cascare, to fall] The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We developed clinical cascades for 6 common neonatal conditions then utilized these to assess 23 health facilities in Kenya and Uganda at 2 time-points in 2016 and 2017. Across the 2 time-points, there was wide variability in the availability of durable goods (range: 491%; S1 Table) and consumable supplies (range: 1796%; S2 Table). Overall, the cascade model estimated mean readiness of 27% (SD: 23) in 2016 and 26% (SD: 28) in 2017 across the 3 stages of care for all 6 conditions. k Guidelines are needed to help providers assess risk of severe hyperbilirubinemia and determine treatment threshold (not assessed in this study). In addition, the neonatal cascades provide detailed information about when and where readiness loss occurs. Measuring emergency obstetric readiness according to the clinical cascades provides a more nuanced picture of where readiness is lost for emergency care; cascade estimates support targeted strategies for closing gaps in critical emergency obstetric supplies. Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health, Postnatal care: Increasing coverage, equity, and quality. We calculated changes in resource availability over time by facility using McNemars test. The end result of the cascade is the production of fibrin, a protein that binds platelets and other materials in a stable clot. c Calculated as the number of admissions to NSCU per month, averaged over 12 months (September 2016 to August 2017), by facility level. These data are from 23 facilities in two regions within two countries of East Africa, which limits generalizability to all LMIC contexts. In Kenya, facilities included 1 county referral hospital, 10 sub-county hospitals, 2 mission hospitals, and 4 health centers. Within each clinical cascade, readiness for individual supplies required the simultaneous presence of all preceding supplies in that cascade. Then, unfortunately, I have to burst their bubbles and say, Okay, great, you get it. Notably, the signal function approach is subject to limitations and recommendations for alternative approaches have led researchers to the rethink the analysis of capacity. Serum bilirubin measurement is preferred (in facilities with laboratory capacity). Linas BP, Barter DM, Leff JA, Assoumou SA, Salomon JA, Weinstein MC, et al. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. The facility assessment data did not require individual informed consent. A waterfall cascades down the cliff from the hills. Department of Pediatrics and Child Health, Maseno University, Maseno, Kenya, 6 Accessed 3 Nov. 2022. Clinical/OVC Collaboration: OVC Program Contribution to Index Testing . Berry KM, Parker W, Mchiza ZJ, Sewpaul R, Labadarios D, Rosen S, et al. The coagulation cascade. Health Statistics and Information Systems, World Health Organization. In the sub-analysis of health clinics, we excluded items that are not expected to be available at this level of facility [37]. Clinical case management involves 13 distinct activities, including engagement of the patient, assessment, planning, linkage with resources, consultation with families, collaboration with psychiatrists, patient psychoeducation, and crisis intervention. In Kenya and Uganda, annual neonatal mortality rates have slowly decreased over the last decade, but remain high at 21 and 20 deaths per 1,000 live births, respectively (2017) [34]. Careers, Johns Hopkins School of Public Health, UNITED STATES. Most learners are quick to comprehend my mnemonic because it helps explain the coagulation cascade " and it soothes their frustration for a bit because it makes sense and they actually understand it. Razavi Nejad M, Eskandari Z, Heidarzadeh M, Afjeh A, Almasi-Hashiani A, Akrami F. Assessing staff-oriented care with developmental support approach in Iranian NICUs, Strategies for neonatal developmental care and family-centered neonatal care. Readiness was defined by the presence of all required supplies/drugs for each clinical cascade and stage of care, and overall across the 3 stages for all 6 conditions. b Caffeine citrate (preferred) or aminophylline is required to help prevent and treat apnea in preterm infants. A dictionary of more than 150 genetics-related terms written for healthcare professionals. By precisely identifying the timing and location of readiness loss, by stage or clinical condition, the cascades could help guide resource allocation decisions and facilitate provision of available, evidence-based interventions to reduce neonatal morbidity and mortality [7]. Determining the physical readiness of facilities to identify and manage complications is an essential component of strategies to reduce neonatal mortality. MedicineNet does not provide medical advice, diagnosis or treatment. By the end of the training, participants will be able to: Describe the important role of index testing as an HIV case finding strategy for children and adolescents living with HIV . To spill over, especially rapidly. Sacks E, Masvawure TB, Atuyambe LM, Neema S, Macwangi M, Simbaya J, et al. Work Environment: Residential Treatment Center. Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, California, United States of America. Something, such as lace, thought to resemble a waterfall or series of small waterfalls, especially an arrangement or fall of material. New Delhi; 2017. cascade: [verb] to fall, pour, or rush in or as if in a cascade. We thank Ryan Keating, Rikita Merai, and Elizabeth Butrick at the University of California San Francisco for overseeing monitoring, evaluation, and program management for the broader work of the Preterm Birth Initiative in Kenya and Uganda. c Term (size 1) masks are required for normal-weight infants and preterm (size 0) masks are required for infants weighing <2500g [36]. Institute of Global Health Sciences, University of California San Francisco, San Francisco, California, United States of America, 3 All statistical analyses were carried out using Stata 15.1 (StataCorp LP, College Station, Texas, United States of America). Dickson KE, Simen-Kapeu A, Kinney M V., Huicho L, Vesel L, Lackritz E, et al. In medicine, a cascade effect may also refer to a chain of events initiated by an unnecessary test, an unexpected result, or patient or physician anxiety, which results in ill-advised tests or treatments that may cause harm to patients as the results are pursued. Since the dataset had fewer than 100 observations or data were not normally distributed, non-parametric statistics with two-sided tests of significance were used for all analyses. HHS Vulnerability Disclosure, Help Specifically, the complement system causes the lysis (bursting) of foreign and infected cells, the phagocytosis (ingestion) of foreign particles and cell debris, and the inflammation of surrounding . Received 2018 Jul 16; Accepted 2018 Oct 25. We estimated overall mean readiness and readiness loss across all conditions and stages. More than 20 proteins are involved in the process, but no cells are in the cascade itself. Waiswa P, Nyanzi S, Namusoko-Kalungi S, Peterson S, Tomson G. I never thought that this baby would survive; I thought that it would die any time: perceptions and care for preterm babies in eastern Uganda, Respectful maternal and newborn care: building a common agenda, Newborn Individualized Developmental Care and Assessment Program (NIDCAP)Family-centered developmentally supportive care. Researchers (MM, HN, GMN, GN, PW, PO, DW) then developed and refined lists of essential supplies, including drugs, needed at each stage of the facility readiness cascades: identification of the condition/emergency (stage 1), treatment (stage 2), and monitoring and modifying treatment as clinically indicated (stage 3). It is a frustrating concept - one that requires patience both to learn and to teach. Deaths in the neonatal period are responsible for 45% of all deaths in children under age 5, with preterm birth being the leading cause [1]. Tunalp , Were W, MacLennan C, Oladapo O, Glmezoglu A, Bahl R, et al. Informed by Potter and Broughs capacity pyramid and based on the obstetric emergency cascade [24,33], we aimed i) to develop clinical cascades to evaluate facility readiness to care for small, sick neonates and ii) to utilize these to assess 23 health facilities in Kenya and Uganda. Across all cascades and stages, there was an increasingly consistent pattern of 30% (SD: 5) to 32% (SD: 2) overall readiness loss, with moderate variability in how loss occurred across stages (SD across stages: 2023; Table 4). Clinical trial/clinical research capabilities for 'CASCADE' protocols: The UG1 Clinical Sites should represent a self-organized consortium of clinicians and/or clinical investigators with expertise and experience in providing clinical care or cancer prevention services to patients and/or communities in collaborative, multi-institutional . This resource was developed to support the comprehensive, evidence-based, peer-reviewed PDQ cancer genetics information summaries. Readiness was consistently highest for essential newborn care. James W. Mold, M.D., and Howard F. Stein, Ph.D. At the monitoring-modifying stage, a significant difference was only identified for essential newborn care (2016: 38% vs. 7%; Table 5). Using the cascade model, we found that overall readiness for neonatal care was 26% among the 23 facilities at both time-points. Keep scrolling for more. This aggregate measure could be used to monitor and compare readiness at the facility-, health system-, or national-level. Therefore, hemostasis means to . complement, in immunology, a complex