Review Of Files Research Articles

Research on the Dilemma and Countermeasure of Cadre Personnel File Management

Personnel file management, as an effective means of cadre management, involves various links such as file collection and sorting, file review, file search and borrowing, file transfer, etc. In order to give full play to its important role in cadre and talent work, this paper briefly summarizes the current situation and development history of cadre and personnel files, and identifies the existing problems and causes of current archive management. The improvement measures are put forward.

Patient Outcomes After Long-Term Acute Care Hospital Closures

Long-term acute care hospitals (LTCHs) are common sites of postacute care for patients recovering from severe respiratory failure requiring mechanical ventilation (MV). However, federal payment reform led to the closure of many LTCHs in the US, and it is unclear how closure of LTCHs may have affected upstream care patterns at short-stay hospitals and overall patient outcomes. To estimate the association between LTCH closures and short-stay hospital care patterns and patient outcomes. This retrospective, national, matched cohort study used difference-in-differences analysis to compare outcomes at short-stay hospitals reliant on LTCHs that closed during 2012 to 2018 with outcomes at control hospitals. Data were obtained from the Medicare Provider Analysis and Review File, 2011 to 2019. Participants included Medicare fee-for-service beneficiaries aged 66 years and older receiving MV for at least 96 hours in an intensive care unit (ie, patients at-risk for prolonged MV) and the subgroup also receiving a tracheostomy (ie, receiving prolonged MV). Data were analyzed from October 2022 to June 2023. Admission to closure-affected hospitals, defined as those discharging at least 60% of patients receiving a tracheostomy to LTCHs that subsequently closed, vs control hospitals. Upstream hospital care pattern outcomes were short-stay hospital do-not-resuscitate orders, palliative care delivery, tracheostomy placement, and discharge disposition. Patient outcomes included hospital length of stay, days alive and institution free within 90 days, spending per days alive within 90 days, and 90-day mortality. Between 2011 and 2019, 99 454 patients receiving MV for at least 96 hours at 1261 hospitals were discharged to 459 LTCHs; 84 LTCHs closed. Difference-in-differences analysis included 8404 patients (mean age, 76.2 [7.2] years; 4419 [52.6%] men) admitted to 45 closure-affected hospitals and 45 matched-control hospitals. LTCH closure was associated with decreased LTCH transfer rates (difference, -5.1 [95% CI -8.2 to -2.0] percentage points) and decreased spending-per-days-alive (difference, -$8701.58 [95% CI, -$13 323.56 to -$4079.60]). In the subgroup of patients receiving a tracheostomy, there was additionally an increase in do-not-resuscitate rates (difference, 10.3 [95% CI, 4.2 to 16.3] percentage points) and transfer to skilled nursing facilities (difference, 10.0 [95% CI, 4.2 to 15.8] percentage points). There was no significant association of closure with 90-day mortality. In this cohort study, LTCH closure was associated with changes in discharge patterns in patients receiving mechanical ventilation for at least 96 hours and advanced directive decisions in the subgroup receiving a tracheostomy, without change in mortality. Further studies are needed to understand how LTCH availability may be associated with other important outcomes, including functional outcomes and patient and family satisfaction.

Abstract 17978: Validation of Contemporary Administrative Codes for Identifying Pulmonary Vein Isolation Procedures

