Emergency medicine departments are often the first point of call or
Although a leading cause of death and disability in much of the world, chronic obstructive pulmonary disease (COPD) has remained conspicuously below the radar of public health authorities.
COPD is the result of several pathobiological processes interacting on
Risks in clinical practice are associated with faulty equipment and medication errors, service standards and competencies as well as human factors. Clinical risk management seeks to minimize the chances and costs of adverse outcomes. It overlaps, but is distinct from risk assessment, which focuses on weighing out the pros and cons of specific medical procedures on specific patients or patient groups; these are the subject of best practice guidelines in evidence-based medicine. Although formal risk management in clinical practice is a recent development, many experts believe its adoption might be quicker than in other sectors.
Clinical risk management and clinical governance
Clinical risk management requires robust tools, protocols and methodologies, accompanied by continuous and active feedback loops. It has become an integral facet of what is known as clinical governance.
The UK
The recently published article in
by Dr Tito Bacarese-Hamilton
Anemia in pregnancy
Anemia is defined as a condition in which the number of red blood cells, or their oxygen carrying capacity, is insufficient to meet the physiological needs of the body[1]. The World Health Organization (WHO) recognizes anemia as a global health problem that affects both developing and developed countries. Notably, iron deficiency anemia (IDA) accounts for most of the anemia that occurs in underprivileged environments generally due to poor diet. There are other causes of anemia that may coexist with iron deficiency, including deficits in other nutrients, e.g. vitamins A, B12, and C, and folic acid; hemolysis occurring with malaria; glucose-6-phosphate dehydrogenase deficiency; as well as congenital hereditary defects in hemoglobin synthesis[2].
Due to its association with levels of iron in the blood and the prevalence of IDA, hemoglobin concentration is recognized by WHO as the most reliable indicator of anemia[2]. During pregnancy, levels of hemoglobin generally vary to accommodate the increasing maternal blood volume and the iron needs of the fetus. Due to this increase in iron requirements, anemia is more prevalent in pregnant women than within the general population. Maternal anemia during pregnancy has been related to increased risk of adverse pregnancy outcomes including premature labour, low birth weight and still birth. Furthermore, at its most severe, anemia can also increase maternal mortality risk. Consequently, many countries conduct interventions within this group to reduce anemia and its adverse effects.
WHO recommends the hemoglobin cut-off for the diagnosis of anemia in pregnant women should be at levels of 110 g/L or less[1]. It also recommends that all pregnant women are tested for hemoglobin levels at the beginning of their third semester in order to detect anemia. However, in some parts of the world where healthcare is fragmented, access to testing facilities to enable detection of anemia before it becomes severe (<70 g/L), and therefore life threatening, can prove difficult.
POCT for anemia in the developing world
Point of care testing (POCT) devices can have a prominent role in improving global health, particularly in developing countries that often cannot afford dedicated laboratories. The use of small, portable and fast POCT analysers circumvents this issue. However, it is essential that POCT devices intended for use in developing countries are fit for purpose in often challenging conditions. Many devices fail because of high temperatures, high humidity and inconsistent sources of electrical power. Therefore, for a POCT device to have a role in screening for anemia, the device needs to be durable and robust, as well as consistently analytically accurate.
Case study: Indonesia
One such POCT device that has been demonstrated to meet the rigorous requirements for reliable anemia testing in any environment is the DiaSpect Tm (EKF Diagnostics, Cardiff, UK). This palm-sized hemoglobin analyser is proving to be highly effective in Indonesia where there is an extremely fragmented hospital service. This is due to the fact that the country is divided into 34 Provinces, which are in turn subdivided into 511 Districts, 185 of which are classified as disadvantaged.
Indonesia
The ICU is the last frontier of medical care, a symbol of both its promise and of its limits. Given the huge costs of operating an ICU, it is also an arena for intense debate about physician responsibility towards patients, in the face of growing competition for scarce medical resources. Rationalizing the use of ICUs and allocating beds to patients more likely to benefit from them has in fact been throwing up challenges for hospital management for over three decades. The biggest of these involves determining when life support should be ended for an ICU patient. In late 2013,
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