Assessing information and communication technology in surgical training, Sudan as example

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Age of blood and adverse outcomes in a maternity population

BACKGROUND In recent times there has been debate around whether longer storage time of blood is associated with increased rates of adverse outcomes following transfusion. It is unclear whether results focused on cardiac or critically ill patients apply to a maternity population. This study investigates whether older blood is associated with increased morbidity and readmission in women undergoing obstetric transfusion. STUDY DESIGN AND METHODS Women giving birth in hospitals in New South Wales, Australia between July 2006‐December 2010 were included in the study population if they had received between 1‐4 red cell units during the birth admission. Information on women’s characteristics, transfusions and outcomes were obtained from 5 routinely collected datasets including blood collection, birth and hospitalisation data. Generalised propensity score methods were used to determine the effect of age of blood on rates of severe morbidity and readmission, independent of confounding factors. RESULTS Transfusion data were available for 2990 women, with a median age of blood transfused of 20 days (interquartile range 14,27 days). There were no differences in the age of blood transfused between women with and without severe morbidity (21 (14,28) vs 22 (15,30) days), and in women readmitted or not (22 (14,28) vs 22 (16,30) days). After considering potential confounding factors, no relationship was found between the age of blood transfused and rates of severe morbidity and readmission. CONCLUSION Among women receiving low volume transfusions during a birth admission, there was no evidence of increased rates of adverse outcomes following transfusion with older blood.NHMRC, Australian Red Cross, NSW Clinical Excellence Commission, AR

Complement-Activating Capacity of Autoantibodies Correlates With Disease Activity in Bullous Pemphigoid Patients

Background: Bullous pemphigoid is a subepidermal blistering skin disease, associated with autoantibodies to hemidesmosomal proteins, complement activation at the dermal-epidermal junction, and dermal granulocyte infiltration. Clinical and experimental laboratory findings support conflicting hypotheses regarding the role of complement activation for the skin blistering induced by pemphigoid autoantibodies. In-depth studies on the pathogenic relevance of autoimmune complement activation in patients are largely lacking. Therefore, the aim of this study was to investigate the pathogenic relevance of complement activation in patients with bullous pemphigoid. Complement activation by autoantibodies in vivo as measured by the intensity of complement C3 deposits in the patients' skin and ex vivo by the complement-fixation assay in serum was correlated with the clinical disease activity, evaluated by Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Bullous Pemphigoid Disease Area Index (BPDAI), as well as, with further immunopathological findings in patients with bullous pemphigoid.Results: Complement-activation capacity of autoantibodies ex vivo, but not deposition of complement in the perilesional skin of patients, correlates with the extent of skin disease (measured by ABSIS and BPDAI) and with levels of autoantibodies.Conclusions: Our study provides for the first time evidence in patients for a pathogenic role of complement activation in bullous pemphigoid and should greatly facilitate the development of novel diagnostic tools and of more specific therapies for complement-dependent autoimmune injury

The epidemiology of polymyalgia rheumatica in primary care: a research protocol

BACKGROUND: Polymyalgia Rheumatica (PMR) is the commonest inflammatory condition seen in older patients in primary care. To date, however, research has been focused on secondary care cohorts rather than primary care where many patients are exclusively managed. This two year prospective inception cohort study of PMR patients will enable us to understand the full spectrum of this condition. METHODS: Patients diagnosed with PMR in primary care will be identified via Read codes and mailed a series of postal questionnaires over a two-year period to assess their levels of pain, stiffness and functioning, as well as medication usage and other health-related and socio-demographic characteristics. In addition, participants will be asked for permission to link their survey data to their general practice electronic medical record and to national mortality and cancer registers. DISCUSSION: This will be the first large-scale, prospective, observational cohort of PMR patients in primary care. The combination of survey data with medical records and national registers will allow for a full investigation of the natural history and prognosis of this condition in the primary care setting, in which the majority of patients are treated, but where little research on the treatment and outcome of consultation has been undertaken. This will provide information that may lead to improved primary care management of PMR

Outcomes and uptake of explicit research skill development across degree programs

