Aesthetic outcome and the need for revision of unilateral cleft lip repair at Komfo Anokye Teaching Hospital

Background: The Millard method of unilateral cleft lip repair has been  associated with a short lip and a flattened nose on the cleft side. The aim of this study was to determine the need for revision surgery followingrepair of unilateral cleft lip repair at the Komfo Anokye Teaching HospitalMethod: Satisfaction with facial appearance (upper lip, nose and general facial appearance) was assessed quantitatively by means of a Visual Analogue Scale (VAS), where 0cm indicates totally unsatisfied or “highly unattractive” and 10cm indicates totally satisfied or “highly attractive”. Three assessors - parents, surgeon and layperson - were purposively selected to score their level of satisfaction with repair of complete and incomplete unilateral cleft lip. The assessors also indicated the need for any revision.Results: The total sample size was 120, of which 40.0% were male and 60.0% were female. There were 79 cases of repaired complete unilateral cleft lip and 41 incomplete unilateral cleft lip. Average scores of satisfactionof parents were 6.6, 6.8 and 7.2 for nose, lip and general facial  appearance (GFA) respectively. Satisfaction scores for surgeon were  6.1(nose), 6.0(lip) and 6.5(GFA), while those of the lay-assessor were5.2(nose), 5.4 (lip) and 6.0(GFA). Concerning the need for revision, parents indicated 30.2% as needing revision, surgeon 33%; and  lay-assessor 40%. Of the cases that needed revision, 33.3% were complete cleft lip and 0.1% were incomplete cleft lip.Conclusion: Parents were more satisfied with unilateral cleft lip repair using the Millard procedure than either the surgeon or lay assessor. Those who needed revision were mostly children who presented with complete unilateral cleft lip

Barriers and facilitators to implementation of cancer treatment and palliative care strategies in low- and middle-income countries: systematic review

© 2018, Swiss School of Public Health (SSPH+). Objectives: To appraise improvement strategies adopted by low- and middle-income countries to increase access to cancer treatments and palliative care; and identify the facilitators and barriers to implementation. Methods: A systematic review was conducted and reported in accordance with PRISMA statement. MEDLINE, CINAHL, and the Cochrane Library databases were searched. Bias was assessed using the Standards for Quality Improvement Reporting Excellence, and evidence graded using the Australian National Health and Medical Research Council system. Results: Of 3069 articles identified, 18 studied were included. These studies involved less than a tenth (n = 12, 8.6%) of all low- and middle-income countries. Most were case reports (58%), and the majority focused on palliative care (n = 11, 61%). Facilitators included: stakeholder engagement, financial support, supportive learning environment, and community networks. Barriers included: lack of human resources, financial constraints, and limited infrastructure. Conclusions: There is limited evidence on sustainable strategies for increasing access to cancer treatments and palliative care in low- and middle-income countries. Future strategies should be externally evaluated and be tailored to address service delivery; workforce; information; medical products, vaccines, and technologies; financing; and leadership and governance

Prevalence and Determinants of Delayed Newborn Bathing among Postnatal Mothers in a Rural Community of Northern Ghana

Globally, an estimated 2.7 million deaths, approximately 45% of under-five deaths occurred in the neonatal period in 2015. This trend led to the inability of many countries to achieve the Millennium Development Goal four (MDG 4) by 2015; hence the introduction of the Sustainable Development Goals(SDGs). Many studies have concluded that poor newborn care including early newborn bathing accounts for high levels of newborn deaths in lowmiddle income countries. This study therefore investigated the prevalence and determinants of delayed newborn bathing among postnatal mothers in Bawku Municipality in the Upper East Region of Ghana. As a community based study, a cross sectional study design was employed using multistage sampling technique to select 407 respondents. The Statistical Package for Social Sciences (SPSS) version 22 now known as Predictive Analytics Software (PASW) was used for data analysis. Generally, knowledge on delayed bathing was low as more than half of the respondents, 55% (n = 224) did not know that newborns are not supposed to be bathed until after 24hours of delivery. With regard to delayed bathing practice, only 22.6% (n = 92) of mothers bathed their newborn babies after 24 hours of delivery whereas 74.4% (n = 303) bathed their newborn babies before 24 hours of delivery. In the final analysis, delayed newborn bathing was predicted by level of education, place of delivery, ethnicity and socioeconomic class. These findings suggest that a substantial number of newborns still receive harmful newborn care practice and these practices are determined by several factors as stated above. Rigorous efforts should therefore be made by the Ministry of Health through the Ghana Health Service and other stakeholders to improve the uptake of recommended newborn care practices at the community

Development of the ‘REadiness SElf-assessment (RESEA) guide’ to assist low and middle-income countries with establishing safe and sustainable radiotherapy services: a pragmatic sequential mixed qualitative methods project

