Service changes’ impact on outpatient nurses and health care assistants

This study investigated the impact of service changes on nurses and healthcare assistants’ job motivation and wellbeing, in outpatient services within a large London acute healthcare organisation. While previous studies have focused on nurse staffing in inpatient settings, outpatient nurses are under-researched (Adynski et al., 2022). Three research questions were explored to seek answers to the research problem which included: How would the outpatient nurses and healthcare assistants be supported and motivated during and after service changes? Based on a relativist ontological stance, a qualitative descriptive methodology grounded the choice of phenomenological approach for this study. Purposive sampling was used for the recruitment of outpatient nursing staff working within three main sites of the reseracher’s organisation. Eighteen participants took part in virtual audio-transcribed semi-structured interviews, which occurred during the surge period of COVID-19 pandemic. Data were initially analysed using NVIVO12 database tool followed by Colaizzi's (1978) phenomenological method. The qualitative data was triangulated with the NHS Staff Survey (2021-2022). Four main themes were generated from the qualitative data as follows: (1) New ways of working with increased nurse-led autonomous activities; (2) lack of staff training and development with perceived limited career progression opportunities; (3) Staff experience during redeployment COVID-19 redeployment; (4) Staff perceived lack of management and leadership support. The findings suggest that two out of the eighteen participants had access to learning and development, which enhanced their job motivation and wellbeing. However, sixteen participants reported lack of access to training and development opportunities due to lack of Training Needs Analysis (TNA). TNA is an essential mechanism for staff to engage in their Continuous Professional Development (CPD) (Dening et al., 2019). Despite the frequent service changes and the outpatient nurses' indelible roles, there was little or no distinct career pathway leading to; lack of job motivation and professional mobility

Effects of the methanol leaf extract of Palisota hirsuta in post-surgical wound management

Plants are important in the management and treatment of wounds. Their medicinal values lie in their phytochemical constituents. Palisota hirsuta Reichb. Ex Endl (Commelinaceae) is used traditionally in the treatment of diseases and wounds. This study evaluates the effects of methanol leaf extract of Palisota hirsuta (MLEPH) in post-surgical wound management, using incision and dead space wound models in rats. Thirty albino rats were used for each model (n=30) by assigning into 5 groups of 6 each. In the incision wound model, an incision wound created surgically on the dorsum of each rat was treated daily by topical application of: Petroleum Jelly (PJ, Group I), Cicatrin® powder (Group II), 1% w/w MLEPH (Group III), 2% w/w MLEPH (Group IV) and 4% w/w MLEPH (Group V) for 10 postoperative days. Wound breaking strength and histopathology were evaluated. In the dead space wound model, a sterilized polypropylene tube was implanted in the left groin region of each rat. They were treated orally daily for 10 postoperative days as follows: 10 mL/kg 5 % Dimethylsulfoxide (DMSO, Group I), 12.5 mg/kg MLEPH (Group II), 25 mg/kg MLEPH (Group III), 50 mg/kg MLEPH (Group IV) and 100 mg/kg MLEPH (Group V). Granulation tissue formation and hydroxyproline assay were assessed. The results showed that wound breaking strength was significantly (p<0.05) higher in the MLEPH and Cicatrin® treated groups. MLEPH (4 %w/w) showed the highest wound breaking strength. This was confirmed by histopathological sections of the healing skin which showed 4% w/w MLEPH (Group V) to have the best wound healing effect. Dry granulation tissue weight was significantly (p<0.05) higher in groups IV and V. Also, the hydroxyproline content was significantly (p<0.05) higher in MLEPH treated groups III-V. From the results obtained, MLEPH has wound healing effects and can be used in post-surgical wound  management.Keywords: Incision, Palisota hirsuta, Post-surgical, Rats, Woun

