The perspectives of nurses and HIV-positive women on a selected model of pregnancy decision-making processes in northeast Thailand

Many women living with HIV intend to become pregnant. This is especially true for women who have received ARV treatment for a certain period. The purpose of this study was to explore the perspectives of nurses and Thai pregnant women living with HIV on pregnancy decision-making processes. This is a descriptive and qualitative study. Small group discussions were conducted with five nurses working with HIV-positive women and in-depth interviews were conducted with five Thai HIV-positive pregnant women. A model of the pregnancy decision-making process was provided to participants for the discussion. The nurses’ and women's perspectives on the model can be divided into two themes: 1) The perspective of the selected model and its five sub-themes, namely: 1.1) How the substantive model reflects the pregnancy decision-making process; 1.2) Complexity; 1.3) Usability; 1.4) Strength; 1.5) Weaknesses, in addition to the perspectives of women and nurses on the application of the model. The model reflects the real-life experiences and decision-making processes of Thai women with HIV, where each category shows the trail of the women's decision-making process. However, the model is complex and requires substantial explanation. From the participant's point of view, the model reflects the barriers to the practices and services provided

'Selling it as a holistic health provision and not just about condoms ?' Sexual health services in school settings: current models and their relationship with sex and relationships education policy and provision

In this article we discuss the findings from a recent study of UK policy and practice in relation to sexual health services for young people, based in - or closely linked with - schools. This study formed part of a larger project, completed in 2009, which also included a systematic review of international research. The findings discussed in this paper are based on analyses of interviews with 51 service managers and questionnaire returns from 205 school nurses. Four themes are discussed. First, we found three main service permutations, in a context of very diverse and uneven implementation. Second, we identified factors within the school context that shaped and often constrained service provision; some of these also have implications for sex and relationships education (SRE). Third, we found contrasting approaches to the relationship between SRE input and sexual health provision. Fourth, we identified some specific barriers that need to be addressed in order to develop 'young people friendly' services in the school context. The relative autonomy available to school head teachers and governors can represent an obstacle to service provision - and inter-professional collaboration - in a climate where, in many schools, there is still considerable ambivalence about discussing 'sex' openly. In conclusion, we identify areas worthy of further research and development, in order to address some obstacles to sexual health service and SRE provision in schools

Embracing virtual outpatient clinics in the era of COVID-19

The response to the COVID-19 pandemic has raised the profile and level of interest in the use, acceptability, safety and effectiveness of virtual outpatient consultations and telemedicine. These models of care are not new but a number of challenges have so far hindered widespread take up and endorsement of these ways of working. With the response to the COVID-19 pandemic, remote and virtual working and consultation have become the default. This paper explores our experience of and learning from virtual and remote consultation and questions how this experience can be retained and developed for the future

Follow-up costs increase the cost disparity between endovascular and open abdominal aortic aneurysm repair

ObjectiveThis study compared the hospital and follow-up costs of patients who have undergone endovascular (EVAR) or open (OR) elective abdominal aortic aneurysm repair.MethodsThe records of 195 patients (EVAR, n = 55; OR, n = 140) who underwent elective aortic aneurysm repair between 1995 and 2004 were reviewed. Primary costing data were analyzed for 54 EVAR and 135 OR patients. Hospital costs were divided into preoperative, operative, and postoperative costs. Follow-up costs for EVAR patients were recorded, with a median follow-up time of 12 months.ResultsMean preoperative costs were slightly higher in the EVAR group (AU $961/US$733 vs AU $869/US$663; not significant). Operative costs were significantly higher in the EVAR group (AU $16,124/US$12,297 vs AU $6077/US$4635; P < .001); this was entirely due to the increased cost of the endograft (AU $10,181/US$7,765 for EVAR vs AU $476/US$363 for OR). Postoperative costs were significantly reduced in the EVAR group (AU $4719/US$3599 vs AU $11,491/US$8,764; P < .001). Total hospital costs were significantly greater in the EVAR group (AU $21,804/US$16,631 vs AU $18,437/US$14,063; P < .001). The increase in total hospital costs was due to a significant difference in graft costs, which was not offset by reduced postoperative costs. The average follow-up cost per year after EVAR was AU $1316/US$999. At 1 year of follow-up, EVAR remained significantly more expensive than OR (AU $23,120/US$17,640 vs AU $18,510/US$14,122; P < .001); this cost discrepancy increased with a longer follow-up.ConclusionsEVAR results in significantly greater hospital costs compared with OR, despite reduced hospital and intensive care unit stays. The inclusion of follow-up costs further increases the cost disparity between EVAR and OR. Because EVAR requires lifelong surveillance and has a high rate of reintervention, follow-up costs must be included in any cost comparison of EVAR and OR. The economic cost, as well as the efficacy, of new technologies such as EVAR must be addressed before their widespread use is advocated

Acute carpal tunnel syndrome: early nerve decompression and surgical stabilization for bony wrist trauma

Background We undertook this study to investigate the outcomes of surgical treatment for acute carpal tunnel syndrome following our protocol for concurrent nerve decompression and skeletal stabilization for bony wrist trauma to be undertaken within 48-hours. Methods We identified all patients treated at our trauma centre following this protocol between 1 January 2014 and 31 December 2019. All patients were clinically reviewed at least 12 months following surgery and assessed using the Brief Michigan Hand Outcomes Questionnaire (bMHQ), the Boston Carpal Tunnel Questionnaire (BCTQ) and sensory assessment with Semmes-Weinstein monofilament testing. Results The study group was made up of 35 patients. Thirty-three patients were treated within 36-hours. Patients treated with our unit protocol for early surgery comprising nerve decompression and bony stabilization within 36-hours, report excellent outcomes at medium term follow up. Conclusions We propose that nerve decompression and bony surgical stabilization should be undertaken as soon as practically possible once the diagnosis is made. This is emergent treatment to protect and preserve nerve function. In our experience, the vast majority of patients were treated within 24-hours however where a short period of observation was required excellent results were generally achieved where treatment was completed within 36-hours

High-Performance Building Design: Keys to Success

The energy-design process optimizes the interaction between the building envelope and systems. Buildings designed and constructed using this process can save between 30% and 75% in energy costs

Photovoltaics for Buildings: Case Studies of High-Performance Buildings with PV

Energy efficiency maximizes the value of photovoltaics (PV) in buildings systems. A fixed-sizre PV system will offset a much larger part of the electrical load in an energy-efficient building than in a building whose energy design has not been optimized

Ahnas El Medineh: The Tomb of Paheri at El Kab

Memoir of two excavations at Ahnas.https://knowledge.e.southern.edu/kweeks_coll/1036/thumbnail.jp