Framework for developing cost-effectiveness analysis threshold: the case of Egypt.

BACKGROUND: Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system. METHODS: We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. RESULTS: The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. CONCLUSION: The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.

Development of the Emirates Multi-Criteria Decision Analysis Tool for Orphan Drugs.

Background The number of orphan drug approvals is currently increasing globally. This creates a significant burden on payers and healthcare systems. This study aimed to create a multi-criteria decision analysis (MCDA) tool for evaluating orphan drugs within the United Arab Emirates (UAE). The intended result of the tool is to provide evidence-based guidance to decision-makers in reimbursement and procurement decisions. Methods We conducted a literature search and local expert interviews to identify relevant preliminary criteria for the MCDA tool. Then we conducted a structured consensus-building session for healthcare experts and decision-makers in the UAE to develop the Emirati MCDA tool for orphan drugs. The experts voted for the criteria to be included in the tool and their ranking according to importance, as well as the weight of each criterion and its scoring function. To improve understanding and facilitate the voting process, experts were provided with a brief illustration of similar tools conducted in other countries before the voting sessions. Finally, the tool was developed in a Microsoft Excel sheet (Microsoft Corporation, Redmond, Washington, United States), and it was validated and tested based on real case studies, then it was fine-tuned accordingly based on the experts' discussions. The final tool was provided to the attendees to guide their decisions in the reimbursement and procurement of orphan drugs. Results The created tool provides a score for each analyzed orphan drug based on its value. Ten criteria were included in the final MCDA tool. These were cost-effectiveness (25.1% of the weight), magnitude of health gain (20.1%), availability of therapeutic alternative (14.3%), disease severity (11%), budget impact (7.9%), disease rarity (5.6%), strength of clinical evidence (5.6%), burden on households (4.5%), indication uniqueness (3.2%), and patients' age (2.6%). Conclusions Implementation of evidence-based healthcare necessitates assessing the fair value of each health technology. Addressing the high unmet medical needs and improving healthcare for patients with rare diseases are priorities within the UAE. The created Emirates MCDA tool for orphan drugs has the potential to help decision-makers implement value-based and evidence-based reimbursement decisions for orphan drugs.

Assessment of Repeat Revascularization in Percutaneous Coronary Intervention Randomized Controlled Trials as a Surrogate for Mortality: A Meta-Regression Analysis.

The association of repeat revascularization after percutaneous coronary intervention (PCI) with mortality is uncertain. To assess the association of repeat revascularization after PCI with mortality in patients with coronary artery disease (CAD). We identified randomized controlled trials comparing PCI with coronary artery bypass graft (CABG) or optimal medical therapy (OMT) using electronic databases through January 1, 2022. We performed a random-effects meta-regression between repeat revascularization rates after PCI (absolute risk difference [%] between PCI and CABG or OMT) with the relative risks (RR) of mortality. We assessed surrogacy of repeat revascularization for mortality using the coefficient of determination (R2), with threshold of 0.80. In 33 trials (21,735 patients), at median follow-up of 4 (2-7) years, repeat revascularization was higher after PCI than CABG [RR: 2.45 (95% confidence interval, 1.99-3.03)], but lower vs OMT [RR: 0.64 (0.46-0.88)]. Overall, meta-regression showed that repeat revascularization rates after PCI had no significant association with all-cause mortality [RR: 1.01 (0.99-1.02); R2=0.10) or cardiovascular mortality [RR: 1.01 (CI: 0.99-1.03); R2=0.09]. In PCI vs CABG (R2=0.0) or PCI vs OMT trials (R2=0.28), repeat revascularization did not meet the threshold for surrogacy for all-cause or cardiovascular mortality (R2=0.0). We observed concordant results for subgroup analyses (enrollment time, follow-up, sample size, risk of bias, stent types, and coronary artery disease), and multivariable analysis adjusted for demographics, comorbidities, risk of bias, MI, and follow-up duration. In summary, this meta-regression did not establish repeat revascularization after PCI as a surrogate for all-cause or cardiovascular mortality.

Post-Bariatric Surgery Patients: A Quality of Life Assessment in Saudi Arabia.

