A novel multi-criteria decision-making approach for prioritization of elective surgeries through formulation of "weighted MeNTS scoring system".

Background: Publicly funded healthcare system has long non-manageable elective surgery waiting lists due to the non-existence of systematic mathematical modelling that can assess the relative priority of patients on elective surgery waiting lists thus denying the provision of surgical support to the patients with higher urgency. Mostly the patients of general surgery are entertain with highly subjective "time-honoured" methods that are inadequate to measure and compare the urgency of surgical procedure. Objective: A methodology of assigning priorities to patients on elective surgery waiting lists has been presented in this paper using weighted criteria objectives. The objectives hve been chosen and assigned weights based on hospital conditions, and in consultation with the surgeons in hospital in Pakistan. Methods: The proposed methodology presents two working contributions; first, a scoring mechanism based on MeNTS scoring system with weighted criterion that objectively translate the condition of patient prior to the surgical procedure; and second, a patient prioritization methodology to select patients for surgeries according to the corresponding scores. Detailed simulation results from actual patient data have been presented to evaluate the effectiveness of the proposed methodology, and its applicability and ease of use has been tested in real-time by surgeons while providing consultations to their patients. Results: The proposed methodology outperforms the traditional "first-come-first-serve" methodology as there was a 30% reduction in average waiting time in elective surgery waiting lists (from 4.246 to 2.956 days) with 103 (90%) of patients being entertained before or within the unprioritized surgeries time span, with 94 patients having surgery within 1 day of being on waiting list (an increase of 47 patients). Moreover, transparency and equity were also found in the adaptation of this strategy to prioritize the elective surgery patients. Conclusions: Prioritizing patients on elective surgery waiting lists is an important concern in surgical field. In most of the methodologies presented in earlier research, prioritization of patients for surgery is carried out subjectively. This study shows that the proposed technique has the potential to decrease the waiting times for patients on elective surgery waiting lists, as well as be presented as an objective methodology for preparing the elective surgery waiting lists to increase the transparency in waiting list.

Fruit Peels: Food Waste as a Valuable Source of Bioactive Natural Products for Drug Discovery.

Fruits along with vegetables are crucial for a balanced diet. These not only have delicious flavors but are also reported to decrease the risk of contracting various chronic diseases. Fruit by-products are produced in huge quantity during industrial processing and constitute a serious issue because they may pose a harmful risk to the environment. The proposal of employing fruit by-products, particularly fruit peels, has gradually attained popularity because scientists found that in many instances peels displayed better biological and pharmacological applications than other sections of the fruit. The aim of this review is to highlight the importance of fruit peel extracts and natural products obtained in food industries along with their other potential biological applications.

Frankincense diterpenes as a bio-source for drug discovery.

INTRODUCTION: Frankincense (Boswellia sp.) gum resins have been employed as an incense in cultural and religious ceremonies for many years. Frankincense resin has over the years been employed to treat depression, inflammation, and cancer in traditional medicines. AREAS COVERED: This inclusive review focuses on the significance of frankincense diterpenoids, and in particular, incensole derivatives for establishment future treatments of depression, neurological disorders, and cancer. The authors survey the available literature and furnish an overview of future perspectives of these intriguing molecules. EXPERT OPINION: Numerous diterpenoids including cembrane, prenylaromadendrane, and the verticillane-type have been isolated from various Boswellia resins. Cembrane-type diterpenoids occupy a crucial position in pharmaceutical chemistry and related industries because of their intriguing biological and encouraging pharmacological potentials. Several cembranes have been reported to possess anti-Alzheimer, anti-inflammatory, hepatoprotective, and antimalarial effects along with a good possibility to treat anxiety and depression. Although some slight drawbacks of these compounds have been noted, including the selectivity of these diterpenoids, there is a great need to address these in future research endeavors. Moreover, it is vitally important for medicinal chemists to prepare libraries of incensole-heterocyclic analogs as well as hybrid compounds between incensole or its acetate and anti-depressant or anti-inflammatory drugs.

Effect of continued professional development on clinical performance in a public sector health care setting.

OBJECTIVE: To determine the effectiveness of intervention by education of doctors in improving the referral rate and quality in a public-sector healthcare setting. METHODS: The quasi-experimental study was conducted from March to September 2012 at PNS Rahat Hospital in naval sailors' residential estate, Karsaz, Karachi. Two awareness sessions were held three months apart by a gynaecologist and a paediatrician. The sessions were aimed at communicating the consultant practice to female general practitioners employed at the two family welfare centres. Pre- and post-intervention data was collected manually from the record registers at the two centers as well as gynaecology and paediatrics outpatient clinics. RESULTS: The study comprised 10 female GPs. In paediatric clinic, there was 47% (118 post intervention/ 187 pre intervention) reduction in referrals for acute gastroenteritis and fever of unknown origin (32 post intervention/75 pre intervention). In gynaecology, 30% (50 post intervention/61 pre intervention) reduction was seen in referrals for severe anaemia in 2nd and 3rd trimesters of pregnancy, and an increase in referrals (35 post intervention/19 pre intervention) for high-risk cases indicating better counselling and case identification. Improved standard of counselling was also reflected by 31% reduced referrals (40 post intervention/ 58 pre intervention) for hyper-emesis gravidarum during the first trimester. The difference in referrals was not statistically significant (p>0.05) for paediatrics, but it was highly significant (p<0.001) for gynaecology. CONCLUSIONS: Healthcare system can function optimally with focus on referral standards and by improving the communication between the primary care physicians and consultants.

Impact of multiparity on iron content in multiparous women.

BACKGROUND: The effect of multiple pregnancies, a very common pattern in reproductive lifestyle of Pakistani women, needs to be addressed to see if it affects the iron content and hence cause iron deficiency. Recognising this deficiency prior to development of anaemia can prevent disastrous consequences that can complicate the life of the mother and foetus especially in developing countries. The objective of this study was to assess the effect that the stress of multiple pregnancies has on the iron status of the body. METHODS: This comparative study was conducted in a focus group of female population. Two hundred subjects were selected by convenient sampling and grouped depending on their parity status. Data regarding diet, and socioeconomic history was collected on pre-designed questionnaire. Serum Ferritin was used to assess iron deficiency using the Electrochemiluminescence Immunoassay (ECLIA). Data was statistically analysed using SPSS-17. RESULTS: Mean value of serum Ferritin in the nulliparous group was 76.52 +/- 4.92 etag/mL with 16% of nulliparous subjects showing lower than normal values. Thirty-six percent of uniparous subjects showed low serum Ferritin values, mean value-being 45.74 +/- 4.51 etag/mL. Seventy-two percent of the multiparous subjects showed iron deficiency with Ferritin levels of < 20 etag/mL. Mean serum Ferritin in this group was 25.21 +/- 2.75 etag/mL. The differences between the Ferritin levels of the study groups were highly significant (p < 0.01). CONCLUSIONS: Multiparous women had lower serum Ferritin levels than the control group suggesting that the stress of multiple pregnancies takes its toll on the iron content of the body.