Pattern of admission, outcome and predictors of trauma patients visiting the surgical emergency department in comprehensive specialized hospital: a retrospective follow-up study.

Background: Traumatic injuries represent a huge burden in the developing world, and a significant proportion has found in low-income and middle-income countries. However, the pattern, outcome and factors of injury varies from setup to setup and is less studied in public health problems. Objective: To assess pattern of admission, outcome and its predictors among trauma patients visiting the surgical emergency department in a comprehensive specialized hospital. Methods: A retrospective follow-up study was conducted, and data were taken from the medical records of patients from 2019 to 2021. A simple random sampling technique was used to get a sample size of 386 from injured patient charts. Data were entered into Epi-Data version 4.6 software and exported to STATA version 14.1 for analysis. The dependent variable was injured patient's outcome, which could be died or not died. The independent variables with P value less than 0.25 in the bi-variable regression analysis were considered for the multivariable regression. Adjusted odds ratio (AOR) with the 95% CI were used to declare statistical significance. Result: About 13.99% of injured patients with (95% CI: 10, 17) had died during the study period. The leading cause of injury was assault (62.44%) followed by road traffic accidents (26.17%). Severe Glasgow Coma Scale (AOR 6.6; 95% CI: 2.6-16.4), length of hospital stay more than or equal to 7 days (AOR=2.8; 95% CI: 1.2-6.2), time of arrival in between 1 and 24 h (AOR=0.15; 95% CI: 0.06-0.37), and upper trunk injury (AOR=6.3; 95% CI: 1.3-28.5) were significantly associated with mortality. Conclusion and recommendation: Mortality after traumatic injury was considerably high. Severe Glasgow Coma Scale, Length of hospital stay more than or equal to 7 days, time of arrival in between 1 and 24 h, and upper trunk injury were the associated factors for mortality. Priority should be given for injured patients with decreased levels of consciousness and upper trunk injury. The establishment of organized pre-hospital emergency services and provision of timely arrival is recommended. The authors recommend prospective follow-up study.

Surgical team member's application of personal protective equipment: an observational study.

Background: Personal protective equipment (PPE) is a term used to refer to clothing or equipment that creates a barrier to protect an individual from work-place hazards, thereby protecting the worker against work-related injuries and illnesses. This study was aimed at determining the compliance of application of personal protective equipment against the standards. Methods: One hundred surgical personnel were included in this study from 21 March 2023 to 23 April 2023. Data were collected through direct observation. The standards were directly changed into question forms with two integral checking components, "Yes", and "No". Data were entered and analyzed by statistical package of social sciences (SPSS) version 25. Result: A total of 100 surgical personnel involved in surgical procedures were assessed for how they applied PPE. Majority of healthcare workers, 61.2%, were compliant with the communicable disease control standard on the application of PPE. The highest compliance rate was observed for the put-on gloves over the gown, while the lowest compliance rate was observed for wearing eye protection. Conclusion and recommendation: The practice of PPE usage by surgical personnel was suboptimal. Healthcare facilities can better protect their staff and patients from the spread of infections and other hazards through PPE use protocols. Donning and doffing must always be methodical and supervised by another staff member, especially during surgical emergencies. PPE should be used in accordance with infection prevention and control guidelines and the level of risk involved in the specific procedure.

Assessment of manual operation note documentation practice: a cross-sectional study.

