ABSTRACT
Déterminer si une cure préopératoire de corticoïdes systémiques réduirait le saignement au cours de la chirurgie endonasale de la polypose naso-sinusienne (PNS) et améliorerait la visualisation du champ opératoire. Méthodes: Étude prospective randomisée incluant des adultes (>18 ans) atteints de PNS primitive résistante au traitement médical et qui vont bénéficier d'une chirurgie endoscopique endonasale. Ces patients sont randomisés en deux groupes: un groupe préparé par des comprimés de prednisolone 20mg, à la posologie de 0.5mg/Kg/j pendant 7 jours avant la chirurgie et un groupe non préparé. Les critères d'évaluation sont: la perte sanguine avec la comparaison des hémoglobines (Hb) pré et postopératoires, le temps opératoire et la visibilité du champ opératoire évaluée par le chirurgien selon le score de Boezaart. Résultats: Nous avons inclus 32 patients. Dix-sept patients dans le groupe non préparé et 15 patients dans le groupe préparé. Les deux groupes étaient comparables sur le plan épidémiologique, clinique et paraclinique (p>0,05). La perte sanguine moyenne était plus importante dans le groupe non préparé (700±487 ml versus 500±480 ml) mais sans différence significative (p=0,38). La différence était statistiquement non significative (p=0,24) entre les 2 groupes pour l'Hb postopératoire et pour la différence d'Hb préopératoire - Hb post opératoire. Le temps opératoire était plus court dans le groupe préparé (80±24 min versus 90±64 min) sans différence statistiquement significative (p=0,11). Le score de Boezaart était comparable (médiane=3) (p=0,29). Conclusion: Cet essai clinique n'a pas démontré que l'administration d'une cure préopératoire de corticothérapie orale peut réduire considérablement la perte de sang au cours de la chirurgie de la PNS et améliorer la visualisation du champ opératoire
Subject(s)
Humans , Epistaxis , Adrenal Cortex Hormones , Postoperative Care , General Surgery , Nose DiseasesABSTRACT
Introduction: The human brain, as efficient as it is, cannot remember everything.It is legally required by law that healthcare providers maintain a record for each of their patients. In anaesthesia, every aspect of the anaesthetic care from preoperative to postoperative care needs to be documented. It is, therefore, essential to review the efficiency of manual record keeping and explore possible ways of improving it. Materials and Methods: This was a retrospective study of all patients of obstetrics undergoing caesarean section between 1st July, 2013 and 30th June, 2014. Study participants were identified from Institutional Anaesthesia record books and clinical record (case notes). With the aid of a questionnaire, relevant information concerning patients' biodata, names of health personnel involved in the surgery and clinical information about vital signs and drug administration were documented from the records. Results: The chart completion rate was 63.88%. Emergency procedures had an average chart completion rate of 51.68% while the charts in elective procedures had a completion rate of 73.4%. The patients' name was the most frequently recorded item. The Apgar score was not recorded in any of the charts reviewed. Critical incidents were poorly charted with a chart completion rate of 36.59%. Conclusion: Manual recording of anaesthesia information is unreliable and results in incomplete anaesthesia records. It is poorer in emergency surgeries as compared to elective ones. A comprehensive approach that would include structured teaching on the importance of chart completion and the use of automated information systems in recording may correct this anomaly
Subject(s)
Anesthesia , Intraoperative Care , Manuals as Topic , Nigeria , Postoperative Care , Surgical Procedures, OperativeABSTRACT
Emergency caesarean section poses obstetric, anesthetic and surgical risks to the mother and the unborn baby and exacerbates anxiety which is deleterious. Preoperative nursing care rendered during this period greatly influence patient's care perception, a concept underpinned in this study. Patients' pre-and postoperative anxiety levels and demographics informed by literature reviewed were evaluated. Demographics included age, the level of education, mode of hospital bill payment, history of major illness, previous surgeries, current medication, smoking and the condition of the newborn. A descriptive cross-sectional survey was conducted in a private and a public hospital among patients undergoing emergency caesarean section. Sixty participants were purposively and systematically sampled from the postnatal ward admission registers using inclusion criteria. A structured questionnaire was used to assess participants' demographics and care satisfaction. Anxiety levels were evaluated using Form Y-6. Ethical approval was obtained from the respective ethical review boards. Multivariate nonparametric statistical analyses using Statistical Package for Social Sciences (SPSS) version 17 computer software was used to analyze data Alongside descriptive statistics. Significant finding observed regarding demographics were on the level of education and mode of hospital hill payment. The highest level of education attained was tertiary 22(73.3%) in private compared to secondary level 14 (46.7%) in the public hospital. The mode of hospital bill payment was through companies' medical schemes 24(80%) in private hospital and through National Health Insurance Fund (NHIF) 22(73.3%) in public. Mann-Whitney U test showed statistically significant differences in only two out of the six anxiety defining statements assessed postoperatively. Participants at the public hospital felt calmer (z=-2.071, p=0.038<0.05) and more relaxed (z=-2.85, p=0.004<0.05) than those at the private hospital. Wilcoxon rank test yielded significant results for only one out of the six care satisfaction defining statements. Participants at the public hospital were more satisfied with the information given by the nurse about what is expected before and after surgery (z=-2.61, p=0.009<0.05) compared to private. This study evidences nurses' ability to render satisfactory care to patients in emergency situations regardless of socio-patients' demographic profile and type of hospital. There is need to initiate and sustain such care surveillance for quality auditing