Introduction: Use of pulmonary vein isolation (PVI) to treat atrial fibrillation continues to grow. Despite great interest in leveraging administrative data for real-world analyses, contemporary procedural codes for identifying PVI have not been validated. Methods: Inpatient PVIs were identified among US Medicare fee-for-service beneficiaries using Current Procedural Terminology (CPT) code 93656 in the Carrier Line Files. Each patient was cross-matched by procedure date with claims from Medicare Provider Analysis and Review Files (MedPAR), in order to compare CPT claims with International Classification of Diseases-10 th Revision Procedure Coding System (ICD-10 PCS) claims submitted by healthcare facilities to bill for each PVI. We performed the reverse for commonly matched ICD-10-PCS codes, to identify their corresponding CPT-billed procedures. Results: We identified 20,388 inpatient PVIs from 1/2017 to 12/2020, of which 14,468 (71%) were linked to MedPAR by same-day procedure date. Of these, 13,156 (91%) were billed as ICD-10 02583ZZ “ Destruction of Conduction Mechanism, Percutaneous Approach ”, with lower use of other codes. However, the reverse process yielded heterogeneous results: among 75,003 procedures billed as ICD-10 02583ZZ, only 15,691 (21%) matched with CPT 93656 (PVI), as several other procedures were interchangeably billed under this same ICD-10 code (Figure). Conclusions: Compared with CPT codes as a gold standard, the ICD-10-PCS code most commonly associated with CPT-billed PVI procedures actually refers to ablation of the atrio-ventricular junction. Yet this same ICD-10-PCS code also matches with a wide range of other procedures distinct from PVI. We conclude that ICD-10-PCS codes alone are not sensitive or specific for identifying PVI in claims, and cannot be reliably used in isolation for health services research on this important procedure.

United States regulatory approval of medical devices used for endovascular neurosurgery: A two-decade review of FDA regulatory files

BackgroundThe evolution of neuroendovascular technologies has progressed substantially. Over the last two decades, the introduction of new endovascular devices has facilitated treatment for more patients, and as a result, the...

Case history factors and audiological screening outcomes in HEU and HIV unexposed neonates at a district level hospital in Gauteng, South Africa

While progress has been made in reducing vertical Mother to Child Transmission (MTCT) of HIV, limited research exists on the health needs of HIV-exposed uninfected (HEU) neonates, particularly in the field of audiology. This lack of research and evidence could impact early detection and intervention efforts. This study aimed to establish relationships and compare outcomes between case history factors and audiological screening results in HEU and HIV-unexposed neonates at a district-level hospital in Gauteng, South Africa. A non-experimental quantitative, descriptive, cross-sectional, comparative research design was employed. Data was collected with a sample size of 212 participants (100 HEU, 112 HIV-unexposed neonates) recruited using quota sampling. The hearing screening process involved case history assessment, medical file review, otoscopy, tympanometry testing, Distortion Product Evoked Otoacoustic Emissions (DPOAE), and Automated Auditory Brainstem Response (AABR) measurements. Descriptive and inferential statistics, including measures of central tendency and parametric tests, were used for data analysis. The findings indicated that 43% of HEU neonates exhibited refer findings on DPOAE, and 43% on AABR, compared to 26% and 25% respectively in the HIV-unexposed neonatal group. Therefore, a statistically significant relationship was established when comparing audiological results between the HEU and HIV-unexposed groups. Case history factors such as mode of delivery, birth weight, and Apgar scores were not associated with hearing loss in either group. However, in the HEU group, a higher proportion of participants referred on the overall screening in the maternal Retroviral Disease (RVD) stage IV group, although statistical significance was not established. This study fills an evidence gap regarding HEU neonates and highlights the need to include this vulnerable population in policy and clinical guidelines related to early hearing detection, intervention, and preventive audiology initiatives.

Management of Secondary Glaucoma Postscleral Buckle Surgery: A Tertiary Hospital Experience in Southwest Nigeria

Abstract Purpose: To evaluate the rate of postoperative intraocular pressure (IOP) elevation and its management in patients who have undergone scleral buckle surgery as a primary intervention for retinal detachment. Materials and Methods: This was a retrospective review of hospital files of scleral buckle surgeries for retinal detachment from January 2016 to December 2021 at the University College Hospital Ibadan. All patients with a previous history of glaucoma, vitreoretinal surgery, or a combination of vitrectomy and scleral buckling procedures were excluded from the review. An IOP of ≥22 mmHg after surgery was considered elevated. Results: A total of 148 patients’ charts were reviewed with 125 patients (131 eyes) included in the study. There were 81 males (64.8%) and the mean age of patients was 45.2 (±18.8) years, with a range of 5–81 years. Rhegmatogenous retinal detachment accounted for 97.7% (128 eyes) of all cases and 118 eyes (90.1%) were recent detachments. Seventy-nine eyes (60.3%) recorded elevated IOP postscleral buckle surgery. The mean elevated IOP postbuckle surgery was 27.9 (±6.2) mmHg and the mean antiglaucoma medications prescribed was 2.4 (±2) with a range of 2–5 medications. Four eyes (5.1%) needed surgical intervention for the elevated IOP. The last follow-up mean IOP was 14.3 (±4.1) mmHg. Conclusion: Elevated IOP frequently complicates scleral buckle procedure and medical treatment is usually sufficient. As a common complication, this should be considered in advance when planning for the procedure, especially in low-income countries like Nigeria where scleral buckling surgery is still in common practice.

