Perioperative Fluid Management for Elective Major Surgery Patients at a Teaching Hospital in Rwanda

Background Every year, over 312 million surgical operations are performed globally. While perioperative goal-directed fluid strategy may reduce postoperative complications among patients undergoing major surgery, poor perioperative fluids management has been linked to adverse postoperative patients’ outcome. Methods This study used quantitative prospective design to assess the perioperative fluids management in 133 patients operated in the theatre of University Teaching Hospital of Butare (CHUB). The SPSS 21 was used to analyze the data, Chi-square test was performed to assess the association between fluid administered and patients’ hydration status with an acceptable cutoff at p<0.05. Results The findings showed that 108 (81.2%) and 25 (18.8%) participants were in dehydration class A and B before surgery and strongly associated with age, surgeries, type and amount of intraoperative fluids. Participants received RL and NS (67.7%), 2091.73 ml, +803.6 ml and lost 218.42+131.9 ml fluid in average. Postoperatively, 53.4% and 46.6% participants were in dehydration class A and B respectively, strongly associated with type and duration of surgery (P<0.05). All participants fasted more than 6 hours. Conclusion The dehydration rate increased intraoperatively in relation to type and duration of surgery and type and amount of fluid administered. Reduced fasting time and effective intraoperative fluid management would improve the patients’ hydration after surgery and postoperative patients’ outcome. Key words: Major Surgery, Elective Surgery, Perioperative care, Fluid management, patients

Download Full-text

Clinical and biological profiles of older adults aged 50 and over compared to those under 50 in people living with HIV attending Kinshasa University Teaching Hospital (DR Congo)

International Journal of Clinical Virology ◽

10.29328/journal.ijcv.1001040 ◽

2021 ◽

Vol 5 (2) ◽

pp. 087-095

Author(s):

Mbula MMK ◽

Longo-Mbenza B ◽

Situakibanza HNT ◽

Mananga GL ◽

Makulo JRR ◽

...

Keyword(s):

Blood Pressure ◽

Teaching Hospital ◽

University Teaching ◽

People Living With Hiv ◽

Chi Square ◽

Stage 4 ◽

History Of ◽

Student’S T ◽

Living With Hiv ◽

Student’S T Test

Background: The survival of people living with HIV (PLWHIVs) is increased and Health systems will have to deal with the early-aging-associated medical conditions. Objective: The objective of this study is to compare the clinical and biological profiles of PLWHIVs aged 50 and over and those aged less than 50 years. Material and methods: This study conducted at Kinshasa University Teaching Hospital (KUTH) covers 6 years. The clinical and biological characteristics of PLWHIVs aged 50 and over were compared with those under 50. Statistical analysis used the means ± SD, the calculation of frequencies, Student’s t-test and Chi-square. Results: PLWHIVs aged 50 or over represented 35.1%. Their average age was 58.0 ± 4.8 years. Women predominate among those under 50 and men among those 50 and over. Married people were more numerous (54% among those under 50). There were more unemployed (50% of PLHIV under 50). Patients 50 years and older were significantly classified as WHO stage 4 with a high frequency of history of tuberculosis, genital herpes, high blood pressure, smoking, vomiting, hepatomegaly, moderate elevation of diastolic blood pressure (DBP) and sytolic blood pressure (SBP), tuberculosis and anemia. Those under 50 had a significantly increased frequency of shingles, hepatitis B-hepatitis C, headaches and more survivals. The mean of Hb, HDL-C, and CD4s+ were significantly lower in patients 50 years and older, and urea, LDL-C, and ALAT levels were significantly higher. Conclusion: The average age was higher from 50 years old. These PLWHIVs were more frequently in WHO stage 4 with more common TB and anemia. Their Hb, HDL-C, and CD4s+ levels were lower while their urea, LDL-C and ALAT levels were significantly elevated.

Download Full-text

BioMed_Central_Tex_Template_v1.06 Exploration of Workplace violence experience among nurses at a selected University teaching Hospital in Rwanda

10.21203/rs.2.17448/v1 ◽

2019 ◽

Author(s):

Valens MUSENGAMANA ◽

Oluyinka Adejumo ◽

Gilbert BANAMWANA ◽

Marie Josée MUKAGENDANEZA ◽

Thimothée Shahidi TWAHIRWA

Keyword(s):

