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Bauer ME, Fuller M, Kovacheva V, Elkhateb R, Azar K, Caldwell M, Chiem V, Foster M, Gibbs R, Hughes BL, Johnson R, Kottukapally N, Rosenstein MG, Cortes MS, Shields LE, Sudat S, Sutton CD, Toledo P, Traylor A, Wharton K, Main E. Performance Characteristics of Sepsis Screening Tools During Antepartum and Postpartum Admissions. Obstet Gynecol 2024; 143:336-345. [PMID: 38086052 PMCID: PMC10922108 DOI: 10.1097/aog.0000000000005480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE To evaluate the performance characteristics of existing screening tools for the prediction of sepsis during antepartum and postpartum readmissions. METHODS This was a case-control study using electronic health record data obtained between 2016 and 2021 from 67 hospitals for antepartum sepsis admissions and 71 hospitals for postpartum readmissions up to 42 days. Patients in the sepsis case group were matched in a 1:4 ratio to a comparison cohort of patients without sepsis admitted antepartum or postpartum. The following screening criteria were evaluated: the CMQCC (California Maternal Quality Care Collaborative) initial sepsis screen, the non-pregnancy-adjusted SIRS (Systemic Inflammatory Response Syndrome), the MEWC (Maternal Early Warning Criteria), UKOSS (United Kingdom Obstetric Surveillance System) obstetric SIRS, and the MEWT (Maternal Early Warning Trigger Tool). Time periods were divided into early pregnancy (less than 20 weeks of gestation), more than 20 weeks of gestation, early postpartum (less than 3 days postpartum), and late postpartum through 42 days. False-positive screening rates, C-statistics, sensitivity, and specificity were reported for each overall screening tool and each individual criterion. RESULTS We identified 525 patients with sepsis during an antepartum hospitalization and 728 patients with sepsis during a postpartum readmission. For early pregnancy and more than 3 days postpartum, non-pregnancy-adjusted SIRS had the highest C-statistics (0.78 and 0.83, respectively). For more than 20 weeks of gestation and less than 3 days postpartum, the pregnancy-adjusted sepsis screening tools (CMQCC and UKOSS) had the highest C-statistics (0.87-0.94). The MEWC maintained the highest sensitivity rates during all time periods (81.9-94.4%) but also had the highest false-positive rates (30.4-63.9%). The pregnancy-adjusted sepsis screening tools (CMQCC, UKOSS) had the lowest false-positive rates in all time periods (3.9-10.1%). All tools had the lowest C-statistics in the periods of less than 20 weeks of gestation and more than 3 days postpartum. CONCLUSION For admissions early in pregnancy and more than 3 days postpartum, non-pregnancy-adjusted sepsis screening tools performed better than pregnancy-adjusted tools. From 20 weeks of gestation through up to 3 days postpartum, using a pregnancy-adjusted sepsis screening tool increased sensitivity and minimized false-positive rates. The overall false-positive rate remained high.
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Affiliation(s)
- Melissa E Bauer
- Department of Anesthesiology and the Department of Obstetrics and Gynecology, Duke University, Durham, North Carolina; the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts; the Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; the Sutter Health Institute for Advancing Health Equity and the Center for Health Systems Research, Sutter Health, Sacramento, Common Spirit Health, the Department of Systems Clinical Informatics, Common Spirit Health, the Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, San Francisco, and the Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, California; the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas; and Wayne State University School of Medicine, Wayne, and the Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan
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Igbinosa II, Leonard SA, Noelette F, Davies-Balch S, Carmichael SL, Main E, Lyell DJ. Racial and Ethnic Disparities in Anemia and Severe Maternal Morbidity. Obstet Gynecol 2023; 142:845-854. [PMID: 37678935 PMCID: PMC10510811 DOI: 10.1097/aog.0000000000005325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/13/2023] [Accepted: 04/20/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate antepartum anemia prevalence by race and ethnicity, to assess whether such differences contribute to severe maternal morbidity (SMM), and to estimate the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. METHODS We conducted a population-based cohort study using linked vital record and birth hospitalization data for singleton births at or after 20 weeks of gestation in California from 2011 through 2020. Pregnant patients with hereditary anemias, out-of-hospital births, unlinked records, and missing variables of interest were excluded. Antepartum anemia prevalence and trends were estimated by race and ethnicity. Centers for Disease Control and Prevention criteria were used for SMM and nontransfusion SMM indicators. Multivariable logistic regression modeling was used to estimate risk ratios (RRs) for SMM and nontransfusion SMM by race and ethnicity after sequential adjustment for social determinants, parity, obstetric comorbidities, delivery, and antepartum anemia. Population attributable risk percentages were calculated to assess the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. RESULTS In total, 3,863,594 births in California were included. In 2020, Black pregnant patients had the highest incidence of antepartum anemia (21.5%), followed by Pacific Islander (18.2%), American Indian-Alaska Native (14.1%), multiracial (14.0%), Hispanic (12.6%), Asian (10.6%), and White pregnant patients (9.6%). From 2011 to 2020, the prevalence of anemia increased more than100% among Black patients, and there was a persistent gap in prevalence among Black compared with White patients. Compared with White patients, the adjusted risk for SMM was high among most racial and ethnic groups; adjustment for anemia after sequential modeling for known confounders decreased SMM risk most for Black pregnant patients (approximated RR 1.47, 95% CI 1.42-1.53 to approximated RR 1.27, 95% CI 1.22-1.37). Compared with White patients, the full adjusted nontransfusion SMM risk remained high for most groups except Hispanic and multiracial patients. Within each racial and ethnic group, the population attributable risk percentage for antepartum anemia and SMM was highest for multiracial patients (21.4%, 95% CI 17.5-25.0%), followed by Black (20.9%, 95% CI 18.1-23.4%) and Hispanic (20.9%, 95% CI 19.9-22.1%) patients. The nontransfusion SMM population attributable risk percentages for Asian, Black, and White pregnant patients were less than 8%. CONCLUSION Antepartum anemia, most prevalent among Black pregnant patients, contributed to disparities in SMM by race and ethnicity. Nearly one in five to six SMM cases among Black, Hispanic, American Indian-Alaska Native, Pacific Islander, and multiracial pregnant patients is attributable in part to antepartum anemia.
