Tertiary Level Public Hospital Research Articles

Prevalence and outcome of delirium among acute general medical inpatients in Cape Town, South Africa.

Delirium is a common, serious, underdiagnosed condition in medical and surgical inpatients with acute conditions. It is associated with increased risk of mortality and morbidity. Data of geriatric cohorts are largely limited to developed countries. To describe prevalence, risk factors and outcomes of delirium among general medical patients admitted to two hospitals in Cape Town, South Africa. This was a prospective cohort study of patients with acute conditions admitted to a general medical inpatient service in secondary- and tertiary-level public hospitals in the Metro West area of Cape Town. Patients ≥18 years of age were recruited daily from all acute medical admissions. Patients were excluded if they were aphasic or their Glasgow coma scale was <8/15. Delirium was diagnosed using the validated confusion assessment method (CAM) tool and performed by trained neuropsychologists. Demographic data were collected by a clinical team and short- and long-term mortality data were obtained using linkage analysis of hospitalised patients and routinely collected provincial death certification records. The median age of inpatients was 51 (interquartile range 36 - 65) years, 29% were HIV-infected and the overall prevalence of delirium was 12.3%. Multivariate predictors of delirium included the presence of an indwelling urinary catheter (odds ratio (OR) 4.47; confidence interval (CI) 2.43 - 8.23), admission with a central nervous system disease (OR 4.34; CI 2.79 - 7.90), pre-existing cognitive impairment (OR 3.02; CI 1.22 - 7.43) and immobility (OR 1.88; CI 1.01 - 3.51). HIV infection was not associated with increased risk of delirium. Delirium was associated with an increased risk of inhospital (delirium v. no delirium: 29% v. 12%; p<0.01) and 12-month (30% v. 20%; p<0.01) mortality, as well as increased length of hospital stay (7 days v. 5 days; p<0.01). In this cohort of medical inpatients (relatively young and with a high HIV prevalence) 1 of 8 (12.3%) patients was delirious. Delirium was associated with adverse outcomes. Delirium risk factors in this young cohort were similar to those in geriatric cohorts in developed countries, and neither HIV nor opportunistic infections increased risk.

Statin consumption and risk of post-endoscopic retrograde cholangiopancreatography pancreatitis

BackgroundThe most frequent complication of endoscopic retrograde cholangiopancreatography (ERCP) is post-ERCP acute pancreatitis (PEP). Statin consumption seems to lower the incidence of acute pancreatitis. We aimed to investigate the relationship between the use of statins and the incidence of PEP. Methodsmulticenter (4 Spanish tertiary-level public hospitals) retrospective cohort study. Adult patients undergoing an ERCP were included in the study. We excluded patients with chronic pancreatitis, with ongoing acute pancreatitis and those who developed other complications after ERCP. Patients were classified into 2 groups: those under statin treatment (group S) and controls (group C). A multivariate analysis was performed (binary logistic regression) including age, center, female gender, previous pancreatitis, suspected sphincter of Oddi dysfunction, difficult cannulation (>10 min), >1 pancreatic guidewire passages, pancreatic injection, pancreatic stenting and presence of choledocholitiasis. Resultsseven hundred and two patients were included, median age 74 (62–82 years), 330 (47%) females, 223 (32%) in group S. Thirty-five (5%) patients developed PEP, 6 (3%) in group S and 29 (6%) in group C. Statin use was not associated with a lower frequency of PEP in univariate analysis, OR 0.429 (95% confidence interval 0.176–1.05, p = 0.06) or in multivariate analysis, adjusted OR 0.5 (0.19–1.32), p = 0.16. Statin use had no effect on severity of PEP, being mild in 50% vs 78.6% in non-statin users, p = 0.306. Conclusionsthe chronic use of statins was not associated with a decreased risk of PEP or a milder course of disease in our sample of patients.

Predictors and in-hospital mortality associated with prolonged emergency department length of stay in New South Wales tertiary hospitals from 2017 to 2018.

