Vitalistic information systems in the South African public health system : a transactional analysis perspective

Includes bibliographical references

HIV-infected patients retreated for tuberculosis with intermittent Category II regimen--treatment outcome at 24-month follow-up.

BACKGROUND The management of tuberculosis re-treatment in HIV-infected individuals is complex. The clinical and radiological manifestations in this group and response to Category II treatment is not well described. METHODS We performed a prospective cohort study of HIV-infected patients retreated for TB due to failure, relapse or default after treatment, at Tuberculosis Research Centre, Chennai, between February 2001 to September 2005. The Category II regimen followed in the TB programme in India (RNTCP) was administered (2 months of Streptomycin (S), Ethambutol (E), INH (H), Rifampicin (R), Pyrazinamide (Z)/1 month of EHRZ/5 months of HRE all given thrice weekly). Antiretroviral treatment was not routinely available at that time. RESULTS Of the 42 patients enrolled, 35 (83%) were males. The mean age was 33.2 (SD-6.3) years. Cough was the commonest (67%) presenting symptom and opacities were the commonest (48%) radiographic occurrence. 31 patients were culture-positive at baseline, drug susceptibility results showed that 21 (68%) were fully susceptible to all first line drugs, four patients (13%) had MDR TB and four had resistance to INH alone. Among the 31 culture-positive patients, 15 patients (48.4%) completed treatment and were declared cured, of whom two subsequently relapsed. All four MDR patients died. Six patients who received ART, survived. CONCLUSION Only 50% of HIV-infected, ART-naive patients who were retreated for tuberculosis using an intermittent Category II regimen had a favourable response to treatment. Early detection of MDRTB and concurrent antiretroviral therapy could contribute to improved outcomes

ABSTRACT BOOK 50th World Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease (The Union)

The International Journal of Tuberculosis and Lung Disease is an official journal of The Union. The Journal’s main aim is the continuing education of physicians and other health personnel, and the dissemination of the most up-to-date infor mation in the field of tuberculosis and lung health. It publishes original articles and commissioned reviews not only on the clinical and biological and epidemiological aspects, but also—and more importantly—on community aspects: fundamental research and the elaboration, implementation and assessment of field projects and action programmes for tuberculosis control and the promo tion of lung health. The Journal welcomes articles submitted on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research

The improvement of organisational performance and healthcare service delivery through knowledge management practices in the Gauteng Department of Health

