scholarly journals OUTCOME OF PRIMARY REPAIR OF VESICOVAGINAL FISTULA (VVF)

2021 ◽  
Vol 12 (2) ◽  
Author(s):  
Muhammed khalid ◽  
Muhammad Hammad Hassan ◽  
Muhammad Asif ◽  
Qadeer Ahmad Tariq
Keyword(s):  
Vesicovaginal Fistula ◽  
Primary Repair ◽  
Preoperative Evaluation ◽  
Healthcare Delivery ◽  
Postoperative Management ◽  
Home Delivery ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Ureteric Orifice ◽  
Vesicovaginal Fistulas

BACKGROUND & OBJECTIVE:  Vesicovaginal fistula is one of the common gynecological problems faced by ladies in developing countries on account of certain significant lacunas in the healthcare delivery system and lack of awareness. The purpose of this study is to highlight our experience of primary vesicovaginal fistula repair. METHODOLOGY: It is a cross-sectional experimental study from February 2019 to February 2020. Nineteen consecutive patients having vesicovaginal fistulas up to 3 cm in size, single in number were included in the study while those having fistulas more than 3 cm, involving urethra, bladder neck, and ureteric orifice were excluded. After a detailed history, physical examination, laboratory workup, and cystoscopic examination under anesthesia, the fistulas were repaired. All information was noted on the pre-planned questionnaire for this purpose. RESULTS: There are around 63% of patients having fistula infratrigonal and the rest percentage on the supratrigonal area of the urinary bladder. The risk factor found hysterectomy in 32% of patients, unsupervised home delivery in 16% of patients, C-Section in 12% of patients, delivery by an untrained person in 26% of patients, induced miscarriages in 5% of patients, and other risk factors found in 12% patients. The 68% of patients managed through transabdominal and the rest 32% patients operated through the transvaginal approach. The surgery, either transabdominal or transvaginal, was successfully done in 84% of patients and failed in the rest of 16% of patients. CONCLUSION: Fistulas due to obstetric trauma were mostly preventable. The success of surgical repair was due to health professionals' expertise, the suitable decision about approach, method of repair, proper preoperative evaluation, and careful postoperative management.

scholarly journals Vesicovaginal Fistula (VVF): Success of primary repair.

2019 ◽  
Vol 26 (12) ◽  
pp. 2090-2094
Author(s):  
Robina Ali ◽  
Ghazala Niaz ◽  
Riffat Ehsan
Keyword(s):  
Vesicovaginal Fistula ◽  
Obstetric Fistula ◽  
Primary Repair ◽  
Tertiary Care ◽  
Home Delivery ◽  
Care Hospital ◽  
Fistula Repair ◽  
Operative Care ◽  
Ureteric Orifice ◽  
Quasi Experimental

Objectives: The main objective of this research is to determine success of primary repair of vesicovaginal fistula at tertiary care hospital. Study Design: Quasi Experimental. Setting: DHQ Hospital, Faisalabad, Obstetrics and Gynaecology Department. Period: From Mar 2015 to Mar 2017. Material & Method: 15 patients were enrolled by consecutive sampling and those having fistulas more than 4cm or involving ureteric orifice, bladder neck or urethra were excluded. After proper history examination, preliminary investigations and EUA, fistula repair was done. All information recorded on proposed proforma for this purpose. Results: Among all 15 patients, 10(66.7%) were having obstetric fistulas and 5(33.3%) were with non obstetric fistula. 07 (46.7%) had home delivery, 3(20%) had delivery at center by untrained persons, 3(20%) had hysterectomy by untrained surgeons i.e. 1(6.7%) for endometriosis, 1(6.7%) for multiple fibroids and 1(6.7%) for ovarian malignancy while 2(13.3%) patients had inducted miscarriages by midwives. 12 (80%) patients had subtrigonal and trigonal fistulas, so underwent transvaginal repair and rest 3(20%) had supratrigonal fistula so transabdominal repair was done. Success of repair was 93.3% (14) and 1 was complicated with failed fistula repair. Conclusion: Most fistulas encountered in this study were caused by obstetrics trauma and are preventable. In existing cases of vesicovaginal fistula, properly trained health professionals with impeccable evaluation, prudent decision about route and technique of repair and good post operative care are key points in success of surgical repair.  

