Microsoft Excel Spreadsheet Research Articles

BN O04 - Trends in the management of bile duct stones in the United Kingdom: Are we following the evidence?

Abstract Background Common bile duct stones (CBDS) are typically managed in two stages: Endoscopic Retrograde Cholangiopancreatography (ERCP) followed by laparoscopic cholecystectomy (LC). However, access to ERCP can be limited or require referral, has a high failure rate, often necessitates additional imaging, and may involve multiple procedures. Increasing evidence suggests that single-stage management, involving LC with intraoperative imaging and bile duct exploration when indicated, is cheaper, more effective, and reduces overall length of stay. British Society of Gastroenterology guidance states that it is a valid alternative to ERCP. This study aimed to determine whether clinical practice aligns with this evidence. Method National Health Service (NHS) Admitted Patient Care publications summarise Hospital Episode Statistics by financial year and are openly accessible. OPCS4 Procedure Codes were screened by two authors and categorised as “operative” or “endoscopic.” Codes detailing the management of CBDS or bile duct exploration were included, while ambiguous codes or those for non-stone indications were excluded. Data pertaining to these codes were extracted from the Admitted Patient Care publications for 2012 to 2022 and summarised in a Microsoft Excel spreadsheet. Trends were analysed using a Non-Seasonal Mann-Kendall Trend Test Results A total of 249,475 procedures for CBDS were performed over the ten-year period, with a mean patient age of 67. Annually, the total number of procedures increased from 21,365 to 27,668 (p=0.002). Endoscopic procedures increased from 19,716 to 25,976 (p=0.002), while operative procedures remained stable (1,649 to 1,692, p=0.431). Consequently, the proportion of endoscopic management rose from 92.3% to 93.9% (p<0.001). The mean age of patients undergoing operative procedures was ten years younger than those undergoing endoscopic procedures (57 vs. 67 years) Conclusion Despite evidence and guidance supporting single-stage procedures, there is a trend towards endoscopic management of CBDS in the UK. This may be due to operational pressures on the NHS, including the sequelae of the COVID-19 pandemic, or reflect challenges within hospital culture, skill mix, or equipment availability.

BN SO37 - Upper GI surgical training in the UK: Are there enough training opportunities? 10-year trends in Benign Upper GI index procedures and the impact of COVID-19

Abstract Background Surgical training was adversely impacted during the COVID pandemic, with reports of reduced logbook numbers and challenges in meeting training competencies. Despite a national elective care recovery plan, and interventions aimed at maintaining training opportunities, waiting list expansion has continued and has particularly impacted benign procedures. Upper GI trainees are all required to achieve “Level 4” (independent) competence in Cholecystectomy and Antireflux surgery, however there are anecdotally. fewer opportunities in the post-COVID era to train in these procedures. This study aimed to evaluate trends in these index procedures and to compare the pre- and post- COVID eras. Method The annual Admitted Patient Care (APC) publications draw on Hospital Episode Statistics and summarise activity for each financial year by OPCS4 codes. Codes pertaining to cholecystectomy and antireflux surgery (the “Benign Upper GI” competences on the Joint Committee of Surgical Training New Curriculum Checklist) were screened for inclusion. Data were extracted from APC publications between 2013 and 2023. These data were summarised in a Microsoft Excel Spreadsheet, categorised by index procedure and divided into pre-covid (2013-2019) and post-covid (2019-2023). Trends were evaluated using a Mann-Kendal Non-Seasonal Trend Test. Comparisons were undertaken using a two tailed unpaired t-test. Results Between 2013 and 2023 there was a statistically significant negative annual trend in the number of cholecystectomies from 75934 to 68182 (p=0.02), with a minimum of 47803 in the 2020-2021 financial year and a non-significant positive trend in the subsequent years. There were significantly fewer cholecystectomies in the 4 years following COVID (mean 77357 vs 63882, p=0.015). Antireflux procedures also underwent a significant negative trend from 5467 to 4745 (p=0.02), with a minimum of 2565 in the 2020-2021 financial year and a non-significant positive trend in subsequent years. Mean post-COVID antireflux procedures were also significantly lower (5548 vs 4256, p=0.03). Conclusion The procedures required for training in Benign Upper GI surgery in the UK are occurring with lower frequency than before the COVID pandemic. Whilst this may reflect ongoing operational pressures, or changes in clinical practice, this evidence suggests that training opportunities are now less frequent. This highlights the importance of focussed training and an awareness of training needs amongst both trainees and their mentors.

