Menstrual pain and associated factors amongst undergraduates of Ambrose Alli University Ekpoma, Edo State, Nigeria

No Abstract

Continuous intraoperative vagus nerve stimulation for monitoring of recurrent laryngeal nerve during minimally invasive esophagectomy

Review Article on Esophageal Surgerypublished_or_final_versio

Outcomes after oesophageal perforation: a retrospective cohort study of patients with different aetiologies

Introduction: The mortality rate after oesophageal perforation is high despite advances in operative and non-operative techniques. In this study, we sought to identify risk factors for hospital mortality after oesophageal perforation treatment. Methods: We retrospectively examined patients treated for oesophageal perforation in a university teaching hospital in Hong Kong between January 1997 and December 2013. Their demographic and clinical characteristics, aetiology, management strategies, and outcomes were recorded and analysed. Results: We identified a cohort of 43 patients treated for perforation of the oesophagus (28 men; median age, 66 years; age range, 30-98 years). Perforation was spontaneous in 22 (51.2%) patients (15 with Boerhaaveâ s syndrome and seven with malignant perforation), iatrogenic in 15 (34.9%), and provoked by foreign body ingestion in six (14.0%). Of the patients, 14 (32.6%) had pre-existing oesophageal disease. Perforation occurred in the intrathoracic oesophagus in 30 (69.8%) patients. Emergent surgery was undertaken in 23 patients: 16 underwent primary repair, six surgical drainage or exclusion, and one oesophagectomy. Twenty patients were managed non-operatively, 13 of whom underwent stenting. Two stented patients subsequently required oesophagectomy. Four patients had clinical signs of leak after primary repair: two were treated conservatively and two required oesophagectomy. Overall, six (14.0%) patients required oesophagectomy, one of whom died. Nine other patients also died in hospital; the hospital mortality rate was 23.3%. Pre-existing pulmonary and hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality (P=0.03, < 0.01, and < 0.01, respectively). Conclusions: Most oesophageal perforations were spontaneous. Mortality was substantial despite modern therapies. Presence of pre-existing pulmonary disease, hepatic disease, and perforation associated with malignancy were significantly associated with hospital mortality. Salvage oesophagectomy was successful in selected patients.published_or_final_versio

Understanding sport clubs as sport policy implementers

The original publication is available at: http://dx.doi.org/10.1080/17430430802196553This article aims at developing a theoretical framework for analysing the implementation of sport policy, as it is conducted by voluntary sport clubs at grass root level. First, three options are presented and discussed: (i) a classical top-down implementation model, (ii) the governance theory of policy tools, and (iii) the Advocacy Coalition Framework. Second, the theoretical perspectives are discussed, and criticized for failing to take sufficiently into account the implementing body of sport policy, namely the voluntary sport clubs. In that respect, an alternative theoretical framework is suggested as a possible solution for analysing the implementation of sport policy; which is the translation perspective of neo-institutionalism. It stresses that, if elements of central policy influence the implementation process at the local level, it does so by the active import, interpretation and implementation of it in the local context. The autonomy of the local sport club in relation to central policy is reinforced by the fact that the activity in sport clubs is mainly done on a voluntary basi

Depression symptomatology and diagnosis: discordance between patients and physicians in primary care settings

<p>Abstract</p> <p>Background</p> <p>To examine the agreement between depression symptoms using an assessment tool (PHQ-9), and physician documentation of the same symptoms during a clinic visit, and then to examine how the presence of these symptoms affects depression diagnosis in primary care settings.</p> <p>Methods</p> <p>Interviewer administered surveys and medical record reviews. A total of 304 participants were recruited from 2321 participants screened for depression at two large urban primary care community settings.</p> <p>Results</p> <p>Of the 2321 participants screened for depression 304 were positive for depression and of these 75.3% (n = 229) were significantly depressed (PHQ-9 score ≥ 10). Of these, 31.0% were diagnosed by a physician with a depressive disorder. A total of 57.6% (n = 175) of study participants had both significant depression symptoms and functional impairment. Of these 37.7% were diagnosed by physicians as depressed. Cohen's Kappa analysis, used to determine the agreement between depression symptoms elicited using the PHQ-9 and physician documentation of these symptoms showed only slight agreement (0.001–0.101) for all depression symptoms using standard agreement rating scales. Further analysis showed that only suicidal ideation and hypersomnia or insomnia were associated with an increased likelihood of physician depression diagnosis (OR 5.41 P sig < .01 and (OR 2.02 P sig < .05 respectively). Other depression symptoms and chronic medical conditions had no affect on physician depression diagnosis.</p> <p>Conclusion</p> <p>Two-thirds of individuals with depression are undiagnosed in primary care settings. While functional impairment increases the rate of physician diagnosis of depression, the agreement between a structured assessment and physician elicited and or documented symptoms during a clinical encounter is very low. Suicidality, hypersomnia and insomnia are associated with an increase in the rate of depression diagnosis even when physician and self report of the symptom differ. Interventions that emphasize the use of routine structured screening of primary care patients might also improve the rate of diagnosis of depression in these settings. Further studies are needed to explore depression symptom assessment during physician patient encounter in primary care settings.</p