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Affiliation(s)
- Irogue I Igbinosa
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, and the Department of Pediatrics, School of Medicine, Stanford University, Stanford, and the BLACK Wellness & Prosperity Center, Fresno, California
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Bauer ME, Albright C, Prabhu M, Heine RP, Lennox C, Allen C, Burke C, Chavez A, Hughes BL, Kendig S, Le Boeuf M, Main E, Messerall T, Pacheco LD, Riley L, Solnick R, Youmans A, Gibbs R. Alliance for Innovation on Maternal Health: Consensus Bundle on Sepsis in Obstetric Care. Obstet Gynecol 2023; 142:481-492. [PMID: 37590980 PMCID: PMC10424822 DOI: 10.1097/aog.0000000000005304] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 08/19/2023]
Abstract
Sepsis in obstetric care is one of the leading causes of maternal death in the United States, with Black, Asian/Pacific Islander, and American Indian/Alaska Native obstetric patients experiencing sepsis at disproportionately higher rates. State maternal mortality review committees have determined that deaths are preventable much of the time and are caused by delays in recognition, treatment, and escalation of care. The "Sepsis in Obstetric Care" patient safety bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people by preventing infection and recognizing and treating infection early to prevent progression to sepsis. This is one of several core patient safety bundles developed by AIM (the Alliance for Innovation on Maternal Health) to provide condition- or event-specific clinical practices that should be implemented in all appropriate care settings. As with other bundles developed by AIM, the "Sepsis in Obstetric Care" patient safety bundle is organized into five domains: Readiness, Recognition and Prevention, Response, Reporting and Systems Learning, and Respectful, Equitable, and Supportive Care. The Respectful, Equitable, and Supportive Care domain provides essential best practices to support respectful, equitable, and supportive care to all patients. Further health equity considerations are integrated into the elements of each domain.
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Affiliation(s)
- Melissa E Bauer
- Department of Anesthesiology and the Department of Obstetrics and Gynecology, Duke University, Durham, and the Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, North Carolina; the Division of Maternal-Fetal Medicine, University of Washington Medical Center, Seattle, Washington; the Division of Maternal-Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts; the American College of Obstetricians and Gynecologists and the Association of Women's Health, Obstetric and Neonatal Nurses, Washington, DC; END SEPSIS, the Department of Emergency Medicine and the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, and the Department of Obstetrics & Gynecology and the Department of Anesthesiology, Weill Cornell Medicine, New York, New York; Health Policy Advantage LLC, Ballwin, Missouri; Sepsis Alliance, San Diego, and the California Maternal Quality Care Collaborative and the Department of Obstetrics and Gynecology, Stanford University, Stanford, California; Evidence-Based Practice, David. P. Blom Administrative Campus, OhioHealth, Columbus, Ohio; the Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas; and the University of Michigan School of Nursing, Ann Arbor, Michigan
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Bane S, Abrams B, Mujahid M, Ma C, Shariff-Marco S, Main E, Profit J, Xue A, Palaniappan L, Carmichael SL. Risk factors and pregnancy outcomes vary among Asian American, Native Hawaiian, and Pacific Islander individuals giving birth in California. Ann Epidemiol 2022; 76:128-135.e9. [PMID: 36115627 PMCID: PMC10144523 DOI: 10.1016/j.annepidem.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/12/2022] [Accepted: 09/08/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To compare frequencies of risk factors and pregnancy outcomes in ethnic groups versus the combined total of Asian American, Native Hawaiian, and Pacific Islander (AANHPI) populations. METHODS Using linked birth and fetal death certificate and maternal hospital discharge data (California 2007-2018), we estimated frequencies of 15 clinical and sociodemographic exposures and 11 pregnancy outcomes. Variability across 15 AANHPI groups was compared using a heat map and compared to frequencies for the total group (n = 904,232). RESULTS AANHPI groups varied significantly from each other and the combined total regarding indicators of social disadvantage (e.g., range for high school-level educational or less: 6.4% Korean-55.8% Samoan) and sociodemographic factors (e.g., maternal age <20 years: 0.2% Chinese-8.8% Guamanian) that are related to adverse pregnancy outcomes. Perinatal outcomes varied significantly (e.g., severe maternal morbidity: 1.2% Korean-1.9% Filipino). No single group consistently had risk factors or outcome prevalence at the extremes, i.e., no group was consistently better or worse off across examined factors. CONCLUSIONS Substantial variability in perinatal risk factors and outcomes exists across AANHPI groups. Aggregation into "AANHPI" is not appropriate for outcome reporting.
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Affiliation(s)
- Shalmali Bane
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA.
| | - Barbara Abrams
- School of Public Health, University of California, Berkeley, CA
| | - Mahasin Mujahid
- Division of Epidemiology and Biostatistics, University of California, Berkeley, CA
| | - Chen Ma
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Elliott Main
- California Maternal Quality Care Collaborative, Stanford University, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford CA
| | - Jochen Profit
- Perinatal Epidemiology and Health Outcomes Research Unit, Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; California Perinatal Quality Care Collaborative, Palo Alto, CA
| | - Aileen Xue
- Department of Nutrition, Case Western Reserve University, Cleveland, OH
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford CA
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Hailu EM, Carmichael SL, Berkowitz RL, Snowden JM, Lyndon A, Main E, Mujahid MS. Racial/ethnic disparities in severe maternal morbidity: An intersectional lifecourse approach. Ann N Y Acad Sci 2022; 1518:239-248. [PMID: 36166238 PMCID: PMC11019852 DOI: 10.1111/nyas.14901] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Despite long-existing calls to address alarming racial/ethnic gaps in severe maternal morbidity (SMM), research that considers the impact of intersecting social inequities on SMM risk remains scarce. Invoking intersectionality theory, we sought to assess SMM risk at the nexus of racial/ethnic marginalization, weathering, and neighborhood/individual socioeconomic disadvantage. We used birth hospitalization records from California across 20 years (1997-2017, N = 9,806,406) on all live births ≥20 weeks gestation. We estimated adjusted average predicted probabilities of SMM at the combination of levels of race/ethnicity, age, and neighborhood deprivation or individual socioeconomic status (SES). The highest risk of SMM was observed among Black birthing people aged ≥35 years who either resided in the most deprived neighborhoods or had the lowest SES. Black birthing people conceptualized to be better off due to their social standing (aged 20-34 years and living in the least deprived neighborhoods or college graduates) had comparable and at times worse risk than White birthing people conceptualized to be worse off (aged ≥35 years and living in the most deprived neighborhoods or had a high-school degree or less). Our findings highlight the need to explicitly address structural racism as the driver of racial/ethnic health inequities and the imperative to incorporate intersectional approaches.
