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Frontiers in Pediatrics 2023The World Health Organization's Expanded Immunization Program was established in 1974 and aimed to provide vaccines to children all over the world. Since the inception...
Missed opportunities for immunization among children 0 to 11 months of age that were attended to at debre tabor comprehensive specialized hospital, south gondar zone, Ethiopia.
BACKGROUND
The World Health Organization's Expanded Immunization Program was established in 1974 and aimed to provide vaccines to children all over the world. Since the inception of this program, numerous initiatives and campaigns have been launched, and millions of children around the world have been saved from death. Many vaccine-preventable diseases, however, remain prevalent in developing countries. This is because most of those countries have low immunization coverage for an unknown number of reasons. As a result, the goal of this study was to examine missed opportunities for immunization among children aged 0 to 11 months.
METHODS
A cross-sectional survey was carried out from May to August 2022. A structured questionnaire was used to collect data, and the sample was chosen using a simple random sampling technique. Before being entered into the Epidata and exported to the Statistical Package for Social Science for analysis, the data were checked for consistency and completeness. The statistical significance was determined using binary and multiple logistic regression analyses. The statistical level of significance was established at ≤ 0.05.
RESULT
In this study, 49.1% of immunization opportunities were missed. Education status [AOR = 2.45, 95% CI = 2.14, 4.22], rural residence [AOR = 4.32, 95% CI = 3.11, 6.38], and perception of caretakers [AOR = 2.13, 95% CI = 1.89, 4.07] were associated with the missed opportunity of immunization.
CONCLUSION
When compared to previous studies, the proportion of missed immunization opportunities was high in this study. The healthcare staff should be applying the multi-dose vial policy, which is recommended by the World Health Organization to increase the services. The doses for BCG and measles should be minimized to lower doses per vial in order to conduct immunization without having to wait for enough children and without worrying about vaccine waste. All infants who visit the hospital should be linked to immunization services.
PubMed: 37181432
DOI: 10.3389/fped.2023.1169328 -
BJOG : An International Journal of... Oct 2009Misoprostol, although originally introduced as a therapy for gastric ulcers, is now widely used in reproductive health. For some indications it is now the optimal... (Review)
Review
Misoprostol, although originally introduced as a therapy for gastric ulcers, is now widely used in reproductive health. For some indications it is now the optimal choice, whilst for others it provides an important alternative, especially in low-resource settings. The optimal dose varies widely from 20 to 600 mcg depending on the indication and gestation. Use of the correct dose is important, too low a dose will be ineffective and overdosage can be dangerous for mother and baby. Evidence-based information about the safest regimens for multiple pregnancy indications are therefore provided in this review.
Topics: Abortion, Incomplete; Abortion, Induced; Abortion, Missed; Evidence-Based Medicine; Female; Fetal Death; Humans; Labor, Induced; Misoprostol; Obstetrics; Oxytocics; Postpartum Hemorrhage; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Preoperative Care
PubMed: 19740175
DOI: 10.1111/j.1471-0528.2009.02329.x -
British Journal of Medicine and Medical... 2015In 2012, reported pertussis reached the highest number of cases (48,277) in the United States since 1955.
BACKGROUND
In 2012, reported pertussis reached the highest number of cases (48,277) in the United States since 1955.
OBJECTIVES
Estimate the prevalence of children who missed the fourth dose of DTaP (Diphtheria and Tetanus toxoids and acellular Pertussis vaccine) by parents' confidences in vaccines and influences from providers, the timeliness of the first through the third dose of DTaP, and selected socio-demographic characteristics; identify the significant risk factors for non-receipt of the fourth dose of DTaP; and evaluate the unadjusted and adjusted risk ratios for missing the fourth dose of DTaP.
METHODS
Data from 16,919 children 19-35 months living in the United States included in the 2011 National Immunization Survey were analyzed. Weighted categorical data analysis and multivariable regression in the context of complex sample survey were applied to assess the prevalence and to determine the independent risk factors.
RESULTS
Overall, 14.7% of children missed the fourth dose of DTaP. Children who were late in receiving the third dose of DTaP had significantly higher risk of missing the fourth dose of DTaP than children who were on-time in receiving the third dose of DTaP (adjusted risk ratio (RR) 2.48; 95%CI (1.92, 3.20)). The risk of missing the fourth dose of DTaP was 62% higher among children whose parents reported they didn't have a good relationship with their child's health-care providers than children whose parents reported having good relationship. Compared with the risk of missing the fourth dose of DTaP among children whose parents were confident in the value of vaccines, the risk was significantly higher for the children whose parents lacked confidence (adjusted RR 1.41; 95%CI (1.05, 1.89)).