Background: Operation note documentation captures the key findings and subtle elements of a surgical strategy and is crucial for patient safety. Poor operation note documentation can negatively influence postoperative patient care. This study aimed to assess manual operation note documentation practice. Methods: An institutional-based, cross-sectional study was conducted from 30 March to 30 April 2022, on 240 operation notes of patient data. Data were entered and analyzed by SPSS version 20. According to the RCSE, the Royal College of Surgeons of England, the practice of operation note documentation was rated excellent for each variable when it met 100%, good if it met more than 50%, and poor if it met less than 50% of the operation notes of patient data. Results: All operation notes (n=240) were handwritten. The practice of manual operation note documentation was deemed excellent in two (7.69%), good in 18 (69.2%), and poor in six (23.1%). Residents wrote 84.2% of the operation notes and surgeons and assistants were identified in greater than 94% of the notes, while anesthesia team members were identified in 90.8%. Estimated blood loss was documented in 4.2% of the notes, and the closure technique was described in 64.2%. The operation note templates did not include antibiotic prophylaxis, runner nurse name, or gauze and instrument counts. The urgency of the surgery and time of documentation had a negative relationship, and the seniority of the operation note writer had a positive relationship with manual operative note documentation practice. Conclusions and recommendations: Compared to the standard, all operation note documentation was incomplete and below the standard. We recommend that this comprehensive and specialized hospital administrator implement a new format for operation notes that incorporates RCSE requirements.

The preparedness of preoperative anesthesia equipment's and monitors for pediatric patients.

In resource-limited settings, providing anaesthesia services to paediatric patients at the operation theatre needs to be considered and optimal utilization of national resources available for the provision of services should be undertaken. Therefore, optimal perioperative care of infants and children requires the availability of monitors and contemporary equipment designed specifically for this purpose. Objective: This study aimed to determine the practice of preoperative anaesthesia equipment and monitor preparation for paediatric patients. Method: A cross-sectional study was employed among 150 consecutively selected paediatrics from April to June 2020. Data were collected by semi-structured questionnaire. Data entry and analysis were done using Epi Data and Stata version 14.0. Descriptive statistics were employed. Result: A total of 150 patients who undergo surgery under anaesthesia were observed in surgical and ophthalmic operation rooms. From those procedures, only stethoscope and small-sized syringes achieved 100% of the standards. But paediatric stylet, paediatric defibrillator and paediatric folly catheter had achieved 0%. The remaining were between 10 and 97% according to standards. Conclusion: Even though some paediatric anaesthesia equipments and monitoring preparation have fulfilled the standards, this study showed practice gaps in majority of cases in the preparation of appropriately sized paediatric equipments and monitors.

Incidence and Predictors of Mortality Among Patients with Traumatic Brain Injury at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: A Retrospective Follow-Up Study.

Background: Traumatic brain injury is a major list of health and socioeconomic problems especially in low- and middle-income countries which influences productive age groups. Differences in patient characteristics, socioeconomic status, intensive care unit admission thresholds, health-care systems, and the availability of varying numbers of intensive care unit (ICU) beds among hospitals had shown to be the causes for the variation on the incidence in mortality following traumatic brain injury across different continents. The aim of this study was to assess the incidence and predictors of mortality among patients with traumatic brain injury at University of Gondar Comprehensive Specialized Hospital. Methods: A retrospective follow-up study was conducted based on chart review and selected patient charts admitted from January, 2017 to January, 2022. Participants in the study were chosen using a simple random sample procedure that was computer generated. Data was entered with epi-data version 4.6 and analyzed using SPSS version 26. Both bivariate and multivariate logistic regression analyses were used, and in multivariate logistic regression analysis, P-value <0.05 with 95% CI was considered statistically significant. Results: The magnitude of mortality was 28.8%. Most of the injuries were caused by assault followed by road traffic accident (RTA). About 30% of the subjects presented with severe head injuries and epidural hematoma (EDH) followed by skull fracture were the most common diagnoses on admission. The independent predictors of mortality were male sex (AOR: 6.12, CI: 1.82, 20.5), severe class injury with Glasco coma scale (GCS <9) (AOR: 5.96, CI: 2.07, 17.12), intraoperative hypoxia episode (AOR: 10.5, CI: 2.6-42.1), hyperthermia (AOR: 25, CI: 5.54, 115.16), lack of pre-hospital care (AOR: 2.64 CI: 1.6-4.2), abnormal appearance on both eyes (AOR: 13.4, CI: 5.1-34.6), in-hospital hypoxia episode and having extra-cranial concomitant injury were positively associated with mortality, while on admission, systolic blood pressure (SBP) of 100-149 (AOR: 0.086, CI: 0.016-0.46) was negatively associated with mortality. Conclusion: The overall mortality rate was considerably high. As a result, traumatic brain injury management should be focused on modifiable factors that increase patient mortality, such as on-admission hypotension, a lack of pre-hospital care, post-operative complications, an intraoperative hypoxia episode, and hyperthermia.

