Search or add a thesis

Advanced Search (Beta)
Home > Day Care Surgery at a New University Teaching Hospital: A Review out of the Aga Khan University Hospital, Nairobi

Day Care Surgery at a New University Teaching Hospital: A Review out of the Aga Khan University Hospital, Nairobi

Thesis Info

Author

Mogere, Edwin

Department

General Surgery (East Africa)

Program

MMed

Institute

Aga Khan University

Institute Type

Private

City

Karachi

Province

Sindh

Country

Pakistan

Thesis Completing Year

2008

Thesis Completion Status

Completed

Subject

Medicine

Language

English

Added

2021-02-17 19:49:13

Modified

2024-03-24 20:25:49

ARI ID

1676728043717

Asian Research Index Whatsapp Chanel
Asian Research Index Whatsapp Chanel

Join our Whatsapp Channel to get regular updates.

Similar


Introduction: Day Care Surgery (DCS) is the surgical care of patients on a planned non-residential basis. The objective of the study was to assess the performance of DCS in the context of a developing country within the private sector. Data from a new DCS unit was compared to internationally accepted indicators of the quality of care. Methodology: A hospital based retrospective chart review of all patients operated on within 10 surgical subspecialties was performed. The review period was the June 2006 to July 2007(12 months). Analysis (SPSS version 11.5): Outcome measures included in-patient to DCS ratio in the various specialties; inpatients qualifying for DCS; overall unplanned admission rates; morbidity rates and the number of inappropriate daycare cases. Univariate analysis was used to test for factors affecting the unplanned admission rate. A logistic regression model was used for multivariate analysis. Results: Inpatient to DCS ratio in all the subspecialties was below recommended benchmarks. Thirty six percent (36%, n=328/910) of inpatients were candidates for DCS. The unplanned admission rate was 12% (n=47/395) with lack of outpatient insurance cover being the commonest reason (48.93%, n=23/47). Multivariate analysis noted only two significant variables, ASA grading and postoperative morbidity. The overall morbidity rate of the DCS cases was 5% (n=18/395) pain being the most common type of morbidity. Almost 3 %( n=13/395) of patients were inappropriately treated as DCS patients. Conclusions: The unplanned admission rate of 12% compares unfavorably with other DCS units. Omitting cases of inappropriate insurance cover, the overall rate falls to 6.45%, comparing well to other units. The retrospective nature of the study placed important limitations on the data acquisition. DCS is a feasible system of healthcare delivery in the private sector of developing countries.
Loading...
Loading...

Similar Books

Loading...

Similar Chapters

Loading...

Similar News

Loading...

Similar Articles

Loading...

Similar Article Headings

Loading...

مولوی مظہر الحق

مولوی مظہرالحق صاحب پٹنہ
جس طرح ہمارا پرانا سال ایک بڑے قومی حادثہ یعنی پرانی تعلیم کے ایک بہترین نمونہ (مولانا حبیب الرحمان عثمانی دیوبندی) کے دائمی فقدان پر ختم ہوا، اسی طرح ہمارے نئے سال کا آغاز بھی ایک بڑے قومی حادثہ یعنی نئی تعلیم کے ایک بہترین نمونہ (مولوی مظہرالحق صاحب بیرسٹر پٹنہ) کی دائمی جدائی سے ہوا، مولوی مظہرالحق صاحب مرحوم کی قومی و سیاسی حیثیت تو الگ ہے، ان کی اخلاقی اور علمی حیثیت بھی کچھ کم قابل ذکر نہیں ہے، وہ فارسی سے واقف، عربی سے آشنا، انگریزی کے ادیب و خطیب اور فلسفہ کے نہایت دقیقہ رس طالبعلم تھے، ان کے علمی کارناموں کا آغاز طوفان نوح کی بحث سے ہوا، الپنچ پٹنہ اور وقت گورکھپور ان کے ابتدائی علمی مباحث کے جولان گاہ تھے، ان کی سب سے آخری علمی تحریر غالباً وہ ہے جو ابھی ابھی پونہ سے شائع ہونے والی انگریزی کی کتاب تصوف و روحانیت پر مقدمہ ہے، وہ نسباً فاروقی تھے، اس لئے ان کی اخلاقی قوت و جرأت کیا سلطنت اور کیا قوم دونوں کے مقابلہ میں برابر تھی، وہ جس کو حق سمجھتے تھے اس کے اظہار میں نہ ان کو سلطنت کی پروا ہوتی تھی اور نہ قوم کی، ان کا یوروپین طرز معاشرت کو الوداع کہہ کر وفعتہ مشرقی اور غالی مشرقی بن جانا ان کی بے مثال اخلاقی جرأت کا نمونہ ہے، مرحوم کی آخری عمر روح و روحانیت کی تحقیق میں صرف ہوئی، خدا ان کی روح کو اپنی مغفرت کی لازوال دولت سے مالا مال کرے، اب وہ وہاں پہنچ چکی ہے، جہاں کے کشف زار کے لئے وہ بے قرار تھی۔ (سید سلیمان ندوی، جنوری ۱۹۳۰ء)

 

Constructive Ways for Dispute Resolution: Employing Alternative Dispute Resolution (ADR) Techniques for The Reclamation of Justice

