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Potential of ketofol to provide adequate sedation and analgesia in women undergoing manual vacuum aspiration in emergency department at the University Teaching Hospitals, Lusaka, Zambia
Get PDFThesisDiagnosis of abortion in Zambia relies on clinical findings coupled with ultrasound examination. The treatment of choice in the first trimester is manual vacuum aspiration (MVA). Reducing the physical pain and anxiety during MVA is the ultimate goal of management for which, several drugs have been used solely or in combination to try to alleviate the pain associated with the procedure with variable results. However, the aspect of anxiety, which is a crucial aspect of care, is not adequately taken care of and perhaps raises ethical issues around performing MVA under local anaesthesia in emotionally vulnerable miscarrying women.
A previous study done at University Teaching Hospital (UTH), Lusaka, Zambia showed that more than 90% of women undergoing MVA experience severe pain, despite receiving preoperative analgesics such as Paracetamol, Ibuprofen and Morphine. Ketofol sedation has not been tried in MVA in our setting in spite of successfully producing adequate sedation action for many short painful procedures.
A pre-post interventional study with historical controls was conducted as a quality improvement study at UTH in the Department of Gynaecology to explore the potential of Ketofol sedation to provide adequate sedation and analgesia in women undergoing MVA. Pain scores were recorded using a Faces Pain Scale during the procedure (reported immediately after the procedure), at 10 minutes and at 60 minutes. During the procedure, sedation scores were determined using Ramsay Sedation Scale as well measuring heart rates and oxygen saturation. Time to discharge was also measured.
A total of 94 women were studied; 54 patients who received UTH standard care in the previous study (oral Paracetamol 1g, Ibuprofen 400mg and Morphine 30mg) and 40 patients who received Ketofol sedation in addition to the UTH standard care which the patients in the historical group also received. Data from 2015 included 54 (57.4%) women who received UTH standard care (oral Paracetamol, Ibuprofen and Morphine). In the current study Ketofol sedation was administered in addition to standard care to 40 women during MVA. There was no statistical difference in all baseline characteristics of participants in both groups; p value >0.05. Pain scores were measured during the procedure (reported immediately afterwards), at 10 minutes and 60 minutes after the procedure. Women in the standard care group reported significantly higher pain scores, median 10 (IQR,8-10) compared to women in the Ketofol group median 2 (IQR 0–2); p<0.001 during the procedure, and also reported more pain at 10 minutes after the procedure however, there was no statistically significant difference in pain recorded at 60 minutes after the procedure. It was further noted that patients in the Ketofol group had significantly lower heart rates during the procedure. addition to this, it was noted, contrary to expectations, that the time to discharge was reduced in the Ketofol group compared to the standard care group, potentially due to reduced pain experienced.
In conclusion, the results suggest that addition of Ketofol sedation to the current UTH standard of care reduced procedural pain experienced during MVA compared to standard care alone as well as producing effective sedation and rapid recovery.
Keywords: Miscarriage, Manual Vacuum Aspiration, Sedation, Ketofo
Potential of ketofol to provide adequate sedation and analgesia in women undergoing manual vacuum aspiration in emergency department at the University Teaching Hospitals, Lusaka, Zambia
No full textThesisDiagnosis of abortion in Zambia relies on clinical findings coupled with ultrasound examination. The treatment of choice in the first trimester is manual vacuum aspiration (MVA). Reducing the physical pain and anxiety during MVA is the ultimate goal of management for which, several drugs have been used solely or in combination to try to alleviate the pain associated with the procedure with variable results. However, the aspect of anxiety, which is a crucial aspect of care, is not adequately taken care of and perhaps raises ethical issues around performing MVA under local anaesthesia in emotionally vulnerable miscarrying women.
A previous study done at University Teaching Hospital (UTH), Lusaka, Zambia showed that more than 90% of women undergoing MVA experience severe pain, despite receiving preoperative analgesics such as Paracetamol, Ibuprofen and Morphine. Ketofol sedation has not been tried in MVA in our setting in spite of successfully producing adequate sedation action for many short painful procedures.
A pre-post interventional study with historical controls was conducted as a quality improvement study at UTH in the Department of Gynaecology to explore the potential of Ketofol sedation to provide adequate sedation and analgesia in women undergoing MVA. Pain scores were recorded using a Faces Pain Scale during the procedure (reported immediately after the procedure), at 10 minutes and at 60 minutes. During the procedure, sedation scores were determined using Ramsay Sedation Scale as well measuring heart rates and oxygen saturation. Time to discharge was also measured.