Background: Improving access to radiotherapy services in low and middle-income countries (LMICs) is challenging. Many LMICs’ radiotherapy initiatives fail because of multi-faceted barriers leading to significant wastage of scarce resources. Supporting LMICs to self-assess their readiness for establishing radiotherapy services will help to improve cancer outcomes by ensuring safe, effective and sustainable evidenced-based cancer care. The aim of the study was to develop practical guidance for LMICs on self-assessing their readiness to establish safe and sustainable radiotherapy services. Methods: The Access to Radiotherapy for Cancer treatment (ARC) Project was a pragmatic sequential mixed qualitative methods design underpinned by the World Health Organisation’s ‘Innovative Care for Chronic Conditions Framework’ and ‘Health System Building Blocks Framework for Action’ conceptual frameworks. This paper reports on the process of overall data integration and meta-inference from previously published components comprising a systematic review and two-part qualitative study (semi-structured interviews and a participant validation process). The meta-inferences enabled a series of radiotherapy readiness self-assessment requirements to be generated, formalised as a REadiness SElf-Assessment (RESEA) Guide’ for use by LMICs. Findings: The meta-inferences identified a large number of factors that acted as facilitators and/or barriers, depending on the situation, which include: awareness and advocacy; political leadership; epidemiological data; financial resources; basic physical infrastructure; radiation safety legislative and regulatory framework; project management; and radiotherapy workforce training and education. ‘Commitment’, ‘cooperation’, ‘capacity’ and ‘catalyst’ were identified as the key domains enabling development of radiotherapy services. Across these four domains, the RESEA Guide included 37 requirements and 120 readiness questions that LMICs need to consider and answer as part of establishing a new radiotherapy service. Conclusions: The RESEA Guide provides a new resource for LMICs to self-assess their capacity to establish safe and sustainable radiotherapy services. Future evaluation of the acceptability and feasibility of the RESEA Guide is needed to inform its validity. Further work, including field study, is needed to inform further refinements. Exploratory and confirmatory factor analyses are required to reduce the data set and test the fit of the four-factor structure (commitment, cooperation, capacity and catalyst) found in the current study

Genetic relatedness in carbapenem-resistant isolates from clinical specimens in Ghana using ERIC-PCR technique.

AIM: Enterobacterial repetitive intergenic consensus (ERIC) sequence analysis is a powerful tool for epidemiological analysis of bacterial species. This study aimed to determine the genetic relatedness or variability in carbapenem-resistant isolates by species using this technique. METHODS: A total of 111 non-duplicated carbapenem-resistant (CR) Gram-negative bacilli isolates from a three-year collection period (2012-2014) were investigated by enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) in four selected hospital laboratories in Ghana. The isolates were also screened for carbapenemase and extended spectrum β-lactamase genes by PCR. RESULTS: A proportion of 23.4% (26/111) of the genomic DNA extracts were carriers of PCR-positive carbapenemase genes, including 14.4% blaNDM-1, 7.2% blaVIM-1 and 1.8% blaOXA-48. The highest prevalence of carbapenemase genes was from non-fermenters, Acinetobacter baumannii and Pseudomonas aeruginosa. For the ESBL genes tested, 96.4% (107/111) of the CR isolates co-harboured both TEM-1 and SHV-1 genes. The ERIC-PCR gel analysis exhibited 1 to 8 bands ranging from 50 to 800 bp. Band patterns of 93 complex dissimilarities were visually distinguished from the 111 CR isolates studied, while the remaining 18 showed band similarities in pairs. CONCLUSION: Overall, ERIC-PCR fingerprints have shown a high level of diversity among the species of Gram-negative bacterial pathogens and specimen collection sites in this study. ERIC-PCR optimisation assays may serve as a suitable genotyping tool for the assessment of genetic diversity or close relatedness of isolates that are found in clinical settings

The use of free autogenous rib grafts in maxillofacial reconstruction

Background: Hard tissue defects in the maxillofacial region due to trauma or ablative surgery result in functional and cosmetic problems. State-of-theart methods for reconstruction include the use of vascularised tissue. Objective: To review our results with the use of non-vascularised rib grafts for maxillofacial reconstruction. Method: Patients who underwent maxillofacial reconstruction using rib at the Komfo Anokye Teaching Hospital during 1996-2004 were studied. The technique for rib harvest and implantation of the graft was standardized. Clindamycin was administered peri-operatively and the harvested rib was temporarily stored in clindamycin/saline before implantation. The graft was successful if it survived beyond 6 months after placement. Follow- up was for at least 12months postoperatively. Results: A total of 29 patients were studied. The indications for grafting included ameloblastoma, malignant disease, cyst, ankylosis, and trauma. Either rib bone only or with cartilage were used. In 90% of patients (26/29) the graft healed uneventfully. Two patients had dehiscence of the wound with exposure of the graft intraorally within two weeks of surgery and were successfully managed with antibiotics. Conclusion: Free autogenous rib was successfully used to reconstruct defects in the maxillofacial region. Further stabilization of the graft by intermaxillary fixation and the prophylactic use of clindamycin may have helped to minimize complications

An Investigation into Self-Regulated Learning in a Virtual Classroom: A Higher Education Perspective

In the wake of the global pandemic COVID-19 and restrictions on human-to-human contacts higher education institutions have turned to e-learning as a solution to keep teaching and learning going Indeed aside from allowing the continuation of education during situations like that the other argument supporting e-learning is because of its social constructivist pedagogy and effective self-regulated learning However the claim of self-regulated learning in the context of e-learning has not empirically been validated Thus based on responses from 116 individuals using a mixed-method approach we sought to evaluate the effect of the use of the Learning Management System on students self-regulated learning Our findings indicate that despite the advantages of convenience and access to materials provided the system did not appear to regulate students learning with significant challenges of unreliable internet connectivity lack of key functionalities and features ultimately impeding optimal use The study discusses these findings and draws implications for theory and practic

Impurity and quaternions in nonrelativistic scattering from a quantum memory

Models of quantum computing rely on transformations of the states of a quantum memory. We study mathematical aspects of a model proposed by Wu in which the memory state is changed via the scattering of incoming particles. This operation causes the memory content to deviate from a pure state, i.e. induces impurity. For nonrelativistic particles scattered from a two-state memory and sufficiently general interaction potentials in 1+1 dimensions, we express impurity in terms of quaternionic commutators. In this context, pure memory states correspond to null hyperbolic quaternions. In the case with point interactions, the scattering process amounts to appropriate rotations of quaternions in the frequency domain. Our work complements a previous analysis by Margetis and Myers (2006 J. Phys. A 39 11567--11581).Comment: 16 pages, no figure