Open Access Original Research Article

Gaps in Laboratory Quality Management Systems in the Volta Region of Ghana

Eric Agboli, Gideon Kye-Duodu, Lawrence Quaye, Robert Adeze-Kpodo, Sylvester Yao Lokpo, Peter Atadja, Fred Binka

Asian Journal of Medicine and Health, Page 1-9
DOI: 10.9734/AJMAH/2018/39254

Background and Aim: Laboratories play a key role in the control and prevention of diseases through the provision of accurate, reliable and timely results. Coordinated activities to direct and control the laboratory with regard to quality is Quality Management Systems (QMS). The study assessed gaps in the QMS of some district laboratories in Ghana.

Study Design:  Non-interventional exploratory study.

Place and Duration of Study: Volta Region of Ghana, February to March 2016.

Methodology: The Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist by World Health Organization’s Regional office for Africa (WHO/AFRO) was used to assess six district laboratories in the Volta Region of Ghana. The six facilities were randomly selected to include laboratories from each of the three sectors (northern, middle, and southern) of the region. The northern sector laboratories were designated N1-HMH and N2-NDH, middle sector (M1-HMH, M2-ADH), and southern sector (S1-SDH, S2-ADH).

Results: The SLIPTA scores for the facilities were all < 55% (0-142points) which is a zero star in the 0-to-5 star rating using the WHO/AFRO laboratory strengthening tool. The S1-SDH laboratory recorded a total score of 17.4% (45points), S2-ADH 11.6% (30points), M1-HMH 17.8% (46points), M2-ADH 9.7% (25points), N1-HMH 5.4% (14points), and N2-NDH 4.7% (12points). M1-HMH had the highest SLIPTA score whilst N2-NDH reported the least score. The Quality System Essentials (QSEs) measured were below 50%. “Management Reviews”, “Internal Audit”, “Corrective Action”, “Client Management and Customer Service” were not performed by any of the facilities whilst “Organization and Personnel” was highly performed. On the average SLIPTA score, the southern sector laboratories performed better whilst the northern sector laboratories exhibited the least performance in relation to QMS.

Conclusion: The star level recorded by the facilities is zero (0) based on 0-to-5 star rating. This implies that the total laboratory QMS is very weak and various stakeholders are encouraged to focus on strengthening district laboratories for effective healthcare delivery. This is a detailed baseline data for measuring improvement through future interventions.

Open Access Original Research Article

A Comprehensive Analysis of Best Practices towards Radiation Safety Measures for Medical Diagnostic Imaging Equipments in Government Hospitals, Tamil Nadu, India

R. Rajan

Asian Journal of Medicine and Health, Page 1-21
DOI: 10.9734/AJMAH/2018/39108

Aims: To evaluate the current maturity of business processes evolved and implemented to comply with regulatory guidelines by Government hospitals for containing man-made ionising radiation while using medical diagnostic imaging equipments. To statistically test and conclude whether any significant differences exist in day-to-day practices between Metro and Non-metro cities hospitals. To test and conclude whether patient queue size influences regulatory compliance score. 

Study Design:  Descriptive Research design has been adopted in this study.

Place and Duration of Study: This study was conducted in Tamil Nadu, India covering 33 metro and non-metro cities, for the period between July 2016 and March 2017.

Methodology: This research has sampled 38 Government hospitals spread across Tamil Nadu, India who has agreed to participate and provide information in this study out of 42 institutions approached. This study is based on the Regulatory guidelines published by Atomic Energy Regulatory Body, the Regulatory Body in India which controls the distribution and usage of Diagnostic Imaging equipments, 7 dependent parameters (Regulatory, Layout Engineering, Technician Competency, Human Safety, Operations Know-How, Radiation Exposure Monitoring and Top Management Commitment) and a structured questionnaire with 70 questions on a seven point scale (inclusive of zero) was constructed and administered for data collection. Non-parametric statistics has been adopted for statistical analysis of data.

