The occurrence of residual curarisation in postoperative patients at an academic hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Medicine in Anaesthesiology, Johannesburg, 2016Postoperative residual curarisation (PORC) resulting from the use of non depolarising muscle relaxants continues to be a significant problem. It is associated with an increase in morbidity and may delay discharge from the recovery room, increasing financial costs. An objective measurement of neuromuscular functioning using an accelerometer is recommended to ensure patient safety. The aim of this study was to describe the occurrence of PORC in the recovery room in patients who have received intermediate acting NDMRs intraoperatively at CHBAH. This was a prospective, contextual and descriptive study. The study sample included ASA 1 to 3 adult patients who had received an intermediate acting NDMR during elective surgery and had given pre operative consent to participate in the study. Neuromuscular function was monitored using acceleromyography. A TOF ratio < 0.9 was defined as having PORC. Data collection took place during December 2014 to February 2015. Data was analysed using descriptive and inferential statistics. The study sample consisted of 55 patients. Twenty five patients had a TOF ratio < 0.9 on arrival in the recovery room. The occurrence of PORC was therefore 45.46%. Intraoperative neuromuscular monitoring was documented to have been done in 3 (5.45%) of the patients. The most frequently used NDMRs were rocuronium 31 (56.36%) and cisatracurium 9 (16.36%). There was no statistically significant differences in the occurrence of PORC relating to the NDMR used (p=0.72) but higher percentages were observed with cisatracurium 5 (55.56%). An anticholinesterase as reversal agent was used in 48 (87.27%) of the patients. PORC was significantly more frequent in patients who did not receive an anticholinesterase (85.71 vs. 39.58%, p=0.03). Three patients presented with a temperature < 35 °C. Incomplete neuromuscular recovery was more frequent in patients with a temperature < 35 °C, 2 (66.67%) compared to the patients with a temperature ≥ 35 °C 23 (44.23%) PORC remains a clinical problem in the recovery room. To ensure patient safety objective neuromuscular monitoring needs to be performed.MT201

Implementing the Use of the Emergency Severity Index Triage Tool in Urgent Care

Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has resulted in superior health outcomes such as control of chronic diseases and decreased mortality or worsening symptoms. The ESI triage tool aims to improve patients\u27 triage based on acuity. The triage protocol also has been shown to reduce door-to-provider time, walkouts, and emergent waiting room events. Purpose: The quality improvement project is aimed at evaluating the significance of triage; minimizing door-to-provider times; lowering the risk of potential adverse events in the waiting area; eradicating perceived barriers to implementation, improving patient outcomes throughout the treatment process, and preventing adverse or near-adverse events. Methods: Pre- and post-study design and PDSA model signified the use in this quality improvement project. The principal investigator utilized this design to evaluate the impact of incorporating the Emergency Severity Index triage system into urgent care centers. Results: The average triage time for the pre-intervention and post-intervention periods were calculated separately. Average triage times pre-intervention was noted to be 45 minutes, while post-intervention triage times ranged between 17 and 18 minutes. Post-implementation data showed improvement in all areas, including identifying patients with urgent medical needs, quickly sorting patients in constrained resource settings, allowing triage nurses to project operation and resource needs, and supporting the discrimination of patients who should not be seen in the emergency department. Conclusion: The triage protocol helped reduce door-to-provider time, walkouts, and emergent waiting room events. Implementing the ESI triage tool led to improved clinical practices and decreased wait times and adverse wait room events

Farmers’ perception on climate change

This study focused on identifies temporal rainfall and temperature variability in Anuradhapura district from 1941 to 2010 and determine farmers’ perception on climate change. This study was conducted in Thantirimale and Mahavilachchiya GN of Mahavilachchiya Divisional Secretariat in Anuradhapura District. Questionnaires and focus group discussions were used to gather primary data. Five years moving average and descriptive statistical tools such as the coefficient of variation and percentages were adopted in the analysis process. Result from descriptive analysis of meteorological data (rainfall and temperature) revealed that the temperature has increased and rainfall has decreased. The majority of the farmers’ perceptions from both areas are parallel with statistical record of meteorological data. Though they have already identified that climate is changing and they knew how to face these changes but they need more awareness about how to adapt to climate change

The Impact of Socioeconomic Status on the Achievement of Chronically Absent Grade 5 Students

Chronic absenteeism has been shown to be a strong predictor of student achievement. However, there is a lack of research studies that examine if differences exist among chronically absent students in Title I and non-Title I settings. The purpose of this causal-comparative study was to determine if socioeconomic status imparts any additional impacts on the achievement of chronically absent students as measured by the Virginia SOLs. The data collected include achievement data from the Virginia SOLs. A quantitative research design was used to examine, analyze, and compare standardized mathematics, English, and science test scores along with attendance rates of fifth grade students attending both Title I and non-Title I schools in the Hampton Roads metropolitan area of Virginia. The population sample consisted of 170 students enrolled in 19 different elementary schools in a Virginia school district. Three two-way analysis of variances (ANOVAS) were used to analyze the samples. Student achievement data for math, English, and science were examined and results indicated that there was no statistically significant interaction between school setting and student attendance. The conclusion along with limitations and recommendations for future research are reported

Awareness of Rational Medication Use and Antibiotic Self- Medication Practices among Undergraduate Students in a University in Sri Lanka

