Hydrocephalus Surgery in Touba City (Senegal): 0% infection Preliminary study about 20 cases

Introduction: Infection is the most common complication encountered after ventriculoperitoneal shunt. The AIMS of this study is to evaluate the effectiveness of antibiotic therapy with protocol in the prevention of post-operative infections after ventriculoperitoneal shunt in our city. Patients and methods: We retrospectively study 20 hydrocephalus cases in one year. They were operated through the classic VP Shunt insertion technique and with the protocol adopted for shunt implantation. They received antibiotic therapy for ten days. Results: In one year we operated 95 patients,20 (21%) cases were hydrocephalus. There were 7 males et 13 females (ratio:0,53) . The age of patients ranged from 15 days to 12 years and the average age was 13,5 months. The average consultation time was 5,6 weeks. Clinically the most common sign were anterior fontanelle tense (100%) , macrocrania (60%) ,vomiting (80%) and sunset eye sign (80%) . Brain CT-scan was performed in all patient,66% of patients had Transfontanelle Ultrasonography and anyone hadn’t performed MRI. All cases underwent surgical treatment. only ventriculoperitoneal shunt was performed and the standard technique protocol to minimize infection was done during surgery. All of them received ceftriaxone 100mg/kg/day for five days then oral relay by thiamphenicol 50mg/Kg/day for five days. The follow up was good no infection was found (0%). Conclusion: Establishing an aseptic protocol for the shunt is essential to reduce the rate of postoperative infections. This result becomes better when we make a combination of antibiotic therapy and protocol. We can achieve infection rates to zero or less than 1% in case of association

Integrating Telemedicine in Assisting Poison Center Service: Line Application

Objective: To characterize Line, a mobile chat application, usage in Ramathibodi Poison Center (RPC) for further improvement of toxicological consultation services. Materials and Methods: Retrospective data were retrieved from Line messages together with concurrently recorded cases in the RPC database for six months, between November 16, 2018 and May 15, 2019. Time of consultation, time to response, types of toxins, reasons for consultation, and delivered content were recorded. Results: Over six months, 12,686 consultations were made via the hotline with 1,181 cases that used Line as an adjunct with 1,301 conversations. Median response time was three minutes. The most common poisonings were pesticides with 525 contacts (40.4%), followed by pharmaceutical agents and animal toxins. Most requests were for treatment suggestions with 731 contacts (56.2%), followed by notifying case progression and substance or animal identification. Among 1,030 files sent by consultees, the most common were photos of substances and animals for identification. Among 997 responses, most RPC staff used Line as an adjunct for treatment suggestions at 659 times (66.1%), followed by substance or animal identification and providing diagnoses. Overall, 602 protocols were delivered. Conclusion: Ten percent of all consultations were accompanied by Line usage. Most contacts were about pesticides and for appropriate treatment. RPC also used Line to effectively deliver diagnoses and treatment and increase coverage nationally. Keywords: Telemedicine, Line, Application, Poison center

The Importance of Telemedicine in a Post COVID World

Telemedicine has found immense popularity, especially in a COVID-19 affected world. Its application shall improve the quality of health care provided to patients and help in time management as it help facilitates optimized referral systems which are based on the immediate/follow up needs of the patient, decision-making, reduction in patient’s waiting time as well as consultation time. This review is an effort to shed light on the main practical applications of teledentistry for emphasizing potentialities, problems, and applications of this relatively new branch in medicine. The paper also highlighted highlight the various aspects of telemedicine in relation to the healthcare sector, its advantages/disadvantages in a post COVID-19 world.