Evaluation of Green Material Selection at PGSD Laboratory Building Universitas Samudra

In today's modern era, infrastructure development should take into account environmental considerations, such as the use of green materials and eco-labeling. This approach is vital for ensuring the long-term well-being of humanity and preventing further increases in global warming caused by construction practices that disregard safe and environmentally friendly materials. This study is focused on evaluating the selection of green materials in the PGSD Laboratory at Universitas Samudra. The assessment is based on the standards set by the Green Building Council Indonesia (GBCI) for Material Sources and Cycles. Data collection involved interviews with the technical team responsible for construction, on-site observations to assess material usage, and a review of various building documentation files. The interviews revealed that the PGSD Laboratory at Universitas Samudra was designed with a 'green campus' or 'green building' concept, emphasizing the use of environmentally friendly materials. Analysis of the materials used in both the structural and architectural aspects of the PGSD Laboratory found that it met 8 out of 10 green building requirements, achieving an overall percentage of 80% in accordance with the Material Sources and Cycle assessment for Greenship GBCI. The use of such materials has had a positive impact, contributing to energy conservation, the preservation of natural resources, environmental health, user comfort, and waste reduction.

Predictors of Viral Suppression among Adults Living with HIV/AIDS in Nigeria: A Retrospective Chart Review.

Over 1.6 million Nigerians have succumbed to the ravaging scourge of the acquired immunodeficiency syndrome (AIDS) epidemic since its discovery. Viral suppression (VS) then becomes a critical cost-effective human immunodeficiency virus (HIV) prevention strategy. We assessed the prevalence and predictors of VS. This retrospective case file review was conducted among adults (aged ≥18 years) living with HIV/AIDS who accessed care at a tertiary health facility in Northwestern Nigeria between January and December 2021. One thousand one hundred and twenty HIV/AIDS-eligible patients accessed care during the study. Their age ranged between 20 and 70 years with a mean of 43.83 ± 10.83 (95% confidence interval [CI]: 43.19-44.46). The patients were mostly female (728; 65.0), residing in urban areas (680; 60.7%), self-employed (440; 39.3%), married (712; 63.6%), receiving antiretroviral therapy (ART) for at most 14 years (916; 81.8%), on first-line ART regimen (812; 72.5%), in HIV clinical stage 1 (964; 86.1%), and with a baseline CD4 count of 199 cells/µl (453; 40.4%). The prevalence of VS of 64.3% (720/1120) was recorded in the study. The predictors of VS were disclosure of HIV status (odds ratio [OR] =2.4; 95% CI = 1.503-3.832), absence of opportunistic infections (OR = 2.6; 95% CI = 1.242-5.406), receiving ART for 15-29 years (OR = 2.1; 95% CI = 1.398-3.292), first-line ART regimen (OR = 3.7; 95% CI = 2.618-5.115), and adequate adherence (OR = 4.7; 95% CI = 3.324-6.766). VS was suboptimal among the study cohort with adequate adherence being its strongest predictor.