system comprising a large number of proteins that act in concert to help eliminate infectious microorganisms. In practice, this often happens when prescribers attribute patients' new signs or symptoms to a medical condition rather than a medication side effect. Cascade: A sequence of successive activation reactions involving enzymes (enzyme cascade) or hormones (hormone cascade) characterized by a series of amplifications of an initial stimulus. d Figure reflects data from all 6 Ugandan facilities and 1 of the 2 Kenyan facilities with a functional NSCU; these data are not routinely collected in Kenyan facilities below the county level. Among the 17 Kenyan facilities, 6 had 1 general doctor, 6 had 1 clinical officer, and 5 had only nurse midwives working in neonatal care. Strengths and limitations of this study. Pediatricians were only available at 2 (9%) facilities, both of which were regional- or district-level hospitals in Uganda. The effectiveness and efficiency of the presented pseudo cascade learning framework were validated for breast cancer treatment normalization in clinical text. Globally, there were 2.7 million neonatal deaths in 2015 [1]. cade ( kas-kd' ), 1. The site is secure. Prabhakar P, Srivastava R. Care of small and sick newborns in special newborn care units (SNCUs) of India: Two year report, April 2013March 2015. Staff recorded the presence or absence of items during facility assessments using a mobile application tool on the OpenDataKit platform (https://opendatakit.org). Among the 5 regional/district/county level facilities, the cascade model estimated mean readiness of 43% (SD: 32) in 2016 and 29% (SD: 28) in 2017 across all stages and conditions (S3 Table). Data collectors verbally inquired with a pharmacist or other pharmacy staff member to determine the availability of drugs. Salam RA, Mansoor T, Mallick D, Lassi ZS, Das JK, Bhutta ZA. The coagulation cascade, or secondary hemostasis, is a series of steps in response to bleeding caused by tissue injury, where each step activates the next and ultimately produces a blood clot. government site. Craig JW, Glick C, Phillips R, Hall SL, Smith J, Browne J. When Manny Machado launched the second in the fifth inning alone, seven pitches after Jurickson Profars three-run shot, Scherzer left to New Yorks ultimate show of tough love with a, In normal times, the prospect of minimum wage increases in states and cities around the country would bring a, Sling last raised prices in 2019, but this years changes come after a, From our third camp, in a massive grove of ponderosas, Cathleen and I run a trail two miles downriver, through forest, meadow and sage, before turning up Loon Creek, which pours forth from the mountains in a turquoise, Officials have warned that energy hoarding could lead to a, Neuroscientist Julie Stamm, a clinical assistant professor in the Department of Kinesiology at the University of Wisconsin-Madison, describes it as a, Saab was able to capture the essence of full-length feathers that, Put yours in a hanging pot that allows the succulent's vines to, Flooding has swept parts of southern Utah in and around Moab and Zion throughout the summer, causing streams of water to, Their figurative daughters got that and more challenges and accolades and remuneration that continue to, Streamlined and efficient processes that eliminate all slack and downtime now mean unforeseen disruptions can quickly, The 164-footer sports a collection of asymmetric aft decks that, But financial regulators and experts say the measures impact would, Post the Definition of cascade to Facebook, Share the Definition of cascade on Twitter, 'Dunderhead' and Other Nicer Ways to Say Stupid, 'Pride': The Word That Went From Vice to Strength. These example sentences are selected automatically from various online news sources to reflect current usage of the word 'cascade.' 4. a. Further, we compared the readiness of facilities with a functional newborn special care unit (NSCU) to those without using the two-sample test of proportions. Slusher T, Vaucher Y, Zamora T, Curtis B. Essential childbirth and postnatal interventions for improved maternal and neonatal health, Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 19802015: a systematic analysis for the Global Burden of Disease Study 2015. Measure DHS Service Provision Assessment Survey: Inventory Questionnaire. For example, a provider can effectively treat a sick neonate requiring immediate care only when all resources needed to identify and treat the underlying condition are simultaneously present in the facility. circumstances that cascaded into a crisis. f A clean cloth (may be brought by the mother), sized approximately 1 square meter, may be folded and securely tied to function as a KMC support wrap/binder. Protein C is activated in a sequence