scholarly journals The characteristics of patients with possible familial hypercholesterolemia—screening a large payer/provider healthcare delivery system

QJM ◽  
2019 ◽  
Vol 113 (6) ◽  
pp. 411-417 ◽  
Author(s):  
A Elis ◽  
M Leventer-Roberts ◽  
A Bachrach ◽  
N Lieberman ◽  
R Durst ◽  
...  
Keyword(s):  
General Population ◽  
Health Services ◽  
Familial Hypercholesterolemia ◽  
Chronic Kidney Disease Stage ◽  
Healthcare Delivery ◽  
Disease Stage ◽  
Study Cohort ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
History Of

Abstract Background Familial hypercholesterolemia (FH) is an under-diagnosed condition. Aim We applied standard laboratory criteria across a large longitudinal electronic medical record database to describe cross-sectional population with possible FH. Methods A cross-sectional study of Clalit Health Services members. Subjects who met the General Population MED-PED laboratory criteria, excluding: age <10 years, documentation of thyroid, liver, biliary or autoimmune diseases, a history of chronic kidney disease stage 3 or greater, the presence of urine protein >300 mg/l, HDL-C>80 mg/dl, active malignancy or pregnancy at the time of testing were considered possible FH. Demographic and clinical characteristics are described at time of diagnosis and at a single index date following diagnosis to estimate the burden on the healthcare system. The patient population is also compared to the general population. Results The study cohort included 12 494 subjects with out of over 4.5 million members of Clalit Health Services. The estimated prevalence of FH in Israel was found to be 1:285. These patients are notably positive for, and have a family history of, cardiovascular disease and risk factors. For most of them the LDL-C levels are not controlled, and only a quarter of them are medically treated. Conclusions By using the modified MED-PED criteria in a large electronic database, patients with possible FH can be identified enabling early intervention and treatment.

scholarly journals Exploring general practitioners’ perceptions about the primary care gatekeeper role in Indonesia

2020 ◽  
Author(s):  
Joko Mulyanto ◽  
Yudhi Wibowo ◽  
Dionne S. Kringos
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Work Experience ◽  
Healthcare Delivery ◽  
Care Facility ◽  
Personal Factors ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
And Performance

Abstract Background In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors. Methods We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors.Results GPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Conclusion GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.

scholarly journals Evaluation of Drug Use Patterns of Out Patient Attendees in a Tertiary Care Teaching Hospital in Dermatology and Venereology Department as a Tool to Promote Rational Prescribing

2014 ◽  
Vol 4 (1) ◽  
pp. 4-9
Author(s):  
Nushrat Noor ◽  
Md Jamal Uddin ◽  
Mohammad Afsan ◽  
Hafiza Akhter ◽  
Farhana Kabir
Keyword(s):  
Tertiary Care ◽  
Inappropriate Prescribing ◽  
Healthcare Delivery ◽  
Essential Medicine ◽  
Cross Sectional Study ◽  
World Health ◽  
Carbon Paper ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Prescribing Indicators

Background: Drug utilization studies are pre requisite for the formulation of drug policies. They offer useful methods for teaching and training in drug therapy and also identify the problems that arise from drug usage in healthcare delivery system and highlight the current approaches to the rational use of medicines. Objectives: The main objective of the prescription audit or evaluation was to measures for improving the prescription practices and to generate information on the core prescribing indicators proposed by the World Health Organization (WHO). Methods: This was a descriptive type of cross sectional study. The study was conducted in the Out Patient Department (OPD) of Dermatology & Venereology in a tertiary care private hospital, Dhaka, Bangladesh in between January and March’2012. A total of 300 prescriptions were obtained with the help of a pre-inserted carbon paper in a special format using WHO core prescribing indicators. Results: The average number of drugs per encounter was 3.8 and no single drug was prescribed by generic name. Use of antibiotic (56% of encounters) was frequent, but injection use (2.67% of encounters) was within the recommendation of WHO. The use of fixed drug combinations (FDCs) was 15.28% of prescribed drugs. Only 22.08% drugs were prescribed from national essential medicine list. Conclusion: The findings from the current study showed a trend towards inappropriate prescribing. DOI: http://dx.doi.org/10.3329/updcj.v4i1.21158 Update Dent. Coll. j: 2014; 4 (1): 04-09

scholarly journals A Study on Different Surgical Methods used for Repair of Vesicovaginal Fistulas in Dhaka Medical College Hospital

