This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:


To compare the efficacy and safety of different prophylactic pharmacological interventions (antiemetic drugs) either against no treatment, placebo or against each other (as mono- or combination prophylaxis) for the prevention of postoperative nausea and vomiting in adults undergoing any type of surgery under general anaesthesia.


To explore the best dose or dose range of the antiemetic drugs in terms of efficacy and safety.


To generate a clinically useful ranking of antiemetic drugs (mono- and combination prophylaxis) according to efficacy and safety.

Drugs for preventing postoperative nausea and vomiting in adults after general anaesthesia: a network meta‐analysis

Cardiopulmonary resuscitation (CPR) is a fundamental skill that should be acquired by all medical community members. This study aims to evaluate the knowledge and attitudes of junior doctors and medical students towards CPR and CPR training at Beni-Suef University Hospital in Upper Egypt, a representative region with conditions common to LMIC settings. In this cross-sectional study, a total of 205 participants (60 junior doctors and 145 medical students) responded to a self-administered questionnaire assessing their knowledge regarding basic life support (BLS) and CPR techniques in neonates, children, and adults, in addition to attitudes towards the importance and necessity of CPR and CPR training. Of the 60 junior doctors that participated in the study, only 31.7% had adequate knowledge of CPR, but up to 95% reported positive attitudes towards CPR training. Among the 145 medical student participants, only 6.2% had adequate knowledge of CPR, while 91% reported positive attitudes towards training. Deficiencies in CPR knowledge were more apparent in questions related to CPR in children and neonates. Junior doctors and medical students with previous CPR training demonstrated significantly better CPR knowledge than their counterparts without prior training. A statistically significant positive correlation was detected between CPR knowledge and attitude towards CPR training among medical students (r = 0.41, p < 0.001). The results of this study demonstrate suboptimal and inadequate CPR knowledge among junior doctors and medical students in a representative hospital in Upper Egypt. However, participants reported overwhelmingly positive attitudes and eagerness towards the implementation of CPR training. Further research needs to be done to establish CPR skill proficiency as well as to investigate barriers to CPR training, effectiveness of available programs, and the potential implementation of such a program in Egypt and other LMICs.

/pdf/knowledge-of-and-attitudes-towards-cardiopulmonary-2nf10cuifh.pdf

Knowledge of and attitudes towards cardiopulmonary resuscitation among junior doctors and medical students in Upper Egypt: cross-sectional study

Major structural cardiovascular diseases are associated with cardiac arrhythmias, but their full spectrum remains unknown in sub-Saharan Africa (SSA), which we addressed in this systematic review. Atrial fibrillation/atrial flutter (AF/AFL) prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, but <1% in the general population. Use of oral anticoagulation is heterogenous (9-79%) across SSA. The epidemiology of sudden cardiac arrest/death is less characterized in SSA. Cardiopulmonary resuscitation is challenging, owing to low awareness and lack of equipment for life-support. About 18% of SSA countries have no cardiac implantable electronic devices services, leaving hundreds of millions of people without any access to treatment for advanced bradyarrhythmias, and implant rates are more than 200-fold lower than in the western world. Management of tachyarrhythmias is largely non-invasive (about 80% AF/AFL via rate-controlled strategy only), as electrophysiological study and catheter ablation centers are almost non-existent in most countries. Highlights - Atrial fibrillation/flutter prevalence is 16-22% in heart failure, 10-28% in rheumatic heart disease, 3-7% in cardiology admissions, and <1% in the general population in sub-Saharan Africa (SSA).- Rates of oral anticoagulation use for CHA2DS2VASC score ≥2 are very diverse (9-79%) across SSA countries.- Data on sudden cardiac arrest are scant in SSA with low cardiopulmonary resuscitation awareness.- Low rates of cardiac implantable electronic devices insertions and rarity of invasive arrhythmia treatment centers are seen in SSA, relative to the high-income countries.

https://globalheartjournal.com/articles/10.5334/gh.808/galley/824/download/

A Systematic Review of the Spectrum of Cardiac Arrhythmias in Sub-Saharan Africa.

https://rapm.bmj.com/content/rapm/44/4/437.full.pdf

Evidence review conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery: focus on anesthesiology for gynecologic surgery

BACKGROUND: The aim of the study is to evaluate the theoretical knowledge and psychomotor skill acquisition of basic life support (BLS) by a group of secondary school students in Nigeria pre and post BLS training. 
METHODS: This was quasi-experimental study design with 210 participants. They were taught on adult BLS and all the participants practiced BLS on a Resusci-Anne manikin immediately after the training. Data were collected using American Heart Association (AHA) structured questionnaire and psychomotor skills checklist for BLS at baseline, and post BLS training. 
RESULTS: The pre-training knowledge score was 1.9±1.4. This increased after the BLS training to 11.4±2.4, and the mean difference between the pre and post BLS training scores was 9.48571. Pre-training psychomotor skill score was 0.00±0.00, this increased to 8.9±1.9 after the training, and the mean difference was 8.90000. The knowledge and psychomotor skill difference between pre and post BLS training was significant (P<0.000).
CONCLUSION: Most Nigerian secondary school students were not knowledgeable about BLS. Therefore, there is need for the creation of more awareness among the students.