Clinical spectrum of COVID-19 at a national referral hospital in western Kenya during the period 2020–2021

IntroductionWe describe the clinical spectrum of COVID-19 cases in western Kenya from 6 April 2020 to 31 May 2021, providing baseline data for further studies into COVID-19 in Kenya.MethodsWe did a retrospective chart review of laboratory and inpatient files of patients diagnosed and managed for COVID-19 at the Moi Teaching and Referral Hospital in Kenya and analyzed the data using Stata® version 16 (StataCorp LP, College Station, TX, USA) and calculated measures of association at 95% CI.ResultsThe patients (n = 1,770) had a mean age of 43 years (SD 20 years) and 55.4% were male. Close to 70% had asymptomatic disease, with the symptomatic cases largely being respiratory in nature. One-quarter had comorbidities. The case fatality rate was 13.6% (n = 240). Male sex increased the odds of mortality by 1.69 (95% CI 1.27–2.25; p ≤ 0.001), and the presence of comorbidities increased the odds of mortality by 3.16 (95% CI 2.38–4.18; p ≤ 0.001). Those aged 59 years and above were 18 times more likely to die from COVID-19 than those below 15 years of age (95% CI 1.61–90.66; p = 0.015).ConclusionCOVID-19 had a significantly high mortality rate in western Kenya. Male sex and the presence of comorbidities increased the risk of severe disease and mortality.

United States Regulatory Approval of Topical Treatments for Dry Eye

PurposeTo report the heterogeneity in methodology of clinical trials submitted to the U.S. Food and Drug Administration (FDA) for approval of topical dry eye treatments. DesignComparative analysis of clinical trials’ methods. MethodsWe reviewed the online, publicly available FDA database, application review files, ClinicalTrials.gov registry records, and journal articles for each FDA-approved topical dry eye treatment. For each trial, we extracted information about the study, patient demographics, treatment names and doses, sample size in each arm, and the measurement instrument in a systematic fashion. ResultsFourteen trials were included that assessed five topical treatments for dry eye (cyclosporine 0.05%, cyclosporine 0.09%, lifitegrast 5%, and loteprednol 0.25% eye drops and varenicline 0.03 mg nasal spray). Median treatment duration was 12 weeks (range, 2 to 24 weeks). In all trials, treatments, including varying concentrations of the same treatment, were compared with vehicle. Twelve trials (85.7%) evaluated a primary clinician-measured clinical sign, and 10 trials (71.4%) evaluated a primary patient-reported symptom. Corneal staining was the most frequently evaluated clinical sign primary outcome, reported in half (6/12) of the trials, and was graded using four different scoring systems. Conjunctival staining, conjunctival hyperemia, and tear production were each measured using two different scoring systems. Ocular discomfort, the only patient-reported symptom primary outcome, was measured using five different instruments. ConclusionA variety of outcome measures were used in these clinical trials. Clinically meaningful dry eye outcome measures and standardized measurements can optimize the assessment of and comparison of therapeutic benefits.

Association of Interview and Holistic Review Metrics With Resident Performance-Related Difficulties in an Internal Medicine Residency Program.

Background The utility of traditional academic factors to predict residency candidates' performance is unclear. Many programs utilize holistic review processes assessing applicants on an expanded range of application and interview characteristics. Determining which characteristics might predict performance-related difficulty in residency is needed. Objective We aim to elucidate factors associated with residency performance-related difficulty in a large academic internal medicine residency program. Methods In 2022, we conducted a retrospective cohort study of Electronic Residency Application Service and interview data for residents matriculating between 2018 and 2020. The primary outcome was a composite of performance-related difficulty during residency (referral to the Clinical Competency Committee; any rotation evaluation score of 2 out of 5 or lower; and/or a confidential "comment of concern" to the program director). Logistic regression models were fit to assess associations between resident characteristics and the composite outcome. Results Thirty-eight of 117 residents met the composite outcome. Gold Humanism Honor Society (odds ratio [OR] 0.24, 95% confidence interval [CI] 0.16-0.87) or Alpha Omega Alpha (OR 0.36, 95% CI 0.14-0.99) members were less likely to have performance-related difficulty, as were residents with higher United States Medical Licensing Examination Step 2 Clinical Knowledge scores (OR 0.97, 95% CI 0.47-1.00). One-point increases in general faculty overall interview score, leadership competency score, and leadership overall score were associated with 41% to 63% lower odds of meeting the composite outcome. Interview or file review "flags" had an OR of 2.82 (95% CI 1.37-5.80) for the composite outcome. Conclusions Seven metrics were associated with the composite outcome of resident performance-related difficulty.

