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BACKGROUND:Meta-analyses of the implementation of a surgical safety checklist (SSC) in observational studies have shown a significant decrease in mortality and surgical complications.OBJECTIVE:To determine the efficacy of the SSC using data from randomised controlled trials (RCTs). METHODS:This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and was registered with PROSPERO (CRD42015017546). A comprehensive search of six databases was conducted using the OvidSP search engine.RESULTS:Four hundred and sixty-four citations revealed three eligible trials conducted in tertiary hospitals and a community hospital; with a total of 6 060 patients. All trials had allocation concealment bias and a lack of blinding of participants and personnel. A single trial that contributed 5 295 of the 6 060 patients to the meta-analysis had no detection; attrition or reporting biases. The SSC was associated with significantly decreased mortality (risk ratio (RR) 0.59; 95% confidence interval (CI) 0.42 - 0.85; p=0.0004; I2=0%) and surgical complications (RR 0.64; 95% CI 0.57 - 0.71; petlt;0.00001; I2=0%). The efficacy of the SSC on specific surgical complications was as follows: respiratory complications RR 0.59; 95% CI 0.21 - 1.70; p=0.33; cardiac complications RR 0.74; 95% CI 0.28 - 1.95; p=0.54; infectious complications RR 0.61; 95% CI 0.29 - 1.27; p=0.18; and perioperative bleeding RR 0.36; 95% CI 0.23 - 0.56; petlt;0.00001.CONCLUSIONS:There is sufficient RCT evidence to suggest that SSCs decrease hospital mortality and surgical outcomes in tertiary and community hospitals. However; randomised evidence of the efficacy of the SSC at rural hospital level is absent
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Checklist , Preoperative Care , Surgical Procedures, OperativeABSTRACT
Background: Reports of adverse drug reactions (ADR) in the era of increasing uptake of antiretroviral drugs particularly in Sub Saharan Africa and especially in Nigeria have been on the rise. Aim: We set out to collate and characterize the pattern of adverse drug reactions in patients on antiretroviral drugs in our treatment centre. Study Design: Retrospective Cross sectional study Place and Duration of Study: The study was carried out at the APIN Centre, Jos University Teaching Hospital, Plateau State, North Central Nigeria from July 2010 to December 2012. Methodology: We reviewed the case files and data base entries of 215 patients attending our treatment centre. These are patients who had reported cases of adverse drug reactions. We took note of demographic profiles of the patients, the medical history as well as the different types of antiretroviral drugs the patients were taking. The types of adverse drug reactions and offending drugs were noted and categorized using descriptive statistics. Results: Out of 215 case files and databases of patients in which there were reports of adverse drug reactions, 80 (37.2%) were male and 135 (62.8%) were female. Almost thirty two percent (31.6%) of the patients were on Zidovudine/Lamivudine/Nevirapine (AZT/3TC/NVP), 14.9%on Zidovudine/Lamivudine/Tenofovir/Lopinavir/ritonavir (AZT/3TC/TDF/LPV/r), 13.5% on Stavudine/Lamivudine/Nevirapine (D4T/3TC/NVP). Anemia was the most common ADR representing 23.4% of all ADRs and 29.3% of all ADRs were associated with Zidovudine. Conclusion: Our study shows that in antiretroviral treatment centre such as our own, healthcare providers/practitioners should take particular note of troubling adverse drug reactions such as anaemia. Healthcare providers/practitioners should particularly have in place alternative treatment regimens as these adverse drug reactions may be potential cause of medication non adherence which in the long run lead to treatment failure.
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Background: Type 2 diabetes (T2D) is a major cause of chronic kidney disease. Control of hypertension and the use of angiotensin converting enzyme inhibitors (ACEI) and/or angiotensin II receptor blockers especially in those with proteinuria have been shown to protect against chronic kidney disease and delay its progression to kidney failure. Methods: We reviewed the medical records of 169 patients at 12 months with a view of auditing the screening for chronic kidney disease and the use of renoprotective measures. Results: Urinalysis was done in 49.1and serum creatinine in 50.3. No patient had glomerular filtration rate estimated. Seventy nine (67.6) of the hypertensive patients were on anti-hypertensives. ACEI was used in 49 (45.8) of these patients BP control was optimal in 29.1. Conclusion: There is poor adherence to guidelines on chronic kidney disease screening and renoprotection in T2D