Exploring registered health professionals' assessment of older adults in care facilities : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy at Massey University, Turitea Campus, Palmerston North, New Zealand /

Older adults in care facilities are increasingly frail, with a number of co-existing conditions and complex health care needs. Before entry into a care facility, and while they are residing in a care facility, older adults are assessed by health professionals from different disciplines. The aim of this research is to gain insight into registered health professionals' 1 Registered health professionals: For this research, the term 'Registered health professionals' includes Dietitians, Diversional Therapists, General Practitioners, Occupational Therapists, Pharmacists, Physiotherapists, Registered Nurses and Social Workers, who are employed or contracted by a care facility. understanding of assessment of older adults in care facilities and how these assessments are utilised by Registered Nurses to create a plan for care. Assessment is an integral part of clinical practice for health professionals. Health professionals assess older adults to plan and deliver care, to instruct others about the care to be provided to the older adult, and to meet contract and audit requirements. For this pilot project, fourteen health professionals who perform assessments of older adults in care facilities participated in this research. Participants were approached via their place of employment. Data were gathered through semi-structured interviews and analysed by Thematic Content Analysis. The following theme was clearly identified in this research: ▪ Fragmentation of the assessment and care planning process, with sub-themes related to ▪ human resource issues ▪ the focus on physical aspects by contracted health professionals ▪ the single-discipline approach to care planning ▪ the lack of formal information sharin

An action plan to assess the current situation of maternal & newborn care at government health facilities in Jharkhand, India

Maternal and child health care especially safe motherhood services are an important factor in the primary health care and are the responsibility of the government and ministry of health. Consolidating and strengthening health network and quality of primary health care is one of the priority issues of the state and the health department for providing good health care and protection to the population. Since, long government health facilities, in spite of being the main source of health care services for majority of people, especially for those having low income; has very poor condition. Therefore, it’s important to improve the quality of services in the government facility, which can be achieved by stressing on the context of care provided. Situational analyses or facility audit are tools which use various approaches to identify the gaps in the structure and Process of the facility, in order to determine the best intervention to improve the performance. This study proposes an ‘Action Plan’ to assess the current quality of care in Govt health facilities in Ranchi, Jharkhand concerning Maternal and newborn care. By using Qualitative and quantitative study Methods like Site assessment, exit interview and focused group discussion. The method aims to identify together with major gaps; the entire minor gaps in the health system responsible for maternal and newborn mortality and morbidity that could be solved at the local level without the involvement of additional resources. The results obtained could be used to frame interventions to strengthen Maternal and newborn care system of Jharkhand.Jharkhand Health Policy Development Economics Adivasi Tribal Ranchi Santali Munda Oraon

Paediatric malaria case-management with Artemether-Lumefantrine in Zambia: a repeat cross-sectional study

BACKGROUND Zambia was the first African country to change national antimalarial treatment policy to artemisinin-based combination therapy – artemether-lumefantrine. An evaluation during the early implementation phase revealed low readiness of health facilities and health workers to deliver artemether-lumefantrine, and worryingly suboptimal treatment practices. Improvements in the case-management of uncomplicated malaria two years after the initial evaluation and three years after the change of policy in Zambia are reported. METHODS Data collected during the health facility surveys undertaken in 2004 and 2006 at all outpatient departments of government and mission facilities in four Zambian districts were analysed. The surveys were cross-sectional, using a range of quality of care assessment methods. The main outcome measures were changes in health facility and health worker readiness to deliver artemether-lumefantrine, and changes in case-management practices for children below five years of age presenting with uncomplicated malaria as defined by national guidelines. RESULTS. In 2004, 94 health facilities, 103 health workers and 944 consultations for children with uncomplicated malaria were evaluated. In 2006, 104 facilities, 135 health workers and 1125 consultations were evaluated using the same criteria of selection. Health facility and health worker readiness improved from 2004 to 2006: availability of artemether-lumefantrine from 51% (48/94) to 60% (62/104), presence of artemether-lumefantrine dosage wall charts from 20% (19/94) to 75% (78/104), possession of guidelines from 58% (60/103) to 92% (124/135), and provision of in-service training from 25% (26/103) to 41% (55/135). The proportions of children with uncomplicated malaria treated with artemether-lumefantrine also increased from 2004 to 2006: from 1% (6/527) to 27% (149/552) in children weighing 5 to 9 kg, and from 11% (42/394) to 42% (231/547) in children weighing 10 kg or more. In both weight groups and both years, 22% (441/2020) of children with uncomplicated malaria were not prescribed any antimalarial drug. CONCLUSION Although significant improvements in malaria case-management have occurred over two years in Zambia, the quality of treatment provided at the point of care is not yet optimal. Strengthening weak health systems and improving the delivery of effective interventions should remain high priority in all countries implementing new treatment policies for malaria.Zambian-Boston University Malaria Project; Health Systems & Services Project sub-contract to Boston University/CIHD by means of a cooperative agreement with USAID/Zambia (Contract number 690-C-00-04-00153-00); Wellcome Trust U

