Fast-track protocol versus conventional protocol on patient outcome:a randomized clinical trial

Background: The aim of this study is to compare fast-track methodology with traditional methods of surgical care in achieving better patient outcome, and ensuring a timely discharge from the hospital, and also note the factors that are responsible for a delayed discharge from the hospital. Materials and Methods: One hundred patients undergoing elective surgeries were randomly allocated into fast-track and traditional protocol of perioperative care. Patients who underwent fast-track protocol (FTP) were started on early oral feeding and were encouraged for early discharge, while the others were made to follow the traditional method of recovery. The gastrointestinal functions, postoperative complications and hospital stay time were recorded. The results were tabulated and analyzed. Results: Early feeding was well tolerated by all the patients in the "fast track" group, while the patients in the control group had increased number of "nil by mouth" days, and this result was statistically significant. Ambulation was started earlier in the case group as compared to the controls, and the mean period of starting of ambulation was statistically significant, in the cases as compared to the controls. The patients in the case group had an earlier discharge from the hospital, as compared to the control group. The most common reason for a delay in discharge from the hospital, in either group, was seen to be inadequate pain relief postoperatively. Conclusion: The FTP can significantly shorten the postoperative hospital stay after elective surgery, as compared to the traditional protocol

Anaemia, renal dysfunction and in-hospital outcomes in patients with heart failure in Botswana

Background. Anaemia and renal dysfunction are associated with an increased morbidity and mortality in heart failure (HF) patients.Objective. To estimate the frequency and impact of anaemia and renal dysfunction on in-hospital outcomes in patients with HF.Methods. A total of 193 consecutive patients with HF admitted to Princess Marina Hospital, Gaborone, Botswana, from February 2014 to February 2015, were studied. Anaemia was defined as haemoglobin <13 g/dL for men and <12 g/dL for women. Renal dysfunction was defined by an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2, calculated by the simplified Modification of Diet in Renal Disease formula. The in-hospital outcomes included length of hospital stay and mortality.Results. The mean (standard deviation (SD)) age was 54.2 (17.1) years and 53.9% of the patients were men. The overall median eGFR was 75.9 mL/min/1.73 m2 and renal dysfunction was detected in 60 (31.1%) patients. Renal dysfunction was associated with hypertension (p=0.01), diabetes mellitus (p=0.01) and a lower haemoglobin level (p=0.008). The mean (SD) haemoglobin was 12.0 (3.0) g/dL and 54.9% of the patients were anaemic. Microcytic, normocytic and macrocytic anaemia were found in 32.1%, 57.5% and 10.4% of patients, respectively. The mean (SD) haemoglobin level for males was significantly higher than for females (12.4 (3.3) g/dL v. 11.5 (2.5) g/dL; p=0.038). Anaemia was more common in patients with diabetes (p=0.028) and in those with increased left ventricular ejection fraction (p=0.005). Neither renal dysfunction nor anaemia was significantly associated with the length of hospital stay or in-hospital mortality.Conclusion. Anaemia and renal dysfunction are prevalent in HF patients, but neither was an independent predictor of length of stay or in-hospital mortality in this population. These findings indicate that HF data in developed countries may not apply to countries in sub-Saharan Africa, and call for more studies to be done in this region

What factors influence the average length of stay among stroke patients in a Nigerian tertiary hospital?

Introduction: Increased emphasis is being laid on ensuring that health resources are efficiently utilized, especially in resource-constrained settings such as in Nigeria. One of the main indices of how efficiently a health institution is being run is Length of Stay (LOS), which is likely to be higher in chronic diseases such as stroke and diabetes. Stroke is a chronic disease that is currently on the rise in Low and Middle income countries (LMICs) who are also characterized by constraint of health resources. This study seeks to determine the LOS of stroke patients as well as factors that affect it.Methods: A retrospective analysis of health records of stroke victims admitted into the medical wards of the University College Hospital, Ibadan between January 2012 and December 2014 was conducted. Data on sociodemographic information, comorbidities and risk factors were extracted while LOS was calculated by counting the number of days the patient was admitted. Analysis was carried to using SPSS.Results: A total of 143 records were used in the final analysis with 53.1% of them being males and having a mean age of 61.5 ± 14.2 years. More than half (53.8%) of the cases were ischemic strokes. The average length of stay was 13.7 ± 8.9 days while bivariate analysis showed that a greater proportion of cases who consumed alcohol, had diabetes and hypertension had LOS of over 7 days than those who did not. However, these differences in proportions were not statistically significant (0.310<p<0.883).Conclusion: LOS of stroke patients in Nigeria was shown to be prolonged especially when compared to similar settings in West Africa. The high prevalence of some of the risk factors of stroke such as diabetes mellitus indicates that policy and advocacy to drive changes in lifestyle are necessary to reduce the incidence of stroke and its consequent burden on health systems

