Comprehensive Medical Management Research Articles

A nationwide survey of Vici syndrome in Japan

BackgroundVici syndrome (VICIS) is a congenital disorder characterized by agenesis of the corpus callosum, cataracts, hypopigmentation, cardiomyopathy, combined immunodeficiency, microcephaly, and failure to thrive. This study aimed to elucidate the number of patients with VICIS, its clinical characteristics and relevant genetic information in Japan. MethodsAfter developing diagnostic criteria for VICIS, we conducted a nationwide questionnaire-based survey of VICIS in Japan. In the initial survey, we investigated the number of VICIS patients who fulfilled definite or probable criteria. The second survey was used to obtain detailed clinical and genetic information of VICIS from institutions that responded to the initial survey. ResultsClinical information was available for 15 patients (12 definite, three probable). As of October 2023, nine patients (60%) were alive and six (40%) had died. All patients presented with developmental delay, agenesis of the corpus callosum, elevated serum aspartate/alanine aminotransferase, hypopigmentation and hypotonia. Developmental delay was profound. Most patients developed recurrent infection, high-arched palate, epilepsy, failure to thrive, and microcephaly. Cardiomyopathy and cataracts, both initially described as principal features in VICIS, were notably uncommon in our study. Based on the information collected, all 14 patients for whom information was available received home medical care: 11 (79%) received tube feeding, three (21%) required noninvasive ventilation, four (29%) required tracheostomy, and four (29%) required home subcutaneous immunoglobulin administration. ConclusionThis study revealed for the first time the nationwide status of patients with VICIS in Japan. The mortality rate of patients with VICIS is as high as 40%, and almost all VICIS patients require various forms of home medical care, necessitating comprehensive management. Additionally, we identified one adult patient, underscoring the need for comprehensive medical management extending into adulthood for patients with VICIS.

The Need for Comprehensive Medical Management in Pyogenic Spondylodiscitis: A Review Article.

The incidence of spontaneous or primary spondylodiscitis has been increasing over the years, affecting the aging population with multiple comorbidities. Several conditions influencing treatment outcomes stand out, such as diabetes mellitus, renal insufficiency, cardiovascular and respiratory dysfunction, and malnutrition. Due to these, the question arises regarding properly managing their current conditions and pre-existing disease states. Treatment plans must consider all concomitant comorbidities rather than just the infectious process. This can be done with the help of multidisciplinary teams to provide comprehensive care for patients with pyogenic spondylodiscitis. To date, there is no article regarding comprehensive medicine for spontaneous pyogenic spondylodiscitis; hence, this paper reviews the evidence available in current literature, recognizes knowledge gaps, and suggests comprehensive care for treating patients with spinal infections. Pre-requisites for implementing multidisciplinary teams include leadership, administrative support, and team dynamics. This group comprises an appointed leader, coordinator, and different subspecialists, such as orthopedic surgeons, infectious disease specialists, internists, rehabilitation doctors, psychiatrists, microbiologists, radiologists, nutritionists, pharmacologists, nurses, and orthotists working together with mutual trust and respect. Employing collaborative teams allows faster time for diagnosis and improves clinical outcomes, better quality of life, and patient satisfaction. Forefront communication is clear and open between all team members to provide holistic patient care. With these in mind, the need for employing multidisciplinary teams and the feasibility of its implementation emerges, showing a promising and logical path toward providing comprehensive care in managing multimorbid patients with pyogenic spondylodiscitis.

Medical Therapy for Peripheral Artery Disease.