The operational impact of medicines shortages on pharmacy Procurement and Distribution (P&D) services at a large teaching hospital

Abstract Introduction There has been a nine-fold increase in medicines shortages in the UK over the last 5 years.1 The reasons are multifactorial including shortages in raw materials, as well as financial and geopolitical instability. The adverse impact on clinicians and patients is well documented however studies on the impact to P&D services is sparse. Aim This study aims to quantify the impact of increasing medicines shortages to P&D services who lead on sourcing and distributing alternative medicines to meet patient needs.1 Method The period between January 2021 and January 2024 of the Pharmacy “Drug Shortages Tracker” was reviewed by the P&D Specialist Pharmacist. Each Shortage was assigned at least one of eight potential managing solutions e.g. “Rationalising Usage” and “Sourcing Unlicensed Alternatives”. The time required to complete the tasks for each shortage was calculated using the following formula: [Sum of the Estimated Time to Complete Each Task* (minutes) x Duration of Shortage (weeks)] + Sum of the Estimated Time to Complete all ‘One Time Only’ Activities’* * Standardised times based on time in motion data [collected in June 2023] and feedback from specialist P&D staff. The data was recorded on a Microsoft Excel spreadsheet which had the following headings: Shortage, Method(s) of Resolution, Duration of Shortage and Total Time to Resolve. This study was deemed a service evaluation by the trust’s Research and Audit Group and therefore ethics approval was not required. Results All 332 shortages are included in the results totalling 1,841 hours of staff time. The year by year breakdown is as follows: From 2021 to 2022, 3 shortages accounting for 49 hours. From 2022 to 2023, an increase to 146 shortages accounting for 898 hours (18-fold increase from previous year). From 2023 to 2024, 183 shortages accounting for 894 hours. The number of shortages recorded per month was 0.24 from 2021 to 2022, 11.2 from 2022 to 2023 and 14 from 2023 to 2024. The mean time required to complete the P&D aspects of a single shortage was 332 minutes. With the most time consuming shortage requiring 1640 minutes in 2022. Discussion This increased volume of shortages nationally has put pressure on P&D services to allocate greater resources to support their management and maintain patient safety. P&D teams are assessed nationally on metrics relating to medicine expenditure.2 In practice, the core services that ensure medicines are available for patients’ takes precedent. The rising challenge of shortages poses a risk to the capacity of P&D teams to carry out both critical tasks and those relating to medicines expenditure. Notable limitations to this study include the numerous interpretations and definitions of shortages which produced inconsistent recordings within the trust3. This was exacerbated by changes to documentation procedures internally. As an example, the variable recording process in 2021 does not provide an accurate representation of the actual period. Other internal changes included the uptake of automated dispensing cabinets which added further complexity to shortage management. Conclusion The growing demands of shortages highlights the need for dedicated shortages teams.

Effects of Repeated Reading Approach on Primary 3 Pupils in Public-Primary Schools in Central Nigeria

The study looked at the effects of repeated reading approach on primary three pupils reading in Pankshin Local Government Area of Plateau State, North Central Nigeria and was carried out in five (5) different public schools located in the rural areas of the Local Government. The main objective of the study was to significantly remedy the reading challenges of primary 3 pupils by increasing their reading ability. The study was a true experimental design of pre-test and post-test with a sample of 110 pupils. The study was conducted within one academic session: September 2022 – July 2023. Means, standard deviation and ANCOVA using IBM SPPS version 22 and Microsoft Excel Spread sheet were used. The study revealed that pupils achieved a significant level of fluency in their reading ability, and it recommended the use of the Repeated Reading Approach to teach learners who have challenges with reading in primary schools.

HIV-related perceived stigma and internalized stigma among people living with HIV/AIDS in Africa: A systematic review and meta-analysis.

HIV-related stigma has significant adverse impacts on people living with HIV/AIDS, such as psychological distress, decreased quality of life, a reluctance to get screened and treated, and a reluctance to disclose their status due to fear of stereotypes or rejection. To determine the pooled prevalence and factors associated with HIV-related perceived stigma and internalized stigma among people living with HIV/AIDS in Africa. Articles that assessed the prevalence and associated factors of HIV-related perceived stigma and internalized stigma were reviewed. PubMed, EMBASE, Google Scholar, African Journal Online, CINAHL, and Science Direct were the databases used to search the primary studies. The data was extracted through a Microsoft Excel spreadsheet and exported to STATA version 14 for further analysis. The I2 test was applied to test heterogeneity, whereas Egger's test and funnel plot were used to check publication bias. In this study, the total sample size was 28,355 (for perceived stigma) and 22,732 (for internalized stigma). The overall pooled prevalence of HIV-related perceived stigma and internalized stigma was determined to be 41.23% and 35.68%, respectively. Based on the subgroup analysis results, the highest pooled prevalence of perceived stigma was observed in Nigeria (50.04%), followed by Ethiopia (41.72%), while the highest prevalence of internalized stigma was observed in Ethiopia (56.13%), followed by Cameroon (44.66%). Females (OR = 1.63: 1.31, 2.02) and rural dwellers (OR = 1.93: 1.36, 2.74) had more odds of experiencing HIV-related perceived stigma. This study concluded that four in ten and more than one-third of people living with HIV/AIDS suffered from perceived and internalized stigma. Thus, special considerations must be given to women and rural dwellers. It is recommended to implement multi-level interventions and foster empowerment and support for individuals living with HIV.

