The impact of the National HIV Health Care Worker Hotline on patient care in South Africa

<p>Abstract</p> <p>Background</p> <p>South Africa has a huge burden of illness due to HIV infection. Many health care workers managing HIV infected patients, particularly those in rural areas and primary care health facilities, have minimal access to information resources and to advice and support from experienced clinicians. The Medicines Information Centre, based in the Division of Clinical Pharmacology at the University of Cape Town, has been running the National HIV Health Care Worker (HCW) Hotline since 2008, providing free information for HIV treatment-related queries via telephone, fax and e-mail.</p> <p>Results</p> <p>A questionnaire-based study showed that 224 (44%) of the 511 calls that were received by the hotline during the 2-month study period were patient-specific. Ninety-four completed questionnaires were included in the analysis. Of these, 72 (77%) were from doctors, 13 (14%) from pharmacists and 9 (10%) from nurses. 96% of the callers surveyed took an action based on the advice received from the National HIV HCW Hotline. The majority of actions concerned the start, dose adaption, change, or discontinuation of medicines. Less frequent actions taken were adherence and lifestyle counselling, further investigations, referring or admission of patients.</p> <p>Conclusions</p> <p>The information provided by the National HIV HCW Hotline on patient-specific requests has a direct impact on the management of patients.</p

Conceptualizing Community Oriented Primary Care (COPC) - the Tshwane, South Africa, health post model

Health sector reforms initiated in South Africa in 1994 adopted a primary health care approach to strengthen the health system and achieve public health outcomes through disease prevention and health promotion.1 This led to the building of many new clinics to make health services more accessible, affordable and equitable. However, the pressures of a predominantly hospitalcentric health care system and emerging epidemics prevented the successful provision of quality comprehensive, integrated primary care to millions of South Africans. Also, little attention was given to community partnerships and multi-sectoral collaboration.The authors thank the Foundation for Professional Development for the financial support.http://www.phcfm.orgam201

Factors associated with patients’ understanding of their management plan in Tshwane clinics

BACKGROUND: This research focused on patients’ views regarding healthcare services and identified factors associated with understanding of their management plan. AIM: To develop a baseline for patient–clinician collaboration and the extent to which patients felt included and understood their treatment plan. SETTING: Tshwane district (South Africa) public health outpatient clinics. METHOD: Medical students interviewed 447 patients in 22 clinics in Tshwane district. Agreement was measured by the percentage of cases in which patients and clinicians were in accord about a particular aspect of the consultation. RESULTS: About one-third of patients incorrectly answered questions on whether changes in lifestyle or diet were prescribed as part of their treatment. The likelihood that patients understood their plan was associated with seeing the same clinician three or more times; having a consultation in their same or a similar language; patient participation in the diagnosis; and feeling that the clinician had explained their health problems to them. CONCLUSIONS: There is need for greater emphasis on continuity of care, the clinicians’ ability to speak the patient’s language and involving patients in the consultation.PRESENTATION: Cette étude se concentrait sur les points de vue des patients concernant les services de santé et les facteurs identifiés associés à la compréhension de leur plan de prise en charge. OBJECTIF: Développer une référence pour la collaboration entre patients et médecins et déterminer la mesure dans laquelle les patients avaient le sentiment d’être inclus à la préparation de leur plan de prise en charge et de le comprendre. CADRE: Centres médicaux publics accueillant des patients en consultation externe dans le district de Tshwane (Afrique du Sud). METHODE: Des étudiants en médecine ont interrogé 447 patients dans 22 centres médicaux dans le district de Tshwane. La concordance était mesurée par le pourcentage de cas dans lesquels les patients et les médecins étaient d’accord sur un aspect particulier de la consultation. RESULTATS: Environ un tiers des patients n’a pas su répondre correctement aux questions visant à déterminer si des changements dans leur style de vie ou régime alimentaire avaient été prescrits dans le cadre de leur traitement. La probabilité que les patients comprennent leur plan était associée au fait de consulter le même médecin à trois reprises ou plus, de consulter dans leur langue ou dans une langue similaire, de participer au diagnostic, et au sentiment que le médecin leur avait expliqué le problème de santé dont ils souffraient. CONCLUSIONS: Il est nécessaire de mettre davantage l’accent sur la continuité de la prise en charge, la capacité des médecins à parler la langue de leurs patients, et l’implication des patients dans la consultation.The authors are indebted to the 2012 class of fifth-year students who took part in this research. We thank them for their commitment to the project as well as their insightful feedback.J.H. (University of Pretoria) was the project leader. J.H., A.R. and T.R. (University of Pretoria) conceptualised and designed the study. L.F., T.R., N.S. (University of Pretoria) and H.K. and S.M. (University of Pretoria and Foundation for Professional Development) were responsible for experimental and questionnaire design. T.M. (University of Pretoria) made significant conceptual contributions to the article. L.F., T.M. and T.R. conducted the analysis and interpretation of the findings and prepared the manuscript. N.S. contributed to data collection and preparation.http://www.phcfm.orgam201