1970 ◽  
Vol 22 (1) ◽  
pp. 12-14
Author(s):  
Rhea Homaira ◽  
Sabera Khatun ◽  
Fahmida Zabin
Keyword(s):  
Vesicovaginal Fistula ◽  
Cross Sectional Study ◽  
Medical College Hospital ◽  
Previous Attempt ◽  
Modified Technique ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Surgical Methods ◽  
Vesicovaginal Fistulas

This cross sectional study was carried out on hundred patients of vesicovaginal fistula who were admitted and underwent surgical treatment in Dhaka Medical college Hospital (DMCH), Dhaka, during the period of January, 2001 to June, 2003. The aim of this study was to obtain the outcome of the different methods of repair of different types of vesicovaginal fistula. An in-depth interview was taken from patients by using an open ended questionnaire. Necessary information about the procedure applied, together with results of operation were recorded in the data sheet. The result of this study showed that the anatomical success in closure of fistula occurred in 94% cases. In 38% of cases the size of the fistula were small in size, in 49% cases location were at the Junction of bladder neck, 78% of cases experienced no postoperative complications. Route of operation were vaginal in 84% cases. Previous attempt of repair were in 62% cases whereas in 38% women had history of operation. Obstetric vesicovaginal fistula is a curable condition. The success rate has been increased over time. More complicated cases which have been failed in previous attempts of repair are being referred. Most of the unsuccessful repair were bad cases (2%). So more training and experience of surgeons for repair of fistulas, employing modified technique wherever applicable can improve the result. DOI: 10.3329/medtoday.v22i1.5598 Medicine Today Vol.22(1) 2010. 12-14

scholarly journals Morbidity profile and prescription audits using WHO core prescribing indicator in government hospitals of Province 1, Nepal

2021 ◽  
Vol 3 (2) ◽  
pp. 15-22
Author(s):  
Shambhu Shah ◽  
Prasanna Dahal ◽  
Anil Kumar Sah ◽  
Surya B. Parajuli ◽  
Naveen Shrestha
Keyword(s):  
Metabolic Diseases ◽  
Healthcare Delivery ◽  
Circulatory System ◽  
Essential Medicine ◽  
Cross Sectional Study ◽  
World Health ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Essential Medicine List ◽  
Tertiary Hospitals

Background: Periodic assessment of morbidity and drug use at various levels of healthcare delivery system is important to recognize common prevalent morbidities and rationalize the use of medicines. The study was conducted to determine the common morbidities and audit prescription using WHO prescribing indicator in government operated tertiary hospitals of eastern Nepal. Methods: A cross-sectional study was carried out in government tertiary hospitals of Province 1, Nepal, from March 2019 to August 2019. For analysis, descriptive statistics were used.  Prescribing characteristics were evaluated using recommended guidelines of the World Health Organization (WHO) prescribing indicators. Results: Six hundred prescriptions were analyzed. The most prevalent morbidity was endocrine, nutrition & metabolic diseases (21.5%) followed by diseases of the respiratory system (19.8%), circulatory system (17.6%), and digestive system (12.8%). The most frequently encountered individual disease entity were hypertension (18.7%), diabetes (15.5%), acid peptic disorders (14%). A total of 2072 drugs were prescribed with an average of 3.45 (± 1.39) drugs per consultation. About 30.2% of prescriptions encountered contain at least one antibiotics, whereas injectable were prescribed in 1.8%. Only 3.9% of total medicines were prescribed in generic name and 31.7% of drug prescribed were from essential medicine list. Conclusion: Among the prescriptions evaluated, diseases of the endocrine, respiratory, cardiovascular, and gastrointestinal systems were the most common morbidities. Polypharmacy was prevalent to some extent whereas prescribing in generic and essential medicine list was poor relative to standard WHO recommendations. However, the overall prescribing of antibiotics and injection were found to be satisfactory.

scholarly journals Physiotherapists’ perceptions of and willingness to use telerehabilitation in Kuwait during the COVID-19 pandemic

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah Ibraheem Albahrouh ◽  
Ali Jasem Buabbas
Keyword(s):  
Data Analysis ◽  
Healthcare Delivery ◽  
Health Sector ◽  
Structured Interviews ◽  
Healthcare Delivery System ◽  
Cross Sectional Survey ◽  
Chi Square ◽  
Cross Sectional ◽  
Suitable Alternative ◽  
Willingness To Use

