A descriptive study to evaluate the effect of guidelines used by counsellors to improve adherence to antiretroviral therapy in the private sector

INTRODUCTION: To achieve a virological outcome to antiretroviral therapy, a high adherence level is required. OBJECTIVE: To implement and evaluate guidelines that will be used by treatment support counsellors in an attempt to increase client adherence to antiretroviral treatment. METHODS: A quasi - experimental comparative study was used to assess whether a structured treatment support guidelines can improve client adherence to antiretroviral therapy. The treatment outcome of two groups was compared: one group received the adherence guidelines and the other group was a historical group where no adherence guidelines were applied. The main outcome measure was whether adherence guidelines improved adherence to ART. PARTICIPANTS: Forty clients were exposed to the adherence guidelines and 34 were not. SETTING: Clients that subscribe to Aids for Aids . Intervention: A structured guideline used by counsellors with regular contact. RESULTS: Specific guidelines used by counsellors to improve adherence to antiretroviral therapy has shown that significantly more clients in the intervention group had their CD4 blood tests done after six months and adhered to regularly claim their medications. In addition were there more clients in the intervention group who had viral loads of less than 400 copies I ml after six months. CONCLUSION: Specific counselling using effective guidelines improve adherence to antiretroviral treatment

An assessment of the adherence to guidelines for the management of asthma exacerbations in selected primary healthcare facilities in the Western Cape

INTRODUCTION: Asthma is described as a chronic inflammatory disorder of the airways. Recurrent episodes of "acute attacks" or exacerbation may occur in susceptible individuals. The onset of these episodes maybe associated with external stimuli such as cold or pollen. Asthma could be a controllable disorder and most people with asthma should be able to lead a normal, productive life if their asthma is managed effectively. A review of literature recommend that adherence to uniform guidelines on asthma management can reduce the frequency of acute attacks. Guidelines for the management of asthma have been implemented in health care facilities in the Western Cape for more than a decade. OBJECTIVE: The objective of this study was to investigate the extent to which doctors adhere to the prescribed asthma guidelines. METHOD: Record review. PARTICIPANTS: Forty records were reviewed. SETTING: The study was conducted at four Primary Health Care (PHC) centres in the Western Cape. INTERVENTION: A review of patient records was done to examine adherence to the implementation of the recommended guidelines. RESULTS: The results are in line with the literature which shows that adherence to the asthma guidelines is sub optimal. CONCLUSION: It is recommended that authorities should regularly follow health care facilities to evaluate to what extend guidelines are adhered to and ongoing training should be given to make health workers aware of these guidelines

A systematic review on effects of physical activity Interventions on early motor development in children with Down syndrome

PURPOSE: The main aim of this review was to evaluate the effect of physical activity on motor development in children with Down Syndrome by means of a systematic review. METHODS: An extensive literature search of published studies in English from 1980 to May 2006 was performed. Of the fifty-eight studies identified only four met the inclusion criteria. This review included studies that investigated the effects of physical activity on motor development in children with Down Syndrome and evaluated the outcomes in terms of the level of activity. RESULTS: One study showed a significant decrease in length of time to independent walking in the intervention group (C l -101(-180.48 - -21.52]. Two studies (N=84) reported a significant improvement in the total developmental quotient following intensive physical activity (wmd and Cl 95% -13.07 [-17. 66, -8.48]. Three studies showed an increased in locomotor developmental skills following physical activity intervention. CONCLUSION: The results of this review support the use of programmes that are designed to improve motor development in children with Down Syndrome. We recommend that physical activity programmes need to be intensive and parents should be incorporated to strengthen the outcomes

A systematic review evaluating the effects of bilateral tubal ligation on menorrhagia and dysmenorrhoea (post-tubal ligation syndrome)

