Dépôt source: UBC Dataverse / Date de publication: / Author: Bone, Jeffrey - Lunaris - Découvrez les données de recherche canadiennes Résultats de recherche

Smart Discharges for Mom & Baby 2.0: A cohort study to develop prognostic algorithms for post-discharge readmission and mortality among mother-infant dyads

Borealis

Wiens, Matthew O; Kenya-Mugisha, Nathan; Namala, Angella; Tagoola, Abner; Bebell, Lisa; Pillay, Yashodani; Ansermino, J Mark; Kissoon, Niranjan; Payne, Beth A; Vidlern, Marianne; Christoffersen-Deb, Astrid; Lavoie, Pascal; Bone, Jeffrey — 2023-05-15 Dataset Description: This dataset contains materials from the Smart Discharges for Mom & Baby parent study within the <a href = "https://bcchr.ca/smart-discharges">Smart Discharges</a> program of research. Materials include the parent study ethics protocol and associated documents. See the Metadata section below for links to related publications and datasets. Background: In low-income country settings, the first six weeks after birth remain a critical period of vulnerability for both mother and newborn. Despite recommendations for routine post-discharge follow-up, few mothers and newborns receive guideline recommended care during this period. Prediction modelling of post-delivery outcomes has the potential to improve outcomes for both mother and newborn by identifying high-risk dyads, improving risk communication, and facilitating a patient-centered approach to postnatal care. Methods: This is a mixed-methods study to explore and map the current postnatal discharge processes in Uganda.We will conduct an observational cohort study (Phase I) to develop and internally validate our risk score and aim to recruit 7,000 mother and newborn dyads from Jinja Regional Referral Hospital and Mbarara Regional Referral Hospital. We will also engage with patients, families, and health workers through patient journey mapping and focus group discussions (Phases II-IV) to identify barriers and facilitators to inform the development of an evidence- and risk-based bundle of interventions to improve postnatal care (PNC) for dyads. The primary outcome is maternal and/or neonatal death or need for re-admission within six weeks of birth. Secondary outcomes include: 1. Post-natal care visits during the 6-week post-discharge period 2. Post-discharge health seeking practices for mothers/newborns during the 6-week post-discharge period 3. Causes of readmission/mortality among those who experience such outcomes, based on verbal autopsies and admission symptom/diagnosis questionnaires. Data Collection Methods: All data will be collected at the point of care using encrypted study tablets. These data will be uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses will systematically collect data on clinical, social and demographic variables. Following discharge, field officers will contact mothers at 6-weeks post-discharge, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for participants who had died following discharge. Direct observation and interviews will be conducted on a sub-set of participants to collect process outcomes and barriers and facilitators to the patient's journey. FGDs will be digitally recorded, transcribed verbatim in the language spoken during the recording and analyzed for emerging themes. Ethics Declaration: Ethics approvals have been obtained from the Makerere University School of Public Health (MakSPH) Institutional Review Board (SPH-2021-177), the Uganda National Council of Science and Technology (UNCST) in Uganda (HS2174ES) and the University of British Columbia in Canada (H21-03709). This study has been registered at clinicaltrials.gov (NCT05730387). Associated datasets: Pending publication NOTE for restricted files: If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator on <a href = "https://www.bcchr.ca/pediatric-sepsis-data-colab">this page</a> under "collaborate with the pediatric sepsis colab."

Smart Discharges for vulnerable refugee children: a cohort study to validate prognostic algorithms for post-discharge readmission and mortality among children living in refugee settings