Teaching Hospital ◽

Workplace Violence ◽

Health Sector ◽

University Teaching ◽

World Health ◽

Research Approach ◽

International Labor Organization ◽

Chi Square ◽

Cross Sectional ◽

Health Organization

Abstract Background Workplace violence is a global problem in the health sector especially in the hospitals affecting healthcare works’ job satisfaction and performance. Workplace violence is present in different forms associated with various factors and the nurses are the most affected. The aim of this study was to explore workplace violence experience among nurses working at a selected University Teaching Hospital in Rwanda.Method The research approach used was quantitative descriptive cross-sectional design. The stratified random sampling was used to recruit 195 participants among 379 nurses. The data was collected using a structured, validated, and self-administered questionnaire that was adapted from the International Labor Organization, International Council of Nurses, World Health Organization and Public Services International. Descriptive statistics were used for analyzing frequencies and percentages. Chi-square test was used for evaluating the association between variables.Results The findings revealed that (58.5%, n=114) of nurses have experienced some types of WPV in the twelve months preceding the study, among them (44.6%, n=108) of nurses were verbally abused. The nurses providing emergency care, the nurses working at the emergency department and nurses working with vulnerable patients like HIV/AIDS patients were associated with workplace violence Chi-square (1, n=195), P=<0.001). The psychological problems has been found as the first consequences of workplace violence.Conclusions Based on the study findings, it was concluded that the hospital management needs to be aware of workplace violence, develop and implement appropriate policies and strategies. These strategies will strengthen nurses’ concentration towards their and will resulting in service delivery improvement.

Download Full-text

1385 “Pre-Op Fasting Times Audit in Colorectal Surgery at A University Teaching Hospital”

British Journal of Surgery ◽

10.1093/bjs/znab259.152 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

S Khan ◽

R Mohideen ◽

K Khan ◽

C Helbren

Keyword(s):

Colorectal Surgery ◽

Teaching Hospital ◽

Elective Surgery ◽

University Teaching ◽

Teaching Hospitals ◽

Hospital Data ◽

Elective Colorectal Surgery ◽

Operation Room ◽

Theatre Staff ◽

University Teaching Hospitals

Abstract Aim Hull University teaching hospitals NHS trust has guidelines for patient fasting times prior to major elective surgery. We aimed to assess the compliance of pre-op fasting times for patients undergoing elective colorectal surgery. Method An initial and later re-audit was undertaken, prospectively, of 20 consecutive patients admitted for elective colorectal surgery at Castle Hill Hospital. Data was collected on a structured proforma and was completed following patient’s interview, ORMIS (operation room system) and Lorenzo (hospital intranet). Results Initial audit demonstrated 10% (2 out of 20) and 5% (1 out of 20) compliance with liquid and solid fasting times, respectively. Following implementation of changes, re-audit demonstrated 60% (12 out of 20) and 0% (0 out of 20) compliance with liquid and solid fasting times respectively Conclusions We concluded that liquid fasting times can be improved further by communication between theatre staff and ward. Whilst solid fasting times can be improved but at an expense of losing a theatre space. A further re-audit [planned in a month period.

Download Full-text

Anaesthesia for abdominal surgery

10.1093/med/9780199642045.003.0061 ◽

2017 ◽

Author(s):

William J. Fawcett

Keyword(s):

Enhanced Recovery ◽

Elective Surgery ◽

Early Recognition ◽

Fluid Management ◽

Gastrointestinal Surgery ◽

Length Of Hospital Stay ◽

Anaesthetic Techniques ◽

Colorectal Metastases ◽

Major Surgery ◽

Variation In Care

Care of patients undergoing major gastrointestinal surgery has been revolutionized in the last decade. The widespread adoption of laparoscopic surgery has bought benefits but also new challenges. Anaesthetic techniques, particularly refinements in analgesic regimens and fluid management, have also brought benefits to patients. However, many more elderly and frail patients are undergoing major surgery which is a challenge in both expertise and resources. Anaesthesia for patients undergoing gastrointestinal surgery has evolved into a package of perioperative care, with the anaesthetist increasingly viewed as the perioperative physician. Anaesthetists are now involved not only within the operating theatre, but with assessing risk for patients, optimizing them prior to surgery, and supervising postoperative care and in particular early recognition and treatment of complications. Liver surgery has become routine for patients particularly with secondary colorectal metastases. Previously, 5-year survival was very rare in these groups of patients, but now approximately half of patients are alive at 5 years. Colorectal surgery has also been transformed and the enhanced recovery programme has typified the way in which many years of dogma have been challenged, to be replaced by evidence-based pathways. Overall, for major elective surgery, results have improved and in general, morbidity, mortality, complications, and length of hospital stay for patients have reduced. For emergency patients, although there have been improvements too, there is still widespread concern about high mortality and marked variation in care between centres.

