Reflecting on why surgical swabs are being left behind and exploring how this could be prevented

2021 ◽  
Vol 29 (6) ◽  
pp. 310-315
Author(s):  
Francesca Spranzi
Keyword(s):  
Postpartum Haemorrhage ◽  
Financial Burden ◽  
Healthcare Providers ◽  
High Morbidity ◽  
Physical Barrier ◽  
Definitive Answer ◽  
Left Behind ◽  
Legal Implications ◽  
Psychological Harm ◽  
Never Event

Surgical swabs are routinely used by obstetricians and midwives to absorb blood during caesarean sections or perineal repairs following a vaginal birth. On rare occasions, a surgical swab can be left behind by mistake inside the patient's body. When an incident involving a retained swab occurs, this is declared a ‘never event’. Although a rare occurrence, a retained surgical swab is the source of high morbidity (infection, pain, secondary postpartum haemorrhage and psychological harm). It is also important to mention the financial burden and the legal implications affecting healthcare providers worldwide. Over the years, several strategies have been implemented in clinical practice to reduce such risk. However, none of these seem to provide a definitive answer. Having offered a brief overview of the evidence surrounding retained surgical swabs, this article presents an innovative approach based on creating a physical barrier by introducing an anchoring point linking the swabs together, making it physically impossible to leave one behind. At present, these modified swabs are undergoing development and testing.

scholarly journals Perceptions of Treatment Burden Among Elders With Diabetes and Comorbid Alzheimer’s Disease and Related Dementias

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 276-276
Author(s):  
Victoria Vaughan Dickson ◽  
Halia Melnyk ◽  
Rosie Ferris ◽  
Joshua Chodosh ◽  
Caroline Blaum
Keyword(s):  
Alzheimer’S Disease ◽  
Older Adults ◽  
Alzheimer's Disease ◽  
Qualitative Study ◽  
Financial Burden ◽  
Controlled Trial ◽  
Healthcare Providers ◽  
Patient Treatment ◽  
Treatment Burden ◽  
Treatment Plans

Abstract Background: An estimated 25% of older adults with diabetes (DM) may have co-occurring Alzheimer’s Disease and Related Dementias (ADRD), complicated by multiple treatment plans and providers. Assessing treatment burden has been limited to patients’ perspectives; little is known about caregiver perceptions of treatment burden despite their important role in personal care and treatment adherence. The purpose of this qualitative study was to describe caregiver perceptions of treatment burden for older adults with DM-ADRD. Methods: This qualitative study was conducted in the formative phase of “Enhanced Quality in Primary care for Elders with DM-ADRD (EQUIPED-ADRD) a pragmatic randomized controlled trial in a large, diverse healthcare system. A diverse sample of caregivers (n=15) of patients enrolled in the RCT participated in interviews about their caregiver role and perceptions of treatment burden of DM-ADRD clinical management. Qualitative data were analyzed using content analysis and themes about treatment burden were compared to domains on the Treatment Burden Questionnaire (TBQ). Results: Caregivers reported high levels of burden related to treatment plans for patients with DM-ADRD. Themes related to complexity and burden of medication management, monitoring (e.g., blood pressure, glucose monitoring), dietary and physical activity regimens, navigating healthcare providers and financial burden were reported. Caregivers also described high levels of emotional burden that was associated with patient’s cognitive decline and family functioning stress. Conclusions: Interventions to reduce treatment burden for patients and caregiver should include activating social/nursing services, respite care and care coordination that may support caregivers especially as patient treatment increases in complexity over time.

Vibrato, the Orchestral Organ and the ‘Prevailing Aesthetic’ in Nineteenth-Century Symphonic Music

2014 ◽  
Vol 11 (1) ◽  
pp. 93-112
Author(s):  
David Hurwitz
Keyword(s):  
Nineteenth Century ◽  
Primary Source ◽  
Source Material ◽  
Orchestral Music ◽  
Definitive Answer ◽  
Left Behind ◽  
History Of ◽  
Organ Builders ◽  
Intrinsic Component ◽  
Modern Myth

The issue of vibrato's presence in the nineteenth-century orchestral string section has become controversial, with musicians often asked to accept the proposition that vibrato existed rarely, if at all. Fortunately an extensive, hitherto overlooked, body of primary source material exists that goes straight to the heart of the matter, offering a definitive answer to the question of whether or not vibrato was an intrinsic component of period orchestral string sonority. It comes from the organ literature and from the history of the instrument's evolution over the course of the long nineteenth century. A group of artists and artisans, working from approximately 1830 to 1930, documented the importance of vibrato to any attempt at reproducing, or at least approximating, the authentic timbre of the orchestral string section. Organ builders and performers noted vibrato's use both as an intrinsic constituent of string tone and as an actively applied expressive device. They discussed it extensively in their literature, gave their instruments the capacity to simulate its effects, and specifically notated its presence in their transcriptions of orchestral music. The information they have left behind dispels the modern myth of ‘pure’, vibratoless orchestral string tone as a timbral norm, and provides a truer sense of the era's prevailing aesthetic.