This research was instigated by testimony of the failure and the subsequent crisis in the South African public healthcare system. Official investigations had brought to light alarming operational deficiencies in institutions under the aegis of the Gauteng Department of Health. The South African public sector and government departments, in general, are currently challenged by a complex transformation process which has a prime objective to ameliorate public accountability, service delivery and budgetary control. They are likewise faced with the equally labyrinthine and demanding task of establishing a public-sector organisation with meaningful and effective operational processes that are, in addition, expected to synchronise with the modern economy. The researcher is unequivocal: the success of the GDH in responding to the challenges of improving organisational performance and healthcare service delivery depends essentially on their knowledge management strategy. Knowledge, across public-sector organisations, is increasingly being acknowledged, not only as a strategic resource but also as a valuable organisational asset. In the context of this research, knowledge is defined as the experience that resides in the minds of people; termed tacit knowledge (as opposed to formal, codified or explicit knowledge). In an analogous manner, research studies abound with evidence that has identified knowledge management as having an influence on operational performance for healthcare service delivery. Yet, a brief inquest indicated that our overall understanding of the existence of the relationship between knowledge management and operational performance for healthcare service delivery in the South African public sector is, at best, exiguous. With these appraisals in mind, the researcher developed a theoretical model that revealed factors that could influence organisational performance and healthcare service delivery. The model focused on knowledge management capabilities and organisational performance. The prime objective was to operationalise the theoretically derived knowledge management capabilities constructs, identify statistically the enhancing or impeding factors that impact on organisational performance and develop a structural equation model to verify this theoretical paradigm. The ambition of this study was similarly to investigate the use of knowledge management by the Gauteng Department of Health for its transformation to achieve improved organisational performance and healthcare service delivery. This study in essence addressed four research questions: Firstly, what was the level of understanding of knowledge management in the Gauteng Department of Health and related healthcare facilities? Secondly, how were knowledge management strategies and practices aligned with the Gauteng Department of Health strategies and operational objectives? Thirdly, how was knowledge management used by the employees in the Gauteng Department of Health? and fourthly, how could the results of the literature review and the empirical data be used to create a knowledge-management culture and a collaborative working environment for the Gauteng Department of Health? The elemental, hypothesised pursuit governing the study was to determine the existence of a relationship between the use of knowledge management and an improvement in organisational performance and healthcare service delivery. Collaterally, what enabling environment would be instituted by the gatekeepers of the institutional praxes to capacitate other staff members specifically so as to include the succession planning conundrum? To accomplish this and after reviewing the literature, the effective factors in knowledge management were identified, namely, knowledge infrastructure proficiencies and knowledge process capabilities. The research followed the parallel mixed-methods approach in gathering and analysing research data. Data was collected using questionnaires with 496 respondents and interviews with 35 interviewees. The sample used in this study comprised employees of the Gauteng Department of Health and its regional healthcare centres. The survey respondents and interview participants were the general staff and executive/senior managers of the Gauteng Department of Health. These individuals were considered to possess the most comprehensive knowledge about their organisation’s characteristics and strategy, which included knowledge management adoption. In order to identify the relationships between the model elements, appropriate tests were initiated using the Statistical Package for Social Sciences. Exploratory and confirmatory factor analyses and structural equation modelling were utilised and the proposed model was then extracted and content analysis was applied in evaluating the resulting qualitative data. The findings of this study furthermore indicated that knowledge management concepts were not universally understood in the Gauteng Department of Health. A structural equation model development strategy, postulated in the factor analysis, also produced a new best-fitting knowledge management capability model based on the new constructs. The structural equation model suggested that significant factors influencing the improvement of the organisational performance and healthcare service delivery are those of knowledge management capability. The regression analysis showed that most of the inter-correlations were significant, thus confirming the theory that knowledge management capabilities have a direct influence on organisational performance and healthcare service delivery. The research contributed theoretically to a comprehensive understanding of the relationship between knowledge management principles and factors that influence organisational performance and healthcare service delivery. Practically, the research contributed to confirming the use of knowledge management by the Gauteng Department of Health could to the improvement of its overall organisational performance and healthcare service delivery. The study further demonstrated the impact of knowledge management activities as a driving force for organisational change and the effect of knowledge management on the improvement of workforce productivity and organisational effectiveness. The new knowledge management capability model could additionally assist the Gauteng Department of Health determining the extent to which knowledge management is used and where to focus in developing and implementing knowledge management strategy. The study encourages practitioners to take cognisance of the fact that organisations are unique and that the factors which enhance or impede knowledge management are to be thoroughly examined. This case study was endorsed for its significant contribution to regional healthcare system, as well as the broader national healthcare structure.School of computingPh. D. (Information Systems

A Practical Guide to Implementation Research on Health Systems

This is an open access resource targeted primarily at post-graduate students intending to undertake field research on health systems interventions in resource-poor environments. The book consists of twelve chapters addressing theory, methodology, analysis, and influencing policy. Each consists of both original text and links to relevant, open access, web-based journal and multi-media materials, including selected case studies.Please note: an eBook version compatible with the Kobo reader is also available to download

From Isolation to Inclusion: Embracing Local Perspectives in Examining the Treatment Model of Care for Aboriginal Persons Affected by Tuberculosis or Leprosy in the Kimberley Region, North Western Australia

