https://www.um.edu.mt/library/oar/handle/123456789/9142 Tue, 07 Apr 2026 06:45:49 GMT 2026-04-07T06:45:49Z https://www.um.edu.mt/library/oar/handle/123456789/9588 Title: Folic acid in preventing recurrence of colorectal adenomas : is it effective? Abstract: The high incidence of patients with recurrent colorectal adenomas have increased interest among researchers in finding a vitamin supplement which may act as a chemo-preventive agent against the development of these lesions. Folic acid was found to be beneficial for various health reasons and also was believed to have an association with the improvement in the DNA methylation of the inner wall lining of the bowel. Therefore the proposed research question for this dissertation is: In patients with a history of colorectal adenomas is folic acid effective in preventing recurrence? An evidence-based approach was used to answer this question. An extensive search using different databases, keywords and MeSH terms ensured the retrieval of pertinent research articles. The PRISMA flow diagram framework was utilised to ensure reliability and validity of the search process. Moreover the use of inclusion and exclusion criteria resulted in the retrieval of 3 meta-analyses and 4 randomised clinical trials. These rank high in the hierarchy of evidence. The Critical appraisal tools adopted from Ajetunmobi (2002) were used to appraise the methodologies of the retrieved studies. The guidelines adopted from Rebar, Gersch, Macnee and McCabe (2011) were used to critique ethical issues of each study, thus ensuring a systematic process. The overall findings of the studies showed no clear increase or decrease in recurrence among patients with a history of colorectal adenomas. That is the findings were inconclusive. Such inconclusive findings could possibly be attributed to folic acid having a dual effect on adenoma development and carcinogenesis. This suggests the need for further high quality research to possibly obtain conclusive results. In this report, it was recommended that education of healthcare professionals and the public is fundamental to prevent any possible consequences when using folic acid in patients with an adenoma history. Until further evidence suggests otherwise, it was recommended that patients with adenoma history should use these supplements with caution and with the physicians' advice. The implementation of more randomised trials was also recommended both at a local level and other foreign countries. Description: B.SC.(HONS)HEALTH SCIENCE Tue, 01 Jan 2013 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/9588 2013-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/9582 Title: Antiseptic use in the prevention of pin site infection Abstract: External fixation is commonly used in Orthopaedics to treat complicated fractures and sometimes employed in elective surgery. It consists of a series of metal pins and wires which are inserted into the bone fragments through the skin and held together by an external framework (Lethaby, Temple & Santy, 2008). The areas where these pins protrude are known as pin sites and infection at these sites is the technique's primary complication. Pin site care, a term commonly used that includes multiple nursing interventions, is highly debated as there is no evidence based standard of care. The aim of this dissertation is to challenge one aspect of such care - whether antiseptic use is necessary to reduce the incidence of pin site infections. Research question: 'In patients with external fixators do antiseptic agents reduce the incidence of pin site infection when compared to non-antiseptic products?' Methods used: A search strategy was conducted from ten electronic data bases accessible from the University of Malta website. The search was extended by manually searching an Orthopaedic journal and also in Google scholar. Those studies which compared antiseptic use against other solutions or no care at all in the cleansing/dressing aspect of pin site care were included. Out of 1175 citations, five RCTs and one prospective study were chosen. For their critical analysis, the Critical Appraisal Skills Programme (CASP) was used. Overall findings: The six studies did not reach a common conclusion. Only two out of the six studies declared that antiseptic use significantly reduces the incidence of pin site infections. Recommendations and implications for practice: The use of antiseptic solutions did not prove to be a determining factor in pin site care in the majority of the studies, although this aspect is highly controversial. It emerged that several considerations need to be taken when dealing with pin site care such as the type and width of pins, the anatomical position of the pins and the duration of the device in situ. It could be that there is no 'one size fits all' protocol. One issue in which there was unanimous agreement was observation. However due to the lack of a uniformly accepted definition of pin site infection comparisons are difficult. There is the need for a standard infection criteria classification system with proven reliability in order to have homogenous infection criteria. Description: B.SC.