CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 1, January/February 2013
AFRICA
109
cardiac diagnostic terminology allows BiomedICUS to accurately
generate diagnostic phrases from discharge summaries. This early
use of NLP in the paediatric cardiovascular domain offers promise to
facilitate EHR implementation for these patients.
1625: A NEW CARDIAC SURGERY PROGRAMME IN
ASWAN: WORKING TOWARDS CREATING A SUSTAIN-
ABLE HUMANITARIAN ACADEMIC CENTRE OF EXCEL-
LENCE
Carin van Doorn
1,2
, Ahmed Afifi
1
, Hatem Hosny
1
, Suzy Kotit
1
, Magdi
Yacoub
1,3
1
Aswan Heart Centre, Egypt
2
Aarhus University Hospital, Denmark
3
Imperial College London, UK
Background:
Until recently, no paediatric cardiac services were
available for 20 million people in upper Egypt and adult services
were difficult to access. The Aswan Heart Centre started in April
2009. It provides care free of charge and aims to become an academic
and clinical centre of excellence.
Methods:
Surgical activity between the start-up of the Centre and the
end of July 2012 were retrospectively reviewed.
Results:
The total number of procedures performed was 761. Initial
operations took place during missions by international teams who
created a culture of training and knowledge transfer. With their
on-going support, the local team increasingly performed opera-
tions, resulting in more continuous activity. A large proportion of
patients underwent surgery for rheumatic valve disease, aiming at
reconstructive procedures. Surgery for congenital heart disease dealt
with advanced cases in children and adults, but increasingly also in
small children, including neonates. A HOCM service was established,
and over the last 18 months coronary revascularisation commenced.
Intra-operative TEE was used routinely with a low threshold to revise
repair if the technical result was suboptimal. Post-operative patients
were initially managed by early extubation and ICU fast-track. Sicker
patients and neonatal surgery required further development of ICU. In
spite of increasing complexity and number of small children, mortal-
ity has remained below 5%. Outpatient and imaging services were
established. Research and teaching are an integral part of the service.
Conclusions:
A shared vision and on-going collaboration between
visiting experts and the host team facilitate the development towards
a sustainable centre of excellence.
1650:ACARDIOSTART (CS) PERFORMANCEANDCOMPLI-
ANCE SCORING SYSTEM FOR EMERGING PAEDIAT-
RIC AND ADULT CARDIOTHORACIC AND VASCULAR
HEALTHCARE PROGRAMMMES
Aubyn Marath
3
, Laura Schiff
5
, Chrisanna Gustafson
6
, Van-Trang
Nguyen
2
, John Connett
2
, Kyle Rudser
2
, Susan Lowry
2
, Janine
Henson
4
, Lazaros Kochilas
1
, James StLouis
1
1
Amplatz Children’s Hospital, University of Minnesota, MN, USA
2
University of Minnesota, MN, USA
3
Oregon Health & Sciences University, OR, and CardioStart
International, USA
4
Fairview Hospital, University of Minnesota, MN, and CardioStart
International, USA
5
Enloe Medical Center, Chico, CA, and CardioStart International,
USA
6
California State University, Chico, CA, and CardioStart International,
USA
Background:
Paediatric cardiac surgery is especially challenging in
emerging healthcare programmes that are personnel and/or equip-
ment deprived; priorities include improving outcome, reducing wait-
ing time and teaching new techniques. No uniformity in structure or
technique exists to ensure that best standards of cardiological surgical
management are implanted; outcomes may not reflect individual or
team competence or programme worthiness. Local teams may be
dazzled but afterwards, overwhelmed and financially depleted. We
have devised a dual-language performance-score (part of a full inter-
national database evaluation already in operation, UMN & OHSU,
USA) to monitor and assist various systems improvements.
Methods:
Visiting and local team performance during the peri-oper-
ative period was evaluated discreetly, without direction or encourage-
ment, using a scoring system addressing admission, transfer from
intensive care and discharge. Admission scoring included: use of
medications, dental checks, antiseptic/antibiotic use, laboratory tests,
consent, allergic status, ‘time out’, and completion of CS’s anaes-
thetic and perfusion checklists. Transfer from intensive care scoring
evaluated airway management, respiratory rate, oxygen requirement,
chest X-ray, ECG/monitor normality, bleeding, serum electrolytes,
neurology and central line status. Discharge from hospital scores
evaluated exercise limit checks, incision and electrolyte status,
completeness of charts, communication with family members and
readiness for discharge.
Results:
Total possible scoring for admission (19), transfer (38)
and discharge (23) (total
=
80) were similar and above 80% among
most 128 patients evaluated. Minor differences between countries
did not impact on peri-operative management or outcome. Local
doctors responded well to the structured check list, which helped
self-organisation.
Conclusions:
CS scoring encourages better discipline in patient care
and transfer, helps identify shortcomings, assists teams to evolve
components of peri-operative management that are vital to success
and a platform to help programme building. This will be refined in
the future by statistical analyses to develop the scores that are predic-
tive of survival and positive outcomes.
1667: PEDIATRIC CARDIOLOGY IN PUBLIC HEATH:
A TELE-NETWORK COVERING OVER 55 000 KM² OF
UNDERSERVED REGIONS IN BRAZIL
Sandra Da Silva Mattos, Claudio Teixeira Régis, Juliana Sousa
Soares de Arújo, Lúcia Roberta Didier Nunes Moser, Carolina Paim
Gomes de Freitas, Rossana Severi, Felipe Alves Mourato, Thiago
Ribeiro Tavares, Renata Grigório Silva Gomes, Sheila Maria Vieira
Hazin
Instituto do Coração de Pernambuco, Recife, Brazil
Objective:
To describe the initial results from a paediatric cardiology
network set up to reverse a picture of high mortality and morbidity
from CHD in a population of around 2.5 million poor people.
Methods and Results:
This prospective, multicentre project was
divided into stages, including problem definition, network structure,
and training and initiation of medical services. Thirteen institutions
have been linked and equipped with iPads, pulse oximeters and port-
able echo machines. Physicians from the referral centre travelled
once a week to perform key activities such as cardiac surgery, and
local teams were supervised by telemedicine. Between January and
July 2012, 10 858 pulse-oximetry tests were performed, 554 (5.1%)
were considered abnormal and 217 babies underwent a screen-
ing echo; 138 anomalies were detected. The relationship between
collected/abnormal oximetries decreased from 17.2% in January to
3.1% in July, suggesting a learning curve in the use of the test. The
number of screening echoes increased over the time of the study. The
network has clinically evaluated over 2 500 patients and 74 surgeries
were performed, with seven deaths. Previously, most of these children
had lengthy stays on waiting lists to be referred outside the State for
diagnosis and treatment.
Conclusions:
Diagnosing and managing children with CHD is a
major challenge in developing countries. The establishment of part-
nership programmes between reference and primary and secondary
centres with the aid of telemedicine is one way to ameliorate this
problem. Careful planning, training, supervision and performance
of key activities by trained personnel are requirements to achieve
successful results.