Eye-tracking analyses of physician face gaze patterns in consultations

Face gaze is a fundamental non-verbal behaviour and can be assessed using eye-tracking glasses. Methodological guidelines are lacking on which measure to use to determine face gaze. To evaluate face gaze patterns we compared three measures: duration, frequency and dwell time. Furthermore, state of the art face gaze analysis requires time and manual effort. We tested if face gaze patterns in the first 30, 60 and 120 s predict face gaze patterns in the remaining interaction. We performed secondary analyses of mobile eye-tracking data of 16 internal medicine physicians in consultation with 100 of their patients. Duration and frequency of face gaze were unrelated. The lack of association between duration and frequency suggests that research may yield different results depending on which measure of face gaze is used. Dwell time correlates both duration and frequency. Face gaze during the first seconds of the consultations predicted face gaze patterns of the remaining consultation time (R2 0.26 to 0.73). Therefore, face gaze during the first minutes of the consultations can be used to predict face gaze patterns over the complete interaction. Researchers interested to study face gaze may use these findings to make optimal methodological choices.

An Equity Analysis on the Household Costs of Accessing and Utilising Primary Health Care Services in Tanzania

Background: Direct and time costs of accessing and using health care may limit health care access, affect welfare loss, and lead to catastrophic spending especially among poorest households. To date, limited attention has been given to time and transport costs and how these costs are distributed across patients, facility and service types especially in poor settings. We aimed to fill this knowledge gap.Methods: We used data from 1407 patients in 150 facilities in Tanzania. Data were collected in January 2012 through patient exit-interviews. All costs were disaggregated across patients, facility and service types. Data were analysed descriptively by using means, medians and equity measures like equity gap, ratio and concentration index. Results: 71% of patients, especially the poorest and rural patients, accessed care on foot. The average travel time and cost were 30 minutes and 0.41USD respectively. The average waiting time and consultation time were 47 minutes and 13 minutes respectively. The average medical cost was 0.23 USD but only18% of patients paid for health care. The poorest and rural patients faced substantial time burden to access health care (travel and waiting) but incurred less transport and medical costs compared to their counterparts. The consultation time was almost similar across patients. Patients spent more time travelling to public facilities and dispensaries while incurring less transport cost than accessing other facility types, but waiting and consultation time was almost similar across facility types. Patients spent more time travelling to public facilities and dispensaries with less transport cost than accessing other facility types. Patients paid less amount in public than in private facilities. Postnatal care and vaccination clients spent less waiting and consultation time and paid less medical cost than antenatal care clients. Conclusions: Our findings reinforce the need for a greater investment in primary health care to reduce access barriers and cost burdens especially among the worse-offs. Facility’s construction and renovation and increased supply of healthcare workers and medical commodities are potential initiatives to consider. Other initiatives may need a multi-sectoral collaboration.

Non-traumatic abdominal surgical emergencies at the Communal Medical Center (CMC) of Matam, Conakry

Aim: The aim of the study was to bring the frequency and management of non-traumatic abdominal surgical emergencies back to the Matam communal medical center. Material and methods: This was a retrospective, descriptive three-year study (January 2016 to December 2018) which focused on the files of patients treated in the surgical department of the surgical medical center (CMC). By Matam, for a non-traumatic abdominal surgical emergency. Results: Non-traumatic abdominal surgical emergencies represented 49.98% compared to surgical pathologies. The average age was 31.36% with extremes of 10 and 75 years. A male predominance was noted with a sex ratio = 1.07. The average consultation time was 5.53 days. Abdominal pain was the main reason for consultation. Acute appendicitis and strangulated hernias were the most common and ultrasound was performed in 21 patients (5.05%) and unprepared abdominal x-ray was performed in 49 patients (11.89%). All cases were operated on urgently. The operative consequences were simple in 94.42%. We noted parietal suppurations in 2.18%, postoperative peritonitis in 2.43% of cases and 9 deaths. The mean hospital stay was 7.14 days. Conclusion: non-traumatic abdominal emergencies constitute a public health problem, the prognosis depends on the quality and the precocity of the patient's care.

