Development of a difficulty airway trolley (DAT) at a tertiary referral hospital in northern Tanzania
2
Citation
0
Reference
10
Related Paper
Citation Trend
Keywords:
Tertiary referral centre
Tertiary referral hospital
Tertiary care
As a tertiary referral centre for ENT and maxillo-facial surgery, our ICU receives complex elective and emergency cases. The frequency, aetiology and outcomes of airway emergencies are poorly described. Understanding these factors is key to improving management.
Tertiary referral centre
Tertiary referral hospital
Etiology
Tertiary care
Cite
Citations (2)
Background: Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU).They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources.We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM 0 -III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality.Methods: This was a retrospective cohort study of adult patients admitted to the ICU of the Aga Khan Hospital, Dar-es-Salaam, Tanzania between August 2018 and April 2020.Demographics, clinical characteristics, outcomes, source of admission, primary admission category, length of stay and the support provided with the worst physiological data within the first hour of ICU admission were extracted.SAPS 3 and MPM 0 -III scores were calculated using an online web-based calculator.The performance of each model was assessed by discrimination and calibration.Discrimination between survivors and nonsurvivors was assessed by the area under the receiver operator characteristic curve (ROC) and calibration was estimated using the Hosmer-Lemeshow goodness-of-fit test.Results: A total of 331 patients were enrolled in the study with a median age of 58 years (IQR 43-71), most of whom were male (n=208, 62.8%), of African origin (n=178, 53.8%) and admitted from the emergency department (n=306, 92.4%).In-hospital mortality of critically ill patients was 16.1%.Discrimination was very good for all models, the area under the receiver-operating characteristic (ROC) curve for SAPS 3 and MPM 0 -III was 0.89 (95%CI:
Tertiary referral hospital
Tertiary referral centre
Cite
Citations (0)
The provision of intensive care has lagged behind demand [1]. Intensive care services in the UK have significant resource restriction. Although rationing of beds has been a priority, equally important is to establish patient safety and also identify strategies to prevent admissions [2], which echoes the importance of early recognition of deteriorating patients and prompt intervention. This study evaluates the epidemiology of unplanned admissions to the ICU in order to identify the associative trends that led to the admission and hence to mitigate the processes of interventional strategies.
Tertiary referral hospital
Cite
Citations (0)
BACKGROUNDMaternal height is one of the parameters which significantly affects the obstetric performance.Short statured women may have small pelvis and are reported to have higher rates of perinatal mortality, low birth weight and operative delivery.Objective-To find out the relationship between maternal height and obstetric outcome with emphasis on the mode of delivery and neonatal outcome. MATERIALS AND METHODSThis Descriptive study was carried out in the Department of Obstetrics and Gynaecology, Institute of Maternal and Child Health (IMCH), Govt.Medical College, Kozhikode, over a period of one year from November 2007 to October 2008.Since the study duration was short, we had to limit the sample size for convenience.Primigravida having singleton pregnancies, cephalic presentation and sure date of LMP with no medical and obstetric complications were selected from antenatal clinic of IMCH.Those with height < 145 cm formed and those with height > 145 cm formed were considered.A semi-structured proforma which contain demographic, antenatal and anthropometric details as well as obstetric and neonatal outcomes were recorded.Pregnancy and foetal outcome were compared using student's 't' test and chi-square test. RESULTSOut of 467 primigravida, 227 women with height < 145 cm formed the study group and the rest 240 formed the control group.The incidence of LSCS in short women was 32.1% compared to 10% in tall women (p < 0.001), which is highly significant.In short statured women, 53% had LSCS due to CPD, whereas in taller women 25% had LSCS for CPD (Z= 4.525, P < 0.0001).CPD was the indication for LSCS in 71.4% of mothers with height < 135 cm and the percentage of CPD decreased with increase in the maternal height.Significant number of babies born to short statured mothers were asphyxiated (11% vs 3.33%) and required NICU admission (17.6% vs 4.58%) in comparison to babies born to mothers of control group. CONCLUSIONWomen with short stature are high-risk population for poor pregnancy outcome.Short statured women are more likely to undergo LSCS for CPD and their babies are more asphyxiated at birth with higher rate of NICU admissions.The need for anthropometric assessment, partographic monitoring, prompt identification of CPD and early possible caesarean section as well as prompt neonatal care are crucial in the prevention of adverse maternal and perinatal morbidity in short statured women.
