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  • 1
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    Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy
    Oxford University Press (OUP) ; 2019
    In:  British Journal of Surgery Vol. 106, No. 2 ( 2019-01-08), p. e103-e112
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 106, No. 2 ( 2019-01-08), p. e103-e112
    Abstract: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P & lt; 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P & lt; 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9·4 (95 per cent c.i. −11·9 to −6·9) per cent; P & lt; 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P & lt; 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P & lt; 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1002/bjs.11051
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2006309-X
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  • 2
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    Global variation in anastomosis and end colostomy formation following left‐sided colorectal resection
    Oxford University Press (OUP) ; 2019
    In:  BJS Open Vol. 3, No. 3 ( 2019-06), p. 403-414
    Details
    In: BJS Open, Oxford University Press (OUP), Vol. 3, No. 3 ( 2019-06), p. 403-414
    Type of Medium: Online Resource
    ISSN: 2474-9842 , 2474-9842
    URL: Issue
    URL: Article
    DOI: 10.1002/bjs5.2019.3.issue-3
    DOI: 10.1002/bjs5.50138
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2902033-5
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  • 3
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    Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair : The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) Study
    American Medical Association (AMA) ; 2023
    In:  JAMA Surgery Vol. 158, No. 8 ( 2023-08-01), p. 865-
    Details
    In: JAMA Surgery, American Medical Association (AMA), Vol. 158, No. 8 ( 2023-08-01), p. 865-
    Abstract: Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR. Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR. Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia. Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients. Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72). Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.
    Type of Medium: Online Resource
    ISSN: 2168-6254
    URL: Article
    DOI: 10.1001/jamasurg.2023.2137
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2023
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  • 4
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    Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study
    Springer Science and Business Media LLC ; 2018
    In:  Surgical Endoscopy Vol. 32, No. 8 ( 2018-08), p. 3450-3466
    Details
    In: Surgical Endoscopy, Springer Science and Business Media LLC, Vol. 32, No. 8 ( 2018-08), p. 3450-3466
    Abstract: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. Methods This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. Results 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33–4.99, p  = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76–2.52, p  = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42–0.71, p   〈  0.001) and SSIs (OR 0.22, 95% CI 0.14–0.33, p   〈  0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11–0.44) and SSI (OR 0.21 95% CI 0.09–0.45). Conclusion A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. Trial registration: NCT02179112.
    Type of Medium: Online Resource
    ISSN: 0930-2794 , 1432-2218
    URL: Article
    DOI: 10.1007/s00464-018-6064-9
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2018
    detail.hit.zdb_id: 1463171-4
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  • 5
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    Global economic burden of unmet surgical need for appendicitis
    Oxford University Press (OUP) ; 2022
    In:  British Journal of Surgery Vol. 109, No. 10 ( 2022-09-09), p. 995-1003
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 109, No. 10 ( 2022-09-09), p. 995-1003
    Abstract: There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and $73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and $75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znac195
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2006309-X
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  • 6
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    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
    Oxford University Press (OUP) ; 2023
    In:  British Journal of Surgery Vol. 110, No. 7 ( 2023-06-12), p. 804-817
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 110, No. 7 ( 2023-06-12), p. 804-817
    Abstract: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znad092
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
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  • 7
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    Assessment of Precautionary Measures Medical Students & Doctors Practiced at Eid-ul-Adha during COVID-19
    Journal of Pakistan Dental Association ; 2022
    In:  Journal of the Pakistan Dental Association Vol. 31, No. 01 ( 2022-4-25), p. 32-37
    Details
    In: Journal of the Pakistan Dental Association, Journal of Pakistan Dental Association, Vol. 31, No. 01 ( 2022-4-25), p. 32-37