Background Bariatric surgery has emerged as the most successful and long-lasting treatment for weight loss because of its effect on losing weight, diminution or elimination of sedentary lifestyle-related comorbidities, and a concomitant decrease in mortality and healthcare expenditures. Understanding its effects on the quality of life of patients is a crucial aspect of treatment. This study aims to assess the quality of life and its associated factors following bariatric surgery in Saudi Arabia. Methodology In this cross-sectional study, 400 adult patients who had undergone bariatric surgery were recruited from different regions in Saudi Arabia between December 2021 and February 2022. Data were collected and analyzed using SPSS version 23 (IBM Corp., Armonk, NY, USA). Results Of the 400 participants, 160 (40%) were males and 240 (60%) were females. The average weight of the participants before surgery was 113.9 ± 18.7 kg (range = 84-146 kg) and after surgery was 84.8 ± 18.3 kg (range = 58-138 kg). The average quality of life score was -0.13 ± 2.0 (range = -3-3). Most of the participants (35%) had a fair quality of life, 25% had very poor quality, 20% had very good quality, 15% had good quality, and 5% had poor quality of life. A statistically significant association (p < 0.001) was found with the following factors: gender, age, nationality, educational level, marital status, and history of chronic diseases. Conclusions Quality of life following bariatric surgery was mostly reported to be fair or average. Several sociodemographic factors were found to be associated with the reported quality of life including age, gender, nationality, educational level, marital status, and history of chronic disease or comorbidities.

Taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan

Abstract The present study was conducted for the taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan. The study area was divided into three sites along the water course namely Dargai Stream, Sakhakot Stream and Shergarh Stream. Fish samples were collected randomly during January to August 2017 with the help of fish gears. A taxonomic key was designed for the collected fish specimens. Ten fish species were identified belonging to 3 orders and 4 families. Family Cyprinidae was the dominant family with seven representative species while families Siluridae, Nemacheilidae and Mastacembelidae were represented by one species each. Lower mean total length and standard length was recorded in Puntius conchonius (Hamilton, 1822) as 9.2 ± 0.6 cm and 7.3 ± 0.6 cm respectively, while highest mean total length and standard length was recorded in Mastacembelus armatus (Lacepede, 1800) as 28.1 ± 1.7 cm and 15.9 ± 2.4 cm respectively. Mean pH of the water ranged from 6.1 at Shergarh Stream in August to 8.7 at Sakhakot Stream in January. Average temperature range was recorded from 10.9 °C in January at Dargai Stream to 18.7 °C in August at Shergarh Stream. No statistically significant difference was found for temperature (p = 0.96) and pH (p = 0.14) in the three water streams. The present study will provide a baseline for the rearing and enhancement of wild stock of the commercially important ichthyofauna in the field of aquaculture and fisheries.

Resumo O presente estudo foi realizado para a avaliação taxonômica, morfométrica e limnológica da ictiofauna comercialmente importante do Riacho Sakhakot, Malakand, Paquistão. A área de estudo foi dividida em três locais ao longo do curso de água, nomeadamente Riacho Dargai, Riacho Sakhakot e Riacho Shergarh. As amostras de peixes foram coletadas aleatoriamente durante janeiro e agosto de 2017, com a ajuda de artes de peixes. Uma chave taxonômica foi projetada para os espécimes de peixes coletados. Foram identificadas dez espécies de peixes pertencentes a 3 ordens e 4 famílias. A família Cyprinidae foi a família dominante, com sete espécies representativas, enquanto as famílias Siluridae, Nemacheilidae e Mastacembelidae foram representadas por uma espécie cada. O comprimento total médio mais baixo e o comprimento padrão foram registrados em Puntius conchonius (Hamilton, 1822) como 9.2 ± 0.6 cm e 7.3 ± 0.6 cm, respectivamente, enquanto o comprimento total médio e o comprimento padrão mais altos foram registrados em Mastacembelus armatus (Lacepede, 1800) como 28.1 ± 1.7 cm e 15.9 ± 2.4 cm, respectivamente. O pH médio da água variou de 6.1 no Riacho Shergarh em agosto a 8.7 no Riacho Sakhakot em janeiro. A faixa de temperatura média foi registrada de 10.9 °C em janeiro no Riacho Dargai a 18.7 °C em agosto no Riacho Shergarh. Não foi encontrada diferença estatisticamente significativa para temperatura (p = 0,96) e pH (p = 0,14) nos três cursos de água. O presente estudo fornecerá uma linha de base para a criação e aprimoramento do estoque selvagem da ictiofauna comercialmente importante no campo da aquicultura e pesca.

Taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan / Avaliação taxonômica, morfométrica e limnológica da ictiofauna comercialmente importante do Riacho Sakhakot, Malakand, Paquistão

The present study was conducted for the taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan. The study area was divided into three sites along the water course namely Dargai Stream, Sakhakot Stream and Shergarh Stream. Fish samples were collected randomly during January to August 2017 with the help of fish gears. A taxonomic key was designed for the collected fish specimens. Ten fish species were identified belonging to 3 orders and 4 families. Family Cyprinidae was the dominant family with seven representative species while families Siluridae, Nemacheilidae and Mastacembelidae were represented by one species each. Lower mean total length and standard length was recorded in Puntius conchonius (Hamilton, 1822) as 9.2 ± 0.6 cm and 7.3 ± 0.6 cm respectively, while highest mean total length and standard length was recorded in Mastacembelus armatus (Lacepede, 1800) as 28.1 ± 1.7 cm and 15.9 ± 2.4 cm respectively. Mean pH of the water ranged from 6.1 at Shergarh Stream in August to 8.7 at Sakhakot Stream in January. Average temperature range was recorded from 10.9 °C in January at Dargai Stream to 18.7 °C in August at Shergarh Stream. No statistically significant difference was found for temperature (p = 0.96) and pH (p = 0.14) in the three water streams. The present study will provide a baseline for the rearing and enhancement of wild stock of the commercially important ichthyofauna in the field of aquaculture and fisheries.

O presente estudo foi realizado para a avaliação taxonômica, morfométrica e limnológica da ictiofauna comercialmente importante do Riacho Sakhakot, Malakand, Paquistão. A área de estudo foi dividida em três locais ao longo do curso de água, nomeadamente Riacho Dargai, Riacho Sakhakot e Riacho Shergarh. As amostras de peixes foram coletadas aleatoriamente durante janeiro e agosto de 2017, com a ajuda de artes de peixes. Uma chave taxonômica foi projetada para os espécimes de peixes coletados. Foram identificadas dez espécies de peixes pertencentes a 3 ordens e 4 famílias. A família Cyprinidae foi a família dominante, com sete espécies representativas, enquanto as famílias Siluridae, Nemacheilidae e Mastacembelidae foram representadas por uma espécie cada. O comprimento total médio mais baixo e o comprimento padrão foram registrados em Puntius conchonius (Hamilton, 1822) como 9.2 ± 0.6 cm e 7.3 ± 0.6 cm, respectivamente, enquanto o comprimento total médio e o comprimento padrão mais altos foram registrados em Mastacembelus armatus (Lacepede, 1800) como 28.1 ± 1.7 cm e 15.9 ± 2.4 cm, respectivamente. O pH médio da água variou de 6.1 no Riacho Shergarh em agosto a 8.7 no Riacho Sakhakot em janeiro. A faixa de temperatura média foi registrada de 10.9 °C em janeiro no Riacho Dargai a 18.7 °C em agosto no Riacho Shergarh. Não foi encontrada diferença estatisticamente significativa para temperatura (p = 0,96) e pH (p = 0,14) nos três cursos de água. O presente estudo fornecerá uma linha de base para a criação e aprimoramento do estoque selvagem da ictiofauna comercialmente importante no campo da aquicultura e pesca.

Taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan / Avaliação taxonômica, morfométrica e limnológica da ictiofauna comercialmente importante do Riacho Sakhakot, Malakand, Paquistão

The present study was conducted for the taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan. The study area was divided into three sites along the water course namely Dargai Stream, Sakhakot Stream and Shergarh Stream. Fish samples were collected randomly during January to August 2017 with the help of fish gears. A taxonomic key was designed for the collected fish specimens. Ten fish species were identified belonging to 3 orders and 4 families. Family Cyprinidae was the dominant family with seven representative species while families Siluridae, Nemacheilidae and Mastacembelidae were represented by one species each. Lower mean total length and standard length was recorded in Puntius conchonius (Hamilton, 1822) as 9.2 ± 0.6 cm and 7.3 ± 0.6 cm respectively, while highest mean total length and standard length was recorded in Mastacembelus armatus (Lacepede, 1800) as 28.1 ± 1.7 cm and 15.9 ± 2.4 cm respectively. Mean pH of the water ranged from 6.1 at Shergarh Stream in August to 8.7 at Sakhakot Stream in January. Average temperature range was recorded from 10.9 °C in January at Dargai Stream to 18.7 °C in August at Shergarh Stream. No statistically significant difference was found for temperature (p = 0.96) and pH (p = 0.14) in the three water streams. The present study will provide a baseline for the rearing and enhancement of wild stock of the commercially important ichthyofauna in the field of aquaculture and fisheries.