scholarly journals An Undiagnosed Paraganglioma in a 58-Year-Old Female Who Underwent Tumor Resection

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
William C. Fox ◽  
Matthew Read ◽  
Richard E. Moon ◽  
Eugene W. Moretti ◽  
Brian J. Colin
Keyword(s):  
Blood Pressure ◽  
Perioperative Management ◽  
Clinical Presentation ◽  
Tumor Resection ◽  
Healthcare Providers ◽  
Surgical Intensive Care Unit ◽  
High Morbidity ◽  
Tumor Removal ◽  
Surgical Intensive Care ◽  
Acute Complications

Paragangliomas and pheochromocytomas are rare neuroendocrine tumors that can have high morbidity and mortality if undiagnosed. Here we report a case of an undiagnosed paraganglioma in a 58-year-old female who underwent tumor resection. The patient became severely hypertensive intraoperatively with paroxysmal swings in blood pressure and then later became acutely hypotensive after tumor removal. She was managed in the surgical intensive care unit (SICU) postoperatively and discharged from the hospital without acute complications. We briefly discuss the epidemiology, clinical presentation, perioperative management, and possible complications of these tumors to assist healthcare providers if one were to encounter them.

scholarly journals A Qualitative Study to Explore the Experience of Parents of Newborns Admitted to Neonatal Care Unit in Rural Rwanda

2020 ◽  
Author(s):  
Samuel Byiringiro ◽  
Rex Wong ◽  
Jenae Logan ◽  
Deogratias Kaneza ◽  
Joseph Gitera ◽  
...  
Keyword(s):  
Qualitative Study ◽  
District Hospital ◽  
Financial Burden ◽  
Healthcare Providers ◽  
Neonatal Care ◽  
Sub Saharan Africa ◽  
Clear Understanding ◽  
Limited Information ◽  
Experience Of Care ◽  
Neonatal Care Unit

Abstract ABSTRACT (310/350 words) Background: Neonatal Care Units (NCUs) provide special care for sick and small newborns and can help reduce neonatal mortality. For parents, the experience of having a hospitalized newborn can be traumatic. In LMIC, especially sub-Saharan Africa, there is limited information about the parents’ experience of care in NCUs. Objective: Our study aimed to explore the experience of parents in the NCU of a rural district hospital in Rwanda. Methods: A qualitative study was conducted with parents whose newborns were hospitalized in the Ruli District Hospital NCU from September 2018 to January 2019. In-depth interviews were conducted using a semi-structured guide in the participants homes by trained data collectors. Data were transcribed, translated, and then coded using a structured code book. All data analyses were conducted using Dedoose software. Results: Twenty-one interviews were conducted primarily with mothers (90.5%, n=19) among newborns who were most often discharged home alive (90.5%, n=19). Parents reported stressful and emotional responses to having their newborns admitted particularly when they lacked clear understanding of their newborn’s condition, generally positive communication and interactions with healthcare providers and other parents, policies and procedures in the NCU that contributed to stress and limited access to newborns by fathers and other family members, and stress due to the high financial burden of NCU care. Conclusion: The admission of a newborn into the NCU alone was a source of stress for parents and caregivers in rural Rwanda. However, there were several positive factors of the NCU including involvement of mothers and support from healthcare providers. The experience in the NCU can be improved when healthcare providers communicate and explain the newborn’s status to the parents and actively involve them in the care of their newborn. Expanding the NCU access for families, encouraging peer support, and ensuring financial accessibility for neonatal care services could contribute to improved experiences for families. KEYWORDS: prematurity, neonatology, family-centered care, neonatal care unit, nurses, patient satisfaction, patient experience

scholarly journals Developing Regional Healthcare Facilities in Maldives through Mudharabah Perpetual Sukuk

2019 ◽  
Vol 6 (2) ◽  
pp. 81-96 ◽  
Author(s):  
Fathimath Badeeu ◽  
Aminath Nafiz ◽  
Aishath Muneeza
Keyword(s):  
Healthcare System ◽  
Compliant Mechanism ◽  
Financial Burden ◽  
Healthcare Providers ◽  
Health Facilities ◽  
Healthcare Facilities ◽  
Term Basis