To determine specific patient, clinical and service factors associated with increased ED length of stay and investigate whether prolonged ED length of stay, as measured by emergency treatment performance (ETP) non-compliance, is an independent predictor of all cause 30-day mortality for patients presenting to, and admitted from ED. This was a retrospective analysis of linked state-wide emergency, inpatient and death data from New South Wales. All patients who presented to a tertiary level public hospital (level 5 or 6) ED and admitted to an in-patient unit were included. Outcomes were the proportion of admitted patients who met ETP targets, and 30-day all-cause mortality. A total of 697 600 eligible cases were identified and analysed. The odds of meeting ETP benchmarks were 62% lower in those with complex or multiple medical comorbidities (odds ratio 0.38, 95% confidence interval 0.37-0.40, P < 0.001) compared with patients with no medical comorbidities. Admission under psychiatry, surgical and oncology service-related groups were associated with decreased ETP. The hazard ratio for 30-day all-cause mortality over time was 28% higher in those not meeting ETP benchmarks after adjusting for age, triage category, comorbidities, ICU and service-related group (hazard ratio 1.28, 95% confidence interval 1.26-1.30, P < 0.001). Patients with complex and multiple medical comorbidities, and those admitted under certain service-related groups such as psychiatry, surgery and oncology were found to have poorer ETP performance. Overall, failure to meet ETP was associated with increased mortality after adjusting for age, case-mix, comorbidities and acuity.

Macrolide-lincosamide-streptogramin B resistance phenotypes and their associated genotypes in Staphylococcus aureus isolates from a tertiary level public hospital of Uruguay

This study was undertaken to investigate the resistance phenotypes to macrolide-lincosamide-streptogramin B (MLSB) antibiotics and their associated genotypes in isolates of Staphylococcus aureus. We analyzed one hundred, consecutive, non-duplicate isolates (methicillin-susceptible MSSA, n=53 and methicillin-resistant MRSA, n=47) obtained from various clinical samples between July 2012 to December 2013. The resistance profile to MLSB antibiotics was determined by phenotypic methods and the resistance genes were detected by PCR assays. All of the isolates were subjected to pulsed-field gel electrophoresis (SmaI-PFGE). The overall prevalence of resistance to MLSB antibiotics was 38% and the resistance phenotype distribution was as follows: cMLSB, 22%; iMLSB, 10%; MSB, 5% and L, 1%. We detected ermA, ermC, ermB and mrsA/B genes in these resistant isolates. The single ermA gene was commonly observed mainly in those with a cMLSB R phenotype, whereas the combination ermA and ermC was more commonly observed in isolates with inducible expression. The patterns of SmaI-PFGE suggest a great genetic diversity in both MRSA and MSSA resistant to MLSB antibiotics. The results demonstrate the local presence of S. aureus resistant to MLSB antibiotics and its most frequently described responsible genes. Some of these isolates, especially those with the iMLSB phenotype, may be associated with therapeutic failure. Therefore, efforts should be directed to the correct detection of all MLSB resistant isolates using appropriate laboratory tests. PFGE results reveal a wide spread of resistance genes rather than the circulation of S. aureus clones resistant to MLSB antibiotics.

Evaluation of Colorectal Surgical Patients and Treatment Modalities in a COVID-19 Pandemic Hospital: A Cross-sectional Study

Objectives: The COVID-19 pandemic has emerged as a significant threat to healthcare systems, and has resulted in treatment algorithms being changed in general surgery clinics, as is the case in all other medical disciplines. In the present study we analyze the outcomes of patients who have undergone elective colorectal surgery in our hospital since the COVID-19 outbreak, as well as the precautionary procedural changes that have been made. Methods: The present study evaluates the approaches applied for the treatment of elective colorectal cancer patients in a pandemic hospital. In this cross-sectional study, conducted in a tertiary-level public hospital in Istanbul, Turkey, a retrospective review is made of the files of patients who underwent elective colorectal surgeries between 11.03.2020, as the date on which first case of COVID-19 was officially identified in Turkey, and 01.05.2020, in the general surgery clinic of a tertiary healthcare facility that has been designated a pandemic hospital. Results: A total of 18 patients underwent a surgical resection in accordance with oncological principles between the defined dates, having been diagnosis with a colorectal malignancy. None of the operated patients were considered suspicious for COVID-19 preoperatively, nor did they have any contact history. Furthermore, there were no suspicions or signs of COVID-19 during the 14-day follow-up of the discharged patients. Conclusion: It was established in the present study that patients undergoing colorectal surgery and patients with COVID-19 infections in the same hospital can be treated successfully without cross-infection through the application of appropriate isolation principles. These successful findings were supported by a 14-day follow-up after discharge.

