Development of an interactive tool to support the evaluation of clinic-based health information systems

Thesis (MEng)--Stellenbosch University, 2021.ENGLISH ABSTRACT: Primary health care is considered the foundation of the health system and the principal vehicle for achieving good health and well-being for all people. A large number of challenges are faced in delivering high-quality care in South Africa’s primary health care system due to numerous adverse factors, including the historic fragmentation of the health system, inadequate infrastructure and immense resource constraints. To mitigate these adverse factors, clinic-based health information systems (CBHIS) aim to consolidate information relevant to the primary health care environment from various stakeholders across multiple areas of interest.However, CBHIS also face various socio-technical problems which lessen their effectiveness. The evaluation of CBHIS allows for these problems to be identified and mitigated; it also helps in establishing trends of well-functioning aspects which may be disseminated for system improvement.Thus, supporting the evaluation of CBHIS would strengthen the primary health care system.In this study, an interactive tool is developed to support the evaluation of CBHIS. The interactive tool is developed, refined and validated through multiple design cycle iterations, as informed by the Design Science Research framework. Various tool components are established by leveraging insights obtained from the Monitoring and Evaluation as well as Information Systems domain. These components are refined through conducting a theoretical case study of the Stock Visibility System and critically evaluated by multiple subject-matter experts to ensure the rigour of the development process and relevance to support evaluation.The components are consolidated and implemented on a computer as the final interactive tool to support the evaluation of CBHIS. The interactive tool comprises three outputs which present a tangible set of interrelated evaluation concepts in a simple, structured and useful manner, namely,a concept inventory, responsive concept map and an evaluation support document. The interactive tool is demonstrated to illustrate its applicability and capacity to support the evaluation of CBHIS.AFRIKAANSE OPSOMMING: Primêre gesondheidsorg word beskou as die grondslag van die gesondheidstelsel en die belangrikste middel om goeie gesondheid en welstand vir alle mense te bewerkstellig. 'n Groot aantal uitdagings verhoed die lewering van hoë gehalte sorg in primêre gesondheid as gevolg van talle nadelige faktore, insluitend die historiese versplintering van die gesondheidstelsel, onvoldoende infrastruktuur en geweldige beperkings op nodige hulpbronne. Dit is clinic-based health information systems(CBHIS) se doelwit om inligting wat vir die primêre gesondheidsorg-omgewing van verskillende belanghebbendes relevant is, op verskillende terreine te konsolideer en sodoende te help om die nadelige faktore waarmee die gesondheidstelsel te kampe het, teverlig.Die stelsels het egter ook verskillende sosio-tegniese probleme wat die doeltreffendheid daarvan verminder. Die evaluering van CBHIS maak dit moontlik om hierdie probleme te identifiseer en teverlig; dithelp ook om tendense vas te stel van goed funksionerende aspekte in die stelsels wat versprei kan word vir algemene verbeterings. Daar bestaan dus ‘nbehoefte om die primêre gesondheidsorgstelsel te versterk deur die ondersteuning van die evaluering van CBHIS. In hierdie studie word 'n interaktiewe hulpmiddel ontwikkel om die evaluering van CBHIS te ondersteun. Die hulpmiddel word ontwikkel, verfyn en bekragtig deur middel van veelvuldige herhalings van die ontwerpsiklus, soos ingelig deur die Design Science Researchraamwerk. Verskeie komponente van die hulpmiddel word vasgestel deur gebruik te maak van insigte wat verkry word uit die Monitering en Evaluering asook die Inligtingstelsels domeine. Hierdie komponente word verfyn deur die uitvoering van 'n teoretiese gevallestudievandie Stock VisibilitySystemen word krities geëvalueer deur verskeie kenners op die gebiede om die noukeurigheid van die ontwikkelingsproses en die relevansie vir evaluering te verseker. Die komponente word op 'n rekenaar gekonsolideer en geïmplementeer as die finaleinteraktiewe hulpmiddel om die evaluering van CBHIS te ondersteun. Die interaktiewe hulpmiddel bevat drie funksionele uitsette wat 'n tasbare stel onderling verwante evalueringskonsepte op 'n eenvoudige, gestruktureerde en nuttige manier bied. Hierdie komponente sluit in: 'n konsepinventaris, 'n responsiewe konsepkaart en 'n ondersteuningsdokument vir evaluering. Die interaktiewe hulpmiddel word gedemonstreer om toepaslik te wees om die evaluering van CBHIS te ondersteun

Inheriting Mary Ainsworth and the Strange Situation: Questions of Legacy, Authority, and Methodology for Contemporary Developmental Attachment Researchers

Mary Ainsworth’s legacy continues to shape the social and developmental sciences well after her death. The Ainsworth Strange Situation Procedure has, for decades, not only provided the underpinning methodology of attachment research, but also the frame of reference for theory. This has produced conditions where, as in psychoanalysis, debates about the future of the paradigm also entail a struggle to claim and negotiate the legacy of a founding figure. To date, historians have only looked at attachment research up to the 1980s. Interviews with 15 leading contemporary attachment researchers revealed Ainsworth’s importance to later research, but also laid bare the challenges of claiming her inheritance in responding to the current challenges facing this area of research

Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition)

In 2008 we published the first set of guidelines for standardizing research in autophagy. Since then, research on this topic has continued to accelerate, and many new scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Accordingly, it is important to update these guidelines for monitoring autophagy in different organisms. Various reviews have described the range of assays that have been used for this purpose. Nevertheless, there continues to be confusion regarding acceptable methods to measure autophagy, especially in multicellular eukaryotes. For example, a key point that needs to be emphasized is that there is a difference between measurements that monitor the numbers or volume of autophagic elements (e.g., autophagosomes or autolysosomes) at any stage of the autophagic process versus those that measure fl ux through the autophagy pathway (i.e., the complete process including the amount and rate of cargo sequestered and degraded). In particular, a block in macroautophagy that results in autophagosome accumulation must be differentiated from stimuli that increase autophagic activity, defi ned as increased autophagy induction coupled with increased delivery to, and degradation within, lysosomes (inmost higher eukaryotes and some protists such as Dictyostelium ) or the vacuole (in plants and fungi). In other words, it is especially important that investigators new to the fi eld understand that the appearance of more autophagosomes does not necessarily equate with more autophagy. In fact, in many cases, autophagosomes accumulate because of a block in trafficking to lysosomes without a concomitant change in autophagosome biogenesis, whereas an increase in autolysosomes may reflect a reduction in degradative activity. It is worth emphasizing here that lysosomal digestion is a stage of autophagy and evaluating its competence is a crucial part of the evaluation of autophagic flux, or complete autophagy. Here, we present a set of guidelines for the selection and interpretation of methods for use by investigators who aim to examine macroautophagy and related processes, as well as for reviewers who need to provide realistic and reasonable critiques of papers that are focused on these processes. These guidelines are not meant to be a formulaic set of rules, because the appropriate assays depend in part on the question being asked and the system being used. In addition, we emphasize that no individual assay is guaranteed to be the most appropriate one in every situation, and we strongly recommend the use of multiple assays to monitor autophagy. Along these lines, because of the potential for pleiotropic effects due to blocking autophagy through genetic manipulation it is imperative to delete or knock down more than one autophagy-related gene. In addition, some individual Atg proteins, or groups of proteins, are involved in other cellular pathways so not all Atg proteins can be used as a specific marker for an autophagic process. In these guidelines, we consider these various methods of assessing autophagy and what information can, or cannot, be obtained from them. Finally, by discussing the merits and limits of particular autophagy assays, we hope to encourage technical innovation in the field

Athletic-ideal internalisation: Lived experiences of female students

Research has shown a clear relationship between the thin-ideal internalisation, disturbed eating and body-related disturbances. With regard to athletic internalisation, the relationship with these outcomes appears to be less detrimental than was found with the thin-ideal. However, minimal research has been done on the lived experiences of individuals subscribing to the athletic-ideal. This qualitative study followed a phenomenological approach to explore the perceptions of nine participants of their athletic-ideal internalisation. Data from semi-structured interviews were analysed through Interpretative Phenomenological Analysis. Results indicated a prominent theme of balance with regard to eating and exercise. In this study, it was evident that pursuits of participants of the athletic-ideal body are more focused on health-related goals than on appearance-related ideals. Following the guidelines of a healthy lifestyle and a balanced exercise routine seems to act as protective factors against body image disturbances, maladaptive eating and compulsive exercise. Keywords: Athletic-ideal; Body dissatisfaction; Eating disturbances; Healthy lifestyle; Obligatory exercise; Thin-idea

Experiences of young adult women with emotionally absent fathers

This study explored the experiences of young adult women (n = 11) who grew up with emotionally absent fathers. The women (White: Afrikaans) were between the ages of 20 and 31 (5 were married, 1 was engaged, 1 was in a relationship, and 4 were single). The participants completed in-depth interviews regarding their retrospective perceptions of emotionally absent father experiences and the related effects on them. Data were thematically analyzed. Findings indicated that the participants experienced difficulty in sharing emotions with their fathers and fathers did not show affection or express their love. The participants perceived their fathers to have shown no interest, approval or acknowledgement of them, and viewed them as untrustworthy. They also believed that relationship qualities with their fathers influenced how they related to men in general. Father emotional absence negatively impacts on daughter's emotional well-being

Sputum color as a marker for bacteria in acute exacerbations of chronic obstructive pulmonary disease: a systematic review and meta-analysis