Patterns of Admission and Clinical Outcomes Among Patients Admitted to Medical Intensive Care Unit of a Teaching and Referral Hospital, Northwest Ethiopia.

BACKGROUND: The intensive care unit (ICU) is a health care delivery service for patients who are in critical condition with potentially recoverable diseases. Patients can benefit from more detailed observation, monitoring and advanced treatment than other wards or department. The care is advancing but in resource-limited settings, it is lagging far behind and mortality is still higher due to various reasons. Therefore, we aimed to determine the admission patterns, clinical outcomes and associated factors among patients admitted medical intensive care unit (MICU). METHODS: A retrospective cross-sectional study was conducted based on a record review of logbook and charts of patients admitted from September, 2015 to April, 2019. Data were entered and analysed using SPSS version 20. Both bivariate and multivariate logistic regression analyses were used and a P-value < 0.05 was considered statistically significant. RESULTS: A total of 738 patients were admitted to medical intensive care unit (MICU) during September, 2015 - April, 2019. Five hundred and four patients (68%) of all intensive care unit (ICU) admissions had complete data. Out of the 504 patients, 268 (53.2%) patients were females. Cardiovascular disease 182(36.1%) was the commonest categorical admission diagnosis. The overall mortality rate was 38.7%. In the multivariate analysis, mortality was associated with need for mechanical ventilation (AOR = 5.87, 95% CI: 3.24 - 10.65) and abnormal mental status at admission (AOR = 2.8, 95% CI: 1.83-4.29). Patients who had stay less than four days in MICU were 5 times more likely to die than those who has stay longer time (AOR= 5.58, 95% CI: 3.58- 8.69). CONCLUSIONS: The overall mortality was considerably high and cardiovascular diseases were the most common cause of admission in MICU. Need for mechanical ventilator, length of intensive care unit stay and mental status at admission were strongly associated with clinical outcome of patients admitted to medical intensive care unit.

Assessment of Awareness, Attitude and Desire for Labor Analgesia and Associated Factors Among Pregnant Women in Ethiopia: A Cross-Sectional Study.

INTRODUCTION: Labor pain is the worst imaginable pain that women experience during their childbearing years. Untreated labor pain has numerous negative consequences, for both the mother and her fetus. Low levels of awareness and attitudes among pregnant women about labor analgesia is a major challenge that affects outcomes for both the mother and fetus. Therefore, this study aimed to assess the awareness of, attitude towards and desire for labor analgesia and its associated factors among pregnant women who visited an antenatal care facility. METHODS: An institution-based, cross-sectional study was conducted from February to March 2019. Data were collected using semi-structured questionnaires by a convenience sampling technique. Data were entered using EpiData 4.2 and exported to SPSS version 20 software for analysis. Both bivariate and multivariate binary logistic regression analysis were used to identify factors associated with awareness, attitude and desire for labor analgesia among pregnant women. Crude odds ratio (COR) and adjusted odds ratio (AOR) were calculated to show the strength of association. RESULTS: A total of 410 participants were included. Thirty-three (8%) of the pregnant women who visited the antenatal care facility were found to have an awareness of labor analgesia. In multivariate analysis, the likelihood of having awareness of labor analgesia was 7.227 times (AOR: 7.227, 95%, CI 2.406-21.720) greater among parous versus nulliparous mothers. The odds of having awareness of labor analgesia were 3.133 times (AOR: 3.133, 95%; CI 1.144-8.581) greater among government employees than among housewives. The odds of having a good attitude towards labor analgesia were 6.488 times (AOR: 6.488, 95% CI 1.894-22.227) higher in government employees than in farmers. Women in the age group of 25-31 years were 1.815 times more likely to want labor analgesia for their next delivery (AOR: 1.815, 95% CI 1.103-2.989). CONCLUSIONS: The awareness of labor analgesia among pregnant women was low. There is a need for teamwork by all stakeholders in health sectors to improve attitudes and increase the desire for labor analgesia among pregnant women who visit antenatal care facilities.