Patients with lower extremity peripheral artery disease (PAD) are at high risk for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). This manuscript will review the current evidence for medical therapy in patients with PAD according to different clinical features and the overall cardiovascular (CV) risk. The management of PAD encompasses non-pharmacologic strategies, including lifestyle modification such as smoking cessation, supervised exercise, Mediterranean diet and weight loss as well as pharmacologic interventions, particularly for high risk patients. Benefits for reduction of CV and limb outcomes have been demonstrated for new therapies, including antithrombotic therapy (i.e., low-dose rivaroxaban plus aspirin), lipid lowering therapy (i.e., proprotein convertase subtilisin/kexin type 9inhibitors), and glucose lowering therapy (i.e., sodium-glucose cotransporter-2inhibitors and glucagon-like peptide-1receptor agonists). However, the adoption of these therapies in PAD remains suboptimal in practice. Implementation science studies have recently shown promising results in PAD patients. Comprehensive medical and non-medical management of PAD patients is crucial to improving patient outcomes, mitigating symptoms, and reducing the risk of MACE and MALE. A personalized approach, considering the patient's overall risk profile and preference, is essential for optimizing medical management of PAD.

MediLog: A Pilot Study of Online Management System for Medical Device Status and Loan

Malaysia's medical device industry is experiencing significant growth, with 309,829 devices procured at a cost of RM 7.78 billion and actively utilized in public hospitals nationwide. This surge highlights the need for an advanced medical device management system to efficiently handle the life cycle of these devices to ensure optimal utilization and streamline operations. Other proposed technological solutions like RFID, RTLS, and infrared tags aim to address these challenges, but their high installation costs pose barriers, especially for government hospitals. To overcome these obstacles, this pilot study advocates for a mobile application as a cost-effective alternative for comprehensive medical data management. The proposed application, developed using MIT Apps, capitalizes on portability, ease of management, and the multifunctionality of mobile platforms. A key feature of the application is the barcode scanner, widely employed across industries for enhanced data capture efficiency. The Real-time Database is integrated into the project, facilitating the swift and accurate storage of medical device information. In essence, the mobile application prototype provides a practical solution to the limitations of manual data management in the biomedical department. Leveraging MIT Apps and incorporating features like the barcode scanner and Real-time Database, the application streamlines the updating of machine details, ensuring users access precise and current information. This approach promotes efficiency, accuracy, and effectiveness in medical device management within the healthcare system.

Association of tooth loss and gallstones: National Health and Nutrition Examination Survey 2017-2018.

Introduction: Gallstones are one of the most common digestive diseases globally, with an estimated affected population of 15% in the United States. Our aim is to assess the current association between oral health and gallstones, exploring potential mediation factors. Methods: Self-reported gallstones were determined based on medical condition questionnaires. Dental status was assessed by dental professionals and oral health questionnaire. Mediation analysis was conducted for body mass index, blood glucose, triglycerides, and cholesterol, and the percentage of mediation effects was calculated. Results: We included 444 patients with gallstones and 3565 non-gallstone participants from National Health and Nutrition Examination Survey. After fully adjusting for all covariates, the prevalence of gallstones is higher when the number of missing teeth is at T3 compared to T1 (odds ratio [OR]: 1.93, confidence interval [CI]: 1.14 - 3.26, p = 0.02, p-trend = 0.01), and there was an inverted L-shaped association between missing teeth and gallstones, with an inflection point of 17. Bone loss around mouth was also associated with gallstones (OR: 1.78, 95% CI: 1.27 - 2.48, p = 0.002), but not root caries and gum disease. Mediation analysis identified blood glucose as a crucial mediator, with a mediation effect ratio of 4.91%. Conclusions: Appropriate lifestyle interventions for patients with missing teeth may help delay the onset of gallstones, such as healthy dietary habits, trace elements supplementing, and managing weight and blood sugar levels. Further exploration of the relationship between oral health and overall health contributes to disease prevention and comprehensive medical management.

Mortality benefit with AF ablation: Impact of normal sinus rhythm seen in CABANA and EAST AFnet.