Theoretical knowledge and psychomotor skill acquisition of basic life support training programme among secondary school students.

Background Cardiopulmonary arrest is not an uncommon event in the medical practice with the causes ranging from reversible to irreversible causes. Therefore the skill in the performance of effective cardiopulmonary resuscitation is an essential part of successful medical practice. In some developed countries the CPR Training programmes were mandatory for all health care givers and even for non medical workers. However in the setting of ours, the situation is not so as most heath workers go for CPR Training programmes by wish except in some few centres were it is mandatory. Aim & objectives To assess the knowledge, attitudes and practices of medical practitioners in relation to cardiopulmonary resuscitation and defibrillation. Setting The study was carried out among medical practitioners in Osun State, Southwest Nigeria. Methods The study was conducted through a survey of medical practitioners in Osun state during an annual general meeting using a self administered questionnaire. Results The response rate was 65% with 65 out of 100 physicians returning the completed questionnaire. Only 40% of respondents had attended a basic and an advanced life support training programme while 30% knew how to operate an automated external defribellator (AED), seventy percent knew the meaning of AED. Most of the respondents that had attended a basic and an advanced life support programme were residents (80%) while 16% were consultants and the remaining 4% were general practitioners. More males (67%) among the respondents that knew how to operate an AED and majority (56%) were in the age range of 30-40years. Eighty two percent of the respondents would prefer to do a chest compression only resuscitation of which 44% were. Conclusion Most of the medical practitioners in Osun State were not knowledgeable about cardiopulmonary resuscitation and defibrillation . The few with the knowledge were from the tertiary institutions. There is therefore the need for the creation of more awareness among medical practitioners, especially among those outside tertiary health facilities.

Cardiopulmonary resuscitation - knowledge, attitude & practices in osun state, nigeria.

BACKGROUND: Trauma remains a leading cause of morbidity and mortality in resource challenged economies I. In Nigeria, the number of deaths due to trauma-induced injuries is on the rise. Major trauma victims are usually from road traffic accidents and are managed at the accident and emergency unit while the severe ones are admitted into the intensive care unit. METHODOLOGY: All trauma admissions to the intensive care unit (ICU) of LAUTECHTeaching Hospital Osogbo over a 5 year period (2008-2012) after ethical approval from the ethical unit of the hospital were reviewed. RESULTS: During the study period, 112 trauma patients were admitted to the ICU, representing 68% of total ICU admissions. The male:female ratio of ICU trauma cases was 3:1. Out of the trauma admissions 83 (74.1%) of the cases came as emergency from the accident and emergency unit while 2.4% and 1.6% respectively came from operating theatre-- and the general ward respectively. 83 (74.1%) of trauma cases admitted were road traffic accidents, while 20 (17.9%) were burns not related to RTA and the remaining 8(9%) were due to falls, fight/ssault. Most of the road traffic accidents related trauma patients admitted to the intensive care unit had head injuries (66.3%) while 7% and 12% had multiple fractures and chest injuries respectively. The mean patient age 35 years and the mean duration of ICU stay was 6.3 ± 8.4 days. Survivors had a longer ICU stay CONCLUSION: Trauma is a major cause of hospitalization and intensive care utilization. It also consumes a significant amount of the health care budget.In most instances it is preventtable.Trauma prevention, the most effective management strategy should include increased public education, improved security, better implementation of legislative measures to ensure safety for all road users, control of firearms, and minimizing domestic and intentional violence. Appropriate, aggressive intensive care in combination with efficient communications,rapid medical evacuation, and an organized emergency multidisciplinary trauma care team will further improve outcome in trauma patients. Language: en

Trauma admissions into the intensive care unit and outcome of care in a tertiary health facility.

BACKGROUND : Post-operative nausea and vomiting (PONV) is a common complications following general anaesthesia and is a leading cause of morbidity following surgery . The mainstay of management them is by the use of antiemetic. METHOD : It was a randomized double blind placebo controlled study. The sample size was calculated as 90 from previous study with 10% attrition to make the 100. They were randomly divided into two groups; group B received dexamethasone prophylactically at induction while group A received placebo also at induction. All patients had balanced general anaesthesia and were taken to the recovery room postoperatively where incidences of postoperative nausea and vomiting were recorded. Patients with incidences of nausea and vomiting were treated with 10mg metoclopramide intravenously while postoperative complications that may be associated with dexamethasone prophylaxis were also noted. RESULTS : The groups were comparable with respect to demographic characteristics. More patients in group A(placebo group)) had incidence of nausea than group B (dexamethasone group) with p value of 0.01 and also more patients in group A had vomiting than group B with p value of 0.02; which was significant. The duration of stay in the recovery room for both groups A and B were however comparable with no statistical difference. CONCLUSION : Dexamethasone when given prophylactically at induction reduces incidence of postoperative nausea and vomiting after  gynaecological surgeries. KEYWORDS : Postoperative nausea (PONV), Dexamethasone, prophylaxis, gynaecology.

T O Olajumoke

Papers

Cardiopulmonary resuscitation - knowledge, attitude & practices in osun state, nigeria.

Trauma admissions into the intensive care unit and outcome of care in a tertiary health facility.

Single dose of dexamethasone for prevention of nausea and vomiting after major gynaecological surgery.