No abstract

Knee hyperextension in supine patients during general anaesthesia leads to popliteal vein compression or occlusion. The likelihood of compression increases with higher BMIs.

Current heel protection devices used in the operating room do not comply with the consensus document of the European and National (North American) Pressure Ulcer Advisory Panels. A complying prototype has been tested. Prospective cohort study comparing interface pressures. While using the prototype device, the heel interface pressure is significantly [mean 0·0 mmHg, standard deviation (SD) 0·0] less than the viscose elastic gel (VEG) mat (mean 174·8 mmHg, SD 64·5), the Action(®) heel block (mean 182·3 mmHg, SD 70·8) and the theatre table (mean 193·2 mmHg, SD 57·1). At the Achilles tendon, the prototype device (mean 16·2 mmHg, SD 19·0) is significantly superior to the Oasis (mean 183·7 mmHg, SD 67·4) and Action(®) heel blocks (mean 112·3 mmHg, SD 64·7). At the lateral malleolus, the prototype device (mean 0·0, SD 0·0) is better than the Action(®) (mean 24·3 mmHg, SD 53·4) and Oasis heel blocks (mean 20·9 mmHg, SD 49·2). At the calf, the prototype (mean 53·7 mmHg, SD 23·0) imposed more pressure than all other devices tested but was not statistically significant compared with the theatre table or the VEG mat. It is possible to design a device that protects the heel, lateral malleolus and Achilles tendon without causing hyperextension of the knee and consequent popliteal vein compression, thereby complying with the above guidelines.

Background: The burden of type 2 diabetes mellitus (T2DM) is increasing in low- and middle-income countries, including sub-Sahara Africa (SSA). However, awareness of and access to T2DM diagnosis and care remain low in SSA, leading to delayed treatment, early morbidity, and mortality. Particularly in rural settings with long distances to health care facilities, community-based care models may contribute to increased timely diagnosis and care. This scoping review aims to summarize and categorize existing models of community-based care for T2DM among non-pregnant adults in SSA, and to synthesize the evidence on acceptance, clinical outcomes, and engagement in care. Method and analysis: This review will follow the framework suggested by Arskey and O’Malley, which has been further refined by Levac et al. and the Joanna Briggs Institute. Electronic searches will be performed in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus, supplemented with backward and forward citation searches. We will include cohort studies, randomized trials and case-control studies that report cases of non-pregnant individuals diagnosed with T2DM in SSA who receive a substantial part of care in the community. Our outcomes of interest will be model acceptability, blood sugar control, end organ damage, and patient engagement in care. A narrative analysis will be conducted, and comparisons made between community-based and facility-based models, where within-study comparison is reported. Conclusion: Care for T2DM has become a global health priority. Community-based care may be an important add-on approach especially in populations with poor access to health care facilities. This review will inform policy makers and program implementers on different community-based models for care of T2DM in SSA, and critically appraise their acceptability and clinical outcomes. It will further identify evidence gaps and future research priorities in community-based T2DM care.

Background Arterial hypertension (aHT) is the leading cardiovascular disease (CVD) risk factor in sub-Saharan Africa; it remains, however, underdiagnosed, and undertreated. Community-based care services could potentially expand access to aHT diagnosis and treatment in underserved communities. In this scoping review, we catalogued, described, and appraised community-based care models for aHT in sub-Saharan Africa, considering their acceptability, engagement in care and clinical outcomes. Additionally, we developed a framework to design and describe service delivery models for long-term aHT care. Methods We searched relevant references in Embase Elsevier, MEDLINE Ovid, CINAHL EBSCOhost and Scopus. Included studies described models where substantial care occurred outside a formal health facility and reported on acceptability, blood pressure (BP) control, engagement in care, or end-organ damage. We summarized the interventions’ characteristics, effectiveness, and evaluated the quality of included studies. Considering the common integrating elements of aHT care services, we conceptualized a general framework to guide the design of service models for aHT. Results We identified 18,695 records, screened 4,954 and included twelve studies. Four types of aHT care models were identified: services provided at community pharmacies, out-of-facility, household services, and aHT treatment groups. Two studies reported on acceptability, eleven on BP control, ten on engagement in care and one on end-organ damage. Most studies reported significant reductions in BP values and improved access to comprehensive CVDs services through task-sharing. Major reported shortcomings included high attrition rates and their nature as parallel, non-integrated models of care. The overall quality of the studies was low, with high risk of bias, and most of the studies did not include comparisons with routine facility-based care. Conclusions The overall quality of available evidence on community-based aHT care is low. Published models of care are very heterogeneous and available evidence is insufficient to recommend or refute further scale up in sub-Sahara Africa. We propose that future projects and studies implementing and assessing community-based models for aHT care are designed and described according to six building blocks: providers, target groups, components, location, time of service delivery, and their use of information systems.