Dynamic QRS complex and ST segment vectorcardiographic monitoring can identify vessel patency in patients with acute myocardial infarction treated with reperfusion therapy

Reperfusion therapy has lowered the mortality in patients suffering acute myocardial infarction. Failure to reperfuse is associated with significantly higher risk of short- and long-term mortality. Detection of reperfusion is thus important. In a prospective pilot study, we used continuous on-line computerized vectorcardiography to monitor 21 patients with acute myocardial infarction treated with reperfusion therapy to noninvasively detect coronary patency. By using trend analysis of QRS vector difference, we were able to correctly blindly identify 15 of 16 patients with a perfused infarct-related artery and four of six patients with a persistently occluded artery at an early anglogram. The present results are based on a limited number of patients, but suggest that QRS complex and ST segment monitoring with continuous on-line vectorcardiography has substantial potential for monitoring patients with acute myocardial infarction treated with reperfusion therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29117/1/0000156.pd

An integrated diagnostic device for neonatal sepsis and childhood pneumonia

Not availabl

Under-utilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: a report from the Euro Heart Survey on Heart Failure

Aims Surveys on heart failure management suggest under-utilization of life-saving evidence-based treatment. Evidence-based medicine and clinical guidelines are based on the results of randomized controlled trials. Therefore, we investigated how patients who fulfilled the enrolment criteria of randomized trials were treated in real life. Methods and results We selected three large placebo-controlled trials of patients with chronic heart failure, in which ACE-inhibitors (ACE-Is), β-blockers, and spironolactone proved to be safe and effective. The major enrolment criteria of trials were identified and applied to patients enrolled in the Euro Heart Survey on Heart Failure to identify the proportion of patients eligible for treatment and also treated appropriately. Of the 10 701 patients who were enrolled in the Euro Heart Survey on Heart Failure, only a small percentage (13%) would have qualified for participation in at least one of the selected trials. Patients who fulfilled enrolment criteria of the identified trials were more likely to be treated with ACE-Is (83% of SOLVD-eligible patients), β-blockers (54% of MERIT-HF-eligible patients), and aldosterone antagonists (43% of RALES-eligible patients) than trial-ineligible patients. Almost half of SOLVD-eligible patients who were treated with ACE-Is received the target dose as recommended in the guidelines, but only <10% of MERIT-HF eligible patients who were treated with β-blockers received the target dose. Conclusion ACE-Is are widely utilized but given in lower doses than proven effective in clinical trials. β-Blockers are underused and given in lower doses to patients who fulfil the enrolment criteria of relevant landmark trial

Operational Issues and Trends Associated with the Pilot Introduction of Zinc for Childhood Diarrhoea in Bougouni District, Mali

Zinc for the treatment of childhood diarrhoea was introduced in a pilot area in southern Mali to prepare for a cluster-randomized effectiveness study and to inform policies on how to best introduce and promote zinc at the community level. Dispersible zinc tablets in 14-tablet blister packs were provided through community health centres and drug kits managed by community health workers (CHWs) in two health zones in Bougouni district, Mali. Village meetings and individual counselling provided by CHWs and head nurses at health centres were the principal channels of communication. A combination of methods were employed to (a) detect problems in communication about the benefits of zinc and its mode of administration; (b) identify and resolve obstacles to implementation of zinc through existing health services; and (c) describe household-level constraints to the adoption of appropriate home-management practices for diarrhoea, including administration of both zinc and oral rehydration solution (ORS). Population-based household surveys with caretakers of children sick in the previous two weeks were carried out before and four months after the introduction of zinc supplementation. Household follow-up visits with children receiving zinc from the health centres and CHWs were conducted on day 3 and 14 after treatment for a subsample of children. A qualitative process evaluation also was conducted to investigate operational issues. Preliminary evidence from this study suggests that the introduction of zinc does not reduce the use of ORS and may reduce inappropriate antibiotic use for childhood diarrhoea. Financial access to treatments, management of concurrent diarrhoea and fever, and high use of unauthorized drug vendors were identified as factors affecting the effectiveness of the intervention in this setting. The introduction of zinc, if not appropriately integrated with other disease-control strategies, has the potential to decrease the appropriate presumptive treatment of childhood malaria in children with diarrhoea and fever in malaria-endemic areas

Operational Issues and Trends Associated with the Pilot Introduction of Zinc for Childhood Diarrhoea in Bougouni District, Mali

