Evaluation of quality assurance instruments in higher education institutions: A case of Oman

The use of a variety of instruments for quality assurance, management, and enhancement in higher education is well recognized. This article investigated the instruClose Panelments used by Higher Education Institutions (HEIs) in Oman to measure, control, and manage the quality of their services in alignment with the standards set by Oman Academic Accreditation Authority (OAAA). Quality Assurance Managers (QAMs) from five HEIs were interviewed to identify the instruments used by them to fulfil the requirements of each standard and the way they make use of the data gathered by using these instruments. Findings from the study reveal that questionnaires and meetings are the most common instruments used by these institutions to measure, control and assure the efficacy of their current quality activities. In addition, HEIs use summary statistics to analyse data and then present them in meetings or through reports. On the other hand, it was found that substantial efforts are made to collect data but the efficient usage of data is missing. The QAMs reported a lack of awareness among the staff on the importance of collecting data since the staff members believe that these data are collected for documentation purposes only. This study emphasizes the importance of using the data gathered from different instruments in decision making and enhancing the quality of HEIs

Foreign body aspiration in adults.

Foreign body aspiration is not an uncommon problem, particularly in children, the elderly, and those with predisposing factors like neurological impairment. In adults, regional differences exist in the type of foreign body aspirated. We report four cases of foreign body aspiration in South Asian adults, three of which were related to the widespread habit of chewing stimulant seeds such as betel nuts (two) and tamarind seed (one). It is important for clinicians to maintain a high index of suspicion for the diagnosis of foreign body inhalation in the appropriate clinical setting. Bronchoscopy is necessary not only for the diagnosis but also for the removal of foreign body from the bronchial tree. Once the foreign body is removed, the improvement in symptoms is usually dramatic, making it rewarding for any physician to manage. Keywords: betel nut, bronchoscopy, foreign body aspiration, stimulant seeds, tamarind see

Single stage bilateral total hip replacement: Is it an option or a risk?

Abstract OBJECTIVE: To evaluate safety and feasibility of two-stage total hip arthroplasty and to compare it with single-stage procedure. METHODS: The retrospective study was conducted at The Aga Khan University Hospital and comprised all cases of total hip replacements between January 2001 and December 2014 that were retrieved from the database using International Classification of Diseases (9th Revision) coding. A standardised questionnaire was completed, including patient demographics, primary diagnosis, peri and postoperative morbidity and mortality. Differences among patients\\u27 data were analysed using chi square test for dichotomous variables and student t-test for continuous variables. RESULTS: Of the 48 cases, 34(71%) had single-stage bilateral total hip replacement and 14(29%) had two-stage procedure. The mean hospital stay in the single-stage group was 8.1±3.2 days compared to 19.6±5 days in the other group. The two-stage group required a significantly greater need for transfusion compared to the single-stage group (P\u3c0.05). There was no statistically significant increase in peri or postoperative complication (p\u3e 0.05). CONCLUSIONS: Simultaneous bilateral total hip arthroplasty was found to be a safe and viable option with a decreased transfusion requirement and shorter hospital stay along with no significant increase in morbidity or mortality

An assessment of facility-based care of diabetes, hypertension, and heart failure across western Kenya

Background: Low- and middle- income countries account for three-fourths of the global non- communicable disease related mortality. In response to the increasing number of non- communicable disease diagnoses in Kenya, the government released a national strategy for non- communicable disease in 2015. The purpose of this study was to assess facility-based care of diabetes, hypertension, and heart failure across western Kenya.Methods: A 71-question cross-sectional survey was administered among facility-based healthcare workers in Siaya County, western Kenya, between October 2015 and January 2016. All Level 4 and 5 facilities, as well as a cohort of lower-level facilities were surveyed.Results: Of the 21 health facilities surveyed, six (31.6%) had specific non-communicable disease clinics. Eleven of the 21 (52.4%) facilities had glucometers, and providers indicated that even these glucometers were often not functional. Three of the 21 facilities (14.3%) had a diabetic registry, one a functioning electrocardiogram machine, and one other a congestive heart failure registry.Conclusions: Facilities at every level were lacking equipment and medications expected by the Kenya’s Essential Package of Health Services. Improvement for follow up and referral services could be achieved through the development of comprehensive non-communicable disease registries

Trends in hospital-based management of acute asthma from a teaching hospital in South Asia.

The aim of this study is to evaluate the hospital-based management of acute asthma in south Asia and to compare practices over a 10-year period. Adult patients (n = 102) admitted at a teaching hospital with acute asthma were studied. Documentation of precipitating factors, family history and physical signs were inadequate in more than half of patients. Pulse oximetry was documented in 95 (93%) patients, but peak flow monitoring was performed only in 50 (49%) patients. Ten-year trend showed deterioration in history and physical examination skills, under use of peak flow readings, and poor pre-discharge instructions. Some aspects of improved care included frequent use of pulse oximeter, preference of inhaled over systemic bronchodilators and increased use of systemic steroids. Significant deficiencies were identified in hospital-based management of acute asthma. Most aspects of asthma care continued to fall short of asthma guidelines