effects on inotropy and myocardial hypertrophy

Die vorliegende Arbeit beschäftigt sich mit den endogenen myokardialen Spiegeln und den inotropen Effekten des Peptidhormons Relaxin und ihren Veränderungen im Gefolge einer Myokardhypertrophie bei arteriellem Hypertonus. Die Untersuchungen werden am Modell der spontan-hypertensiven Ratte durchgeführt. Relaxin ist ein vor 80 Jahren erstmals beschriebenes Peptidhormon. Wurden zunächst umfassende Einflüsse auf das Bindegewebe, die Uterusmuskulatur und die Brustdrüse während der Schwangerschaft entdeckt und Relaxin als „Schwangerschaftshormon“ klassifiziert, so fand man in den letzten dreißig Jahren zahlreiche Effekte von Relaxin auf Hypophyse, das Gefäßsystem, die Nierenfunktion, das Herz und die Blutgerinnung sowie Effekte auf das Bindegewebe auch außerhalb der Schwangerschaft. 2001 wurde Relaxin als kompensatorischer Mediator im komplexen Zusammenspiel zahlreicher neurohumoraler Faktoren im Rahmen der Herzinsuffizienz beim Menschen beschrieben. Eine Hypertrophie des Herzmuskels als Antwort auf erhöhte hämodynamische Belastung des Herzens wird durch eine Vielzahl verschiedener physiologischer (Sportler) und pathologischer Stimuli ausgelöst. In den letzten Jahren zeigte sich zunehmend, dass auch die nichtmyozytären Anteile des Herzen, also insbesondere die Fibroblasten mit der von ihnen regulierten extrazellulären Matrix (ECM), einen wesentlichen Anteil an dem zunächst physiologischen, dann jedoch verhängnisvollen Umbau des Herzens im Rahmen der sich entwickelnden Herzinsuffizienz haben. Sind Hypertrophie der Myozyten und Fibrose des Herzen möglicherweise zunächst als eine vorteilhafte Anpassung anzusehen, so sind sie im weiteren Verlauf verbunden mit einer Erhöhung des Risikos für die Entwicklung einer diastolischen und systolischen Herzinsuffizienz und maligner Herzrhythmusstörungen. In der vorliegenden Arbeit wird erstmals nachgewiesen, dass die linksatriale und linksventrikuläre Relaxinexpression bei spontan-hypertensiven Ratten (SHR) verglichen mit normotensiven Artgenossen auf mRNA- und rRLX-3-Protein-Ebene erhöht ist und innerhalb der Gruppe der SHR invers mit der ventrikulären und atrialen Myokardmasse korreliert. Positiv inotrope Effekte von Relaxin auf atriales, nicht aber auf ventrikuläres Myokard, konnten bestätigt werden und unterschieden sich – im Gegensatz zu den deutlich verminderten positiv- inotropen Wirkungen des β-Agonisten Isoprenalin - in der Gruppe der SHR nicht von den positiv-inotropen Effekten in der Kontrollgruppe. Damit gelang erstmals im Tiermodell der Nachweis einer erhaltenen atrialen positiven Inotropie durch Relaxin bei chronischer Hypertonie und Hypertrophie. Die Befunde weisen darauf hin, dass die erhöhte endogene linkskardiale Relaxinexpression bei chronischer arterieller Hypertension der Entwicklung einer kardialen Hypertrophie/Fibrose entgegenwirkt.For the first time the peptide hormone relaxin was described 80 years ago. While in the first decades mainly effects on connective tissue, uterus and mammary gland during pregnancy were discovered and relaxin was classified a “pregnancy hormone”, during the past 30 years various effects on pituitary gland, blood vessels, kidney, heart, blood-coagulation and effects on connective tissue independent of pregnancy were discovered. In 2001 relaxin was for the first time proven to be a player in the complex interactions of neurohumoral factors of human heart failure. Myocardial hypertrophy as consequence of an increased cardiac workload is caused by many various physiologic (sportsmen) and pathologic stimuli. In recent years it became more and more evident that also the non-myocyte parts of the heart, especially the fibroblasts and the extra-cellular matrix (ECM) contribute fundamentally to the initially physiologic but later detrimental cardiac remodelling during heart failure. Even if hypertrophy and fibrosis may be beneficial in early stages of chronically increased cardiac stress in later stages these changes are accompanied by the increasing risk of cardiac failure and malign arrhythmias. In this publication for the first time evidence is provided that left-ventricular and left-atrial transcription and translation of relaxin in spontaneous hypertensive rats (SHR) is elevated compared with normotensive rats. Furthermore there is evidence of an inverse correlation of relaxin expression and myocardial hypertrophy. Known positively inotropic effects on atrial myocardium were confirmed – but while the positively inotropic effects of the β-agonistic isoprenaline are relevantly attenuated in hypertrophic rat hearts the positively inotropic effects of relaxin are fully preserved. This is the first prove of preserved positively inotropic effects of relaxin in chronic hypertension and myocardial hypertrophy. The results strongly support the assumption that increased endogenous left-cardiac expression of relaxin in spontaneous hypertensive rats counteracts myocardial hypertrophy and fibrosis

