Resource allocation within the National AIDS Control Program of Pakistan: a qualitative assessment of decision maker's opinions

BACKGROUND: Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program. METHODS: A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to allocate resources within the program were conducted. RESULTS: HIV was not considered a priority issue by all study participants and external funding for the program was thought to have been accepted because of poor foreign currency reserves and donor agency influence rather than local need. Political influences from the federal government and donor agencies were thought to manipulate distribution of funds within the program. These influences were thought to occur despite the existence of a well-laid out procedure to determine allocation of public resources. Lack of collaboration among departments involved in decision making, a pervasive lack of technical expertise, paucity of information and an atmosphere of ad hoc decision making were thought to reduce resistance to external pressures. CONCLUSION: Development of a unified program vision through a consultative process and advocacy is necessary to understand goals to be achieved, to enhance program ownership and develop consensus about how money and effort should be directed. Enhancing public sector expertise in planning and budgeting is essential not just for the program, but also to reduce reliance on external agencies for technical support. Strengthening available databases for effective decision making is required to make financial allocations based on real, rather than perceived needs. With a large part of HIV program funding dedicated to public-private partnerships, it becomes imperative to develop public sector capacity to administer contracts, coordinate and monitor activities of the non-governmental sector

Memoar senarai kiprah sejarah; diangkat dari majalah Tempo; buku ketiga

viii.; 326 hal.; ill.; 19 c

Evaluation and Comparison of Contrast Sensitivity in Patients with Zaraccom Ultraflex or F260 Intraocular Lens Inserted

Purpose: In this study, we evaluated the optic performance of Zaraccom UF intraocular lens (IOL) by comparing the contrast sensitivity of IOLs in photopic and mesopic lighting conditions in patients who were operated for cataract and inserted Zaraccom Ultraflex (UF) or Zaraccom F260 (F260) IOL. Methods: In this prospective study, we included 60 eyes of 60 patients (Group 1: 30 patients UF, Group 2: 30 patients F260) who had undergone phacoemulsification with implantation of IOL in the posterior chamber between 2009 and 2010 in Ophthalmology Department at Cumhuriyet University. The patients were examined routinely at the 1. day, 1. week and 1. month postoperatively. At the third month, the best-corrected visual acuity values were recorded; then,, the contrast sensitivity tests at 1.5, 3, 6, 12 and 18 cpd were examined in all patients in all frequencies in photopic (with and without glare) and mesopic (with and without glare) lighting conditions. Results: When comparing the contrast sensitivity results in the two groups, we found that UF group’s values were higher in all spatial frequencies (1.5, 3, 6, 12 and 18 cpd). The results were statistically significantly greater for the test frequencies of mesopic without glare 1.5 (p=0.016) and 18 (p=0.005) cpd, mesopic with glare 6 (p=0.002) cpd, photopic without glare 1.5 (p=0.01), 3 (p=0.04), 6 (p=0.001) and 12 (p=0.001) cpd, photopic with glare 6 (p=0.01) and 12 (p=0.02) cpd (p<0.05). Conclusion: These results show that both IOLs provide good level of contrast sensitivity, but better visual perception is achieved with UF IOL. We think that the High Modulation Transfer Function (MTF) value of the UF IOL is an important factor for the obtained results. (Turk J Ophthalmol 2011; 41: 230-5

Effectiveness of local anesthetic application methods in postoperative pain control in laparoscopic cholecystectomies; a randomised controlled trial

Background: Laparoscopic cholecystectomy is a minimally invasive procedure that causes pain originating from parietal and visceral peritoneum. Many studies have been conducted to improve postoperative pain management and comfort of patients. Various methods such as local anesthetic injection (LAI) at trocar access points, intraperitoneal local anesthetic injection (IPLA), pneumoperitoneum pressure reduction, transversus abdominis plane block (TAPB), and reducing the number of trocars used during the operation were attempted to reduce postoperative pain. Methods: In this study, we compared LAI, TAPB and IPLA methods with the control group in which no local anesthetic was applied to reduce postoperative pain after laparoscopic cholecystectomy. We also demonstrated the effect of these methods on postoperative pain, need for additional analgesics, length of hospitalization, and patient satisfaction. Results: Overall, 160 patients aged 18-74 years who underwent laparoscopic cholecystectomy for cholelithiasis between October 2018 and August 2019 were included in the study and divided into four groups as follows: LAI group, TAPB group, IPLA group, and the control group without any intervention. Visual Analog Scale (VAS) values at 1, 2, 4, 6, 12, and 24 h in the control group were significantly higher than in the LAI, TAPB, and IPLA groups. Further, VAS values at 1, 2, 4, 6, 12, and 24 h in the IPLA group were significantly higher than in the LAI and TAPB groups. No significant difference was observed between the LAI and TAPB groups in terms of VAS values at 1, 2, 4, 6, and 24 h. VAS values at 12 h in the LAI group were significantly higher than in the TAPB group. Conclusions: Peroperative local anesthetic administration methods were more effective in preventing pain after laparoscopic cholecystectomy compared to the control group. In addition to reducing postoperative pain, these methods reduced the need for postoperative analgesics and increased patient satisfaction