AJOL - African Journals Online
Not a member yet
221688 research outputs found
Sort by
Effects of Roy's Adaptation Model on Quality of Life in People with Opioid Abuse under Methadone Maintenance Treatment: A Randomized Trial
No full textBACKGROUND፡ Opioid abuse is one of the most obvious problems in today's world and directly affects individuals' quality of life. The present study aimed to investigate the effects of Roy's adaptation model on the quality of life in people with opioid abuse under methadone maintenance treatment.METHODS: This randomized trial study was conducted in 2021 on 72 patients with opioid abuse under methadone maintenance treatment at the Center for Addiction Harm Reduction in Isfahan. The samples were randomly allocated into intervention (n=36) and control groups (n=36) based on the table of random numbers by computer. The intervention was conducted by implementing Roy's adaptation model in the intervention group. To analyze the data, paired t-test, independent sample t-test, chi-square test, and analysis of covariance were used.RESULTS: The mean ± standard deviation of the quality of life score in the intervention group (28.96±4.79) was significantly different than before the intervention (24.02±6.09) (P<0.001). At the same time, it was not significantly different in the control group. The mean ± standard deviation of the quality of life score in the intervention group (24.02±6.09) was not significantly different from the control group (20.55±8.53) before the intervention.CONCLUSION: Roy's adaptation model had positive effects on the quality of life score in patients with opioid abuse. On the other hand, patients' quality of life indicates the effectiveness of methadone maintenance treatment. Therefore, it is suggested to use this model in nursing care programs
Acne Vulgaris and Its Association with Dietary Habits at a Tertiary Care Hospital in Karachi, Pakistan
No full textBACKGROUND: Acne is a common skin disorder among younger age group. Dietary pattern are the key determinants among acne patients. The objective of this study is to determine the association of acne vulgaris with dietary habits among patients at tertiary care hospital in Karachi, Pakistan.METHODS: it is a cross sectional study and participants were selected through simple random sampling from outpatient department of tertiary care hospital in Karachi, Pakistan. Patients presenting with acne irrespective of severity and treatment were included in the study. Bivariate analyses conducted at 95% CI and p=<0.05 considered statistically significant.RESULTS: Females gender (62%) and family history (61%) was significantly associated with acne. Face region was most (92%) affected by acne. GI upset most common co-morbid illness with Acne (p=0.006). After adjustment of covariate, those consume oily food [Daily oily food; Twice a weekly oily food)]; sugar rich food [Daily consumed sugar; Twice a weekly consumed] and less glass of water [8-10 glass per day; 6-8 glass per day; less than 6 glass per] were significantly associated with acne.CONCLUSION: Study found that un-healthy diet is significantly associated with acne. Common dietary predictors for acne were frequent use of oily food, sugary food, and less amount of drink water
An Assessment of Ophthalmic Services in the Ashanti Region, Ghana
Full text linkPurpose: This survey was designed to assess the available ophthalmic service delivery units and the eye health promotion strategy in the Ashanti region of Ghana.
Methods: Twenty-four (24) eye care delivery units in 10 districts, randomly selected from the 43 in the Ashanti region, were assessed for this cross-sectional study, using a structured questionnaire adopted from the Questionnaire on Available Human Resources, Infrastructure and Equipment. The structured, pretested questionnaire was used to collect data from the most senior eye cadre in each of the facilities, with respect to the available human resources, infrastructure and service delivery. Thereafter the availability and implementation of eye health promotion tools were determined by interviewing district directors of health services and eye care cadres in the sampled districts.
Results: Of the sampled districts, 40% do not have any ophthalmic facilities operated by the Ghana Health Service (GHS) and three (30%) of the sampled districts also do not have any private ophthalmic service delivery units. All sampled eye care facilities were equipped with most of the basic, but essential, diagnostic and refraction equipment, including visual acuity charts, trial lens sets, trial lens frames and ophthalmoscopes. Fewer of the sampled facilities provided specialty services, such as contact lens services (20.8%), low vision services (8.3%), and binocular vision care (25.0%). None of the districts (100%) had a formalised eye health promotion and advocacy strategy.
