Background Perioperative mortality rate is regarded as a credible quality and safety indicator of perioperative care, but its documentation in low- and middle-income countries is poor. We developed and tested an electronic, provider report–driven method in an East African country. Methods We deployed a data collection tool in a Kenyan tertiary referral hospital that collects case-specific perioperative data, with asynchronous automatic transmission to central servers. Cases not captured by the tool (nonobserved) were collected manually for the last two quarters of the data collection period. We created logistic regression models to analyze the impact of procedure type on mortality. Results Between January 2014 and September 2015, 8,419 cases out of 11,875 were captured. Quarterly data capture rates ranged from 423 (26%) to 1,663 (93%) in the last quarter. There were 93 deaths (1.53%) reported at 7 days. Compared with four deaths (0.53%) in cesarean delivery, general surgery (n = 42 [3.65%]; odds ratio = 15.80 [95% CI, 5.20 to 48.10]; P < 0.001), neurosurgery (n = 19 [2.41%]; odds ratio = 14.08 [95% CI, 4.12 to 48.10]; P < 0.001), and emergency surgery (n = 25 [3.63%]; odds ratio = 4.40 [95% CI, 2.46 to 7.86]; P < 0.001) carried higher risks of mortality. The nonobserved group did not differ from electronically captured cases in 7-day mortality (n = 1 [0.23%] vs. n = 16 [0.58%]; odds ratio =3.95 [95% CI, 0.41 to 38.20]; P = 0.24). Conclusions We created a simple solution for high-volume, prospective electronic collection of perioperative data in a lower- to middle-income setting. We successfully used the tool to collect a large repository of cases from a single center in Kenya and observed mortality rate differences between surgery types.
Outcomes & Evaluation: The results confirm that the problem of cold chain breaches is a global issue, occurring extensively in developed and developing countries. The severity of the problem relates, in part, to the type of medical product. Research indicates that temperature-damaged medicines can cause disease outbreaks, adverse events and inaccurate diagnoses. Regardless of the type of medical product, improper temperature control contributes to costly waste. Some of the most effective cold chain solutions have been implemented by countries with the most challenging delivery systems. These solutions should be considered for broader adoption globally. Going Forward: One meta-analysis cannot transform the issue of cold chain integrity into a burning priority for public health stakeholders. It is hoped, however, that this study's findings will increase public health leaders' awareness and prioritization of cold chain problems and solutions. One fundamental next step would be a global forum in which cold chain innovations and best practices are shared.
identified in laboratory conditions. This spectral "fingerprint" is then replicated in field-tests of suspected pharmaceuticals. Findings: The Baseline Spectral Absorbance Profile (B-SAP) procedure guides the user through sample preparation and testing that allocates the sample to one of five categories: 1) Expected compound is present at labeled concentration, no obvious impurities 2) Expected compound is present at labeled concentration, evidence of impurities 3) Expected compound is present at non-labeled concentration, no obvious signs of impurities 4) Expected compound is present at nonlabeled concentration, evidence of impurities 5) Expected compound cannot be detected. For proof of concept, investigators used 2% Lidocaine HCL as representative of a compound critical for treatment at the frontiers of global health (ubiquitously available and critical for pain management). The B-SAP was developed and tested against six samples of random substances with similar visual characteristics developed by a third party. Four additional sample were included: two of 2% lidocaine HCL, and two of Lidocaine at random concentrations. Testing results correctly allocated each sample to the correct category. Interpretation: Future research will develop testing procedure and B-SAPs for compounds critical for treatment of WHO defined seven neglected tropical diseases. Current research is also developing a lowcost, portable UV-Vis spectrophotometer to enable maximum field implementation of the B-SAP testing procedure. Funding: WNEU.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.