospective descriptive study using the Hospitalization Minimum Data Set (CMBD in Spanish). All CMBD’s hospital discharges with echinococcosis diagnosis placed in first diagnostic position were reviewed. Hospitalization rates were computed and clinical characteristics were described. Spatial and temporal distribution of hospital discharges was also assessed. Between 1997 and 2012, 14,010 hospitalizations with diagnosis of CE were recorded, 55% were men and 67% were aged over 45 years. Pediatric hospitalizations occurred during the whole study period. The 95.2% were discharged at home, and only 1.7% were exitus. The average cost was 8,439.11 €. The hospitalization rate per 100,000 per year showed a decreasing trend during the study period. All the autonomous communities registered discharges, even those considered as non-endemic. Maximum rates were reached by Extremadura, Castilla-Leon and Aragon. Comparison of the CMBD data and the official Compulsory Notifiable Diseases (CND) reports from 2005 to 2012 showed that official data were lower than registered hospitalization discharges. Conclusions Hospitalizations distribution was uneven by year and autonomous region. Although CE hospitalization rates have decreased considerably due to the success of control programs, it remains a public health problem due to its severity and economic impact. Therefore, it would be desirable to improve its oversight and

  11. Storage Media Profiles and Health Record Retention Practice Patterns in Acute Care Hospitals

    PubMed Central

    Rinehart-Thompson, Laurie A

    2008-01-01

    This exploratory study examined the health record retention practices among health information management professionals in acute care general hospitals in the United States. A descriptive research design was used, and data were collected using a self-reporting survey. Respondents answered questions about the relationship between researcher-assigned storage media profiles (descriptions of the type or types of media on which facilities maintain health records); retention periods and factors affecting record retention periods; retention of secondary data; vendor usage; and continued reliance on paper in environments where electronic health records exist. Storage media profiles were found to be significantly related to facility operational and research needs and to the convenience of not purging records. These findings have implications for federal policy promoting the implementation of electronic health records by 2014. PMID:18574517

  12. Storage media profiles and health record retention practice patterns in acute care hospitals.

    PubMed

    Rinehart-Thompson, Laurie A

    2008-01-01

    This exploratory study examined the health record retention practices among health information management professionals in acute care general hospitals in the United States. A descriptive research design was used, and data were collected using a self-reporting survey. Respondents answered questions about the relationship between researcher-assigned storage media profiles (descriptions of the type or types of media on which facilities maintain health records); retention periods and factors affecting record retention periods; retention of secondary data; vendor usage; and continued reliance on paper in environments where electronic health records exist. Storage media profiles were found to be significantly related to facility operational and research needs and to the convenience of not purging records. These findings have implications for federal policy promoting the implementation of electronic health records by 2014. PMID:18574517

  13. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  14. Hospital Electronic Health Record Adoption and Its Influence on Postoperative Sepsis

    ERIC Educational Resources Information Center

    Fareed, Naleef

    2013-01-01

    Electronic Health Record (EHR) systems could make healthcare delivery safer by providing benefits such as timely access to accurate and complete patient information, advances in diagnosis and coordination of care, and enhancements for monitoring patient vitals. This study explored the nature of EHR adoption in U.S. hospitals and their patient…

  15. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Condition of participation: Special medical record requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS...

  16. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Condition of participation: Special medical record requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS...

  17. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Condition of participation: Special medical record requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS OF PARTICIPATION FOR...

  18. 42 CFR 482.61 - Condition of participation: Special medical record requirements for psychiatric hospitals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Condition of participation: Special medical record requirements for psychiatric hospitals. 482.61 Section 482.61 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION CONDITIONS...

  19. A Study of the Access to the Scholarly Record From a Hospital Health Science Core Collection.

    ERIC Educational Resources Information Center

    Williams, James F., II; Pings, Vern M.

    This study is an effort to determine possible service performance levels in hospital libraries, based on access to the scholarly record of medicine through selected lists of clinical journals and indexing and abstracting journals. Specific emphasis is placed on (1) the citation verification through the use of the index and abstract journals, (2)…

  20. Evaluating the Risk of Re-identification of Patients from Hospital Prescription Records

    PubMed Central

    Emam, Khaled El; Dankar, Fida K; Vaillancourt, Régis; Roffey, Tyson; Lysyk, Mary

    2009-01-01

    Background: Pharmacies often provide prescription records to private research firms, on the assumption that these records are de-identified (i.e., identifying information has been removed). However, concerns have been expressed about the potential that patients can be re-identified from such records. Recently, a large private research firm requested prescription records from the Children’s Hospital of Eastern Ontario (CHEO), as part of a larger effort to develop a database of hospital prescription records across Canada. Objective: To evaluate the ability to re-identify patients from CHEO’S prescription records and to determine ways to appropriately de-identify the data if the risk was too high. Methods: The risk of re-identification was assessed for 18 months’ worth of prescription data. De-identification algorithms were developed to reduce the risk to an acceptable level while maintaining the quality of the data. Results: The probability of patients being re-identified from the original variables and data set requested by the private research firm was deemed quite high. A new de-identified record layout was developed, which had an acceptable level of re-identification risk. The new approach involved replacing the admission and discharge dates with the quarter and year of admission and the length of stay in days, reporting the patient’s age in weeks, and including only the first character of the patient’s postal code. Additional requirements were included in the data-sharing agreement with the private research firm (e.g., audit requirements and a protocol for notification of a breach of privacy). Conclusions: Without a formal analysis of the risk of re-identification, assurances of data anonymity may not be accurate. A formal risk analysis at one hospital produced a clinically relevant data set that also protects patient privacy and allows the hospital pharmacy to explicitly manage the risks of breach of patient privacy. PMID:22478909

  1. Maternal and Hospital Factors Associated with First-Time Mothers' Breastfeeding Practice: A Prospective Study.

    PubMed

    Tsai, Tzu-I; Huang, Shu-Her; Lee, Shoou-Yih D

    2015-01-01

    Continuity of breastfeeding is infrequent and indeterminate. Evidence is lacking regarding factors associated with breastfeeding at different postpartum time points. This prospective study investigated the change in, and correlates of, breastfeeding practices after delivery at a hospital and at 1, 3, and 6 months postpartum among first-time mothers. We followed a cohort of 300 primiparous mothers of Taiwan who gave birth at two hospitals during 2010-2011. Logistic and Cox regression analyses were performed to determine factors that were correlated with breastfeeding practices. In the study sample, the rate of exclusive breastfeeding during the hospital stay was 66%; it declined to 37.5% at 1 month and 30.2% at 3 months postpartum. Only 17.1% of women reported continuing breastfeeding at 6 months. Early initiation of breastfeeding, rooming-in practice, and self-efficacy were significantly related to exclusive breastfeeding during the hospital stay. After discharge, health literacy, knowledge, intention, and self-efficacy were positively and significantly associated with breastfeeding exclusivity. Later initiation (hazard ratio=1.53; 95% confidence interval, 1.05, 1.97), shorter intention (hazard ratio=1.42; 95% confidence interval, 1.13, 1.68), and self-efficacy (hazard ratio=0.98; 95% confidence interval, 0.96, 0.99) were important predictors of breastfeeding cessation within 6 months of delivery. Continuous breastfeeding practice for 6 months is challenging and difficult for new mothers. Results showed that factors related to breastfeeding varied over time after delivery. Interventions seeking to sustain breastfeeding should consider new mothers' needs and barriers at different times. PMID:26110594

  2. Visualizing collaborative electronic health record usage for hospitalized patients with heart failure

    PubMed Central

    Carson, Matthew B; Lee, Young Ji; Schneider, Daniel H; Skeehan, Connor T; Scholtens, Denise M

    2015-01-01

    Objective To visualize and describe collaborative electronic health record (EHR) usage for hospitalized patients with heart failure. Materials and methods We identified records of patients with heart failure and all associated healthcare provider record usage through queries of the Northwestern Medicine Enterprise Data Warehouse. We constructed a network by equating access and updates of a patient’s EHR to a provider-patient interaction. We then considered shared patient record access as the basis for a second network that we termed the provider collaboration network. We calculated network statistics, the modularity of provider interactions, and provider cliques. Results We identified 548 patient records accessed by 5113 healthcare providers in 2012. The provider collaboration network had 1504 nodes and 83 998 edges. We identified 7 major provider collaboration modules. Average clique size was 87.9 providers. We used a graph database to demonstrate an ad hoc query of our provider-patient network. Discussion Our analysis suggests a large number of healthcare providers across a wide variety of professions access records of patients with heart failure during their hospital stay. This shared record access tends to take place not only in a pairwise manner but also among large groups of providers. Conclusion EHRs encode valuable interactions, implicitly or explicitly, between patients and providers. Network analysis provided strong evidence of multidisciplinary record access of patients with heart failure across teams of 100+ providers. Further investigation may lead to clearer understanding of how record access information can be used to strategically guide care coordination for patients hospitalized for heart failure. PMID:25710558

  3. Light on maternal mortality in India.

    PubMed

    Bhatia, J C

    1990-01-01

    In order to investigate the degree and causes of maternal mortality in Anantapur District, Andhra Pradesh, India, detailed enquiries were made at the grass roots and the records of health facilities were examined. The number of maternal deaths proved to be much higher than would have been revealed by a perusal of official data alone. Many women in a serious condition died on the way to hospital or soon after arrival because the means of transport were too slow or otherwise unsuitable. Maternal mortality rates varied substantially from place to place, reflecting differing levels of economic development and the presence or absence of primary health centres and subcentres. PMID:2271096

  4. Investment subsidies and the adoption of electronic medical records in hospitals.

    PubMed

    Dranove, David; Garthwaite, Craig; Li, Bingyang; Ody, Christopher

    2015-12-01

    In February 2009 the U.S. Congress unexpectedly passed the Health Information Technology for Economic and Clinical Health Act (HITECH). HITECH provides up to $27 billion to promote adoption and appropriate use of Electronic Medical Records (EMR) by hospitals. We measure the extent to which HITECH incentive payments spurred EMR adoption by independent hospitals. Adoption rates for all independent hospitals grew from 48 percent in 2008 to 77 percent by 2011. Absent HITECH incentives, we estimate that the adoption rate would have instead been 67 percent in 2011. When we consider that HITECH funds were available for all hospitals and not just marginal adopters, we estimate that the cost of generating an additional adoption was $48 million. We also estimate that in the absence of HITECH incentives, the 77 percent adoption rate would have been realized by 2013, just 2 years after the date achieved due to HITECH. PMID:26596789

  5. Removal of paper-based health records from Norwegian hospitals: effects on clinical workflow.

    PubMed

    Lium, Jan Tore; Faxvaag, Arild

    2006-01-01

    Several Norwegian hospitals have, plan, or are in the process of removing the paper-based health record from clinical workflow. To assess the impact on usage and satisfaction of electronic health record (EHR) systems, we conducted a survey among physicians, nurses and medical secretaries at selected departments from six Norwegian hospitals. The main feature of the questionnaire is the description of a set of tasks commonly performed at hospitals, and respondents were asked to rate their usage and change of ease compared to previous routines for each tasks. There were 24 tasks for physicians, 19 for nurses and 23 for medical secretaries. In total, 64 physicians, 128 nurses and 57 medical secretaries responded, corresponding to a response rate of 68%, 58% and 84% respectively. Results showed a large degree of use among medical secretaries, while physicians and nurses displayed a more modest degree of use. Possibly suggesting that the EHR systems among clinicians still is considered more of an administrative system. Among the two latter groups, tasks regarding information retrieval were used more extensively than tasks regarding generating and storing information. Also, we observed large differences between hospitals and higher satisfaction with the part of the system handling regular electronic data than scanned document images. Even though the increase in use among clinicians after removing the paper based record were mainly in tasks where respondents had no choice other than use the electronic health record, the attitude towards EHR-systems were mainly positive. Thus, while removing the paper based record has yet to promote new ways of working, we see it as an important step towards the EHR system of tomorrow. Several Norwegian hospitals have shown that it is possible. PMID:17108645

  6. [Two years experience of computerised medical records in a regional hospital].

    PubMed

    Vigal Brey, Guillermo; Trelles Martín, Angel

    2012-10-01

    The introduction of computerised medical records in public hospitals is, without a doubt, one of the biggest changes made in patient health care in the last few years. It is a gradual process and is not exempt from difficulties, but it will surely set a challenge in the way information is handled in health care. Taking this path, in November 2008, the computer program SELENE, from the multinational company Siemens, was purchased in the centre were we carry out our surgical activities. The introduction of this program was preceded by an intensive training course for all the workers in the hospital. At the start, it was decided that the computer application would come into operation throughout the entire hospital, replacing the handwritten records. There were difficult days during its gradual introduction, but the computerised medical record has been well accepted by the great majority of the workers at the centre. After the initial stage of becoming accustomed, design problems started to be seen in the application, as well as their possible solutions. Currently, the use of the SELENE program has led to fluid health care within the hospital, although there are problems which can be resolved with adequate funding. PMID:21955838

  7. Racial/ethnic disparities in maternal morbidities: a statewide study of labor and delivery hospitalizations in Wisconsin.

    PubMed

    Cabacungan, Erwin T; Ngui, Emmanuel M; McGinley, Emily L

    2012-10-01

    We examined racial/ethnic disparities in maternal morbidities (MM) and the number of MM during labor and delivery among hospital discharges in Wisconsin. We conducted a retrospective cohort study of hospital discharge data for 206,428 pregnant women aged 13-53 years using 2005-2007 Healthcare Cost and Utilization Project State Inpatient Dataset (HCUP-SID) for Wisconsin. After adjustments for covariates, MM (preterm labor, antepartum and postpartum hemorrhage, hypertension in pregnancy, gestational diabetes, membrane-related disorders, infections and 3rd and 4th perineal lacerations) were examined using logistic regression models, and number of MM (0, 1, 2, >2 MM) were examined using multivariable ordered logistic regressions with partial proportional odds models. African-Americans had significantly higher likelihood of infections (OR = 1.74; 95% CI 1.60-1.89), preterm labor (OR = 1.42; 1.33-1.50), antepartum hemorrhage (OR = 1.63; 1.44-1.83), and hypertension complicating pregnancy (OR = 1.39; 1.31-1.48) compared to Whites. Hispanics, Asian/Pacific Islanders, and Native Americans had significantly higher likelihood of infections, postpartum hemorrhage, and gestational diabetes than Whites. Major perineal lacerations were significantly higher among Asian/Pacific Islanders (OR = 1.53; 1.34-1.75). All minority racial/ethnic groups, except Asians, had significantly higher likelihood of having 0 versus 1, 2 or >2 MM, 0 or 1 versus 2 or >2 MM, and 0, 1 or 2 versus >2 MM than white women. Findings show significant racial/ethnic disparities in MM, and suggest the need for better screening, management, and timely referral of these conditions, particularly among racial/ethnic women. Disparities in MM may be contributing to the high infant mortality and adverse birth outcomes among different racial/ethnic groups in Wisconsin. PMID:22105738

  8. Patient-Held Maternal and/or Child Health Records: Meeting the Information Needs of Patients and Healthcare Providers in Developing Countries?

    PubMed Central

    Turner, Kathleen E.; Fuller, Sherrilynne

    2011-01-01

    Though improvements in infant and maternal mortality rates have occurred over time, women and children still die every hour from preventable causes. Various regional, social and economic factors are involved in the ability of women and children to receive adequate care and prevention services. Patient-held maternal and/or child health records have been used for a number of years in many countries to help track health risks, vaccinations and other preventative health measures performed. Though these records are primarily designed to record patient histories and healthcare information and guide healthcare workers providing care, because the records are patient-held, they also allow families a greater ability to track their own health and prevention strategies. A literature search was performed to answer these questions: (1) What are maternal information needs regarding pregnancy, post-natal and infant healthcare, especially in developing countries? (2) What is known about maternal information seeking behavior in developing countries? (3) What is the history and current state of maternal and/or child patient-held healthcare records, do they provide for the information needs of the healthcare provider and what are the effects and outcomes of patient-held records in general and for maternal and/or child health in particular? Specific information needs of pregnant women and mothers are rarely studied. The small numbers of maternal information behavior results available indicate that mothers, in general, prefer to receive health information directly from their healthcare provider as opposed to from other sources (written, etc.) Overall, in developing countries, patient-held maternal and/or child healthcare records have a mostly positive effect for both patient and care provider. Mothers and children with records tend to have better outcomes in healthcare and preventative measures. Further research into the information behaviors of pregnant women and mothers to determine

  9. Validity of a hospital-based obstetric register using medical records as reference

    PubMed Central

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Johansen, Nanna Roed; Rørbye, Christina; Weber, Tom; Due, Pernille; Koushede, Vibeke

    2015-01-01

    Background Data from hospital-based registers and medical records offer valuable sources of information for clinical and epidemiological research purposes. However, conducting high-quality epidemiological research requires valid and complete data sources. Objective To assess completeness and validity of a hospital-based clinical register – the Obstetric Database – using a national register and medical records as references. Methods We assessed completeness of a hospital-based clinical register – the Obstetric Database – by linking data from all women registered in the Obstetric Database as having given birth in 2013 to the National Patient Register with coverage of all births in 2013. Validity of eleven selected indicators from the Obstetric Database was assessed using medical records as a golden standard. Using a random sample of 250 medical records, we calculated proportion of agreement, sensitivity, specificity, and positive and negative predictive values for each indicator. Two assessors independently reviewed medical records and inter-rater reliability was calculated as proportion of agreement and Cohen’s κ coefficient. Results We found 100% completeness of the Obstetric Database when compared to the Danish National Patient Register. Except for one delivery all 6,717 deliveries were present in both registers. Proportion of agreement between the Obstetric Database and medical records ranged from 91.1% to 99.6% for the eleven indicators. The validity measures ranged from 0.70 to 1.00 indicating high validity of the Obstetric Database. κ coefficients from the inter-rater reliability ranged from 0.71 to 1.00. Conclusion Completeness and validity of the Obstetric Database were found acceptable when using the National Patient Register and medical records as golden standards. The Obstetric Database therefore offers a valuable source for examining clinical, administrative, and research questions. PMID:26648757

  10. A detailed description and assessment of outcomes of patients with hospital recorded QTc prolongation.

    PubMed

    Laksman, Zachary; Momciu, Bogdan; Seong, You Won; Burrows, Patricia; Conacher, Susan; Manlucu, Jaimie; Leong-Sit, Peter; Gula, Lorne J; Skanes, Allan C; Yee, Raymond; Klein, George J; Krahn, Andrew D

    2015-04-01

    Corrected QT (QTc) interval prolongation has been shown to be an independent predictor of mortality in many clinical settings and is a common finding in hospitalized patients. The causes and outcomes of patients with extreme QTc interval prolongation during a hospital admission are poorly described. The aim of this study was to prospectively identify patients with automated readings of QTc intervals >550 ms at 1 academic tertiary hospital. One hundred seventy-two patients with dramatic QTc interval prolongation (574 ± 53 ms) were identified (mean age 67.6 ± 15.1 years, 48% women). Most patients had underlying heart disease (60%), predominantly ischemic cardiomyopathy (43%). At lease 1 credible and presumed reversible cause associated with QTc interval prolongation was identified in 98% of patients. The most common culprits were QTc interval-prolonging medications, which were deemed most responsible in 48% of patients, with 25% of these patients taking ≥2 offending drugs. Two patients were diagnosed with congenital long-QT syndrome. Patients with electrocardiograms available before and after hospital admission demonstrated significantly lower preadmission and postdischarge QTc intervals compared with the QTc intervals recorded in the hospital. In conclusion, in-hospital mortality was high in the study population (29%), with only 4% of patients experiencing arrhythmic deaths, all of which were attributed to secondary causes. PMID:25665761

  11. Epidemiology of Leishmaniasis in Spain Based on Hospitalization Records (1997–2008)

    PubMed Central

    Gil-Prieto, Ruth; Walter, Stefan; Alvar, Jorge; de Miguel, Angel Gil

    2011-01-01

    All the records from the Spanish information system for hospital data of patients diagnosed with leishmaniasis during a 12-year period (1997–2008) were studied. The 2,028 individuals were hospitalized because of leishmaniasis, as indicated by the principal diagnostic code. The average hospitalization rate was 0.41/100,000 inhabitants. One-third of them were co-infected with human immunodeficiency virus (HIV). The incidence of hospitalization in the adult population with leishmaniasis co-infected with HIV increased with age, peaked at 35–39 years of age and subsequently declined. In the pediatric population, all leishmaniasis cases occurred in HIV-negative children. Incidence of hospitalizations was highest in Madrid and in the Mediterranean coast. The cost per inpatient hospital care was $9,601 corresponding to an annual direct cost of more than $1.5 million for inpatient care alone. The economical burden of leishmaniasis is not neglectable and in the 12-year study period it represented more than $19 million. PMID:22049034

  12. [The prevalence of intestinal parasites in children brought to the Kars Maternal and Children's Hospital with complaints of gastrointestinal symptoms].

    PubMed

    Arslan, Mükremin Ozkan; Sari, Bariş; Kulu, Bahar; Mor, Neriman

    2008-01-01

    This study was carried out to determine the prevalence of intestinal parasites in 2-6 year-old children who were brought to Kars Maternal and Children's Hospital with complaints of gastrointestinal symptoms during March-June 2007. Fecal samples were taken from children and brought to the parasitology laboratory of the Faculty of Veterinary Medicine to be examined for intestinal parasites. Fecal samples were examined by centrifugal formalin ether, zinc-sulphate floatation, and modified acid fast techniques. Lugol solution was used during microscopic examination and suspected samples were also examined by the Giemsa dye technique. The prevalence of intestinal parasites in children was found to be 36.2% (50/138). Protozoan and helminth parasites were found to be 34.1% (47/138) and 2.9% (4/138) in the fecal samples examined, respectively. Giardia intestinalis (10.9%), Entamoeba histolytica/dispar (10.1%), Entamoeba coli (8%), Blastocystis hominis (6.5%), Endolimax nana (4.3%), Chilomastix mesnili (1.4%), Ascaris lumbricoides (1.4%), Entamoeba hartmanni (0.7%), Cyclospora cayetanensis (0.7%), Enterobius vermicularis (0.7%) and Hymenolepis nana (0.7%) were identified from the feces of children of Kars and vicinity. No Cryptosporidium spp. was detected. PMID:18985583

  13. Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis

    PubMed Central

    Zipfel, Rebecca; Neuburger, Jenny; Hutchings, Andrew; Darzi, Ara; Black, Nick

    2015-01-01

    Objectives To determine the proportion of avoidable deaths (due to acts of omission and commission) in acute hospital trusts in England and to determine the association with the trust’s hospital-wide standardised mortality ratio assessed using the two commonly used methods - the hospital standardised mortality ratio (HSMR) and the summary hospital level mortality indicator (SHMI). Design Retrospective case record review of deaths. Setting 34 English acute hospital trusts (10 in 2009 and 24 in 2012/13) randomly selected from across the spectrum of HSMR. Main outcome measures Avoidable death, defined as those with at least a 50% probability of avoidability in view of trained medical reviewers. Association of avoidable death proportion with the HSMR and the SHMI assessed using regression coefficients, to estimate the increase in avoidable death proportion for a one standard deviation increase in standardised mortality ratio. Participants 100 randomly selected hospital deaths from each trust. Results The proportion of avoidable deaths was 3.6% (95% confidence interval 3.0% to 4.3%). It was lower in 2012/13 (3.0%, 2.4% to 3.7%) than in 2009 (5.2%, 3.8% to 6.6%). This difference is subject to several factors, including reviewers’ greater awareness in 2012/13 of orders not to resuscitate, patients being perceived as sicker on admission, minor differences in review form questions, and cultural changes that might have discouraged reviewers from criticising other clinicians. There was a small but statistically non-significant association between HSMR and the proportion of avoidable deaths (regression coefficient 0.3, 95% confidence interval −0.2 to 0.7). The regression coefficient was similar for both time periods (0.1 and 0.3). This implies that a difference in HSMR of between 105 and 115 would be associated with an increase of only 0.3% (95% confidence interval −0.2% to 0.7%) in the proportion of avoidable deaths. A similar weak non-significant association was

  14. Assessing Reliability of Medical Record Reviews for the Detection of Hospital Adverse Events

    PubMed Central

    Ock, Minsu; Lee, Sang-il; Jo, Min-Woo; Lee, Jin Yong; Kim, Seon-Ha

    2015-01-01

    Objectives: The purpose of this study was to assess the inter-rater reliability and intra-rater reliability of medical record review for the detection of hospital adverse events. Methods: We conducted two stages retrospective medical records review of a random sample of 96 patients from one acute-care general hospital. The first stage was an explicit patient record review by two nurses to detect the presence of 41 screening criteria (SC). The second stage was an implicit structured review by two physicians to identify the occurrence of adverse events from the positive cases on the SC. The inter-rater reliability of two nurses and that of two physicians were assessed. The intra-rater reliability was also evaluated by using test-retest method at approximately two weeks later. Results: In 84.2% of the patient medical records, the nurses agreed as to the necessity for the second stage review (kappa, 0.68; 95% confidence interval [CI], 0.54 to 0.83). In 93.0% of the patient medical records screened by nurses, the physicians agreed about the absence or presence of adverse events (kappa, 0.71; 95% CI, 0.44 to 0.97). When assessing intra-rater reliability, the kappa indices of two nurses were 0.54 (95% CI, 0.31 to 0.77) and 0.67 (95% CI, 0.47 to 0.87), whereas those of two physicians were 0.87 (95% CI, 0.62 to 1.00) and 0.37 (95% CI, -0.16 to 0.89). Conclusions: In this study, the medical record review for detecting adverse events showed intermediate to good level of inter-rater and intra-rater reliability. Well organized training program for reviewers and clearly defining SC are required to get more reliable results in the hospital adverse event study. PMID:26429290

  15. A New Model for the Organizational Structure of Medical Record Departments in Hospitals in Iran

    PubMed Central

    Moghaddasi, Hamid; Hosseini, Azamossadat; Sheikhtaheri, Abbas

    2006-01-01

    The organizational structure of medical record departments in Iran is not appropriate for the efficient management of healthcare information. In addition, there is no strong information management division to provide comprehensive information management services in hospitals in Iran. Therefore, a suggested model was designed based on four main axes: 1) specifications of a Health Information Management Division, 2) specifications of a Healthcare Information Management Department, 3) the functions of the Healthcare Information Management Department, and 4) the units of the Healthcare Information Management Department. The validity of the model was determined through use of the Delphi technique. The results of the validation process show that the majority of experts agree with the model and consider it to be appropriate and applicable for hospitals in Iran. The model is therefore recommended for hospitals in Iran. PMID:18066362

  16. A new model for the organizational structure of medical record departments in hospitals in Iran.

    PubMed

    Moghaddasi, Hamid; Hosseini, Azamossadat; Sheikhtaheri, Abbas

    2006-01-01

    The organizational structure of medical record departments in Iran is not appropriate for the efficient management of healthcare information. In addition, there is no strong information management division to provide comprehensive information management services in hospitals in Iran. Therefore, a suggested model was designed based on four main axes: 1) specifications of a Health Information Management Division, 2) specifications of a Healthcare Information Management Department, 3) the functions of the Healthcare Information Management Department, and 4) the units of the Healthcare Information Management Department. The validity of the model was determined through use of the Delphi technique. The results of the validation process show that the majority of experts agree with the model and consider it to be appropriate and applicable for hospitals in Iran. The model is therefore recommended for hospitals in Iran. PMID:18066362

  17. The influence of institutional pressures on hospital electronic health record presence.

    PubMed

    Fareed, Naleef; Bazzoli, Gloria J; Farnsworth Mick, Stephen S; Harless, David W

    2015-05-01

    Electronic health records (EHR) are a promising form of health information technology that could help US hospitals improve on their quality of care and costs. During the study period explored (2005-2009), high expectations for EHR diffused across institutional stakeholders in the healthcare environment, which may have pressured hospitals to have EHR capabilities even in the presence of weak technical rationale for the technology. Using an extensive set of organizational theory-specific predictors, this study explored whether five factors - cause, constituents, content, context, and control - that reflect the nature of institutional pressures for EHR capabilities motivated hospitals to comply with these pressures. Using information from several national data bases, an ordered probit regression model was estimated. The resulting predicted probabilities of EHR capabilities from the empirical model's estimates were used to test the study's five hypotheses, of which three were supported. When the underlying cause, dependence on constituents, or influence of control were high and potential countervailing forces were low, hospitals were more likely to employ strategic responses that were compliant with the institutional pressures for EHR capabilities. In light of these pressures, hospitals may have acquiesced, by having comprehensive EHR capabilities, or compromised, by having intermediate EHR capabilities, in order to maintain legitimacy in their environment. The study underscores the importance of our assessment for theory and policy development, and provides suggestions for future research. PMID:25840047

  18. Underreporting of Driver Alcohol Involvement in United States Police and Hospital Records: Capture-Recapture Estimates

    PubMed Central

    Miller, Ted R.; Gibson, Rekaya; Zaloshnja, Eduard; Blincoe, Lawrence J.; Kindelberger, John; Strashny, Alexander; Thomas, Andrea; Ho, Shiu; Bauer, Michael; Sperry, Sarah; Peng, Justin; Singleton, Mike; Smith, Tracy J.; Zhang, Ying

    2012-01-01

    This paper analyzes what portion of US nonfatal crashes are alcohol-involved and how well police and hospitals detect involvement. A capture recapture model estimated alcohol involvement from levels detected by police and hospitals and the extent of detection overlap. We analyzed 550,933 Crash Outcome Data Evaluation System driver records from 2006–2008 police crash report censuses probabilistically linked to hospital inpatient and emergency department (ED) discharge censuses for CT, KY (admissions only), MD, NE, NY, SC, and UT. We computed national estimates from NHTSA’s General Estimates System. Nationally an estimated 7.5% of drivers in nonfatal crashes and 12.9% of nonfatal crashes were alcohol-involved. (Crashes often involve multiple drivers but rarely are two alcohol-involved.) Police correctly identified an estimated 32% of alcohol-involved drivers in non-fatal crashes including 48% in injury crashes. Excluding KY, police in the six states reported 47% of alcohol involvement for cases treated in EDs and released and 39% for admitted cases. In contrast, hospitals reported 28% of involvement for ED cases and 51% for admitted cases. Underreporting varied widely between states. Police reported alcohol involvement for 44% of those who hospitals reported were alcohol-involved, while hospitals reported alcohol involvement for 33% of those who police reported were alcohol-involved. Police alcohol reporting completeness rose with police-reported driver injury severity. At least one system reported 62% of alcohol involvement. Police and hospitals need to communicate better about alcohol involvement. Despite the proven effectiveness of brief alcohol intervention, EDs rarely detect, much less intervene with crash-involved drinking drivers. Both police and EDs particularly need to assess alcohol involvement in minor injury better. PMID:23169120

  19. Underreporting of driver alcohol involvement in United States police and hospital records: capture-recapture estimates.

    PubMed

    Miller, Ted R; Gibson, Rekaya; Zaloshnja, Eduard; Blincoe, Lawrence J; Kindelberger, John; Strashny, Alexander; Thomas, Andrea; Ho, Shiu; Bauer, Michael; Sperry, Sarah; Peng, Justin; Singleton, Mike; Smith, Tracy J; Zhang, Ying

    2012-01-01

    This paper analyzes what portion of US nonfatal crashes are alcohol-involved and how well police and hospitals detect involvement. A capture recapture model estimated alcohol involvement from levels detected by police and hospitals and the extent of detection overlap. We analyzed 550,933 Crash Outcome Data Evaluation System driver records from 2006-2008 police crash report censuses probabilistically linked to hospital inpatient and emergency department (ED) discharge censuses for CT, KY (admissions only), MD, NE, NY, SC, and UT. We computed national estimates from NHTSA's General Estimates System.Nationally an estimated 7.5% of drivers in nonfatal crashes and 12.9% of nonfatal crashes were alcohol-involved. (Crashes often involve multiple drivers but rarely are two alcohol-involved.) Police correctly identified an estimated 32% of alcohol-involved drivers in non-fatal crashes including 48% in injury crashes. Excluding KY, police in the six states reported 47% of alcohol involvement for cases treated in EDs and released and 39% for admitted cases. In contrast, hospitals reported 28% of involvement for ED cases and 51% for admitted cases. Underreporting varied widely between states. Police reported alcohol involvement for 44% of those who hospitals reported were alcohol-involved, while hospitals reported alcohol involvement for 33% of those who police reported were alcohol-involved. Police alcohol reporting completeness rose with police-reported driver injury severity. At least one system reported 62% of alcohol involvement. Police and hospitals need to communicate better about alcohol involvement. Despite the proven effectiveness of brief alcohol intervention, EDs rarely detect, much less intervene with crash-involved drinking drivers. Both police and EDs particularly need to assess alcohol involvement in minor injury better. PMID:23169120

  20. Evaluation of Unpreparedness When Issuing Copies of Medical Records in Tertiary Referral Hospitals

    PubMed Central

    Moon, Myong-Mo; Seo, Sun-Won; Park, Woo-Sung; Kim, Yoon; Kim, Sung-Soo; Choi, Eun-Mi; Park, Jong; Park, Il-Soon

    2010-01-01

    Objectives As a baseline study to aid in the development of proper policy, we investigated the current condition of unpreparedness of documents required when issuing copies of medical records and related factors. Methods The study was comprised of 7,203 cases in which copies of medical records were issued from July 1st, 2007 through June 30th, 2008 to 5 tertiary referral hospitals. Data from these hospitals was collected using their established electronic databases and included study variables such as unpreparedness of the required documents as a dependent variable and putative covariates. Results The rate of unpreparedness of required documents was 14.9%. Multiple logistic regression analysis revealed the following factors as being related to the high rate of unpreparedness: patient age (older patients had a higher rate), issuance channels (on admission > via out-patient clinic), type of applicant (others such as family members > for oneself > insurers), type of original medical record (utilization records on admission > other records), issuance purpose (for providing insurer > medical use), residential area of applicant (Seoul > Honam province and Jeju), and number of copied documents (more documents gave a lower rate). The rate of unpreparedness differed significantly among the hospitals; suggesting that they may have followed their own conventional protocols rather than legal procedures in some cases. Conclusions The study results showed that the level of compliance to the required legal procedure was high, but that problems occurred in assuring the safety of the medical information. A proper legislative approach is therefore required to balance the security of and access to medical information. PMID:21818431

  1. An ECG simulator for generating maternal-foetal activity mixtures on abdominal ECG recordings.

    PubMed

    Behar, Joachim; Andreotti, Fernando; Zaunseder, Sebastian; Li, Qiao; Oster, Julien; Clifford, Gari D

    2014-08-01

    Accurate foetal electrocardiogram (FECG) morphology extraction from non-invasive sensors remains an open problem. This is partly due to the paucity of available public databases. Even when gold standard information (i.e derived from the scalp electrode) is present, the collection of FECG can be problematic, particularly during stressful or clinically important events.In order to address this problem we have introduced an FECG simulator based on earlier work on foetal and adult ECG modelling. The open source foetal ECG synthetic simulator, fecgsyn, is able to generate maternal-foetal ECG mixtures with realistic amplitudes, morphology, beat-to-beat variability, heart rate changes and noise. Positional (rotation and translation-related) movements in the foetal and maternal heart due to respiration, foetal activity and uterine contractions were also added to the simulator.The simulator was used to generate some of the signals that were part of the 2013 PhysioNet Computing in Cardiology Challenge dataset and has been posted on Physionet.org (together with scripts to generate realistic scenarios) under an open source license. The toolbox enables further research in the field and provides part of a standard for industry and regulatory testing of rare pathological scenarios. PMID:25071094

  2. Health care professionals’ pain narratives in hospitalized children’s medical records. Part 1: Pain descriptors

    PubMed Central

    Rashotte, Judy; Coburn, Geraldine; Harrison, Denise; Stevens, Bonnie J; Yamada, Janet; Abbott, Laura K

    2013-01-01

    BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children. OBJECTIVES: To describe health care professionals’ use of written language related to the quality and quantity of pain experienced by hospitalized children. METHODS: Free-text pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized on 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was used. RESULTS: Pain narratives were documented a total of 5390 times in 1518 of the 3822 children’s medical records (40%). Overall, word choices represented objective and subjective descriptors. Two major categories were identified, with their respective subcategories of word indicators and associated cues: indicators of pain, including behavioural (eg, vocal, motor, facial and activities cues), affective and physiological cues, and children’s descriptors; and word qualifiers, including intensity, comparator and temporal qualifiers. CONCLUSIONS: The richness and complexity of vocabulary used by clinicians to document children’s pain lend support to the concept that the word ‘pain’ is a label that represents a myriad of different experiences. There is potential to refine pediatric pain assessment measures to be inclusive of other cues used to identify children’s pain. The results enhance the discussion concerning the development of standardized nomenclature. Further research is warranted to determine whether there is congruence in interpretation across time, place and individuals. PMID:24093122

  3. International Classification of Impairments, Disabilities and Handicaps: exercises in its application in a hospital medical record.

    PubMed

    Ford, B

    1984-01-01

    The principles and philosophies of the WHO International Classification of Impairments, Disabilities and Handicaps were enthusiastically espoused by all staff of a large rehabilitation hospital. It was universally seen as an accurate and standardized way of recording and reporting a patient's functional state and opened up opportunities for research between causation and consequences of diseases, the relations of impairments to handicaps, and so on. In short, it promised a hard data base about disability, which presently has been studied only anecdotally, or by large random community samples. The joy of the principle turned into torment when the attempts to apply the system to current and past medical records were made. Retrospective codification of existing records was found to be virtually impossible. Recorded data were patchy, insufficiently precise to translate into IDH codes and the codifier had to make so many value judgements, interpretations and guesses to squeeze what was written on the record into IDH codes. A totally new and disciplined way of making notations in medical records would be required to make this method applicable, and such a discipline presents challenges to the medical administrator which dwarfs the production of the WHO manual.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:6241185

  4. Nurses' perceptions of and attitudes toward an electronic medical record system at Seoul National University Hospital.

    PubMed

    Ahn, Tae-Sa; Park, Ihn Sook; You, Ock-Su; Shin, Hyeon-Ju; Woo, Kyung-Shun; Jo, Eun-Mee

    2006-01-01

    In an effort to investigate nurses' perceptions of and attitudes toward the use of electronic medical record (EMR) systems, 904 nurses in a university hospital were surveyed for demographic data and their perceptions of and attitudes toward an EMR system 6 months after its implementation. The questionnaire consisted of demographic information, perception statements relating to the effect of an EMR system, and attitude statements toward an EMR system (assessed on 4-point Likert scales, Cronbach's alpha = 0.979). Nurses' perceptions and attitudes were generally positive and correlated with the type of nursing unit, and their age, years of nursing experience, and job title. This result reinforces that nurses are generally accepting of the implementation of a new EMR system. However, strategies are needed for improving the satisfaction of nurses who have a negative perception of and attitude toward EMR systems. It is recommended that the findings of our study be implemented in other hospitals with ongoing EMR projects. PMID:17102423

  5. The Macalister archive: records from the Queen's Hospital, Sidcup, 1917-1921.

    PubMed

    Bamji, A N

    1993-04-01

    The Queen's Hospital opened in 1917 to care for soldiers receiving facial injuries in Western Front trenches, usually as a result of a gunshot wound. Some 8000 patients were treated by the medical teams of the UK, the Dominions and the USA. The wartime records were removed by their respective sections in 1921, but Queen Mary's Hospital has recently reacquired those of the New Zealand section, rescued from imminent destruction by Professor A.D. Macalister, late Dean of the Dental School at Dunedin, and kindly donated by him. There are 282 sets of case-notes containing typescript summaries, clinical photographs and radiographs, drawings, 77 watercolor paintings and a life-size wax model of head and upper torso illustrating some of the surgical techniques. The archive is a fine example of medical illustration 75 years ago, and provides invaluable detail on the plastic surgery and dental reconstructive methods that were developed at Sidcup. PMID:8409222

  6. Performance improvement indicators of the Medical Records Department and Information Technology (IT) in hospitals

    PubMed Central

    Ajami, Sima; Ketabi, Saedeh; Torabiyan, Fatemeh

    2015-01-01

    Medical Record Department (MRD) has a vital role in making short and long term plans to improve health system services. The aim of this study was to describe performance improvement indicators of hospital MRD and information technology (IT). Collection of Data: A search was conducted in various databases, through related keywords in articles, books, and abstracts of conferences from 2001 to 2009. About 58 articles and books were available which were evaluated and finally 15 of them were selected based on their relevance to the study. MRD must be capable of supporting tasks such as patient care and continuity, institute management processes, medical education programs, medical research, communication between different wards of a hospital and administrative and medical staff. The use of IT in MRD can facilitate access to department, expedite communication within and outside department, reduce space with electronic medical records, reduce costs, accelerate activities such as coding by use of coding guide software and facilitate retrieval of records that will ultimately improve the performance of MRD. PMID:26150874

  7. Levels and causes of maternal mortality in southern India.

    PubMed

    Bhatia, J C

    1993-01-01

    Most studies of maternal mortality are hospital based. However, in developing countries, where many such deaths take place in the home, hospital statistics do not reflect the true extent of maternal mortality. Furthermore, the socioeconomic and demographic factors and health behavior affecting maternal mortality are rarely known. A study conducted in 1986 in South India demonstrates a new approach to investigating maternal mortality that combines the collection of information from hospital and health-facility records, field surveys, and case-control studies. The findings from this study indicate that there were 7.98 maternal deaths per 1,000 live births. Approximately one-half of the deaths occurred in the home or on the way to the hospital. Maternal deaths accounted for 36 percent of mortality for women of reproductive age. Analysis reveals that many of these deaths were preventable and that significant differentials existed with regard to demographic, social, and behavioral factors between the cases of maternal deaths and the controls. PMID:8296332

  8. Recording signs of deterioration in acute patients: The documentation of vital signs within electronic health records in patients who suffered in-hospital cardiac arrest.

    PubMed

    Stevenson, Jean E; Israelsson, Johan; Nilsson, Gunilla C; Petersson, Göran I; Bath, Peter A

    2016-03-01

    Vital sign documentation is crucial to detecting patient deterioration. Little is known about the documentation of vital signs in electronic health records. This study aimed to examine documentation of vital signs in electronic health records. We examined the vital signs documented in the electronic health records of patients who had suffered an in-hospital cardiac arrest and on whom cardiopulmonary resuscitation was attempted between 2007 and 2011 (n = 228), in a 372-bed district general hospital. We assessed the completeness of vital sign data compared to VitalPAC™ Early Warning Score and the location of vital signs within the electronic health records. There was a noticeable lack of completeness of vital signs. Vital signs were fragmented through various sections of the electronic health records. The study identified serious shortfalls in the representation of vital signs in the electronic health records, with consequential threats to patient safety. PMID:24782478

  9. The incidence of adverse events in Swedish hospitals: a retrospective medical record review study

    PubMed Central

    Soop, Michael; Fryksmark, Ulla; Köster, Max; Haglund, Bengt

    2009-01-01

    Objectives To estimate the incidence, nature and consequences of adverse events and preventable adverse events in Swedish hospitals. Design A three-stage structured retrospective medical record review based on the use of 18 screening criteria. Setting Twenty-eight Swedish hospitals. Population A representative sample (n = 1967) of the 1.2 million Swedish hospital admissions between October 2003 and September 2004. Main Outcome Measures Proportion of admissions with adverse events, the proportion of preventable adverse events and the types and consequences of adverse events. Results In total, 12.3% (n = 241) of the 1967 admissions had adverse events (95% CI, 10.8–13.7), of which 70% (n = 169) were preventable. Fifty-five percent of the preventable events led to impairment or disability, which was resolved during the admission or within 1 month from discharge, another 33% were resolved within 1 year, 9% of the preventable events led to permanent disability and 3% of the adverse events contributed to patient death. Preventable adverse events led to a mean increased length of stay of 6 days. Ten of the 18 screening criteria were sufficient to detect 90% of the preventable adverse events. When extrapolated to the 1.2 million annual admissions, the results correspond to 105 000 preventable adverse events (95% CI, 90 000–120 000) and 630 000 days of hospitalization (95% CI, 430 000–830 000). Conclusions This study confirms that preventable adverse events were common, and that they caused extensive human suffering and consumed a significant amount of the available hospital resources. PMID:19556405

  10. Exploring the Relationships between the Electronic Health Record System Components and Patient Outcomes in an Acute Hospital Setting

    ERIC Educational Resources Information Center

    Wiggley, Shirley L.

    2011-01-01

    Purpose: The purpose of this study was to examine the relationship between the electronic health record system components and patient outcomes in an acute hospital setting, given that the current presidential administration has earmarked nearly $50 billion to the implementation of the electronic health record. The relationship between the…

  11. Delay in the provision of adequate care to women who died from abortion-related complications in the principal maternity hospital of Gabon.

    PubMed

    Mayi-Tsonga, Sosthene; Oksana, Litochenko; Ndombi, Isabelle; Diallo, Thierno; de Sousa, Maria Helena; Faúndes, Aníbal

    2009-11-01

    Deaths resulting from unsafe induced abortions represent a major component of maternal mortality in countries with restrictive abortion laws. Delays in obtaining care for maternal complications constitute a known determinant of a woman's risk of death. However, data on the role of delays in providing care at health care facilities are sparse. The association between the cause of maternal death (abortion versus post-partum haemorrhage or eclampsia) and the time interval between admission to hospital and the initiation of treatment were evaluated among women who died at the Maternité du Centre Hospitalier de Libreville, Gabon, between 1 January 2005 and 31 December 2007. The women's characteristics and the time between diagnosis of the condition that led to death and the initiation of treatment were compared for each cause of death. After controlling for selected variables, the mean time between admission and treatment was 1.2 hours (95% CI: 0.0-5.6) in the case of women who died from post-partum haemorrhage or eclampsia and 23.7 hours (95% CI: 21.1-26.3) in the case of women who died of abortion-related complications. In conclusion, delay in initiating care was far greater in cases of women with complications of unsafe abortion compared to other pregnancy-related complications. Such delays may constitute an important determinant of the risk of death in women with abortion-related complications. PMID:19962639

  12. Association between maternal exposure to housing renovation and offspring with congenital heart disease: a multi-hospital case–control study

    PubMed Central

    2013-01-01

    Background Congenital heart disease (CHD) is one of the most prevalent birth defects. Housing renovations are a newly recognized source of indoor environmental pollution that is detrimental to health. A growing body of research suggests that maternal occupational exposure to renovation materials may be associated with an increased risk of giving birth to fetuses with CHD. However, the effect of indoor housing renovation exposure on CHD occurrence has not been reported. Methods A multi-hospital case–control study was designed to investigate the association between maternal periconceptional housing renovation exposure and the risk of CHD for offspring. In total, 346 cases and 408 controls were enrolled in this study from four hospitals in China. Exposure information was based on a questionnaire given to women during pregnancy. The association between housing renovation exposure and CHD occurrence was assessed by estimating odds ratios (OR) with logistic regression models adjusted for potential confounders. Results The risk for CHD in offspring was significantly associated with maternal exposure to housing renovations (AOR: 1.89, 95% CI: 1.29-2.77). There were similar risks for cardiac defects with or without extra-cardiac malformation (AOR of 2.65 and 1.76, respectively). Maternal housing renovation exposure may increase the fetus’ risk of suffering from conotruncal defect or anomalous venous return. There were significant risks for cardiac defects if the pregnant woman moved into a new house within one month after decoration at either 3 months before pregnancy (AOR: 2.38, 95% CI: 1.03 to 5.48) or during first trimester (AOR: 4.00, 95% CI: 1.62 to 9.86). Conclusions Maternal exposure to housing renovations may have an increased risk of giving birth to fetuses with some selected types of CHD. This relationship was stronger for women who moved into a newly decorated house. However, considering the limited number of subjects and the problem of multiple exposures

  13. Maternal and perinatal mortality.

    PubMed

    Krishna Menon, M K

    1972-01-01

    A brief analysis of data from the records of the Government Hospital for Women and Children in Madras for a 36-year period (1929-1964) is presented. India with a population of over 550 million has only 1 doctor for each 6000 population. For the 80% of the population which is rural, the doctor ratio is only 88/1 million. There is also a shortage of paramedical personnel. During the earlier years of this study period, abortions, puerperal infections; hemorrhage, and toxemia accounted for nearly 75% of all meternal deaths, while in later years deaths from these causes were 40%. Among associated factors in maternal mortality, anemia was the most frequent, it still accounts for 20% and is a contributory factor in another 20%. The mortality from postpartum hemorrhage was 9.3% but has now decreased to 2.8%. Eclampsia is a preventable disease and a marked reduction in maternal and perinatal mortality from this cause has been achieved. Maternal deaths from puerperal infections have dropped from 25% of all maternal deaths to 7%. Uterine rupture has been reduced from 75% to 9.3% due to modern facilities. Operative deliveries still have an incidence of 2.1% and a mortality rate of 1.4% of all deliveries. These rates would be further reduced by more efficient antenatal and intranatal care. Reported perinatal mortality of infants has been reduced from 182/1000 births to an average of 78/1000 in all areas, but is 60.6/1000 in the city of Madras. Socioeconomic standards play an important role in perinatal mortality, 70% of such deaths occurring in the lowest economic groups. Improvement has been noted in the past 25 years but in rural areas little progress has been made. Prematurity and low birth weights are still larger factors in India than in other countries, with acute infectious diseases, anemia, and general malnutrition among mothers the frequent causes. Problems requiring further efforts to reduce maternal and infant mortality are correct vital statistics, improved

  14. Prevention of blindness from glaucoma using the King's College Hospital computerized problem orientated medical record.

    PubMed Central

    Crick, R. P.

    1975-01-01

    (1) Chronic glaucoma accounts for a high proportion of blindness which is preventable and calls for energetic action because existing knowledge is not applied as it should be because of the indifference of the Department of Health and Social Security to the glaucoma problem. (2) The condition is frequently insidious and advanced before being identified, and requires life-long supervision. (3) When diagnosed, the management of glaucoma is frequently inadequate and intermittent for a variety of reasons. (4) AtKing's College Hospital, a Glaucoma Centre has been initiated to supervise accurately and regularly a large number of glaucoma patients, assisted by numerical recording and computer analysis. While we are fortunate in having a computer in the hospital, it is important to emphasize that the system can be operated without this facility, either by employing manual methods, or by batch processing. It would be both possible and desirable to organize recording a nd analysis on a regional basis in collaboration with hospitals wishing to participiate. (5) Attempts are being made to improve the early diagnosis ofglaucoma by better communication between the hospital ophthalmologists, and other members of the medical, optical, and ancillary professions by lectures, demonstrations, and publications. (6) Research is always hampered by the absence of factual knowledge. It is planned to use fully the opportunity for research into glaucoma made possible by this basic organization. At present however, we consider it more important to carry out investigations into the problems of organizing the investigation, treatment, and follow-up of glaucoma patients than t o embark on a few individual projects of research. We are serously hampered in our work by shortage of funds for staff and facilities, but we look forward confidently to the time when, with the essential support of the Department of Health, these methods will give us access to the facts of glaucoma, which besides enabling

  15. Maternal-effect genes as the recording genes of Turing-Child patterns: sequential compartmentalization in Drosophila.

    PubMed

    Schiffmann, Yoram

    2012-05-01

    The early embryo is often a two-dimensional surface. The fate map is the subdivision of this surface into regions which give rise to parts of the phenotype. It is shown for Drosophila that the fate map is generated by the spontaneous and sequential formation of Turing-Child (TC) eigenfunction patterns. These patterns are recorded by the maternal-effect genes. The addition of the nodal lines of the TC patterns yields the correct number, positions, sequences and symmetries of regional boundaries. A simplest nontrivial 'homeotic transformation' is suggested and explained. A single mutation converts a region in one end of the fate map to a mirror-symmetric image of a nonadjacent region in the other end of the fate map, and this is attributed to the geometry of the TC patterns. This geometry also determines the initial shape of the zygotic gene expression. The vision of William Bateson that biological form is shaped like Chladni's patterns in acoustics and music is justified. A similar sequence of TC patterns occurs in the normal development of all organisms, and it is suggested that artificial intervention which completes the full sequence of TC patterns can be useful in the context of regenerative medicine and this is illustrated with the sea urchin. PMID:22564772

  16. Using electronic health records to improve quality and efficiency: the experiences of leading hospitals.

    PubMed

    Silow-Carroll, Sharon; Edwards, Jennifer N; Rodin, Diana

    2012-07-01

    An examination of nine hospitals that recently implemented a comprehensive electronic health record (EHR) system finds that clinical and administrative leaders built EHR adoption into their strategic plans to integrate inpatient and outpatient care and provide a continuum of coordinated services. Successful implementation depended on: strong leadership, full involvement of clinical staff in design and implementation, mandatory staff training, and strict adherence to timeline and budget. The EHR systems facilitate patient safety and quality improvement through: use of checklists, alerts, and predictive tools; embedded clinical guidelines that promote standardized, evidence-based practices; electronic prescribing and test-ordering that reduces errors and redundancy; and discrete data fields that foster use of performance dashboards and compliance reports. Faster, more accurate communication and streamlined processes have led to improved patient flow, fewer duplicative tests, faster responses to patient inquiries, redeployment of transcription and claims staff, more complete capture of charges, and federal incentive payments. PMID:22826903

  17. Benefits negotiation: three Swedish hospitals pursuit of potential electronic health record benefits.

    PubMed

    Jeansson, John S

    2013-01-01

    At the very heart of Swedish healthcare digitalisation are large investments in electronic health records (EHRs). These integrated information systems (ISs) carry promises of great benefits and value for organisations. However, realising IS benefits and value has, in general, proven to be a challenging task, and as organisations strive to formalise their realisation efforts a misconception of rationality threatens to emerge. This misconception manifests itself when the formality of analysis threatens to underrate the impact of social processes in deciding which potential benefits to pursue. This paper suggests that these decisions are the result of a social process of negotiation. The purpose of this paper is to observe three benefits analysis projects of three Swedish hospitals to better understand the character and management of proposed benefits negotiations. Findings depict several different categories of benefits negotiations, as well as key factors to consider during the benefits negotiation process. PMID:24191344

  18. Concordance of Electronic Health Record (EHR) Data Describing Delirium at a VA Hospital

    PubMed Central

    Spuhl, Joshua; Doing-Harris, Kristina; Nelson, Scott; Estrada, Nicolette; Fiol, Guilherme Del; Weir, Charlene

    2014-01-01

    BACKGROUND Delirium is a common syndrome in elderly hospitalized patients that is correlated with poor outcomes and higher costs yet health care teams often overlook its diagnosis and treatment. Poor data quality in EHR systems can be contributing to this as a common tool teams use to communicate and record data about their patients. METHODS Data were gathered from 30 patients chosen randomly that spanned various data domains in the EHR. These were analyzed for concordance as an indicator of data quality. RESULTS Concordance was high between the physician and nursing narrative documentation. The other domains of data were drastically less concordant. DISCUSSION The low concordance between structured and narrative data domains suggests that clinicians are forgoing the features available in modern EHR systems and opting to work in narrative. For informatics, this can be troubling as narrative data are difficult to compute. PMID:25954416

  19. Early Experiences with Mobile Electronic Health Records Application in a Tertiary Hospital in Korea

    PubMed Central

    Park, Minah; Hong, Eunseok; Kim, Sunhyu; Ahn, Ryeok; Hong, Jungseok; Song, Seungyeol; Kim, Tak; Kim, Jeongkeun; Yeo, Seongwoon

    2015-01-01

    Objectives Recent advances in mobile technology have opened up possibilities to provide strongly integrated mobile-based services in healthcare and telemedicine. Although the number of mobile Electronic Health Record (EHR) applications is large and growing, there is a paucity of evidence demonstrating the usage patterns of these mobile applications by healthcare providers. This study aimed to illustrate the deployment process for an integrated mobile EHR application and to analyze usage patterns after provision of the mobile EHR service. Methods We developed an integrated mobile application that aimed to enhance the mobility of healthcare providers by improving access to patient- and hospital-related information during their daily medical activities. The study included mobile EHR users who accessed patient healthcare records between May 2013 and May 2014. We performed a data analysis using a web server log file analyzer from the integrated EHR system. Cluster analysis was applied to longitudinal user data based on their application usage pattern. Results The mobile EHR service named M-UMIS has been in service since May 2013. Every healthcare provider in the hospital could access the mobile EHR service and view the medical charts of their patients. The frequency of using services and network packet transmission on the M-UMIS increased gradually during the study period. The most frequently accessed service in the menu was the patient list. Conclusions A better understanding regarding the adoption of mobile EHR applications by healthcare providers in patient-centered care provides useful information to guide the design and implementation of future applications. PMID:26618036

  20. Detection of segments with fetal QRS complex from abdominal maternal ECG recordings using support vector machine

    NASA Astrophysics Data System (ADS)

    Delgado, Juan A.; Altuve, Miguel; Nabhan Homsi, Masun

    2015-12-01

    This paper introduces a robust method based on the Support Vector Machine (SVM) algorithm to detect the presence of Fetal QRS (fQRS) complexes in electrocardiogram (ECG) recordings provided by the PhysioNet/CinC challenge 2013. ECG signals are first segmented into contiguous frames of 250 ms duration and then labeled in six classes. Fetal segments are tagged according to the position of fQRS complex within each one. Next, segment features extraction and dimensionality reduction are obtained by applying principal component analysis on Haar-wavelet transform. After that, two sub-datasets are generated to separate representative segments from atypical ones. Imbalanced class problem is dealt by applying sampling without replacement on each sub-dataset. Finally, two SVMs are trained and cross-validated using the two balanced sub-datasets separately. Experimental results show that the proposed approach achieves high performance rates in fetal heartbeats detection that reach up to 90.95% of accuracy, 92.16% of sensitivity, 88.51% of specificity, 94.13% of positive predictive value and 84.96% of negative predictive value. A comparative study is also carried out to show the performance of other two machine learning algorithms for fQRS complex estimation, which are K-nearest neighborhood and Bayesian network.