It’s a battlefield! A thematic analysis of narratives shared in Cape Town emergency departments

BackgroundThe Emergency Department(ED) team need to make sense of an ever-changing dynamic environment. The stories people tell about everyday occurrences are central to how sense-making occurs. These stories also contribute...

Gender-based violence and its determinants among refugees and internally displaced women in Africa: systematic review and meta-analysis

BackgroundGender-based violence is a serious public health concern and affects a large number of women and girls in humanitarian emergencies. Despite this, there is a dearth of the summary data to address the issue. Therefore, this study aimed to assess the estimated pooled magnitude and factors associated with gender-based violence among refugees and internally displaced women in Africa.MethodsPubMed/MEDLINE, Google Scholar, African Journals OnLine, PsycINFO, and EMBASE were among the databases that were used to search the primary articles. The reviewed papers were articles that evaluated the prevalence and contributing variables of gender-based violence against refugees and internally displaced women in Africa. We extracted the data using a Microsoft Excel spreadsheet, which we exported into Stata version 14 for further analysis. The I2 test was applied to identify statistical heterogeneity. We used a random effect meta-analysis methodology because of the heterogeneity. A funnel plot and Egger’s weighted regression test were used to examine publication bias.ResultsThis systematic review and meta-analysis reviewed 17 primary studies with a total of 6,161 refugees and internally displaced women in Africa. The findings of this study revealed that the estimated pooled prevalence of gender-based violence among refugees and internally displaced women was determined to be 48.20% (95% CI: 39.28, 57.12). Young age (AOR = 3.68, CI: 2.63, 5.14), alcohol consumption (AOR = 2.53, CI: 1.56, 4.11), and having no social protection (AOR = 3.21, CI: 2.22, 4.63) were factors significantly associated with gender-based violence.Conclusions and recommendationsThe present study showed that almost half of refugees and internally displaced women residing in Africa were survivors of gender-based violence. Younger women, alcohol users, and those without social protection were more likely to experience gender-based violence. Therefore, it is recommended that accessible information about the consequences of gender-based violence and early intervention for survivors be provided, taking these factors into consideration.

Immunohistochemical Expression of MDM2, Bcl-2, SATB2 and Ki-67 in Histological Variants of Unicystic Ameloblastoma.

To characterize the immunohistochemical expression of MDM2, Bcl-2, SATB2 and Ki-67 in histological variants of unicystic ameloblastoma (UA). Following the ethical approval, forty (40) patients with unicystic ameloblastoma were retrieved from the archives and subjected to immunohistochemistry (IHC). Sociodemographic and clinical data were also retrieved. The results were entered into a Microsoft Excel spreadsheet and analyzed using SPSS software. Human tooth germs, which served as the control, showed moderate expression of Bcl-2 and MDM2 with slight proliferative activity in ameloblasts and moderate expression of SATB2 in ectomesenchyme and odontoblasts. Luminal UA (Type 1) showed low Ki-67 index and negative to mild Bcl-2 and MDM2 expression, whilst Type 1.2 (luminal and intraluminal), Type 1.2.3 (luminal, intraluminal and mural), and Type 1.3 (luminal and mural), including the recurrent cases, showed moderate to intense expression with high mean Ki-67 index. The difference between the study groups was statistically significant (p value < 0.001). No expression of SATB2 was noted in any histological variant of UA. Furthermore, no significant differences were noted in age, gender, site and location between the groups. In contrast to luminal variant of UA, mural±intraluminal variants and recurrent cases demonstrate higher expression of Bcl-2 and MDM2 with higher mean Ki-67 index. It may thus be prudent to provide aggressive treatment for cases, not just with mural follicles but also for the patients with intraluminal plexiform proliferation, to prevent recurrence and improve patient outcomes.

Knowledge and attitude towards HPV infection, HPV vaccination and cervical cancer among middle- and high-school students in Gwalior

