/library/oar/handle/123456789/75776 2025-10-31T18:59:45Z 2025-10-31T18:59:45Z /library/oar/handle/123456789/76007 2021-05-20T10:12:17Z 2021-05-01T00:00:00Z

Title: Gambling can seriously damage your health Abstract: Gambling is one of the earliest forms of entertainment and an ancient activity, possibly dating as far back as the middle pre-history Palaeolithic era (circa 50,000 years ago). Dice, dating to before 3,000BC, have been discovered in ancient Mesopotamia (now Western Asia), gambling houses have been recorded in China in 1,000BC, early playing cards in the 800s AD, and the first casino opened in Venice, Italy in 1638. Gambling, gaming and betting have been defined interchangeably but, arguably, equate to one another. Gambling is known to become addictive, and is reinforced by repeated losses. It can be stratified, ranging from ‘none’, to ‘occasional’, ‘recreational’, ‘at risk’, ‘problem’ and finally ‘pathological’ gamblers. However, this is a continuum and all ‘problem gamblers’ started off as non-gamblers and ‘worked their way up the ladder’. Gambling is mostly associated with male gender, and ‘pathological gamblers’ make up around 0.1-3.0 (median 1.5)% of any given western population, increasing to 2.3-13.0 (median 5.4)% if ‘problem’ and ‘pathological’ gamblers are combined.

2021-05-01T00:00:00Z Curmi, Arthur Debattista, Jonathan Busuttil, Gerald Holmes, Kelvin Pace, Keith Sciberras, John /library/oar/handle/123456789/76006 2021-05-20T10:11:42Z 2021-05-01T00:00:00Z

Title: Assessing referrals to urology outreach in cases of acute urinary retention Authors: Curmi, Arthur; Debattista, Jonathan; Busuttil, Gerald; Holmes, Kelvin; Pace, Keith; Sciberras, John Abstract: INTRODUCTION: Acute Urinary Retention (AUR) is the sudden and often painful inability to pass urine characterised by a palpable or percussible bladder. It constitutes 45% of all lower urinary tract consultations and is encountered in different medical specialties. A local guideline was set up to delineate the management of acute urinary retention (AUR) in July 2018. It describes the clinical features, investigations and treatment required according to the severity of the episode. The aim of this audit is to assess the demographics of patients making use of the Urology Outreach Unit (cases of AUR), and trends in investigations done, treatment chosen and outcomes on such patients.; METHOD: All patients older than 16 years of age who presented with AUR between March 2018 and September 2018 were included. Data was obtained from Urology TWOC forms and corroborated with the hospital online system.; RESULTS: 89 (37.6%) of the referrals were done from Accident and Emergency Department (A&E), and 86 (36.3%) were referred from Urology firms. Urinalysis and Microscopy was sent in 45.1% of cases. Renal profile (serum) was taken in 70.5% of cases. The most commonly used catheter type used was silicone (89.6%). Catheter size of 16F was used in 83.8% of the cases. The average days spent with the catheter in situ was 11.7 days. The average attempts at TWOC was 1.1 times (max of 3). 83.5% of patients were then advised to continue their medical therapy with appropriate follow up following a successful TWOC. The rest were scheduled for a repeat TWOC (13.1%), fitted with a long-term catheter (1.69%), advised regarding self-intermittent catheterisation (1.27%), or referred for TURP (0.42%).; CONCLUSION: This audit shows variable compliance to clinical guidelines. An active role of the clinician in the management and treatment of AUR might improve treatment and reduce the risk of further episodes of AUR.

2021-05-01T00:00:00Z Attard Cortis, Petramay Abela, Glenn /library/oar/handle/123456789/76005 2021-05-20T10:11:25Z 2021-05-01T00:00:00Z

Title: Measuring obstetric anaesthesia workload : empirical research using a mixed methods design as part of a quality and safety improvement project Authors: Attard Cortis, Petramay; Abela, Glenn Abstract: BACKGROUND: Obstetric anaesthetists at Mater Dei Hospital considered the quality and safety of their work was deteriorating due to increasing workload. Literature suggests various ways of measuring this including the delivery rate, caesarian section rate, epidural rate, the obstetric anaesthesia activity index or a combination. The Objectives were: to define the obstetric anaesthesia workload; to benchmark to standards set by international bodies; and to make evidence-based recommendations to improve safety and quality.; METHODS: This single-centre study was performed between September 24 and November 20, 2017. It was an empirical research study using a mixed methods design. This allowed for data triangulation. Data was analyzed using SPSS.; RESULTS: In 58 days, there were 669 births, 198 (29.6%) of which were by a lower segment Caesarean section (LSCS). On 30 days (52%), elective work over-ran, adding to the on-call workload. Average theatre cases in 24-hours were 3.81 ± 1.55. Epidural rate was 28.4% (n=190). The mean number of epidurals in a 24-hour period was 3.28 ± SD1.609. On 7 days (12%), not all requested epidurals were done because the anaesthetist was busy. Significant 'hidden workload' was identified including patient reviews on 39 days (67%), vascular access outside theatre on 21 days (36%) and stand-by requests on 29 days (50%). There was no statistically significant difference between the work done on weekdays versus weekends.; CONCLUSIONS: We identified a significant amount of “hidden workload” in obstetric anaesthesia and workflow inefficiencies. Recommendations are being implemented to increase quality and safety of obstetric anaesthesia in Malta.

2021-05-01T00:00:00Z Muscat, Edward Miggiani, Timothy Sladden, David Manche, Alexander /library/oar/handle/123456789/76004 2021-05-20T10:08:51Z 2021-05-01T00:00:00Z

Title: A comparison of intraoperative cell salvage use with cardiotomy suction in cardiothoracic surgery Authors: Muscat, Edward; Miggiani, Timothy; Sladden, David; Manche, Alexander Abstract: INTRODUCTION: Intraoperative cell salvage has been shown to be a safe and effective means of blood transfusion in elective surgery. Most cardiac units now employ cell salvage for complex cases but few use it routinely in all cardiac procedures requiring cardiopulmonary bypass.; AIM: To demonstrate if there was any haematological benefit of autologous transfusion using intra-operative cell salvage over single use of cardiotomy suction in patients undergoing cardiac surgery.; METHODS: All patients who had operations performed by the cardiac surgical team over a twenty month period formed part of this study including valve replacements and coronary artery bypass grafting. The patients were divided into two groups; the cell saver group and the control group. The haematological variations of these patients' blood results were analysed preoperatively, immediately post-operatively and 24 hours post-operatively.; RESULTS: 451 patients were operated on in a 20 month period. 230 patients in the control group and 221 patients in the cell saver group. Intra-operative cell salvage demonstrated a better immediate post-operative haemoglobin level (10.31 g/dL) compared to the non-cell saver group (9.99 g/dL). The p-value was 0.003 after comparison between pre-operative haemoglobin and post-operative haemoglobin in the cell saver group.; CONCLUSION: Intra-operative cell salvage demonstrated a minimal increment in haemoglobin in the immediate post-operative period when compared with cardiotomy suction alone. Even though the improvement in haemoglobin is only significant until 24 hours post-operation, this is an overall increased benefit in the immediate recovery period.

2021-05-01T00:00:00Z