  1. Adoption and Barriers to Adoption of Electronic Health Records by Nurses in Three Governmental Hospitals in Eastern Province, Saudi Arabia.

    PubMed

    El Mahalli, Azza

    2015-01-01

    Although electronic health records (EHRs) have been implemented in many hospitals and healthcare providers benefit from their effective and efficient data processing, their evaluation from nurses has received little attention. This project aimed to assess the adoption and barriers to the use of an EHR system by nurses at three governmental hospitals implementing the same EHR software and functionalities in Eastern Province, Saudi Arabia. The study was a cross-sectional, paper-based questionnaire study. SPSS version 20 was used for data entry and analysis, and descriptive statistics were calculated. The study found underutilization of almost all functionalities among all hospitals and no utilization of any communication tools with patients. In addition, there were no instances of "allowing patients to use the Internet to access parts of their health records." The most frequently cited barrier among all hospitals was "loss of access to medical records transiently if computer crashes or power fails" (88.6 percent). This was followed by "lack of continuous training/ support from information technology staff in hospital" (85.9 percent), "additional time required for data entry" (84.9 percent), and "system hanging up problem" (83.8 percent). Complexity of technology (81.6 percent) and lack of system customizability (81.1 percent) were also frequently reported problems. The formation of an EHR committee to discuss problems with the system in Saudi hospitals is recommended. PMID:26604875

  2. [Assistance to delivery according to hospital classification].

    PubMed

    Lopez-escobar, G; Daza-parada, L; Riano-gamboa, G; Fortney, J

    1979-06-01

    Between March and October 1977 40 urban Colombian hospitals participated in an evaluation of services given to women with high risk pregnancies. The purpose of the study was to find out whether high risk cases go to the more appropriate and better equipped hospitals. A total of 13,450 deliveries were observed at random, i.e. 8.3% of all deliveries in all 40 hospitals during the same time. Social, cultural, and clinical characteristics of mothers and infants were carefully recorded. It was found that Social Security hospitals had the lowest number of high risk patients, a moderate number of surgical interventions, and the lowest maternal and perinatal mortality rate. On the other hand, average size hospitals serviced a larger number of high risk patients, had the highest rate of surgical intervention and of perinatal mortality, and a moderate maternal mortality rate. University hospitals, with the highest concentration of high risk patients and with a moderate incidence of surgical interventions, had a moderate rate of perinatal mortality, and a high rate of maternal mortality. Obviously not all high risk patients were serviced by the best equipped hospitals and by the best prepared personnel, which resulted in a high rate of maternal-infant morbidity and mortality. It would be necessary to reorganize all available services in a more functional way, so that high risk patients can be assisted and treated in the most appropriate environment. PMID:12310258

  3. Adoption and Barriers to Adoption of Electronic Health Records by Nurses in Three Governmental Hospitals in Eastern Province, Saudi Arabia

    PubMed Central

    Mahalli, Azza El.

    2015-01-01

    Although electronic health records (EHRs) have been implemented in many hospitals and healthcare providers benefit from their effective and efficient data processing, their evaluation from nurses has received little attention. This project aimed to assess the adoption and barriers to the use of an EHR system by nurses at three governmental hospitals implementing the same EHR software and functionalities in Eastern Province, Saudi Arabia. The study was a cross-sectional, paper-based questionnaire study. SPSS version 20 was used for data entry and analysis, and descriptive statistics were calculated. The study found underutilization of almost all functionalities among all hospitals and no utilization of any communication tools with patients. In addition, there were no instances of “allowing patients to use the Internet to access parts of their health records.” The most frequently cited barrier among all hospitals was “loss of access to medical records transiently if computer crashes or power fails” (88.6 percent). This was followed by “lack of continuous training/ support from information technology staff in hospital” (85.9 percent), “additional time required for data entry” (84.9 percent), and “system hanging up problem” (83.8 percent). Complexity of technology (81.6 percent) and lack of system customizability (81.1 percent) were also frequently reported problems. The formation of an EHR committee to discuss problems with the system in Saudi hospitals is recommended. PMID:26604875

  4. [Social representations by health professionals of sexual violence against women: a study in three municipal public maternity hospitals in Rio de Janeiro, Brazil].

    PubMed

    Cavalcanti, Ludmila Fontenele; Gomes, Romeu; Minayo, Maria Cecília de Souza

    2006-01-01

    The purpose of this study was to analyze social representations of sexual violence against women, as constructed and reproduced in prenatal care settings in three municipal maternity hospitals in Rio de Janeiro, Brazil. This qualitative research explored two themes: ideas about and explanations of sexual violence committed against woman. The forty-five interviews conducted with health professionals were examined using thematic content analysis. The results show that social representations of sexual violence against women were associated with ideas of suffering, behavioral disturbances, and forced sexual intercourse. The explanations offered for why this type of violence occurs included gender relations, urban violence, and ascription of blame to the victim. It can be concluded that hegemonic patterns of asymmetrical relations persist, even in the discourse of maternity health professionals, who are the point of reference for attending to victims of sexual violence. Incorporating the analytical category of gender into healthcare professional training could make prenatal care an important gateway for the recognition and management of sexual violence against women. PMID:16470280

  5. Hospitalizations of Infants and Young Children with Down Syndrome: Evidence from Inpatient Person-Records from a Statewide Administrative Database

    ERIC Educational Resources Information Center

    So, S. A.; Urbano, R. C.; Hodapp, R. M.

    2007-01-01

    Background: Although individuals with Down syndrome are increasingly living into the adult years, infants and young children with the syndrome continue to be at increased risk for health problems. Using linked, statewide administrative hospital discharge records of all infants with Down syndrome born over a 3-year period, this study "follows…

  6. High Hospitalization Rates in Survivors of Childhood Cancer: A Longitudinal Follow-Up Study Using Medical Record Linkage

    PubMed Central

    Sieswerda, Elske; Font-Gonzalez, Anna; Reitsma, Johannes B.; Dijkgraaf, Marcel G. W.; Heinen, Richard C.; Jaspers, Monique W.; van der Pal, Helena J.; van Leeuwen, Flora E.; Caron, Huib N.

    2016-01-01

    Hospitalization rates over time of childhood cancer survivors (CCS) provide insight into the burden of unfavorable health conditions on CCS and health care resources. The objective of our study was to examine trends in hospitalizations of CCS and risk factors in comparison with the general population. We performed a medical record linkage study of a cohort of 1564 ≥five-year CCS with national registers. We obtained a random sample of the general population matched on year of birth, gender and calendar year per CCS retrieved. We quantified and compared hospitalization rates of CCS and reference persons from 1995 until 2005, and we analyzed risk factors for hospitalization within the CCS cohort with multivariable Poisson models. We retrieved hospitalization information from 1382 CCS and 25583 reference persons. The overall relative hospitalization rate (RHR) was 2.2 (95%CI:1.9–2.5) for CCS compared to reference persons. CCS with central nervous system and solid tumors had highest RHRs. Hospitalization rates in CCS were increased compared to reference persons up to at least 30 years after primary diagnosis, with highest rates 5–10 and 20–30 years after primary cancer. RHRs were highest for hospitalizations due to neoplasms (10.7; 95%CI:7.1–16.3) and endocrine/nutritional/metabolic disorders (7.3; 95%CI:4.6–11.7). Female gender (P<0.001), radiotherapy to head and/or neck (P<0.001) or thorax and/or abdomen (P = 0.03) and surgery (P = 0.01) were associated with higher hospitalization rates in CCS. In conclusion, CCS have increased hospitalization rates compared to the general population, up to at least 30 years after primary cancer treatment. These findings imply a high and long-term burden of unfavorable health conditions after childhood cancer on survivors and health care resources. PMID:27433937

  7. Establishing a Personal Health Record System in an Academic Hospital: One Year's Experience

    PubMed Central

    Ro, Hyun Jung; Jung, Se Young; Hwang, Hee; Yoo, Sooyoung; Baek, Hyunyoung; Lee, Kiheon; Bae, Woo Kyung; Han, Jong-Soo; Kim, Sarah; Park, Hwayeon

    2015-01-01

    Background Personal health records (PHRs) are web based tools that help people to access and manage their personalized medical information. Although needs for PHR are increasing, current serviced PHRs are unsatisfactory and researches on them remain limited. The purpose of this study is to show the process of developing Seoul National University Bundang Hospital (SNUBH)'s own PHR system and to analyze consumer's use pattern after providing PHR service. Methods Task force team was organized to decide service range and set the program. They made the system available on both mobile application and internet web page. The study enrolled PHR consumers who assessed PHR system between June 2013 and June 2014. We analyzed the total number of users on a monthly basis and the using pattern according to each component. Results The PHR service named Health4U has been provided from June 2013. Every patient who visited SNUBH could register Health4U service and view their medical data. The PHR user has been increasing, especially they tend to approach via one way of either web page or mobile application. The most frequently used service is to check laboratory test result. Conclusion For paradigm shift toward patient-centered care, there is a growing interest in PHR. This study about experience of establishing and servicing the Health4U would contribute to development of interconnected PHR. PMID:26019761

  8. Signs of the 2009 Influenza Pandemic in the New York-Presbyterian Hospital Electronic Health Records

    PubMed Central

    Khiabanian, Hossein; Holmes, Antony B.; Kelly, Brendan J.; Gururaj, Mrinalini; Hripcsak, George; Rabadan, Raul

    2010-01-01

    Background In June of 2009, the World Health Organization declared the first influenza pandemic of the 21st century, and by July, New York City's New York-Presbyterian Hospital (NYPH) experienced a heavy burden of cases, attributable to a novel strain of the virus (H1N1pdm). Methods and Results We present the signs in the NYPH electronic health records (EHR) that distinguished the 2009 pandemic from previous seasonal influenza outbreaks via various statistical analyses. These signs include (1) an increase in the number of patients diagnosed with influenza, (2) a preponderance of influenza diagnoses outside of the normal flu season, and (3) marked vaccine failure. The NYPH EHR also reveals distinct age distributions of patients affected by seasonal influenza and the pandemic strain, and via available longitudinal data, suggests that the two may be associated with distinct sets of comorbid conditions as well. In particular, we find significantly more pandemic flu patients with diagnoses associated with asthma and underlying lung disease. We further observe that the NYPH EHR is capable of tracking diseases at a resolution as high as particular zip codes in New York City. Conclusion The NYPH EHR permits early detection of pandemic influenza and hypothesis generation via identification of those significantly associated illnesses. As data standards develop and databases expand, EHRs will contribute more and more to disease detection and the discovery of novel disease associations. PMID:20844592

  9. The association between bankruptcy and hospital-presenting attempted suicide: a record linkage study.

    PubMed

    Kidger, Judi; Gunnell, David; Jarvik, Jeffrey G; Overstreet, Karen A; Hollingworth, William

    2011-12-01

    The associations between admissions to an emergency department following attempted suicide and personal bankruptcy in the preceding and subsequent 2 years were evaluated. Records from a level 1 trauma center (June 1993-December 2002) in Seattle, WA, were linked with case files from the local U.S. District Bankruptcy Court (June 1991 onward). Univariable and multivariable logistic regression models were used to examine the risk of bankruptcy in (i) the 2 years after and (ii) the 2 years before a suicide attempt using a violent method, compared to patients admitted for any other reason. After adjusting for several confounders, patients who had attempted suicide were more likely than other patients to experience bankruptcy in the following 2 years (OR = 2.10, 95% CIs: 1.29, 3.42). A somewhat weaker association was seen with bankruptcy in the preceding 2 years (OR = 1.68, 95% CIs 1.06; 2.67). Attempted suicide is therefore associated with bankruptcy in the preceding and following 2 years. Changes to legislation, improved mental health counselling for those in financial difficulty, and provision of financial advice to those admitted to hospital following a suicide attempt may reduce future cases of serious self-harm and completed suicide. PMID:22145826

  10. [Audit as a tool to assess and promote the quality of medical records and hospital appropriateness: metodology and preliminary results].

    PubMed

    Poscia, Andrea; Cambieri, Andrea; Tucceri, Chiara; Ricciardi, Walter; Volpe, Massimo

    2015-01-01

    In the actual economic context, with increasing health needs, efficiency and efficacy represents fundamental keyword to ensure a successful use of the resources and the best health outcomes. Together, the medical record, completely and correctly compiled, is an essential tool in the patient diagnostic and therapeutic path, but it's becoming more and more essential for the administrative reporting and legal claims. Nevertheless, even if the improvement of medical records quality and of hospital stay appropriateness represent priorities for every health organization, they could be difficult to realize. This study aims to present the methodology and the preliminary results of a training and improvement process: it was carried out from the Hospital Management of a third level Italian teaching hospital through audit cycles to actively involve their health professionals. A self assessment process of medical records quality and hospital stay appropriateness (inpatients admission and Day Hospital) was conducted through a retrospective evaluation of medical records. It started in 2012 and a random sample of 2295 medical records was examined: the quality assessment was performed using a 48-item evaluation grid modified from the Lombardy Region manual of the medical record, while the appropriateness of each days was assessed using the Italian version of Appropriateness Evaluation Protocol (AEP) - 2002ed. The overall assessment was presented through departmental audit: the audit were designed according to the indication given by the Italian and English Ministry of Health to share the methodology and the results with all the involved professionals (doctors and nurses) and to implement improvement strategies that are synthesized in this paper. Results from quality and appropriateness assessment show several deficiencies, due to 40% of minimum level of acceptability not completely satisfied and to 30% of inappropriateness between days of hospitalization. Furthermore, there are

  11. Health care professionals’ pain narratives in hospitalized children’s medical records. Part 2: Structure and content

    PubMed Central

    Rashotte, Judy; Harrison, Denise; Coburn, Geraldine; Yamada, Janet; Stevens, Bonnie J

    2013-01-01

    BACKGROUND: Although clinical narratives – described as free-text notations – have been noted to be a source of patient information, no studies have examined the composition of pain narratives in hospitalized children’s medical records. OBJECTIVES: To describe the structure and content of health care professionals’ narratives related to hospitalized children’s acute pain. METHODS: All pain narratives documented during a 24 h period were collected from the medical records of 3822 children (0 to 18 years of age) hospitalized in 32 inpatient units in eight Canadian pediatric hospitals. A qualitative descriptive exploration using a content analysis approach was performed. RESULTS: Three major structural elements with their respective categories and subcategories were identified: information sources, including clinician, patient, parent, dual and unknown; compositional archetypes, including baseline pain status, intermittent pain updates, single events, pain summation and pain management plan; and content, including pain declaration, pain assessment, pain intervention and multidimensional elements of care. CONCLUSIONS: The present qualitative analysis revealed the multidimensionality of structure and content that was used to document hospitalized children’s acute pain. The findings have the potential to inform debate on whether the multidimensionality of pain narratives’ composition is a desirable feature of documentation and how narratives can be refined and improved. There is potential for further investigation into how health care professionals’ pain narratives could have a role in generating guidelines for best pain documentation practice beyond numerical representations of pain intensity. PMID:24093123

  12. [Local communalization of clinical records between the municipal community hospital and local medical institutes by using information technology].

    PubMed

    Iijima, Shohei; Shinoki, Keiji; Ibata, Takeshi; Nakashita, Chisako; Doi, Seiko; Hidaka, Kumi; Hata, Akiko; Matsuoka, Mio; Waguchi, Hideko; Mito, Saori; Komuro, Ryutaro

    2012-12-01

    We introduced the electronic health record system in 2002. We produced a community medical network system to consolidate all medical treatment information from the local institute in 2010. Here, we report on the present status of this system that has been in use for the previous 2 years. We obtained a private server, set up a virtual private network(VPN)in our hospital, and installed dedicated terminals to issue an electronic certificate in 50 local institutions. The local institute applies for patient agreement in the community hospital(hospital designation style). They are then entitled to access the information of the designated patient via this local network server for one year. They can access each original medical record, sorted on the basis of the medical attendant and the chief physician; a summary of hospital stay; records of medication prescription; and the results of clinical examinations. Currently, there are approximately 80 new registrations and accesses per month. Information is provided in real time allowing up to date information, helping prescribe the medical treatment at the local institute. However, this information sharing system is read-only, and there is no cooperative clinical pass system. Therefore, this system has a limit to meet the demand for cooperation with the local clinics. PMID:23268886

  13. Following Up Crack Users after Hospital Discharge Using Record Linkage Methodology: An Alternative to Find Hidden Populations

    PubMed Central

    Gonçalves, Veralice Maria; Pedroso, Rosemeri; dos Santos, Antônio Marcos; Diemen, Lisia Von; Pechansky, Flavio

    2015-01-01

    This paper presents the probabilistic record linkage (PRL) methodology as an alternative way to find or follow up hard-to-reach population as crack users. PRL was based on secondary data from public health information systems and the strategy used from standardization; phonetic encoding and the rounds of matching data were described. A total of 293 patient records from medical database and two administrative datasets obtained from Ministry of Health Information Systems were used. Patient information from the medical database was the identifiers to the administrative datasets containing data on outpatient treatment and hospital admissions. 40% of patient records were found in the hospital database and 12% were found in the outpatient database; 95% of the patients were hospitalized up to 5 times, and only 10 out of them had outpatient information. The record linkage methodology by linking government databases may help to address research questions about the path of patients in the care network without spending time and financial resources with primary data collection. PMID:26425565

  14. Evaluation of organizational maturity based on people capacity maturity model in medical record wards of Iranian hospitals

    PubMed Central

    Yarmohammadian, Mohammad H.; Tavakoli, Nahid; Shams, Assadollah; Hatampour, Farzaneh

    2014-01-01

    Context: People capacity maturity model (PCMM) is one of the models which focus on improving organizational human capabilities. Aims: The aim of this model's application is to increase people ability to attract, develop, motivate, organize and retain the talents needed to organizational continuous improvement. Settings and Design: In this study, we used the PCMM for investigation of organizational maturity level in medical record departments of governmental hospitals and determination strengths and weaknesses of their staff capabilities. Materials and Methods: This is an applied research and cross sectional study in which data were collected by questionnaires to investigation of PCMM model needs in medical record staff of governmental hospitals at Isfahan, Iran. We used the questionnaire which has been extracted from PCMM model and approved its reliability with Cronbach's Alpha 0.96. Statistical Analysis Used: Data collected by the questionnaire was analyzed based on the research objectives using SPSS software and in accordance with research questions descriptive statistics were used. Results: Our findings showed that the mean score of medical record practitioners, skill and capability in governmental hospitals was 35 (62.5%) from maximum 56 (100%). There is no significant relevance between organizational maturity and medical record practitioners, attributes. Conclusions: Applying PCMM model is caused increasing staff and manager attention in identifying the weaknesses in the current activities and practices, so it will result in improvement and developing processes. PMID:25077147

  15. The PEN & PAD medical record model: development of a nursing record for hospital-based care of the elderly.

    PubMed

    Heathfield, H A; Hardiker, N; Kirby, J; Tallis, R; Gonsalkarale, M

    1994-12-01

    The PEN & PAD Medical Record model describes a framework for an information model, designed to meet the requirements of an electronic medical record. This model has been successfully tested in a computer-based record system for General Practitioners as part of the PEN & PAD (GP) Project. Experiences of using the model for developing computer-based nursing records are reported. Results show that there are some problems with directly applying the model to the nursing domain. Whilst the main purpose of the nursing record is to document and communicate a patient's care, it has several other, possibly incompatible, roles. Furthermore, the structure and content of the information contained within the nursing record is heavily influenced by the need for the nursing profession to visibly demonstrate the philosophical frameworks underlying their work. By providing new insights into the professional background of nursing records, this work had highlighted the need for nurses to clarify and make explicit their uses of information, and also provided them with some tools to assist in this task. PMID:7869943

  16. Cost-Benefit Analysis of Electronic Medical Record System at a Tertiary Care Hospital

    PubMed Central

    Choi, Jong Soo; Lee, Woo Baik

    2013-01-01

    Objectives Although Electronic Medical Record (EMR) systems provide various benefits, there are both advantages and disadvantages regarding its cost-effectiveness. This study analyzed the economic effects of EMR systems using a cost-benefit analysis based on the differential costs of managerial accounting. Methods Samsung Medical Center (SMC) is a general hospital in Korea that developed an EMR system for outpatients from 2006 to 2008. This study measured the total costs and benefits during an 8-year period after EMR adoption. The costs include the system costs of building the EMR and the costs incurred in smoothing its adoption. The benefits included cost reductions after its adoption and additional revenues from both remodeling of paper-chart storage areas and medical transcriptionists' contribution. The measured amounts were discounted by SMC's expected interest rate to calculate the net present value (NPV), benefit-cost ratio (BCR), and discounted payback period (DPP). Results During the analysis period, the cumulative NPV and the BCR were US$3,617 thousand and 1.23, respectively. The DPP was about 6.18 years. Conclusions Although the adoption of an EMR resulted in overall growth in administrative costs, it is cost-effective since the cumulative NPV was positive. The positive NPV was attributed to both cost reductions and additional revenues. EMR adoption is not so attractive to management in that the DPP is longer than 5 years at 6.18 and the BCR is near 1 at 1.23. However, an EMR is a worthwhile investment, seeing that this study did not include any qualitative benefits and that the paper-chart system was cost-centric. PMID:24175119

  17. Referrals to integrative medicine in a tertiary hospital: findings from electronic health record data and qualitative interviews

    PubMed Central

    Griffin, Kristen H; Rivard, Rachael L; Christianson, Jon B; Dusek, Jeffery A

    2016-01-01

    Objective To examine patterns of, and decision-making processes, informing referrals for inpatient access to integrative medicine (IM) services at a large, acute care hospital. Design Retrospective electronic health record review and structured qualitative interviews. Setting A 630-bed tertiary care hospital with an IM service available to inpatients. Participants IM referrals of all inpatients aged ≥18 years between July 2012 and December 2014 were identified using the hospital's electronic health record. Fifteen physicians, 15 nurses and 7 administrators were interviewed to better understand roles and perspectives in referring patients for IM services. Results In the study hospital, primary sources of referrals for IM services were the orthopaedic and neuroscience/spine service lines. While the largest absolute number of IM referrals was made for patients with lengths of stay of 3 days or fewer, a disproportionate number of total IM referrals was made for patients with long lengths of stay (≥10 days), compared with a smaller percentage of patients in the hospital with lengths of stay ≥10 days. Physicians and nurses were more likely to refer patients who displayed strong symptoms (eg, pain and anxiety) and/or did not respond to conventional therapies. IM referrals were predominantly nurse-initiated. A built-in delay in the time from referral initiation to service delivery discouraged referrals of some patients. Conclusions Conventional providers refer patients for IM services when these services are available in a tertiary hospital. Referral patterns are influenced by patient characteristics, operational features and provider perspectives. Nurses play a key role in the referral process. Overcoming cultural and knowledge differences between conventional and IM providers is likely to be a continuing challenge to providing IM in inpatient settings. PMID:27456330

  18. Screening for atrial fibrillation with baseline and intermittent ECG recording in an out-of-hospital population

    PubMed Central

    2013-01-01

    Background the objective of this study is to investigate the detection rate of undiagnosed atrial fibrillation (AF) with short intermittent ECG recordings during four weeks among out-of-hospital patients, having at least one additional risk factor (CHADS2) for stroke. Method Design: Cross-sectional study. Setting: Eight family practice centres and two hospital-based out-patient clinics in Sweden. Subjects: 989 out-of-hospital patients, without known AF, having one or more risk factors associated with stroke (CHADS2). Interventions: All individuals were asked to perform 10-second handheld ECG recordings during 28 days, twice daily and when having palpitations. Main outcome measures: Episodes of AF on handheld ECG recordings were defined as irregular supraventricular extrasystoles in series with a duration of 10 seconds. Results 928 patients completed registration. AF was found in 35 of 928 patients; 3.8% (95% confidence interval [CI] 2.7–5.2). These 35 patients had a mean age of 70.7 years (SD ± 7.7; range 53–85) and a median CHADS2 of 2 (range 1–4). Conclusions Intermittent handheld ECG recording over a four week period had a detection rate of 3.8% newly diagnosed AF, in a population of 928 out-of-hospital patients having at least one additional risk factor for stroke. Intermittent handheld ECG registration is a feasible method to detect AF in patients with an increased risk of stroke in whom oral anticoagulation (OAC) treatment is indicated. PMID:23758799

  19. Maternal mortality in Sirur.

    PubMed

    Shrotri, A; Pratinidhi, A; Shah, U

    1990-01-01

    The research aim was 1) to determine the incidence of maternal mortality in a rural health center area in Sirur, Maharashtra state, India; 2) to determine the relative risk; and 3) to make suggestions about reducing maternal mortality. The data on deliveries was obtained between 1981 and 1984. Medical care at the Rural Training Center was supervised by the Department of Preventive and Social Medicine, the B.J. Medical College in Pune. Deliveries numbered 5994 singleton births over the four years; 5919 births were live births. 15 mothers died: 14 after delivery and 1 predelivery. The maternal mortality rate was 2.5/1000 live births. The maternal causes of death included 9 direct obstetric causes, 3 from postpartum hemorrhage of anemic women, and 3 from puerperal sepsis of anemic women with prolonged labor. 2 deaths were due to eclampsia, and 1 death was unexplained. There were 5 (33.3%) maternal deaths due to indirect causes (3 from hepatitis and 2 from thrombosis). One woman died of undetermined causes. Maternal jaundice during pregnancy was associated with the highest relative risk of maternal death: 106.4. Other relative risk factors were edema, anemia, and prolonged labor. Attributable risk was highest for anemia, followed by jaundice, edema, and maternal age of over 30 years. Maternal mortality at 30 years and older was 3.9/1000 live births. Teenage maternal mortality was 3.3/1000. Maternal mortality among women 20-29 years old was lowest at 2.1/1000. Maternal mortality for women with a parity of 5 or higher was 3.6/1000. Prima gravida women had a maternal mortality rate of 2.9/1000. Parities between 1 and 4 had a maternal mortality rate of 2.3/1000. The lowest maternal mortality was at parity of 3. Only 1 woman who died had received more than 3 prenatal visits. 11 out of 13 women medically examined prenatally were identified with the following risk factors: jaundice, edema, anemia, young or old maternal age, parity, or poor obstetric history. The local

  20. Pharmacological Prophylaxis for Venous Thromboembolism Among Hospitalized Patients With Acute Medical Illness: An Electronic Medical Records Study.

    PubMed

    Rosenman, Marc; Liu, Xianchen; Phatak, Hemant; Qi, Rong; Teal, Evgenia; Nisi, Daniel; Liu, Larry Z; Ramacciotti, Eduardo

    2016-01-01

    Patients hospitalized with acute medical illness have an elevated risk of venous thromboembolism (VTE). American College of Chest Physicians guidelines list various chronic illnesses, sepsis, advanced age, history of VTE, and immobility as risk factors and recommend prophylactic anticoagulation using fondaparinux, low-molecular weight heparin, or low-dose unfractionated heparin. The objectives of this study were to examine pharmacological prophylaxis against VTE among hospitalized medically ill patients and to assess demographic and clinical correlates related to VTE prophylaxis. A retrospective (1999-2010) electronic medical records study included patients aged 40 years and older hospitalized for at least 3 days, with significant medical illness or with a VTE hospitalization 30-365 days before admission. Each patient's first qualifying hospitalization was analyzed. Exclusions were if VTE treatment was started within 1 day of admission, or if warfarin (and not heparin or enoxaparin) was used. Prophylaxis was defined if the first inpatient dose of subcutaneous heparin or enoxaparin was at prophylaxis levels (lower than treatment levels). Multivariable logistic regression was used to examine factors associated with VTE prophylaxis. Among 12,980 patients, 22.1% received prophylaxis (11.8% with enoxaparin, 10.3% with heparin). VTE prophylaxis was positively associated with year of hospitalization, subcutaneous heparin in the month before admission, aspirin, self-pay status, age, and sepsis. VTE prophylaxis was negatively associated with smoking, alcohol, warfarin in the past 30 days, and primary diagnoses of stroke, infectious disease, or inflammatory bowel disease. Pharmacological VTE prophylaxis has increased significantly over the past 12 years but is still largely underused in patients hospitalized with acute medical illness. Multiple demographic, behavioral, and clinical factors are associated with inpatient VTE prophylaxis. PMID:26720163

  1. [New data on maternal mortality in India].

    PubMed

    Bhatia, J C

    1990-01-01

    A survey was carried out in urban and rural areas of the district of Anantapur, Andhra Pradesh state, India, between July 1, 1984-June 30, 1985 by a team of 6 interviewers and 1 supervisor to identify investigate, and study the causative factors/characteristics of the causes of maternal deaths. They visited each of the 15 hospitals in the district collecting information about maternal deaths that occurred in the reproductive age range of 15-49 years. 22 health centers and 50% of subcenters were also visited, registers were examined, and staff and families were also interviewed. The hospitals and centers served 569,500 people. During the 1st phase in the rural area all main village centers, 181 village subcenters, and 1192 other villages in the district with a total population of 1,090,640 were covered. During the 2nd phase all towns in the urban zones, 10 primary centers, 65 subcenters, and 135 others were visited. The maternal mortality rate was 7.9/1000 live births, well above the national average. 36% of female mortality occurred in women in reproductive age, but fewer than 1/2 of these deaths were registered and only 1/3 figured in center and subcenter records. In rural areas maternal mortality was 8.3/1000, ahead of the urban rate of 5.4/1000. 63% of 284 deaths detailed were related to live births, 14% to stillbirths, 10% to abortions, and 13% to obstructed labor. 19% of total maternal deaths occurred before birth, 12% during labor, and 69% after delivery. Among clinical causes of death sepsis accounted for 36%, hemorrhage for 12%, eclampsia for 9%, retention of placenta for 7%, and infectious hepatitis for 10%. 80% of these deaths could have been avoided by timely antenatal care, treatment of previous complaints, and medical attention and hospitalization at the right time. PMID:12179349

  2. Documentation of Medical Records in Hospitals of Mazandaran University of Medical Sciences in 2014: a Quantitative Study

    PubMed Central

    Saravi, Benyamin Mohseni; Asgari, Zolaykha; Siamian, Hasan; Farahabadi, Ebrahim Bagherian; Gorji, Alimorad Heidari; Motamed, Nima; Fallahkharyeki, Mohammad; Mohammadi, Ramin

    2016-01-01

    Introduction: Documentation of patient care in medical record formats is always emphasized. These documents are used as a means to go on treating the patients, staff in their own defense, assessment, care, any legal proceedings and medical science education. Therefore, in this study, each of the data elements available in patients’ records are important and filling them indicates the importance put by the documenting teams, so it has been dealt with the documentation the patient records in the hospitals of Mazandaran province. Method: This cross-sectional study aimed to review medical records in 16 hospitals of Mazandaran University of Medical Sciences (MazUMS). In order to collection data, a check list was prepared based on the data elements including four forms of the admission, summary, patients’ medical history and progress note. The data recording was defined as “Yes” with the value of 1, lack of recording was defined as “No” with the value of 2, and “Not applied” with the value of 0 for the cases in which the mentioned variable medical records are not applied. Results: The overall evaluation of the documentation was considered as 95-100% equal to “good”, 75-94% equal to “average” and below -75% equal to “poor”. Using the stratified random sample volume formula, 381 cases were reviewed. The data were analyzed by the SPSS version 19 and descriptive statistics. Results: The results showed that %62 of registration and all the four forms were in the “poor” category. There was no big difference in average registration among the hospitals. Among the educational groups Gynecology and Infectious were equal and had the highest average of documentation of %68. In the data categories, the highest documentation average belonged to the verification, %91. Conclusion: According to the overall assessment in which the rate of documentation was in the category “week”, we should make much more efforts to reach better conditions. Even if a data

  3. BMI upon discharge from hospital and its relationship with survival: an observational study utilising linked patient records

    PubMed Central

    Ray, Daniel; Falcaro, Milena; McNulty, David; Shallcross, Laura; Wood, John; Pagano, Domenico

    2016-01-01

    Objective Current advice for patients being discharged from hospital suggests a body mass index of 18.5 to 24 kgm−2, although this aspirational target may often not be achieved. We examined the relationship between body mass index on discharge from hospital and subsequent mortality over a maximum follow-up of 3.8 years. Design We conducted a survival analysis using linked hospital records data with national hospital episode statistics and national death certification data. Participants & Setting The analysis included adult patients who were admitted to University Hospitals Birmingham NHS Foundation Trust for a period of over 24 h during 2011, excluding day cases and regular day case attenders. Main outcome measures The relationship between body mass index and mortality at medium term was estimated separately in both men and women, after accounting for case-mix. Results For both males and females, the relationship between body mass index at discharge and the loge hazard of death was strongly non-linear (p = 0.0002 for females and p < 0.0001 for males) and predictive (both p < 0.0001). In all models, the optimal body mass index range associated with best survival was 25 to 35 kgm−2, with a sharp increase in risk for lower body mass index. Conclusions There was little evidence to support current aspirational body mass index targets in the discharge population. Hospitals should ensure adequate nutrition especially among those with a reduced body mass index. PMID:27053359

  4. Containing Ontario's hospital costs under universal insurance in the 1980s: what was the record?

    PubMed

    Detsky, A S; O'Rourke, K; Naylor, C D; Stacey, S R; Kitchens, J M

    1990-03-15

    In recent years the Ontario government has been concerned that the proportion of public expenditures devoted to health care is at an all-time high. In addition, the media have devoted considerable attention to specific incidents that may represent inadequate funding of hospital services. To shed light on the debate on health care expenditures we analysed the trend in expenditures of Ontario's hospital sector in the 1980s in terms of the amount of inputs (e.g., labour) used to produce hospital services (e.g., a patient-day or admission) and after adjustment for general inflation. As in the 1970s the number of inputs grew relatively slowly during the 1980s. Inputs per patient-day grew at an annual rate of 0.46% and inputs per admission at an annual rate of 2.4%. Cost increases were largely accounted for by hospital wage increases; this could have been due to Ontario's rapidly expanding economy. These findings indicate that Ontario has continued to be successful in containing the number of inputs used in the hospital sector. However, after two decades of substantial success with publicly acceptable cost control, the government faces increased scrutiny as the media and the public focus attention on several areas of perceived inadequate funding in health care services. PMID:2107020

  5. Classification of hospital acquired complications using temporal clinical information from a large electronic health record.

    PubMed

    Warner, Jeremy L; Zhang, Peijin; Liu, Jenny; Alterovitz, Gil

    2016-02-01

    Hospital acquired complications (HACs) are serious problems affecting modern day healthcare institutions. It is estimated that HACs result in an approximately 10% increase in total inpatient hospital costs across US hospitals. With US hospital spending totaling nearly $900 billion per annum, the damages caused by HACs are no small matter. Early detection and prevention of HACs could greatly reduce strains on the US healthcare system and improve patient morbidity & mortality rates. Here, we describe a machine-learning model for predicting the occurrence of HACs within five distinct categories using temporal clinical data. Using our approach, we find that at least $10 billion of excessive hospital costs could be saved in the US alone, with the institution of effective preventive measures. In addition, we also identify several keystone features that demonstrate high predictive power for HACs over different time periods following patient admission. The classifiers and features analyzed in this study show high promise of being able to be used for accurate prediction of HACs in clinical settings, and furthermore provide novel insights into the contribution of various clinical factors to the risk of developing HACs as a function of healthcare system exposure. PMID:26707449

  6. Maternal oral health status and preterm low birth weight at Muhimbili National Hospital, Tanzania: a case-control study

    PubMed Central

    Mumghamba, Elifuraha GS; Manji, Karim P

    2007-01-01

    Background The study examined the relationship between oral health status (periodontal disease and carious pulpal exposure (CPE)) and preterm low-birth-weight (PTLBW) infant deliveries among Tanzanian-African mothers at Muhimbili National Hospital (MNH), Tanzania. Methods A retrospective case-control study was conducted, involving 373 postpartum mothers aged 14–44 years (PTLBW – 150 cases) and at term normal-birth-weight (TNBW) – 223 controls), using structured questionnaire and full-mouth examination for periodontal and dentition status. Results The mean number of sites with gingival bleeding was higher in PTLBW than in TNBW (P = 0.026). No significant differences were observed for sites with plaque, calculus, teeth with decay, missing, filling (DMFT) between PTLBW and TNBW. Controlling for known risk factors in all post-partum (n = 373), and primiparaous (n = 206) mothers, no significant differences were found regarding periodontal disease diagnosis threshold (PDT) (four sites or more that had probing periodontal pocket depth 4+mm and gingival bleeding ≥ 30% sites), and CPE between cases and controls. Significant risk factors for PTLBW among primi- and multiparous mothers together were age ≤ 19 years (adjusted Odds Ratio (aOR) = 2.09, 95% Confidence interval (95% CI): 1.18 – 3.67, P = 0.011), hypertension (aOR = 2.44, (95% CI): 1.20 – 4.93, P = 0.013) and being un-married (aOR = 1.59, (95% CI): 1.00 – 2.53, P = 0.049). For primiparous mothers significant risk factors for PTLBW were age ≤ 19 years (aOR = 2.07, 95% CI: 1.13 – 3.81, P = 0.019), and being un-married (aOR = 2.58, 95% CI: 1.42 – 4.67, P = 0.002). Conclusions These clinical findings show no evidence for periodontal disease or carious pulpal exposure being significant risk factors in PTLBW infant delivery among Tanzanian-Africans mothers at MNH, except for young age, hypertension, and being unmarried. Further research incorporating periodontal pathogens is recommended. PMID:17594498

  7. A Qualitative Exploration of Workarounds Related to the Implementation of National Electronic Health Records in Early Adopter Mental Health Hospitals

    PubMed Central

    Ser, Gloria; Robertson, Ann; Sheikh, Aziz

    2014-01-01

    Aims To investigate the perceptions and reported practices of mental health hospital staff using national hospital electronic health records (EHRs) in order to inform future implementations, particularly in acute mental health settings. Methods Thematic analysis of interviews with a wide range of clinical, information technology (IT), managerial and other staff at two early adopter mental health National Health Service (NHS) hospitals in London, UK, implementing national EHRs. Results We analysed 33 interviews. We first sought out examples of workarounds, such as delayed data entry, entering data in wrong places and individuals using the EHR while logged in as a colleague, then identified possible reasons for the reported workarounds. Our analysis identified four main categories of factors contributing to workarounds (i.e., operational, cultural, organisational and technical). Operational factors included poor system integration with existing workflows and the system not meeting users' perceived needs. Cultural factors involved users' competence with IT and resistance to change. Organisational factors referred to insufficient organisational resources and training, while technical factors included inadequate local technical infrastructure. Many of these factors, such as integrating the EHR system with day-to-day operational processes, staff training and adequate local IT infrastructure, were likely to apply to system implementations in various settings, but we also identified factors that related particularly to implementing EHRs in mental health hospitals, for example: EHR system incompatibility with IT systems used by mental health–related sectors, notably social services; the EHR system lacking specific, mental health functionalities and options; and clinicians feeling unable to use computers while attending to distressed psychiatric patients. Conclusions A better conceptual model of reasons for workarounds should help with designing, and supporting the

  8. Electronic Medical Record-Based Predictive Model for Acute Kidney Injury in an Acute Care Hospital.

    PubMed

    Laszczyńska, Olga; Severo, Milton; Azevedo, Ana

    2016-01-01

    Patients with acute kidney injury (AKI) are at risk for increased morbidity and mortality. Lack of specific treatment has meant that efforts have focused on early diagnosis and timely treatment. Advanced algorithms for clinical assistance including AKI prediction models have potential to provide accurate risk estimates. In this project, we aim to provide a clinical decision supporting system (CDSS) based on a self-learning predictive model for AKI in patients of an acute care hospital. Data of all in-patient episodes in adults admitted will be analysed using "data mining" techniques to build a prediction model. The subsequent machine-learning process including two algorithms for data stream and concept drift will refine the predictive ability of the model. Simulation studies on the model will be used to quantify the expected impact of several scenarios of change in factors that influence AKI incidence. The proposed dynamic CDSS will apply to future in-hospital AKI surveillance in clinical practice. PMID:27577501

  9. Which clinical scenarios do surgeons record as complications? A benchmarking study of seven hospitals

    PubMed Central

    Visser, Annelies; Ubbink, Dirk T; Gouma, Dirk J; Goslings, J Carel

    2015-01-01

    Objectives To investigate agreement and potential differences in the application and interpretation of the definition among surgical departments of various hospitals. Design 24 cases were formulated including general, trauma, gastrointestinal and vascular surgery, and based on points of discussion about the definition and ambiguities regarding complication registration as encountered in daily practice. The cases were presented to the surgical staff and residents in seven Dutch hospitals, using the national registration system of complications and an electronic response system. Results In total, 134 participants responded. Interpretation differences were particularly found regarding: (1) complications considered as logical consequences of a surgical procedure; (2) complications occurring after radiological interventions; (3) severity criteria such as when to consider a complication as a ‘(probably) permanent damage or function loss’; (4) registering a cancelled operation as a complication and (5) patients with serial complications during hospital stay. Conclusions The definition of surgical complications as currently applied in the Netherlands does not ensure a uniform complication registration. Improvement of this registration system is mandatory before benchmarking of these findings in the public domain is appropriate. Modifications of the current definition of a surgical complication, and improved consensus about specific clinical situations and training of surgeons might improve the quality of benchmarking. PMID:26033948

  10. Maternal microchimerism

    PubMed Central

    Ye, Jody; Vives-Pi, Marta; Gillespie, Kathleen M

    2014-01-01

    Increased levels of non-inherited maternal HLA alleles have been detected in the periphery of children with type 1 diabetes and an increased frequency of maternal cells have been identified in type 1 diabetes pancreas. It is now clear that the phenotype of these cells is pancreatic,1 supporting the hypothesis that maternal cells in human pancreas are derived from multipotent maternal progenitors. Here we hypothesize how increased levels of maternal cells could play a role in islet autoimmunity. PMID:25093746

  11. Sentiment Measured in Hospital Discharge Notes Is Associated with Readmission and Mortality Risk: An Electronic Health Record Study

    PubMed Central

    McCoy, Thomas H.; Castro, Victor M.; Cagan, Andrew; Roberson, Ashlee M.; Kohane, Isaac S.; Perlis, Roy H.

    2015-01-01

    Natural language processing tools allow the characterization of sentiment–that is, terms expressing positive and negative emotion–in text. Applying such tools to electronic health records may provide insight into meaningful patient or clinician features not captured in coded data alone. We performed sentiment analysis on 2,484 hospital discharge notes for 2,010 individuals from a psychiatric inpatient unit, as well as 20,859 hospital discharges for 15,011 individuals from general medical units, in a large New England health system between January 2011 and 2014. The primary measures of sentiment captured intensity of subjective positive or negative sentiment expressed in the discharge notes. Mean scores were contrasted between sociodemographic and clinical groups in mixed effects regression models. Discharge note sentiment was then examined for association with risk for readmission in Cox regression models. Discharge notes for individuals with greater medical comorbidity were modestly but significantly lower in positive sentiment among both psychiatric and general medical cohorts (p<0.001 in each). Greater positive sentiment at discharge was associated with significantly decreased risk of hospital readmission in each cohort (~12% decrease per standard deviation above the mean). Automated characterization of discharge notes in terms of sentiment identifies differences between sociodemographic groups, as well as in clinical outcomes, and is not explained by differences in diagnosis. Clinician sentiment merits investigation to understand why and how it reflects or impacts outcomes. PMID:26302085

  12. Sentiment Measured in Hospital Discharge Notes Is Associated with Readmission and Mortality Risk: An Electronic Health Record Study.

    PubMed

    McCoy, Thomas H; Castro, Victor M; Cagan, Andrew; Roberson, Ashlee M; Kohane, Isaac S; Perlis, Roy H

    2015-01-01

    Natural language processing tools allow the characterization of sentiment--that is, terms expressing positive and negative emotion--in text. Applying such tools to electronic health records may provide insight into meaningful patient or clinician features not captured in coded data alone. We performed sentiment analysis on 2,484 hospital discharge notes for 2,010 individuals from a psychiatric inpatient unit, as well as 20,859 hospital discharges for 15,011 individuals from general medical units, in a large New England health system between January 2011 and 2014. The primary measures of sentiment captured intensity of subjective positive or negative sentiment expressed in the discharge notes. Mean scores were contrasted between sociodemographic and clinical groups in mixed effects regression models. Discharge note sentiment was then examined for association with risk for readmission in Cox regression models. Discharge notes for individuals with greater medical comorbidity were modestly but significantly lower in positive sentiment among both psychiatric and general medical cohorts (p<0.001 in each). Greater positive sentiment at discharge was associated with significantly decreased risk of hospital readmission in each cohort (~12% decrease per standard deviation above the mean). Automated characterization of discharge notes in terms of sentiment identifies differences between sociodemographic groups, as well as in clinical outcomes, and is not explained by differences in diagnosis. Clinician sentiment merits investigation to understand why and how it reflects or impacts outcomes. PMID:26302085

  13. Melanoma in the Italian Population and Regional Environmental Influences: A National Retrospective Survey on 2001–2008 Hospitalization Records

    PubMed Central

    Piscitelli, Prisco; Neglia, Cosimo; Falco, Andrea; Rivezzi, Matteo; Agnello, Nadia; Argentiero, Alberto; Chitano, Giovanna; Distante, Chiara; Della Rosa, Giulia; Vinci, Giorgia; De Donno, Antonella; Distante, Alessandro; Romanini, Antonella

    2015-01-01

    Objective: To assess the burden of regional environmental factors influencing the incidence of Melanoma in the Italian population and overcome the problem of partial population coverage by local cancer registries and thematic archives. Methods: We analyzed the Italian national hospitalization records from 2001 to 2008 provided by the Ministry of Health, excluding hospital re-admissions of the same patients, in order to assess the occurrence of Melanoma over a 8-year period. Data were presented by age groups (absolute number of cases from 20 to ≥80 years old) and per Region (rates per 100,000 inhabitants) for each year. Results: The overall number of new hospitalizations due to malignant Melanoma increased by 16.8% from 2001 (n = 4846) to 2008 (n = 5823), with the rate per 100,000 inhabitants passing from 10.5 to almost 12.0 at a national level. The majority of new diagnoses of malignant Melanoma was observed in two age groups: 61–70 years old (from 979 in 2001 up to 1209 in 2008, corresponding to 15.1 and 18.1 new cases per 100,000 inhabitants, respectively) and 71–80 years old (from 954 in 2001 up to 1141 in 2008, corresponding to 19.5 and 21.8 new cases per 100,000 inhabitants, respectively). The number of hospitalizations due to Melanoma increased in all age groups with the only exception of the youngest patients aged 20–30 years old. The highest increases over the 8-year period were observed in people aged ≥81 years old (+34%), 61–70 years old (+20%) and surprisingly in the age group 31–40 years old (+17%). Southern Regions showed lower hospitalization rates compared to Northern Italy and Region Lazio. The highest increases between 2001 and 2008 were observed in Trentino/Alto Adige, Friuli Venezia Giulia, Valla d’Aosta and Veneto Region. Conclusions: Hospitalizations due to malignant Melanoma in Italy seem to be influenced by environmental or population-related factors showing a decreasing incidence rate from the Northern to Southern Regions

  14. The Association between Bankruptcy and Hospital-Presenting Attempted Suicide: A Record Linkage Study

    ERIC Educational Resources Information Center

    Kidger, Judi; Gunnell, David; Jarvik, Jeffrey G.; Overstreet, Karen A.; Hollingworth, William

    2011-01-01

    The associations between admissions to an emergency department following attempted suicide and personal bankruptcy in the preceding and subsequent 2 years were evaluated. Records from a level 1 trauma center (June 1993-December 2002) in Seattle, WA, were linked with case files from the local U.S. District Bankruptcy Court (June 1991 onward).…

  15. Integration of data from remote monitoring systems and programmers into the hospital electronic health record system based on international standards.

    PubMed

    van der Velde, E T; Foeken, H; Witteman, T A; van Erven, L; Schalij, M J

    2012-02-01

    Remote follow-up of implanted ICDs may offer a solution to the problem of overcrowded outpatient clinics. All major device companies have developed a remote follow-up solution. Data obtained from the remote follow-up systems are stored in a central database system, operated and owned by the device company and accessible for the physician or technician. However, the problem now arises that part of the patient's clinical information is stored in the local electronic health record (EHR) system in the hospital, while another part is only available in the remote monitoring database. This may potentially result in patient safety issues. Ideally all information should become available in the EHR system. IHE (Integrating the Healthcare Enterprise) is an initiative to improve the way computer systems in healthcare share information. To address the requirement of integrating remote monitoring data in the local EHR, the IHE Implantable Device Cardiac Observation (IDCO) profile has been developed. In our hospital, we have implemented the IHE IDCO profile to import data from the remote databases from two device vendors into the departmental Cardiology Information System. Data are exchanged via an HL7/XML communication protocol, as defined in the IHE IDCO profile. PMID:22231151

  16. Hepatitis C: improving the quality of screening in a community hospital by implementing an electronic medical record intervention.

    PubMed

    Shahnazarian, Vahe; Karu, Eric; Mehta, Parag

    2015-01-01

    Both the Centers for Disease Control and Prevention (CDC) and the U.S. Preventive Services Task Force (USPSTF) have recommended that adults born between the years of 1945-1965 should receive one-time testing for Hepatitis C Virus (HCV). In fact, Governor Andrew Cuomo of the State of New York had signed a bill on October 23, 2013 which mandated NY hospitals and healthcare providers to offer HCV testing to all "Baby Boomers." For our project, we wanted to increase our community hospital's compliance with this law and improve the quality of patient care in doing so. An electronic medical record intervention was implemented in conjunction with our information technology services department. This intervention would flag eligible patients and would run them through a predetermined algorithm to see if they needed HCV testing. Multiple plan, do, study, act (PDSA) cycles were run during the length of the study and many changes were made in order to achieve maximum effect. We ended up increasing our HCV testing rate from 47.2% (pre-intervention) to 87.9% (final month of the study), which was statistically significant with a p-value of <0.0000001. We also ended up with a framework that is both generalizable to other projects and is also self-sustaining, so that it can continue to run itself once all the project members have finished working there as house staff. PMID:26734374

  17. Understanding Nurses' Perceptions of Electronic Health Record Use in an Acute Care Hospital Setting.

    PubMed

    Strudwick, Gillian; McGillis Hall, Linda; Nagle, Lynn; Trbovich, Patricia

    2016-01-01

    Electronic health records (EHRs) are being implemented in health care environments in an effort to improve the safety, quality and efficiency of care. However, not all of these potential benefits have been demonstrated in empirical research. One of the reasons for this may be a number of barriers that prevent nurses from being able to incorporate EHRs into their professional practice. A review of the literature revealed a number of barriers to, and facilitators of EHR use by nurses. Among these, EHR usability, organizational context, and individual nurse characteristics were found to be concepts that influence use. It is currently unknown how these concepts together might influence nurses' perceptions of their ability to use the technology to support the nursing process. In this poster, the authors will describe a study aimed at achieving a better understanding of nurses' perceptions of their EHR use by investigating the concepts of EHR usability, organizational context and select individual nurse characteristics. PMID:27332345

  18. Two-year hospital records of burns from a referral center in Western Iran: March 2010-March 2012

    PubMed Central

    Ahmadijouybari, Touraj; Najafi, Farid; Moradinazar, Mehdi; Karami-matin, Behzad; Karami-matin, Reza; Ataie, Maria; Hatami, Masoumeh; Purghorbani, Samira; Amee, Vahid

    2014-01-01

    Abstract: Background: Burns are among the most common injuries affecting a great number of people worldwide annually. In Iran, especially in its western region and in Kermanshah province, burns have a relatively high incidence. The present study was aimed at investigating epidemiological characteristics in Western Iran. Methods: Within a cross-sectional study, the data on all patients attending the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during 2010-2011 and 2011-2012 (24 months) were collected. Then, age, gender, cause of burns, total body surface area, and time of the occurrence were extracted from the hospital records. The data were analyzed using the SPSS statistical package (Version 19, for Windows). We used chi-squared test when we compared the categorical responses between two or more groups. For comparing means between two groups we used t-test. In addition, trends were investigated using linear regression. Results: Overall 13 248 people were referred to the Burns Center at Imam Khomeini Hospital (Kermanshah, Iran) during the period of study, including 328 cases of self-immolation. The mean age of the patients was 27±19 years and 29±13 years for unintentional burns and self-immolation respectively. Out of the total number of unintentional cases, 6 519 (50.5%) were men, while the corresponding percentage of men among the self-immolation cases was 16.6% (p less than 0.001). Trends in the number of cases were cyclic, with the highest and lowest number of burns cases being in March and May. Overall, hot liquids and flammable materials were the two most important causes of unintentional burns. However, flammable materials were the main cause of burns among self-immolation cases. During hospital admission, 168 (51%) self-immolation victims and 43 (0.33%) unintentional burn victims died. Conclusions: While major preventive measures are not adequately used in developing countries, burns and their burden can be significantly reduced by increasing

  19. Using survival analysis to determine association between maternal pelvis height and antenatal fetal head descent in Ugandan mothers

    PubMed Central

    Munabi, Ian Guyton; Luboga, Samuel Abilemech; Mirembe, Florence

    2015-01-01

    Introduction Fetal head descent is used to demonstrate the maternal pelvis capacity to accommodate the fetal head. This is especially important in low resource settings that have high rates of childbirth related maternal deaths and morbidity. This study looked at maternal height and an additional measure, maternal pelvis height, from automotive engineering. The objective of the study was to determine the associations between maternal: height and pelvis height with the rate of fetal head descent in expectant Ugandan mothers. Methods This was a cross sectional study on 1265 singleton mothers attending antenatal clinics at five hospitals in various parts of Uganda. In addition to the routine antenatal examination, each mother had their pelvis height recorded following informed consent. Survival analysis was done using STATA 12. Results It was found that 27% of mothers had fetal head descent with an incident rate of 0.028 per week after the 25th week of pregnancy. Significant associations were observed between the rate of fetal head descent with: maternal height (Adj Haz ratio 0.93 P < 0.01) and maternal pelvis height (Adj Haz ratio 1.15 P < 0.01). Conclusion The significant associations observed between maternal: height and pelvis height with rate of fetal head descent, demonstrate a need for further study of maternal pelvis height as an additional decision support tool for screening mothers in low resource settings. PMID:26918071

  20. Maternal understanding of infective endocarditis after hospitalization: assessing the knowledge of mothers of children with congenital heart disease and the practical implications.