Was COVID-19 Associated With Worsening Inequities in Stroke Treatment and Outcomes?

Background COVID-19 stressed hospitals and may have disproportionately affected the stroke outcomes and treatment of Black and Hispanic individuals. Methods and Results This retrospective study used 100% Medicare Provider Analysis and Review file data from between 2016 and 2020. We used interrupted time series analyses to examine whether the COVID-19 pandemic exacerbated disparities in stroke outcomes and reperfusion therapy. Among 1 142 560 hospitalizations for acute ischemic strokes, 90 912 (8.0%) were Hispanic individuals; 162 752 (14.2%) were non-Hispanic Black individuals; and 888 896 (77.8%) were non-Hispanic White individuals. The adjusted odds of mortality increased by 51% (adjusted odds ratio [aOR], 1.51 [95% CI, 1.34-1.69]; P<0.001), whereas the rates of nonhome discharges decreased by 11% (aOR, 0.89 [95% CI, 0.82-0.96]; P=0.003) for patients hospitalized during weeks when the hospital's proportion of patients with COVID-19 was >30%. The overall rates of motor deficits (P=0.25) did not increase, and the rates of reperfusion therapy did not decrease as the weekly COVID-19 burden increased. Black patients had lower 30-day mortality (aOR, 0.70 [95% CI, 0.69-0.72]; P<0.001) but higher rates of motor deficits (aOR, 1.14 [95% CI, 1.12-1.16]; P<0.001) than White individuals. Hispanic patients had lower 30-day mortality and similar rates of motor deficits compared with White individuals. There was no differential increase in adverse outcomes or reduction in reperfusion therapy among Black and Hispanic individuals compared with White individuals as the weekly COVID-19 burden increased. Conclusions This national study of Medicare patients found no evidence that the hospital COVID-19 burden exacerbated disparities in treatment and outcomes for Black and Hispanic individuals admitted with an acute ischemic stroke.

Educator's blueprint: Holistic applicant file review in undergraduate and postgraduate medical education.

Medical schools and graduate medical education programs are tasked each year with selecting the next class of trainees, often from large applicant pools with enormous quantities of data to be processed. Review of applicant files must therefore be efficient, equitable, and effective in maximizing the likelihood of trainee success and alignment with institutional missions and values. In this article, we discuss 10 strategies to optimize the file review process for trainee selection. Using these strategies, educators can ensure rigorous and accountable file review processes for their training programs.

Thrombosis incidence in major paediatric burns.

Major burns are associated with multiple risk factors for thrombosis such as decreased mobilization and systemic inflammation. It is unclear if these factors are offset by the inherent lower thrombosis risk in the paediatric patient. As such there is no consensus on thromboprophylaxis for paediatric burns patients, in contrast to this being a mainstay of treatment in the adult population. This retrospective cohort study examines the incidence of, and risk factors for, thrombotic events in major paediatric burns with a view to establish guidelines for prevention. Review of major paediatric burns, defined as % total body surface area (%TBSA) ≥30%, at the Adelaide Women's and Children's Hospital (WCH) over a 16-year period. Coding data and the local burns database were used to identify participants with subsequent review of case files. Of the cohort (n = 23), six cases (26%) were complicated by thrombotic events. These patients had the most extensive burns averaging 68.5% TBSA, longer PICU admissions and associated interventions. These data points were more than doubled in the cohort diagnosed with a thrombus. Of the six events, five were secondary to central venous catheters (CVC) and one deep venous thrombosis (DVT) to the left calf. The incidence of thrombotic events in our study was significant albeit in a small population. There is a strong association between large %TBSA and thrombus, with clots mostly forming around CVCs. While further research is required, this study demonstrates screening and targeted thromboprophylaxis may be required for major paediatric burns.

Cardiovascular Risk Scores among Asymptomatic Adults with Haemophilia.