Occupational stress and cognitive failure of nurses and associations with self-reported adverse events: A national cross-sectional survey.

To determine correlations for nurse self-reported occupational stress, prevalence of cognitive failure (CF), and adverse events. Cross-sectional nationwide survey. Tertiary-level public hospitals (N=115) from 13 provinces in Iran were recruited and 2,895 nurses surveyed (August 2016-December 2017). Participants' self-reported demographic information, occupational stress, CF, and frequency of adverse events were analysed using chi-square, t tests, and binary logistic regression. This study showed that 29.1% of nurses had experienced adverse events in the past six months. Significant predictors for reported adverse events from logistic regression were 'Role stressors', 'Interpersonal relations stressors', and 'Action', while 'Working environment stressors' was protective for reported adverse events. Demographic predictors of adverse events were longer work hours and male gender, while those working in critical care units, general wards, and other wards had higher reported adverse events than for emergency wards. Occupational stress and CF are associated with the reporting of adverse events. Further research is needed to assess interventions to address occupational stress and CF to reduce adverse events. Adverse events compromise patient safety, lead to increased healthcare costs, and impact nursing staff. Higher self-reported adverse events were associated with higher reported stressors and CF. Understanding the factors that influence occupational stress, CF, and adverse events will support quality patient care and safety.

Mortalidade neonatal em Luanda, Angola: o que pode ser feito para sua redução?

Introdução: Um dos principais indicadores de saúde é a taxa de mortalidade infantil, que é uma métrica de condições de vida e desenvolvimento populacional. A redução da mortalidade neonatal requer um conhecimento adequado dos fatores reais em cada nível de atenção à saúde, de modo que os recursos maternos e humanos sejam eficientemente avaliados. Os países que deram atenção especial à melhoria dos serviços de saúde para todo o ciclo gravídico-puerperal atingiram a redução da mortalidade infantil, especialmente a mortalidade neonatal precoce. Objetivo: O presente estudo tem como objetivo descrever o perfil e analisar os fatores de risco associados à mortalidade neonatal em uma maternidade pública de nível terciário localizada em Luanda, Angola. Método: Trata-se de um estudo retrospectivo de corte transversal com abordagem quantitativa, utilizando dados secundários de base provincial em instrumentos de registro hospitalar e ministerial de janeiro a dezembro de 2012. Resultados: Os resultados mostram que os óbitos neonatais não são meras ocorrências, pois indicam falhas dos poderes políticos, de profissionais do sistema de saúde e das famílias. Conslusão: Este estudo sugere que o maior fator de risco para mortalidade ao nascimento em Luanda é o tipo de parto (c-section) e que este dado não está relacionado com a idade da mãe ou com o nascimento prematuro. Identificamos também que houve maior mortalidade entre os meses de maio a julho, durante o período de menor índice de chuvas na região. No entanto, são necessários mais estudos que possam fornecer um quadro lógico e argumentos para políticas realistas para mitigar a mortalidade neonatal.

Treatment Patterns and Costs Associated with Stage IV Non-Small Cell Lung Cancer in a Mexican Population: A Chart Review.