    PubMed

    Knöchelmann, Anja; Geyer, Siegfried; Grosser, Urte

    2014-02-01

    This study aimed to examine the knowledge of mothers of children with congenital heart disease as well as the association of cardiological factors and maternal characteristics with maternal understanding. Mothers of 135 children (≤2 years old) were interviewed to assess maternal knowledge of infective endocarditis (IE) using the Hannover Inventory of Parental Knowledge of Congenital Heart Disease. Two subscales, endocarditis and risk factors, were used. Cardiological data as well as maternal characteristics were collected. Two-thirds of the mothers achieved only low scores, answering 0-20 % of the questions correctly (endocarditis = 64.4 %; risk factors = 71.1 %). Mothers with higher education recalled the correct definition of IE (P = 0.001) and the importance of dental hygiene (P = 0.004) more often. Mothers with only one child were more likely to know the most typical symptom (P = 0.007). The severity of the heart disease and the requirement of endocarditis prophylaxis did not influence maternal understanding. Yet, mothers assessing the heart disease as severe showed better knowledge (typical symptom P = 0.021; importance of dental hygiene P = 0.007). If mothers learned the diagnosis before their child's birth, they remembered relevant information more often. Mothers receiving information by the medical staff and from the Internet showed better knowledge (definition P = 0.014; importance of dental hygiene P = 0.001). Due to low levels of knowledge, more efforts must be put into the education of mothers. Educational programs should take maternal characteristics into account, providing written material and thereby keeping the instruction of lower-educated persons in mind. Furthermore, education should be focused on mothers of children requiring IE prophylaxis. PMID:23982219

  1. [A fetal extraction device used in under-equipped countries: the obstetrical vacuum extractor. Results of 393 vacuum extractions in the Maternity Hospital in Sélestat. (Reflections on the use of this device in African practice)].

    PubMed

    Pambou, O; Wurch, T; Weygandt, J M; Treisser, A

    1991-01-01

    The level of mortality and feto-maternal morbidity in under-equipped countries is frightening. It is important to find answers. Among these: the obstetrical Ventouse is an instrument that can be used for extracting the fetus without too much difficulty. It is relatively easy to learn and to apply as compared with forceps (so long as the mechanism by which it is used is understood). The conditions under which it can be used are well defined at present: term pregnancy, the woman must be in labour, fetal membranes must be ruptured, the cervix must be completely dilated, presentation must be cephalic and the head must be engaged. 393 Ventouse extractions were carried out between 1982 and 1988 at the Maternity Hospital of Selastat and this resulted in delivery of 393 infants in good health. No maternal or fetal mortality occurred in the series. The maternal morbidity was low at 0.76% and the fetal morbidity was only 4.7%. In view of our experience, we believe that the tendency for black women to have android pelves makes it preferable to use the Ventouse as against the forceps because it has several advantages. In view of the literature and of their practice, the authors advise that the obstetric Ventouse should be used in under-equipped countries where conditions of practice are often precarious and the team poorly qualified. This will reduce the mortality and morbidity due to delivery. Pregnant women are insufficiently educated. The quality of health personnel is inadequate. The health services are inadequate for the needs of the population.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2019713

  2. Drugs-Related Death Soon after Hospital-Discharge among Drug Treatment Clients in Scotland: Record Linkage, Validation, and Investigation of Risk-Factors

    PubMed Central

    White, Simon R.; Bird, Sheila M.; Merrall, Elizabeth L. C.; Hutchinson, Sharon J.

    2015-01-01

    We validate that the 28 days after hospital-discharge are high-risk for drugs-related death (DRD) among drug users in Scotland and investigate key risk-factors for DRDs soon after hospital-discharge. Using data from an anonymous linkage of hospitalisation and death records to the Scottish Drugs Misuse Database (SDMD), including over 98,000 individuals registered for drug treatment during 1 April 1996 to 31 March 2010 with 705,538 person-years, 173,107 hospital-stays, and 2,523 DRDs. Time-at-risk of DRD was categorised as: during hospitalization, within 28 days, 29–90 days, 91 days–1 year, >1 year since most recent hospital discharge versus ‘never admitted’. Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0–1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients’ high DRD-rate soon after hospital-discharge in 2006–2010. DRD-rate in the 28 days after hospital-discharge did not vary by length of hospital-stay but was significantly higher for clients who had ever-injected versus otherwise. Three leading discharge-diagnoses accounted for only 150/290 DRDs in the 28 days after hospital-discharge, but ever-injectors for 222/290. Hospital-discharge remains a period of increased DRD-vulnerability in 2006–2010, as in 1996–2006, especially for those with a history of injecting. PMID:26539701

  3. Drugs-Related Death Soon after Hospital-Discharge among Drug Treatment Clients in Scotland: Record Linkage, Validation, and Investigation of Risk-Factors.

    PubMed

    White, Simon R; Bird, Sheila M; Merrall, Elizabeth L C; Hutchinson, Sharon J

    2015-01-01

    We validate that the 28 days after hospital-discharge are high-risk for drugs-related death (DRD) among drug users in Scotland and investigate key risk-factors for DRDs soon after hospital-discharge. Using data from an anonymous linkage of hospitalisation and death records to the Scottish Drugs Misuse Database (SDMD), including over 98,000 individuals registered for drug treatment during 1 April 1996 to 31 March 2010 with 705,538 person-years, 173,107 hospital-stays, and 2,523 DRDs. Time-at-risk of DRD was categorised as: during hospitalization, within 28 days, 29-90 days, 91 days-1 year, >1 year since most recent hospital discharge versus 'never admitted'. Factors of interest were: having ever injected, misuse of alcohol, length of hospital-stay (0-1 versus 2+ days), and main discharge-diagnosis. We confirm SDMD clients' high DRD-rate soon after hospital-discharge in 2006-2010. DRD-rate in the 28 days after hospital-discharge did not vary by length of hospital-stay but was significantly higher for clients who had ever-injected versus otherwise. Three leading discharge-diagnoses accounted for only 150/290 DRDs in the 28 days after hospital-discharge, but ever-injectors for 222/290. Hospital-discharge remains a period of increased DRD-vulnerability in 2006-2010, as in 1996-2006, especially for those with a history of injecting. PMID:26539701

  4. 'I Used to Fight with Them but Now I Have Stopped!': Conflict and Doctor-Nurse-Anaesthetists' Motivation in Maternal and Neonatal Care Provision in a Specialist Referral Hospital

    PubMed Central

    Aberese-Ako, Matilda; Agyepong, Irene Akua; Gerrits, Trudie; Van Dijk, Han

    2015-01-01

    Background and Objectives This paper analyses why and how conflicts occur and their influence on doctors and nurse-anaesthetists' motivation in the provision of maternal and neonatal health care in a specialist hospital. Methodology The study used ethnographic methods including participant observation, conversation and in-depth interviews over eleven months in a specialist referral hospital in Ghana. Qualitative analysis software Nvivo 8 was used for coding and analysis of data. Main themes identified in the analysis form the basis for interpreting and reporting study findings. Ethics Statement Ethical clearance was obtained from the Ghana Health Service Ethics Review board (approval number GHS-ERC:06/01/12) and from the University of Wageningen. Written consent was obtained from interview participants, while verbal consent was obtained for conversations. To protect the identity of the hospital and research participants pseudonyms are used in the article and the part of Ghana in which the study was conducted is not mentioned. Results Individual characteristics, interpersonal and organisational factors contributed to conflicts. Unequal power relations and distrust relations among doctors and nurse-anaesthetists affected how they responded to conflicts. Responses to conflicts including forcing, avoiding, accommodating and compromising contributed to persistent conflicts, which frustrated and demotivated doctors and nurse-anaesthetists. Demotivated workers exhibited poor attitudes in collaborating with co-workers in the provision of maternal and neonatal care, which sometimes led to poor health worker response to client care, consequently compromising the hospital's goal of providing quality health care to clients. Conclusion To improve health care delivery in health facilities in Ghana, health managers and supervisors need to identify conflicts as an important phenomenon that should be addressed whenever they occur. Effective mechanisms including training managers

  5. Healthcare resource implications of hypoglycemia-related hospital admissions and inpatient hypoglycemia: retrospective record-linked cohort studies in England

    PubMed Central

    McEwan, Philip; Larsen Thorsted, Brian; Wolden, Michael; Jacobsen, Judith; Evans, Marc

    2015-01-01

    Objective Using a retrospective cohort study, the mean length of hospital stay (LoS) and total per-patient expenditure for hypoglycemia requiring admission to hospital were estimated. In a separate matched retrospective cohort study, the effect of inpatient hypoglycemia on LoS, expenditure, and risk of all-cause mortality while admitted was investigated. Methods The cohorts consisted of patients aged ≥18 years with a diagnosis of type 1 or 2 diabetes between January 1, 2002 and October 30, 2012 in the Clinical Practice Research Datalink database, who had initiated insulin treatment and had a recording of hypoglycemia in the same period. In the matched retrospective cohort study, exposed patients (who experienced hypoglycemia in hospital) were case-matched with patients who did not experience hypoglycemia during admission (unexposed). Generalized linear regression was used to estimate LoS. Risk of all-cause mortality was evaluated via logistic regression. Results In the retrospective cohort study (1131 patients), mean LoS was 5.46 (95% CI 4.62 to 6.45) days for type 1 diabetes, and 5.04 (95% CI 4.46 to 5.71) days for type 2 diabetes. Mean cost per admission was £1034 (95% CI £855 to £1253). In the matched retrospective cohort study (1079 pairs of patients), exposed patients had a mean LoS of 11.91 days (95% CI 10.96 to 12.94 days) versus 4.80 (95% CI 4.41 to 5.23) for unexposed patients, p<0.0001. Exposed patients had a higher mortality risk compared with unexposed patients (OR 1.439 (95% CI 1.060to 1.952), p=0.0195). Total average per-patient cost for exposed patients was GBP (£)2235, 40% (p<0.0001) higher than total average admission cost in unexposed patients. Conclusions Hypoglycemia has a significant negative impact on patient outcomes, healthcare resource use, and expenditure. PMID:25815204

  6. Follow up policy after treatment for Hodgkin's disease: too many clinic visits and routine tests? A review of hospital records.

    PubMed Central

    Radford, J. A.; Eardley, A.; Woodman, C.; Crowther, D.

    1997-01-01

    OBJECTIVE: To examine the effectiveness of routine clinic review in detecting relapse after treatment for Hodgkin's disease. DESIGN: Review of hospital records. SETTING: Regional centre for cancer treatment and research. SUBJECTS: 210 patients with Hodgkin's disease recruited to a chemotherapy trial protocol between 1984 and the end of 1990 who had achieved a complete or partial remission after treatment. MAIN OUTCOME MEASURES: The number of clinic visits made by patients over the period of observation, the number of relapses occurring during that time, and the route by which relapse was detected. RESULTS: The 210 patients generated 2512 outpatient reviews, and 37 relapses were detected. Thirty relapses (81%) were diagnosed in patients who described symptoms, which in 15 cases had resulted in an earlier appointment being arranged. In only four cases (11%; 95% confidence interval 4% to 25%) was relapse detected as a result of routine physical examination on investigation of a patient who did not have symptoms. CONCLUSIONS: Relapse of Hodgkin's disease after treatment is usually detected as a result of the investigation of symptoms rather than by routine screening of asymptomatic patients. It is therefore proposed that the frequency of routine follow up visits should be reduced and greater emphasis placed on patient education. This should underline the importance of symptoms and encourage patients to arrange an earlier appointment if these develop. PMID:9040326

  7. Comprehensive Evaluation of Electronic Medical Record System Use and User Satisfaction at Five Low-Resource Setting Hospitals in Ethiopia

    PubMed Central

    Fritz, Fleur

    2015-01-01

    Background Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an

  8. Maternal and fetal outcomes in term premature rupture of membrane

    PubMed Central

    Endale, Tigist; Fentahun, Netsanet; Gemada, Desta; Hussen, Mamusha Aman

    2016-01-01

    BACKGROUND: Premature rupture of membrane (PROM) is linked to significant maternal prenatal mortalities and morbidity. In Ethiopia, where maternal mortality is still high, the maternal and fetal outcomes in PROM is very important to decrease maternal and child mortality and for better management and prevention of complications. Thus, this study aimed to detect the maternal and fetal outcomes and associated factors in term PROM at Mizan-Aman General Hospital, south-west Ethiopia. METHODS: A retrospective cross sectional study was conducted using data available at Mizan-Aman General Hospital during a period of 3 years (January 2011 to December 2013). We examined records of 4 525 women who gave birth in the hospital; out of these women, 185 were diagnosed with term PROM and all of them were included in the study. The data of these women were collected using a checklist based on registration books. The data were analyzed using SPSS version 20.0 statistical package. The association between independent and dependent variables was assessed by bivariate and multiple logistic regression analyses. 95%CI and P value less than 0.05 were considered statistically significant. RESULTS: Of the 4 525 women who gave birth in the hospital, 202 were complicated by term PROM. About 22.2% of the women showed unfavorable maternal outcomes. The most common cause of maternal morbidity and mortality was puerperal sepsis. About 33.5% of neonates experienced unfavorable outcomes. The duration of PROM >12 hours (AOR=5.6, 95%CI 1.3–24.1) latency >24 hours (AOR=2.8, 95%CI 1.7–11.8), residing in rural areas (AOR=4.2, 95%CI 3.96–29.4) and birth weight less than 2 500 g were associated with unfavorable outcomes. CONCLUSION: Women residing in rural areas, long latency, and neonates with birth weight less 2 500 g may have unfavorable outcomes. Therefore, optimum obstetric and medical care is essential for the reduction of the devastating complications related to disorders. PMID:27313811

  9. Evaluation of natural language processing from emergency department computerized medical records for intra-hospital syndromic surveillance

    PubMed Central

    2011-01-01

    Background The identification of patients who pose an epidemic hazard when they are admitted to a health facility plays a role in preventing the risk of hospital acquired infection. An automated clinical decision support system to detect suspected cases, based on the principle of syndromic surveillance, is being developed at the University of Lyon's Hôpital de la Croix-Rousse. This tool will analyse structured data and narrative reports from computerized emergency department (ED) medical records. The first step consists of developing an application (UrgIndex) which automatically extracts and encodes information found in narrative reports. The purpose of the present article is to describe and evaluate this natural language processing system. Methods Narrative reports have to be pre-processed before utilizing the French-language medical multi-terminology indexer (ECMT) for standardized encoding. UrgIndex identifies and excludes syntagmas containing a negation and replaces non-standard terms (abbreviations, acronyms, spelling errors...). Then, the phrases are sent to the ECMT through an Internet connection. The indexer's reply, based on Extensible Markup Language, returns codes and literals corresponding to the concepts found in phrases. UrgIndex filters codes corresponding to suspected infections. Recall is defined as the number of relevant processed medical concepts divided by the number of concepts evaluated (coded manually by the medical epidemiologist). Precision is defined as the number of relevant processed concepts divided by the number of concepts proposed by UrgIndex. Recall and precision were assessed for respiratory and cutaneous syndromes. Results Evaluation of 1,674 processed medical concepts contained in 100 ED medical records (50 for respiratory syndromes and 50 for cutaneous syndromes) showed an overall recall of 85.8% (95% CI: 84.1-87.3). Recall varied from 84.5% for respiratory syndromes to 87.0% for cutaneous syndromes. The most frequent cause of

  10. Alternative Maternity Services in Washington State.

    ERIC Educational Resources Information Center

    Starzyk, Patricia M.

    The nature of maternity services has changed in the past 20 years, with a movement away from traditional (physician delivery in a hospital) towards other alternative services. This study examined alternative maternity services in Washington State, which ranks eighth in the country in the use of such services. Data were collected from birth and…

  11. Maternal mortality in Riyadh, Saudi Arabia.

    PubMed

    Chattopadhyay, S K; Sengupta, B S; Chattopadhyay, C; Zaidi, Z; Showail, H

    1983-09-01

    The maternal mortality in the Maternity and Children Hospital, Riyadh, during the years 1978-1980 was 52 per 100 000 births, when the total births were 55 428. This is higher than the rate reported from the hospitals in developed countries but lower than rates reported by the university hospitals of developing countries such as India, Thailand and Nigeria. Haemorrhage, associated disease, pulmonary embolism and infection, in that order, were the main causes of maternal deaths. The main avoidable factor was failure by the patient to seek the medical care. Much could be done in reducing deaths due to haemorrhage by improving blood transfusion facilities in the peripheral hospitals. Adequate health education, especially of rural women and their midwives, is a crucial factor in improving the maternal death rate for the country as a whole. PMID:6615737

  12. Maternal Immunization

    PubMed Central

    Chu, Helen Y.; Englund, Janet A.

    2014-01-01

    Maternal immunization has the potential to protect the pregnant woman, fetus, and infant from vaccine-preventable diseases. Maternal immunoglobulin G is actively transported across the placenta, providing passive immunity to the neonate and infant prior to the infant's ability to respond to vaccines. Currently inactivated influenza, tetanus toxoid, and acellular pertussis vaccines are recommended during pregnancy. Several other vaccines have been studied in pregnancy and found to be safe and immunogenic and to provide antibody to infants. These include pneumococcus, group B Streptococcus, Haemophilus influenzae type b, and meningococcus vaccines. Other vaccines in development for potential maternal immunization include respiratory syncytial virus, herpes simplex virus, and cytomegalovirus vaccines. PMID:24799324

  13. Epidemiological Changes in Leishmaniasis in Spain According to Hospitalization-Based Records, 1997–2011: Raising Awareness towards Leishmaniasis in Non-HIV Patients

    PubMed Central

    Jimenez, B. Carolina; Granados, Marisol; San Martín, Juan Victor; Aparicio, Pilar

    2015-01-01

    In Spain, Leishmania infantum is endemic, human visceral and cutaneous leishmaniasis cases occurring both in the Peninsula, as well as in the Balearic Islands. We aimed to describe the clinical characteristics of leishmaniasis patients and the changes in the disease evolution after the introduction of antiretroviral therapy in 1997. In this descriptive study, we used Spanish Centralized Hospital Discharge Database for the hospitalized leishmaniasis cases between 1997 and 2011. We included in the analysis only the records having leishmaniasis as the first registered diagnosis and calculated the hospitalization rates. Disease trend was described taking into account the HIV status. Adjusted odds-ratio was used to estimate the association between clinical and socio-demographic factors and HIV co-infection. Of the total 8010 Leishmaniasis hospitalizations records, 3442 had leishmaniasis as first diagnosis; 2545/3442 (75.6%) were males and 2240/3442 (65.1%) aged between 14-65 years. Regarding disease forms, 2844/3442 (82.6%) of hospitalizations were due to visceral leishmaniasis (VL), while 118/3442 (3.4%) hospitalizations were cutaneous leishmaniasis (CL). Overall, 1737/2844 of VL (61.1%) were HIV negatives. An overall increasing trend was observed for the records with leishmaniasis as first diagnosis (p=0.113). Non-HIV leishmaniasis increased during this time period (p=0.021) while leishmaniasis-HIV co-infection hospitalization revealed a slight descending trend (p=0.717). Leishmaniasis-HIV co-infection was significantly associated with male sex (aOR=1.6; 95% CI: 1.25-2.04), 16-64 years age group (aOR=17.4; 95%CI: 2.1-143.3), visceral leishmaniasis aOR=6.1 (95%CI: 3.27-11.28) and solid neoplasms 4.5 (95% CI: 1.65-12.04). The absence of HIV co-infection was associated with lymph/hematopoietic neoplasms (aOR=0.3; 95%CI:0.14-0.57), other immunodeficiency (aOR=0.04; 95% CI:0.01-0.32) and transplant (aOR=0.01; 95%CI:0.00-0.07). Our findings suggest a significant increase of

  14. Protocol to describe the analysis of text-based communication in medical records for patients discharged from intensive care to hospital ward

    PubMed Central

    Parsons Leigh, Jeanna; Brown, Kyla; Buchner, Denise; Stelfox, Henry T

    2016-01-01

    Introduction Effective communication during hospital transitions of patient care is fundamental to ensuring patient safety and continuity of quality care. This study will describe text-based communication included in patient medical records before, during and after patient transfer from the intensive care unit (ICU) to a hospital ward (n=10 days) by documenting (1) the structure and focus of physician progress notes within and between medical specialties, (2) the organisation of subjective and objective information, including the location and accessibility of patient data and whether/how this changes during the hospital stay and (3) missing, illegible and erroneous information. Methods This study is part of a larger mixed methods prospective observational study of ICU to hospital ward transfer practices in 10 ICUs across Canada. Medical records will be collected and photocopied for each consenting patient for a period of up to 10 consecutive days, including the final 2 days in the ICU, the day of transfer and the first 7 days on the ward (n=10 days). Textual analysis of medical record data will be completed by 2 independent reviewers to describe communication between stakeholders involved in ICU transfer. Ethics and dissemination Research ethics board approval has been obtained at all study sites, including the coordinating study centre (which covers 4 Calgary-based sites; UofC REB 13-0021) and 6 additional study sites (UofA Pro00050646; UBC PHC Hi4-01667; Sunnybrook 336-2014; QCH 20140345-01H; Sherbrooke 14-172; Laval 2015-2171). Findings from this study will inform the development of an evidence-based tool that will be used to systematically analyse the series of notes in a patient's medical record. PMID:27401367

  15. Maternal immunization

    PubMed Central

    Moniz, Michelle H; Beigi, Richard H

    2014-01-01

    Maternal immunization holds tremendous promise to improve maternal and neonatal health for a number of infectious conditions. The unique susceptibilities of pregnant women to infectious conditions, as well as the ability of maternally-derived antibody to offer vital neonatal protection (via placental transfer), together have produced the recent increased attention on maternal immunization. The Advisory Committee on Immunization Practices (ACIP) currently recommends 2 immunizations for all pregnant women lacking contraindication, inactivated Influenza and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap). Given ongoing research the number of vaccines recommended during pregnancy is likely to increase. Thus, achieving high vaccination coverage of pregnant women for all recommended immunizations is a key public health enterprise. This review will focus on the present state of vaccine acceptance in pregnancy, with attention to currently identified barriers and determinants of vaccine acceptance. Additionally, opportunities for improvement will be considered. PMID:25483490

  16. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    PubMed

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  17. Incorporating immunizations into routine obstetric care to facilitate Health Care Practitioners in implementing maternal immunization recommendations

    PubMed Central

    Webb, Heather; Street, Jackie; Marshall, Helen

    2014-01-01

    Immunization against pertussis, influenza, and rubella reduces morbidity and mortality in pregnant women and their offspring. Health care professionals (HCPs) caring for women perinatally are uniquely placed to reduce maternal vaccine preventable diseases (VPDs). Despite guidelines recommending immunization during the perinatal period, maternal vaccine uptake remains low. This qualitative study explored the role of obstetricians, general practitioners, and midwives in maternal vaccine uptake. Semi-structured interviews (n = 15) were conducted with perinatal HCPs at a tertiary maternity hospital in South Australia. HCPs were asked to reflect on their knowledge, beliefs, and practice relating to immunization advice and vaccine provision. Interviews were transcribed and coded using thematic analysis. Data collection and analysis was an iterative process, with collection ceasing with theoretical saturation. Participants unanimously supported maternal vaccination as an effective way of reducing risk of disease in this vulnerable population, however only rubella immunity detection and immunization is embedded in routine care. Among these professionals, delegation of responsibility for maternal immunization was unclear and knowledge about maternal immunization was variable. Influenza and pertussis vaccine prevention measures were not included in standard pregnancy record documentation, information provision to patients was “ad hoc” and vaccinations not offered on-site. The key finding was that the incorporation of maternal vaccinations into standard care through a structured process is an important facilitator for immunization uptake. Incorporating vaccine preventable disease management measures into routine obstetric care including incorporation into the Pregnancy Record would facilitate HCPs in implementing recommendations. Rubella prevention provides a useful “template” for other vaccines. PMID:24509790

  18. Use of a homecare Electronic Health Record (EHR) to find associations between patient characteristics and hospitalizations for heart failure in patients using telehealth

    PubMed Central

    Radhakrishnan, Kavita; Jacelon, Cynthia S; Bigelow, Carol; Roche, Joan; Marquard, Jenna; Bowles, Kathryn H

    2016-01-01

    Summary Data from homecare electronic health records were used to explore the association of patient characteristics with re-hospitalizations of patients with heart failure (HF) during a 60-day period of telemonitoring following hospital discharge. Data from 403 Medicare patients with HF who had used telehealth from 2008 to 2010 were analysed. There were 112 all-cause (29%) and 73 cardiac-related (19%) re-hospitalizations within 60 days of being admitted to the homecare agency. In adjusted analyses, the patients’ prescribed number of medications and type of prescribed cardiac medications were significantly (P<0.05) associated with increased risk of re-hospitalization. After stratifying the sample by illness severity, age and gender, other significant (P<0.05) predictors associated with increased risk of all-cause and cardiac re-hospitalization were psychiatric co-morbidity, co-morbidities related to pulmonary and obesity within gender, beta blocker prescription in females and primary HF diagnosis in the oldest age stratum. The study’s findings may assist homecare agencies seeking to allocate resources without compromising patient care. PMID:23528787

  19. Use of a homecare electronic health record to find associations between patient characteristics and re-hospitalizations in patients with heart failure using telehealth.

    PubMed

    Radhakrishnan, Kavita; Jacelon, Cynthia S; Bigelow, Carol; Roche, Joan; Marquard, Jenna; Bowles, Kathryn H

    2013-02-01

    Data from homecare electronic health records were used to explore the association of patient characteristics with re-hospitalizations of patients with heart failure (HF) during a 60-day period of telemonitoring following hospital discharge. Data from 403 Medicare patients with HF who had used telehealth from 2008 to 2010 were analysed. There were 112 all-cause (29%) and 73 cardiac-related (19%) re-hospitalizations within 60 days of the start of telemonitoring. In adjusted analyses, the patients' number of medications and type of cardiac medications were significantly (P < 0.05) associated with an increased risk of re-hospitalization. After stratifying the sample by illness severity, age and gender, other significant (P < 0.05) predictors associated with an increased risk of all-cause and cardiac re-hospitalization were psychiatric co-morbidity, pulmonary and obesity co-morbidities within gender, beta blocker prescription in females and primary HF diagnosis in the oldest age stratum. The study's findings may assist homecare agencies seeking to allocate resources without compromising patient care. PMID:23528787

  20. Medically unexplained illness and the diagnosis of hysterical conversion reaction (HCR) in women’s medicine wards of Bangladeshi hospitals: a record review and qualitative study

    PubMed Central

    2012-01-01

    Background Frequent reporting of cases of hysterical conversion reaction (HCR) among hospitalized female medical patients in Bangladesh’s public hospital system led us to explore the prevalence of “HCR” diagnoses within hospitals and the manner in which physicians identify, manage, and perceive patients whom they diagnose with HCR. Methods We reviewed admission records from women’s general medicine wards in two public hospitals to determine how often and at what point during hospitalization patients received diagnoses of HCR. We also interviewed 13 physicians about their practices and perceptions related to HCR. Results Of 2520 women admitted to the selected wards in 2008, 6% received diagnoses of HCR. HCR patients had wide-ranging symptoms including respiratory distress, headaches, chest pain, convulsions, and abdominal complaints. Most doctors diagnosed HCR in patients who had any medically-unexplained physical symptom. According to physician reports, women admitted to medical wards for HCR received brief diagnostic evaluations and initial treatment with short-acting tranquilizers or placebo agents. Some were referred to outpatient psychiatric treatment. Physicians reported that repeated admissions for HCR were common. Physicians noted various social factors associated with HCR, and they described failures of the current system to meet psychosocial needs of HCR patients. Conclusions In these hospital settings, physicians assign HCR diagnoses frequently and based on vague criteria. We recommend providing education to increase general physicians’ awareness, skill, and comfort level when encountering somatization and other common psychiatric issues. Given limited diagnostic capacity for all patients, we raise concern that when HCR is used as a "wastebasket" diagnosis for unexplained symptoms, patients with treatable medical conditions may go unrecognized. We also advocate introducing non-physician hospital personnel to address psychosocial needs of HCR

  1. Influential Factors for and Outcomes of Hospitalized Patients with Suicide-Related Behaviors: A National Record Study in Taiwan from 1997–2010

    PubMed Central

    Lin, Yu-Wen; Huang, Hui-Chuan; Lin, Mei-Feng; Shyu, Meei-Ling; Tsai, Po-Li; Chang, Hsiu-Ju

    2016-01-01

    Background Investigating the factors related to suicide is crucial for suicide prevention. Psychiatric disorders, gender, socioeconomic status, and catastrophic illnesses are associated with increased risk of suicide. Most studies have typically focused on the separate influences of physiological or psychological factors on suicide-related behaviors, and have rarely used national data records to examine and compare the effects of major physical illnesses, psychiatric disorders, and socioeconomic status on the risk of suicide-related behaviors. Objectives To identify the characteristics of people who exhibited suicide-related behaviors and the multiple factors associated with repeated suicide-related behaviors and deaths by suicide by examining national data records. Design This is a cohort study of Taiwan’s national data records of hospitalized patients with suicide-related behaviors from January 1, 1997, to December 31, 2010. Participants The study population included all people in Taiwan who were hospitalized with a code indicating suicide or self-inflicted injury (E950–E959) according to the International Classification of Disease, Ninth Revision, Clinical Modification. Results Self-poisoning was the most common method of self-inflicted injury among hospitalized patients with suicide-related behaviors who used a single method. Those who were female, had been hospitalized for suicide-related behaviors at a younger age, had a low income, had a psychiatric disorder (i.e., personality disorder, major depressive disorder, bipolar disorder, schizophrenia, alcohol-related disorder, or adjustment disorder), had a catastrophic illness, or had been hospitalized for suicide-related behaviors that involved two methods of self-inflicted injury had a higher risk of hospitalization for repeated suicide-related behaviors. Those who were male, had been hospitalized for suicide-related behaviors at an older age, had low income, had schizophrenia, showed repeated suicide

  2. Predicting admissions and time spent in hospital over a decade in a population-based record linkage study: the EPIC-Norfolk cohort

    PubMed Central

    Hayat, Shabina; Khaw, K T

    2016-01-01

    Objective To quantify hospital use in a general population over 10 years follow-up and to examine related factors in a general population-based cohort. Design A prospective population-based study of men and women. Setting Norfolk, UK. Participants 11 228 men and 13 786 women aged 40–79 years in 1993–1997 followed between 1999 and 2009. Main outcomes measures Number of hospital admissions and total bed days for individuals over a 10-year follow-up period identified using record linkage; five categories for admissions (from zero to highest ≥7) and hospital bed days (from zero to highest ≥20 nights). Results Over a period of 10 years, 18 179 (72.7%) study participants had at least one admission to hospital, 13.8% with 7 or more admissions and 19.9% with 20 or more nights in hospital. In logistic regression models with outcome ≥7 admissions, low education level OR 1.14 (1.05 to 1.24), age OR per 10-year increase 1.75 (1.67 to 1.82), male sex OR 1.32 (1.22 to 1.42), manual social class 1.22 (1.13 to 1.32), current cigarette smoker OR 1.53 (1.37 to 1.71) and body mass index >30 kg/m² OR 1.41 (1.28 to 1.56) all independently predicted the outcome with p<0.0001. Results were similar for those with ≥20 hospital bed days. A risk score constructed using male sex, manual social class, no educational qualifications; current smoker and body mass index >30 kg/m², estimated percentages of the cohort in the categories of admission numbers and hospital bed days in stratified age bands with twofold to threefold differences in future hospital use between those with high-risk and low-risk scores. Conclusions The future probability of cumulative hospital admissions and bed days appears independently related to a range of simple demographic and behavioural indicators. The strongest of these is increasing age with high body mass index and smoking having similar magnitudes for predicting risk of future hospital usage. PMID:26792216

  3. [Death certificates of women in childbearing age: search for maternal deaths].

    PubMed

    Gil, Mariana Marcos; Gomes-Sponholz, Flavia Azevedo

    2013-01-01

    In Brazil, there is a lack of complete records on death certificates, and its reliability is questioned, especially for causes attributed to pregnancy and childbirth. We investigated, based on death certificates of women in reproductive age, any fields for identifying maternal deaths. Documentary research, conducted in hospital records. We analyzed in death certificates, maternal and no maternal deaths, inconclusive deaths and hidden deaths. To analyze the underlying causes of death we used ICD 10th Revision. Of the 301 death certificates reviewed, 60% had the fields 43/44 completed, and 40% had these fields blank and/or ignored. We found 58.5% of no maternal deaths, 2% of maternal deaths and 39.5% inconclusive. The analysis of inconclusive deaths allowed us to classify 4.3% as hidden deaths. To overcome the incompletitudes of civil registries, it is necessary that all health professionals be committed to the reliability of the information, so the priority target could be reached. PMID:23887780

  4. Pattern of Maternal Complications and Low Birth Weight: Associated Risk Factors among Highly Endogamous Women.

    PubMed

    Bener, Abdulbari; Salameh, Khalil M K; Yousafzai, Mohammad T; Saleh, Najah M

    2012-01-01

    Objective. The objective of the study was to examine the pattern of low birth weight LBW, maternal complications, and its related factors among Arab women in Qatar. Design. This is a prospective hospital-based study. Setting. The study was carried out in Women's Hospital, Doha. Subjects and Methods. Pregnant women in their third trimester were identified in the log book of Women's Hospital and recruited into the study during first week of January 2010 to July 2011. Only 1674 (out of 2238) Arab women (74.7%) consented to participate in this study. Data on clinical and biochemistry parameters were retrieved from medical records. Follow-up data on neonatal outcome was obtained from labor room register. Results. The incidence of LBW (<2500 g) was 6.7% among Arab women during 2010 in Qatar. Distribution of gestational diabetes mellitus (GDM), antepartum hemorrhage (APH), maternal anemia, premature rupture of membrane (PROM), maternal occupation, parity, sheesha smoking, and parental consanguinity were significantly different (P < 0.05) between mothers of LBW and normal birth weight NBW (≥2500 g) babies. Multivariable logistic regression analysis revealed that previous LBW, consanguinity, parity, smoking shesha, GDM, APH, anemia, PROM, maternal occupation, and housing condition were significantly associated with LBW adjusting for gestational age. Conclusion. Maternal complications such as GDM, APH, anemia, PROM, and smoking shesha during pregnancy are significantly increasing the risk of LBW outcome. Screening and prompt treatment for maternal complications and health education for smoking cessation during routine antenatal visits will help in substantial reduction of LBW outcome. PMID:22991672

  5. Development and implementation of a secure, integrated management system for medical images and electronic clinical records for small hospitals.

    PubMed

    Pereira, Javier; Castro, Antonio F; Perez, Juan L; Novoa, Francisco J; Vázquez, Jose M; Teijeiro, Jorge; Pazos, Alejandro; Ezquerra, Norberto

    2007-06-01

    The field of Medical Informatics is currently experiencing increasing demands for new models of the Picture Archiving and Communication Systems (PACS) and Digital Imaging and Communications in Medicine (DICOM) protocols. Despite of the considerable advantages of current systems, implementation in hospitals is remarkably slow, due primarily to difficulties in integration and relatively high costs. Even though the success of DICOM standards has greatly contributed to the development of PACS, many hospitals remain unable to support it or to make full use of its potential because various imaging modalities in use at these sites generate images that cannot be stored in the PACS and cannot be managed in a centralized manner without DICOM standardization modules. Furthermore, the imaging modalities being used in such smaller centers are expensive and unlikely to be replaced, making DICOM compliance untenable. With this in mind, this paper describes the design, development, and implementation of a management system for medical diagnostic imaging, based on the DICOM standard and adapted to the needs of a small hospital. The system is currently being implemented in the San Rafael Hospital at A Coruna in Spain, and integrated with the existing hospital information system (HIS). We have studied the networking infrastructure of the hospital and its available image generation devices, and have subsequently carried out a series of measurements including transmission times, image file size, compression ratios, and many others that allow us to analyze the behavior of the system. Results obtained from these investigations demonstrate both the flexibility of using such a "small-hospital" DICOM-based framework as well as the relative cost-effectiveness of the system. In this regard, the approach, described herein, might serve as a model for other small, and possibly mid-sized, medical centers. PMID:17603833

  6. Maternal Depression and Parent Management Training Outcomes.

    PubMed

    Dempsey, Jack; McQuillin, Samuel; Butler, Ashley M; Axelrad, Marni E

    2016-09-01

    This study examines the impact of maternal depression on reductions in children's behavior problems severity following implementation of the Brief Behavioral Intervention-a brief, manualized parent management training treatment. The parents of 87 children aged 2-6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated. PMID:27448152

  7. Guided imagery: an innovative approach to improving maternal sleep quality.

    PubMed

    Schaffer, Linda; Jallo, Nancy; Howland, Lois; James, Kathy; Glaser, Dale; Arnell, Kathy

    2013-01-01

    Mothers of preterm infants are at risk for poor sleep quality, which may adversely affect their health, maternal-infant attachment, and infant caretaking activities. This study examined the relationship of an 8-week relaxation guided imagery intervention on sleep quality and the association between sleep quality and maternal distress (perceived stress, depressive symptoms, and state anxiety) in 20 mothers of hospitalized preterm infants. Mothers received a CD (compact disc) with three 20-minutes recordings and were asked to listen to at least 1 recording daily for 8 weeks. This analysis used self-report data gathered at baseline and 8 weeks. Pearson correlations were used to examine the relationships between mean cumulative relaxation guided imagery use and measures of maternal distress and sleep quality scores at 8 weeks. Complete data on 19 mothers were available for analysis. At 8 weeks, higher mean relaxation guided imagery use was inversely correlated with sleep quality scores (r = -0.30); sleep quality scores were positively correlated with stress (r = 0.42), depressive symptoms (r = 0.34), and anxiety (r = 0.39) scores. In mothers of preterm infants, sleep quality was negatively affected by mental distress and may be improved by a guided imagery intervention. PMID:23618936

  8. Development of an Integrated Medical Record System at a Large Hospital Using COSTAR as a Designing Tool

    PubMed Central

    Schteingart, R.; Wachenchauzer, R.; Jamschon, R.; Uman, G.; Visciglio, H.; Donovan, K.; D'Adamo, G.; Panuncio, C.

    1982-01-01

    It is usually very complex to design an Integrated Information System in a hospital that includes both in-patient and out-patient medical care data. The difficulty appears because each department within the organization tends to create its own information system, according to its requirements and interests, and absolutely unaware of the requirements of the other departments. In this article, we will describe the design, programming and implementation of an integrated information system in a hospital. It has a unique data base to store all the in-patient and out-patient information. COSTAR experience was used to design this system. Advantages and disadvantages of using COSTAR in a hospital with 850 beds and 2.500 daily out-patient visits are pointed out, and the new system designed on the basis of COSTAR functionality is described.

  9. Effect of an electronic health record on the culture of an outpatient medical oncology practice in a four-hospital integrated health care system: 5-year experience.

    PubMed

    Brockstein, Bruce; Hensing, Thomas; Carro, George W; Obel, Jennifer; Khandekar, Janardan; Kaminer, Lynne; Van De Wege, Christine; de Wilton Marsh, Robert

    2011-07-01

    The electronic health record (EHR) was adopted into the NorthShore University HealthSystem, a four-hospital integrated health system located in suburban Chicago, in 2003. By 2005, all chemotherapy and medicine order entry was conducted through the EHR, completing the incorporation of a fully paperless EHR in our hospital-based oncology practice in both the inpatient and outpatient settings. The use of the EHR has dramatically changed our practice environment by improving efficiency, patient safety, research productivity, and operations, while allowing evaluation of adherence to established quality measures and incorporation of new quality improvement initiatives. The reach of the EHR has been substantial and has influenced every aspect of care at our institution over the short period since its implementation. In this article, we describe subjective and objective measures, outcomes, and achievements of our 5-year EHR experience. PMID:22043197

  10. Maternal Employment

    ERIC Educational Resources Information Center

    Clark, Sam

    1975-01-01

    The overwhelming evidence from years of research is that maternal employment, by itself, has little influence on the behaviors of children. More relevant issues are: mother's reasons for working, family's acceptance of mother's employment, quality of substitute child care, family's social and emotional health, and economic conditions. (Author/AJ)

  11. Using an electronic medical record system to describe injury epidemiology and health care utilization at an inner-city hospital in Indiana.

    PubMed

    Odero, Wilson W; Tierney, William M; Einterz, Robert M; Mungai, Simon

    2004-12-01

    Injuries are a major public health problem worldwide. In the USA, injuries cause 146, 400 deaths annually, with 31 million non-fatal injury visits to emergency departments (EDs). EDs thus represent an important source of injury data. The primary objective of the current study was to describe the epidemiology of injury-related ED visits and assess injury-related utilization of health care resources in an inner-city hospital in Indiana, using data stored in a computerized medical record system. It involved a retrospective review of the records for injury visits to EDs and injury admissions over a 3-year period. The variables extracted and analysed included patients' demographics, external cause of injury, diagnosis, length of stay, ED and hospital charges. A total of 60,470 injury-related ED visits were made, the majority of patients were male (61.6%), uninsured (63.1%), treated in ED and discharged (98.4%). The leading causes of injury were falls (18.8%), motor vehicle crashes (18.4%), assaults (17.6%), being struck (11.2%) and overexertion (10.6). Firearms caused most injury deaths (32.4%; n = 314); motor vehicle crashes were the leading cause of hospitalization (26.6%; n = 642) and also the most expensive to treat as inpatients (mean charge $19,190). The mean charge per patient treated and discharged was $150 compared to $11,116 for patients admitted. These findings demonstrate the value of computerized medical records in capturing and storing E-coded injury data. The system generates data that can be used for epidemiological surveillance and injury prevention at the local level, and for assessment of impact of specific injuries on health care resources. PMID:15903162

  12. [Psychiatry at the maternal clinic].

    PubMed

    Ammälä, Antti-Jussi

    2015-01-01

    Various mental disorders are encountered at the maternal clinic. Pregnancy predisposes to some mental disorders, most commonly depressive and anxiety disorders. The recognition of substance use disorders during pregnancy is very important, but difficult owing to the associated disgrace. An eating disorder with an onset preceding the pregnancy may cause problems for growth and development of the fetus and should thus be identified early enough. The rare but severe postpartum psychosis may often break out only after discharge from the maternity hospital. Drug therapy during pregnancy requires careful consideration and clear-cut reasoning. PMID:26237899

  13. Preterm Labor and Maternal Hypoxia in Patients With Community-Acquired Pneumonia

    PubMed Central

    Pinell, Phillip; Martens, Mark G.; Faro, Sebastian

    1996-01-01

    Objective: We sought to determine if preterm labor is associated with the degree of maternal hypoxia in pregnant women with community-acquired pneumonia but no other maternal diseases. Methods: We retrospectively reviewed the medical records of all antepartum patients admitted with a diagnosis of community-acquired pneumonia to an inner-city university hospital between 1983 and 1987. Included in this review were only the patients with radiologically confirmed diagnose of pneumonia and documented arterial blood gases on room air at the time of admission, but no other maternal diseases. Results: A total of 22 cases were identified. There was no maternal mortality, but there were 2 patients (9%) who developed respiratory failure requiring mechanical ventilation. Bacteremia with Streptococcus pneumoniae was documented in 1 patient (5%). Preterm labor complicated 5 cases (23%) and led to preterm delivery in 3 patients (14%). Terbutaline tocolysis was instituted in 3 patients, but was discontinued in 1 patient who was allowed to deliver because of her worsening condition. Preterm labor was associated with the WBC count on admission, usually > 18,000/mm3, but no statistically significant correlation with the severity of maternal hypoxia was noted. Five patients (23%) were incorrectly diagnosed at the time of admission, 4 with an initial diagnosis of pyelonephritis and 1 with an initial diagnosis of cholecystitis. Conclusions: Community-acquired pneumonia in the antepartum period is responsible for significant maternal and fetal complications even in the absence of other maternal diseases. Preterm labor and delivery remain frequent, and tocolysis should be used cautiously. At the time of admission, the diagnosis may be difficult. The degree of maternal hypoxia on admission does not correlate with the presence of preterm labor. PMID:18476096

  14. Topical non-steroidal anti-inflammatory drugs and admission to hospital for upper gastrointestinal bleeding and perforation: a record linkage case-control study.

    PubMed Central

    Evans, J. M.; McMahon, A. D.; McGilchrist, M. M.; White, G.; Murray, F. E.; McDevitt, D. G.; MacDonald, T. M.

    1995-01-01

    OBJECTIVE--To evaluate the relation between topically applied non-steroidal anti-inflammatory drugs and upper gastrointestinal bleeding and perforation. DESIGN--A case-control study with 1103 patients admitted to hospital for upper gastrointestinal bleeding or perforation between January 1990 and December 1992 (cases). Two different control groups were used, with six community controls and with two hospital controls for each case. Previous exposure to topical and oral non-steroidal anti-inflammatory drugs and ulcer healing drugs was assessed. STUDY POPULATION--The population of 319,465 people who were resident in Tayside and were registered with a Tayside general practitioner between January 1989 and October 1994. A record linkage database containing all data on hospital events and dispensed drugs between 1989 and 1992 was used for this population. MAIN OUTCOME MEASURES--Unadjusted and adjusted odds ratios of exposure in those admitted to hospital compared with controls. RESULTS--Significant unadjusted associations were detected between all three classes of drug and upper gastrointestinal complications. The significant association detected for topical non-steroidal anti-inflammatory drugs was no longer evident in analyses which adjusted for the confounding effect of concomitant exposure to oral anti-inflammatories and ulcer healing drugs (odds ratio = 1.45; 95% confidence interval 0.84 to 2.50 with community controls; 1.06; 0.60 to 1.88 with hospital controls). CONCLUSION--In this study topical non-steroidal anti-inflammatory drugs were not significantly associated with upper gastrointestinal bleeding and perforation after adjustment for the confounding effects of concomitant use of oral anti-inflammatories and ulcer healing drugs. PMID:7613317

  15. Cohort Records Study of 19,655 Women Who Received Postabortion Care in a Tertiary Hospital 2010–2013 in China: What Trends Can Be Observed?

    PubMed Central

    Luo, Zhen-Yu; Quan, Song; Chai, Dong-Ning; Zhang, Wei-Hong

    2016-01-01

    The retrospective cohort epidemiological study was to investigate the characteristics of women who underwent induced abortion. Data were retrospectively collected from women who underwent induced abortions (n = 19,655) at the Xiamen Maternity and Child Health Care Hospital (2010–2013). The characteristics of women who underwent induced abortions included mean age, unmarried status, no previous deliveries, first pregnancy, ≥2 abortions including the current one, and a history of caesarian section. From 2010 to 2013, mean age increased and declines were observed in the ratio of induced abortions to live births, the proportion of induced abortions among women of 15–24 years, those who were unmarried, had their first pregnancy, or had no history of delivery. However, the rates of induced abortions increased among women who were lactating, had a history of caesarian section, or had an interpregnancy interval of <6 months. This snapshot of induced abortions in China might suggest that the numbers are increasing but the ratio to live births has fallen. Methods should be improved to prevent unwanted pregnancies and reduce the number of induced abortions in China. It must be emphasized that differences in mentality and culture between countries might limit the representativeness of these results. PMID:26989681

  16. Cohort Records Study of 19,655 Women Who Received Postabortion Care in a Tertiary Hospital 2010-2013 in China: What Trends Can Be Observed?

    PubMed

    Luo, Zhen-Yu; Quan, Song; Chai, Dong-Ning; Zhang, Wei-Hong

    2016-01-01

    The retrospective cohort epidemiological study was to investigate the characteristics of women who underwent induced abortion. Data were retrospectively collected from women who underwent induced abortions (n = 19,655) at the Xiamen Maternity and Child Health Care Hospital (2010-2013). The characteristics of women who underwent induced abortions included mean age, unmarried status, no previous deliveries, first pregnancy, ≥2 abortions including the current one, and a history of caesarian section. From 2010 to 2013, mean age increased and declines were observed in the ratio of induced abortions to live births, the proportion of induced abortions among women of 15-24 years, those who were unmarried, had their first pregnancy, or had no history of delivery. However, the rates of induced abortions increased among women who were lactating, had a history of caesarian section, or had an interpregnancy interval of <6 months. This snapshot of induced abortions in China might suggest that the numbers are increasing but the ratio to live births has fallen. Methods should be improved to prevent unwanted pregnancies and reduce the number of induced abortions in China. It must be emphasized that differences in mentality and culture between countries might limit the representativeness of these results. PMID:26989681

  17. Recorded categories of non-principal diagnoses in Victorian public hospital transient ischaemic attack and stroke admissions.

    PubMed

    Nadathur, Shymala G

    2008-01-01

    Information about the number and types of non-principal diagnoses (NPDs) would make an important contribution to prediction of outcome and hence patient management. The study reported here is based on analysis of three fiscal years of the Victorian public hospital transient ischaemic attack (TIA) and stroke admissions. The incidence of NPDs and co-occurrence of NPD-associated prefix categories (that identify the onset or relevance of each condition to the episode) are described in each of the broad stroke subtypes. The distributions of length of stay and in-hospital deaths in the cohorts without and with NPDs and in the various prefix categories are determined. The study also compares the age and gender distribution in the various subpopulations of interest. The importance of collecting complete and accurate data on nature of NPDs and its potential in describing the complexity of presentation are discussed. PMID:18941264

  18. Variation between Hospitals with Regard to Diagnostic Practice, Coding Accuracy, and Case-Mix. A Retrospective Validation Study of Administrative Data versus Medical Records for Estimating 30-Day Mortality after Hip Fracture

    PubMed Central

    Kristoffersen, Doris Tove; Skyrud, Katrine Damgaard; Lindman, Anja Schou

    2016-01-01

    Background The purpose of this study was to assess the validity of patient administrative data (PAS) for calculating 30-day mortality after hip fracture as a quality indicator, by a retrospective study of medical records. Methods We used PAS data from all Norwegian hospitals (2005–2009), merged with vital status from the National Registry, to calculate 30-day case-mix adjusted mortality for each hospital (n = 51). We used stratified sampling to establish a representative sample of both hospitals and cases. The hospitals were stratified according to high, low and medium mortality of which 4, 3, and 5 hospitals were sampled, respectively. Within hospitals, cases were sampled stratified according to year of admission, age, length of stay, and vital 30-day status (alive/dead). The final study sample included 1043 cases from 11 hospitals. Clinical information was abstracted from the medical records. Diagnostic and clinical information from the medical records and PAS were used to define definite and probable hip fracture. We used logistic regression analysis in order to estimate systematic between-hospital variation in unmeasured confounding. Finally, to study the consequences of unmeasured confounding for identifying mortality outlier hospitals, a sensitivity analysis was performed. Results The estimated overall positive predictive value was 95.9% for definite and 99.7% for definite or probable hip fracture, with no statistically significant differences between hospitals. The standard deviation of the additional, systematic hospital bias in mortality estimates was 0.044 on the logistic scale. The effect of unmeasured confounding on outlier detection was small to moderate, noticeable only for large hospital volumes. Conclusions This study showed that PAS data are adequate for identifying cases of hip fracture, and the effect of unmeasured case mix variation was small. In conclusion, PAS data are adequate for calculating 30-day mortality after hip-fracture as a quality

  19. The importance of cardiovascular pathology contributing to maternal death: Confidential Enquiry into Maternal Deaths in South Africa, 2011–2013

    PubMed Central

    Soma-Pillay, Priya; Seabe, Joseph; Soma-Pillay, Priya; Seabe, Joseph; Sliwa, Karen

    2016-01-01

    Summary Aims Cardiac disease is emerging as an important contributor to maternal deaths in both lower-to-middle and higher-income countries. There has been a steady increase in the overall institutional maternal mortality rate in South Africa over the last decade. The objectives of this study were to determine the cardiovascular causes and contributing factors of maternal death in South Africa, and identify avoidable factors, and thus improve the quality of care provided. Methods Data collected via the South African National Confidential Enquiry into Maternal Deaths (NCCEMD) for the period 2011–2013 for cardiovascular disease (CVD) reported as the primary pathology was analysed. Only data for maternal deaths within 42 days post-delivery were recorded, as per statutory requirement. One hundred and sixty-nine cases were reported for this period, with 118 complete hospital case files available for assessment and data analysis. Results Peripartum cardiomyopathy (PPCM) (34%) and complications of rheumatic heart disease (RHD) (25.3%) were the most important causes of maternal death. Hypertensive disorders of pregnancy, HIV disease infection and anaemia were important contributing factors identified in women who died of peripartum cardiomyopathy. Mitral stenosis was the most important contributor to death in RHD cases. Of children born alive, 71.8% were born preterm and 64.5% had low birth weight. Seventy-eight per cent of patients received antenatal care, however only 33.7% had a specialist as an antenatal care provider. Avoidable factors contributing to death included delay in patients seeking help (41.5%), lack of expertise of medical staff managing the case (29.7%), delay in referral to the appropriate level of care (26.3%), and delay in appropriate action (36.4%). Conclusion The pattern of CVD contributing to maternal death in South Africa was dominated by PPCM and complications of RHD, which could, to a large extent, have been avoided. It is likely that there were

  20. Maternal vitamin D status during pregnancy and child outcomes

    PubMed Central

    Gale, Catharine R; Robinson, Sian M; Harvey, Nicholas C; Javaid, M Kassim; Jiang, Benyu; Martyn, Christopher N; Godfrey, Keith M; Cooper, Cyrus

    2009-01-01

    Objective: To investigate whether exposure to high maternal concentrations of 25(OH)-vitamin D in pregnancy poses any risk to the child. Design: Prospective study. Setting: Princess Anne Maternity Hospital, Southampton, UK. Subjects: 596 pregnant women were recruited. 466 (78%) children were examined at birth, 440 (74%) at age 9 months and 178 (30%) at age 9 years. Methods: Maternal (OH)-vitamin D concentrations were measured in late pregnancy. Anthropometry of the child was recorded at birth, 9 months and 9 years. At 9 months, atopic eczema was assessed. At 9 years, children had an echocardiogram and a DXA scan, blood pressure, arterial compliance and carotid intima-media thickness were measured and intelligence and psychological function assessed. Results: There were no associations between maternal 25(OH)-vitamin D concentrations and the child's body size or measures of the child's intelligence, psychological health or cardiovascular system. Children whose mothers' concentration of 25(OH)-vitamin D in pregnancy was >75 nmol/l had an increased risk of eczema on examination at 9 months (OR 3.26, 95% CI 1.15-9.29, p=0.025) and asthma at age 9 years (OR 5.40, 95% CI, 1.09-26.65, p=0.038) compared to children whose mothers' concentration was <30 nmol/l. Conclusion: Exposure to maternal concentrations of 25(OH)-vitamin D in pregnancy in excess of 75 nmol/l does not appear to influence the child's intelligence, psychological health or cardiovascular system; there could be an increased risk of atopic disorders, but this needs confirmation in other studies. PMID:17311057

  1. Conversion and Data Quality Assessment of Electronic Health Record Data at a Korean Tertiary Teaching Hospital to a Common Data Model for Distributed Network Research

    PubMed Central

    Yoon, Dukyong; Ahn, Eun Kyoung; Park, Man Young; Cho, Soo Yeon; Ryan, Patrick; Schuemie, Martijn J.; Shin, Dahye; Park, Hojun

    2016-01-01

    Objectives A distributed research network (DRN) has the advantages of improved statistical power, and it can reveal more significant relationships by increasing sample size. However, differences in data structure constitute a major barrier to integrating data among DRN partners. We describe our experience converting Electronic Health Records (EHR) to the Observational Health Data Sciences and Informatics (OHDSI) Common Data Model (CDM). Methods We transformed the EHR of a hospital into Observational Medical Outcomes Partnership (OMOP) CDM ver. 4.0 used in OHDSI. All EHR codes were mapped and converted into the standard vocabulary of the CDM. All data required by the CDM were extracted, transformed, and loaded (ETL) into the CDM structure. To validate and improve the quality of the transformed dataset, the open-source data characterization program ACHILLES was run on the converted data. Results Patient, drug, condition, procedure, and visit data from 2.07 million patients who visited the subject hospital from July 1994 to November 2014 were transformed into the CDM. The transformed dataset was named the AUSOM. ACHILLES revealed 36 errors and 13 warnings in the AUSOM. We reviewed and corrected 28 errors. The summarized results of the AUSOM processed with ACHILLES are available at http://ami.ajou.ac.kr:8080/. Conclusions We successfully converted our EHRs to a CDM and were able to participate as a data partner in an international DRN. Converting local records in this manner will provide various opportunities for researchers and data holders. PMID:26893951

  2. Strategies for reducing maternal mortality.

    PubMed

    Clark, Steven L

    2012-02-01

    The maternal death rate in the United States has shown no improvement in several decades and may be increasing. On the other hand, hospital systems that have instituted comprehensive programs directed at the prevention of maternal mortality have demonstrated rates that are half of the national average. These programs have emphasized the reduction of variability in the provision of care through the use of standard protocols, reliance on checklists instead of memory for critical processes, and an approach to peer review that emphasizes systems change. In addition, elimination of a small number of repetitive errors in the management of hypertension, postpartum hemorrhage, pulmonary embolism, and cardiac disease will contribute significantly to a reduction in maternal mortality. Attention to these general principles and specific error reduction strategies will be of benefit to every practitioner and more importantly to the patients we serve. PMID:22280865

  3. [Influence of tobacco smoking on newborn's birth weight--analisys of dates concerning births from Maternity Hospital named. Dr S. Mossor's in Opole City].