John Willison, Said Al Sarawi, Cynthia Bottema, Susan Hazel, Ursula Henderson, Sophie Karanicolas, Clinton Kempster, Ursula McGowan, Julia Miller, Kogi Naidoo, Brian Ng, Edward Palmer, Simon Pyke, Catherine Snelling, Richard Warner, Michael Wilmore, Glen Croy, Leanne McCann, Susan Mayson, Lyn Torres, Suniti Bandaranaike, Tai Peseta, Rowena Harpe

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Digital feedback assemblages: Portfolio feedback in the industrial design studio

Traditionally in industrial design studios, the review and assessment of student learning occurs within the context of verbal critiques and a paper-based portfolio. Students are constantly required to assimilate various points of view within the critiques and display their understanding in the further development of their design portfolio. A number of weaknesses are associated with this process, including students' ability to remember what occurred during the critique and then to apply it in practice. To respond to these issues, as well as to give more effective feedback, students were asked to create and submit a digital portfolio of their work for feedback and assessment. This digital portfolio was then reviewed and an assemblage of textual, visual and audio feedback was returned to the student for reflection and integration into their subsequent design work. While the assemblage of textual, visual and audio feedback had some demands, overall the advantages far outweighed these. It was found to support student learning and was well received by students. For the lecturer, using this method contributed to enhancing practice in the design studio

In vivo evaluation of the anticancer activity of the gemcitabine and doxorubicin combined in a nanoemulsion

Context: Doxorubicin (DOX) and gemcitabine (GEM) are anticancer drugs that were combined in a nanoemulsion (NE) to reduce their adverse side effects. Aim: To detect the antitumor activity of the combination formulas of GEM and DOX, loaded either in water (GEM+DOX-Sol) or in NEs (GEM–DOX combination/loaded NE [GEM+DOX/LNE]), in female Swiss albino mice inoculated with Ehrlich ascites carcinoma (EAC). Settings and Design: The anticancer assessment of the NE formulas was implemented in 200 mice, which were divided into 10 groups. Materials and Methods: It includes the detection of the change in body weight, analysis of the hematological and serum biochemical profiles, and study of the histopathologic alterations of the heart tissues. Statistical Analysis: One-factor analysis of variance was used. Results: Mice treated with GEM + DOX/LNE, which have an z-average of 155.38±2.33nm and zeta potential of −38.5±1.3 mV, recorded a considerable improvement in the mean survival time (MST), which was 60 days, as compared to the EAC control group, which has an MST of 28 days. It also restored the hematological and serum biochemical parameters toward normal values. Conclusions: The combination of GEM and DOX in NE has significantly diminished the cardiotoxicity of DOX and hematotoxicity of GEM while improving their antitumor properties

Microcontroller-based electrolyte analyzer

Electrolytes are important to the hydration of the body especially for the athletes. These electrolytes are minerals in body fluids where electricity is conducted to carry signals to their destinations. The electrolytes serves a role in retaining the balance of fluids between the inside of the cell and the outside of the cell. This is important specifically for hydration, nerve impulses, and muscle function and pH level. Having an imbalance electrolyte, higher level or lower level will result to detrimental effects to a persons health. These can range from hormonal deficiencies, kidney failure, muscle fatigue, paralysis, and more related diseases with connection to electrolyte imbalance. Especially in cases regarding kidney regulation, electrolytes are very important to the monitoring of a critically ill person. Electrolyte analyzers can detect salt ions, calcium ions, potassium and other minerals. The electrolyte analyzer utilizes advance ISE or Ion-Selective Electrode technology for precise measurement of testing and it has different electrodes which are specific for each ions of interest. The Ion-Selective Elctrde is a device that can detect a variety of minerals in solutions. It works by measuring the voltage potential between the sensing electrode and the reference electrode. The electrolyte level detector will use Ion Selective Electrodes (ISE) as its sensor due to its capability to know the calcium, potassium, and sodium levels of the body. The display module would be comprised of a microcontroller-based system and an LCD display that will show the electrolyte levels detected by the circuit. The output of the ISE detector will then be transmitted toa database using a wireless connection that will transmit the results of the circuit wirelessly. The database where the patients can examine the information gathered from the test can be accessed using a computer