Current Issue : July - September Volume : 2013 Issue Number : 3 Articles : 4 Articles
Background: Pakistan was among the leading countries in south Asia which started the family planning program\r\nin late 50s, forecasting the need to control the population. Despite this early intervention, fertility rate has declined\r\nbut slower in Pakistan as compared to most other Asian countries. Pakistan has almost a stagnant contraceptive\r\nprevalence rate for more than a decade now, perhaps owing to the inadequate performance of the family planning\r\nprograms. The provision and use of long term contraceptives such as IUCD has always been low (around 2%) and\r\nassociated with numerous issues. Married women who want to wait before having another child, or end\r\nchildbearing altogether, are not using any long term method of contraception.\r\nMethodology: A descriptive qualitative study was conducted from May to July 2012, to explore and understand\r\nthe perceptions of women regarding the use of IUCDs and to understand the challenges/issues at the service\r\nprovider�s end. Six FGDs with community women and 12 in-depth interviews were conducted with family planning\r\nproviders. The data was analyzed using the Qualitative Content Analysis approach.\r\nResults: The study revealed that the family planning clients are reluctant to use IUCDs because of a number of\r\nmyths and misconceptions associated with the method. They have reservations about the provider�s capability and\r\nquality of care at the facility. Private health providers are not motivated and are reluctant to provide the IUCDs\r\nbecause of inadequate counseling skills, lack of competence and improper supporting infrastructure. Government\r\nprograms either do not have enough supplies or trained staff to promote the IUCD utilization.\r\nConclusion: Besides a well-designed community awareness campaign, providers� communication and counseling\r\nskills have to be enhanced, as these are major contributing factors in IUCD acceptance. Ongoing training of all\r\nfamily planning service providers in IUCD insertion is very important, along with strengthening of their services....
Background: Colonoscopes are designed with balance between flexibility, required to negotiate angulations, and\r\nstiffness, required to counteract the propensity for looping in unfixed sections of the colon, which retards\r\nadvancement of the instrument. Colonoscopy can be challenging with old instruments that have lost native\r\nstiffness and become less responsive to torquing.\r\nA new intraluminal stiffening device has become available in two grades of stiffness. However, there is no\r\npublished evidence of its effectiveness. This randomized, controlled trial was designed to determine the\r\neffectiveness of the stiffening wires in improving cecal intubation rate and time following routine application. A\r\nsecondary analysis determines effectiveness of application only after intractable failure with the unaided\r\ncolonoscope.\r\nMethods: The colonoscope tested was an Olympus CF-100TL, approximately fifteen years old. Patients were\r\nrandomly assigned to the unaided colonoscope or the standard or firm wire introduced routinely on entry into\r\ntransverse colon. Each phase of colonoscopy was timed. Failure to advance the colonoscope for 5 minutes (despite\r\nusual manipulations to minimize looping) required switching to another intervention according to a prescribed\r\nmethodology and the originally assigned intervention was recorded as failed.\r\nResults: The study was terminated after accrual of 112 participants (target sample size 480) because the colonoscope\r\nrequired repairs (no damage attributable to stiffening wires) which would have been uneconomical. There were no\r\nstatistically significant differences between per-protocol cecal intubation rates (81.1, 71.1 and 70.3 percent respectively),\r\na finding which persisted after multiple imputation for a virtual sample size of 480. Similarly, there were no statistically\r\nsignificant differences between per-protocol cecal intubation times (15, 16.2 and 13.9 minutes). However, a statistically\r\nsignificant improvement in cecal intubation rate (from 81.1% to 97.3%, P = 0.0313) was achieved when the wires were\r\napplied after intractable failure of the unaided colonoscope in the first intervention group.\r\nConclusions: Routine application of either stiffening wire does not improve caecal intubation rate nor time compared\r\nto the unaided colonoscope. However, application of the stiffening wires after intractable failure of the unaided\r\ncolonoscope enabled a statistically significant improvement in cecal intubation rate....
