Grace Hospital Research Articles

Knowledge, perception and cervical cancer screening practices among nurses and midwives: a case study of Our Lady of Grace Hospital in the Asikuma Odoben Brakwa district, Central region-Ghana.

Cervical cancer prevention can be achieved through comprehensive programs involving education, awareness creation, vaccination, screening, and early treatment. Health workers have a vital role to play in achieving this. Hence, they must be adequately equipped with the requisite knowledge of the condition since they provide information to their clients. This study determined the knowledge, perception, and screening practices on cervical cancer among female nurses and midwives in the Central Region of Ghana. A quantitative descriptive cross-sectional survey amongst nurses and midwives was used for the study. A convenience sampling technique was applied to yield a representative sample of 130 female nurses and midwives working in Our Lady of Grace Hospital in the Central Region, Ghana. Data was collected from the participants using a self-administered questionnaire. The data was analysed using SPSS version 20, and standard descriptive statistics such as proportions were used to summarize the survey data. Almost all the nurses (99%) had heard of cervical cancer. Majority (97.1%) of the respondents believed cervical cancer is preventable however, 67.6% also believed that it is incurable. Almost half (42.2%) of the respondents did not perceive themselves as at risk of cervical cancer. Thus, only 11.8% of the nurses had ever screened for cervical cancer. However, majority (92.2%) were willing to recommend the screening to others. The respondents of this study had some knowledge of cervical cancer however had low patronage for recommended screening practices. Therefore, strategies must be implemented to increase screening practices among female nurses.

Management of patients at the hepatopancreatobiliary unit of a London teaching hospital during the COVID-19 pandemic

To mitigate COVID-19-related shortage of treatment capacity, the hepatopancreatobiliary (HPB) unit of the Royal Free Hospital London (RFHL) transferred its practice to independent hospitals in Central London through the North Central London Cancer Alliance. The aim of this study was to critically assess this strategy and evaluate perioperative outcomes. Prospectively collected data were reviewed on all patients who were treated under the RFHL HPB unit in six hospitals between November 2020 and October 2021. A total of 1541 patients were included, as follows: 1246 (81%) at the RFHL, 41 (3%) at the Chase Farm Hospital, 23 (2%) at the Whittington Hospital, 207 (13%) at the Princess Grace Hospital, 12 (1%) at the Wellington Hospital and 12 (1%) at the Lister Hospital, Chelsea. Across all institutions, overall complication rate were 40%, major complication (Clavien–Dindo grade ≥ 3a) rate were 11% and mortality rates were 1.4%, respectively. In COVID-19-positive patients (n = 28), compared with negative patients, complication rate and mortality rates were increased tenfold. Outsourcing HPB patients, including their specialist care, to surrounding institutions was safe and ensured ongoing treatment with comparable outcomes among the institutions during the COVID-19 pandemic. Due to the lack of direct comparison with a non-pandemic cohort, these results can strictly only be applied within a pandemic setting.

Predictors of ischemic and hemorrhagic complications in patients with myocardial infarction at 18-month follow-up: a single-center registry study

