21 research outputs found
The feasibility of novel point-of-care diagnostics for febrile illnesses at health centres in Southeast Asia: a mixed-methods study
Background The decline of malaria in Southeast Asia means other causes of fever are increasingly relevant, but often undiagnosed. The objective of this study was to assess the feasibility of point-of-care tests to diagnose acute febrile illnesses in primary care settings. Methods A mixed-methods study was conducted at nine rural health centres in western Cambodia. Workshops introduced health workers to the STANDARD(TM) Q Dengue Duo, STANDARD(TM) Q Malaria/CRP Duo and a multiplex biosensor detecting antibodies and/or antigens of eight pathogens. Sixteen structured observation checklists assessed users’ performances and nine focus group discussions explored their opinions. Results All three point-of-care tests were performed well under assessment, but sample collection was difficult for the dengue test. Respondents expressed that the diagnostics were useful and could be integrated into routine clinical care, but were not as convenient to perform as standard malaria rapid tests. Health workers recommended that the most valued point-of-care tests would directly inform clinical management (e.g. a decision to refer a patient or to provide/withhold antibiotics). Conclusions Deployment of new point-of-care tests to health centres could be feasible and acceptable if they are user-friendly, selected for locally circulating pathogens and are accompanied by disease-specific education and simple management algorithms
Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study
Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.
Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.
Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001).
Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication
Perbandingan Sikap Menggunakan Komputer antara Dosen dan Anggota e-Learning Community
Background: E-learning community (eLC) of the School of Medicine Atma Jaya Catholic University of Indonesia consisted of twelve students. eLC trained lecturers about e-learning in personal or small group format. This study aimed to compare the differences between the development of computer-related attitude between lecturers and e-learning community members upon the service from e-learning community for lecturers. Method: This research was an experimental quantitative and qualitative study. Subjects were 12 students of eLC and 32 lecturers who received eLC’s services. The quantitative data was collected through questionnaires of the Computer Anxiety Rating Scale (CARS) and Computer Self-Efficacy (CSE). The qualitative data was collected through focus group discussion and in-depth interviews. CARS and CSE data were collected four times: (1) prior to the eLC trainings, (2) right after the eLC first training, (3) after the second training of eLC, and (4) right after one month of the last training from eLC. Data analysis was conducted using Friedman test, Mann-Whitney test. Qualitative data analysis were performed using content analysis.Results: There was a significant decrease from the score of CARS 1 to the score of CARS 4 for the eLC members (p=0,045). Results of CSE for eLC members showed no significant differences across the data collection. For faculty members, the significant differences were found between CARS 3 and CARS 4 (p=0,014). CSE scores of faculty members showed no significant differences. Comparison of CARS and CSE between faculty members and eLC members showed no significant differences. The qualitative data analysis showed some important aspects found in both of the groups. There are communication, interaction, the importances of eLC trainings, as well as suggestions to both of the groups about e-learning. Subjects’ opinions were divided into two groups: one who experienced positive changes in their computer-related attitude and one who did not experience any changes. Conclusion: Faculty members found that eLC were important in relation to e-learning training for lecturers. Students strongly agreed that being the member of eLC made him/her had a great opportunity to closely communicate to their lecturers. The faculty members’ anxiety level of computer using was low; on the other hand, their awareness of computer technology was good enough. The institution should employ this opportunity to apply e-learning more seriously and extensively. </jats:p
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A scoping review of the post-discharge care needs of babies requiring surgery in the first year of life.
Congenital anomalies are among the leading causes of under-5 mortality, predominantly impacting low- and middle-income countries (LMICs). A particularly vulnerable group are babies with congenital disorders requiring surgery in their first year. Addressing this is crucial to meet SDG-3, necessitating targeted efforts. Post-discharge, these infants have various care needs provided by caregivers, yet literature on these needs is scant. Our scoping review aimed to identify the complex care needs of babies post-surgery for critical congenital cardiac conditions and non-cardiac conditions. Employing the Joanna Briggs Institute's methodological framework for scoping reviews we searched Pubmed, EMBASE, CINAHL, PsychINFO, and Web of Science databases. Search terms included i) specific congenital conditions (informed by the literature and surgeons in the field), ii) post-discharge care, and iii) newborns/infants. English papers published between 2002-2022 were included. Findings were summarised using a narrative synthesis. Searches yielded a total of 10,278 papers, with 40 meeting inclusion criteria. 80% of studies were conducted in High-Income Countries (HICs). Complex care needs were shared between cardiac and non-cardiac congenital conditions. Major themes identified included 1. Monitoring, 2. Feeding, and 3. Specific care needs. Sub-themes included monitoring (oxygen, weight, oral intake), additional supervision, general feeding, assistive feeding, condition-specific practices e.g., stoma care, and general care. The post-discharge period poses a challenge for caregivers of babies requiring surgery within the first year of life. This is particularly the case for caregivers in LMICs where access to surgical care is challenging and imposes a financial burden. Parents need to be prepared to manage feeding, monitoring, and specific care needs for their infants before hospital discharge and require subsequent support in the community. Despite the burden of congenital anomalies occurring in LMICs, most of the literature is HIC-based. More research of this nature is essential to guide families caring for their infants post-surgical care
Themes and sub-themes of complex needs identified.
Themes and sub-themes of complex needs identified.</p
Description of each critical congenital heart defect and common non-cardiac congenital anomalies requiring surgery in the first year of life.
Description of each critical congenital heart defect and common non-cardiac congenital anomalies requiring surgery in the first year of life.</p
Bar graph of complex needs in non-cardiac congenital conditions.
This graph represents the complex needs mentioned in papers discussing non-cardiac congenital conditions and the number of articles in the review that discussed each of these complex needs.</p
Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.
Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.</p
Bar graph of complex needs in cardiac congenital conditions.
This graph represents the complex needs mentioned in papers discussing cardiac congenital conditions and the number of articles in the review that discussed each of these complex needs.</p
Data extraction table.
Please note references [45, 54–68] are included in the scoping review, further information on these papers is included in the data extraction table. (PDF)</p