ABSTRACT Background: There is little information available regarding knowledge and attitudes towards the human papillomavirus (HPV) and its vaccines among the students in mainland India. Furthermore, there has not been much information accessible on how to increase their understanding of and readiness to receive HPV and associated vaccines, which could be crucial for the future success of vaccination campaigns. This study aims to assess the knowledge and attitude of middle- and high-school students towards HPV infection, HPV vaccine and cervical cancer prevention. Method: The present study was an observational study conducted from July 2023 to December 2023 in the Gwalior District of Northern India among the 490 students aged 11–16 years. A self-administered questionnaire was used to collect information from the students. The collected data was entered into an Microsoft Excel spreadsheet for easy calculation. Frequency and percentage were calculated and significance in proportion was tested using the chi-square test. P value was judged at a 5% level of significance. Results: The average age of the student was 13.67 ± 1.95 years range between 11 years and 16 years with a 0.52:1 sex ratio. Out of the 490 enrolled participants, 41.0% of subjects had previously heard about cervical cancer. About 64.7% of students heard it from the mass media. A total of 181 (36.9%) knew that cervical cancer was caused by HPV infection. Only 168 (34.3%) participants knew the fact that men were also infected by HPV infection. Only 12.4% knew that a healthy-looking person could have an HPV infection. Only 11.6% had shown their willingness for the HPV vaccination. There was a significant difference observed among the males and females regarding knowledge questions. Males (54.76%) heard more about cervical cancer than females (33.85%). Males had more knowledge (60.1%) regarding cervical cancer caused by HPV infection as compared with females (24.8%). Conclusion: Students’ awareness of HPV and the HPV vaccine was low. Training that focusses on HPV information in addition to sex education is needed to promote HPV vaccine coverage.

Fabricated of Photovoltaic Thermal System with Phase Change Material

At present, solar energy is widely recognized as one of the primary sources of renewable energy. Nonetheless, conventional solar photovoltaic (PV) panels suffer a significant decrease in efficiency when exposed to extreme temperatures, making them unsuitable for long-term operation. To address these limitations, hybrid photovoltaic thermal (PVT) systems with phase change materials (PCM) have emerged as sophisticated solutions, leveraging thermal energy for water heating and PCM for thermal energy storage. This work aims to evaluate key economic parameters of fabricated PVT system (with and without PCM) against commercial solar water heaters and electric heaters, using metrics such as payback period and annual worth. The calculations are carried out using Microsoft Excel spreadsheets. The results reveal that the payback period for PVT systems, both with and without PCM, exceeds 25 years, primarily due to the high initial costs associated with PVT technology. In contrast, solar water heaters and electric water heaters offer shorter payback periods. Specifically, after 25 years, the annual worth for the fabricated PVT system is MYR 923.12. Essentially, the economic analysis suggests that the PVT system has a longer operational lifetime than solar water heaters and electric heaters, despite the extended payback period. This economic analysis has the potential to encourage the large-scale fabrication and installation of efficient PVT-PCM systems. It provides consumers with a viable alternative to consider installing PVT and PVT-PCM systems instead of PV and solar thermal systems separately. Additionally, this study contributes to reducing carbon emissions and advancing the Sustainable Development Goals (SDGs).

An Audit of the Fifth Irish Hip Fracture Standard in patients &amp;gt;=70 years following hip fracture

Abstract Background Hip fractures are a significant cause of morbidity and mortality in older adults. Bone health assessment is key in the reduction of future fracture risk. The aim of our study was to examine the adherence to the fifth Irish Hip Fracture Standard in patients &amp;gt;=70 years presenting to Letterkenny University Hospital (LUH) with a hip fracture and to examine the number of patients who were commenced on bone protection. Methods We included patients &amp;gt;=70 years who were admitted under the Orthopaedic service following a hip fracture between January and June 2023 in LUH and were identified the database maintained by the using Fracture Liaison Nurse. Data collected included age, month in which hip fracture occurred, patient resident in Ireland, patient alive/deceased, patient on bone protection prior to fracture, patient commenced on bone protection or patient declined treatment. Data was recorded in a Microsoft excel spreadsheet and was analysed by the clinical audit facilitator. We measured our data against the British Geriatric Society guideline on the use of IV zoledronate following hip fracture. Results 76 patients were admitted to LUH with a hip fracture &amp;gt;=70 years between January and June 2023. 100% of patients were reviewed by the fracture liaison service and following this it was recommended that 46 patients (60%) be commenced on bone protection. A letter was sent to each patient’s General Practitioner outlining the recommendation for bone protection. On follow up only 7/46 (15.2%) had been started on treatment. Conclusion The fracture liaison service is appropriately identifying patients who require treatment, despite this, patients are not starting the necessary bone protection in the community. This has prompted our service to establish an IV zoledronate clinic for patients following hip fracture and to generate a plan for ongoing treatment of this patient cohort.