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Affiliation(s)
- Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
| | - Suzan L Carmichael
- Division of Neonatal & Developmental Medicine, Department of Pediatrics, and Division of Maternal-Fetal Medicine and Obstetrics, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Palo Alto, USA
| | - Rachel L Berkowitz
- Department of Public Health and Recreation, College of Health and Human Sciences, San Jose State University, San Jose, California, USA
| | - Jonathan M Snowden
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon, USA
| | - Audrey Lyndon
- Rory Meyers College of Nursing, New York University, New York, New York, USA
| | - Elliott Main
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, California, USA
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Ledger S, Douglas H, Main E. 270 A dose of weekly supervised exercise helps protect lung function in children and young people with cystic fibrosis. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00960-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Raywood E, Filipow N, Stanojevic S, Shannon H, Douglas H, Tanriver G, Murray N, O'Connor R, Hill L, Dawson C, Davies G, Stott L, Saul G, Kuzhagaliyev T, van Schaik T, Furtuna B, Liakhovich O, Booth J, Kapoor K, Main E. 276 Effects of quantity and quality of daily airway clearance treatments on lung function in children and young people with cystic fibrosis: Results from Project Fizzyo. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00966-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Main E, Filipow N, Raywood E, Tanriver G, Douglas H, Davies G, Murray N, O'Connor R, Stott L, Saul G, Kuzhagaliyev T, Liakhovich O, Furtuna B, van Schaik T, Booth J, Dawson C, Hill L, Kapoor K, Stanojevic S. 271 Impact of habitual levels of moderate to vigorous physical activity on forced expiratory volume in 1 second in children and young people with cystic fibrosis: Results from Project Fizzyo. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00961-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Saynor Z, Cunningham S, Morrison L, Main E, Reid S, Urquhart D. P217 Exercise as airway clearance therapy (ExACT) in cystic fibrosis: a UK-based e-Delphi survey of patients, caregivers and health professionals. J Cyst Fibros 2022. [DOI: 10.1016/s1569-1993(22)00546-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Leong Y, Simmonds J, Main E. The functional capacity of children with haemophilia in a single UK centre: A retrospective cross-sectional study. Physiotherapy 2021. [DOI: 10.1016/j.physio.2021.10.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Snowden JM, Lyndon A, Kan P, El Ayadi A, Main E, Carmichael SL. Severe Maternal Morbidity: A Comparison of Definitions and Data Sources. Am J Epidemiol 2021; 190:1890-1897. [PMID: 33755046 DOI: 10.1093/aje/kwab077] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/14/2022] Open
Abstract
Severe maternal morbidity (SMM) is a composite outcome measure that indicates serious, potentially life-threatening maternal health problems. There is great interest in defining SMM using administrative data for surveillance and research. In the United States, one common way of defining SMM at the population level is an index developed by the Centers for Disease Control and Prevention. Modifications to this index (e.g., exclusion of maternal blood transfusion) have been proposed; some research defines SMM using an index introduced by Bateman et al. (Obstet Gynecol. 2013;122(5):957-965). Birth certificate data are also increasingly being used to define SMM. We compared commonly used US definitions of SMM among all California births (2007-2012) using the kappa (κ) statistic and other measures. We also evaluated agreement between maternal morbidity fields on the birth certificate as compared with health insurance claims data. Concordance between the 7 definitions of SMM analyzed was generally low (i.e., κ < 0.41 for 13 of 21 two-way comparisons). Low concordance was particularly driven by the presence/absence of transfusion and claims data versus birth certificate definitions. Low agreement between administrative data-based definitions of SMM highlights that results can be expected to differ between them. Further research on validity of SMM definitions, using more fine-grained data sources, is needed.
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Affiliation(s)
| | - Elliott Main
- Maternal-Fetal Medicine and Obstetrics, School of Medicine, Stanford University, Stanford, California
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Mujahid MS, Kan P, Leonard SA, Hailu EM, Wall-Wieler E, Abrams B, Main E, Profit J, Carmichael SL. Birth hospital and racial and ethnic differences in severe maternal morbidity in the state of California. Am J Obstet Gynecol 2021; 224:219.e1-219.e15. [PMID: 32798461 DOI: 10.1016/j.ajog.2020.08.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 07/10/2020] [Accepted: 08/10/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Birth hospital has recently emerged as a potential key contributor to disparities in severe maternal morbidity, but investigations on its contribution to racial and ethnic differences remain limited. OBJECTIVE We leveraged statewide data from California to examine whether birth hospital explained racial and ethnic differences in severe maternal morbidity. STUDY DESIGN This cohort study used data on all births at ≥20 weeks gestation in California (2007-2012). Severe maternal morbidity during birth hospitalization was measured using the Centers for Disease Control and Prevention index of having at least 1 of the 21 diagnoses and procedures (eg, eclampsia, blood transfusion, hysterectomy). Mixed-effects logistic regression models (ie, women nested within hospitals) were used to compare racial and ethnic differences in severe maternal morbidity before and after adjustment for maternal sociodemographic and pregnancy-related factors, comorbidities, and hospital characteristics. We also estimated the risk-standardized severe maternal morbidity rates for each hospital (N=245) and the percentage reduction in severe maternal morbidity if each group of racially and ethnically minoritized women gave birth at the same distribution of hospitals as non-Hispanic white women. RESULTS Of the 3,020,525 women who gave birth, 39,192 (1.3%) had severe maternal morbidity (2.1% Black; 1.3% US-born Hispanic; 1.3% foreign-born Hispanic; 1.3% Asian and Pacific Islander; 1.1% white; 1.6% American Indian and Alaska Native, and Mixed-race referred to as Other). Risk-standardized rates of severe maternal morbidity ranged from 0.3 to 4.0 per 100 births across hospitals. After adjusting for covariates, the odds of severe maternal morbidity were greater among nonwhite women than white women in a given hospital (Black: odds ratio, 1.25; 95% confidence interval, 1.19-1.31); US-born Hispanic: odds ratio, 1.25; 95% confidence interval, 1.20-1.29; foreign-born Hispanic: odds ratio, 1.17; 95% confidence interval, 1.11-1.24; Asian and Pacific Islander: odds ratio, 1.26; 95% confidence interval, 1.21-1.32; Other: odds ratio, 1.31; 95% confidence interval, 1.15-1.50). Among the studied hospital factors, only teaching status was associated with severe maternal morbidity in fully adjusted models. Although 33% of white women delivered in hospitals with the highest tertile of severe maternal morbidity rates compared with 53% of Black women, birth hospital only accounted for 7.8% of the differences in severe maternal morbidity comparing Black and white women and accounted for 16.1% to 24.2% of the differences for all other racial and ethnic groups. CONCLUSION In California, excess odds of severe maternal morbidity among racially and ethnically minoritized women were not fully explained by birth hospital. Structural causes of racial and ethnic disparities in severe maternal morbidity may vary by region, which warrants further examination to inform effective policies.