Tertiary referral centre
Tertiary care
Tertiary referral hospital
Cite
Citations (0)
Abacavir
Antiviral Therapy
Cite
Citations (0)
Tertiary referral hospital
Tertiary care
Cite
Citations (0)
Background: According to the National AIDS Control Organization (NACO), HIV prevalence in India is 0.36% and people living with HIV are around 2.47 million. Although antiretroviral treatment (ART) does not cure HIV/AIDS, but effective ART regimens inhibit the efficient replication of the HIV virus, and reduce viremia to undetectable levels. Methods: HIV positive patients qualified to be enrolled in to the study were those who attended the infectious diseases clinic at least twice (one follow-up visit at least six months apart), between January 2009 to December 2011. The protocol was approved by the Ethical Committee of the IMS, BHU. History and detail of patients were recorded on a pre-designed performa which included the socio-demographic profile of the patients, mode of transmission, presenting symptoms, opportunistic infections and many others. Results: 5308 HIV positive patients were registered during three year of study period at the ART Centre of IMS, BHU. Of these 3379 (63.7%) were males and 1929 (36.3%) were females. Heterosexual mode of transmission was commonest in the study group and amounted to 70.5% of total HIV patients on ART. Pulmonary tuberculosis was most common opportunistic infection and was present in 1045(19.7%) of patients on ART. CD4 counts of the patients were significantly inversely correlated with the number of symptoms and the number of opportunistic infections. Conclusions: HIV infection is one of the major infectious diseases in this part of India, and being chronic and lifelong in nature, its impact is huge compared to other infectious diseases. People with high risk behavior and the spouse of the affected couple need to be educated for primary and secondary prevention of the disease.
Opportunistic infection
Cite
Citations (5)
In sub-Saharan Africa the availability of intensive care unit (ICU) services is limited by a variety of factors, including lack of financial resources, lack of available technology and well-trained staff. Tanzania has four main referral hospitals, located in zones so as to serve as tertiary level referral centers. All the referral hospitals have some ICU services, operating at varying levels of equipment and qualified staff. We analyzed and describe the disease patterns and clinical outcomes of patients admitted in ICUs of the tertiary referral hospitals of Tanzania. This was a retrospective analysis of ICU patient records, for three years (2009 to 2011) from all tertiary referral hospitals of Tanzania, namely Muhimbili National Hospital (MNH), Kilimanjaro Christian Medical Centre (KCMC), Mbeya Referral Hospital (MRH) and Bugando Medical Centre (BMC). MNH is the largest of the four referral hospitals with 1300 beds, and MRH is the smallest with 480 beds. The ratio of hospital beds to ICU beds is 217:1 at MNH, 54:1 at BMC, 39:1 at KCMC, and 80:1 at MRH. KCMC had no infusion pumps. None of the ICUs had a point-of-care (POC) arterial blood gas (ABG) analyzer. None of the ICUs had an Intensive Care specialist or a nutritionist. A masters-trained critical care nurse was available only at MNH. From 2009–2011, the total number of patients admitted to the four ICUs was 5627, male to female ratio 1.4:1, median age of 34 years. Overall, Trauma (22.2%) was the main disease category followed by infectious disease (19.7%). Intracranial injury (12.5%) was the leading diagnosis in all age groups, while pneumonia (11.7%) was the leading diagnosis in pediatric patients (<18 years). Patients with tetanus (2.4%) had the longest median length ICU stay: 8 (5,13) days. The overall in-ICU mortality rate was 41.4%. The ICUs in tertiary referral hospitals of Tanzania are severely limited in infrastructure, personnel, and resources, making it difficult or impossible to provide optimum care to critically ill patients and likely contributing to the dauntingly high mortality rates.
Tertiary referral hospital
Medical record
Cite
Citations (97)
Tertiary referral centre
Tertiary referral hospital
Tertiary care
Cite
Citations (2)
Aim and objective: To identify indication and fetomaternal outcome of emergency obstetric referral to our hospital so as to reduce fetomaternal morbidity and mortality.Materials and methods: This retrospective observational study was done at the Department of Obstetrics and Gynecology, LTMMC and LTMGH, Sion, Mumbai, for a duration of 1 year from January 2020 to December 2020.All referred patients in emergency for obstetrics indications above 20 weeks were analyzed for fetomaternal outcome and their indication of referral.Results: In our study, of a total of 7,751 delivered patients, 2,233 (28.8%) cases were referred.Maximum 1,711 (76.6%) cases were in the 21-30 years age-group and (66.86%) cases referred from secondary centers.The most common referral indication was fetal, meconium-stained amniotic fluid, and fetal distress 432 (19.4%), followed by preterm labor 291 (11.1%) as maternal indication.One thousand seven hundred twenty-seven (77.4%) patients delivered by lower segment cesarean section.Maternal morbidity was seen in 370 (16.6%) patients, of which 41 (11%) patients required intensive care unit admission.Maternal mortalities were 12.Total 1,832 (80.8%) neonates were shifted to mother and 325 (14.3%) required NICU admission. Conclusion:To reduce unnecessary referrals and burden on tertiary care hospitals, first referral units (FRUs) should be strengthened and healthcare workers should be trained in essential and emergency obstetric care, which will help in reducing morbidity and mortality.
Tertiary referral centre
Tertiary care
Tertiary referral hospital
Cite
Citations (4)