Adherence to national guidelines in prevention of mother to child transmission of HIV

Background: Mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV) contributes to over 90% of the paediatric HIV infections. The national PMTCT guidelines make recommendations for specific interventions to reduce perinatal transmission. Data on adherence to the guidelines by caregivers and quality of PMTCT care is however limited.objective: To evaluate the extent to which PMTCT care offered to HIV positive women admitted for delivery at Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH) adheres to National Guidelines in order to reduce vertical transmission of HIV during labour and delivery.Design: A cross-sectional study.Setting: Kenyatta National Hospital and Pumwani Maternity Hospitalfrom January to April 2009.Subjects: All consenting HIV positive women admitted to the labour wards at the two facilities and planned for delivery.Results: A total of 370 women were enrolled, 266 at Pumwani Maternity Hospital and 104 at Kenyatta National Hospital. Among the enrolled women 357 (96.4%) had been counselled on vertical transmission and 205(55.4%) had HIV disease staging by CD4 cell count. There were no significant differences between the two study sites in the proportion of women counselled on MTCT (p=0.398) and receiving HIV disease staging by CD4 testing (p=0.28). Three hundred and forty nine (94.3%) women were offered varied ARV regimens for PMTCT. 101(27.3%) received HAART, 94(26.9%) were given single dose nevirapine and 130(37%) received AZT+NVP combination prophylaxis. Twenty one women received no ARV prophylaxis. Overall, 268 women (72.5%) had spontaneous vertex delivery. An episiotomy rate of 7% was observed and no vacuum delivery was recorded. A Caesarean section rate of 27.5% was recorded with PMTCT as aan indication in almost half of the cases. Women delivered at KNH were more likely to receive HAART (p<0.001) and to be delivered by elective caesarean (p<0.001).Conclusion: A great majority of HIV positive women admitted for delivery received counseling on vertical transmission and were offered ARVs for PMTCT. Many women did not get CD4 measurement and clinical staging as recommended in the National guidelines

Do clinicians adhere to practice guidelines? A descriptive study at a referral hospital in Kenya

Background: Clinical guidelines when implemented correctly have shown to improve disease outcomes. This study describes utilization of Kenya National guidelines in managing ante partum haemorrhage (APH) in 3rd trimester.Objective: To describe adherence to clinical guideline in management of antepartum haemorrhage at Garissa Provincial General Hospital Design: Crossectional mixed methods studySetting: Garissa Provincial General HospitalSubjects: Medical records of patients managed for APH between 2002 and 2012 and Key Informant Interviews (KIIs) of Health workers.Results: 36.1% of the cases assessed were managed with strict adherence to guidelines. 90% of health care workers had high levels of awareness of the existence of guidelines and sited utilization challenges attributed to resource inadequacies.Conclusion: Clinicians are skilled on APH guidelines, but adherence levels are still low. Therefore, continuous appraisal of clinical practices, availing equipment, facilities and supplies to reinforce adherence is recommended

A user evaluation of speech/phrase recognition software in critically ill patients: a DECIDE-AI feasibility study

Objectives: Evaluating effectiveness of speech/phrase recognition software in critically ill patients with speech impairments. Design: Prospective study. Setting: Tertiary hospital critical care unit in the northwest of England. Participants: 14 patients with tracheostomies, 3 female and 11 male. Main outcome measures: Evaluation of dynamic time warping (DTW) and deep neural networks (DNN) methods in a speech/phrase recognition application. Using speech/phrase recognition app for voice impaired (SRAVI), patients attempted mouthing various supported phrases with recordings evaluated by both DNN and DTW processing methods. Then, a trio of potential recognition phrases was displayed on the screen, ranked from first to third in order of likelihood. Results: A total of 616 patient recordings were taken with 516 phrase identifiable recordings. The overall results revealed a total recognition accuracy across all three ranks of 86% using the DNN method. The rank 1 recognition accuracy of the DNN method was 75%. The DTW method had a total recognition accuracy of 74%, with a rank 1 accuracy of 48%. Conclusion: This feasibility evaluation of a novel speech/phrase recognition app using SRAVI demonstrated a good correlation between spoken phrases and app recognition. This suggests that speech/phrase recognition technology could be a therapeutic option to bridge the gap in communication in critically ill patients. What is already known about this topic: Communication can be attempted using visual charts, eye gaze boards, alphabet boards, speech/phrase reading, gestures and speaking valves in critically ill patients with speech impairments. What this study adds: Deep neural networks and dynamic time warping methods can be used to analyse lip movements and identify intended phrases. How this study might affect research, practice and policy: Our study shows that speech/phrase recognition software has a role to play in bridging the communication gap in speech impairment

Effects of body weight and condition changes after parturition on the reproductive performance of Sahiwal and Friesian cattle

Nutrition has a profound influence on reproductive performance after parturition. Cows are in a typical state of negative energy balance, because nutritional requirements for milk production and maintenance of body function exceed that ingested from the feed. This is reflected by changes in body weight and condition postpartum which influence resumption of ovarian activity. The study objectives were to assess weight and body condition changes after parturition and their influence on reproductive performance of Sahiwal and Friesian lactating cows. Forty in-calf cows comprising 20 Friesians and Sahiwals were selected and upon calving, observed for 24 weeks postpartum. Parameters recorded were weekly live weight and body condition scores postpartum while reproductive attributes included days to commencement of luteal activity and insemination. Data were analyzed using GLM of SAS. There were breed differences in weight of cows at the start of the experiment with Friesians being heavier than Sahiwals. Friesians lost a mean of 31.2 Kg from calving to commencement of luteal activity which occurred 10 weeks postpartum and improved from this loss to register a deficit of 11.3 kg at insemination which occurred 14 weeks after calving while the Sahiwals lost a mean of 27 kg after 6 weeks postpartum at commencement of luteal activity and a further 8 kg to insemination occurring 10 weeks after calving. The mean weight loss for Friesians from calving to commencement of luteal activity was 0.45 kg/day while that of Sahiwals was 0.64 kg/day. The relative weight loss was 6 and 7% for Friesians and Sahiwals respectively. The mean body condition loss for the two breeds showed Sahiwals lost less body condition at commencement of luteal activity than Friesians (-0.19 vs -0.33) and resumed cyclicity earlier than Friesians which had better recovery rates from weight and body condition depression postpartum. This shows that Friesians lose weight rapidly and quickly recover at time of insemination while the weight loss for the Sahiwals is gradual and takes longer to recover. Friesians showed weight recovery after 15 weeks postpartum and this is when insemination occurred, while the nadir of weight depression occurred between weeks 5 and 7 postpartum and coincided with peak milk production. In both breeds insemination occurred 4 weeks after commencement of luteal activities. The Sahiwal depression was gradual and the recovery trends were not so clear-cut. The mean body weight at calving for Friesians inseminated and calved was 427kg compared with those that did not calve averaging 451kg while Sahiwals that calved had a mean weight of 381kg compared to those that didn’t averaging 389kg. This is an indication that heavier cows had difficulty in conceiving. There was a positive association between body weight and condition scores postpartum in Sahiwals while Friesians exhibited a negative association, due to the differences in adaptation to negative energy balance after parturition for the two breeds