The biomechanics and pathogenesis of seat belt syndrome: literature review

Background: Seatbelts are the most effective means of providing occupant protection in a vehicular accident. This works by two mechanisms; by preventing ejection from the vehicle which has been reported to be the leading cause of both injury and death in accidents. Ejection converts the passenger into a “Passenger missile” and thrown out of the vehicle on impact against some stationary objects outside the vehicle – trees, earth, Pillars, culverts, and even on innocent by-standers! Also, ejected passengers can suffer roll-over injuries if the vehicle tumbles over and rolls over and/or crushes the ejected (1) passenger! Seat belts prevent compression injuries, by deploying Airbags. In 70% of collisions, Seatbelts trigger off the deployment of air bags. These air bags restrain the occupant from being flung about in the vehicle and making contact with the vehicular panels like the steering wheel and other environmental surfaces in the vehicle - especially in frontal (or headon) collisions The airbags thus deployed prevent subsequent compression between the patient's organs and some of these (2) framework thus preventing catastrophic compression/blunt injuries.Maximum protection is therefore achieved by the simultaneous use of seatbelts and airbags and this combination has been (3) shown to reduce both the severity and fatality of motor vehicular injuries.Aim: To do an extensive literature search looking for an explanation of how the seat belt, a seemingly safe/protective device can become a weapon of severe and at times very fatal injury.Methodology: Literature search about “Mechanism of Seat-belt syndrome” was done via websites like “Netting the evidence“ website: www.shef.ac.uk/scharr/ir/netting which gave us a comprehensive list of internet resources and also sites for virtual library. We also visited the Cochraine library via their website www.thecochrainelibrary.com which supplied us with the database of Abstracts and Reviews. We also looked at Systematic Review and Controlled trials of high impact collisions using robots, baboons and other mammals. We also used the Pubmed Advanced Search tool looking for the “Mechanism of Seat belt syndromes”Results: The relative risk taken by an occupant without a seat-belt is 70% higher than that of a belted occupant. Therefore seatbelts, properly installed and properly worn, offers the best protection for the automotive occupant during impact.Conclusion: Seat-belts do not prevent accidents; they only work when accidents have occurred. The simultaneous action of seat-belts and air-bags have shown to reduce both the severity and fatality of motor vehicular injuries.Keywords: Seat Belt; Seatbelt Sign; Visceral Injury, Chance Fractur

Surgical emergency presentation in a private teaching hospital in Nigeria: a 2- year review

Background: Pattern of admissions into the accident and emergency units vary worldwide with most studies showing surgical preponderance. Unlike the outcome of our study that showed more of medical cases, another study done in University College Hospital (UCH), Ibadan, Nigeria showed that 61% of admissions into the accident and emergency unit were surgical with trauma in general constituting 45.1%. With rising population and reduced funding, most tertiary care hospitals in developing countries grapple with high patient admissions into their emergencyunits. Lack of adequate personnel and facilities to cater for such patients result in poor patient satisfaction and management. Adequate funding and regular training of personnel should therefore be emphasized if we are to approach the standard care provided in developed countries 4 and reap a satisfactory outcome in care of emergency surgical situations.Method: This is a 2-year retrospective study, data of all patients admitted in the adult accident and emergence section of Babcock University between January 2016 and December 2017 were retrieved and reviewed. Frequencies were presented as absolute values, charts and percentages.Results: In 2016, a total of 1901 emergency cases presented to the adult accident and emergency unit of Babcock University Teaching Hospital of which 341 were surgical. In 2017, a total of 1887 emergency cases were seen in the adult accident and emergency unit of Babcock University Teaching Hospital of which 363 [17.24%] were surgical. Overall, a total of 3788 emergency cases presented of which 704 [17.24%] were surgical cases. Of these 704 cases ,457 of them [64.9%] were acute surgical emergencies like head injuries, burns, cholecystitis, intestinal obstruction, testicular torsion, deep laceration injuries, acute urinary retention, fractures, appendicitis, pleural effusion, upper GI bleeding, , cervical spine injuries [table 1] and the remaining 247 cases [35.1%] were non-emergencies (cold) cases. Of these 457 surgical emergencies, appendicitis accounted for 133 [ 29.10%] of cases making it the commonest surgical emergency that presented in our hospital in these two years.Conclusion: The most common surgical emergency was acute appendicitis 133 cases [40.06%]followed closely by deep lacerations resulting from road traffic accidents 98 cases [25.83%] and head injuries 47cases [13.4%] among others This study also highlights the pattern of emergency surgical cases expected from the accident and emergency department of a typical private hospital which does not always mimic the pattern seen in other public hospitals. This information may help the management in recruiting appropriate staff for the surgical emergency unit/department of a teaching hospitalKeywords: Babcock University Teaching Hospital, Adult Accident and Emergency Unit, Surgical Emergency, Appendicectom

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Work Environment and the Job Satisfaction of Librarians in Private Universities in South-East and South-West, Nigeria

The need for a conducive work environment and job satisfaction is heightened by the conviction that the university library constitutes the powerhouse of knowledge responsible for providing information materials for teaching, learning and research. The study, therefore, investigated the relationship between work environment and the job satisfaction of Librarians in private universities in South-East and South-West, Nigeria. The study adopted the survey research design. The population of the study consisted of one hundred and eighty-one (181) librarians. Total enumeration technique was employed for the study. Data was collected using a self-structured questionnaire that was scrutinized by experts and subjected to a reliability test using Cronbach Alpha. The questionnaire was considered reliable and valid with a reliability coefficient of .90. Analyses of data was carried out using descriptive statistics and Pearson Product Moment Correlation. Results affirmed that private university libraries in South-East and South-West, Nigeria have good work environments as indicated in the average mean score of ( = 3.8) even though issues of noise level and power supply received low ratings. It also established that librarians in the study area are satisfied with their jobs ( = 3.5) irrespective of the fact that reward systems (financial and non-financial), including untimely payment of salaries received low ratings. A positive relationship was established between work environment and job satisfaction (r = .856, p\u3c.05). The study, therefore, concluded that work environment has significant effect on job satisfaction and recommended that library management should invest in the welfare of librarians to enhance job satisfaction amongst others. Job satisfaction, Librarians, Work environment, Private university libraries

Work Environment and the Job Satisfaction of Librarians in Private Universities in South-East and South-West, Nigeria

The need for a conducive work environment and job satisfaction is heightened by the conviction that the university library constitutes the powerhouse of knowledge responsible for providing information materials for teaching, learning and research. The study, therefore, investigated the relationship between work environment and the job satisfaction of Librarians in private universities in South-East and South-West, Nigeria. The study adopted the survey research design. The population of the study consisted of one hundred and eighty-one (181) librarians. Total enumeration technique was employed for the study. Data was collected using a self-structured questionnaire that was scrutinized by experts and subjected to a reliability test using Cronbach Alpha. The questionnaire was considered reliable and valid with a reliability coefficient of .90. Analyses of data was carried out using descriptive statistics and Pearson Product Moment Correlation. Results affirmed that private university libraries in South-East and South-West, Nigeria have good work environments as indicated in the average mean score of ( = 3.8) even though issues of noise level and power supply received low ratings. It also established that librarians in the study area are satisfied with their jobs ( = 3.5) irrespective of the fact that reward systems (financial and non-financial), including untimely payment of salaries received low ratings. A positive relationship was established between work environment and job satisfaction (r = .856, p\u3c.05). The study, therefore, concluded that work environment has significant effect on job satisfaction and recommended that library management should invest in the welfare of librarians to enhance job satisfaction amongst others. Job satisfaction, Librarians, Work environment, Private university libraries