Оценка влияния горных работ на формирование поля напряжений и деформирование выработок в условиях шахты «Нестор»

Наведено результати аналітичних та експериментальних досліджень з оцінки впливу гірничих робіт на напружено-деформований стан покрівлі в умовах шахти «Нестор».The results of analytical and experimental studies on the impact of mining on the stress-strain state of the roof in the mine "Nestor"

Antenatal Deep Vein Thrombosis with an Underlying Thrombophilia

Deep vein thrombosis (DVT) can cause severe morbidity in the puerperium and, less commonly, during pregnancy. A woman who developed DVT as a result of thrombophilia was successfully managed with anti-coagulant therapy. The case highlights the need for thrombophilia screening in pregnancy. Key Words: Thrombosis, Thrombophilia, Pregnancy [ Trop J Obstet Gynaecol, 2004;21:177-179

Condom Tamponade in the Management of Primary Postpartum Haemorrhage: A Report of three cases in Ghana

Postpartum haemorrhage is one of the major causes of maternal mortality worldwide. The leading cause of primary postpartum haemorrhage is uterine atony and active management of the third stage of labour with oxytocin is recommended for preventing primary postpartum haemorrhage. Parenteral oxytocin is also the drug of choice for medical management of postpartum haemorrhage secondary to uterine atony. Condom uterine balloon tamponade is a low cost technique that can be used as a second-line option for treatment. We report retrospectively three cases of primary PPH secondary to uterine atony which were managed successfully with condom tamponade. Condom tamponade is effective in managing post partum haemorrhage secondary to uterine atony and we advocate for the training of all skilled attendants on how to insert the condom tamponade. (Afr J Reprod Health 2015; 19[3]: 151-157). Keywords: condom temponade, postpartum haemorrhage, management L’hémorragie du post-partum est une des principales causes de mortalité maternelle dans le monde entier. La principale cause de l'hémorragie du post-partum principale est l'atonie utérine et la gestion active de la troisième phase du travail à l'ocytocine est recommandée pour prévenir les hémorragies du postpartum primaire. L’ocytocine parentérale est également le médicament de choix pour la gestion médicale des hémorragies du post-partum secondaire à une atonie utérine. La tamponnade du ballon du préservatif utérin est une technique à faible coût qui peut être utilisée comme une option de deuxième ligne pour le traitement. Nous rapportons rétrospectivement trois cas de la HPP primaire, secondaire à une atonie utérine qui ont été gérés avec succès avec la tamponnade du préservatif. La tamponnade du préservatif est efficace dans la gestion de l’hémorragie du post-partum secondaire à une atonie utérine et nous proposons que tous les agents qualifiés soient formés sur la manière d insérer la tamponnade du préservatif. (Afr J Reprod Health 2015; 19[3]: 151-157). Mots-clés: tamponnade du préservatif, hémorragie du post-partum, gestio

The third delay: understanding waiting time for obstetric referrals at a large regional hospital in Ghana

Abstract Background Delay in receiving care significantly contributes to maternal morbidity and mortality. Much has been studied about reducing delays prior to arrival to referral facilities, but the delays incurred upon arrival to the hospital have not been described in many low- and middle-income countries. Methods We report on the obstetric referral process at Ridge Regional Hospital, Accra, Ghana, the largest referral hospital in the Ghana Health System. This study uses data from a prospectively-collected cohort of 1082 women presenting with pregnancy complications over a 10-week period. To characterize which factors lead to delays in receiving care, we analyzed wait times based on reason for referral, time and day of arrival, and concurrent volume of patients in the triage area. Results The findings show that 108 facilities refer patients to Ridge Regional Hospital, and 52 facilities account for 90.5% of all transfers. The most common reason for referral was fetal-pelvic size disproportion (24.3%) followed by hypertensive disorders of pregnancy (9.8%) and prior uterine scar (9.1%). The median arrival-to-evaluation (wait) time was 40 min (IQR 15–100); 206 (22%) of women were evaluated within 10 min of arrival. Factors associated with longer wait times include presenting during the night shift, being in latent labour, and having a non-time-sensitive risk factor. The median time to be evaluated was 32 min (12–80) for women with hypertensive disorders of pregnancy and 37 min (10–66) for women with obstetric hemorrhage. In addition, the wait time for women in the second stage of labour was 30 min (12–79). Conclusions Reducing delay upon arrival is imperative to improve the care at high-volume comprehensive emergency obstetric centers. Although women with time-sensitive risk factors such as hypertension, bleeding, fever, and second stage of labour were seen more quickly than the baseline population, all groups failed to be evaluated within the international standard of 10 min. This study emphasizes the need to improve hospital systems so that space and personnel are available to access high-risk pregnancy transfers rapidly

The cost-effectiveness of a program to reduce intrapartum and neonatal mortality in a referral hospital in Ghana.