    PubMed

    Guzikowski, Wojciech; Pirogowicz, Iwona

    2008-01-01

    Despite wide education, tobacco smoking while being pregnant is very important issue in perinatology. It is important problem because of life style of polish society, including pregnant women. Clinical observation of this issue is pointing on risk of occurring pathology in pregnancy, unfavorable consequences for neonate also many distant pathological effects among children. Purpose of this was getting an answer for question: whether in current social and economic situation there is connection between low birth mass and smoking tobacco during pregnancy. Under analysis were found births between 38th and 40th one hundred successive births (according to book of birth-room from 2860 labors in hospital in Opol, 2007) of mothers are smoking up to 10 cigarettes a day (group I), mothers smoking 11-20 cigarettes a day (group II) and mothers that are not smoking. This works affirms that smoking has negative influence on child birth mass. It is also displayed that higher the number of smoked cigarettes the higher percent of newborns with low birth mass and higher number o fetus with intrauterine growth retardation. Among mothers that are smoking the biggest group were young women (mean. 24, years) and multipara female (58%). PMID:19189515

  4. Pregnancy Outcomes of Mothers with Detectable CMV-Specific IgM Antibodies: A Three-Year Review in a Large Irish Tertiary Referral Maternity Hospital

    PubMed Central

    Drew, Richard J.; Stapleton, Patrick; Abu, Hala; Healy, Eibhlín; Ferguson, Wendy; De Gascun, Cillian; O'Gorman, Joanne; Eogan, Maeve

    2015-01-01

    A retrospective audit was performed for all obstetric patients who had positive CMV IgM results between January 2012 and December 2014 in the Rotunda Hospital, Ireland. In total, 622 CMV IgM positive tests were performed on samples from 572 patients. Thirty-seven patients had a positive CMV IgM result (5.9%) on the Architect system as part of the initial screening. Three patients were excluded as they were not obstetric patients. Of the 34 pregnant women with CMV IgM positive results on initial screening, 16 (47%) had CMV IgM positivity confirmed on the second platform (VIDAS) and 18 (53%) did not. In the 16 patients with confirmed positive CMV IgM results, four (25%) had acute infection, two (12.5%) had infection of uncertain timing, and ten (62.5%) had infection more than three months prior to sampling as determined by the CMV IgG avidity index. Two of the four neonates of women with low avidity IgG had CMV DNA detected in urine. Both these cases had severe neurological damage and the indication for testing their mothers was because the biparietal diameter (BPD) was less than the 5th centile at the routine 20-week gestation anomaly scan. PMID:26696757

  5. Examining Evidence-Based Content Related to Hospital Acquired Pressure Ulcer Prevention in Paper and Electronic Health Records

    ERIC Educational Resources Information Center

    Jaekel, Camilla M.

    2012-01-01

    Although there have been great advancements in the Electronic Health Record (EHR), there is a dearth of rigorous research that examines the relationship between the use of electronic documentation to capture nursing process components and the impact of consistent documentation on patient outcomes (Daly, Buckwalter & Maas, 2002; Gugerty, 2006;…

  6. Midwives’ knowledge and attitudes when encountering Gender-Based Violence in their practice at a maternity-hospital in Kingston, Jamaica

    PubMed Central

    Pitter, Cynthia Pearl

    2016-01-01

    Introduction Gender-based violence (GBV) can have devastating consequences for pregnancy because both mother and child are at risk. Midwives are in a strategic position to identify and empower pregnant women experiencing GBV; however, currently midwives in Jamaica are not required to screen for GBV, neither are they prepared to do so. Aim This study forms the baseline of a larger study designed to improve the capacity of midwives to identify and treat pregnant women experiencing GBV in Jamaica. This specific component assessed midwives’ knowledge and attitudes when encountering GBV in their practice in Kingston, Jamaica. Methods A qualitative study design was used. Six practicing midwives were purposely selected to participate in a focus group discussion at the antenatal clinic of a hospital in Kingston, Jamaica. Results All six respondents said it was very important to screen for GBV among pregnant women in their care. The findings from their report revolved around six themes, namely midwives have suboptimal knowledge, are exposed to women experiencing GBV in pregnancy, lack professional preparedness, report gaps in the institutional framework to guide their practice, are concerned for their safety and security, and are willing to intervene. Conclusion This study confirmed that midwives are aware of the problem and are willing to intervene but are faced with lack of formal procedures to detect and treat pregnant women who are experiencing GBV. Findings could be used to inform a protocol which is being developed to guide midwives’ practice. Findings could also be incorporated in the national strategy to eliminate GBV. PMID:26894744

  7. Death Anxiety in Hospitalized End-of-Life Patients as Captured from a Structured Electronic Health Record

    PubMed Central

    Lodhi, Muhammad Kamran; Cheema, Umer Iftikhar; Stifter, Janet; Wilkie, Diana J.; Keenan, Gail M.; Yao, Yingwei; Ansari, Rashid; Khokhar, Ashfaq A.

    2015-01-01

    The nursing outcomes of hospitalized patients whose plans of care include death anxiety, which is a diagnosis among patients at the end-of-life, are obscure. The authors of the current article applied data mining techniques to nursing plan-of-care data for patients diagnosed with death anxiety, as defined by North American Nursing Diagnosis Association International, from four different hospitals to examine nursing care outcomes and associated factors. Results indicate that <50% of patients met the expected outcome of comfortable death. Gerontology unit patients were more likely to meet the expected outcome than patients from other unit types, although results were not statistically significant. Younger patients (i.e., age <65) had a lower chance of meeting the outcome compared with older patients (i.e., age ≥65) (χ2(1) = 9.266, p < 0.004). Longer stays improved the chances of meeting the outcome (χ2(2) = 6.47, p < 0.04). Results indicate that death anxiety outcomes are suboptimal and suggest the need to better educate clinicians about diagnosing and treating death anxiety among patients who face the end-of-life transition. PMID:25157534

  8. ‘Shell shock’ Revisited: An Examination of the Case Records of the National Hospital in London

    PubMed Central

    Linden, Stefanie Caroline; Jones, Edgar

    2014-01-01

    During the First World War the National Hospital for the Paralysed and Epileptic, in Queen Square, London, then Britain’s leading centre for neurology, took a key role in the treatment and understanding of shell shock. This paper explores the case notes of all 462 servicemen who were admitted with functional neurological disorders between 1914 and 1919. Many of these were severe or chronic cases referred to the National Hospital because of its acknowledged expertise and the resources it could call upon. Biographical data was collected together with accounts of the patient’s military experience, his symptoms, diagnostic interpretations and treatment outcomes. Analysis of the notes showed that motor syndromes (loss of function or hyperkinesias), often combined with somato-sensory loss, were common presentations. Anxiety and depression as well as vegetative symptoms such as sweating, dizziness and palpitations were also prevalent among this patient population. Conversely, psychogenic seizures were reported much less frequently than in comparable accounts from German tertiary referral centres. As the war unfolded the number of physicians who believed that shell shock was primarily an organic disorder fell as research failed to find a pathological basis for its symptoms. However, little agreement existed among the Queen Square doctors about the fundamental nature of the disorder and it was increasingly categorised as functional disorder or hysteria. PMID:25284893

  9. ["I was like a ticking bomb": Experiences of severe maternal morbidity in the Metropolitan Area of Buenos Aires].

    PubMed

    Szulik, Dalia; Szwarc, Lucila

    2015-12-01

    With the objective of recording and analyzing women's experiences with severe maternal morbidity from their perspective, between February and May 2011, 16 semi-structured interviews with women treated in the public hospitals of the Buenos Aires Metropolitan Area who suffered from severe maternal morbidity were carried out. In their testimonies, women report a number of delays in care, such as difficulties in identifying the problem on time, obstacles in accessing health centers and important faults in the management of obstetric emergencies. They describe the event as surprising, distressing and painful, a perception reinforced by the violation of their rights and significant communication problems. These findings are meant as a step towards the holistic and comprehensive study of severe maternal morbidity, as well as to confirm the urgent need for further research from a gender and humans rights perspective. PMID:26676597

  10. Quality of documentation on antibiotic therapy in medical records: evaluation of combined interventions in a teaching hospital by repeated point prevalence survey.

    PubMed

    Vercheval, C; Gillet, M; Maes, N; Albert, A; Frippiat, F; Damas, P; Van Hees, T

    2016-09-01

    This study aimed to improve the quality of documentation on antibiotic therapy in the computerized medical records of inpatients. A prospective, uncontrolled, interrupted time series (ITS) study was conducted by repeated point prevalence survey (PPS) to audit the quality of documentation on antibiotic therapy in the medical records before and after a combined intervention strategy (implementation of guidelines, distribution of educational materials, educational outreach visits, group educational interactive sessions) from the antimicrobial stewardship team (AST) in the academic teaching hospital (CHU) of Liège, Belgium. The primary outcome measure was the documentation rate on three quality indicators in the computerized medical records: (1) indication for treatment, (2) antibiotics prescribed, and (3) duration or review date. Segmented regression analysis was used to analyze the ITS. The medical records of 2306 patients receiving antibiotics for an infection (1177 in the pre-intervention period and 1129 in the post-intervention period) were analyzed. A significant increase in mean percentages in the post-intervention period was observed as compared with the pre-intervention period for the three quality indicators (indication documented 83.4 ± 10.4 % vs. 90.3 ± 6.6 %, p = 0.0013; antibiotics documented 87.9 ± 9.0 % vs. 95.6 ± 5.1 %, p < 0.0001; and duration or review date documented 31.9 ± 15.4 % vs. 67.7 ± 15.2 %, p < 0.0001). The study demonstrated the successful implementation of a combined intervention strategy from the AST. This strategy was associated with significant changes in the documentation rate in the computerized medical records for the three quality indicators. PMID:27255220

  11. Simple interventions can greatly improve clinical documentation: a quality improvement project of record keeping on the surgical wards at a district general hospital

    PubMed Central

    Glen, Peter; Earl, Naomi; Gooding, Felix; Lucas, Emily; Sangha, Nicole; Ramcharitar, Steve

    2015-01-01

    Clinical documentation is an integral part of the healthcare professional's job. Good record keeping is essential for patient care, accurate recording of consultations and for effective communication within the multidisciplinary team. Within the surgical department at the Great Western Hospital, Swindon, the case notes were deemed to be bulky and cumbersome, inhibiting effective record keeping, potentially putting patients' at risk. The aim of this quality improvement project was therefore to improve the standard of documentation, the labelling of notes and the overall filing. A baseline audit was firstly undertaken assessing the notes within the busiest surgical ward. A number of variables were assessed, but notably, only 12% (4/33) of the case notes were found to be without loose pages. Furthermore, less than half of the pages with entries written within the last 72 hours contained adequate patient identifiers on them. When assessing these entries further, the designation of the writer was only recorded in one third (11/33) of the cases, whilst the printed name of the writer was only recorded in 65% (21/33) of the entries. This project ran over a 10 month period, using a plan, do study, act methodology. Initial focus was on simple education. Afterwards, single admission folders were introduced, to contain only information required for that admission, in an attempt to streamline the notes and ease the filing. This saw a global improvement across all data subsets, with a sustained improvement of over 80% compliance seen. An educational poster was also created and displayed in clinical areas, to remind users to label their notes with patient identifying stickers. This saw a 4-fold increase (16%-68%) in the labelling of notes. In conclusion, simple, cost effective measures in streamlining medical notes, improves the quality of documentation, facilitates the filing and ultimately improves patient care. PMID:26734440

  12. Effects of prenatal care on maternal postpartum behaviors

    PubMed Central

    Reichman, Nancy E.; Corman, Hope; Schwartz-Soicher, Ofira

    2010-01-01

    Most research on the effectiveness of prenatal care has focused on birth outcomes and has found small or no effects. It is possible, however, that prenatal care is “too little too late” to improve pregnancy outcomes in the aggregate, but that it increases the use of pediatric health care or improves maternal health-related parenting practices and, ultimately, child health. We use data from the Fragile Families and Child Wellbeing birth cohort study that have been augmented with hospital medical record data to estimate effects of prenatal care timing on pediatric health care utilization and health-related parenting behaviors during the first year of the child’s life. We focus on maternal postpartum smoking, preventive health care visits for the child, and breastfeeding. We use a multi-pronged approach to address the potential endogeneity of the timing of prenatal care. We find that first trimester prenatal care appears to decrease maternal postpartum smoking by about 5 percentage points and increase the likelihood of 4 or more well-baby visits by about 1 percentage point, and that it may also have a positive effect on breastfeeding. These findings suggest that there are benefits to standard prenatal care that are generally not considered in evaluations of prenatal care programs and interventions. PMID:20582158

  13. Assessment of maternal mortality in Tanzania.

    PubMed

    Walraven, G E; Mkanje, R J; van Roosmalen, J; van Dongen, P W; Dolmans, W M

    1994-05-01

    The results from a prospective community survey, a sisterhood method survey, and a hospital survey were compared in order to ascertain a reliable and inexpensive method for estimating direct deaths from obstetric complications of pregnancy. The maternal mortality ratio was used to express risk of dying during pregnancy. The surveys were conducted in Kwimba District in Mwanza region of northwestern Tanzania: in August 1989 to March 1991 in the community study within the primary health care area of Sumve Hospital, which supplied data on maternal mortality between 1986 and 1990. The sisterhood survey was conducted in 2 villages in 1990, of which 1 village was included in the community survey. The village study included 447 women, of whom 421 remained in the survey and delivered 427 infants (415 live born); there was 1 maternal death. The sisterhood method engaged 2865 respondents and the lifetime risk of maternal death was estimated at 297 and the proportional maternal mortality rate was 13.9%. There were 82 maternal deaths and 589 deaths from all causes among sisters aged 15 years and older. 7526 women were included in the hospital survey, of which 7335 births were represented; there were 62 maternal deaths. The maternal mortality risk was 845 among hospital admissions. 69% of all maternal deaths were accounted for by direct causes. Most deaths were attributed to the top 5 worldwide causes: obstructed labor, puerperal sepsis, postpartum hemorrhage, complications of abortion, and preeclampsia. There were few reports of abortions and abortion-related mortality. Relapsing fever or Borrelia infection was an indirect cause of death common to the region and particularly hazardous to pregnant women. Many hospital deaths were emergency admissions. The conclusion was that the sisterhood method provided a better indication of the extent of maternal mortality within the community. Other advantages were the small sample and the speed, quickness, and low cost. Hospital data

  14. Maternal characteristics and timing of presentation following pre-labour rupture of membranes

    PubMed Central

    Osaikhuwuomwan, James A.; Osemwenkha, Abieyuwa P.

    2014-01-01

    Background: To examine the influence of maternal characteristics on timing of presentation for intervention following pre-labour rupture of membrane (PROM) at term. Materials and Methods: This was a descriptive study of cases of term PROM with singleton births at the University of Benin Teaching Hospital (UBTH) from October 2011 to December 2012. Interval from onset of PROM to presentation to hospital was used as dependent variable. From the study population, two groups were identified based on time interval (≤24 hours or >24 hours) from PROM to presentation to hospital and their relationship to socio-demographic characteristic examined. Results: Over the study period, records of 110 women met the inclusion criteria and were selected for analysis. Their mean age was 29.26 ± 0.67 years; they were all married with 41.8% being nulliparous women. The mean gestational age at presentation with PROM was 38.5 ± 1.2. Over 50% had tertiary level of education. Overall, 38.2% were in social class 1. With regard to maternal response behaviour to PROM, 65.5% presented to the hospital within 24 hours while 34.5% presented after 24 hours of rupture of membranes. Majority of those that presented within 24 hours of PROM were in (upper) social class 1 and 2 and this differed significantly from those that presented after 24 hours, most of whom were in (lower) social class 3,4 and 5; [56 (77.8%) vs 16 (22.2%) and 14 (36.8%) vs 24 (63.2%)] P = 0.0001. Conclusion: Delay in presentation after PROM, illustrative of maternal under utilisation of BPACR package, is associated with being in a lower social class. Socio-economic and educational empowerment of women is advocated, while prospective research on maternal perception and attitude towards ANC is proposed. PMID:24970972

  15. Maternity telehealth: ringing the changes.

    PubMed

    Finlay, Dorothy; Brown, Sheona

    2013-12-01

    This article describes NHS Scotland's Maternity telehealth options project and the implementation of the recommendations made. This 17-month project resulted in the development of national documentation for recording telehealth calls; the development of a self-directed eLearning tool on maternity telehealth call structure which was made available to all health boards in Scotland; a comprehensive programme of training on telehealth for student midwives; a programme of 'Train-the-trainer' events for qualified midwives to enable the cascade of learning throughout the service. The project also involved collaboration with Health Scotland, signposting for women to contact the appropriate caregiver at the appropriate time. PMID:24386706

  16. Conducting research using the electronic health record across multi-hospital systems: semantic harmonization implications for administrators.

    PubMed

    Bowles, Kathryn H; Potashnik, Sheryl; Ratcliffe, Sarah J; Rosenberg, Melissa; Shih, Nai-Wei; Topaz, Maxim; Holmes, John H; Naylor, Mary D

    2013-06-01

    Administrators play a major role in choosing and managing the use of the electronic health record (EHR). The documentation policies and EHR changes enacted or approved by administrators affect the ability to use clinical data for research. This article illustrates the challenges that can be avoided through awareness of the consequences of customization, variations in documentation policies and quality, and user interface features. Solutions are posed that assist administrators in avoiding these challenges and promoting data harmonization for research and quality improvement. PMID:23708504

  17. Improving maternity care in Ethiopia through facility based review of maternal deaths and near misses.

    PubMed

    Gebrehiwot, Yirgu; Tewolde, Birukkidus T

    2014-10-01

    The present study aimed to initiate facility based review of maternal deaths and near misses as part of the Ethiopian effort to reduce maternal mortality and achieve United Nations Millennium Development Goals 4 and 5. An in-depth review of all maternal deaths and near misses among women who visited 10 hospitals in four regions of Ethiopia was conducted between May 2011 and October 2012 as part of the FIGO LOGIC initiative. During the study period, a total of 2774 cases (206 deaths and 2568 near misses) were reviewed. The ratio of maternal deaths to near misses was 1:12 and the overall maternal death rate was 728 per 100 000 live births. Socioeconomic factors associated with maternal mortality included illiteracy 1672 (60.3%) and lack of employment outside the home 2098 (75.6%). In all, 1946 (70.2%) women arrived at hospital after they had developed serious complications owing to issues such as lack of transportation. Only 1223 (44.1%) women received prenatal follow-up and 157 (76.2%) deaths were attributed to direct obstetric causes. Based on the findings, facilities adopted a number of quality improvement measures such as providing 24-hour services, and making ambulances available. Integrating review of maternal deaths and near misses into regular practice provides accurate information on causes of maternal deaths and near misses and also improves quality of care in facilities. PMID:25261109

  18. The preferences of users of electronic medical records in hospitals: quantifying the relative importance of barriers and facilitators of an innovation

    PubMed Central

    2014-01-01

    Background Currently electronic medical records (EMRs) are implemented in hospitals, because of expected benefits for quality and safety of care. However the implementation processes are not unproblematic and are slower than needed. Many of the barriers and facilitators of the adoption of EMRs are identified, but the relative importance of these factors is still undetermined. This paper quantifies the relative importance of known barriers and facilitators of EMR, experienced by the users (i.e., nurses and physicians in hospitals). Methods A discrete choice experiment (DCE) was conducted among physicians and nurses. Participants answered ten choice sets containing two scenarios. Each scenario included attributes that were based on previously identified barriers in the literature: data entry hardware, technical support, attitude head of department, performance feedback, flexibility of interface, and decision support. Mixed Multinomial Logit analysis was used to determine the relative importance of the attributes. Results Data on 148 nurses and 150 physicians showed that high flexibility of the interface was the factor with highest relative importance in their preference to use an EMR. For nurses this attribute was followed by support from the head of department, presence of performance feedback from the EMR and presence of decisions support. While for physicians this ordering was different: presence of decision support was relatively more important than performance feedback and support from the head of department. Conclusion Considering the prominent wish of all the intended users for a flexible interface, currently used EMRs only partially comply with the needs of the users, indicating the need for closer incorporation of user needs during development stages of EMRs. The differences in priorities amongst nurses and physicians show that different users have different needs during the implementation of innovations. Hospital management may use this information to

  19. Maternal Care and Attachment Security in Ordinary and Emergency Contexts.

    ERIC Educational Resources Information Center

    Posada, German; Jacobs, Amanda; Carbonell, Olga A.; Alzate, Gloria; Bustamante, Maria R.; Arenas, Angela

    1999-01-01

    Two studies examined the relationship between maternal sensitivity and infant security of attachment in home and hospital contexts. Results are discussed in terms of links between methodology and effect sizes, the generality of links between maternal care and child security, need for research on caregiving in ordinary and emergency situations, and…

  20. Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe.

    PubMed

    Munyaradzi Kenneth, Dodzo; Marvellous, Mhloyi; Stanzia, Moyo; Memory, Dodzo-Masawi

    2016-01-01

    Religion affects people's daily lives by solving social problems, although it creates others. Female sexual and reproductive health are among the issues most affected by religion. Apostolic sect members in Zimbabwe have been associated with higher maternal mortality. We explored apostolic beliefs and practices on maternal health using 15 key informant interviews in 5 purposively selected districts of Zimbabwe. Results show that apostolicism promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care. It causes delays in recognizing danger signs, deciding to seek care, reaching and receiving appropriate health care. The existence of a customized spiritual maternal health system demonstrates a huge desire for positive maternal health outcomes among apostolics. We conclude that apostolic beliefs and practices exacerbate delays between onset of maternal complications and receiving help, thus increasing maternal risk. We recommend complementary and adaptive approaches that address the maternal health needs of apostolics in a religiously sensitive manner. PMID:27509018

  1. Praying until Death: Apostolicism, Delays and Maternal Mortality in Zimbabwe

    PubMed Central

    2016-01-01

    Religion affects people’s daily lives by solving social problems, although it creates others. Female sexual and reproductive health are among the issues most affected by religion. Apostolic sect members in Zimbabwe have been associated with higher maternal mortality. We explored apostolic beliefs and practices on maternal health using 15 key informant interviews in 5 purposively selected districts of Zimbabwe. Results show that apostolicism promotes high fertility, early marriage, non-use of contraceptives and low or non-use of hospital care. It causes delays in recognizing danger signs, deciding to seek care, reaching and receiving appropriate health care. The existence of a customized spiritual maternal health system demonstrates a huge desire for positive maternal health outcomes among apostolics. We conclude that apostolic beliefs and practices exacerbate delays between onset of maternal complications and receiving help, thus increasing maternal risk. We recommend complementary and adaptive approaches that address the maternal health needs of apostolics in a religiously sensitive manner. PMID:27509018

  2. Does prenatal care benefit maternal health? A study of post-partum maternal care use.

    PubMed

    Liu, Tsai-Ching; Chen, Bradley; Chan, Yun-Shan; Chen, Chin-Shyan

    2015-10-01

    Most studies on prenatal care focus on its effects on infant health, while studying less about the effects on maternal health. Using the Longitudinal Health Insurance claims data in Taiwan in a recursive bivariate probit model, this study examines the impact of adequate prenatal care on the probability of post-partum maternal hospitalization during the first 6 months after birth. The results show that adequate prenatal care significantly reduces the probability of post-partum maternal hospitalization among women who have had vaginal delivery by 43.8%. This finding suggests that the benefits of prenatal care may have been underestimated among women with vaginal delivery. Timely and adequate prenatal care not only creates a positive impact on infant health, but also yields significant benefits for post-partum maternal health. However, we do not find similar benefits of prenatal care for women undergoing a cesarean section. PMID:26189913

  3. Improving maternal confidence in neonatal care through a checklist intervention

    PubMed Central

    Radenkovic, Dina; Kotecha, Shrinal; Patel, Shreena; Lakhani, Anjali; Reimann-Dubbers, Katharina; Shah, Shreya; Jafree, Daniyal; Mitrasinovic, Stefan; Whitten, Melissa

    2016-01-01

    Previous qualitative studies suggest a lack of maternal confidence in care of their newborn child upon discharge into the community. This observation was supported by discussion with healthcare professionals and mothers at University College London Hospital (UCLH), highlighting specific areas of concern, in particular identifying and managing common neonatal presentations. The aim of this study was to design and introduce a checklist, addressing concerns, to increase maternal confidence in care of their newborn child. Based on market research, an 8-question checklist was designed, assessing maternal confidence in: feeding, jaundice, nappy care, rashes and dry skin, umbilical cord care, choking, bowel movements, and vomiting. Mothers were assessed as per the checklist, and received a score representative of their confidence in neonatal care. Mothers were followed up with a telephone call, and were assessed after a 7-day-period. Checklist scores before as compared to after the follow-up period were analysed. This process was repeated for three study cycles, with the placement of information posters on the ward prior to the second study cycle, and the stapling of the checklist to the mother's personal child health record (PCHR) prior to the third study cycle. A total of 99 mothers on the Maternity Care Unit at UCLH were enrolled in the study, and 92 were contactable after a 7-day period. During all study cycles, a significant increase in median checklist score was observed after, as compared to before, the 7-day follow up period (p < 0.001). The median difference in checklist score from baseline was greatest for the third cycle. These results suggest that introduction of a simple checklist can be successfully utilised to improve confidence of mothers in being able to care for their newborn child. Further investigation is indicated, but this intervention has the potential for routine application in postnatal care. PMID:27335642

  4. ADOPTION OF THE WHO ASSESSMENT TOOL ON THE QUALITY OF HOSPITAL CARE FOR MOTHERS AND NEWBORNS IN ALBANIA

    PubMed Central

    Mersini, Ehadu; Novi, Silvana; Tushe, Eduard; Gjoni, Maksim; Burazeri, Genc

    2012-01-01

    Aim: The aim of the adoption process of the “Quality of hospital care for mothers and newborns babies, assessment tool” (WHO, 2009) was to provide the Albanian health professionals of maternity hospitals with a tool that may help them assess the quality of perinatal care and identify key areas of pregnancy, childbirth and newborn care that need to be improved. Methods: Four maternity hospitals (one university hospital and three regional hospitals) were selected for the assessment using this standard tool covering over 600 items grouped into 13 areas ranging from supportive services to case management. Sources of information consisted of site visits, hospital statistics, medical records, observation of cases and interviews with staff and patients. A score was assigned to each item (range 0-3) and area of care. The assessments were carried out in two rounds: in 2009 and in 2011. These assessments provided semi-quantitative data on the quality of hospital care for mothers and newborns. Results: Data collected on the first round established a baseline assessment, whereas the second round monitored the subsequent changes. The findings of the second round revealed improvements encountered in all maternities, notwithstanding differences in the levels of improvement between maternities, not necessarily linked with extra financial inputs. Conclusions: The Albanian experience indicates a successful process of the adoption of the WHO tool on the quality of hospital care for mothers and newborn babies. The adopted tool can be used country-wide as a component of a quality improvement strategy in perinatal health care in Albania. PMID:23378688

  5. Pregnancy Outcome of Women With Gestational Diabetes in a Tertiary Level Hospital of North India

    PubMed Central

    Saxena, Pikee; Tyagi, Swati; Prakash, Anupam; Nigam, Aruna; Trivedi, Shubha Sagar

    2011-01-01

    Background: Women with gestational diabetes mellitus (GDM) pose an important public health problem because diabetes not only affects the maternal and fetal outcome, but these women and their fetuses are also at an increased risk of developing diabetes and related complications later in their life. Objectives: The study was conducted to determine the maternal and fetal outcomes of 50 diabetic vs 50 normoglycemic pregnancies. Materials and Methods: This was a retrospective analytical record-based study conducted in a tertiary level hospital. Detailed information regarding maternal, fetal, and labor outcome parameters was recorded in a prestructured proforma and compared in normoglycemic and diabetic pregnancies. Results: Patients with obesity, history of diabetes in the family, spontaneous abortions, and gestational diabetes in previous pregnancies had a greater incidence of GDM in current pregnancy (P<0.05 for all). Hypertension, polyhydramnios, macrosomia, fetopelvic disproportion, and cesarean sections were more (P<0.001) among diabetic pregnancies. Congenital anomalies, polycythemia, hypocalcemia, and hyperbilirubinemia were also observed to be more (P<0.05) in neonates born to diabetics, suggesting an adverse effect of hyperglycemia in utero. Conclusion: Diabetes during pregnancy is associated with higher maternal and fetal morbidity. Therefore, early screening, detection, close monitoring, and intervention is essential to reduce maternal and fetal short- and long-term adverse effects, especially in high-risk groups. Pregnancy provides an opportunity to the clinician to control the disease process and inculcate healthy lifestyle practices in these patients. PMID:21976796

  6. [Prevention of cot death in maternity hospitals].

    PubMed

    Fleurigeon, Aline; Billard, Estelle; Monfort, Sara; Brochard, Mélissa; Angeli, Francine; Éoche, Danielle

    2015-01-01

    Part of the role of the child health nurse is to promote the health of infants and families in a public health community approach. She designs and implements health education actions. Raising parents' awareness of how to position newborns when they sleep and the prevention of cot death is a public health priority. PMID:26146000

  7. Birthing Centers and Hospital Maternity Services

    MedlinePlus

    ... Looking for Health Lessons? Visit KidsHealth in the Classroom What Other Parents Are Reading Upsetting News Reports? What to Say Vaccines: Which Ones & When? Smart School Lunches Emmy-Nominated Video "Cerebral Palsy: Shannon's ...

  8. Risk of Adverse Infant Outcomes Associated with Maternal Tuberculosis in a Low Burden Setting: A Population-Based Retrospective Cohort Study

    PubMed Central

    LaCourse, Sylvia M.; Greene, Sharon A.; Dawson-Hahn, Elizabeth E.; Hawes, Stephen E.

    2016-01-01

    Background. Maternal tuberculosis (TB) may be associated with increased risk of adverse infant outcomes. Study Design. We examined the risk of low birth weight (LBW), small for gestational age (SGA), and preterm birth (<37 weeks) associated with maternal TB in a retrospective population-based Washington State cohort using linked infant birth certificate and maternal delivery hospitalization discharge records. We identified 134 women with births between 1987 and 2012 with TB-associated ICD-9 diagnosis codes at hospital delivery discharge and 536 randomly selected women without TB, frequency matched 4 : 1 on delivery year. Multinomial logistic regression analyses were performed to compare the risk of LBW, SGA, and preterm birth between infants born to mothers with and without TB. Results. Infants born to women with TB were 3.74 (aRR 95% CI 1.40–10.00) times as likely to be LBW and 1.96 (aRR 95% CI 0.91–4.22) as likely to be SGA compared to infants born to mothers without TB. Risk of prematurity was similar (aRR 1.01 95% CI 0.39–2.58). Conclusion. Maternal TB is associated with poor infant outcomes even in a low burden setting. A better understanding of the adverse infant outcomes associated with maternal TB, reflecting recent trends in US TB epidemiology, may inform potential targeted interventions in other low prevalence settings. PMID:26989338

  9. Risk of Adverse Infant Outcomes Associated with Maternal Tuberculosis in a Low Burden Setting: A Population-Based Retrospective Cohort Study.

    PubMed

    LaCourse, Sylvia M; Greene, Sharon A; Dawson-Hahn, Elizabeth E; Hawes, Stephen E

    2016-01-01

    Background. Maternal tuberculosis (TB) may be associated with increased risk of adverse infant outcomes. Study Design. We examined the risk of low birth weight (LBW), small for gestational age (SGA), and preterm birth (<37 weeks) associated with maternal TB in a retrospective population-based Washington State cohort using linked infant birth certificate and maternal delivery hospitalization discharge records. We identified 134 women with births between 1987 and 2012 with TB-associated ICD-9 diagnosis codes at hospital delivery discharge and 536 randomly selected women without TB, frequency matched 4 : 1 on delivery year. Multinomial logistic regression analyses were performed to compare the risk of LBW, SGA, and preterm birth between infants born to mothers with and without TB. Results. Infants born to women with TB were 3.74 (aRR 95% CI 1.40-10.00) times as likely to be LBW and 1.96 (aRR 95% CI 0.91-4.22) as likely to be SGA compared to infants born to mothers without TB. Risk of prematurity was similar (aRR 1.01 95% CI 0.39-2.58). Conclusion. Maternal TB is associated with poor infant outcomes even in a low burden setting. A better understanding of the adverse infant outcomes associated with maternal TB, reflecting recent trends in US TB epidemiology, may inform potential targeted interventions in other low prevalence settings. PMID:26989338

  10. Maternal mortality in Yazd Province, Iran

    PubMed Central

    Karimi-Zarchi, Mojgan; Ghane-Ezabadi, Marzie; Vafaienasab, Mohammadreza; Dehghan, Ali; Ghasemi, Fateme; Zaidabadi, Mahbube; Zanbagh, Leila; Yazdian-Anari, Pouria; Teimoori, Soraya

    2016-01-01

    Introduction Five hundred thousand maternal deaths occur each year worldwide, many of which are in developing countries. The maternal mortality rate is a measure that demonstrates the degree of adequacy of prenatal care and of economic and social conditions. The aim of this study was to determine the frequency and causes of pregnancy-related mortality rates in Yazd Province. Methods This cross-sectional study examined the maternal deaths related to pregnancy that were recorded in Yazd Province, Iran, from 2002 to 2011. All maternal deaths that occurred during pregnancy, during delivery, and 42 days after birth were analyzed in this study. The data were collected through a questionnaire, and both direct and indirect causes of maternal deaths were determined. Results Forty pregnancy-related deaths occurred in this period, and the maternal mortality rate was 20.8 deaths per 100,000 live births. The mean age of death in the mothers in this study was 29.17. Fifty-five percent of women of the women who died delivered their babies by cesarean section, and only 20% of them delivered their babies vaginally. Bleeding was the most common cause of maternal mortality (30%), and it was associated directly with maternal mortality. Furthermore 20% of the mothers died due to heart disease and cardiac complications, which were associated indirectly with maternal mortality. Conclusion Cesarean section and its complications were the main cause of death in many cases. Thus, providing a strategic plan to reduce the use of this procedure, educate mothers, and ensure adequate access to pre-maternal care and to care during pregnancy are the most important measures that can be taken to decrease the maternal mortality rate. PMID:27054003

  11. Maternal sounds elicit lower heart rate in preterm newborns in the first month of life

    PubMed Central

    Rand, Katherine; Lahav, Amir

    2015-01-01

    Background The preferential response to mother’s voice in the fetus and term newborn is well documented. However, the response of preterm neonates is not well understood and more difficult to interpret due to the intensive clinical care and range of medical complications. Aim This study examined the physiological response to maternal sounds and its sustainability in the first month of life in infants born very pretermaturely. Methods Heart rate changes were monitored in 20 hospitalized preterm infants born between 25 and 32 weeks of gestation during 30-minute exposure vs. non-exposure periods of recorded maternal sounds played inside the Neonatal incubator. A total of 13,680 min of HR data was sampled throughout the first month of life during gavage feeds Heart rate with and without exposure to maternal sounds. Results During exposure periods, infants had significantly lower heart rate compared to matched periods of care Auditory without exposure on the same day (p < .0001). This effect was observed in all infants, across the first month of life, irrespective of day of life, gestational age at birth, birth weight, age at testing, Apgar score, caffeine therapy, and requirement for respiratory support. No adverse effects were observed. Conclusion Preterm newborns responded to maternal sounds with decreased heart rate throughout the first month of life. It is possible that maternal sounds improve autonomic stability and provide a more relaxing environment for this population of newborns. Further studies are needed to determine the therapeutic implications of maternal sound exposure for optimizing care practices and developmental outcomes. PMID:25194837

  12. [Costs of maternal-infant care in an institutionalized health care system].

    PubMed

    Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

    1998-01-01

    Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities. PMID:9528219

  13. Maternal mortality in southern India.

    PubMed

    Rao, P S; Amalraj, A

    1994-01-01

    In a 4 year prospective community survey of 20,000 women randomly selected in North Arcot District of Tamil Nadu State in South India, the maternal mortality rates per 1,000 liveborn were estimated to be 17.4 and 16.6 for rural and semi-urban areas, respectively. The rates based only on direct causes were 11.9 in rural and 14.4 in semi-urban areas. As expected, these figures are considerably higher than those based on official or hospital statistics. Factors associated with such high mortality and the implications for programme planning and implementation are discussed. PMID:7855917

  14. Maternal Mortality at Federal Medical Centre Yola, Adamawa State: A Five-Year Review

    PubMed Central

    Bukar, M; Kunmanda, V; Moruppa, JY; Ehalaiye, B; Takai, UI; Ndonya, DN

    2013-01-01

    Background: The North Eastern region of Nigeria has one of the highest maternal mortality ratios (MMRs) in the world, and most of these deaths are preventable. Culture, religion and customs that prevent access to care contribute immensely to these deaths. Aim: To review and document the MMR. Materials and Methods: This was a retrospective study of all maternal deaths recorded at the Federal Medical Centre Yola (FMCY). The case notes of all cases of maternal deaths from January 2007 to December 2011 were retrieved and relevant data obtained and analyzed. The age, parity, literacy level, booking status, causes of maternal deaths, were analysed. Data were presented in tables and percentages, using SPSS version 16(Chicago, USA 2006). Results: There were 54 maternal deaths among the 8497 deliveries, giving an overall MMR of 636 per 100,000 deliveries. Thirty three folders (33) folders were retrieved and 28 had complete information for analysis. The mean (SD) age and parity were 28.2 (6.2) and 3.4 (2.0), respectively. Most deaths (9/28; 32.1%) were in the age group of 20-24 years. Multiparae (14/28; 50%) constituted the largest parity group. Majority (16/28; 57.1) were non-literates, 16/28 (57.1%) were of Hausa/Fulani extraction and 12/28 (42.9%) were unbooked. The leading causes of maternal mortality were preeclampsia/eclampsia (9/28; 32.1%), obstetric hemorrhage (8/28; 28.6%) and severe anemia (3/28; 10.7%). All those who died of preeclampsia/eclampsia were Hausa/Fulani. Most (14/28; 50%) deaths occurred within 24 h of admission. Majority of the deaths were Muslims (χ2 = 15.108, P = <0.001). Ethnicity had no significant influence on maternal death (χ2 = 15.550, P = 0.21). Conclusion: In conclusion, the MMR in FMCY is higher than the national average. The fact that most deaths occurred within 24 h of admission suggests that many of the patients delayed reaching the referring center for a variety of reasons. Preventive measures should focus on this delay, which is

  15. Metabolic adjustments to moderate maternal nutrient restriction.

    PubMed

    Schlabritz-Loutsevitch, Natalia E; Dudley, Christopher J; Gomez, Jeremiah J; Nevill, C Heath; Smith, Bonnie K; Jenkins, Susan L; McDonald, Thomas J; Bartlett, Thad Q; Nathanielsz, Peter W; Nijland, Mark J

    2007-08-01

    Reduced food availability in pregnancy influences fetal growth, obstetric outcomes and offspring health in both developing and developed countries. The objective of the present study was to determine responses to moderate global maternal nutrient restriction (MNR) during pregnancy in baboons (Papio hamadryas) - an established non-human primate model for pregnancy-related research. Starting at 30 d gestation (dG), twelve pregnant baboons received 70 % of food (MNR group) consumed by twenty ad libitum-fed pregnant controls. Maternal body weight, BMI, food intake and physical activity were measured before pregnancy, at 90 dG and at 165 dG (full-term 180 dG). Fetal and placental weights were recorded at the time of Caesarean section (90 and 165 dG). Activity patterns were also evaluated in fourteen non-pregnant female baboons. Behavioural observations were made in five non-pregnant, six control and four MNR animals. Pregnant baboons decreased overall physical activity and energy-expensive behaviours compared with non-pregnant baboons. In the MNR group, maternal weight, weight gain and maternal physical activity were reduced compared with the control animals. MNR decreased placental weight and volume compared with control, while fetal weight and length were unaffected. We conclude that decreased physical activity and increased usage of maternal available body stores play an important role in the maternal response to pregnancy. Also, adaptations in maternal behaviour and energy utilisation protect fetal growth during moderate MNR. PMID:17391566

  16. The burden of breast cancer in Italy: mastectomies and quadrantectomies performed between 2001 and 2008 based on nationwide hospital discharge records

    PubMed Central

    2012-01-01

    Background Where population coverage is limited, the exclusive use of Cancer Registries might limit ascertainment of incident cancer cases. We explored the potentials of Nationwide hospital discharge records (NHDRs) to capture incident breast cancer cases in Italy. Methods We analyzed NHDRs for mastectomies and quadrantectomies performed between 2001 and 2008. The average annual percentage change (AAPC) and related 95% Confidence Interval (CI) in the actual number of mastectomies and quadrantectomies performed during the study period were computed for the full sample and for subgroups defined by age, surgical procedure, macro-area and singular Region. Re-admissions of the same patients were separately presented. Results The overall number of mastectomies decreased, with an AAPC of −2.1% (−2.3 -1.8). This result was largely driven by the values observed for women in the 45 to 64 and 65 to 74 age subgroups (−3.0%, -3.4 -3.6 and −3.3%, -3.8 -2.8, respectively). We observed no significant reduction in mastectomies for women in the remaining age groups. Quadrantectomies showed an overall +4.7 AAPC (95%CI:4.5–4.9), with no substantial differences by age. Analyses by geographical area showed a remarkable decrease in mastectomies, with inter-regional discrepancies possibly depending upon variability in mammography screening coverage and adherence. Quadrantectomies significantly increased, with Southern Regions presenting the highest average rates. Data on repeat admissions within a year revealed a total number of 46,610 major breast surgeries between 2001 and 2008, with an overall +3.2% AAPC (95%CI:2.8-3.6). Conclusions In Italy, NHDRs might represent a valuable supplemental data source to integrate Cancer Registries in cancer surveillance. PMID:23168067

  17. Maternal near miss in the intensive care unit: clinical and epidemiological aspects

    PubMed Central

    Oliveira, Leonam Costa; da Costa, Aurélio Antônio Ribeiro

    2015-01-01

    Objective To analyze the epidemiological clinical profile of women with maternal near miss according to the new World Health Organization criteria. Methods A descriptive crosssectional study was conducted, in which the records of patients admitted to the obstetric intensive care unit of a tertiary hospital in Recife (Brazil) over a period of four years were analyzed. Women who presented at least one near miss criterion were included. The variables studied were age, race/color, civil status, education, place of origin, number of pregnancies and prenatal consultations, complications and procedures performed, mode of delivery, gestational age at delivery, and maternal near miss criteria. The descriptive analysis was performed using the program Epi-Info 3.5.1. Results Two hundred fifty-five cases of maternal near miss were identified, with an overall ratio of maternal near miss of 12.8/1,000 live births. Among these cases, 43.2% of the women had incomplete primary education, 44.7% were primiparous, and 20.5% had undergone a previous cesarean section. Regarding specific diagnoses, there was a predominance of hypertensive disorders (62.7%), many of which were complicated by HELLP (hemolysis, elevated liver enzymes, and low platelets) syndrome (41.2%). The laboratory near miss criteria were the most often observed (59.6%), due mainly to the high frequency of acute thrombocytopenia (32.5%). Conclusions A high frequency of women who had a low level of education and who were primiparous was observed. According to the new criteria proposed by the World Health Organization, hypertensive pregnancy disorders are still the most common among maternal near miss cases. The high frequency of HELLP syndrome was also striking, which contributed to acute thrombocytopenia being the most frequent near miss criterion. PMID:26270856

  18. Prenatal Depressive Symptoms and Toddler Behavior Problems: The Role of Maternal Sensitivity and Child Sex.

    PubMed

    Edwards, Renee C; Hans, Sydney L

    2016-10-01

    Increasing evidence suggests that maternal depression during pregnancy is associated with child behavioral outcomes even after accounting for later maternal depression. The purpose of this study was to examine various mechanisms, including maternal sensitivity, neonatal problems, and concurrent maternal depression, that might explain the association between prenatal maternal depressive symptoms and toddler behavior problems. Young, low income, African American mothers (n = 196) were interviewed during pregnancy and at 24-months postpartum, medical records were collected at the birth, and mother-child interactions were video-recorded at 24 months. Path analyses revealed that the association between prenatal depression and toddler behavior problems was mediated by maternal sensitivity and maternal depressive symptoms at 24 months. No evidence was found for a mediating effect of neonatal problems. Path models examining sex differences suggested that different mediating factors may be important for boys and girls, with boys being particularly susceptible to the effects of maternal sensitivity. PMID:26521260

  19. Maternal anxiety: course and antecedents during the early postpartum period.

    PubMed

    Britton, John R

    2008-01-01

    The early course and antecedents of postpartum anxiety are unknown. This study sought to determine the course and antecedents of maternal anxiety during the first month postpartum and to develop a model to predict 1-month anxiety using information obtainable before perinatal hospital discharge. Two hundred and ninety-six mothers were screened before discharge with the State (SS) and Trait (TS) Scales of the State Trait Anxiety Inventory (STAI). Demographic characteristics were assessed by questionnaire and medical record review, and psychiatric history, measures of perinatal stress, and resilient factors were determined by focused questions and formal instruments. At 1-month postpartum, the SS was repeated. Scores on the SS were significantly higher at 1 month than immediately postpartum (35.30+/-0.68 versus 33.38+/-0.60, mean+/-standard error, P=.004), but only 58.6% of mothers with high pre-discharge anxiety had high anxiety at 1 month. One-month anxiety correlated with pre-discharge SS and TS scores, a history of psychiatric problems including depressed mood, medical and negative social life events, lack of pregnancy planning and prenatal class attendance, perceived peripartum stress, and duration of postpartum hospital stay. Inverse correlations were observed with education, household income, and resiliency factors. In multivariate modeling, anxiety trait, education, history >or=2 years of depression, and perception of peripartum stress accounted for 50% of the variance in the 1-month SS score. Maternal anxiety increases during the first postpartum month. Women with high trait anxiety, low education, a history of depressed mood, and a perception of high peripartum stress are at risk for experiencing anxiety at this time. PMID:17397041

  20. Assessing the ability of health information systems in hospitals to support evidence-informed decisions in Kenya

    PubMed Central

    Kihuba, Elesban; Gathara, David; Mwinga, Stephen; Mulaku, Mercy; Kosgei, Rose; Mogoa, Wycliffe; Nyamai, Rachel; English, Mike

    2014-01-01

    Background Hospital management information systems (HMIS) is a key component of national health information systems (HIS), and actions required of hospital management to support information generation in Kenya are articulated in specific policy documents. We conducted an evaluation of core functions of data generation and reporting within hospitals in Kenya to facilitate interpretation of national reports and to provide guidance on key areas requiring improvement to support data use in decision making. Design The survey was a cross-sectional, cluster sample study conducted in 22 hospitals in Kenya. The statistical analysis was descriptive with adjustment for clustering. Results Most of the HMIS departments complied with formal guidance to develop departmental plans. However, only a few (3/22) had carried out a data quality audit in the 12 months prior to the survey. On average 3% (range 1–8%) of the total hospital income was allocated to the HMIS departments. About half of the records officer positions were filled and about half (13/22) of hospitals had implemented some form of electronic health record largely focused on improving patient billing and not linked to the district HIS. Completeness of manual patient registers varied, being 90% (95% CI 80.1–99.3%), 75.8% (95% CI 68.7–82.8%), and 58% (95% CI 50.4–65.1%) in maternal child health clinic, maternity, and pediatric wards, respectively. Vital events notification rates were low with 25.7, 42.6, and 71.3% of neonatal deaths, infant deaths, and live births recorded, respectively. Routine hospital reports suggested slight over-reporting of live births and under-reporting of fresh stillbirths and neonatal deaths. Conclusions Study findings indicate that the HMIS does not deliver quality data. Significant constraints exist in data quality assurance, supervisory support, data infrastructure in respect to information and communications technology application, human resources, financial resources, and

  1. The O3-Vet project: integration of a standard nomenclature of clinical terms in a veterinary electronic medical record for veterinary hospitals.

    PubMed

    Zaninelli, M; Campagnoli, A; Reyes, M; Rojas, V

    2012-11-01

    In order to improve the hospital information system of the Chilean University Hospital, the Veterinary Medicine School of Universidad de Chile made a research cooperation with Università San Raffaele Roma to develop and test a new release of the O3-Vet software application. O3-Vet was selected by the Chilean University mainly for two reasons: (1) it uses human medicine standardized technologies such as "Health Level 7" (HL7) and "Integrating the Healthcare Enterprise" (IHE), which allow a good level of data sharing and hospital management; (2) it is open source, which means it can be adapted to specific hospital needs. In the new release, a subset of diagnostic terms was added from the "Systematized Nomenclature of Medicine Clinical Terms" (SNOMED CT), selected by the "American Animal Hospital Association" (AAHA) to standardize the filing of clinical data and its retrieval. Results from a limited survey of veterinarians of the University (n=9) show that the new release improved the management of the Chilean University Hospital and the ability to retrieve useful clinical data. PMID:22595264

  2. Improving reporting of infant deaths, maternal deaths and stillbirths in Haryana, India.

    PubMed

    Negandhi, Preeti H; Neogi, Sutapa B; Chopra, Sapna; Phogat, Amit; Sahota, Rupinder; Gupta, Ravikant; Gupta, Rakesh; Zodpey, Sanjay

    2016-05-01

    Underreporting hampers the accurate estimation of the numbers of infant and maternal deaths and stillbirths in India. In Haryana state, a surveillance-based model - the Maternal Infant Death Review System - was launched in 2013 to try to resolve this issue. The system is a mixture of routine passive data collection and active surveillance by specially recruited and trained field volunteers. The volunteers gather the relevant data from child day-care centres, community health centres, cremation grounds, hospitals, the municipal corporation's offices and primary health centres and regularly visit health subcentres. The collected data are triangulated against the standard death registers and discussions with relevant community members. The details of any unregistered death are rapidly uploaded on the system's web-based platform. In April 2014, we made field observations, reviewed records and conducted in-depth interviews with the key stakeholders to see if the system's performance matched the state government's planned objectives. The data collected indicate that implementation of the system has led to quantitative and qualitative improvements in reporting of infant and maternal deaths and stillbirths. Completeness and consistency in the reporting of deaths are essential for focused policy and programmatic interventions and there remains scope for improvement in Haryana via further reform and changes in policy. The model in its current form is potentially sustainable and scalable in similar settings elsewhere. PMID:27147767

  3. Improving reporting of infant deaths, maternal deaths and stillbirths in Haryana, India

    PubMed Central

    Neogi, Sutapa B; Chopra, Sapna; Phogat, Amit; Sahota, Rupinder; Gupta, Ravikant; Gupta, Rakesh; Zodpey, Sanjay

    2016-01-01

    Abstract Underreporting hampers the accurate estimation of the numbers of infant and maternal deaths and stillbirths in India. In Haryana state, a surveillance-based model – the Maternal Infant Death Review System – was launched in 2013 to try to resolve this issue. The system is a mixture of routine passive data collection and active surveillance by specially recruited and trained field volunteers. The volunteers gather the relevant data from child day-care centres, community health centres, cremation grounds, hospitals, the municipal corporation’s offices and primary health centres and regularly visit health subcentres. The collected data are triangulated against the standard death registers and discussions with relevant community members. The details of any unregistered death are rapidly uploaded on the system’s web-based platform. In April 2014, we made field observations, reviewed records and conducted in-depth interviews with the key stakeholders to see if the system’s performance matched the state government’s planned objectives. The data collected indicate that implementation of the system has led to quantitative and qualitative improvements in reporting of infant and maternal deaths and stillbirths. Completeness and consistency in the reporting of deaths are essential for focused policy and programmatic interventions and there remains scope for improvement in Haryana via further reform and changes in policy. The model in its current form is potentially sustainable and scalable in similar settings elsewhere. PMID:27147767

  4. [A Maternal Health Care System Based on Mobile Health Care].