Facteurs d'allongement du delai d'admission des brules graves a l'Hopital Central de Yaounde

Objectifs : Le but de cette etude etait de determiner les facteurs d'allongement du delai d'admission des brules graves en reanimation a Hopital Central de Yaounde. Patients et methodes : Il s'agi d'une etude prospective; descriptive et analytique; qui a couvert la periode allant du 1er janvier 2012 au 31 decembre 2013. Nous avons inclus 57 patients admis en reanimation pour une brulure grave et chez ces patients; nous avons analyse les donnees sociodemographiques; les caracteristiques de la brulure; les donnees sur la prise en charge prehospitaliere et l'admission en reanimation (date; heure). Resultats : Les accidents domestiques etaient en tete des circonstances de survenue (77;2) et la brulure thermique par ebouillantement etait la plus frequentes (61;4 ). La prise en charge medicale etait inexistante sur les lieux de l'accident; les patients n'avaient recu que des traitements traditionnels. Les patients etaient transportes par des vehicules non medicalises vers des centres de soins peripheriques en premiere reference (79); ou ils ont ete retenus pendant au moins 24 heures avant leur transfert secondaire a l'Hopital Central de Yaounde. Le delai d'admission en reanimation etait superieur a 12 heures (79); cet allongement etant du a la retention des victimes dans les centres de soins peripheriques; a l'automedication et aux pratiques traditionnelles; aux difficultes de transfert des patients liees aux moyens financiers limites et a l'ignorance. Conclusion : Le brule grave necessite une prise en charge precoce et adequate. Une chaine de secours devrait etre mise en place pour ameliorer la qualite la prise en charge initiale

Outcome of non-operative management of femoral shaft fractures in children

Background: Femoral shaft fractures are common injuries in childhood. There is paucity of information on their presentation and outcome of the available treatment methods in the African population. This study evaluated the outcome of non-operative methods of treatment of femoral shaft fractures in our centre. Patients and Methods: A retrospective review of the database of children aged 14 years and below with femoral shaft fractures treated non-operatively over a 10-year period. Results: A total of 134 patients with 138 fractures met the study criteria. This consisted of 71 boys (mean age = 6.1 years ± SD) and 63 girls (mean age = 6.5 years ± SD). Pedestrian vehicular accident was the most common cause of femoral shaft fractures in the study population. The midshaft was the most common site of fractures. There were associated injuries to other parts of the body (especially head injury) in 34.3% of the patients. The commonest mode of treatment was skin traction only (87.7%). The mean time to fracture union was 4.9 weeks ± SD (range = 3-15 weeks). The mean length of hospitalisation was 6.7 weeks ± SD (range = 5 days-11 weeks). There was a fairly strong positive correlation between the length of hospitalisation and the presence of associated injuries, especially head injury, upper limb fractures and bilaterality of the fractures. The mean total cost of treatment was #7685 (Naira) or $51.2 (range = $14.2-$190). At the last follow up, 97.8% of the fractures united without significant angulation or shortening. Conclusion: The outcome of non-operative treatment of femoral shaft fractures in our setting is comparable to the results of other workers. Methods of treatment that shorten the length of hospitalisation without unduly increasing cost should be encouraged

The Experience and Psychosocial Needs of Patients with Traumatic Fractures Treated for more than Six Months at Doctors on Call for Service Hospital; Goma; Democratic Republic of Congo

Background: Trauma-related consultations; admissions and complications are the leading problems at Doctors on Call for Service (DOCS) Hospital; Goma; Democratic Republic of Congo; and yet no studies have been carried out to document the experience of long-stay traumatic-fracture patients in this hospital. Aim: The aim of this study was to explore the experience and psychosocial needs of patients with traumatic fractures treated for more than six months at DOCS Hospital. Methods: Six free-attitude interviews were conducted with purposively selected patients. The interviews were recorded with a tape recorder and transcribed verbatim; and content analysis was used to identify themes from the interviews. Results: All patients could clearly connect the injury experience to severe pain that lingered on for weeks or months for some patients; accompanied by other symptoms such as insomnia; poor appetite and psychological symptoms. Most patients felt disabled; were abandoned by relatives or friends and experienced financial problems. Some benefited from the injury by way of strengthened marital links. Some patients complained of poor information about their illness and the management plan and did not appreciate the treatment from caregivers; while some disclosed their needs and expectations and appreciated the caregivers who showed interest in them. Conclusions: The experience of long-term trauma has negative effects on the whole person of the patient; including his or her work and family; and some patients continue to suffer from the effects of the traumatic event up to six months later. The needs of patients suffering from trauma include reassurance by physicians and nurses; more information and participation in the decision-making process; regular visits from friends and family; and better bedside manners from caregivers