    Abstract: OBJECTIVE: To analyze the precautionary measures that medical students and clinicians practiced during Eid-ul-Adha' 2020." METHODOLOGY: An online cross-sectional survey was conducted on medical students and doctors/clinicians/faculty in Balochistan, where the questionnaire (10 items) was posted on google platforms after Eid-ul-Adha between 10th to 31st December 2020. Inclusion criteria consisted of first to third year medical students and clinicians whereas fourth and final year, house officers and postgraduate students were excluded. Pilot study demonstrated reliability of questionnaire Cronbach's alpha 0.624. SPSS version 23 was used for analysis. RESULTS: In current study majority (n=82/126) of the study participants were males, more than half of them were medical students (n=73/126). Eighty percent (80%) participants (n=66/82) offered Eid's congregational prayer in masjids, 11/82 prayed at home only five (n=5/82) of them didn't perform prayer at all; majority (64%) of them practiced SOPs at the time of prayer in Masjid. In family gatherings, 73% followed all precautionary measures whereas 10% avoided SOP's. At the time of ritual livestock sacrifice, 62% participants followed whereas only 10% didn't follow to any precautions. During meat distribution, 68.5% study participants practiced all precautionary measures and just 2.7% did not follow SOP's during meat distribution. No significant difference was found between medical students and doctors in practicing precautionary measures, except during meat distribution (p-0.009). CONCLUSION: Medical students and doctors practiced precautionary measures well. However, statistically significant relation was found between medical students and doctors praying in masjids and maintaining a safe distance in Eid gatherings during this pandemic. KEYWORDS: COVID-19, Eid-ul-Adha, Precautionary Measures, Medical Students, Doctors.
    Type of Medium: Online Resource
    ISSN: 1680-2292 , 2306-5885
    Uniform Title: Assessment of Precautionary Measures Medical Students & Doctors Practiced at Eid-ul-Adha during COVID-19
    URL: Issue
    URL: Journal
    URL: Article
    DOI: 10.25301/JPDA.311
    DOI: 10.25301/JPDA
    DOI: 10.25301/JPDA.311.32
    Language: Unknown
    Publisher: Journal of Pakistan Dental Association
    Publication Date: 2022
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  • 8
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    Nanoparticles as a Novel Tool to Inhibit Inflammatory Cytokines in Human Lymphocytes and Macrophages of Coronary Artery Disease
    Elsevier BV ; 2022
    In:  Journal of Pharmaceutical Sciences Vol. 111, No. 5 ( 2022-05), p. 1509-1521
    Details
    In: Journal of Pharmaceutical Sciences, Elsevier BV, Vol. 111, No. 5 ( 2022-05), p. 1509-1521
    Type of Medium: Online Resource
    ISSN: 0022-3549
    URL: Article
    DOI: 10.1016/j.xphs.2022.01.001
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1491821-3
    SSG: 15,3
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  • 9
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    Exploring Medical Professionalism amongst Postgraduate Trainees of Bolan Medical Complex Hospital Quetta
    Shaikh Zayed Medical Complex Lahore ; 2024
    In:  Proceedings Vol. 38, No. 2 ( 2024-04-29), p. 116-121
    Details
    In: Proceedings, Shaikh Zayed Medical Complex Lahore, Vol. 38, No. 2 ( 2024-04-29), p. 116-121
    Abstract: Introduction: The traditional educational system has concentrated on cognition acquisition and skills essential for physician practice. However, medical educationists are focusing more on good professional doctors now, having a cognitive foundation to work alongside their social roles as a physician-to-be. Aims and Objectives: To assess medical professionalism amongst postgraduate trainees at Bolan Medical Complex Hospital, Quetta. Place and Duration of study: Bolan Medical Complex Hospital, Quetta during February 2024. Material and Methods: A cross-sectional study was conducted to determine professionalism utilizing a pre-validated questionnaire termed Professionalism Assessment Tool (PAT) from 47 Postgraduates (PGs) of the Neurosurgery, General Medicine, and Psychiatry departments. Data was entered and analyzed using SPSS version 29 was used to calculate frequencies and percentages. The chi-square test was utilized to evaluate the association between professional years and items. A p-value of ? 0.05 is considered significant. Results: All 18 PGs from the psychiatry department, 23/36 (64%) from General Medicine, and all 6 from Neurosurgery filled out the questionnaire. 55.3%(n=25/47) were above 25 years of age, The majority were males (n=31, 66%) and 34% females, 36% (n=17/47) PGs were from 1st year of training. Item no 1 and 5 of Domain I and Domain 3 present the highest percentage score (52.4%) respectively. Highly statistically significant results (p- 〈 0.001) were obtained between professional years of training and items 4, 6, 1, and 3 of Domain 2, 3, and 4. Conclusion: PGs followed feedback to improve and meet their learning goals. PGs understood their professional responsibilities and felt qualified to finish assignments to the highest standard reliably and courteously. They were aware of the benefits of working in teams, and they took feedback to help reach their learning goals.