Atrial fibrillation (AF) is significantly associated with morbidity and mortality and erodes the quality and quantity of life. It is standard of care to treat patients with AF and an increased risk of stroke with oral anticoagulation therapy, but the more daunting question many clinicians face is whether to pursue a "rate-only" or "rhythm" control strategy. Historical studies over the years have sought to answer this question but have found no significant difference in major clinical outcomes between the two strategies. There are opportunities based on new data to improve the natural history of the disease. The EAST AFnet trial for the first time revealed a significant morbidity and mortality advantage to rhythm control therapy when performed early in the disease process of AF and in the setting of comprehensive medical management that was maintained. The CABANA trial clearly demonstrated that catheter ablation was a more effective long-term treatment of AF in general and significantly lowers risk of AF progression compared to medical therapy. Like multiple prior trials of rhythm management strategies, when rhythm control was effective in these trials, independent of therapy assignment, there was a significantly lower risk of adverse outcomes and death. These contemporary data provide optimism that the pervasive mortality risk in patients with AF observed over the past 50 years may be improved by the timing, use, and efficacy of use of therapeutic interventions.

Evaluation of Solid Medical Waste Management in Bogor Regional Public Hospitals

Healthcare facilities generate medical waste. If not properly managed, medical waste can damage the environment and spread diseases. Many hospitals in Indonesia do not adhere to medical waste management regulations. This study aimed to evaluate the management of solid medical waste at four public hospitals in Bogor District, Indonesia. A case study design was used to obtain a comprehensive description of the solid medical waste management activities in the hospitals. Data were collected through direct observations, interviews, and document reviews. This study revealed that the medical waste generated in all hospitals was infectious, pathological, pharmaceutical, chemical, and cytotoxic, totaling approximately 4,000-12,000 kg. Hospitals A, B, C, and D fulfilled the Ministry of Environment and Forestry Regulation No. P56 of 2015 criteria, achieving compliance rates of 77%, 83.78%, 83.3%, and 86.48%, respectively. However, several activities of the hospitals did not meet the standards for waste reduction, segregation, on-site transport, temporary storage, and human resource quality. It is important that hospitals establish comprehensive and compliant medical waste management systems.

Role of Metabolic Nutrition in Newborn Screening and Inherited Metabolic Disorders

The expansion of newborn screening (NBS) encompasses a wide range of inherited metabolic disorders, including disorders of carbohydrate, lipid, and protein metabolism. Effective treatment of these disorders requires comprehensive nutrition and medical management. This review highlights the intricacies of medical nutrition therapy for several common metabolic disorders and underscores the crucial role of metabolic dietitians in managing these patients.

The treatment of refractory periorbital dermatitis.

Refractory periorbital dermatitis has a chronic course with exacerbations leading to discomfort and cosmetic issues, yet characterization of treatment options is limited. The objective was to present comprehensive demographic data and medical management of a series of patients with refractory periorbital dermatitis. Retrospective review identified patients treated at a single institution from January 2010 to August 2020. Descriptive analyses were performed. Demographic data and treatment history were reviewed and data including medication, use, date of use and discontinued use, reason for discontinuation (if applicable), refractory status, formulation, concentration, and dose frequency were extracted. Descriptive analyses. Forty-five patients were included. The average age at first diagnosis was 60.3 years (sd 14.9). 82.2% were women and 84.4% identified as Caucasian. Triamcinolone cream was most frequently used followed by tobramycin-dexamethasone, tacrolimus, and neomycin-polymyxin-dexamethasone. Less than 30% of patients on triamcinolone were refractory. 13.3% of patients used topical hydrocortisone, with over 80% of these patients experiencing refractory episodes of persistent irritation and erythema. Most patients were refractory during initial use or the first recurrence of periorbital dermatitis flare. By better characterizing the diverse treatment regimens in a unique subset of refractory patients, we hope to better inform potential courses of medical management for periorbital dermatitis.

More time in a community setting: A service evaluation of the impact of intrathecal drug delivery systems on place of care of patients with cancer pain.

