Luke's Hospital Research Articles

Assessing the prevalence of hepatitis B virus infection among health care workers in a referral hospital in Kisantu, Congo DR: a pilot study

We aimed to determine hepatitis B virus (HBV) prevalence and risk factors for health care workers (HCWs) to contract HBV infection in a referral hospital in the Democratic Republic of Congo. From October 2015 to August 2016, we recruited 97 HCWs (55 males and 42 females, aged 41.2 ± 10 yr) from Kisantu St. Luke’s Hospital, a Congolese referral hospital located in the province of Kongo Central. Serum samples were assayed for HBV markers using ELISA. A questionnaire was used to record the HCWs’ demographics, medical histories, and risk factors. The overall prevalence of exposure to HBV infection [HBsAg+, and/or hepatitis B core antibody (anti-HBc)+] was 56.7% (55/97). HBsAg positivity was found in 18.6% (18/97) of the HCWs whereas 29.9% (29/97) were anti-HBc positive. Approximately 8.2% (8/97) of the HCWs tested positive for both HBsAg and anti-HBc. Being a physician [odds ratio (OR)=2.8 (95% CI: 1.34–12.23)], a laboratory technician [OR=3.35 (95% CI: 1.35−5.21)], and having multiple sex partners [OR=3.05 (95% CI: 1.13−9.09)] were found to be factors associated with HBV infection. Exposure to HBV is common among HCWs at Kisantu St. Luke’s Hospital. Isolated HBsAg was also prevalent among them. There is a high risk that HBV could be spread to others. Therefore, there is an urgent need for HBV screening, treatment, and vaccination policies.

Physical Therapy Following Total Hip Replacement and Assessment of the Effects on the Quality of Life

Introduction: Hip osteoarthritis (HOA) is a serious clinical and social problem and is considered a civilisation disease. HOA is a chronic condition that causes joint cartilage damage. Its symptoms increase slowly, resulting in considerable limitations in hip joint mobility and severe pain. Advanced degenerative changes constitute one of the main indications for total hip replacement. Aim: To assess the effects of physical therapy procedures on the quality of life in patients after total hip replacement. Material and Methods: The study group consisted of 25 patients aged 60 to 79 years, staying at the specialist St. Luke Hospital in Końskie. Patients were examined in two stages, namely before surgery and after physical therapy and rehabilitation, up to 6 months after hip replacement. Results: After total hip replacement, patients showed statistically significant improvements in the ranges of motion of the hip and reductions in pain, which contributed to better motor skills and improved patient independence in everyday life. Conclusions: Total hip replacement and comprehensive rehabilitation performed in the study patients improved the ranges of motion in the hip joint, which contributed to an improvement in gait, functioning, and physical fitness and a significantly better quality of life.

Automated Fetal Head Detection and Circumference Estimation from Free-Hand Ultrasound Sweeps Using Deep Learning in Resource-Limited Countries

Ultrasound imaging remains out of reach for most pregnant women in developing countries because it requires a trained sonographer to acquire and interpret the images. We address this problem by presenting a system that can automatically estimate the fetal head circumference (HC) from data obtained with use of the obstetric sweep protocol (OSP). The OSP consists of multiple pre-defined sweeps with the ultrasound transducer over the abdomen of the pregnant woman. The OSP can be taught within a day to any health care worker without prior knowledge of ultrasound. An experienced sonographer acquired both the standard plane—to obtain the reference HC—and the OSP from 183 pregnant women in St. Luke's Hospital, Wolisso, Ethiopia. The OSP data, which will most likely not contain the standard plane, was used to automatically estimate HC using two fully convolutional neural networks. First, a VGG-Net-inspired network was trained to automatically detect the frames that contained the fetal head. Second, a U-net-inspired network was trained to automatically measure the HC for all frames in which the first network detected a fetal head. The HC was estimated from these frame measurements, and the curve of Hadlock was used to determine gestational age (GA). The results indicated that most automatically estimated GAs fell within the P2.5–P97.5 interval of the Hadlock curve compared with the GAs obtained from the reference HC, so it is possible to automatically estimate GA from OSP data. Our method therefore has potential application for providing maternal care in resource-constrained countries.