    PubMed

    Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

    2016-02-01

    Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals. PMID:27382731

  5. Hospital Waste Management in Nonteaching Hospitals of Lucknow City, India

    PubMed Central

    Manar, Manish Kumar; Sahu, Krishna Kumar; Singh, Shivendra Kumar

    2014-01-01

    Objective: To assess hospital waste management in nonteaching hospitals of Lucknow city. Materials and Methods: A cross-sectional, descriptive study was conducted on the staffs of nonteaching hospitals of Lucknow from September 2012 to March 2013. A total of eight hospitals were chosen as the study sample size. Simple random sampling technique was used for the selection of the nonteaching hospitals. A pre-structured and pre-tested interview questionnaire was used to collect necessary information regarding the hospitals and biomedical waste (BMW) management of the hospitals. The general information about the selected hospitals/employees of the hospitals was collected. Results: Mean hospital waste generated in the eight nonteaching hospitals of Lucknow was 0.56 kg/bed/day. About 50.5% of the hospitals did not have BMW department and colored dustbins. In 37.5% of the hospitals, there were no BMW records and segregation at source. Incinerator was used only by hospital A for treatment of BMW. Hospital G and hospital H had no facilities for BMW treatment. Conclusion: There is a need for appropriate training of staffs, strict implementation of rules, and continuous surveillance of the hospitals of Lucknow to improve the BMW management and handling practices. PMID:25657950

  6. Community-linked maternal death review (CLMDR) to measure and prevent maternal mortality: a pilot study in rural Malawi

    PubMed Central

    Bayley, Olivia; Chapota, Hilda; Kainja, Esther; Phiri, Tambosi; Gondwe, Chelmsford; King, Carina; Nambiar, Bejoy; Mwansambo, Charles; Kazembe, Peter; Costello, Anthony; Rosato, Mikey

    2015-01-01

    Background In Malawi, maternal mortality remains high. Existing maternal death reviews fail to adequately review most deaths, or capture those that occur outside the health system. We assessed the value of community involvement to improve capture and response to community maternal deaths. Methods We designed and piloted a community-linked maternal death review (CLMDR) process in Mchinji District, Malawi, which partnered community and health facility stakeholders to identify and review maternal deaths and generate actions to prevent future deaths. The CLMDR process involved five stages: community verbal autopsy, community and facility review meetings, a public meeting and bimonthly reviews involving both community and facility representatives. Results The CLMDR process was found to be comparable to a previous research-driven surveillance system at identifying deaths in Mchinji District (population 456 500 in 2008). 52 maternal deaths were identified between July 2011 and June 2012, 27 (52%) of which would not have been identified without community involvement. Based on district estimates of population (500 000) and crude birth rate (35 births per 1000 population), the maternal mortality ratio was around 300 maternal deaths per 100 000 live births. Of the 41 cases that started the CLMDR process, 28 (68%) completed all five stages. We found the CLMDR process to increase the quantity of information available and to involve a wider range of stakeholders in maternal death review (MDR). The process resulted in high rates of completion of community-planned actions (82%), and district hospital (67%) and health centre (65%) actions to prevent maternal deaths. Conclusions CLMDR is an important addition to the established forms of MDR. It shows potential as a maternal death surveillance system, and may be applicable to similar contexts with high maternal mortality. PMID:25897028

  7. Caregivers' role in maternal-fetal conflict.

    PubMed

    Avci, Ercan

    2015-01-01

    The case, which occurred in a public hospital in Turkey in 2005, exhibits a striking dilemma between a mother's and her fetus' interests. For a number of reasons, the mother refused to cooperate with the midwives and obstetrician in the process of giving birth, and wanted to leave the hospital. The care providers evaluated the case as a matter of maternal autonomy and asked the mother to give her consent to be discharged from the hospital, which she did despite the fact that her cervix was fully open. She left the hospital and gave birth shortly thereafter. Subsequently, the baby died two days later. In light of the contemporary ethical principles, the mother's competency could be debatable due to the physical and psychological conditions the mother confronted. Furthermore, protection of the fetus' life should have been taken into account by the caregivers when making a decision concerning discharging of the mother. PMID:25981283

  8. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

    PubMed

    2014-08-22

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2014. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014. In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that

  9. Mother-baby friendly hospital.

    PubMed

    Aragon-choudhury, P

    1996-01-01

    In Manila, the Philippines, the Dr. Jose Fabella Memorial Hospital has been a maternity hospital for 75 years. It averages 90 deliveries a day. Its fees are P200-P500 for a normal delivery and P800-P2000 for a cesarean section. Patients pay what they can and pay the balance when they can. The hospital provides a safe motherhood package that encompasses teaching responsible parenthood, prenatal care, labor, delivery, postpartum care, breast feeding, family planning, and child survival. In 1986, the hospital introduced innovative policies and procedures that promote, protect, and support breast feeding. It has a rooming-in policy that has saved the hospital P6.5 million so far. In the prenatal stage, hospital staff inform pregnant women that colostrum protects the newborn against infections, that suckling stimulates milk production, and that there is no basis to the claim of having insufficient breast milk. Sales representatives of milk substitutes are banned from the hospital. Staff confiscate milk bottles or formula. A lactation management team demonstrates breast feeding procedures. Mothers also receive support on the correct way of breast feeding from hospital staff, volunteers from the Catholic Women's League, consumer groups, and women lawyers. The hospital's policy is no breast milk, no discharge. This encourages mothers to motivate each other to express milk immediately after birth. The hospital has received numerous awards for its breast feeding promotion efforts. UNICEF has designated Fabella Hospital as a model of the Baby-Friendly Hospital Initiative. The hospital serves as the National Lactation Management Education Training Center. People from other developing countries have received training in lactation management here. The First Lady of the Philippines, the First Lady of the US, and the Queen of Spain have all visited the hospital. The hospital has also integrated its existing services into a women's health care center. PMID:12347466

  10. On solid ground. Revenue gains continue to outpace growth in expenses, allowing U.S. hospitals to enjoy record profit and margin.

    PubMed

    Evans, Melanie

    2007-10-29

    Hospitals enjoyed a surge in profits last year, reporting an aggregate profit margin of 6%. Executives at financially strong systems credit long-term efforts to improve performance for the results. Elizabeth Concordia, left, of the University of Pittsburgh Medical Center system, says its efforts stressed ongoing consolidation and integration to wipe out waste and errors. PMID:18020051

  11. Nurses’ Perceptions of Usefulness of Nursing Information System: Module of Electronic Medical Record for Patient Care in Two University Hospitals of Iran

    PubMed Central

    Kahouei, Mehdi; Baba Mohammadi, Hassan; Askari Majdabadi, Hesamedin; Solhi, Mahnaz; Parsania, Zeinab; Said Roghani, Panoe; Firozeh, Mehri

    2014-01-01

    Introduction: For almost fifteen years, the application of computer in hospitals increasingly has become popular. Nurses’ beliefs and attitudes towards computer is one of the most important indicators of the application of nursing information system. The purpose of this study was to investigate the perceptions of nurses on the usefulness of nursing information system for patient care. Methods: Here, a descriptive study was carried out. Sample was consisted of 316 nurses working in teaching hospitals in an urban area of Iran. This study was conducted during 2011 to 2012. A reliable and valid questionnaire was developed as a data collection tool. The collected data was analyzed using descriptive and inferential statistics. Results: It was not believed that nursing information system was useful for patient care. However, it was mentioned that nursing information system is useful in some aspects of patient care such as expediting care, making early diagnosis and formulating diet plan. A significant association was found between the demographic background of sample and their perceptions of the usefulness of nursing information system (P<0.05). Conclusion: Totally, it can be concluded that nursing information system has a potential for improving patient care in hospital settings. Therefore, policy makers should consider implementing nursing information system in teaching hospitals. PMID:24757398

  12. Norovirus - hospital

    MedlinePlus

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... fluids ( dehydration ). Anyone can become infected with norovirus. Hospital patients who are very old, very young, or ...

  13. Maternal and neonatal outcomes of macrosomic pregnancies

    PubMed Central

    Weissmann-Brenner, Alina; Simchen, Michal J.; Zilberberg, Eran; Kalter, Anat; Weisz, Boaz; Achiron, Reuven; Dulitzky, Mordechai

    2012-01-01

    Summary Background To compare maternal and neonatal outcomes of term macrosomic and adequate for gestational age (AGA) pregnancies. Material/Methods A retrospective analysis was performed on all term singleton macrosomic (birth weight ≥4000 g) and AGA (birth weight >10th percentile and <4000 g) pregnancies delivered at our hospital between 2004 and 2008. Data collected included maternal age, gestational age at delivery, mode of delivery, birth weight, fetal gender, maternal and neonatal complications. Comparisons were made between macrosomic and AGA pregnancies and between different severities of macrosomia (4000–4250 g, 4250–4500 g and ≥4500 g). Results The study population comprised of 34,685 pregnancies. 2077 neonates had birth weight ≥4000 g. Maternal age and gestational age at delivery were significantly higher for macrosomic neonates. Significantly more macrosomic neonates were born by cesarean section, and were complicated with shoulder dystocia, neonatal hypoglycemia, and had longer hospitalization period (both in vaginal and cesarean deliveries). Specifically, the odds ratio (OR) relative to AGA pregnancies for each macrosomic category (4000–4250 g, 4250–4500 g and ≥4500 g) of shoulder dystocia was 2.37, 2.24, 7.61, respectively, and for neonatal hypoglycemia 4.24, 4.41, 4.15, respectively. The risk of post partum hemorrhage was statistically increased when birth weight was >4500 g (OR=5.23) but not for birth weight between 4000–4500 g. No differences were found in the rates of extensive perineal lacerations between AGA and the different macrosomic groups. Conclusions Macrosomia is associated with increased rate of cesarean section, shoulder dystocia, neonatal hypoglycemia, and longer hospitalization, but not associated with excessive perineal tears. Increased risk of PPH was found in the >4500g group. PMID:22936200

  14. Next steps to reduce maternal morbidity and mortality in the USA.

    PubMed

    Kilpatrick, Sarah J

    2015-03-01

    Maternal mortality is rising in the USA. The pregnancy-related maternal mortality ratio increased from 10/100,000 to 17/100,000 live births from the 1990s to 2012. A large proportion of maternal deaths are preventable. This review highlights a national approach to reduce maternal death and morbidity and discusses multiple efforts to reduce maternal morbidity, death and improve obstetric safety. These efforts include communication and collaboration between all stake holders involved in perinatal health, creation of national bundles addressing key maternal care areas such as hemorrhage management, call for all obstetric hospitals to review and analyze all cases of severe maternal morbidity, and access to contraception. Implementation of interventions based on these efforts is a national imperative to improve obstetric safety. PMID:25776293

  15. Combined Effect of Fetal Sex and Advanced Maternal Age on Pregnancy Outcomes

    PubMed Central

    Weissmann-Brenner, Alina; Simchen, Michal J.; Zilberberg, Eran; Kalter, Anat; Dulitzky, Mordechai

    2015-01-01

    Background Fetal sex and maternal age are each known to affect outcomes of pregnancies. The objective of the present study was to investigate the influence of the combination of maternal age and fetal sex on pregnancy outcomes in term and post-term singleton pregnancies. Material/Methods This was a retrospective study on term singleton pregnancies delivered between 2004 and 2008 at the Chaim Sheba Medical Center. Data collected included maternal age, fetal sex, and maternal and neonatal complications. The combined effect of fetal sex and maternal age on complications of pregnancy was assessed by multivariable logistic regression models. Results The study population comprised 37,327 pregnancies. The risk of operative deliveries increased with maternal age ≥40 and in pregnancies with male fetuses. The risk of maternal diabetes and of longer hospitalization increased as maternal age increased, and in women <40 carrying male fetuses. The risk of hypertensive disorders increased in pregnancies with males as maternal age advanced. The risk of shoulder dystocia and neonatal respiratory complications increased in male neonates born to women<40. The risk of neonatal hypoglycemia increased in males for all maternal ages. Conclusions Risk assessment for fetal sex and advanced maternal age were given for different pregnancy complications. Knowledge of fetal sex adds value to the risk assessment of pregnancies as maternal age increases. PMID:25892459

  16. Maternal Grand Multiparity and the Risk of Severe Mental Disorders in Adult Offspring

    PubMed Central

    Lahti, Marius; Eriksson, Johan G.; Heinonen, Kati; Kajantie, Eero; Lahti, Jari; Wahlbeck, Kristian; Tuovinen, Soile; Pesonen, Anu-Katriina; Mikkonen, Maiju; Osmond, Clive; Räikkönen, Katri

    2014-01-01

    Background Previous studies have shown that maternal grand multiparity may predict an increased risk of mental disorders in young adult offspring, but whether such effects persist throughout adulthood remains unknown. The current study examined if maternal grand multiparity predicts the risks of severe mental disorders, suicides, suicide attempts and dementias throughout adult life. Methods Our study sample comprised 13243 Helsinki Birth Cohort Study 1934–1944 participants (6905 men and 6338 women). According to hospital birth records, 341 offspring were born to grand multiparous mothers. From Finnish national hospital discharge and causes of death registers, we identified 1682 participants diagnosed with mental disorders during 1969–2010. Results Maternal grand multiparity predicted significantly increased risks of mood disorders (Hazard Ratio = 1.64, p = 0.03), non-psychotic mood disorders (Hazard Ratio = 2.02, p = 0.002), and suicide attempts (Hazard Ratio = 3.94, p = 0.01) in adult offspring. Furthermore, women born to grand multiparous mothers had significantly increased risks of any severe mental disorder (Hazard Ratio = 1.79, p = 0.01), non-psychotic substance use disorders (Hazard Ratio = 2.77, p = 0.02) schizophrenia, schizotypal and delusional disorders (Hazard Ratio = 2.40, p = 0.02), mood disorders (Hazard Ratio = 2.40, p = 0.002), non-psychotic mood disorders (Hazard Ratio = 2.91, p<0.001), and suicide attempts (Hazard Ratio = 5.05, p = 0.01) in adulthood. The effects of maternal grand multiparity on offspring psychopathology risk were independent of maternal age and body mass index at childbirth, and of year of birth, sex, childhood socioeconomic position, and birth weight of the offspring. In contrast, no significant effects were found among men. Conclusions Women born to grand multiparous mothers are at an increased risk of severe mental disorders and suicide attempts across

  17. 'The pregnant women are here for the sake of the teaching institution': The lying-in hospital of Göttingen University, 1751 to c. 1830.

    PubMed

    Schlumbohm, J

    2001-01-01

    Drawing on the admission records, the medical casebooks and the publications of its director, this article explores how the University of Göttingen's maternity hospital achieved its three official goals: teaching medical students, training female midwives, and providing shelter for needy parturient women. Since educating medical men was the most important aim of the hospital, the paper particularly focuses on how the demands of instruction shaped day-to-day obstetrical practices, especially under the directorship of Professor Friedrich Benjamin Osiander (1792-1822). He was a keen advocate of the forceps, whereas the first director, Professor Johann Georg Roederer (1751-63), had taken a moderate, that is a much less interventionist, approach to obstetrics. Osiander avowedly was determined to subordinate the parturient women to the demands of the clinic and to treat them as 'living manikins'. In spite of that, there is evidence that the pregnant and parturient women, most of whom were unmarried and from the lower classes, made use of the lying-in hospital for their own purposes, and that sometimes they refused to play the role assigned to them. The link between the maternity hospital and the rise of the man-midwife and of 'scientific' obstetrics appears to have been particularly strong in the case of Göttingen and other German university hospitals, compared with lying-in hospitals in other countries where the link was more indirect. PMID:14524351

  18. Medication Adherence Patterns after Hospitalization for Coronary Heart Disease. A Population-Based Study Using Electronic Records and Group-Based Trajectory Models

    PubMed Central

    Librero, Julián; Sanfélix-Gimeno, Gabriel; Peiró, Salvador

    2016-01-01

    Objective To identify adherence patterns over time and their predictors for evidence-based medications used after hospitalization for coronary heart disease (CHD). Patients and Methods We built a population-based retrospective cohort of all patients discharged after hospitalization for CHD from public hospitals in the Valencia region (Spain) during 2008 (n = 7462). From this initial cohort, we created 4 subcohorts with at least one prescription (filled or not) from each therapeutic group (antiplatelet, beta-blockers, ACEI/ARB, statins) within the first 3 months after discharge. Monthly adherence was defined as having ≥24 days covered out of 30, leading to a repeated binary outcome measure. We assessed the membership to trajectory groups of adherence using group-based trajectory models. We also analyzed predictors of the different adherence patterns using multinomial logistic regression. Results We identified a maximum of 5 different adherence patterns: 1) Nearly-always adherent patients; 2) An early gap in adherence with a later recovery; 3) Brief gaps in medication use or occasional users; 4) A slow decline in adherence; and 5) A fast decline. These patterns represented variable proportions of patients, the descending trajectories being more frequent for the beta-blocker and ACEI/ARB cohorts (16% and 17%, respectively) than the antiplatelet and statin cohorts (10% and 8%, respectively). Predictors of poor or intermediate adherence patterns were having a main diagnosis of unstable angina or other forms of CHD vs. AMI in the index hospitalization, being born outside Spain, requiring copayment or being older. Conclusion Distinct adherence patterns over time and their predictors were identified. This may be a useful approach for targeting improvement interventions in patients with poor adherence patterns. PMID:27551748

  19. System failure. Most U.S. hospitals have never filed a report with the databank that records doctor suspensions; critics say it's time for a new method.

    PubMed

    Romano, Michael

    2005-07-25

    The National Practitioner Data Bank was born in 1990, touted as an authoritative way to track doctors whose privileges were suspended. Initial predictions expected up to 10,000 reports yearly, but only about 10,800 reports have been made in 15 years. Many believe hospitals skirt the system by just issuing lesser punishments. "It happens," admits Mark Pincus, right, the databank administrator. PMID:16101245

  20. Sequential observation of infant regulated and dysregulated behavior following soothing and stimulating maternal behavior during feeding

    PubMed Central

    Brown, Lisa F.; Pridham, Karen A.; Brown, Roger

    2014-01-01

    Purpose To describe maternal behaviors occurring before infant regulated or dysregulated behavior at three times in early infancy and examine behavioral patterns over time with their prematurely born infants. Method & Design Video-recordings of 37 dyads were coded on infant regulated and dysregulated behaviors following maternal soothing and stimulating behaviors. Results At each time, infants showed more regulation after maternal soothing than after maternal stimulating. Further study is merited. Practice Implications Knowing infant regulation and dysregulation following categories of maternal behavior could help mothers anticipate infant regulatory or dysregulatory behavior in response to their own behavior and identify supportive caregiving strategies. PMID:24417766

  1. Iraqi Nurses’ Perspectives on Safety Issues in Maternity Services

    PubMed Central

    Jamil Piro, Tiran; Ghiyasvandian, Shahrzad; Salsali, Mahvash

    2015-01-01

    Background: Studies introduce maternal and neonatal safety phenomena as important challenges to the public health, particularly in low-income countries. However, few researches are conducted on the identification of safety issues in maternity hospitals in Iraq. It was the first study on nurses’ perspectives on safety issues in Kurdistan, Iraq. Objectives: The current study aimed to describe nurses’ perspectives on what constitutes a safe maternity service in Kurdistan, Iraq. Patients and Methods: A qualitative design, based on a content analysis approach, was used. Ten Kurdish nurses who worked in the delivery room of Kurdistan, Iraq maternity hospital were recruited through purposive sampling. Semi-structured interviews were performed to collect data. All interviews were audiotaped and transcribed verbatim. Sampling continued to the level of data saturation. Data analysis was performed based on the steps suggested by Graneheim and Lundman. Results: Thematic analysis led to the identification of six main categories including stressful job, lack of schedule and job description, providing care with limited resources, professional unaccountability, regional sociopolitical factors, and inadequate training. Conclusions: Iraqi nurses identified factors such as limited health resources, lack of job description, and professional unaccountability as major safety issues in maternity services. These findings alarm the need to ensure the provision of females and neonates with appropriate care. This, however, would require coordination between Iraqi Kurdistan health authorities to provide midwifery care facilities, high-quality and relevant staff training, and an effective healthcare system in the maternity units. PMID:26576445

  2. Data re-entry overload: time for a paradigm shift in maternity IT?

    PubMed Central

    Fawdry, Rupert; Bewley, Susan; Cumming, Grant; Perry, Helga

    2011-01-01

    This paper provides an overview of maternity information technology (IT) in Britain, questioning the usability, effectiveness and cost efficiency of the current models of implementation of electronic maternity records. UK experience of hand-held paper obstetric notes and computerized records reveals fundamental problems in the relationship between the two complementary methods of recording maternity data. The assumption that paper records would inevitably be replaced by electronic substitutes has proven false; the rigidity of analysable electronic records has led to immense incompatibility problems. The flexibility of paper records has distinct advantages that have so far not been sufficiently acknowledged. It is suggested that continuing work is needed to encourage the standardization of electronic maternity records, via a new co-creative, co-development approach and continuing international electronic community debate. PMID:21969478

  3. [Maternal refusal to consent to a cesarean delivery, stillbirth].

    PubMed

    Defline, A; Obadia, M; El Djerbi, A; Plevy, P; Lepercq, J

    2014-01-01

    The doctor-lawyer perspective that we discuss is a maternal refusal to consent to a cesarean delivery for a fetal indication in June 2011. Despite repeated information of the risks during a three-week hospitalization for pre-eclampsia, after being assured of the proper understanding of the seriousness of the situation by the patient and spouse, and after consideration to transfer to another hospital, the reiterated refusal led to a late fetal extraction resulting in term stillbirth. PMID:23972774

  4. Current status of pregnancy-related maternal mortality in Japan: a report from the Maternal Death Exploratory Committee in Japan

    PubMed Central

    Hasegawa, Junichi; Sekizawa, Akihiko; Tanaka, Hiroaki; Katsuragi, Shinji; Osato, Kazuhiro; Murakoshi, Takeshi; Nakata, Masahiko; Nakamura, Masamitsu; Yoshimatsu, Jun; Sadahiro, Tomohito; Kanayama, Naohiro; Ishiwata, Isamu; Kinoshita, Katsuyuki; Ikeda, Tomoaki

    2016-01-01

    Objective To clarify the problems related to maternal deaths in Japan, including the diseases themselves, causes, treatments and the hospital or regional systems. Design Descriptive study. Setting Maternal death registration system established by the Japan Association of Obstetricians and Gynecologists (JAOG). Participants Women who died during pregnancy or within a year after delivery, from 2010 to 2014, throughout Japan (N=213). Main outcome measures The preventability and problems in each maternal death. Results Maternal deaths were frequently caused by obstetric haemorrhage (23%), brain disease (16%), amniotic fluid embolism (12%), cardiovascular disease (8%) and pulmonary disease (8%). The Committee considered that it was impossible to prevent death in 51% of the cases, whereas they considered prevention in 26%, 15% and 7% of the cases to be slightly, moderately and highly possible, respectively. It was difficult to prevent maternal deaths due to amniotic fluid embolism and brain disease. In contrast, half of the deaths due to obstetric haemorrhage were considered preventable, because the peak duration between the initial symptoms and initial cardiopulmonary arrest was 1–3 h. Conclusions A range of measures, including individual education and the construction of good relationships among regional hospitals, should be established in the near future, to improve primary care for patients with maternal haemorrhage and to save the lives of mothers in Japan. PMID:27000786

  5. Maternal outcomes of magnesium sulphate and diazepam use in women with severe pre-eclampsia and eclampsia in Ethiopia

    PubMed Central

    Kassie, Gizat M.; Negussie, Dereje; Ahmed, Jemal H.

    2013-01-01

    Background Preferred anticonvulsant used to treat and prevent fits in eclampsia currently is magnesium sulphate. Clinical monitoring of tendon reflexes, respiration rate and measuring hourly urine output should be done to ensures safe administration of magnesium sulphate Objective This study was conducted to evaluate maternal outcomes of magnesium sulphate and diazepam use in the management of severe pre-eclampsia and eclampsia in Jimma University Specialized Hospital. Methods A retrospective hospital based cross-sectional comparative study was conducted using data collection format. Data was collected from the hospital delivery care register and patient chart records of all pregnant women who presented with the diagnosis of severe pre-eclampsia and eclampsia in two years and three months period from January, 2010 to April, 2012. Data analysis was done by SPSS version 16.0. A P-value of <0.05 was considered statistically significant in all tests. Results A total of 357 patient charts, 217 from magnesium sulphate and 140 from diazepam treated pregnant women group, were reviewed and analyzed. Three pregnant women from the magnesium sulphate treated group and eleven pregnant women from diazepam treated group had at least one convulsion after taking the drug. Greater proportion of patients in the magnesium sulphate treated group had less than four days postpartum stay as compared to the diazepam treated patients (82.3% versus 66.2%). Seizure occurrence, duration of postpartum hospital stays and birth outcome had a statistically significant association with the type of anticonvulsant used. Conclusions Magnesium sulphate is more effective than diazepam in the management of severe pre-eclamptic and eclamptic pregnant women in terms of seizure prevention, shortening postpartum hospital stay and reducing maternal morbidities. PMID:25035717

  6. The sisterhood method of estimating maternal mortality: the Matlab experience.

    PubMed

    Shahidullah, M

    1995-01-01

    This study reports the results of a test of validation of the sisterhood method of measuring the level of maternal mortality using data from a Demographic Surveillance System (DSS) operating since 1966 in Matlab, Bangladesh. The records of maternal deaths that occurred during 1976-90 in the Matlab DSS area were used. One of the deceased woman's surviving brothers or sisters, aged 15 or older and born to the same mother, was asked if the deceased sister had died of maternity-related causes. Of the 384 maternal deaths for which siblings were interviewed, 305 deaths were correctly reported, 16 deaths were underreported, and the remaining 63 were misreported as nonmaternal deaths. Information on maternity-related deaths obtained in a sisterhood survey conducted in the Matlab DSS area was compared with the information recorded in the DSS. Results suggest that in places similar to Matlab, the sisterhood method can be used to provide an indication of the level of maternal mortality if no other data exist, though the method will produce negative bias in maternal mortality estimates. PMID:7618193

  7. Psychobiological influences on maternal sensitivity in the context of adversity.

    PubMed

    Finegood, Eric D; Blair, Clancy; Granger, Douglas A; Hibel, Leah C; Mills-Koonce, Roger

    2016-07-01

    This study evaluated prospective longitudinal relations among an index of poverty-related cumulative risk, maternal salivary cortisol, child negative affect, and maternal sensitivity across the first 2 postpartum years. Participants included 1,180 biological mothers residing in rural and predominantly low-income communities in the United States. Multilevel growth curve analyses indicated that an index of cumulative risk was positively associated with maternal cortisol across the postpartum (study visits occurring at approximately 7, 15, and 24 months postpartum) over and above effects for African American ethnicity, time of day of saliva collection, age, parity status, having given birth to another child, contraceptive use, tobacco smoking, body mass index, and breastfeeding. Consistent with a psychobiological theory of mothering, maternal salivary cortisol was negatively associated with maternal sensitivity observed during parent-child interactions across the first 2 postpartum years over and above effects for poverty-related cumulative risk, child negative affect, as well as a large number of covariates associated with cortisol and maternal sensitivity. Child negative affect expressed during parent-child interactions was negatively associated with observed maternal sensitivity at late (24 months) but not early time points of observation (7 months) and cumulative risk was negatively associated with maternal sensitivity across the postpartum and this effect strengthened over time. Results advance our understanding of the dynamic, transactional, and psychobiological influences on parental caregiving behaviors across the first 2 postpartum years. (PsycINFO Database Record PMID:27337514

  8. Transparency in Maternity Care: Empowering Women to Make Educated Choices

    PubMed Central

    McAllister, Elan

    2008-01-01

    The author of this guest editorial calls for a higher level of transparency in maternity care. The public should have access to information about hospital and provider policies and practices so that women and their families can determine where and with whom to birth. Currently, many grassroots-level projects, including The Birth Survey, are addressing this need. PMID:19436532

  9. Testing the fetal overnutrition hypothesis; the relationship of maternal and paternal adiposity to adiposity, insulin resistance and cardiovascular risk factors in Indian children

    PubMed Central

    Veena, Sargoor R; Krishnaveni, Ghattu V; Karat, Samuel C; Osmond, Clive; Fall, Caroline HD

    2012-01-01

    Objective We aimed to test the fetal overnutrition hypothesis by comparing the associations of maternal and paternal adiposity (sum of skinfolds) with adiposity and cardiovascular risk factors in children. Design Children from a prospective birth cohort had anthropometry, fat percentage (bio-impedance), plasma glucose, insulin and lipid concentrations and blood pressure measured at 9·5 years of age. Detailed anthropometric measurements were recorded for mothers (at 30 ± 2 weeks’ gestation) and fathers (5 years following the index pregnancy). Setting Holdsworth Memorial Hospital, Mysore, India. Subjects Children (n 504), born to mothers with normal glucose tolerance during pregnancy. Results Twenty-eight per cent of mothers and 38 % of fathers were overweight/obese (BMI ≥ 25·0 kg/m2), but only 4 % of the children were overweight/obese (WHO age- and sex-specific BMI ≥ 18·2 kg/m2). The children’s adiposity (BMI, sum of skinfolds, fat percentage and waist circumference), fasting insulin concentration and insulin resistance increased with increasing maternal and paternal sum of skinfolds adjusted for the child’s sex, age and socio-economic status. Maternal and paternal effects were similar. The associations with fasting insulin and insulin resistance were attenuated after adjusting for the child’s current adiposity. Conclusions In this population, both maternal and paternal adiposity equally predict adiposity and insulin resistance in the children. This suggests that shared family environment and lifestyle, or genetic/epigenetic factors, influence child adiposity. Our findings do not support the hypothesis that there is an intrauterine overnutrition effect of maternal adiposity in non-diabetic pregnancies, although we cannot rule out such an effect in cases of extreme maternal obesity, which is rare in our population. PMID:22895107

  10. Impact of maternal BMI and sampling strategy on the concentration of leptin, insulin, ghrelin and resistin in breast milk across a single feed: a longitudinal cohort study

    PubMed Central

    Andreas, Nicholas J; Hyde, Matthew J; Herbert, Bronwen R; Jeffries, Suzan; Santhakumaran, Shalini; Mandalia, Sundhiya; Holmes, Elaine; Modi, Neena

    2016-01-01

    Objectives We tested the hypothesis that there is a positive association between maternal body mass index (BMI) and the concentration of appetite-regulating hormones leptin, insulin, ghrelin and resistin in breast milk. We also aimed to describe the change in breast milk hormone concentration within each feed, and over time. Setting Mothers were recruited from the postpartum ward at a university hospital in London. Breast milk samples were collected at the participants’ homes. Participants We recruited 120 healthy, primiparous, breastfeeding mothers, aged over 18 years. Mothers who smoked, had multiple births or had diabetes were excluded. Foremilk and hindmilk samples were collected from 105 women at 1 week postpartum and 92 women at 3 months postpartum. Primary and secondary outcome measures We recorded maternal and infant anthropometric measurements at each sample collection and measured hormone concentrations using a multiplex assay. Results The concentration of leptin in foremilk correlated with maternal BMI at the time of sample collection, at 7 days (r=0.31, p=0.02) and 3 months postpartum (r=0.30, p=<0.00). Foremilk insulin correlated with maternal BMI at 3 months postpartum (r=0.22, p=0.04). Breast milk ghrelin and resistin were not correlated with maternal BMI. Ghrelin concentrations at 3 months postpartum were increased in foremilk compared with hindmilk (p=0.01). Concentrations of ghrelin were increased in hindmilk collected at 1  week postpartum compared with samples collected at 3 months postpartum (p=0.03). A trend towards decreased insulin concentrations in hindmilk was noted. Concentrations of leptin and resistin were not seen to alter over a feed. Conclusions A positive correlation between maternal BMI and foremilk leptin concentration at both time points studied, and foremilk insulin at 3 months postpartum was observed. This may have implications for infant appetite regulation and obesity risk. PMID:27388351

  11. Salmonella isolation from hospital areas.

    PubMed Central

    Harvey, R. W.; Price, T. H.; Joynson, D. H.

    1979-01-01

    Evidence of the presence of salmonellas in a paediatric ward, a special care baby unit, a maternity unit and a hospital kitchen was obtained by culture of sewer swabs, faeces and food samples. The survey was designed to cause as little administrative interference as possible. The technical aspects of the survey did not strain laboratory facilities. Minimal secondary spread of salmonella infection was experienced. PMID:390044

  12. Status of maternal and new born care at first referral units in the state of West Bengal.

    PubMed

    Biswas, A B; Nandy, S; Sinha, R N; Das, D K; Roy, R N; Datta, S

    2004-01-01

    A study was conducted in 12 First Referral Units (FRUs), selected through multistage sampling, from 6 districts of West Bengal. Infrastructure facilities, record keeping, referral system and MCH indicators related to newborn care were documented. Data was collected by review of records, interview and observation using a pre-designed proforma. Inadequate infrastructure facilities (e.g. no sanctioned posts of specialists, no blood bank at rural hospitals declared as First Referral Units etc.); poor utilization of equipment like neonatal resuscitation sets, radiant warmer etc, lack of training of the service providers were evident. Records/registers were available but incomplete. Referral system was found to be almost nonexistent. Most of the deliveries (86.1%) were normal delivery. Deliveries (87.71%) and immediate neonatal resuscitation (94.9%) were done mostly by nursing personnel. Institution based maternal, perinatal and early neonatal mortality rates were found to be 5.6, 62.4 and 25.2 per 1000 live births respectively. Eclampsia (48.9%), hemorrhage (17.7%), puerperal sepsis (7.1%) were reported to be major causes of maternal mortality. Common causes of early neonatal mortality were birth asphyxia (54.3%), sepsis (14.6%) and prematurity/LBW (12.4%). PMID:15704722

  13. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

    PubMed Central

    Armstrong, Susan J.; Rispel, Laetitia C.; Penn-Kekana, Loveday

    2015-01-01

    Background Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private) in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36). Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision of consistent and high

  14. Lifesaving emergency obstetric services are inadequate in south-west Ethiopia: a formidable challenge to reducing maternal mortality in Ethiopia

    PubMed Central

    2013-01-01

    Background Most maternal deaths take place during labour and within a few weeks after delivery. The availability and utilization of emergency obstetric care facilities is a key factor in reducing maternal mortality; however, there is limited evidence about how these institutions perform and how many people use emergency obstetric care facilities in rural Ethiopia. We aimed to assess the availability, quality, and utilization of emergency obstetric care services in the Gamo Gofa Zone of south-west Ethiopia. Methods We conducted a retrospective review of three hospitals and 63 health centres in Gamo Gofa. Using a retrospective review, we recorded obstetric services, documents, cards, and registration books of mothers treated and served in the Gamo Gofa Zone health facilities between July 2009 and June 2010. Results There were three basic and two comprehensive emergency obstetric care qualifying facilities for the 1,740,885 people living in Gamo Gofa. The proportion of births attended by skilled attendants in the health facilities was 6.6% of expected births, though the variation was large. Districts with a higher proportion of midwives per capita, hospitals and health centres capable of doing emergency caesarean sections had higher institutional delivery rates. There were 521 caesarean sections (0.8% of 64,413 expected deliveries and 12.3% of 4,231 facility deliveries). We recorded 79 (1.9%) maternal deaths out of 4,231 deliveries and pregnancy-related admissions at institutions, most often because of post-partum haemorrhage (42%), obstructed labour (15%) and puerperal sepsis (15%). Remote districts far from the capital of the Zone had a lower proportion of institutional deliveries (<2% of expected births compared to an overall average of 6.6%). Moreover, some remotely located institutions had very high maternal deaths (>4% of deliveries, much higher than the average 1.9%). Conclusion Based on a population of 1.7 million people, there should be 14 basic and four

  15. Maternal deaths in Tanzania -- a challenge.

    PubMed

    1994-08-01

    A reproductive health approach to health care has many consequences for women in Tanzania. Conditions are currently such that in one hospital in Amana there were 30 to 40 deliveries daily, but only 2 beds. The consequence was patients were treated while lying on the floor. The main city hospital did not have a vacuum aspirator, resuscitation equipment for newborns, or a sterilizer. A Dar es Salaam study shows a hospital maternal mortality rate of 754/100,000 live births, which is much higher than the 200-400/100,000 live births estimated by the WHO. The barriers to women's health are low socioeconomic status, poor nutrition, lack of income, lack of employment opportunities, and limited access to basic sanitation. There is discrimination against women in food, education, and economic independence, and social custom that denies decision making about marriage and reproduction. Access to information is limited to mother and child clinics. Men tend not to be involved in family planning or in treatment for sexually transmitted diseases. Strategies have been narrowly focused on maternal mortality, rather than on reproductive health and the right to live. Pregnancy threatens the right to life. PMID:12222520

  16. Medical records and record-keeping standards.

    PubMed

    Carpenter, Iain; Ram, Mala Bridgelal; Croft, Giles P; Williams, John G

    2007-08-01

    The structure of medical records becomes ever more critical with the advent of electronic records. The Health Informatics Unit (HIU) of the Royal College of Physicians has two work streams in this area. The Records Standards programme is developing generic standards for all entries into medical notes and standards for the content of admission, handover and discharge records. The Information Laboratory (iLab) focuses on hospital episode statistics and their use for monitoring clinician performance. Clinician endorsement of the work is achieved through extensive consultations. Generic medical record-keeping standards are now available. PMID:17882846

  17. [Agreement between data from prenatal care cards and maternal recall in a medium-sized Brazilian city].

    PubMed

    Zanchi, Mariza; Gonçalves, Carla Vitola; Cesar, Juraci A; Dumith, Samuel de Carvalho

    2013-05-01

    Prenatal care is a key indicator of the quality of health services. The current study aimed to evaluate the correlation between data from prenatal care cards and maternal recall in the city of Rio Grande, Rio Grande do Sul State, Brazil. The cross-sectional study included all mothers from 2010 who had received prenatal care. Interviews were conducted with a pre-coded questionnaire in the maternity hospital. Of the 2,288 mothers interviewed, 1,228 (53.7%) had the prenatal care card with them and thus comprised the group for comparison. The analysis used kappa correlation and confidence interval. The variables six or more prenatal visits, clinical breast and gynecological examination, two blood tests, VDRL, HIV serology, urine test, and tetanus vaccination showed statistically significant differences between annotated and maternal recall data (p ≤ 0.001). Adequacy of prenatal care based on the guidelines of the Program for Humanization of Prenatal Care (PHPN) was 23.9% according to information provided by the patients and 4.4% according to information recorded on the prenatal cards (p ≤ 0.001). The prenatal care card showed underreporting, which limited the quality assessment of prenatal care. PMID:23703007

  18. Effectiveness and safety of 1 vs 4 h blood pressure profile with clinical and laboratory assessment for the exclusion of gestational hypertension and pre-eclampsia: a retrospective study in a university affiliated maternity hospital

    PubMed Central

    McCarthy, Elizabeth Anne; Carins, Thomas A; Hannigan, Yolanda; Bardien, Nadia; Shub, Alexis; Walker, Susan P

    2015-01-01

    Objective We asked whether 60 compared with 240 min observation is sufficiently informative and safe for pregnancy day assessment (PDAC) of suspected pre-eclampsia (PE). Design A retrospective study of 209 pregnant women (475 PDAC assessments, 6 months) with routinely collected blood pressure (BP), symptom and laboratory information. We proposed a 60 min screening algorithm comprising: absence of symptoms, normal laboratory parameters and ≤1high-BP reading (systolic blood pressure, SBP 140 mm Hg or higher or diastolic blood pressure, DBP 90 mm Hg or higher). We also evaluated two less inclusive screening algorithms. We determined short-term outcomes (within 4 h): severe hypertension, proteinuric hypertension and pregnancy-induced hypertension, as well as long-term outcome: PE-related diagnoses up to the early puerperium. We assessed performance of alternate screening algorithms performance using 2×2 tables. Results 1 in 3 women met all screen negative criteria at 1 h. Their risk of hypertension requiring treatment in the next 3 h was 1.8% and of failing to diagnose proteinuric hypertensive PE at 4 h was 5.1%. If BP triggers were 5 mm Hg lower, 1 in 6 women would be screen-negative of whom 1.1% subsequently develops treatment-requiring hypertension and 4.5% demonstrate short-term proteinuric hypertension. We present sensitivity, specificity, negative and positive likelihood ratios for alternate screening algorithms. Conclusions We endorse further research into the safest screening test where women are considered for discharge after 60 min. Safety, patient and staff satisfaction should be assessed prospectively. Any screening test should be used in conjunction with good clinical care to minimise maternal and perinatal hazards of PE. PMID:26582404

  19. Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London.

    PubMed

    Hull, Sally A; McKibben, Shauna; Homer, Kate; Taylor, Stephanie Jc; Pike, Katy; Griffiths, Chris

    2016-01-01

    Inappropriate prescribing in primary care was implicated in nearly half of asthma deaths reviewed in the UK's recent National Review of Asthma Deaths. Using anonymised EMIS-Web data for 139 ethnically diverse general practices (total population 942,511) extracted from the North and East London Commissioning Support Unit, which holds hospital Secondary Uses Services (SUS)-linked data, we examined the prevalence of over-prescribing of short-acting β2-agonist inhalers (SABA), under-prescribing of inhaled corticosteroid (ICS) inhalers and solo prescribing of long-acting β2-agonists (LABA) to assess the risk of hospitalisation for people with asthma for 1 year ending August 2015. In a total asthma population of 35,864, multivariate analyses in adults showed that the risk of admission increased with greater prescription of SABA inhalers above a baseline of 1-3 (4-12 SABA: odds ratio (OR) 1.71; 95% confidence interval (CI) 1.20-2.46, ⩾13 SABA: OR 3.22; 95% CI 2.04-5.07) with increasing British Thoracic Society step (Step 3: OR 2.90; 95% CI 1.79-4.69, Step 4/5: OR 9.42; 95% CI 5.27-16.84), and among Black (OR 2.30; 95% CI 1.64-3.23) and south Asian adult populations (OR 1.83; 95% CI 1.36-2.47). Results in children were similar, but risk of hospitalisation was not related to ethnic group. There is a progressive risk of hospital admission associated with the prescription of more than three SABA inhalers a year. Adults (but not children) from Black and South Asian groups are at an increased risk of admission. Further work is needed to target care for these at-risk groups. PMID:27537194

  20. Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London

    PubMed Central

    Hull, Sally A; McKibben, Shauna; Homer, Kate; Taylor, Stephanie JC; Pike, Katy; Griffiths, Chris

    2016-01-01

    Inappropriate prescribing in primary care was implicated in nearly half of asthma deaths reviewed in the UK’s recent National Review of Asthma Deaths. Using anonymised EMIS-Web data for 139 ethnically diverse general practices (total population 942,511) extracted from the North and East London Commissioning Support Unit, which holds hospital Secondary Uses Services (SUS)–linked data, we examined the prevalence of over-prescribing of short-acting β2-agonist inhalers (SABA), under-prescribing of inhaled corticosteroid (ICS) inhalers and solo prescribing of long-acting β2-agonists (LABA) to assess the risk of hospitalisation for people with asthma for 1 year ending August 2015. In a total asthma population of 35,864, multivariate analyses in adults showed that the risk of admission increased with greater prescription of SABA inhalers above a baseline of 1–3 (4–12 SABA: odds ratio (OR) 1.71; 95% confidence interval (CI) 1.20–2.46, ⩾13 SABA: OR 3.22; 95% CI 2.04–5.07) with increasing British Thoracic Society step (Step 3: OR 2.90; 95% CI 1.79–4.69, Step 4/5: OR 9.42; 95% CI 5.27–16.84), and among Black (OR 2.30; 95% CI 1.64–3.23) and south Asian adult populations (OR 1.83; 95% CI 1.36–2.47). Results in children were similar, but risk of hospitalisation was not related to ethnic group. There is a progressive risk of hospital admission associated with the prescription of more than three SABA inhalers a year. Adults (but not children) from Black and South Asian groups are at an increased risk of admission. Further work is needed to target care for these at-risk groups. PMID:27537194

  1. Using Electronic Health Record (EHR) “Big Data” to Examine the Influence of Nurse Continuity on a Hospital-Acquired Never Event

    PubMed Central

    STIFTER, Janet; YAO, Yingwei; LODHI, Muhammad Kamran; LOPEZ, Karen Dunn; KHOKHAR, Ashfaq; WILKIE, Diana J.; KEENAN, Gail M.

    2015-01-01

    Background There is little research demonstrating the influence of nurse continuity on patient outcomes despite an intuitive belief that continuity of care makes a difference in care outcomes. Objective To examine the influence of nurse continuity (the number of consecutive care days by the same/consistent RN[s]) on the prevention of hospital-acquired pressure ulcers (HAPU). Method A secondary use of data from the Hands on Automated Nursing Data System (HANDS) was performed for this comparative study. The HANDS is a nursing plan of care (POC) “big data” database containing 42,403 episodes documented by 787 nurses, on 9 units, in four hospitals and includes nurse staffing and patient characteristics. Via data mining, we created an analytic dataset of 840 care episodes, 210 with and 630 without HAPUs, matched by nursing unit, patient age, and patient characteristics. Logistic regression analysis determined the influence of nurse continuity and additional nurse-staffing variables on the presence of HAPUs. Results Poor nurse continuity (Continuity Index=.21-.42 [1.0=optimal continuity]) was noted on all nine study units. Nutrition, mobility, perfusion, hydration, and skin problems on admission as well as patient age were associated with HAPUs (p<.001). Controlling for patient characteristics, nurse continuity and the interactions between nurse continuity and other nurse-staffing variables were not significantly associated with HAPU development. Discussion Patient characteristics including nutrition, mobility, and perfusion were associated with HAPUs, but nurse continuity was not. One study implication is that to reduce the incidence of HAPUs the most effective resource utilization might be in the continued development of best practices to address patient characteristics that lead to pressure ulcer vulnerability rather than a focus on nurse staffing. PMID:26325278

  2. Maternal and Handicapped Child Characteristics Associated with Maternal Involvement Behavior.

    ERIC Educational Resources Information Center

    Huntington, Gail S.

    Eighty-six mother-infant pairs were studied to determine the extent to which maternal and child variables predicted maternal involvement. The infants, ranging in age from 3-36 months, were examined on temperament and developmental status. Maternal characteristics studied were temperament, locus of control, and socioeconomic status. Criterion…

  3. Maternal Separation Anxiety and Child Care: Effects on Maternal Behavior.

    ERIC Educational Resources Information Center

    Storm, Heidi A.; Ridley-Johnson, Robyn

    Maternal separation anxiety influences maternal behavior, attitudes about employment, and employment decisions made by mothers. This study examined the relationship between maternal separation anxiety and the number of hours a child was in substitute care. The sample consisted of 44 mothers and their children who ranged in age from 12 to 41 months…

  4. Maternal and neonatal tetanus.

    PubMed

    Thwaites, C Louise; Beeching, Nicholas J; Newton, Charles R

    2015-01-24

    Maternal and neonatal tetanus is still a substantial but preventable cause of mortality in many developing countries. Case fatality from these diseases remains high and treatment is limited by scarcity of resources and effective drug treatments. The Maternal and Neonatal Tetanus Elimination Initiative, launched by WHO and its partners, has made substantial progress in eliminating maternal and neonatal tetanus. Sustained emphasis on improvement of vaccination coverage, birth hygiene, and surveillance, with specific approaches in high-risk areas, has meant that the incidence of the disease continues to fall. Despite this progress, an estimated 58,000 neonates and an unknown number of mothers die every year from tetanus. As of June, 2014, 24 countries are still to eliminate the disease. Maintenance of elimination needs ongoing vaccination programmes and improved public health infrastructure. PMID:25149223

  5. Temporal evolution and spatial distribution of maternal death

    PubMed Central

    Carreno, Ioná; Bonilha, Ana Lúcia de Lourenzi; da Costa, Juvenal Soares Dias

    2014-01-01

    OBJECTIVE To analyze the temporal evolution of maternal mortality and its spatial distribution. METHODS Ecological study with a sample made up of 845 maternal deaths in women between 10 and 49 years, registered from 1999 to 2008 in the state of Rio Grande do Sul, Southern Brazil. Data were obtained from Information System on Mortality of Ministry of Health. The maternal mortality ratio and the specific maternal mortality ratio were calculated from records, and analyzed by the Poisson regression model. In the spatial distribution, three maps of the state were built with the rates in the geographical macro-regions, in 1999, 2003, and 2008. RESULTS There was an increase of 2.0% in the period of ten years (95%CI 1.00;1.04; p = 0.01), with no significant change in the magnitude of the maternal mortality ratio. The Serra macro-region presented the highest maternal mortality ratio (1.15, 95%CI 1.08;1.21; p < 0.001). Most deaths in Rio Grande do Sul were of white women over 40 years, with a lower level of education. The time of delivery/abortion and postpartum are times of increased maternal risk, with a greater negative impact of direct causes such as hypertension and bleeding. CONCLUSIONS The lack of improvement in maternal mortality ratio indicates that public policies had no impact on women’s reproductive and maternal health. It is needed to qualify the attention to women’s health, especially in the prenatal period, seeking to identify and prevent risk factors, as a strategy of reducing maternal death. PMID:25210825

  6. Maternity waiting facilities for improving maternal and neonatal outcome in low-resource countries

    PubMed Central

    van Lonkhuijzen, Luc; Stekelenburg, Jelle; van Roosmalen, Jos

    2014-01-01

    Background A maternity waiting home (MWH) is a facility within easy reach of a hospital or health centre which provides emergency obstetric care (EmOC). Women may stay in the MWH at the end of their pregnancy and await labour. Once labour starts, women move to the health facility so that labour and giving birth can be assisted by a skilled birth attendant. The aim of the MWH is to improve accessibility to skilled care and thus reduce morbidity and mortality for mother and neonate should complications arise. Some studies report a favourable effect on the outcomes for women and their newborns. Others show that utilisation is low and barriers exist. However, these data are limited in their reliability. Objectives To assess the effects of a maternity waiting facility on maternal and perinatal health. Search methods We searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (27 January 2012), CENTRAL (The Cochrane Library 2011, Issue 4 of 4), MEDLINE (1966 to January 2012), EMBASE (1980 to January 2012), CINAHL (1982 to January 2012), African Journals Online (AJOL) (January 2012), POPLINE (January 2012), Dissertation Abstracts (January 2012) and reference lists of retrieved papers. Selection criteria Randomised controlled trials including quasi-randomised and cluster-randomised trials that compared perinatal and maternal outcome in women using a MWH and women who did not. Data collection and analysis There were no randomised controlled trials or cluster-randomised trials identified from the search. Main results There were no randomised controlled trials or cluster-randomised trials identified from the search. Authors’ conclusions There is insufficient evidence to determine the effectiveness of maternity waiting facilities for improving maternal and neonatal outcomes. PMID:23076927

  7. Emergency Obstetric Care in a Rural Hospital: On-call Specialists Can Manage C-sections

    PubMed Central

    Ashtekar, Shyam V; Kulkarni, Madhav B; Ashtekar, Ratna S; Sadavarte, Vaishali S

    2012-01-01

    Background: Institutional birth and Emergency Obstetric Care (EmOC) are important strategies of the National Rural Health Mission (NRHM). While the Community Health Center (CHC) is expected to serve EmOC needs in NRHM, the CHCs are hamstrung due to chronic shortage of specialist doctors. Alternative strategies are therefore needed for ensuring EmOC. Objectives: This study aims to estimate the EmOC needs in a private rural hospital from case records and find some useful predictors for caesarian section (C-section) and to assess C-section needs in the context of on-call specialist support. Materials and Methods: We analyzed a two-decade series of 2587 obstetric cases in a private rural hospital for normal deliveries and EmOC including C-section. Results: About 80% of the obstetric cases were normal deliveries. Of the remaining 20% cases that required EmOC, nearly one-third required C-section. In the series, two maternal deaths occurred due to hemorrhage. About 13% case records showed past abortion, which adds to EmOC workload. Primipararous mothers with higher age had a greater incidence (23%) of C-section. The C-section rate shows a steady rise from 3% to above 10% in the series. Conclusions: This rural hospital required C-section in 6.4% cases. This C-section workload was managed with the help of on-call specialists. The local hospital team could manage 93.6% of the cases and abortions with only two maternal deaths. This strategy of an on-call specialist team can be an option for CHCs till resident specialists are adequately available. PMID:23112445

  8. Trends in Maternal Morbidity Before and During Pregnancy in California

    PubMed Central

    Fridman, Moshe; Korst, Lisa M.; Chow, Jessica; Lawton, Elizabeth; Mitchell, Connie

    2014-01-01

    Objectives. We examined trends in maternal comorbidities in California. Methods. We conducted a retrospective cohort study of 1 551 017 California births using state-linked vital statistics and hospital discharge cohort data for 1999, 2002, and 2005. We used International Classification of Diseases, Ninth Revision, Clinical Modification codes to identify the following conditions, some of which were preexisting: maternal hypertension, diabetes, asthma, thyroid disorders, obesity, mental health conditions, substance abuse, and tobacco use. We estimated prevalence rates with hierarchical logistic regression models, adjusting for demographic shifts, and also examined racial/ethnic disparities. Results. The prevalence of these comorbidities increased over time for hospital admissions associated with childbirth, suggesting that pregnant women are getting sicker. Racial/ethnic disparities were also significant. In 2005, maternal hypertension affected more than 10% of all births to non-Hispanic Black mothers; maternal diabetes affected nearly 10% of births to Asian/Pacific Islander mothers (10% and 43% increases, respectively, since 1999). Chronic hypertension, diabetes, obesity, mental health conditions, and tobacco use among Native American women showed the largest increases. Conclusions. The prevalence of maternal comorbidities before and during pregnancy has risen substantially in California and demonstrates racial/ethnic disparity independent of demographic shifts. PMID:24354836

  9. The Impact of Cardiac Diseases during Pregnancy on Severe Maternal Morbidity and Mortality in Brazil

    PubMed Central

    Campanharo, Felipe F.; Cecatti, Jose G.; Haddad, Samira M.; Parpinelli, Mary A.; Born, Daniel; Costa, Maria L.; Mattar, Rosiane

    2015-01-01

    Background To evaluate maternal heart disease as a cause or complicating factor for severe morbidity in the setting of the Brazilian Network for Surveillance of Severe Maternal Morbidity. Methods and Findings Secondary data analysis of this multicenter cross-sectional study was implemented in 27 referral obstetric units in Brazil. From July 2009 to June 2010, a prospective surveillance was conducted among all delivery hospitalizations to identify cases of severe maternal morbidity (SMM), including Potentially Life-Threatening Conditions (PLTC) and Maternal Near Miss (MNM), using the new criteria established by the WHO. The variables studied included: sociodemographic characteristics, clinical and obstetric history of the women; perinatal outcome and the occurrence of maternal outcomes (PLTC, MNM, MD) between groups of cardiac and non-cardiac patients. Only heart conditions with hemodynamic impact characterizing severity of maternal morbidity were considered. 9555 women were included in the Network with severe pregnancy-related complications: 770 maternal near miss cases and 140 maternal death cases. A total of 293 (3.6%) cases were related to heart disease and the condition was known before pregnancy in 82.6% of cases. Maternal near miss occurred in 15% of cardiac disease patients (most due to clinical-surgical causes, p<0.001) and 7.7% of non-cardiac patients (hemorrhagic and hypertensive causes, p<0.001). Maternal death occurred in 4.8% of cardiac patients and in 1.2% of non-cardiac patients, respectively. Conclusions In this study, heart disease was significantly associated with a higher occurrence of severe maternal outcomes, including maternal death and maternal near miss, among women presenting with any severe maternal morbidity. PMID:26650684

  10. [Medical record management and risk management processes. State of the art and new normative guidelines about the organization and the management of the sanitary documentation in the National Health System or Hospital Trusts].