Zinc for the treatment of childhood diarrhoea was introduced in a pilot area in southern Mali to prepare for a cluster-randomized effectiveness study and to inform policies on how to best introduce and promote zinc at the community level. Dispersible zinc tablets in 14-tablet blister packs were provided through community health centres and drug kits managed by community health workers (CHWs) in two health zones in Bougouni district, Mali. Village meetings and individual counselling provided by CHWs and head nurses at health centres were the principal channels of communication. A combination of methods were employed to (a) detect problems in communication about the benefits of zinc and its mode of administration; (b) identify and resolve obstacles to implementation of zinc through existing health services; and (c) describe household-level constraints to the adoption of appropriate home-management practices for diarrhoea, including administration of both zinc and oral rehydration solution (ORS). Population-based household surveys with caretakers of children sick in the previous two weeks were carried out before and four months after the introduction of zinc supplementation. Household follow-up visits with children receiving zinc from the health centres and CHWs were conducted on day 3 and 14 after treatment for a subsample of children. A qualitative process evaluation also was conducted to investigate operational issues. Preliminary evidence from this study suggests that the introduction of zinc does not reduce the use of ORS and may reduce inappropriate antibiotic use for childhood diarrhoea. Financial access to treatments, management of concurrent diarrhoea and fever, and high use of unauthorized drug vendors were identified as factors affecting the effectiveness of the intervention in this setting. The introduction of zinc, if not appropriately integrated with other disease-control strategies, has the potential to decrease the appropriate presumptive treatment of childhood malaria in children with diarrhoea and fever in malaria-endemic areas

Opinions: What business anthropology is, what it might become… and what, perhaps, it should not be

No available abstract

Person-centred care: Possibilities, barriers and effects in hospitalised patients

The need for a person-centred rather than disease-centred approach to care is considered an important part of care today. However, healthcare professionals still tend to focus on the disease within the per- son rather than on the person with the disease. Envisioning care tailored to each patient’s capabilities and needs, the perspective of this thesis places the person with a long-term illness at the centre of the care process. The core concept of person-centred care (PCC), as defined in this thesis, is a partnership between the patient (and often relatives) and healthcare professionals that is based on respect and dignity. The patient’s narrative is a prerequisite for this relationship, which also must be safeguarded through documentation. The overall aim of this thesis was to investigate the possibilities, barriers and effects of a PCC in the everyday hospital setting focusing on persons with chronic heart failure (CHF). Ethnographic fieldwork, a patient-reported care experience questionnaire and interviews were used to explore the possibilities and barriers of PCC. The effects of PCC were investigated using a quasi-experimental before and after design. In a national sample of patients hospitalised in Sweden during 2010, patients with poor self-rated health and physical dependence reported significantly less positive care experiences regarding com- munication of care and participation than patients with good self-rated health and without physical dependence (p<0.0001). Ethnographic fieldwork in a university hospital ward revealed a care envi- ronment with structures that either promoted or impeded both the patients’ and healthcare profession- als’ different actions and relationships. The design of the hospital environment, focus on biomedical routines and limited opportunities for dialogue, restricted the choices available to both patients and healthcare professionals. The healthcare professionals, primarily registered nurses, felt that the struc- tures restricted their ability to provide optimal care for the patient, which in turn made them feel guilty. The patients seemed to accept the prerequisites of the hospital structures and routines and as- sumed a role of passive recipients of care. However, patients with CHF often have untapped personal resources (e.g., independence and vitality) prior to hospitalisation that may potentially be exploited to engage the patient and improve care. Levels of self-rated independence (Activities of Daily Living - ADL) and beliefs in one’s ability to achieve/attain goals in life (self-efficacy) were high. However, when patients were grouped by functional impact of symptoms on everyday life, a significant nega- tive correlation between poor functional status and low self-efficacy (r=-0.27, p<0.001) was found. Patient interviews strengthened the quantitative findings that patients were independent prior to hos- pital admission, and described a pattern wherein patients increasingly restricted their social spaces to areas nearby their homes during illness deterioration. In the PCC intervention group (n=125) length of indexed hospital stay (LOS) was one day shorter (p=0.16) and ADL was better (p=0.07) than in the conventional treatment group (n=123). When the PCC intervention was fully implemented by the healthcare professional during the entire hospital stay (per protocol analysis, n=74) LOS was reduced by 2.5 days (p=0.01) and ADL level was preserved (p=0.04). Despite reduced LOS, health related quality of life (HRQoL) and time-to-first readmission did not differ between groups. Implementation of PCC in the hospital setting requires increased equality and awareness of the capa- bilities and resources of both patients and healthcare professionals. The care environment with its al- most hegemonic focus on the biomedical explanatory model and routine-based structures restricts the choices available to both patients and healthcare professionals, hence counteracting PCC. The find- ings suggest that a fully implemented PCC approach shortens hospital stay and maintains functional performance in patients hospitalised for worsening CHF, without increasing risk for readmission or jeopardising patients’ HRQoL. The use of patient narratives in combination with simple instruments to uncover the inherent resources of the patient as a starting point for initiating the partnership may serve as a basis for and facilitate collaboration between professionals and patients in setting common care/treatment goals

The way forward for integrated community case managementprogrammes: A summary of lessons learned to date and future priorities