Aim. To identify predictors of ischemic and hemorrhagic events in patients with myocardial infarction (MI) after 18 months of follow-up.Material and Methods. The single-center prospective study included 478 patients with MI. The exclusion criteria were as follows: age < 18 years; MI as a complication of myocardial revascularization; atrial fibrillation; intake of anticoagulants after MI. During inpatient treatment, the risk of ischemic and hemorrhagic events was calculated according to the PRECISE-DAPT score, GRACE hospital discharge risk score, CRUSADE bleeding score. After 18 months, we evaluated the rate of ischemic (cardiovascular death, unstable angina, life-threatening arrhythmia, non-fatal MI and stroke, acute decompensated heart failure, elective repeated and/ or emergency revascularization) and haemorrhagic events and the amount of corresponding therapy.Results. At 18 months post-MI, patients were at high risk of developing both ischemic events (cardiovascular death: 32.0%; recurrent MI: 16.3%; repeated myocardial revascularization: 18.5%; unstable angina: 13.8%; stroke: 3.6%) and hemorrhagic events (bleeding rate of 39.7% according to the TIMI score), most of which occurred during the first 12 months post-MI. Double antiplatelet therapy (DAPT) was prescribed to 86.5% patients upon discharge (including a triple antithrombotic therapy in 8.6% patients). Patient adherence to treatment was 66.7% and 60.6% at 6 and 12 months of follow-up, respectively. After 18 months, DAPT was prescribed exclusively to patients suffered from recurrent ischemic events or those who underwent repeated myocardial revascularization (17.4% patients in total). The main reason to cancel DAPT was bleeding, although it was minor in most cases. Predictors of ischemic events (fatal and non-fatal) at 18 months of follow-up were PRECISE- DAPT score (odds ratio (OR) = 1.108, 95% confidence interval (CI) = 1.054-1.164, р < 0.001), GRACE score (OR = 1.032, 95% CI = 1.016-1.048, р < 0.001), left ventricular ejection fraction (LVEF) < 40% (OR = 4.256, 95% CI = 1.510-12.001, р = 0.006). Predictors of hemorrhagic events at 18-month follow-up were PRECISE-DAPT score (OR = 1.025, 95% CI = 1.009-1.041, р = 0.002), peripheral artery disease (PAD) (OR = 2.459, 95% CI = 1.365-4.428, р = 0.003), intake of sulfonylurea for diabetes mellitus (OR = 2.523, 95% CI = 1.266-5.028; р = 0.009), unsuccessful percutaneous coronary intervention (PCI) or conservative treatment of MI (OR = 3.792, 95% CI = 1.799-7.996, р < 0.001).Conclusion. Predictors of ischemic events (fatal and non-fatal) in the long-term period after MI include PRECISE-DAPT and GRACE scores, and LVEF below 40%. Predictors of hemorrhagic events at 18-month follow-up were PRECISE- DAPT scores, PAD, taking sulfonylurea for diabetes mellitus, unsuccessful PCI or conservative treatment of MI.

Five-Year Experience of Eviscerations in a District Hospital in Ghana: A Five-Year Experience

Purpose: Destructive eye surgeries have been described as necessary evils. Even though they are important and sometimes life-saving, their psychological impacts on the patients are many. This study sought to determine the prevalence and main indications of evisceration in Our Lady of Grace Hospital in the Asikuma–Odoben-Brakwa District of the Central Region of Ghana.
 Methodology: The mixed method study design was used. A five-year review of all cases of eviscerations from 2012-1016, was conducted. Also, in-depth interviews of 9 patients purposively selected, who had undergone eviscerations during the period under review were conducted. Data analysis was largely descriptive.
 Result: Out of a total of 2996 ocular surgeries conducted within the 5-year period, 101 were eviscerations. This gives a 5-year prevalence of 3.4 per 100 surgeries. Out of the 101 cases of eviscerations, 81 were included in the analysis due to the availability of complete data. The mean age of patients was 50 years (SD 1.53). The majority of patients who underwent eviscerations were 60 years and more. Right (51%) and left (49%) eyes were eviscerated in nearly equal proportion. The occupations of the majority of patients were farmers/fisherfolks (55.6%) and trading (19.8%). Most (76.5%) eviscerations were due to non-trauma-related causes mainly infections (55.6%). The trauma-related indications for evisceration (23.4%) were stick/vegetative materials, stone/particles, and assault.
 Unique Contribution to Theory, Policy and Practice: Eye infections and injuries which are largely preventable were the main causes of eviscerations in this study. Public education to encourage early reporting is needed. The aged should be discouraged from engaging in unprotected manual farm-related activities.

Clinical utility of local over general anesthetic tonsillectomy using the BiZact™ device

PurposeTonsillectomy under general anesthesia may be viewed preferentially to local anesthesia, due to mitigation of potential airway compromise secondary to intraoperative hemorrhage, patient discomfort and anxiety. However, this is offset by risk of increased trauma (via the endotracheal tube and gag), adverse medication reactions and cost. Here we evaluated the case for use of local anesthesia in tonsillectomy using the BiZact™ (Medtronic) device by comparing surgical outcomes and cost factors across patients where either local or general anesthesia was employed. Materials and methodsRetrospective cohort study of 59 BiZact™ tonsillectomy patients (38 under local anesthetic, and 21 under general anesthetic) from a single surgeon at Tauranga Hospital (public) and Grace Hospital (private) in New Zealand; March 2018 to June 2021. ResultsNeither patient group had any primary postoperative hemorrhage and there was comparable incidence of secondary hemorrhage (one case in each cohort). Local anesthetic tonsillectomy was well tolerated with only 2 patients requiring conversion to general anesthetic secondary to anxiety. Local anesthetic proved to be cost-effective, with a halving of hospital length of stay and significant associated overall cost saving, and did not add significantly to operating or total theatre time. Local anesthetic tonsillectomies where perioperative sedation was not required were associated with additional reductions in recovery and overall hospital stay, and cost. ConclusionsLocal anesthetic BiZact™ tonsillectomy is evidently safe and cost-effective.

Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument.

Lowering Nighttime Blood Pressure With Bedtime Dosing of Antihypertensive Medications: Controversies in Hypertension - Con Side of the Argument.

Cord Blood Haematological Profiling Study: Predictive Markers of Neonatal Health Status at Birth in Anyigba, North Central Nigeria

Background: Neonatal mortality refers to the death of a live-born babies within the first 28 days of life remains a global public health challenge. Cord blood being the medium of communication, transmission of nutrients and wastes between mothers and fetus can reflect the health status of baby at birth if properly utilized. Owing to multiple factors involved in neonatal mortality, this study used umbilical cord blood haematological parameters to ascertain the health status of neonates at birth, the aim of this study is to use umbilical cord blood haematological parameters for management of neonates at birth.
 Methodology: This research is a cross-sectional study carried out at the Departments of Obstetrics and Gynaecology and Medical Laboratory Department, Kogi State University Teaching Hospital, Anyigba, North Central Nigeria between January, and December, 2020. Cord blood from 164 babies delivered in Kogi State University Teaching Hospital, Grimard Catholic Hospital, and Amazing Grace Hospital between January and December, 2020 were analyzed for haematological parameters using Sysmex XP-300 automated haematology analyzer. The data obtained were expressed as mean ±standard deviation using SPSS statistical software, version 23.0. The indicator level of statistical significance was set at p<0.05.
 Results: The results showed significant increase (p<0.05) of WBC, RBC, MCV, MCH and MCHC in unstable babies compared to the stable babies, significant decrease (p<0.05) in the platelets, neutrophil and mixed among unstable babies compared to the stable babies, but no significant difference in PCV, haemoglobin and lymphocyte counts of both stable and unstable babies. The results also demonstrated 25 deaths per 1000 live newborn neonates within 48hour during the period of study.
 Conclusion: This study shows that cord blood haematological parameters at birth can be used to ascertain the health status of neonates.

Implementation of Outpatient Pharmacist-led Hypertension Management for Under-Resourced Patients: A Pilot Study.

The purpose of this study was to implement and evaluate a pharmacist-led hypertension (HTN) program for under-resourced patients discharged from the emergency department (ED) or screened at community health events who are lacking a regular primary care provider (PCP) relationship. This was a single arm, prospective, pilot study to recruit patients from the Detroit Medical Center (DMC) Sinai Grace Hospital (SGH) ED and community health events. The outpatient pharmacist-led transitional care clinic (TCC) was implemented through a collaborative practice agreement (CPA) with ED physicians. Eligible patients 18 to 60 years with elevated blood pressure (BP) (> 140/90 mmHg) and lacking a PCP relationship were referred to the TCC for HTN management. The primary outcome measure was change in systolic and diastolic BP (SBP and DBP). Difference in BP values was evaluated using Wilcoxon Signed Ranks test and descriptive statistics were used to explain demographic data. There were 116 patients enrolled May 2017 to August 2018; 44 (37.9%) completed visit one [cohort 1], 30 (25.9%) completed at least three visits [cohort 2], and 16 (13.8%) completed five visits [cohort 3]. Most patients were African American (AA) 97.7%, 47.8% were male, and an average of 42.11 (SD 9.70) years. For cohorts 2 and 3, there was significant reduction in BP between TCC visits one and two and the reduction was maintained through five visits for patients that remained in the study. Patients who completed five visits (n=16) showed a significant change from visit one to visit five in SBP of -23 mmHg (p=0.002) and achieved BP goal with an average SBP 139 mmHg (SD 19.33) and DBP 90 mmHg (SD 10.17). The pharmacist-led TCC was successfully implemented. Outpatient pharmacists collaborating with ED physicians increased access to HTN management with a positive impact on BP outcomes in an under-resourced population.