The mortality rate of Brazilian people with haemophilia (PwH) is decreasing, but the relative incidence of deaths associated with cardiovascular disease (CVD) is increasing. We aimed to describe the CVD risk score of PwH according to Pooled Cohort Equations Risk (PCER) Calculator tool and its treatment recommendations. We also compared the PCER estimates with the respective Framingham Risk Score (FRS). This cross-sectional study included male PwH ≥ 40 years treated at the Comprehensive Haemophilia Treatment Centre of Pernambuco (Recife/Brazil). PwH with a previous CVD event or a low-density lipid cholesterol ≥ 5.0 mmol/L were excluded. Interviews, medical file reviews, and blood tests were performed. The PCER tool was used to estimate the CVD risk and compare it with the respective FRS. A p-value < 0.05 was accepted as statistically significant. Thirty PwH were included. Median age was 51.5 [interquartile range-IQR; 46.0-59.5] years. The prevalence of obesity, systemic arterial hypertension, diabetes mellitus, hypertriglyceridaemia, hypercholesterolaemia, and hypoHDLaemia were 20%, 67%, 24%, 14%, 47%, and 23%, respectively. The median PCER score was 6.9% [IQR; 3.1-13.2], with 50% having a high risk (PCER ≥ 7.5%). Statin use was suggested for 54% of PwH. Blood pressure was poorly controlled in 47% of PwH. The agreement between PCER and FRS was 80% (κ = 0.60; p = 0.001). Half of the male people with haemophilia aged 40 years or older had a 10-year high risk of developing CVD with strong recommendations to improve control of dyslipidaemia and blood pressure.

Emotion dysregulation – A bridge between ACE and aggressive antisocial behavior

PurposeForensic populations have high prevalence rates of adverse childhood experiences (ACE), but specific pathways from childhood victimization to adult victimizing behavior remain unclear. Difficulties in emotion regulation may prove to be a more proximal risk factor that functions as a pathway between ACE and aggressive antisocial behavior (AAB). In this study, we investigated concurrent associations between ACE, AAB, and difficulties in emotion regulation and tested the mediational role of emotion dysregulation. MethodsA forensic psychiatric inpatient sample (N = 97) was recruited from a maximum-security forensic psychiatric hospital in Sweden. Data were collected through file reviews and self-reports and analyzed with mediation and correlation analyses. ResultsWidespread bivariate associations among the study variables emerged, with small to moderate effect sizes. Distinct emotion regulation difficulties had unique relations to ACE and to different forms of AAB respectively. Evidence of significant indirect effects was limited and inconsistent across different types of analyses. ConclusionsDeficits in emotion regulation might be an important target of change in efforts to reduce AAB in forensic psychiatric patients with past ACE exposure. Attention to different dimensions of emotion regulation is crucial to deliver comprehensive interventions.

The Characteristics of Patients Admitted to a Forensic Psychiatric Intensive Care Unit in Australia

Background: Psychiatric intensive care units (PICUs) house some of the highest acuity patients within the mental health system. Little is known about patient characteristics and adverse events occurring in these settings and this study aimed to examine clinical, demographic and offending characteristics and correlates of problem behaviours for patients admitted to the first forensic PICU in Australia. Aims: To identify common characteristics held by patients admitted to one high secure forensic PICU in Australia. Method: Retrospective file review occurred for patients admitted between March 2019 and May 2020, during which 96 male patients were admitted. Results: Mean (range) age was 37.3 (21–76) years, and when admitted most patients were: single (n = 80; 83.3%), homeless (n = 52; 54.2%), had not completed high-school education (n = 60; 62.5%), had histories of trauma (n = 38; 39.6%) and antisocial behaviour (n = 40; 41.7%) in adolescence and presented with personality disorder (n = 23; 24.0%) and substance abuse (n = 93; 96.9%). Frequent problem behaviours, particularly aggression (n = 65; 67.7%), were encountered and rates of seclusion (n = 62; 64.6%) were high. Segregation in prison prior to admission and co-morbid personality disorder were associated with increased likelihood of aggression or self-harm respectively occurring. Conclusion: With high mental illness acuity and significant behavioural risk complicated by multi-vulnerability, forensic PICUs need specialist environments, models of care and high level relational and de-escalation staff expertise to maintain safety and promote recovery.

