AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, ne...AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.展开更多
AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the  ...AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.展开更多
Background: Pain is the common experience among post operative patients admitted to the intensive care unit. Inadequate management can lead to undesired complications which can increase risk for morbidity and mortalit...Background: Pain is the common experience among post operative patients admitted to the intensive care unit. Inadequate management can lead to undesired complications which can increase risk for morbidity and mortality. Objective: The aim of this study was to assess pain management and factors associated with its severity among post surgical patients admitted in intensive care unit at MNH. Method: A prospective study was conducted from October 2017 to February 2018 involving a total of 123 post operative patients aged 18 years and above admitted to the surgical and obstetric intensive care units. Structured questionnaires were used to obtain the required perioperative information. Severity of pain was assessed by using the Numerical Rating Scale (NRS). Data was analyzed using SPSS version 23.0. Frequency, percentages, tables and charts were used to summarize the study findings. Bivariate analysis and multivariate logistic regression were done. P-value of Results: The prevalence of severe post operative pain within 24 and 72 hours was 32.1% and 41.5% respectively. Pre operative use of analgesia (OR: 2.66, CI: 1.15 - 6.12, P value = 0.02), abdominal surgery (OR: 4.12 CI: 1.12 - 15.88, P value = 0.03) and thoracic surgeries (OR;7.42, CI: 1.54 - 35.88, P value = 0.01) was significantly associated with severe pain. Age, sex, ASA class, duration of surgery, and level of education did not show significant association with pain severity. Opioids prescribed postoperatively were pethidine (70.7%), morphine (11.4%) and fentanyl (11.4%). Other analgesics used were paracetamol (60.2%) and diclofenac (22%). Conclusion: The magnitude of post operative pain was high. Pre operative uses of analgesia, abdominal and thoracic surgery were the factors associated with severe pain. Pethidine and paracetamol were the most prescribed drugs, however the prescription pattern used was inadequate to control pain.展开更多
Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effectiv...Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published </span><span style="font-family:Verdana;">during</span><span style="font-family:Verdana;"> 2000-2018. The following databases were searched</span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable</span><span style="font-family:""> </span><span style="font-family:Verdana;">effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.展开更多
As the treatment options,modalities and technology has grown,mortality in intensive care unit(ICU)has been on the decline.More and more patients are being discharged to wards and in the care of their loved ones after ...As the treatment options,modalities and technology has grown,mortality in intensive care unit(ICU)has been on the decline.More and more patients are being discharged to wards and in the care of their loved ones after at times prolonged treatment,sometimes in isolation.These survivors have a lower life expectancy and a poorer quality of life.They can have substantial familial financial implications and an economic impact on the healthcare system in terms of increased and continued utilisation of services,the so-called post intensive care syndrome(PICS).But it is not only the patient who is the sufferer.The mental health of the loved ones and family members may also be affected,which is termed as PICS-family.In this review,we shall be reviewing the definition,epidemiology,clinical features,diagnosis and evaluation,treatment and follow up of PICS.We shall also focus on measures to prevent,rehabilitate and understand the ICU stay from patients’perspective on how to redesign the ICU,post ICU care needs for a better patient outcome.展开更多
<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Gabapentin is routinely prescribed preoperatively to decrease...<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Gabapentin is routinely prescribed preoperatively to decrease postoperative pain intensity. It is included in the enhanced recovery after surgery (ERAS) recommendations. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To analyze correlation of gabapentin dosage and post anesthesia care unit (PACU) length of stay (LOS) and cost. </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective chart review of patients who underwent general anesthesia and received preoperative oral gabapentin from June 2017 </span></span><span style="font-family:Verdana;">to</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> August 2017 for pelvic and breast procedures. The main outcome was correlation between PACU LOS and gabapentin dosage in the outpatients. Financial analysis was performed to assess the cost to the hospital associated with increased LOS. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Of the 636 patients, 405 patients received 300 </span><span style="font-family:Verdana;">mg and 231 patients received 100 mg gabapentin. Mean dosage per kg (mg/k</span><span style="font-family:Verdana;">g ±</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">SD) was 3.12</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">1.51 (range: </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.86 to 6.12). PACU LOS was 96</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">77 (minutes ±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">SD) in patients receiving 100 mg and 120</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">96 in patients receiving 300 mg capsule (p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.001). Linear regression analysis, failed to show a </span><span style="font-family:Verdana;">statistically significant correlation between per kg dosage and PACU LOS (</span><span style="font-family:Verdana;">p</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.13). Using multiple regression analysis, we calculated the correlation coefficient to be +1.71 minutes per 1mg/kg gabapentin (95% CI: -</span><span style="font-family:Verdana;">3.75 to +7.10, p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.54) after adjusting for confounders. Adding 3</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">mg/kg to pre-op g</span><span style="font-family:Verdana;">abapentin dosage of all outpatients cost on average</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> an extra $9794 per mo</span><span style="font-family:;" "=""><span style="font-family:Verdana;">nth in this cohort. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Every 1mg/kg increase in gabapentin dosage adds an estimated 7.1 minutes to PACU LOS. A 3</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">mg/kg increase in gabapentin adds estimated 22 additional minutes in PACU LOS. Unfortunately, increase LOS is associated with increased hospital costs.</span>展开更多
Background: Postoperative wound healing has been a problem which causes high mortality in the developing world;postoperative wound has been reported to cause devastating consequences and a measurable mortality. There ...Background: Postoperative wound healing has been a problem which causes high mortality in the developing world;postoperative wound has been reported to cause devastating consequences and a measurable mortality. There is a limited number of published studies in Tanzania investigating Nursing practice on post-operative wound care in surgical wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania. This study assesses nursing practice on postoperative wound care by nurses in surgical wards at Muhimbili National Hospital. Methods: A cross-sectional study of surgical nurses was carried out through the use of randomly selected surgical wards at Muhimbili National Hospital in Tanzania from September 2011 to July 2013. A multistage cluster sampling technique was used to obtain a suitable number of study participants. Data collection was done using a checklist from a convenient sample of 71 nurses in selected surgical wards. Results: The result indicates that a big number of the participants were female (76.5%) and those of the age group 25 to 34 years were 40.8%. Participants exceeding a half of the selected sample reported to have poor post-operative wound care practice (57.7%). In comparison, male participants scored higher, and had better practice than their female counterparts, however, there was no considerable difference in the scores (P = 0.803). During set-up and preparation phase, the washing of hands before starting and after the completion of procedure was taken into consideration by less than half of the participants (49.3%). All participants did not ensure the environment is clean and take into account the patient’s privacy through the use of screen or even closing the room. The report shows that nurses take into consideration putting on clean gloves during the removal of the old dressing (99%), the use of sterile gloves during wound dressing was taken into consideration by most of the nurses (63%). Good practice was noted in applying dressing solution as recommended (85%), dry sterile dressing was applied by (90%), arrangement and setting up of dressing forceps and other items that may be needed in order of their application using forceps (20%), usage of forceps to dip gauze into antiseptic solution (35%) and cleaning of the wound cleaning from least contaminated to most contaminated area was only adhered to by (34%). Post-operative counseling and giving to the patient not to temper with the wound was done by a representation of only 15% of nurses. All the nurses did not do the documentation of the changes observed on the wound nor did they report on the patients comfort and the date and time after the procedure wound changes, reported patient comfort, and recorded date or time after the procedure. Conclusion: Majority of the nurses in surgical wards do not follow the postoperative wound care checklist provided by MNH although they know its importance. Assessment of the wound and documentation continues to be a problem in the nursing profession in Tanzania. Nurses are reasonably knowledgeable about the principal of wound dressing;however, lack of knowledge on some of the key principles of wound dressing is worth noting. Almost half of the nurses do not wash hands before and after the procedures, they don’t use single gauze in one direction only, not cleaning from least contaminated to most contaminated area, which can lead to wound contamination.展开更多
