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Routine Preoperative Laboratory Testing: Economic Burden on Pre-Surgical Patients

Open Journal of Anesthesiology 2017年第1期7卷 15-22页

作者： Bright Ighodaro Obasuyi akwasi antwi-kusi Department of Anaesthesiology University of Port Harcourt Teaching Hospital Port Harcourt Nigeria Department of Anaesthesia and Intensive Care Komfo Anokye Teaching Hospital Kumasi Ghana

Background: Routine pre-operative test, results in significant cost to the hospital and expense for the patient. The cost of a single laboratory test may be negligible but too many tests have increased cost for many national health schemes. Most of these patients cannot afford this extra cost thereby delaying surgery and adding up to emergencies. Implementation of change is necessary to reduce economic burden on the patient and enhance patient care. The aim of this study was to determine the economic burden of preoperative laboratory tests on pre-surgical patients in Komfo Anokye Teaching Hospital with a view to making appropriate recommendations that will reduce costs for the patients. Methodology: This was a prospective, cross-sectional study of patients undergoing elective surgery at K.A.T.H from 1st to 31st March 2014. A quantitative technique was used to effectively quantify laboratory results that were contained in a patient’s folder before an elective surgical procedure. Close and open ended questionnaire was developed and answered by reviewing patient’s folders during the pre-anaesthesia assessment. Cost of various laboratory investigations was obtained on request from one private laboratory and the KATH main laboratory. Data were analyzed using Statistical Package of Social Sciences (SSPS) version 22 and Microsoft Excel 2010. Results: The total cost of preoperative laboratory investigations in the study population was GHC 15, 321.19 (GHC 92.85 per individual);and for tests that were not indicated, GHC 3, 266.83 (GHC19.80 per individual). Conclusion: Routine preoperative laboratory tests ordered by Surgeons in Komfo Anokye Teaching Hospital impose an economic burden on the patients. The development of a comprehensive guideline that will help in the ordering of preoperative laboratory investigation will reduce costs for the patients.

关键词： Preoperative Laboratory Investigations Economic Burden

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Endotracheal Cuff Pressures Generated by Different Members of the Anaesthesia Services in a Ghanaian Teaching Hospital

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Open Journal of Anesthesiology 2013年第10期3卷 427-432页

作者： akwasi antwi-kusi Gabriel Boakye Wilfred Sam Awortwi Department of Anaesthesia and Intensive Care Komfo Anokye Teaching Hospital Kumasi Ghana

Background: The main function of the endotracheal tube (ETT) cuff is to ensure a tight seal between the tracheal wall and the endotracheal tube to prevent stomach contents from entering the trachea during ventilation thus preventing aspiration. Whereas excessive inflation of the cuff is associated with complications as a result of impaired blood supply to the trachea mucosa, low inflation pressure puts the patient at risk of aspiration. This study sought to find the accuracy of correctly estimating the cuff pressure and whether experience has effect on the accuracy. Methods: After approval from the Ethics Committee, we observed 199 patients who had general anaesthesia and had been intubated at the Komfo Anokye Teaching Hospital,KumasiGhana. Anaesthesia practitioners were blinded to the study. The endotracheal cuff pressure was measured using a low pressure manometer. The experience of the Anaesthetist was also noted. Results: Only 26% of the cuff pressures measured were within the acceptable range of 20-30 cm H2O. 4.5% of the pressures measured were below the acceptable minimum value of20 cm H2O hence exposing the patient to the risk of aspiration. 68% of the cuff pressures measured were above the maximum pressure of30 cm H2O. Physician anaesthetists were likely to inflate the cuff correctly. They had average inflation pressures of24 cm H2O with minimum and maximum inflation pressures of15 cm H2O and32 cm H2O respectively. Resident physician anaesthetists inflate the endotracheal pressures moderately high, an average of41.64 cm H2O. Nurse anaesthetists and student nurse anaesthetists had a tendency to overinflate the endotracheal cuff above the recommended range of 20-30 cm H2O. Their mean inflating pressures were 64.7 and 68.54 respectively. Conclusion: ETT cuff pressures measured by the low pressure aneroid manometer in patients undergoing general anaesthesia in Komfo Anokye Teaching Hospital are routinely high and are significantly higher when inflated by nurse a