Download Full-text

Correlation of postoperative fluid balance and weight and their impact on outcomes

Langenbeck s Archives of Surgery ◽

10.1007/s00423-020-02004-9 ◽

2020 ◽

Vol 405 (8) ◽

pp. 1191-1200

Author(s):

Fabio Butti ◽

Basile Pache ◽

Michael Winiker ◽

Fabian Grass ◽

Nicolas Demartines ◽

...

Keyword(s):

Weight Gain ◽

Postoperative Complications ◽

Fluid Balance ◽

Fluid Management ◽

Major Complication ◽

Major Surgery ◽

Weight Changes ◽

Entire Cohort ◽

Prolonged Length ◽

Duration Of Surgery

Abstract Introduction Normovolemia after major surgery is critical to avoid complications. The aim of the present study was to analyze correlation between fluid balance, weight gain, and postoperative outcomes. Methods All consecutive patients undergoing elective or emergency major abdominal surgery needing intermediate care unit (IMC) admission from September 2017 to January 2018 were included. Postoperative fluid balances and daily weight changes were calculated for postoperative days (PODs) 0–3. Risk factors for postoperative complications (30-day Clavien) and prolonged length of IMC and hospital stay were identified through uni- and multinominal logistic regression. Results One hundred eleven patients were included, of which 55% stayed in IMC beyond POD 1. Overall, 67% experienced any complication, while 30% presented a major complication (Clavien ≥ III). For the entire cohort, median cumulative fluid balance at the end of PODs 0–1–2–3 was 1850 (IQR 1020–2540) mL, 2890 (IQR 1610–4000) mL, 3890 (IQR 2570–5380) mL, and 4000 (IQR 1890–5760) mL respectively, and median weight gain was 2.2 (IQR 0.3–4.3) kg, 3 (1.5–4.7) kg, and 3.9 (2.5–5.4) kg, respectively. Fluid balance and weight course showed no significant correlation (r = 0.214, p = 0.19). Extent of surgery, analyzed through Δ albumin and duration of surgery, significantly correlated with POD 2 fluid balances (p = 0.04, p = 0.006, respectively), as did POD 3 weight gain (p = 0.042). Prolonged IMC stay of ≥ 3 days was related to weight gain ≥ 3 kg at POD 2 (OR 2.8, 95% CI 1.01–8.9, p = 0.049). Conclusion Fluid balance and weight course showed only modest correlation. POD 2 weight may represent an easy and pragmatic tool to optimize fluid management and help to prevent fluid-related postoperative complications.

Download Full-text

Coadministration of AYUSH 64 as an adjunct to Standard of Care in mild and moderate COVID-19: A randomised, controlled, multicentric clinical trial

10.1101/2021.06.12.21258345 ◽

2021 ◽

Author(s):

Arvind Chopra ◽

Girish Tillu ◽

Kuldeep Chaudhary ◽

Govind Reddy ◽

Alok Srivastava ◽

...

Keyword(s):

Teaching Hospital ◽

College Teaching ◽

Standard Of Care ◽

Time Frame ◽

University Teaching ◽

National Guidelines ◽

Open Label ◽

Chi Square ◽

Convenience Sample ◽

Randomised Controlled

Objectives: To compare the co-administration of an Ayurvedic drug AYUSH 64 as an adjunct to standard of care (SOC) and SOC for efficacy and safety in the management of COVID-19. Design: Multicentre, parallel efficacy, randomized, controlled, open-label, assessor blind, exploratory trial with a convenience sample. Patients followed to complete 12 weeks of study duration. Setting: COVID-19 dedicated non-intensive care wards at 1 government hospital, 1 medical college teaching hospital and 1 medical university teaching hospital Participants: 140 consenting, eligible, hospitalized adult patients suffering from mild and moderate symptomatic COVID-19 and confirmed by a diagnostic (SARS-CoV-2) RT-PCR assay on nasal and throat swab were randomized to SOC or SOC plus AYUSH 64. To be withdrawn if the disease becomes severe. Interventions: Two tablets of AYUSH 64, 500 mg each, twice daily after meals, and continued till study completion. SOC (symptomatic and supportive) as per national guidelines of India for mild and moderate disease. Main outcome measures: Time period to clinical recovery (CR) from randomization baseline and proportion with CR within 28 days time frame; CR defined in the protocol Results: 140 patients randomized (70 in each arm); 138 patients with CR qualified for analysis. Both groups were matched at baseline. The mean time to CR from randomization was significantly superior in AYUSH 64 group (95% CI -3.03 to 0.59 days); a higher proportion (69.7%) in the first week (p=0.046, Chi-square). No significant differences observed for COVID-19 related blood assays (such as D-Dimer). AYUSH 64 arm showed significant (p<0.05) superior persistent improvement in general health, quality of life, fatigue, anxiety, stress, sleep, and other psychosocial metrics. 1 patient on SOC required critical care. 48 adverse events (AE) reported in each group. Barring three SAE (in SOC), AE were mild and none were drug-related. 22 participants (8 on AYUSH) were withdrawn. No deaths were reported. Conclusions: AYUSH 64 hastened recovery, reduced hospitalization, and improved overall health in mild and moderate COVID-19 when co-administered with SOC under medical supervision. It was safe and well-tolerated. Further studies are warranted. Trial registration: The Clinical Trials Registry India Number CTRI/2020/06/025557 Funding: CCRAS, Ministry of AYUSH, Government of India