Healthcare Workers (HCWs) are constantly at risk of exposure to viral infections such as hepatitis B virus (HBV), human immune deficiency virus (HIV) and hepatitis C virus (HCV). We aim at demonstrating the results of...Healthcare Workers (HCWs) are constantly at risk of exposure to viral infections such as hepatitis B virus (HBV), human immune deficiency virus (HIV) and hepatitis C virus (HCV). We aim at demonstrating the results of a three-year period of a surveillance program in Iran with the prospective follow-up of HCWs exposed to blood-borne viruses. HCWs who had experienced an occupational exposure to HBV, HCV or HIV from September 2005 to 2008 were enrolled in the study. Age, gender, route of exposure, type of fluid, type of virus, job, department, working shift, work experience, wearing gloves when exposed, history of HBV vaccination and the serum level of anti HBs antibody were recorded for all participants through an individual interview. Serum samples were taken from both HCWs and the sources of exposure and were tested by enzyme linked immunosorbent assay (ELISA). The data were gathered through questionnaires completed by a nurse under the supervision of a specialist of infectious diseases. In this study, 100 HCWs who were occupationally exposed to HIV, HCV or HBV were included. Most exposures had occurred among nurses (35%), followed by residents (29%), interns (18%), housekeepers (7%), the lab staff (6%), and specialists (5%). Most of the exposures had occurred in emergency (21%) and surgical (20%) wards. The most common route of exposure was percutaneous injuries (77%) and the most common cases had contacted with needles and angiocaths (71.1%) during injection or opening vein routes (21%). Establishing a surveillance system for registering the occurrence of occupational hazardous exposures, performing prophylactic measures and following up the exposed is a necessity in hospitals so that the number of exposures and occupational diseases among the HCWs can be decreased.展开更多
This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or)...This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.展开更多
Background: The 2018 demographic and health survey reports low coverage in the continuum of antenatal care over the period 2013 to 2018. However, little remains known about this indicator since the Ebola epidemic cris...Background: The 2018 demographic and health survey reports low coverage in the continuum of antenatal care over the period 2013 to 2018. However, little remains known about this indicator since the Ebola epidemic crisis was over. This epidemic has been reported to decrease utilization of maternal health services. This study aims to determine the coverage and factors associated with four or more antenatal care visits in Guinea in the post-Ebola context. Methods: This was a cross-sectional study using secondary data from the most recent (2018) Guinea Demographic and Health Survey. Women aged 15 to 49 years constituted our study population. Our sample included women who had their most recent birth over the last 24 months preceding data collection and whether or not they had performed 4 antenatal care (ANC) visits. Factors associated with performing four or more antenatal visits were assessed through a multivariate logistic regression analysis using Stata software version 15.1. The final model was constructed using the bottom-up stepwise method. Hosmer and Leeshawn’s goodness-of-fit test was used for model specification. Results: Among the 2634 women in the sample, 41% had four or more ANC visits. Factors associated with attending four or more ANC visits included education level, poverty quintile and region. Women with a secondary or higher education were 44% more likely to attend four or more ANC visits (OR = 1.44, 95% CI = [1.07 - 1.92]. Those whose spouses had secondary or education level were 1.66 times more likely to attend four or more ANC visits. Women from moderately wealthy households were 76% more likely to attend four or more ANC visits (OR = 1.76, 95% CI = [1.30 - 2.39]. Women from wealthier households were 2.52 times more likely to attend four or more ANC visits (OR = 2.52, 95% CI = [1.30 - 2.39]). Women living in Boké and Nzérékoré regions were 44% and 47% less likely to attend four or more ANC visits, respectively (OR = 0.56, IC 95% = [0.35 - 0.94]) and (OR = 0.53, IC 95% = [0.31 - 0.89]). Conclusion: Attending four or more ANC visits declined in the post-Ebola epidemic context in Guinea from 57% in 2012 to 41% in 2018. To improve coverage in four or more ANC visits in this context, there is a need for policies and programs to address education, poverty and administrative region factors.展开更多