Engaging Family Doctors to Participate in Curriculum Development of Undergraduate Community-Based Learning

Conference Theme: Innovations in Primary CarePoster Presentation: no. 19INTRODUCTION: The MBBS program at the University of Hong Kong (HKU) has been undergoing a curriculum review. One objective is to enhance community-based learning. Family doctors are the community’s frontline healthcare providers, and many take students for attachments. They are well-placed to advice on curriculum. This study aimed to seek the views of family doctors regarding curriculum design and outcomes for undergraduate learning. METHODS: This was a mixed-method semi-qualitative study. A questionnaire was posted to all doctors involved in Family Medicine teaching at HKU regarding curriculum content, structure, and barriers to teaching. Responses were analysed descriptively. Highly-rated teachers were interviewed to identify desired student outcomes and explore how to implement new teaching programs. Content analysis was used to identify themes. RESULTS: 73 questionnaires were returned (response rate 55.3%). Over 80% of the respondents preferred teaching pre-clinical or junior clinical students and focus on communication and interpersonal skills, common conditions and professional skills and attitudes. 68% preferred a longitudinal relationship with the same student. Lack of time and difficulty integrating teaching and service were the main barriers to teaching.12 interviews were conducted. Emergent themes related to program design, scheduling and faculty support to facilitate teaching. A broad range of student outcomes were identified. DISCUSSION: Experiential learning opportunities are necessary for medical students and there are many desired outcomes for learning in the community. Clinical teaching is a challenging but rewarding task for family doctors. A longitudinal mentorship program may be one approach which can benefit both our students and teachers

Attitudes and confidence towards cardiopulmonary resuscitation and use of the automated external defibrillator among family physicians in Hong Kong

Objective: To investigate the attitudes and confidence towards cardiopulmonary resuscitation (CPR) and using the automated external defibrillator (AED) amongst family physicians in Hong Kong. Design: A questionnaire survey Subjects: Members of the Hong Kong College of Family Physicians. Main outcome measures: Self-reported attitudes, confidence, concerns and perceived educational needs towards CPR and AED. Results: 178 completed questionnaires were received (response rate 11.7%). The majority of respondents had positive attitudes towards CPR/AED. 79% thought that AED was an essential clinic equipment. 87% felt that clinic staff should be familiar with CPR, and 96% felt that CPR/AED skills should be kept up-to-date. The majority of respondents were also confident in performing CPR either within the clinic (88%) or in the street (79%), and in using an AED in resuscitation (79%). A significant proportion of respondents were concerned about risk of infection from victims during CPR (58%), risk of injury to victim or oneself (37%), and risk of being sued (25%). The majority of respondents also perceived the need for regular CPR/AED training (93%). Respondents working in the public sector were more confident to use AED, less concerned about injury and agreed more that AED was considered an essential clinic equipment and clinic staff should know CPR. Respondents with CPR certification were more confident to perform CPR, to use AED, and agreed more that clinic staff should know CPR. Conclusion: Most respondents recognised CPR and AED skills as important and felt confident to perform resuscitation. Those with exposure to training felt more confident in performing CPR and using an AED, irrespective of their qualifications and whether or not in possession of post-graduate qualifications. Most respondents expressed the need to receive regular CPR/AED training to update the skills. A significant proportion of respondents still had concerns about risks associating with CPR/AED, but the perceived risks could be reduced through education and training.link_to_OA_fulltex