CONCLUSIONS
Timeliness in receiving the first through the third dose of DTaP, influences from providers, and parents' confidence in the value of vaccines are the five significant risk factors for missing the fourth dose of DTaP vaccination. They are all modifiable. Future interventions to improve parental relationships with providers and attitudes toward vaccines could help improve pertussis vaccination coverage.
PubMed: 32337176
DOI: 10.9734/BJMMR/2015/16117 -
Clinical Therapeutics Jan 2008Approximately 3 days a month, some 15% to 20% of patients with hypertension do not recall having taken their antihypertensive medication. Individuals with this frequency... (Randomized Controlled Trial)
Randomized Controlled Trial
Ambulatory blood pressure-lowering effects of valsartan and enalapril after a missed dose in previously untreated patients with hypertension: a prospective, randomized, open-label, blinded end-point trial.
BACKGROUND
Approximately 3 days a month, some 15% to 20% of patients with hypertension do not recall having taken their antihypertensive medication. Individuals with this frequency of missed doses may be at increased risk for a cardiovascular event and may have a poorer long-term prognosis.
OBJECTIVE
This study used ambulatory blood pressure monitoring (ABPM) to compare the blood pressure (BP)-lowering effects of valsartan and enalapril over the 24 hours after missing 1 dose in previously untreated patients with mild to moderate essential hypertension.
METHODS
This was a prospective, randomized, open-label, parallel-group, blinded end-point trial in previously untreated patients (age >18 years) with mild to moderate essential hypertension (European Society of Hypertension-European Society of Cardiology guidelines: systolic BP 140-179 mm Hg or diastolic BP 90-109 mm Hg). Patients were randomly assigned to receive 16 weeks of treatment with valsartan 160 mg/d or enalapril 20 mg/d, taken on waking. ABPM was conducted for 48 consecutive hours at baseline and again after 16 weeks of therapy. Patients took a dose of their assigned treatment at the beginning of the final session of ABPM and were instructed to skip the next daily dose.
RESULTS
The study enrolled 148 Spanish patients (84 men, 64 women; mean [SD] age, 45.8 [10.7] years) with previously untreated hypertension. At the end of treatment, there were significant differences between groups during the first 24 hours of ABPM, starting in the final 6 hours of the dosing interval (P < 0.001). There was no significant change in BP reduction between the first and second 24-hour periods of ABPM with valsartan (-2.1/-1.4 mm Hg), whereas enalapril was associated with a significant increase in BP over this period (5.5/3.8 mm Hg; P < 0.001 vs first 24 hours; P = 0.032 vs valsartan).
CONCLUSIONS
In this study in previously untreated patients with mild to moderate essential hypertension, valsartan was associated with a sustained BP-lowering effect beyond the initial 24 hours after dosing, whereas enalapril was not. There was no significant change in the efficacy of valsartan in the 24 hours after a missed dose. At the doses tested, valsartan was more effective than enalapril, both during active treatment and after a missed dose.
Topics: Antihypertensive Agents; Blood Glucose; Blood Pressure; Blood Pressure Monitoring, Ambulatory; Cholesterol; Enalapril; Female; Humans; Hypertension; Male; Medication Adherence; Middle Aged; Prospective Studies; Severity of Illness Index; Tetrazoles; Uric Acid; Valine; Valsartan
PubMed: 18343247
DOI: 10.1016/j.clinthera.2008.01.012 -
Journal of Psychosocial Nursing and... Jul 19921. Missed-dose management, or the handling of a forgotten or omitted dose, is a necessary self-care skill for persistently and severely mentally ill patients. 2. A...
1. Missed-dose management, or the handling of a forgotten or omitted dose, is a necessary self-care skill for persistently and severely mentally ill patients. 2. A missed dose should generally be taken as soon as it is remembered, and doses should not be doubled. 3. Individual drug-specific instructions about missed-dose management are available for antipsychotics, antidyskinetics, and lithium. 4. Teaching patients about missed-dose management as well as the use of reminders to minimize missed doses are important nursing activities.
Topics: Humans; Mental Disorders; Patient Compliance; Patient Education as Topic; Psychiatric Nursing; Self Care
PubMed: 1494996
DOI: 10.3928/0279-3695-19920701-05 -
Cureus Sep 2023Recognizing the symptoms of vincristine-induced peripheral neuropathy (VIPN) earlier is crucial to preventing the persistent neurological sequelae. The treatment of...
INTRODUCTION
Recognizing the symptoms of vincristine-induced peripheral neuropathy (VIPN) earlier is crucial to preventing the persistent neurological sequelae. The treatment of neuropathy is to discontinue the drug, and the effect of a missed dose of vincristine on treatment success is unclear. This study aims to evaluate VIPN in children with malignancy and the effect of skipping vincristine doses on the treatment success of patients at a single center, retrospectively.