A Profile on Health Status and Medical Conditions of Patients Staying Longer than the Set Norm at a District Hospital in South Africa

The average length of hospital stay is regarded as a key determinant of greater hospital costs. The objectives of this quantitative; retrospective; descriptive study were to determine the health status and medical conditions of patients with increased length of stay at a district hospital in Limpopo Province. A total of 609 patients' records with longer than average length of stay; from January to December 2007; were selected by stratified random sampling. The most prevalent diseases for staying longer were infectious and parasitic diseases; symptoms; signs etc; and injury; poisoning and consequences of causes yielding more than a third (36and 12; respectively; for each classification). Neoplasm-related admissions; in which cancer was identified as the most prevalent; stayed in hospital for an average of 14.6 days. The average length of stay for all disease classifications ranged from 7.1 days to 14.6 days. The length of stay at Elim Hospital is mostly influenced by the type of health conditions which are diagnosed. Further research is needed to find influential factors that might contribute to patients staying longer than normal

A Profile on and Medical Conditions of Patients Staying Longer Than the Set Norm at a District Hospital in South Africa

The average length of hospital stay is regarded as a key determinant of greater hospital costs. The objectives of this quantitative; retrospective; descriptive study were to determine the health status and medical conditions of patients with increased length of stay at a district hospital in Limpopo Province. A total of 609 patients' records with longer than average length of stay; from January to December 2007; were selected by stratified random sampling. The most prevalent diseases for staying longer were infectious and parasitic diseases; symptoms; signs etc; and injury; poisoning and consequences of causes yielding more than a third (36 and 12; respectively; for each classification). Neoplasm-related admissions; in which cancer was identified as the most prevalent; stayed in hospital for an average of 14.6 days. The average length of stay for all disease classifications ranged from 7.1 days to 14.6 days. The length of stay at Elim Hospital is mostly influenced by the type of health conditions which are diagnosed. Further research is needed to find influential factors that might contribute to patients staying longer than normal

Day case surgery in Nigeria

Patient care in Nigeria is mostly government funded; from primary to tertiary levels; with little contribution from private sector and non-governmental organizations. Healthcare provision has become more complex and expensive partly due to increasing population; aging; and frequent cancellations of electives; but also due to the increasing emergence of new diseases; as well as shrinkage of resources in many developing countries like Nigeria; resulting from recent economic downturn; and political instability. Therefore; it is important to introduce and popularize the concept of day case surgery; as this may help hospitals and healthcare providers to streamline resources by reducing length of hospital stay; decreasing morbidity and mortality; and providing valuable bed services to emergencies. It also helps to reduce time lost away from work and indirectly helps to decrease loss of revenue for the individual and state. Many hospitals in Nigeria provide day care services with patients admitted to the general surgical wards; and no dedicated day surgery units (DSUs); as currently practised in developed countries. DSUs are the best way to achieve results and so it is important for all to embrace this concept in order to improve healthcare delivery to the rapidly expanding populations. A systematic search of the current published literature was carried out to look for articles related to day case surgery (day care or day surgery) in Nigeria and to examine some published articles in relation to the surgical subspecialities; with a view to highlighting current practice in Nigeria and how it conforms to ideal practice elsewhere. Recommendations and suggestions are made on how to implement and popularize this concept in our hospitals

Outcome of Patients with Severe Abdominal Sepsis in the Intensive Care - Experience at Charlotte Maxeke Johannesburg Academic Hospital

Despite advances in diagnosis; surgery; antimicrobial therapy and intensive care support; the mortality rate associated with intra-abdominal sepsis remains unacceptably high. The aim of the present study was to identify prognostic factors in 54 consecutive cases with abdominal sepsis admitted to the intensive care unit (ICU) over a two-year period; from January 2001 to December 2002. This was a retrospective record review of cases with abdominal sepsis admitted to the ICU. Of 54 patients that were studied; only 14 survived. The mortality rate was 74.1. Non-survivors had significantly longer ICU stay; had more relook laparotomies; more blood transfusions and a significantly higher APACHE II score on admission to the ICU. Other results revealed that non-survivors required significantly more inotropic support and corticosteroids; had a lower paO2/FiO2 ratio and had more total arenteral nutrition days. None of the patients who urvived required dialysis. The number of relook laparotomies were higher in the non-survivors and the maximum number of relook laparotomies were four in the survivors and 13 in the non-survivors. The non-survivors were also more likely to have an open abdomen. We conclude that patients with abdominal sepsis have an extremely high mortality and utilise an enormous amount of limited intensive care resources. The length of ICU stay; APACHE II score on admission; number of relook laparotomies; whether the abdomen was left open or not; and requirement for inotropic support; dialysis; total parenteral nutrition and blood transfusions were predictive of adverse outcomes in these patients

