<p>Syftet var att genom journalgranskning kartlägga i vilken omfattning identifiering och dokumentation görs av förekomsten av avoidable factors hos skallskadade patienter, av sjuksköterskor på en neurointensivvårdsavdelning (NIVA), samt undersöka överensstämmelsen mellan dokumentation och monitorvärden rörande intrakraniellt tryck (ICP), cerebralt perfusionstryck (CPP), systoliskt blodtryck (SBT) och temperatur som registrerats via övervakningsutrustningen. Dokumentationen gjordes med ledning av en befintlig guideline. Urvalet var konsekutivt och studien innefattade 25 patienter. Antalet bedömningar i studien var totalt 2176 stycken. Vid 85 % av bedömningstillfällena dokumenterade sjuksköterskan i bedömningsformuläret. För ICP, CPP och SBT bedömdes det vid 70-80 % av tillfällena som att inga problem hade funnits och vid 55 % av tillfällena bedömdes det att det inte varit några problem med temperaturen. Det fanns signifikanta skillnader mellan då avvikelser och inga avvikelser var dokumenterade för insulttiden för ICP, samt insulttiden och monitormedelvärde för CPP och temperatur. Med hjälp av guidelines och formulär för att dokumentera avoidable factors kan patienter med sekundära insulter identifieras i stor utsträckning. Insulttiden då värdena avviker från det normala väger in starkare i bedömningen än hur avvikande värdet varit.</p><p>Att vårda skallskadade patienter innebär att<strong> </strong>ständigt väga behovet av omvårdnadsåtgärder mot risken för att det kan leda till sekundära insulter.</p><p> </p>

Syftet var att genom journalgranskning kartlägga i vilken omfattning identifiering och dokumentation görs av förekomsten av avoidable factors hos skallskadade patienter, av sjuksköterskor på en neurointensivvårdsavdelning (NIVA), samt undersöka överensstämmelsen mellan dokumentation och monitorvärden rörande intrakraniellt tryck (ICP), cerebralt perfusionstryck (CPP), systoliskt blodtryck (SBT) och temperatur som registrerats via övervakningsutrustningen. Dokumentationen gjordes med ledning av en befintlig guideline. Urvalet var konsekutivt och studien innefattade 25 patienter. Antalet bedömningar i studien var totalt 2176 stycken. Vid 85 % av bedömningstillfällena dokumenterade sjuksköterskan i bedömningsformuläret. För ICP, CPP och SBT bedömdes det vid 70-80 % av tillfällena som att inga problem hade funnits och vid 55 % av tillfällena bedömdes det att det inte varit några problem med temperaturen. Det fanns signifikanta skillnader mellan då avvikelser och inga avvikelser var dokumenterade för insulttiden för ICP, samt insulttiden och monitormedelvärde för CPP och temperatur. Med hjälp av guidelines och formulär för att dokumentera avoidable factors kan patienter med sekundära insulter identifieras i stor utsträckning. Insulttiden då värdena avviker från det normala väger in starkare i bedömningen än hur avvikande värdet varit. Att vårda skallskadade patienter innebär att ständigt väga behovet av omvårdnadsåtgärder mot risken för att det kan leda till sekundära insulter.

Magister Curationis - MCur / Background: The neonatal period starts at birth and ends 28 days after birth, and is the most defence less period in the newborn's life. Improving newborn health is a priority for the Ministry of Health and Social Services (MoHSS) in Namibia. The national neonatal mortality rate stood at 21.80 per 1000 live births in the country, and Namibia was unable to attain Millennium Development Goal 4 which focused on reduction of the child mortality rate by two-thirds between 1990 and 2015. Aim: This study investigated the factors contributing to neonatal deaths at a national hospital in the Khomas region of Namibia, with the following objectives: (i) to identify causes of early neonatal deaths; (ii) to identify the causes of late neonatal deaths; and (iii) to identify avoidable and unavoidable factors contributing to neonatal deaths. Methodology: The study used a quantitative research approach with a retrospective descriptive design to investigate factors contributing to neonatal deaths. The primary data were collected from a population of 231 record files of all neonates who died during the period 1 January to 31 December 2013 while admitted to the national hospital before 28 completed days of life. Results: The study identified that of the neonates who died, 67.1% (n=155) were early neonatal deaths (during the first 0–7 days of life), while 32.9% (n=76) died during the late neonatal period (from 8–28 days of life). Of the neonates who died, 50.6% (n=117) were male and 48.48% (n=112) were female. The causes of early and late neonatal deaths were similar, although they happened at different stages. The causes of early neonatal deaths have been identified as respiratory distress syndrome (RDS) – 24.2% (n=56); neonatal sepsis – 12.1% (n=28); birth asphyxia – 11.7 % (n=27); congenital abnormalities – 14.7 % (n=34); hemorrhagic diseases of newborns – 3.9% (n=9); and unknown – 0.6% (n=1). Neonatal sepsis caused the highest number of late neonatal deaths 17.7 %,( n=41); followed by RDS – 7.4% (n=17); congenital abnormalities – 3.9% (n=9); birth asphyxia – 3.1% (n=7); birth trauma – 0.4% (n=1); and unknown factors – 0.4 % (n=1). The study revealed that avoidable factors related to healthcare providers had a severe impact on neonatal deaths, while congenital abnormalities were unavoidable factors. Conclusion: The study concluded that most neonatal deaths are related to actions or inactions of the healthcare providers and could be avoided. Recommendations: Based on the results of the study, further research is required to assess the knowledge, skills, and behaviors of the healthcare providers. Training and education about neonatal resuscitation needs to be carried out on a regular basis.