BackgroundThe available evidence regarding the clinical characteristics, treatment patterns, adverse events (AEs), and costs of treating patients with stage IV non-small cell lung cancer (NSCLC) in Mexico is scarce.ObjectiveOur objective was to describe the clinical characteristics, treatment patterns, and direct costs associated with Mexican patients diagnosed with stage IV NSCLC who had completed two or more lines of systemic antineoplastic treatment.MethodsA multicenter retrospective cohort study was designed to collect data from the medical records of patients treated at tertiary-level public hospitals in Mexico (multicenter chart review). We calculated costs from the viewpoint of payers based on data regarding therapy and service utilization.ResultsA total of 115 patients were included. Median patient age was 61 years (interquartile range [IQR] 52.4–68.5), and 51.3% were female. The most common NSCLC type was non-squamous (92.2%), and the typical histology was adenocarcinoma (88.7%). All patients received first- and second-line therapy: 54.78% completed a third-line, 27.82% a fourth-line, 7.82% a fifth-line, 2.6% a sixth-line, and 1.7% a seventh-line active therapy. Carboplatin was the most frequently used therapy (28.6%) followed by docetaxel (23.3%), nivolumab (16.7%), and irinotecan (13.3%). AEs occurred in 53% of the patients and none was fatal. In total, 59 patients (51.3%) required hospitalization during the observation period. The median cost per patient was $US7039.40, with a minimum of $US628.30 and a maximum of $US3,557,364.20. Median overall survival of the cohort was 12 months (95% confidence interval 9.8–14.1).ConclusionsIn Mexico, NSCLC is usually diagnosed at stage IV. This study shows considerable variation in chemotherapy regimens, leading to a wide range in treatment cost. The understanding of NSCLC treatment patterns in Mexico will help to identify and address unmet needs.

Risk and Exposure of Musculoskeletal Disorders among Dental Surgeons Working in Dhaka City

Background: Musculoskeletal disorders (MSDs) are the most important occupational health problems particularly in dental professionals. Dentists are among the workers who are more often susceptible to this disorder, as because their work includes risk factors that may lead to this disorder. The study aims to determine the prevalence of MSDs among dental surgeons , also the risk and exposure of this disorder by assessing job postures and the correlation between them.&#x0D; Methods : This cross sectional study was conducted among purposively selected 86 dental surgeons working in eight different tertiary level public and private hospitals in Dhaka city. A structured questionnaire was used for data collection, where Nordic Musculoskeletal Questionnaire(NMQ) used which records the prevalence of MSDs in terms of musculoskeletal symptoms and to assess the risk and exposure of MSDs, Rapid Entire Body Assessment (REBA) score sheet, Quick Exposure Check (QEC) have been used respectively by 10- 15 minutes observing each study subject during different dental operating procedures. After data collection analysis of data was performed by using SPSS software (Version 22).&#x0D; Results : More than 63 % and 47 % of the participants reported pain and discomfort in at least one body region in the last 12 months and the last 7 days respectively. The major affected part was neck, followed by lower back, shoulders and hands / wrists. In different field of specialization among the study subjects musculoskeletal symptoms were highest in oral and maxillofacial surgeons followed by general practitioners, orthodontists, endodontists, prosthodontists. The exposure assessment (QEC) showed that a small percentage (22.1%) have acceptable exposure, where 30.2%, 47.7% had medium exposure and high exposure respectively. Whereas the risk assessment (REBA) showed that 59.3% of the participants were in medium risk group that necessitates further investigation and needs to implement change. Pearson’s correlation test indicated that there is a strong positive correlation between the current exposure and the risk (r = 0.832) and the relationship between exposure and risk of MSDs was found to be highly significant as p &lt; 0.01. Highly significant association found between risk level according to REBA score and the exposure level according to QEC score with MSDs ( as p value &lt; .01).&#x0D; Conclusion: This study concludes that high prevalence of MSDs and high risk levels as well as exposure levels according to REBA and QEC, suggest inappropriate and incorrect ergonomic postural habits existing among the dental surgeons which necessitates further investigation and attention on this issue to combat with this disorder among dental professionals.&#x0D; Update Dent. Coll. j: 2019; 9 (1): 3-7

Establishing Appropriate Agency Relationships for Providers in China.

