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THIRTY DAY MORTALITY AND RELATED VARIABLES IN OPEN HEART PATIENTS AT THE KENYAT'TA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To determine the thirty-day mortality of open-heart patients at the KenyattaNational Hospital in Nairobi from June 1973 to October 2000 and; to look at likely variablesrelated to mortality.Design: A retrospective analysis of data from the unit database. Data on this database werecollected prospectively from September 1997 to the time of study. Data in respect of theperiod prior lto this were collected retrospectively from patient files, ward and theatrerecords.Setting: Kenyatta National Hospital (KNH), Nairobi.Patients: A total of 563 open-heart patients operated at the KNH were included in the study.Results: The thirty-day mortality rate calculated at 17.4% for the study period compared toa hospital mortality rate of 16.9 %.Surgical repair for complex congenital pathology, surgeryon patients with, a left atrial (LA) dimension or a left ventricular end systolic dimension(LVESD) greater than 5 cm orland a cross clamp time greater than 60 minutes all had asignificantly g,reater risk of mortality on bivariate analysis. This is compared to surgery forsimple hole in the heart, LA and LVESD dimensions less than 5cm and cross clamp times lessthan 60 minutes (pc0.05). The increased risk of mortality with these variables was 3.33,3.95,3.18 and 1.8 times greater than their counterparts, respectively. For patients having surgeryfor an acquired pathology, only a cross clamp time greater than 60 minutes and a left atrialsize greater than 5cm were independent risk factors for thirty day mortality using logisticregression an:alysis. For patients having surgery for correction of a congenital defect, only across clamp time of more than 60 minutes was an independent predictor of mortality(p < 0.05).Conclusions: The higher mortality rate is amongst others, probably related to the latepresentation of our patients for surgery when their myocardial function is below theoptimum for surgery. There is a need to bring down the mortality through more stringentpatient selection, preoperative preparation and reduction of surgical ischaenlic times,however without depriving the patients in need of surgery
WARFARIN-RELATED BLEEDING FOLLOWING OPEN HEART SURGERY IN NAIROBI
No full textObjectives: To review anticoagulant-related bleeding in heart valve patients on warfarin atthe Kenyatta National Hospital and to determine the variables associated with anticoagulantrelatedbleeding.Design: A combined retrospective and prospective review of patients operated at theKenyatta National Hospital. Retrospective period from June 1973 to 31st July 1997, whileprospective period from August 1st 1997 to June 1st 2000.Setting: Surgical Outpatient Department, Kenyatta National Hospital, Nairobi.Main outcome measures: Linearised occurrence rate of anticoagulant-related bleeding andthe one- five- and ten- year bleed free rates. Independent risk factors associated withanticoagulant-related bleeding determined using Cox's proportional hazards.Results: Thirty one bleeding episodes were recorded in 150 patients followed up for a totalof 745 patient-years. The risk of occurrence of the first bleed was 16.0% ; while the risk of asubsequent bleed increased thereafter with a 16.7%, 50% and 50% riskafter the first, secondand third bleeds respectively. The linearised rate for minor anticoagulant-related bleed was4.16% per patient per year however, half the bleeds occurred within the first year of valveimplantation or previous bleeding episode. The one-, five- and ten- year bleed free rates forall valves combined were 93%, 85% and 78% respectively. There was no statisticallysignicant difference between the curves comparing the bleed free rates for the first andsecond bleeding episodes (p=0.098). The number of valves implanted, the site of implant andthe time to the occurrence of bleeding were independent risk factors associated with theoccurrence of bleeding (p<.05).Conclusion: The occurrence of anticoagulant-related bleeding is relatively common beingslightly above theinternationally reported range. Most episodes of bleeding will occur withinone year of hospital discharge or the previous bleeding episode. The riskof another bleedingepisode occurring increases with each episode with up to a 50% risk of re-bleed after thesecond bleeding episode. In this study, the number of valves implanted, their position and thetime of occurrence of the bleed were risk factors to the occurrence of bleeding
FOLLOW UP OF OESOPHAGEAL CANCER THERAPY AT THE KENYATTA NATIONAL HOSPITAL, NAIROBI