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Affiliation(s)
- Mahasin S Mujahid
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA.
| | - Peiyi Kan
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Stephanie A Leonard
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Elleni M Hailu
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Elizabeth Wall-Wieler
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Barbara Abrams
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, CA
| | - Elliott Main
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Jochen Profit
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA; Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
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Van Otterloo L, Main E, Seacrist M, Morton CH. Quality Improvement Opportunities Identified Through Case Review of Pregnancy-Related Deaths From Cardiovascular Disease. J Obstet Gynecol Neonatal Nurs 2020. [DOI: 10.1016/j.jogn.2020.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Phibbs C, Lorch S, Schmitt S, Main E, Kozhimannil K, Leonard S, Phibbs C. Racial/Ethnic Disparities in Costs, Length of Stay, and Severity of Severe Maternal Morbidity. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- C. Phibbs
- Loyola Marymount University Los Angeles CA United States
| | - S. Lorch
- Leonard Davis Institute of Health Economics Philadelphia PA United States
| | - S. Schmitt
- Stanford University Palo Alto CA United States
| | - E. Main
- California Maternal Quality Care Collaborative Stanford University School of Medicine Stanford CA United States
| | - K. Kozhimannil
- Department of Health Policy & Management School of Public Health University of Minnesota Minneapolis MN United States
| | - S. Leonard
- Stanford University School of Medicine Stanford CA United States
| | - C. Phibbs
- Stanford University & Palo Alto VA Menlo Park CA United States
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Phibbs C, Leonard S, Kozhimannil K, Main E, Phibbs C, Schmitt S, Lorch S. Expanding the Estimate of the Costs of Severe Maternal Morbidity to Include Readmissions, Physician Fees, and Infant Costs. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- C. Phibbs
- Stanford University & Palo Alto VA Menlo Park CA United States
| | - S. Leonard
- Stanford University School of Medicine Stanford CA United States
| | - K. Kozhimannil
- Department of Health Policy & Management School of Public Health University of Minnesota Minneapolis MN United States
| | - E. Main
- California Maternal Quality Care Collaborative Stanford University School of Medicine Stanford CA United States
| | - C. Phibbs
- Loyola Marymount University Los Angeles CA United States
| | - S. Schmitt
- Stanford University Palo Alto CA United States
| | - S. Lorch
- Leonard Davis Institute of Health Economics Philadelphia PA United States
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O’Connor R, Raywood E, Douglas H, Main E, Pao C. P299 Use of the Polar™ H10 Heart Rate Sensor during the Modified Shuttle Walk Test in children with cystic fibrosis: can we demonstrate maximal response? J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30628-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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Chan AL, Guo N, Popat R, Robakis T, Blumenfeld YY, Main E, Scott KA, Butwick AJ. Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression. J Racial Ethn Health Disparities 2020; 8:220-229. [PMID: 32474833 DOI: 10.1007/s40615-020-00774-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/13/2020] [Accepted: 05/11/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To estimate racial and ethnic differences in rates of hospital-based care associated with postpartum depression. METHODS This is a retrospective cohort study using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes within data from the Office of Statewide Planning and Development in California. We included primiparous women who underwent delivery hospitalization from 2008 to 2012. The primary outcome was the first postpartum hospital encounter with a ICD-9-CM code for depression over a 9-month period after delivery. We examined the cumulative incidence of hospital-based care for postpartum depression by race/ethnicity. Logistic regression was used to estimate relative risk. RESULTS The study cohort consisted of 984,167 primiparous women: 314,037 (32%) were non-Hispanic White; 59,754 (6%) were non-Hispanic Black; 150,855 (15%) were non-Hispanic Asian; 448,770 (46%) were Hispanic; and 10,399 (1%) were other races. The cumulative incidence of hospital-based care for postpartum depression was highest for Black women (39; 95% CI = 34-44 per 10,000 deliveries) and lowest for Asian women (7; 95% CI = 5-8 per 10,000 deliveries). Compared with White women, hospital-based care for postpartum depression was more likely to be provided to Black women (OR = 2.3; 95% CI = 1.9-2.7), whereas care was less likely for Asians (OR = 0.4; 95% CI = 0.3-0.5) and Hispanics (OR = 0.8; 95% CI = 0.7-1.0). Similar findings were observed after excluding women with antepartum depression, adjusting for sociodemographic and clinical variables, and stratifying according to care settings. CONCLUSION Compared with White women, hospital-based care for postpartum depression more frequently impacts Black women. Identifying and improving inequities in access to and utilization of mental health care for postpartum women should be a maternal health priority.
