Scaling up proven public health interventions through a locally owned and sustained leadership development programme in rural Upper Egypt

<p>Abstract</p> <p>Introduction</p> <p>In 2002, the Egypt Ministry of Health and Population faced the challenge of improving access to and quality of services in rural Upper Egypt in the face of low morale among health workers and managers.</p> <p>From 1992 to 2000, the Ministry, with donor support, had succeeded in reducing the nationwide maternal mortality rate by 52%. Nevertheless, a gap remained between urban and rural areas.</p> <p>Case description</p> <p>In 2002, the Ministry, with funding from the United States Agency for International Development and assistance from Management Sciences for Health, introduced a Leadership Development Programme (LDP) in Aswan Governorate. The programme aimed to improve health services in three districts by increasing managers' ability to create high performing teams and lead them to achieve results.</p> <p>The programme introduced leadership and management practices and a methodology for identifying and addressing service delivery challenges. Ten teams of health workers participated.</p> <p>Discussion and evaluation</p> <p>In 2003, after participation in the LDP, the districts of Aswan, Daraw and Kom Ombo increased the number of new family planning visits by 36%, 68% and 20%, respectively. The number of prenatal and postpartum visits also rose.</p> <p>After the United States funding ended, local doctors and nurses scaled up the programme to 184 health care facilities (training more than 1000 health workers). From 2005 to 2007, the Leadership Development Programme participants in Aswan Governorate focused on reducing the maternal mortality rate as their annual goal. They reduced it from 85.0 per 100,000 live births to 35.5 per 100,000. The reduction in maternal mortality rate was much greater than in similar governorates in Egypt. Managers and teams across Aswan demonstrated their ability to scale up effective public health interventions though their increased commitment and ownership of service challenges.</p> <p>Conclusions</p> <p>When teams learn and apply empowering leadership and management practices, they can transform the way they work together and develop their own solutions to complex public health challenges. Committed health teams can use local resources to scale up effective public health interventions.</p

Effect of autoclave sterilisation and heat activated sodium hypochlorite irrigation on the performance of nickel-titanium rotary files against cyclic fatigue

The present study aims to assess the impact of heat-activated sodium hypochlorite (NaOCl) and/or autoclave sterilisation on the cyclic fatigue resistance (CFR) of heat-treated nickel-titanium rotary files used in root canal treatment. The CFR of One Curve (OC) files was evaluated under the following conditions: as received (Group 1; control), immersion in NaOCl at 23 ± 1ºC (Group 2), immersion in NaOCl at 60 ± 1ºC (Group 3), autoclave sterilisation at 135 1ºC (Group 4), combined treatment of autoclave sterilisation and immersion in NaOCl at 23 ± 1ºC (Group 5), and combined treatment of autoclave sterilisation and immersion in NaOCl at 60 ± 1ºC (Group 6). A simulated root canal in a zirconia block was utilised to test the performance of the files. All the types of treatments resulted in significant reductions in fracture resistance of the OC files. Immersion of the files in NaOCl at 23ºC revealed the smallest reduction, while combined treatment of autoclaving and immersion in NaOCl at 60ºC caused the greatest reduction. Autoclave sterilisation or exposure of OC files to 2.5% NaOCl adversely affect the cyclic fatigue life and increasing solution temperature or combined treatment caused additionally significant reduction in CFR

Difusion Weighted Imaging Characteristics Differentiate Acute Symptomatic Cerebral Microbleeds From Silent Microbleeds: An Acute Pontine Microhemorrhage Case Presentation

Scopu

Akut İnme Tedavisinde Intravenöz Trombolitik Tedavi: Sık Görülen Sistemik Sorunlar Ve Çözümleri

Scopu

Clinical challenges associated with the endovascular treatment of acute stroke in a patient with infective endocarditis.

Although stroke is common in infective endocarditis (IE), only 26 cases of thrombectomy have been reported to date for IE-related acute stroke. We report a 40-year-old man who presented with left middle cerebral artery occlusion of unknown cause. Multiple attempts of mechanical aspiration thrombectomy and stentrievers failed to recanalize the artery. Effective revascularization was eventually achieved by placing a self-expanding intracranial stent. Post-procedurally the patient was diagnosed with IE with mitral valve insufficiency, mandating emergent valvular replacement while the patient was still on tirofiban infusion. On follow-up, the patient had a modified Rankin’s score of 0, had no recurrent stroke, and the intracranial stent remained patent yet stenosed. Based on the use of a self-expanding intracranial stent in the setting of IE, we discuss the consequences of the fibrotic and inflammatory content of the embolus and the associated high risk of intracranial hemorrhage which complicates clinical decision making.PubMe

Akut İnme Tedavisinde Intravenöz Trombolitik Tedavi: Sorunlar Ve Çözümler

Scopu