OAR@UM Collection:

Laparoscopic omentoplasty and split skin graft for deep sternal wound infection and dehiscence patient

Fri, 01 Jan 2016 00:00:00 GMT

Title: Laparoscopic omentoplasty and split skin graft for deep sternal wound infection and dehiscence patient Authors: Sladden, David; Darmanin, Francis X.; Axisa, Benedict; Galea, Joseph Abstract: Treatment of sternotomy dehiscence secondary to infection is complex. We describe a case where following debridement and negative pressure therapy the greater omentum was harvested laparoscopically, pedicled on the right gastroepiploic artery and transposed through a subxiphoid window and laid into the chest wound. The omentum was covered with a split skin graft. The omental transposition provided a healthy vascular bed for the skin graft to be laid on top of. This technique allows for larger defects to be closed when due to the amount of bone loss the sternum cannot be brought together. Such procedures are normally performed when all other measures have failed and myocutaneous flaps cover the omentoplasty. Our case is novel in that the laparoscopic harvest and the use of direct skin grafting make this an option to be considered earlier as a single definitive procedure.

Referral tickets to secondary healthcare : is communication effective?

Fri, 01 Jan 2016 00:00:00 GMT

Title: Referral tickets to secondary healthcare : is communication effective? Authors: Cassar, Matthew; Mifsud, Janine; Vella Fondacaro, Daniel; Debono, Joseph Abstract: Communication between primary and secondary health care relies primarily on referral tickets. They determine how patients’ details are conveyed and hence the quality of care. The aim of this study was to assess the quality of referral tickets at the Surgical Outpatients at Mater Dei Hospital in Malta and to develop recommendations for improvement. Consecutive referral tickets between the 7th February and 4th March 2015 were prospectively included in the study and analysed for completeness. The data was entered into a proforma which was revised after the first ten entries. A total of 351 referral tickets were included in the study. Names and surnames were present in all reports and identification number in 99.42% of cases. 44.16% of referrals were inappropriate according to clinical details. The majority of the forms had a history of presenting complaint (98.29%) while the past history, drug history / allergies and examination findings were available in 69.23%, 67.81% and 76.64% respectively. The source of referral was not clear in 56.13%. Only 69.23% of all referral tickets were completely legible while 30.77% were partly legible. This study shows the need for an overhaul in the referral system. Recommendations include the use of electronic referrals and the introduction of feedback letters by hospital specialists.

The effect of community-based drug rehabilitation programs on recidivism in Malta

Fri, 01 Jan 2016 00:00:00 GMT

Title: The effect of community-based drug rehabilitation programs on recidivism in Malta Authors: Axiak, Claire Abstract: Background: The argument for financing therapeutic community-based drug rehabilitation programs for inmates is compelling. Numerous studies have established the positive effect of such treatment on reducing recidivism, especially treatment based on the therapeutic community model. Methods: This quasiexperimental retrospective cohort study examined the impact of therapeutic community-based drug rehabilitation programs on recidivism amongst drug inmates released from the national prison of Malta between 2005 and 2008 (i.e. “the reference period”). An experimental group consisting in all drug inmates who participated in at least one program during the time spent in prison for a conviction that ended during the reference period was compared to two comparison groups of inmates who did not attend such a program or who had attended in the past. Chi-square tests and ANOVA were employed in the analysis. Results: There was no statistically significant difference (p<0.05) between the three groups with regard to sex, age on admission and occupation but there was a highly significant difference with regard to the number of previous convictions, prison-basedopioid substitution treatment (given to all inmatesconvicted for heroin-related offences) and prison-based psychiatric treatment. On fitting a generalized linear model with a logit link function to control for opioid substitution treatment and the number of previous convictions it emerged that the difference between groups was not significant and thus the null hypothesis was not rejected. Conclusion: Participation of inmates in therapeutic community-based drug rehabilitation programs did not in itself emerge as a significant predictor of recidivism. In this regard, possible limitations that may have contributed to the lack of significant results were discussed. Inmates who were not administered any opioid substitution treatment (i.e. corresponding to all those who were incarcerated for drug offences other than heroin) were 74% less likely to reoffend compared to those who were given methadone or tramadol. Moreover, the likelihood of recidivism was 1.7 times greater for each additional prior incarceration (p<0.001).

Terrorist attacks and the male to female ratio at birth : the bombings of Madrid (3/2004) and London (7/2005)

Fri, 01 Jan 2016 00:00:00 GMT

Title: Terrorist attacks and the male to female ratio at birth : the bombings of Madrid (3/2004) and London (7/2005) Authors: Mamo, Julian; Grech, Victor E. Abstract: Introduction: Males are usually in excess of females at birth and the ratio is often expressed as M/F (male divided by total births). Several factors have been shown to be associated with changes in M/F, including major terrorist attacks. These are associated with a transient lowering of M/F for a one month period, three to five months after such events. This study was carried out in order to ascertain whether the Madrid March 2004 bombings and the London July 2005 bombings were similarly associated with changes in M/F in their respective populations. Methods: Monthly live births by gender for Madrid and Spain for 2004 and for England and Wales for 2005 were obtained from the two countries’ National Statistics Offices. Results: There were no significant dips in M/F for any of the months following the March 2004 bombings in Madrid or in Spain. There were no significant dips in M/F for any of the months following the July 2005 London bombings. Discussion: Research to date has shown M/F dips following catastrophic or tragic events, including major terrorist actions with extensive media coverage. Equivalent dips were not noted in this study for the terrorist acts in these instances. The reasons for this may be one or a combination of the following. The population size was not sufficiently large in order to detect an M/F dip. Alternatively, the events were not felt to be sufficiently momentous by the populace such that an M/F dip was not produced. Yet another possibility is that these particular populations are somehow hardier and more resistant to such influences. Not all terrorist events universally cause a significant reduction in M/F.