Introduction: This article is an analysis of post-abortion care in 56 health facilities after their capacity building by the Burkina Faso Society of Obstetricians and Gynecologists (SOGOB). Patients and Methods: In 20...Introduction: This article is an analysis of post-abortion care in 56 health facilities after their capacity building by the Burkina Faso Society of Obstetricians and Gynecologists (SOGOB). Patients and Methods: In 2012, with funds from Safe Abortion Action Fund, the SOGOB trained care providers and equipped 56 health facilities for post abortion care. Statistical data on the management of incomplete abortions after the capacity building were analyzed. The significance level was set at 0.05. Results: There were 6316 cases of abortion that have been managed in 56 health facilities. The evacuation of the uterine contents for incomplete abortion has been provided to 6167 patients. Manual vacuum aspiration (MVA) and misoprostol were used respectively in 69.4% and 26.9% of cases to evacuate uterine content. Post-treatment complications were 1.8% for MVA and 0.9% for misoprostol (p = 0.004). MVA’s complication rate in the health facilities of the 1<sup>st</sup> level of care (1.7%) was not different from the third level of care (1.2%) with p = 0.21. A modern method of contraception was provided after abortion to 65.7% of the patients. In addition to the post abortion care, 7.3% of the patients received other reproductive health services. The community was involved in the development process of post abortion care in the facilities of the first level of care. Conclusion: The support of health facilities by SOGOB has provided post abortion care to thousands of women with little complications. Given the good results, an extension to other health facilities is desirable.展开更多
目的评估血栓后综合征患者自我报告工具的测量性能,为临床评估工具的选择提供依据。方法检索Embase、Medline、Springer Link、Web of Science、PubMed、维普数据库、万方数据库、中国知网等数据库中关于血栓后综合征患者自我报告工具...目的评估血栓后综合征患者自我报告工具的测量性能,为临床评估工具的选择提供依据。方法检索Embase、Medline、Springer Link、Web of Science、PubMed、维普数据库、万方数据库、中国知网等数据库中关于血栓后综合征患者自我报告工具的原始研究,检索时限为建库至2024年12月10日。由2名研究人员独立筛选文献并提取相关资料,基于选择健康测量工具的统一标准(consensus-based standards for the selection of health measurement ins-truments,COSMIN)对评估工具进行评价,若出现分歧,由第3名研究人员决定。结果共纳入10个评估工具,所有评估工具均存在不同程度的方法学问题。根据COSMIN指南,静脉功能不全生活质量/症状问卷(VEINES-the quality of life/symptom,VEINES-QOL/Sym)和患者报告Villalta量表第2版(the Patient Reported Villalta Scale Version 2,Villalta-PVR2)为A类评估工具,其余量表为B类评估工具。结论评估工具的选择应取决于具体临床情况,并进一步在不同环境和人群中进行验证,优先推荐Villalta-PVR2量表用于基层筛查,VEINES-QOL/Sym量表用于专科随访,在研究场景的多维探索中,可采用多种测评工具共同协作的形式。展开更多
文摘AIM To synthesize the available evidence focusing on morbidities in pediatric survivors of critical illness that fall within the defined construct of postintensive care syndrome(PICS) in adults, including physical, neurocognitive and psychological morbidities.METHODS A comprehensive search was conducted in MEDLINE, EMBASE, the Cochrane Library, Psyc INFO, and CINAHL using controlled vocabulary and key word terms to identify studies reporting characteristics of PICS in pediatric intensive care unit(PICU) patients. Two reviewers independently screened all titles and abstracts and performed data extraction. From the 3176 articles identified in the search, 252 abstracts were identified for full text review and nineteen were identified for inclusion in the review. All studies reporting characteristics of PICS in PICU patients were included in the final synthesis. RESULTS Nineteen studies meeting inclusion criteria published between 1995 and 2016 were identified and categorized into studies reporting morbidities in each of three categories-physical, neurocognitive and psychological. The majority of included articles reported prospective cohort studies, and there was significant variability in the outcome measures utilized. A synthesis of the studies indicate that morbidities encompassing PICS are well-described in children who have survived critical illness, often resolving over time. Risk factors for development of these morbidities include younger age, lower socioeconomic status, increased number of invasive procedures or interventions, type of illness, and increased benzodiazepine andnarcotic administration.CONCLUSION PICS-related morbidities impact a significant proportion of children discharged from PICUs. In order to further define PICS in children, more research is needed using standardized tools to better understand the scope and natural history of morbidities after hospital discharge. Improving our understanding of physical, neurocognitive, and psychological morbidities after critical illness in the pediatric population is imperative for designing interventions to improve long-term outcomes in PICU patients.