Implementing an Inpatient Protocol: Improving Time to Treatment for STEMIs

SESSION TITLE: Cardiovascular 2 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Recent studies suggest a higher mortality for inpatient STEMIs compared to STEMI patients who arrive in the emergency department (ED) or are transferred from an outside facility. The question of how to improve outcomes and definition of optimum treatment in hospitalized patients experiencing a STEMI merits greater concern and attention across the nation. Part of the increased mortality can be due to less timely reperfusion as a result of unfamiliar personnel on non-cardiac floors. St Luke's Hospital, a community hospital in suburban Missouri, recently instituted a protocol for inpatient STEMIs in order to decrease time to reperfusion. The focus was to give non-cardiology personnel the appropriate guidance to facilitate reperfusion similar to the ED protocol. This analysis of recent inpatient STEMIs was done to identify gaps and barriers to prompt treatment; including difficulty in identifying symptoms, interpreting ECGs, as well as long delays in decision making. METHODS: For the last ten years there has been a protocol in place at our hospital for STEMI patients that come through the ED in association with national door-to-balloon time (D2B) initiatives. The goal is to apply a similar protocol to inpatients already in the hospital. We instituted a protocol for treatment of inpatients STEMIs according to the current standards of care established by the American College of Cardiology. This protocol includes four steps that need to be followed to implement timely treatment: 1) identify a STEMI on an ECG, 2) have the ECG over-read by a qualified physician, 3) activate the STEMI team, and 4) have the care handed off to the STEMI team of cardiac catheterization laboratory nurses and the interventional cardiologist on call. We defined the initial time as the time that the ECG was performed; a “door” time was deemed inappropriate and any other measure was too ambiguous. RESULTS: Prior to initiating the protocol, there were 8 inpatient STEMI patients; and 7 inpatient STEMI patients after the protocol implementation. The average time to reperfusion for patients prior to the change was 406 minutes. The average time to reperfusion for patients after the protocol rollout was 68 minutes. A significant improvement was achieved with time to reperfusion defined as time of the initial ECG to balloon or device intervention after implementation of the inpatient STEMI protocol (p<0.05). CONCLUSIONS: In a community hospital, it is feasible and necessary to implement a protocol for inpatient STEMI management which will greatly improve the time to appropriate treatment. Some areas identified for improvement include false activations, following a protocol on non-cardiac floors, and stricter definition of time-to-treatment, as this was difficult to determine since the patient did not have “door” time but rather, a symptom that prompted an ECG. CLINICAL IMPLICATIONS: It is possible and necessary to implement a protocol for inpatient STEMI management to improve time to appropriate treatment in a community hospital; however there are still areas identified for further research. DISCLOSURE: The following authors have nothing to disclose: Erika Leung, Ryan Medas, Mary Randazzo, Tinashe Maduke, Onyema Nnanna, Morton Rinder No Product/Research Disclosure Information

Safety of Gastrointestinal Endoscopic Procedures in Patients With Severe Heart Failure