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Affiliation(s)
- Avis L Chan
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Nan Guo
- Department of Anesthesiology, Perioperative, and Pain Medicine (MC:5640), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Rita Popat
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Thalia Robakis
- Department of Psychiatry, Icahn School of Medicine Mount Sinai, Manhattan, NY, USA
| | - Yair Y Blumenfeld
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
| | - Elliott Main
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA.,California Maternal Quality Care Collaborative, Stanford University School of Medicine, Stanford, CA, USA
| | - Karen A Scott
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Alexander J Butwick
- Department of Anesthesiology, Perioperative, and Pain Medicine (MC:5640), Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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France E, Hoskins G, Hoddinott P, Hagen S, Williams B, Main E, Treweek S, Glasscoe C, Dhouieb E, Cunningham S, Semple K. P357 A before-and-after feasibility study of an intervention to increase chest physiotherapy adherence among young children with cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30649-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Raywood E, Douglas H, Kapoor K, Stott L, Saul G, Main E. P356 Technical support requirements for remote monitoring of physiotherapy in children with cystic fibrosis. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30648-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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White VanGompel E, Perez S, Wang C, Datta A, Cape V, Main E. Measuring labor and delivery unit culture and clinicians' attitudes toward birth: Revision and validation of the Labor Culture Survey. Birth 2019; 46:300-310. [PMID: 30407646 DOI: 10.1111/birt.12406] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cesarean delivery rates in the United States vary widely between hospitals, which cannot be fully explained by hospital or patient factors. Cultural factors are hypothesized to play a role in cesarean overuse, yet tools to measure labor culture are lacking. The aim of this study was to revise and validate a survey tool to measure hospital culture specific to cesarean overuse. METHODS A panel of clinicians and researchers compiled an item bank from validated surveys, added newly created items, and performed four rounds of iterative revision and consolidation. Obstetricians, family physicians, midwives, anesthesiologists, and labor nurses were recruited from 79 hospitals in California. Exploratory factor analysis was used to reduce the number of survey items and identify latent constructs to form the basis of subscales. Confirmatory factor analysis examined reliability in 31 additional hospitals. Poisson regression assessed associations between hospitals' mean score on each individual item and cesarean rates. RESULTS A total of 1718 individuals from 70 hospitals were included in the exploratory factor analysis. The final Labor Culture Survey (LCS) consisted of 29 items and six subscales: "Best Practices to Reduce Cesarean Overuse," "Fear of Vaginal Birth," "Unit Microculture," "Physician Oversight," "Maternal Agency," and "Cesarean Safety." CONCLUSIONS The revised LCS is a valid and reliable tool to measure constructs shown to be associated with cesarean rates. These findings support prior research that has shown that hospital culture is measurable, and that clinician attitudes are predictive of clinician behaviors. Unique to our survey is the construct of labor and delivery unit microculture.
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Affiliation(s)
- Emily White VanGompel
- The University of Chicago Pritzker School of Medicine, Chicago, Illinois.,NorthShore University HealthSystem, Evanston, Illinois
| | - Susan Perez
- California State University, Sacramento, Sacramento, California
| | - Chi Wang
- NorthShore University HealthSystem, Evanston, Illinois
| | - Avisek Datta
- NorthShore University HealthSystem, Evanston, Illinois
| | - Valerie Cape
- California Maternal Quality Care Collaborative, Stanford University, Stanford, California
| | - Elliott Main
- Department of Obstetrics and Gynecology, California Maternal Quality Care Collaborative, Stanford University School of Medicine, Stanford, California
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22
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Raywood E, Douglas H, Kapoor K, Murray N, O'Connor R, Shannon H, Davies G, Main E. ePS3.07 The complexity of defining adherence to airway clearance treatments in clinical trials. J Cyst Fibros 2019. [DOI: 10.1016/s1569-1993(19)30265-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Abstract
OBJECTIVE To assess hospital unit culture and clinician attitudes associated with varying rates of primary cesarean delivery. DATA SOURCES/STUDY SETTING Intrapartum nurses, midwives, and physicians recruited from 79 hospitals in California participating in efforts to reduce cesarean overuse. STUDY DESIGN Labor unit culture and clinician attitudes measured using a survey were linked to the California Maternal Data Center for birth outcomes and hospital covariates. METHODS Association with primary cesarean delivery rates was assessed using multivariate Poisson regression adjusted for hospital covariates. PRINCIPAL FINDINGS 1718 respondents from 70 hospitals responded to the Labor Culture Survey. The "Unit Microculture" subscale was strongly associated with primary cesarean rate; the higher a unit scored on 8-items describing a culture supportive of vaginal birth (eg, nurses are encouraged to spend time in rooms with patients, and doulas are welcomed), the cesarean rate decreased by 41 percent (95% CI = -47 to -35 percent, P < 0.001). Discordant attitudes between nurses and physicians were associated with increased cesarean rates. CONCLUSIONS Hospital unit culture, clinician attitudes, and consistency between professions are strongly associated with primary cesarean rates. Improvement efforts to reduce cesarean overuse must address culture of care as a key part of the change process.
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Affiliation(s)
- Emily White VanGompel
- The University of Chicago Pritzker School of MedicineEvanstonIllinois
- NorthShore University HealthSystemEvanstonIllinois
| | - Susan Perez
- Department of Kinesiology and Health ScienceCalifornia State University, SacramentoSacramentoCalifornia
| | - Avisek Datta
- NorthShore University HealthSystemEvanstonIllinois
| | - Chi Wang
- Biostatistics and ResearchNorthShore University HealthSystemEvanstonIllinois
| | - Valerie Cape
- California Maternal Quality Care CollaborativeStanford UniversityStanfordCalifornia
| | - Elliott Main
- Department of Obstetrics and GynecologyStanford University School of MedicineStanfordCalifornia
- California Maternal Quality Care CollaborativeStanford University School of MedicineStanfordCalifornia
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24
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Nijagal MA, Wissig S, Stowell C, Olson E, Amer-Wahlin I, Bonsel G, Brooks A, Coleman M, Devi Karalasingam S, Duffy JMN, Flanagan T, Gebhardt S, Greene ME, Groenendaal F, R Jeganathan JR, Kowaliw T, Lamain-de-Ruiter M, Main E, Owens M, Petersen R, Reiss I, Sakala C, Speciale AM, Thompson R, Okunade O, Franx A. Standardized outcome measures for pregnancy and childbirth, an ICHOM proposal. BMC Health Serv Res 2018; 18:953. [PMID: 30537958 PMCID: PMC6290550 DOI: 10.1186/s12913-018-3732-3] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/19/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Value-based health care aims to optimize the balance of patient outcomes and health care costs. To improve value in perinatal care using this strategy, standard outcomes must first be defined. The objective of this work was to define a minimum, internationally appropriate set of outcome measures for evaluating and improving perinatal care with a focus on outcomes that matter to women and their families. METHODS An interdisciplinary and international Working Group was assembled. Existing literature and current measurement initiatives were reviewed. Serial guided discussions and validation surveys provided consumer input. A series of nine teleconferences, incorporating a modified Delphi process, were held to reach consensus on the proposed Standard Set. RESULTS The Working Group selected 24 outcome measures to evaluate care during pregnancy and up to 6 months postpartum. These include clinical outcomes such as maternal and neonatal mortality and morbidity, stillbirth, preterm birth, birth injury and patient-reported outcome measures (PROMs) that assess health-related quality of life (HRQoL), mental health, mother-infant bonding, confidence and success with breastfeeding, incontinence, and satisfaction with care and birth experience. To support analysis of these outcome measures, pertinent baseline characteristics and risk factor metrics were also defined. CONCLUSIONS We propose a set of outcome measures for evaluating the care that women and infants receive during pregnancy and the postpartum period. While validation and refinement via pilot implementation projects are needed, we view this as an important initial step towards value-based improvements in care.