文摘AIM: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn’s disease following intestinal resection.METHODS: In the “POCER” study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.RESULTS: Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.CONCLUSION: Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.
文摘Background: Pain is the common experience among post operative patients admitted to the intensive care unit. Inadequate management can lead to undesired complications which can increase risk for morbidity and mortality. Objective: The aim of this study was to assess pain management and factors associated with its severity among post surgical patients admitted in intensive care unit at MNH. Method: A prospective study was conducted from October 2017 to February 2018 involving a total of 123 post operative patients aged 18 years and above admitted to the surgical and obstetric intensive care units. Structured questionnaires were used to obtain the required perioperative information. Severity of pain was assessed by using the Numerical Rating Scale (NRS). Data was analyzed using SPSS version 23.0. Frequency, percentages, tables and charts were used to summarize the study findings. Bivariate analysis and multivariate logistic regression were done. P-value of Results: The prevalence of severe post operative pain within 24 and 72 hours was 32.1% and 41.5% respectively. Pre operative use of analgesia (OR: 2.66, CI: 1.15 - 6.12, P value = 0.02), abdominal surgery (OR: 4.12 CI: 1.12 - 15.88, P value = 0.03) and thoracic surgeries (OR;7.42, CI: 1.54 - 35.88, P value = 0.01) was significantly associated with severe pain. Age, sex, ASA class, duration of surgery, and level of education did not show significant association with pain severity. Opioids prescribed postoperatively were pethidine (70.7%), morphine (11.4%) and fentanyl (11.4%). Other analgesics used were paracetamol (60.2%) and diclofenac (22%). Conclusion: The magnitude of post operative pain was high. Pre operative uses of analgesia, abdominal and thoracic surgery were the factors associated with severe pain. Pethidine and paracetamol were the most prescribed drugs, however the prescription pattern used was inadequate to control pain.
文摘Saharan Africa (SSA) contributes 29% of the global unsafe abortions with 62% of abortion-related deaths. This is due to restrictive abortion laws, low quality post abortion care (PAC) and inadequate access to effective modern contraception. The overall objective was to review current literature on PAC in SSA and make recommendations for improvement especially in Cameroon. A literature review was conducted on PAC in SSA published </span><span style="font-family:Verdana;">during</span><span style="font-family:Verdana;"> 2000-2018. The following databases were searched</span><span style="font-family:Verdana;">:</span><span style="font-family:Verdana;"> MEDLINE, POPLINE, COCHRANE Library, African Index Medicus and GOOGLE Scholar. Thirty articles were reviewed from 16 countries ranging from observational studies to systematic reviews with meta-analysis. Major outcomes: 1) Manual vacuum aspiration (MVA) and misoprostol are equally safe and effective. 2) There is comparable</span><span style="font-family:""> </span><span style="font-family:Verdana;">effectiveness between physicians and trained mid-level cadres in PAC management. 3) PAC contraception uptake was increased when offered immediately before patient leaves the facility. 4) Gaps to PAC service use include inadequate access, low quality care and less adolescent-friendly environment. Task shifting of PAC to trained mid-level staff, decentralization of medical PAC using misoprostol, offering post abortion counselling and contraception to clients before leaving the health facility, encouraging linkage and provider-community partnership in PAC and reinforcement of advocacy for less restrictive abortion laws in Cameroon are recommended.
文摘As the treatment options,modalities and technology has grown,mortality in intensive care unit(ICU)has been on the decline.More and more patients are being discharged to wards and in the care of their loved ones after at times prolonged treatment,sometimes in isolation.These survivors have a lower life expectancy and a poorer quality of life.They can have substantial familial financial implications and an economic impact on the healthcare system in terms of increased and continued utilisation of services,the so-called post intensive care syndrome(PICS).But it is not only the patient who is the sufferer.The mental health of the loved ones and family members may also be affected,which is termed as PICS-family.In this review,we shall be reviewing the definition,epidemiology,clinical features,diagnosis and evaluation,treatment and follow up of PICS.We shall also focus on measures to prevent,rehabilitate and understand the ICU stay from patients’perspective on how to redesign the ICU,post ICU care needs for a better patient outcome.