Assessment of Hypertension Care in a Nigerian Hospital

Purpose: To describe and compare the treatment pattern of patients with hypertension using the JNC 7 guideline, and to assess patients’ body mass index (BMI) and their knowledge of hypertension in a Nigerian secondary health care facility.Methods: A cross-sectional, prospective, and observational study of 200 consecutive patients was conducted. Data were gathered on the patients’ demographics and clinical characteristics, including body mass index. Patients’ knowledge of hypertension was assessed using a 9-item instrument. Descriptive statistics was used to compute percentage frequency distributions of the variables. Inferential statistics employed Students’ t-test and one-way ANOVA at 95 % confidence interval.     Results: Females were 131 (65.5 %), 138 (69.0 %) were either overweight or obese, 107 (53.5 %) had blood pressure ≥ 160/100 mmHg (Stage 2); 150 (75 %) did not know that hypertension is chronic and 132 (66 %) were not aware of risk of non-adherence. Poor knowledge of risk factors was associated with gender, marital status, income, and level of education (p < 0.05). Patients, 167 (83.5 %) received a combination of two antihypertensive medications with 88 (44 %) having thiazide diuretic as first line, and lifestyle modification was not an integral component of care.Conclusion: Most patients received thiazide diuretic medication but not lifestyle education. Obesity was a common risk factor among the study group. Patients’ knowledge of hypertension was below average and they may need to be educated on hypertension and its effective management using drugs and lifestyle changes.Keywords: Antihypertensive medication, Hypertension, Lifestyle, Nigeria, Patient knowledg

Prognosis and outcome of acute stroke in the University College Hospital Ibadan, Nigeria

Background: Many factors influence the outcome of acute stroke, the third leading cause of morbidity and mortality globally.Objective: To identify the determinants of outcome of acute stroke.Materials and Methods: A prospectively study of 66 adult patients who presented to the medical emergency unit of University College Hospital (U.C.H), Ibadan, in coma from acute stroke, from August 2004 to March 2005, was undertaken after obtaining ethical clearance and written consent of the patients’ relations.Result: Acute stroke constituted 33% of medical coma, 3.2% of hospital emergencies, 1.0% of total hospital admissions, and 7.3% of medical deaths during the study period. The stroke subtypes were intracerebral hemorrhage (78.8%) and large cerebral infarction (21.2%) with respective case fatalities of 69.7% and 13.6% at 4 weeks. Males constituted 75.8% of the patient population with sex-specific mortality of 68.2%. The highest age specific mortality of 65.2% was in the 40-59 years group. The common risk factors were systemic hypertension, obesity, alcohol/substance abuse, and diabetes mellitus. Co-morbidities included aspiration pneumonia, recurrent seizures, hyperglycemia, and sepsis.Conclusion: Age above 39 years, male gender, systemic hypertension, early onset of coma after stroke, and presence of co-morbidities were associated with poor stroke outcome

Evaluation of Community Pharmacists' Involvement in Primary Health Care.

Objective: To evaluate the involvement of community pharmacists in primary health care; determine extent of the pharmacists' participation in curative and preventive services, as well as partially assess quality of the involvement. Methods: A 27-item self-completion questionnaire with 0.92 reliability was administered to 110 community pharmacists in Benin City, Nigeria. Data were collected on a scale that ranged from 27 to 135 with an assumed neutral point of 81 and statistically analysed. Results: Respondents scored 87.92 31.31, and over half (55%) were above the neutral point. This implies a slightly satisfactory but not significant involvement (p = 0.25447). Mean total rating on curative services was 92.6129.6, p = 0.0759 with 58% above the neutral point. Infectious diseases accounted for majority of the interventions. Involvement in preventive services was very poor. Only 31% scored above the neutral point with a rating of 65.6131.05, p = 0.2377. Quality of involvement was 94.7736.18 which was not significant (p = 0.2866). Majority of the respondents (94%) claimed they would be prepared to participate in further training on primary health care programme. Conclusion: Community pharmacists are marginally involved in the primary health care programmes in Benin City and are willing to improve on their performance. Continuing education on primary health care and incorporation of primary health care role of community pharmacists in the curriculum of pharmacy schools might be helpful. Keywords: Benin City, Community pharmacists, primary health care. Tropical Journal of Pharmaceutical Research 2002; 1(2): 67-7

Treatment Outcomes in Patients Receiving Combination Antiretroviral Therapy in Central Hospital, Benin City, Nigeria