The Control and Analysis of Hidden Performance Costs as a Result of Traffic Jam in Kampala Capital City

Hidden costs represent the economic impacts of dysfunctions that disrupt the management and functioning of companies and organizations in terms of working conditions, work organization, communication-coordination-consultation, time management, integrated training or strategic implementation. These costs are called hidden because they are generally not, or poorly taken into account by the traditional accounting systems of organizations. The measurements carried out by Iseor for more than forty years in 1,310 companies or organizations in 37 countries, show that the hidden costs represent in the order of € 15,000 to € 60,000 in loss of added value per person and per year according to the companies. They thus represent a gigantic endogenous source of added value, subject to knowing not only how to measure them, but also to put in place suitable methodologies to convert them into performance and self-finance survival and development strategies. Hidden costs do not appear in a company's information systems, general and cost accounting or budget. However, they allow the organization to understand some of its economic difficulties and to find levers for improving its performance. As they are neither measured nor monitored, hidden costs are not factored into business decisions. Such an omission leads to analyzes, erroneous interpretations and inappropriate decisions.

Implementing an Electronic Clinical Decision Support Tool Into Routine Care: A Qualitative Study of Stakeholders’ Perceptions of a Post-Mastectomy Breast Reconstruction Tool

Objective. To explore barriers and facilitators to implementing an evidence-based clinical decision support (CDS) tool (BREASTChoice) about post-mastectomy breast reconstruction into routine care. Materials and Methods. A stakeholder advisory group of cancer survivors, clinicians who discuss and/or perform breast reconstruction in women with cancer, and informatics professionals helped design and review the interview guide. Based on the Consolidated Framework for Implementation Research (CFIR), we conducted qualitative semistructured interviews with key stakeholders (patients, clinicians, informatics professionals) to explore intervention, setting characteristics, and process-level variables that can impact implementation. Interviews were transcribed, coded, and analyzed based on the CFIR framework using both inductive and deductive methods. Results. Fifty-seven potential participants were contacted; 49 (85.9%) were eligible, and 35 (71.4%) were enrolled, continuing until thematic saturation was reached. Participants consisted of 13 patients, 13 clinicians, and 9 informatics professionals. Stakeholders thought that BREASTChoice was useful and provided patients with an evidence-based source of information about post-mastectomy breast reconstruction, including their personalized risks. They felt that BREASTChoice could support shared decision making, improve workflow, and possibly save consultation time, but were uncertain about the best time to deliver BREASTChoice to patients. Some worried about cost, data availability, and security of integrating the tool into an electronic health record. Most acknowledged the importance of showing clinical utility to gain institutional buy-in and encourage routine adoption. Discussion and Conclusion. Stakeholders felt that BREASTChoice could support shared decision making, improve workflow, and reduce consultation time. Addressing key questions such as cost, data integration, and timing of delivering BREASTChoice could build institutional buy-in for CDS implementation. Results can guide future CDS implementation studies.

Indications and outcomes of the percutaneous nephrostomy at Urology-Andrology Teaching Hospital of CNHU-HKM in Cotonou