    Type of Medium: Online Resource
    ISSN: 2518-203X , 1815-4905
    URL: Article
    DOI: 10.47489/szmc.v38i2.506
    Language: Unknown
    Publisher: Shaikh Zayed Medical Complex Lahore
    Publication Date: 2024
    detail.hit.zdb_id: 3137484-0
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  • 10
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    TENNIS ELBOW : COMPARISON OF PLATELET RICH PLASMA WITH STEROID INJECTION IN TREATMENT
    Independent Medical Trust ; 2018
    In:  The Professional Medical Journal Vol. 25, No. 02 ( 2018-02-10), p. 196-200
    Details
    In: The Professional Medical Journal, Independent Medical Trust, Vol. 25, No. 02 ( 2018-02-10), p. 196-200
    Abstract: Introduction: Lateral epicondylitis, also called as Tennis Elbow is the primarycause of musculo-skeletal ache including extensor origin of forearm. Repetitive movements areconsidered to be the root cause of this disorder. This disorder involves overexertion of fingers andwrist extensors that causes significant disability ultimately affecting the quality of life. The basisfor diagnosing lateral epicondylitis is very clear clinically. The strategy of injecting steroid locallyhas proven to dispense predictable and consistent transient relief of pain. Recent treatmentinvolve Platelet Rich Plasma (PRP) administration locally. Study Design: Prospective study.Period: 01-07-2014 to 30-06-2016. Setting: Department of Orthopedic Surgery Allied /DHQHospital Faisalabad. Subject and Methods: Total of 38 patients aging 25-60 years belongingto either gender with Lateral Epicondylitis who met inclusion criteria were enrolled in this studyand divided in two (2) groups A and B. The group which was treated with steroid injection waslabeled as A and group B comprised of patients which were treated with prepared PRP injection.Outcome was analyzed on the basis of Visual Analogue Scale of pain and functional outcomeusing qDash scores at baseline, 6 weeks and 12 weeks. Results: In Group A, baseline VASwas 7.3 + 2.1 and q DASH was 83+1.2. At 6 weeks and 12 weeks VAS was 5.3+ 3.1 and 6.1+1.2 respectively. qDash scores were 78 + 4.2 and 63 + 1.6 at 6 and 12 weeks respectively.In Group B VAS was 7.2+ 2.2, 5.3 +1.3, 3.2+ 1.2 at baseline, 6 weeks and 12 weeks. WhileqDash Scores were 81+3.2, 74+3.7, 58+1.2 at baseline, 6 weeks and 12 weeks respectively.Conclusion: Steroid and PRP are effective equally for treating lateral epicondylitis. Accordingto this study, PRP is ranked superior to steroid for its long term effectiveness in controlling painand improve functional outcome.
    Type of Medium: Online Resource
    ISSN: 2071-7733 , 1024-8919
    URL: Article
    DOI: 10.29309/TPMJ/2018.25.02.442
    Language: Unknown
    Publisher: Independent Medical Trust
    Publication Date: 2018
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