Introduction: Gastrointestinal (GI) endoscopic procedures are minimally invasive; however, there is evidence to suggest they may precipitate cardiovascular hemodynamic complications such as arrhythmias and myocardial infarction. These complications are more common in patients with primary cardiovascular and pulmonary diseases. Heart failure is a well-recognized factor for perioperative and postoperative cardiac events. Our aim to assess the factors associated with the safety and peri-procedural complications of GI endoscopies in patients with severe heart failure (defined as systolic heart failure with ejection fraction less than 30%, or severe diastolic heart failure). Methods: Through retrospective chart review, we collected de-identified data about patients with severe heart failure who underwent GI endoscopies at St Luke's hospital Kansas City MO. We assessed incidence of complications and mortality in the 30 days following procedure. Results: Our study included 207 patients with severe heart failure. Mean age was 64.8 years with 142 (68.9%) males. Sample included 133 (64.3%) Caucasian patients, 62 (30%) of African American population. Around half of our sample presented with heart failure exacerbation with fluid overload 95 (45.5%). All our patients underwent some sort of GI procedure (EGD 47.8%, Colonoscopy 15.4%, both 29.4%, other procedures 7.4%). Mortality within 30 days after procedure was 4.3% (9/207). The 30-day complications incidence was 19.8% (41/207) compared to around 0.5-1% incidence in literature. Immediate complications within hours of procedure was determined to be 21.3% (44/207) compared to 1.4% incidence in literature. Factors this study included were all found to positively correlate with mortality; especially positive smoking history (P=0.006, OR 6.87), history of recent MI (P=0.04, OR 4.4), elevated INR (P=0.03, OR 2.08)). Moreover, the 30-day complications were significantly associated with hyper-volemic status (P=0.035), NYHA class (P=0.02), positive smoking history (P=0.003). Whereas, the immediate complications were significantly associated with increased BMI (P=0.032, OR 1.07), Presence of lung disease (P=0.011, OR 3.13). Conclusion: Severe heart failure patients are at high risk for mortality and complications after GI procedures. Several factors are especially associated with such risk and within limitations of a retrospective study can predict poor outcome.

Coronary atherosclerosis in indigenous South American Tsimane: a cross-sectional cohort study

Conventional coronary artery disease risk factors might potentially explain at least 90% of the attributable risk of coronary artery disease. To better understand the association between the pre-industrial lifestyle and low prevalence of coronary artery disease risk factors, we examined the Tsimane, a Bolivian population living a subsistence lifestyle of hunting, gathering, fishing, and farming with few cardiovascular risk factors, but high infectious inflammatory burden. We did a cross-sectional cohort study including all individuals who self-identified as Tsimane and who were aged 40 years or older. Coronary atherosclerosis was assessed by coronary artery calcium (CAC) scoring done with non-contrast CT in Tsimane adults. We assessed the difference between the Tsimane and 6814 participants from the Multi-Ethnic Study of Atherosclerosis (MESA). CAC scores higher than 100 were considered representative of significant atherosclerotic disease. Tsimane blood lipid and inflammatory biomarkers were obtained at the time of scanning, and in some patients, longitudinally. Between July 2, 2014, and Sept 10, 2015, 705 individuals, who had data available for analysis, were included in this study. 596 (85%) of 705 Tsimane had no CAC, 89 (13%) had CAC scores of 1-100, and 20 (3%) had CAC scores higher than 100. For individuals older than age 75 years, 31 (65%) Tsimane presented with a CAC score of 0, and only four (8%) had CAC scores of 100 or more, a five-fold lower prevalence than industrialised populations (p≤0·0001 for all age categories of MESA). Mean LDL and HDL cholesterol concentrations were 2·35 mmol/L (91 mg/dL) and 1·0 mmol/L (39·5 mg/dL), respectively; obesity, hypertension, high blood sugar, and regular cigarette smoking were rare. High-sensitivity C-reactive protein was elevated beyond the clinical cutoff of 3·0 mg/dL in 360 (51%) Tsimane participants. Despite a high infectious inflammatory burden, the Tsimane, a forager-horticulturalist population of the Bolivian Amazon with few coronary artery disease risk factors, have the lowest reported levels of coronary artery disease of any population recorded to date. These findings suggest that coronary atherosclerosis can be avoided in most people by achieving a lifetime with very low LDL, low blood pressure, low glucose, normal body-mass index, no smoking, and plenty of physical activity. The relative contributions of each are still to be determined. National Institute on Aging, National Institutes of Health; St Luke's Hospital of Kansas City; and Paleocardiology Foundation.