Gender and psychiatric diagnosis: a 5-year retrospective study in a Nigerian federal medical centre

The role of gender in psychiatry disorders is becoming increasingly important. This study is therefore; aimed at identifying gender pattern of admissions to a public mental health centre with regards to demographic characteristic; psychiatry diagnosis and length of stay on admission. Method: In this retrospective study Hospital records of 388 patients admitted at the psychiatric section of the Federal Medical Centre (FMC) Makurdi; between January; 2004 and December; 2008 were studied for gender differences regarding demographic attributes; length of stay and psychiatry diagnoses. Results: Findings revealed that more men than women were admitted overall. Most men (56) were less than 30 years old whereas 60.6of women were within 30-59 years aged bracket. For men the main diagnosis was schizophrenia (30.5); followed by substance related disorders (16.5) then depression (14.0); for women the main diagnosis was also schizophrenia (30.3); this was followed by depression (24.5); only one woman was diagnosed with substance related disorder. A statistically significant association was also found between having a personality disorder and being a male (p=0.009). Most female were single and belong to the lowest occupational group. There was no significant difference in the gender distribution of patients with respect to length of stay on admission (p=0.161). Conclusion: The results revealed how psychiatry diagnosis is significantly influence by gender issues. We therefore recommend that; for a more effective psychiatry formulation; it is imperative to pay attention to gender issues that may affect the development of psychopathology

Prolonged Hospital Stay in Measles Patients

Background: Measles is still a major cause of childhood morbidity and mortality in Nigeria despite the availability of safe and effective vaccines. The burden of measles using length of hospital stay as a result of complications in hospitalised children with measles is reported. Methods: We carried out a two year retrospective study of children admitted with measles into the department of Paediatrics; University of Maiduguri Teaching Hospital. Results: Three hundred and nine children (11.2of Paediatric admission) aged 6-90 months (median 13 months) with a male: female ratio of 1.6: 1 were admitted with measles. Forty three (14) patients were aged less than 9-months. Seventy two per cent (223) of the subjects were not immunised against measles. Length of stay ranged between 4 and 32 days (mean; 8.7 days; median; 16 days) and total bed days were 3561 days. Forty per cent (124) of the measles admissions were for more than 14 days (prolonged hospitalisation). Infants and unvaccinated from low socio-economic class were more likely to have prolonged hospitalization. The most frequent complication associated with prolonged length of stay was bronchopneumonia (70.2). Two of the children suffered acute measles encephalopathy. Conclusions: Therapy for measles and its complications may be a major drain on medical care resources in this part of Nigeria; especially among young children who are unvaccinated and from low socio-economic class

Long stay patients in a psychiatric hospital in Lagos, Nigeria

Objective: In the face of recently introduced government health reform and the dwindling number of available beds for acutely ill patients, a cross sectional study was carried out on long-stay patients at the 100 years old psychiatric hospital Yaba, Lagos, Nigeria with a view to discharging most of them. Method: Necessary consent was obtained from the Hospital Research and Ethical Committee. All the long-stay patients were evaluated with a specially designed proforma to elicit socio-demographic, clinical and long-stay variables. Further more, each of them had clinical assessment to make diagnosis in accordance with ICD - 10 and finally, the subjects were also assessed with the Brief Psychiatric Rating Scale (BPRS). Results: Fifty-one (51) subjects; that is, occupying 10.7% of the hospital functional beds fulfilled the criteria of long-stay. They included 36 (70.6%) males and 15(24.4%) females. The mean age was 47.3±16.5 years with age range of 18-92 years. The average length of stay was 11.4±15.0 years and range of 0.5 to 57 years; with significant gender difference (males higher than females) (t =3.51, p<0.02). The vast majority of the subjects were diagnosed with schizophrenia (84.3%), followed by mental retardation with seizure disorder (5.9%). One-third (33.3%) of the subjects had co-morbid physical pathologies most especially epilepsies, hypertension, Koch/'s disease, HIV/AIDS. Despite being on high doses of antipsychotics (conventional and/or atypical) the majority of the subjects (86.3%) exhibited poor mental state with BPRS scores of ≥10. The mean BPRS score was 23.6±22.0 and range of 4-56 with a significant gender difference (t = 3.66, p< 0.02). Conclusion: These patients would continue to require long-stay hospitalization despite been a burden to the study center; or, in the alternative provision of mid­way facilities for their rehabilitation