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Affiliation(s)
- Malini Anand Nijagal
- University of California, Zuckerberg San Francisco General Hospital, San Francisco, CA USA
| | - Stephanie Wissig
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Caleb Stowell
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Elizabeth Olson
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
- University of Maryland School of Medicine, Baltimore, MD 21201 USA
| | | | | | - Allyson Brooks
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA USA
| | | | | | - James M N Duffy
- Balliol College, University of Oxford, Oxford, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Stefan Gebhardt
- Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | | | | | - Tessa Kowaliw
- South Australian Maternity Reform Association (SAMRA) Inc, Adelaide, Australia
| | | | - Elliott Main
- California Maternal Quality Care Collaborative, Stanford, CA USA
| | - Michelle Owens
- University of Mississippi Medical Center, Jackson, MS USA
| | - Rod Petersen
- Women and Children’s Health Network, North Adelaide, South Australia
| | - Irwin Reiss
- University Hospital Southampton, Hampshire, UK
| | - Carol Sakala
- National Partnership for Women & Families, Washington, D.C., USA
| | | | - Rachel Thompson
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH USA
| | - Oluwakemi Okunade
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
| | - Arie Franx
- International Consortium for Health Outcomes Measurement, Cambridge, MA USA
- Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, 3508 AB The Netherlands
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25
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Chapman RL, Shannon H, Koutoumanou E, Main E. Effect of inspiratory rise time on sputum movement during ventilator hyperinflation in a test lung model. Physiotherapy 2018; 105:283-289. [PMID: 30409468 DOI: 10.1016/j.physio.2018.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 06/03/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Physiotherapists may use ventilator hyperinflation to enhance secretion clearance for intubated patients. This study investigated the effects of altering percentage inspiratory rise time (IRT) on sputum movement, ratio of peak inspiratory to expiratory flow rate (PIF:PEF ratio) and net peak expiratory flow (PEF) during ventilator hyperinflation in a test lung model. DESIGN Laboratory-based bench study. INTERVENTIONS Simulated sputum (two viscosities) was inserted into clean, clear tubing and connected between a ventilator and a resuscitation bag. Thirty-six ventilator hyperinflation breaths were applied for each 5% incremental increase in IRT between 0% and 20%. MAIN OUTCOME MEASURES The primary outcome was sputum displacement (cm). Secondary outcomes included PIF:PEF ratio and net PEF. RESULTS Significant cephalad sputum movement of 2.42cm (1.59 to 3.94) occurred with IRT between 5% and 20%, compared with caudad movement of 0.53 cm (0.31 to 1.53) at 0% IRT (median sputum movement difference 3.7cm, 95% confidence interval 2.2 to 4.8, P<0.001). Incremental increases in IRT percentage produced linear enhancements in PIF:PEF ratio and net PEF for both sputum concentrations (P<0.001). However, once the critical threshold for PIF:PEF ratio of 0.9 was achieved, the distance of sputum movement remained consistent for all IRT values exceeding 5%. CONCLUSIONS Significant increases in sputum movement occurred when IRT percentage was lengthened to achieve the optimal PIF:PEF ratio, irrespective of sputum viscosity. This provides a theoretical rationale for therapists to consider this technique when treating mechanically ventilated patients. As no additional sputum movement was seen beyond the critical PIF:PEF ratio threshold, a low IRT percentage may potentially be used to achieve effective sputum movement.
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Affiliation(s)
- R L Chapman
- Physiotherapy Programme, UCL Great Ormond Street Institute of Child Health, London, UK; Therapy Services, Hampshire Hospital's NHS Foundation Trust, Winchester, UK.
| | - H Shannon
- Physiotherapy Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - E Koutoumanou
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | - E Main
- Physiotherapy Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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Douglas H, Rand S, Denford S, Bryon M, Main E. P241 Why won't children keep exercising? Barriers and facilitators to exercise and physical activity maintenance - a qualitative study. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30536-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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27
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Douglas H, Bryon M, Denford S, Rand S, Main E. P144 Exercise: love it, hate it, or somewhere in-between? Identifying exercise self-efficacy and the impact of personal training in children and young people with CF. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30439-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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28
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Henderson ZT, Ernst K, Simpson KR, Berns S, Suchdev DB, Main E, McCaffrey M, Lee K, Rouse TB, Olson CK. The National Network of State Perinatal Quality Collaboratives: A Growing Movement to Improve Maternal and Infant Health. J Womens Health (Larchmt) 2018; 27:221-226. [PMID: 29634446 PMCID: PMC11009782 DOI: 10.1089/jwh.2018.6941] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
State Perinatal Quality Collaboratives (PQCs) are networks of multidisciplinary teams working to improve maternal and infant health outcomes. To address the shared needs across state PQCs and enable collaboration, Centers for Disease Control and Prevention (CDC), in partnership with March of Dimes and perinatal quality improvement experts from across the country, supported the development and launch of the National Network of Perinatal Quality Collaboratives (NNPQC). This process included assessing the status of PQCs in this country and identifying the needs and resources that would be most useful to support PQC development. National representatives from 48 states gathered for the first meeting of the NNPQC to share best practices for making measurable improvements in maternal and infant health. The number of state PQCs has grown considerably over the past decade, with an active PQC or a PQC in development in almost every state. However, PQCs have some common challenges that need to be addressed. After its successful launch, the NNPQC is positioned to ensure that every state PQC has access to key tools and resources that build capacity to actively improve maternal and infant health outcomes and healthcare quality.
