Pneumatic tourniquets in maxillofacial surgery: do we need to change practice? A national study.

The use of pneumatic tourniquets during the harvest of free flaps is an established practice in oral and maxillofacial surgery. Their use can be associated with severe but preventable complications, for which operating surgeons are ultimately responsible. The aim of this study was to find any pitfalls concerning the safe use of tourniquets by maxillofacial surgeons. An electronic questionnaire based on the Association of Perioperative Registered Nurses (AORN) guidelines was distributed to maxillofacial surgeons nationally. A total of 37 questionnaires were completed and analysed. The mean (range) score for the knowledge-based questions for all respondents was 72.8% (47.3%-94.7%). The number of clinicians who answered correctly on topics relating to cuff position, reperfusion time and contraindications for the use of tourniquets were 15, 10 and 6, respectively. A total of 35 clinicians had had no formal training on the application of a tourniquet. Our study shows that knowledge about their use by maxillofacial surgeons is poor, and it highlights the importance of formal education during basic and higher surgical training.

An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania.

CONTEXT: Little is known about pregnancy outcomes among the approximately 11 million refugees worldwide, 25% of whom are women of reproductive age. OBJECTIVE: To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp. DESIGN: Cross-sectional review of records and survey, conducted in February and March 1998. SETTING: Mtendeli refugee camp, Tanzania. PARTICIPANTS: For the overall assessment, 664 Burundi women who had a pregnancy outcome during a recent 5-month period (September 1, 1997-January 31, 1998) and their 679 infants; 538 women (81%) completed the survey. MAIN OUTCOME MEASURES: Incidence of fetal death (fetus born > or =500 g or > or =22 weeks' gestation with no signs of life), low birth weight (<2500 g), neonatal death (death <28 days of life), and maternal death (deaths during or within 42 days of pregnancy from any cause related to or aggravated by the pregnancy or its management). RESULTS: The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcome, those with poor pregnancy outcome were more likely to report prior high socioeconomic status (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), having a first or second pregnancy (OR, 2.2; 95% CI, 1.4-3.4), and having 3 or more episodes of malaria during pregnancy (OR, 2.0; 95% CI, 1.4-3.1). Neonatal and maternal deaths accounted for 16% of all deaths during the period studied. CONCLUSIONS: Poor pregnancy outcomes were common in this refugee setting, and neonatal and maternal deaths, 2 important components of reproductive health-related deaths, contributed substantially to overall mortality.