Conclusion: In the Ashanti region of Ghana, there exists an uneven distribution of ophthalmic facilities; limited specialised ophthalmic services; insufficient eye care cadres; and very limited advanced diagnostic equipment. The ratio of eye care cadres to population lags behind the VISION 2020 target. Of the districts, 60% do not have public-funded eye clinics. There is no evidence of existing eye health promotion strategies at the district level in the Ashanti region of Ghana
Microsatellite instability in north Indian colorectal cancer patients and its clinicopathological correlation
Full text linkBackground: Colorectal cancer (CRC) is the third most deadly and fourth most commonly diagnosed cancer in the world. Microsatellite instability (MSI) has been found associated with CRC, especially in prognostication. The present study has been carried out to find the genetic instability as demonstrated by MSI and its clinicopathological correlation in north Indian patients.Methods: This prospective study was carried out on 103 CRC patients admitted for surgery between 2014 and 2018. MSI testing was done using 5-panel markers (BAT25, BAT26, D2S123, D5S346, and D17S250) by standard polymerase chain reaction (PCR) technique. The various clinicopathological factors were analysed to see their association with MSI status and also their effect on survival. Univariate analysis was performed by using the 2-tailed Student’s t-test for continuous non-normally distributed variables, and categorical variables were compared using the chi-square test. Multivariate correlation analysis was performed by logistic regression test using SPSS version 16.0 (IBM Corporation, Armonk, NY, USA). Kaplan–Meier analysis was done to detect the patient’s survival. A p-value < 0.05 was considered statistically significant.Results: The frequency of MSI in patient population that we studied was 41.7% (43/103). MSI tumours were significantly associated with family history (OR = 5.63, p = 0.022*, 95% CI = 1.1–28.6) and tumour-infiltrating lymphocytes (TILS) (OR = 2.60, p = 0.023*, 95% CI = 1.1–6.0). The patients surviving longer (< 5 years vs > 5 years) were found significantly associated with MSI-high (MSI-H) (OR = 3.76, p = 0.029*, 95% CI = 1.2–4.5).Conclusion: Family history of cancer and presence of TILS were significantly associated with the presence of SI-H tumours; also, patients surviving more than 5 years had more MSI-H phenotype
Immunohistochemical determination of mismatch repair gene product in colorectal carcinomas in a young indigenous African cohort
Full text linkBackground: Colorectal cancer (CRC) in the indigenous African population of South Africa is uncommon (age standardised incidence rates of 11.29 for males and 7.27/100 000 for females) and tends to occur at a young age. Lynch syndrome (LS), an inherited mismatch repair (MMR) gene abnormality, accounts for 3–4% of newly diagnosed CRCs in high incidence areas. There is some evidence that the contribution of an MMR abnormality to the overall CRC burden may be increased in low incidence areas. We aimed to determine the prevalence of MMR deficiency in an indigenous African population.Methods: A cohort of 66 self-declared indigenous African patients, less than 50 years of age at diagnosis with CRC was identified from clinical and pathological records. The original histopathology was reviewed to confirm the diagnosis and features suggestive of MMR abnormality determined (pushing edge, mucinous, lymphocytic infiltration, Crohn’s like reaction). Where sufficient tissue was available, samples were sectioned and stained for the four MMR proteins.Results: Histopathological examination confirmed adenocarcinoma in 31 individuals. At least one feature suggestive of MMR was identified in 22 of these specimens. Twenty-seven cases were stained for all four MMR proteins using standard immunohistochemistry (IHC). MMR deficiency was found in 37% (n = 10/27) of cases. Median age of diagnosis was 35 years in the MMR-proficient group and 44 years in the MMR-deficient group, p < 0.008. No other significant differences between the groups were noted.Conclusion: MMR deficiency was common in colorectal carcinomas in the older patients in this cohort, but very young indigenous Africans CRCs do not appear to result from mismatch repair gene mutations
Patient perceptions of surgical training in the private sector in South Africa – a single centre survey
Full text linkBackground: As the worldwide demand for specialist surgeons increases, and to complement surgical training provided through governmental institutions, private hospitals are increasingly hosting trainees. Wits Donald Gordon Medical Centre (WDGMC) is a private academic hospital in Johannesburg with a Colorectal Unit (CRU) that hosts several trainees. While published studies demonstrate that the involvement of trainees in surgery does not adversely impact outcomes, private patients' perceptions of the role of trainees in their care have not been as widely researched.Methods: This was a prospective, cross-sectional study using a self-administered questionnaire hosted on a REDCap database. Statistical analysis was performed using SPSS version 26.Results: One hundred and seventy-four patients participated in the study, and 74.1% of respondents felt that training of doctors should occur in private hospitals in South Africa. Of the sample, 83.3% would allow a supervised trainee to perform a part of their operation, provided they had been made aware of trainee participation in advance (78%). Sixty per cent of patients felt that interaction with a trainee enhanced their care, and 52.3% of patients suggested that seeing more than one doctor a day improved their experience.Conclusion: Our results suggest that privately funded patients support the surgical training of medical doctors in private academic training hospitals, and they are willing to be participants in the training process. Moreover, training programmes in this setting appear to enhance the patient experience. We are optimistic that these findings could be used to advocate for expanded training opportunities across the private sector in South Africa