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Affiliation(s)
- Zsakeba T Henderson
- 1 Division of Reproductive Health, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Kelly Ernst
- 2 March of Dimes Foundation , White Plains, New York
| | - Kathleen Rice Simpson
- 2 March of Dimes Foundation , White Plains, New York
- 3 Mercy Hospital , St. Louis, Missouri
| | - Scott Berns
- 4 National Institute for Children's Health Quality , Boston, Massachusetts
| | - Danielle B Suchdev
- 1 Division of Reproductive Health, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Elliott Main
- 5 California Maternal Quality Collaborative, Stanford University , Palo Alto, California
| | - Martin McCaffrey
- 6 Perinatal Quality Collaborative of North Carolina , Chapel Hill, North Carolina
- 7 University of North Carolina , Chapel Hill, North Carolina
| | - Karyn Lee
- 2 March of Dimes Foundation , White Plains, New York
| | - Tara Bristol Rouse
- 6 Perinatal Quality Collaborative of North Carolina , Chapel Hill, North Carolina
| | - Christine K Olson
- 1 Division of Reproductive Health, Centers for Disease Control and Prevention , Atlanta, Georgia
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29
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Henderson ZT, Ernst K, Simpson KR, Berns SD, Suchdev DB, Main E, McCaffrey M, Lee K, Rouse TB, Olson CK. The National Network of State Perinatal Quality Collaboratives: A Growing Movement to Improve Maternal and Infant Health. J Womens Health (Larchmt) 2018; 27:123-127. [DOI: 10.1089/jwh.2017.6844] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zsakeba T. Henderson
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kelly Ernst
- March of Dimes Foundation, White Plains, New York
| | - Kathleen Rice Simpson
- March of Dimes Foundation, White Plains, New York
- Mercy Hospital, St. Louis, Missouri
| | - Scott D. Berns
- National Institute for Children's Health Quality (NICHQ), Boston, Massachusetts
| | - Danielle B. Suchdev
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elliott Main
- California Maternal Quality Collaborative, Stanford University, Palo Alto, California
| | - Martin McCaffrey
- Perinatal Quality Collaborative of North Carolina, Chapel Hill, North Carolina
- University of North Carolina, Chapel Hill, North Carolina
| | - Karyn Lee
- March of Dimes Foundation, White Plains, New York
| | - Tara Bristol Rouse
- Perinatal Quality Collaborative of North Carolina, Chapel Hill, North Carolina
| | - Christine K. Olson
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Douglas H, Bryon M, Ledger S, Main E. 392 My quality of life or yours? The discrepancies between parent and child reported quality of life scores. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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31
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Lagrew DC, Mills M, Mikes K, Chan K, Trial J, Deeds T, Rubinstein B, Main E. 822: Rapid reduction of the NTSV CS rate in multiple community hospitals using a multi-dimensional QI approach. Am J Obstet Gynecol 2017. [DOI: 10.1016/j.ajog.2016.11.731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Robles D, Blumenfeld YJ, Lee HC, Gould JB, Main E, Profit J, Melsop K, Druzin M. Opportunities for maternal transport for delivery of very low birth weight infants. J Perinatol 2017; 37:32-35. [PMID: 27684426 PMCID: PMC5214878 DOI: 10.1038/jp.2016.174] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 08/30/2016] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess frequency of very low birth weight (VLBW) births at non-level III hospitals. STUDY DESIGN Retrospective cohort study using linked California birth certificate and discharge data of 2008 to 2010 for deliveries of singleton or first-born infant of multiple gestations with birth weight 400 to 1500 g. Delivery rates by neonatal level of care were obtained. Risk of delivery at non-level III centers was estimated in univariable and multivariable models. RESULTS Of the 1 508 143 births, 13 919 (9.2%) were VLBW; birth rate at non-level III centers was 14.9% (8.4% in level I and 6.5% in level II). Median rate of VLBW births was 0.3% (range 0 to 4.7%) annually at level I and 0.5% (range 0 to 1.6%) at level II hospitals. Antepartum stay for >24 h occurred in 14.0% and 26.9% of VLBW births in level I and level II hospitals, respectively. CONCLUSION Further improvement is possible in reducing VLBW infant delivery at suboptimal sites, given the window of opportunity for many patients.
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Affiliation(s)
- Diana Robles
- Department of Obstetrics & Gynecology, University of California, San Francisco, San Francisco, CA
| | - Yair J. Blumenfeld
- Department of Obstetrics & Gynecology, Stanford University, Stanford, CA,March of Dimes Prematurity Research Center, Stanford University, Stanford, CA
| | - Henry C. Lee
- March of Dimes Prematurity Research Center, Stanford University, Stanford, CA,Department of Pediatrics, Stanford University, Stanford, CA,California Perinatal Quality Care Collaborative, Stanford, CA
| | - Jeffrey B. Gould
- March of Dimes Prematurity Research Center, Stanford University, Stanford, CA,Department of Pediatrics, Stanford University, Stanford, CA,California Perinatal Quality Care Collaborative, Stanford, CA
| | - Elliott Main
- California Maternal Quality Care Collaborative, Stanford, CA,Sutter Pacific Medical Foundation, San Francisco, CA
| | - Jochen Profit
- March of Dimes Prematurity Research Center, Stanford University, Stanford, CA,Department of Pediatrics, Stanford University, Stanford, CA,California Perinatal Quality Care Collaborative, Stanford, CA
| | - Kathryn Melsop
- California Maternal Quality Care Collaborative, Stanford, CA
| | - Maurice Druzin
- Department of Obstetrics & Gynecology, Stanford University, Stanford, CA,March of Dimes Prematurity Research Center, Stanford University, Stanford, CA
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Affiliation(s)
- T H Parker
- Department of Biology, Whitman College, 345 Boyer Avenue, Walla Walla, WA, 99362, U.S.A..
| | | | - S Nakagawa
- Evolution & Ecology Centre, School of Biological Earth and Environmental Sciences, University of New South Wales, Sydney, 2052, Australia
| | - J Gurevitch
- Department of Ecology and Evolution, Stony Brook University, Stony Brook, NY, 11794-5245, U.S.A
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Snowden JM, Mission JF, Marshall NE, Quigley B, Main E, Gilbert WM, Chung JH, Caughey AB. The Impact of maternal obesity and race/ethnicity on perinatal outcomes: Independent and joint effects. Obesity (Silver Spring) 2016; 24:1590-8. [PMID: 27222008 PMCID: PMC4925263 DOI: 10.1002/oby.21532] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 02/27/2016] [Accepted: 03/25/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Independent and joint impacts of maternal race/ethnicity and obesity on adverse birth outcomes, including pre-eclampsia, low birth weight, and macrosomia, were characterized. METHODS Retrospective cohort study of all 2007 California births was conducted using vital records and claims data. Maternal race/ethnicity and maternal body mass index (BMI) were the key exposures; their independent and joint impact on outcomes using regression models was analyzed. RESULTS Racial/ethnic minority women of normal weight generally had higher risk as compared with white women of normal weight (e.g., African-American women, pre-eclampsia adjusted odds ratio [aOR] 1.60, 95% confidence interval [CI]: 1.48-1.74 vs. white women). However, elevated BMI did not usually confer additional risk (e.g., pre-eclampsia aOR comparing African-American women with excess weight with white women with excess weight, 1.17, 95% CI: 0.89-1.54). Obesity was a risk factor for low birth weight only among white women (excess weight aOR, 1.24, 95% CI: 1.04-1.49 vs. white women of normal weight) and not among racial/ethnic minority women (e.g., African-American women, 0.95, 95% CI: 0.83-1.08). CONCLUSIONS These findings add nuance to our understanding of the interplay between maternal race/ethnicity, BMI, and perinatal outcomes. While the BMI/adverse outcome gradient appears weaker in racial/ethnic minority women, this reflects the overall risk increase in racial/ethnic minority women of all body sizes.