Subject(s)
Anxiety , Cesarean Section , Emergencies , Hospitals, Private , Hospitals, Public , Kenya , Patient Satisfaction , Postoperative Care , Preoperative CareABSTRACT
Background: Audit of Surgical mortality seeks to focus on improvement in the process of surgical care and not on individual surgical ability. Audit of surgical mortality was conducted to establish the factors associated with the surgical deaths in Virika Hospital to propose ways of improvement. Methods: The study was conducted in Virika Mission Hospital in Western Uganda; a 155 bed capacity hospital with a surgical bed capacity of 32 located in rural Uganda.Individual case file review of the fourty three surgical deaths from 1 st July 2008 to 31 st June 2009 was conducted. Additional data was retrieved from hospital admission register; operation registers; and death certificate books. Results: The operation death rate was 1.3; all were emergencies; and 82.6were done under general anaesthesia and17.4died on table. The laparotomy death rate was 12.5; Herniorrhaphy 0.9; drainage of pus 1.4and wound suture 0.4. Surgery was delayed due to lack of blood in only one case but there was no record of lack of any resource for delaying surgery. Surgical conditions were: Injuries 39.5; Intestinal perforations 30.2; Intestinal obstruction 20.9and others 9.3. The hospital had no high dependency unit and no intensive care unit. No postmortem was conducted in all cases. Conclusion: Overall the Audit identified client; provider; administrative and community-related factors that need to be addressed collectively to reduce surgical mortality in Virika hospital. Audit of surgical mortality should be part of he health workers' general approach to making more information available in a meaningful way for continuous improvement of surgical services
Subject(s)
Postoperative Care , Postoperative Complications/mortality , Surgical Procedures, OperativeABSTRACT
Background: Caesarean delivery is an important aspect of emergency obstetric care and a major tool in the reduction of maternal and perinatal morbidity and mortality. This study was done to determine the caesarean section rate; ascertain the trend of emergency caesarean section; indications for emergency caesarean section and emergency caesarean morbidity and mortality at the Federal Medical Centre Makurdi. Method: A retrospective analysis of the clinical records of all patients delivered by caesarean section between January 2004 and December 2006 at the Federal Medical Centre Makurdi in north central Nigeria was conducted. Results: There were 4011 deliveries with 420 caesarean sections during the review period giving a caesarean section rate of 10.5. Emergency caesarean sections accounted for 351 (83.6) caesarean deliveries. The rate of emergency caesarean section decreased from 89.7in 2004 to 77.2in 2006. The leading indication for emergency caesarean section was cephalopelvic disproportion; accounting for 138 (39.3) cases; while antepartum haemorrhage and foetal distress followed in that order. There were 9 maternal deaths associated with emergency caesarean section giving a caesarean mortality rate of s 2.1Conclusion: Emergency caesarean sections account for 5 out of every 6 caesarean deliveries in our centre with a decreasing trend relative to elective caesarean sections. The emergency caesarean mortality is high
Subject(s)
Cesarean Section/mortality , Emergency Treatment , Postoperative CareABSTRACT
Advanced tongue cancer may have a devastating effect on a person's ability to speak and to swallow. Very little is known about the surgical management and speech and swallowing rehabilitation of persons with advanced tongue cancer in South Africa. The aim of this study was to obtain information regarding clinical practices in treatment and rehabilitation. Questionnaires were distributed to 450 surgeons and 150 speech-language pathologists in South Africa. The response rate was 16 for the surgeons and 33 for the speech-language pathologists. Results showed that only a small number of surgeons and speech-language pathologists in South Africa are involved in the treatment of persons with advanced tongue cancer. Surgeons prefer combined modality treatment (surgery and post-operative radiotherapy) in the primary treatment of patients with advanced tongue cancer; but the use of radiochemotherapy is growing. Total glossectomy is a very radical procedure; but it is sometimes used by surgeons to treat patients with advanced disease. Total glossectomy with laryngeal preservation is preferred to total glossolaryngectomy by surgeons; in order to preserve laryngeal voice. Patients with total glossectomy form only a small part of the caseload of speech-language pathologists. Swallowing rehabilitation includes aspects such as dietary changes; compensatory swallowing techniques and airway protection mechanisms. Speech intelligibility is targeted in speech rehabilitation; but alternative communication is sometimes recommended for patients who have undergone total glosso-laryngectomy
Subject(s)
Deglutition , Glossectomy , Postoperative Care , Speech , Tongue Neoplasms/surgeryABSTRACT
L'enorme reduction du nombre des patients causee par le taux seuil d'hematocrite fixe a 34;nous a pousse a initier cette etude;tandis que dans les pays developpes plusieurs etudes menees avec un taux d'hematocrite au voisinage de 30se passent sans probleme majeure. Les arguments theoriques et biocliniques de notre etude nous permettent aujourd'hui d'affirmer qu'en ce qui concerne les noirs et pour nos pays en voie de developpement un hematocrite a 32peut s'averer satisfaisant et benefique pour nos patients. La mesure de l'hematocrite reste une variable sure; et satisfaisante pour l'evaluation de cette technique d'epargne sanguine. Il permet d'evaluer les pertes sanguines et de surveiller l'evolution des patients hemodilues. Il fait partie integrante de l'hemogramme au meme titre que l'hemoglobine tel que defini par la nomenclature des actes de biologie