Etiological Profile and Treatment Outcome of Epistaxis at a Tertiary Care Hospital in Northwestern Tanzania: A Prospective Review of 104 Cases.

Epistaxis is the commonest otolaryngological emergency affecting up to 60% of the population in their lifetime, with 6% requiring medical attention. There is paucity of published data regarding the management of epistaxis in Tanzania, especially the study area. This study was conducted to describe the etiological profile and treatment outcome of epistaxis at Bugando Medical Centre, a tertiary care hospital in Northwestern Tanzania. This was a prospective descriptive study of the cases of epistaxis managed at Bugando Medical Centre from January 2008 to December 2010. Data collected were analyzed using SPSS computer software version 15. A total of 104 patients with epistaxis were studied. Males were affected twice more than the females (2.7:1). Their mean age was 32.24 ± 12.54 years (range 4 to 82 years). The modal age group was 31-40 years. The commonest cause of epistaxis was trauma (30.8%) followed by idiopathic (26.9%) and hypertension (17.3%). Anterior nasal bleeding was noted in majority of the patients (88.7%). Non surgical measures such as observation alone (40.4%) and anterior nasal packing (38.5%) were the main intervention methods in 98.1% of cases. Surgical measures mainly intranasal tumor resection was carried out in 1.9% of cases. Arterial ligation and endovascular embolization were not performed. Complication rate was 3.8%. The overall mean of hospital stay was 7.2 ± 1.6 days (range 1 to 24 days). Five patients died giving a mortality rate of 4.8%. Trauma resulting from road traffic crush (RTC) remains the most common etiological factor for epistaxis in our setting. Most cases were successfully managed with conservative (non-surgical) treatment alone and surgical intervention with its potential complications may not be necessary in most cases and should be the last resort. Reducing the incidence of trauma from RTC will reduce the incidence of emergency epistaxis in our centre

APEX: Current Status of the Airborne Dispersive Pushbroom Imaging Spectrometer

ABSTRACT Over the past few years, a joint Swiss/Belgium ESA initiative resulted in a project to build a precursor mission of future spaceborne imaging spectrometers, namely APEX (Airborne Prism Experiment). APEX is designed to be an airborne dispersive pushbroom imaging spectrometer operating in the solar reflected wavelength range between 400 and 2500 nm. The system is optimized for land applications including limnology, snow, and soil, amongst others. The instrument is optimized with various steps taken to allow for absolute calibrated radiance measurements. This includes the use of a pre-and post-data acquisition internal calibration facility as well as a laboratory calibration and a performance model serving as a stable reference. The instrument is currently in its breadboarding phase, including some new results with respect to detector development and design optimization for imaging spectrometers. In the same APEX framework, a complete processing and archiving facility (PAF) is developed. The PAF not only includes imaging spectrometer data processing up to physical units, but also geometric and atmospheric correction for each scene, as well as calibration data input. The PAF software includes an Internet based web-server and provides interfaces to data users as well as instrument operators and programmers. The software design, the tools and its life cycle are discussed as well

APEX: Current Status of the Airborne Dispersive Pushbroom Imaging Spectrometer

ABSTRACT Over the past few years, a joint Swiss/Belgium ESA initiative resulted in a project to build a precursor mission of future spaceborne imaging spectrometers, namely APEX (Airborne Prism Experiment). APEX is designed to be an airborne dispersive pushbroom imaging spectrometer operating in the solar reflected wavelength range between 400 and 2500 nm. The system is optimized for land applications including limnology, snow, and soil, amongst others. The instrument is optimized with various steps taken to allow for absolute calibrated radiance measurements. This includes the use of a pre-and post-data acquisition internal calibration facility as well as a laboratory calibration and a performance model serving as a stable reference. The instrument is currently in its breadboarding phase, including some new results with respect to detector development and design optimization for imaging spectrometers. In the same APEX framework, a complete processing and archiving facility (PAF) is developed. The PAF not only includes imaging spectrometer data processing up to physical units, but also geometric and atmospheric correction for each scene, as well as calibration data input. The PAF software includes an Internet based web-server and provides interfaces to data users as well as instrument operators and programmers. The software design, the tools and its life cycle are discussed as well

Posterior epistaxis: systematic review on the effectiveness of surgical therapies

