OAR@UM Collection:

The attainment of knowledge

2019-12-15T06:10:15Z

Title: The attainment of knowledge Authors: Savona-Ventura, Charles Abstract: Writing two and a half millennia ago, Confucius stated that “By three methods we may learn wisdom: First, by reflection, which is noblest; Second, by imitation, which is easiest; and Third by experience, which is the bitterest.” The edict fully applies to modern medical education and training. The attainment of knowledge through experience may be the fruit of the personal and/or collective compilation of knowledge gathered by personal observation of individual cases or case series. It may also incorporate formal randomized clinical experimentation to compare outcomes attained from two or more different management options. Originally transmitted down the generations by oral tutor-student communication, it eventually was more widely made available by the publication of case presentations, case series, or randomized controlled trials. This compilation of knowledge by experience is the most bitter since for every success story documented, there would be several failures that would have fallen by the wayside or eventual successes that were only accepted after a pendular shift in attitudes towards their use. The importance of experiential knowledge in current practice can be best illustrated by Isaac Newton’s comment that "If I have seen further it is by standing on the shoulders of giants." We are where we are today because of the giants that have preceded us. With their experiential, experimental and rational acquisition of knowledge throughout the ages, they have laid down the foundations of knowledge that we have developed and rely upon in modern practice.

The Department of Health Diabetes Mellitus health information technology database in Malta : a basis for a Maltese diabetes national register

2019-12-15T06:10:09Z

Title: The Department of Health Diabetes Mellitus health information technology database in Malta : a basis for a Maltese diabetes national register Authors: Azzopardi, Joseph; Fava, Stephen Abstract: Government Diabetes clinics in Malta share a Web based computerised system that offers a user friendly Windows based approach to day to day diabetes care. The system can also produce research related data and administrative reports to help local health care providers identify problems and implement programs to improve standards of diabetes care. The database can be used as the basis for a National Diabetes Registry. The system has a dataset shared with the European Union DG-SANCO EUBIROD System. EUBIROD can create comparative reports on data aggregated from various centres across Europe. This paper describes the function of the system and its evolution over a number of years. Some pending issues are discussed.

Maternal preconception intake of folic acid in Malta

2019-12-15T06:10:25Z

Title: Maternal preconception intake of folic acid in Malta Authors: Gatt, Miriam; Borg, Marika; Grech Mercieca, Elaine; Calleja, Neville Abstract: Background: Neural tube defects (NTDs) are serious birth defects arising from abnormalities in neural tube development during early embryogenesis. Research shows that taking folic acid (FA) prior to and throughout the first 12 weeks of pregnancy will significantly decrease the occurrence of NTDs. The prevalence of NTDs in Malta is 10.0/10,000 births, yet this rate can be brought down to 5.0-6.0/10,000 births with preconception FA. This study aims to investigate the maternal intake of preconception FA in Malta. Methods: The National Obstetric Information System (NOIS) collects detailed demographic, pregnancy, delivery and infant outcome data on all births in Malta. One of the variables recorded at the first antenatal visit is whether the mother took FA prior to pregnancy. NOIS data for 2015 was obtained, Excel and SPSS were used for analysis. Results: 4385 women delivered a baby in 2015, of these 1125 (25.7%) reported taking FA before pregnancy. Both univariate and multivariate logistic regression showed that maternal age, parity, education, nationality, locality of residence, marital status, planned pregnancy and use of artificial reproductive technology were all significantly associated with taking preconception FA (p<0.001). Conclusion: Although preconception folic acid supplementation has been advised since the early 1990s, in Malta only a quarter of mothers are taking this before pregnancy. This low compliance is also documented in other countries. Several maternal factors have been found to be associated with better intake of preconception FA. Effective methods of increasing maternal preconception intake of FA are necessary to decrease the rate of NTDs in Malta.

Return to work after hernia repair

2019-12-15T06:10:08Z

Title: Return to work after hernia repair Authors: Grech, Gabriella; Caruana Dingli, Gordon Abstract: Background: The development of mesh repairs and the introduction of laparoscopic techniques have decreased recurrence rates of hernia and made the return to usual activities faster. Provided the surgery is uncomplicated and the patient does not need to lift more than 10kg at work, it appears safe to encourage a return to work soon after surgery. Methods: The study involved obtaining data of patients that had open, primary unilateral elective hernia repair surgery from January to June 2015. These patients were operated by all the surgical firms working at Mater Dei Hospital and all were performed by experienced specialists. 100 patients were interviewed over the phone. Results: Age of patients ranged from 20 to 84 years with a median age of 65 years. The absolute majority of patients were males (90 %). 43% of patients were given information about return to work after hernia repair by a senior doctor where 51% advised to return to work 6 weeks after hernia repair. 69% of patients adhered to the advice that they were given. 39% of self-employed patient returned to work earlier than advised as opposed to 26.3% of employed who returned to work before advised.