    PubMed

    Spolaore, P; Murolo, G; Sommavilla, M

    2003-01-01

    Recent health care reforms, the start of accreditation processes of health institutions, and the introduction also in the health system of risk management concepts and instruments, borrowed from the enterprise culture and the emphasis put on the protection of privacy, render evident the need and the urgency to define and to implement improvement processes of the organization and management of the medical documentation in the hospital with the aim of facilitation in fulfilment of regional and local health authorities policies about protection of the safety and improvement of quality of care. Currently the normative context that disciplines the management of medical records inside the hospital appears somewhat fragmentary, incomplete and however not able to clearly orientate health operators with the aim of a correct application of the enforced norms in the respect of the interests of the user and of local health authority. In this job we individuate the critical steps in the various phases of management process of the clinical folder and propose a new model of regulations, with the purpose to improve and to simplify the management processes and the modalities of compilation, conservation and release to entitled people of all clinical documentation. PMID:15049537

  11. Maternal effects on offspring mortality in rhesus macaques (Macaca mulatta)

    PubMed Central

    Blomquist, Gregory E.

    2012-01-01

    The genetics of primate life histories are poorly understood, but quantitative genetic patterns in other mammals suggest phenotypic differences among individuals early in life can be strongly affected by interactions with mothers or other caretakers. I used generalized linear mixed model extensions of complex pedigree quantitative genetic techniques to explore regression coefficients and variance components for infant and juvenile mortality rates across pre-reproductive age classes in the semi-free ranging Cayo Santiago rhesus macaques. Using a large set of records (max. n=977 mothers, 6240 offspring), strong maternal effects can be identified early in development but they rapidly “burn off” as offspring age and mothers become less consistent buffers from increasingly prominent environmental variation. The different ways behavioral ecologists and animal breeders have defined and studied maternal effects can be subsumed, and even blended, within the quantitative genetic framework. Regression coefficients identify loss of the mother, maternal age, and offspring age within their birth cohort as having significant maternal effects on offspring mortality, while variance components for maternal identity record significant maternal influence in the first month of life. PMID:23315583

  12. Maternal age and birth defects: a population study.

    PubMed

    Baird, P A; Sadovnick, A D; Yee, I M

    1991-03-01

    Since more and more women in developed countries are delaying childbearing to an older age, it is important to find out whether birth defects, other than those resulting from chromosomal anomalies, are related to maternal age. We have studied all 26,859 children with birth defects of unknown aetiology identified among 576,815 consecutive livebirths in British Columbia. All these cases' records were linked with provincial birth records to allow determination of maternal age at birth. We excluded children with chromosomal anomalies and those with other birth defects of known aetiology. Only 3 of the 43 birth defect categories studied showed significant maternal-age-specific trends: there were decreasing linear trends with maternal age for patent ductus arteriosus (chi 2 = 36.65, 1 df, p less than 0.01) and hypertrophic pyloric stenosis (chi 2 = 4.90, 1 df, p less than 0.05) and a bell-shaped curve (risk increasing to maternal age 30 then falling) for congenital dislocatable hip/hip click. The findings from this population-based analysis of no association between the incidence of birth defects of unknown aetiology and advancing maternal age should be reassuring to healthy women who opt to delay childbearing. PMID:1671898

  13. Maternal effects on offspring mortality in rhesus macaques (Macaca mulatta).

    PubMed

    Blomquist, Gregory E

    2013-03-01

    The genetics of primate life histories are poorly understood, but quantitative genetic patterns in other mammals suggest phenotypic differences among individuals early in life can be strongly affected by interactions with mothers or other caretakers. I used generalized linear mixed model extensions of complex pedigree quantitative genetic techniques to explore regression coefficients and variance components for infant and juvenile mortality rates across prereproductive age classes in the semifree ranging Cayo Santiago rhesus macaques. Using a large set of records (maximum n = 977 mothers, 6,240 offspring), strong maternal effects can be identified early in development but they rapidly "burn off" as offspring age and mothers become less consistent buffers from increasingly prominent environmental variation. The different ways behavioral ecologists and animal breeders have defined and studied maternal effects can be subsumed, and even blended, within the quantitative genetic framework. Regression coefficients identify loss of the mother, maternal age, and offspring age within their birth cohort as having significant maternal effects on offspring mortality, while variance components for maternal identity record significant maternal influence in the first month of life. PMID:23315583

  14. Calculation of Costs of Pregnancy- and Puerperium-related Care: Experience from a Hospital in a Low-income Country

    PubMed Central

    Medin, E.; Gazi, R.; Koehlmoos, T.P.; Rehnberg, C.; Saifi, R.; Bhuiya, A.; Khan, J.

    2010-01-01

    Calculation of costs of different medical and surgical services has numerous uses, which include monitoring the performance of service-delivery, setting the efficiency target, benchmarking of services across all sectors, considering investment decisions, commissioning to meet health needs, and negotiating revised levels of funding. The role of private-sector healthcare facilities has been increasing rapidly over the last decade. Despite the overall improvement in the public and private healthcare sectors in Bangladesh, lack of price benchmarking leads to patients facing unexplained price discrimination when receiving healthcare services. The aim of the study was to calculate the hospital-care cost of disease-specific cases, specifically pregnancy- and puerperium-related cases, and to indentify the practical challenges of conducting costing studies in the hospital setting in Bangladesh. A combination of micro-costing and step-down cost allocation was used for collecting information on the cost items and, ultimately, for calculating the unit cost for each diagnostic case. Data were collected from the hospital records of 162 patients having 11 different clinical diagnoses. Caesarean section due to maternal and foetal complications was the most expensive type of case whereas the length of stay due to complications was the major driver of cost. Some constraints in keeping hospital medical records and accounting practices were observed. Despite these constraints, the findings of the study indicate that it is feasible to carry out a large-scale study to further explore the costs of different hospital-care services. PMID:20635637

  15. Maternal Sexuality and Breastfeeding

    ERIC Educational Resources Information Center

    Bartlett, Alison

    2005-01-01

    In this paper I consider the ways in which lactation has been discussed as a form of maternal sexuality, and the implications this carries for our understanding of breastfeeding practices and sexuality. Drawing on knowledge constructed in the western world during the last half of the twentieth century, the paper identifies a shift between the…

  16. Maternal Attitudes. Progress Report.

    ERIC Educational Resources Information Center

    Harnischfeger, Annegret; Wiley, David E.

    This paper discusses ways in which maternal attitudes may serve as mediating variables linking social class characteristics of the family to the socialization of children. Reference is made to the Family Problem Scale (Ernhart and Loevinger) which provides a psychological characterization of social class levels on five dimensions or subscales:…

  17. Maternity Leave in Taiwan

    ERIC Educational Resources Information Center

    Feng, Joyce Yen; Han, Wen-Jui

    2010-01-01

    Using the first nationally representative birth cohort study in Taiwan, this paper examines the role that maternity leave policy in Taiwan plays in the timing of mothers returning to work after giving birth, as well as the extent to which this timing is linked to the amount of time mothers spend with their children and their use of breast milk…

  18. Rural maternity care: can we learn from Wal-Mart?

    PubMed

    van Teijlingen, E R; Pitchforth, E

    2010-03-01

    In many countries rural maternity care is under threat. Consequently rural pregnant women will have to travel further to attend larger maternity units to receive care and deliver their babies. This trend is not dissimilar from the disappearance of other rural services, such as village shops, banks, post offices and bus services. We use a comparative approach to draw an analogy with large-scale supermarkets, such as the Wal-Mart and Tesco and their effect on the viability of smaller rural shops, depersonalisation of service and the wider community. The closure of a community-maternity unit leads to women attending a different type of hospital with a different approach to maternity care. Thus small community-midwifery units are being replaced, not by a very similar unit that happens to be further away, but by a larger obstetric unit that operates on different models, philosophy and notions of risk. Comparative analysis allows a fresh perspective on the provision of rural maternity services. We argue that previous discussions focusing on medicalisation and change in maternity services can be enhanced by drawing on experience in other sectors and taking a wider societal lens. PMID:20004606

  19. Maternal mortality in Vietnam in 1994-95.

    PubMed

    Hieu, D T; Hanenberg, R; Vach, T H; Vinh, D Q; Sokal, D

    1999-12-01

    This report presents the first population-based estimates of maternal mortality in Vietnam. All the deaths of women aged 15-49 in 1994-95 in three provinces of Vietnam were identified and classified by cause. Maternal mortality was the fifth most frequent cause of death. The maternal mortality ratio was 155 deaths per 100,000 live births. This ratio compares with the World Health Organization's estimates of 430 such deaths globally and 390 for Asia. The maternal mortality ratio in the delta regions of these provinces was half that of the mountainous and semimountainous regions. Because a larger proportion of the Vietnamese population live in delta regions than elsewhere, the maternal mortality ratio for Vietnam as a whole may be lower than that of the three provinces studied. Maternal mortality is low in Vietnam primarily because a relatively high proportion of deliveries take place in clinics and hospitals, where few women die in childbirth. Also, few women die of the consequences of induced abortion in Vietnam because the procedure is legal and easily available. PMID:10674328

  20. Maternal cerebrovascular accidents in pregnancy: incidence and outcomes

    PubMed Central

    Walsh, Jennifer; Murphy, Cliona; Murray, Aoife; O'Laoide, Risteard; McAuliffe, Fionnuala M

    2010-01-01

    Stroke occurring during pregnancy and the postnatal period is a rare but potentially catastrophic event. The aim of this study was to examine the incidence and outcomes of pregnancies complicated by maternal stroke in a single centre. This is a prospective study of over 35,000 consecutive pregnancies over a four-year period at the National Maternity Hospital in Dublin from 2004 to 2008; in addition we also retrospectively examined all cases of maternal mortality at our institution over a 50-year period from 1959 to 2009. We prospectively identified eight cases of strokes complicating pregnancy and the postnatal period giving an overall incidence of 22.34 per 100,000 pregnancies or 24.74 per 100,000 deliveries. There were no stroke-related mortalities during that time. Retrospective analysis of maternal mortality revealed 102 maternal deaths over a 50-year period, 19 (18.6%) of which were due to cerebrovascular accidents. In conclusion, strokes complicating pregnancy and the puerperium remain a rare event and though there appears to be evidence that the incidence is increasing, the associated maternal mortality appears to be falling.

  1. Maternal mortality and morbidity. Women's reproductive health in Tanzania.

    PubMed

    Alloo, F

    1994-01-01

    Sexuality is a taboo for women in a patriarchal society. Tanzania has inadequate reproductive health care. Aspects of reproductive health are dealt with in safe motherhood or maternal and child health programs. Tanzania's health policy is based on women as mothers; it does not refer to women's right. For women in Tanzania, reproductive health is the right to live. Thousands of Tanzanian women die every year due to maternal complications. In an effort to contribute to the improvement of the conditions in health institutions and the advancement of women's status in the country, the Tanzania Media Women's Association (TAMWA) and the Medical Women's Association of Tanzania (MEWATA) joined in the organization of a Reproductive Health Meeting in Dar es Salaam. At the conference, major factors causing maternal mortality and morbidity, such as complications of abortion, anaemia in pregnancy, hypertensive disorders in pregnancy and puerperal sepsis, were discussed. A World Health Organization (WHO) report indicated that maternal mortality in Tanzania was 200-400/100,000 live births, while a survey conducted by MEWATA showed that maternal deaths at the Muhimbili Medical Center in the capital were 754/100,000 live births in 1991. Many maternal deaths could be prevented if hospitals were be properly equipped. Tanzanian women's poor health results in large part from their low socioeconomic status, poor nutrition, lack of income and employment. TAMWA chairperson Fatma Alloo and Dr. Kimambo (Ministry of Health) endorsed a national women's health movement to demand a government commitment to a holistic reproductive health policy. PMID:12288398

  2. A retrospective analysis of the clinical case records of 'autistic psychopaths' diagnosed by Hans Asperger and his team at the University Children's Hospital, Vienna.

    PubMed Central

    Hippler, Kathrin; Klicpera, Christian

    2003-01-01

    To date, it is questionable whether the diagnostic criteria for Asperger syndrome (AS) as stated by ICD-10 or DSM-IV still reflect Asperger's original account of 'autistic psychopathy' (AP) from the 1940s. The present study examined 74 clinical case records of children with AP diagnosed by Hans Asperger and his team at the Viennese Children's Clinic and Asperger's private practice between 1950 and 1986. The characteristic features of the children are outlined, including reasons for referral, parental background, behavioural problems, cognitive functioning, communication and interests. Results show that the patients of Asperger described in our study represent a subgroup of children with very high intellectual functioning, specific circumscribed interests and talents but impaired social, communication and motor skills. Sixty-eight percent of the sample met ICD-10 criteria for AS, while 25% fulfilled the diagnostic criteria for autism. Implications for the diagnosis of AS are discussed. PMID:12639327

  3. Breastfeeding is Associated with Reduced Childhood Hospitalization: Evidence from a Scottish Birth Cohort (1997-2009)

    PubMed Central

    Ajetunmobi, Omotomilola M.; Whyte, Bruce; Chalmers, James; Tappin, David M.; Wolfson, Linda; Fleming, Michael; MacDonald, Alison; Wood, Rachael; Stockton, Diane L.

    2015-01-01

    Objective To evaluate the risk of childhood hospitalization associated with infant feeding patterns at 6-8 weeks of age in Scotland. Study design A retrospective population level study based on the linkage of birth, death, maternity, infant health, child health surveillance, and admission records for children born as single births in Scotland between 1997 and 2009 (n = 502 948) followed up to March 2012. Descriptive analyses, Kaplan Meier tests, and Cox regression were used to quantify the association between the mode of infant feeding and risk of childhood hospitalization for respiratory, gastrointestinal, and urinary tract infections, and other common childhood ailments during the study period. Results Within the first 6 months of life, there was a greater hazard ratio (HR) of hospitalization for common childhood illnesses among formula-fed infants (HR 1.40; 95% CI 1.35-1.45) and mixed-fed infants (HR 1.18; 95% CI 1.11-1.25) compared with infants exclusively breastfed after adjustment for parental, maternal, and infant health characteristics. Within the first year of life and beyond, a greater relative risk of hospitalization was observed among formula-fed infants for a range of individual illnesses reported in childhood including gastrointestinal, respiratory, and urinary tract infections, otitis media, fever, asthma, diabetes, and dental caries. Conclusions Using linked administrative data, we found greater risks of hospitalization in early childhood for a range of common childhood illnesses among Scottish infants who were not exclusively breastfed at 6-8 weeks of age. PMID:25556021

  4. Alloimmunization due to red cell antibodies in Rhesus positive Omani Pregnant Women: Maternal and Perinatal outcome

    PubMed Central

    Al-Dughaishi, Tamima; Al-Rubkhi, Ikhlass S.; Al-Duhli, Maymoona; Al-Harrasi, Yusra; Gowri, Vaidyanathan

    2015-01-01

    Objective: This study is aimed to determine the prevalence of alloimmunization due to antibodies to red blood cell (RBC) antigens (other than rhesus [Rh] antigen) and report the maternal, perinatal, and neonatal outcomes. Materials and Methods: A retrospective review of medical records of all patients with minor RBCs antibodies alloimmunization who were followed and delivered at Sultan Qaboos University Hospital, Oman from June 2011 to June 2013. Maternal characteristics, antibody type, antibody titer in addition to perinatal and neonatal outcomes were reviewed. Results: There were 1160 patients with Rh positive status in the study. The most common ABO blood group was O, followed by A, B, and AB. We found 33 out of 1160 Rh positive women alloimmunized with minor RBCs antibodies that gave a prevalence of minor RBCs alloimmunization of 2.7%. The most frequent antibody was anti-E 38%, followed by anti-c 17% and anti-kell 17%. 6 of these 33 patients were identified to have significant antibody titer, and two cases showed evidence of fetal anemia. Only one case required an intrauterine blood transfusion. The most common neonatal complication was jaundice in 53%, followed by respiratory distress syndrome in 28%. Two cases complicated by neonatal anemia required a postnatal blood transfusion. Conclusion: Alloimmunization with anti-E, anti-c, and anti-kell were the most common antibodies among the study group. Minor RBCs alloimmunization was an important cause of neonatal morbidity. PMID:26420934

  5. Exposure to maternal voice in preterm infants: a review.

    PubMed

    Krueger, Charlene

    2010-02-01

    The mother's voice, along with other developmentally appropriate sensory events (ie, touch, light, smells), stimulates maturation of the sensory systems and helps shape normal fetal development. While vast changes in the neonatal intensive care unit have occurred over the last 2 decades, little research has addressed the loss of exposure to maternal voice for the preterm infant. To address this gap, we compared studies that directly investigated effects of exposure to maternal voice on preterm infants. Studies reviewed were conducted between 1972 and 2007. All presented recordings of maternal voice at sound levels above current recommendations, and few of the findings reached statistical significance. Some potentially positive developmental effects were indicated. Future study of the effects of exposure to maternal voice on preterm infants using recommended sound levels is needed. PMID:20150775

  6. Maternal expectations: new mothers, nurses, and breastfeeding.

    PubMed

    Martucci, Jessica

    2012-01-01

    By the middle of the 20th century, breastfeeding rates had fallen to less than 20% in some areas of the United States. Despite these grim statistics, many mothers continued to seek information, advice, and the experience of breastfeeding their infants. This article explores the role that nurses played in these women's struggles to breastfeed in the years between the end of World War II and the 1970s. The role of the nurse in shaping the meaning and experience of breastfeeding in America has been an important, albeit often overlooked, part of the history of infant feeding. In addition to exploring the ways in which hospital policies and structures shaped nurses' relationships with breastfeeding mothers, this article looks at how different maternal ideologies influenced the nature of these (mostly) same-sex interactions. This article argues that the ideas about, and experiences with, motherhood had important implications for how nurses and mothers approached the practice of breastfeeding in the hospital. PMID:22359999

  7. Morbidity and mortality amongst infants of diabetic mothers admitted into Soba university hospital, Khartoum, Sudan

    PubMed Central

    Kheir, Abdelmoneim E.M.; Berair, Rabih; Gulfan, Islam G.I.; Karrar, Mohamed Z.; Mohammed, Zuhlel A.O.

    2012-01-01

    The prevalence of diabetes during pregnancy is increasing and this is associated with an increased risk of complications in both mother and fetus. The aim of this research is to study the neonatal complications of maternal diabetes. This was a prospective observational study that was conducted in Soba university hospital between September 2010 and March 2011. All infants born to diabetic mothers during the study period were admitted to the neonatal care unit for evaluation. Data on sex, gestational age, and birth weight, mode of delivery, complications, investigations, birth injury, and length of hospital stay were recorded. Maternal data were retrieved from records. Data was analyzed using Minitab 15. A total of 50 infants of diabetic mothers (IDMs) were included in the study. Thirty infants (60%) were females and 20 (40%) were males. Forty two (84%) of the neonates were born by caesarian section, only 7(14%) were born by spontaneous vaginal delivery. Birth injury was observed in 4% of them. The mean gestational age was 37.2±2.051 weeks. The median birth weight was 3.5 kg. 14 (28%) of the babies were macrosomic, and 17 (34%) were large for gestational age (LGA). Congenital anomalies were found in 3 (6%), hypoglycemia in 6 (12%), hyperbillirubinaemia in 10 (20%), hypocalcaemia and hypomagnesaemia each occurred in 2%, transient tachypnea of the newborn occurred in 5 (10%) of the neonates and respiratory distress syndrome in 2%. Cardiomyopathy occurred in 2% and mortality was 4%. We concluded that macrosomia, LGA, and hyperbillirubinaemia were the commonest complications in IDMs, maternal glycaemic control was found to have a significant effect on a number of outcomes.

  8. Phonological Reduction in Maternal Speech in Northern Australian English: Change over Time

    ERIC Educational Resources Information Center

    Buchan, Heather; Jones, Caroline

    2014-01-01

    Segmental variation in maternal speech to children changes over time. This study investigated variation in non-citation speech processes in a longitudinal, 26-hour corpus of maternal northern Australian English. Recordings were naturalistic parent-child interactions when children (N = 4) were 1;6, 2;0, and 2;6. The mothers' speech was…

  9. National survey of hospital patients.

    PubMed Central

    Bruster, S.; Jarman, B.; Bosanquet, N.; Weston, D.; Erens, R.; Delbanco, T. L.

    1994-01-01

    OBJECTIVE--To survey patients' opinions of their experiences in hospital in order to produce data that can help managers and doctors to identify and solve problems. DESIGN--Random sample of 36 NHS hospitals, stratified by size of hospital (number of beds), area (north, midlands, south east, south west), and type of hospital (teaching or non-teaching, trust or directly managed). From each hospital a random sample of, on average, 143 patients was interviewed at home or the place of discharge two to four weeks after discharge by means of a structured questionnaire about their treatment in hospital. SUBJECTS--5150 randomly chosen NHS patients recently discharged from acute hospitals in England. Subjects had been patients on medical and surgical wards apart from paediatric, maternity, psychiatric, and geriatric wards. MAIN OUTCOME MEASURES--Patients' responses to direct questions about preadmission procedures, admission, communication with staff, physical care, tests and operations, help from staff, pain management, and discharge planning. Patients' responses to general questions about their degree of satisfaction in hospitals. RESULTS--Problems were reported by patients, particularly with regard to communication with staff (56% (2824/5020) had not been given written or printed information); pain management (33% (1042/3162) of those suffering pain were in pain all or most of the time); and discharge planning (70% (3599/5124) had not been told about warning signs and 62% (3177/5119) had not been told when to resume normal activities). Hospitals failed to reach the standards of the Patient's Charter--for example, in explaining the treatment proposed and giving patients the option of not taking part in student training. Answers to questions about patient satisfaction were, however, highly positive but of little use to managers. CONCLUSIONS--This survey has highlighted several problems with treatment in NHS hospitals. Asking patients direct questions about what happened

  10. Maternal mortality in India: current status and strategies for reduction.

    PubMed

    Prakash, A; Swain, S; Seth, A

    1991-12-01

    The causes (medical, reproductive factors, health care delivery system, and socioeconomic factors) of maternal mortality in India and strategies for reducing maternal mortality are presented. Maternal mortality rates (MMR) are very high in Asia and Africa compared with Northern Europe's 4/100,000 live births. An Indian hospital study found the MMR to be 4.21/1000 live births. 50-98% of maternal deaths are caused by direct obstetric causes (hemorrhage, infection, and hypertensive disorders, ruptured uterus, hepatitis, and anemia). 50% of maternal deaths due to sepsis are related to illegal induced abortion. MMR in India has not declined significantly in the past 15 years. Age, primi and grande multiparity, unplanned pregnancy, and related illegal abortion are the reproductive causes. In 1985 WHO reported that 63-80% of maternal deaths due to direct obstetric causes and 88-98% of all maternal deaths could probably have been prevented with proper handling. In India, coordination between levels in the delivery system and fragmentation of care account for the poor quality of maternal health care. Mass illiteracy is another cause. Effective strategies for reducing the MMR are 1) to place a high priority on maternal and child health (MCH) services and integrate vertical programs (e.g., family planning) related to MCH; 2) to give attention to care during labor and delivery, which is the most critical period for complications; 3) to provide community-based delivery huts which can provide a clean and safe delivery place close to home, and maternity waiting rooms in hospitals for high risk mothers; 4) to improve the quality of MCH care at the rural community level (proper history taking, palpation, blood pressure and fetal heart screening, risk factor screening, and referral); 5) to improve quality of care at the primary health care level (emergency care and proper referral); 6) to include in the postpartum program MCH and family planning services; 7) to examine the

  11. [Social inequalities in maternal health].

    PubMed

    Azria, E; Stewart, Z; Gonthier, C; Estellat, C; Deneux-Tharaux, C

    2015-10-01

    Although medical literature on social inequalities in perinatal health is qualitatively heterogeneous, it is quantitatively important and reveals the existence of a social gradient in terms of perinatal risk. However, published data regarding maternal health, if also qualitatively heterogeneous, are relatively less numerous. Nevertheless, it appears that social inequalities also exist concerning severe maternal morbidity as well as maternal mortality. Analyses are still insufficient to understand the mechanisms involved and explain how the various dimensions of the women social condition interact with maternal health indicators. Inadequate prenatal care and suboptimal obstetric care may be intermediary factors, as they are related to both social status and maternal outcomes, in terms of maternal morbidity, its worsening or progression, and maternal mortality. PMID:26433316

  12. Are Free Maternity Services Completely Free of Costs?

    PubMed Central

    Acharya, Jeevan

    2015-01-01

    Objectives The Government of Nepal revised free maternity health services, “Aama Surakshya Karyakram”, beginning at the start of Fiscal Year 2012/13, which specifies the services to be funded, the tariffs for reimbursement, and the system for claiming and reporting on free deliveries each month. This study was designed to investigate the amount of monetary expenditure incurred by families using apparently free maternity services. Methods Between August 2014 and December 2014, a hospital-based cross-sectional study was conducted at Manipal Teaching Hospital and Western Regional Hospital. Nepalese women were not involved with family finances and had very little knowledge of income or expenditures. Therefore, face-to-face interviews with 384 postpartum mothers with their husbands or the head of the family household were conducted at the time of discharge by using a pre-tested semi-structural questionnaire. Results The average monthly family income was 19,272.4 NRs (189.01 US$), the median duration of hospital stay was 4 days (range, 2−19 days), and the median patient expenditure was equivalent to 13% of annual family income. The average total visible cost was 3,887.07 NRs (38.1 US$). When the average total hidden cost of 27,288.5 NRs (267.6 US$) was added, then the average total maternity care expenditure was 31,175.6 NRs (305.76 US$), with an average cost per day of 7,167.5 NRs (70.29 US$). The mean patient expenditure on food and drink, clothes, transport, and medicine was equivalent to 53.07%, 9.8%. 7.3%, and 5.6% of the mean total maternity care expenditure, respectively. The earnings lost by respondent women, husbands, and heads of household were 5,963.7 NRs (58.4 US$), 7,429.3 NRs (72.9 US$), and 6,175.9 NRs (60.6 US$), respectively. Conclusion The free maternity service in Nepal has high out-of-pocket expenditures, and did not represent a system completely free of costs. Therefore, arrangements should be made by hospitals free of cost to provide

  13. Prematurity and Low Birth Weight did not Correlate with Anti-Toxoplasma gondii Maternal Serum Profiles – a Brazilian Report

    PubMed Central

    Spegiorin, Lígia Cosentino Junqueira Franco; Vaz-Oliani, Denise Cristina Mós; Galão, Eloisa Aparecida; Oliani, Antonio Hélio; de Mattos, Luiz Carlos; de Mattos, Cinara Cássia Brandão

    2015-01-01

    Gestational Toxoplasma gondii infection is considered a major risk factor for miscarriage, prematurity and low birth weight in animals. However, studies focusing on this topic in humans are scarce. The objective of this study is to determine whether anti-Toxoplasma gondii maternal serum profiles correlate prematurity and low birth weight in humans. The study examined 213 pregnant women seen at the High-Risk Pregnancy Hospital de Base, São José do Rio Preto, São Paulo, Brazil. All serological profiles (IgM-/IgG+; IgM-/IgG-; IgM+/IgG+) were determined by ELISA commercial kits. Maternal age, gestational age and weight of the newborn at birth were collected and recorded in the Statement of Live Birth. Prematurity was defined as gestational age <37 weeks and low birth weight ≤ 2499 grams. The t-test was used to compare values (p < 0.05). The mean maternal age was 27.6±6.6 years. Overall, 56.3% (120/213) of the women studied were IgM-/IgG+, 36.2% (77/213) were IgM-/IgG- and 7.5% (16/213) were IgM+/IgG+. The average age of the women with serological profile IgM+/IgG+ (22.3±3.9 years) was different from women with the profile IgM-/IgG+ (27.9±6.7 years, p = 0.0011) and IgM-/IgG- (27.9±6.4 years, p = 0.0012). There was no statistically significant difference between the different serological profiles in relation to prematurity (p = 0.6742) and low birth weight (p = 0.7186). The results showed that prematurity and low birth weight did not correlate with anti-Toxoplasma gondii maternal serum profiles. PMID:26192182

  14. Quality of Maternal and Neonatal Care in Albania, Turkmenistan and Kazakhstan: A Systematic, Standard-Based, Participatory Assessment

    PubMed Central

    Tamburlini, Giorgio; Siupsinskas, Gelmius; Bacci, Alberta

    2011-01-01

    Background Progress in maternal and neonatal mortality has been slow in many countries despite increasing access to institutional births, suggesting deficiencies in the quality of care. We carried out a systematic assessment of the quality of maternal and newborn care in three CEE/CIS countries, using an innovative approach to identify priority issues and promote action. Methods A standard-based tool, covering over 400 items grouped in 13 main areas ranging from support services to case management, was used to assess a sample of ten maternity hospitals in Albania, Kazakhstan and Turkmenistan. Sources of information were visit to services, medical records, observation of cases, and interviews with staff and mothers. A score (range 0 to 3) was attributed to each item and area of care. The assessment was carried out by a multidisciplinary team of international and national professionals. Local managers and staff provided the necessary information and were involved in discussing the findings and the priority actions. Results Quality of care was found to be substandard in all 13 areas. The lowest scores (between one and two) were obtained by: management of normal labour, delivery, obstetric complications and sick babies; infection prevention; use of guidelines and audits; monitoring and follow-up. Neonatal care as a whole scored better than obstetric care. Interviewed mothers identified lack of information, insufficient support during labour and lack of companionship as main issues. Actions to improve quality of care were identified at facility as well as at central level and framed according to main health system functions. Conclusions Quality of care is a key issue to improve maternal and neonatal outcomes, particularly in countries such as CEE/CIS where access to institutional births is nearly universal. Approaches that involve health professionals and managers in comprehensive, action-oriented assessments of quality of care are promising and should be further

  15. Changing perspectives of infectious causes of maternal mortality

    PubMed Central

    Halder, Ajay; Vijayselvi, Reeta; Jose, Ruby

    2015-01-01

    Objective Infections significantly contribute to maternal mortality. There is a perceived change in the spectrum of such infections. This study aims to estimate the contribution of various types of infections to maternal mortality. Material and Methods We retrospectively reviewed records of maternal death cases that took place between 2003 and 2012 in the Christian Medical College, Vellore, India. The International Classification of Diseases-Maternal Mortality was used to classify the causes of deaths and World Health Organization near-miss criteria were used to identify organ dysfunction that occurred before death. Infections during pregnancy were divided into three groups, i.e., pregnancy-related infections, pregnancy-unrelated infections, and nosocomial infections. Results In this study, 32.53% of maternal deaths were because of some type of infection as the primary cause. The contribution of pregnancy-related infections was comparable with that of pregnancy-unrelated infections (16.03% vs. 16.50%). Metritis with pelvic cellulitis, septic abortions, tuberculosis, malaria, scrub typhus, and H1N1 influenza (influenza A virus subtype) were among the most commonly encountered causes of maternal death due to infections. Another 7.07% of cases developed severe systemic infection during the course of illness as nosocomial infection. A significant majority of mothers were below 30 years of age, were primiparae, had advanced gestational age, and had operative delivery. Cardiovascular and respiratory system dysfunctions were the most common organ dysfunctions encountered. Conclusion The contribution of pregnancy-unrelated infections to maternal deaths is significant. Control of these diverse community-acquired infections holds the key to a reduction in maternal mortality along with the promotion of clean birthing practices. Nosocomial infections should not be underestimated as a contributor to maternal mortality. PMID:26692770

  16. Impact of the Jamaican birth cohort study on maternal, child and adolescent health policy and practice.

    PubMed

    McCaw-Binns, A; Ashley, D; Samms-Vaughan, M

    2010-01-01

    The Jamaica Perinatal Morbidity and Mortality Survey (JPMMS) was a national study designed to identify modifiable risk factors associated with poor maternal and perinatal outcome. Needing to better understand factors that promote or retard child development, behaviour and academic achievement, we conducted follow-up studies of the birth cohort. The paper describes the policy developments from the JPMMS and two follow-up rounds. The initial study (1986-87) documented 94% of all births and their outcomes on the island over 2 months (n = 10 508), and perinatal (n = 2175) and maternal deaths (n = 62) for a further 10 months. A subset of the birth cohort, identified by their date of birth through school records, was seen at ages 11-12 (n = 1715) and 15-16 years (n = 1563). Findings from the initial survey led to, inter alia, clinic-based screening for syphilis, referral high-risk clinics run by visiting obstetricians, and the redesign and construction of new labour wards at referral hospitals. The follow-up studies documented inadequate academic achievement among boys and children attending public schools, and associations between under- and over-nutrition, excessive television viewing (>20 h/week), inadequate parental supervision and behavioural problems. These contributed to the development of a television programming code for children, a National Parenting Policy, policies aimed at improving inter-sectoral services to children from birth to 5 years (Early Childhood Commission) and behavioural interventions of the Violence Prevention Alliance (an inter-sectoral NGO) and the Healthy Lifestyles project (Ministry of Health). Indigenous maternal and child health research provided a local evidence base that informed public policy. Collaboration, good communication, being vigilant to opportunities to influence policy, and patience has contributed to our success. PMID:20078824

  17. Family Planning in the Hospital Setting

    PubMed Central

    Russell, Keith P.; Meier, Gitta

    1969-01-01

    Although the availability of oral contraceptives and the development of improved intrauterine contraceptive devices have greatly increased the general utilization of family planning services, there are still great segments of our population which are not yet reached, especially in the economically deprived areas. Since over 98 percent of all obstetrical deliveries now occur in hospitals, it seems logical that it is on hospital maternity services that these deficiencies might often be best overcome. Although this is primarily a medical problem, the use of paramedical personnel can greatly augment the physician's practice in these areas. Family planning services should be an integral part of comprehensive maternity care, not alone in the physician's office but also in the hospital setting. PMID:5784113

  18. Utilizing Longitudinal Measures of Fetal Growth to Create a Standard Method to Assess the Impacts of Maternal Disease and Environmental Exposure

    PubMed Central

    Cantonwine, David E.; Ferguson, Kelly K.; Mukherjee, Bhramar; Chen, Yin-Hsiu; Smith, Nicole A.; Robinson, Julian N.; Doubilet, Peter M.; Meeker, John D.; McElrath, Thomas F.

    2016-01-01

    Impaired or suboptimal fetal growth is associated with an increased risk of perinatal morbidity and mortality. By utilizing readily available clinical data on the relative size of the fetus at multiple points in pregnancy, including delivery, future epidemiological research can improve our understanding of the impacts of maternal, fetal, and environmental factors on fetal growth at different windows during pregnancy. This study presents mean and standard deviation ultrasound measurements from a clinically representative US population that can be utilized for creating Z-scores to this end. Between 2006 and 2012, 18, 904 non-anomalous pregnancies that received prenatal care, first and second trimester ultrasound evaluations, and ultimately delivered singleton newborns at Brigham and Women’s hospital in Boston were used to create the standard population. To illustrate the utility of this standard, we created Z-scores for ultrasound and delivery measurements for a cohort study population and examined associations with factors known to be associated with fetal growth. In addition to cross-sectional regression models, we created linear mixed models and generalized additive mixed models to illustrate how these scores can be utilized longitudinally and for the identification of windows of susceptibility. After adjustment for a priori confounders, maternal BMI was positively associated with increased fetal size beginning in the second trimester in cross-sectional models. Female infants and maternal smoking were associated with consistently reduced fetal size in the longitudinal models. Maternal age had a non-significant association with increased size in the first trimester that was attenuated as gestation progressed. As the growth measurements examined here are widely available in contemporary obstetrical practice, these data may be abstracted from medical records by investigators and standardized with the population means presented here. This will enable easy extension

  19. Evaluation of intoxicated patients hospitalized in a newly-opened level two pediatric intensive care unit

    PubMed Central

    Güngörer, Vildan; Yisldırım, Nurdan Kökten

    2016-01-01

    Aim: The study aimed to retrospectively examine the demographic and etiological characteristics, prognosis and length of stay in intensive care unit of intoxicated patients hospitalized in Level two Pediatric Intensive Care Unit in Maternity and Child Health Hospital of Samsun. Material and Methods: The study retrospectively examined the records of patients hospitalized between 14th March 2014 and 14th March 2015 in Level two Pediatric Intensive Care Unit in Maternity and Child Health Hospital of Samsun with respect to age, gender, cause of poisoning, time of emergency department admission, length of hospitalization and prognosis. Results: Of 82 patients admitted to the Intensive Care Unit, 29 (35.3%) were male and 53 (64.6%) were female. The mean age of the male and female patients was 7.89±6.3 years and 11.2±5.7 years, respectively and the mean age of the study group was 10.04±6.1. Twenthy one (39,6%) of the female patients were at the age group of 0–14 years and 32 (60.4%) were at the age group of 14–18 years. Twenthy (68.9%) of the male patients were at the age group of 0–14 years and nine (31.1%) were at the age group of 14–18 years. The cause of poisoning was drug intoxication (antidepressants, antibiotics, painkillers and other drugs) in 64 patients (78%) and the remaining 18 patients (22%) were admitted to hospital for other causes (rat poison, mushroom, carbonmonoxide, scorpion stings, bonzai and pesticides). Thirthy eight (46.3%) of all the patients used such substances for suicidal purpose. Thirthy three (62.2%) of these were female and 32 were at the age group of 14–18 years. Fourty (48.7%) of the patients who ingested medication ingested one drug, while 24 (29.2%) ingested multiple drugs. Antidepressants were found to be the most commonly used drugs (31.2%). The mean hospital admission time was 3.41±2 hours and the mean time of intensive care unit stay was 2.89±1.04 days. No mortality was recorded. Thirthy patients (36.5%) were referred

  20. Improving adolescent maternal health.

    PubMed

    Baxter, C; Moodley, D

    2015-11-01

    Each year thousands of adolescent girls and young women in South Africa (SA) become pregnant and many die from complications related to pregnancy and childbirth. Although women of all ages are susceptible, girls<15 years of age are five times as likely, and those aged 15-19 years twice as likely, to die from complications related to childbirth than women in their 20s. In SA, non-pregnancy-related infections (e.g. HIV), obstetric haemorrhage and hypertension contributed to almost 70% of avoidable maternal deaths. In addition to the implementation of standardized preventive interventions to reduce obstetric haemorrhage and hypertension, better reproductive health services for adolescents, access to HIV care and treatment for women infected with HIV, and improved access to and uptake of long-acting reversible contraception are important ingredients for reducing maternal mortality among adolescents. PMID:26937508

  1. Maternal obesity and pregnancy.

    PubMed

    Johnson, S R; Kolberg, B H; Varner, M W; Railsback, L D

    1987-05-01

    We examined the risk of maternal obesity in 588 pregnant women weighing at least 113.6 kilograms (250 pounds) during pregnancy. Compared with a control group matched for age and parity, we found a significantly increased risk in the obese patient for gestational diabetes, hypertension, therapeutic induction, prolonged second stage of labor, oxytocin stimulation of labor, shoulder dystocia, infants weighing more than 4,000 grams and delivery after 42 weeks gestation. Certain operative complications were also more common in obese women undergoing cesarean section including estimated blood loss of more than 1,000 milliliters, operating time of more than two hours and wound infection postoperatively. These differences remained significant after controlling for appropriate confounding variables. We conclude that maternal obesity should be considered a high risk factor. PMID:3576419

  2. Maternal Hartnup disorder.

    PubMed

    Mahon, B E; Levy, H L

    1986-07-01

    We describe childbearing in two unrelated women with Hartnup disorder, an inborn error of neutral amino acid transport. Two living, unaffected offspring born after untreated and uneventful pregnancies, one from each woman, have had normal growth and development. The older one had an IQ of 92 at 4 years while the younger one at 4 months had a Development Quotient of 107 on the Mental Scale and 102 on the Motor Scale. A third offspring had a neural tube defect complicated by hydrocephalus and died at 3 months. This mother had a family history of major congenital anomalies. We think that this experience supports the view that Hartnup disorder in the mother, unlike phenylketonuria, does not have an adverse effect on the fetus. The presence of normal ratios of the amino acid concentrations between maternal and umbilical veins in one mother also suggests that placental transport of free amino acids, unlike renal transport, may not be reduced in maternal Hartnup disorder. PMID:3728570

  3. Incidence and etiology of hemolytic-uremic syndrome in children in Norway, 1999–2008 – a retrospective study of hospital records to assess the sensitivity of surveillance

    PubMed Central

    2014-01-01

    Background Public awareness of hemolytic-uremic syndrome (HUS), especially related to Shiga toxin-producing Escherichia coli (STEC), has increased in Europe in recent years; accentuated in Norway by a national outbreak in 2006 and in a European context especially by the 2011 outbreak originating in Germany. As STEC surveillance is difficult due to diagnostic challenges in detecting non-O157 infections, surveillance of HUS can be used to indicate the burden of STEC infection. Until 2006, notification of HUS to the Norwegian Communicable Disease Surveillance System (MSIS) was based on microbiologically confirmed infection with enterohemorrhagic Escherichia coli (EHEC), humanpathogenic STEC. In 2006, diarrhea-associated HUS (D+HUS) was made notifiable based on clinical criteria alone. The incidence and etiology of HUS in children in Norway has not previously been described. Methods In order to assess the sensitivity of STEC and D+HUS surveillance and describe the incidence and etiology of HUS in children in Norway, we conducted a nationwide retrospective study collecting data from medical records from pediatric departments for the period 1999–2008 and compared them with data from MSIS. Descriptive statistics are presented as proportions, median, average and mean values with ranges and as incidence rates, calculated using population numbers provided by official registries. Results Forty-seven HUS cases were identified, corresponding to an average annual incidence rate of 0.5 cases per 100,000 children. Diarrhea-associated HUS was identified in 38 (81%) cases, of which the median age was 29 months, 79% were <5 years of age and 68% were girls. From 1999 to 2006, thirteen more diarrhea-associated HUS cases were identified than had been notified to MSIS. From the change in notification criteria to 2008, those identified corresponded to those notified. STEC infection was verified in 23 (49%) of the HUS cases, in which O157 was the most frequently isolated sporadic

  4. Maternal filicide theoretical framework.

    PubMed

    Mugavin, Marie

    2008-01-01

    The maternal filicide theoretical framework (MFTF) was developed to enrich the understanding of how traumatic experiences during formative years can affect a woman's relationship with her own child. Exposure to a known set of vulnerabilities can foster triggers that predispose a woman to respond impulsively and violently toward her child. Comprehensive assessment of vulnerable families is essential for the prevention of fatal and nonfatal abuse. The MFTF may be applied to both crimes. PMID:18522605

  5. Planning Nurses in Maternity Care: a Stochastic Assignment Problem

    NASA Astrophysics Data System (ADS)

    Phillipson, Frank

    2015-05-01

    With 23 percent of all births taking place at home, The Netherlands have the highest rate of home births in the world. Also if the birth did not take place at home, it is not unusual for the mother and child to be out of hospital in a few hours after the baby was born. The explanation for both is the very well organised maternity care system. However, getting the right maternity care nurse available on time introduces a complex planning issue that can be recognized as a Stochastic Assignment Problem. In this paper an expert rule based approach is combined with scenario analysis to support the planner of the maternity care agency in his work.

  6. To Assess the Effect of Maternal BMI on Obstetrical Outcome

    NASA Astrophysics Data System (ADS)

    Lakhanpal, Shuchi; Aggarwal, Asha; Kaur, Gurcharan

    2012-06-01

    AIMS: To assess the effect of maternal BMI on complications in pregnancy, mode of delivery, complications of labour and delivery.METHODS:A crossectional study was carried out in the Obst and Gynae department, Kasturba Hospital, Delhi. The study enrolled 100 pregnant women. They were divided into 2 groups based on their BMI, more than or equal to 30.0 kg/m2 were categorized as obese and less than 30 kg/m2 as non obese respectively. Maternal complications in both types of patients were studied.RESULTS:CONCLUSION: As the obstetrical outcome is significantly altered due to obesity, we can improve maternal outcome by overcoming obesity. As obesity is a modifiable risk factor, preconception counseling creating awareness regarding health risk associated with obesity should be encouraged and obstetrical complications reduced.

  7. Irish midwives’ experiences of providing maternity care to non-Irish women seeking asylum

    PubMed Central

    Tobin, Carolyn L; Murphy-Lawless, Jo

    2014-01-01

    Background Immigration and asylum seeking has been an important social and political phenomenon in Ireland since the mid 1990s. Inward migration to Ireland was seen in unprecedented numbers from 1995 onward, peaking in 2002 with 11,634 applications for refugee status. Asylum and immigration is an issue of national and international relevance as the numbers of displaced people worldwide continues to grow, reaching the highest level in 20 years at 45.2 million in 2012. Midwives provide the majority of care to childbearing women around the world, whether working as autonomous practitioners or under the direction of an obstetrician. Limited data currently exist on the perspectives of midwives who provide care to childbearing women while they are in the process of seeking asylum. Such data are important to midwifery leaders, educators, and policy-makers. The aims of this study were to explore midwives’ perceptions and experiences of providing care to women in the asylum process and to gain insight into how midwives can be equipped and supported to provide more effective care to this group in the future. Methods Data were collected via indepth unstructured interviews with a purposive sample of ten midwives from two sites, one a large urban inner city hospital, and the second, a smaller more rural maternity hospital. The interviews were audio-recorded and transcribed verbatim. The data were analyzed using content analysis. Results Five themes emerged from the data, barriers to communication, understanding cultural difference, challenges of caring for women who were unbooked, the emotional cost of caring, and structural barriers to effective care. Conclusion Findings highlight a need to focus on support and education for midwives, improved maternity services for immigrant women, and urgent policy revision. PMID:24516340

  8. Maternal-fetal conflict.

    PubMed

    Fasouliotis, S J; Schenker, J G

    2000-03-01

    Advances in prenatal care have brought about a greater understanding as to the special status of the fetus to the point that it is considered a patient in its own regard. Pregnant women generally follow the medical recommendations of their physicians that are intended for the benefit of their baby. Any situation where maternal well-being or wishes contradict fetal benefit constitutes a maternal-fetal conflict. Such situations include a broad range of possible interventions, non-interventions, and coercive influences. In such cases, the attending physician is expected to attain an attitude that involves either the respect of the woman's autonomy and right to privacy, which precludes any approach other than to accept her decision, or to modify this absolute for the beneficence of the fetus. Current ethical viewpoints range from absolute respect for maternal autonomy with no persuasion allowed, to gentle persuasion and to others which permit intervention and overriding of the woman's autonomy. Court-ordered decisions enforcing the pregnant woman to undergo a procedure in order to improve fetal outcome have been criticized as an invasion of a woman's privacy, limitation of her autonomy, and taking away of her right to informed consent. PMID:10733034

  9. Refining Measurement of Substance Use Disorders Among Women of Child-Bearing Age Using Hospital Records: The Development of the Explicit-Mention Substance Abuse Need for Treatment in Women (EMSANT-W) Algorithm.

    PubMed

    Derrington, Taletha Mae; Bernstein, Judith; Belanoff, Candice; Cabral, Howard J; Babakhanlou-Chase, Hermik; Diop, Hafsatou; Evans, Stephen R; Kotelchuck, Milton

    2015-10-01

    Substance use disorder (SUD) in women of reproductive age is associated with adverse health consequences for both women and their offspring. US states need a feasible population-based, case-identification tool to generate better approximations of SUD prevalence, treatment use, and treatment outcomes among women. This article presents the development of the Explicit Mention Substance Abuse Need for Treatment in Women (EMSANT-W), a gender-tailored tool based upon existing International Classification of Diseases, 9th Edition, Clinical Modification diagnostic code-based groupers that can be applied to hospital administrative data. Gender-tailoring entailed the addition of codes related to infants, pregnancy, and prescription drug abuse, as well as the creation of inclusion/exclusion rules based on other conditions present in the diagnostic record. Among 1,728,027 women and associated infants who accessed hospital care from January 1, 2002 to December 31, 2008 in Massachusetts, EMSANT-W identified 103,059 women with probable SUD. EMSANT-W identified 4,116 women who were not identified by the widely used Clinical Classifications Software for Mental Health and Substance Abuse (CCS-MHSA) and did not capture 853 women identified by CCS-MHSA. Content and approach innovations in EMSANT-W address potential limitations of the Clinical Classifications Software, and create a methodologically sound, gender-tailored and feasible population-based tool for identifying women of reproductive age in need of further evaluation for SUD treatment. Rapid changes in health care service infrastructure, delivery systems and policies require tools such as the EMSANT-W that provide more precise identification methods for sub-populations and can serve as the foundation for analyses of treatment use and outcomes. PMID:25680703

  10. Placental cadmium as an additional noninvasive bioindicator of active maternal tobacco smoking.

    PubMed

    Piasek, Martina; Jurasović, Jasna; Sekovanić, Ankica; Brajenović, Nataša; Brčić Karačonji, Irena; Mikolić, Anja; Grgec, Antonija Sulimanec; Stasenko, Sandra

    2016-01-01

    Tobacco smoke (TS) is a mixture of chemicals that is known to exert carcinogenic and endocrine-disrupting effects, as well as adverse effects on various systems. In TS nicotine is the major alkaloid and cadmium (Cd) the most abundant metal ion. The aim of this investigation was to assess exposure to Cd attributed to TS in healthy postpartum subjects (mean age 28 years) after term vaginal delivery in a clinical hospital by determining metal levels in maternal blood, placenta, and cord blood in relation to nicotine in maternal hair (12-cm-long samples). Two study groups were compared based upon self-reporting data: smokers (n = 32; continual cigarette smoking 3 months before and 9 months during pregnancy) and nonsmokers (n = 54; including passive smokers whose parameters did not differ from unexposed nonsmokers). In smokers compared to nonsmokers maternal hair nicotine concentrations increased approximately sevenfold, while Cd levels rose fourfold in maternal blood and up to twofold in placenta. Significant positive correlations were noted between maternal hair nicotine and placental Cd, maternal hair nicotine and maternal blood Cd, and placental Cd and maternal blood Cd. Levels of cord blood Cd were low in both study groups (<0.1 ng/ml). Data indicate that Cd in placenta may serve as a noninvasive bioindicator in addition to commonly used noninvasive hair nicotine in maternal TS assessment, especially in cases where unavailable or inappropriate (short or chemically treated) hair samples occur. PMID:27210017

  11. Meeting the community halfway to reduce maternal deaths? Evidence from a community-based maternal death review in Uttar Pradesh, India

    PubMed Central

    Raj, Sunil Saksena; Maine, Deborah; Sahoo, Pratap Kumar; Manthri, Suneedh; Chauhan, Kavita

    2013-01-01

    ABSTRACT Background: Uttar Pradesh (UP) is the most populous state in India with the second highest reported maternal mortality ratio in the country. In an effort to analyze the reasons for maternal deaths and implement appropriate interventions, the Government of India introduced Maternal Death Review guidelines in 2010. Methods: We assessed causes of and factors leading to maternal deaths in Unnao District, UP, through 2 methods. First, we conducted a facility gap assessment in 15 of the 16 block-level and district health facilities to collect information on the performance of the facilities in terms of treating obstetric complications. Second, teams of trained physicians conducted community-based maternal death reviews (verbal autopsies) in a sample of maternal deaths occurring between June 1, 2009, and May 31, 2010. Results: Of the 248 maternal deaths that would be expected in this district in a year, we identified 153 (62%) through community workers and conducted verbal autopsies with families of 57 of them. Verbal autopsies indicated that 23% and 30% of these maternal deaths occurred at home and on the way to a health facility, respectively. Most of the women who died had been taken to at least 2 health facilities. The facility assessment revealed that only the district hospital met the recommended criteria for either basic or comprehensive emergency obstetric and neonatal care. Conclusions: Life-saving treatment of obstetric complications was not offered at the appropriate level of government facilities in a representative district in UP, and an inadequate referral system provided fatal delays. Expensive transportation costs to get pregnant women to a functioning medical facility also contributed to maternal death. The maternal death review, coupled with the facility gap assessment, is a useful tool to address the adequacy of emergency obstetric and neonatal care services to prevent further maternal deaths. PMID:25276519

  12. Hospital auditors--friend or foe?

    PubMed

    Okamoto, C L

    1987-05-01

    Now, with the direct linkage to the hospital's financial position, medical record departments are sharing part of the internal review process which hospital financial areas have historically undergone. Without a good financial background, most medical record managers lack the basic understanding of the purpose and usefulness of financial auditors. It is critical that medical record managers understand that purpose so that they can better serve their institutions. This article discusses the process undertaken and the results produced by hospital financial auditors, so that record managers gain benefits from financial auditor reviews, and see them as friends, rather than foes. PMID:10282197

  13. Standardized severe maternal morbidity review: rationale and process.

    PubMed

    Kilpatrick, Sarah J; Berg, Cynthia; Bernstein, Peter; Bingham, Debra; Delgado, Ana; Callaghan, William M; Harris, Karen; Lanni, Susan; Mahoney, Jeanne; Main, Elliot; Nacht, Amy; Schellpfeffer, Michael; Westover, Thomas; Harper, Margaret

    2014-08-01

    Severe maternal morbidity and mortality have been rising in the United States. To begin a national effort to reduce morbidity, a specific call to identify all pregnant and postpartum women experiencing admission to an intensive care unit or receipt of 4 or more units of blood for routine review has been made. While advocating for review of these cases, no specific guidance for the review process was provided. Therefore, the aim of this expert opinion is to present guidelines for a standardized severe maternal morbidity interdisciplinary review process to identify systems, professional, and facility factors that can be ameliorated, with the overall goal of improving institutional obstetric safety and reducing severe morbidity and mortality among pregnant and recently pregnant women. This opinion was developed by a multidisciplinary working group that included general obstetrician-gynecologists, maternal-fetal medicine subspecialists, certified nurse-midwives, and registered nurses all with experience in maternal mortality reviews. A process for standardized review of severe maternal morbidity addressing committee organization, review process, medical record abstraction and assessment, review culture, data management, review timing, and review confidentiality is presented. Reference is made to a sample severe maternal morbidity abstraction and assessment form. PMID:25004341

  14. Causes of maternal mortality in rural Bangladesh, 1976-85.

    PubMed

    Fauveau, V; Koenig, M A; Chakraborty, J; Chowdhury, A I

    1988-01-01

    Of a total of 1037 women of reproductive age who died during the period 1976-85 in the Matlab area that was under demographic surveillance, 387 (37%) were maternal deaths. The mean maternal mortality over the 10-year period was 5.5 per 1000 live births (101 per 100 000 women of reproductive age). Major causes of maternal death, which were assessed using a combination of record review and field interviews, included postpartum haemorrhage (20%), complications of abortion (18%), eclampsia (12%), violence and injuries (9%), concomitant medical causes (9%), postpartum sepsis (7%), and obstructed labour (6.5%). Deaths caused by postpartum haemorrhage were positively associated with both maternal age and parity, whereas those caused by eclampsia and injuries were more common among young and low-parity women. If maternal deaths arising from complications of abortion are disregarded, 20% of all maternal deaths occurred during pregnancy, 44% during labour and the two days following delivery, and 36% during the remaining postpartum period.These findings support the need to develop a service strategy to address the risks of childbearing and childbirth in areas such as rural Bangladesh, where almost all deliveries take place at home. This strategy must be based not only on preventive and educational interventions, including family planning and antenatal care, but also on systematic attendance at home deliveries by trained professional midwives, backed up by an effective chain of referral. PMID:3264766

  15. Hospital fundamentals.

    PubMed

    Althausen, Peter L; Hill, Austin D; Mead, Lisa

    2014-07-01

    Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols. PMID

  16. The effect of heavy maternal workload on fetal growth retardation and preterm delivery. A study among southern Thai women.