Severity of Wound-Related Pain and Associated Factors Among Patients Who Underwent Wound Management at Teaching and Referral Hospital, Northwest Ethiopia.

BACKGROUND: Wound management is one of the commonly performed procedures in hospitals. It can be a major source of pain and pain may be a frequently experienced but under-considered component of wound management. Therefore, we aimed to determine the severity of wound-related pain and identifying factors associated with it among patients who underwent wound management. PATIENTS AND METHODS: An institutional-based, cross-sectional study was conducted from March to May, 2020 in the University of Gondar Comprehensive Specialized Hospital. A total of 424 patients were included in this study. Data were collected by direct observation, chart review, and interview of patients by using questionnaires. Statistical analysis had performed using SPSS 25.00 version statistical software. Descriptive statistics were conducted to summarize patients' information and to determine the prevalence of pain. Bi-variable analysis was performed to determine each of the independent variables and only variables with a P-value<0.2 were entered into the multivariable analysis. The strength of the association was present by odds ratio and 95% Confidence interval. P-value<0.05 was consider as statistically significant. RESULTS: The prevalence of moderate-to-severe wound-related pain during wound management was 94.1% (95% CI=91.7-96.2). Anxiety (AOR=18.16; 95% CI=4.83-68.23), acute wound (AOR=11.49; 95% CI=1.013-130.2), baseline pain (AOR=3.51; 95% CI=1.18-10.46), and analgesia intake (AOR=0.026; 95% CI=0.001-0.895) were significantly associated with the severity of wound-related pain. CONCLUSION: The prevalence of moderate-to-severe wound-related pain was considerably high. Anxiety, type of wound, baseline pain, and analgesia intake were the independent risk factors. Therefore, wound care providers should assess the severity of wound-related pain and manage accordingly. Additionally, more emphasis should be given for patients who have baseline pain, anxiety, and acute wound.

Efficacy of single-injection unilateral thoracic paravertebral block for post open cholecystectomy pain relief: a prospective randomized study at Gondar University Hospital.

BACKGROUND: Cholecystectomy can be associated with considerable postoperative pain. While the benefits of paravertebral block (PVB) on pain after thoracotomy and mastectomy have been demonstrated, not enough investigations on the effects of PVB on pain after open cholecystectomy have been conducted. We tested the hypothesis that a single-injection thoracic PVB reduces pain scores, decreases opioid consumption, and prolongs analgesic request time after cholecystectomy. METHODS: Of 52 patients recruited, 50 completed the study. They were randomly allocated into two groups: the paravertebral group and the control group. The outcome measures were the severity of pain measured on numeric pain rating scale, total opioid consumption, and first analgesic request time during the first postoperative 24 hours. RESULT: The main outcomes recorded during 24 hours after surgery were Numerical Rating Scale (NRS) pain scores (NRS, 0-10), cumulative opioid consumption, and the first analgesic request time. Twenty four hours after surgery, NRS at rest was 4 (3-6) vs 5 (5-7) and at movement 4 (4-7) vs 6 (5-7.5) for the PVB and control groups, respectively. The difference between the groups over the whole observation period was statistically significant (P<0.05). Twenty-four hours after surgery, median (25th-75th percentile) cumulative morphine consumption was 0 (0-2) vs 2.5 (2-4) mg (P<0.0001) and cumulative tramadol consumption was 200 (150-250) mg vs 300 (200-350) mg in the paravertebral and in the control group, respectively (P=0.003). After surgery, the median (25th-75th percentile) first analgesic requirement time was prolonged in the PVB group in statistically significant fashion (P<0.0001). CONCLUSION AND RECOMMENDATIONS: Single-shot thoracic PVB as a component of multi-modal analgesic regimen provided superior analgesia when compared with the control group up to 24 postoperative hours after cholecystectomy, and we recommend this block for post cholecystectomy pain relief.