The Jigsaw effect: Impact of Jigsaw learning technique on nursing students to learn the concepts of normal labor

Introduction: Learning and reproducing the contents learnt in the examination is a part of every student's life especially in professional courses like nursing where the entire curriculum is made concise into 3 - 4 years. Making the teaching and learning strategies more student friendly has helped to retain student's attention and instil in them the interest to learn and perform better. Jigsaw Technique is one of the cooperative learning technique in which students equally participate, prepare and lead a group thus learning for themselves as well as preparing their group. The purpose of this study was to investigate the impact of jigsaw learning technique on nursing students as it is found beneficial in teaching. The technique also helps to revolve the learning material for peers in learning process and thereby help to build interpersonal and interactive skills among students. Objectives: To assess the existing level of knowledge on normal labour concepts among nursing students. To plan and implement the Jigsaw learning technique for learning the concepts of normal labour. To determine the effectiveness of Jigsaw learning technique by doing the post assessment on knowledge of normal labour among nursing students. Methodology: Using Simple Random Sampling technique, 40 diploma nursing students were recruited and their pre-knowledge was assessed on the concepts of normal labor and its management. The same group was taught the Jigsaw Technique of learning and their post knowledge was assessed. There was a significant difference in the performance of the students on the self-administered questionnaire before and after the intervention. The study was conducted at St. Luke's Hospital's College of Nursing , Shrirampur. Results and interpretation: There is significant difference between pre test 19 (47.5%) and post test knowledge score 36 (90.0%) at (p value) 0.05 level, analyzed by paired 't' test. Conclusion: The Jigsaw Learning method proved to be an effective educational learning tool for nursing students.

Introduction to the Seventeenth Symposium on Cardiac Arrhythmias: Words in Honor of Dr. Ali Massumi.

My name is Mehran Massumi and I am the son of Ali Massumi, the man who started this electrophysiology conference 17 years ago.Ali Massumi was born on 15 January 1945 in the town of Nain, Iran. In 1971, he graduated at the top of his class from the University of Tehran, where he met his wife (eventually to become my mother), Vida. Upon completion of his medical training, the couple moved to Buffalo, New York, where my father completed his internal medicine residency at Millard Fillmore Hospital. Next, with my older brother in tow, my parents moved to Houston, where my father pursued his fellowship in Cardiovascular Diseases at the Texas Heart Institute. He graduated from his fellowship in 1979 and joined the prestigious Hall-Garcia Cardiology Associates, where he remained a partner during the entire course of his medical career.Throughout his professional life, my father received many accolades and was widely considered one of the best clinical electrophysiologists in this field. He was routinely named amongst the best cardiologists by local, state, and national media outlets; and he was the personal physician to many members of the Royal Family of Oman.But it wasn't the awards or praise that drove him to be great. He was a teacher, who loved nothing more than to teach. When he gained a full professorship at the Baylor College of Medicine, he was the youngest physician at the time to do so. Loved by the fellows whom he helped to train, he won so many “Attending of the Year” awards that a moratorium was placed on his winning, in order to give other physicians a chance. He trained more than 180 cardiologists and more than 30 electrophysiologists, many of whom are sitting here today.My father passed away on 13 March 2015, just 3 weeks after last year's conference. Despite failing health and generalized weakness from lymphoma, he still mustered the energy to attend the event, a testament to how much he cared about continuing education in the field of cardiac electrophysiology.Although we all wish he were here today to open this year's meeting, I am positive that he is looking down on us from above and could not be happier that his memory and his conference live on. I know that this conference is in the very capable hands of his partners, Drs. Mohammad Saeed, Abdi Rasekh, and Mehdi Razavi, 3 colleagues whom he very much admired and respected.On behalf of myself, my family, and my father's colleagues at St. Luke's Hospital and the Texas Heart Institute, I want to thank all of you for your attendance at this symposium that meant so much to him.