Borealis

Wiens, Matthew O; Toliva,Opar Bernard; Nsungwa-Sabiiti, Jesca; Mwaka, Savio; Komugisha, Clare; Nyalwal, Beatrice Lydiah Adhiambo; Bone, Jeffrey; Nguyen, Vuong; Kenya-Mugisha, Nathan — 2024-07-22 Background: In many African countries, pediatric post-discharge mortality following in-hospital treatment for severe infectious illness is higher than in-hospital mortality (5-8%). Risk algorithms can be used to help health workers identify those most vulnerable to poor post-discharge outcomes. They can also assist health workers in providing personalized discharge counselling and recommending effective follow-up care. This can improve overall system efficiency. While this approach has shown promise among general pediatric populations, no research has addressed issues of post-discharge morbidity and mortality within the refugee context, where unique vulnerabilities exist. This study aims to validate the Smart Discharges approach to improve outcomes among children in refugee settings, and ultimately to build a generalizable and inclusive solution to improving pediatric post-discharge outcomes. Methods: This study is a prospective observational cohort study that will be conducted at 3 health facilities in Lamwo District, northern Uganda between April 2023 and September 2024. We will enroll 1,500 children under 13 years of age between the three study sites of Padibe HCIV, Paluda HCIII, and Palabek Kal HCIII. The primary objective is to validate, calibrate, and refine the Smart Discharges risk-prediction algorithm in a representative cohort of refugee children. Secondary objectives include: i) to describe the epidemiology of, and risk factors for, post-discharge mortality of children in the context of refugee settings; ii) to describe the post-discharge health seeking patterns of children in the context of refugee settings; and iii) to evaluate the pediatric discharge process at 3 health facilities providing discharge care to children living in refugee settings. Following enrollment a research nurse will obtain and record clinical and demographic variables required for model validation including vital signs, oxygen saturation, anthropometric data, prior care seeking, co-morbidities and diagnoses. A rapid diagnostic test using blood, which will require a finger prick to collect < 0.5ml of blood, will be conducted to assess the patient's HIV status, malaria parasitemia, and hemoglobin (hemocue). All enrolled children will receive phone follow-up from study staff at 2-, 4- and 6 months following hospital discharge for research purposes. Verbal autopsies, often used in this context to determine cause of death, will be conducted for all children who die following discharge. All study sites will also undergo the discharge module of a 5-survey Facility Scan developed by the Pediatric Sepsis Data CoLaboratory’s (Sepsis CoLab) to support health facilities in identifying and assessing quality improvement priorities and initiatives.This will be done at both baseline (conclusion of clinical study activities) and 4 months following the completion of study activities to measure the facility readiness to implement improved discharge care, and its persistence over time. Ethics Declaration: Ethical approval has been obtained from the University of British Columbia Children’s & Women’s Research Ethics Board in Canada (H23-00012) and the Makerere School of Public Health Research Ethics Board in Uganda (SPH-2023-369). NOTE for restricted files: If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

Derivation and internal validation of a data-driven prediction model to guide frontline health workers in triaging children under-five in Nairobi, Kenya

Borealis

Mawji, Alishah; Akech, Samuel; Mwaniki, Paul; Dunsmuir, Dustin; Bone, Jeffrey; Wiens, Matthew O; Gorges, Matthias; Kimutai, David; Kissoon, Niranjan; English, Mike; Ansermino, J Mark — 2024-11-19 Background: Many hospitalized children in developing countries die from infectious diseases. Early recognition of those who are critically ill coupled with timely treatment can prevent many deaths. A data-driven, electronic triage system to assist frontline health workers in categorizing illness severity is lacking. This study aimed to develop a data-driven parsimonious triage algorithm for children under five years of age. Methods: This was a prospective observational study of children under-five years of age presenting to the outpatient department of Mbagathi Hospital in Nairobi, Kenya between January and June 2018. A study nurse examined participants and recorded history and clinical signs and symptoms using a mobile device with an attached low-cost pulse oximeter sensor. The need for hospital admission was determined independently by the facility clinician and used as the primary outcome in a logistic predictive model. We focused on the selection of variables that could be quickly and easily assessed by low skilled health workers. Results: The admission rate (for more than 24 hours) was 12% (N=138/1,132). We identified an eight-predictor logistic regression model including continuous variables of weight, mid-upper arm circumference, temperature, pulse rate, and transformed oxygen saturation, combined with dichotomous signs of difficulty breathing, lethargy, and inability to drink or breastfeed. This model predicts overnight hospital admission with an area under the receiver operating characteristic curve of 0.88 (95% CI 0.82 to 0.94). Low- and high-risk thresholds of 5% and 25%, respectively were selected to categorize participants into three triage groups for implementation. Conclusion: A logistic regression model comprised of eight easily understood variables may be useful for triage of children under the age of five based on the probability of need for admission. This model could be used by frontline workers with limited skills in assessing children. External validation is needed before adoption in clinical practice. NOTE for restricted files: If you are not yet a CoLab member, please complete our <a href = "https://rc.bcchr.ca/redcap/surveys/?s=EDCYL7AC79">membership application survey</a> to gain access to restricted files within 2 business days. Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator at <a href = mailto:sepsiscolab@bccchr.ca>sepsiscolab@bcchr.ca</a> or visit our <a href = "https://wfpiccs.org/pediatric-sepsis-colab/">website</a>.

Limiter à la zone sur la carte

Instructions pour la recherche cartographique

1.Activez le filtre cartographique en cliquant sur le bouton « Limiter à la zone sur la carte ».

2.Déplacez la carte pour afficher la zone qui vous intéresse. Maintenez la touche Maj enfoncée et cliquez pour encadrer une zone spécifique à agrandir sur la carte. Les résultats de la recherche changeront à mesure que vous déplacerez la carte.

3.Pour voir les détails d’un emplacement, vous pouvez cliquer soit sur un élément dans les résultats de recherche, soit sur l’épingle d’un emplacement sur la carte et sur le lien associé au titre.

Remarque : Les groupes servent à donner un aperçu visuel de l’emplacement des données. Puisqu’un maximum de 50 emplacements peut s’afficher sur la carte, il est possible que vous n’obteniez pas un portrait exact du nombre total de résultats de recherche.

Recherche

Résultats de recherche

Instructions pour la recherche cartographique

Détails de la recherche

Limiter par :

Dépôt source Effacer

Date de publication

Auteur(s) Effacer