关键词： Endotracheal Cuff Pressure Aneroid Manometer Intubation Tracheal Stenosis

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Negative Pressure Pulmonary Oedema: Management in Resource-Challenged Hospital: Two-Case Reports

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Open Journal of Anesthesiology 2019年第7期9卷 133-139页

作者： William Addison akwasi antwi-kusi Olivia Oppong Kwame Nkrumah University of Science and Technology Kumasi Ghana KNUST Hospital Kumasi Ghana

Negative Pressure pulmonary oedema (NPPO) is a medical emergency. It occurs when there is a strong inspiratory effort in obstructed upper airway. Laryngospasm is the main cause of postextubation negative pressure pulmonary oedema. Though it is life-threatening, early diagnosis and prompt treatment lead to rapid resolution with no residual respiratory complications. The mainstay management is to provide respiratory support, mostly in the intensive care unit. The recommended mode of respiratory support is to provide an invasive or non-invasive positive airway pressure. This requires the use of a ventilator. Most surgery centres in sub-Saharan Africa do not have intensive care unit or ventilators in their recovery wards. We report two cases of postextubation NPPO which occurred in a typical African hospital with no ventilator. All these two cases were successfully managed with a non-rebreather mask. The periods of resolution, both clinical and radiological, were 24 - 48 hrs. This is not significantly different from the resolution periods quoted in literature from cases managed in well-resourced centres with means of positive pressure ventilation. We therefore conclude that early detection and prompt initiation of management are important keys which can lead to good outcomes, even in low-resource centres.

关键词： Pulmonary Oedema (PO) Negative Pressure Pulmonary Oedema (NPPO)

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Anaesthesia for Pectoralis Major Myocutaneous Flap in a Patient with a Major Facial Defect and Restricted Mouth Opening: A Case Report

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Open Journal of Anesthesiology 2013年第3期3卷 165-167页

作者： akwasi antwi-kusi Wilfred Sam-Awortwi Gabriel Boakye Department of Anaesthesia and Intensive Care Komfo Anokye Teaching Hospital Kumasi Ghana.

Perioperative airway management in patients with oro-facial cancers who has undergone chemo/or radiotherapy poses a great challenge to the anaesthesiologist. These challenges are mainly due to either a mass in the oral cavity or a limited mouth opening making intubation difficult or a major facial defect making mask ventilation difficult. We present our first time experience in a 27-year-old man with a malignant lymphoma of the right cheek who had undergone chemotherapy and needed plastic surgery to restore the face.

关键词： Pectoralis Major Myocutaneous Flap Fibreoptic Intubation Anaesthesia Airway

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Preoperative Laboratory Testing by Surgeons: Implication on Anaesthetic Management

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International Journal of Clinical Medicine 2019年第6期10卷 345-352页

作者： akwasi antwi-kusi William Addison Bright Ighodaro Obasuyi Philip Domoyeri Department of Anaesthesia and Intensive Care Komfo Anokye Teaching Hospital Kumasi Ghana Department of Anaesthesiology University of Port Harcourt Teaching Hospital Port Harcourt Nigeria Koforidua Regional Hospital Koforidua Ghana

Background: Request for preoperative laboratory investigations is usually done by surgeons. On some occasions, the patient may come with laboratory investigations that have been requested by the primary physician. This occurs in situations where the primary physician saw the patient first and referred to the surgeon. There is usually no indications based on history or physical examination before these laboratory request is done but rather on speculations that the “anaesthetist may require them”. This is done in order to avoid cancellation or delay of cases. The aim of this study was to find out how tests ordered in Komfo Anokye Teaching Hospital (K.A.T.H.) by the surgeons affected the decisions of the anaesthetists in the perioperative management of the patients. Methodology: This was a prospective, cross sectional study of patients undergoing elective surgery at K.A.T.H from 1st to 31st March 2014. A quantitative technique was used to effectively quantify laboratory results that were contained in a patient’s folder before an elective surgical procedure. A close and open-ended questionnaire was developed and answered by reviewing patient’s folders during the pre-anesthesia assessment. Data were analyzed using Statistical Package of Social Sciences (SSPS) version 22. Results: The average age of patients studied was 50 years. Abnormal test results did not influence the anaesthetic management in 70.5% of cases but led to either delay or cancelation of cases or requirement for transfusion of blood or blood products in 29.5% of cases. Conclusion: Preoperative laboratory tests ordered by Surgeons in KomfoAnokye Teaching Hospital do not significantly influence the anaesthetic managements of patients.

