Quality care in vesico-vaginal obstetric fistula: case series report from the regional hospital of Maroua-Cameroon

The World Health Organization (WHO) proposes a successful closure rate for first repair of vesico-vaginal obstetric fistula to be at 85% in each facility, with the continence achievement among the closed cases at 90 %. We are reporting the vesico-vaginal obstetric fistula outcome at the provincial hospital of Maroua- Cameroon from 2005 to August 2007. Among the overall 32 patients with vesico-vaginal fistula operated, 25 patients were at their first operation. The complete closure of vesico-vaginal fistula (VVF) was 23/25 (92%) and among the 23 patients with complete closure 17(74%) had good continence. When we consider only the 25 patients who were at their first operation, the overall closure of VVF was 23/25 (92%) and among them 17/23 (74%) were continent. Large lesion, bladder neck lesions, vaginal adherence and rigid margin are associated with failure/incontinence. These factors must be taken into consideration when preparing patients for surgery or when assigning them to a surgeon within the surgical team

Nonequilibrium effects due to charge fluctuations in intrinsic Josephson systems

Nonequilibrium effects in layered superconductors forming a stack of intrinsic Josephson junctions are investigated. We discuss two basic nonequilibrium effects caused by charge fluctuations on the superconducting layers: a) the shift of the chemical potential of the condensate and b) charge imbalance of quasi-particles, and study their influence on IV-curves and the position of Shapiro steps.Comment: 17 pages, 2 figures, revised version slightly shortene

The organisational and human resource challenges facing primary care trusts : protocol of a multiple case study

BACKGROUND: The study is designed to assess the organisational and human resource challenges faced by Primary Care Trusts (PCTs). Its objectives are to: specify the organisational and human resources challenges faced by PCTs in fulfilling the roles envisaged in government and local policy; examine how PCTs are addressing these challenges, in particular, to describe the organisational forms they have adopted, and the OD/HR strategies and initiatives they have planned or in place; assess how effective these structures, strategies and initiatives have been in enabling the PCTs to meet the organisational and human resources challenges they face; identify the factors, both internal to the PCT and in the wider health community, which have contributed to the success or failure of different structures, strategies and initiatives. METHODS: The study will be undertaken in three stages. In Stage 1 the key literature on public sector and NHS organisational development and human resources management will be reviewed, and discussions will be held with key researchers and policy makers working in this area. Stage 2 will focus on detailed case studies in six PCTs designed to examine the organisational and human resources challenges they face. Data will be collected using semi-structured interviews, group discussion, site visits, observation of key meetings and examination of local documentation. The findings from the case study PCTs will be cross checked with a Reference Group of up to 20 other PCG/Ts, and key officers working in organisational development or primary care at local, regional and national level. In Stage 3 analysis of findings from the preparatory work, the case studies and the feedback from the Reference Group will be used to identify practical lessons for PCTs, key messages for policy makers, and contributions to further theoretical development

Action semantics in retrospect

This paper is a themed account of the action semantics project, which Peter Mosses has led since the 1980s. It explains his motivations for developing action semantics, the inspirations behind its design, and the foundations of action semantics based on unified algebras. It goes on to outline some applications of action semantics to describe real programming languages, and some efforts to implement programming languages using action semantics directed compiler generation. It concludes by outlining more recent developments and reflecting on the success of the action semantics project

Hypertension au cours de la grossesse: Aspects cliniques et épidémiologiques a l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaounde, Cameroun.

L’hypertension artérielle est rencontrée dans presque 10% des grossesses. C’est la 3e cause de mortalité maternelle. Des 4 entités cliniques décrites, la prééclampsie occupe le rôle principal, cependant nous ne savons pas quelle est la place des autres entités. Pendant une période d’un an allant du 1er octobre 2005 au 30 septembre 2006, une étude transversale et descriptive a été menée sur les caractéristiques de la maladie hypertensive au cours de la grossesse. Toutes les patientes avec une tension artérielle supérieure ou égale 140/90 mm Hg, reçues à l’Hôpital Gynéco-Obstétrique et Pédiatrique de Yaoundé ont été retenues. Pour un total de 1629 accouchements, nous avons recensé 134 cas d’hypertension soit une prévalence de 8,2%. Cette pathologie survient dans notre série de manière préférentielle chez la primipare entre 20 et 30 ans. La prééclampsie était la principale entité pathologique avec 77,88% des patientes hypertendues, suivie de l’hypertension gestationnelle avec 15,38% des patientes, et de la prééclampsie surajoutée avec 5,76%. Seulement 0,96% des gestantes avaient une hypertension chronique. Les complications surviennent chez 10,96% des patientes. L’hématome retro - placentaire était la principale complication maternelle, alors que la prématurité et la mort foetale in utéro étaient les complications les plus fréquentes chez les nouveau-nés. Les complications, qu’elles soient maternelles ou foetales, sont l’apanage des formes sévères de l’hypertension. La maladie hypertensive au cours de la grossesse est une cause importante de morbidité et de mortalité maternelle dans notreenvironnement. La prééclampsie est l’entité clinique la plus fréquente et comporte plus de complications foetales et maternelles surtout dans les formes sévères.MOTS CLES: Hypertension artérielle - Grossesse - Complications

