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1.
Ann Biomed Eng ; 49(8): 1874-1887, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33880630

RESUMO

Throughout the estrus cycle, the extracellular matrix (ECM) and cervical smooth muscle cells (cSMC) coordinate to accomplish normal physiologic function in the non-pregnant cervix. While previous uniaxial experiments provide fundamental knowledge about cervical contractility and biomechanics, the specimen preparation is disruptive to native organ geometry and does not permit simultaneous assessment of circumferential and axial properties. Thus, a need remains to investigate cervical contractility and passive biomechanics within physiologic multiaxial loading. Biaxial inflation-extension experiments overcome these limitations by preserving geometry, ECM-cell interactions, and multiaxially loading the cervix. Utilizing in vivo pressure measurements and inflation-extension testing, this study presented methodology and examined maximum biaxial contractility and biomechanics in the nulliparous murine cervix. The study showed that increased pressure resulted in decreased contractile potential in the circumferential direction, however, axial contractility remained unaffected. Additionally, total change in axial stress ([Formula: see text]) increased significantly (p < 0.05) compared to circumferential stress ([Formula: see text]) with maximum contraction. However, passive stiffness was significantly greater (p < 0.01) in the circumferential direction. Overall, axial cSMC may have a critical function in maintaining cervical homeostasis during normal function. Potentially, a loss of axial contractility in the cervix during pregnancy may result in maladaptive remodeling such as cervical insufficiency.


Assuntos
Colo do Útero/metabolismo , Matriz Extracelular/metabolismo , Contração Muscular , Força Muscular , Músculo Liso/metabolismo , Miócitos de Músculo Liso/metabolismo , Animais , Fenômenos Biomecânicos , Feminino , Camundongos
2.
BMJ Open ; 9(10): e031800, 2019 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-31594896

RESUMO

INTRODUCTION: Effective, scalable strategies for improving surgical quality are urgently needed in low-income and middle-income countries; however, there is a dearth of evidence about what strategies are most effective. This study aims to evaluate the effectiveness of Safe Surgery 2020, a multicomponent intervention focused on strengthening five areas: leadership and teamwork, safe surgical and anaesthesia practices, sterilisation, data quality and infrastructure to improve surgical quality in Tanzania. We hypothesise that Safe Surgery 2020 will (1) increase adherence to surgical quality processes around safety, teamwork and communication and data quality in the short term and (2) reduce complications from surgical site infections, postoperative sepsis and maternal sepsis in the medium term. METHODS AND ANALYSIS: Our design is a prospective, longitudinal, quasi-experimental study with 10 intervention and 10 control facilities in Tanzania's Lake Zone. Participants will be surgical providers, surgical patients and postnatal inpatients at study facilities. Trained Tanzanian medical data collectors will collect data over a 3-month preintervention and postintervention period. Adherence to safety as well as teamwork and communication processes will be measured through direct observation in the operating room. Surgical site infections, postoperative sepsis and maternal sepsis will be identified prospectively through daily surveillance and completeness of their patient files, retrospectively, through the chart review. We will use difference-in-differences to analyse the impact of the Safe Surgery 2020 intervention on surgical quality processes and complications. We will use interviews with leadership and surgical team members in intervention facilities to illuminate the factors that facilitate higher performance. ETHICS AND DISSEMINATION: The study has received ethical approval from Harvard Medical School and Tanzania's National Institute for Medical Research. We will report results in peer-reviewed publications and conference presentations. If effective, the Safe Surgery 2020 intervention could be a promising approach to improve surgical quality in Tanzania's Lake Zone region and other similar contexts.