关键词： Preoperative Laboratory Investigations Surgeons Anaesthetic Management Implication

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Successful Anaesthetic Management of Caesarean Section: An Experience on a Patient with Myasthenia Gravis and Difficult Airway

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Open Journal of Obstetrics and Gynecology 2019年第6期9卷 789-793页

作者： akwasi antwi-kusi William Addison Elizabeth Esi Crentsil Anthony Yeboah Rex Mawuli Kwadjo Djokoto Department of Anaesthesiology Komfo Anokye Teaching Hospital Kumasi Ghana Department of Obstetrics and Gynaecology Komfo Anokye Teaching Hospital Kumasi Ghana

The anaesthetic management of the pregnant woman with myasthenia gravis (MG) is very challenging to the anaesthesiologist. This situation becomes exaggerated in emergency settings in a low resource area, especially when attending anesthesiologists for the first time took care of her. Here, we present a case that illustrates this situation. A G3 P2 pregnant woman presented for an emergency caesarean section (CS) due to premature rupture of the membranes. The patient had been misinformed by her neurophysician not to undergo general anaesthesia at CS. She had no motor weakness and no bulbar symtoms. The only abnormal finding was a stiff neck and a Mallampati #2 score, which predicted a difficult airway. Spinal anaesthesia was not successful after several attempts. General anaesthesia was considered but again intubation was not successful. We performed anesthesia with a second generation laryngeal mask airway with successful CS. Pregnant women with MG require personalised care from a multidisciplinary team. While regional anaesthesia is reported to be the better choice in CS for women with MG, regional anesthesia is not always possible. Anesthesia should be chosen in a patient-by-patient manner. The present case illustrates such conditions, of which description may be useful for anesthesiologists and obstetricians.

关键词： Myasthenia Gravis Failed Spinal Difficult Intubation Second Generation Laryngeal Mask Airway

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Mother’s of Children with Cleft Lip and/or Palate, Perception about Aetiology, Social Reaction and Treatment of Cleft

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Journal of Biosciences and Medicines 2015年第10期3卷 98-101页

作者： akwasi antwi-kusi William Addisson A. Acheampong Oti Ama A. Amuasi Daniel Kwesi Sabbah Wilson Eva Bernice Joseph Abu-Sakyi Kwame Nkrumah University of Science and Technology Kumasi Ghana Komfo Anokye Teaching Hospital Oral Health Directorate Kumasi Ghana Kwame Nkrumah University of Science and Technology Hospital Kumasi Ghana

Background: Religious, cultural beliefs and demographical differences can have a huge impact in shaping people’s reactions and attitudes toward cleft children. Myths and folk beliefs frequently accompany the birth of a child with deformities especially in Africa. Objective: Evaluate cleft mothers with cleft children attending a multidisciplinary cleft clinic at Komfo Anokye Teaching Hospital about their experiences on aetiology, expectation, family reaction and treatment of cleft lip and palate. Methodology: The study design was a cross-sectional study which involved consecutive mothers of cleft lip and palate children reporting to Komfo Anokye Teaching Hospital (KATH) Cleft clinic by using a structured questionnaire. The study period was from January to June 2013. Results: The highest recorded response (47.50%) from mothers was that their nuclear families had been supportive. The least recorded nuclear family reaction was indifferent to child’s condition (3.70%). 47.50% of mothers reported their extended family members had been supportive whereas the least recorded reaction of extended family members (1.25%) was avoidant behaviour. 52 Mothers (65%) answered that they are not mocked by members of the society whereas 28 (35%) answered they were mocked. Conclusion: The above study demonstrates that mother’s educational background was low. Some mothers still believe CL/P is caused by evil spirit even though they are in the minority. Most mothers were hopeful that their babies will have a normal life after surgery. There was high level of family support for cleft families.