ObjectiveTo evaluate the cost-effectiveness of a program intended to reduce intrapartum and neonatal mortality in Accra, Ghana.DesignQuasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis.MethodsA program integrating leadership development, clinical skills and quality improvement training was piloted at the Greater Accra Regional Hospital from 2013 to 2016. The number of intrapartum and neonatal deaths prevented were estimated using the hospital's 2012 stillbirth and neonatal mortality rates as a steady-state assumption. The cost-effectiveness of the intervention was calculated as cost per disability-adjusted life year (DALY) averted. In order to test the assumptions included in this analysis, it was subjected to probabilistic and one-way sensitivity analyses.Main outcome measuresIncremental cost-effectiveness ratio (ICER), which measures the cost per disability-adjusted life-year averted by the intervention compared to status quo.ResultsFrom 2012 to 2016, there were 45,495 births at the Greater Accra Regional Hospital, of whom 5,734 were admitted to the newborn intensive care unit. The budget for the systems strengthening program was US $1,716,976. Based on program estimates, 307 (±82) neonatal deaths and 84 (±35) stillbirths were prevented, amounting to 12,342 DALYs averted. The systems strengthening intervention was found to be highly cost effective with an ICER of US$139 (±$44), an amount significantly lower than the established threshold of cost-effectiveness of the per capita gross domestic product, which averaged US$1,649 between 2012-2016. The results were found to be sensitive to the following parameters: DALYs averted, number of neonatal deaths, and number of stillbirths.ConclusionAn integrated approach to system strengthening in referral hospitals has the potential to reduce neonatal and intrapartum mortality in low resource settings and is likely to be cost-effective. Sustained change can be achieved by building organizational capacity through leadership and clinical training

The cost effectiveness of a quality improvement program to reduce maternal and fetal mortality in a regional referral hospital in Accra, Ghana.

To evaluate the cost-effectiveness of a quality improvement intervention aimed at reducing maternal and fetal mortality in Accra, Ghana.Quasi-experimental, time-sequence intervention, retrospective cost-effectiveness analysis.Data were collected on the cost and outcomes of a 5-year Kybele-Ghana Health Service Quality Improvement (QI) intervention conducted at Ridge Regional Hospital, a tertiary referral center in Accra, Ghana, focused on systems, personnel, and communication. Maternal deaths prevented were estimated comparing observed rates with counterfactual projections of maternal mortality and case-fatality rates for hypertensive disorders of pregnancy and obstetric hemorrhage. Stillbirths prevented were estimated based on counterfactual estimates of stillbirth rates. Cost-effectiveness was then calculated using estimated disability-adjusted life years averted and subjected to Monte Carlo and one-way sensitivity analyses to test the importance of assumptions inherent in the calculations.Incremental Cost-effectiveness ratio (ICER), which represents the cost per disability-adjusted life-year (DALY) averted by the intervention compared to a model counterfactual.From 2007-2011, 39,234 deliveries were affected by the QI intervention implemented at Ridge Regional Hospital. The total budget for the program was $2,363,100. Based on program estimates, 236 (±5) maternal deaths and 129 (±13) intrapartum stillbirths were averted (14,876 DALYs), implying an ICER of$158 ($129-$195) USD. This value is well below the highly cost-effective threshold of $1268 USD. Sensitivity analysis considered DALY calculation methods, and yearly prevalence of risk factors and case fatality rates. In each of these analyses, the program remained highly cost-effective with an ICER ranging from$97-$218.QI interventions to reduce maternal and fetal mortality in low resource settings can be highly cost effective. Cost-effectiveness analysis is feasible and should regularly be conducted to encourage fiscal responsibility in the pursuit of improved maternal and child health

Baseline characteristics of study population and incidence of complications, stratified by uncomplicated and complicated severe pre-eclampsia (n = 50), Ridge Regional Hospital, Accra, Ghana, 2013.

<p>*Complicated severe preeclampsia includes: ‘imminent of eclampsia’, ‘eclampsia’, ‘perinatal mortality’ and ‘one or more WHO criteria of life-threatening conditions’</p><p>** Significant at P<0.05</p><p>SD = standard deviation, SVD = spontaneous vaginal delivery, CS = caesarian section</p><p>^a = Student’s t-test</p><p>^b = Mann-Whitney U test</p><p>^c = Pearson’s Chi-square test</p><p>Baseline characteristics of study population and incidence of complications, stratified by uncomplicated and complicated severe pre-eclampsia (n = 50), Ridge Regional Hospital, Accra, Ghana, 2013.</p

Mean adherence per protocol for total study sample and stratified by uncomplicated and complicated severe pre-eclampsia (n = 50), Ridge Regional Hospital, Accra, Ghana, 2013.

<p>Mean adherence per protocol for total study sample and stratified by uncomplicated and complicated severe pre-eclampsia (n = 50), Ridge Regional Hospital, Accra, Ghana, 2013.</p

The audit cycle (adapted from Crombie et al 1993) [21].

<p>The audit cycle (adapted from Crombie et al 1993) [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0125749#pone.0125749.ref021" target="_blank">21</a>].</p