Obstetric care provider’s knowledge about the use of low dose aspirin for preeclampsia prevention in low and middle income countries: a systematic review and meta-analysis

Introduction: Preeclampsia can elevate the likelihood of unfavorable consequences for a mother, such as severe morbidity and mortality. World Health Organization recommends low dose acetylsalicylic acid (aspirin, 75 mg per day) for the prevention of preeclampsia in women at moderate or high risk of developing the condition. The use of low dose aspirin is dependent on the knowledge of health care providers working in the antenatal care units. We found inconsistent figures regarding the knowledge level of health care providers on low dose aspirin for preeclampsia prevention around different low and middle income countries in the world. Thus, determining the pooled knowledge level of health care providers is very important.MethodsThis systematic review and meta-analysis (SRMA) was conducted on the knowledge level of among obstetric care providers towards preeclampsia prevention in low and middle income countries. We identified relevant literature in the English language only. A comprehensive search was conducted on databases such as PubMed, Google Scholar, HINARI, and Scopus. Subsequently, all datasets were exported to Mendeley reference manager and transferred to a Microsoft Excel spreadsheet to eliminate duplicate data during the review process. The extracted Microsoft Excel spreadsheet format data was imported to STATA software version 17 (STATA corporation, Texas, USA) for analysis. Then random effect model was used to estimate the pooled level of knowledge of health care providers on low dose aspirin for preeclampsia prevention in low income countries. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among all the studies included in this SRMA.ResultA total of 1231 articles were identified through our search strategies, including Google Scholar, PubMed, Hinari and Scopus. Ultimately, six articles met the eligibility criteria for inclusion in the final SRMA. The pooled knowledge level of healthcare providers regarding the use of low-dose aspirin for preeclampsia prevention in low-income countries was found to be 16.38% (95% CI: 4.36–28.40). The Cochrane heterogeneity index, with a substantial I2 value of 98.89% and a significant P-value of 0.01, indicated significant heterogeneity among the primary studies included.Conclusionthe knowledge level of obstetric care providers in low and middle income countries is found very low and all the governmental and non-governmental organizations should strive to enhance the knowledge of obstetric care providers on the use of low dose aspirin for preeclampsia prevention in low and middle income countries.

Systematic conservation prioritization with the prioritizr R package.

Plans for expanding protected area systems (prioritizations) need to fulfill conservation objectives. They also need to account for other factors, such as economic feasibility and anthropogenic land-use requirements. Although prioritizations are often generated with decision support tools, most tools have limitations that hinder their use for decision-making. We outlined how the prioritizr R package (https://prioritizr.net) can be used for systematic conservation prioritization. This decision support tool provides a flexible interface to build conservation planning problems. It can leverage a variety of commercial (e.g., Gurobi) and open-source (e.g., CBC and SYMPHONY) exact algorithm solvers to identify optimal solutions in a short period. It is also compatible with a variety of spatially explicit (e.g., ESRI Shapefile, GeoTIFF) and nonspatial tabular (e.g., Microsoft Excel Spreadsheet) data formats. Additionally, it provides functionality for evaluating prioritizations, such as assessing the relative importance of different places selected by a prioritization. To showcase the prioritizr R package, we applied it to a case study based in Washington state (United States) for which we developed a prioritization to improve protected area coverage of native avifauna. We accounted for land acquisition costs, existing protected areas, places that might not be suitable for protected area establishment, and spatial fragmentation. We also conducted a benchmark analysis to examine the performance of different solvers. The prioritization identified 12,400km2 of priority areas for increasing the percentage of species' distributions covered by protected areas. Although open source and commercial solvers were able to quickly solve large-scale conservation planning problems, commercial solvers were required for complex, large-scale problems.. The prioritizr R package is available on the Comprehensive R Archive Network (CRAN). In addition to reserve selection, it can inform habitat restoration, connectivity enhancement, and ecosystem service provisioning. It has been used in numerous conservation planning exercises to inform best practices and aid real-world decision-making.

A Five-Year Trend Analysis of Antibacterial Resistance Patterns Among Non-fermenting Gram-Negative Bacilli: A Retrospective Study From the ICU Settings of a Tertiary Care Hospital.

