Risk factors of road traffic accidents (RTA) in context of Bangladesh

Objective: To explore the risk factors related to road traffic accident in context of Bangladesh. Design: This was a cross sectional type of descriptive study. Settings: The study was conducted at emergency and casualty department of Dhaka Medical College Hospital (DMCH) and Sir Salimullah Medical College (SSMC) & Mitford Hospital, Dhaka respectively. Study Period: The study was conducted from July 2007 to June 2008. Subjects: A total of 400 Road Traffic Accident (RTA) patients attended during data collection period of 3 months at Dhaka Medical College and Sir Salimullah Medical College (SSMC) & Mitford Hospitals were consider as the study population. Result: This study included 400 Road Traffic Accident (RTA) patients. Among them, 23.8% patients due to accidents were related to truck accidents followed by bus (20.3%) and CNG Taxi (11.3%) respectively It has been revealed that frequency of accidents caused by new vehicles and old vehicles were almost equal (36.5%) and 13.5% vehicle were overloaded when accidents happened. Fast speeds of the vehicles (62%) were responsible for accidents. About 31% stated that even with normal speed accident was happened. About 44.8% accidents were caused due to collision with other vehicles as stated by the patients. Majority of the patients (52.8%) stated that drivers were looked healthy, 17.8% drunker and 5.5% looked drowsy when they drove vehicles during accident. Majority (55%) of them drove in wrong side of the road. In 78.3% cases, there was no traffic signal and though available, 39.1% driver did not follow traffic signal. About 25% patients stated that defective road is the factor of causation of accidents. Majority (76.75%) of the patients opined that accident was happened during day time and in sufficient light (66%). Weather was foggy stated by 16% patients. Only 6.75% victims used protective measure during accidents. Conclusion: This study was conducted with a view to explore the risk factors related to road traffic accident. Nevertheless, it is not feasible to draw a concrete conclusion. But on the basis of this study findings, it may be stated that a greater part of Road Traffic Accidents (RTA) can be prevented by specific preventive measures and also taking personal precautions. It is also to be concluded that countywide wide mass scale study should be carried out in this specific emerging field to combat road traffic accidents as a major public health issue

Urban-rural differentials of non-communicable diseases behavioural risk factors among adult people in northeastern Bangladesh

Background: The rapid social, cultural and economic changes in Bangladesh have given rise to a number of deaths that can be attributed to non-communicable diseases. The hospital records showed that death from cardiovascular diseases accounted for more than 12 percent of all deaths. Objectives: This study was undertaken to generate information that might be useful in prevention and control of these diseases. Methods: A total of 1627 respondents were selected using systematic random sampling technique for this cross-sectional descriptive study. Urban & rural settings in north eastern Bangladesh. The study period was from November 2004 to December 2005

Informed consent: a socio-legal study

Introduction: Informed consent [IC] is a recognized socio-legal obligation for the medical profession. The doctrine of IC involves the law, which aims to ensure the lawfulness of health assistance and tends to reflect the concept of autonomy of the person requiring and requesting medical and/or surgical treatment. Recent changes in the health care delivery system and the complex sociological settings, in which it is practiced, have resulted in an increase in judicial activity and medical negligence lawsuits for physicians. While IC is a well-established practice, it often fails to meet its stated purpose. In the common law, the standard of medical care to disclose risks has been laid down by the Bolam test- a familiar concept to most physicians, but it has been challenged recently in many jurisdictions. This paper aims to discuss some important judgments in cases of alleged medical negligence so as to familiarize doctors regarding their socio-legal obligations. We also propose to discuss some factors that influence the quality of IC in clinical practice. Methods: Literature review. Results: The law of medical consent has been undergoing changes in recent years. Case law appears to be evolving towards a more patient centered standard of disclosure. Patient’s expectations are higher and they are aware of the power of exercising their rights. Failure to obtain IC is one of the common allegations in medical malpractice suits. Conclusion: The medical professionals need to change their mindset and avoid claims of negligence by providing information that is “reasonable” in the eyes of the court. Key Words: Informed consent, medical negligence, Medical ethics, Investigation, Bolam tes

Die Schule der Frauen : Abonnement suspendu ; heute Montag den 16ten December 1805 ; Lustpiel in 3 Aufzügen

von Moliere. Frey, doch getreu übersetzt von Kotzebue. Personen: Herr Wohlbrück, Mad. Lüders, Herr Pfeil, Herr Annoni, Herr Heuser, Herr Meinert, Mad. Annoni, Herr GrunerIn Fraktu

Factors Associated with the Outcome of Open Tibial Fractures

Background: Although open tibial fractures are common in Malaysia, the outcomes for these patients have not been evaluated in the literature. This retrospective study was conducted to examine the factors associated with infection and non-union in open tibial fractures managed at Hospital Tengku Ampuan Afzan (HTAA), Kuantan, in 2009. Methods: From 1 January until 31 December 2009, the Department of Orthopaedics of HTAA managed 58 patients with open tibial fracture who had a minimum of a one year follow-up period. The median age was 24.5 years (range: 4 to 72 years). The open tibial fractures were graded using the Gustilo open fracture classification as follows: 4 grade I, 21 grade II, 24 grade IIIA and 9 grade IIIB. All open fractures were subjected to a standard treatment protocol at HTAA, which includes the use of prophylactic antibiotics, emergency debridement, fracture stabilisation, wound coverage, and bone reconstruction when required. The mean time from injury to the initial debridement was 29.7 hours (range: 13 to 216 hours). Results: Seventeen (29%) cases were complicated by infection, and 10 patients (17%) developed non-union. The grade of the open fracture was significantly associated with infection, and age and the time interval between the injury and the initial wound debridement were significantly associated with non-union. Conclusions: The high rates of infection and non-union, particularly in severe open fractures, indicate that there is a need to improve the management of open tibial fractures treated at HTAA. The time to initial debridement is an important factor that can be readily amended to improve the outcome. Further studies with larger sample sizes are likely needed to replicate and confirm our findings

Factors associated with the outcome of open tibial fractures

Background: Although open tibial fractures are common in Malaysia, the outcomes for these patients have not been evaluated in the literature. This retrospective study was conducted to examine the factors associated with infection and non-union in open tibial fractures managed at Hospital Tengku Ampuan Afzan (HTAA), Kuantan, in 2009. Methods: From 1 January until 31 December 2009, the Department of Orthopaedics of HTAA managed 58 patients with open tibial fracture who had a minimum of a one year follow-up period. The median age was 24.5 years (range: 4 to 72 years). The open tibial fractures were graded using the Gustilo open fracture classification as follows: 4 grade I, 21 grade II, 24 grade IIIA and 9 grade IIIB. All open fractures were subjected to a standard treatment protocol at HTAA, which includes the use of prophylactic antibiotics, emergency debridement, fracture stabilisation, wound coverage, and bone reconstruction when required. The mean time from injury to the initial debridement was 29.7 hours (range: 13 to 216 hours). Results: Seventeen (29%) cases were complicated by infection, and 10 patients (17%) developed non-union. The grade of the open fracture was significantly associated with infection, and age and the time interval between the injury and the initial wound debridement were significantly associated with non-union. Conclusions: The high rates of infection and non-union, particularly in severe open fractures, indicate that there is a need to improve the management of open tibial fractures treated at HTAA. The time to initial debridement is an important factor that can be readily amended to improve the outcome. Further studies with larger sample sizes are likely needed to replicate and confirm our findings. Keywords: assessment, case management, fractures, open, patient outcome, tibi