文摘<strong>Background:</strong><span style="font-family:;" "=""><span style="font-family:Verdana;"> Gabapentin is routinely prescribed preoperatively to decrease postoperative pain intensity. It is included in the enhanced recovery after surgery (ERAS) recommendations. </span><b><span style="font-family:Verdana;">Objective:</span></b><span style="font-family:Verdana;"> To analyze correlation of gabapentin dosage and post anesthesia care unit (PACU) length of stay (LOS) and cost. </span><b><span style="font-family:Verdana;">Study Design:</span></b><span style="font-family:Verdana;"> A retrospective chart review of patients who underwent general anesthesia and received preoperative oral gabapentin from June 2017 </span></span><span style="font-family:Verdana;">to</span><span style="font-family:;" "=""><span style="font-family:Verdana;"> August 2017 for pelvic and breast procedures. The main outcome was correlation between PACU LOS and gabapentin dosage in the outpatients. Financial analysis was performed to assess the cost to the hospital associated with increased LOS. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Of the 636 patients, 405 patients received 300 </span><span style="font-family:Verdana;">mg and 231 patients received 100 mg gabapentin. Mean dosage per kg (mg/k</span><span style="font-family:Verdana;">g ±</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">SD) was 3.12</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">1.51 (range: </span><span style="font-family:Verdana;">0</span><span style="font-family:Verdana;">.86 to 6.12). PACU LOS was 96</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">77 (minutes ±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">SD) in patients receiving 100 mg and 120</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">±</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">96 in patients receiving 300 mg capsule (p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">0.001). Linear regression analysis, failed to show a </span><span style="font-family:Verdana;">statistically significant correlation between per kg dosage and PACU LOS (</span><span style="font-family:Verdana;">p</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.13). Using multiple regression analysis, we calculated the correlation coefficient to be +1.71 minutes per 1mg/kg gabapentin (95% CI: -</span><span style="font-family:Verdana;">3.75 to +7.10, p</span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> 0</span><span style="font-family:Verdana;">.54) after adjusting for confounders. Adding 3</span><span style="font-family:;" "=""> </span><span style="font-family:;" "=""><span style="font-family:Verdana;">mg/kg to pre-op g</span><span style="font-family:Verdana;">abapentin dosage of all outpatients cost on average</span></span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> an extra $9794 per mo</span><span style="font-family:;" "=""><span style="font-family:Verdana;">nth in this cohort. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Every 1mg/kg increase in gabapentin dosage adds an estimated 7.1 minutes to PACU LOS. A 3</span></span><span style="font-family:;" "=""> </span><span style="font-family:Verdana;">mg/kg increase in gabapentin adds estimated 22 additional minutes in PACU LOS. Unfortunately, increase LOS is associated with increased hospital costs.</span>
文摘Background: Postoperative wound healing has been a problem which causes high mortality in the developing world;postoperative wound has been reported to cause devastating consequences and a measurable mortality. There is a limited number of published studies in Tanzania investigating Nursing practice on post-operative wound care in surgical wards at Muhimbili National Hospital, Dar-es-Salaam, Tanzania. This study assesses nursing practice on postoperative wound care by nurses in surgical wards at Muhimbili National Hospital. Methods: A cross-sectional study of surgical nurses was carried out through the use of randomly selected surgical wards at Muhimbili National Hospital in Tanzania from September 2011 to July 2013. A multistage cluster sampling technique was used to obtain a suitable number of study participants. Data collection was done using a checklist from a convenient sample of 71 nurses in selected surgical wards. Results: The result indicates that a big number of the participants were female (76.5%) and those of the age group 25 to 34 years were 40.8%. Participants exceeding a half of the selected sample reported to have poor post-operative wound care practice (57.7%). In comparison, male participants scored higher, and had better practice than their female counterparts, however, there was no considerable difference in the scores (P = 0.803). During set-up and preparation phase, the washing of hands before starting and