Intrathecal Drug Delivery Systems are underutilised in the management of refractory cancer pain despite evidence of their efficacy. Not all patients who are offered this treatment modality accept it. There is no current evidence that indicates if the use of intrathecal drug delivery systems impacts on place of care for patients with cancer related pain. This service evaluation compared place of care, place of death and morphine equivalent daily dose at end of life for patients in whom Intrathecal Drug Delivery was successfully established versus those who chose comprehensive medical management. A retrospective longitudinal cohort study of 45 patients with cancer pain comparing those who had ongoing analgesia successfully delivered via an implanted Intrathecal Drug Delivery System (n = 28) with those who continued to receive comprehensive medical management (n = 17). There was a markedly greater time spent in the community in the intrathecal group than the medical management group (median 126.5vs 25.5 days; p = 0.002) and a lower morphine equivalent daily dose at end of life (median 127.5vs 440.0 p = 0.022). In patients with advanced cancer, the successful establishment of intrathecal analgesia is associated with more time in the community and a lower morphine equivalent daily dose at end of life. The study has low numbers, and the sample was retrospectively selected. Nevertheless, these findings suggest the initial investment of time in an inpatient setting may be beneficial. Further research is required, using larger, prospective studies of patient outcomes in this setting.

Case Report on Myleomeningiocele with Cerebellar Tonsillar

Myelomeningocele is a form of neural tube abnormality that causes the spinal cord and meninges to protrude through a hole in the spinal column. It is uncommon for myelomeningocele to be associated with cerebellar tonsillar herniation. This instance demonstrates the difficulties in detecting and controlling this comorbid illness. Myelomeningocele with cerebellar tonsillar herniation is a severe congenital disorder involving the protrusion of the spinal cord and meninges through a defect in the vertebral column, accompanied by downward displacement of the cerebellar tonsils. It is associated with significant neurological and physical impairments, requiring comprehensive medical management and rehabilitation. Early diagnosis, intervention, and on-going multidisciplinary care are crucial for individuals affected by this condition to maximize their potential and improve their overall well-being. We present a case of a female child who was admitted to the NICU for further evaluation and management of myelomeningocele. On examination, the child was active with vitals stable. On local examination, swelling is present at the Lumbosacral region of size 5*4 cm. All investigations and septic screens sent reports within normal limits. MRI was done s/o Spina bifid occulta with LS myelomeningocele with cerebellar tonsillar descent (likely Arnold Chiari Malformation type.

Infectious healthcare waste management among private dental practitioners in the Rabat-Salé-Kénitra region, Morocco: A cross-sectional study on knowledge, attitudes, and practices.

The increase in dental healthcare facilities and the use of single-use equipment have increased the production of healthcare waste. Their mismanagement exposes healthcare workers, waste managers, and the population to an infectious risk and negatively impacts the environment. Therefore, a correct management procedure has to be adopted from separation through storage to disposal. This study aimed to investigate dentists' knowledge, attitudes, and practices regarding managing infectious healthcare waste in private dental offices. A descriptive and analytical cross-sectional survey was conducted between December 2020 and March 2021 among private dentists registered at the Moroccan National Council of Dentists in the Rabat-Salé-Kénitra region. A questionnaire was developed to assess waste management in dental offices. Of the 500 questionnaires distributed, 190 completed and exploitable questionnaires were collected. Only 27.3% of healthcare waste managers in dental practices received training, 21,5% of practitioners assimilated the used gloves into household waste, 71.5% disposed of the waste generated by their offices directly into public bins, and 86.4% were unaware of Moroccan law 28-00 on waste management and disposal. This study highlights dentists' apparent lack of knowledge regarding healthcare waste management, and significant gaps were identified between actual practices and recommended regulations. To address these issues, developing a comprehensive medical waste management plan is crucial to encourage the practical cooperation of all stakeholders in this sector.

A Retrospective Analysis of Clinically Focused Exome Sequencing Results of 372 Infants with Suspected Monogenic Disorders in China.