O presente estudo foi realizado para a avaliação taxonômica, morfométrica e limnológica da ictiofauna comercialmente importante do Riacho Sakhakot, Malakand, Paquistão. A área de estudo foi dividida em três locais ao longo do curso de água, nomeadamente Riacho Dargai, Riacho Sakhakot e Riacho Shergarh. As amostras de peixes foram coletadas aleatoriamente durante janeiro e agosto de 2017, com a ajuda de artes de peixes. Uma chave taxonômica foi projetada para os espécimes de peixes coletados. Foram identificadas dez espécies de peixes pertencentes a 3 ordens e 4 famílias. A família Cyprinidae foi a família dominante, com sete espécies representativas, enquanto as famílias Siluridae, Nemacheilidae e Mastacembelidae foram representadas por uma espécie cada. O comprimento total médio mais baixo e o comprimento padrão foram registrados em Puntius conchonius (Hamilton, 1822) como 9.2 ± 0.6 cm e 7.3 ± 0.6 cm, respectivamente, enquanto o comprimento total médio e o comprimento padrão mais altos foram registrados em Mastacembelus armatus (Lacepede, 1800) como 28.1 ± 1.7 cm e 15.9 ± 2.4 cm, respectivamente. O pH médio da água variou de 6.1 no Riacho Shergarh em agosto a 8.7 no Riacho Sakhakot em janeiro. A faixa de temperatura média foi registrada de 10.9 °C em janeiro no Riacho Dargai a 18.7 °C em agosto no Riacho Shergarh. Não foi encontrada diferença estatisticamente significativa para temperatura (p = 0,96) e pH (p = 0,14) nos três cursos de água. O presente estudo fornecerá uma linha de base para a criação e aprimoramento do estoque selvagem da ictiofauna comercialmente importante no campo da aquicultura e pesca.

Taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan.

The present study was conducted for the taxonomic, morphometric and limnological assessment of the commercially important ichthyofauna of Sakhakot Stream, Malakand, Pakistan. The study area was divided into three sites along the water course namely Dargai Stream, Sakhakot Stream and Shergarh Stream. Fish samples were collected randomly during January to August 2017 with the help of fish gears. A taxonomic key was designed for the collected fish specimens. Ten fish species were identified belonging to 3 orders and 4 families. Family Cyprinidae was the dominant family with seven representative species while families Siluridae, Nemacheilidae and Mastacembelidae were represented by one species each. Lower mean total length and standard length was recorded in Puntius conchonius (Hamilton, 1822) as 9.2 ± 0.6 cm and 7.3 ± 0.6 cm respectively, while highest mean total length and standard length was recorded in Mastacembelus armatus (Lacepede, 1800) as 28.1 ± 1.7 cm and 15.9 ± 2.4 cm respectively. Mean pH of the water ranged from 6.1 at Shergarh Stream in August to 8.7 at Sakhakot Stream in January. Average temperature range was recorded from 10.9 °C in January at Dargai Stream to 18.7 °C in August at Shergarh Stream. No statistically significant difference was found for temperature (p = 0.96) and pH (p = 0.14) in the three water streams. The present study will provide a baseline for the rearing and enhancement of wild stock of the commercially important ichthyofauna in the field of aquaculture and fisheries.

A prospective study on the feasibility of cochlear implantation during the coronavirus disease 2019 crisis and trends of assessment: experience in a UK centre.

