Accelerating the spread of laboratory quality improvement efforts in Botswana

Background: In 2002, the Ministry of Health (MoH) of Botswana began its journey toward laboratory accreditation in an effort to enhance the quality of laboratory services. Aftera difficult start, the MoH recognised the need for a more practical and sustainable method for change that could be implemented nationally; they therefore adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme.Objective: This study describes the spread of laboratory quality improvement efforts in Botswana.Methods: Eight laboratories were enrolled into the SLMTA programme in 2010, which included a series of workshops and improvement projects conducted over nine months. Four of these laboratories received supplementary training and focused mentorship from the Botswana Bureau of Standards (BOBS). Laboratory performance was measured at baseline and exit using the World Health Organization Regional Office for Africa’s StepwiseLaboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. One laboratory did not receive an exit audit and was thus excluded from the analysis.Results: An 18 percentage-point improvement was observed when comparing the median baseline score (53%) to the median exit score (71%) for the seven laboratories. Laboratories that received additional training and mentorship from BOBS improved 21 percentage points, whilst non-BOBS-mentored laboratories improved eight percentage points. Hospital management buy-in and strong laboratory staff camaraderie were found to be essential forthe positive changes observed.Conclusion: SLMTA facilitated improvements in laboratory quality management systems,yielding immediate and measurable results. This study suggests that pairing the SLMTA programme with additional training and mentorship activities may lead to further increases in laboratory performance; and that SLMTA is a practical approach to extending quality improvement to MOH laboratories.</jats:p

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Proximate and Mineral Nutrition of Common Bean Genotypes as Influenced by Harvesting Time

Common bean is the most consumed legume by humans and hence significant for global food security and nutritive value mainly iron (Fe) and zinc (Zn). The objective of the study was to evaluate the effect of harvesting time and genotypes on proximate and mineral composition of common bean. Two field experiments were carried out in Sebele (24o33&amp;prime;S, 25o54&amp;prime;E, 994 m above sea level) horticultural fields during summer 2018/2019. Treatments included two common bean genotypes DAB 564 (white) or 520 (red) and three harvesting stages as the early, mid and late season harvest. In both seasons, genotype and harvesting time significantly (P &amp;lt; 0.05) influenced proximate, macro and micro mineral composition of common bean seeds. Generally genotypes studied had a sufficient amount of proximate and mineral content with crude protein, iron (Fe) and zinc (Zn) content as the most abundant minerals at a range between 20-22%, 33-101 mg g-1 and 41-45 mg g-1, respectively across harvesting times. Genotype DAB 564 (white coloured) significantly (P &amp;lt; 0.05) produced seeds with the highest concentration of proximate and mineral contents especially zinc (45 mg g-1) and iron (70 mg g-1) content irrespective of season. Harvesting common bean seed early or mid-stage produced high seed concentration of proximate, micro and macro mineral content across genotype or season. </jats:p

A Percutaneous Knotless Technique for Acute Achilles Tendon Ruptures

Achilles tendon ruptures are a common tendon injury, usually occurring in middle-aged men during recreational sporting activities. Both nonoperative and operative management are employed to treat these injuries. Several operative treatments are described in the literature, including percutaneous Achilles repair, mini-open repair, and open repair. Open Achilles repair is associated with higher rates of impaired wound healing and infection, whereas minimally invasive techniques have been reported to have an increased risk of iatrogenic sural nerve injury. More recently, low complication rates, improved cosmetic appearance, reduced operating times, and improved clinical outcomes have been reported for the percutaneous Achilles repair technique. In this Technical Note, we present our preferred technique using the Percutaneous Achilles Repair System (Arthrex, Naples, FL), which has been reported to have minimal wound and nerve complications, and early return to activity