Physicians play multiple roles in a health system. They typically serve simultaneously as the agent for patients, for insurers, for their own medical practices, and for the hospital facilities where they practice. Theoretical and empirical results have demonstrated that financial relations among these different stakeholders can affect clinical outcomes as well as the efficiency and quality of care. What are the physicians’ roles as the agents of Chinese patients? The marketization approach of China’s economic reforms since 1978 has made hospitals and physicians profit-driven. Such profit-driven behavior and the financial tie between hospitals and physicians have in turn made physicians more the agents of hospitals rather than of their patients. While this commentary acknowledges physicians’ ethics and their dedication to their patients, it argues that the current physician agency relation in China has created barriers to achieving some of the central goals of current provider-side health care reform efforts. In addition to eliminating existing perverse financial incentives for both hospitals and physicians, the need for which is already agreed upon by numerous scholars, we argue that the success of the ongoing Chinese public hospital reform and of overall health care reform also relies on establishing appropriate physician-hospital agency relations. This commentary proposes 2 essential steps to establish such physician-hospital agency relations: (1) minimize financial ties between senior physicians and tertiary-level public hospitals by establishing a separate reimbursement system for senior physicians, and (2) establishing a comprehensive physician professionalism system underwritten by the Chinese government, professional physician associations, and major health care facilities as well as by physician leadership representatives. Neither of these suggestions is addressed adequately in current health care reform activities.

Emergency nurses' knowledge about tissue plasminogen activator therapy and their perception about barriers for thrombolysis in acute stroke care

Introduction: Thrombolytic therapy using tissue plasminogen activator (t-PA) has been proven to be a cost-effective means of treating acute stroke. However, several factors lead to the underutilization of this treatment. This study was undertaken to assess the knowledge of emergency nurses regarding t-PA therapy and to identify the barriers perceived by them in the utilization of thrombolysis in acute stroke.Materials and Methods: A cross-sectional survey was conducted among 30 nurses working in the emergency department of a tertiary level public hospital in India. A self-administered questionnaire was used to assess their knowledge and perceived barriers.Results: Against a total score of 26, the score of the sample ranged from 13 to 22 with a mean score of 17.9 ± 2.4. The mean accuracy rate of the questions was 68.6 ± 25.3. Three major categories of barriers were identified in the efficient utilization of thrombolytic therapy. These were patient-related barriers, organizational barriers, and behavioral barriers. “Unaffordability of t-PA therapy due to financial constraints” and “patients not reaching the facility in the window period” were the two topmost barriers for thrombolysis identified by the nurses.Conclusion: Ongoing continuing nursing education is essential to fill the knowledge gap of nurses regarding thrombolysis. Sufficient measures need to be taken at prehospital, institutional, and personnel levels to mitigate the barriers for thrombolysis so that no eligible patients are left without the benefits of the treatment.

Delivering postpartum family planning services in Nepal: are providers supportive?

BackgroundHealth service providers play a key role in addressing women’s need for pregnancy prevention, especially during the postpartum period. Yet, in Nepal, little is known about their views on providing postpartum family planning (PPFP) services and postpartum contraceptive methods such as immediate postpartum intra-uterine devices (PPIUD). This paper explores the perspectives of different types of providers on PPFP including PPIUD, their confidence in providing PPFP services, and their willingness to share their knowledge and skills with colleagues after receiving PPFP and PPIUD training.MethodsIn-depth interviews were conducted with 14 obstetricians/gynecologists and nurses from six tertiary level public hospitals in Nepal after they received PPFP and PPIUD training as part of an intervention aimed at integrating PPFP counseling and insertion into routine maternity care services. The interviews were audio recorded, transcribed, and analyzed using a thematic approach.ResultsProviders identified several advantages of PPFP, supported the provision of such services, and were willing to transfer their newly acquired skills to colleagues in other facilities who had not received PPFP and PPIUD training. However, many providers identified several supply-side and training-related barriers to providing high quality PPFP services, such as, (i) lack of adequate human resources, particularly a FP counselor; (ii) work overload; (iii) lack of private space for counseling; (iv) lack of IUDs and information, education and counseling materials; and (v) lack of support from hospital management.ConclusionsProviders appeared to be motivated to deliver quality PPFP services and transfer their knowledge to colleagues but identified several barriers which prevented them from doing so. Future efforts to improve provision of quality PPFP services should address the barriers identified by providers.