(HONS)HEALTH SCIENCE Tue, 01 Jan 2013 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/9582 2013-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/9511 Title: Non-invasive ventilation reduces the need for endotracheal intubation in chronic obstructive pulmonary disease patients Abstract: Chronic obstructive pulmonary disease is the third leading cause of death in noncommunicable diseases. In Malta four per cent of the total admissions to hospital in 2011 were due to this respiratory disease. The primary treatment in acute respiratory failure is Oxygen Therapy. Non-invasive positive pressure ventilation is also used but there is still lack of knowledge, and is still not clear whether non-invasive ventilation reduces the risks for endotracheal intubation. The PICO question formulated to guide this dissertation was: In patients who suffer an acute respiratory failure due to COPD, will NPPV be more efficacious than conventional O2 therapy, in reducing the risk of endotracheal intubation? Population - patients with COPD Intervention - non-invasive positive pressure ventilation Comparison - O2 therapy Outcome - reduction of the risk of endotracheal intubation Various databases were searched for relevant clinical trials from the year 1990 till the end of September 2012. Inclusion and exclusion criteria that were applied included studies written in English only and available in full text. Only randomised controlled trials and systematic reviews were included, and studies that answered the PICO question. Nine papers were retrieved for evaluation of the methodology quality and, to appraise those articles, the tools CONSORT 2010 and PRISMA 2009 were applied. Different but positive results were identified because of different factors used in the studies such as difference in the severity of chronic obstructive pulmonary disease; in the equipment and the time used, non-invasive positive pressure ventilation was applied. All the articles showed positive results, and found that non-invasive ventilation reduced the risk of endotracheal intubation when compared to oxygen therapy. One article did not find statistical significant results but still recommended the use of non-invasive ventilation. The introduction of training and education of health professionals with regards to noninvasive positive pressure ventilation is needed in the Maltese healthcare setting and research conducted locally is needed to compare results and formulate guidelines and protocols to help health professionals in their decision making. Description: B.SC.(HONS)HEALTH SCIENCE Tue, 01 Jan 2013 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/9511 2013-01-01T00:00:00Z https://www.um.edu.mt/library/oar/handle/123456789/9505 Title: Pre-operative mechanical bowel preparation : an unnecessary procedure Abstract: The use of Mechanical Bowel Preparation (MBP) in patients undergoing elective bowel surgery has been a traditionally held practice within the surgical domain in an attempt to reduce postoperative complications, mainly anastomotic leaks and postoperative infections. However, the surgical dogma surrounding the use of MBP started to be challenged by results coming up from research on emergency colon surgeries, which did not require the use of MBP (Zmora et al., 2003). In view of this emerging debate, the current investigation aimed to determine whether MBP does, in fact, reduce anastomotic leaks and postoperative infections following colon surgery using an evidence-based approach. As a result, the PICO question: In adult patients undergoing elective colon and rectal surgery, how does mechanical bowel preparation compared to no bowel preparation compare in reducing the risk of postoperative infections and anastomotic leaks?, was set. A search strategy, using the University of Malta e-library portal, has led to the identification of 7 meta-analyses, 3 systematic reviews, 8 RCTs and a prospective observational (cohort) study. Guiding this process, to minimize selection bias, was the use of established eligibility criteria, to include studies comparing the measured outcomes set for this investigation following the exposure of the mentioned intervention. Several combinations of relevant keywords were used to identify the 19 suitable research studies, retained for this investigation. These studies were appraised using the Critical Appraisal Skills Programme (CASP) tools for RCTs, systematic reviews and cohort studies, while the AMSTAR tool was used to appraise the meta-analyses. Results failed to show any statistical significant difference in reducing the risk of postoperative infections and anastomotic leaks between the two interventions (i.e. MBP and no MBP), thus leading to the conclusion that MBP is an unnecessary procedure prior to bowel surgery. This investigation recommends further larger research studies to confirm such conclusions and to expose these results to local stakeholders so that the suggested change in clinical practice is achieved for the benefit of our patients and of the local health care setting. Description: B.SC.(HONS)HEALTH SCIENCE Tue, 01 Jan 2013 00:00:00 GMT https://www.um.edu.mt/library/oar/handle/123456789/9505 2013-01-01T00:00:00Z