that starts with Protein C and thrombin binding to a cell surface protein thrombomodulin. Cascade: A sequence of successive activation reactions involving enzymes (enzyme cascade) or hormones (hormone cascade) characterized by a series of amplifications of an initial stimulus. b NSCUs are expected to provide feeding support for small and sick infants (including IV fluids and nasogastric tubes); infection prevention and management (including antibiotics); oxygen therapy (with pulse oximetry); phototherapy; incubators or radiant warmers; and space for neonatal resuscitation and KMC. This contrasts with discrete processing models which require full sequential completion of each stage of the process. Gender-based violence is widespread and is a barrier to HIV treatment adherence and retention To help address this gap, the cascade model provides an intuitive set of overall, condition-specific, and health system readiness indicators for basic and comprehensive levels of newborn care. [ kas-kd] a series of steps or stages (as of a physiological process) that, once initiated, continues to the final step because each step is triggered by the preceding one, resulting in amplification of the signal, information, or effect at each stage. No significant changes in the availability of consumable supplies by facility were identified (S2 Table). Using this tool, data collectors could also record any additional notes of interest. The cascade model assesses the physical readiness of facilities to provide newborn care, but it does not assess human resource availability or healthcare providers skills. Feeding and Fluids in the Premature and Sick Newborn in the Low-Middle Income Countries In: zdemir , editor. Patients with complement deficiencies encounter clinical problems that depend on the role of the specific complement protein in normal function. Although 87% of facilities had ampicillin (or penicillin) and 78% had gentamicin (S2 Table), far fewer had the resources to identify infections and accurately administer first-line antibiotics (13% stage 2 readiness; Table 3; Figs Figs22 and and44). There was mild to moderate variability in the timing of readiness loss, with the majority occurring in the identification stage. Comparatively, the obstetric cascade study found increased variability in timing of readiness loss. The cascade model estimated mean readiness of 26.326.6% across the 3 stages for all conditions. In 2012, new signal functions were proposed for routine and emergency newborn care, including KMC, IV fluids, cup feeding, oxygen, antibiotics, and PMTCT [18]; however, these have not been widely adopted globally. Across all 6 cascades, mean readiness loss by stage ranged from 4349% for identification, 3140% for treatment, and 1213% for monitoring-modifying treatment (Table 4). Major mortality reduction could be achieved by improving care in low- and middle-income countries (LMIC) [25]. Conversely, some of these interventions also carry a risk of harm when administered by inadequately trained staff or without proper equipment. Remember that Tylenol PM contains diphenhydramine (a highly anticholinergic medication . In 2017, mean readiness was 57% (SD: 24) in the identification stage, 17% (SD: 14) in the treatment stage, and 4% (SD: 6) in the monitoring-modifying stage. Potter and Brough emphasized that the key components of a functioning health system (i.e., facility/staff, skills, tools) are hierarchical in nature, and depend greatly upon the availability and functionality of each other [24,25]. MeSH terms Family Holistic Health This is an open access article distributed under the terms of the, GUID:F85D752D-9832-45C9-A892-41A472DB4918, GUID:1EEE6FB0-ADFA-468C-8052-E816CC83975F, GUID:250F4A28-205C-43EC-AFC6-80A880288E0C, GUID:33DB1A35-4905-47CD-B314-5D4A5A46CA13, GUID:5BFADC56-5211-48DF-8AF9-27E757942CB6, GUID:308D045B-E5AE-4A26-82DA-2EF9B3C67092, GUID:AD6F57D5-9654-47C8-A3C7-F767911953CB, GUID:170A7ABE-5947-4BAC-9F44-FCFBD8B31BA8. 2. One study found that women who experience discrimination or abuse during childbirth are less likely to seek facility-based delivery care in the future [61]; such experiences may also deter postnatal care-seeking [12]. Variability was summarized using the absolute range and SD since resource availability varied greatly. Estimated preterm birth rates are 12% for Kenya and 14% for Uganda [35]. The complement cascade is a complex series of molecular events that results in the permeabilization of microbial membranes. See cascade screening centres below. New Delhi; 2014. We obtained ethical approval from the Institutional Review Boards of Makerere University, the Uganda National Council for Science and Technology, the Kenya Medical Research Institute, and the University of California San Francisco. Later prescriptions increase the risk