A total of 94 women were studied; 54 patients who received UTH standard care in the previous study (oral Paracetamol 1g, Ibuprofen 400mg and Morphine 30mg) and 40 patients who received Ketofol sedation in addition to the UTH standard care which the patients in the historical group also received. Data from 2015 included 54 (57.4%) women who received UTH standard care (oral Paracetamol, Ibuprofen and Morphine). In the current study Ketofol sedation was administered in addition to standard care to 40 women during MVA. There was no statistical difference in all baseline characteristics of participants in both groups; p value >0.05. Pain scores were measured during the procedure (reported immediately afterwards), at 10 minutes and 60 minutes after the procedure. Women in the standard care group reported significantly higher pain scores, median 10 (IQR,8-10) compared to women in the Ketofol group median 2 (IQR 0–2); p<0.001 during the procedure, and also reported more pain at 10 minutes after the procedure however, there was no statistically significant difference in pain recorded at 60 minutes after the procedure. It was further noted that patients in the Ketofol group had significantly lower heart rates during the procedure. addition to this, it was noted, contrary to expectations, that the time to discharge was reduced in the Ketofol group compared to the standard care group, potentially due to reduced pain experienced.
In conclusion, the results suggest that addition of Ketofol sedation to the current UTH standard of care reduced procedural pain experienced during MVA compared to standard care alone as well as producing effective sedation and rapid recovery.
Keywords: Miscarriage, Manual Vacuum Aspiration, Sedation, Ketofo
An assessment of dust exposure levels and factors associated with the occurrence of respiratory symptoms among workers in the road construction industry in Lusaka, Zambia
Get PDFThesisResearch into dust exposure in the road construction industry and the prevalence of respiratory
symptoms in Zambia has not been extensively conducted despite the respiratory symptoms
forming the primary burden of occupational illnesses in Zambia. The absence of literature in this
industry on occupational respiratory health symptoms and database for these workers formed the
rationale for this present study.
This study assessed respirable dust exposure levels and factors associated with the occurrence of
occupation respiratory health symptoms in Lusaka district (n=145). A cross sectional survey
among road construction workers, conducted at three road construction sites; (Lusaka-Chisamba),
(Lusaka- Kafue) and (Matero - Lilanda) roads. Personal dust samplers were used to assess the dust
exposure levels and an adapted American thoracic health questionnaire was used to capture
respiratory symptoms and factors associated with the occurrence of respiratory health symptoms.
Spirometry test was also used to determine the lung function capacity of the road construction
workers. Fisher’s exact test was used to test for bivariate associations and logistic regression was
used for crude and adjusted multivariate analysis between social demographic factors, job
category, cumulative respirable dust, use of PPE, smoking and years exposed.
The prevalence of respiratory symptoms was nose irritation (59.3%), wheezing (45%) phlegm 29%
and shortness of breath (39.3%).The mean respirable dust exposure level was 1.768mg-yr/m3.
Exposure to a cumulative respirable dust concentration of ≥1.768mg-yrs/m3 was significantly
associated with shortness of breath (OR 1.317; 95% CI; 0.125-0.802), (p-value (0.015). On factors
associated with the occurrence of respiratory symptoms, education levels (tertiary education) was
significantly associated with nose irritation (OR 0.257,95%CI; 0.076-0.862), (p-value 0.028) and
job category (land clearing works) (OR 2.382; 95% CI;0.159-0.919), (P-value 0.032).The non-use
of personal protective equipment by workers was significantly associated with respiratory
symptom phlegm (OR 1.256, 95% CI;3.526-3.384), (p-value (0.007) and wheezing (OR
3.775,95% CI; 1.416-1.958), (p-value 0.008). The spirometry test results showed that 96% of the
road construction workers had normal lung function, while only 4% of the workers had mildly to
moderate lung impairment with the force expiratory volume ratio (FEV1) between 60% - 79%.
It is therefore, recommended that dust control measures be put in place at road construction sites in
order to prevent dust exposure and the occurrence of respiratory symptoms and diseases.
Key words: Dust Exposure, Factors Associated, Respiratory Symptoms, Prevalence and Use of
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Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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