Effects of community health volunteers on infectious diseases of children under five in Volta Region, Ghana: study protocol for a cluster randomized controlled trial.

BACKGROUND: In many low- and middle-income countries, community health volunteers (CHVs) are employed as a key element of the public health system in rural areas with poor accessibility. However, few studies have assessed the effectiveness of CHVs in improving child health in sub-Saharan Africa through randomized controlled trials. The present study aims to measure the impact of health promotion and case management implemented by CHVs on the health of under-5 children in Ghana. METHODS/DESIGN: This study presents the protocol of a cluster-randomized controlled trial assessing the impacts of CHVs, in which the community was used as the randomization unit. A phase-in design will be adopted, and the intervention arm will be implemented in the intervention arm during the first phase and in the control arm during the second phase. The key intervention is the deployment of CHVs, who provide health education, provide oral rehydration solutions and zinc tablets to children with diarrhea, and diagnose malaria using a thermometer and a rapid diagnostic test kit during home visits. The primary endpoints of the study are the prevalence of diarrhea and fever/malaria in children under 5 years of age, as well as the proportion of affected children receiving case management for diarrhea and malaria. The first and second rounds of household surveys to collect data will be conducted in the first phase, and the final round will be conducted during the second phase. DISCUSSION: With growing attention paid to the roles of CHVs as an essential part of the community health system in low-income countries, this study will contribute valuable information to the body of knowledge on the effects of CHVs. TRIAL REGISTRATION: ISRCTN49236178 . (June 16th, 2015).

Efficacy of intravenous fluid warming during goal-directed fluid therapy in patients undergoing laparoscopic colorectal surgery: a randomized controlled trial.

OBJECTIVE: To evaluate the clinical efficacy of intravenous (IV) fluid warming in patients undergoing laparoscopic colorectal surgery. METHODS: Adult patients undergoing laparoscopic colorectal surgery were randomly assigned to receive either IV fluids at room temperature (control group) or warmed IV fluids (warm fluids group). Each patient received a standardized goal-directed fluid regimen based on stroke volume variances. Oesophageal temperature was measured at 15 min intervals for 2 h after induction of anaesthesia. RESULTS: A total of 52 patients were enrolled in the study. The drop in core temperature in the warm fluids group was significantly less than in the control group 2 h after the induction of anaesthesia. This significant difference was seen from 30 min after induction. CONCLUSION: IV fluid warming was associated with a smaller drop in core temperature than room temperature IV fluids in laparoscopic colorectal surgery incorporating goal-directed fluid therapy.

The Effect of Improved Water Supply on Diarrhea Prevalence of Children under Five in the Volta Region of Ghana: A Cluster-Randomized Controlled Trial.

Although a number of studies have been conducted to explore the effect of water quality improvement, the majority of them have focused mainly on point-of-use water treatment, and the studies investigating the effect of improved water supply have been based on observational or inadequately randomized trials. We report the results of a matched cluster randomized trial investigating the effect of improved water supply on diarrheal prevalence of children under five living in rural areas of the Volta Region in Ghana. We compared the diarrheal prevalence of 305 children in 10 communities of intervention with 302 children in 10 matched communities with no intervention (October 2012 to February 2014). A modified Poisson regression was used to estimate the prevalence ratio. An intention-to-treat analysis was undertaken. The crude prevalence ratio of diarrhea in the intervention compared with the control communities was 0.85 (95% CI 0.74-0.97) for Krachi West, 0.96 (0.87-1.05) for Krachi East, and 0.91 (0.83-0.98) for both districts. Sanitation was adjusted for in the model to remove the bias due to residual imbalance since it was not balanced even after randomization. The adjusted prevalence ratio was 0.82 (95% CI 0.71-0.96) for Krachi West, 0.95 (0.86-1.04) for Krachi East, and 0.89 (0.82-0.97) for both districts. This study provides a basis for a better approach to water quality interventions.

Analysis of anesthesia-related medical disputes in the 2009-2014 period using the Korean Society of Anesthesiologists database.

Using the Korean Society of Anesthesiologists database of anesthesia-related medical disputes (July 2009-June 2014), causative mechanisms and injury patterns were analyzed. In total, 105 cases were analyzed. Most patients were aged < 60 yr (82.9%) and were classified as American Society of Anesthesiologists physical status ≤ II (90.5%). In 42.9% of all cases, the injuries were determined to be 'avoidable' if the appropriate standard of care had been applied. Sedation was the sec most common type of anesthesia (37.1% of all cases), following by general anesthesia. Most sedation cases (27/39, 69.2%) showed a common lack of vigilance: no pre-procedural testing (82.1%), absence of anesthesia record (89.7%), and non-use of intra-procedural monitoring (15.4%). Most sedation (92.3%) was provided simultaneously by the non-anesthesiologists who performed the procedures. After the resulting injuries were grouped into four categories (temporary, permanent/minor, permanent/major, and death), their causative mechanisms were analyzed in cases with permanent injuries (n=20) and death (n=82). A 'respiratory events' was the leading causative mechanism (56/102, 54.9%). Of these, the most common specific mechanism was hypoxia secondary to airway obstruction or respiratory depression (n=31). The sec most common damaging event was a 'cardiovascular events' (26/102, 25.5%), in which myocardial infarction was the most common specific mechanism (n=12). Our database analysis demonstrated several typical injury profiles (a lack of vigilance in seemingly safe procedures or sedation, non-compliance with the airway management guidelines, and the prevalence of myocardial infarction) and can be helpful to improve patient safety.

A laparoscopic gastrectomy approach decreases the incidence and severity of emergence agitation after sevoflurane anesthesia.

PURPOSE: Compared to open gastrectomy (OG), laparoscopic gastrectomy (LG) has improved short-term outcomes and equivalent oncological outcomes. In this study, a potential short-term advantage of LG over OG, reduced risk of emergence agitation, was evaluated. METHODS: This retrospective study compared LG versus OG with respect to emergence agitation in 400 adult patients who underwent sevoflurane anesthesia. In all cases, a serial Richmond Agitation-Sedation Scale (RASS) assessment was performed in the postanesthesia care unit (PACU). Patients with a RASS score ≥+1 at any time were considered to have emergence agitation. Severe agitation was defined as a RASS score of +3 or +4. RESULTS: This study included 214 OG group subjects and 186 LG group subjects in the analysis. The overall incidence of emergence agitation was significantly lower in the LG group than the OG group (23.7 vs. 43.5 %, p < 0.001). The LG group had a significantly lower incidence of severe agitation than the OG group (1.1 vs. 4.7 %, p = 0.035). Multivariate logistic regression analysis demonstrated that the type of surgery (OG vs. LG), as well as current smoking, total dose of rescue opioids used in the PACU, and maximum pain score in the PACU, were independent risk factors for emergence agitation (odds ratio, 1.984; 95 % confidence interval, 1.249-3.153; p = 0.004). Patients with emergence agitation had significantly increased PACU stays (p = 0.024). CONCLUSIONS: Compared to an open approach, a laparoscopic gastrectomy approach can provide the short-term benefit of decreased emergence agitation.