The context was designed to optimize the diagnostic utility of clinically focused exome sequencing (CFES) and shorten the diagnostic odyssey among pediatric patients suspected of monogenic disorders (MDs). Here, we retrospectively analyzed the clinical notes of 372 patients from different areas in the Jiangxi province that were referred for a diagnostic CFES and analysis from June 2018 to March 2022 with symptoms suggestive of MDs. In our study, preliminary tests using the proband-only clinical exome sequencing as a cost-effective first-tier diagnostic test for pediatric patients with unidentified MDs, supplemented by family segregation studies for targeted variants when indicated. Probands with confirmed diagnostic (CD) or likely diagnostic (LD) genetic influences accounted for 12% of all cases, whereas those with an uncertain diagnosis accounted for 48%. We also found that systemic primary carnitine deficiency (CDSP) (SLC22A5 gene) and phenylketonuria (PAH gene) were relatively more prevalent, and these patients with CDSP had the most frequent c.1400C > G variant (p.S467C) and c.51C > G variant (p. F17L) in this study. In addition, statistical analysis revealed that the estimates of diagnostic yields varied across certain phenotypic features of patients, and patients with specific phenotypic traits tended to benefit more from CFES. The CFES may be a first-line genetic test for diagnosing young children with suspected genetic conditions, as it validates the identification of molecular genetics alterations and facilitates comprehensive medical management. Moreover, we found that infants exhibiting metabolism/homeostasis abnormalities, craniofacial /otolaryngology/ ophthalmologic abnormalities, and/or the integument were significantly more likely to receive a genetic diagnosis via CFES than infants without such features. However, due to the current study's low diagnostic yield and inherent limitations, high-quality clinical studies with larger sample sizes are still needed to provide more likely results and confirm our findings.

Management of Medical Rehabilitation in Stroke Infarction Patients at Type C Hospitals: Case Report

Stroke rehabilitation is the comprehensive medical management and rehabilitation of disabilities caused by stroke using a neurorehabilitation approach with the aim of optimizing recovery and/or modifying the remaining symptoms so that the stroke survivor can independently perform functional activity, adapt to the environment, and live a quality life. We present a case of medical rehabilitation for an infarct-related stroke with hypocalcemia, hypertension, and Type II diabetes. In this case, treatment at a hospital of type C is limited to initial treatment and medical rehabilitation; the acute and subacute phases, which provide modifications to previous MMT and ADL dependence, are less intensive. Early evaluation and treatment are crucial for optimizing rehabilitation.

The perceptions of older people living with hiv/aids towards physical activity and exercise

BackgroundOlder people living with HIV (OPLWH) require significant levels of support, including healthcare and rehabilitation interventions. People living with HIV are living longer, but still experience health-related impairments that affect functional activity, participation in day-to-day interactions, livelihoods and overall quality of life. Physical activity and exercise should be included as part of the comprehensive medical management for OPLWH but the investigation of prior studies reveal a gap in understanding and prescription. Our study aimed to explore the perceptions of OPLWH about physical activity and exercise.MethodsThe study adopted a phenomenological, qualitative design, using in-depth interviews, to understand OPLWH perceptions of physical activity and exercise, and their need for, and access to, physical activity and exercise programmes in a community in South Africa. Nine [9] males and seven [7] females participated in the study.ResultsSixteen individuals voluntarily participated in face-to-face, semi-structured interviews which took place at the healthcare facility where they received regular treatment. All participants were 50 years and older. Personal gratification and the ability to perform activities of daily living as well as participate in community activities were believed to be strong motivators for exercise participation, while barriers to exercise were attributed to physical health issues; lack of proper instruction as well as stigma associated with HIV status within their communities. Participants also favored a combination of aerobic, flexibility and strength activities, as well as proper supervision and instruction within a group exercise setting.ConclusionThe qualitative nature of our study provided an in-depth understanding of the perceptions of OPLWH towards physical activity and exercise. Our study highlighted the factors that hinder adherence to physical activity and exercise in this population. Many indicated that they would love to engage in structured physical activity programmes, but did not know where, when or how to begin. Creating a suitable environment with proper supervision and instruction by suitably qualified health professionals are essential when developing a community-based exercise programme for OPLWH.