Rationale: Diagnosing bacterial infection as the etiology in acute exacerbations of chronic obstructive pulmonary disease (AECOPDs) remains challenging. Sputum discoloration is easily measured and often used as a marker of bacterial infection in AECOPD, although high-quality evidence for this practice is lacking. Objectives: To determine the diagnostic accuracy of sputum color as a marker for bacteria in AECOPD. Methods: Articles were searched for in electronic databases, and the gray literature were reviewed. Quality assessment of included articles was performed using the revised Quality Assessment of Diagnostic Accuracy Studies tool. A meta‐analysis was conducted using a bivariate logistic regression model with random effects. Analysis was conducted on individual sputum samples rather than on individual participants so that each sample represented a unique index test. Results: Of the 1,600 candidate studies, 13 eligible studies satisfied the inclusion criteria. These included prospective cohort studies (n = 3), cross-sectional studies (n = 3), and secondary analyses of randomized controlled trials (n = 7). The included studies were all from Europe and North America. Most studies scored high risk of bias in at least one domain. In total, this systematic review and meta-analysis included 5,770 sputum samples. The estimated pooled sensitivity and specificity were 81% (95% confidence interval [CI], 70–88%) and 50% (95% CI, 35–65%), respectively, and these results were not significantly altered in a series of sensitivity analyses. Conclusions: Sputum color has limited value as a stand-alone test in diagnosing bacterial infection as the etiology in AECOPD because of its moderate sensitivity and poor specificity

Sputum colour as a marker for bacteria in acute exacerbations of COPD: protocol for a systematic review and meta-analysis

Background Chronic obstructive pulmonary disease (COPD) is a major cause of years of life lost globally. Acute exacerbations of COPD (AECOPD) drive disease progression, reduce quality of life and are a source of mortality in COPD. Approximately 50% of AECOPD are due to bacterial infections. Diagnosing bacterial infection as the aetiology of AECOPD however remains challenging as investigations are limited by practicality, accuracy and expense. Clinicians have traditionally used sputum colour as a marker of bacterial infection in AECOPD, despite the lack of high-quality evidence for this practice. The aim of this systematic review and meta-analysis is to determine the diagnostic accuracy of sputum colour in the diagnosis of bacterial causes of AECOPD. Methods Articles will be searched for in electronic databases (MEDLINE, Google Scholar Scopus, Web of Science, Africa-Wide, CINAHL and Health Source Nursing Academy) and we will conduct a review of citation indexes and the grey literature. Two reviewers will independently conduct study selection, against pre-defined eligibility criteria, data extraction and quality assessment of included articles using the QUADAS-2 tool. We will perform a meta‐analysis using a bivariate logistic regression model with random effects. We will explore heterogeneity through the visual examination of the forest plots of sensitivities and specificities and through the inclusion of possible sources of heterogeneity as covariates in a meta-regression model if sufficient studies are included in the analysis. We also perform a sensitivity analysis to explore the effect of study quality on our findings. The results of this review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement and will be submitted for peer-review and publication. Discussion The findings of this review will assist clinicians in diagnosing the aetiology of AECOPD and may have important implications for decision making in resource-limited settings, as well as for antimicrobial stewardship. Systematic review registration PROSPERO CRD4201914149

Exploring the role, needs and challenges of relatives of mothers with HIV or HIV and psychosis: a qualitative study

This study explored types and nature of supports by relatives of mothers living with HIV and psychosis in comparison to mothers with HIV only. Interview data on their experiences of their roles, needs and challenges were collected from 33 relatives on mothers with HIV and psychosis (n=12, females=10, blacks =12, age ranges 21 to 62) and those with HIV only (n=21, females=16, blacks =21, age ranges 18 to 63). The data were thematically analysed utilizing Atlas.ti. The results showed that relatives in both groups provided a variety of supporting roles. Important challenges were experiencing the negative consequences of especially HIV in combination with psychosis in their lives and dealing with the caregiving responsibilities without having enough information. Important strengths included utilizing support networks and remaining hopeful. Support needs for carers of mothers living with HIV related psychosis or HIV only, can be enhanced with increasing social and material resources at the community level. Supporting needs can be addressed by empowering communities through psycho-educatio

Kidney disease in Africans with HIV and tuberculosis

OBJECTIVE: To describe the spectrum of kidney disease in African patients with HIV and tuberculosis (TB). METHODS: We used data from three cohorts: consecutive patients with HIV/TB in South London (UK, 2004-2016; n = 95), consecutive patients with HIV/TB who underwent kidney biopsy in Cape Town (South Africa, 2014-2017; n = 70), and consecutive patients found to have HIV/TB on autopsy in Abidjan (Cote d'Ivoire, 1991; n = 100). Acute kidney injury (AKI) was ascertained using the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. In the Cape Town cohort, predictors of recovery of kidney function at six months were assessed using Cox regression. RESULTS: In the London cohort, the incidence of moderate/severe AKI at 12 months was 15.1 (95%CI 8.6-26.5) per 100 person-years, and the prevalence of chronic and end-stage kidney disease (ESKD) 13.7% and 5.7% respectively. HIV-associated nephropathy (HIVAN) was diagnosed in 6% of patients in London, and in 6% of autopsy cases in Abidjan. Evidence of renal TB was present in 60% of autopsies in Abidjan and 61% of kidney biopsies in Cape Town. HIVAN and acute tubular necrosis (ATN) were also common biopsy findings in Cape Town. In Cape Town, 40 patients were dialyzed, of whom 28 (70%) were able to successfully discontinue renal replacement therapy. Antiretroviral therapy status, CD4 cell count, eGFR at biopsy and renal pathology, other than ATN, were not predictive of eGFR recovery. CONCLUSIONS: Kidney disease was common in Africans with HIV/TB. Monitoring of kidney function, and provision of acute dialysis to those with severe kidney failure, is warranted