INTRODUCTION: The complaints about the tubal sterilization surgery leading to post-tubal ligation syndrome first surfaced in the 1950s. With the introduction in the 1970s of laparoscopy, which was a less invasive surgery, more women choose tubal ligation as a family planning method, and reports of complaints of tubal-ligation syndrome increased. Changes in menstrual flow, dysmenorrhoea, menorrhagia and change in cycle length after tubal sterilization have been reported in several studies since 1970. The term "post tubal ligation syndrome" has been used to refer to these changes. Often studies have failed to account for the cause in the menstrual changes other than tubal ligation.Objective: The primary objective of this research project was to evaluate the long-term risks associated with female tubal ligation by executing a systematic review. SEARCH STRATEGY: An electronic search of available search engines was used to draw literature relevant to bilateral tubal ligation. SELECTION CRITERIA TYPES OF STUDIES: All randomized controlled, quasi-randomized or clinical controlled trials that mention an experimental and comparison group (own controls were allowed), reporting on long-term risks associated with changes in the menstrual cycle after female sterilization were included in the review. TYPES OF PARTICIPANTS: Women in their reproductive years who had a tubal ligation compared to women who did not have a tubal ligation. TYPES OF INTERVENTION: Tubal sterilization (by macro- or micro-surgery, laparotomy, minilaparotomy or laparoscopy). TYPES OF OUTCOME MEASURES: Outcome measures relevant to post-tubal sterilization long-term risks concentrating on: Dysmenorrhoea, menorrhagia and duration of menstruation period. DATA ANALYSIS: The reviewer extracted the data unto a data collection sheet. Thereafter it was captured onto a computer. Review Manager software program was used for analyses. RESULTS: The results showed that women who have a tubal ligation have an increased risk to experience dysmenorrhoea and menorrhagia after the procedure. They may also be at risk to experience an increase in the duration of their menstruation period

Side-effects of oral misoprostol in the third stage of labour – a randomised placebo controlled trial

Background. Misoprostol, an irlexpensive, stable, orally active prostaglandirl analogue, has been suggested for use in the prevention of postpartum haemorrhage. Potential side-effects, however, need to be quantified.Objective. To compare the rate of postpartum shivering and pyrexia following oral misoprostol 600 pg and placebo.Design. A double-blind placebo-controlled trial. Women irl labour were randomly allocated to receive either misoprostol 600 pg orally or placebo after delivery. Conventional oxytocics were given immediately if blood loss was thought to be more than usual. Side-effects were recorded. Postpartum blood loss in the first hour was measured by collection in a special flat plastic bedpan.Setting. The labour ward of an academic hospital irl Johannesburg, with 7 000 deliveries per annum.Main outcome measures. Shivering and pyrexia.Results. The groups were well matched. Misoprostol use was associated with more shivering (44% versus 11%, relative risk (RR) 4.03, 95% confidence irlterval (Cl) 2.85 - 5.70), pyrexia ~ 37.8°C (38% v. 6%, RR 6.23, Cl 3.89 - 9.97), I-hour systolic blood pressure ~ 140 mmHg (33% v. 25%, RR 1.32, Cl 1.031.70), and diastolic blood pressure ~ 90 mmHg (10.5% v. 3.0%, RR 3.44, Cl 1.67 -7.11). There were no other significant differences. The study was not designed to be large enough to assess a difference irl blood loss ~ 1 000 ml (9% v. 9.7%, RR 0.93, Cl 0.56 - 1.53). Possible effects on blood loss may have been obscured by the lesser use of additional oxytocics irl the misoprostol group (14% v. 18%, RR 0.78, Cl 0.54 - 1.13). Conclusions. This study has shown the association of postpartum oral misoprostol 600 Jlg with shivering, pyrexia and hypertension. The increased blood pressure, as for the trend towards increased abdominal pain, may be secondary to the uterotonic effect of misoprostol. Large randomised trials are needed to assess the effectiveness of misoprostol in the prevention of postpartum haemorrhage, against which the disadvantages demonstrated here can be weighed

