Patterns of child mortality in rural area of Burkina Faso: evidence from the Nanoro health and demographic surveillance system (HDSS)

Background Half of global child deaths occur in sub-Saharan Africa. Understanding child mortality patterns and risk factors will help inform interventions to reduce this heavy toll. The Nanoro Health and Demographic Surveillance System (HDSS), Burkina Faso was described previously, but patterns and potential drivers of heterogeneity in child mortality in the district had not been studied. Similar studies in other districts indicated proximity to health facilities as a risk factor, usually without distinction between facility types. Methods Using Nanoro HDSS data from 2009 to 2013, we estimated the association between under-5 mortality and proximity to inpatient and outpatient health facilities, seasonality of death, age group, and standard demographic risk factors. Results Living in homes 40–60 min and > 60 min travel time from an inpatient facility was associated with 1.52 (95% CI: 1.13–2.06) and 1.74 (95% CI: 1.27–2.40) greater hazard of under-5 mortality, respectively, than living in homes < 20 min from an inpatient facility. No such association was found for outpatient facilities. The wet season (July–November) was associated with 1.28 (95% CI: 1.07, 1.53) higher under-5 mortality than the dry season (December–June), likely reflecting the malaria season. Conclusions Our results emphasize the importance of geographical proximity to health care, distinguish between inpatient and outpatient facilities, and also show a seasonal effect, probably driven by malaria.

Inpatient Facility Distribution and Primary Healthcare Centers Demand Based on Location-Quotient in Bali within 2015-2019 Period

The study of access to primary healthcare centers (PHCs) in the middle region of Indonesia, including Bali, is scarce. A study on primary healthcare access is worth undertaken in this region because it is usually given less attention regarding its fair distribution of healthcare facilities in relation to their population. This study aimed at determining geographical distribution and concentration of PHCs facility and demand in Bali Province. This study focused on the inpatient facility and demand of PHCs in relation to population. Data of PHCs’ inpatient facility and demand of each regency/city and population data were obtained from Bali Health Profile of 2015 to 2019. Location quotients (LQ) of inpatient facility and inpatient demand for each regency/city were calculated to determine the spatial concentration of the two variables compared to the provincial average. Our study found that there was variation in facility and demand for inpatient care in PHCs in Bali. A low level of inpatient facility and demand was seen in Regency of Buleleng, Denpasar, and Gianyar, while a high level of facility and demand for inpatient facility was observed in Regency of Jembrana, Tabanan, Klungkung, and Karangasem. A unique finding was also noticed in Bangli Regency, where the inpatient facility of PHC was high, while the inpatient demand was low. This might indicate a need for evaluation of the inpatient facility of PHC in this Regency. Keywords: Access to healthcare, Bali, inpatient care, puskesmas, primary healthcare centers.

HRSA’s evidence-based tele-emergency network grant program: Multi-site prospective cohort analysis across six rural emergency department telemedicine networks

Background The Health Resources and Services Administration (HRSA), Federal Office of Rural Health Policy (FORHP) funded the Evidence-Based Tele-Emergency Network Grant Program (EB TNGP) to serve the dual purpose of providing telehealth services in rural emergency departments (teleED) and systematically collecting data to inform the telehealth evidence base. This provided a unique opportunity to examine trends across multiple teleED networks and examine heterogeneity in processes and outcomes. Method and findings Six health systems received funding from HRSA under the EB TNGP to implement teleED services and they did so to 65 hospitals (91% rural) in 11 states. Three of the grantees provided teleED services to a general patient population while the remaining three grantees provided teleED services to specialized patient populations (i.e., stroke, behavioral health, critically ill children). Over a 26-month period (November 1, 2015 –December 31, 2017), each grantee submitted patient-level data for all their teleED encounters on a uniform set of measures to the data coordinating center. The six grantees reported a total of 4,324 teleED visits and 99.86% were technically successful. The teleED patients were predominantly adult, White, not Latinx, and covered by Medicare or private insurance. Across grantees, 7% of teleED patients needed resuscitation services, 58% were rated as emergent, and 30% were rated as urgent. Across grantees, 44.2% of teleED patients were transferred to another inpatient facility, 26.0% had a routine discharge, and 24.5% were admitted to the local inpatient facility. For the three grantees who served a general patient population, the most frequent presenting complaints for which teleED was activated were chest pain (25.7%), injury or trauma (17.1%), stroke symptoms (9.9%), mental/behavioral health (9.8%), and cardiac arrest (9.5%). The teleED consultation began before the local clinician exam in 37.8% of patients for the grantees who served a general patient population, but in only 1.9% of patients for the grantees who provided specialized services. Conclusions Grantees used teleED services for a representative rural population with urgent or emergent symptoms largely resulting in transfer to a distant hospital or inpatient admission locally. TeleED was often available as the first point of contact before a local provider examination. This finding points to the important role of teleED in improving access for rural ED patients.