Tanzania: Logistic System Capacity and Site Readiness to expand PMTCT and Initiate ART

In September 2003, JSI/DELIVER conducted an assessment of the logistics system capacity and individual site readiness to provide PMTCT services and to initiate ART at selected public sector health facilities in Tanzania. The purpose of the assessment was to support government expansion of PMTCT from five pilot sites to 28 health facilities in five regions by addressing the logistics system constraints to ensuring a reliable and uninterrupted supply of the broad range of commodities required for PMTCT and ART, and by conducting an evaluation of the overall readiness of each site to provide these services. Several private providers, nongovernmental and faith-based organizations, and employer-based programs were included in the assessment to learn about PMTCT and ART in these sectors and to identify opportunities for public/private sector collaboration in expanding service delivery and ensuring effective commodity distribution. In addition, interviews with pharmaceutical company representatives and visits to retail pharmacies provided an overview of current commercial sector distribution of ARV drugs in Tanzania. The main findings showed an urgent need to build logistics management capacity within the central level MOH to—Coordinate multiple sources of rapidly increasing funding for commodity procurement. Strengthen commodity-forecasting capacity. Align procurement cycles and supplier lead times with the in-country supply pipeline and demand for services. At the facility level, assessment findings showed that individual site readiness is heavily constrained by the availability and quality of human resources; laboratory infrastructure and capacity; and lack of an established inventory control system and standardized pharmacy management procedures

Predictive validity of the Short-Term Assessment of Risk and Treatability (START) for multiple adverse outcomes:the effect of diagnosis

The Short-Term Assessment of Risk and Treatability (START) assists risk assessment for seven risk outcomes based on scoring of risk and protective factors and assignment of clinically-informed risk levels. Its predictive validity for violence and self-harm has been established in males with schizophrenia, but accuracy across pathologically diverse samples is unknown. Routine START assessments and 3-month risk outcome data of N = 527 adult, inpatients in a UK secure mental health facility were collected. The sample was divided into diagnostic groups; predictive validity was established using receiver operating characteristics regression (rocreg) analysis in which potential covariates were controlled. In most single-diagnosis groups START risk factors ('vulnerabilities'), protective factors ('strengths'), and clinically-informed estimates predicted multiple risk outcomes with effect sizes similar to previous research. Self-harm was not predicted among patients with an organic diagnosis. The START risk estimates predicted physical aggression in all diagnostic groups, and verbal aggression, self-harm and self-neglect in most diagnostic groups. The START can assist assessment of aggressive, self-harm, and self-neglect across a range of diagnostic groups. Further research with larger sample sizes of those with multiple diagnoses is required.</p

Measuring antibiotic availability and use in 20 low- and middle-income countries

Objective To assess antibiotic availability and use in health facilities in low- and middle-income countries, using the service provision assessment and service availability and readiness assessment surveys. Methods We obtained data on antibiotic availability at 13 561 health facilities in 13 service provision assessment and 8 service availability and readiness assessment surveys. In 10 service provision assessment surveys, child consultations with health-care providers were observed, giving data on antibiotic use in 22 699 children. Antibiotics were classified as access, watch or reserve, according to the World Health Organization’s AWaRe categories. The percentage of health-care facilities across countries with specific antibiotics available and the proportion of children receiving antibiotics for key clinical syndromes were estimated. Findings The surveys assessed the availability of 27 antibiotics (19 access, 7 watch, 1 unclassified). Co-trimoxazole and metronidazole were most widely available, being in stock at 89.5% (interquartile range, IQR: 11.6%) and 87.1% (IQR: 15.9%) of health facilities, respectively. In contrast, 17 other access and watch antibiotics were stocked, by fewer than a median of 50% of facilities. Of the 22 699 children observed, 60.1% (13 638) were prescribed antibiotics (mostly co-trimoxazole or amoxicillin). Children with respiratory conditions were most often prescribed antibiotics (76.1%; 8972/11 796) followed by undifferentiated fever (50.1%; 760/1518), diarrhoea (45.7%; 1293/2832) and malaria (30.3%; 352/1160). Conclusion Routine health facility surveys provided a valuable data source on the availability and use of antibiotics in low- and middle-income countries. Many access antibiotics were unavailable in a majority of most health-care facilities