Promoting childbirth companions in South Africa: a randomised pilot study

<p>Abstract</p> <p>Background</p> <p>Most women delivering in South African State Maternity Hospitals do not have a childbirth companion; in addition, the quality of care could be better, and at times women are treated inhumanely. We piloted a multi-faceted intervention to encourage uptake of childbirth companions in state hospitals, and hypothesised that lay carers would improve the behaviour of health professionals.</p> <p>Methods</p> <p>We conducted a pilot randomised controlled trial of an intervention to promote childbirth companions in hospital deliveries. We promoted evidence-based information for maternity staff at 10 hospitals through access to the World Health Organization Reproductive Health Library (RHL), computer hardware and training to all ten hospitals. We surveyed 200 women at each site, measuring companionship, and indicators of good obstetric practice and humanity of care. Five hospitals were then randomly allocated to receive an educational intervention to promote childbirth companions, and we surveyed all hospitals again at eight months through a repeat survey of postnatal women. Changes in median values between intervention and control hospitals were examined.</p> <p>Results</p> <p>At baseline, the majority of hospitals did not allow a companion, or access to food or fluids. A third of women were given an episiotomy. Some women were shouted at (17.7%, N = 2085), and a few reported being slapped or struck (4.3%, N = 2080). Despite an initial positive response from staff to the childbirth companion intervention, we detected no difference between intervention and control hospitals in relation to whether a companion was allowed by nursing staff, good obstetric practice or humanity of care.</p> <p>Conclusion</p> <p>The quality and humanity of care in these state hospitals needs to improve. Introducing childbirth companions was more difficult than we anticipated, particularly in under-resourced health care systems with frequent staff changes. We were unable to determine whether the presence of a lay carer impacted on the humanity of care provided by health professionals. </p> <p><b>Trial registration</b>: Current Controlled Trials ISRCTN33728802</p

Titrated oral misoprostol solution- a new method of labour induction

Background. Misoprostol, a cheap, stable, orally active prostaglandin analogue, is effective for labour induction when administered either vaginally or orally, but uterine hyperstimulation and rupture have been reported. Previous studies of oral misoprostol for labour induction have used fixed dosages 3 - 6-hourly.Objectives. To develop a new method of misoprostol use for labour induction using very small, frequent, titrated oral dosages, and to pilot effectiveness.Study design. Open clinical pilot study.Setting. Coronation Hospital, an academic hospital in Johannesburg, South Africa.Methods. We developed a method using 2-hourly titrated misoprostol doses commencing with 20 μg, increased after three doses to 40 μg. To administer such small doses we dissolved one rnisoprostol tablet in 200 ml water. A pilot study of this method was undertaken in 25 women with various indications for induction of labour.Results. Eighteen women (72%) delivered vaginally within 32 hours of induction and two women developed uterine hyperstirnulation. The caesarean section rate was 20%.Conclusions. Women may respond to much smaller dosages of misoprostol than are currently in use. A multicentre randomised trial of this method is underway. We emphasise the dangers inherent in the current unregistered use of misoprostol in clinical practice

Misoprostol for treating postpartum haemorrhage: a randomized controlled trial [ISRCTN72263357]

BACKGROUND: Postpartum haemorrhage remains an important cause of maternal death despite treatment with conventional therapy. Uncontrolled studies and one randomised comparison with conventional oxytocics have reported dramatic effects with high-dose misoprostol, usually given rectally, for treatment of postpartum haemorrhage, but this has not been evaluated in a placebo-controlled trial. METHODS: The study was conducted at East London Hospital Complex, Tembisa and Chris Hani Baragwanath Hospitals, South Africa. Routine active management of the third stage of labour was practised. Women with more than usual postpartum bleeding thought to be related to inadequate uterine contraction were invited to participate, and to sign informed consent. All routine treatment was given from a special 'Postpartum Haemorrhage Trolley'. In addition, participants who consented were enrolled by drawing the next in a series of randomised treatment packs containing either misoprostol 5 × 200 μg or similar placebo, which were given 1 orally, 2 sublingually and 2 rectally. RESULTS: With misoprostol there was a trend to reduced blood loss ≥500 ml in 1 hour after enrolment measured in a flat plastic 'fracture bedpan', the primary outcome (6/117 vs 11/120, relative risk 0.56; 95% confidence interval 0.21 to 1.46). There was no difference in mean blood loss or haemoglobin level on day 1 after birth < 6 g/dl or blood transfusion. Side-effects were increased, namely shivering (63/116 vs 30/118; 2.14, 1.50 to 3.04) and pyrexia > 38.5°C (11/114 vs 2/118; 5.69, 1.29 to 25). In the misoprostol group 3 women underwent hysterectomy of whom 1 died, and there were 2 further maternal deaths. CONCLUSIONS: Because of a lower than expected incidence of the primary outcome in the placebo group, the study was underpowered. We could not confirm the dramatic effect of misoprostol reported in several unblinded studies, but the results do not exclude a clinically important effect. Larger studies are needed to assess substantive outcomes and risks before misoprostol enters routine use