Factors Impacting Hydrocephalus Incidence in Intracerebral Hemorrhage: A Retrospective Analysis

To test which intracerebral hemorrhage (ICH) characteristics impact incidence of hydrocephalus and characterize subsequent impact on outcomes. A search of the electronic medical record of Sinai Grace Hospital between January 2009 and April 2018 using International Classification of Diseases, Ninth Revision and Tenth Revision codes for ICH identified 847 patients. After excluding patients with hemorrhagic conversion of stroke, subarachnoid hemorrhage, and traumatic hemorrhage, 560 patients remained for analysis. Generalized linear modeling was used to assess variance in modified Rankin Scale (mRS) score and length of stay. Incidence of hydrocephalus on arrival varied with ICH volume (P < 0.001), intraventricular hemorrhage (IVH) status (P < 0.001), bleed location (P < 0.001), and external ventricular drain (EVD) status (P < 0.001). An EVD was inserted in 47% of patients presenting with IVH (n= 102/217), while 4% of patients without IVH received an EVD (n= 14/343) (P < 0.001). Hemorrhage locations had different rates of EVD placement: thalamic 43%, basal ganglia 22%, cerebellar 28%, brainstem 21%, lobar 7% (P < 0.001). Shunt dependency did not vary between bleed locations (P= 0.072). Variance in mRS score was explained by IVH, bleed location, hydrocephalus on arrival, and ICH volumes. In particular, cerebellar hemorrhage location was associated with better outcomes (mean discharge mRS score of 3.3 vs. 3.9, P < 0.001). Bleed characteristics affect incidence of hydrocephalus on admission, rates of long-term shunt dependency, and outcomes. Hemorrhage location did not predict shunt dependency; however, it did predict outcomes. Specifically, cerebellar ICH was associated with a better discharge mRS score.

Exploring Challenges of Hospital Chaplains in Transdisciplinary Teams

Hospital chaplains experience obstacles in contributing to team objectives when a part of transdisciplinary teams. This case study explores the communication challenges of membership on transdisciplinary teams for hospital chaplains, using a fictional account based on data from a previous study. Chaplain David Howard is one of three chaplains at Grace Hospital and is assigned to the newly formed palliative care transdisciplinary team. The purpose of this team is to work towards providing quality care to patients in the upcoming integrative medicine wing. Although the team is tasked with improving the quality of life for patients, David notices that his concerns of quality care often clash with his medical colleagues' concerns about improved medical health outcomes. As the team's differing perspectives are revealed, it is evident that their communication is crucial to their ability to work together successfully.

305EMF Effective Nutritional Analyses as a Predictive Utility for 30-Day Cardiac Recovery

Persons consuming a micronutrient rich diet (eg, vitamins) have lower cardiovascular disease risk and there is interest in how the micronutrient environment might influence cardiac recovery post-acute myocardial infarction (AMI). Accordingly, we sought to investigate the relationship between nicotinamide specifically, and micro-nutritional profiles generally and AMI recovery with a goal of identifying plausible biologic targets to improve post-AMI outcomes. Since African Americans (AA) experience the highest rate of mortality and rehospitalization post-AMI, our study focuses on enrolling AA patients. Study will recruit 100 patients at emergency departments (EDs) of Detroit Receiving (DRH), Sinai Grace (SGH), and Harper University Hospitals (HUH) with age > 18 and primary diagnosis of AMI defined by 4th Universal Definition of MI. Comorbidities may alter micronutrient levels, excluding: active chronic alcohol/drug users, hepatic failure, renal failure, HIV; pregnant women, those with metabolic disorders except diabetes, and prisoners. We record 30-day post-AMI cardiac-related rehospitalization and mortality by chart review, phone follow-up, and social security death index. Procedures include collection of 2mL plasma stored at -80 C prior to micronutrient extraction and profiling. Liquid chromatography-mass spectrometry analysis of vitamins are performed using QTrap 6500 mass spectrometer (AB Sciex, Singapore) with multi-reaction monitoring to detect molecular ion-daughter combinations. Sample sizes (Table 1) calculation and power analysis (Table 2) were performed using G*Power software. With 100 patients, we anticipate 18 readmissions and 12 deaths, with 0.81 power to evaluate the association of nicotinamide deficiency and post-AMI outcomes with significance of 0.05 (one tail, normal distribution) with R2=0 and odds ratio=2 in the logistic regression adjusted for age, sex, biomarker data, clinical intervention, and medical history. Broad micronutrient profile and post-AMI outcomes assessed by principal component analysis (PCA). 15 individual micronutrients will be assayed. Patient records will be normalized (mean 0, unit variance within each analyte), and PCA will identify the set of micronutrients responsible for the majority of patient variation. Our study enrollment is on hold because of COVID-19 since February 2020. With publicly reported AMI readmission and mortality rates from DRH, HUH, and SGH, we estimate 18% AMI patients readmitted and 12% die 30 days post-discharge (prevalence 30%). We assume 50% patients with reduced nicotinamide plasma concentrations, which may make them two times more likely to die than those with greater concentrations. If their nicotinamide level increase one unit, adverse outcomes reduced by 5%. Micronutrients may contribute to post-AMI outcomes. Our study will be the first to evaluate this in an AA cohort of ED patients. Our hypothesis is that individual variation in micronutrient concentrations will partition study participants into groups. We will examine the prevalence of 30-day outcomes within groupings and identify which micronutrients contribute most robustly to the groupings.

