11 research outputs found

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

    Get PDF
    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

    Adherence to Highly Active Antiretroviral Therapy (HAART): A Sel-reported Case Study from a Rural Area in Cameroon

    No full text
    The paper reports on an investigation of factors militating against adherence to highly active anti-retroviral therapy in a rural area in Cameroon: A pre-tested interviewer-administered questionnaire was administered to 108 HIV positive patients on treatment with antiretrovirals. Adherence was evaluated on the following drug combinations Nevirapine /Lamivudine/ Stavudine (Triomune); Efavirenz/Lamivudine/ Zidovudine and Indinavir/ Lamivudine /Stavudine. The correlation of factors like income, educational level, age, gender, medication type and adherence was evaluated. The effect of ascertained factors such as drug type, finance, medication side effects, forgetting to take medication, difficulty in fitting drug schedule with daily activities, shame to get refills and level of conviction on efficacy of drug on adherence are discussed herein. (Key Words: HIV/AIDS, Treatment, Anti-retroviral, Adherence. Sahel Medical Journal Vol.7(4) 2004: 119-12
    corecore