Parkside Hospital was a mental health facility at Victoria Road in Macclesfield, Cheshire, England. The administration block survives and is a Grade II listed building.
ABSTRACT Background To facilitate the drive towards Universal Health Coverage (UHC) several countries in the West African subregion have over the last two decades adopted the system of National Health Insurance (NHI) to finance their health services. However, most of these countries continue to face challenges safeguarding the insured population against catastrophic health expenditure (CHE) and impoverishment due to health spending. The aim of this study is to describe the extent of financial risk protection among households enrolled under NHI schemes in West Africa and summarize potential learnings. Methods We conducted a systematic review of observational studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published in English between 2005 and 2022 were searched for using keywords, synonyms and MeSH terms related to NHI, financial risk protection and UHC in all West African countries on the following electronic databases: PubMed/Medline, Web of Science and CINAHL via EBSCOhost and Embase via Ovid and Google Scholar. The quality of included studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. Two independent reviewers assessed the studies for inclusion, extracted data and conducted quality assessment. We present the findings of the narrative synthesis consisting of thematic synthesis for qualitative data and a Synthesis Without Meta-analysis (SWiM) for quantitative data. The study protocol was published in PROSPERO under the ID CRD42022338574 on 28th June 2022. Results Of the 1,279 articles initially identified, nine were eligible for inclusion. These were cross-sectional studies (n=8) and retrospective cohort study (n=1) published between 2011 and 2021 in Ghana (n=8) and Nigeria (n=1). Two-thirds of the included studies reported that enrollment into the NHI showed a positive (protective) effect on CHE at different thresholds and one study showed a protective effect of NHI on impoverishment due to health spending. However, almost all of the included studies (n=8) reported that a proportion of insured households still encountered CHE with one-third of them reporting more than 50% of insured households incurring CHE. Key determinants of CHE and impoverishment due to health spending reported consisted of income, employment and educational status of household members as well as household size, household health profile, gender of household head and distance of household from health facility. Discussion Households insured under NHI schemes in some West African countries (Ghana and Nigeria) are better protected against CHE and impoverishment due to health spending compared to uninsured households as evidenced in other studies. However, insured households continue to incur CHE and impoverishment due to health expenditure resulting from gaps identified in the current design of NHI schemes in these West African countries. Conclusion To protect insured households from the financial burden due to health spending and advance the drive towards UHC in West Africa, governments should consider investing more into research on NHI, implementing nationwide compulsory NHI programmes and establishing a multinational West African collaboration to co-design a sustainable context- specific NHI system based on solidarity, equity and fairness in financial contribution.
Background: Penile inversion vaginoplasty is a commonly performed genital gender-affirming procedure in transgender women. The creation of an adequate functional neovaginal depth in cases of too little usable penile skin is a challenge. The bilateral pedicled epilated scrotal flap (BPES-flap) can be used as an easy adjunctive technique and may serve as a tool in the surgical armamentarium of the gender surgeon. Aim: To describe the use, dissection, design subtypes, and surgical outcomes of the BPES-flap in vaginoplasty. Methods: Perioperative considerations and different flap design subtypes were described to illustrate the possible uses of the BPES-flap in vaginoplasty. A retrospective chart study was performed on the use of this flap in 3 centers (blinded for review purposes). Outcomes: The main outcome measures are description of surgical technique, flap design possibilities, and postoperative complications. Results: A total of 42 transgender women were included (median age: 28 years (range 18-66), mean body mass index: 24.5 +/- 3.5). The mean penile length and width preoperatively were 9 +/- 3.1 and 2.9 +/- 0.2 cm, respectively. With a mean follow up of 13 +/- 10 months, total flap necrosis occurred in one case (2.4%). Partial flap necrosis occurred also in one. Neovaginal reconstruction was successful in all patients with a mean vaginal depth of 13.5 +/- 1.3 cm and width of 3.3 +/- 1.3 cm. Partial prolapse of the neovaginal top occurred in 3 patients (7%). Clinical Implications: The BPES-flap is a useful addition to the arsenal of surgeons performing feminizing genital reconstructive surgery. Strengths & Limitations: Strenghts comprise (1) the description of the surgical technique with clear images, (2) completeness of data, and (3) that data are from a multicenter study. A weakness is the retrospective nature with limited follow-up time. Conclusion: The BPES-flap is a vascularized scrotal flap that can be raised on the bilateral inferior superficial perineal arteries. It may be used for neovaginal depth creation during vaginoplasty and may be quicker to perform than full-thickness skin grafting. Copyright (C) 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
C reactive protein (CRP) as a marker of infection is well established. Temporary indwelling urinary catheter following genital reconstructive surgery (GRS) is standard in our practice, though some patients have been re-admitted with urinary sepsis following catheter removal. Catheter stream urine (CSU) culture results are only available for patients after they have been discharged from the hospital. Our aim was to investigate the utility of CRP as a predictor of urinary sepsis. We performed a prospective cohort study on consecutive patients undergoing GRS at one institution. CRP and CSU cultures were taken prior to catheter removal day 7 post op and analysed. Patients were split into 2 groups based on CSU result. Data was recorded and statistical analysis performed to compare the differences between the groups. 100 patients were included. Data for 6 patients was excluded as it was unavailable. 32 patients had a positive CSU, and 62 had a negative CSU. The mean CRP in the positive and negative group were 46.1 mg/L and 31.2mg/L respectively. There was a significant difference between the two groups (p=0.01621).