Differentiation of early first‐trimester cranial neural tube defects

Neural tube defects (NTDs) are one of the most commonly reported birth defects and are the result of failure of primary neurulation, the folding and fusion of the neural plate1. We report on three early first-trimester cases with different types of cranial neural tube defects (NTD) not previously reported in ultrasound studies. Previously, it was believed that the process of neural tube closure occurred in a ‘zipper-like’ fashion, starting at one point and proceeding in both cranial and caudal directions. However, neural tube closure is a more complex process. More recently, Nakatsu et al. described three different closure initiation sites of the human neural tube after studying miscarried embryos2. Following from this closure model six different types of cranial NTDs were distinguished, based on location of the closure defect (Figure S1)2. Survival rates significantly decreased if the rhombencephalon, or fourth ventricle, was involved in the defect (Types III, IV and V) with two-thirds of cases failing to survive beyond 7 weeks' gestational age. Embryos with total dysraphism (Type VI) failed to survive at an even earlier stage. However, 70% of the embryos with a rostral defect (Types I and II) did survive beyond 7 weeks. In Case 1 (crown–rump length (CRL), 23 mm) and Case 2 (CRL, 13 mm) a cranial defect was seen from the mesencephalon to the rhombencephalon, suggestive of Type IV (Figure 1 and Figure S2). In Case 3 (CRL, 14 mm) the neural tube did not close at the parietal region of the head and most likely represents a Type II cranial NTD (Figure 2). We concluded that some of the different types of cranial NTDs can be diagnosed in vivo using high-frequency two- and three-dimensional transvaginal ultrasound during the early first trimester of pregnancy. Increasing awareness of the existence of different types of cranial NTDs is important in beginning to unravel the etiology of the development of NTDs. If good documentation exists the different types of cranial NTDs might be linked to different genetic pathways or environmental factors3. However, since the moment of demise in the majority of cases appears to be before 10 weeks' gestation, detection remains a challenge. The existence of different types of cranial NTDs is a rather recent insight and the implications for counseling are not yet well understood. Understanding the cause of these malformations might contribute to determination of increased risks in couples and development of new prevention strategies. The in vivo detection of cranial NTDs raises the question whether these women are at increased risk for recurrence of NTD. If so, in a subsequent pregnancy, an increased dosage of supplemental folic acid is indicated and additional ultrasound examinations are recommended. In conclusion, different types of cranial NTDs can be diagnosed using transvaginal ultrasound examination in early pregnancy. Detection of these NTDs is of particular importance in beginning to understand etiology, in developing prevention strategies, in counseling patients and in initiating new research projects. This research was financially supported by Erasmus Trustfonds, Erasmus MC Vriendenfonds, Meindert de Hoop Foundation and Fonds NutsOhra. L. Baken*†, N. Exalto†, B. Benoit‡, P. J. van der Spek§, E. A. P. Steegers† and I. A. L. Groenenberg† †Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; ‡Department of Obstetrics and Gynecology, Princess Grace Hospital, Monaco; §Department of Bioinformatics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands *Correspondence. (e-mail: l.baken@erasmusmc.nl) Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Editorial introductions

