A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia.

BACKGROUND: Any health care system that strives to deliver good health and well-being to its population relies on a trained workforce. The aim of this study was to enumerate surgical provider density, describe operative productivity and assess the association between key surgical system characteristics and surgical provider productivity in Liberia. METHODS: A nationwide survey of operation theatre logbooks, available human resources and facility infrastructure was conducted in 2018. Surgical providers were counted, and their productivity was calculated based on operative numbers and full-time equivalent positions. RESULTS: A total of 286 surgical providers were counted, of whom 67 were accredited specialists. This translated into a national density of 1.6 specialist providers per 100,000 population. Non-specialist physicians performed 58.3 percent (3607 of 6188) of all operations. Overall, surgical providers performed a median of 1.0 (IQR 0.5-2.7) operation per week, and there were large disparities in operative productivity within the workforce. Most operations (5483 of 6188) were categorized as essential, and each surgical provider performed a median of 2.0 (IQR 1.0-5.0) different types of essential procedures. Surgical providers who performed 7-14 different types of essential procedures were more than eight times as productive as providers who performed 0-1 essential procedure (operative productivity ratio = 8.66, 95% CI 6.27-11.97, P < 0.001). CONCLUSION: The Liberian health care system struggles with an alarming combination of few surgical providers and low provider productivity. Disaggregated data can provide a high-resolution picture of local challenges that can lead to local solutions.

Neonatal nurses' knowledge of and attitudes toward caring for cocaine-exposed infants and their mothers.

The knowledge, attitudes, and backgrounds of 215 nurses employed in the nurseries of six hospitals were studied by means of a questionnaire survey. The nurses' attitudes toward the mothers of cocaine-addicted infants were found to be generally negative and/or judgmental and their knowledge to be low. More experience with nursing cocaine-addicted infants and greater acuity of the neonatal unit in which the nurse worked correlated with more positive attitudes toward the infants but not toward their mothers. Knowledge and attitude correlated positively with formal education, inservice education, and self-education, but the correlations were weak.

The use of sustained-release morphine in a hospice setting.

Thirty-seven patients with advanced cancer requiring oral administration of strong narcotics for pain control have been treated with one or other of two commercially-available, sustained-release morphine preparations. Patients were followed up primarily at home, supervised by a local hospice care team, and received daily dosage ranging from 60 mg to 420 mg morphine administered as 30 mg sustained-release tablets delivered at intervals from 6 to 10 hours for 'Roxanol SR' and from 8 to 14 hours for 'MS Contin'. Duration of treatment ranged from 2 to 80 days, and 17 of 19 patients who received sustained-release morphine for 20 or more days achieved a stable dosage schedule. Thirty-five of the 37 patients obtained good to excellent analgesia and only 2 of them required intermittent 'rescue' doses of standard morphine between doses of the sustained-release preparation. From experience with the use of the two preparations it was considered that 'MS Contin' was preferable because of the smaller size of the tablets and because of the longer duration of analgesia provided. It is concluded that sustained-release morphine preparations offer a safe and efficacious alternative to immediate-release analgesics and can help to improve the quality of life for the patient and care-givers.

Perspectives on the pain of the hospice patient.

Behind the physical disfigurement and emotional ravages of advanced malignancy, it is the pain of cancer that is most dreaded. Severe biological pain is experienced by fewer than half of patients dying from cancer. Hospice physicians have the expertise to control the pain of those cancer patients who do experience it. The cancer patient may experience other forms of pain that can be equally devastating: pain of isolation, pain of abandonment, and pain of loss of role. It is important for the occupational therapist working in a hospice setting to understand all aspects of pain management, and the occupational therapy treatment strategies which can improve the quality of life and perception of pain for the hospice patient. Through presentation of case studies, the authors illustrate applications of occupational therapy assessments and interventions in respect to two hospice patients. The occupational therapy treatment strategies effected an improvement in the quality of life for these patients and consequently their perception of pain of loss of role. Occupational therapists, as part of the hospice team, play an important part in giving patients an opportunity to live out their lives in as dignified and purposeful a manner as their disease permits.

The treatment of the hospice patient: from occupational history to occupational role.

The nature of hospice care, particularly from the point of view of the occupational therapist, is presented in respect to the treatment of a 26-year-old patient. This case study demonstrates the role of the occupational therapist in helping a patient deal with his feelings of isolation, in helping him cope with severe physical limitations to maintain a maximum level of independence, and in helping him to deal with relationships with his fiance, family, and friends. The reader is given a sense of the quality of communication between therapist and patient. Finally, a view of what the therapist can expect realistically when offering hospice care is considered.

Selective intra-arterial vasopressin: clinical efficacy and complications.

A retrospective analysis of results obtained over a three year period in 66 patients receiving selective intra-arterial vasopressin (SIAV) for control of 69 episodes of massive gastrointestinal bleeding was presented. SIAV was used when there was a failure of conventional medical therapy and the patient's pathology and/or complicating medical conditions necessitated an attempt at controlling an emergent condition by nonoperative means. Hemmorrhage was completely controlled in 43% of variceal bleeds, 67% of hemorrhage gastritis, 45% of bleeding ulcers, and in 62% of colonic sources. The incidence of rebleeding following initial control was 16%. The surgical mortality for patients who were initial failures of SIAV was 50%. Patients undergoing elective surgery after complete control by SIAV had an 8% mortality. There were five catheter related complications. Minor complications occurred in 41% of patients, but required no treatment. Major complications occurred in 40% of cirrhotic and 21% of noncirrhotic bleeding episodes; and were a contributing factor in five cirrhotic deaths and three noncirrhotic deaths. In critically ill patients in the setting of an Intensive Care Unit, selective intra-arterial vasopressin appears: 1) to be an effective means of controlling certain types of gastrointestinal hemorrhage; 2) to provide an opportunity for an increase in survival rate.

["DKS4T-01 Monitor" complex for the control of the status of critically ill patients]. / Kompleks "Monitor DKS4T-01" dlia kontrolia sostoianiia tiazelobol'nykh.

To exercise control over the condition of critically ill patients a monitoring unit DKC4T-01 which permits it to measure the cardio- and hemodynamic parameters is recommended. The monitoring unit signals "alarm" when the pertinent indicators deviate from the permissible values. The block-wise design of the unit allows also the separate use of individual instruments and devices of this complex setup.