Improving management of tuberculosis in people living with HIV in South Africa through integration of HIV and tuberculosis services: a proof of concept study

Abstract Background South Africa’s tuberculosis burden is the third highest globally and is closely associated with the country’s devastating HIV epidemic. The separation of HIV and TB services in primary healthcare services in South Africa hampers TB case finding in patients who are co-infected with HIV and TB. This operational proof of concept study assessed an approach to improving tuberculosis detection and treatment by integrating tuberculosis management into HIV care. Methods The intervention involved workforce re-engineering accompanied by changes to the physical environment in three primary healthcare facilities in Gert Sibande district, Mpumalanga Province, that allowed HIV providers to test their HIV patients for TB and initiate and monitor TB treatment when indicated. To assess the proof of concept we compared the management of TB patients by HIV and TB providers, by reviewing the records of all facility patients who tested positive for tuberculosis between July 2015 and February 2016. We also considered the perceptions of healthcare providers and facility managers about the intervention through structured interviews. Results Approximately 30% of the 1855 patients with presumed TB in the three clinics had been identified by HIV providers. The percentage of patients consecutively tested for TB was 81.0% and 85.0% (p = 0.0551) for HIV and TB providers, respectively. Of the patients identified with TB by HIV and TB providers, 75.4% and 79.2% (p = 0.2876), respectively, were initiated on treatment. The defaulter rate was higher among HIV, compared to TB, providers (12.8% versus 4.2%). Overall, healthcare providers and facility managers had positive views of the intervention but raised concerns regarding potential increase in workload and administrative issues, as well as infection control. Conclusions The results of this proof-of-concept study indicate that the full spectrum of TB services can be easily and effectively integrated into existing HIV care programs. However, a possible shift in the service providers’ workload, including administrative tasks, must be tackled and effective infection control must be ensured. Further research is needed to assess the impact of TB service integration into the scope of HIV care (or other chronic care programs) on patient outcomes, including analysis of routine data

Maritime Anomaly Detection for Vessel Traffic Services: A Survey

A Vessel Traffic Service (VTS) plays a central role in maritime traffic safety. Regulations are given by the International Maritime Organization (IMO) and Guidelines by the International Association of Marine Aids to Navigation and Lighthouse Authorities (IALA). Accordingly, VTS facilities utilize communication and sensor technologies such as an Automatic Identification System (AIS), radar, radio communication and others. Furthermore, VTS operators are motivated to apply Decision Support Tools (DST), since these can reduce workloads and increase safety. A promising type of DST is anomaly detection. This survey presents an overview of state-of-the-art approaches of anomaly detection for the surveillance of maritime traffic. The approaches are characterized in the context of VTS and, thus, most notably, sorted according to utilized communication and sensor technologies, addressed anomaly types and underlying detection techniques. On this basis, current trends as well as open research questions are deduced