关键词： Cleft Aetiology Beliefs Family Reaction

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Drugging in the absence of p53

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Journal of Molecular Cell Biology 2019年第3期11卷 255-264页

作者： Obed akwasi Aning Chit Fang Cheok Institute of Molecular and Cell Biology A*STARSingapore Department of Pathology Yong Loo Lin School of MedicineNational University of SingaporeSingapore Department of Biochemistry Yong Loo Lin School of MedicineNational University of SingaporeSingapore

Inactivation of the p53 gene is a key driver of tumorigenesis in various cancer cohorts and *** quest for a successful p53-based therapy that holds the promise of treating more than half of the cancer population has culminated in extensive knowledge about the role and function of p53 and led to new proposed innovative strategies against p53-defective *** will discuss some of these latest studies with a focus on metabolic regulation and DNA damage response and also highlight novel functions of p53 in these pathways that may provide a contemporary rationale for targeting p53 loss in tumors.

关键词： therapeutics metabolism DNA damage replication stress p53 synthetic lethality

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Assessing the palliative aspects of green innovations in the non-linear tendencies of environmental sustainability-financial globalization nexus among West African states

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Geoscience Frontiers 2024年第6期15卷 207-228页

作者： Mohammed Musah Stephen Taiwo Onifade Elma Satrovic Joseph akwasi Nkyi Department of Accounting Banking and FinanceSchool of BusinessGhana Communication Technology UniversityAccraGhana School of Accounting and Finance Economics DepartmentUniversity of VaasaFI-65200 VaasaFinland Department of International Trade and Logistics Faculty of EconomicsAdministrative and Social SciencesHasan Kalyoncu UniversityGaziantepTürkiye Department of Accounting Banking and FinanceBusiness SchoolGhana Communication Technology UniversityAccraGhana

A reconciliation of the disagreement on whether financial globalization(FG)affects ecological footprint through the scale,technique and composition effects cannot be achieved without an explicit understanding of the direct and indirect interactions of FG with environmental ***,the novel perspective of this study lies in the investigation of how green innovations moderate the non-linear tendencies in the FG-environmental sustainability link among western African states given the abundance of natural resources and the prevailing pace of economic *** core findings are obtained from robust analysis based on cross-sectional autoregressive distributed lag(CS-ARDL)technique,the augmented mean group(AMG)technique,and the common correlated effects mean group(CCEMG)advanced ***,the beneficial ecological impacts of green innovations were *** per direct impact,enhanced financial globalization(FG)exhibits non-linear detrimental ecological ***,green innovations cushion the observed adverse ecological effects of ***,resource rents reduce ecological footprint within the moderating framework of green innovation as the environmental Kuznets curve(EKC)is validated among the ***,a bidirectional causal link between financial globalization,green innovations,economic growth,natural resources,and ecological footprint was ***,the significant policy implication is for the West African states to decisively increase their investments in green innovations while strategically encouraging the share of ecologically friendly resources in total resource utilization to guarantee a more sustainable environment.

关键词： Green innovations Ecological footprint Natural resources Financial globalization West Africa

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The Relationship Between Exchange Rate Volatility and Foreign Direct Investment in West Africa

The Relationship Between Exchange Rate Volatility and Foreig...

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作者： Appiah akwasi 上海财经大学

学位级别：硕士

这篇文章的目的是调查,研究并查明汇率波动是否会对撒哈拉以南的4个非洲国家的国外收入造成影响。撒哈拉以南的非洲国家通常都是经济不发达国家(简称LEDC‘s)而且都有被殖民统治的历史。同样地,这篇文章让我们能了解到世界的历史演变造... 详细信息

这篇文章的目的是调查,研究并查明汇率波动是否会对撒哈拉以南的4个非洲国家的国外收入造成影响。撒哈拉以南的非洲国家通常都是经济不发达国家(简称LEDC‘s)而且都有被殖民统治的历史。同样地,这篇文章让我们能了解到世界的历史演变造就了我们今天的经济。很多人对这个研究也很感兴趣,但是目前针对西非国家的研究非常的少,所以无法得出能达成广泛共识的结论,而且自然而然地是根据研究者所在的国家而定的。所有提到的这些国家虽然都有被殖民统治的历史,但是它们各自通往独立国家的道路却是不同的。本文研究的是这些国家从独立以后到现代为止的时间段。文中用到的日期是从1995年到2018年之间,引用的是世界银行的可靠数据。经过大量回归分析和计量经济学检验后,结果表明,在撒哈拉以南非洲地区,汇率波动率与FDIIF之间存在很强的相关性。汇率波动率是根据实际有效汇率使用多变量GARCH模型生成的。

关键词：汇率波动外国直接流入加纳尼日利亚科特迪瓦喀麦隆面板数据 MGARCH

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