Assuntos
Docentes de Medicina , Cirurgia Geral/normas , Procedimentos Cirúrgicos Obstétricos , Complicações Pós-Operatórias , Gestão da Segurança , Procedimentos Cirúrgicos Operatórios , Lista de Checagem/métodos , Lista de Checagem/normas , Docentes de Medicina/organização & administração , Docentes de Medicina/normas , Humanos , Estudos Longitudinais , Procedimentos Cirúrgicos Obstétricos/efeitos adversos , Procedimentos Cirúrgicos Obstétricos/normas , Salas Cirúrgicas/organização & administração , Salas Cirúrgicas/normas , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Melhoria de Qualidade/organização & administração , Gestão da Segurança/métodos , Gestão da Segurança/normas , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/normas , Tanzânia/epidemiologia
3.
BMJ Glob Health ; 4(2): e001282, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31139445

RESUMO

Despite emergency and essential surgery and anaesthesia care being recognised as a part of Universal Health Coverage, 5 billion people worldwide lack access to safe, timely and affordable surgery and anaesthesia care. In Tanzania, 19% of all deaths and 17 % of disability-adjusted life years are attributable to conditions amenable to surgery. It is recommended that countries develop and implement National Surgical, Obstetric and Anesthesia Plans (NSOAPs) to systematically improve quality and access to surgical, obstetric and anaesthesia (SOA) care across six domains of the health system including (1) service delivery, (2) infrastructure, including equipment and supplies, (3) workforce, (4) information management, (5) finance and (6) Governance. This paper describes the NSOAP development, recommendations and lessons learnt from undertaking NSOAP development in Tanzania. The NSOAP development driven by the Ministry of Health Community Development Gender Elderly and Children involved broad consultation with over 200 stakeholders from across government, professional associations, clinicians, ancillary staff, civil society and patient organisations. The NSOAP describes time-bound, costed strategic objectives, outputs, activities and targets to improve each domain of the SOA system. The final NSOAP is ambitious but attainable, reflects on-the-ground priorities, aligns with existing health policy and costs an additional 3% of current healthcare expenditure. Tanzania is the third country to complete such a plan and the first to report on the NSOAP development in such detail. The NSOAP development in Tanzania provides a roadmap for other countries wishing to undertake a similar NSOAP development to strengthen their SOA system.

5.
World J Surg ; 41(12): 3038-3045, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29030677

RESUMO

Recognizing the unmet need for surgical care in Ethiopia, the Federal Ministry of Health (FMOH) has pioneered innovative methodologies for surgical system development with Saving Lives through Safe Surgery (SaLTS). SaLTS is a national flagship initiative designed to improve access to safe, essential and emergency surgical and anaesthesia care across all levels of the healthcare system. Sustained commitment from the FMOH and their recruitment of implementing partners has led to notable accomplishments across the breadth of the surgical system, including but not limited to: (1) Leadership, management and governance-a nationally scaled surgical leadership and mentorship programme, (2) Infrastructure-operating room construction and oxygen delivery plan, (3) Supplies and logistics-a national essential surgical procedure and equipment list, (4) Human resource development-a Surgical Workforce Expansion Plan and Anaesthesia National Roadmap, (5) Advocacy and partnership-strong FMOH partnership with international organizations, including GE Foundation's SafeSurgery2020 initiative, (6) Innovation-facility-driven identification of problems and solutions, (7) Quality of surgical and anaesthesia care service delivery-a national peri-operative guideline and WHO Surgical Safety Checklist implementation, and (8) Monitoring and evaluation-a comprehensive plan for short-term and long-term assessment of surgical quality and capacity. As Ethiopia progresses with its commitment to prioritize surgery within its Health Sector Transformation Plan, disseminating the process and outcomes of the SaLTS initiative will inform other countries on successful national implementation strategies. The following article describes the process by which the Ethiopian FMOH established surgical system reform and the preliminary results of implementation across these eight pillars.


Assuntos
Cirurgia Geral/organização & administração , Reforma dos Serviços de Saúde , Segurança do Paciente , Anestesiologia/organização & administração , Atenção à Saúde/organização & administração , Etiópia , Governo Federal , Cirurgia Geral/educação , Cirurgia Geral/normas , Humanos , Liderança , Salas Cirúrgicas , Qualidade da Assistência à Saúde
6.
BMJ Glob Health ; 1(1): e000011, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28588908