Attitude of Iranian Nephrologists Toward Living Unrelated Kidney Donation

Living unrelated kidney donation (LURD) is increasing worldwide due to the shortage of cadaveric kidneys. In our country an LURD program has been practiced since 1988. This study sought to evaluate the attitude of Iranian nephrologists towards various aspects of the program. Questionnaires including 20 queries were sent to nephrologists. Among 100 randomly selected nephrologists, 50 completed and returned the questionnaires. Forty six (92) and 45 (90) believed that LURD has potential minor short- and long-term complications, respectively. Forty two percent assumed renal failure was a potential complication. Ninety two percent used to inform donors about the complications, all verbally. Thirty four percent and 72 assumed inhalational opium addiction and heroin addiction were contraindications to LURD, respectively. Twenty eight percent and 68 believed that the amount of recipients' gift and the governmental award are not sufficient, respectively. Thirty two percent believed that all compensation should be paid by the government. Sixty six percent believed that donors should be given social advantages, and 26 believed that they should not, in order to not enhance persuasion of nonaltruistic donation. Eighty eight percent claimed that donor follow-up is not regularly done and should be organized. Finally, 30 agreed and 19 disagreed with LURD. We conclude that despite the success of our LURD program in elimination of the transplant waiting list, most Iranian nephrologists believe that there should be some revisions. Verbal information about complications may not be sufficient to help the donors to make a correct decision. We should reconsider the method and amount of financial compensation and organize a regular follow-up program. © 2007 Elsevier Inc. All rights reserved

In Vitro Ultramorphological Assessment of Apoptosis on CEMss Induced by Linoleic Acid-Rich Fraction from Typhonium flagelliforme Tuber

The plant Typhonium flagelliforme, commonly known as “rodent tuber” in Malaysia, is often used as a health supplement and traditional remedy for alternative cancer therapies, including leukemia. This study aimed to evaluate in vitro anti-leukemic activity of dichloromethane extract/fraction number 7 (DCM/F7) from T. flagelliforme tuber on human T4 lymphoblastoid (CEMss) cell line. The DCM extract of tuber has been fractionated by column chromatography. The obtained fractions were evaluated for its cytotoxicity toward CEMss cells as well as human primary blood lymphocytes (PBLs). Assessment of apoptosis produced by the most active fraction was evaluated by various microscopic techniques and further confirmation of apoptosis was done by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. Phytochemical screening was done by gas chromatography-mass spectrometry (GC-MS). The results shows that 7 out of 12 fractions showed significant cytotoxicity against the selected cell line CEMss, in which fractions DCM/F7, DCM/F11 and DCM/F12 showed exceptional activity with 3, 5 and 6.2 μg ml−1, respectively. Further studies in the non-cancerous PBL exhibited significant selectivity of DCM/F7 compared to other fractions. Cytological observations showed chromatin condensation, cell shrinkage, abnormalities of cristae, membrane blebbing, cytoplasmic extrusions and formation of apoptotic bodies as confirmed collectively by double-staining of acridine orange (AO)/propidium iodide (PI), SEM and TEM. In addition, DCM/F7 has increased the cellular DNA breaks on treated cells. GC-MS revealed that DCM/F7 contains linoleic acid, hexadecanoic acid and 9-hexadecanoic acid. The present results indicate that T. flagelliforme possess a valuable anti-leukemic effect and was able to produce distinctive morphological features of cell death that corresponds to apoptosis

Increased Expression of Cytotoxic T-Lymphocyte-Associated Protein 4 by T Cells, Induced by B7 in Sera, Reduces Adaptive Immunity in Patients With Acute Liver Failure.

BACKGROUND & AIMS: Patients with acute liver failure (ALF) have defects in innate immune responses to microbes (immune paresis) and are susceptible to sepsis. Cytotoxic T-lymphocyte-associated protein 4 (CTLA4), which interacts with the membrane receptor B7 (also called CD80 and CD86), is a negative regulator of T-cell activation. We collected T cells from patients with ALF and investigated whether inhibitory signals down-regulate adaptive immune responses in patients with ALF. METHODS: We collected peripheral blood mononuclear cells from patients with ALF and controls from September 2013 through September 2015 (45 patients with ALF, 20 patients with acute-on-chronic liver failure, 15 patients with cirrhosis with no evidence of acute decompensation, 20 patients with septic shock but no cirrhosis or liver disease, and 20 healthy individuals). Circulating CD4+ T cells were isolated and analyzed by flow cytometry. CD4+ T cells were incubated with antigen, or agonist to CD3 and dendritic cells, with or without antibody against CTLA4; T-cell proliferation and protein expression were quantified. We measured levels of soluble B7 molecules in supernatants of isolated primary hepatocytes, hepatic sinusoidal endothelial cells, and biliary epithelial cells from healthy or diseased liver tissues. We also measured levels of soluble B7 serum samples from patients and controls, and mice with acetaminophen-induced liver injury using enzyme-linked immunosorbent assays. RESULTS: Peripheral blood samples from patients with ALF had a higher proportion of CD4+ CTLA4+ T cells than controls; patients with infections had the highest proportions. CD4+ T cells from patients with ALF had a reduced proliferative response to antigen or CD3 stimulation compared to cells from controls; incubation of CD4+ T cells from patients with ALF with an antibody against CTLA4 increased their proliferative response to antigen and to CD3 stimulation, to the same levels as cells from controls. CD4+ T cells from controls up-regulated expression of CTLA4 after 24-48 hours culture with sera from patients with ALF; these sera were found to have increased concentrations of soluble B7 compared to sera from controls. Necrotic human primary hepatocytes exposed to acetaminophen, but not hepatic sinusoidal endothelial cells and biliary epithelial cells from patients with ALF, secreted high levels of soluble B7. Sera from mice with acetaminophen-induced liver injury contained high levels of soluble B7 compared to sera from mice without liver injury. Plasma exchange reduced circulating levels of soluble B7 in patients with ALF and expression of CTLA4 on T cells. CONCLUSIONS: Peripheral CD4+ T cells from patients with ALF have increased expression of CTLA4 compared to individuals without ALF; these cells have a reduced response to antigen and CD3 stimulation. We found sera of patients with ALF and from mice with liver injury to have high concentrations of soluble B7, which up-regulates CTLA4 expression by T cells and reduces their response to antigen. Plasma exchange reduces levels of B7 in sera from patients with ALF and might be used to restore antimicrobial responses to patients