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Affiliation(s)
- Jonathan M Snowden
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
- School of Public Health, Oregon Health & Science University/Portland State University, Portland, Oregon, USA
| | - John F Mission
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nicole E Marshall
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Brian Quigley
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Elliott Main
- California Maternal Quality Care Collaborative (CMQCC), Stanford, California, USA
| | | | - Judith H Chung
- University of California, Irvine Medical Center, Orange, California, USA
| | - Aaron B Caughey
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, Oregon, USA
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Bladen M, Main E, Khair K, Hubert N, Koutoumanou E, Liesner R. The incidence, risk and functional outcomes of intracranial haemorrhage in children with inherited bleeding disorders at one haemophilia center. Haemophilia 2016; 22:556-63. [DOI: 10.1111/hae.12938] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Affiliation(s)
- M. Bladen
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - E. Main
- Institute of Child Health; University College London; London UK
| | - K. Khair
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - N. Hubert
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
| | - E. Koutoumanou
- Institute of Child Health; University College London; London UK
| | - R. Liesner
- Great Ormond Street Hospital for Children NHS Foundation Trust; Haemophilia Centre; London UK
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Gilbert W, Abreo A, McNally C, Poeltler D, Main E. 506: Variation in transfusion rates and Maternal Levels of Care: Implications for quality indicators and the measurement of Severe Maternal Morbidity (SMM). Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2015.10.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Douglas H, Ledger S, Main E, Rand S, Giardini A, Aurora P. 322 A case of asymptomatic exercise and Wolff–Parkinson–White syndrome: Physio's be aware! J Cyst Fibros 2015. [DOI: 10.1016/s1569-1993(15)30496-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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38
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Bladen M, Khair K, Koutoumanou E, Leisner R, Hubert N, Main E. The incidence, risk and functional outcomes of intracranial haemorrhage in children with inherited bleeding disorders. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rand S, Prasad S, Main E. New incremental field step-test (iSTEP) is valid and feasible in measuring near maximal exercise performance in children with cystic fibrosis. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.1777] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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40
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Alderson L, Main E, Kemp J. Development of gender specific paediatric gait centiles for interpretation of objective gait analysis in the clinical setting. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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41
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Omar A, Main E, Rand S. EzPAP®: the effects of increasing gas flow and the alteration of breathing pattern on airway pressures, flows and volume. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.2049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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42
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Kemp J, Main E, Alderson L. The importance of multi-speed gait analysis in paediatrics. Physiotherapy 2015. [DOI: 10.1016/j.physio.2015.03.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lee V, Darney B, Snowden J, Main E, Gilbert W, Chung J, Caughey A. 881: Term elective induction of labor and risk of cesarean delivery in nulliparous obese women. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Robles D, Blumenfeld Y, Lee H, Gould J, Main E, Profit J, Melsop K, Druzin M. 464: Opportunities for maternal transport of pregnancies at risk for delivery of VLBW infants – results from the california maternal quality care collaborative. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Snowden J, Marshall N, Darney B, Main E, Gilbert W, Chung J, Caughey A. 573: Obesity, height, and race/ethnicity: joint effects on cesarean delivery. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Snowden J, Darney B, Cheng Y, Marshall N, Main E, Gilbert W, Chung J, Caughey A. 322: Maternal obesity and perinatal outcomes: does the definition of obesity matter? Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Akinlabi K, Main E, Garrod R, Harvey A. S28 Neuromuscular electrical stimulation (NMES), a new strategy in the pulmonary rehabilitation of patients with severe and very severe MRC 4 and 5 Chronic Obstructive Pulmonary Disease (COPD): Abstract S28 Table 1. Thorax 2013. [DOI: 10.1136/thoraxjnl-2013-204457.35] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mitchell C, Lawton E, Morton C, McCain C, Holtby S, Main E. California Pregnancy-Associated Mortality Review: Mixed Methods Approach for Improved Case Identification, Cause of Death Analyses and Translation of Findings. Matern Child Health J 2013; 18:518-26. [DOI: 10.1007/s10995-013-1267-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bladen M, Main E, Hubert N, Koutoumanou E, Liesner R, Khair K. Factors affecting the Haemophilia Joint Health Score in children with severe haemophilia. Haemophilia 2013; 19:626-31. [PMID: 23534671 DOI: 10.1111/hae.12108] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2013] [Indexed: 11/30/2022]
Abstract
Joint damage from bleeding episodes leads to physical or functional limitations in people with haemophilia. Various factors may influence the frequency and severity of joint damage. This study examined whether age, prophylaxis, history of high-titre inhibitors (HTI) and bleeding events influenced the Haemophilia Joint Health Score (HJHS) in children. Medical and physiotherapy notes of boys with severe haemophilia, aged 4-18 years, were reviewed to identify factors associated with increased HJHS. The HJHS of 83 boys (median age: 11) ranged from 0 to 25, with 44/83 (53%) having a score of zero. The median HJHS was 0 (mean 2.6). In the non-HTI group, the HJHS for boys on late prophylaxis was 2.68 times higher than those who started early and the HJHS was on average 10% higher for every additional recent bleed. In this group the odds of having a zero score fell by 30% for every year increase in age. Boys with a history of HTI had higher HJHS scores than the non-HTI group, and age, number of recent bleeds and tolerized status were positively associated with HJHS. The score rose on average by 28% for every year of age and by 76% for non-tolerized boys. This study provides further evidence supporting early prophylaxis use and the importance of immune tolerance therapy. The HJHS is a useful tool for identifying and tracking changes in joint health with respect to therapy or disease progression. With improvements in haemophilia treatment, the disproportionate number of zero scores will continue to make interpretation of the HJHS challenging.
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Affiliation(s)
- M Bladen
- Haemophilia Centre, Great Ormond St Hospital for Children, NHS Foundation Trust, London, UK.
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