The Gelbs' Lifelong Journey with O'Neill

The Gelbs' Lifelong Journey with O'Neill

Claude D Arnaud, Jr, MD (1929–2016): ASBMR Loses a Founding Father

Claude D Arnaud, Jr, MD (1929–2016): ASBMR Loses a Founding Father

Changing trends of acute pancreatitis – St. Luke's hospital in comparison to the Irish population

Changing trends of acute pancreatitis – St. Luke's hospital in comparison to the Irish population

Changing trends of acute pancreatitis – St. Luke's hospital in comparison to the Irish population

Changing trends of acute pancreatitis – St. Luke's hospital in comparison to the Irish population

A review of abnormal birth positions and complications in Uyo, Akwa Ibom State

Introduction: Abnormal birth positions persisting to term have been associated with serious complications such as uterine rupture, umbilical cord prolapse, cervical spine injury, nuchal arms, and fetal head entrapment. Aim: The purpose of this study was to find out the most common abnormal birth position, mode of delivery, and associated complications at birth. Materials and Methods: This study covered the period of 5 years from 2005 to 2009 in three major hospitals in Uyo Local Government Area of Akwa Ibom State. The hospitals are St. Luke Hospital established in 1937, Mainland Hospital (a private hospital) established in 1975, and University of Uyo Teaching hospital established 1996. Totally, 1100 term singleton fetuses in abnormal birth positions were considered in this study. Results: Six different types of abnormal birth positions were recorded viz.: Breech 70.00% (the most common fetal malposition), transverse lie 14.73%, occiput posterior 8.45%, face presentation 3.27%, shoulder 1.91%, and compound 1.64%. Associated complications observed were umbilical cord prolapse (the most common complication) 6.27%, ruptured uterus 1.64%, and shoulder dislocation 0.54%. The rate of cesarean delivery for these fetuses was high (68.36%) compared to vaginal delivery (31.64%). Conclusion: Pregnant women are hereby encouraged to make childbirth a medically-centered hospital event to avoid unnecessary loss of their lives and/or that of their babies to complications of pregnancy and childbirth.

Implementation of a phased medical educational approach in a developing country

ObjectiveHealthcare provider education can serve as one method for improving healthcare in developing countries. Working with providers at St Luke Hospital in Haiti, we developed a phased educational approach through partnership development, face-to-face teaching, and virtual educational tools.DesignOur novel approach included three phases: direct patient care, targeted education, and utilization of the train-the-trainer model. Our end goal was an educational system that could be utilized by the local medical staff to continually improve their medical knowledge, even after our educational project was completed. We implemented pre- and post-lecture evaluations during our teaching phase to determine whether the education provided was effective and beneficial. Additionally, we provided medical lectures on a shared file internet platform, Box.com, during the train-the-trainer phase to allow healthcare providers in Haiti to access the educational content electronically.ResultsIn total, 47 lectures were given to 150 medical providers, including nurses, physicians, and pharmacists. Pre- and post-lecture evaluations were administered. The mean was 30.63 (14.40) for pre-lecture evaluations and 93.36 (9.80) for post-lecture evaluations indicating improvement out of a total of 100 possible points. Our collaborative Box.com account contains 214 medical education lectures available for viewing as a constant resource to St Luke Hospital staff. Thus far, 20 of the 43 (47%) Haitian medical providers have viewed lectures, with an average of 5.6 lectures viewed per person. Qualitative data suggest that these methods improved communication between healthcare staff, promoted better ways of triaging patients, and improved job satisfaction.ConclusionsA phased educational approach can improve healthcare workers’ knowledge through partnership in a developing country. Educating local providers is one way of ensuring that in-country healthcare staff will improve their medical knowledge and expertise.