Comparison of Medicine Availability Measurements at Health Facilities: Evidence from Service Provision Assessment Surveys in Five Sub-Saharan African Countries.

With growing emphasis on health systems strengthening in global health, various health facility assessment methods have been used increasingly to measure medicine and commodity availability. However, few studies have systematically compared estimates of availability based on different definitions. The objective of this study was to compare estimates of medicine availability based on different definitions. A secondary data analysis was conducted using data from the Service Provision Assessment (SPA) - a nationally representative sample survey of health facilities - conducted in five countries: Kenya SPA 2010, Namibia SPA 2009, Rwanda SPA 2007, Tanzania SPA 2006, and Uganda SPA 2007. For 32 medicines, percent of facilities having the medicine were estimated using five definitions: four for current availability and one for six-month period availability. 'Observed availability of at least one valid unit' was used as a reference definition, and ratios between the reference and each of the other four estimates were calculated. Summary statistics of the ratios among the 32 medicines were calculated by country. The ratios were compared further between public and non-public facilities within each country. Across five countries, compared to current observed availability of at least one valid unit, 'reported availability without observation' was on average 6% higher (ranging from 3% in Rwanda to 8% in Namibia), 'observed availability where all units were valid' was 11% lower (ranging from 2% in Tanzania to 19% in Uganda), and 'six-month period availability' was 14% lower (ranging from 5% in Namibia to 25% in Uganda). Medicine availability estimates vary substantially across definitions, and need to be interpreted with careful consideration of the methods used

Health consultation : Sub-Slab Gas and Air Sampling Data Alcoa – Davenport Works CERCLIS No. IAD005270160 Riverdale, Scott County, Iowa (2005)

The U.S. Environmental Protection Agency (EPA), the Alcoa – Davenport Works Facility (Alcoa), and concerned citizens and community leaders of Riverdale, Iowa requested the Iowa Department of Public Health (IDPH) Hazardous Waste Site Health Assessment Program to evaluate the health impacts of exposures to volatile organic vapors detected within residences located immediately to the west of the Alcoa property. This health consultation addresses inhalation exposure to individuals that may have occupied the currently vacant residences in which the air sampling was completed

Laboratory Focus on Improving the Culture of Biosafety: Statewide Risk Assessment of Clinical Laboratories That Process Specimens for Microbiologic Analysis

The Wisconsin State Laboratory of Hygiene challenged Wisconsin laboratories to examine their biosafety practices and improve their culture of biosafety. One hundred three clinical and public health laboratories completed a questionnaire-based, microbiology-focused biosafety risk assessment. Greater than 96% of the respondents performed activities related to specimen processing, direct microscopic examination, and rapid nonmolecular testing, while approximately 60% performed culture interpretation. Although they are important to the assessment of risk, data specific to patient occupation, symptoms, and travel history were often unavailable to the laboratory and, therefore, less contributory to a microbiology-focused biosafety risk assessment than information on the specimen source and test requisition. Over 88% of the respondents complied with more than three-quarters of the mitigation control measures listed in the survey. Facility assessment revealed that subsets of laboratories that claim biosafety level 1, 2, or 3 status did not possess all of the biosafety elements considered minimally standard for their respective classifications. Many laboratories reported being able to quickly correct the minor deficiencies identified. Task assessment identified deficiencies that trended higher within the general (not microbiology-specific) laboratory for core activities, such as packaging and shipping, direct microscopic examination, and culture modalities solely involving screens for organism growth. For traditional microbiology departments, opportunities for improvement in the cultivation and management of highly infectious agents, such as acid-fast bacilli and systemic fungi, were revealed. These results derived from a survey of a large cohort of small- and large-scale laboratories suggest the necessity for continued microbiology-based understanding of biosafety practices, vigilance toward biosafety, and enforcement of biosafety practices throughout the laboratory setting