Improving Clerkship to Enhance Patients' Quality of care (ICEPACQ): a baseline study.

BACKGROUND: Proper and complete clerkships for patients have long been shown to contribute to correct diagnosis and improved patient care. All sections for clerkship must be carefully and fully completed to guide the diagnosis and the plan of management; moreover, one section guides the next. Failure to perform a complete clerkship has been shown to lead to misdiagnosis due to its unpleasant outcomes, such as delayed recovery, prolonged inpatient stay, high cost of care and, at worst, death. OBJECTIVE: The objectives of the study were to determine the gap in clerkship, the impact of incomplete clerkship on the length of hospital stay, to explore the causes of the gap in clerkship of the patients and the strategies which can be used to improve clerkship of the patients admitted to, treated and discharged from the gynecological ward in Mbale RRH. METHODOLOGY: This was a mixed methods study involving the collection of secondary data via the review of patients' files and the collection of qualitative data via key informant interviews. The files of patients who were admitted from August 2022 to December 2022, treated and discharged were reviewed using a data extraction tool. The descriptive statistics of the data were analyzed using STATA version 15, while the qualitative data were analyzed via deductive thematic analysis using Atlas ti version 9. RESULTS: Data were collected from 612 patient files. For qualitative data, a total of 8 key informant interviews were conducted. Social history had the most participants with no information provided at all (83.5% not recorded), with biodata and vital sign examination (20% not recorded) having the least number. For the patients' biodata, at least one parameter was recorded in all the patients, with the greatest gap noted in terms of recording the nearest health facility of the patient (91% not recorded). In the history, the greatest gap was noted in the history of current pregnancy (37.5% not provided at all); however, there was also a large gap in the past gynecological history (71% not recorded at all), past medical history (71% not recorded at all), past surgical history (73% not recorded at all) and family history (80% not recorded at all). The physical examination revealed the greatest gap in the abdominal examination (43%), with substantial gaps in the general examination (38.5% not recorded at all) and vaginal examination (40.5% not recorded at all), and the vital sign examination revealed the least gap. There was no patient who received a complete clerkship. There was a significant association between clerkships and the length of hospital stay. The causes of the gap in clerkships were multifactorial and included those related to the hospital, those related to the health worker, those related to the health care system and those related to the patient. The strategies to improve the clerkship of patients also included measures taken by health care workers, measures taken by hospitals and measures taken by the government. CONCLUSION AND RECOMMENDATION: There is a gap in the clerkships of patients at the gynecological ward that is recognized by the stakeholders at the ward, with some components of the clerkship being better recorded than others, and no patients who received a complete clerkship. There was a significant association between clerkships and the length of hospital stay. The following is the recommended provision of clerkship tools, such as the standardized clerkship guide and equipment for patient examination, continuous education of health workers on clerkships and training them on how to use the available tools, the development of SOPs for patient clerkships, the promotion of clerkship culture and the supervision of health workers.

Multivariate analysis of heavy metals content of beef from Soroti, Uganda.

Information about food hygiene and quality in the sub-Saharan African countries remains scarce at a time when many of their citizenry are beginning to acquire the much coveted middle income status. Confounding this are challenges linked to monitoring on a continuous basis the safety of food produced by such lucrative industries as the beef industry. The objective of the current study was to initiate a process of encouraging changes in the status quo, by showing how a first step in that direction might look like. Using heavy metal contents of representative beef samples from butcheries in Soroti, Uganda, typical of a sub-Saharan country, we demonstrate how relationships and common sources of metals in food could be identified in a multivariate space. Beef samples from 40 sites were analyzed by atomic absorption spectrometry for iron (Fe), zinc (Zn), nickel (Ni), chromium (Cr), lead (Pb), copper (Cu), cobalt (Co) and cadmium (Cd). The study showed that all beef samples contained these metals, the extent of which were in the order: Fe > Zn >> Ni, Cr > Pb > Cu, Co > Cd. By correlation analysis, the pairs Ni and Cr, Cd and Co, Ni and Fe or Cr and Fe were found to be most likely coming from similar sources. At least three distinct characteristics of beef consumed in Soroti were also found, a distinction perhaps arising from three major categories of feedlots used to raise donor cattle. The incremental risk of children or adults developing cancer over a lifetime was estimated and found to fall into three categories, two of which are separately explained by the presence of Cr or Ni. The sources of these metals remain a matter of speculation on our part. More studies are needed to determine these sources and to understand the nature of cancer risk in the three categories of beef identified here.

Applying multivariate analysis to characterize waragi spirits from Acoli, Uganda, by their metal contents.

Quality control during spirits production and means of authenticating or verifying sources of spirits in the sub-Saharan region of Africa are limited due to lack of resources and the scientific acumen required to develop methodologies for characterizing spirits. However, the increasing needs to protect consumers from negligence, or willful contamination of spirits in this region underscores the urgency with which growth in this area must happen. In this paper, we describe a multivariate statistical framework upon which characterization, identification and authentication of spirits could be developed. The framework exploits the unique chemical fingerprints of spirits with the goal of accomplishing three functions simultaneously: the detection of class differences, the authentication of spirits and the verification of sources. In a test case using the metal contents of 17 Ugandan spirits, this framework shows (i) that a class of unrecorded spirits known locally as Lira-Lira can be singled out from other spirits by their Cu contents, (ii) that localities from where the Lira-Lira spirits were purchased can be resolved to within 8 km by cluster analysis and principal component analysis, (iii) that cluster analysis loadings and scores, placed side-by-side, can pair spirits and their unique discriminating contaminants directly, (iv) that the most important metals for authenticating 13 spirits, source verification and production methods are Al, Sr, Ba, Mn, Zn and Cu (high concentration variability across samples is the qualifying factor), (v) that common sources of contamination can be detected by Pearson correlation analysis (this study finds that Sn/Cd, Pb/Cr, Tl/Cr, Pb/Ni or Cu/Ag as well as the triad Se/As/Ni in the 13 Ugandan spirits are from similar sources), and (vi) that inconsistency in spirits production can be detected with empirical data. Such rudimentary solutions to characterizing spirits have never been offered to the sub-Saharan countries.