Supporting neonatal resuscitation in low-resource settings : Innovations and new strategies

Background: Lack of oxygen at birth, birth asphyxia, accounts annually for around 700 000 deaths. Heart rate is important in evaluating a neonate and effective positive pressure ventilation (PPV) may prevent neonatal deaths. Evaluating heart rate by auscultation may be inaccurate and standard face-mask ventilation (FMV) may be inadequate. NeoTap Life Support (NeoTapLS) is a free-of-charge smartphone app for heart rate recording designed for low-resource settings. The laryngeal mask airway (LMA) is a tube used as an alternative to a face mask. Both of these innovations may be task-shifted to midwives who are on the front-line of neonatal resuscitation in low-resource settings. This thesis reports on investigations into whether these innovations and new strategies can potentially increase adherence to guidelines and thereby reduce neonatal mortality and morbidity. Methods: Two observational studies and a clinical trial were conducted in Sweden and Uganda between 2014 and 2019. We investigated the accuracy and speed of heart rate assessment by NeoTapLS compared to a manikin, a metronome, pulse oximetry and electrocardiography, in simulations and in clinical use. A phase III open-label superiority randomized clinical trial, the NeoSupra Trial, compared LMA with face mask as a primary device for neonatal resuscitation carried out by midwives. The study involved neonates at ≥34 weeks of gestation and/or an expected birth weight of ≥2000 gram, thereby requiring PPV at birth. The primary outcome was a composite of 7-day mortality and moderate-to-severe hypoxic-ischemic encephalopathy, daily evaluated by Thompson scoring through Day 5. Results: Simulation studies showed a high correlation between measured and true values. In the manikin study, 93.5% of the auscultations and 86.3% of the palpations differed by ≤5 beats, mean acquisition time 14.9 vs. 16.3 s. In the metronome study, 77% differed by ≤10. In clinical assessment by doctors of neonates not needing PPV 88% differed by ≤10 and by midwives in neonates needing PPV 48% differed by ≤10, median acquisition time 5 vs. 2.7 s. NeoTapLS showed very good sensitivity and specificity in detecting heart rate <100 bpm. The NeoSupra Trial had a complete follow-up data of 99.2%; the primary outcome occurred in 27.4% in the LMA arm and 24.4% in the FMV arm (adjusted relative risk, 1.16; 95% confidence interval 0.90 to 1.51; P=0.26). Seven-day mortality was 21.7% in LMA and 18.4% in FMV (adjusted relative risk 1.21; 95% confidence interval, 0.90 to 1.63). The proportion of moderate-to-severe HIE was 11.2 vs. 10.1% (adjusted relative risk, 1.27; 95% confidence interval, 0.84 to 1.93). Intervention-related adverse events were few and similar between the arms. Conclusion: NeoTapLS is well adapted in the context it was used for swift and accurate heart rate recording by doctors. Clinical assessment by midwives was less accurate, suggesting that they may benefit from auscultation-focused training. LMA was safe in the hands of midwives but was not superior to a face mask in reducing early neonatal death and moderate-to-severe hypoxic-ischemic encephalopathy. It is suggested further investigations of these innovations and new strategies to explore the possibility of task-shifting its use to midwives in low-resource settings.Doktorgradsavhandlin

Diagnosis and Management of Pediatric Diseases

A screenshot of some the most rapidly evolving fields in Neonatology and Pediatrics with articles reviewing some metabolic dysregulations as well as non-oncologic diseases that may occur in infancy, childhood, youth. The illustrative material with original photographs and drawings highlighting some pathogenetic concepts are keystones of this book

Implementation of bayesian therapeutic drug monitoring in modern patient care

The variability observed in drug exposure has a direct impact on the overall response to drug. The largest part of variability between dose and drug response resides in the pharmacokinetic phase, i.e. in the dose-concentration relationship. Among possibilities offered to clinicians, Therapeutic Drug Monitoring (TDM; Monitoring of drug concentration measurements) is one of the useful tool to guide pharmacotherapy. TDM aims at optimizing treatments by individualizing dosage regimens based on blood drug concentration measurement. Bayesian calculations, relying on population pharmacokinetic approach, currently represent the gold standard TDM strategy. However, it requires expertise and computational assistance, thus limiting its large implementation in routine patient care. The overall objective of this thesis was to implement robust tools to provide Bayesian TDM to clinician in modern routine patient care. To that endeavour, aims were (i) to elaborate an efficient and ergonomic computer tool for Bayesian TDM: EzeCHieL (ii) to provide algorithms for drug concentration Bayesian forecasting and software validation, relying on population pharmacokinetics (iii) to address some relevant issues encountered in clinical practice with a focus on neonates and drug adherence. First, the current stage of the existing software was reviewed and allows establishing specifications for the development of EzeCHieL. Then, in close collaboration with software engineers a fully integrated software, EzeCHieL, has been elaborated. EzeCHieL provides population-based predictions and Bayesian forecasting and an easy-to-use interface. It enables to assess the expectedness of an observed concentration in a patient compared to the whole population (via percentiles), to assess the suitability of the predicted concentration relative to the targeted concentration and to provide dosing adjustment. It allows thus a priori and a posteriori Bayesian drug dosing individualization. Implementation of Bayesian methods requires drug disposition characterisation and variability quantification trough population approach. Population pharmacokinetic analyses have been performed and Bayesian estimators have been provided for candidate drugs in population of interest: anti-infectious drugs administered to neonates (gentamicin and imipenem). Developed models were implemented in EzeCHieL and also served as validation tool in comparing EzeCHieL concentration predictions against predictions from the reference software (NONMEM®). Models used need to be adequate and reliable. For instance, extrapolation is not possible from adults or children to neonates. Therefore, this work proposes models for neonates based on the developmental pharmacokinetics concept. Patients' adherence is also an important concern for drug models development and for a successful outcome of the pharmacotherapy. A last study attempts to assess impact of routine patient adherence measurement on models definition and TDM interpretation. In conclusion, our results offer solutions to assist clinicians in interpreting blood drug concentrations and to improve the appropriateness of drug dosing in routine clinical practice