    PubMed

    Tuntiseranee, P; Geater, A; Chongsuvivatwong, V; Kor-anantakul, O

    1998-11-01

    Heavy maternal workloads are considered to be hazardous to the fetus. The effects of physical activity during pregnancy on low birth weight (LBW), small for gestational age (SGA), and prematurity were assessed from a sample of 1797 women in a follow-up study at the antenatal clinic of two hospitals in southern Thailand. The women were interviewed twice, at 17 and 32 gestational weeks. Outcome data were obtained from medical records and the newborn gestational age determined using Dubowitz's score. The risk of SGA was elevated for women working > 50 hours/week, squatting in work, commuting > 1 hour/day, and having high psychological job demands; the risk of preterm delivery was increased with obstetrical complications. Women who worked long hours and had demanding work conditions had an elevated risk of giving birth to SGA infants but not of preterm delivery. PMID:9830610

  17. Maternal cardiac metabolism in pregnancy.

    PubMed

    Liu, Laura X; Arany, Zolt

    2014-03-15

    Pregnancy causes dramatic physiological changes in the expectant mother. The placenta, mostly foetal in origin, invades maternal uterine tissue early in pregnancy and unleashes a barrage of hormones and other factors. This foetal 'invasion' profoundly reprogrammes maternal physiology, affecting nearly every organ, including the heart and its metabolism. We briefly review here maternal systemic metabolic changes during pregnancy and cardiac metabolism in general. We then discuss changes in cardiac haemodynamic during pregnancy and review what is known about maternal cardiac metabolism during pregnancy. Lastly, we discuss cardiac diseases during pregnancy, including peripartum cardiomyopathy, and the potential contribution of aberrant cardiac metabolism to disease aetiology. PMID:24448314

  18. Patient characteristics associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (COPD) following primary care COPD diagnosis: a cohort study using linked electronic patient records

    PubMed Central

    Hunter, L C; Lee, R J; Butcher, I; Weir, C J; Fischbacher, C M; McAllister, D; Wild, S H; Hewitt, N; Hardie, R M

    2016-01-01

    Objectives To investigate patient characteristics of an unselected primary care population associated with risk of first hospital admission and readmission for acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Design Retrospective open cohort using pseudonymised electronic primary care data linked to secondary care data. Setting Primary care; Lothian (population approximately 800 000), Scotland. Participants Data from 7002 patients from 72 general practices with a COPD diagnosis date between 2000 and 2008 recorded in their primary care record. Patients were followed up until 2010, death or they left a participating practice. Main outcome measures First and subsequent admissions for AECOPD (International Classification of Diseases (ICD) 10 codes J44.0, J44.1 in any diagnostic position) after COPD diagnosis in primary care. Results 1756 (25%) patients had at least 1 AECOPD admission; 794 (11%) had at least 1 readmission and the risk of readmission increased with each admission. Older age at diagnosis, more severe COPD, low body mass index (BMI), current smoking, increasing deprivation, COPD admissions and interventions for COPD prior to diagnosis in primary care, and comorbidities were associated with higher risk of first AECOPD admission in an adjusted Cox proportional hazards regression model. More severe COPD and COPD admission prior to primary care diagnosis were associated with increased risk of AECOPD readmission in an adjusted Prentice-Williams-Peterson model. High BMI was associated with a lower risk of first AECOPD admission and readmission. Conclusions Several patient characteristics were associated with first AECOPD admission in a primary care cohort of people with COPD but fewer were associated with readmission. Prompt diagnosis in primary care may reduce the risk of AECOPD admission and readmission. The study highlights the important role of primary care in preventing or delaying a first AECOPD admission. PMID:26801463

  19. An Investigation of the Stillbirths at a Tertiary Hospital in Limpopo Province of South Africa

    PubMed Central

    Ntuli, Sam Thembelihle; Malangu, Ntambwe

    2012-01-01

    Objective: To determine the stillbirth rate and identify the causal factors associated with it in a tertiary hospital. Methods: A retrospective review of records of women who had stillbirths at a tertiary hospital of the Limpopo Province was conducted. The study period was two years from January 1, 2009 to December 31, 2010. The hospital maternity registers were used to identify the women who gave birth during the study period. Data were collected using a data collection form designed for the study. The data collected included maternal age, parity, gestation, mode of delivery, obstetric complications, infant or foetal’s gender and weight; whether the birth was fresh stillbirth or macerated and cause of stillbirth. Results: There were 5597 deliveries during the two years period of the study. The hospital-based stillbirth rate was 38.4 per 1000 births, with 71% being macerated. The majority of women with stillborn infant in this study were in the age group (24%) 20-34 years, followed by (23%) aged 35 years and older. Nulliparity was associated with stillbirth. Unexplained intrauterine foetal death, hypertensive disease, placenta abruptio was the leading causes of stillbirth. Conclusion: In this study stillbirth rate seems to be unacceptably high, though less than those reported in other settings. The causal factors associated with it were identified as nulliparity, unexplained intrauterine foetal deaths, hypertensive disease, and placenta abruptio. Because of the high rate of stillbirths reported in this study, it is recommended that interventions be made to introduce fetal autopsies at the tertiary healthcare facilities and that an educational intervention aimed teaching pregnant women be instituted. PMID:23121750

  20. Characterization of babies discharged from Cabell Huntington Hospital during the calendar year 2005 with the diagnoses of neonatal abstinence syndrome.

    PubMed

    Baxter, F Ross; Nerhood, Robert; Chaffin, David

    2009-01-01

    Recent concern regarding the impact of maternal drug abuse on neonatal well being was the impetus for this retrospective cohort study of newborns diagnosed with neonatal abstinence syndrome that were discharged from Cabell Huntington Hospital during the calendar year 2005. Medical records of the neonates and their mothers were analyzed for a variety of health related outcomes and healthcare cost. Forty-eight neonates were diagnosed with Neonatal Abstinence Syndrome in 2005, forty of which required NICU assistance. The average maternal age at delivery was 26; gravity was 3.1 and most were single, separated or divorced. The majority had poor or inconsistent prenatal care. Twenty-one delivered by cesarean section most often for fetal distress. Most delivered prematurely with an average gestation of 35.9 weeks. Half of the mothers went into preterm labor with half of those having premature ruptured membranes. Opiates were the most common maternal substance found, while neonates most often tested positive for methadone. Nearly 90% of the mothers smoked. Thirty-four of the mothers were found to continue illicit drug abuse while pregnant, while another eight were seen in a methadone clinic for a history of abuse. Most of the neonates required weaning with methadone. The majority of our study cases were funded by Medicaid, mostly by West Virginia with total hospital costs exceeding 1.7 million dollars. Direct cost attributed to detoxification was in excess of $180,000. The number of neonates diagnosed with Neonatal Abstinence Syndrome has nearly tripled from 2003 to 2007. The problem of maternal drug abuse and addiction during pregnancy has dramatic effects on both their unborn children and our local healthcare system. Increased awareness of this growing problem is needed so that earlier interventions can be implemented. It is our opinion that all obstetrical patients at risk should be screened early and often so that those affected individuals can be managed more

  1. Prenatal Maternal Smoking and Tourette Syndrome: A Nationwide Register Study.

    PubMed

    Leivonen, Susanna; Chudal, Roshan; Joelsson, Petteri; Ekblad, Mikael; Suominen, Auli; Brown, Alan S; Gissler, Mika; Voutilainen, Arja; Sourander, Andre

    2016-02-01

    This is the first nationwide register-based study to examine the relationship between prenatal maternal smoking and Tourette syndrome. A total of 767 children diagnosed with Tourette syndrome were identified from the Finnish Hospital Discharge Register. Each case was matched to four controls. Information on maternal smoking during pregnancy was obtained from the Finnish Medical Birth Register. Conditional logistic regression models were used for statistical analyses. Prenatal maternal smoking was associated with Tourette syndrome when comorbid with ADHD (OR 4.0, 95 % CI 1.2-13.5, p = 0.027 for exposure during first trimester, OR 1.7, 95 % CI, 1.05-2.7, p = 0.031 for exposure for the whole pregnancy). There was no association between maternal smoking during pregnancy and Tourette syndrome without comorbid ADHD (OR 0.5, 95 % CI 0.2-1.3, p = 0.166, OR 0.9, 95 % CI 0.7-1.3, p = 0.567). Further research is needed to elucidate the mechanisms behind the association between prenatal maternal smoking and Tourette syndrome with comorbid ADHD. PMID:25796373

  2. A system for counting fetal and maternal red blood cells.

    PubMed

    Ge, Ji; Gong, Zheng; Chen, Jun; Liu, Jun; Nguyen, John; Yang, Zongyi; Wang, Chen; Sun, Yu

    2014-12-01

    The Kleihauer-Betke (KB) test is the standard method for quantitating fetal-maternal hemorrhage in maternal care. In hospitals, the KB test is performed by a certified technologist to count a minimum of 2000 fetal and maternal red blood cells (RBCs) on a blood smear. Manual counting suffers from inherent inconsistency and unreliability. This paper describes a system for automated counting and distinguishing fetal and maternal RBCs on clinical KB slides. A custom-adapted hardware platform is used for KB slide scanning and image capturing. Spatial-color pixel classification with spectral clustering is proposed to separate overlapping cells. Optimal clustering number and total cell number are obtained through maximizing cluster validity index. To accurately identify fetal RBCs from maternal RBCs, multiple features including cell size, roundness, gradient, and saturation difference between cell and whole slide are used in supervised learning to generate feature vectors, to tackle cell color, shape, and contrast variations across clinical KB slides. The results show that the automated system is capable of completing the counting of over 60,000 cells (versus ∼2000 by technologists) within 5 min (versus ∼15 min by technologists). The throughput is improved by approximately 90 times compared to manual reading by technologists. The counting results are highly accurate and correlate strongly with those from benchmarking flow cytometry measurement. PMID:24879644

  3. Decline in maternal mortality in Matlab, Bangladesh: a cautionary tale.

    PubMed

    Ronsmans, C; Vanneste, A M; Chakraborty, J; van Ginneken, J

    This study examines the impact of the Maternal-Child Health and Family Planning (MCH-FP) program in the Matlab, Bangladesh. Data were obtained from the Matlab surveillance system for treatment and comparison areas. This study reports the trends in maternal mortality since 1976. The MCH-FP area received extensive services in health and family planning since 1977. Services included trained traditional birth attendants and essential obstetric care from government district hospitals and a large number of private clinics. Geographic ease of access to essential obstetric care varied across the study area. Access was most difficult in the northern sector of the MCH-FP area. Contraception was made available through family welfare centers. Tetanus immunization was introduced in 1979. Door-to-door contraceptive services were provided by 80 female community health workers on a twice-monthly basis. In 1987, a community-based maternity care program was added to existing MCH-FP services in the northern treatment area. The demographic surveillance system began collecting data in 1966. During 1976-93 there were 624 maternal deaths among women aged 15-44 years in Matlab (510/100,000 live births). 72.8% of deaths were due to direct obstetric causes: postpartum hemorrhage, induced abortion, eclampsia, dystocia, and postpartum sepsis. Maternal mortality declined in a fluctuating fashion in both treatment and comparison areas. Direct obstetric mortality declined at about 3% per year. After 1987, direct obstetric mortality declined in the north by almost 50%. After the 1990 program expansion in the south, maternal mortality declined, though not significantly, in the south. Maternal mortality declined in the south comparison area during 1987-89 and stabilized. The comparison area of the north showed no decline. PMID:9428252

  4. Maternal and neonatal sepsis caused by Haemophilus influenzae type d.

    PubMed

    Warren, S; Tristram, S; Bradbury, R S

    2010-03-01

    A 29-year-old pregnant woman was admitted to hospital with signs of sepsis and threatened pre-term labour. The premature neonate also showed signs of sepsis. Haemophilus influenzae biotype III was cultured from a midstream urine sample taken from the mother, maternal placental swabs and neonatal blood cultures. The placental and neonatal isolates were both found to be serotype d by PCR, and were indistinguishable by PFGE. PMID:19926730

  5. Hospital Hints

    MedlinePlus

    ... Division of Geriatrics and Clinical Gerontology Division of Neuroscience FAQs Funding Opportunities Intramural Research Program Office of ... have to spend the night in the hospital. Learning more about what to expect and about people ...

  6. Cortisol and ACTH plasma levels in maternal filicides and violent psychiatric women.

    PubMed

    Spironelli, Chiara; Gradante, Federica; Gradante, Giuseppe; Angrilli, Alessandro

    2013-05-01

    Maternal filicide may be considered the result of significant interactions between increased individual vulnerability and overwhelming environmental stress. The present study examined whether the biological vulnerability to stress and psychotic depression in criminally insane filicidal women was associated with an imbalance of stress-related hormones. Early-morning plasma levels of hormones associated with depression and chronic stress, i.e., thyroid hormones, Cortisol and Adrenocorticotropic hormone (ACTH), were measured in 10 filicidal inpatients recovered in a high-security psychiatric hospital for the criminally insane and 10 matched psychiatric, non-filicidal, criminal mothers with comparable traumatic/abuse records. Filicidal mothers had higher than normative Cortisol levels and significantly higher ACTH levels than both the normative values and plasma levels of non-filicidal women. Levels of thyroid hormones fell within normal ranges, without between-groups differences. In addition, while psychiatric controls had the expected Cortisol-ACTH positive correlation, mothers who killed their children revealed no relationship between the two hormones. HPA in the group of filicide perpetrators was altered despite they had received antidepressant pharmacological treatment. The observed imbalance of hypothalamic-pituitary-adrenal (HPA) axis indicates a possible filicides' reduced sensitivity of the adrenal glands to ACTH, probably due to the pre-hospitalization long-term affective stress which preceded child homicide. The results reveal the existence of large psycho-biological stress-sensitivity in filicides, and careful post-discharge psychiatric follow-up of such women is recommended. PMID:23375405

  7. [Out-of-hospital births].

    PubMed

    Fernández Domínguez, N; Leal Gómez, E; García Lavandeira, S; Vázquez Rodríguez, M

    2016-01-01

    Childbirth is a physiological process and, as such, there should be limited assistance for the woman to ensure that it follows its natural process, avoiding any possible complication and, if they do appear, attempting to resolve them. Health personnel should try to achieve a balance between safety and the least possible outside assistance. The out-of-hospital delivery is considered an emergency as it happens unexpectedly, that is, without being previously planned. Given that it has to be treated outside the ideal conditions of a maternity ward, it is considered as an emergency. PMID:26006314

  8. Hospital philanthropy.

    PubMed

    Smith, Dean G; Clement, Jan P

    2013-01-01

    It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise. PMID:23614267

  9. Maternal ethanol ingestion: effect on maternal and neonatal glucose balance

    SciTech Connect

    Witek-Janusek, L.

    1986-08-01

    Liver glycogen availability in the newborn is of major importance for the maintenance of postnatal blood glucose levels. This study examined the effect of maternal ethanol ingestion on maternal and neonatal glucose balance in the rate. Female rats were placed on 1) the Lieber-DeCarli liquid ethanol diet, 2) an isocaloric liquid pair-diet, or 3) an ad libitum rat chow diet at 3 wk before mating and throughout gestation. Blood and livers were obtained from dams and rat pups on gestational days 21 and 22. The pups were studied up to 6 h in the fasted state and up to 24 h in the fed state. Maternal ethanol ingestion significantly decreased litter size, birth weight, and growth. A significantly higher mortality during the early postnatal period was seen in the prenatal ethanol exposed pups. Ethanol significantly decreased fed maternal liver glycogen stores but not maternal plasma glucose levels. The newborn rats from ethanol ingesting dams also had significantly decreased liver glycogen stores. Despite mobilizing their available glycogen, these prenatal ethanol exposed pups became hypoglycemic by 6 h postnatal. This was more marked in the fasted pups. Ethanol did not affect maternal nor neonatal plasma insulin levels. Thus maternal ethanol ingestion reduces maternal and neonatal liver glycogen stores and leads to postnatal hypoglycemia in the newborn rat.

  10. Child Health, Maternal Marital and Socioeconomic Factors, and Maternal Health

    ERIC Educational Resources Information Center

    Garbarski, Dana; Witt, Whitney P.

    2013-01-01

    Although maternal socioeconomic status and health predict in part children's future health and socioeconomic prospects, it is possible that the intergenerational association flows in the other direction such that child health affects maternal outcomes. Previous research demonstrates that poor child health increases the risk of adverse…

  11. Maternal Depression, Maternal Expressed Emotion, and Youth Psychopathology

    ERIC Educational Resources Information Center

    Tompson, Martha C.; Pierre, Claudette B.; Boger, Kathryn Dingman; McKowen, James W.; Chan, Priscilla T.; Freed, Rachel D.

    2010-01-01

    Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two…

  12. The association of maternal social class with maternal diet and the dimensions of babies in a population of London women.

    PubMed

    Wynn, S W; Wynn, A H; Doyle, W; Crawford, M A

    1994-01-01

    Records of the diets of 513 London mothers towards the end of the first trimester of pregnancy have been reported previously to show the maternal nutritional intakes associated with birthweight in the optimum range, which may be assumed to approximate to basic maternal needs for reproduction. The diets associated with low birthweight and small head size were also recorded and were found to be inferior. The present paper shows social class gradients for baby size and 35 essential dietary components, providing an indication of which basic maternal nutritional needs were not always met. There was no social class gradient for intake of total energy, or the energy carriers carbohydrate and fat. There were, however, statistically highly significant social class gradients for intake of protein, seven minerals and six B-vitamins, all of which were also highly significantly correlated with birthweight. Maternal intake of these 14 components of diet fell progressively as birthweight fell, but only for the mothers of smaller babies below 3270g, the median for the study. Further increase of maternal intakes of any nutrient by mothers whose babies were above median did not apparently further increase birthweight. The social and medical problem presented by maternal nutrition is that of a minority of women who enter pregnancy with qualitatively inadequate nutritional status. This minority is found in all social classes but increases from social class I to V, and further still among single mothers. The women comprising this minority eat foods not meeting basic maternal needs for a range of nutrients characteristic of whole grains, vegetables and fruit and dairy produce, which may partly be explained by their high cost. PMID:8065668

  13. Maternal nutrition, health, and survival.

    PubMed

    Christian, Parul

    2002-05-01

    The burden of maternal morbidity and mortality in developing countries is high. Each year, 600,000 women die from pregnancy-related causes and 62 million women suffer from morbidity and complications of pregnancy. The extent to which maternal nutrition can improve maternal health and survival is not well understood. Excluding deaths due to induced abortions, the other four main causes of maternal mortality (preeclampsia, hemorrhage, obstructed labor, and infection) may be amenable to nutrition interventions. The role of calcium in reducing the incidence of preeclampsia and hypertension is promising, but more research in deficient populations is urgently needed. Antenatal iron supplementation, although frequently recommended to prevent anemia during pregnancy, has had little program success. Severe anemia may be an important cause of maternal mortality, but convincing evidence is lacking on the health consequences of mild-to-moderate maternal anemia. Knowledge of the etiology of anemia is important in identifying effective strategies for combating it. Other vitamins such as folate, B12, and vitamin A may enhance the effect of iron supplementation in populations where multiple nutrition deficiencies exist. Maternal night blindness is widespread in South Asian women. In Nepal, this condition is associated with markedly increased risks of vitamin A deficiency, anemia, morbidity, and maternal and infant mortality. These findings need to be replicated elsewhere in South Asia. One study has shown vitamin A and beta carotene supplementation to reduce maternal mortality and morbidity. These findings need testing in different settings with emphasis on investigating the mechanisms of the effect. The area of prepregnancy nutrition and its influence on prolonged and obstructed labor is wide open for investigation. The scope for research in the area of maternal nutrition and health is large and the onus is on nutritionists to bring to the forefront the role of nutrition in

  14. Maternal Gatekeeping: Antecedents and Consequences

    ERIC Educational Resources Information Center

    Gaunt, Ruth

    2008-01-01

    This study examined maternal gatekeeping, its background and psychological antecedents, and its consequences for paternal and maternal involvement in child care. In sum, 209 couples with 6- to 36-month-old children completed extensive questionnaires. Analyses revealed that various dimensions of gate-keeping were differentially associated with the…

  15. Evolution of maternal effect senescence

    PubMed Central

    Moorad, Jacob A.; Nussey, Daniel H.

    2016-01-01

    Increased maternal age at reproduction is often associated with decreased offspring performance in numerous species of plants and animals (including humans). Current evolutionary theory considers such maternal effect senescence as part of a unified process of reproductive senescence, which is under identical age-specific selective pressures to fertility. We offer a novel theoretical perspective by combining William Hamilton’s evolutionary model for aging with a quantitative genetic model of indirect genetic effects. We demonstrate that fertility and maternal effect senescence are likely to experience different patterns of age-specific selection and thus can evolve to take divergent forms. Applied to neonatal survival, we find that selection for maternal effects is the product of age-specific fertility and Hamilton’s age-specific force of selection for fertility. Population genetic models show that senescence for these maternal effects can evolve in the absence of reproductive or actuarial senescence; this implies that maternal effect aging is a fundamentally distinct demographic manifestation of the evolution of aging. However, brief periods of increasingly beneficial maternal effects can evolve when fertility increases with age faster than cumulative survival declines. This is most likely to occur early in life. Our integration of theory provides a general framework with which to model, measure, and compare the evolutionary determinants of the social manifestations of aging. Extension of our maternal effects model to other ecological and social contexts could provide important insights into the drivers of the astonishing diversity of lifespans and aging patterns observed among species. PMID:26715745

  16. Evolution of maternal effect senescence.

    PubMed

    Moorad, Jacob A; Nussey, Daniel H

    2016-01-12

    Increased maternal age at reproduction is often associated with decreased offspring performance in numerous species of plants and animals (including humans). Current evolutionary theory considers such maternal effect senescence as part of a unified process of reproductive senescence, which is under identical age-specific selective pressures to fertility. We offer a novel theoretical perspective by combining William Hamilton's evolutionary model for aging with a quantitative genetic model of indirect genetic effects. We demonstrate that fertility and maternal effect senescence are likely to experience different patterns of age-specific selection and thus can evolve to take divergent forms. Applied to neonatal survival, we find that selection for maternal effects is the product of age-specific fertility and Hamilton's age-specific force of selection for fertility. Population genetic models show that senescence for these maternal effects can evolve in the absence of reproductive or actuarial senescence; this implies that maternal effect aging is a fundamentally distinct demographic manifestation of the evolution of aging. However, brief periods of increasingly beneficial maternal effects can evolve when fertility increases with age faster than cumulative survival declines. This is most likely to occur early in life. Our integration of theory provides a general framework with which to model, measure, and compare the evolutionary determinants of the social manifestations of aging. Extension of our maternal effects model to other ecological and social contexts could provide important insights into the drivers of the astonishing diversity of lifespans and aging patterns observed among species. PMID:26715745

  17. Midwifery workforce profile in Limpopo Province referral hospitals

    PubMed Central

    Ogunbanjo, Gboyega A.

    2014-01-01

    Background In sub-Saharan Africa including South Africa, maternal mortality rates remain unacceptably high due to a shortage of registered nurses with advanced midwifery diplomas. Objective To determine the profile of registered nurses (RNs) involved in maternity care in public referral hospitals of the Limpopo Province, South Africa. Method A cross-sectional descriptive study was conducted in all maternity units of Limpopo's public referral hospitals. The study population comprised of 210 registered nurses, who became the study sample. Data on their educational profile and work experience in midwifery was analysed using STATA version 9.0. Results The mean age of the 210 registered nurses was 44.5 ± 9.1 years (range 21 to 62). The majority (152/210; 70%) were 40 years and older, 56% (117/210) had been working for more than 10 years, and 63/210 (30%) were due to retire within 10 years. Only 22% (46/210) had advanced midwifery diplomas, i.e. after their basic undergraduate training. Only six (2.9%) of the RNs providing maternity care in these referral hospitals were studying for advanced midwifery diplomas at the time of the study. Conclusion This study demonstrated a shortage of registered nurses with advanced midwifery training/diplomas in referral hospitals of the Limpopo Province. This has a potentially negative effect in reducing the high maternal mortality rate in the province. PMID:26245396

  18. Maternal filicide in Turkey.

    PubMed

    Eke, Salih Murat; Basoglu, Saba; Bakar, Bulent; Oral, Gokhan

    2015-01-01

    Filicide occurs in every socioeconomic stratum around the world. This study was conducted to evaluate motives, psychopathological aspects, and socio-demographic factors of 74 filicide cases of women in Turkey. Mean age of mothers, most of whom committed infanticide, was 26 years, and breakdown of criminal offenses are as follows: "to get rid of unwanted babies" (24.3%), "acute psychotic-type filicide" (21.6%), "fatal child abuse and neglect" (17.6%), "to get revenge" (12.2%), "protect the lonely child from the harm and badness after suicide" (10.8%), and "pity" (9.5%) motives. Results showed that maternal filicide cannot be reduced to only mental instability or environmental factors and indicates deficiencies in the capacity of the mothers' role in connecting with their child and with parenting skills. Finally, with regard to defendants' motives, similar factors that contribute to committing maternal filicide should be considered while making an assessment of the data and determining employee risk groups. PMID:25066272

  19. Alpha 2 macroglobulin is a maternally-derived immune factor in amphioxus embryos: New evidence for defense roles of maternal immune components in invertebrate chordate.

    PubMed

    Pathirana, Anjalika; Diao, Mingyue; Huang, Shibo; Zuo, Lingling; Liang, Yujun

    2016-03-01

    In fish, a series of maternal derived immune components have been identified in their eggs or embryos at very early stages, which are proposed to provide protections to themselves against pathogenic attacks from hostile environment. The phenomenon of maternal immunity has been also recorded in several invertebrate species, however, so far, very limited information about the maternal immune molecules are available. In this study, it was demonstrated maternal alpha2 macroglobulin (A2m) protein, an important innate immune factor, exists in the fertilized eggs of amphioxus Branchiostoma japonicum, an invertebrate chordate. Maternal mRNA of A2m was also detected in amphioxus embryos at very early developing stages. In addition, it was recorded that the egg lysate prepared from the newly fertilized eggs can inhibit the growth of both Gram-negative bacterium Escherichia coli and Gram-positive bacterium Staphylococcus aureus in a concentration dependent manner. The bacteriostatic activity can be reduced notably after precipitated A2m with anti-A2m antibody. Thus maternal A2m is partly attributed to the bacteriostatic activity. It was further demonstrated that recombinant A2m can bind to E. coli cells directly. All these points come to a result that A2m is a maternal immune factor existing in eggs of invertebrate chordate, which may be involved in defense their embryos against harmful microbes' attacks. PMID:26796816

  20. Six years' experience of symphysiotomy in a teaching hospital.

    PubMed

    Norman, R J

    1978-12-30

    One hundred and sixty-one symphysiotomies were performed at Harari Maternity Hospital, Rhodesia, over a 6-year period. Indications for the operation are discussed and fetal and maternal results reviewed. Seventy-two patients suffered from postoperative complications but the majority of these were minor and of short duration. Multiparous patients did not have a higher morbidity than did primiparous ones. It is concluded that symphysiotomy has a useful role to play in a teaching hospital, provided it is performed by an experienced surgeon on carefully selected patients. PMID:746479

  1. Fetal growth and birth size is associated with maternal anthropometry and body composition.

    PubMed

    Thame, Minerva; Osmond, Clive; Trotman, Helen

    2015-10-01

    The objective was to investigate the association of maternal weight, height and body composition with fetal growth. We recruited 425 women at the University Hospital of the West Indies, Jamaica, who had singleton pregnancies, were less than 15 weeks gestation and had no systemic illness. Maternal weight, height and skinfold thicknesses were measured at the first antenatal visit and lean mass was calculated. Sonographic measurements of the fetus were made at 15, 25 and 35 weeks gestation. Weight, crown-heel length and head circumference were measured at birth. Analyses were confined to 360 (85%) women; 65 women did not complete the study. Maternal height was positively associated with femoral length at 25 and 35 weeks gestation and with head circumference at 35 weeks (all P < 0.02). Maternal weight was positively associated with abdominal circumference and femoral length at 25 weeks, and with larger head and abdominal circumference and longer femur at 35 weeks (all P < 0.02). Maternal lean mass had similar associations to maternal weight and they were both positively associated with estimated fetal weight (all P < 0.02). All three maternal measurements were positively associated with birthweight, length and head circumference. Maternal size was associated with fetal size as early as 25 weeks gestation, with height strongly associated with femoral length, and with weight and lean mass strongly associated with abdominal circumference. PMID:23241104

  2. [Treating mother and baby in conjoint hospitalization in a psychiatric hospital].

    PubMed

    Maizel, S; Fainstein, V; Katzenelson, S K

    1998-09-01

    Since 1990 we have been admitting mothers with postpartum psychiatric morbidity together with their babies to our open psychiatric ward. The aim of conjoint hospitalization is to maintain and develop the bond between mother and baby while treating the mother's psychiatric disorder. The presence of the infant in the hospital allows both a thorough evaluation of the mothers' maternal ability and to use the infant as a facilitator of the mothers' recovery by engaging maternal functions. It prevents the infants from being placed in a foster home for the duration of the mothers' hospitalization. Readily available in Britain and Australia, such conjoint hospitalization is controversial and rarely available elsewhere. In the past 5 years we hospitalized 10 women with 11 babies (1 woman was hospitalized twice, after different births). All women had received psychiatric treatment prior to childbirth, but this was the first psychiatric hospitalization for 2 of them. Diagnoses (DSM-IIIR) were chronic paranoid schizophrenia (4), affective disorder (4), schizo-affective schizophrenia (1) and borderline personality disorder (1). 8 were suffering from active psychotic symptoms on admission. They were treated pharmacologically, received individual and group psychotherapy, and participated in all ward activities. Families were engaged in marital, family and/or individual therapy according to need. All participated in cognitive-behavior treatment tailored to individual need to build and enrich the mother-infant bond. All improved significantly and were able to function independently on discharge, but in 1 case adoption was recommended. PMID:9885632

  3. [Laennec Hospital].

    PubMed

    Dauphin, A; Mazin-Deslandes, C

    2000-01-01

    When the Laennec Hospital of Paris closed, after 366 years of activities for the patients, the articles about the circumstances of the foundation and the main stapes of the institution which became an very famous university hospital it present the available information of the history of the apothecaries, of the "gagnants-maitrise", pharmacists and the pharmacy's interns who succeeded themselves to create and dispense the medicaments necessary to the patients hospitalized or welcomed in ambulatory. It describes the evolution of the places, of the material, of forms, of the organization, of the medicaments and of the missions of what became the Pharmacy department after the recent individualization of the biological analysis in the biochemistry. PMID:11625687

  4. Pain management policies and practices in pediatric emergency care: a nationwide survey of Italian hospitals

    PubMed Central

    2013-01-01

    Background Pain experienced by children in emergency departments (EDs) is often poorly assessed and treated. Although local protocols and strategies are important to ensure appropriate staff behaviours, few studies have focussed on pain management policies at hospital or department level. This study aimed at describing the policies and reported practices of pain assessment and treatment in a national sample of Italian pediatric EDs, and identifying the assocoated structural and organisational factors. Methods A structured questionnaire was mailed to all the 14 Italian pediatric and maternal and child hospitals and to 5 general hospitals with separate pediatric emergency room. There were no refusals. Information collected included the frequency and mode of pain assessment, presence of written pain management protocols, use of local anaesthetic (EMLA cream) before venipuncture, and role of parents. General data on the hospital and ED were also recorded. Multiple Correspondence Analysis was used to explore the multivariable associations between the characteristics of hospitals and EDs and their pain management policies and practices. Results Routine pain assessment both at triage and in the emergency room was carried out only by 26% of surveyed EDs. About one third did not use algometric scales, and almost half (47.4%) did not have local protocols for pain treatment. Only 3 routinely reassessed pain after treatment, and only 2 used EMLA. All EDs allowed parents’ presence and most (17, 89.9%) allowed them to stay when painful procedures were carried out. Eleven hospitals (57.9%) allowed parents to hold their child during blood sampling. Pediatric and maternal and child hospitals, those located in the North of Italy, equipped with medico-surgical-traumatological ED and short stay observation, and providing full assessment triage over 24 hours were more likely to report appropriate policies for pain management both at triage and in ER. A nurses to admissions ratio

  5. Lessons from history--maternal and infant mortality.

    PubMed

    1989-07-15

    Historical analysis of trends in infant and maternal mortality rates reveal different patterns and factors that influence them. Recent international and urban-rural differences in trends, associations with population density and the influence of parental social class and income has led to questioning the long accepted interpretation of the sharp decline of infant mortality in Britain (at the turn of the century) as due to such measures as pure water supplies, sewage disposal and pasteurization of milk. Several authors now believe that direct control of fertility influenced parity and birth spacing, with all other factors contributing to the decline in infant mortality. While the drop in infant mortality rates can be attributable to social and environmental influence, trends in maternal mortality differ considerably. Even though high maternal mortality has often been associated with areas of poverty, such a link has been indirect; the determining factor is the place of delivery, and the skill and care of the birth attendant. The decline in maternal mortality rates began by the mid-1930's and have been halved every 10 years since. National concerns due to high rates of maternal mortality led to different organizational solutions. The US adopted a specialist obstetrician/hospital-based delivery system; the Netherlands combined midwives with home delivery; New Zealand trained midwives but with delivery in hospitals, and Britain included specialized obstetricians with better training of midwives and general practitioners. All of these variations had no effect on mortality rates. The decline is attributed to the use of sulphonamids followed by penicillin and improvements in medical management. In a recent publication entitled "Working for Patients", mortality rates continue to remain the outcome measures to be used universally while infant mortality rates are considered crude and not amenable to health interventions. PMID:2567902

  6. Facility Death Review of Maternal and Neonatal Deaths in Bangladesh

    PubMed Central

    Biswas, Animesh; Rahman, Fazlur; Eriksson, Charli; Halim, Abdul; Dalal, Koustuv

    2015-01-01

    Objectives To explore the experiences, acceptance, and effects of conducting facility death review (FDR) of maternal and neonatal deaths and stillbirths at or below the district level in Bangladesh. Methods This was a qualitative study with healthcare providers involved in FDRs. Two districts were studied: Thakurgaon district (a pilot district) and Jamalpur district (randomly selected from three follow-on study districts). Data were collected between January and November 2011. Data were collected from focus group discussions, in-depth interviews, and document review. Hospital administrators, obstetrics and gynecology consultants, and pediatric consultants and nurses employed in the same departments of the respective facilities participated in the study. Content and thematic analyses were performed. Results FDR for maternal and neonatal deaths and stillbirths can be performed in upazila health complexes at sub-district and district hospital levels. Senior staff nurses took responsibility for notifying each death and conducting death reviews with the support of doctors. Doctors reviewed the FDRs to assign causes of death. Review meetings with doctors, nurses, and health managers at the upazila and district levels supported the preparation of remedial action plans based on FDR findings, and interventions were planned accordingly. There were excellent examples of improved quality of care at facilities as a result of FDR. FDR also identified gaps and challenges to overcome in the near future to improve maternal and newborn health. Discussion FDR of maternal and neonatal deaths is feasible in district and upazila health facilities. FDR not only identifies the medical causes of a maternal or neonatal death but also explores remediable gaps and challenges in the facility. FDR creates an enabled environment in the facility to explore medical causes of deaths, including the gaps and challenges that influence mortality. FDRs mobilize health managers at upazila and district

  7. Neurocysticercosis in pregnancy: maternal and fetal outcomes.

    PubMed

    D'Cruz, Rebecca F; Ng, Sher M; Dassan, Pooja

    2016-07-01

    Neurocysticercosis (NCC) is a parasitic infection with the larvae of Taenia solium from contaminated pork. It is a leading cause of seizures in the developing world. Symptoms may be secondary to live or degenerating cysts, or previous infection causing calcification or gliosis. Diagnosis is based on clinical presentation, radiological confirmation of intracranial lesions and immunological testing. Management involves symptom control with antiepileptics and antiparasitic agents. Few cases have been described of maternal NCC during pregnancy. We describe a 25-year-old female presenting to a London hospital with secondary generalized seizures. MRI of the brain confirmed a calcified lesion in the right parietal lobe, and she gave a corroborative history of NCC during her childhood in India. She was stabilized initially on antiepileptics, but during her pregnancy presented with breakthrough seizures and radiological evidence of NCC reactivation. She was managed symptomatically with antiepileptics and completed the pregnancy to term with no fetal complications. PMID:27471595

  8. Neurocysticercosis in pregnancy: maternal and fetal outcomes

    PubMed Central

    D'Cruz, Rebecca F.; Ng, Sher M.; Dassan, Pooja

    2016-01-01

    Neurocysticercosis (NCC) is a parasitic infection with the larvae of Taenia solium from contaminated pork. It is a leading cause of seizures in the developing world. Symptoms may be secondary to live or degenerating cysts, or previous infection causing calcification or gliosis. Diagnosis is based on clinical presentation, radiological confirmation of intracranial lesions and immunological testing. Management involves symptom control with antiepileptics and antiparasitic agents. Few cases have been described of maternal NCC during pregnancy. We describe a 25-year-old female presenting to a London hospital with secondary generalized seizures. MRI of the brain confirmed a calcified lesion in the right parietal lobe, and she gave a corroborative history of NCC during her childhood in India. She was stabilized initially on antiepileptics, but during her pregnancy presented with breakthrough seizures and radiological evidence of NCC reactivation. She was managed symptomatically with antiepileptics and completed the pregnancy to term with no fetal complications. PMID:27471595

  9. Economic consequences of maternal illness in rural Bangladesh.

    PubMed

    Powell-Jackson, Timothy; Hoque, Mohammad Enamul

    2012-07-01

    We use panel data on household consumption combined with information taken from the medical records of women who gave birth in health facilities to explore the economic consequences of maternal ill health, in the context of a rural population in Bangladesh. The findings suggest that there is a large reduction in household resources associated with maternal illness, driven almost entirely by spending on health care. In spite of this loss of resources, we find that households are able to fully insure consumption against maternal ill health, although confidence intervals are unable to rule out a small effect. Households in our study area are shown to have good access to informal credit (whether it be from local money lenders or family relatives), and this appears critical in helping to smooth consumption in response to these health shocks, at least in the short term. PMID:21557382

  10. The Impact of Maternal Obesity on Maternal and Fetal Health

    PubMed Central

    Leddy, Meaghan A; Power, Michael L; Schulkin, Jay

    2008-01-01

    The increasing rate of maternal obesity provides a major challenge to obstetric practice. Maternal obesity can result in negative outcomes for both women and fetuses. The maternal risks during pregnancy include gestational diabetes and preeclampsia. The fetus is at risk for stillbirth and congenital anomalies. Obesity in pregnancy can also affect health later in life for both mother and child. For women, these risks include heart disease and hypertension. Children have a risk of future obesity and heart disease. Women and their offspring are at increased risk for diabetes. Obstetrician-gynecologists are well positioned to prevent and treat this epidemic. PMID:19173021

  11. Second trimester abortion as a cause of maternal death: a case report

    PubMed Central

    Avcioglu, Sümeyra Nergiz; Altinkaya, Sündüz Özlem; Küçük, Mert; Zafer, Emre; Sezer, Selda Demircan; Yüksel, Hasan

    2015-01-01

    Each year, an estimated 529 000 maternal deaths occur worldwide. In literature, it is known that maternal mortality can occur during pregnancy, peripartum and also in postpartum period. Although very rare, maternal deaths may occur after spontaneous abortion. In present case, 37 year old G5P4 (Caesarean Section) women was admitted to Adnan Menderes University, Obstetrics and Gynecology clinic with diagnosis of missed abortion at 18 weeks’ gestation. She had been hospitalized in the public maternity hospital for five days due to abortus incipience and prolapse of amnion membranes but had no contractions. Fetal heart beats ceased at the second day of hospitalization. Medically induced abortion was recommended but not accepted by the patient. At the fifth day of hospitalization, she was referred to our clinic due to deterioration of general health condition, low blood pressure and tachycardia. In emergency department, it was determined that she was not oriented, had confusion, had blood pressure of 49/25 mmHg and tachycardia. In ultrasonographic examination, 18 week in utero ex fetus was determined and there was free fluid in abdominopelvic cavity. The free fluid was suspected to be amniotic fluid due to rupture of uterus. Laparotomy was performed, no uterine rupture, hematoma or atony was observed. However during laparotomy, a very bad smelling odor, might be due to septicemia, was felt in the operation room. Cardiac arrest occurred during that operation. In autopsy report, it was concluded that maternal death was because of remaining of inutero ex fetus for a long time. In conclusion, although very rare, maternal deaths after spontaneous abortion may occur. Because spontaneous abortion is a common outcome of pregnancy, continued careful, strict monitoring and immediate treatment of especially second trimester spontaneous abortion is recommended to prevent related, disappointing, unexpected maternal deaths. PMID:26958124

  12. Suicidal behavior-related hospitalizations among pregnant women in the USA, 2006-2012.

    PubMed

    Zhong, Qiu-Yue; Gelaye, Bizu; Miller, Matthew; Fricchione, Gregory L; Cai, Tianxi; Johnson, Paula A; Henderson, David C; Williams, Michelle A

    2016-06-01

    Suicide is one of the leading causes of maternal mortality in many countries, but little is known about the epidemiology of suicide and suicidal behavior among pregnant women in the USA. We sought to examine trends and provide nationally representative estimates for suicidal behavior (including suicidal ideation and suicide and self-inflicted injury) among pregnant women from 2006 to 2012 in the USA. Pregnant women aged 12-55 years were identified through pregnancy- and delivery-related hospitalization records from the National (Nationwide) Inpatient Sample. Suicidal behavior was identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Annual, nationwide estimates and trends were determined using discharge and hospital weights. The prevalence of suicidal ideation more than doubled from 2006 to 2012 (47.5 to 115.0 per 100,000 pregnancy- and delivery-related hospitalizations), whereas the prevalence of suicide and self-inflicted injury remained stable. Nearly 10 % of suicidal behavior occurred in the 12-18-year group, showing the highest prevalence per 100,000 pregnancy- and delivery-related hospitalizations (158.8 in 2006 and 308.7 in 2012) over the study period. For suicidal ideation, blacks had higher prevalence than whites; women in the lowest income quartile had the highest prevalence. Although the prevalence of suicidal behavior was higher among hospitalizations with depression diagnoses, more than 30 % of hospitalizations were for suicidal behavior without depression diagnoses. Our findings highlight the increasing burden and racial differences in suicidal ideation among US pregnant women. Targeted suicide prevention efforts are needed for high-risk pregnant women including teens, blacks, and low-income women. PMID:26680447

  13. Maternal outcomes among pregnant women receiving live attenuated influenza vaccine

    PubMed Central

    Toback, Seth L.; Beigi, Richard; Tennis, Patricia; Sifakis, Frangiscos; Calingaert, Brian; Ambrose, Christopher S.

    2011-01-01

    Please cite this paper as: Toback et al. (2012) Maternal outcomes among pregnant women receiving live attenuated influenza accine. Influenza and Other Respiratory Viruses 6(1), 44–51. Background  Although the live attenuated influenza vaccine (LAIV) prescribing information contains warnings/precautions against use during pregnancy, administration of LAIV to pregnant women does occur. Data regarding maternal outcomes after LAIV administration during pregnancy are limited. Objectives  Maternal outcomes after LAIV vaccination during pregnancy were examined. Methods  Data from a health insurance claims database that covers approximately 50 million individuals were analyzed for the six influenza seasons from 2003–2004 through 2008–2009. Emergency department (ED) visits and hospitalizations occurring within 42 days of vaccination were analyzed by primary diagnosis; outcomes were categorized as cardiopulmonary, obstetric, and other. Cohort characteristics were analyzed using descriptive statistics. Results  Of 834 999 pregnancies identified, 138 (0·017%) were among women who received LAIV vaccinations. Of the 138 pregnant women, 13% were ≤19 years, 67% were 20–34 years, and 20% were ≥35 years of age. Eight events occurred within 42 days of vaccination: one ED visit for bronchitis, two hospitalizations for hyperemesis gravidarum and premature labor, and five ED visits/hospitalizations for common medical conditions. All outcomes identified after LAIV exposure occurred at rates similar to rates in unvaccinated pregnant women reported in the medical literature. Conclusions  Administration of LAIV to pregnant women is rare; the rate has remained constant since 2004–2005. In this cohort, there was no evidence of significant maternal adverse outcomes after receipt of LAIV. These data may offer some reassurance to providers and pregnant women in the event of inadvertent LAIV administration, but do not support the routine use of LAIV in

  14. Maternal Phenylketonuria (MPKU)

    PubMed Central

    Schoonheyt, W.E.; Hanley, W.B.; Clarke, J.T.R.; Austin, V.; Howe, D.A.

    1986-01-01

    Untreated maternal phenylketonuria (MPKU) is a major cause of microcephaly, congenital heart disease, intrauterine growth retardation and mental retardation in the offspring of mothers who have the disease. There is evidence, however, that dietary restriction of phenylalanine in the mother before conception and throughout the pregnancy will reduce the risk of these congenital anomalies in the fetus. It is important to be alert to this preventable cause of developmental retardation and congenital abnormalities in all pregnancies until the stage is reached where every woman of child-bearing age has been through the neonatal PKU-screening program. Family physicians are advised to consider prenatal or premarital screening for PKU of all female patients of child-bearing age for the next generation. PMID:21267327

  15. Eclampsia-scenario in a hospital--a ten years study.

    PubMed

    Pal, A; Bhattacharyya, R; Adhikari, S; Roy, A; Chakrabarty, D; Ghosh, P; Banerjee, C

    2011-08-01

    This cross sectional record based institutional study was conducted in the Department of Obstetrics & Gynaecology, Burdwan Medical College, Burdwan over ten years (1999-2008) aiming analysis of eclamptic mothers for evaluation of maternal and perinatal outcome with different anticonvulsant medications. Total 5991 pregnant mothers with eclampsia admitted in the inpatient department of the tertiary care teaching hospital were recruited for the study, irrespective of their previous antenatal check up history. Subjects with known seizure disorders were excluded from the study. The subjects were managed according to standard regimens (Menon, Ph-sodium, diazepam & magnesium sulphate) and results were documented in standardised format. Case fatality rate, mean induction delivery time & birth-weight, perinatal mortality rates were recorded. Study reveals that the incidence of eclampsia <20 years was 6.97% and majority (5.41%) came from rural areas. Eclampsia was noted primarily in primigravida (7.43%) and unbooked (6.41%) mothers. Ante partum eclampsia predominated (64%) and incidence of caesarean section was 22.25%.The overall case fatality rate was 6.05% and eclampsia contributed 27.85% of all maternal deaths during the last two years of the study period. The overall incidence of low birth weight baby was 26.96% and perinatal mortality was 30.33% (1411/4651).The incidence of perinatal mortality and low birth weight babies are lower in the last 4 years when compared to earlier studies. Proper socio-demographic assessment of pregnancy with eclampsia, planned delivery, shorter induction delivery interval, good control of convulsion by magnesium sulphate, intensive intranatal monitoring causes less maternal and perinatal morbidity and mortality. PMID:21877608

  16. Neuroendocrine Regulation of Maternal Behavior

    PubMed Central

    Bridges, Robert S.

    2015-01-01

    The expression of maternal behavior in mammals is regulated by the developmental and experiential events over a female’s lifetime. In this review the relationships between the endocrine and neural systems that play key roles in these developmental and experiential that affect both the establishment and maintenance of maternal care are presented. The involvement of the hormones estrogen, progesterone, and lactogens are discussed in the context of ligand, receptor, and gene activity in rodents and to a lesser extent in higher mammals. The roles of neuroendocrine factors, including oxytocin, vasopressin, classical neurotransmitters, and other neural gene products that regulate aspects of maternal care are set forth, and the interactions of hormones with central nervous system mediators of maternal behavior are discussed. The impact of prior developmental factors, including epigenetic events, and maternal experience on subsequent maternal care are assessed over the course of the female’s lifespan. It is proposed that common neuroendocrine mechanisms underlie the regulation of maternal care in mammals. PMID:25500107

  17. Maternal Mortality in Rural South Ethiopia: Outcomes of Community-Based Birth Registration by Health Extension Workers

    PubMed Central

    Yaya, Yaliso; Data, Tadesse; Lindtjørn, Bernt

    2015-01-01

    Introduction Rural communities in low-income countries lack vital registrations to track birth outcomes. We aimed to examine the feasibility of community-based birth registration and measure maternal mortality ratio (MMR) in rural south Ethiopia. Methods In 2010, health extension workers (HEWs) registered births and maternal deaths among 421,639 people in three districts (Derashe, Bonke, and Arba Minch Zuria). One nurse-supervisor per district provided administrative and technical support to HEWs. The primary outcomes were the feasibility of registration of a high proportion of births and measuring MMR. The secondary outcome was the proportion of skilled birth attendance. We validated the completeness of the registry and the MMR by conducting a house-to-house survey in 15 randomly selected villages in Bonke. Results We registered 10,987 births (81·4% of expected 13,492 births) with annual crude birth rate of 32 per 1,000 population. The validation study showed that, of 2,401 births occurred in the surveyed households within eight months of the initiation of the registry, 71·6% (1,718) were registered with similar MMRs (474 vs. 439) between the registered and unregistered births. Overall, we recorded 53 maternal deaths; MMR was 489 per 100,000 live births and 83% (44 of 53 maternal deaths) occurred at home. Ninety percent (9,863 births) were at home, 4% (430) at health posts, 2·5% (282) at health centres, and 3·5% (412) in hospitals. MMR increased if: the male partners were illiterate (609 vs. 346; p= 0·051) and the villages had no road access (946 vs. 410; p= 0·039). The validation helped to increase the registration coverage by 10% through feedback discussions. Conclusion It is possible to obtain a high-coverage birth registration and measure MMR in rural communities where a functional system of community health workers exists. The MMR was high in rural south Ethiopia and most births and maternal deaths occurred at home. PMID:25799229

  18. Maternal Responsive-Didactic Caregiving in Play Interactions with 10-Month-Olds and Cognitive Development at 18 Months

    ERIC Educational Resources Information Center

    Mermelshtine, Roni; Barnes, Jacqueline

    2016-01-01

    Maternal responsive-didactic caregiving (RDC) and infant advanced object play were investigated in a sample of 400 mothers and their 10-month-old infants during video-recorded semi-structured play interactions. Three maternal behaviours: contingent response, cognitively stimulating language and autonomy-promoting speech were coded and infant…

  19. Academic Hospitality

    ERIC Educational Resources Information Center

    Phipps, Alison; Barnett, Ronald

    2007-01-01

    Academic hospitality is a feature of academic life. It takes many forms. It takes material form in the hosting of academics giving papers. It takes epistemological form in the welcome of new ideas. It takes linguistic form in the translation of academic work into other languages, and it takes touristic form through the welcome and generosity with…

  20. Hospitality Management.

    ERIC Educational Resources Information Center

    College of the Canyons, Valencia, CA.

    A project was conducted at College of the Canyons (Valencia, California) to initiate a new 2-year hospitality program with career options in hotel or restaurant management. A mail and telephone survey of area employers in the restaurant and hotel field demonstrated a need for, interest in, and willingness to provide internships for such a program.…

  1. Maternal mortality in rural Gambia: levels, causes and contributing factors.

    PubMed Central

    Walraven, G.; Telfer, M.; Rowley, J.; Ronsmans, C.

    2000-01-01

    A demographic study carried out in a rural area of the Gambia between January 1993 and December 1998 recorded 74 deaths among women aged 15-49 years. Reported here is an estimation of maternal mortality among these 74 deaths based on a survey of reproductive age mortality, which identified 18 maternal deaths by verbal autopsy. Over the same period there were 4245 live births in the study area, giving a maternal mortality ratio of 424 per 100,000 live births. This maternal mortality estimate is substantially lower than estimates made in the 1980s, which ranged from 1005 to 2362 per 100,000 live births, in the same area. A total of 9 of the 18 deaths had a direct obstetric cause--haemorrhage (6 deaths), early pregnancy (2), and obstructed labour (1). Indirect causes of obstetric deaths were anaemia (4 deaths), hepatitis (1), and undetermined (4). Low standards of health care for obstetric referrals, failure to recognize the severity of the problem at the community level, delays in starting the decision-making process to seek health care, lack of transport, and substandard primary health care were identified more than once as probable or possible contributing factors to these maternal deaths. PMID:10859854

  2. Maternal and Child Health in Mongolia at 3 Years After Childbirth: A Population-Based Cross-Sectional Descriptive Study.

