scholarly journals Active search strategies, clinicoimmunobiological determinants and training for implementation research confirm hidden endemic leprosy in inner São Paulo, Brazil

2021 ◽  
Vol 15 (6) ◽  
pp. e0009495
Author(s):  
Fred Bernardes Filho ◽  
Claudia Maria Lincoln Silva ◽  
Glauber Voltan ◽  
Marcel Nani Leite ◽  
Ana Laura Rosifini Alves Rezende ◽  
...  
Keyword(s):  
Spatial Epidemiology ◽  
Implementation Strategies ◽  
Disease Spread ◽  
Case Detection Rate ◽  
Primary Care Teams ◽  
Quasi Experimental ◽  
Hands And Feet ◽  
The Town ◽  
And Training

Background This study evaluates implementation strategies for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzes immunoepidemiological aspects and follow-up of individuals living in a presumptively nonendemic area in Brazil. Methodology/Principal findings Quasi-experimental study based on LSQ throughout Jardinópolis town by community health agents, theoretical-practical trainings for primary care teams, dermatoneurological examination, anti-PGL-I serology, RLEP-PCR, and spatial epidemiology. A Leprosy Group (LG, n = 64) and Non-Leprosy Group (NLG, n = 415) were established. Overall, 3,241 LSQs were distributed; 1,054 (32.5%) LSQ were positive for signs/symptoms (LSQ+). Among LSQ+ respondents, Q2-Tingling (pricking)? (11.8%); Q4-Spots on the skin? (11.7%); Q7-Pain in the nerves? (11.6%); Q1-Numbness in your hands and/or feet? (10.7%) and Q8-Swelling of hands and feet? (8.5%) were most frequently reported symptoms. We evaluated 479 (14.8%) individuals and diagnosed 64 new cases, a general new case detection rate (NCDR) of 13.4%; 60 were among 300 LSQ+ (NCDR-20%), while 4 were among 179 LSQ negative (NCDR-2.23%). In LG, Q7(65%), Q2(60%), Q1(45%), Q4(40%) and Q8(25%) were most frequent. All 2x2 crossings of these 5 questions showed a relative risk for leprosy ranging from 3 to 5.8 compared with NLG. All patients were multibacillary and presented hypochromatic macules with loss of sensation. LG anti-PGL-I titers were higher than NLG, while 8.9% were positive for RLEP-PCR. The leprosy cases and anti-PGL-I spatial mappings demonstrated the disease spread across the town. Conclusions/Significance Implementation actions, primarily LSQ administration focused on neurological symptoms, indicate hidden endemic leprosy in a nonendemic Brazilian state.

scholarly journals Improving the Recording of Diagnoses in Primary Care with Team Incentives: A Controlled Longitudinal Follow-Up Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Tuomo Lehtovuori ◽  
Timo Kauppila ◽  
Jouko Kallio ◽  
Anna M. Heikkinen ◽  
Marko Raina ◽  
...  
Keyword(s):  
Primary Care ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Follow Up Study ◽  
Primary Care Teams ◽  
Before And After ◽  
Quasi Experimental ◽  
Clinically Significant ◽  
Made In

Introduction. We studied whether primary care teams respond to financial group bonuses by improving the recording of diagnoses, whether this intervention leads to diagnoses reflecting the anticipated distribution of diseases, and how the recording of a significant chronic disease, diabetes, alters after the application of these bonuses. Methods. We performed an observational register-based retrospective quasi-experimental follow-up study with before-and-after setting and two control groups in primary healthcare of a Finnish town. We studied the rate of recorded diagnoses in visits to general practitioners with interrupted time series analysis. The distribution of these diagnoses was also recorded. Results. After group bonuses, the rate of recording diagnoses increased by 17.9% (95% CI: 13.6–22.3) but not in either of the controls (−2.0 to −0.3%). The increase in the rate of recorded diagnoses in the care teams varied between 14.9% (4.7–25.2) and 33.7% (26.6–41.3). The distribution of recorded diagnoses resembled the respective distribution of diagnoses in the former studies of diagnoses made in primary care. The rate of recorded diagnoses of diabetes did not increase just after the intervention. Conclusions. In primary care, the completeness of diagnosis recording can be, to varying degrees, influenced by group bonuses without guarantee that recording of clinically significant chronic diseases is improved.

scholarly journals Modul pendamping KMS sebagai sarana ibu untuk memantau pertumbuhan balita

2018 ◽  
Vol 3 (1) ◽  
pp. 42
Author(s):  
Agus Hendra Al Rahmad
Keyword(s):  
Experimental Design ◽  
Infant Growth ◽  
T Test ◽  
Growth Chart ◽  
Growth Monitoring ◽  
Quasi Experimental ◽  
Kolmogorov Smirnov ◽  
And Training ◽  
Identity Knowledge