Integrated community case management (iCCM) programming is an important and increasingly common strategy used to deliver essential health and nutrition interventions to families in sub–Saharan Africa. Between 3 and 5 March 2014, over 400 individuals from 35 countries in sub–Saharan Africa and 59 international partner organisations gathered in Accra, Ghana for an iCCM Evidence Review Symposium. The objective of the Symposium was twofold: first, to review the current state of the art of iCCM implementation by bringing together researchers, donors, government, implementers and partners to review the map of the current landscape and status of evidence in key iCCM programme areas, in order to draw out priorities, lessons and gaps for improving child and maternal–newborn health and nutrition. Second, to assist African countries to integrate and take action on key frontline iCCM findings presented during the evidence Symposium around eight thematic areas: 1) Coordination, Policy Setting and Scale up; 2) Human Resources and Deployment; 3) Supervision & Performance Quality Assurance; 4) Supply Chain Management; 5) Costs, and cost-effectiveness and financing; 6) Monitoring, Evaluation and Health Information Systems; 7) Demand generation and social mobilisation; and 8) Impact and outcome evaluations. The eight thematic areas were based on the CCM benchmark framework, a tool for iCCM program planners and managers to systematically design and implement iCCM programs from the early phases through expansion and scale up. The framework specifies key steps that should be completed for each component and phase of implementation

Home management of childhood diarrhoea in southern Mali--Implications for the introduction of zinc treatment

Diarrhoea remains one of the leading killers of young children. A recent meta-analysis demonstrated that a two-week course of zinc tablets once daily significantly reduces the severity and duration of diarrhoea and mortality in young children (Bhutta et al., 2000. Therapeutic effects of oral zinc in acute and persistent diarrhea in children in developing countries: Pooled analysis of randomized controlled trials. American Journal of Clinical Nutrition, 72(6), 1516-1522). Formative research is being conducted in a number of countries to prepare for the large-scale promotion of this new treatment. In-depth and semi-structured interviews with parents, community health workers, and traditional healers were conducted to examine the household management of diarrhoea in the Sikasso region of southern Mali in preparation for the introduction of a short-course of daily zinc for childhood diarrhoea at the community level. Supporting data from a subsequent household survey are also presented. Although nearly all parents knew oral rehydration solution (ORS) could replace lost fluids, its inability to stop diarrhoea caused parents to seek antibiotics from local markets, traditional medicines or anti-malarials to cure the illness. The notion of combining multiple treatments to ensure the greatest therapeutic benefit was prevalent, and modern medicines were often administered simultaneously with traditional therapies. As parents often deem ORS insufficient and judge that an additional treatment should be combined with ORS to cure diarrhoea, the concept of joint therapy of zinc and ORS should be well accepted in the community. Mothers-in-law and fathers, who play a significant role in decisions to seek treatment for sick children, as well as traditional healers, should also be considered when designing new programs to promote zinc. Similarities with formative research conducted for a previous generation of diarrhoea control programmes are discussed.Diarrhoea Zinc Oral rehydration therapy Ethnomedicine Child health Mali

Plasmodium falciparum Merozoite Surface Proteins Polymorphisms and Treatment Outcomes among Patients with Uncomplicated Malaria in Mwanza, Tanzania

Background. The severity of malaria infection depends on the host, parasite and environmental factors. Merozoite surface protein (msp) diversity determines transmission dynamics, P. falciparum immunity evasion, and pathogenesis or virulence. There is limited updated information on P. falciparum msp polymorphisms and their impact on artemether-lumefantrine treatment outcomes in Tanzania. Therefore, this study is aimed at examining msp genetic diversity and multiplicity of infection (MOI) among P. falciparum malaria patients. The influence of MOI on peripheral parasite clearance and adequate clinical and parasitological response (ACPR) was also assessed. Methods. Parasite DNA was extracted from dried blood spots according to the manufacture’s protocol. Primary and nested PCR were performed. The PCR products for both the block 2 region of msp1 and the block 3 regions of msp2 genes and their specific allelic families were visualized on a 2.5% agarose gel. Results. The majority of the isolates, 58/102 (58.8%) for msp1 and 69/115 (60.1%) for msp2, harboured more than one parasite genotypes. For the msp1 gene, K1 was the predominant allele observed (75.64%), whereas RO33 occurred at the lowest frequency (43.6%). For the msp2 gene, the 3D7 allele was observed at a higher frequency (81.7%) than the FC27 allele (76.9%). The MOIs were 2.44 for msp1 and 2.27 for msp2 (p=0.669). A significant correlation between age and multiplicity of infection (MOI) for msp1 or MOI for msp2 was not established in this study (rho = 0.074, p=0.521 and rho = −0.129, p=0.261, respectively). Similarly, there was no positive correlation between parasite density at day 1 and MOI for both msp1 (rho = 0.113, p=0.244) and msp2 (rho = 0.043, p=0.712). The association between MOI and ACPR was not observed for either msp1 or mps2 (p=0.776 and 0.296, respectively). Conclusions. This study reports high polyclonal infections, MOI and allelic frequencies for both msp1 and msp2. There was a lack of correlation between MOI and ACPR. However, a borderline significant correlation was observed between day 2 parasitaemia and MOI