of further side effects, drug interactions, and patient harm. Cascade processing occurs in information processing when later stages of a process are completed before earlier stages have been completed. It is a process that involves multiple interlinked steps. Finally, we thank Damien Scogin (dls4.com) for his skillful design of the cascade figures and his intuitive ability to visually display the key messages arising from the data. In 2009, EOC was replaced by Emergency Obstetric and Newborn Care (EmONC), and the list of signal functions was expanded to include neonatal resuscitation (with a bag and mask) at facilities providing basic or comprehensive levels of care [16]. Means were used to estimate overall readiness and loss of readiness because these measures were based on few observations, thus medians would not accurately capture the range of observations. Every Newborn: Health-systems bottlenecks and strategies to accelerate scale-up in countries, Guidelines for Monitoring the Availability and Use of Obstetric Services, Monitoring emergency obstetric care: a handbook. As a result, a few variables necessary for complete modeling of the essential newborn care, infection-convulsions, and jaundice cascades were not available. Morgan M, Maina B, Waiyego M, Mutinda C, Aluvaala J, Maina M, et al. We described facility characteristics and neonatal care variables with standard descriptive statistics, including mean, standard deviation (SD), median, interquartile range (IQR), frequency, and proportion. Data collectors confirmed the presence and functionality of items located in neonatal units, labor rooms, and maternity wards through visual identification. We conducted facility assessments at two time-points, approximately nine months apart, in 2016 and 2017, to determine if any changes in supply availability occurred over time. Further, facilities with a NSCU had significantly increased treatment readiness for essential newborn care, poor feeding-hypothermia, respiratory distress-apnea, and infection-convulsions, relative to facilities without a NSCU. 2. 65. Strengthening Newborn Health and Prevention of Birth Defects: Report of the South-East Asia Regional Network Meeting. https://www.thefreedictionary.com/cascade, At the second degree it forms a perpendicular, Withdrawing my hand when another hand already stretcheth out to it; hesitating like the, So now Della's beautiful hair fell about her, rippling and shining like a, In the midst of the grove was a fine lawn, sloping down towards the house, near the summit of which rose a plentiful spring, gushing out of a rock covered with firs, and forming a constant, This ledge formed a flat spot, above which a beautiful, At a less advanced season of the year the typhoon, according to a famous meteorologist, would have passed away like a luminous, The jets d'eau , which were regarded as wonderful in 1653, are still so, even at the present time; the, On either side it appeared hemmed in by steep and green acclivities, which, uniting near the spot where I lay, formed an abrupt and semicircular termination of grassy cliffs and precipices hundreds of feet in height, over which flowed numberless small, Far below, the river frothed and flowed over pebbly shallows, or broke tumultuously over boulders and, Some came rushing down gullies and ravines; others tumbled in crystal, "Morning glory vines cascaded over old-fashioned bamboo lattices". 1702, in the meaning defined at intransitive sense, French, from Italian cascata, from cascare to fall, from Vulgar Latin *casicare, from Latin casus fall. This study has several limitations. Notably, poor-quality care is now considered to be a greater barrier to mortality reduction in LMICs than insufficient access [56]. This is likely related to the fact that 100% of Ugandan facilities had a functional NSCU, whereas nearly 90% of Kenyan facilities did not. explained netflix time x young pussy galle x young pussy galle Signal functions for emergency obstetric care as an intervention for reducing maternal mortality: a survey of public and private health facilities in Lusaka District, Zambia. Among the 17 Kenyan facilities, overall mean readiness was 23% (SD: 23) in 2016 and 22% (SD: 28) in 2017 (S4 Table). Why I Teach the Coagulation Cascade. g Ballard, Dubowitz, or simplified postnatal gestational age assessment tool is required to calculate gestational age when last menstrual period (LMP) is unavailable, unreliable, or incongruent with appearance. We identified increased overall readiness among facilities with a NSCU compared to those without. Mean readiness ranged from 11.6% (respiratory distress-apnea) to 47.8% (essential newborn care) across both time-points. Ameh C, Msuya S, Hofman J, Raven J, Mathai M, van den Broek N. Status of Emergency Obstetric Care in Six Developing