Purpose: This study investigated mortality rate, early CD4 responses, pattern of ARVs substitutions and medication adherence of HIV-infected patients on first-line triple combination antiretroviral therapy (ART) in Central Hospital, Benin City, Nigeria. Methods: A retrospective assessment of 196 HIV-infected patients on first-line combination ART regimens was performed following 18 months of therapy. Medication adherence assessment of a 69- patient follow-up target group was based on a study-specific questionnaire. Paired sample t-test and simple linear correlation were used to test the association of the CD4-cell counts at different time intervals. Kaplan-Meier model was used to assess survival functions while log-rank test was applied to assess statistical difference at 95 % confidence interval (CI). Mean age of participants was 33.6 years (95 % CI, 32.1 - 35.2; 67.9 % were females. Results: At ART initiation, 27.0 % were at WHO clinical stage II, 47.0 % at stage III. Mortality rate (N = 196) was 20.3 deaths per 100 patient-months; 31.6 % occurred in < 30 days while 52.6 % occurred post-120 days of treatment. The mean CD4-cell count (cells/mm3) at ART initiation was 179.2 which increased to 328.5 at 3 months, 325.6 at 6 months, 357.4 at 12 months, and 366.7 at 18 months, (p < 0.01). Patients started on stavudine-based or efavirenz-based regimens were considerably more likely to have that drug substituted, compared to patients started on zidovudine-based or nevirapine-based regimens. The level of adherence reported after 18 months on ART was 73.8 %. Conclusion: In this setting, patients receiving ART showed significant improvements in CD4-cell status but adherence level was relatively poor. Patients were more stable on zidovudine-based or nevirapinebased regimens than on stavudine-based or efavirenz-based regimens. Early mortality rate was high, indicating a need for early interventions.Keywords: Antiretroviral therapy; HIV/AIDS; Mortality; Therapy outcomes, Nigeri

Gauging Portuguese community pharmacy users' perceptions

Objective: To assess perceptions related to facets of community pharmacy usage within the Portuguese general population. Methods: An ONSA (The Governmental Public Health Observatory) instrument was used, the ECOS (Em Casa Observamos Saúde) sample. This consisted of a national representative sample of household units with telephone. General demographics and pharmacy users’ perceptions related to five facets of community pharmacy usage were collected by telephone interviews. Main Results: Almost one-third (31.9%) of the participants were probable chronic drug users, hence in regular contact with the community pharmacy. Thirty-four percent preferred not to talk with the person who dispenses their prescribed drugs. Most users (47.6%) expressed opinions of pharmacists as being health care rather than business oriented, although one quarter of the sample was not sure. A large majority (73.7%) would like pharmacists to participate in their treatment decisions, but 55.1% did not seem able to distinguish between pharmacists and non-pharmacist technical staff, working at the pharmacy counter. Most significant predictors of users’ dichotomous perceptions related to the usage facets surveyed were age, education and occupation. Being older, less literate and economically inactive increased the odds of inappropriate users’ perceptions of the pharmacists. Conclusions: Results showed that erroneous concepts and behaviours exist within the Portuguese population in relation to the community pharmacists’ role. This is a matter for pharmacy professional and educational bodies to take into account when developing intervention strategies, in particular when communicating with the general public

Outcome of cardiovascular risk assessment among rural community dwellers in ezionum, Nigeria-implications for public health

Background: Cardiovascular disease is a major cause of mortality worldwide. Risk assessment has been shown to reduce cardiovascular morbidity and mortality. In view of their proximity and accessibility, community pharmacies could be a suitable site forcardiovascular risk assessment and other preventive health activities especially in rural underserved populations. The objective of this study was to assess outcome of cardiovascular risk assessment among rural community dwellers.Materials and methods: Five hundred and five community dwellers aged 40 to 80 years were recruited for the study. Cardiovascular risk assessment was performed using the region specific WHO/ISH risk assessment charts. Blood pressure, diabetes status, total non- fasting cholesterol, and age were used to estimate risk category. Demographic variables and clinical characteristics were expressed as frequency and percentage. Regression analysis was done to identify predictors of high risk category.Results: More than 30% of subjects were hypertensive. Nearly 30% were overweight and had abnormal cholesterol levels. The proportion of subjects in the high risk category was 8.9%. Systolic blood pressure, random blood sugar and advancing age were the highest predictors of high risk category.Conclusion: Accessibility, proximity and availability are unique characteristics of community pharmacies that could be exploited to support community based screening services.Keywords: Cardiovascular risk assessment, community pharmacy, rural community dwellers, Nigeria