Vascular endothelial growth factor, endostatin levels and clinical features among patients with ulcerative colitis and irritable bowel syndrome and among healthy controls: a cross-sectional analytical study.

Increased angiogenetic activity in inflammatory bowel disease (IBD) has been shown in previous studies. The aim of this study was to evaluate the relationship of serum vascular endothelial growth factor (VEGF) and endostatin levels with clinical features and mucosal expression in patients with ulcerative colitis (UC). Cross-sectional analytical study conducted in a tertiary-level public hospital. Serum VEGF and endostatin levels were determined in 82 individuals: 39 with UC, 28 with irritable bowel syndrome (IBS) and 15 healthy controls (HCs), using enzyme-linked immunosorbent assays (ELISA). VEGF and endostatin expressions were studied using immunohistochemistry (IHC). Mean serum VEGF and endostatin levels were significantly higher in patients with UC than in patients with IBS and in HCs (511.9 ± 377.5 pg/ml, 305.0 ± 121.42 pg/ml and 36.1 ± 40.6 pg/ml; P = 0.001 for VEGF; and 155.50 ± 59.8 ng/ml, 116.9 ± 23.8 ng/ml and 102.2 ± 22.4 ng/ml; P < 0.001 for endostatin, respectively). There was a positive correlation between serum VEGF and endostatin levels (r = 0.422; P < 0.01). Mean H-scores for VEGF expression were higher in the active UC group than in the inactive UC and IBS groups, in the stroma, endothelium and epithelium. Mean H-scores for endostatin expression were higher in the active UC group than in the inactive UC and IBS groups, in the stroma and endothelium. There was no endostatin expression in the epithelium. Increased endostatin appears to be a defensive reaction to increased VEGF in patients with UC.

Cost Incurred by the Family for Surgery in Their Children: A Bangladesh Perspective.

Cost of getting health services is a major concern in Bangladesh as well as in many other countries. A family has to bear more than half of the health care cost despite many facilities provided by the public hospitals. This out-of-pocket (OOP) expenditure drives many families under the poverty line. The aim of this study was to find out the exact cost incurred by the family for a surgical operation of their child in the public and private sectors in Bangladesh. A cross-sectional study was conducted to find out the cost of child surgery in different settings of public and private hospitals in Chittagong division, Bangladesh. Cost of herniotomy was then compared across different settings. In this study, cost of operation in urban private hospitals was highest mostly due to surgeon and anesthetist fee. The cost was lowest in outreach programs as surgeon fee, anesthetist fee and accommodation cost was nil; food and transport cost was minimum. However, cost of accommodation, food, transport and medicine contributed significantly to OOP expenditure especially in tertiary-level public hospitals, in both indoor and day care settings, and also in private urban hospitals. Our study provides some insight into the OOP expenditure in different health care settings in Bangladesh. This study might be useful in developing a strategy to minimize the OOP expenditure in this country.

Minimally invasive versus standard approach in LeFort 1 osteotomy in patients with history of cleft lip and palate

