Doing Pre-operative Investigations in Emergency Department; a Clinical Audit

Introduction: Pre-operative investigations for emergency surgical patients differ between centers. Following established guidelines can reduce unnecessary investigation, cost of treatment and hospital stay. The present audit was carried out to evaluate the condition of doing pre-operative investigations for three common surgical emergencies compared to National Institute for Health and Care Excellence (NICE) guidelines and local criteria.Methods: A retrospective clinical audit of acute-appendicitis, abscess and hernia patients admitted to the emergency department was carried out over a one-year period from July 2014 to July 2015. Data of laboratory investigations, their indication, cost and duration of hospital stay was collected and compared with NICE-guidelines.Results: A total of 201 patients were admitted to the emergency department during the audit period. These included 77(38.3%) cases of acute-appendicitis, 112 (55.7%) cases of abscesses, and 12 (6%) cases of hernia. Investigations not indicated by NICE-guidelines included 42 (20.9%) full blood counts, 29 (14.4%) random blood sugars, 26 (12.9%) urea tests, 4 (2%) chest x-rays, 13 (6.5%) electrocardiographs, and 58 (28.9%) urine analyses. These cost 25,675 Rupees (245.46 Dollars) in unnecessary investigation costs and 65.7 days of additional hospital stay.Conclusions: Unnecessary investigations for emergency surgical patients can be reduced by following NICE-guidelines. This will reduce workload on emergency services, treatment costs and the length of hospital stay

Contraception knowledge and practices among women in Peshawar

Background: Contraception is an integral component for addressing the population emergency faced by resource deprived third-world countries like Pakistan but studies in this regard are lacking. Aims and Objectives: This study was conducted to assess the knowledge and practice of contraception among women in Peshawar. Materials and Methods: This cross-sectional prospective observational study was carried out from March 2020 to November 2021. All women of reproductive age were included in the study. Biodata, socio-economic status (SES), reproductive data, knowledge and practice of contraception were collected from a total of 1260 women during the study period. Results: One thousand two hundred and sixty females of reproductive age visiting the hospital were studied. Regarding reproductive health and contraception 431 (34.2%) had no knowledge and 415 (32.9%) had wrong information. Only 387 (30.7%) patients had correct information about fertility window, 447 (35.5%) had erroneous knowledge about it and 426 (33.8%) were completely uninformed about it. 609 (48.3%) patients were of low SES. 617 (49%) patients were motivated for contraception while 643 (51%) rejected it. 377 (29.9%) patients used no method for contraception, 398 (31.6%) used injectables while the remaining methods included; 225 (17.9%) implants, 68 (5.4%) natural withdrawal and 67 (5.3%) intrauterine contraceptive device. Conclusions: The study population lacked or had inadequate knowledge about reproductive health and contraception. Further, studies should be carried out for a wider understanding of the lack of contraceptive knowledge and practices to control the ballooning population growth and the lack of reproductive and contraceptive health services and practices

Comparison of Foley's catheter and misoprostol versus misoprostol alone on labour induction

Background: Labour is traditionally induced with sub lingual (SL) misoprostol but researchers have proposed greater effectives and benefits if Foley's catheter is also used. Aims and Objectives: The aim was to study the effect of cervical Foley's catheter and misoprostol on labour induction in comparison to SL misoprostol alone. Materials and Methods: This randomised controlled trial was conducted from January 2020 to January 2021 on a study population of 96 female patients. They were distributed by lottery method into Groups 0; having been given SL misoprostol alone and Group 1; given the same in addition to cervical Foley's catheter. After randomisation, each group of 48 patients was noted for the method of delivery and time from induction to delivery in hours. Results: Groups 0 and 1 had 48 patients each with a total of 96 patients. Overall means for age in years and age of gestation in weeks were 25.80 ± 5.73 and 39.51 ± 1.13, respectively. Overall parity was 1.88 ± 0.83. Normal vaginal delivery (NVD) was seen in 25 (26%) patients in Group 0 and 34 (35.4%) in Group 1, P = 0.01. Meantime from induction to delivery for Group 0 was 17.89 ± 1.05 h and for Group 1 13.93 ± 1.47 h respectively, with a difference of 3.96 ± 0.42 h and P = 0.01. Conclusion: The combination of misoprostol and Foley's catheter in the cervix is associated with more vaginal deliveries characterised by shorter times of delivery

Standard of surgical venous thrombo-prophylaxis in admitted patients

Objective: To determine the standard of venous-thrombosis prophylaxis at the Surgical Department of Khyber Teaching Hospital, Peshawar. Methods: A retrospective clinical audit of patients admitted to the surgical department over a one-year period from July 2014 to July 2015 was carried out. Data on risk assessment for venous thrombosis and prophylaxis was collected, including indications for enoxaparin and graduated stockings, their prescription and use. The correct dose and timing for enoxaparin, review of prophylaxis and counselling was also noted. Results: 157 patients, including 37 (23.6%) males and 120 (76.4%) females requiring thromboembolism prophylaxis were admitted to the emergency department during the audit period. Mean age was 50.97±12.74 years. Enoxaparin was indicated in all 157 patients, prescribed to 126 (80.3%) and administered in 120 (76.4%), respectively. Only 80 (51%) patients received the correct dosage and 85 (54.1%) patients received it at the required time. Graduated stockings were indicated in 110 (70.1%) patients, prescribed in 35(22.3%) cases and applied in 28 (17.8%), respectively. Review of prophylaxis was not performed in any of the patients at 72 hours. Counselling and information was provided to 31 (19.7%) patients. Thrombotic events occurred in 17 (10.8%) cases, of which 12 (7.6%) were lower limb deep venous thromboses and 5 (3.2%) were cases of pulmonary embolism. Conclusions: The audit fell short of the guidelines. Enoxaparin was prescribed and administered only in certain cases, both with the wrong timing and dosage. Stockings administration was rare and its counselling was lacking. Review of management was not performed in any case. The proposed recommendations should be implemented and assessed afterwards with a second audit cycle. [Arch Clin Exp Surg 2017; 6(2.000): 74-80