Download Full-text

Assessment of Caregivers’ Knowledge about Medications and Medical Conditions by Time of Discharge in the Paediatric Department at University Teaching Hospital of Zambia

University of Zambia Journal of Agricultural and Biomedical Sciences ◽

10.53974/unza.jabs.4.3.385 ◽

2020 ◽

Vol 4 (3) ◽

pp. 10-16

Author(s):

Paul Bowa ◽

Keyword(s):

Health Care Providers ◽

Teaching Hospital ◽

University Teaching ◽

Medical Conditions ◽

Care Providers ◽

Chi Square ◽

Level Of Education ◽

Paediatric Patients ◽

Paediatric Department ◽

Level Of Knowledge

Background: Discharge is a period of transition from hospital to home that transfer responsibilities from the inpatient health care providers to patients and primary Caregivers. The study assessed Caregivers’ Knowledge about medications and medical conditions by the time their paediatric patients are discharged. Methods: A Cross-Sectional Study was carried out at University Teaching Hospital, paediatric department in Lusaka city of Zambia. 369 Caregivers were assessed on level of knowledge about medical conditions and medications of their discharged paediatric patients using data collected by a Pre-Tested Interview administered questionnaire. A knowledge index was developed representing the number of correct answers. Chi-square test analysis was used to indicate the significance of the results. Results: Most Caregivers were married (78.8%),Parents (82.2%), Unemployed(57.7%) with Primary level of Education (45.5%).The study found that 35.5% were very knowledgeable,27.6% had average knowledge and 36.9 % were not knowledgeable about Medical conditions. 16.5% were very knowledgeable,35.5% were average knowledgeable and 48.5 were not knowledgeable about Medications. The overall knowledge about Medical condition and Medications was poor with only 11.9% very knowledgeable,35.5% average knowledgeable and 52.6% not knowledgeable. Study of Pearson Chi-square reviewed that there is a statistically significant association between Age(P=0.000), Gender(P=0.023), Duration of Hospital stay(0.000),of Education (0.000), Occupation (0.000) and Relationship of Caregiver (0.002) to Level of knowledge. Discussion: Generally, Caregivers were not knowledgeable about the medical conditions and medications of their paediatric patients. However, the study findings indicated that Caregivers were more knowledgeable about medical conditions than medications. Female parent Caregivers are more likely to be knowledgeable than male Caregivers. Similarly, those who stay longer in Hospital, with a high level of Education, and Health workers are likely to be knowledgeable.

Download Full-text

Knowledge and Acceptability of Human Papillomavirus Vaccination among Women Attending the Gynaecological Outpatient Clinics of a University Teaching Hospital in Lagos, Nigeria

Journal of Tropical Medicine ◽

10.1155/2017/8586459 ◽

2017 ◽

Vol 2017 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Kehinde S. Okunade ◽

Oyebola Sunmonu ◽

Gbemisola E. Osanyin ◽

Ayodeji A. Oluwole

Keyword(s):

Teaching Hospital ◽

Hpv Vaccination ◽

Relevant Information ◽

Hpv Infection ◽

Cross Sectional Study ◽

University Teaching ◽

Hpv Vaccines ◽

Chi Square ◽

Human Papillomavirus Vaccination ◽

Cross Sectional

Objectives. This study was aimed at determining the knowledge and acceptability of HPV vaccine among women attending the gynaecology clinics of the Lagos University Teaching Hospital (LUTH). Methods. This was a descriptive cross-sectional study involving 148 consecutively selected women attending the gynaecology clinic of LUTH. Relevant information was obtained from these women using an interviewer-administered questionnaire. The data was analysed and then presented by simple descriptive statistics using tables and charts. Chi-square statistics were used to test the association between the sociodemographical variables and acceptance of HPV vaccination. All significance values were reported at P<0.05. Results. The mean age of the respondents was 35.7±9.7 years. The study showed that 36.5% of the respondents had heard about HPV infection while only 18.9% had knowledge about the existence of HPV vaccines. Overall, 81.8% of the respondents accepted that the vaccines could be administered to their teenage girls with the level of education of the mothers being the major determinant of their acceptability (P=0.013). Conclusions. Awareness of HPV infections and existence of HPV vaccines is low. However, the acceptance of HPV vaccines is generally high. Efforts should be made to increase the awareness about cervical cancer, its aetiologies, and prevention via HPV vaccination.