In the remote Kimberley region of North Western Australia, tuberculosis (TB) and leprosy continue to affect a small number of Aboriginal people, despite historical efforts to eliminate either disease. Treatment, predominantly antibiotic therapy, is a principal therapeutic intervention used to cure TB and leprosy and halt infection transmission. Decisions made around treatment therefore impact not only the individual person affected, but also their families and communities. The well-worn models of Directly Observed Therapy (DOT) and case management are used nationally to assist treatment continuity and completion. Neither model has been substantiated for cultural appropriateness nor for meeting the specific needs of Aboriginal people. Given the important role of treatment, this thesis uses decolonial theory to critically examine how culturally secure and person-centred care practice could be better incorporated into the current treatment model of care used in the Kimberley region for Aboriginal persons affected by TB or leprosy. To achieve this, qualitative methods were employed to explore the lived experience of Aboriginal persons affected by either disease, as well as community members and Health Care Workers involved in care. In addition, archival research of historical documents relating to treatment was conducted. The findings of this research revealed deeper narratives about medication safety concerns, the importance of family history knowledge for early treatment intervention, and challenges relating to integrating TB and leprosy management into primary health care due to competing priorities of more prevalent chronic diseases. Health care relationships were found to play a key role in optimising treatment. However, gaps and inconsistences were identified within these relationships in the areas of two-way trust, communicating importance and consequences of treatment, providing feedback, shared treatment decision-making, and the provision of culturally respectful support. Family relationships and connection to culture were also significant for psychosocial support. Understanding the history of TB and leprosy treatment specific to the region was found to be an integral part of understanding contemporary treatment models and in identifying ongoing colonising within the way health care services for the treatment of TB and leprosy are delivered. Using these findings, a novel treatment model of care is presented. This offers theoretical and practical strategies to re-think and apply culturally responsive approaches to optimising treatment for Aboriginal persons affected by TB or leprosy. This has the potential benefit of improved wellbeing and elimination of disease for current and future generations

Development of a nanobody-based amperometric immunocapturing assay for sensitive and specific detection of Toxocara canis excretory-secretory antigen

Introduction Human Toxocariasis (HT) is a zoonosis that, despite of its wide distribution around the world, remains poorly diagnosed. The identification of specific IgG immunoglobulins against the Toxocara canis Excretory-Secretory antigen (TES), a mix of glycoproteins that the parasite releases during its migration to the target organs in infected patients, is currently the only laboratory tool to detect the disease. The main drawbacks of this test are the inability to distinguish past and active infections together with lack of specificity. These factors seriously hamper the diagnosis, follow-up and control of the disease. Aim To develop an amperometric immunocapturing diagnostic assay based on single domain immunoglobulins from camelids (nanobodies) for specific and sensitive detection of TES. Methods After immunization of an alpaca (Vicugna pacos) with TES, RNA from peripheral blood lymphocytes was used as template for cDNA amplification with oligo dT primers and library construction. Isolation and screening of TES-specific nanobodies were carried out by biopanning and the resulting nanobodies were expressed in Escherichia coli. Two-epitopes amperometric immunocapturing assay was designed using paramagnetic beads coated with streptavidin and bivalent nanobodies. Detection of the system was carried out with nanobodies chemically coupled to horseradish peroxidase. The reaction was measured by amperometry and the limit of detection (LOD) was compared to conventional sandwich ELISA. Results We obtained three nanobodies that specifically recognize TES with no-cross reactivity to antigens of Ascaris lumbricoides and A. suum. The LOD of the assay using PBST20 0.05% as diluent was 100 pg/ml, 10 times more sensitive than sandwich ELISA. Conclusion Sensitive and specific detection of TES for discrimination of active and past infections is one of the most difficult challenges of T. canis diagnosis. The main advantage of our system is the use of two different nanobodies that specifically recognize two different epitopes in TES with a highly sensitive and straightforward readout. Considering that the amounts of TES available for detection in clinical samples are in the range of picograms or a few nanograms maximum, the LOD found in our experiments suggests that the test is potentially useful for the detection of clinically relevant cases of HT

Pharmacokinetics of Extended vs Intermittent Intravenous Infusion of Meropenem in Critically Ill Patients Receiving Continuous Veno-Venous Haemofiltration

peer reviewe