ESTIMATION OF THIRD FINGER MOTION USING ENSEMBLE KALMAN FILTER

Post-stroke is a stage a patient undergoes if the patient has had a previous stroke. Stroke is a big and serious problem. As the second most common cause of disability of people at age of over 60 years. For patients having experienced a stroke, rehabilitation is a way to make them able to do activities of daily living as before. Stroke Rehabilitation is a comprehensive medical management and rehabilitation (in medical, emotional, social, and vocational aspects) concerning disabilities caused by stroke through a neuro-rehabilitation approach with the aim of optimizing recovery. The finger prosthetic arm robot is one of the results of the health technology development to help accelerate the rehabilitation process specifically for finger movements. One of the efforts to develop a finger robot is to estimate the movement of the fingers, in this case the finger size used is taken from those of Javanese people in Indonesia as the data to be simulated. In this paper is an estimation of the finger motion,particularly that of the third finger of the right hand, conducted using the Ensemble Kalman Filter (EnKF) method. The simulation results produced the third finger motion estimates with an accuracy of around 92% - 99%.

Myth and Truth in Opioid Consumption with Intrathecal Morphine Pump Implantation in Chronic Pain: A Retrospective Cohort Study with Claims Database in South Korea.

To investigate the opioid consumption and the healthcare resource utilization in patients with the intrathecal drug delivery system (IDDS) therapy and the comprehensive medical management (CMM) alone. A retrospective cohort study with a customized claims database. In a university-based hospital. Patients with complex regional pain syndrome, post-laminectomy syndrome, and fibromyalgia. Using propensity score matching (1:3), we selected patients with morphine infusion through IDDS (IDDS group) and CMM alone (CMM group). The primary endpoints were comparisons of average morphine equivalents daily dosages (MEDD, mg/day) for 6 and 12 months from an index date. The number of emergency room (ER) visits and hospitalizations and the total medical expenditures were compared as secondary outcomes. In total, 82 patients (N = 23 in the IDDS group and N = 59 in the CMM group) were analyzed. Although a 6-month average MEDD did not reach statistical significance, a 12-month average MEDD was significantly decreased in the IDDS group compared to the CMM group (53.2 ± 46.3 vs 123.9 ± 176.4, respectively; P = 0.008). ER visits were more frequent in the IDDS group than the CMM group at baseline (5.4 vs 0.5, respectively; P = .002), which was maintained for 12 months (P < 0.001). Otherwise, the number of hospitalization and the medical expenditures for pain management were not different between the groups for 12 months. The combined IDDS therapy had some benefits in reducing opioid consumption for 1-year follow-up compared to the CMM alone in chronic noncancer pain patients.

Guidelines for ethical behavior relating to clinical practice issues in neuromuscular and electrodiagnostic medicine.

The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) developed guidelines to formalize the ethical standards that neuromuscular and electrodiagnostic (EDX) physicians should observe in their clinical and scientific activities. Neuromuscular and EDX medicine is a subspecialty of medicine that focuses on evaluation, diagnosis, and comprehensive medical management, including rehabilitation of individuals with neuromuscular disorders. Physicians working in this subspecialty focus on disorders of the motor unit, including muscle, neuromuscular junction, axon, plexus, nerve root, anterior horn cell, and the peripheral nerves (motor and sensory). The neuromuscular and EDX physician's goal, working with other allied health professionals, is to diagnose and treat these conditions to mitigate their impact and improve the patient's quality of life. The guidelines are consistent with the Principles of Medical Ethics adopted by the American Medical Association and represent a revision of previous AANEM guidelines.

