Tracheoscopy with the rapiscope to verify endotracheal tube placement

STUDY OBJECTIVE: To determine whether tracheoscopy is an accurate and quick method for verifying correct placement of the tracheal tube after intubation. DESIGN: Prospective, randomized study. SETTING: Operating rooms of a teaching hospital. PATIENTS: 26 patients scheduled for surgery and general anesthesia. INTERVENTIONS: 8.0-mm tracheal tubes were inserted into both the trachea and the esophagus. Tracheoscopy was performed consecutively through both tracheal tubes by a variety of clinicians. MEASUREMENTS: The times taken to correctly identify the trachea and the esophagus were recorded. MAIN RESULTS: Correct identification of either the esophagus or the trachea occurred with a 100% sensitivity and a 96% specificity. The mean time to recognize either the trachea or the esophagus was 22.0 seconds. CONCLUSIONS: Tracheoscopy is a reliable method for quickly verifying proper endotracheal placement of a tracheal tube.     

Strengthening human resources for health through multisectoral approaches and leadership: the case of Cameroon

Problem

Cameroon has a severe shortage of human resources for health (HRH) and those that are available are concentrated in urban areas.

Approach

As the result of a national emergency plan for the years 2006–2008, innovative strategies and a multisectoral partnership – led by the Ministry of Public Health and supported by diverse national and international organizations – were developed to address the shortages and maldistribution of HRH in Cameroon.

Local setting

At the time that the emergency plan was developed, Cameroon had health services of poor quality, an imbalance between HRH training and employment, a maldistribution of HRH between urban and rural areas and a poor allocation of financial resources for HRH. It also lacked an accreditation system for use in the training of health workers.

Relevant changes

Between 2007 and 2009, the number of active health workers in Cameroon increased by 36%, several new institutions for higher education in health care and training schools for paramedical staff and midwives were opened, and a national strategy for universal health coverage was developed.

Lessons learnt

In the improvement of HRH, strong leadership is needed to ensure effective coordination and communication between the many different stakeholders. A national process of coordination and facilitation can produce a consensus-based view of the main HRH challenges. Once these challenges have been identified, the stakeholders can plan appropriate interventions that are coordinated, evidence-based and coherent.     

Mental health interventions by lay counsellors: a systematic review and meta-analysis

ObjectiveTo investigate the effectiveness of community-based mental health interventions by professionally trained, lay counsellors in low- and middle-income countries.MethodsWe searched PubMed®, Cochrane Central Register of Controlled Trials, PROSPERO and EBSCO databases and professional section publications of the United States National Center for PTSD for randomized controlled trials of mental health interventions by professionally trained, lay counsellors in low- and middle-income countries published between 2000 and 2019. Studies of interventions by professional mental health workers, medical professionals or community health workers were excluded because there are shortages of these personnel in the study countries. Additional data were obtained from study authors. The primary outcomes were measures of post-traumatic stress disorder, depression, anxiety and alcohol use. To estimate effect size, we used a random-effects meta-analysis model.FindingsWe identified 1072 studies, of which 19 (involving 20 trials and 5612 participants in total) met the inclusion criteria. Hedges'' g for the aggregate effect size of the interventions by professionally trained, lay counsellors compared with mostly either no intervention or usual care was −0.616 (95% confidence interval: −0.866 to −0.366). This result indicates a significant, medium-sized effect. There was no evidence of publication bias or any other form of bias across the studies and there were no extreme outliers among the study results.ConclusionThe use of professionally trained, lay counsellors to provide mental health interventions in low- and middle-income countries was associated with significant improvements in mental health symptoms across a range of settings.     

Medical Negligence - Going Dutch

Forensic DNA profiling combines the dynamic science of molecular genetics with the complexities of the forensic context. As such, throughout its twenty-year history, this field has seen continuous change, remarkable growth and an associated level of public, legal and scientific scrutiny previously unknown in the forensic sciences. Almost ubiquitously, applications of forensic DNA profiling have focused on resolving the identity of the donor of a particular sample of biological evidence. This is typically achieved by targeting non-coding microsatellite (or STR) loci. Recently however, novel techniques have emerged that target different DNA polymorphisms and allow scientists to address additional questions about the evidence, beyond the identification of source. In this short review we introduce an example of this next generation of forensic DNA techniques, single nucleotide polymorphisms (or SNPs). We summarise their molecular and technological basis and the manner in which they may be applied to further advance the capabilities of forensic investigators.     

Persistent pigmented purpuric eruption associated with mycosis fungoides: a case report and review of the literature

A purpuric eruption may be an unusual early manifestation of mycosis fungoides (MF). On the other hand, persistent pigmented purpuric dermatoses (PPPD) may, occasionally, evolve to cutaneous T-cell lymphoma. Coexistence of these two conditions has been reported, but it is extremely rare. We present the case of an elderly woman with a long-standing pruritic, pigmented purpuric eruption. On 1-year follow-up, histological features suggesting early MF were observed and molecular analysis of the rearrangement of T-cell receptor genes revealed clonality. Our patient may represent a case of PPPD evolving to MF, a case of MF clinically featuring PPPD, or an intermediate condition in a nosological continuity extending from PPPD to MF. A persistent pigmented purpuric eruption may rarely be a harbinger of cutaneous T-cell lymphoma. Therefore, vigilant long-term follow-up of PPPD is highly recommended.     

Psychiatry,psychology, law and homosexuality — uncomfortable bedfellows

The author analyses the history of the classification of homosexuality as a psycho‐sexual disorder and looks to the role of the law in propagating misunderstandings about sexual orientation. Looking to the causes of homophobia, he highlights the need for it to be eliminated, contending that until this occurs hatred, discrimination, disadvantage and violence will persist He argues that those who cause these feelings, and not those whom they target are the ones who need the assistance of scientific psychology and psychiatry and that those who are their targets need the strong assistance, protection and equal justice of the law.