As the courts are not in a stance to hold up the entire load of the judicial system, multitudinous contentions impart themselves to settlement by alternative methods such as arbitration, conciliation, mediation, negotiation, etc. The Alternative dispute resolution processes not only lay out procedural pliability but also save valuable time & money and eschew the tensity of a conventional trial. Nearly all the discords involving civil, labour, commercial, and family strife, wherein the parties are capacitated to wind up a resolution, can be resolved by an alternative dispute resolution system. Alternate dispute resolution methods have also been evinced to operate in the business environment, principally in respect of disputation comprising intellectual property, securities, real estate, construction projects, joint ventures, partnership differences, personal injury, professional liability, product liability, contract interpretation and performance and insurance coverage. To dwindle the logjam of cases, there is a crucial need to organize and encourage alternate dispute resolution services for the settlement of both national and international conflicts. These services require to be nutrified on sound notions, prowess in their application and comprehensive and contemporary provisions. Although ADR has proven to be an efficacious mechanism as it has provided a congenial atmosphere, a less formal and less complicated forum for copious disputes, due to lack of awareness of its quiddity at the ground root level has abrupted its quantum leap. This paper aims to provide the gist of ADR concerning India by focusing on its purpose, advantages and disadvantages, (fruitful) modes of conflict resolution, highlighting the importance of Lok Adalat, significance and effectiveness of ADR in conflict resolution and ways to overcome the persisting deficiencies.

Fabrication and Evaluation of Solid Lipid Nanoparticles for Niclosamide Bcs-Ii and Sulfasalazine Bcs-Iv Drugs

New drug entities with poor aqueous solubility are becoming more prevalent as result of high-throughput screening in drug discovery. Poor aqueous solubility presents significant challenges, as it reduces the absorption and oral bioavailability. Several formulation approaches have been employed to overcome the limitations of low dissolution rate and/or solubility including; pH-adjustment, co-solvents, surfactants, inclusion complexes, lipid-based formulations i.e. Solid lipid nanoparticles (SLNs) and Nanostructured lipid carriers (NLCs), and nano-suspensions. In this study efforts are made for the selection of formulation approach based on the drug properties and the required specifications of the final dosage form. Among these formulation approaches solid lipid nanoparticles were selected with the aim of improving solubility/bioavailability of the poorly water-soluble drugs; BCS-II (Niclosamide) and BCS-IV (Sulfasalazine). Two different techniques i.e. Micro-emulsion Technique and Solvent Emulsification Diffusion Technique were used to fabricate SLNs. The SLNs formulations were characterized by Scanning Electron Microscopy (SEM), Differential Scanning Calorimetry (DSC), Powder X-ray Diffraction (P-XRD) and Fourier Transform Infrared (FT-IR). The SLNs formulations loaded with Niclosamide and Sulfasalazine were successfully converted to solid dosage form followed by similarity study. In-vitro studies of SLNs formulations in comparison with marketed dosage form showed improvement in solubility and dissolution while the in-vivo studies confirmed improved oral bioavailability. Niclosamide loaded SLNs fabricated by Micro Emulsion Technique having particle size 204.2 ± 2.2 nm, polydispersity index 0.328 ± 0.02, zeta potential -33.16 ± 2mv, entrapment efficiency 84.4 ± 0.02%, and drug loading capacity 5.27 ± 0.03% were obtained. Different kinetic models showed zero order kinetics and Case-II transport mechanism. In-vivo pharmacokinetic study showed 2.15-fold increase in peak plasma concentration for Niclosamide loaded SLNs while relative bioavailability (Fr) of 11.08. Fabrication of Niclosamide loaded SLNs using Solvent Emulsification Diffusion Technique showed particle size 208.6 ± 2.2 nm, polydispersity index 0.376 ± 0.04, zeta potential -34.11 ± 1.2 mv, entrapment efficiency 85.4 ± 0.04% and drug loading capacity 3.18 ± 0.04 %. Observed zero order kinetics with case-II transport, the range in the parenthesis might be helpful for the drug release mechanism. 2.04-fold increase in peak plasma concentration was observed in pharmacokinetic study with relative bioavailability (Fr) of 10.59. In case of Sulfasalazine-SLNs prepared by Micro Emulsion Technique having particle size 217.2 ± 3.2nm, PDI 0.373 ± 0.02, zeta potential -35.26 ± 2mV, entrapment efficiency 89.1 ± 0.03% and drug loading capacity 2.87 ± 0.05% were obtained. Kinetic modelling studies showed mixed order kinetics for drug release. Release exponent was more than 0.89, regarded as Super Case-II diffusion mechanism. In-vivo pharmacokinetic study showed 2.43-fold increase in oral bioavailability of sulfasalazine as SLN formulation compared to commercial product. Solvent Emulsification Diffusion Technique was used to fabricate Sulfasalazine loaded SLNs, showed particle size 202.3 ± 2.2 nm, PDI 0.376 ± 0.02, zeta potential -35.82 ± 2 mV, entrapment efficiency 86.3 ± 0.02% and drug loading capacity 3.03 ± 0.04%. Zero order kinetics and Case-II transport mechanism for drug release was observed with 1.86-fold increase in peak plasma concentration during pharmacokinetic study. These studies validated that, SLNs as nanoparticulate drug delivery system enhanced oral bioavailability of Niclosamide and Sulphasalazine. Hence, these studies provide new strategies for the oral bioavailability of hydrophobic drugs.