OBJECTIVES: To demonstrate the feasibility of continuing cochlear implantation during the coronavirus disease 2019 crisis and to report on trends of referrals via the neonatal hearing screening programme. METHODS: A prospective case series was conducted on children who underwent cochlear implantation during the coronavirus disease 2019 crisis in the UK and a sample of referrals via the neonatal hearing screening programme. A step-by-step description of peri-operative management is included. RESULTS: Regionally, between February and May 2020, 106 babies were referred via the neonatal hearing screening programme to paediatric audiology. Eleven children were operated on during the coronavirus disease 2019 study period. None of the 11 children developed coronavirus symptoms. DISCUSSION: It is widely recognised that the demands of managing the current pandemic may compromise screening, clinical assessment and elective surgery. Time-sensitive issues such as cancer management have gained prominence, but a similar need exists for timely paediatric cochlear implantation. CONCLUSION: Implantation in the paediatric population during the coronavirus disease 2019 pandemic is feasible with careful planning.

Assessment of the vasoactive effects of the (S)-epimers of ergot alkaloids in vitro.

Ergot alkaloids are produced by the fungus Claviceps purpurea and their levels are carefully monitored in animal and human diets due to their harmful effects and widespread contamination of cereal crops. Ergot alkaloids exist in two forms known as the (R)- and (S)-epimers with only the former being monitored in diets in North America. The (S)-epimers of ergot alkaloids are thought to be biologically inactive and, therefore, harmless. A major mechanism by which the (R)-epimers of ergot alkaloids produce their toxic effect is through vasoconstriction. Therefore, the objective of this study was to examine the vasoactivity potential (contractile response) of four (S)-epimers, namely ergocryptinine, ergocristinine, ergocorninine, and ergotaminine utilizing an in vitro arterial tissue bath system. Bovine metatarsal arteries (n = 6, ergocryptinine and ergocorninine; n = 6, ergocristinine and ergotaminine; n = 6 arteries/(S)-epimer, total n = 12) were collected from healthy mixed-breed beef steers immediately after slaughter, cut into 3-mm arterial cross sections, and suspended in a tissue bath with continuously oxygenated Krebs-Henseleit buffer. To assess the contractile response of each (S)-epimer, a cumulative contractile dose-response curve was constructed by incubating arteries with increasing concentrations (1 × 10-11 to 1 × 10-6 M) of that (S)-epimer. Contractile responses were recorded as grams of tension and were normalized to an initial contraction of phenylephrine. Contrary to the widespread belief, all tested (S)-epimers were found vasoactive and produced a concentration-dependent arterial contractile response similar to what has been reported for the (R)-epimers. The arterial contractile response to ergotaminine was strongest and was significantly greater than that of ergocryptinine and ergocristinine at the highest concentration used (P ≤ 0.01). Our results indicate that the (S)-epimers are biologically active and are likely harmful similar to the (R)-epimers. The levels of (S)-epimers should be carefully monitored in human and animal diets worldwide.

Toxicity assessment of reduced graphene oxide and titanium dioxide nanomaterials on gram-positive and gram-negative bacteria under normal laboratory lighting condition.

Toxicity effect of reduced graphene oxide (rGO) and titanium dioxide (TiO2) nanomaterials (NMs) on Gram-positive (Bacillus subtilis) and Gram-negative (Escherichia coli) bacteria was assessed. For both strains, study demonstrated that the toxicity was time and concentration dependent which led to reduction in growth rate and cell death. Upon NMs exposure, an instantaneous cell death in E. coli culture was observed. This is in contrast with B. subtilis, in which the culture growth remained in the log phase; however their growth rate constant, µ g was reduced by ∼70%. The discrepancy between E. coli and B. subtilis was due to strain-specific response upon contact with NMs. TEM, SEM and EDX analysis revealed direct physical surface-surface interaction, as evidence from the adherence of NMs on the cell surface.

First Successful Large-Scale Introduction of an Enhanced Recovery after Bariatric Surgery (ERABS) Program in the Middle East: The Results and Lessons Learned of Tawam Hospital/Johns Hopkins, a Tertiary Governmental Center in the UAE.