Non-fermenting gram-negative bacilli (NFGNB) infections have emerged as a serious health concern in ICUs. Multi-drug resistant (MDR) strains of NFGNB can evolve by acquiring resistance genes to at least one agent in three or more antibacterial categories. This study aimed to analyse the prevalence of NFGNB, the distribution of MDR strains, and antibiotic resistance trends of NFGNB in different ICUs of a tertiary care hospital over a period of five years. This retrospective study was conducted in a tertiary care teaching hospital in eastern India, including a total of 20,256 samples received from various ICUs over five years. Data retrieved from the Laboratory Information System (LIS) of the hospital, and repetitive isolates from the same patients, were excluded. All samples were processed according to standard microbiological protocols by automated systems. Data were entered into a Microsoft Excel spreadsheet (Microsoft® Corp., Redmond, WA, USA), analysed using Epi Info software, and presented using descriptive statistics. Chi-square and Fisher's exact tests (where appropriate) were used as tests of significance, with a p-value of <0.05 considered statistically significant. A total of 18,032 culture-positive samples out of 20,256 samples showed growth of 18,659 bacteria. Out of these, 952 isolates were NFGNB. The prevalence of NFGNB was found to be 5.10% among all isolated bacteria. The predominant sources were respiratory samples (37.3%). Acinetobacter spp. emerged as the most prevalent NFGNB (46.5%), followed by Pseudomonas spp. (31%) and Burkholderia spp. (14.3%). Among the NFGNB isolates, 61.76% exhibited MDR, with the highest prevalence of MDR strains seen in Elizabethkingia spp. (94.7%). Among the most prevalent NFGNB, Acinetobacter spp., 64.8% were MDR strains. Trend analysis of antibiotic resistance patterns of Acinetobacter spp. indicated a substantial increase for trimethoprim-sulfamethoxazole by 18.5%, minocycline (44.4%), amikacin (20.4%), and ceftazidime (7.4%), whereas there was a reduced trend in resistance to carbapenems (6.5%), ciprofloxacin (4.7%), and cefepime (3.7%) over five years. In Pseudomonas spp., resistance to meropenem increased by 17.4%, and for ceftazidime (11.8%), amikacin (10.6%), and piperacillin-tazobactam (7.9%), whereas resistance to aztreonam diminished by 13.9%. Burkholderia spp. exhibited a 23.5% escalation in resistance to meropenem and ceftazidime (5.9%), while resistance to levofloxacin experienced a decrease of 30.2%. The study showed the prevalence of various NFGNB as 5.10% in ICU settings, with Acinetobacter spp. (46.5%) being the most common isolated bacteria. Notably, 61.76% of the isolates were MDR. Antibiotic trend analysis over five years showed increasing resistance of Acinetobacter spp. to trimethoprim-sulfamethoxazole, minocycline, and ceftazidime, with improved susceptibility for carbapenems, ciprofloxacin, and cefepime. Pseudomonas spp. showed increased susceptibility to aztreonam and rising resistance for meropenem, piperacillin-tazobactam, ceftazidime, and amikacin. In Burkholderia spp., there was increased susceptibility to levofloxacin and rising resistance to meropenem and ceftazidime. These findings focus on the need for vigilant antibiotic stewardship, with the adoption of appropriate infection prevention and control practices to restrict the emergence and spread of MDR NFGNB infections in ICU settings of hospitals.

Categorization of the Inevitable Causes of Blood and Components Wastage Detected in South Indian Urban Blood Centre

Background: Since there is no artificial substitute for human blood, it plays a vital role in the patient management in this era of modern medicine. Therefore the donated blood from a healthy donor is precious and must not be wasted without proper utilization. Blood wastage is a universal phenomenon which needs a careful approach with strict guidelines. The study aims at categorizing the various inevitable causes of wastage with an attempt to determine ways of preventing the loss due to non-utilization. Materials and Methods: A retrospective – cross sectional study was conducted in a newly started Stand-alone Blood Centre in South Indian Urban city between June, 2022 and June 2024.All the components including Whole Blood (WB), Packed Red Blood Cell Concentrate (PRBC), Platelet concentrate (PC) and Fresh Frozen Plasma (FFP) were included in the study. The reasons for blood and component wastage was noted down from the various Registers of the Blood Centre and all the data was analyzed using Microsoft Excel Spread Sheet. Results: A total of 2456 units of blood were collected. 5284 components were prepared from these which includes 42 units of Whole Blood, 2397 Packed Red Blood cells(PRBC), 2393 Fresh frozen Plasma(FFP), 452 Platelet Concentrate(PC).Overall discard rate was found to be 11.90%. PC discard rate was highest (49.34%) followed by WBU (19.04%), PRBC (13.01%) AND FFP (3.59%). The commonest cause for the discarding was expiry of the shelf life of blood bags (74.72%) followed by damaged bags (9.69%) and TTI’s (6.76%). Conclusion: Blood and its components wastage is an inevitable reality which needs to be approached as upmost priority. Zero wastage of blood and components may be targeted by recommendations like appropriate training of the blood bank staff, keeping negative group donors on reserve, strictly following FIFO policy while dispensing blood, whole blood unit collection may be minimized, encouraging Single Donor Platelets (SDP) by apheresis instead of Random Donor Platelets (RDP) preparation, Blood Utilization Committee to be made mandatory and permission for reciprocal sharing of blood components among blood banks.

Implementation of the World Health Organization Minimum Dataset for Emergency Medical Teams to Create Disaster Profiles for the Indonesian SATUSEHAT Platform Using Fast Healthcare Interoperability Resources: Development and Validation Study.

