A multi-site assessment of knowledge of Ebola virus disease among health workers in south-west Nigeria

Objective: Nigeria may have been certified free from Ebola Virus Disease (EVD) by the World Health Organization, but not without its aftermath on many, especially among health workers who came in contact with the infected during the West African outbreak in 2014.This study was conducted among health workers in three tertiary hospitals in South-West Nigeria. It aimed at assessing their knowledge of EVD in a bid to forestall future contagion from patients.Method: 600 consenting participants selected through two-stage sampling method were involved in the study. Primary data was retrieved through self-administered questionnaire.Results: Majority (84.0%) of the participants knew that EVD can be contacted through blood and bodily fluid of an infected person, (78.0%) knew that EVD can be prevented by avoiding contact with an infected person, while (76.0%) identified bleeding from orifices as one of the signs of EVD. However, (6.0%) of the participants did not know how EVD can be prevented.Conclusion: Result showed that participants have average knowledge of EVD and therefore, are not adequately informed of EVD. The study recommended wider dissemination of adequate information on EVD among health workers in tertiary hospitals to forestall future contagion of the infection from patients.Keywords: Knowledge, EVD, Contagion, Outbreak, Prevention, Bleedin

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Sperm morphology in relation to semen cation concentration in Yankasa rams

The morphological appearance of sperm cells is a major criterion in semen evaluation. The optimal production of semen of high biological value is influenced by numerous factors. Therefore, a study was conducted to  evaluate the relationship between sperm morphological characteristics and semen cation concentrations in 62  rams of Yankasa breed of sheep. Semen samples were collected from each animal on weekly basis for 52 weeks  with electroejaculator. The sperm morphological characteristics examined were: detached mid-piece and tail (DMT), detached head (DH), mid-piece droplet (MPD, coiled and bent tail (CBT) and acrosomal abnormality (ACR). The semen cation parameters measured were: sodium ion (Na+), potassium ion (K+) and calcium ion (Ca2+). Pearson correlation matrix of SAS was used to determine the relationships among and between the  measured characteristics. The result of the study showed that correlations among the sperm morphological  characteristics were low and not significant except that between DH and DMT which was perfect (p<0.01; r = 1.00). On the other hand, semen cation concentrations were positively correlated but not significant among themselves except the correlation between Na+ and K+ (p<0.01; r = 0.37) which was significant. Relating the semen cation concentration with sperm morphological characteristics, it was discovered that potassium ion (K+) measured was negatively and significantly correlated with all the morphological attributes (DMT & DH, r= -0.36 @ p<0.01; CBT & ACR, r= -0.38 @ p<0.05; MPD, r= -0.32 @ p<0.05). It was concluded that DH is highly associated with DMT while Na+ concentration was an indicator for K+ level in the semen as shown in the result.  Also, the higher the potassium ion in semen, the lower the level of sperm morphological abnormalities and vice versa in Yankasa rams. Keywords: Sperm morphological characteristics, semen cation concentrations, Yankasa ram

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Background Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Results Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusions After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies

Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and meta-analysis

Aim Previous studies reported conflicting evidence on the effects of obesity on outcomes after gastrointestinal surgery. The aims of this study were to explore the relationship of obesity with major postoperative complications in an international cohort and to present a metaanalysis of all available prospective data. Methods This prospective, multicentre study included adults undergoing both elective and emergency gastrointestinal resection, reversal of stoma or formation of stoma. The primary end-point was 30-day major complications (Clavien–Dindo Grades III–V). A systematic search was undertaken for studies assessing the relationship between obesity and major complications after gastrointestinal surgery. Individual patient meta-analysis was used to analyse pooled results. Results This study included 2519 patients across 127 centres, of whom 560 (22.2%) were obese. Unadjusted major complication rates were lower in obese vs normal weight patients (13.0% vs 16.2%, respectively), but this did not reach statistical significance (P = 0.863) on multivariate analysis for patients having surgery for either malignant or benign conditions. Individual patient meta-analysis demonstrated that obese patients undergoing surgery formalignancy were at increased risk of major complications (OR 2.10, 95% CI 1.49–2.96, P < 0.001), whereas obese patients undergoing surgery for benign indications were at decreased risk (OR 0.59, 95% CI 0.46–0.75, P < 0.001) compared to normal weight patients. Conclusions In our international data, obesity was not found to be associated with major complications following gastrointestinal surgery. Meta-analysis of available prospective data made a novel finding of obesity being associated with different outcomes depending on whether patients were undergoing surgery for benign or malignant disease