BACKGROUND: Although enhanced recovery after bariatric surgery (ERABS) has proven to be safe and cost-effective, this concept is relatively new in the Middle East. METHODS: A retrospective analysis of consecutive registered cohorts of patients who underwent primary and purely laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB) were compared before introduction of ERABS (2010-2014) and after ERABS (2015-2017) at Tawam Hospital/Johns Hopkins, the UAE. RESULTS: A total of 462 eligible bariatric patients (LSG 414 and LRYGB 48) were operated on before and 1602 (LSG 1436 and LRYGB 166) after introduction of the ERABS. Significant improvements of mean patient time of the patient being within the OR for LSG (from 2:27 to 1:23 min, p = 0.000) and LRYGB (from 3:17 to 1:59 min, p = 0.000) were achieved when comparing pre-ERABS with after introduction of ERABS. Furthermore, there was a significant decrease in LOS in both LSG (from 3.2 to 1.5 days, p = 0.000) and in LRYGB (from 3.5 to 1.7 days, p = 0.000). Major (CD classification III-IV) complications decreased significantly in LSG (from 13.8 to 0.8%, p = 0.000) and were similar in LRYGB (from 4.2% to 3.0%, p = NS). The readmission rate for LSG (from 2.9 to 2.6%, p = NS) or LRYGB (from 0 to 4.8%, p = NS) and the reoperation rates after LSG (from 0.7 to 0.5%, p = NS) and LRYGB (from 0 to 2.4%, p = NS) did not differ between both groups following introduction of ERABS. CONCLUSIONS: Implementation of a standardized ERABS program in the Middle East is feasible and safe and leads to reduced LOS and OR times.

Assessment of Caregiving Constructs: Toward a Personal, Familial, Group, and Cultural Construction of Dementia Care through the Eyes of Personal Construct Psychology.

Conditions that cause cognitive impairment and behavioural and personality changes, such as Alzheimer's disease (AD) and related dementia, have global impact across cultures. However, the experience of dementia care can vary between individuals, families, formal caregivers, and social groups from various cultures. Self-reported measures, caregiving stress models, and conceptual theories have been developed to address the physical, financial, psychological, and social factors associated with the experience of dementia care. Given the cross-cultural variability in the experience of dementia care, it is important for such methodologies to take individual and cultural construct systems into account. We contend that personal and group constructs associated with dementia care should be explored in both the formal and informal caregiving contexts. Therefore, in this paper we introduce the theory of Personal Construct Psychology (PCP) with its explicit philosophy, well-elaborated theory, and derived assessment methods as a potential constructivist research approach to examine the personal, familial, group, and cultural construct systems that determine the experience of dementia caregiving. These concepts and assessment procedures are illustrated in this paper through case study examples and scenarios from the context of dementia care with a focus on family home caregivers. This paper elaborates the assessment and therapeutic approaches of personal construct theory (PCT) to further expand alternatives for support services and program interventions and to amplify policies for dementia care within and across cultures.

Influence of Social Deprivation on Outcome of Open Arterial Surgery in Tertiary Care: An Observational Study.

BACKGROUND AND OBJECTIVE: Health equity is playing an increasing role in British government health policy. Evidence of social deprivation affecting outcomes in surgery is poor. This study aimed to assess the influence of social deprivation on the outcome of major arterial surgery. MATERIALS AND METHODS: A retrospective cohort study was undertaken in patients undergoing elective or emergency open surgery for abdominal aortic aneurysms or lower limb arterial reconstruction over an eight and a half year period within one institution. Patient deprivation was calculated for each patient with the Index of Multiple Deprivation (IMD) score. This was then entered into multivariate models to determine its effect on mortality and postoperative length of stay after adjustment for confounders. RESULTS: Five hundred and six patients were included in the study. There were 45 deaths (8.9%) and median (IQR) postoperative length of stay was 8 (4-15) days. The median (IQR) IMD score was 46.4 (28.3-64.5). IMD score correlated with ASA grade and was significantly higher in smokers, patients with respiratory disease and those with left ventricular failure. IMD (OR = 1.01; 95% CI = 0.99-1.03; p = .45) did not affected mortality, which was associated with aortic surgery, emergency surgery, and high ASA grade. Postoperative length of stay, which was longer with/after aortic surgery, tissue loss, emergency surgery, high ASA grade, low haemoglobin, and age over 80 years was also independent of deprivation (Spearman's rho = -0.49, p = .28). DISCUSSION: No effect of social deprivation on mortality or length of stay in patients undergoing major arterial surgery was identified.

Paediatric day case tonsillectomy: a safe, feasible and an economical way to treat patients--Yorkhill experience.