No full textObjective: To determine the pattern of follow-up for oesophageal cancer patients followinghospital discharge and reviewing followup results of the differctnt treatment modalities withemphasis on oesophagectomies.Design: A retrospective hospital based study covering the per od January 1987 to January2001.Setting: Surgical outpatient clinic, Kenyatta National Hospital, Nairobi.Main outcome measures: Determination and the comparison of the one, two and three-yearfollowup rates for the different treatment modalities and theil. median follow-up period inaddition to reviewing the common variables associated with fc~llow-up.Results: The median followup for patients managed by oesopha gectomy was 9.5 months witha 43%, 22% and 10% one-. two- and three-year followup rates respectively. This comparedto a median of two months and a 7% and 3% one-, and two- yeir follow-up rate for patientsmanaged by intubation, and a 3-month median followup with a one- and two- year followuprate of 12% and 4% respectively for radiotherapy treatetl patients. Oesophagectomypatients had a better followup compared to intubations and radiotherapy (pc.00001).Oesophagectomy for stage T4 tumours had an apparently better follow-up compared to bothstage TI-3 tumours and patients managed with intubations (p =.002 and .02 respectively)
WEIGHT CHANGE POST OESOPHAGECTOMY FOR CARCINOMA OF OESOPHAGUS
No full textABSTRACTObjective: To determine the pattern of weight changes observed in postoperative oesophagectomypatients at the Kenyatta National Hospital and evaluating weight change with selected preoperativevariables.Design: A prospective analysis of post-operative weight change of patients following oesophagectomyutilising body mass index (BMI).Setting: The cardiothoracic unit, Kenyatta National Hospital.Subjects: All patients with oesophageal cancer, with a confirmed histological diagnosis of squamouscell carcinoma and discharged post oesophagectomy.Interventions: Oesophagectomy.Main outcome measure: Changes observed in the BMI during respective clinic visits.Results: Fifty nine patients were enrolled into the study with a mean preoperative weight of50.4 kilograms and mean BMI of 19.4 kg/m2 (± 4.3). Sixty seven point seven percent of patientspreoperatively fell into the underweight category (less than 20kg/m2); normal were 16 patients(27.1%) and overweight included six patients (10.2%). Postoperatively the majority of patientscontinued to loose weight and the overall average BMI at the study endpoint was calculated as18.0 kg/m2 (± 3.2). This value was significantly lower compared with the preoperative value (p =0.004). None of the selected variables showed a significant relationship to the postoperative weightchange pattern observed, though the patients gaining weight postoperatively had an apparentlybetter survival pattern compared to the others. Analysis of the selected variables versus weightchange pattern (gain, stable or weight loss) showed no significant relationships.Conclusion: This study population presented a lower initial preoperative weight compared tosimilar studies from the developed world, with the majority being underweight. The majority ofpatients exhibited a continued postoperative weight loss with only a small number showing anyweight gain. The study unfortunately was not able to demonstrate association of weight changewith any of the selected variables
RACHS - l SYSTEM IN RISK STRATIFICATION FOR CONGENITAL HEART DISEASE SURGERY OUTCOME
No full textBackground: The Risk Adjustment in Congenital Heart Surgery (RACHS-1) system has been used as a benchmark to compare surgical results in developed countries. Its ability to stratify postoperative mortality risk has been validated in several developed countries, however, this has not been examined in a developing country.Objectives: To assess the ability of the RACHS-1 system to stratify postoperative mortality risk in a developing country.Design: Retrospective study over a five year period between 1st January 2002 and 31st December 2006.Setting: Kenyatta National Hospital, a teaching and referral hospital in Nairobi, Kenya.Subjects: Three hundred and seventeen consecutive operations were performed on 313 patients aged between 0.25 and 204 months.Results: Operations were performed in RACHS-1 categories 1, 2, 3 and 4 with hospital mortalities of 2.5%, 16.9%, 29.4% and 50% respectively. The difference in mortality between categories 1 and 2 was significant (p-value of 0.0003), however, the difference in mortality between categories 2 and 3 and categories 3 and 4 was not significant (pvalues 0.193 and 0.67 respectively).Conclusions: The RACHS-1 system did not adequately stratify risk in a low case load setting. The use of the RACHS-1 method as a benchmark to compare surgical results of paediatric cardiac surgery services in developing countries may be limited
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
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