Measurement of CP violation parameters and polarisation fractions in Bs0→J/ψK‾∗0 {\mathrm{B}}_{\mathrm{s}}^0\to \mathrm{J}/\psi {\overline{\mathrm{K}}}^{\ast 0} decays

The first measurement of ${C\!P}$ asymmetries in the decay ${B_s^0\to J/\psi \overline{K}^{*}(892)^{0}}$ and an updated measurement of its branching fraction and polarisation fractions are presented. The results are obtained using data corresponding to an integrated luminosity of $3.0\,fb^{-1}$ of proton-proton collisions recorded with the LHCb detector at centre-of-mass energies of $7$ and $8\,\mathrm{TeV}$. Together with constraints from ${B^0\to J/\psi \rho^0}$, the results are used to constrain additional contributions due to penguin diagrams in the ${C\!P}$-violating phase ${{\phi}_{s}}$, measured through ${B_s^0}$ decays to charmonium.The first measurement of CP asymmetries in the decay ${B}_s^0\to J/\psi {\overline{\mathrm{K}}}^{\ast }{(892)}^0$ and an updated measurement of its branching fraction and polarisation fractions are presented. The results are obtained using data corresponding to an integrated luminosity of 3.0 fb^{−}^{1} of proton-proton collisions recorded with the LHCb detector at centre-of-mass energies of 7 and 8 TeV. Together with constraints from B$^{0}$ → J/ψ ρ$^{0}$, the results are used to constrain additional contributions due to penguin diagrams in the CP -violating phase ϕ$_{s}$ , measured through B$_{s}^{0}$ decays to charmonium.The first measurement of ${C\!P}$ asymmetries in the decay ${B_s^0\to J/\psi \overline{K}^{*}(892)^{0}}$ and an updated measurement of its branching fraction and polarisation fractions are presented. The results are obtained using data corresponding to an integrated luminosity of $3.0\,fb^{-1}$ of proton-proton collisions recorded with the LHCb detector at centre-of-mass energies of $7$ and $8\,\mathrm{TeV}$. Together with constraints from ${B^0\to J/\psi \rho^0}$, the results are used to constrain additional contributions due to penguin diagrams in the ${C\!P}$-violating phase ${{\phi}_{s}}$, measured through ${B_s^0}$ decays to charmonium

Measurement of the B0s→μ+μ− Branching Fraction and Effective Lifetime and Search for B0→μ+μ− Decays

A search for the rare decays Bs0→μ+μ- and B0→μ+μ- is performed at the LHCb experiment using data collected in pp collisions corresponding to a total integrated luminosity of 4.4  fb-1. An excess of Bs0→μ+μ- decays is observed with a significance of 7.8 standard deviations, representing the first observation of this decay in a single experiment. The branching fraction is measured to be B(Bs0→μ+μ-)=(3.0±0.6-0.2+0.3)×10-9, where the first uncertainty is statistical and the second systematic. The first measurement of the Bs0→μ+μ- effective lifetime, τ(Bs0→μ+μ-)=2.04±0.44±0.05  ps, is reported. No significant excess of B0→μ+μ- decays is found, and a 95% confidence level upper limit, B(B0→μ+μ-)<3.4×10-10, is determined. All results are in agreement with the standard model expectations.A search for the rare decays $B^0_s\to\mu^+\mu^-$ and $B^0\to\mu^+\mu^-$ is performed at the LHCb experiment using data collected in $pp$ collisions corresponding to a total integrated luminosity of 4.4 fb$^{-1}$. An excess of $B^0_s\to\mu^+\mu^-$ decays is observed with a significance of 7.8 standard deviations, representing the first observation of this decay in a single experiment. The branching fraction is measured to be ${\cal B}(B^0_s\to\mu^+\mu^-)=\left(3.0\pm 0.6^{+0.3}_{-0.2}\right)\times 10^{-9}$, where the first uncertainty is statistical and the second systematic. The first measurement of the $B^0_s\to\mu^+\mu^-$ effective lifetime, $\tau(B^0_s\to\mu^+\mu^-)=2.04\pm 0.44\pm 0.05$ ps, is reported. No significant excess of $B^0\to\mu^+\mu^-$ decays is found and a 95 % confidence level upper limit, ${\cal B}(B^0\to\mu^+\mu^-)<3.4\times 10^{-10}$, is determined. All results are in agreement with the Standard Model expectations