HIV Care Coordination promotes care re-engagement and viral suppression among people who have been out of HIV medical care: an observational effectiveness study using a surveillance-based contemporaneous comparison group

BackgroundMedical care re-engagement is critical to suppressing viral load and preventing HIV transmission, morbidity and mortality, yet few rigorous intervention studies address this outcome. We assessed the effectiveness of a Ryan White Part A-funded HIV Care Coordination Program relative to ‘usual care,’ for short-term care re-engagement and viral suppression among people without recent HIV medical care.MethodsThe Care Coordination Program was launched in 2009 at 28 hospitals, health centers, and community-based organizations in New York City. Designed for people with HIV (PWH) experiencing or at risk for poor HIV outcomes, the Care Coordination Program provides long-term, comprehensive medical case management utilizing interdisciplinary teams, structured health education and patient navigation. The intervention was implemented as a safety-net services program, without a designated comparison group. To evaluate it retrospectively, we created an observational, matched cohort of clients and controls. Using the HIV surveillance registry, we identified individuals meeting program eligibility criteria from December 1, 2009 to March 31, 2013 and excluded those dying prior to 12 months of follow-up. We then matched clients to controls on baseline status (lacking evidence of viral suppression, consistently suppressed, inconsistently suppressed, or newly diagnosed in the past 12 months), start of follow-up and propensity score. For this analysis, we limited to those out of care at baseline (defined as having no viral load test in the 12 months pre-enrollment) and still residing within jurisdiction (defined as having a viral load or CD4 test reported to local surveillance and dated within the 12-month follow-up period). Using a GEE model with binary error distribution and logit link, we compared odds of care re-engagement (defined as having ≥ 2 laboratory events ≥ 90 days apart) and viral suppression (defined as having HIV RNA ≤ 200 copies/mL on the most recent viral load test) at 12-month follow-up.ResultsAmong 326 individuals out of care at baseline, 87.2% of clients and 48.2% of controls achieved care re-engagement (Odds Ratio: 4.53; 95%CI 2.66, 7.71); 58.3% of clients and 49.3% of controls achieved viral suppression (Odds Ratio: 2.05; 95%CI 1.30, 3.23).ConclusionsHIV Care Coordination shows evidence of effectiveness for care and treatment re-engagement.

Application of Multi-Criteria Decision Approach in the Assessment of Medical Waste Management Systems in Nigeria

Globally, the pandemic of COVID-19 has penetrated all spheres of human endeavors, and noteworthy is the tremendous increase in the volume of healthcare wastes generated in Nigeria. There has been an increase in medical waste materials produced as a result of the extensive use of both disposable personal protective equipment (PPE), such as face shields and nose and face masks, and highly infectious waste materials, such as contaminated syringes, needles, and soiled bandages from diagnosed positive cases. Despite the huge volume in waste generation, a standardized evaluation framework is currently lacking in the management of medical wastes in Nigeria. This study has developed a novel assessment framework for managing medical wastes, which is curated from the technical guidelines of the World Health Organization (WHO). The applicability of the framework was examined on seven designated public and private-owned hospitals in Ota. The fuzzy analytical hierarchy process (FAHP) and analytical hierarchy process (AHP) approaches of multi-criteria decision analysis were utilized in modelling an evaluation framework for the objective of medical waste management. Carefully designed interview questionnaires, observations, and site visits were carried out to obtain data from healthcare professionals in Ota. Results show that waste segregation was practiced more decisively in private hospitals than public hospitals. Waste segregation is established as a key determinant in implementing an effective waste management system in any healthcare facility. The success of waste segregation in healthcare institutions is highly dependent on good hospital management, organizational policies, efficient budget planning for waste management, and the operational running cost. Disposal methods investigated were mostly open burning and incessant dumping for most public health care centers. Deficient waste management practices were observed in waste disposal, waste transportation, storage, and organizational policies. While the awareness and capacity building on occupational safety practices and environmental public health is widely known by health workers and waste handlers, compliance and enforcement are critical challenges. The validation of results using fuzzy TOPSIS and a sensitivity analysis shows a high degree of the consistency, stability, and robustness of the model. Findings from the present study can aid decision making, as this will benefit policy makers and key stakeholders in developing more comprehensive and effective medical waste management guidelines in Nigeria. In addition, future decision-making studies could augment the results from the current research by assessing the impact of the pandemic preparedness and response on medical waste management.