METHODS
Medical records of the children with cancer who received vincristine in our institution between 2013 and 2020 were analyzed retrospectively.
RESULTS
Vincristine neuropathy was found in 42 (7%) of 598 pediatric patients who received at least one dose of vincristine during the study period. Neuropathy developed at a statistically significantly lower cumulative dose in patients younger than seven years of age (p=0.04). The mean neuropathy duration of the cases was 8.5 months, and the findings of 40 (95.2%) cases improved. The mean cumulative dose was higher in patients with diffuse nerve involvement. The missed dose of vincristine was lower in the cases in complete remission compared to the other cases and higher doses of vincristine were missed in the stable disease group than in the remission group (p=0.03).
CONCLUSION
VIPN can be encountered in less cumulative doses, mainly in the younger age group. Missed doses of vincristine may affect treatment success, and more comprehensive studies are needed to show this effect more clearly.
PubMed: 37771936
DOI: 10.7759/cureus.46063 -
JAMA Surgery Apr 2014Enoxaparin sodium is widely used for deep vein thrombosis (DVT) prophylaxis, yet DVT rates remain high in the trauma and general surgery populations. Missed doses during...
IMPORTANCE
Enoxaparin sodium is widely used for deep vein thrombosis (DVT) prophylaxis, yet DVT rates remain high in the trauma and general surgery populations. Missed doses during hospitalization are common.
OBJECTIVE
To determine if missed doses of enoxaparin correlate with DVT formation.
DESIGN, SETTING, AND PARTICIPANTS
Data were prospectively collected among 202 trauma and general surgery patients admitted to a level I trauma center.
MAIN OUTCOMES AND MEASURES
Deep vein thrombosis screening was performed using a rigorous standardized protocol.
RESULTS
The overall incidence of DVT was 15.8%. In total, 58.9% of patients missed at least 1 dose of enoxaparin. The DVTs occurred in 23.5% of patients who missed at least 1 dose and in 4.8% of patients who did not (P < .01). On univariate analysis, the need for mechanical ventilation (71.8% vs 44.1%), the performance of more than 1 operation (59.3% vs 40.0%), and male sex (75% vs 56%) were associated with DVT formation (P < .05 for all). A bivariate logistic regression was then performed, which revealed age 50 years or older and interrupted enoxaparin therapy as the only independent risk factors for DVT formation. The DVT rate did not differ between trauma and general surgery populations or in patients receiving once-daily vs twice-daily dosing regimens.
CONCLUSIONS AND RELEVANCE
Interrupted enoxaparin therapy and age 50 years or older are associated with DVT formation among trauma and general surgery patients. Missed doses occur commonly and are the only identified risk factor for DVT that can be ameliorated by physicians. Efforts to minimize interrupted enoxaparin prophylaxis in patients at risk for DVT should be optimized.
Topics: Anticoagulants; Dose-Response Relationship, Drug; Enoxaparin; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Oregon; Prospective Studies; Risk Factors; Surgical Procedures, Operative; Trauma Centers; Treatment Outcome; Venous Thrombosis; Wounds and Injuries
PubMed: 24577627
DOI: 10.1001/jamasurg.2013.3963 -
Avicenna Journal of Phytomedicine 2023To determine whether addition of evening primrose to a misoprostol-based abortion regimen can increase the success of abortion.
OBJECTIVE
To determine whether addition of evening primrose to a misoprostol-based abortion regimen can increase the success of abortion.
MATERIALS AND METHODS
In this randomized clinical trial., 148 women referring to Niknafas Hospital in Rafsanajn with diagnosis of missed abortion were randomly allocated into two 74-subject groups. The intervention group used 2000 mg vaginal evening primrose capsules the night before the hospitalization, while the control group did not receive any medication. Both groups received an initial dose of 800 μg of vaginal misoprostol after admission and the next dose was given three hours later if necessary.
RESULTS
The two groups had significant differences in terms of full abortion, consistency and dilatation of cervix, duration between the first dose of misoprostol until the ejection of fetus, the misoprostol dose administered, and the level of vaginal bleeding during the hospitalization. They had no significant differences regarding curettage, duration of hospitalization, or side effects. The mean pain score had no significant difference between the two groups, though the score was lower in the intervention group (p>0.05).
CONCLUSION
Administration of vaginal evening primrose before vaginal misoprostol was found to be more effective compared to misoprostol alone in missed abortion.
