ABSTRACT
Background: Tube blockage in the Intensive Care Unit (ICU) leads to preventable deaths. Routine change of tube for ongoing airway management is one of the indications for tracheostomy tube (TT) changes. However, there are limited data or evidence to recommend the frequency of such change. Aim: The study aims to determine the frequency of routine TT change in adult ICU patients. Subjects and Methods: A retrospective evaluation of ICU records of the patients who had been on TT for >5 days from July 2013 to April 2015 was performed. Data with regard to age, sex, diagnosis, and on tube days (TDs) before the TT was changed with either confirmed/suspicion of blockage and nonblockage were collected. Patients who had blockage and nonblockage were analyzed as individual groups as well as compared using INSTAT software to find the statistical estimates. Results: A total of 62 patients (72.58% males; mean ± standard deviation age: 50.62 ± 18.47 years; mean intubated days of 11.42) with a total of 1022 TT days were evaluated. Fifty-six episodes of tube blockage and 57 episodes (each >5 TT days) of nonblockage were analyzed and compared. The 95% confidence interval (CI) for mean of on TDs for nonblockage and blockage was 7.16–8.27 and 8.08–9.84 days, respectively, in the study population (P = 0.0171). Conclusion: The frequency for routine change of single-lumen TT for ongoing airway management in ICU patient should be 7–10 days taking the lowest 95% CI for nonblockage as the earliest point and the highest 95% CI for blockage as the late point.
ABSTRACT
Teaching is an integral part of the medical profession. The current ‘teacher-centred’ medical teaching is running without proper training or knowledge of teaching methodology. This has led to many medical teachers not being properly trained in teaching methods. The Medical Council of India (MCI) has initiated faculty development programmes by introducing a basic course workshop on medical education technologies (MET) to provide basic knowledge, skills and attitudes to all faculty in medical colleges.1 However, this basic course workshop is presently limited to the existing permanent faculty. On the other hand, a lot of the teaching is actually done by resident doctors. So, the Medical Education Unit (MEU) of our institution decided to adapt the existing workshop for residents, run it as a pilot project and evaluate the pre- and post-workshop knowledge along with feedback with regard to the usefulness of the 2-day workshop as a tool for developing the residents knowledge on the teaching–learning process. The workshop was done with the approval of the institute. Data are expressed in percentages and analysed by appropriate statistical tests using INSTAT software (GraphPad software, Inc, La Zolla, CA, USA).
ABSTRACT
The study assessed the timing and causes of neonatal deaths in a rural area of Bangladesh. A populationbased demographic surveillance system, run by the International Centre for Diarrhoeal Disease Research, Bangladesh, recorded livebirths and neonatal deaths during 2003-2004 among a population of 224,000 living in Matlab, a rural subdistrict of eastern Bangladesh. Deaths were investigated using the INDEPTH/ World Health Organization verbal autopsy. Three physicians independently reviewed data from verbal autopsy interview to assign the cause of death. There were 11,291 livebirths and 365 neonatal deaths during the two-year period. The neonatal mortality rate was 32.3 per 1,000 livebirths. Thirty-seven percent of the neonatal deaths occurred within 24 hours, 76% within 0-3 days, 84% within 0-7 days, and the remaining 16% within 8-28 days. Birth asphyxia (45%), prematurity/low birthweight (15%), sepsis/meningitis (12%), respiratory distress syndrome (7%), and pneumonia (6%) were the major direct causes of death. Birth asphyxia (52.8%) was the single largest category of cause of death in the early neonatal period while meningitis/ sepsis (48.3%) was the single largest category in the late neonatal period. The high proportion of deaths during the early neonatal period and the far-higher proportion of neonatal deaths caused by birth asphyxia compared to the global average (45% vs 23-29%) indicate the lack of skilled birth attendance and newborn care for the large majority of births that occur in the home in rural Bangladesh. Resuscitation of newborns and management of low-birthweight/premature babies need to be at the core of neonatal interventional packages in rural Bangladesh.