ABSTRACT
@#practice and care environments are important aspects ofnursing care. The use of a reliable and valid scale canmonitor the quality of handover and provide information forcontinuous improvement of practice. This study aims todescribe the perception of nurses, on the domains of qualityof information, efficiency, interaction and support andpatient involvement. Method: A cross-sectional descriptive study was conductedamong 450 nurses from 37 wards in Hospital Kuala Lumpur.Nurses on shift duty were recruited by conveniencesampling from the Medical, Surgery, Obstetrics &Gynaecology, Orthopaedic and Paediatric wards. Using avalidated questionnaire (Handover Evaluation Scale), nursesself-rated their perceptions using a 7-point scale andprovided open-ended responses to the strengths andchallenges that they faced. Descriptive and inferentialanalyses were done while open-ended questions weresummarised based on key themes. Results: A total of 414 nurses completed the survey (92.0%response rate). Nurses had an overall mean (SD) perceptionscore of 5.01 (SD 0.56). They perceived good interaction andsupport during handover and on the quality of informationthat they received, with mean scores of 5.54 (SD 0.79) and5.19 (SD 0.69), respectively. There was an associationbetween the departments where the nurses worked and theiroverall perceptions on nursing handover (p<0.001).Interruptions being the most common theme emerged fromthe open-ended section.Conclusion: Despite having substantial interaction andsupport amongst nurses, opportunities for improvementswere noted. Improvements in the quality of handoverinformation and reducing interruptions should be the mainemphases as these were perceived to be essential in thecurrent handover practices by nurses.
ABSTRACT
Association between chronic hepatitis C [CHC] infection and insulin resistance [IR] is still challenging. The study assessed the impact of using direct acting antivirals [DAAs] on IR and the effect of IR on the treatment response. A total of 101 Egyptian patients with CHC who were eligible to Sofosbuvir based treatment were prospectively involved. All the patients were subjected to baseline liver function test, fasting and post prandial blood glucose, fasting insulin, quantitative HCV PCR and abdominal ultrasound. All the patients received sofosbuvir and daclatasvir with or without ribavirin for 12 weeks. HOMA-IR evaluated IR, both at baseline and at the end of treatment. The results showed that patients' mean age was 48.59+/-10.56 years; with female dominance [58.4%]. An overall sustained response [SVR] was successfully achieved in 96 patients [95.04%]. Baseline IR [defined as HOMA-IR >2] was identified in 64 patients [63.4%] with a median value of 3.07. Patients with positive sustained virologic response [SVR] had lower median values of HOMA-IR than those with negative SVR; both at baseline and the end of treatment [p=0.004, p=0.04; respectively]. By the end of treatment, ALT, AST, and FBG showed a significant decrease [p=0.0001]. Fasting insulin and HOMA-IR showed a slight improvement [p>0.05]
ABSTRACT
Twin-Reversed Arterial Perfusion [TRAP] is a rare complication of monochorionic twins with a prevalence of 1 in 35,000 pregnancies. It is characterized by a structurally normal twin pump perfusing an anomalous recipient twin via an artery-to-artery anastomosis in a reverse direction. To highlight Twin-Reversed Arterial Perfusion sequence and its clinical variable presentation. Prospective review. Obstetrics and Gynecology Department, Salmaniya Medical Complex [SMC]. All patients with TRAP sequence, diagnosed by ultrasound were followed up until delivery. Clinical presentation, ultrasound findings, outcome and management were reviewed. Three patients with a diagnosis of TRAP sequence who had been managed conservatively were included in the study. The first two patients had amorphous acardius and presented with polyhydramnios and both had favorable outcomes for the surviving twin. The third case was triplet pregnancy, which ended unfortunately with extreme permaturity at 23 weeks of gestation of acepahlus acardius and two normal fetuses. TRAP sequence is a rare complication of monochorionic twins. Accurate antenatal diagnosis is essential to improve the prognosis of this rare entity