Abstract A19: SHARE speaks: English, Japanese, Spanish, and cultures too

Abstract The poster will portray the many languages SHARE speaks both linguistically and culturally to meet the needs of underserved communities. The main focus will be on one of their latest special projects which is the Ambassador Program. It is a grassroots effort to reach medically underserved Latino/Hispanic and African American communities in New York City. Through educational presentations, trained survivors and other trained health advocates build public awareness and health empowerment regarding breast and ovarian cancers. The message is Be Informed, Empowered and Know Your Body! During outreach, women of African Ameican and Caribbean heritage frequently voiced they were looking for a support group with “people that look like me”. As a result of these comments, SHARE has begun to fill a void with the creation of a breast and ovarian cancers support group in the Harlem neighborhood of New York City. SHARE's mission is to create and sustain a supportive network and community of women affected by breast or ovarian cancer. SHARE brings these women and their families and friends together with others who have experienced breast or ovarian cancer, and provides participants with the opportunity to receive and exchange information, support, strength and hope. SHARE's work focuses on empowerment, education and advocacy to bring better healthcare, an improved quality of life, and a cure for these diseases. SHARE offers monthly educational programs on breast and ovarian cancers by medical professionals, researchers and health practitioners. LatinaSHARE is celebrating 20 yrs. of service to both the English and Spanish speaking Latino communities. They have breast and ovarian cancers helplines in English and Spanish. They offer breast and ovarian cancers support groups with some groups focused on women of African American and Caribbean, Japanese and Latino heritages. Another one of SHARE's special projects is the Survivor Patient Navigators. It has two bilingual breast cancer survivors who work at Bellevue Hospital Breast Clinic and Mt. Sinai/St. Luke's Hospital Breast Clinic respectively. They help newly diagnosed patients especially Latina patients who only speak Spanish understand their diagnosis and empower them to be involved in their treatment decisions. Citation Format: Desiree Walker. SHARE speaks: English, Japanese, Spanish, and cultures too. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A19.

William H. Wymer

William Hinkson Wymer was born in Chicago, Illinois, on 26 March 1920 at St. Luke's Hospital, the son of Lula Hinkson Wymer and William W. Wymer of Koscuisco County, Indiana, and Chicago. He had antecedents in the Revolutionary War; Weimer and Shoemaker from Germany, and Burkett from Basel, Switzerland. Bill attended John W. Cook Elementary School, Calumet Senior High School, and Morgan Park Junior College in Chicago. He got his bachelor's degree in entomology at Louisiana State University in Baton Rouge, Louisiana, and did graduate work at the University of Minnesota. In his youth, Bill was drawn to boats through the Sea Scouts at Jackson Park on Lake Michigan. He migrated to the Columbia Yacht Club at Grant Park Harbor and crewed during several summers on a 55-foot yawl, Beverly . Later he moved up to the 46-foot cutter Kid Sister , which participated in all the yacht races out of Chicago on Lake Michigan. He participated in three Chicago-to-Mackinac Island Yacht Races, the longest freshwater sailing race in the world. During World War II and its aftermath, from 1943 to 1948, Bill signed on as a ship's officer in the U.S. Army Transport Service (ATS), based at Quarry Heights, Canal Zone. He served as third officer to first officer (third mate to chief mate) and sailed from New Orleans and Puerto …

Use of NPWT with and without Soft Port technology in infected foot wounds undergoing partial diabetic foot amputation.

Negative pressure wound therapy (NPWT) has previously been shown to be effective in closing diabetic foot wounds that have undergone amputation over a 16-week period. For patients with plantar foot wounds, NPWT is a key therapy. An alternative NPWT with and without a novel soft, flexible port system needs to be evaluated for its comparable efficacy. Our objective was to show the non-inferiority of an alternative negative pressure system, and in a small subset, a novel foam dressing system. We performed a single centre prospective study of patients with diabetes undergoing open bone resection in the foot for acutely infected wounds. Wounds were treated with NPWT/soft port technology (SPT), for 112 days or until primary closure or the wound was deemed ready for delayed primary closure. Rate of closure and quality of life were analysed. A previously published cohort was used as a control. Of the 30 patients initially recruited, 29 met eligibility requirements and had NPWT applied a median of 2 days postoperatively. There were seven patients (24%) who had delayed primary closure (mean=58 days) and 52% had sufficient progress to change in treatment (15/29; mean=62 days). Only one patient reached the 112-day mark without sufficient progress to be closed. The primary method of delayed primary closure was split-thickness skin graft. There was a reduction in wound area 56.3% (initial mean area=17.4cm(2) to final mean area=7.6 cm(2); p=0.001) at the end of treatment (mean=58.7 days) reduced to 4.3cm(2) a 67.2% reduction (p=0.004) at the end of study (112 days). The alternative NPWT and the soft port technology was well tolerated and effective in the population in aggregate. There was no inferiority between the two technologies. The aggregate closure or progression to be ready for closure rate of 75% at 69 days compares very favourably with previously published data for NPWT in this population of 56% at 56 days (range: 26-92 days). Both cohorts did significantly better than previously published standard of care closure rates of 39% at 77 days. J.C. Lantis is a paid consultant for Smith & Nephew, Acelity, Macrocure and Manukamed. This trial as supported by an institutional grant to St Luke's and Roosevelt Hospital sponsored by Smith & Nephew. The outcome of the trial had no bearing on the condition of the grant. No investigator holds an equity position in Smith & Nephew. C. Gendics is a paid consultant of Acelity.