after the completion of procedure was taken into consideration by less than half of the participants (49.3%). All participants did not ensure the environment is clean and take into account the patient’s privacy through the use of screen or even closing the room. The report shows that nurses take into consideration putting on clean gloves during the removal of the old dressing (99%), the use of sterile gloves during wound dressing was taken into consideration by most of the nurses (63%). Good practice was noted in applying dressing solution as recommended (85%), dry sterile dressing was applied by (90%), arrangement and setting up of dressing forceps and other items that may be needed in order of their application using forceps (20%), usage of forceps to dip gauze into antiseptic solution (35%) and cleaning of the wound cleaning from least contaminated to most contaminated area was only adhered to by (34%). Post-operative counseling and giving to the patient not to temper with the wound was done by a representation of only 15% of nurses. All the nurses did not do the documentation of the changes observed on the wound nor did they report on the patients comfort and the date and time after the procedure wound changes, reported patient comfort, and recorded date or time after the procedure. Conclusion: Majority of the nurses in surgical wards do not follow the postoperative wound care checklist provided by MNH although they know its importance. Assessment of the wound and documentation continues to be a problem in the nursing profession in Tanzania. Nurses are reasonably knowledgeable about the principal of wound dressing;however, lack of knowledge on some of the key principles of wound dressing is worth noting. Almost half of the nurses do not wash hands before and after the procedures, they don’t use single gauze in one direction only, not cleaning from least contaminated to most contaminated area, which can lead to wound contamination.
文摘Healthcare Workers (HCWs) are constantly at risk of exposure to viral infections such as hepatitis B virus (HBV), human immune deficiency virus (HIV) and hepatitis C virus (HCV). We aim at demonstrating the results of a three-year period of a surveillance program in Iran with the prospective follow-up of HCWs exposed to blood-borne viruses. HCWs who had experienced an occupational exposure to HBV, HCV or HIV from September 2005 to 2008 were enrolled in the study. Age, gender, route of exposure, type of fluid, type of virus, job, department, working shift, work experience, wearing gloves when exposed, history of HBV vaccination and the serum level of anti HBs antibody were recorded for all participants through an individual interview. Serum samples were taken from both HCWs and the sources of exposure and were tested by enzyme linked immunosorbent assay (ELISA). The data were gathered through questionnaires completed by a nurse under the supervision of a specialist of infectious diseases. In this study, 100 HCWs who were occupationally exposed to HIV, HCV or HBV were included. Most exposures had occurred among nurses (35%), followed by residents (29%), interns (18%), housekeepers (7%), the lab staff (6%), and specialists (5%). Most of the exposures had occurred in emergency (21%) and surgical (20%) wards. The most common route of exposure was percutaneous injuries (77%) and the most common cases had contacted with needles and angiocaths (71.1%) during injection or opening vein routes (21%). Establishing a surveillance system for registering the occurrence of occupational hazardous exposures, performing prophylactic measures and following up the exposed is a necessity in hospitals so that the number of exposures and occupational diseases among the HCWs can be decreased.
文摘This meta-synthesis presents the results of qualitative studies on puerperal perception concerning woman’s care in the post-partum period. Four databases were researched using keywords such as “postnatal care” (or) “postpartum period”, (and) “care”, “women”, “perception”, “qualitative research”, “women’s health services”, “community health services”, “allied health personnel”, “primary health care”, resulting in 9 articles for analysis. Six themes were identified: interpersonal relationship, information, communication, attending the necessities, service organization and other supports. Results report mainly on the unsatisfactory professional care for women, appreciating the form of dealing with promptness and the timing to be attended;trust;content, coherence and the way to inform;clarification of doubts;friendly conversation and clinical assistance. The professional workload was restricted on postpartum period care quality. There were gaps found in clinical practice and in dialogical communication and information on women’s health necessities.