ObjectiveCompare literature-reported efficiency and complications of the standard maxillary advancement surgery with those of a minimally invasive mucosal approach in patients with CL/P requiring Le Fort 1 osteotomy. DesignMeta-analysis vs. retrospective analysis of 18 consecutive cases. SettingDepartment of maxillofacial surgery at a tertiary-level public general hospital. ParticipantsThe meta-analysis encompassed Medline, Embase and Cochrane, years 1990 to 2014, inclusive. The local series concerned all squeletally mature adolescents with non-syndromic CL/P who underwent orthognathic surgery between 30 April 2004 and 27 January 2012. InterventionsMinimally invasive approach and perioperative orthodontics including intermaxillary fixation for 3 months after surgery. Main outcome measure(s)Assessment of complications. Standard lateral cephalograms were taken before surgery, then <1 week and 12 months after surgery. Delaire's cephalometric analysis was performed and the position of the maxilla was recorded. ResultsThere were no significant differences between the literature and our series regarding sex and type of deformity (P=0.634 and 0.779, respectively). The mean horizontal and vertical relapse rates were 0.61 and 1.17mm (vs. 1.29 and 1.48mm in the meta-analysis) and the overall complication rate was 22.2% (vs. 12.76% but P=0.271). There was a significant difference regarding the palatal fistula rate (0 here vs. 21.43% in meta-analysis, P=0.028). ConclusionsThe minimally invasive approach showed trends toward less relapse and less complications than conventional approaches. This technique seems adapted to the management of patients with CL/P sequelae. Other benefiting groups are underway.

Reducing the rate of cesarean delivery on maternal request through institutional and policy interventions in Wenzhou, China.

The objective of this study was to evaluate the effect of institutional and policy interventions on reducing the rate of cesarean delivery on maternal request (CDMR) in Wenzhou, China. Institutional interventions included health education, painless delivery introduction, and doula care. Additionally, a series of health policies were developed by the Chinese central and local governments to control cesarean section rates, mostly through controlling CDMR rates. We conducted a pre-/post-intervention study using 131,312 deliveries between 2006 and 2014 in three tertiary-level public hospitals in Wenzhou, China. Chi-square tests and predictive models were used to examine changes in the CDMR rate before and after institutional and policy interventions. After institutional interventions were introduced, the overall CDMR rate increased from 15.76% to 16.34% (p = 0.053), but the average annual growth rate (AAGR) of the overall CDMR rate quickly declined from 20.11% to -4.30%. After policy interventions were introduced, the overall CDMR rate, the AAGR of the overall CDMR rate, and the probability of performing CDMR declined. Further, the overall probability of a woman undergoing CDMR decreased in all three age groups (group one: <24; group two: 24–34; group three: >34) after institutional and policy interventions. These results show that institutional and policy interventions can reduce the CDMR rate. Additionally, the CDMR rate should be included in hospitals’ performance assessment matrix to reduce the CDMR rate further.

Awareness about blood donation among donors at a specialized tertiary level public hospital.

Adequate and safe blood supply has remained a challenge in developing countries like ours. There is a high dependency on family replacement and remunerated blood donors in our environment which carries an attendant increased risk of transfusion transmissible infection. This descriptive type of cross sectional study was conducted at transfusion medicine department of National Institute of Neurosciences &amp; Hospital in Dhaka city during the period January to December 2015 with the aim to assess the awareness about blood donation among donors which includes knowledge and practice of blood donation. A total purposively selected 150 donors were interviewed by using a structured questionnaire which focused on knowledge and practice related variables. The statistical analysis was done by using the SPSS software (Version-21). The associations between the demographic factors were analyzed by using the Chi square test and Fisher’s Exact test. Among 150 donors, 124 (82.7%) were male and 26 (17.3%) were female donors, the mean age of the donors was 28.4 (± 7.2) years. 78 (52.0%) donors knew about the interval of blood donation and 84 (56.0%) knew about the age limit for the donation, but 86 (57.3%), 71 (47.3%) did not know the required Hb level to donate blood and volume of blood in each donation respectively. More than half (56.0%) had past history of blood donation and 103 (68.6%) of the donors showed positive effects like a feeling of satisfaction after blood donation. There were highly significant association found between blood donation and sex (p value.016). A majority (86.9%) of the donors were willing to be regular donors. The donors showed positive effects like a sense of satisfaction after the donation. Creating an opportunity for blood donation by conducting many blood donation camps may increase the voluntary blood donations.Update Dent. Coll. j: 2016; 6 (2): 21-26

The effect of neoprene thumb abduction splints on upper limb function in children with cerebral palsy