Background: The percutaneous nephrostomy constitutes a backup remedy allowing the derivation of urine and thus cancelling the emergency, while waiting for adequate etiological treatment. The objective of this study was to determine indications and outcomes of the percutaneous nephrostomy at Urology-Andrology Teaching Hospital of the National Centre Academic Hospital Hubert KOUTOUKOU MAGA (CNHU-HKM) of Cotonou. Methods: It was a retrospective study carried out from January 1st, 2016 to May 30, 2020. Results: The placement of nephrostomy tubes has been indicated in 15.26% of urine derivations for the obstruction of the upper urinary tract. The average age of patients was 54.85 years with extremes of 28 and 70 years. The two sexes are interested in the same proportion, 10 cases for each. The average consultation time is 31.4 days with the extremes of 5 and 90 days. The obstruction was bilateral in 19 cases on 20. The gynaecological cancers were majority with 9 cases follow-up of those of the colon (4 cases), of the bladder (3 cases) and of the prostate (3 cases). The drainage was unilateral in 18 cases out of 20. The mean blood creatinine rate is 145.52 mg/l with extremes of 10 and 436 mg/l. Blood creatinine rate was pathological in 19 of our patients; it has been ameliorated among patients having an elevated initial creatinine blood level but without reaching normal values in 18 out of 19 patients. The lowest rates of creatinine blood level have been reached after 10.33 days with extremes of 2 and 23 days. After the percutaneous nephrostomy, the surgical abstention has been decided in 13 cases, the dialysis had been done in 5 cases, the reimplantation + installation of the probe double J in 1 case and the chemotherapy in 1 case. The main reason of death of the patients having undergone the nephrostomy was the ionic disorders (13 cases out of 18) mainly the hyperkalemia and the hyponatremia followed of anemia (3 cases out of 18) and of the uremic coma (2 cases out of 18). The middle duration of hospitalization after the drainage was of 16.85 days, with extremes of 1 and 50 days. The death occurred at 18 out of 20 patients and the middle period of survival was 31.25 days with extremes of 1 to 60 days. Conclusion: The percutaneous nephrostomy remains the beneficial alternative for the derivation of the upper urinary tract instead of the double J installation. Popularization of percutaneous nephrostomy would reduce the morbidity and mortality linked to complications of obstructive syndrome of the upper urinary tract; hence the need for awareness for early urological consultation

Interventions using ‘heart age’ for cardiovascular disease risk communication: Systematic review of psychological, behavioural and clinical effects (Preprint)

BACKGROUND Cardiovascular disease (CVD) risk communication is a challenge for clinical practice, where doctors find it difficult to explain the absolute risk of a CVD event to patients with varying health literacy. Converting the probability to ‘heart age’ is increasingly used to promote lifestyle change in a more intuitive way, but a rapid review of biological age interventions found no clear evidence that they motivate behaviour change. OBJECTIVE We aimed to identify the content and effects of heart age interventions in more detail to better understand this finding. METHODS Systematic review of quantitative and qualitative studies presenting heart age interventions to adults for the purpose of CVD risk communication. The review was conducted in April 2020, and updated in March 2021. The Johanna Briggs risk of bias assessment tool was applied to randomised studies. Behaviour change techniques described in the intervention methods were coded using Michie et al.’s taxonomy. RESULTS From 7,926 results, 16 eligible studies were identified: 5 randomised online experiments, 5 randomised clinical trials, 2 mixed methods studies with quantitative outcomes and 4 with qualitative analysis. Direct comparisons between heart age and absolute risk in 5 online experiments included 5,514 consumers and found that heart age: increased positive/negative emotional responses (4/5 studies), risk perception (4/5 studies; but not necessarily more accurate) and recall (4/4 studies), reduced credibility (2/3 studies), and generally had no effect on lifestyle intentions (4/5 studies). One study compared heart age and absolute risk to fitness age, and found reduced lifestyle intentions for fitness age. When heart age was combined with additional strategies (e.g. in person/phone counselling) in applied settings for 9,582 patients, it improved risk control (e.g. reduced cholesterol and absolute risk) compared to usual care in most trials (4/5 studies) up to 1 year. However, clinical outcomes were no different when directly compared to absolute risk (1/1 study). Mixed methods studies echoed the outcomes in the randomised trials, but also identified consultation time and content as an important outcome, as well as differences between receiving an older heart age versus young/equal to current age. The heart age interventions described in these studies included a wide range of behaviour change techniques, and conclusions were sometimes biased in favour of heart age with insufficient supporting evidence. Risk of bias assessment indicated issues with all randomised trials. CONCLUSIONS This review found little evidence that heart age motivates lifestyle behaviour change more than absolute risk, but either format can improve clinical outcomes when combined with other behaviour change strategies. The label for the “heart age” concept can affect outcomes and should be pre-tested with the intended audience. Future research should consider consultation time and differentiate between older and younger heart age results. INTERNATIONAL REGISTERED REPORT RR2-10.1101/2020.05.03.20089938