文摘Background: The 2018 demographic and health survey reports low coverage in the continuum of antenatal care over the period 2013 to 2018. However, little remains known about this indicator since the Ebola epidemic crisis was over. This epidemic has been reported to decrease utilization of maternal health services. This study aims to determine the coverage and factors associated with four or more antenatal care visits in Guinea in the post-Ebola context. Methods: This was a cross-sectional study using secondary data from the most recent (2018) Guinea Demographic and Health Survey. Women aged 15 to 49 years constituted our study population. Our sample included women who had their most recent birth over the last 24 months preceding data collection and whether or not they had performed 4 antenatal care (ANC) visits. Factors associated with performing four or more antenatal visits were assessed through a multivariate logistic regression analysis using Stata software version 15.1. The final model was constructed using the bottom-up stepwise method. Hosmer and Leeshawn’s goodness-of-fit test was used for model specification. Results: Among the 2634 women in the sample, 41% had four or more ANC visits. Factors associated with attending four or more ANC visits included education level, poverty quintile and region. Women with a secondary or higher education were 44% more likely to attend four or more ANC visits (OR = 1.44, 95% CI = [1.07 - 1.92]. Those whose spouses had secondary or education level were 1.66 times more likely to attend four or more ANC visits. Women from moderately wealthy households were 76% more likely to attend four or more ANC visits (OR = 1.76, 95% CI = [1.30 - 2.39]. Women from wealthier households were 2.52 times more likely to attend four or more ANC visits (OR = 2.52, 95% CI = [1.30 - 2.39]). Women living in Boké and Nzérékoré regions were 44% and 47% less likely to attend four or more ANC visits, respectively (OR = 0.56, IC 95% = [0.35 - 0.94]) and (OR = 0.53, IC 95% = [0.31 - 0.89]). Conclusion: Attending four or more ANC visits declined in the post-Ebola epidemic context in Guinea from 57% in 2012 to 41% in 2018. To improve coverage in four or more ANC visits in this context, there is a need for policies and programs to address education, poverty and administrative region factors.
文摘Introduction: This article is an analysis of post-abortion care in 56 health facilities after their capacity building by the Burkina Faso Society of Obstetricians and Gynecologists (SOGOB). Patients and Methods: In 2012, with funds from Safe Abortion Action Fund, the SOGOB trained care providers and equipped 56 health facilities for post abortion care. Statistical data on the management of incomplete abortions after the capacity building were analyzed. The significance level was set at 0.05. Results: There were 6316 cases of abortion that have been managed in 56 health facilities. The evacuation of the uterine contents for incomplete abortion has been provided to 6167 patients. Manual vacuum aspiration (MVA) and misoprostol were used respectively in 69.4% and 26.9% of cases to evacuate uterine content. Post-treatment complications were 1.8% for MVA and 0.9% for misoprostol (p = 0.004). MVA’s complication rate in the health facilities of the 1<sup>st</sup> level of care (1.7%) was not different from the third level of care (1.2%) with p = 0.21. A modern method of contraception was provided after abortion to 65.7% of the patients. In addition to the post abortion care, 7.3% of the patients received other reproductive health services. The community was involved in the development process of post abortion care in the facilities of the first level of care. Conclusion: The support of health facilities by SOGOB has provided post abortion care to thousands of women with little complications. Given the good results, an extension to other health facilities is desirable.
文摘目的评估血栓后综合征患者自我报告工具的测量性能,为临床评估工具的选择提供依据。方法检索Embase、Medline、Springer Link、Web of Science、PubMed、维普数据库、万方数据库、中国知网等数据库中关于血栓后综合征患者自我报告工具的原始研究,检索时限为建库至2024年12月10日。由2名研究人员独立筛选文献并提取相关资料,基于选择健康测量工具的统一标准(consensus-based standards for the selection of health measurement ins-truments,COSMIN)对评估工具进行评价,若出现分歧,由第3名研究人员决定。结果共纳入10个评估工具,所有评估工具均存在不同程度的方法学问题。根据COSMIN指南,静脉功能不全生活质量/症状问卷(VEINES-the quality of life/symptom,VEINES-QOL/Sym)和患者报告Villalta量表第2版(the Patient Reported Villalta Scale Version 2,Villalta-PVR2)为A类评估工具,其余量表为B类评估工具。结论评估工具的选择应取决于具体临床情况,并进一步在不同环境和人群中进行验证,优先推荐Villalta-PVR2量表用于基层筛查,VEINES-QOL/Sym量表用于专科随访,在研究场景的多维探索中,可采用多种测评工具共同协作的形式。
