Exploring Cadaver Skin For Standardization Of Rabbit And Porcine Burn Models In Research.

Burn animal models provide substantial insights into burn pathophysiology. Choice of the apt model is important for determining the clinical efficacy of new medicines. Therefore, standardization of burn models is crucial for scientific research. Use of common techniques like hot water, electricity and incandescent instruments to generate animal burn models is widely reported. However, great discrepancy in employed temperature and exposure times demands user-dependent standardization of the animal model prior to research. Establishment of custom generated in vivo burn models giving consideration to reduced use, suffering and risk of the experimental animal is equally crucial. Accordingly, this pilot study demonstrates a novel approach using rabbit and porcine cadaver skin for standardization of burn parameters prior to use in live animal models. Using a custom-made soldering iron coupled to a 16cm2 surface area copper plate, burns at randomly chosen temperatures of 80˚C and 120˚C, with exposure times ranging from 60s to 180s, were produced on rabbit and porcine cadaver skins. On gross and histopathological analysis, parameters required to generate characteristic changes for deep partial and full thickness burn involvement were established. The identified temperature and exposure time parameters were further validated in live animal models. In vivo validation established the success of this approach, highlighting reduced animal use, ease, reproducibility and efficacy in burn model standardization. The findings of this study will hopefully encourage researchers to opt for cadaver skin to determine parameters required to generate a specific degree of burn prior to its use in live animals for burn research.

Les modèles animaux permettent des avancées substantielles dans la compréhension de la physiopathologie des brûlures. Le choix du modèle est important pour évaluer l'efficacité de nouvelles thérapeutiques, donc la standardisation de ces modèles est cruciale. Les utilisations de l'eau chaude, de l'électricité et de solides chauds est couramment décrite. Cependant, la grande variabilité des températures et des temps de contact nécessite une calibration avant chaque étude expérimentale. Il est en outre nécessaire de développer des modèles in vivo à façon tout en réduisant le risque d'erreur et la souffrance animale. Cette étude décrit l'utilisation de peaux de lapins et de porcs morts pour la standardisation des modèles de brûlure les utilisant. Nous utilisons un fer à souder couplé à une plaque de cuivre de 16 cm², pouvant délivrer une température réglable entre 80 et 120°C pendant 60 à 180 s sur de la peau de lapin ou de porc morts. Nous avons défini les paramètres permettant de réaliser des brûlures intermédiaires ou profondes, objectivées par études macro- et microscopiques, validés ensuite chez l'animal vivant. Cette étape a permis de confirmer l'efficacité de cette approche qui réduit le nombre d'animaux d'expérience, est aisée et reproductible et bien corrélée à l'approche in vivo. Cette étude devrait conduire les équipes a réaliser une calibration ex vivo avant de réaliser une étude in vivo de brûlure expérimentale.

A framework for healthcare quality improvement in India: the time is here and now!

Healthcare in India has been undergoing rapid changes in the last decade. As demand outpaces supply, quality improvement (QI) initiatives and tools can be beneficial to enhance safe, effective, efficient, equitable and timely care. Healthcare quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. This article discusses the framework for QI and reviews the Plan-Do-Study-Act (PDSA), Lean and Six Sigma methodologies, and briefly discusses key patient safety and quality measurement concepts. The PDSA cycle assists in testing the ideas through small tests of change or "pilots". Six Sigma aims at reducing variations in processes, and the Lean methodology predominantly focuses on enhancing process efficiency and eliminating non-value added steps in the process. It is likely that such structured problem solving approaches will provide an objective and systematic method of enhancing quality in healthcare institutions across India. As increasing attention being is paid on enhancing the quality of life through the Quality Council of India and accreditation of hospitals in India through the International Organization for standardization and National Accreditation Board for hospitals and healthcare providers, a focus on QI by institutional leaders and healthcare providers is key to enhancing the safety and quality of healthcare in India. Central to this also will be leadership buy-in, identification of a core faculty or team that will be the initiators of change, a respect for the need for faculty training and education in QI, measurement of issues to identify key priorities to focus on, and enhanced information systems where resources permit the same.

The HIV/AIDS epidemic in Nigeria: progress, problems and prospects.