Download Full-text

Awareness and prevention of anemia among pregnant women attending antenatal clinic at a University Teaching Hospital in Nigeria

Calabar Journal of Health Sciences ◽

10.25259/cjhs_22_2020 ◽

2020 ◽

Vol 4 ◽

pp. 20-26

Author(s):

Iyabo Yewande Ademuyiwa ◽

Sunday Joseph Ayamolowo ◽

Monisola Omoyeni Oginni ◽

Michael Oluwole Akinbode

Keyword(s):

Pregnant Women ◽

Teaching Hospital ◽

Antenatal Clinic ◽

Cross Sectional Study ◽

University Teaching ◽

Chi Square ◽

Cross Sectional ◽

Ethical Approval ◽

Chi Square Test ◽

In Pregnancy

Objectives: During pregnancy, the fetus requires iron for blood formation so does the mother, this increases the iron requirement which is higher than that of non-pregnant women. This study assessed the level of awareness and prevention of anemia among pregnant women attending the antenatal clinic at Lagos University Teaching Hospital (LUTH), Lagos, Nigeria. Material and Methods: A descriptive cross-sectional study was conducted among 182 pregnant women attending the antenatal clinic at LUTH in Lagos, Nigeria. A balloting system was done to select the respondents in the clinic that runs 4 times a week, with an estimated number of 70 pregnant women per clinic. Data were collected using a structured self-administered questionnaire and analyzed with the Statistical Package of the Social Sciences version 22. Descriptive and inferential statistics were used for analysis, Chi-square test was done for the association between the variables at P < 0.05 level of significance. Ethical approval was obtained from the Human Research Ethical Committee of LUTH with approval number (ADM/DCST/HREC/APP/2589). Informed consent was taken and respondents were reassured of the privacy and confidentiality of the information obtained. Results: The highest percentage (33.3%) of the respondents was within the range of 26–30 years with a mean age of 28.18 ± 0.84 years. Majority of the women had a good level of awareness of anemia (68.89%) and good overall practices (73.89%) of prevention of anemia in pregnancy. There was no significant relationship between the respondents’ level of awareness of anemia and its prevention (χ2 = 1.533, P = 0.216). Conclusion: The study has shown that even though awareness and prevention practices were good, there is a need to create more awareness among pregnant women and also to give adequate health education on prevention of anemia to produce favorable outcome in pregnancy for both the child and mother.

Download Full-text

Exploration of workplace violence among nurses at a selected University Teaching Hospital in Rwanda

10.21203/rs.2.18002/v2 ◽

2020 ◽

Author(s):

Gilbert Banamwana

Keyword(s):

Teaching Hospital ◽

Workplace Violence ◽

Health Sector ◽

University Teaching ◽

World Health ◽

International Labor Organization ◽

Chi Square ◽

Cross Sectional ◽

And Performance ◽

Health Organization

Abstract Background: Workplace violence is a global problem in the health sector especially in the hospitals affecting healthcare works’ job satisfaction and performance. Workplace violence is present in different forms associated with various factors and the nurses are the most affected. The aim of this study was to explore workplace violence experience among nurses working at a selected University Teaching Hospital in Rwanda.Method: There search approach used was quantitative descriptive cross-sectional design. The stratified random sampling was used to recruit 195 participants among 379 nurses. The data was collected using a structured, validated, and self-administered questionnaire that was adapted from the International Labor Organization, International Council of Nurses, World Health Organization and Public Services International. Descriptive statistics were used for analyzing frequencies and percentages. Chi-square test was used for evaluating the association between variables.Results: The findings revealed that (58.5%, n=114) of nurses have experienced some types of WPV in the twelve months preceding the study, among them (44.6%, n=108) of nurses were verbally abused. The nurses providing emergency care, the nurses working at the emergency department and nurses working with vulnerable patients like HIV/AIDS patients were associated with workplace violence Chi square(1, n=195), P=<0.001). The psychological problems has been found as the first consequences of workplace violence.Conclusions: Based on the study findings, it was concluded that the hospital management needs to be aware of workplace violence, develop and implement appropriate policies and strategies. These strategies will strengthen nurses’ concentration towards their and will resulting in service delivery improvement.

Download Full-text