Conformity to the Surviving Sepsis Campaign International Guidelines among Physicians in a general Inensive care unit in Nairobi

Background: There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage. Objectives: To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit. Design: Cross sectional observational study. Setting: The general intensive care unit, Aga Khan University Hospital, Nairobi. Subjects: Admitting physicians from all specialties in the general intensive care unit. Results: The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had moderate conformity rates for blood cultures prior to administering antibiotics (57%) and administration of antibiotics within first hour of recognition of septic shock (54%). There was high conformity rate to the glucose control policy (81%), use of protective lung strategy in acute lung injury/Acute respiratory distress syndrome, venous thromboembolism prophylaxis (100%) and stress ulcer prophylaxis (100%) in the management bundle. Conformity was moderate for use of sedation, analgesia and muscle relaxant policy (69%), continuous renal replacement therapies (54%) and low for steroid policy (35%), administration ofdrotrecogin alfa (0%) and selective digestive decontamination (15%). Conclusion: There is varying conformity to the international sepsis guidelines among physicians caring for patients in our general ICU. Since increased conformity would improve survival and reduce morbidity, there is need for sustained education and guideline based performance improvement.East African Medical Journal Vol. 87 No. 8 August 201

Conformity to the surviving sepsis campaign international guidelines among physicians in a general intensive care unit in Nairobi

Background: There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage. Objectives: To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit. Design: Cross sectional observational study. Setting: The general intensive care unit, Aga Khan University Hospital, Nairobi. Subjects: Admitting physicians from all specialties in the general intensive care unit. Results: The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had moderate conformity rates for blood cultures prior to administering antibiotics (57%) and administration of antibiotics within first hour of recognition of septic shock (54%). There was high conformity rate to the glucose control policy (81%), use of protective lung strategy in acute lung injury/Acute respiratory distress syndrome, venous thromboembolism prophylaxis (100%) and stress ulcer prophylaxis (100%) in the management bundle. Conformity was moderate for use of sedation, analgesia and muscle relaxant policy (69%), continuous renal replacement therapies (54%) and low for steroid policy (35%), administration ofdrotrecogin alfa (0%) and selective digestive decontamination (15%). Conclusion: There is varying conformity to the international sepsis guidelines among physicians caring for patients in our general ICU. Since increased conformity would improve survival and reduce morbidity, there is need for sustained education and guideline based performance improvement

Reminder systems for self uterine massage in the prevention of postpartum blood loss

Background: Uterine massage may significantly reduce post partum blood loss and could be patient-driven.Objective: To assess the effectiveness of an alarm reminder system for self uterine massage in the prevention of post partum blood loss.Design: A random controlled trial.Setting: Meru District Hospital, Kenya.Subjects: One hundred and twenty seven (127) women were randomly assigned to a 15 minute alarm reminder system (71) and non-alarm (56) control arm during the fourth stage of labour.Results: Uterine massage compliance was better in the alarm group compared to the non-alarm group ( Average massage of seven and two in two hours respectively P-value <0.0001), however the difference in blood loss was not significant 45.6 ml (95% CI 43-46) vs 47.1 ml (95% CI 43-52)ml p-value 0.892.Conclusion: Uterine massage compliance is remarkably increased by the use of an alarm reminder

Reminder Systems for Self uterine massage in the prevention of postpartum blood loss

Background: Uterine massage may significantly reduce post partum blood loss and could be patient-driven. Objective: To assess the effectiveness of an alarm reminder system for self uterine massage in the prevention of post partum blood loss. Design: A random controlled trial. Setting: Meru District Hospital, Kenya. Subjects: One hundred and twenty seven (127) women were randomly assigned to a 15 minute alarm reminder system (71) and non-alarm (56) control arm during the fourth stage of labour. Results: Uterine massage compliance was better in the alarm group compared to the non-alarm group ( Average massage of seven and two in two hours respectively P-value Conclusion: Uterine massage compliance is remarkably increased by the use of an alarm reminder