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS David L. OliveDavid L. OliveDr David Olive is certified by the American Board of Obstetrics and Gynecology in both Obstetrics and Gynecology as well as Reproductive Endocrinology and Infertility. He is also certified in advanced gynecologic laparoscopy and hysteroscopy by the Accreditation Council of Gynecologic Endoscopy. Dr Olive received his medical degree from Baylor College of Medicine, Houston, TX, USA in 1979. He completed a residency in obstetrics and gynecology at Northwestern University, Chicago, IL, USA, and a fellowship in reproductive endocrinology at Duke University, Durham, NC, USA. Dr Olive was previously a faculty member at the University of Arkansas, USA, the University of Texas, USA, professor and chief of Reproductive Endocrinology at Yale University, USA, and more recently professor, chief of reproductive Endocrinology, and vice chairman of Academic Development at the University of Wisconsin-Madison, USA. Dr Olive has authored more than 300 publications in scientific journals and the popular press. He has acted as an editor or reviewer for over 20 professional journals and has been an investigator on numerous scientific grants. He has lectured extensively around the world on topics such as infertility, endometriosis, fibroids, and clinical epidemiology. He is a past president of the American Association of Gynecologic Laparoscopists and the Board of Trustees of the AAGL/SRS Fellowship in Gynecologic Endoscopy. Dr Olive is currently President of Wisconsin Fertility and Reproductive Surgery Associates and co-founder of the Wisconsin Fertility Institute. Recently he was named to the steering committee to develop a maternal-child health center in Leogane, Haiti, to which he devotes considerable time and effort. Colin J. DavisColin J. DavisMr Colin Davis is a Consultant Obstetrician and Gynaecologist and Honorary Senior Lecturer for Gynaecology at St Bartholomew's and the Royal London Hospitals, UK. He is a Fellow of the Royal College of Obstetricians and Gynaecologists and obtained his Doctorate of Medicine from Imperial College London, UK. He is one of the few surgeons in the UK leading the way in new endoscopic techniques including; laparoscopic tubal microsurgery, laparoscopic surgery for severe endometriosis, laparoscopic myomectomy and hysterectomy. He has established a nationally recognised minimal access training centre at St Bartholomew's Hospital. Mr Colin Davis is the Training Programme Director for the London Deanery for Obstetrics and Gynaecology as well as an Inspector for the Royal College of Obstetricians and Gynaecologists subspecialty training programme in Reproductive Medicine and Surgery. He has a PhD research programme examining genetic expression in endometriosis and has written a number of papers and books on the topics of tubal surgery and endometriosis. He co-authored the 3rd Atlas of Endometriosis. He practices at St Bartholomew's Hospital London as well as the Princess Grace Hospital, The Portland Hospital and the London Clinic, UK.

Contamination Levels of Some Selected Wells in Ogbomoso South Local Government Area, Nigeria and the Implications on Human Health

Incident of water-borne diseases is becoming more rampant in developing countries in the 21st century. This paper examines the contamination levels of some selected wells in Ogbomoso South Local Government Area (LGA), Oyo State, Nigeria. Methodology includes administering of structured questionnaire, field survey/sampling and laboratory analysis. The first set of questionnaires sought information on water sources, quality, supply and treatment. These were administered in 10 selected major locations which included: Ajegunle, Arinkinkin, Arowomole, Caretaker, Esanu-Aje, Ita-Olola, Malete, Oke-Alapata, Ora-Gada and Sunsun. The other set which was administered in 6 randomly selected Health Institutions viz: Oyo State General Hospital, Alaafia Tayo, Oore-Ofe, Bethel, Favour, and Grace Hospitals had questions on health-related issues. Ten (10) wells were randomly selected for sampling, one in each location. Results were compared with WHO’s Drinking Water Standards. Questionnaires revealed that residents depended mostly on wells for water supply; the water quality was low; supply was irregular; quantity was inadequate and boiling was the commonest treatment method. Health Officials established that some residents consumed improperly treated well water and there were some incidences of water-related diseases. Laboratory analyses showed that samples from Ajegumle and Esanu-Aje had colour values above the standard. Also, the pH was observed to vary from slightly acidic to slightly alkaline with values ranging between 6.0 and 8.1. Only Arinkinkin and Ita-Olola areas had permissible values of total alkalinity and Oke-Alapata had the highest chloride value of 400 mg/l while the highest nitrate concentration was at Esanu-Aje (127.58 mg/l). Study concludes that water supply in the area is not fully supportive to health. To abate the problem, it is recommended that aside boiling, each household should endeavour to coagulate, filter, soften and disinfect well water before consumption. Also, personal hygiene within each household must always be emphasized and improved upon.