Countries Five Years before the MDG Targets for Maternal and Newborn Health. In Uganda, facilities included 1 regional referral hospital, 3 district hospitals, and 2 mission/private non-for-profit (PNFP) hospitals. Methods: We utilized the clinical cascade model to estimate emergency readiness for 6 common neonatal conditions of 20 government hospitals in Amhara, Ethiopia. will also be available for a limited time. g Ceftriaxone or cefotaxime is required as a second-line therapy for meningitis and other severe infections not responding to initial antibiotics within 23 days. a Calculated as the number of deliveries per month, averaged over 12 months (September 2016 to August 2017), by facility level. Measure DHS, United States Agency for International Development. Hemostasis is the mechanism that leads to cessation of bleeding from a blood vessel. The complement cascade can be activated via innate or specific immune responses. In line with the WHO guidelines on managing possible serious bacterial infections in young infants when referral is not feasible [51], we replaced IV cannula sets with sterile syringes and needles (for IM injection) in the neonatal infection-convulsions cascade sub-analysis of health clinics. cade (ks-kd) n. 1. This study identified a consistent pattern of 3032% overall readiness loss across cascades and stages, which is comparable to that seen in the obstetric cascade study in Kenya [33]. It begins with trauma to the lining of the blood vessel. Changes in resource availability over time by facility were calculated using McNemars test. The WHO has developed a quality of care framework for pregnant women and newborns in facilities, which highlights the overarching need for both competent human resources and essential physical resources and additionally requires evidence-based practices for routine and emergency care; actionable information systems; functional referral systems; effective communication; respect and dignity; and emotional support [57]. Initial evaluation of patients in clinical situations in which the prevalence of disease is low (6) -Testing in clinical situations in which there is a high prevalence of connective tissue diseases (eg, rheumatology specialty practice) f A weighing scale is required for accurate dosing of antibiotics and other medications. An appeal for better use of health-system output indicators with evidence from Zambia and Sri Lanka. In epidemiology, a clinical case definition, [1] a clinical definition, or simply a case definition [2] lists the clinical criteria by which public health professionals determine whether a person's illness is included as a case in an outbreak investigationthat is, whether a person is considered directly affected by an outbreak. Send us feedback. The HIV treatment cascade was developed as a tool to identify gaps in care delivery and to prioritize resources with the goal of improving public health [2628]. Gabrysch S, Zanger P, Seneviratne HR, Mbewe R, Campbell OMR. A Delphi study suggested that special care, including KMC, feeding support, IV fluids, oxygen, and management of infections and jaundice, could prevent 70% of deaths in preterm neonates [7]. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications, Pocket book of hospital care for children: guidelines for the management of common childhood illnesses, Equipment and drugs for newborn care according to service delivery level, WHO recommendations on postnatal care of the mother and newborn: 2013, WHO recommendations on interventions to improve preterm birth outcomes. Global report on preterm birth and stillbirth (3 of 7)- evidence for effectiveness of interventions. For both groups, readiness was again lowest for respiratory distress-apnea (27% and 3%, respectively) and highest for essential newborn care (54% and 39%, respectively; Table 5). Count every newborn; A measurement improvement roadmap for coverage data. Tertiary facilities offering neonatal intensive care are expected to additionally provide CPAP, mechanical ventilation, surfactant therapy, and 24-hour laboratory support [8]. In contrast to health facility inventories and signal functions widely used to evaluate EmONC capacity [16,44,45], the cascades pragmatically assess and quantify a facilitys capacity to identify and manage six common neonatal conditions. Notably, the third stage (monitoring-modifying treatment) of each cascade includes one or more guidelines related to newborn care practices, e.g., referral of sick newborns; however, few previous studies assessing facility readiness for EmONC have utilized clinical guidelines as tracer items [33,47,68]. Overall mean readiness was increased at the 6 Ugandan facilities, ranging from 32% (SD: 28) in 2016 to 39% (SD: 31) in 2017 (S4 Table). 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