Telerehabilitation approach for patients with hand impairment

Purpose: Telerehabilitation is one of the newest branches of telemedicine which has been developed because patients need regular trainings outside the medical institution but still under specialist supervision. It helps maintain regularity of exercises and reduces costs. The professional and advanced systems for telerehabilitation are presented in papers however, there is still lack of development of minor systems which provide therapeutic values and are more accessible to people. Therefore we focus on a solution for hand telerehabilitation of post-stroke patients, based solely on a personal computer and camera. Methods: We focused on the manipulative hand (fingers, metacarpus, wrist) movements trainings for patients with cerebral palsy. The contact between patient and physiotherapist is provided by using web cameras and web service. Additionally the camera can be used to monitor the effectiveness of performed exercises. Computer vision system keeps track of the patient’s hand movement. The digital image processing is used to detect if the patient performs exercises correctly. Results: We created web service and software application TeleReh that provides therapeutic values for the hand impaired people. The created system was evaluated by three physiotherapists, one doctor and a cerebral palsy patient. Conclusions Our solution applies to all patients who have undergone basic rehabilitation in hospital and need to continue hand rehabilitation at home. The main advantages are: easily adaptation to the individual needs and abilities, monitoring the progress by using automatically generated reports after each training session. It is worth noticing, that discussion between IT specialists, rehabilitants and patients was necessary to achieve good results

Priority setting for health in the context of devolution in Kenya: Implications for health equity and community-based primary care

Devolution changes the locus of power within a country from central to sub-national levels. In 2013, Kenya devolved health and other services from central government to 47 new sub-national governments (known as counties). This transition seeks to strengthen democracy and accountability, increase community participation, improve efficiency and reduce inequities. With changing responsibilities and power following devolution reforms, comes the need for priority-setting at the new county level. Priority-setting arises as a consequence of the needs and demand for healthcare resources exceeding the resources available, resulting in the need for some means of choosing between competing demands. We sought to explore the impact of devolution on priority-setting for health equity and community health services. We conducted key informant and in-depth interviews with health policymakers, health providers and politicians from 10 counties (n = 269 individuals) and 14 focus group discussions with community members based in 2 counties (n = 146 individuals). Qualitative data were analysed using the framework approach. We found Kenya's devolution reforms were driven by the need to demonstrate responsiveness to county contexts, with positive ramifications for health equity in previously neglected counties. The rapidity of the process, however, combined with limited technical capacity and guidance has meant that decision-making and prioritization have been captured and distorted for political and power interests. Less visible community health services that focus on health promotion, disease prevention and referral have been neglected within the prioritization process in favour of more tangible curative health services. The rapid transition in power carries a degree of risk of not meeting stated objectives. As Kenya moves forward, decision-makers need to address the community health gap and lay down institutional structures, processes and norms which promote health equity for all Kenyans

What Is Currently Known about Intramedullary Spinal Cord Abscess among Children? A Concise Review

Intramedullary spinal cord abscesses (ISCA) are rare. Typical symptoms include signs of infection and neurological deficits. Symptoms among (younger) children can be highly uncharacteristic. Therefore, prompt and proper diagnoses may be difficult. Typical therapeutic options include antibiotics and neurosurgical exploration and drainage. In this review, we analyze published cases of ISCA among children. Most pediatric cases were found to be under the age of 6 years. The typical symptoms included motor deficits in 89.06%, infection signs in 85.94%, and sensory deficits in 39.06%. Urinary dysfunction was observed in 43.75%, and bowel dysfunction in 17.19%. The predisposing factors included dermal sinuses, (epi)dermoid cysts, prior infection, iatrogenic disorder, and trauma. The most common pathogens were: Staphylococcus aureus, Mycobacterium tuberculosis, Escherichia coli, and Proteus mirabilis. The pediatric population has good outcomes as 45.93% of patients had complete neurological recovery and only 26.56% had residual neurological deficits. Fifteen (23.44%) had persistent neurological deficits. Only one (1.56%) patient died with an ISCA. In two (3.13%) cases, there were no details about follow-up examinations