Open Access Short Communication

Total Quality Management (TQM) of the Clinical Laboratory; Improving Patient Care

Tunji Akande

Journal of Advances in Medicine and Medical Research, Page 1-5
DOI: 10.9734/JAMMR/2018/40929

Background: Public and private pressures to contain cost and improvement of test result require that the clinical laboratories adopt new systems for managing quality.

Objectives: To review the management process for improving the quality of all aspects of laboratory operations.

Method:  Application of the concept and principles of total quality management.

Result: The users of health care laboratories are satisfied with the quality of laboratory service and their expectations are met by the laboratory performance. This enables faster and more accurate diagnoses and in turn, faster recovery of patients and shortened hospital stay.

Conclusion: Total quality management of the Clinical laboratories is an absolute necessity for monitoring performance that satisfies the needs and expectations of users and patients.

Open Access Original Research Article

Work Absenteeism amongst Health Care Workers in a Tertiary Health Institution in Sokoto, Nigeria

M. O. Oche, R. A. Oladigbolu, J. T. Ango, N. C. Okafoagu, U. M. Ango

Journal of Advances in Medicine and Medical Research, Page 1-9
DOI: 10.9734/JAMMR/2018/40467

Aim: This study was aimed at assessing the pattern and reasons for work absenteeism among health care workers at the Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria.

Study Design: This was a cross-sectional descriptive study carried out amongst health workers at the Usmanu Danfodiyo University, Sokoto, Nigeria. The study was carried out at the study site from 6th October to 11th December 2017. Using a systematic sampling method, a total of 242 study subjects were recruited for the study. Data collected were entered into and analyzed using IBM SPSS computer software with a level of statistical significance set at p= p< 0.05.

Results: One hundred and ten (45.5%) out of 242 had at least one spell of absence in a year. Absence was highest among the nurses (50.0%) and was lowest among pharmacists (0.9%) with overall absenteeism rate of 1.5%. One hundred and thirty – eight (78.0%) of respondents that were absent from work was due to sickness/illness that affected themselves majorly (88.7%) which was mainly due to Malaria (76.6%) followed by RTA (26.2%).

Conclusion: The most frequent reason for workers' absence was sickness or illness with malaria accounting for the most significant number of spells. Although absenteeism rate in this study was found to be very low, the findings underscore the need to put in place adequate sickness absence surveillance and management aimed at addressing the relevant reasons and improving the working conditions of health workers.

Open Access Original Research Article

Mortality among Preterm Babies in a Resource-poor Setting: What Time is Crucial?

Tinuade A. Ogunlesi, Victor A. Ayeni

Journal of Advances in Medicine and Medical Research, Page 1-7
DOI: 10.9734/JAMMR/2018/40833

Background: Preterm babies contribute the bulk of neonatal deaths globally. Neonatal deaths constitute about 46% of childhood deaths. Therefore, reduction of mortality among preterm babies is desired for reduction of childhood mortality.

Objective: To examine the pattern of mortality among preterm babies in a resource-poor tertiary facility setting and relate it to the place of birth and duration of admission when the deaths occurred.

Methods: A retrospective study of the hospital records of all preterm babies who died between 2011 and 2015 in a tertiary hospital in southwest Nigeria. Factors associated with death within 24 hours and 72 hours of admission were statistically determined.

Results: Out of a total of 1936 neonatal admission, 648 (33.5%) were preterm babies out of which 142 (21.9%) died. The preterm deaths formed 45.6% of all neonatal deaths during this period. The 142 preterm deaths comprised 59 (41.5%) out-born and 83 (58.5%) in-born babies. Death within 72 hours of admission occurred among 36% of in-born babies compared to 71.2% of out-born babies. A significantly higher proportion of babies who died within 24 hours were out-born (p < 0.0001) and less than 32 weeks of gestation (p = 0.025). Death occurring within 72 hours of admission was associated with out-born status (p < 0.0001) and presence of severe asphyxia (p = 0.045).

Conclusion: Most of the deaths within the first 72 hours of admission occurred among out-born preterm babies suggesting worse clinical state, especially with severe asphyxia. Special interventions required to minimise the delivery of preterm babies outside the hospital are desired.

Open Access Original Research Article

Reduction in Jejunal Fluid Absorption In vivo through Distension and Cholinergic Stimulation Not Attributable to Enterocyte Secretion

M. L. Lucas, H. L. Kenward, P. C. Watson, S. R. Sabir, C. J. R. Turkington, P. Tainsh, S. McColl, V. S. Graham, E. McNaughton

Journal of Advances in Medicine and Medical Research, Page 1-13
DOI: 10.9734/JAMMR/2018/39184

Jejunal fluid absorption in vivo was reduced by distension and by hydrostatic pressure and further declined on adding E. coli STa enterotoxin but no net fluid secretion was detected. Luminal atropine reduced pressure mediated reductions in fluid absorption to normal values but intravenous hexamethonium was without effect. A neural component to inhibition of absorption by pressure (though not stretch) may be mediated by axon reflexes within cholinergic neurons.Perfusion of cholinergic compounds also reduced net fluid absorption but did not cause secretion. In order to show that these actions were not secretory processes stimulated by cholinergic compounds that offset normal rates of absorption, these compounds were tested for their ability to cause net secretion in loops that were perfused with solutions in which choline substituted for sodium ion. In addition, these perfusates additionally contained E. coli STa enterotoxin or EIPA (ethyl-isopropyl-amiloride) to minimize absorption.In these circumstances, where it might be expected to do so if it were acting through a secretory rather than an absorptive mechanism, carbachol did not cause net fluid secretion. Cholinergic stimulation and pressure induced distension are thought to reduce net fluid absorption through inducing secretion but are found only to reduce fluid absorption.In conclusion, distension and cholinergic stimulation of the small intestine are two further circumstances in which fluid secretion is assumed to explain their action on fluid movement, as required by the enterocyte secretion model of secretion but, which like STa enterotoxin, instead are only able to reduce fluid absorption. This casts further doubt on the widespread validity of the enterocyte secretion model for fluid appearance in the lumen in diarrhoeal diseases.

