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Perioperative medical management is challenging because of the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources use recommendations derived from individual studies and do not include a multidisciplinary focus on formal consensus. The Society for Perioperative Assessment and Quality Improvement identified a lack of authoritative clinical guidance as an opportunity to use its multidisciplinary membership to improve evidence-based perioperative care. The Society for Perioperative Assessment and Quality Improvement seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this consensus statement is to provide practical guidance on the preoperative management of immunosuppressive, biologic, antiretroviral, and anti-inflammatory medications. A panel of experts including hospitalists, anesthesiologists, internal medicine physicians, infectious disease specialists, and rheumatologists was appointed to identify the common medications in each of these categories. The authors then used a modified Delphi process to critically review the literature and to generate consensus recommendations.

Introduction Scant literature exists on the non-urgent use of emergency departments in Sub-Saharan Africa and its effects on the provision of effective emergency care services. With the surge in the prevalence of non-communicable diseases compounded by an already prevailing significant problem of communicable diseases and injuries in this setting, there has been a rising demand for emergency care services. This has led to ED overcrowding, increased healthcare costs, extended waiting periods and overstretched essential services. The main objective of this study was to determine why patients visit the ED for non-urgent care. Methods A descriptive qualitative study was conducted at a tertiary university hospital ED in Nairobi, Kenya. Purposive sampling was used to select patients triaged as less urgent or non-urgent. In-depth interviews were conducted until thematic saturation was achieved. The interviews were audio recorded, transcribed verbatim and analyzed thematically. Results Thematic saturation was reached after interviewing twenty-four patients. The obtained data was discussed under three main themes: (1) reasons why patients visited the ED for non-urgent care, (2) patients understanding of the roles of the ED, and (3) patients' perceptions about the urgency of their medical conditions. Several factors were identified as contributing to the non-urgent use of the ED including positive experiences during past visits, a perception of availability of better services and the closure of other departments after office-hours and on weekends. It was found that non-urgent ED visits occurred despite most patients having an understanding of the role of the ED as an appropriate location for the treatment of patients with life threatening conditions. Conclusion This study highlights several reasons why patients with non-urgent medical conditions seek care in the ED despite being able to correctly identify its purpose within the national emergency care framework. Regular patient education regarding which conditions warrant ED attendance and alternative sites of care for non-urgent conditions could potentially help reduce ED patient numbers.

Compliance with cardiac performance measures for guideline-directed medical therapy remains suboptimal. There is a compelling need to identify modifiable factors that influence compliance rates, so that these factors can be addressed as targets of quality improvement. This study examines the relationship between cardiovascular provider experience and compliance with performance measures for outpatients with coronary artery disease (CAD), heart failure, and atrial fibrillation in the PINNACLE Registry. We hypothesize that providers who have been practicing longer, especially those further out from certification who may not be required to recertify, will have lower compliance rates with key cardiac performance measures. Using clinical data from January 1, 2013 to March 31, 2014 in the PINNACLE Registry, we employed a multilevel hierarchical logistic regression analysis to examine the relationship between cardiac performance measures and provider experience, defined by the number of years since initial cardiology board certification (

Dispersal is a key evolutionary force affecting gene flow and genetic diversity. Therefore, analysis of population connectivity plays an important role in protecting endangered species. Ottelia acuminata var. jingxiensis is a perennial endangered aquatic plant, and present in several karst rivers of Yunnan–Guizhou Plateau. We estimated the genetic variation and population connectivity by nuclear microsatellites in 11 populations mainly from three rivers. The plant showed low genetic diversity (HE = 0.205–0.367), which was mainly explained by its critically restricted geographical range. Meanwhile, relatively low genetic differentiation (FST = 0.186; G”ST = 0.242) was found compared with that of other studies about varieties of O. acuminata in isolated habitats. Cluster analyses based on different approaches consistently showed populations from the same river clustered together, suggesting water flow acting as corridors for dispersal; additionally, bidirectional gene flows within and among rivers indicated that zoochory or mankind were also major contributors to gene exchange. The results showed that contemporary gene flow was much lower than historical gene flow, suggesting that recent habitat fragmentation resulted in decreased gene flow. We recommend watercourse dredging within rivers to enhance habitat stability and to improve connectivity among populations. In addition, the different populations from different rivers or isolated habitats should be protected to maintain the genetic diversity.

Purpose The Child Depression Inventory (CDI) is a commonly used measure of depression among youth and has been used in studies conducted in sub-Saharan Africa demonstrating positive effects of financial asset-building interventions on physical and mental health outcomes. However, before we can be certain that asset building does indeed improve mental health functioning, we must first be sure that the instruments used to measure mental health in this population are valid and culturally appropriate. Methods This two-part study used baseline data from a sample of youth (N = 1,348, 13–18 years) participating in the YouthSave-Impact Study Kenya to clarify the psychometric properties of the 10-item CDI (study A), and then used the 10-item CDI to assess the relationship between financial assets and mental health functioning among this sample of adolescents (study B). Results Factor analysis on the 10-item CDI indicated a one-factor eight-item measure with excellent model fit. Invariance testing indicated that the measure performed differently for male and female respondents. Finally, using the latent structure as the dependent variable, the second part of the analysis established that cash savings were associated with depression. Female and male adolescents with savings reported lower depression (female β = −.17, p ≤ .003; male β = −.12, p ≤ .020) than other youth. Conclusion This study identified a reasonable one-factor eight-item depression measure that was noninvariant across gender. This validated measure was used to confirm the association between financial assets and mental health outcomes, hence, supporting the hypothesis that financial assets are associated with mental health outcomes.

Spectroscopic techniques utilizing FTIR, 1 H and 13 C NMR spectral fingerprints of the neat oils, as well as standard titrimetric and GC–MS analyses were all employed to determine the quality parameters and fatty acid (FA) profiles for Soxhlet-extracted seed oils of four indigenous plants from Botswana: Tylosema esculentum (morama), Schinziophyton rautanenii (mungongo), Citrullus lanatus (kgengwe) and Bauhinia petersiana (mogose). The physicochemical parameters and FA composition obtained from spectroscopic methods were found to be similar to those obtained from classical procedures indicating that oil quality parameters can reliably be obtained from spectroscopic data. The FA analysis showed the presence of 73–84% unsaturated FAs in the four seed oils. In addition, spectroscopic data clearly established the presence of the uncommon tri-unsaturated FA, α -eleostearic acid ( α -ESA) in mungongo seed oil which was quantified as 25% by 13 C NMR. Generally, the high levels of unsaturated FAs in the oils indicate their suitability in health food supplements. Industrial relevance The four plants studied are highly treasured in the areas where they grow due to the fact that they have for centuries provided food security, and means of livelihood for populations living in the Kalahari Desert and other marginal regions of the southern Africa region. Currently, there is a drive to add value to such often underutilized plants to aid in poverty alleviation by processing and marketing the products as healthy food supplements or cosmetic formulations. To this end, reliable methods for characterization and comparison of the FA composition of the seed oils from different geographical locations is required. The development of rapid, non-destructive spectroscopic techniques that can be applied directly on the neat oils is therefore an important venture.