Background: Compliant vascular phantoms are desirable for in-vitro patient-specific experiments and device\r\ntesting. TangoPlus FullCure 930W is a commercially available rubber-like material that can be used for PolyJet rapid\r\nprototyping. This work aims to gather preliminary data on the distensibility of this material, in order to assess the\r\nfeasibility of its use in the context of experimental cardiovascular modelling.\r\nMethods: The descending aorta anatomy of a volunteer was modelled in 3D from cardiovascular magnetic\r\nresonance (CMR) images and rapid prototyped using TangoPlus. The model was printed with a range of increasing\r\nwall thicknesses (0.6, 0.7, 0.8, 1.0 and 1.5 mm), keeping the lumen of the vessel constant. Models were also printed\r\nin both vertical and horizontal orientations, thus resulting in a total of ten specimens. Compliance tests were\r\nperformed by monitoring pressure variations while gradually increasing and decreasing internal volume. Knowledge\r\nof distensibility was thus derived and then implemented with CMR data to test two applications. Firstly, a\r\npatient-specific compliant model of hypoplastic aorta suitable for connection in a mock circulatory loop for in-vitro\r\ntests was manufactured. Secondly, the right ventricular outflow tract (RVOT) of a patient necessitating pulmonary\r\nvalve replacement was printed in order to physically test device insertion and assess patientââ?¬â?¢s suitability for\r\npercutaneous pulmonary valve intervention.\r\nResults: The distensibility of the material was identified in a range from 6.5 Ã?â?? 10-3 mmHg-1 for the 0.6 mm case, to\r\n3.0 Ã?â?? 10-3 mmHg-1 for the 1.5 mm case. The models printed in the vertical orientation were always more compliant\r\nthan their horizontal counterpart. Rapid prototyping of a compliant hypoplastic aorta and of a RVOT anatomical\r\nmodel were both feasible. Device insertion in the RVOT model was successful.\r\nConclusion: Values of distensibility, compared with literature data, show that TangoPlus is suitable for\r\nmanufacturing arterial phantoms, with the added benefit of being compatible with PolyJet printing, thus\r\nguaranteeing representative anatomical finishing, and quick and inexpensive fabrication. The appealing possibility\r\nof printing models of non-uniform wall thickness, resembling more closely certain physiological scenarios, can also\r\nbe explored. However, this material appears to be too stiff for modelling the more compliant systemic venous\r\nsystem....
Background: The hand-assisted technique enables the rapid extraction of the graft, shortening the warm ischemia\r\ntime (WIT), and the retroperitoneoscopic approach is potentially associated with a less incidence of postoperative\r\nileus in donor nephrectomy for living kidney transplantation. The aim of this study was to assess the efficacy and\r\nsafety of retroperitoneoscopic donor nephrectomy with a gel-sealed hand-assist access device (GelPort), which is a\r\nwound sealing device that permits the access of the hand to the surgical field, free trocar site choice within it, and\r\nrapid conversion to open surgery if necessary, while preserving the pneumoperitoneum/pneumoretroperitoneum.\r\nMethods: Seventy-five consecutive donors receiving this procedure were retrospectively studied. A 2-cm skin\r\nincision was made at the midpoint between the tip of the 12th rib and superior border of the iliac bone in the\r\nmidaxillary line, through which retroperitoneal space was made. Preperitoneal wound with a 6 ââ?¬â?? 7-cm pararectal\r\nincision in the upper abdominal region was connected to the retroperitoneal space. A GelPort was put inside the\r\npararectal surgical wound. The principle was pure retroperitoneoscopic surgery; hand-assist was applied for\r\nretraction of the kidney in the renal vessel control and graft extraction.\r\nResults: The mean operation time including waiting time for recipient preparation was 242.2Ã?±37.0 (range: 214.0ââ?¬â??\r\n409.0) min, and the mean amount of blood loss was 164.3Ã?±146.6 (range: 10.0ââ?¬â??1020.0) ml. The mean WIT was\r\n2.8Ã?±1.0 (range: 1.0ââ?¬â??6.0) min. The shortage of renal vessels or ureter was observed in none of the grafts. No donor\r\nexperienced blood transfusion, open conversion, or injury of other organs. Blood loss was greater in patients with\r\nbody mass index (BMI) of 25 kg/m2 or higher than in those with BMI of <25 kg/m2 (218.4Ã?±98.8 vs. 154.8Ã?±152.1 ml,\r\nP=0.031). No donor had postoperative ileus or reported wound pain leading to decreased activity of daily life or\r\nwound cosmetic problem.\r\nConclusions: Retroperitoneoscopic hand-assisted donor nephrectomy with the mentioned approach was\r\nsuggested to be a feasible option without compromising safety, although further improvement in surgical\r\ntechniques is warranted....
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