The National Disaster Management Agency (Badan Nasional Penanggulangan Bencana) handles disaster management in Indonesia as a health cluster by collecting, storing, and reporting information on the state of survivors and their health from various sources during disasters. Data were collected on paper and transferred to Microsoft Excel spreadsheets. These activities are challenging because there are no standards for data collection. The World Health Organization (WHO) introduced a standard for health data collection during disasters for emergency medical teams (EMTs) in the form of a minimum dataset (MDS). Meanwhile, the Ministry of Health of Indonesia launched the SATUSEHAT platform to integrate all electronic medical records in Indonesia based on Fast Healthcare Interoperability Resources (FHIR). This study aims to implement the WHO EMT MDS to create a disaster profile for the SATUSEHAT platform using FHIR. We extracted variables from 2 EMT MDS medical records-the WHO and Association of Southeast Asian Nations (ASEAN) versions-and the daily reporting form. We then performed a mapping process to match these variables with the FHIR resources and analyzed the gaps between the variables and base resources. Next, we conducted profiling to see if there were any changes in the selected resources and created extensions to fill the gap using the Forge application. Subsequently, the profile was implemented using an open-source FHIR server. The total numbers of variables extracted from the WHO EMT MDS, ASEAN EMT MDS, and daily reporting forms were 30, 32, and 46, with the percentage of variables matching FHIR resources being 100% (30/30), 97% (31/32), and 85% (39/46), respectively. From the 40 resources available in the FHIR ID core, we used 10, 14, and 9 for the WHO EMT MDS, ASEAN EMT MDS, and daily reporting form, respectively. Based on the gap analysis, we found 4 variables in the daily reporting form that were not covered by the resources. Thus, we created extensions to address this gap. We successfully created a disaster profile that can be used as a disaster case for the SATUSEHAT platform. This profile may standardize health data collection during disasters.

Clinico-pathologic characteristics of gastrointestinal perforations from a tertiary care hospital in Pakistan

Background: Hollow viscus perforation is one of Pakistan’s most commonly encountered surgical emergencies. Gastroduodenal perforations account for the most common site of perforations worldwide. However, the Pakistani population has a different pattern. Objective: The aim of this study was to determine the clinico-pathologic features of patients and the effectiveness of surgical options in the emergency management of bowel perforation. Materials and Methods: This retrospective, observational study was conducted at the Department of General Surgery, Unit-III, Lahore General Hospital, Lahore from January 1, 2021 to December 31, 2021. Data on demographic profiles, clinical presentation, risk factors, site of perforation, and surgical details of 73 patients with gastrointestinal perforation admitted via emergency were collected and analyzed using the Microsoft Excel (Microsoft Corp., Redmond, WA) spreadsheet. Results: There were 74% females out of the 73 included cases. Perforation was most common among the age group of 21–25 years. Abdominal pain was present in all patients, followed by vomiting in 46.6% of cases. Guarding was observed as the most common sign in 78.1% of patients. The ileum was the most common site of perforation in 41.1% of cases, while typhoid was the most common cause of bowel perforation in 20.5% of patients. In 42.5% of cases, stoma was made, followed by primary closure in 16.4% of patients. Conclusion: This study shows an increased incidence of perforation in the ileum in the Pakistani population, different from the rest of the world and common in youth. An increased incidence of perforation due to typhoid highlights the prevalence and inadequate treatment of this disease.

Prevalence and determinants of orthopedic surgical site infections in rural northern Ghana: a retrospective cohort study

BackgroundThe annual incidence of orthopedic surgeries has been steadily rising globally. The rise in orthopedic surgeries is associated with increased surgical site infection, which is linked with high mortality, extended hospital stays, and decreased quality of patient life. There is a dearth of knowledge on the magnitude and risk factors of orthopedic surgical site infections in Ghana.ObjectiveTo investigate the prevalence and determinants of orthopedic surgical site infections in St. Theresa’s Hospital, Nandom.MethodA retrospective cohort design among 1032 patients who underwent orthopedic surgeries between January 2014 and December 2018. Admission and patient record books constituted the data sources. The data were initially extracted into a Microsoft Excel spreadsheet, cleaned, and exported to SPSS version 27 and R for coding and analysis.ResultsThe prevalence of orthopedic surgical site infection was 9.3%. The determinants of orthopedic surgical site infections were: male sex (OR = 2.33, 95%CI 1.04, 5.51) p = 0.04; self-employed (OR = 3.25, 95%CI 1.2, 10.29) p = 0.030; unemployed/retired (OR = 4.61, 95%CI 1.35, 17.72) p = 0.019; duration of admission (OR = 1.03, 95%CI 1.01, 1.05) p = 0.002; number of days on postoperative medications (OR = 1.21, 95%CI 1, 1.46) p = 0.045; white blood cell count (OR = 1.04, 95%CI 0.98, 1.08) p = 0.050; and revised surgery (OR = 9.89, 95%CI 5.32, 18.79) p = 0.001.ConclusionThis study's prevalence of orthopedic surgical site infection was 9.3%. Surgical site infections are the most surveyed and common types of healthcare-associated infections that occur in low and middle-income countries. Several factors may contribute to these infections. Standardized guidelines are needed to consolidate the prevention of these infections globally.