Nigeria is Africa's most populous country, and is home to the third largest number of persons living with HIV/ AIDS in the world. Poverty, stigma, discrimination, and a poorly coordinated health system constitute major barriers to HIV treatment and prevention efforts. The purpose of this paper is to review the current status of the HIV/AIDS epidemic in Nigeria, analyze the challenges facing provision of HIV/AIDS services, examine the prospects of attaining universal access to HIV prevention, treatment, care and support, and advance recommendations for developing quality, sustainable and efficient HIV/AIDS services in Nigeria. HIV programs in Nigeria must emphasize sustainability of current foreign-donor driven treatment and prevention initiatives by engaging all segments of the society and enhancing community leadership and ownership of the programs.

HIV voluntary counselling and testing in Nakuru, Kenya: findings from a community survey.

OBJECTIVES: HIV voluntary counselling and testing (VCT) is important for prevention, detection and treatment of HIV infection. A study was conducted to determine the extent of utilization of VCT, and to study the attitudes and preferences of the community regarding VCT. METHODS: A total of 301 adults, aged 18-49 years, residing in Nakuru, Kenya were randomly selected using a two-stage sampling process. A self-administered questionnaire delivered during home visits was used to collect data over a 4-week period. RESULTS: The majority of study participants (184 of 287; 64.1%) had never been tested for HIV; 77 (26.8%) had received VCT, and 26 (9.1%) had received HIV testing without counselling. A total of 219 (78.2%) of the 280 responding participants expressed readiness to have VCT. The majority of participants (216 of 296; 73%) preferred VCT, while 46 (15.5%) preferred testing without counselling. The majority (227; 76.7%) preferred couple testing and dedicated clinics and private doctors' offices as testing facilities. The choice of a nearby facility was ranked above the provision of anonymity by most participants (162 of 298; 54.4%; vice versa for 136 of 298; 45.6%). CONCLUSIONS: With HIV/AIDS continuing to be a major public health concern in Kenya, the issues surrounding acceptance and use of VCT need to be addressed. Enhancing community awareness of the benefits of early HIV diagnosis, providing couple-based VCT as an integral part of VCT and increasing access to VCT testing sites may enhance utilization of VCT.

Debulking of free myocutaneous flaps for head and neck reconstruction using an arthroscopic shaver.

Most reconstructive surgeons prefer a myocutaneous free flap for head and neck reconstruction due to its bulk and superiority in bacterial suppression. To obtain proper symmetry and contouring in the head and neck region, ancillary procedures usually have to be performed. Eleven head and neck cancer patients underwent resection and reconstruction with myocutaneous flaps that resulted in unacceptable facial contouring. Delayed flap debulking with an arthroscopic shaver was performed. All 11 patients were satisfied with their facial contouring and symmetry after one session of debulking. There were no complications such as flap necrosis, seroma or haematoma. This novel technique done under local anaesthesia is effective for debulking myocutaneous free flaps and removing fibrotic tissues. It is simple, safe and produces a reliable and satisfactory outcome.

The reality of unsafe abortion in a rural community in South India.

Though the law in India has permitted medical termination of pregnancy on broad legal grounds for over two decades, unsafe abortions carried out by unqualified providers show no signs of decreasing. A community-based study was undertaken in rural South India to determine the prevalence of induced abortion, women's reasons for seeking abortion, who was providing abortions and whether the procedures were safe or unsafe. A cross-sectional study design was used that included focus group discussions with 88 women and a quantitative survey with 195 married women who had a birth interval of two or more years since their last pregnancy. There was a high prevalence of induced abortion (28 per cent) among the study population, mainly among women who were not using contraception. Most abortions were carried out in the first trimester of pregnancy and unqualified practitioners performed 65 per cent of terminations. The preference for illegal, untrained providers in a country where abortion is legally available exposes the ambiguity in the status of abortion and how inadequacies in legal service provision have served to promote and sustain unsafe providers and practices. An integrated approach to family planning and reproductive health which includes abortion is imperative if the reproductive health status of Indian women is to be improved. The poor utilisation of existing government facilities suggests the need for improving the quality of services, expansion of abortion facilities and the introduction of safer methods of abortion. To do this, a re-examination and re-framing of aspects of the 1971 abortion law is needed.