INTRODUCTION: Children with cerebral palsy (CP) have limitations in hand function due to weakness and spasticity, with long term effects causing shortening and stiffness of muscles in the hand and arm. The soft neoprene thumb abductor splint is prescribed by occupational therapists to correct these impairments. There is insufficient evidence for the effectiveness of this splint on upper limb function in children with CP with a thumb-in-palm deformity within the South African public health context. METHODS: A non-blinded randomised intervention study was carried out in a CP clinic at a tertiary level public hospital. Twenty-eight CP children between the age of 18 and 68 months, presenting with thumb-in-palm deformity, functioning on a Level II to IV on the Gross Motor Function Classification Scale (GMFCS) participated in the study. The Quality of Upper Extremity Skills Test (QUEST) was used to assess upper limb function in terms of dissociated movement, grasps, weight bearing and protective extension to obtain baseline information. Both the intervention and control groups received monthly individual occupational therapy and a home programme over a three month period. The intervention group additionally received a soft neoprene thumb abduction splint. RESULTS: No statistically significant differences between the intervention and control groups were found. Clinically relevant between group differences indicated by effect sizes were found however with large effect sizes the for the total QUEST score and weight bearing. The effect size for improvement within the intervention group was large for dissociated movement and weight bearing with and without the splint on as well as for grasps with the splint on. Only dissociated movement showed a clinically relevant medium effect size for change within the control group. Protective extension decreased within both groups except for the intervention group with the splint on. The caregivers/parents perceived the home programme as easy to follow, and those who were prescribed the splint mostly reported that it was easy to use. CONCLUSION: Soft neoprene thumb abduction splints have a positive effect on weight bearing and upper limb function in children with thumb-in-palm deformity, particularly with the splint on. Further research is recommended in the area of splinting in CP. Key words: Cerebral palsy, thumb-in-palm deformity, neoprene thumb abductor splint, QUEST

Long-term outcomes of hepatic resection for colorectal liver metastases at a New Zealand tertiary level public hospital.

Colorectal cancer is common with half of all patients developing metastases to the liver. The aim of this study was to document the survival for patients undergoing liver resection for colorectal cancer metastases. A review of all patients undergoing hepatic resection for colorectal liver metastases at a New Zealand tertiary level public hospital over a 9-year period was performed. Primary survival outcomes assessed were overall survival (OS) and disease-free survival (DFS). Of the 116 patients followed-up with a median (range) of 53 (10-116) months, the OS at 5 years was 53%. Median survival was 6.5 years. At end of follow-up, 57% of patients were alive and 49% were alive without recurrence. The overall rate of recurrence was 39%. This study confirms that excellent long term survival can be achieved with hepatic resection for colorectal liver metastases.

Influence of type 2 diabetes mellitus on liver histology among morbidly obese individuals. A cross-sectional study.

Nonalcoholic fatty liver disease (NAFLD) has become a public health concern. It encompasses a wide spectrum of histological abnormalities and has close relationships with insulin resistance and type 2 diabetes mellitus (T2DM). This study sought to compare the histological alterations observed in morbidly obese individuals with and without T2DM who underwent Roux-en-Y gastric bypass. Cross-sectional study in a tertiary-level public hospital. This was a cross-sectional study on 197 individuals who underwent gastric bypass surgery between 2011 and 2013. NAFLD was assessed through liver biopsies. T2DM was diagnosed through the International Diabetes Federation criteria. Non-diabetics presented significantly more biopsies without any histological abnormalities, regarding steatosis (42.6% versus 25.5%; P = 0.0400), fibrosis (60.6% versus 36.2%; P = 0.0042) and steatohepatitis (27.3% versus 12.8%; P = 0.0495), while diabetics presented significantly higher frequency of moderate forms of steatosis (36.2% versus 20%; P = 0.0307) and fibrosis (23.4% versus 4%; P = 0.0002). T2DM was associated with more advanced forms of NAFLD within the population studied. NAFLD has previously been correlated with severe forms of heart disease. Screening for and early detecting of NAFLD in high-risk populations are important for avoiding further development of severe forms and the need for liver transplantation.