Correlation of Risk Scores with Coronary Anatomy in Non-ST-elevation Acute Coronary Syndrome

The literature lacks studies regarding the correlation between risk scores and coronary anatomy in acute coronary syndrome (ACS) OBJECTIVE: Correlate risk scores with the severity of the coronary lesion in ACS with non-ST elevation. A total of 582 patients were analyzed between July 2004 and October 2006. The correlation between TIMI risk scores and GRACE (hospital and six months) scores was performed for patients with coronary lesion ≥ 50%, using Spearman's non-parametric method. Multiple regression logistics was used to determine the predictive ability of the scores to discriminate to discriminate who will have a coronary lesion ≥ 50%. Most subjects were male (319 or 54.8%), mean age of 59.9 (± 10.6) years. A positive correlation was observed between risk scores and coronary lesion ≥ 50% (TIMI r = 0.363 [p < 0.0001]; hospital GRACE r = 0.255 [p < 0.0001]; GRACE at six months r = 0.209 [< 0.0001]). The area under the ROC curve for each score to determine to discriminate who will have a coronary lesion > 50% was: TIMI = 0.704 [CI95% 0.656-0.752; p <0.0001]; hospital GRACE = 0.623 [CI95% 0.573-0.673; p < 0.0001]; GRACE at six months= 0.562 [CI95% 0.510-0.613; p ;= 0.0255]. Comparing the areas under the ROC curve, it was found: TIMI versus hospital GRACE: p = 0.01; TIMI versus GRACE at six months:p < 0.0001; hospital GRACE versus GRACE at six months: p = 0.0461. Risk scores correlate with the severity of coronary lesions, and the TIMI risk score showed the best predictive ability.

Oculofacial contour asymmetries: Management of combined treatment with hyalurostructure and botulinum toxin injections

Purpose. To assess the long-term results of the treatment of oculofacial asymmetries using a combined injection schedule for injections of hyaluronic acid, with a specific micro cannula and botulinum toxin. Method. A retrospective study was conducted from January 2009 to January 2010. Patients were treated in the Alcazar Eye Clinic and Oculoplastic Department in Princess Grace Hospital, Monaco. We selected patients complaining of asymmetrical periorbital features who received treatment with hyalurostructure and botulinum toxin injection in one or more sessions. Nine patients were selected and presented with the following symptoms: asymmetry of eyebrow position (2 patients), superior orbital hollow (2 patients), tear trough (2 patients) and orbital volume (ocular prosthesis) (3 patients). The objective was to evaluate the efficiency of combined treatment in one or more sessions on these oculofacial asymmetries. Hyaluronic acid injections were done using hyalurostructure. Hyaluronic acid gel (Restylane Lidocaine) was used with a 25 gauge reinforced micro-cannula (pix'l +, Thiebaud). This was combined with injections of botulinum toxin (azzalure*) to areas of muscular hyperaction. Follow-up was done at 1 year by clinical examination, photography and patient satisfaction. Complications of this combined treatment have been identified. Results. At 1-year follow-up, 88% of patients were satisfied or very satisfied with their results. There were no more complications secondary to both treatments in the same session. It was not noticed more hematomas and bruises than in classical injection method. The action of toxin is constant over time despite the association of hyaluronic acid injections. Conclusion. Combined treatments with toxin and hyaluronic acid in oculofacial asymmetries are efficient and can be proposed in the same session. These treatments must be repeated to maintain and optimize muscle contraction and volume loss. Use of hyalurostructure and botulinum toxin treatment in the same session is effective and safe.