    PubMed

    Takehara, Kenji; Dagvadorj, Amarjargal; Hikita, Naoko; Sumya, Narantuya; Ganhuyag, Solongo; Bavuusuren, Bayasgalantai; Ota, Erika; Haruna, Megumi; Yoshida, Mikako; Kita, Sachiko; Noma, Hisashi; Mori, Rintaro

    2016-05-01

    Objectives In recent years Mongolia has made great advances towards Millennium Development Goals to reduce maternal and child mortality, however few studies have investigated maternal and child health status several years after childbirth. Our study aims to describe priority health issues in maternal and child health in Mongolia 3 years after childbirth, and key areas requiring further health policy development. Methods We conducted a population-based cross-sectional study in Bulgan province, Mongolia. Participants were women who gave birth in 2010 and lived in Bulgan in 2013, and their children who were almost 3 years of age. Data was collected using structured interviews, self-administered questionnaires, transcribed records from the Maternal and Child Health Handbook, anthropometric measurements, and a developmental assessment tool. Results Data was obtained from 1,019 women and 1,013 children (recovery rate: 94.1 %). Among women, 171 (17.2 %) were obese and had an average body mass index (BMI) of 25.7, 40 (4.4 %) experienced intimate partner violence (IPV) and 356 (36.2 %) reported urinary incontinence in the past month. Among children, 110 (10.8 %) were assessed as at risk of developmental delay, 131 (13.1 %) were overweight or obese, burns accounted for the highest number of serious accidents at 173 (17.0 %) while lower respiratory tract infections (LRTIs) were the most frequent cause of pediatric hospitalization. Conclusions for Practice Further development in health policy is required in Mongolia to target the significant health challenges of obesity, IPV, and urinary incontinence in women, and obesity, development delay, burns, and LRTIs in children. PMID:26676976

  3. The Maternal and Newborn Health Registry Study of the Global Network for Women’s and Children’s Health Research

    PubMed Central

    Goudar, Shivaprasad S.; Carlo, Waldemar A.; McClure, Elizabeth M.; Pasha, Omrana; Patel, Archana; Esamai, Fabian; Chomba, Elwyn; Garces, Ana; Althabe, Fernando; Kodkany, Bhalachandra; Sami, Neelofar; Derman, Richard J.; Hibberd, Patricia L.; Liechty, Edward A.; Krebs, Nancy F.; Hambidge, K. Michael; Buekens, Pierre; Moore, Janet; Wallace, Dennis; Jobe, Alan H.; Koso-Thomas, Marion; Wright, Linda L.; Goldenberg, Robert L.

    2012-01-01

    Objective To implement a vital statistics registry system to register pregnant women and document birth outcomes in the Global Network for Women’s and Children’s Health Research sites in Asia, Africa, and Latin America. Methods The Global Network sites began a prospective population-based pregnancy registry to identify all pregnant women and record pregnancy outcomes up to 42 days post-delivery in more than 100 defined low-resource geographic areas (clusters). Pregnant women were registered during pregnancy, with 42-day maternal and neonatal follow-up recorded—including care received during the pregnancy and postpartum periods. Recorded outcomes included stillbirth, neonatal mortality, and maternal mortality rates. Results In 2010, 72 848 pregnant women were enrolled and 6-week follow-up was obtained for 97.8%. Across sites, 40.7%, 24.8%, and 34.5% of births occurred in a hospital, health center, and home setting, respectively. The mean neonatal mortality rate was 23 per 1000 live births, ranging from 8.2 to 48.5 per 1000 live births. The mean stillbirth rate ranged from 13.7 to 54.4 per 1000 births. Conclusion The registry is an ongoing study to assess the impact of interventions and trends regarding pregnancy outcomes and measures of care to inform public health. PMID:22738806

  4. Birthweight outcomes in Bolivia: the role of maternal height, ethnicity, and behavior.

    PubMed

    Delajara, Marcelo; Wendelspiess Chávez Juárez, Florian

    2013-01-01

    We identify maternal behavioral factors associated with birthweight in Bolivia using data from the Demographic and Health Survey (DHS) of 2003. We estimate birthweight as a function of maternal behavior and the child's sex and gestational age. We control for maternal height, ethnicity, education, and wealth, and for differences observed across Bolivian regions in educational and health outcomes, demographic indicators, and altitude. We find that maternal age, fertility record, and birth spacing behavior are the main observable behavioral factors associated with birthweight, and that maternal height is associated with gestational age, a main determinant of birthweight. We also find that after controlling for gestational age, both ethnicity and altitude have an insignificant effect on birthweight. PMID:22560303

  5. Neonatal records and the computer.

    PubMed Central

    Walker, C H

    1977-01-01

    To use a combined single document clinical case sheet/computer record which can form the basic document for a life medical record is a practical proposition. With adequate briefing doctors and nurses soon become familiar with the record and appreciate its value. Secretarial and clerical requirements are reduced to a minimum as transcription of medical data is eliminated, so greatly speeding up processing and feed back to the medical services. A few illustrations of trends in neonatal statistics and of computer linked maternal/neonatal data are presented. PMID:879830

  6. Maternal care in the soft tick Antricola marginatus.

    PubMed

    Labruna, M B; Nava, S; Guzmán-Cornejo, C; Venzal, J M

    2012-08-01

    Among spiders, scorpions, and whip spiders, a common type of maternal care consists of females carrying newly hatched offspring on their body for a few days until they are able to live independently. While this maternal care has been suggested to occur in different argasid tick species, it has been recorded only once, for Antricola marginatus in Cuba; however, this earlier record only superficially mentioned the occurrence of this behavior, with no further details. Here we report the occurrence of maternal care in the argasid tick A. marginatus under natural conditions in a cave at Yucatan, Mexico, where 8 A. marginatus females, while walking on bat guano, had their body entirely covered by a mean number of 305 ± 112 conspecific unfed larvae (range: 105-466). Larvae covered the entire idiosoma of the female tick, where they were motionless or displayed just slight movement. This result substantially expands the number of unique characters that have been found only in Antricola spp. ticks, when compared to the other tick genera. Our findings also indicate that maternal care evolved independently in different taxa of Arachnida, since it has been reported for species of Araneae, Scorpiones, and Amblypygi, and here for an Acari species. PMID:22300344

  7. Maternal Blood Lipid Profile during Pregnancy and Associations with Child Adiposity: Findings from the ROLO Study

    PubMed Central

    Geraghty, Aisling A.; Alberdi, Goiuri; O’Sullivan, Elizabeth J.; O’Brien, Eileen C.; Crosbie, Brenda; Twomey, Patrick J.; McAuliffe, Fionnuala M.

    2016-01-01

    Background The in-utero environment affects fetal development; it is vital to understand how maternal diet during pregnancy influences childhood body composition. While research indicates that triglycerides in hyperglycaemic women may increase birth weight, little is known about this relationship in euglycemic women. This study examines the relationship between maternal blood lipid status and infant adiposity up to 2 years of age. Methods Data from 331 mother-child pairs from the ROLO longitudinal birth cohort study was analysed. Maternal dietary intakes were recorded and fasting blood lipids, leptin and HOMA were measured in early and late pregnancy and cord blood. Infant anthropometric measurements and skin-fold thicknesses were recorded at birth, 6 months and 2 years. Correlation and regression analyses were used to explore associations between maternal blood lipid status and infant adiposity. Results All maternal blood lipids increased significantly during pregnancy. Maternal dietary fat intake was positively associated with total cholesterol levels in early pregnancy. Late pregnancy triglycerides were positively associated with birth weight (P = 0.03) while cord blood triglycerides were negatively associated with birth weight (P = 0.01). Cord HDL-C was negatively associated with infant weight at 6 months (P = 0.005). No other maternal blood lipids were associated with infant weight or adiposity up to 2 years of age. Conclusion Maternal and fetal triglycerides were associated with birth weight and cord HDL-C with weight at 6 months. Thus, maternal lipid concentrations may exert in-utero influences on infant body composition. There may be potential to modulate infant body composition through alteration of maternal diet during pregnancy. PMID:27560495

  8. Suboptimal care and maternal mortality among foreign-born women in Sweden: maternal death audit with application of the ‘migration three delays’ model

    PubMed Central

    2014-01-01

    Background Several European countries report differences in risk of maternal mortality between immigrants from low- and middle-income countries and host country women. The present study identified suboptimal factors related to care-seeking, accessibility, and quality of care for maternal deaths that occurred in Sweden from 1988–2010. Methods A subset of maternal death records (n = 75) among foreign-born women from low- and middle-income countries and Swedish-born women were audited using structured implicit review. One case of foreign-born maternal death was matched with two native born Swedish cases of maternal death. An assessment protocol was developed that applied both the ‘migration three delays’ framework and a modified version of the Confidential Enquiry from the United Kingdom. The main outcomes were major and minor suboptimal factors associated with maternal death in this high-income, low-maternal mortality context. Results Major and minor suboptimal factors were associated with a majority of maternal deaths and significantly more often to foreign-born women (p = 0.01). The main delays to care-seeking were non-compliance among foreign-born women and communication barriers, such as incongruent language and suboptimal interpreter system or usage. Inadequate care occurred more often among the foreign-born (p = 0.04), whereas delays in consultation/referral and miscommunication between health care providers where equally common between the two groups. Conclusions Suboptimal care factors, major and minor, were present in more than 2/3 of maternal deaths in this high-income setting. Those related to migration were associated to miscommunication, lack of professional interpreters, and limited knowledge about rare diseases and pregnancy complications. Increased insight into a migration perspective is advocated for maternity clinicians who provide care to foreign-born women. PMID:24725307

  9. Oxytocin and Maternal Brain Plasticity.

    PubMed

    Kim, Sohye; Strathearn, Lane

    2016-09-01

    Although dramatic postnatal changes in maternal behavior have long been noted, we are only now beginning to understand the neurobiological mechanisms that support this transition. The present paper synthesizes growing insights from both animal and human research to provide an overview of the plasticity of the mother's brain, with a particular emphasis on the oxytocin system. We examine plasticity observed within the oxytocin system and discuss how these changes mediate an array of other adaptations observed within the maternal brain. We outline factors that affect the oxytocin-mediated plasticity of the maternal brain and review evidence linking disruptions in oxytocin functions to challenges in maternal adaptation. We conclude by suggesting a strategy for intervention with mothers who may be at risk for maladjustment during this transition to motherhood, while highlighting areas where further research is needed. PMID:27589498

  10. Partnership Transitions and Maternal Parenting

    PubMed Central

    Beck, Audrey N.; Cooper, Carey E.; McLanahan, Sara; Brooks-Gunn, Jeanne

    2011-01-01

    We use data from the Fragile Families and Child Wellbeing Study (N = 1,975) to examine the association between mothers’ partnership changes and parenting behavior during the first five years of their children’s lives. We compare coresidential with dating transitions, and recent with more distal transitions. We also examine interactions between transitions and race/ethnicity, maternal education and family structure at birth. Findings indicate that both coresidential and dating transitions were associated with higher levels of maternal stress and harsh parenting; recent transitions had stronger associations than distal transitions. Maternal education significantly moderates these associations, with less educated mothers responding more negatively to instability in terms of maternal stress, and more educated mothers responding more negatively in terms of literacy activities. PMID:21423848

  11. Maternal Competence, Expectation, and Involvement

    ERIC Educational Resources Information Center

    Heath, Douglas H.

    1977-01-01

    Presents a study of maternal competence, expectations and involvement in child rearing decisions in relation to paternal personality and marital characteristics. Subjects were 45 thirty-year-old mothers. (BD)

  12. Maternal Care Determinant of Longevity?

    PubMed

    Giorgio, Marco; Renzi, Chiara; Oliveri, Serena; Pravettoni, Gabriella

    2016-04-01

    Maternal care is an essential early environment in mammals that ensures emotional regulation and adaptive fitness of progeny. Longevity and healthy aging are associated with favorable environmental factors including fitting social and behavioral features. In the present review, we discuss the findings that link rearing conditions and early maternal care with life span and aging from an evolutionary, psychological, and molecular perspective. The quality of maternal care may influence internal adaptation through a variety of parallel mechanisms including emotional regulation, stress sensitivity, coping and other behavioral strategies in response to events requiring adaptation. From a biological perspective, it regulates physiological pathways that may persist in adulthood through epigenetic mechanisms, influencing disease susceptibility and, potentially, longevity. Abnormal maternal care induces maladaptation that persists over the life span, may accelerate the onset of aging associated diseases, and shorten life span. This may have important implications in the development of preventive approaches and early interventions. PMID:27548096

  13. Client satisfaction of maternity care in Lorestan province Iran

    PubMed Central

    Changee, Farahnaz; Irajpour, Alireza; Simbar, Masoumeh; Akbari, Soheila

    2015-01-01

    Background: Client satisfaction is an important indicator for assessment of the quality of care provided. Detecting patients dissatisfaction and trying to find the most effective and costly services is the basic way for improvement of service quality. The purpose of this study was to determine the satisfaction level of women in the maternity care centers (hospitals) of Lorestan University of Medical Sciences, Iran. Materials and Methods: In this descriptive cross-sectional study, the satisfaction level of 200 patients who received care during childbirth in province hospitals was assessed using a researcher-made questionnaire. Women in maternity care units completed the questionnaires. Results: The mean maternity care satisfaction score was 66.6 ± 3.5. The lowest satisfaction level was related to getting to know the delivery room (64%) and vaginal examination (66%). The highest satisfaction score was related to confidentiality of the information (86%) and trusting the midwife (84%). Regarding the environmental factors, the lowest satisfaction was related to respecting silence in the pain room (69.5%) and the highest was related to cleanliness and hygiene of the delivery room (84%). Conclusions: Our results suggest the relative satisfaction of women receiving care in the health centers of Lorestan province; but this level of satisfaction does not mean that the delivery of care in this province is perfect. By reviewing the policies and the existing care programs regarding promoting the quality of services, managers can increase clients’ satisfaction. PMID:26120342

  14. Neurotensin inversely modulates maternal aggression.

    PubMed

    Gammie, S C; D'Anna, K L; Gerstein, H; Stevenson, S A

    2009-02-18

    Neurotensin (NT) is a versatile neuropeptide involved in analgesia, hypothermia, and schizophrenia. Although NT is released from and acts upon brain regions involved in social behaviors, it has not been linked to a social behavior. We previously selected mice for high maternal aggression (maternal defense), an important social behavior that protects offspring, and found significantly lower NT expression in the CNS of highly protective females. Our current study directly tested NT's role in maternal defense. Intracerebroventricular (i.c.v.) injections of NT significantly impaired defense in terms of time aggressive and number of attacks at all doses tested (0.05, 0.1, 1.0, and 3.0 microg). Other maternal behaviors, including pup retrieval, were unaltered following NT injections (0.05 microg) relative to vehicle, suggesting specificity of NT action on defense. Further, i.c.v. injections of the NT receptor 1 (NT1) antagonist, SR 48692 (30 microg), significantly elevated maternal aggression in terms of time aggressive and attack number. To understand where NT may regulate aggression, we examined Fos following injection of either 0.1 microg NT or vehicle. Thirteen of 26 brain regions examined exhibited significant Fos increases with NT, including regions expressing NT1 and previously implicated in maternal aggression, such as lateral septum, bed nucleus of stria terminalis, paraventricular nucleus, and central amygdala. Together, our results indicate that NT inversely regulates maternal aggression and provide the first direct evidence that lowering of NT signaling can be a mechanism for maternal aggression. To our knowledge, this is the first study to directly link NT to a social behavior. PMID:19118604

  15. GENETIC EVALUATION OF STILLBIRTH IN UNITED STATES HOLSTEINS USING A SIRE-MATERNAL GRANDSIRE THRESHOLD MODEL

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A sire-maternal grandsire threshold model was used for genetic evaluation of stillbirth in U.S. Holsteins. Calving ease and stillbirth records for herds reporting at least 10 dead calves were extracted from the AIPL database. About half of the 14 million calving ease records in the database have a k...

  16. The assessment of combined first trimester screening in women of advanced maternal age in an Asian cohort

    PubMed Central

    Li, Sarah Weiling; Barrett, Angela Natalie; Gole, Leena; Tan, Wei Ching; Biswas, Arijit; Tan, Hak Koon; Choolani, Mahesh

    2015-01-01

    INTRODUCTION First trimester screening (FTS) is a validated screening tool that has been shown to achieve detection rates of 84%–90% for trisomies 21, 18 and 13. However, its effectiveness for different maternal ages has not been assessed. The present study aimed to assess the performance of FTS in an Asian population, and to compare its effectiveness in older (≥ 35 years) and younger (< 35 years) women. The potential use of noninvasive prenatal test (NIPT) as a contingent screening test is also examined. METHODS Data on cases of FTS performed on singleton pregnancies over a six-year period was collated from two Singapore maternal centres, National University Hospital and Singapore General Hospital. Cases that had a 1:250 risk of trisomy were considered to be screen-positive. Pregnancy outcomes were obtained from birth records or karyotype test results. RESULTS From 10,289 FTS cases, we obtained a sensitivity of 87.8%, a specificity of 97.6%, a false positive rate of 2.4% and a false negative rate of 0.06% for the detection of aneuploidy. The overall detection rate for trisomy 21 was 86.5%–85.7% for older women and 87.5% for younger women. The mean number of invasive tests required per case of trisomy 21 was 9.3 in younger women, 8.6 in older women and 13.5 in women with intermediate risk (1:250–1,000). CONCLUSION While the performance of FTS was similar in younger and older women, more invasive procedures were required to diagnose trisomy 21 in women with intermediate risk. It may be advantageous to offer contingent NIPT to this group of women to reduce the risk of iatrogenic fetal loss. PMID:25640099

  17. Elevated maternal serum folate in the third trimester and reduced fetal growth: a longitudinal study.

    PubMed

    Takimoto, Hidemi; Hayashi, Fumi; Kusama, Kaoru; Kato, Noriko; Yoshiike, Nobuo; Toba, Mikayo; Ishibashi, Tomoko; Miyasaka, Naoyuki; Kubota, Toshiro

    2011-01-01

    This study aimed to examine the association of fetal growth and elevated third trimester maternal serum folate due to folic acid (FA) supplement intake. Dietary intake, use of FA supplements, weight, and blood biomarkers of B-vitamins (serum folate, pyridoxal, vitamin B(12), and plasma total homocysteine) were observed in 33 healthy pregnant women at the third trimester (average gestational age 35 wk). Birth outcomes were assessed through hospital birth records. Infant anthropometry and maternal blood biomarkers were followed up at 1 mo postpartum. Fourteen women were taking FA supplements at the third trimester. Dietary intake was similar among FA users and non-users, but serum folate and pyridoxal were significantly higher in users (11.6±6.7 vs. 6.1±3.2 ng/mL, and 13.8±21.7 vs. 3.2±1.4 ng/mL, respectively). Plasma total homocystein (tHcy) was higher in non-users compared to users, but not significantly. Nine FA users and eight non-users had low serum vitamin B(12) values (<203 pg/mL). Nine FA users and all non-users had low serum pyridoxal values (<7.0 ng/mL). Infant birthweight was significantly lower in users compared to non-users (2,894±318 vs. 3,154±230 g). At 1 mo postpartum, infant weight and length were similar between FA users and non-users, but infant weight gain was larger in users. Higher serum folate values due to FA use in the third trimester was related to reduced fetal size. Excess FA under low vitamin B(6) and B(12) status may affect fetal growth. PMID:21697631

  18. Stochastic optimization for the detection of changes in maternal heart rate kinetics during pregnancy

    NASA Astrophysics Data System (ADS)

    Zakynthinaki, M. S.; Barakat, R. O.; Cordente Martínez, C. A.; Sampedro Molinuevo, J.

    2011-03-01

    The stochastic optimization method ALOPEX IV has been successfully applied to the problem of detecting possible changes in the maternal heart rate kinetics during pregnancy. For this reason, maternal heart rate data were recorded before, during and after gestation, during sessions of exercises of constant mild intensity; ALOPEX IV stochastic optimization was used to calculate the parameter values that optimally fit a dynamical systems model to the experimental data. The results not only demonstrate the effectiveness of ALOPEX IV stochastic optimization, but also have important implications in the area of exercise physiology, as they reveal important changes in the maternal cardiovascular dynamics, as a result of pregnancy.

  19. Causes of maternal mortality decline in Matlab, Bangladesh.

    PubMed

    Chowdhury, Mahbub Elahi; Ahmed, Anisuddin; Kalim, Nahid; Koblinsky, Marge

    2009-04-01

    Bangladesh is distinct among developing countries in achieving a low maternal mortality ratio (MMR) of 322 per 100,000 livebirths despite the very low use of skilled care at delivery (13% nationally). This variation has also been observed in Matlab, a rural area in Bangladesh, where longitudinal data on maternal mortality are available since the mid-1970s. The current study investigated the possible causes of the maternal mortality decline in Matlab. The study analyzed 769 maternal deaths and 215,779 pregnancy records from the Health and Demographic Surveillance System (HDSS) and other sources of safe motherhood data in the ICDDR,B and government service areas in Matlab during 1976-2005. The major interventions that took place in both the areas since the early 1980s were the family-planning programme plus safe menstrual regulation services and safe motherhood interventions (midwives for normal delivery in the ICDDR,B service area from the late 1980s and equal access to comprehensive emergency obstetric care [EmOC] in public facilities for women from both the areas). National programmes for social development and empowerment of women through education and microcredit programmes were implemented in both the areas. The quantitative findings were supplemented by a qualitative study by interviewing local community care providers for their change in practices for maternal healthcare over time. After the introduction of the safe motherhood programme, reduction in maternal mortality was higher in the ICDDR,B service area (68.6%) than in the government service area (50.4%) during 1986-1989 and 2001-2005. Reduction in the number of maternal deaths due to the fertility decline was higher in the government service area (30%) than in the ICDDR,B service area (23%) during 1979-2005. In each area, there has been substantial reduction in abortion-related mortality--86.7% and 78.3%--in the ICDDR,B and government service areas respectively. Education of women was a strong predictor

  20. Maternity Leave in Taiwan

    PubMed Central

    Feng, Joyce Yen; Han, Wen-Jui

    2011-01-01

    Using the first nationally representative birth cohort study in Taiwan, this paper examines the role that maternity leave policy in Taiwan plays in the timing of mothers returning to work after giving birth, as well as the extent to which this timing is linked to the amount of time mothers spend with their children and their use of breast milk versus formula. We found that the time when mothers returned to work coincided with the duration of guaranteed leave. In particular, mothers with a labor pension plan resumed work significantly earlier than mothers with no pension plan, and mothers with no pension plan returned to work significantly later than those with pension plans. The short leave of absence guaranteed under existing policies translated into mothers spending less time with their children and being more likely to exclusively use formula by 6 months after birth. In contrast, mothers who resumed work later than 6 months after birth were more likely to have not worked before birth or to have quit their jobs during pregnancy. Implications and recommendations for parental leave policy in Taiwan are discussed. PMID:21603074

  1. Maternal mortality in Pakistan. A success story of the Faisalabad district.

    PubMed

    Bashir, A

    1991-04-01

    Maternal-child health care interventions in Pakistan's Faisalabad District have produced dramatic reductions in maternal mortality and are potentially replicable in other developing country settings. In the late-1970s, health personnel became concerned with the high rates of maternal mortality, infant mortality, malnutrition, fertility, and illegal abortion in the district. Since 80% of deliveries in Pakistan are carried out by traditional birth attendants (TBAs), the author initiated a program of refresher courses for TBAs in the district. In the 10 years since 1978, 5500 urban and rural TBas have participated in these annual seminars and been provided with information on detection of high-risk pregnancies for referral, sepsis prevention, prenatal care, neonatal resuscitative measures, and family planning. During this same 10-year period, maternal mortality dropped from 10.1 to 1.86/1000, largely as a result of referral of complicated cases to the District Headquarters Hospital. Another innovation was the Faisalabad FLying Squad service, an emergency ambulance equipped with medicines and trained staff that can rapidly transport women who develop complications during delivery to the hospital. In the 1 year since program inception in January 1989, there have been 73 calls for the emergency service. In 1990, designated The Year of the Mother and Child, lectures on family planning, maternal-child health, and the availability of the obstetric Flying Squad were given throughout the district. The main causes of the 48 maternal deaths in the district in 1989 (maternal mortality rate of 0.86/1000) were insistence on home delivery and reluctance to go to the hospital. PMID:12343200

  2. Outcomes of the Evidence-Based Pitocin Administration Checklist at a Tertiary-Level Hospital.

    PubMed

    Wojnar, Danuta M; Cowgill, Karen; Hoffman, Lindsay; Carlson, Hannah

    2013-12-16

    Pitocin, a synthetic form of the hormone oxytocin, is a high-alert medication that heightens patient harm when used incorrectly. This investigation examined the outcomes of an evidence-based Pitocin administration checklist used for labor augmentation at a tertiary-level hospital. Data came from patient records. Using the Perinatal Trigger Tool, N = 372 clinical records (n = 194 prior to and n = 178 following checklist implementation) were reviewed. Checklist implementation resulted in statistically significant reductions in the duration of hospitalization (1.72 vs. 2.02 days, p = .0005), presence of meconium (23.7% vs. 6.7%, p < .001), maternal fevers (7.2% vs. 2.3%, p = .030), and episiotomies (8.8% vs. 1.7%, p = .002), and clinically important reduction in APGAR scores < 7 at 5 min (3.6%-0.6%, p = .069) and instrumented deliveries (11.9%-8.4%, p = .307). A universal Pitocin checklist implementation can improve birth outcomes and costs of care. PMID:24347308

  3. Pattern and outcome of antenatal care among women attending a Catholic mission hospital in Ibadan, Nigeria.

    PubMed

    Aluko, J O; Oluwatosin, A

    2008-09-01

    Antenatal care (ANC) services have the aim of monitoring the course of pregnancy, in order to promote favourable outcomes. In spite of the fact that its components have been found to improve pregnancy outcomes, maternal/infant morbidity and mortality still remain public health problems in most developing countries including Nigeria. These unacceptable health indicators form the basis of this study. The records of 581 women who attended ANC at the Catholic Hospital between October 2005 and September 2006 were accessed. The data collected with the aid of a checklist were processed using statistical package of social sciences (SPSS). The age range of the participants was 17-45; with the mean age of 30.3 (SD = 4.8). Three hundred and forty-seven (59.7%), sixty-nine (29.1%) of the women had tertiary and secondary education respectively. A total of 325 (55.9%) were nulliparous. Only 44 (7.6%) of the women began ANC at the first trimester. Out of 159 abortions recorded among the women, 72 (45%) were self-induced prior to marriage. Findings showed apparent low rate of first trimester booking, irregular antenatal clinic visits and initiation of ANC at the appearance of symptoms of illness among the women studied. Therefore the study recommends hospitals to adopt the WHO modified ANC with fewer visits to improve better compliance and coverage, provision of family life education especially on the benefits of early ANC booking and family planning services through available media. PMID:18982815

  4. What Is and What Should Be: Maternal Perceptions of Their Roles in the NICU.

    ERIC Educational Resources Information Center

    Bruns, Deborah A.; McCollum, Jeanette A.; Cohen-Addad, Nicole

    1999-01-01

    This study examined the development of maternal roles in seven mothers of medically fragile, premature infants in the neonatal intensive care unit (NICU) of an urban, teaching hospital using data sources such as interviews, observations, and document review. Mothers gradually assumed caregiving roles of worrier, novice, learner and expert and…

  5. Associations of Psychosocial Factors with Maternal Confidence among Japanese and Vietnamese Mothers

    ERIC Educational Resources Information Center

    Goto, Aya; Nguyen, Quang Vinh; Nguyen, Thi Tu Van; Pham, Nghiem Minh; Chung, Thi Mong Thuy; Trinh, Huu Phuc; Yabe, Junko; Sasaki, Hitomi; Yasumura, Seiji

    2010-01-01

    We conducted this cross-sectional study among 392 Japanese and 294 Vietnamese mothers who attended routine child health visits in a Japanese city and at a tertiary hospital in Vietnam, in order to investigate the prevalence and associated sociodemographic, parenting, and psychological characteristics of low maternal confidence in child rearing…

  6. Reducing high maternal mortality rates in western China: a novel approach.

    PubMed

    Gyaltsen Gongque Jianzan, Kunchok; Gyal Li Xianjia, Lhusham; Gipson, Jessica D; Kyi Cai Rangji, Tsering; Pebley, Anne R

    2014-11-01

    Among the Millennium Development Goals, maternal mortality reduction has proven especially difficult to achieve. Unlike many countries, China is on track to meeting these goals on a national level, through a programme of institutionalizing deliveries. Nonetheless, in rural, disadvantaged, and ethnically diverse areas of western China, maternal mortality rates remain high. To reduce maternal mortality in western China, we developed and implemented a three-level approach as part of a collaboration between a regional university, a non-profit organization, and local health authorities. Through formative research, we identified seven barriers to hospital delivery in a rural Tibetan county of Qinghai Province: (1) difficulty in travel to hospitals; (2) hospitals lack accommodation for accompanying families; (3) the cost of hospital delivery; (4) language and cultural barriers; (5) little confidence in western medicine; (6) discrepancy in views of childbirth; and (7) few trained community birth attendants. We implemented a three-level intervention: (a) an innovative Tibetan birth centre, (b) a community midwife programme, and (c) peer education of women. The programme appears to be reaching a broad cross-section of rural women. Multilevel, locally-tailored approaches may be essential to reduce maternal mortality in rural areas of western China and other countries with substantial regional, socioeconomic, and ethnic diversity. PMID:25555773

  7. Impact of specialization in gynecology and obstetrics departments on pregnant women's choice of maternity institutions.

    PubMed

    Adachi, Yoshimi; Iso, Hiroyasu; Shen, Junyi; Ban, Kanami; Fukui, On; Hashimoto, Hiroyuki; Nakashima, Takako; Morishige, Kenichiro; Saijo, Tatuyoshi

    2013-01-01

    In April 2008, specialization in gynecology and obstetrics departments was introduced in the Sennan area of Osaka prefecture in Japan that aimed at solving the problems of regional provisions of obstetrics services (e.g., shortage of obstetricians, overworking of obstetricians, and provision of specialist maternity services for high-risk pregnancies). Under this specialization, the gynecology and obstetrics departments in two city hospitals were combined and reconstructed into two centers, i.e., the gynecological care center in Kaizuka City Hospital and the prenatal care center in Izumisano City Hospital. This paper investigates to what extent and how this specialization affected pregnant women's choices of the prenatal care center and other maternity institutions. We used birth certificate data of 15,927 newborns from the Sennan area between April 1, 2007 and March 30, 2010, for Before and After Analysis to examine changes in pregnant women's choices of maternity institutions before and after the specialization was instituted. Our results indicated that this specialization scheme was, to some extent, successful on the basis of providing maternity services for high-risk pregnancies at the prenatal care center (i.e., Izumisano City Hospital) and having created a positive effect by pregnant women to other facilities in the nearby area. PMID:24364885

  8. Improved Maternal and Child Health Care Access in a Rural Community.

    ERIC Educational Resources Information Center

    Carcillo, Joseph A.; And Others

    1995-01-01

    Describes an underserved rural community in which health care initiatives increased access to comprehensive care. Over a 3-year period, increased accessibility to maternal and child health care also increased use of preventive services, thus decreasing emergency room visits and hospitalizations as well as low birth weight, risk of congenital…

  9. CD Recorders.

    ERIC Educational Resources Information Center

    Falk, Howard

    1998-01-01

    Discussion of CD (compact disc) recorders describes recording applications, including storing large graphic files, creating audio CDs, and storing material downloaded from the Internet; backing up files; lifespan; CD recording formats; continuous recording; recording software; recorder media; vulnerability of CDs; basic computer requirements; and…

  10. Tender Beginnings program: an educational continuum for the maternity patient.

    PubMed

    Brown, Susan E H

    2006-01-01

    The Tender Beginnings program demonstrates a comprehensive educational plan for maternity patients that can be extended throughout pregnancy, the birth process, and into the postpartum period. In today's healthcare environment, where the maternity patient continues to experience a shortened stay structure, the hurried learning process that is absorbed over a 48-hour stay is often ineffectual. This program provides a strategy and framework for effective teaching that can be successfully implemented all through the peripartum period. Budgetary constraints have given way to an innovative approach and opportunity for the healthcare specialist to explore an entrepreneurial relationship within the structure of the program. The Tender Beginnings program has proven to be a true integration of community educational outreach, nurse entrepreneurship, hospital-based education, and postpartum/neonatal follow-up. PMID:16915052

  11. Maternal scaffolding behavior: links with parenting style and maternal education.

    PubMed

    Carr, Amanda; Pike, Alison

    2012-03-01

    The purpose of this study was to specify the relationship between positive and harsh parenting and maternal scaffolding behavior. A 2nd aim was to disentangle the effects of maternal education and parenting quality, and a 3rd aim was to test whether parenting quality mediated the association between maternal education and scaffolding practices. We examined associations between positive and harsh parenting practices and contingent and noncontingent tutoring strategies. Ninety-six mother-child dyads (49 boys, 47 girls) from working- and middle-class English families participated. Mothers reported on parenting quality at Time 1 when children were 5 years old and again approximately 5 years later at Time 2. Mother-child pairs were observed working together on a block design task at Time 2, and interactions were coded for contingent (contingent shifting) and noncontingent (fixed failure feedback) dimensions of maternal scaffolding behavior. Positive and harsh parenting accounted for variance in contingent behavior over and above maternal education, whereas only harsh parenting accounted for unique variance in noncontingent scaffolding practices. Our findings provide new evidence for a more differentiated model of the relation between general parenting quality and specific scaffolding behaviors. PMID:22004338

  12. Planned Out-of-Hospital Birth and Birth Outcomes

    PubMed Central

    Snowden, Jonathan M.; Tilden, Ellen L.; Snyder, Janice; Quigley, Brian; Caughey, Aaron B.; Cheng, Yvonne W.

    2016-01-01

    Background The frequency of planned out-of-hospital birth in the United States has increased in recent years. The value of studies assessing the perinatal risks of planned out-of-hospital birth versus hospital birth has been limited by cases in which transfer to a hospital is required and a birth that was initially planned as an out-of-hospital birth is misclassified as a hospital birth. Methods We performed a population-based, retrospective cohort study of all births that occurred in Oregon during 2012 and 2013 using data from newly revised Oregon birth certificates that allowed for the disaggregation of hospital births into the categories of planned in-hospital births and planned out-of-hospital births that took place in the hospital after a woman’s intrapartum transfer to the hospital. We assessed perinatal morbidity and mortality, maternal morbidity, and obstetrical procedures according to the planned birth setting (out of hospital vs. hospital). Results Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P = 0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth. Planned out-of-hospital birth was also strongly associated with unassisted vaginal delivery (93.8%, vs. 71.9% with planned in-hospital births; P<0.001) and with decreased odds for obstetrical procedures. Conclusions Perinatal mortality was higher with planned out-of-hospital birth than with planned in-hospital birth, but the absolute risk of death was low in both settings. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human

  13. Maternal nutrition and perinatal survival.

    PubMed

    Rush, D

    2001-09-01

    This review addresses the relationship between maternal nutrition and the survival of the foetus and infant. This survey was undertaken because wide-scale programmes on maternal feeding are in process, based, not on a critical synthesis of currently-available empirical research, but on a series of nested and, at times, weakly supported, assumptions. It is concluded that: (i) maternal weight and weight gain are remarkably resistant to either dietary advice or supplementation; (ii) nutritionally-induced increased birth-weight does not universally increase the chance of survival of the offspring, since pre-pregnancy weight, at least in affluent, industrialized societies-while associated with increased birth-weight-is also associated with higher perinatal mortality; (iii) while dietary supplements during pregnancy do have a modest effect on birth-weight, in contrast to a large effect in famine or near-famine conditions, this is not mediated by maternal energy deposition; and (iv) declining peripheral fat stores in late pregnancy are associated with accelerated foetal growth, and improved nutrition can lead to lower fat stores. Rather, the component of maternal weight gain associated with accelerated foetal growth is water, and, presumably, plasma volume. In the few studies, large and thorough enough to adequately address the issues, maternal feeding--both in famine and non-famine conditions--has led to lower perinatal, primarily foetal, mortality; the mechanisms are not likely to have been due only to the acceleration of foetal growth. It is concluded that there is currently an inadequate base of secure knowledge to foster improvement in the health and nutrition of poor mothers and children. The public and policy-makers alike must be informed that greater knowledge relating maternal nutrition to perinatal outcome is urgently needed to create sound health advice and to mount effective programmes. PMID:11761778

  14. Maternal Age and Contractility of Human Myometrium in Pregnancy.

    PubMed

    Crankshaw, Denis J; O'Brien, Yvonne M; Crosby, David A; Morrison, John J

    2015-10-01

    There is controversy as to whether maternal age exerts an influence on the contractility of human myometrium in pregnancy. The aim of this study was to examine a series of functional contractile parameters of human myometrium in vitro, over a broad range of maternal ages. Myometrial tissue specimens were obtained at cesarean delivery from 32 women with maternal ages ranging from 28 to 52 years. Using in vitro recordings, a number of contractile parameters including maximal amplitude, mean contractile force, time to maximal amplitude, maximum rate of rise, and occurrence of simple and complex (biphasic and multiphasic) contractions were examined for spontaneous and induced contractile activity. The relationship between maternal age and individual parameters was evaluated using linear regression analysis. For all contractile parameters examined, for both spontaneous and induced contractions, no significant correlation was observed with maternal age between 28 and 52 years. The mean maximum amplitude values for spontaneous and oxytocin-induced contractions were 23 ± 3 and 43 ± 5 mN, respectively. The mean contractile forces for spontaneous and oxytocin-induced contractions were 1.5 ± 0.2 and 6.5 ± 0.9 mN, respectively. There was no variation in the proportion of biphasic or multiphasic contractions with maternal age. These results indicate there is no significant functional impairment of uterine contractility and no lack in responsiveness of myometrium in vitro, in the older mother. These findings do not support the concept that there may be a biological basis for dysfunctional labor or increased cesarean delivery rates in older parturients. PMID:25759369

  15. Intimate Partner Violence During Pregnancy: Maternal and Neonatal Outcomes

    PubMed Central

    Ray, Ellen; Sharps, Phyllis; Bullock, Linda

    2015-01-01

    Abstract The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered “risky,” including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient–provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health. PMID:25265285

  16. Intimate partner violence during pregnancy: maternal and neonatal outcomes.

    PubMed

    Alhusen, Jeanne L; Ray, Ellen; Sharps, Phyllis; Bullock, Linda

    2015-01-01

    The effects of intimate partner violence (IPV) on maternal and neonatal outcomes are multifaceted and largely preventable. During pregnancy, there are many opportunities within the current health care system for screening and early intervention during routine prenatal care or during episodic care in a hospital setting. This article describes the effects of IPV on maternal health (e.g., insufficient or inconsistent prenatal care, poor nutrition, inadequate weight gain, substance use, increased prevalence of depression), as well as adverse neonatal outcomes (e.g., low birth weight [LBW]), preterm birth [PTB], and small for gestational age [SGA]) and maternal and neonatal death. Discussion of the mechanisms of action are explored and include: maternal engagement in health behaviors that are considered "risky," including smoking and alcohol and substance use, and new evidence regarding the alteration of the hypothalamic-pituitary-adrenal axis and resulting changes in hormones that may affect LBW and SGA infants and PTB. Clinical recommendations include a commitment for routine screening of IPV in all pregnant women who present for care using validated screening instruments. In addition, the provision of readily accessible prenatal care and the development of a trusting patient-provider relationship are first steps in addressing the problem of IPV in pregnancy. Early trials of targeted interventions such as a nurse-led home visitation program and the Domestic Violence Enhanced Home Visitation Program show promising results. Brief psychobehavioral interventions are also being explored. The approach of universal screening, patient engagement in prenatal care, and targeted individualized interventions has the ability to reduce the adverse effects of IPV and highlight the importance of this complex social disorder as a top priority in maternal and neonatal health. PMID:25265285

  17. Maternal health phone line: saving women in papua new Guinea.

    PubMed

    Watson, Amanda H A; Sabumei, Gaius; Mola, Glen; Iedema, Rick

    2015-01-01

    This paper presents the findings of a research project which has involved the establishment of a maternal health phone line in Milne Bay Province of Papua New Guinea (PNG). Mobile phones and landline phones are key information and communication technologies (ICTs). This research study uses the "ICTs for healthcare development" model to ascertain benefits and barriers to the successful implementation of the Childbirth Emergency Phone. PNG has a very high maternal mortality rate. The "three stages of delay" typology was developed by Thaddeus and Maine to determine factors that might delay provision of appropriate medical treatment and hence increase risk of maternal death. The "three stages of delay" typology has been utilised in various developing countries and also in the present study. Research undertaken has involved semi-structured interviews with health workers, both in rural settings and in the labour ward in Alotau. Additional data has been gathered through focus groups with health workers, analysis of notes made during phone calls, interviews with women and community leaders, observations and field visits. One hundred percent of interviewees (n = 42) said the project helped to solve communication barriers between rural health workers and Alotau Provincial Hospital. Specific examples in which the phone line has helped to create positive health outcomes will be outlined in the paper, drawn from research interviews. The Childbirth Emergency Phone project has shown itself to play a critical role in enabling healthcare workers to address life-threatening childbirth complications. The project shows potential for rollout across PNG; potentially reducing maternal morbidity and maternal mortality rates by overcoming communication challenges. PMID:25923199

  18. Maternal Health Phone Line: Saving Women in Papua New Guinea

    PubMed Central

    Watson, Amanda H.A.; Sabumei, Gaius; Mola, Glen; Iedema, Rick

    2015-01-01

    This paper presents the findings of a research project which has involved the establishment of a maternal health phone line in Milne Bay Province of Papua New Guinea (PNG). Mobile phones and landline phones are key information and communication technologies (ICTs). This research study uses the “ICTs for healthcare development” model to ascertain benefits and barriers to the successful implementation of the Childbirth Emergency Phone. PNG has a very high maternal mortality rate. The “three stages of delay” typology was developed by Thaddeus and Maine to determine factors that might delay provision of appropriate medical treatment and hence increase risk of maternal death. The “three stages of delay” typology has been utilised in various developing countries and also in the present study. Research undertaken has involved semi-structured interviews with health workers, both in rural settings and in the labour ward in Alotau. Additional data has been gathered through focus groups with health workers, analysis of notes made during phone calls, interviews with women and community leaders, observations and field visits. One hundred percent of interviewees (n = 42) said the project helped to solve communication barriers between rural health workers and Alotau Provincial Hospital. Specific examples in which the phone line has helped to create positive health outcomes will be outlined in the paper, drawn from research interviews. The Childbirth Emergency Phone project has shown itself to play a critical role in enabling healthcare workers to address life-threatening childbirth complications. The project shows potential for rollout across PNG; potentially reducing maternal morbidity and maternal mortality rates by overcoming communication challenges. PMID:25923199

  19. Appropriate criteria for identification of near-miss maternal morbidity in tertiary care facilities: A cross sectional study

    PubMed Central

    Souza, JP; Cecatti, JG; Parpinelli, MA; Serruya, SJ; Amaral, E

    2007-01-01

    Background The study of severe maternal morbidity survivors (near miss) may be an alternative or a complement to the study of maternal death events as a health care indicator. However, there is still controversy regarding the criteria for identification of near-miss maternal morbidity. This study aimed to characterize the near miss maternal morbidity according to different sets of criteria. Methods A descriptive study in a tertiary center including 2,929 women who delivered there between July 2003 and June 2004. Possible cases of near miss were daily screened by checking different sets of criteria proposed elsewhere. The main outcome measures were: rate of near miss and its primary determinant factors, criteria for its identification, total hospital stay, ICU stay, and number and kind of special procedures performed. Results There were two maternal deaths and 124 cases of near miss were identified, with 102 of them admitted to the ICU (80.9%). Among the 126 special procedures performed, the most frequent were central venous access, echocardiography and invasive mechanical ventilation. The mean hospital stay was 10.3 (± 13.24) days. Hospital stay and the number of special procedures performed were significantly higher when the organ dysfunction based criteria were applied. Conclusion The adoption of a two level screening strategy may lead to the development of a consistent severe maternal morbidity surveillance system but further research is needed before worldwide near miss criteria can be assumed. PMID:17848189

  20. Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study

    PubMed Central

    Sayinzoga, Felix; Bijlmakers, Leon; van Dillen, Jeroen; Mivumbi, Victor; Ngabo, Fidèle; van der Velden, Koos

    2016-01-01

    Objective Presenting the results of 5 years of implementing health facility-based maternal death audits in Rwanda, showing maternal death classification, identification of substandard (care) factors that have contributed to death, and conclusive recommendations for quality improvements in maternal and obstetric care. Design Nationwide facility-based retrospective cohort study. Settings All cases of maternal death audited by district hospital-based audit teams between January 2009 and December 2013 were reviewed. Maternal deaths that were not subjected to a local audit are not part of the cohort. Population 987 audited cases of maternal death. Main outcome measures Characteristics of deceased women, timing of onset of complications, place of death, parity, gravida, antenatal clinic attendance, reported cause of death, service factors and individual factors identified by committees as having contributed to death, and recommendations made by audit teams. Results 987 cases were audited, representing 93.1% of all maternal deaths reported through the national health management information system over the 5-year period. Almost 3 quarters of the deaths (71.6%) occurred at district hospitals. In 44.9% of these cases, death occurred in the post-partum period. Seventy per cent were due to direct causes, with post-partum haemorrhage as the leading cause (22.7%), followed by obstructed labour (12.3%). Indirect causes accounted for 25.7% of maternal deaths, with malaria as the leading cause (7.5%). Health system failures were identified as the main responsible factor for the majority of cases (61.0%); in 30.3% of the cases, the main factor was patient or community related. Conclusions The facility-based maternal death audit approach has helped hospital teams to identify direct and indirect causes of death, and their contributing factors, and to make recommendations for actions that would reduce the risk of reoccurrence. Rwanda can complement maternal death audits with other

  1. The Association of Maternal Lifestyle with Birth Defects in Shaanxi Province, Northwest China

    PubMed Central

    Pei, Leilei; Kang, Yijun; Cheng, Yue; Yan, Hong

    2015-01-01

    Background The main objective was to investigate the burden of birth defects among alive infants and explore the impact of maternal lifestyle during pregnancy on the burden of birth defects in Northwest China. Methods A stratified multi-stage sampling method was used to study infants born during 2010–2013 (and their mothers) in Shaanxi province of Northwest China. Socio-demographic information was collected using a structured questionnaire, and medical records from the local hospitals were used to determine the final diagnosis of birth defects. Poisson regression analysis was performed to assess the association between maternal lifestyles during pregnancy and the burden of birth defects, while adjusting for potential confounders. Results We sampled 29098 infants, of whom 629 (i.e. 216.17 per 10000) were observed to have congenital defects. Cardiovascular system defects (77.32 per 10000) were found to be the most common. Mothers who had ever consumed alcohol during pregnancy were found to have infants with a higher prevalence of some categories of birth defects, including nervous system (Prevalence Rate Ratio, PRR:14.67, 95%CI:1.94, 110.92), cardiovascular system (PRR:3.22, 95%CI: 1.02, 10.16) and oral clefts (PRR:9.02, 95%CI: 2.08, 39.10) in contrast to infants of mothers without any alcohol consumption. Maternal passive smoking during pregnancy lead to the increased burden of malformations of eye, ear, face and neck (PRR:1.95, 95%CI:1.15, 3.33), cardiovascular system (PRR:1.70, 95%CI: 1.25, 2.31) and respiratory system (PRR:9.94, 95%CI: 2.37, 41.76) in their newborns. Further, tea or coffee consumption during pregnancy was positively correlated with the burden of specific birth defects, such as cardiovascular system (PRR: 2.44, 95%CI: 1.33, 4.46) and genital organs (PRR:14.72, 95%CI: 1.87, 116.11) among infants. Conclusions The prevalence of birth defects was high in Shaanxi province of Northwest China. The unhealthy lifestyles of mothers during pregnancy may

  2. Aetiology of maternal mortality using verbal autopsy at Sokoto, North-Western Nigeria

    PubMed Central

    Umar, Sadiq

    2013-01-01

    Abstract Background Maternal mortality in developing countries is higher than that in developed countries. There are few published articles on the factors associated with maternal deaths in northern Nigeria. Objectives The objective of this study was to identify the medical causes and factors associated with maternal mortality in Sokoto, northern Nigeria. Method A verbal autopsy questionnaire was used to interview close relatives of women within the reproductive age group who had died of pregnancy-related complications in the Sokoto metropolis during the preceding two years. A multistage sampling method using simple random sampling at each step was used to select areas of study within the Sokoto metropolis. Data analysis was carried out using a statistical package for social sciences (SPSS), version 19, and the Spearman correlation was used to test association. Significance level was set at 0.05. Results The major causes of death were haemorrhage (48.3%), eclampsia (19%) and prolonged labour (13.8%). The association between maternal mortality and the absence of antenatal booking was significant (p < 0.001); the association between maternal mortality and the ‘three delays’ was also significant (p = 0.013). The association between maternal mortality and educational status and occupation was, however, not significant (p = 0.687 and p = 0.427 respectively). Conclusion The medical causes of maternal mortality identified in this study were similar to those of the hospital-based studies in the area. In addition, an association between maternal deaths and the ‘three delays’ and the absence of antenatal booking was found. There is a need for public education efforts to address these factors in order to reduce maternal mortality in the study area.

  3. Unsafe driving behaviors and hospitalization.

    PubMed

    Van Tuinen, M

    1994-04-01

    The medical costs associated with motor vehicle crashes are difficult to measure. Most attempts have used crash data and cost data that are only indirectly related to each other or have followed patients in a few hospitals or trauma centers. These studies produce localized estimates or rough national estimates of limited use to policy makers. The result has been a dependence on more readily available mortality data, such as the Fatal Accident Reporting System, to guide automotive safety efforts. The limitations of mortality data and the increasing sophistication of medical care data bases have resulted in a strong interest in obtaining crash-linked morbidity data. Hence, in 1993, the National Highway Traffic Safety Administration (NHTSA) awarded the Missouri Department of Health and six other applicants grants to link automotive crash records to statewide ambulance trip, outpatient care, hospitalization and mortality records. By identifying an individual across multiple data sets, states would be able to determine directly the relationship of driver behaviors and crash characteristics to hospitalization rates and other medical outcomes. Examination of hospital pay source information would expose the toll of automotive crashes on public tax dollars. Having recently completed the record linkage phase of this project, Missouri Department of Health staff are beginning to analyze the impact of automotive crashes on health care costs in Missouri. In this report, three unsafe driving behaviors, failure to use a safety device (seatbelts and motorcycle helmets), driving under the influence of alcohol, and speeding, are related to the risk of hospitalization or death, hospital costs, and expected pay source. PMID:8202067

  4. The impact of critical total quality management practices on hospital performance in the ministry of health hospitals in saudi arabia.

    PubMed

    Alaraki, Mohammad Shamsuddin

    2014-01-01

    Total Quality Management (TQM) offers a method for solving quality and patient safety problems and bringing significant improvement to hospital performance. However, only few studies have been conducted in this area in developing countries, particularly in Saudi Arabia. This research is carried out in an attempt to address this gap, exploring the impact of applying TQM practices on hospital performance in the Saudi Ministry of Health hospitals. The study has included 4 hospitals in Tabuk Region, namely, King Khaled Hospital, King Fahad Hospital, Maternity and Children Hospital, and Hagel General Hospital. The data collection was done by the researcher when 400 questionnaires were distributed using a convenient sampling technique to access the required data. The response rate was 67.25% of the total questionnaires distributed. The TQM practices used in the study were as follows: leadership, employee management, information analysis, training, customer focus, continuous improvement, process management, and supplier management. The findings of the research show a significant positive correlation between the 8 practices of TQM and hospital performance with a correlation coefficient r value of 0.9 (P = .0001). The study also reveals that Saudi hospitals are facing difficulties in engaging the clinical staff in their quality initiative. Moreover, our findings show that accredited hospitals have significantly applied TQM practices more than unaccredited hospitals. PMID:24368721

  5. Maternal Child Abuse and its Association with Maternal Anxiety in the Socio-Cultural Context of Iran

    PubMed Central

    Douki, Zahra Esmaeili; Esmaeili, Mohammad Reza; Vaezzadeh, Nazanin; Mohammadpour, Reza Ali; Azimi, Hamideh; Sabbaghi, Robabeh; Esmaeil, Mousa; Shahhosseini, Zohreh

    2013-01-01

    Objectives The prevalence of parental violence has been an area of major public concern. There are few available data detailing the ways parents and other caregivers discipline children, particularly in low and middle income countries. This study focuses on the prevalence of different types of maternal child abuse and its association with maternal anxiety in the socio-cultural context of Iran. Methods Participants in this cross-sectional study consisted of 562 mothers with the last child aged from 1 month to 12 years old who attended the Amirkola Children’s Referral Hospital in Mazandaran Province, Iran, seeking healthcare services for their children. Demographic characteristics of the mothers, their children and reactions to conflicts with children were evaluated by a validated version of Conflict Tactics Scale for Parent and Child. Also, the relationship between maternal anxiety and child abuse was assessed using the Spielberger State-Trait Anxiety Inventory. The association between variables was examined by Pearson correlation coefficient, independent t-test, one-way ANOVA, and multivariate regression. Results The prevalence of mother-to-child corporal punishment, severe physical abuse and very severe physical abuse were 436 (78%), 260 (46%) and 180 (32%), respectively. Verbal emotional abuse was reported by 506 (90%) participants and nonverbal emotional abuse was reported in 374 (67%) cases. A correlation was observed between child abuse and mothers’ age (p=0.02), as well as with the number of children in the family (p=0.03), and the mothers’ trait anxiety (p<0.001). Conclusion Overall, the assessment of maternal child abuse should be an important focus for evaluation in mothers with anxiety and vice versa, when child abuse is suspected, maternal psychological assessment should be essential. PMID:24223243

  6. Maternal Employment and Adolescent Development

    PubMed Central

    Ruhm, Christopher J.

    2009-01-01

    This study investigates how maternal employment is related to the cognitive development and body weight of 10 and 11 year olds, controlling for a wide variety of child, mother and family characteristics. The results suggest that limited market work benefits youths who are relatively “disadvantaged” and even long hours, which occur infrequently, are unlikely to leave them much worse off. By contrast, maternal labor supply is estimated to have more uniformly harmful consequences for “advantaged” adolescents. The negative cognitive effects for these youths probably partly occur because maternal labor supply reduces the time spent in enriching home environments. Some of the growth in obesity may be related to determinants of excess weight common to the child and mother. PMID:19830269

  7. Improving maternal care reduces mortality.

    PubMed

    1987-01-01

    Reduction of maternal mortality in developing countries by community-based action is complex but possible. Deaths related to pregnancy are primarily due to bleeding, infection, toxemia and illegal abortion. The excess maternal deaths in developing countries are also related to high numbers of high-risk pregnancies, total lack of prenatal and obstetric care in some areas, poor nutrition and overwork. The basic interventions available to communities include prenatal care, improved alarm and transport systems, referral centers and improved community-based care. Prenatal care can include nutritional supplements and exams and referrals by traditional birth attendants, targeting women suffering from toxemia, bleeding and infections. Local ambulances with life-support equipment, and maternity waiting houses are examples of ways of dealing with transport problems. Referral centers should be capable of providing sterile conditions and blood transfusions. Nurses can be trained to do caesarean sections. Birth attendants can use checklists to administer antibiotics and oxytocic drugs, for example. PMID:12281272

  8. Cost estimate of hospital stays for premature newborns in a public tertiary hospital in Brazil

    PubMed Central

    Desgualdo, Claudia Maria; Riera, Rachel; Zucchi, Paola

    2011-01-01

    OBJECTIVES: To estimate the direct costs of ho