An audit of trauma laparotomy in children and adolescents highlights the role of damage control surgery and the need for a trauma systems approach to injury in this vulnerable population
Full text linkBackground: This study reviews the indications and outcome of emergency laparotomy for paediatric trauma in a South African trauma centre.Methods: This was a retrospective study of all children less than 18 years of age who underwent an emergency laparotomy for trauma between December 2012 and October 2020 at Grey’s Hospital in Pietermaritzburg.Results: During the eight-year period under review, a total of 136 children of which 107 were male underwent a laparotomy for trauma. The median age was 14 years. There were 80 (57.1%) blunt mechanisms, and the rest were penetrating mechanisms. A total of 46 (33%) patients required ICU admission. Thirty-four patients developed a complication. These included nine cases of pneumonia, one case of renal failure, two patients developed abdominal collections, three woundrelated complications, three neurological complications and one miscellaneous complication. There were seven (5%) deaths. The penetrating cohort were older than the blunt cohort. Solid viscera were more likely to be injured in the blunt cohort and hollow viscera more likely in the penetrating cohort. A total of 16 (11%) patients underwent damage control surgery (DCS). Of this cohort, there were three female children. Six sustained blunt trauma and ten penetrating trauma. A total of six (37%) of these children died.Conclusion: Emergency laparotomy for trauma in children is not infrequent in Pietermaritzburg and there is a high incidence of penetrating trauma in this cohort. The response to increased degrees of physiological derangement is the application of DCS. Ongoing efforts to develop and strengthen a paediatric trauma service appear to be justified
Colorectal cancer in South Africa study on the effect of delayed diagnosis to treatment intervals on survival
Full text linkBackground: Data on colorectal cancer (CRC) diagnosis to treatment interval (DTI), an index of quality assurance in high-income countries (HICs) is lacking in South Africa. This study aimed to determine DTIs and their impact on CRC survival in a South African cohort.Methods: Participants (n = 289) from the Colorectal Cancer in South Africa (CRCSA) cohort were identified for inclusion. The DTI was defined as the duration between the diagnosis and initial definitive treatment and categorised into approximate quartiles (Q1–4). The DTI quartiles were 0–14 days, 15–28 days, 29–70 days, and ≥ 71 days. Overallsurvival (OS) was illustrated using the Kaplan–Meier method and compared between DTI groups using Cox proportional hazards (PH) regression.Results: There was no significant impact of the DTI (as quartiles) on overall CRC survival. The median length of time between DTI in this cohort was 29 days. Significant associations were identified between the DTI and self-reported ethnicity (p-value = 0.025), the site of the malignancy (colon vs rectum) (p-value < 0.0001), multidisciplinary team(MDT) review (p-value = 0.015) and the initial treatment modality (p-value < 0.0001).Conclusion: Prolonged DTIs did not significantly impact survival for those with CRC in the CRCSA cohort. Symptom to diagnosis time should be investigated as a determinant of surviva
Striking a balance between usability and quality control in electronic health records
Full text linkBackground: This project is the first formal usability review of the hybrid electronic medical registry (HEMR) since its implementation in 2012.Methods: A synchronous usability evaluation by novice operators was followed by a survey of veteran users. The usability evaluation was done by moderated think-aloud interview while completing tasks for a mock patient. The veteran survey was paper-based and focused on satisfaction of the system.Results: A total of 141 comments on system errors were identified by the novice doctors. These consisted of 123 unique problems, of which three were hardware faults and were thus excluded. The identified issues were categorised into errors of control (27%), minimalist (21%), error (17%), match (13%), flexibility, visibility and consistency (9% each), and history (4%). Every unique usability violation was evaluated by the three experts who agreed that 82 of the 141 errors (58%) were valid and applicable. The other 59 items were rejected, not only because of the inability to reproduce some errors or programme shortcomings, but also because a series of “hurdles” were purposely included in the software to decrease cognitive dissonance and reduce error by the users. The survey of veteran users showed high levels of contentment with the system with regards to efficiency, satisfaction and preference.Conclusion: Despite many usability complaints by novices, almost half of them were rejected. Although usability in electronic health systems is important, it can often be sacrificed for more imperative aims such as safety, error filtering and clinical decision support
Colonic perforation in a right atraumatic diaphragmatic hernia
Full text linkA 38-year female with no prior medical or surgical history presented with pleuritic pain and respiratory distress. Imaging revealed a right diaphragmatic hernia with colonic content. At right anterolateral thoracotomy, a diaphragmatic hernia containing a perforated right hemi-colon was found. The colon was resected in the chest and continuity restored via a laparotomy. This case illustrates the risk of obstruction, ischaemia and perforation and highlights the importance of early identification and prompt surgical management to reduce morbidity and mortality