Intérêt du tricuspid annular displacement (TAD) dans l’évaluation de la dysfonction ventriculaire droite au cours de l’embolie pulmonaire

Background Echocardiographic criteria of right ventricular dysfunction (RVD) in acute pulmonary embolism (PE) differ among published studies. Assessment of RV systolic function remains difficult because of the RV's complex shape. We aimed to evaluate RV systolic function with TAD in patients (pts) with acute PE. TAD (QLAB, Philips Medical Imaging) was based on a tissue-tracking algorithm that is ultrasound beam angle independent for automated detection of tricuspid annular displacement. Design Prospective and observational study. Methods All adults’ pts who were diagnosed with PE from December 2008 to December 2009 at Princess Grace Hospital, Monaco were eligible for this study after exclusion of history of heart failure. We evaluated 36 consecutive pts with PE (18 male, mean age 62.7 years), which underwent echocardiography, plasma BNP titration during the first day after admission, and a second echocardiography obtained within 48 hours before discharge. Results TAD value were significantly lower in pts with abnormal RV function by echocardiogram (15.9 ± 0.3 vs. 12.7 ± 0.2 ; P = 0.026). Pts with a normal BNP (< 80 pg/ml) had an elevated TAD (16.4 ± 0.2 vs. 11.2 ± 0.3 mm ; P < 0.0001). At discharge, echocardiographic data were obtained from 33 pts (mean: 8.3 ± 3.5 days). RV end diastolic diameter, RV to LV diameter, pulmonary arterial systolic pressure, mean pulmonic valve acceleration time, RV FAC, Sa and TAD were significantly improved. There was no difference between TAD among pts with echocardiographic RVD at baseline vs. pts without RVD (14.9 ± 3.7 vs. 16.1 ± 2.9 mm ; P = 0.3). Four pts who deteriorated during short-term observation had substantially lower TAD values than those with uncomplicated courses (7.7 ± 0.4 mm vs. 14.6 ± 0.2 mm ; P = 0.001). In conclusion, impaired TAD was associated with decreased RV systolic function in pts with acute PE. To identify the clinical meaning of decreased TAD, larger trials with longer follow-up periods are needed.

141 Usefulness of tricuspid annular displacement (TAD) to identify right ventricular dysfunction in normotensive patients with acute pulmonary embolism

Echocardiographic criteria of right ventricular dysfunction (RVD) in acute pulmonary embolism (PE) differ among published studies. Assessment of RV systolic function remains difficult because of the RV's complex shape. We aimed to evaluate RV systolic function with TAD in patients (pts) with acute PE. TAD (QLAB, Philips Medical Imaging) was based on a tissue tracking algorithm that is ultrasound beam angle independent for automated detection of tricuspid annular displacement. All adults pts who were diagnosed with PE from december 2008 to march 2009 at Princesse Grace Hospital, Monaco were eligible for this study after exclusion of history of heart failure. We evaluated 22 consecutive pts with PE (12 male, mean age 62,2 years) which underwent echocardiography, plasma BNP titration during the first day after admission, and a second echocardiography obtained within 48 hours before discharge. TAD showed significant positive correlation with RV FAC (R 2 = 0,49; p= 0,0003) and Sa (R 2 = 0,43 ; p= 0,001). Among pts with PE who presented signs of RVD, TAD value was 12.5 +/–5.4 mm vs 15.9 +/–2.7mm (p=0.05). TAD value was 17 +/– 4.2mm when BNP level was less than 80 pg/mL vs 11.1 +/– 3.7 (p= 0.007) among pts who had BNP level > 80 pg/mL. After treatment, follow-up echocardiographic data were obtained from 21 pts (mean: 8.8+/-3.6 days). Mean pulmonic valve acceleration time, Sa and TAD were significantly improved (p<0.05). There was no difference between TAD among pts with echocardiographic RVD at baseline vs pts without RVD (15 +/– 4.2 vs 16.4 +/– 3mm; p=0.3). Three pts who deteriorated during short-term observation had substantially lower TAD values than those with uncomplicated courses (6.5 +/– 1.2mm vs 14.9 +/– 4.1mm; p= 0.006). impaired TAD was associated with decreased RV systolic function in pts with acute PE. To identify the clinical meaning of decreased TAD, larger trials with longer follow-up periods are needed.

Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department

In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project. Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles. Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

Women’s Health: Does City Life Alter Breast Density?

Women’s Health: Does City Life Alter Breast Density?