Long and short Integrated Management of Childhood Illness (IMCI) training courses in Afghanistan: a cross- sectional cohort comparison of post-course knowledge and performance

Background: In 2003 the Afghan Ministry of Public Health (MoPH) adopted the Integrated Management of Childhood Illness (IMCI) for delivering child health services in primary care facilities. Key problems were subsequently identified: high cost of training, frequent health worker turnover and poor quality of IMCI implementation by those trained – specifically in the use of job aids and protocols for assessment, classification, treatment and counselling. The high financial, human resources and opportunity costs of implementing IMCI spurred the MoPH to prioritize developing a shortened IMCI course of comparable quality to the 11-Day training. Methods: This cross-sectional evaluation compared knowledge before and after training, and health worker performance in assessment, classification and treatment of sick children in two similar cohorts, eight months post-training. Results: The mean increase in knowledge scores of the thirty 7-Day course trainees was 29 [95% Confidence Interval (CI): 24, 34] compared to 23 (95% CI: 18, 28) in the 31 trained in the 11-Day course. During assessment visits, mean scores in the 7-Day course trainees and the 11-Day course trainees were 93% (95% CI: 91, 95) versus 94% (95% CI: 91, 96) in assessment; 95% (95% CI: 89, 100) versus 96% (95% CI: 91, 100) in classification; 95% (95% CI: 92, 100) versus 97% (95% CI: 95, 100) in treatment; and 81% (95% CI: 76, 86) versus 80% (95% CI: 75, 85) in counselling. The 7-Day course was 36% less expensive than the 11-Day course. For each course opportunity costs, measured as numbers of children who potentially received poorer care than usual during trainee absence, were 3,160 for the 11-Day course and 2,016 for the 7-Day course. This measure was chosen because trainee absence commonly resulted in higher patient volumes per remaining provider or complete closure of a health facility with one single health worker. Conclusion: Given similar performance and knowledge of health workers trained in both courses, potential cost savings, the possibility of training more health workers and the relative ease with which health workers in remote settings might participate in a shorter course, it seems prudent to standardize the 7-Day course in Afghanistan where child mortality rates remain unacceptably high

Knowledge and Perceptions of Latent Tuberculosis Infection among Chinese Immigrants in a Canadian Urban Centre

Background. Since most tuberculosis (TB) cases in immigrants to British Columbia (BC), Canada, develop from latent TB infection (LTBI), treating immigrants for LTBI can contribute to the eradication of TB. However, adherence to LTBI treatment is a challenge that is influenced by knowledge and perceptions. This research explores Chinese immigrants\u27 knowledge and perceptions towards LTBI in Greater Vancouver. Methods. This mixed methods study included a cross-sectional patient survey at BC\u27s Provincial TB clinics and two focus group discussions (FGDs) with Chinese immigrants. Data from FGDs were coded and analyzed in Simplified Chinese. Codes, themes, and selected quotes were then translated into English. Results. The survey identified a mean basic knowledge score: 40.0% (95% CI: 38.3%, 41.7%). FGDs confirmed that Chinese immigrants\u27 knowledge of LTBI was low, and they confused it with TB disease to the extent of experiencing LTBI associated stigma. Participants also expressed difficulties navigating the health system which impeded testing and treatment of LTBI. Online videos were the preferred format for receiving health information. Conclusion. We identified striking gaps in knowledge surrounding an LTBI diagnosis. Concerns of stigma may influence acceptance and adherence of LTBI treatment in Chinese immigrants. Integrating these findings into routine health care is recommended

Long and Short Integrated Management of Childhood Illness (IMCI) Training Courses in Afghanistan: A Cross-sectional Cohort Comparison of Post-Course Knowledge and Performance