Systemic emergency department performance in a low resource tertiary health facility in central Kenya: Micro level emergency care system evaluation.

Emergency care system (ECS) performance is a proxy indicator of emergency care (EC) response and health systems resilience. The Emergency Care and System Assessment tool (ECSA) provides a structure for measuring emergency department (ED) systemic performance, using high quality ECS metrics. These metrics aligned with WHO targeted priority action areas facilitate synergies in supporting ECS evaluation at the micro level. Retrospective file reviews and anecdotal evidence from a low resource tertiary health facility between 1st January 2020 - 31st May 2021 showed that: - the governance structure had administrative and financial autonomy from the public healthcare system, healthcare financing was mostly out of pocket (OPP) and the human resource ecosystem was structured in operations, enforcement and training to drive EC quality improvement. More than two thirds of the patients were high acuity but only 2% of the patients died. Most sentinel ED functions were available at the facility however the facility does not have a developed prehospital care, neurosurgical nor a burns unit. Micro ECS framework derived from ECSA objectively interrogates performance of the healthcare system that supports EC in a tertiary facility.

A survey of flexible bronchoscopy practice at Kenyatta National Hospital, Kenya

Objectives: Flexible bronchoscopy (FB) is an essential diagnostic and therapeutic tool for managing respiratory diseases, and an audit of its practice is important; it enhances standardization of practice and improves outcomes and patient safety. This study aimed to describe the FB practice at Kenyatta National Hospital (KNH) regarding indications, peri-procedure practice, gross and histologic findings, and safety. Materials and Methods: This study was a quantitative and retrospective chart review of files of 282 patients who underwent flexible bronchoscopies over 5 years in KNH. Results: We reviewed 282 flexible bronchoscopies done between January 2016 and December 2020. There was a significant documentation gap (22%); 54 out of the 282 cases audited had incomplete documentation. The male-to-female ratio was 1:1, with a median age of 51 years. Most (58.2%) of the patients were residents of counties outside Nairobi. Despite a lack of evidence for routine evaluation, we noted significant rates (75.9%) of routine laboratory evaluations (International normalized ratio (INR), platelet count). The most common indication of bronchoscopy was the evaluation of a lung mass (100) 35.7%, pulmonary infiltrate 53 (18.9%), and assessment for interstitial lung disease 39 (13.9%). The most common gross bronchoscopic findings were visible tumors at 38.5% (107) and normal endoscopic findings at 29.5% (82). The practice was safe, with a complication rate of 3.2%. The most common diagnostic outcome was lung cancer (40.1%), with adenocarcinoma being the most common (45.1%) histologic subtype. The diagnostic yield for malignancy where there was a visible tumor was 87.2%. Conclusion: Our study showed that FB practice at KNH is safe and provides a good diagnostic yield, but a significant documentation gap and record keeping exist. Adenocarcinoma was the most predominant lung cancer histologic subtype among the mostly non-smoker population.

Cochlear implant: factors that impact hearing outcomes

Background: Cochlear implant has been providing hearing rehabilitation to patients with severe hearing loss. However, not all patients achieve optimal results, and the goal of this study was to evaluate the factors that influence hearing outcomes in cochlear implantation. Methods: This was a retrospective analysis of the patients who underwent cochlear implantation in our institution between 2018 and 2021. Review of clinical files and complementary tests, and analysis of hearing outcomes and complications were performed. Results: Sixty-nine cochlear implants were placed in 64 patients, with an average age of 49.3 years. In initial evaluation post activation and 1 year after implantation, the average pure tone average (PTA) was 37 dB, with a vocal discrimination of 48.7% at 50 dB, and 28, 6 dB, with a discrimination of 73.8% at 50 dB, respectively. Patients with postlingual deafness had better hearing outcomes at 1 year post surgery, in both PTA (27.9 compared to 33 dB) and discrimination at 50 dB (76.5 compared to 56.1%). Only one case had a major complication. Conclusions: In conclusion, we found that increased implant use by the patient, postlingual deafness, and in-creased surgeon experience, were factors that improved hearing outcomes in patients undergoing cochlear implantation.