Reflections on a 'virtual' practice development unit: changing practice through identity development

Aims. This paper draws together the personal thoughts and critical reflections of key people involved in the establishment of a ‘virtual’ practice development unit of clinical nurse specialists in the south of England. Background. This practice development unit is ‘virtual’ in that it is not constrained by physical or specialty boundaries. It became the first group of Trust-wide clinical nurse specialists to be accredited in the UK as a practice development unit in 2004. Design and methods. The local university was asked to facilitate the accreditation process via 11 two-hour audio-recorded learning sessions. Critical reflections from practice development unit members, leaders and university staff were written 12 months after successful accreditation, and the framework of their content analysed. Findings and discussion. Practice development was seen as a way for the clinical nurse specialists to realize their potential for improving patient care by transforming care practice in a collaborative, interprofessional and evolutionary manner. The practice development unit provided a means for these nurses to analyse their role and function within the Trust. Roberts’ identity development model for nursing serves as a useful theoretical underpinning for the reflections contained in this paper. Conclusions. These narratives provide another example of nurses making the effort to shape and contribute to patient care through organizational redesign. This group of nurses began to realize that the structure of the practice development unit process provided them with the means to analyse their role and function within the organization and, as they reflected on this structure, their behaviour began to change. Relevance to clinical practice. Evidence from these reflections supports the view that practice development unit participants have secured a positive and professional identity and are, therefore, better able to improve the patient experience

Geographic Distribution of Childbirth among Adolescents in Cameroon from 2003 to 2005

Objective. To determine the frequency and the trend of adolescents (10–19 years) in childbirth within a period of 3 years in referral maternity units in Cameroon. Method. Descriptive and retrospective study for a 3-year period (2003–2005) in referral maternity units headed by a qualified Obstetrician-Gynecologist. We analyzed the trend and geographic distribution of 8222 adolescent deliveries over 3 years. Epi Info 3.5 software was used for data analysis. Chi square test for trend was used to assess the contribution of adolescent deliveries over years. The trend was considered significant if P < .05. Results. During the period of the study, there was a total of 8387 deliveries. We excluded 165 women because of lack of information about age. We therefore included a total of 8222 adolescent deliveries. Overall, the contribution of adolescents to deliveries ranged from 6.87% to 26.51%, depending on the region with a national mean of 14.23%. Adolescents aged 16 or less contributed to 2.82% of deliveries while those aged from 17 to 19 contributed to 11.41%. The contribution of adolescents to deliveries decreased significantly over 3 years (P < .0001). Conclusion. The study underscores the importance of Public Health programs in strengthening maternity services for adolescents in Cameroon while taking into consideration geographic differences

Working and learning across professional boundaries

This paper focuses on a context where interdisciplinarity intersects with interprofessionality: the work of children's services professionals who address the needs of children identified as vulnerable. It draws on evidence and perspectives from two disciplines - educational studies and health care - to consider the issues and challenges posed by learning and/or working across disciplinary boundaries and why these have proved so obdurate

The Self stepping into the shoes of the Other: Understanding and developing self-perceptions of empathy among prospective physical education teachers through a special school placement

Teachers who demonstrate a high degree of empathy are said to have more positive attitudes towards pupils with disabilities. Therefore, this article sought to explore the influence of a special school placement on prospective teachers’ self-perceptions of empathy. Thirty-two final year undergraduate students participated in focus group interviews and were selected because they aspired to be a physical education teacher and had attended a placement in a special school. Interview transcripts were analysed and the following themes constructed: Stepping into the shoes of the Other; Frustrated ‘for’ not ‘with’ pupils with disabilities; Empathy for planning inclusive lessons and ‘reading’ pupil body language; and Knowing when not to show empathy. All prospective teachers felt that: (a) they could empathise with pupils with disabilities; (b) situated learning experiences within the placement enabled them to reflect on the ways in which their empathy influences their teaching now and could continue to do so in the future; and (c) it was important that teachers demonstrated empathy. Thus, it is recommended that all prospective teachers gain some experience teaching in special schools. Our research also warns against teachers claiming the last, conclusive word about who children with disabilities are, what they think, how they feel and what they want, in myriad contexts and situations

Phenomenological Theory of Superconductivity and Magnetism in Ho1−x_{1-x}Dyx_xNi2_2B2_2C

The coexistence of the superconductivity and magnetism in the Ho$_{1-x}$Dy$_x$Ni$_2$B$_2$C is studied by using Ginzburg-Landau theory. This alloy shows the coexistence and complex interplay of superconducting and magnetic order. We propose a phenomenological model which includes two magnetic and two superconducting order parameters accounting for the multi-band structure of this material. We describe phenomenologically the magnetic fluctuations and order and demonstrate that they lead to anomalous behavior of the upper critical field. The doping dependence of $T_c$ in Ho$_{1-x}$Dy$_x$Ni$_2$B$_2$C showing a reentrance behavior are analyzed yielding a very good agreement with experimental data.Comment: 4 pages, 3 figures, REVTeX, submitted to PR