Purpose: To evaluate the practice of self-medication and evaluate the knowledge of rational use of antibiotics among undergraduate students of University of Peradeniya, Sri Lanka.Method: A cross-sectional, recall study was conducted among the university student population who practice self-medication in the study location. Stratified, random sampling technique was used to distribute 246 questionnaires in eight faculties of the institution. The response rate was 71%, and 175 completed questionnaires were analyzed to determine significant differences and correlation with different variables.Results: A majority of the study sample were females (54%), aged 23 - 25 years (46.9%). The most frequently used antibiotic was amoxicillin (95.4%). Common cold with fever was the disease condition treated by a large majority (84.9%). Knowledge on dose, frequency, duration and side-effects of antibiotics among students was moderate, with a mean value of 58.3%. There was a significant difference in knowledge on antibiotics between health science and non-health science students although no significant difference was observed in knowledge with respect to gender, academic year and family income.Conclusion: Antibiotic consumption was associated with students’ academic background. This study highlights the need for interventions to assure rational use of antibiotics.Keywords: Antibiotics, Self-medication, Rational use, Undergraduate students, Awarenes

Floristic Composition, Life Form and Chorology of Plant Life at Al-Saoda, Asir Region, South-Western Saudi Arabia

Asir highlands constitute a major part of south-western Saudi Arabia, and have a temperate climate at elevations above 2500 m a.s.l. This area has a complicated topography. The variations in elevation and topography have resulted in distinctive vegetational zones.  Floristic composition, life form and chorology of plant life at Al-Saoda region south – western Saudi Arabia was studied. Three  major  wadis (sites) were investigated , every site was represented by three localities representing up-stream , mid-stream and down-stream portions of each site. Nine field trips were carried out during 18 months  .Vegetation of  three localities ( Wadi Tahlal , Wadi Al-Moght  and Beni Mazen ) was studied .  Results revealed that the region considers a hot-spot in the Kingdom in term of plant diversity and more diverse compared with other well studied regions in Saudi Arabia. A total of 103 plant species belonging to 40  families were recorded in study area. The major plant families that contributed in the formation of vegetation of the area in question were Asteraceae ( 22.3%) followed by Papilionaceae( 8.7%) ,poaceae,  ( 6.7%), Lamiaceae  ( 5%), Mimosoaceae ( 4%) while other families each was represented by two or one species. Therophytes exhibited the maximum number of species (35%), followed by chaemophytes (32%), hemicryptophytes (15%) and phanerophytes (9.8%), while the least frequent life form class was geophytes and epiphytes .Chorological characteristic of the recorded flora showed that Saharo-Arabian and Sudanian elements constitute % of  the total flora. Keywords: dsfloristic composition , vegetation , Asir region ,chorology , diversit

Investigation of Medication Errors: A Prescription Survey from Sri Lanka

Purpose: To identify and quantify possible errors in handwritten outpatient prescriptions in relation to adherence to standard guidelines on the layout and content of prescriptions.Method: A sample of 200 handwritten outpatient prescriptions were collected from two pharmacies located in a sub-urban (Aluthgama) and an urban (Kandy) area in Sri Lanka. Data were extracted using a pilot-tested questionnaire and the legibility of the prescription was assessed by three independent investigators. The results from the suburban area were compared with those from the urban area.Results: Based on the layout of the prescription, the presence of patient information was unsatisfactory. Patient name and age were present in less than half of the prescriptions. However, prescriber information except registration number was present in more than 75 % of the prescriptions. Date of consultation was present in &gt; 81.5 % of the prescriptions. Non-standard abbreviations were used in 36.5 % of the prescriptions while incomplete units were observed in 51 % of the prescriptions. Nearly half of the prescriptions from both urban and suburban locations were illegible. Occurrence of prescriber details was a significantly different between Aluthgama and Kandy.Conclusion: Prescription errors are common in outpatient settings of Aluthgama and Kandy areas in Sri Lanka. Standardized prescription writing process in relation to layout, use of abbreviations, and units and legibility, is proposed as a potential solution to overcome this problem.Keywords: Medication error, Prescriptions, Standardized prescription writing, Prescriber information, Non-standard abbreviatio

Inter-Role Conflicts And Women Sales Workers’ Well-Being: The Moderating Role Of Control, Involvement And Recovery

The purpose of this research is to examine empirically whether inter-role conflicts (work-family conflict and family-work conflict) affect women sales workers’ well-being. Furthermore, to examine how the role of control, involvement and recovery can moderate the relationship between inter-role conflicts and employee well-being

Formulation And Evaluation Of Palm Oil Esters Based Nanoemulsion For Topical Delivery Of Ketoprofen

In this study emulsions with varying ratios of surfactant or its mixtures (Tween 80®, Tween 85® and Span 20®) were prepared using POE as the oil phase. The transparency of the mixtures was used as visual indications that nano-emulsions were formed and were reconfirmed by measuring the droplets size using laser scattering spectroscopy (Nanophox). The gel area of the triangle phase diagrams produced was used as one of criteria to determine the suitable HLB value of the nano-emulsion’s emulsifier for POE and for selection of several promising formulae. It was noted that largest gel area produced by HLB 15, 13.72 and 12. From these three phase diagrams three common points namely A, B and C were selected and mixtures of POE and surfactant constituted in them were used to study the solubility of ketoprofen

Impact of Air Pollution on the Performance of Hymenopteran Pollinators

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