Safe birth matters: facilitators and barriers to uptake of the WHO safe childbirth checklist tool in a Tanzania Regional Hospital

Background: The World Health Organization (WHO) developed the Safe Birth Checklist (SCC) to facilitate best practices in safe birthing practices. The SCC is utilizing existing evidence-based WHO guidelines and recommendations which has combined those into a single and practical bedside tool. The SCC is the first checklist-based intervention to target the prevention of maternal and neonatal deaths. Objective: The objective of this project was to pilot-test the World Health Organization Safe Childbirth Checklist with Maternity Regional Hospital in, Tanzania. Study Design and Methods: Retrospective analysis on 35 charts were completed to identify presence or absence of documentation aligned with evidenced based checklist items. Staff training, end user observations and focus group discussions were utilized to elicit feedback about the tool and the process. Descriptive statistics and manual content analysis were used to analyze the rate of uptake and ownership over the checklist. The Checklist is broken down into four sections or time points (that are considered natural pause points in the care of laboring women). The four different pause points are admission, delivery, post-partum, and discharge Results: We trained 26 participants out of 32 staff how to use the SCC. Delivery time point had the lowest at SCC completion rate at 39% compared to discharge having the highest completion rate at 93%. There was variation in completion rate of the checklist items at each time point. Checklist items at the beginning of each time point were completed between 94% and 100% of the time with the latter checklist list items completed between 29% and 57% of the time Conclusion: This project was able to identify facilitators and potential barriers to the successful uptake of the Safe Childbirth Checklist in Shinyanga Regional Hospital. Based on these findings, the MOH have opportunities to utilize those findings in the scale-up of the implementation of the checklist and future evaluation activities

The Sμ Tandem Repeat Region Is Critical for Ig Isotype Switching in the Absence of Msh2

AbstractDeficiencies of the Msh2 protein or the Sμ tandem repeat (SμTR) sequences each reduce isotype switching in mice by about 2- to 3-fold. We find that switching in mice deficient for both Msh2 and SμTR is nearly ablated. We propose that the SμTR provides closely spaced cleavage sites that can undergo switch recombination independent of Msh2, whereas cleavages in sequences flanking the SμTR require Msh2 processing to allow recombinational joining. We also find that changes in Sμ sequences alter the focus of switch junctions within Sγ sequences, indicating that sequences of switch regions act together in the choice of switch recombination junctions. These findings help to explain the conservation of tandemly repeated switch regions associated with heavy chain constant genes in species capable of switching

Treatment outcome and prognostic factor analysis in transplant-eligible Chinese myeloma patients receiving bortezomib-based induction regimens including the staged approach, PAD or VTD

BACKGROUND: We have reported promising outcomes using a staged approach, in which bortezomib/thalidomide/dexamethasone was used only in 14 patients with suboptimal response to VAD (vincristine/adriamycin/dexamethasone) before autologous stem cell transplantation (ASCT). Here we compared the outcomes of the staged approach with frontline PAD (bortezomib/doxorubicin/dexamethasone) or VTD (bortezomib/thalidomide/dexamethasone) induction, and analysed prognostic factors for outcome. PATIENTS AND METHODS: Ninety-one transplant-eligible Chinese patients received three induction regimens prior to ASCT [staged approach (N = 25), PAD (N = 31), VTD (N = 35)]. and received thalidomide maintenance for 2 years post-ASCT. RESULTS: 43 (47.3%) patients had International Staging System (ISS) III disease. By an intention-to-treat analysis, the overall CR/nCR rate were 37.4% post-induction, and 62.6% post-ASCT. Five-year overall (OS) and event-free (EFS) survivals were 66% and 45.1%. There was no difference of the post-induction CR/nCR rate, EFS or OS between patients induced by these three regimens. Moreover, ISS III disease did not affect CR/nCR rates. Multivariate analysis showed that ISS and post-ASCT CR/nCR impacted OS while ISS and post-induction CR/nCR impacted EFS. CONCLUSIONS: These three induction regimens produced comparable and favorable outcomes in myeloma. The unfavorable outcome of ISS stage III persisted despite upfront/early use of bortezomib. CR/nCR predicted favorable survivals

A system study on the merchandise management system of Duty Free Philippines Corporation

