Diagnostic accuracy of Alvarado scoring system relative to histopathological diagnosis for acute appendicitis: A retrospective cohort study.

Background: Acute appendicitis (AA) is a surgical emergency that requires prompt diagnosis and suitable management. It may lead to complications resulting in mortality. To evaluate the diagnostic accuracy of the Alvarado scoring system (ASS) for acute appendicitis concerning histopathological data. Methodology: About 120 patients were selected for this study consisting of 96 males and 24 females age between 20 and 60. Alvarado scoring system is calculated for each patient after collecting data about demographics, laboratory findings, and clinical examination. Then, we compared it with histopathological diagnosis taking it as a gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. SPSS version 20 was used for analyzing the data. Results: About 120 patients were included in our study. The male to female ratio was 3:1. Sensitivity and specificity were 83.3% and 41% respectively. While PPV and NPV were 85% and 41% respectively. The negative appendectomy rate was 21%. The area under the curve for receiving operating characteristics is 0.628. Conclusion: ASS is a useful diagnostic tool regarding sensitivity and positive predictive value, especially in developing countries. It is cheap, reliable, and can be easily applied.

Copper mixed-triazolate frameworks featuring the thiophene-containing ligand towards enhanced photodegradation of organic contaminants in water.

By using a thiophene-containing triazole ligand -3,5-di(thiophen-2-yl)-1H-1,2,4-triazole (3,5-Th2-tzH) and 3,5-diphenyl-1H-1,2,4-triazole (3,5-Ph2-tzH) in different molar ratio in the reactant, copper(I) mixed-triazolate frameworks CuMtz-1 {[Cu8(3,5-Ph2-tz)6-x(3,5-Th2-tz)x](BF4)2(CH3OH)3} (x = 0.5 for CuMtz-1a and 1.1 for CuMtz-1b) were firstly synthesized and characterized by PXRD, IR, 1H NMR, SEM, TG and UV-vis DRS. They have been evaluated as photocatalysts for the degradation of organic pollutants in water. It was found that the rate constants towards the degradation of both traditional and emerging organic contaminants over CuMtz-1b were significantly improved, i.e. by 160% for methyl orange, 210% for rhodamine B, 80% for methyl blue and 180% for sulfasalazine in comparison with that catalyzed over the parent MOF CuTz-1 {[Cu8(3,5-Ph2-tz)6](BF4)2(CH3OH)3} under Xe lamp irradiation in the absence of H2O2. More importantly, the degradation efficiency of methyl orange and sulfasalazine by CuMtz-1b without the addition of H2O2 was quite comparable with that by CuTz-1 with the addition of H2O2 under both Xe lamp irradiation and natural sunlight. The enhancement on the degradation efficiency can be attributed to the increased light absorption ability and the change of the band structure caused by the incorporation of thiophene-containing triazole ligand.

Evaluating quality standards' adherence in surgical care: a case study from Pakistan.

OBJECTIVE: To explore the extent of adherence to surgical quality standards and areas of improvement. DESIGN: Multi-method case study was done. Assessment of observed/actual and self-reported adherence to quality standards in surgical care was done on WHO's safe-surgery checklist. Client satisfaction through exit interviews assessed of all operated during 1 month. Semi-structured interviews of key informants were conducted to identify areas of improvements in surgical care in this hospital. SETTING: Conducted in a tertiary care teaching hospital in Lahore, Pakistan. PARTICIPANTS: Out of all 154 patients during 1 month were admitted with indications for surgery and 35.71% patients gave consent and participated in the study. OUTCOME MEASURE: Actual and reported adherence data were categorized in excellent, good, satisfactory and poor adherence to standards. For in-depth interviews, themes were identified from textual data. RESULTS: Overall activities in surgical department were performed well, patients were satisfied and hospital surgical mortality rate was zero but infection control measures needs attention and these practices were found poor with high re-operation and re-admissionrate (P-value < 0.001). Adherence to standards of surgical quality was inadequate in pre-operative, operative and post-op steps as assessed on the checklist but actual adherence was different from reported adherence by surgical care providers. CONCLUSION: This case study shows a complete picture of surgical care quality in a hospital of Pakistan. Discrepancy between perceived/reported adherence and actual practice was found. Patients' satisfaction is not a reliable outcome measure of surgical care quality.

How Do Patients Perceive and Expect Quality of Surgery, Diagnostics, and Emergency Services in Tertiary Care Hospitals? An Evidence of Gap Analysis From Pakistan.

OBJECTIVES: Service quality is one of the important gears to appraise services and determine the gray areas that need improvement. In countries with a resource-poor health system, the first step of measuring quality is yet to be taken. This study seeks to inform policy makers in developing contextual service quality models by identifying service quality gaps in tertiary care teaching hospitals using patients' perspective. METHODS: A cross-sectional study was performed using multistage cluster sampling, and a modified version of the SERVQUAL (SERV-service, QUAL-quality) instrument was administered to determine patient's expectations and perceptions. A total of 817 completed questionnaires were obtained from patients and/or their attendants using convenience sampling. RESULTS: Data analysis revealed statistically significant negative quality gaps between expectations and perceptions of tangibility, reliability, empathy, assurance, responsiveness, and communication. The difference in mean expectation and perception for responsiveness across the sexes was significant (p < 0.003; p < 0.037, respectively) as well as in perception of communication (p < 0.026). Other dimensions and overall hospital expected and perceived quality were independent of sex. Educational status showed significant difference in expectation and perception in responsiveness (p < 0.005), but the perception of each dimension was significantly different in different educational categories (assurance: p < 0.001; empathy: p < 0.001; reliability: p < 0.001; tangibility: p < 0.001; responsiveness: p < 0.001; communication: p < 0.001; and for overall service quality: p < 0.001). Age and service departments showed no relationship with any of the perceived or expected dimension of service quality of hospitals. CONCLUSIONS: Tertiary care hospitals failed to meet patients' expectations in all major areas of service quality, posing a question of how hospitals implement and evaluate their quality assurance policy.