OBJECTIVE: The optimal surgical treatment for patients with posterior epistaxis and failed conservative therapy is unknown. Therefore we planned a systematic review studying all available publications assessing the effect on bleeding recurrence and postoperative complications of ligation of the internal maxillary artery or the sphenopalatine artery. METHODS: We searched the electronic databases Medline, Medline In Process, and Cochrane Library. Data extraction was performed following standard methods. RESULTS: Twenty-eight studies could be included in the systematic review. All studies were retrospective and no single study comparing different methods could be identified. Fifteen studies reported on the effect of the ligation of the internal maxillary artery (LIMA) and 13 on the effect of the ligation of the sphenopalatine artery (LSA). The severity of postoperative complications and duration of hospital stay seem to be lower in the LSA group. A conclusive statement about the frequency of rebleeding in the two groups is not possible. CONCLUSION: According to the available data on postoperative complications and duration of hospital stay ligation of the sphenopalatine artery compared favourably to the ligation of the internal maxillary artery. The most effective treatment for patients with posterior epistaxis including costs should be evaluated in a controlled clinical trial

WIPAKO® Winterthurer Interprofessionelles Ausbildungskonzept Kommunikation und Kooperation in Gesundheitsberufen: Konzept, Entwicklungsprozess und Implementierung

Objective: The positioning and training of communicative and social competencies to improve interprofessional cooperation is and will be a challenge for educational institutions. The aim of this project was to reorient the interprofessional training elements of bachelor programs in terms of both content and structure, to improve the legally required practical relevance and to aim for a sustainable anchoring through the targeted design of the development process. WIPAKO® facilitates the acquisition of communicative and social competencies as a prerequisite for cooperation between the health and medical professions.Methodology: Once suitable process structures had been created, an interprofessional committee of experts defined the training elements (competencies, content, learning and teaching methods, learning objective review and evaluation) in an iterative consensus process based on various framework models and on the involvement of the various stakeholders in the individual study programs.Results: A training concept focusing on communicative and social competencies for interprofessional cooperation is available. The consistent interprofessional development of the concept promoted joint responsibility for training in the sense of an organizational development process.Conclusion: The outlined procedure for the conceptualization and implementation of a corresponding framework model and the framework model itself provide the basis for the empirical examination of competence acquisition and the sustainable anchoring of interprofessional training elements. This will provide suggestions for other educational institutions facing similar challenges.Zielsetzung: Die Verortung und Ausbildung kommunikativer und sozialer Kompetenzen zur Verbesserung der interprofessionellen Zusammenarbeit fordern Bildungsinstitutionen aktuell und künftig heraus. Ziel des vorliegenden Projektes war, die interprofessionellen Ausbildungselemente der Bachelorprogramme inhaltlich wie strukturell neu auszurichten, den gesetzlich geforderten Praxisbezug zu verbessern und durch die gezielte Gestaltung des Entwicklungsprozesses die nachhaltige Verankerung anzutreben. WIPAKO® ermöglicht den Erwerb kommunikativer und sozialer Kompetenzen als Voraussetzung für die Zusammenarbeit der Gesundheits- und Medizinalberufe.Methodik: Nach der Schaffung geeigneter Prozessstrukturen, legte ein interprofessionell zusammengesetztes Expert*innen-Gremium in einem iterativen Konsensverfahren basierend auf verschiedenen Rahmenmodellen und dem Einbezug der verschiedenen Stakeholder der einzelnen Studiengänge die Ausbildungselemente (Kompetenzen, Inhalte, Lern- und Lehrmethoden, Lernzielüberprüfung und Evaluation) fest.Ergebnisse: Ein Ausbildungskonzept mit Fokus auf kommunikative und soziale Kompetenzen zur interprofessionellen Zusammenarbeit liegt vor. Durch die konsequente interprofessionelle Erarbeitung des Konzeptes wurde im Sinne eines Organisationsentwicklungsprozesses die gemeinsame Verantwortung für die Ausbildung gefördert.Schlussfolgerung: Das skizzierte Vorgehen zur Konzeption und Implementierung eines entsprechenden Rahmenmodells und das Rahmenmodell selbst schaffen Grundlagen für die empirische Überprüfung des Kompetenzerwerbes und der nachhaltigen Verankerung interprofessioneller Ausbildungselemente. Damit werden Anregungen gegeben für andere Bildungsinstitutionen, die vor ähnlichen Herausforderungen stehen