53 research outputs found
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
Challenging Varieties of Capitalism's Account of Business Interests: The New Social Market Initiative and German Employers' Quest for Liberalization, 2000-2014
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
durchgefĂĽhrt. 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 auĂźerhalb 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 fĂĽr 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
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