Improvement in Documentation of Intake and Output Chart

Intake and Output (I/O) records in hospitals were often found to be incomplete and illegible. The form used to record I/O is not user-friendly — i.e., they feature miniscule boxes, ‘total’ lines that do not correspond with shift changes and lack of instructions. Complaints often received from Specialists & Doctors regarding calculation errors or no totalling of I/O. Moreover, Nursing Sisters objective rounds often saw incompleteness of I/O chart. This study aims to identify the types of mistakes in recording the existing I/O chart. The second aim is to find out whether shift totalling of I/O chart helps in reducing mistakes. We try to determine whether the identified mistakes were repeated in the new I/O Chart. This study was conducted from October till December 2010 in 9 selected wards in Sibu Hospital. Data collection was divided into 3 phases. A pre-implementation audit using a checklist was carried out. The compliance rate of completeness of documentation of I/O Chart was 63%. A one month trial of new I/O chart was being done in the selected 9 wards. Post implementation audit showed a significant improvement of compliance rate (88%). Feedback from health care workers (N=110) showed that, 89% of doctors (n=17) and 60% of nurses (n=93) in the sample prefer to use the new format as more practical and relevant to the changing shift of nurses and doctors’ ward round. It is suggested to implement the new format to increase compliance rate of documentation of I/O charting. Briefing should be given to nurses periodically and the new format should be introduced to nursing students in nursing colleges.

French Health Care System ; what can we learn?

All public systems look for the best organizational structure to funnel part of their national income into healthcare services. Appropriate policies may differ widely across country settings. Most healthcare systems fall under one of two broad categories, either Bismark or Beveridge systems. There is no simple ideal model for the organization of health services, but most healthcare systems that follow the Beveridge healthcare model are poor performers. The Libyan Health system is a low responsive, inefficient and underperforming system that lacks goals and/or SMART. [Specific, Measurable, Achievable, Realistic, Time specific] objectives. A look at different organization models in the world would reinforce efforts to reorganize and improve the performance of the Libyan National Healthcare services. The French Health Care System [FHCS] ranked first according to the WHO and the European Health Consumer Powerhouse. The FHCS was described to have a technically efficient, generous healthcare system that provides the best overall health care. This makes the FHCS a practical model of organization having many of the essential aspects of a modern national health service. In this review, we describe the main features of the FHCS, current challenges and future trends with particular attention paid to aspects that could be of importance to the Libyan Healthcare System

Human bone marrow-derived mesenchymal stem cells

Mesenchymal stem cells [MSCs] have elicited a great clinical interest, particularly in the areas of regenerative medicine and induction of tolerance in allogeneic transplantation. Previous reports demonstrated the feasibility of transplanting MSCs, which generates new prospects in cellular therapy. Recently, injection of MSCs induced remission of steroid-resistant acute graft-versus-host disease [GVHD]. This review summarizes the knowledge and possible future clinical uses of MSCs

Efficacy of combined exercises for balance, mobility and strength to reduce risk falls in elderly subjects

This study was conducted to investigate the effect of exercise programs of balance, mobility, and strength to reduce falls in elderly population. A total of 60 subjects with age 65:80 years with previous falling history participated in the study. The subjects were divided into three equal groups [1] a control group received no exercise program, [2] exercise group 1 received a program of balance exercise and mobility exercise, and [3] exercise group 2 received a program of balance exercise and strengthening exercise. The exercise program was delivered twice daily 6 days/week for three months. Each subject is evaluated before and after the exercise program using balance test and functional mobility test Analysis of the data revealed that both exercise groups were significantly higher than the control group on all measures of balance and mobility tests, the significant difference was clear between groups in tandem stance and single limb stance, P< 0.0001. When comparing each exercise group to control there was significant increase of both exercise groups than control group P=0.001. In addition when comparing both exercise groups regarding the five conditions of the balance test there was increase of exercise group 1 than exercise group 2 but this increase was not significant where P< 0.2. Four months followup revealed only 1 fall due to environmental hazards among the exercise groups and 3 falls among non exercise group. In conclusion multidimensional exercise can improve balance and mobility function which could be reflected on reducing the falling frequency of older individuals with emphasizing on the preferable effect of combined balance and mobility exercises than combined balance and strengthening exercises

Competition between soybean and cowpea rhizobia and bradyrhizobia in nodulating soybean.

The competitive interactions among four strains that nodulate soybean and cowpea rhizobia were studied in soybean plants grown under pot and field conditions. All the possible combination between the four strains; Bradyrhizobium japonicum USDA 110, Rhizobium fredii USDA 191, Rhizobium spp. [Arachis] strain 1 and Bradyrhizobium spp. [Vigna] strain 2 were studied to obtain single, double, triple and quadruple inocula. Developed plants were examined after 45 and 90 days from planting to record number, dry weight and nitrogenase activity of the root nodules as well as the dry weight and N-content of shoots. Nodule occupancy by the tested strains was also determined by agglutination and double gel diffusion techniques. Data showed that dual inoculation with R. fredii USDA 191 and B. Japonicum USDA 110 showed maximal effects on all tested parameters and provided soybean plants with 75% of its N-requirements. However, no nodules were developed on soybean roots inoculated with Rhizobium spp. [Arachis] strain 1 in single or combined inocula, Bradyrhizobium spp. [Vigna] strain 2 formed effective nodules in both cases

Peripheral vascular injuries

Recent refinements in the management of traumatic peripheral vascular injuries has led to marked improvement in patient survival and limb salvage. 43 patients who sustained such injuries were reviewed. Recent auxiliary investigations included conventional angiography, nuclear angiography, Doppler ultrasound flow detector and intra-operative angiography. Primary repair could be accomplished in all cases. Vein grafts were used in 86% and direct repair in 14%. No primary amputation was resorted to though 7% [3 cases] 'eventually had amputation