RESUMO

The Millennium Development Goals have ended and the Sustainable Development Goals have begun, marking a shift in the global health landscape. The frame of reference has changed from a focus on 8 development priorities to an expansive set of 17 interrelated goals intended to improve the well-being of all people. In this time of change, several groups, including the Lancet Commission on Global Surgery, have brought a critical problem to the fore: 5 billion people lack access to safe, affordable surgical and anaesthesia care when needed. The magnitude of this problem and the world's new focus on strengthening health systems mandate reimagined roles for and renewed commitments from high income country actors in global surgery. To discuss the way forward, on 6 May 2015, the Commission held its North American launch event in Boston, Massachusetts. Panels of experts outlined the current state of knowledge and agreed on the roles of surgical colleges and academic medical centres; trainees and training programmes; academia; global health funders; the biomedical devices industry, and news media and advocacy organisations in building sustainable, resilient surgical systems. This paper summarises these discussions and serves as a consensus statement providing practical advice to these groups. It traces a common policy agenda between major actors and provides a roadmap for maximising benefit to surgical patients worldwide. To close the access gap by 2030, individuals and organisations must work collectively, interprofessionally and globally. High income country actors must abandon colonial narratives and work alongside low and middle income country partners to build the surgical systems of the future.

7.
Health Promot Pract ; 16(4): 609-16, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25564454

RESUMO

This article presents preliminary findings of the impact of an innovative care management model for diabetic patients. The model was implemented by seven Federally Qualified Health Centers serving 10,000 diabetic patients in Miami-Dade County. A primary intervention of this model is a centralized care management team that makes previsit phone calls to diabetic patients who have scheduled appointments. These previsit phone calls optimize patient knowledge and self-management goals, and provide patient care coordinators with relevant clinical information to optimize the office visit and help to ensure completion of recommended diabetic preventive and chronic care services. Data suggest that following the implementation of this care management model, more diabetic patients are receiving regular care, and compliance with recommended tests and screenings has improved.


Assuntos
Diabetes Mellitus/terapia , Comportamentos Relacionados com a Saúde , Administração dos Cuidados ao Paciente/métodos , Cooperação do Paciente , Assistência Centrada no Paciente/métodos , Adolescente , Adulto , Idoso , Centros Comunitários de Saúde , Comportamento Cooperativo , Diabetes Mellitus/sangue , Feminino , Florida , Promoção da Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde , Cooperação do Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/organização & administração , Avaliação de Programas e Projetos de Saúde , Qualidade da Assistência à Saúde , Sistema de Registros , Telefone , Adulto Jovem
10.
J Family Med Prim Care ; 2(3): 270-3, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24479096

RESUMO

BACKGROUND AND OBJECTIVES: Owing to the high prevalence of osteoporosis and falls, elderly people are at risk of developing hip fractures. The objective of the current study is to assess the quality-of-life (QOL) of elderly (>60 years) with untreated hip fractures in a rural developmental block in Southern India. METHODOLOGY: Twenty-one elderly with an untreated fracture neck of femur were identified with the help of community level health workers. EuroQol (EQ-5D) was administered to assess the QOL before and after the event. QOL was also assessed among a comparison group, matched for age and sex among neighborhood people. Wilcoxon signed rank test and Mann-Whitney U test were used to compare EQ-5D mean scores with before the event scores and the comparison group scores respectively. RESULTS: Of people with hip fracture, 57.1% (12/21), 76.2% (16/21), 81% (17/21), 52.6% (11/21) and 85.7% (18/21) reported severe problems with mobility, pain, usual activity, self-care and anxiety respectively. The EQ-5D mean score among the elderly with fracture neck of the femur was 0.08 (SD 0.27). It was low when compared with the same subjects before the occurrence of the event (Z -4.05, P < 0.001) and as compared with the comparison group (Z -5.77 P < 0.001). CONCLUSION: The QOL scores assessed using EQ-5D index scores was poor among people with untreated fracture neck of the femur as compared with the comparison group and also as compared to their status before the occurrence of the event. A vast majority of study participants reported severe problems with mobility, pain, usual activity and self-care and anxiety domains of EQ-5D questionnaire.

13.
Int J Clin Exp Med ; 3(4): 347-9, 2010 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-21072269
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