operative care at_the_hospital_shabani
Post on 11-May-2015
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What is necessary to provide good care for
persons with SB and H?
Operative care / hospital set up
Dr H. K. Shabani MD PhD FCS Neurosurgeon, Muhimbili Orthopedic Institute
Hospitals treating NTD children in Tanzania
MOI 2005 todate. (Ω 200 patients)
Muhimbili Medical Centre ?;
CCBRT 1996-2005 (Ω 102 patients)
KCMC
Hydom Christian Health Centre (Luth Ref Hosp)
BUGANDO
Seliani hosp
MOI hydrocephalus series
MOI receives patients from all over
the country
MKOA
MKOA
znz
tanga
tabora
singida
ruvuma
rukwa
pwani
mwanza
mtw
ara
moro
mbeya
knjaro
kigoma
iringadsm
dodoma
arusha
Fre
qu
en
cy
40
30
20
10
0
NTD Rx CENTRES
1000 km
Why only few hospitals in Tz are involved in SB/H treatment?
Prerequisite for SB/H good treatment outcome at the hospital settings:
Patient selection
Proper pre operative work-up
SMART treatment guidelines and proper surgical procedure
Proper post-operative follow-up and in-patient care
Right time for discharge and organized outpatient follow up plan
Prerequisite for SB/H good treatment outcome at the hospital settings:
Patient selection
Proper pre operative work-up
SMART treatment guidelines and proper surgical procedure
Proper post-operative follow-up and in-patient care
Right time for discharge and organized outpatient follow up plan
Late VS Early presentation
Nutritional status
Co morbidity ( pneumonia, septicemia etc)
Prerequisite for SB/H good treatment outcome at the hospital settings:
Patient selection
Proper pre operative work-up
SMART treatment guidelines and proper surgical procedure
Proper post-operative follow-up and in-patient care
Right time for discharge and organized outpatient follow up plan
• Lab facility including staff
• Imaging facility – ultrasound/ CT scan
• Consent for surgery
• Teamwork – anesthetist, surgeon,
theatre nurse, supporting staffs etc
• Theatre facility
Prerequisite for SB/H good treatment outcome at the hospital settings:
Patient selection
Proper pre operative work-up
SMART treatment guidelines and proper surgical procedure
Proper post-operative follow-up and in-patient care
Right time for discharge and organized outpatient follow up plan
• Updating surgical treatment guidelines in order to
minimize VP shunt infections, and to ensure
good outcome
• CME to ensure quality care
Pre surgery
8/12 old
Post surgery
2yr old
Occipital encephalocoele
Repair achieved in one stage operation
SMART treatment guidelines and proper surgical procedure
Frontoethmoidal encephalocoele
Pre surgery Post surgery #1
?
#2 etc
Sometimes repair requires multistage operations
Cosmesis
CSF leak
SMART treatment guidelines and proper surgical procedure
SMART treatment guidelines and proper surgical procedure
Multidisciplinary approach in coordination sometimes is required
Thoracic SB and TEV child
Prerequisite for SB/H good treatment outcome at the hospital settings:
Patient selection
Proper pre operative work-up
SMART treatment guidelines and proper surgical procedure
Proper post-operative follow-up and in-patient care
Right time for discharge and organized outpatient follow up plan
• Intensive care set up, treatment guidelines
• Committed supporting staff and collaborating care professionals
• Wound care
• Nutrition
Prerequisite for SB/H good treatment outcome at the hospital settings:
Patient selection
Proper pre operative work-up
SMART treatment guidelines and proper surgical procedure
Proper post-operative follow-up and in-patient care
Right time for discharge and organized outpatient follow up plan
• Established engagement with collaborating team e.g.
physiotherapy, club foot clinic, CBR worker etc
• Proper counseling ensures good follow up
• Database management to ensure Rx continuation /
evaluation and dissemination
Suggestions?
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