The purpose of this paper is to identify the underlying issues of healthcare system in Maldives in order to provide an understanding of the challenges facing healthcare providers in islands and atolls in a wider context. The paper scrutinizes the financial burden faced by the current healthcare system in Maldives. It also proposes shariah compliant mechanism that can be utilized to minimize financial burden in a long-term basis. It is hoped that the outcome of the research will assist the policymakers of Maldives to devise a shariah compliant mechanism to finance the development of atoll and island health facilities in a sustainable manner.

scholarly journals A prospective study to evaluate oral iron preparations in antenatal women at a tertiary care hospital

2017 ◽  
Vol 6 (4) ◽  
pp. 851
Author(s):  
Satyanarayana V. ◽  
Shabeer D. ◽  
Suma Jayaram ◽  
Basavaraj Bhandare
Keyword(s):  
Pregnant Women ◽  
Ferrous Sulphate ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Oral Iron ◽  
High Morbidity ◽  
Care Hospital ◽  
Acid Therapy ◽  
Detailed Medical History ◽  
Iron Preparation

Background: Iron deficiency is the most common cause of anemia in pregnancy worldwide. It can be mild, moderate or severe. Severe anemia can have very serious consequences for mothers and babies. Pregnant women requiring medication represent a challenge to healthcare providers to avoid any teratogenic risk to foetus. The purpose of this study was to provide information about the most effective iron preparations prescribed to pregnant women and to evaluate the haemoglobin status before and after oral iron therapy.Methods: This was a Prospective observational study conducted in the Department of Obstetrics and Gynaecology, Rajarajeswari Medical College and Hospital, between October 2013 and March 2014.This study was conducted by reviewing the antenatal care Outpatient department case papers of 200 pregnant women who were anaemic.Results: Demographic profile, detailed medical history and drug intake in current pregnancy was noted. The prescription pattern was assessed. Of the three common iron preparations prescribed, Ferrous sulphate was the most common preparation. Findings of our study showed that all pregnant anaemic women included in the study were provided with iron and folic acid therapy and the most effective oral iron preparation was Ferrous sulphate.Conclusions: Present study shows that ferrous sulphate is the most common iron preparation prescribed. Ferrous sulphate and ferrous fumarate preparations showed better improvement in Hb levels. Anaemia is common among all pregnant women and therefore it raises the concern about high morbidity and mortality associated with pregnancy outcome. This can be minimized by educating pregnant women about importance of balanced diet and utilization of antenatal facilities even during early pregnancy. 

scholarly journals Socio-economic drivers of Drug-Resistant Tuberculosis in Africa: A Scoping Review

2020 ◽  
Author(s):  
Lesley-Ann Lynnath Cannon ◽  
Kelechi Elizabeth Oladimeji ◽  
Daniel Ter Goon
Keyword(s):  
Scoping Review ◽  
Negative Impact ◽  
Financial Burden ◽  
Health Concern ◽  
High Morbidity ◽  
Economic Factors ◽  
Drug Resistant ◽  
African Countries ◽  
Eligibility Criteria ◽  
Socio Economic Factors

Abstract Background: Drug-resistant TB (DR-TB) remains a public health concern due to the high morbidity and mortality rates from the disease. The DR-TB is a multifaceted illness with expensive treatment regimens, toxic medications and most often the long duration of treatment constitutes a substantial financial burden on both infected patients and the health system. Despite significant research advances in the diagnosis and treatment, there is a paucity of synthesized evidence on how socio-economic factors are associated with DR-TB. This review aims to address this gap by synthesizing available evidence and data on the common socio-economic drivers of DR-TB infection in Africa.Methods: A systematic search was conducted on PUBMED and Google Scholar databases from January 2011 to January 2020 using Joanna Briggs Institute’s scoping review approach. An updated search was conducted on 21 September 2020. The eligibility criteria only included systematic reviews and studies with quantitative research methods (cross-sectional, case-control, cohort, and randomized-control trials). Studies conducted in Africa and focusing on socio-economic factors influencing DR-TB burden in African countries were also considered. Data was extracted from all the studies that met the eligibility criteria based on the study’s objectives.Results: Out of the 154 articles that were retrieved for review, 20 abstracts of these articles met all the eligibility criteria. Of the 20 articles, 17 quantitative and 3 reviews. 2 additional articles were found eligible, following the updated search. The following themes were identified as major findings: Social and economic drivers associated with DR-TB. Substance abuse of which, stigma and discrimination were the prominent social drivers. Economic drivers included poverty, financial constraints because of job loss, loss of productive time during hospital admission and treatment costs.Conclusion: This review has highlighted which socio-economic factors contribute to DR- TB This is relevant to assist DR-TB management program and TB stakeholders in different settings to address identified socio-economic gaps and to reduce its negative impact on the programmatic management of DR TB. Therefore, redirecting strategies with more focus on socio-economic empowerment of DR-TB patients could be one of the innovative solutions to reduce the spread and eliminate DR-TB in Africa.

