METHODOLOGY: The PRISMA guidelines and MOOSE checklist were followed for this review. Publications in English from year 1990 to 2017 that included data on the timing and type of burn surgery and outcomes were included. Searches were done using Web of Science, Cochrane collaboration and Pubmed using keywords "Burn and surgery", "Burn and excision", "Burn and excision and grafting" and "burn and skin grafting". Trial quality was evaluated using the Newcastle-Ottawa scale. Outcomes compared for early and late excisions were length of stay (LOS), sepsis and mortality between LICs and HICs.
RESULTS: From 278 citations, we selected 41 for full text evaluation, and identified 16 eligible trials. LOS is shorter in early excision compared to late excision in both LICs and HICs. Mortality is lower in late excision compared to early excision in both LICs and HICs. Further subgroup analysis of elderly patients in HICs confirmed that mortality is lower in late excision and unchanged if the elderly are excluded. Early excision reduces sepsis in both LIC and HIC.
DISCUSSION: The variable definitions of age, timing of excision, variable nature of % TBSA comparison, mixed inclusion of inhalation injury, co-morbidities and unquantified access to resources make the data difficult to interpret and it is not possible to draw accurate conclusions on the role of early excision for burns in low-middle income countries. A prospective study is needed in order to answer this question.
Methods: We systematically searched PubMed, EMBASE and Web of Science for studies published from their starting dates to Aug 7, 2018. The sex-specific hazard ratios (HRs) and their pooled ratio (women vs men) of all-cause and CHD mortality associated with type 2 diabetes were obtained through an inverse variance-weighted random-effects meta-analysis. Subgroup analyses were used to explore the potential sources of heterogeneity.
Results: The 35 analyzed prospective cohort studies included 2 314 292 individuals, among whom 254 038 all-cause deaths occurred. The pooled women vs men ratio of the HRs for all-cause and CHD mortality were 1.17 (95% CI: 1.12-1.23, I2 = 81.6%) and 1.97 (95% CI: 1.49-2.61, I2 = 86.4%), respectively. The pooled estimate of the HR for all-cause mortality was approximately 1.30 in articles in which the duration of follow-up was longer than 10 years and 1.10 in articles in which the duration of follow-up was less than 10 years. The pooled HRs for all-cause mortality in patients with type 2 diabetes was 2.33 (95% CI: 2.02-2.69) in women and 1.91 (95% CI: 1.72-2.12) in men, compared with their healthy counterparts.
Conclusions: The effect of diabetes on all-cause and CHD mortality is approximately 17 and 97% greater, respectively, for women than for men.
PRESENTATION OF CASE: A 72-year-old female presented to us with right-sided abdominal pain for 3 weeks, associated with vomiting and diarrhoea. She had an appendectomy done 30 years ago and a recent myocardial infarction. Abdominal examination revealed a previous appendectomy scar and tenderness over the right lumbar region. Computed tomography showed ileocaecal intussusception. Right hemicolectomy with a double barrel stoma was performed as she was unstable intraoperatively. Histopathological examination of the tumour showed a well-differentiated neuroendocrine tumour. Subsequent PET scan showed no systemic disease and a reversal of the stoma was done. She remained disease free for a year.
DISCUSSION: Our patient had undergone a right hemicolectomy despite the high risk of mortality, as there is a high chance of malignancy. Double barrel stoma was done, as she was unstable intraoperatively. Fortunately, she recovered well and had her stoma reversed without any further recurrence of her disease.
CONCLUSION: Adult patients who present with intussusception should be managed with resection, as there is a high possibility of a malignancy. Early resection should be planned to prevent further spread of the tumour.
BACKGROUND: With increasing demand for hospitals to provide end-of-life care, the low quality of palliative care provided in hospital settings is an issue of growing concern in developing countries. Most dying patients receive their care from general nurses, irrespective of the nurses' specialty or level of training.
METHOD: A structured cross-sectional questionnaire survey was conducted of 553 nurses working at a teaching hospital in Malaysia.
RESULTS: The mean scores for nurses' knowledge about end-of-life care, their attitudes towards end-of-life care and the perceived quality of end-of-life care were low. The factors identified as significantly associated with the quality of end-of-life care were nurses' levels of knowledge and their attitudes towards end-of-life care.
DISCUSSION: Factors that contributed to the low quality of end-of-life care were inadequate knowledge and negative attitudes. These findings may reflect that end-of-life care education is not well integrated into nursing education.
CONCLUSION: The findings of this study suggest that there is a need to increase the nurses' level of knowledge and improve their attitude towards end-of-life care in order to enhance the quality of care provided to dying patients.
IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse managers and hospital policymakers should develop strategies to enhance nurses' level of knowledge, as well as providing adequate emotional support for nurses who care for dying patients and their families. Nurses should be proactive in increasing their knowledge and adopting more positive attitudes towards end-of-life care.