Results: The analysis of compliance data has shown exceptional compliance in all the variables studied and found to be at the higher side of the measurement scale (Regulatory 5, Layout Engineering 6, Technician Competency 6, Human Safety 6, Operations Know-How 6, Radiation Exposure Monitoring 6 and Top Management Commitment 6). The Chi-square test has concluded that there is no significant difference in regulatory compliance score between Government hospitals in metro cities and non-metro cities (Minimal chi-square value 0.109547; df 6 and ‘P’ value 0.9999). Spearman Rank correlation coefficient ‘rho’ was found to be - 0.095, with a “P” value (0.5712) more significant than alpha (0.05) at 95 percent confidence interval established very weak negative and insignificant relationship between patient queue size and compliance index.

Conclusion: It was quite evident from this research study that Government hospitals have established an extraordinary level of regulatory compliance (between Very High Compliance and Complete Presence of best practices recommended by AERB).The most distinguishing feature that has led to superior compliance is the full-time availability of Radiation Safety Officer as a change leader in all the hospitals. The patient crowd size did not influence compliance score, and it was due to the inherent nature of superior commitment from Top Management. This research study further recommends similar research work in other states of India and high tech global practices in information security prevalent in monitoring hospitals for safeguarding Patient Health Information (PHI).

Open Access Case Study

Bizarre Retroperitoneal Fibromatosis: Challenges in Management

M. A. Nabil, S. S. Lenny, P. R. Reena, I. Azim, H. Harunarashid

Asian Journal of Medicine and Health, Page 1-6
DOI: 10.9734/AJMAH/2018/38261

A desmoid tumour is a type of benign neoplasm arising from the proliferation of fibroblast cells. Although histologically benign, retroperitoneal desmoid tumours resection can be challenging to surgeons due to its infiltrative nature. Surgery can be mutilating and pose significant morbidity and mortality. We present a case of a 27-year-old lady with retroperitoneal mass presented with chronic abdominal pain.

Open Access Case Study

Acute Adult Ileo-Ileal Intussusceptions: A Case Report

E. Seddik, A. Mahboub, M. Bendib, L. Griche, A. Khenchouche

Asian Journal of Medicine and Health, Page 1-5
DOI: 10.9734/AJMAH/2018/38463

We relate here the case of a 47 year old patient with no particular history, admitted in the emergency department for an occlusive syndrome which had developed gradually. The onset of symptoms was marked by moderate abdominal pain with bilious vomiting. The symptomatic treatment had no effect; the pain became intense and diffused to the entire abdomen accompanied by uncontrollable vomiting and the passage of gas and stool were stopped. Ultrasonography of abdomen showed target signs in cross section and sandwich sign in longitudinal section which are characteristic of intussusceptions. The abdominal computed tomography (CT) allows diagnostic certainty of discovering the possible etiology. It showed the presence of an intestinal occlusion. The laparotomy revealed an ileo-ileal intussusception caused by an ileal tumor. We performed a segmental small bowel resection with anastomosis. Histological study confirmed the benign nature of the tumor evoking an aspect in favor of an inflammatory pseudotumor of the small intestine.

Open Access Case Study

Case of an Adult with Attention Deficit/Hyperactivity Disorder: The Course of Treatment for Improvement in Processing Speed

Junko Okuyama, Shunichi Funakoshi, Rie Suzuki, Ryo Nomura, Takashi Ono, Yoshihisa Kakuto, Hiroo Matsuoka

Asian Journal of Medicine and Health, Page 1-6
DOI: 10.9734/AJMAH/2018/39365

Aims: Adult attention-deficit/hyperactivity disorder (ADHD) is one of the developmental disabilities that have a negative causal relationship with the ability to socialise. The diagnosis and effective treatment of adult ADHD is difficult, and this study aims to introduce useful diagnosis and treatment method, focusing on the processing speed of an adult ADHD patient.

Presentation of Case: A 35-year-old male, who frequently altered his occupation, visited our hospital. Three types of psychological assessment were used on him: Adult ADHD Self Report Scale (ASRS-v1.1), Autism-Spectrum Quotient Japanese version (AQ-J), and the Wechsler Adult Intelligence Scale (WAIS)-Third edition.

Results: Significant changes only started manifesting when cognitive behaviour therapy (CBT), which focused on processing speed, was used. 

Conclusion: Various types of CBT have been employed, but the approach we chose to apply is comparatively easier to carry out.