Background: In 2003 the Afghan Ministry of Public Health (MoPH) adopted the Integrated Management of Childhood Illness (IMCI) for delivering child health services in primary care facilities. Key problems were subsequently identified: high cost of training, frequent health worker turnover and poor quality of IMCI implementation by those trained – specifically in the use of job aids and protocols for assessment, classification, treatment and counselling. The high financial, human resources and opportunity costs of implementing IMCI spurred the MoPH to prioritize developing a shortened IMCI course of comparable quality to the 11-Day training. Methods:This cross-sectional evaluation compared knowledge before and after training, and health worker performance in assessment, classification and treatment of sick children in two similar cohorts, eight months post-training. Results:The mean increase in knowledge scores of the thirty 7-Day course trainees was 29 [95% Confidence Interval (CI): 24, 34] compared to 23 (95% CI: 18, 28) in the 31 trained in the 11-Day course. During assessment visits, mean scores in the 7-Day course trainees and the 11-Day course trainees were 93% (95% CI: 91, 95) versus 94% (95% CI: 91, 96) in assessment; 95% (95% CI: 89, 100) versus 96% (95% CI: 91, 100) in classification; 95% (95% CI: 92, 100) versus 97% (95% CI: 95, 100) in treatment; and 81% (95% CI: 76, 86) versus 80% (95% CI: 75, 85) in counselling. The 7-Day course was 36% less expensive than the 11-Day course. For each course opportunity costs, measured as numbers of children who potentially received poorer care than usual during trainee absence, were 3,160 for the 11-Day course and 2,016 for the 7-Day course. This measure was chosen because trainee absence commonly resulted in higher patient volumes per remaining provider or complete closure of a health facility with one single health worker. Conclusion:Given similar performance and knowledge of health workers trained in both courses, potential cost savings, the possibility of training more health workers and the relative ease with which health workers in remote settings might participate in a shorter course, it seems prudent to standardize the 7-Day course in Afghanistan where child mortality rates remain unacceptably high

Bilateral intracorporeally sutured inguinal herniorrhaphy using 3-dimensional laparoscopy in a dog.

A 7-month-old, intact male, mixed breed dog with bilateral inguinal hernias underwent general anesthesia for laparoscopic bilateral inguinal herniorrhaphy via a 3-port approach. A 3-dimensional laparoscopic system was used to perform the procedure immediately following prescrotal open castration. Intracorporeal suturing with polypropylene was performed, and 2 cruciate sutures were placed to close each inguinal ring. The caudal aspect of each inguinal ring was left slightly open so as not to disrupt the passage or patency of vessels and nerves. No intra- or post-operative complications occurred. One year after surgery, the dog has no evidence of recurrence of the inguinal hernias. Key clinical message: This case report demonstrates a novel minimally invasive approach to inguinal herniorrhaphy in a dog with no reported complications and a good long-term outcome. Intracorporeally sutured inguinal herniorrhaphy is feasible in dogs with good results, although additional cases are needed to gain experience with this technique in dogs with varying presentations of inguinal hernias

Is model of care associated with infant birth outcomes among vulnerable women? A scoping review of midwifery-led versus physician-led care

This scoping review investigates if, over the last 25 years in high resource countries, midwives’ patients of low socioeconomic position (SEP) were at more or less risk of adverse infant birth outcomes compared to physicians’ patients. Reviewers identified 917 records in a search of 12 databases, grey literature, and citation lists. Thirty-one full documents were assessed and nine studies met inclusion criteria. Eight studies were assessed as moderate in quality; one study was given a weak rating. Of the moderate quality studies, the majority found no statistical difference in outcomes according to model of care for preterm birth, low or very low birth weight, or NICU admission. No study reported a statistically significant difference for small for gestational age birth (2 studies), or mean or low Apgar score (4 studies). However, one study found a reduced risk of preterm birth (AOR=0.70, p<0.01), and heavier mean infant birth weight (3325 g vs. 3282 g, p<0.01) for midwifery patients. Another study reported lower risk of low (RR=0.59, 95% CI: 0.46, 0.73) and very low birthweight (RR=0.44, 95% CI: 0.23, 0.85) for midwifery care. And, a third study reported a decrease in stays (1–3 days) in NICU (Adjusted Risk Difference=−1.8, 95% CI: −3.9, 0.2) for midwifery patients, though no overall difference in NICU admission of any duration. Other studies reported significant differences favoring midwifery care for mean birth weight (3598 g vs. 3407.3 g, p<0.05; 3233 g vs. 3089 g, p<0.05; 2 studies) and very low birth weight (OR=0.35, 95% CI:0.1, 0.9), for sub-groups within the larger study populations. This scoping review documented heterogeneity in study designs and analytical methods, inconsistent findings, moderate methodological quality, and lack of currency. There is a need for new studies to definitively establish if and how a midwifery-led model of care influences birth outcomes for women of low SEP. Keywords: Midwifery, Socioeconomic position, Vulnerable women, Prenatal care, Infant birth outcome, Preterm birt