Perinatal audit has been tested and proved an important tool for reduction of perinatal mortality and assessment of quality of perinatal care. At Muhimbili National Hospital (MNH), a tertiary hospital in Dar es salaam, Tanzania we performed a retrospective cross-sectional study using data from an obstetrics database to classify all perinatal deaths during 1999-2003. We also determined the prevalence of anaemia in pregnancy and its impact on perinatal outcome. Furthermore, we conducted a perinatal audit to study potential determinants and causes of perinatal and neonatal deaths and their avoidability. We also assessed the quality of care of patients admitted with eclampsia using a criteria based audit. Stillbirth, early neonatal and perinatal mortality rates (PMR) were 96, 27 and 124 respectively. A large proportion of foetuses (38%) had no audible foetal heart beat on admission at MNH labour ward and the majority of the neonatal deaths were asphyxiated at delivery. The PMR for multiples and singletons were 269 and 118 respectively resulting in a rate ratio of 2.4 (95%CI: 2.1-2.4). The prevalence of anaemia and severe anaemia was 68% and 5.8%, respectively. Severity of anaemia increased the risk of preterm delivery with ORs of 1.4, 1.4 and 4.1 for women with mild, moderate and severe anaemia as compared to women with normal haemoglobin levels. The corresponding risks for LBW and VLBW were 1.2, 1.7 and 3.8, and 1.5, 1.9 and 4.2 respectively. The prevalence of preterm delivery and LBW was 17% and 14% respectively. The hospital-based incidence of eclampsia was 504 per 10,000 women or 5.1 % of all mothers admitted. Suboptimal care were identified on criteria regarding management plan by senior staff, review of the plans by specialist obstetrician, delay on caesarean section, monitoring patients on magnesium sulphate and inadequate use of the laboratory. Two out of three patients requiring operation were not operated within set standards. Birth asphyxia was the main cause of intrapartum fresh stillbirth (47%) and early neonatal deaths (51%), whereas eclampsia (25%) and preeclampsia (8.3%) were main maternal medical conditions. The majority of stillbirths were fresh, indicating foetal demise during labour or just before delivery. The audit study identified suboptimal care in about 80% of audited cases out of which about 50% were found to be the likely cause of the adverse perinatal outcome. Inadequate maternal and foetal monitoring during labour were the main suboptimal factors, though delay in referral and operative interventions were also prominent. Based on these studies, we conclude that: The perinatal mortality (PMR) in this study was higher than the national average. About one in four perinatal deaths at MNH can be attributed to avoidable factors linked to obstetric care Main causes of perinatal and neonatal deaths were intrapartum birth asphyxia, immaturity related and infections            Management of patients in labour needs to be improved Suboptimal care that is essentially avoidable included: inadequate monitoring of patients during labour, delay of care,    e.g. long decision to surgery interval, and delayed referral of patients fromprimary hospitals The prevalence of anaemia in pregnancy was very high; and low birth weight and preterm delivery was independently associated with severity of anaemia The prevalence of eclampsia at MNH was high and the case management needs to be improved

Magister Public Health - MPH / Despite all measures taken by the South African government since 1994, there is a contiuous increase of maternal mortality in the country and the Northwest Province is amongst the highest. Studies to date combining the review of maternal deaths and severe acute maternal morbidity (SAMM) have been conducted primarily in urban areas. The aim of this study was to determine the causes of death and avoidable factors for maternal mortality and severe acute maternal morbidity in a rural regional hospital from 01/01/2005 to 30/04/2006. / South Africa

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.