THE FIRST ASIA – PASIFIC PARTNERSHIP ON HEALTH AND NUTRITION IMPROVEMENT (APHNI) CONFERENCE: OVERCOMING GLOBAL HEALTH ISSUE BY CAPACITY BUILDING OF HEALTH PROVIDER

This seminar will be the first International Seminar which is going to be conducted by the Faculty of Health Sciences of Alma Ata University on October, 2019 at Grand Dafam Rohan Hotel, Yogyakarta. This International Seminar is organized as an effort to improve our understanding to increase the capacity of health workers in addressing the global health issues. In addition, this international seminar is also a mean to expose researches conducted by many researchers from universities and practitioners in Indonesia and neighborhood countries and to disseminate them to more people. This Proceeding contains articles resulted from various disciplines researches related to medicine, nutrition and dietetics, pharmacy, nursing, obstetrics and hospital management. This proceeding, hopefully, can be a reference for students, lecturers, and health practitioners. Furthermore, the issuance of these proceedings can be used as a reference in the development of future research, as well as a reference in an effort to improve health services

ATHENA Research Book

The ATHENA European University is an alliance of nine Higher Education Institutions with the mission of fostering excellence in research and innovation by facilitating international cooperation. The ATHENA acronym stands for Advanced Technologies in Higher Education Alliance. The partner institutions are from France, Germany, Greece, Italy, Lithuania, Portugal, and Slovenia: the University of Orléans, the University of Siegen, the Hellenic Mediterranean University, the Niccolò Cusano University, the Vilnius Gediminas Technical University, the Polytechnic Institute of Porto, and the University of Maribor. In 2022 institutions from Poland and Spain joined the alliance: the Maria Curie-Skłodowska University and the University of Vigo. This research book presents a selection of the ATHENA university partners' research activities. It incorporates peer-reviewed original articles, reprints and student contributions. The ATHENA Research Book provides a platform that promotes joint and interdisciplinary research projects of both advanced and early-career researchers

Investigation of mobile devices usage and mobile augmented reality applications among older people

Mobile devices such as tablets and smartphones have allow users to communicate, entertainment, access information and perform productivity. However, older people are having issues to utilise mobile devices that may affect their quality of life and wellbeing. There are some potentials of mobile Augmented Reality (AR) applications to increase older users mobile usage by enhancing their experience and learning. The study aims to investigate mobile devices potential barriers and influence factors in using mobile devices. It also seeks to understand older people issues in using AR applications

Usability analysis of contending electronic health record systems

In this paper, we report measured usability of two leading EHR systems during procurement. A total of 18 users participated in paired-usability testing of three scenarios: ordering and managing medications by an outpatient physician, medicine administration by an inpatient nurse and scheduling of appointments by nursing staff. Data for audio, screen capture, satisfaction rating, task success and errors made was collected during testing. We found a clear difference between the systems for percentage of successfully completed tasks, two different satisfaction measures and perceived learnability when looking at the results over all scenarios. We conclude that usability should be evaluated during procurement and the difference in usability between systems could be revealed even with fewer measures than were used in our study. © 2019 American Psychological Association Inc. All rights reserved.Peer reviewe

Timely and reliable evaluation of the effects of interventions: a framework for adaptive meta-analysis (FAME)

Most systematic reviews are retrospective and use aggregate data AD) from publications, meaning they can be unreliable, lag behind therapeutic developments and fail to influence ongoing or new trials. Commonly, the potential influence of unpublished or ongoing trials is overlooked when interpreting results, or determining the value of updating the meta-analysis or need to collect individual participant data (IPD). Therefore, we developed a Framework for Adaptive Metaanalysis (FAME) to determine prospectively the earliest opportunity for reliable AD meta-analysis. We illustrate FAME using two systematic reviews in men with metastatic (M1) and non-metastatic (M0)hormone-sensitive prostate cancer (HSPC)

2016 Oklahoma Research Day Full Program

This document contains all abstracts from the 2016 Oklahoma Research Day held at Northeastern State University