PubMed: 38089421
DOI: 10.22038/AJP.2023.22179 -
Seminars in Cancer Biology Dec 2002Nasopharyngeal carcinoma (NPC) is highly radiosensitive and patients presenting with early disease have a high cure rate after radiotherapy. For patients presenting with... (Review)
Review
Nasopharyngeal carcinoma (NPC) is highly radiosensitive and patients presenting with early disease have a high cure rate after radiotherapy. For patients presenting with locoregionally advanced disease, despite a high initial control rate with radiotherapy, the subsequent failure rates are significant. Concurrent cisplatin-radiotherapy with or without adjuvant chemotherapy have been demonstrated to significantly improve survival and is currently the standard treatment strategy for patients with locoregionally advanced disease. Encouraging phase II trials have been reported on the use of neoadjuvant chemotherapy followed by concurrent chemotherapy-radiotherapy, which may provide the optimal way to deliver chemoradiation in NPC. Improved radiotherapy techniques using intensity modulated methods or three-dimensional conformal methods may further improve local control by reducing geographical misses while preserving normal organ functions.
Topics: Chemotherapy, Adjuvant; Combined Modality Therapy; Dose Fractionation, Radiation; Humans; Immunotherapy; Nasopharyngeal Neoplasms; Salvage Therapy
PubMed: 12450735
DOI: 10.1016/s1044579x02000925 -
JAMA Network Open Jun 2021Venous thromboembolism (VTE) is a common complication of COVID-19. It is not well understood how hospitals have managed VTE prevention and the effect of prevention...
IMPORTANCE
Venous thromboembolism (VTE) is a common complication of COVID-19. It is not well understood how hospitals have managed VTE prevention and the effect of prevention strategies on mortality.
OBJECTIVE
To characterize frequency, variation across hospitals, and change over time in VTE prophylaxis and treatment-dose anticoagulation in patients hospitalized for COVID-19, as well as the association of anticoagulation strategies with in-hospital and 60-day mortality.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study of adults hospitalized with COVID-19 used a pseudorandom sample from 30 US hospitals in the state of Michigan participating in a collaborative quality initiative. Data analyzed were from patients hospitalized between March 7, 2020, and June 17, 2020. Data were analyzed through March 2021.
EXPOSURES
Nonadherence to VTE prophylaxis (defined as missing ≥2 days of VTE prophylaxis) and receipt of treatment-dose or prophylactic-dose anticoagulants vs no anticoagulation during hospitalization.
MAIN OUTCOMES AND MEASURES
The effect of nonadherence and anticoagulation strategies on in-hospital and 60-day mortality was assessed using multinomial logit models with inverse probability of treatment weighting.
RESULTS
Of a total 1351 patients with COVID-19 included (median [IQR] age, 64 [52-75] years; 47.7% women, 48.9% Black patients), only 18 (1.3%) had a confirmed VTE, and 219 (16.2%) received treatment-dose anticoagulation. Use of treatment-dose anticoagulation without imaging ranged from 0% to 29% across hospitals and increased over time (adjusted odds ratio [aOR], 1.46; 95% CI, 1.31-1.61 per week). Of 1127 patients who ever received anticoagulation, 392 (34.8%) missed 2 or more days of prophylaxis. Missed prophylaxis varied from 11% to 61% across hospitals and decreased markedly over time (aOR, 0.89; 95% CI, 0.82-0.97 per week). VTE nonadherence was associated with higher 60-day (adjusted hazard ratio [aHR], 1.31; 95% CI, 1.03-1.67) but not in-hospital mortality (aHR, 0.97; 95% CI, 0.91-1.03). Receiving any dose of anticoagulation (vs no anticoagulation) was associated with lower in-hospital mortality (only prophylactic dose: aHR, 0.36; 95% CI, 0.26-0.52; any treatment dose: aHR, 0.38; 95% CI, 0.25-0.58). However, only the prophylactic dose of anticoagulation remained associated with lower mortality at 60 days (prophylactic dose: aHR, 0.71; 95% CI, 0.51-0.90; treatment dose: aHR, 0.92; 95% CI, 0.63-1.35).
CONCLUSIONS AND RELEVANCE
This large, multicenter cohort of patients hospitalized with COVID-19, found evidence of rapid dissemination and implementation of anticoagulation strategies, including use of treatment-dose anticoagulation. As only prophylactic-dose anticoagulation was associated with lower 60-day mortality, prophylactic dosing strategies may be optimal for patients hospitalized with COVID-19.
Topics: Aged; Anticoagulants; COVID-19; Female; Hospital Mortality; Hospitalization; Humans; Incidence; Male; Middle Aged; Retrospective Studies; SARS-CoV-2; Survival Rate; United States; Venous Thromboembolism
PubMed: 34115129
DOI: 10.1001/jamanetworkopen.2021.11788