Abstract Background Telerehabilitation has been considered a suitable alternative healthcare delivery system during the COVID-19 outbreak, and many studies have promoted its feasibility in delivering physical care to patients who live with pain and disability. Physiotherapists’ perceptions and willingness are two key factors that influence the provision of remote physiotherapy. Aim To investigate physiotherapists’ perceptions of and willingness to use telerehabilitation in Kuwait during the COVID-19 pandemic and to explore the barriers that may hinder the use of telerehabilitation in this sector. Methods The following methods were used: (1) a cross-sectional survey and (2) face-to-face semi-structured interviews. In the cross-sectional survey, an electronic questionnaire was sent to 747 physiotherapists who were working in the governmental health sector. The questionnaire included four sections: perceptions of telerehabilitation, comfort with technology, willingness to use telerehabilitation, and barriers to using telerehabilitation. Six interviews were conducted with physiotherapy managers to explore the barriers and facilitators of telerehabilitation practice. Data analysis In this study, descriptive data analysis was conducted, and a cross-tabulation technique was used to find the associations between the variables, in which chi-square tests were used to identify the significance of the results, where p < 0.05. Thematic content analysis was used for the interviews. Results Only 273 completed questionnaires were received, giving a response rate of 36.5%. Most of the respondents (237; 86.8%) considered telerehabilitation a viable option to deliver healthcare to patients during the COVID-19 pandemic. In spite of the lack of information and communication technology (ICT) (156; 57.1%), 89% (243) of the respondents were willing to integrate telerehabilitation into their conventional practice, as cultural and social norms were not against the use of telerehabilitation systems. The results indicate that the more the physiotherapists used the internet and email in their work and the more comfortable they were with technology, the more willing they were to use telerehabilitation systems (p = 0.01). The physiotherapy managers reported that patients’ privacy and the confidentiality of their data were considered barriers. Conclusion In Kuwait, physiotherapists show overall positive perceptions towards and a willingness to use telerehabilitation to facilitate patients’ access to physiotherapy services. There are several barriers to employing telerehabilitation. Accordingly, recommendations are suggested.

scholarly journals Assessment of infrastructure of first referral unit facilities in Surguja division: a responsibility of providing emergency obstetric care

2019 ◽  
Vol 6 (12) ◽  
pp. 5168
Author(s):  
Abha Ekka ◽  
Shubra A. Gupta ◽  
Divya Sahu ◽  
Anmol Madhur Minj ◽  
G. P. Soni
Keyword(s):  
Healthcare Delivery ◽  
Essential Medicine ◽  
Emergency Obstetric Care ◽  
Obstetric Care ◽  
Cross Sectional Study ◽  
Civil Infrastructure ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
Physical Infrastructure ◽  
Maternal And Newborn

Background: Availability of emergency obstetric care (EmOC) is one of interventions to reduce maternal and newborn deaths. The health system fails when effective and affordable health interventions do not reach the population, when Poor infrastructure, drugs and equipment are lacking, and qualified human resources are scarce. The objective of the present study was to assess the availability of EmOC infrastructure in first referral units (FRUs) of Surguja division, Chhattisgarh.Methods: A cross sectional study was designated with 13 FRUs of Surguja division. A semi structured, closed-ended questionnaires was observed on the basis of check list, reviewing record, and interview by available staff.Results: FRUs of Surguja division for physical infrastructure scored 68.5%, for essential medicine 69.2%, for equipments 50.7%, for instruments 45.3% and for availability of blood 34.6%, for health man power category of specialist score was 25.7% but for supportive staff 65.4%.Conclusions: Our study revealed three existing bottlenecks in the healthcare delivery system as inadequate civil infrastructure, short fall of specialists as well as inadequate supplies of drugs and equipment, hampering the function of facility.

scholarly journals Exploring General Practitioners’ Perceptions About the Primary Care Gatekeeper Role in Indonesia

2020 ◽  
Author(s):  
Joko Mulyanto ◽  
Yudhi Wibowo ◽  
Dionne S. Kringos
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Work Experience ◽  
Healthcare Delivery ◽  
Care Facility ◽  
Personal Factors ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
And Performance

Abstract Background In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors. Methods We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors.ResultsGPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Conclusion GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.

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