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Biomedical subjects

D A Watters

Publications and source records attributed to D A Watters.

At least 37 records · Page 2Linked to original sources
PubMed1995

Quality assurance in surgery. Patient perceptions of quality.

Quality assessment and assurance should be concerned not only with technical aspects of health care but also the patient's views. This paper examines patient perceptions of the quality of care through structured interviews and focus group discussions in Port Moresby General Hospital, Papua New Guinea. The results indicated a need for more concern for patient well-being, greater attention to provision of information and improvements in living conditions in the hospital. The findings of this study will be used as a means to improve the patient's experience of surgical care. Similar studies could be performed as a measure of quality in other hospitals in the developing world.

Adolescent↗
PubMed1994

The repair of frontal encephaloceles in Papua New Guinea.

Frontal encephaloceles are common in Papua New Guinea (PNG). Seventeen cases collected over 7 years are reported. Eleven frontal (sincipital) encephaloceles were repaired successfully via an extracranial approach. One of these patients with a frontonasal encephalocele developed a recurrence following the extracranial approach, which was subsequently repaired intracranially. Three patients with small naso-ethmoidal encephaloceles were repaired intracranially via an extradural approach. The other three cases have not yet had surgical correction. Complex craniofacial surgery which corrects hypertelorism as well as the encephalocele is unavailable in the developing world. For the general surgeon in the developing world, the extracranial approach is recommended for the frontonasal encephaloceles, and the intracranial approach for the naso-ethmoidal and naso-orbital encephaloceles. Hydrocephalus and epilepsy have not developed in the patients.

Child, Preschool↗
PubMed1994

Surgery, surgical pathology and HIV infection: lessons learned in Zambia.

HIV (human immunodeficiency virus) infection is prevalent in many areas of sub-Saharan Africa. Seropositivity rates reach 10-15% in urban adults, 21% in critically ill adults and 30% in surgical inpatients aged 21-40 years. AIDS (acquired immune deficiency syndrome) is a multisystem disease which presents to the surgeon with a wide range of pathologies including Kaposi's sarcoma, lymphadenopathy and sepsis. The more common sites for sepsis are the female genital tract, anorectum, pleural cavity, soft tissues (necrotizing fasciitis) and bone and joints. To prevent iatrogenic HIV infection more use should be made of autologous blood. Occupational exposure to HIV infection can be minimized by double-gloving, protecting the eyes when operating and ensuring that theatre gowns are waterproof. The risk of HIV infection from a needlestick injury is 0.4%. Although contact with blood during a surgical procedure is common, the risk is lower than for a hollow needlestick injury.

AIDS-Related Opportunistic Infections↗
PubMed1994

Dumbbell schwannoma causing acute spinal cord compression: case report.

A case is presented of acute spinal cord compression by a thoracic dumbbell spinal schwannoma in a young woman with neurofibromatosis type 1 (NF-1). A successful outcome was achieved with total excision of the lesion and decompression of the spinal cord. Greater recognition of the reversibility of spinal cord compression in the developing world is necessary to reduce major permanent morbidity.

Adult↗
PubMed1993

Tourniquet injury in a Papuan snakebite victim.

We report a case of snake bite complicated by tourniquet induced ischaemic damage and rhabdomyolysis causing acute renal failure. The case highlights the dangers of tourniquet use and of sudden release. We outline measures which can be taken to minimize morbidity in such patients.

Acute Kidney Injury↗
PubMed1993

Quality assurance in surgery: surgical audit in the developing world.

Surgical audit is an essential component of quality assurance in surgery, particularly in the developing world, where resources and skills are limited. The structure, process and outcome of care can be measured. With regard to structure, in developing countries the delivery of care is influenced by lack of resources and access to surgical skills. The number of operations not being done needs to be estimated as well as the throughput of surgery. With regard to process, ward rounds and writing in case-notes are daily activities which affect the process of care. The use of investigations, particularly ones which are expensive or have risks, should be audited to ensure there is maximum cost-benefit to both the patient and the health care system. Surveys of patient perception of quality are also important. With regard to outcome, surgeons measure quality by auditing complications and mortality. Audit and mortality meetings should be held to discuss problems and how they can be avoided. The factors responsible for 34 deaths at Port Moresby General Hospital are presented. To be reliable, mortality audits should grade illness severity, for example, by using the Glasgow Coma Scale to grade the severity of a head injury. Where mortality rates are low, for example, in patients with fractures, long-term follow-up of disability may be a more appropriate measure of outcome and quality than mortality rates.

Developing Countries↗
PubMed1992

Role of ultrasound in the management of thyroid nodules.

One hundred twenty patients undergoing thyroid surgery for thyroid nodules or goiter were examined by preoperative ultrasound and fine needle aspiration (FNA) cytology. In the determination of whether a lesion was malignant, FNA had sensitivity, specificity, and positive predictive values of 86%, 85%, and 58%, respectively. Ultrasound had sensitivity, specificity, and positive predictive values of 74%, 83%, and 51%, respectively. The different types of thyroid pathology showed different ultrasonic features in most cases, although no single feature was pathognomonic. Malignant lesions tended to be solid and hypoechoic without a halo, but there was a cystic element in 26% of the lesions and calcification in 37%. Ultrasound was superior to FNA in diagnosing nodular goiter with sensitivity, specificity, and positive predictive values of 70%, 93%, and 92%, respectively, compared with 55%, 86%, and 83%, respectively. The two modalities are complementary.

Adolescent↗
PubMed1991

Audit of 'surgery in general' in an African teaching hospital.

A 1-year prospective audit of 2233 operations performed by one general surgical unit in a Central African teaching hospital is presented. In addition to the usual 'general surgical' procedures, operations also included emergency craniotomy, reconstructive surgery for open fractures, and hysterectomy. There were 37 (1.7%) postoperative deaths and 45 other deaths in non-operated patients. Ten of 14 deaths due to sepsis in the 20-40-year age group were associated with HIV infection. The implications for teaching and training of surgical specialists in the tropics are discussed.

Emergency Service, Hospital↗