Outcome of open reduction for the neglected posterior dislocation of the elbow in a low-to-middle income country.

Neglected posterior dislocation of the elbow is common in developing countries. We evaluated the clinical results of open reduction focusing on range of motion (ROM), stability and pain. Sixteen patients were treated for neglected dislocation of the elbow between January 2008 and December 2012 at St. Luke's Catholic Hospital and College of Nursing, Wolisso, Ethiopia. Mean time from injury was 2.8 months (range, 2-48 months). All patients underwent open reduction using Speed's technique. Mean follow-up was 12 months (range, 12-36 months). Range of motion (ROM) was measured, stability was checked with the lateral pivot shift apprehension test. All patients improved their range of motion (ROM). Pain decreased. One patient developed instability during the rehabilitation programme; in the remaining patients pivot shift test was negative. Open reduction is an effective method to restore joint stability, improve function of neglected posterior dislocation of the elbow.

Live birth rates after MESA or TESE in men with obstructive azoospermia: is there a difference?

How do live birth rates compare after intracytoplasmic sperm injection (ICSI) for men with obstructive azoospermia when using sperm derived from testicular sperm extraction (TESE) versus microsurgical epididymal sperm aspiration (MESA)? Our study suggests that proximal epididymal sperm (from MESA) result in higher live birth rates as compared with testicular sperm (from TESE) in couples where the man has obstructive azoospermia due to congenital bilateral absence of the vas deferens (CBAVD) or vasectomy. For couples with obstructive azoospermia, MESA (epididymal sperm) and TESE (testicular sperm) have generally been assumed to be equivalent for use in ICSI. But this assumption has never been confirmed, and this view has important clinical and basic scientific consequences. This was a retrospective study of a consecutive cohort of 374 men with obstructive azoospermia and normal spermatogenesis, who underwent IVF and ICSI using either epididymal sperm or testicular sperm in the period 2000-2009. The study included men undergoing MESA or TESE at St. Luke's Hospital for obstructive azoospermia due to CBAVD or vasectomy. A total of 280 couples underwent MESA and 94 underwent TESE with ICSI. The live birth rate was 39% after MESA-ICSI and 24% after TESE-ICSI. The MESA-ICSI cycles also resulted in a significantly higher implantation rate and significantly higher clinical and ongoing pregnancy rates than the TESE-ICSI cycles. There was no significant difference in results between fresh or frozen sperm for both MESA and TESE. When adjusted for the available confounders, the odds ratio for live birth was significantly in favour of MESA-ICSI versus TESE-ICSI (OR 1.82; 95% CI 1.05-3.67). The only significant confounders were female age and ovarian reserve. This is a retrospective cohort study and not a randomized clinical trial. Our study suggests that some aspect of sperm maturation after the sperm leaves the testicle to enter the epididymis is required for the most optimal results, even when ICSI is used for fertilization. No funding was used and there are no competing interests.

Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti

BackgroundIn the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain.ObjectiveWe hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages.DesignWe conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs.ResultsThe PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of ‘real-time’ medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization.ConclusionsAn efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.