In an age of ever increasing competitiveness where efficiency and productivity of a company’s operations may be the deciding factor of its profitability, it is important now more than ever to leverage the wealth of tools provided by information technology. A study on the Merchandise Management System of Duty Free Philippines Corp. (DFP), which is a world-class retail company that provides tourists and returning Filipinos with imported merchandise at reduces costs than the competition thanks of being free of duties and customs taxes. Specifically, the sales and inventory data from DFP’s directly owned and fast-moving merchandise was analyzed across their Integrated & Forward warehouses and Store a.k.a Fiestamall. Over the period of the study, the main problem was identified to be the major overstocking of the top four products within the scope of the study. It was determined that inventory levels exceed the Reorder Point plus 10% by as much as 164.13%. The true causes of the overstock that were revealed to be that the logical/software side of the Duty Free’s ERP system, currently the MMS, must undergo fundamental changes in order to significantly improve usability and functionality, and also that a clear, transparent SOP needs to not only be designed but also communicated effectively to the Stockkeepers and Stockclerks, with an active monitoring and user feedback system in place. Be developing a customized inventory model for Duty Free Phils. Corp. based on their past inventory data, and by implementing this in a highly-cost effective and modern ERP solution based on open source technology, DFP Corp. may effectively minimize overstock levels to only 8.2% at most over the Reorder Point for any given product line, satisfying the system objectives and earning the company an estimated$987,588.96 by the end of three-year period. In order to realize the potential cost savings outlined in the study, it is recommended for Corp. to implement the proposed ERP system, and to follow the implementation schedule which highlights the need for user testing and feedback. To ease the migration of the users’ current workflow to the proposed system, various other programs are recommended to be deployed in conjunction with the implementation of ERP solution, particularly in light of the users’ previous failure when attempting to upgrade to their current system; all users must undergo seminars and workshops to get accustomed to the new system, and; a system to convenient and open culture of communication between users and IT personnel must be set up to address problems promptly

Children and the coronavirus disease 2019 pandemic: a Caribbean perspective

This study aims to assess coronavirus disease 2019 (COVID-19) surveillance methods, health resources, vaccination coverage and income stratification and quantify burdens of disease and death in children and adolescents in the Caribbean. The investigation was a descriptive, cross-sectional study that included 15 Caribbean countries/territories and utilized surveys and secondary data sources. Quarantine and isolation measures were robust and surveillance strategies were similar. Pediatric specialists were available across the region, but few had designated pediatric hospitals or high-dependency units. There were more cases in children on islands with larger populations. Compared to high-income countries/territories, upper and lower middle-income countries/territories had higher disease burdens, fewer doctors and nurses per 1 000 population, lower bed capacities, and lower vaccination coverage. Child and adolescent cases ranged from 0.60% to 16.9%, compared with a global case rate of 20.2% in 2021. By August 2021 there were 33 deaths among children from Haiti, Jamaica, Trinidad and Tobago, and Barbados. The respective case fatality rates for 09-year-olds and 1019-year-olds were 2.80 and 0.70 in Haiti, 0.10 and 0.20 in Jamaica, and 0.00 and 0.14 in Trinidad, compared with 0.17 and 0.1 globally. Overall COVID-19 incidence and mortality in children were consistent with global estimates. Limited resources have been offset by availability of pediatricians across the region, and minimally direct effects on children. Prioritization of admission of specific at-risk groups, training of first responders and vaccination campaigns targeting pregnant women and vulnerable children and adolescents could benefit countries with low vaccine coverage rates and limited resources

Breakthrough invasive fungal diseases during echinocandin treatment in high-risk hospitalized hematologic patients

The frequency of breakthrough invasive fungal diseases (IFDs) during echinocandin therapy is unclear. We retrospectively analyzed 534 hematologic patients treated with echinocandin (caspofungin, N = 55; micafungin, N = 306; anidulafungin, N = 173). Four proven IFDs were found, caused by Candida parapsilosis (N = 2), C. parapsilosis and Candida glabrata (N = 1), and Fusarium species (N = 1). Four cases of possible IFDs were observed, all showing pulmonary infection. One case showed features suggestive of hepatosplenic candidiasis. Six of these eight cases had previously received the purine analog clofarabine. Breakthrough IFD during echinocandin treatment occurred infrequently (1.5 %), caused predominantly by Candida species. Clofarabine usage was an important risk factor. © 2013 Springer-Verlag Berlin Heidelberg.link_to_subscribed_fulltex

Insulin management and metabolic control of Type 1 diabetes mellitus in childhood and adolescence in 18 countries

SCOPUS: ar.jFLWINinfo:eu-repo/semantics/publishe