Reliability of Goniometric Techniques for Measuring Hip Flexor Length Using the Modified Thomas Test.

The modified Thomas test (MTT) is commonly used to assess the flexibility of hip musculature, including the iliopsoas, rectus femoris, and tensor fascia latae. This measurement is important to include in a comprehensive musculoskeletal examination. However, existing research shows conflicting results regarding its reliability, particularly due to variations in controlling pelvic tilt during testing, which may lead to inaccurate measurements of hip extension when quantifying the test outcomes. This study aimed to evaluate the intra- and inter-rater reliability of the Modified Thomas Test (MTT) in assessing hip flexor length using a goniometer. It was hypothesized that controlling for pelvic tilt would enhance the reliability of these measurements. Intra- and inter-rater reliability study. Sixty-four healthy individuals were recruited to participate in this study. The MTT was performed twice on each leg by both an experienced and a student physical therapist. Blinded goniometric measurements for hip extension range of motion (ROM) in the MTT position were taken with neutral pelvic tilt being enforced via palpation. A double-blind protocol was used where both examiners were unaware of each other's measurements and the goniometer was covered to blind the measuring therapist to the values as well. ROM values were entered into a Microsoft Excel spreadsheet and quantified using SPSS software. Statistical analysis included calculating Intraclass Correlation Coefficients (ICCs) and Standard Errors of Measurement (SEMs) using SPSS software. The study included 64 participants (mean age = 23.7 ± 4.34 years). The MTT demonstrated high intra-rater reliability (ICC = 0.911) and inter-rater reliability (ICC = 0.851). The SEMs indicated minimal variability around the mean scores. The average hip extension ROM measured was 5.43± 9.73 degrees. These results suggest that the MTT is a reliable tool for assessing hip flexor length in clinical practice, particularly when pelvic tilt is controlled. These results have important implications for accurately testing orthopedic limitations that can contribute to low back, hip, and knee pain. 3.

Nonpneumatic anti-shock garment utilization for obstetric hemorrhage management and its predictors among obstetric care providers in Ethiopia: a systematic review and meta-analysis

IntroductionNon-pneumatic Anti-Shock Garment (NASG) is a lightweight, reusable first aid compression device that squeezes blood from the lower extremities and centralizes blood circulation to vital organs of the body. Postpartum hemorrhage followed by severe preeclampsia/eclampsia is the leading primary cause of maternal death (A reduction in extreme maternal adverse outcomes and faster recovery from shock are more likely to occur with earlier NASG intervention. The median blood loss reduced by half when the NASG was used for obstetric hemorrhage management, which was associated with significantly reduced maternal mortality among the most severe cases.ObjectiveTo estimate the pooled prevalence of NASG utilization and its predictors in Ethiopia.MethodsAppropriate and comprehensive searches of PubMed, MEDLINE, EMBASE, Google Scholar, HINARI, and Scopus were performed. The electronic literature search was last performed on November 18/2023. All observational study designs were eligible for this SRMA. All cross sectional studies reporting the prevalence/proportion of NASG utilization for obstetric hemorrhage management among obstetric care providers and associated factors were included in this SRMA. Primary studies lacking the outcome of interest were excluded from the SRMA. The extracted Microsoft Excel spreadsheet data were imported into STATA software version 17 (STATA Corporation, Texas, USA) for analysis. A random-effects model was used to estimate the pooled prevalence of NASG utilization among obstetric care providers in Ethiopia. The Cochrane Q-test and I2 statistics were computed to assess the heterogeneity among the studies included in the SRMA.ResultA total of 1623 articles were found by using our search strategies and seven studies comprising 2335 participants were ultimately included in the SRMA. The pooled prevalence of NASG utilization for obstetric hemorrhage in Ethiopia was 43.34% (95% CI: 35.25, 51.42%). The findings of this subgroup analysis by sample size showed that the pooled prevalence of NASG utilization for obstetric hemorrhage was greater in studies with sample sizes of less than the mean sample size (48.6%; 95% CI: 32.34, 64.86%). Receiving training (AOR = 3.88, 95% CI: 2.08–5.37), having good knowledge (AOR = 1.99, 95% CI: 1.28–3.16), positive attitude (AOR = 2.16, 95% CI: 1.62–2.75) and having available NASGs in the facility (AOR = 4.89, 95%CI: 2.88–8.32) were significantly associated with the use of NASGs for obstetric hemorrhage management.ConclusionThe level of NASG utilization for obstetric hemorrhage in Ethiopia is low. Receiving training, good knowledge, positive attitudes and availability of NASG were significantly associated with the utilization of NASG. Therefore, policy makers and other stakeholders should emphasize enhancing the knowledge and attitudes of obstetric care providers through continuous support and training. At the same time, they should work strictly in providing devices for all the health facilities.