scholarly journals Recommendations from the Association for European Paediatric and Congenital Cardiology for training in pulmonary hypertension

2019 ◽  
Vol 29 (11) ◽  
pp. 1323-1327 ◽  
Author(s):  
Hannes Sallmon ◽  
Shahin Moledina ◽  
Dimpna C. Albert ◽  
Maurice Beghetti ◽  
Rolf M. F. Berger ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Medical Training ◽  
Healthcare Providers ◽  
High Morbidity ◽  
Therapeutic Approaches ◽  
Non Invasive ◽  
European Paediatric ◽  
Recent Developments ◽  
Children And Young Adults ◽  
Multiple Health

AbstractPulmonary hypertension is a complex and progressive condition that is either idiopathic or heritable, or associated with one or multiple health conditions, with or without congenital or acquired cardiovascular disease. Recent developments have tremendously increased the armamentarium of diagnostic and therapeutic approaches in children and young adults with pulmonary hypertension that is still associated with a high morbidity and mortality. These modalities include non-invasive imaging, pharmacotherapy, interventional and surgical procedures, and supportive measures. The optimal, tailored diagnostic and therapeutic strategies for pulmonary hypertension in the young are rapidly evolving but still face enormous challenges: Healthcare providers need to take the patient’s age, development, disease state, and family concerns into account when initiating advanced diagnostics and treatment. Therefore, there is a need for guidance on core and advanced medical training in paediatric pulmonary hypertension. The Association for European Paediatric and Congenital Cardiology working group “pulmonary hypertension, heart failure and transplantation” has produced this document as an expert consensus statement; however, all recommendations must be considered and applied in the context of the local and national infrastructure and legal regulations.

scholarly journals Renal risk profiling in newly diagnosed hypertensives in an urban population in Nigeria

1970 ◽  
Vol 19 (4) ◽  
pp. 2863-2873 ◽  
Author(s):  
Aderoju Gbadegesin ◽  
Oluyomi Okunola ◽  
Olugbenga Ayodele ◽  
Fatiu Arogundade ◽  
Abubakre Sanusi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Urban Population ◽  
Financial Burden ◽  
Urban Setting ◽  
High Morbidity ◽  
Newly Diagnosed ◽  
Risk Profiling ◽  
History Of ◽  
Analgesic Use ◽  
Control Study

Introduction: Hypertension is a cause and consequence of chronic kidney disease globally. The other factors that work in concert with hypertension to cause CKD are yet to be clearly elucidated. Studies have identified proteinuria, dyslipidemia, obesity, smoking and family history of CKD as renal risk factors. Due to the high morbidity and mortality associated with occurrence of CKD including the enormous financial burden involved in its management, the knowledge of prevention and understanding of the risk factors for development of CKD is highly essential. Therefore, Identifying well defined risk factors that display strong graded association with the occurrence and progression of CKD can help in elucidating potential targets for disease modification. Objective: The aim of this study was to determine the prevalence of renal risk factors and their impact on kidney function in newly diagnosed hypertensive Nigerians.Methods: This was a case control study of two hundred and fifty newly diagnosed hypertensive Nigerians recruited from two contiguous hospitals in an urban setting in south western Nigeria. Another group of two hundred and fifty apparently healthy age and sex matched normotensive Nigerians in the same community were recruited as controls.Results: Seventy (28%) of the newly diagnosed hypertensives had estimated glomerular filtration rate of less than 60ml/min, while 42.4% and 18.8% of the subjects and the controls had microalbuminuria respectively. The newly diagnosed hypertensives had significantly higher prevalence of analgesic use (86.4% versus 41.6%, p < 0.001), alcohol consumption (20.8% versus 12%, p = 0.008), use of canned salted food (18.8% versus 8.4%, p= 0.001) and central obesity (36.1% versus 26.8%, p= 0.025) compared to controls.Conclusion: There is a significant occurrence of modifiable renal risk factors in newly diagnosed hypertensives and this offers a platform for instituting preventive strategies in the community.Keywords: Renal risk, hypertensives, urban population, Nigeria.

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