Open Access Original Research Article

Dengue in a Municipality with High Human Development Index. SP, Brazil

Leonor de Castro Monteiro Loffredo, Rodolpho Telarolli Júnior, Walter Manso Figueiredo, Bruno Lian Sartore Segantini, Christian Wagner Maurencio, Fabiano Santos Galego, João Ramalho Borges, Társis Eschaquetti Benevides

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/40896

Aim: Dengue is an important public health problem in the world, typical of tropical regions and has become an urban disease. The incidence of dengue was studied, as the epidemiological and clinical aspects of the patients in an area of SP State in 2015. Design: It was a cross-sectional study. Subjects: The digital data file of the Special Health Service of Araraquara-SESA of São Paulo University-USP was used, as also was the population data of The Brazilian Institute of Geography and Statistics-IBGE. The demographic and clinical characteristics of the patients were obtained for the year 2015. The incidence was calculated, and the findings are presented in tables and graphs.

Results: In 2015, there were 8,296 confirmed cases of dengue, with an incidence of 3,660 per 100,000 inhabitants, 99.5% being autochthonous. The majority were female (53.9%), 11.5% of the cases were of less than 14 years of age and 16.1% were elderly. The majority of the patients were white (54.8%), with 1st or 2nd -grade schooling. Fever, headache, retro-orbital pain, and myalgia were the prevalent signs, which appeared in isolation or in association and Den1 was the circulating serotype. There were 9 deaths, the fatality rate being 108 per 100,000.

Conclusion: The demographic and epidemiological pattern of dengue in the city accompanied those of the rest of the country. Despite having a high Human Development Index and almost universal coverage of basic sanitation, the city faced an epidemic with high incidence in 2015.

Open Access Original Research Article

Human Development Index and Inflammatory Bowel Diseases

L. A. R. Takahashi, D. T. Cardial, I. L. Argani, L. R. R. Arnoni, V. N. Cury, L. F. A. C. C. Silva, A. O. Júnior, S. D. F. Borato

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/40710

Background: Inflammatory Bowel Disease has a growing incidence, especially in countries with increasing urbanization and increasing exposure to risk factors leading to inflammatory bowel disease. Such morbidity is still marked by the lack of epidemiological studies in the world.

Aims: To determine whether there is a correlation between the Human Development Index and Inflammatory Bowel Diseases in Brazil; and if there are variations between the different states of Brazil.

Methods: The Ecological study on secondary data analysis of Brazilian population diagnosed according to ICD-10 with Crohn's Disease and Ulcerative Colitis, from 2010 to 2014. The Ministry of Health provided data collection. We used mean and standard deviation for quantitative variables with normal distribution, and Pearson Test for the correlation between hospitalization for inflammatory bowel disease, type of hospitalization and Human Development Index for each year studied.

Results: The correlation between the Human Development Index in Brazil and the total number of hospitalizations for inflammatory bowel diseases each year was shown to be moderate positive (p <0.01). In the descriptive analysis per year, the mean hospitalization and the Human Development Index remained constant, and the standard deviation was relatively high.

Conclusion: There is a correlation between inflammatory bowel disease and Human Development Index in Brazil.

Open Access Original Research Article

Evaluation of Pastorex Staph Plus Rapid Agglutination Test to Confirm Staphylococcus aureus Isolated from Clinical Specimens in a Tertiary Care Teaching Hospital

Dipmala Das, Pritam Gupta, Ankana Chakraborty, K. K. Haldar

Journal of Advances in Medicine and Medical Research, Page 1-8
DOI: 10.9734/JAMMR/2018/40673

Background: Staphylococcus aureus is one of the most common pathogen isolated. Accurate and rapid identification of S. aureus and MRSA is of great importance for proper care of the patient. Keeping this in mind, we had used Pastorex Staph plus rapid agglutination test to confirm S. aureus.

Aim: To evaluate Pastorex Staph plus rapid agglutination test for confirming Staphylococcus aureus isolated from clinical specimens.

Study Design: Cross-sectional type.

Methodology: This study was conducted in a tertiary care hospital in Eastern India. It included all clinical samples, where Staphylococcus spp. was isolated. The phenotypic confirmation of the isolate was done by slide coagulase test, tube coagulase test, mannitol fermentation test and Pastorex Staph plus rapid agglutination test. Methicillin Resistant Staphylococcus aureus (MRSA) strains were identified as per CLSI 2017 guideline. Statistical analyses of the results were done to evaluate the validity, diagnostic accuracy & reliability of the tests. Tube coagulase test was taken as the gold standard test.

Results: Among the total 83 Staphylococcus spp. isolates, 31 isolates (37%) were Staphylococcus aureus. Among these S. aureus isolates, only 1(3.2%) isolate was MRSA. Statistical analysis showed that, in identification of Staphylococcus aureus, Pastorex Staph plus test had highest sensitivity (100%), specificity (98%) and diagnostic accuracy (98.4%) with Cohen’s Kappa coefficient as 0.97.

Conclusion: Considering the sensitivity, specificity, accuracy and Cohen's kappa coefficient, it was concluded that Pastorex Staph plus rapid agglutination test can be used as rapid and effective method to diagnose S. aureus.