Case series: Pleural effusion caused by urinary ultrafiltrate in two cats without evidence of urinary obstruction, trauma, or simultaneous perinephric pseudocysts.

ObjectivesTo describe the diagnostic techniques, surgical treatments, and outcomes of two cats with recurrent pleural transudate caused by urinary ultrafiltrate.AnimalsTwo cats without evidence of trauma, urinary tract obstruction, or concurrent perinephric pseudocysts that were evaluated and treated for recurrent pleural transudate caused by urinary ultrafiltrate.Study designShort case series.MethodsMultiphase contrast CT scan revealed leakage of contrast media from the kidneys bilaterally into the retroperitoneal spaces in both cats. Renal scintigraphy performed in one cat revealed progressive accumulation of 99mTc diethylenetriamine penta-acetic acid (Tc-DTPA) in the pleural space. Exploratory laparotomy localized the leakage of fluid to renal capsular defects bilaterally in both cats. The retroperitoneum was incised bilaterally to promote fluid drainage into the peritoneum, and nephropexies were performed.ResultsOne cat had long-term survival with recurrent, though decreasing volumes of, pleural effusion. The second cat was euthanized 16 days postoperatively for progressive renal disease.ConclusionThe diagnosis of spontaneous urinary ultrafiltrate accumulation in the pleural space of cats without evidence of trauma, urinary tract obstruction, or concurrent perinephric pseudocysts has not previously been reported. The surgical correction described reduced but did not completely eliminate the rate of pleural effusion accumulation

Choledochal stenting for treatment of extrahepatic biliary obstruction in cats.

BACKGROUND: Limited information currently exists regarding the clinical progression and outcomes of cats that undergo choledochal stenting as a treatment for extrahepatic biliary obstruction (EHBO). HYPOTHESIS/OBJECTIVES: Describe clinical characteristics, indications for choledochal stent placement, procedure, and outcomes in a cohort of cats undergoing choledochal stenting and evaluate risk factors associated with survival as well as recurrence of EHBO in affected cats. ANIMALS: Twenty-three client-owned cats undergoing choledochal stent placement. METHODS: Retrospective study. Medical records from 6 academic institutions were reviewed, and data were extracted and analyzed statistically. RESULTS: Median age of cats was 10.1 years (range, 2-16), and all cats had at least 2 clinical signs. Most common clinical signs were vomiting in 20/22 (90.9%), inappetence in 19/22 (86.4%), and lethargy in 19/23 (82.6%). Procedural complications were uncommon and rarely related to the stenting procedure. Clinical signs improved postoperatively in 15/20 (75.0%) cats and serum total bilirubin concentration decreased postoperatively in 13/19 (68.4%) cats. Eighteen (78.3%) cats survived to discharge. Recurrence of EHBO was documented in 7/18 (38.9%) cats that survived to discharge. Cholelithiasis was associated with recurrence of EHBO. Median survival time for cats that survived to discharge was 931 days (range, 19-3034). Absence of peritoneal effusion was associated with survival to discharge. CONCLUSIONS AND CLINICAL IMPORTANCE: Choledochal stenting was an effective treatment modality in cats with EHBO with few procedural complications and potential for prolonged survival, but substantial risk for recurrence of EHBO was identified