Analysis of requirements for modern finishing materials in interior solutions for inpatient facility ward units

This article is devoted to the detailed analysis of modern requirements for finishing materials, used in the interiors of inpatient facility ward units. The authors have studied a number of regulatory normative documents acting in the territory of the Russian Federation and analyzed the practical experience of interior decoration of ward units at the health care capital construction facilities. The authors highlight and describe the main requirements for the finishing materials for the inpatient facility ward units and point out the peculiarities of solutions in the interiors. A classification of modern finishing materials (with an indication of their technical characteristics) used in the decoration of interiors of long-term care units is made on the basis of the practical experience studied by the authors taking into account the functional purpose of the premises as well as the variants of visual design of interiors of inpatient facility ward units.

Idiopathic Hemolacria: a case report

Hemolacria or bloody tears is a rare condition resulting from local and systemic causes. Most of the time cause remains unknown and is inferred to be psychogenic in nature. Management includes identification of the cause along with psycho-social intervention. Here I report a rare presentation of bloody tears in a 16 year adolescent female admitted in our inpatient facility with history and discussion.

The use of personal telemedical system for monitoring the condition of patients during rehabilitation in the inpatient facility

An autonomous wearable patient monitor with the function of broadcasting the measured parameters via wireless channels of computer networks to the server (to the cloud), and from there to the central console of the department, remote computers, tablets and doctors’ smartphones was tested. It was used to monitor the vital parameters of the patient’s body during rehabilitation in the inpatient facility. Various load programs have been tested: exercise therapy, kinesiotherapy, mechanotherapy, and verticalization.

Predicting nonroutine discharge in patients undergoing surgery for vertebral column tumors

OBJECTIVEMore than 8000 patients are treated annually for vertebral column tumors, of whom roughly two-thirds will be discharged to an inpatient facility (nonroutine discharge). Nonroutine discharge is associated with increased care costs as well as delays in discharge and poorer patient outcomes. In this study, the authors sought to develop a prediction model of nonroutine discharge in the population of vertebral column tumor patients.METHODSPatients treated for primary or metastatic vertebral column tumors at a single comprehensive cancer center were identified for inclusion. Data were gathered regarding surgical procedure, patient demographics, insurance status, and medical comorbidities. Frailty was assessed using the modified 5-item Frailty Index (mFI-5) and medical complexity was assessed using the modified Charlson Comorbidity Index (mCCI). Multivariable logistic regression was used to identify independent predictors of nonroutine discharge, and multivariable linear regression was used to identify predictors of prolonged length of stay (LOS). The discharge model was internally validated using 1000 bootstrapped samples.RESULTSThe authors identified 350 patients (mean age 57.0 ± 13.6 years, 53.1% male, and 67.1% treated for metastatic vs primary disease). Significant predictors of prolonged LOS included higher mCCI score (β = 0.74; p = 0.026), higher serum absolute neutrophil count (β = 0.35; p = 0.001), lower hematocrit (β = −0.34; p = 0.001), use of a staged operation (β = 4.99; p < 0.001), occurrence of postoperative pulmonary embolism (β = 3.93; p = 0.004), and surgical site infection (β = 9.93; p < 0.001). Significant predictors of nonroutine discharge included emergency admission (OR 3.09; p = 0.001), higher mFI-5 score (OR 1.90; p = 0.001), lower serum albumin level (OR 0.43 per g/dL; p < 0.001), and operations with multiple stages (OR 4.10; p < 0.001). The resulting statistical model was deployed as a web-based calculator (https://jhuspine4.shinyapps.io/Nonroutine_Discharge_Tumor/).CONCLUSIONSThe authors found that nonroutine discharge of patients with surgically treated vertebral column tumors was predicted by emergency admission, increased frailty, lower serum albumin level, and staged surgical procedures. The resulting web-based calculator tool may be useful clinically to aid in discharge planning for spinal oncology patients by preoperatively identifying patients likely to require placement in an inpatient facility postoperatively.