INTRODUCTION: Day case surgery is widely encouraged as it has many benefits. In this study, we evaluate the feasibility of paediatric tonsillectomies as day case surgery procedures in a tertiary paediatric centre. METHODS: The outcome of paediatric tonsillectomy performed as day case procedures was studied for four months. We recorded complication rates in comparison to the standard in-patient practice. RESULTS: 23 paediatric patients were included in this study. The age of the patients ranged from four to 11 years, with mean age of 6.5. No patients suffered post-operative complications within the first 24 h. Two patients were re-admitted due to a post-operative complication (8.6%) and one patient for a non-operative cause (4.3%) beyond the initial 24 h. CONCLUSION: Paediatric Day Case Paediatric Tonsillectomy is a safe, feasible and an economical way to manage patients. It should be practised as a day case where appropriate and when criteria are met.

Physicians knowledge and attitude of opioid availability, accessibility and use in pain management in Bangladesh.

This survey was conducted on 1000 physicians with pain management responsibilities practicing in 47 districts in Bangladesh. The response rate was 58.3%. The physicians had a mean of 21 years in practice. It was notable that 66% of the physicians had seen cancer patients in the last 12 months and 63% had seen patients with advanced stage cancer where opioids are considered as the mainstay of treatment. It was discouraging that 85% of the physicians preferred to prescribe pethidine, when patients needed opioids for severe pain. 53% of the physicians were not aware of the 'Bangladesh Narcotics law, 1990'. 89% of the physicians would restrict opioid dosage in pain management to prevent drug tolerance or addiction. Oncology physicians displayed significantly higher knowledge scores. The results demonstrated physicians' poor knowledge, attitude and perceived barriers regarding opioids. Effective education strategies need to be addressed using the study result.

Geochemical assessment of metal concentrations in sediment core of Korangi Creek along Karachi Coast, Pakistan.

Sediment core from Korangi Creek, one of the polluted coastal locations along the Karachi Coast Pakistan, was collected to trace the history of marine pollution and to determine the impact of industrial activity in the area. Down core variation of metals such as Ca, K, Mg, Al, S, Ti, V, Cr, Mn, Fe, Ni, Cu and Zn was studied in the 72.0 cm core. Nuclear analytical techniques, proton induced X-rays emission (PIXE), was employed to ascertain the chemical composition in sediment core. Grain size analysis and sediment composition of cored samples indicated that Korangi creek sediments are clayey in nature. Correlation matrix revealed a strong association of Ni, Cu, Cr and Zn with Fe and Mn. To infer anthropogenic input, enrichment factor (EF), degree of contamination and pollution load index were calculated. EF showed severe enrichment in surface sediment for Ni, Cu, Cr and Zn, indicating increased industrial effluents discharge in recent years. The study suggests that heavy metal discharge in the area should be regulated. If the present trend of enrichment is allowed to continue unabated, it is most likely that the local food web complexes in the creek might be at highest risk.

US-guided therapy of calcific tendinopathy: clinical and radiological outcome assessment in shoulder and non-shoulder tendons.

PURPOSE: To analyze the effectiveness and complication rate of ultrasound (US)-guided perforation and lavage using a two-needle technique with 16 - 18 G needles in the treatment of patients with calcific tendinopathy in the shoulder, elbow, hip, and knee by radiological and clinical follow-up. MATERIALS AND METHODS: A retrospective chart review was performed and 40 patients (13 male, 27 female; mean age, 53.5 years; range 24 -74 years) were identified as having received US-guided perforation and lavage due to symptomatic calcific tendinopathy of the rotator cuff tendons, triceps, extensor and flexor tendons at the elbow, rectus femoris tendon and patellar tendons. The radiographic outcome was assessed by comparison of the size and quality of the calcification before and 6 weeks after the procedure. On US images, the quality of the acoustic shadow was assessed, together with other alterations of the tendon and surrounding tissue. Patients were interviewed by telephone to assess the clinical outcome regarding pre-treatment and post-treatment pain and tendon function. RESULTS: 34 shoulder tendons and 6 non-shoulder tendons were identified. The mean calcium reduction was 39.9 mm(2) (range, 0 - 215; p < 0.001), while 80 % of patient showed a resolution of more than 60 % resulting in good clinical improvement. A very low complication rate was found (1 partial tear). CONCLUSION: The US-guided perforation and lavage technique is an effective and safe treatment for rotator cuff calcifications as well as for other body tendons. Although the two-needle technique and large needles were used in this study, a very low complication rate was detected.