Rendahnya pemahaman masyarakat terutama ibu-ibu balita dalam melihat KMS, termasuk dalam pemantauan pertumbuhan balita mereka berdampak terhadap rendahnya kunjungan atau partisipasi masyarakat. Pemahaman yang kurang baik tentang pemantauan pertumbuhan balita akan berpengaruh terhadap kunjungan ke posyandu, dan memungkinkan balita tidak terpantau status gizi. Penelitian bertujuan untuk meningkatkan pengetahuan ibu balita tentang pemantauan pertumbuhan balita. Desain kuasi-eksperimen melalui pendekatan analitik pada 50 ibu-ibu yang mempunyai balita dilakukan di Kecamatan Lhoknga sejak Agustus – September 2017. Pengumpulan data secara wawancara menggunakan kuesioner terkait identitas, pengetahuan. Analisis yang digunakan yaitu Kolmogorov Smirnov, uji F (Levene’s Test for Equality of Variances) serta untuk membuktikan hipotesis, maka digunakan statistik dependent t-test dan independent t-test. Hasil penelitian menunjukan pelatihan modul pendamping KMS bagi ibu signifikan dalam meningkatkan pengetahuan sebesar 13,0% atau mempunyai selisih rerata 2,6 (CI 95%: 1,17 – 3,93) dengan nilai p= 0,001 (p < 0,05). Kesimpulan, untuk meningkatkan pengetahuan ibu dalam memantau pertumbuhan balita maka sangat baik digunakan modul pendamping KMS. Saran, perlu tindak lanjut berupa penyuluhan maupun pelatihan secara kontinu dalam meningkatkan angka pemantauan pertumbuhan kepada ibu-ibu balita, yang dapat dilakukan secara intensif dengan melibatkan tenaga penyuluh yang profesional.Kata kunci :  KMS, pemantauan pertumbuhan, pengetahuan, ibu balita   The low understanding of the community, especially mothers of under-five children in seeing Growth Chart, including in monitoring the growth of their toddlers, has an impact on low visits or public participation. Inadequate understanding of infant growth monitoring will affect visitation to Health Center, and allow child not to be monitored nutritional status. The aim of this research is to improve mother's knowledge about infant growth monitoring. Quasi-experimental design through an analytic approach in 50 mothers with toddlers was conducted in Lhoknga Sub-District from August to September 2017. Data collection was interviewed using questionnaires related to identity, knowledge. The analysis used is Kolmogorov Smirnov, F-test (Levene's Test for Equality of Variances) and to prove hypothesis, hence statistic dependent t-test and independent t-test. The results showed that the training of growth chart is an assistant module for the mother was significant in increasing the knowledge of 13,0% or had a difference of 2,6 (95% CI: 1,17 – 3,93) with p = 0,001 (p <0,05). In conclusion, to improve mother's knowledge in monitoring the growth of toddler hence very good used growth chart companion module. Suggestion, need follow-up in the form of counseling and training continuously in increasing growth monitoring number to mother of a toddler, which can be done intensively by involving professional extension workers.Keywords: Growth Chart, growth monitoring, knowledge, mother of a toddler

Pendayagunaan Sampah Menjadi Produk Kerajinan

2017 ◽  
Vol 17 (1) ◽  
pp. 83
Author(s):  
Nur Fatoni ◽  
Rinaldy Imanuddin ◽  
Ahmad Ridho Darmawan
Keyword(s):  
Waste Management ◽  
Raw Materials ◽  
Economic Value ◽  
Waste Materials ◽  
Waste Collection ◽  
Garbage Disposal ◽  
Waste Separation ◽  
And Training

Waste management is still defined as limited to collection, transportation and garbage disposal. The follow-up of the meaning is the provision of facilities such as garbage bins, garbage trucks and waste collection land. Waste management has not included waste separation. Segregation of waste can minimize the amount of waste that must be discharged to the final place. Segregation of waste can supply recyclable raw materials and handicrafts made from garbage. The manufacture of handicraft products from garbage is still local and requires socialization and training. It is needed to increase the number of craftsmen and garbage absorption on the crafters. Through careful socialization and training, citizens' awareness of waste management becomes advanced by making handicrafts of economic value from waste materials.

scholarly journals Strategies to Integrate Genomic Medicine into Clinical Care: Evidence from the IGNITE Network

2021 ◽  
Vol 11 (7) ◽  
pp. 647
Author(s):  
Nina R. Sperber ◽  
Olivia M. Dong ◽  
Megan C. Roberts ◽  
Paul Dexter ◽  
Amanda R. Elsey ◽  
...  
Keyword(s):  
Precision Medicine ◽  
Program Implementation ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Implementation Strategies ◽  
Clinical Decision ◽  
Implementing Change ◽  
Implementation Outcomes ◽  
Planning Framework

The complexity of genomic medicine can be streamlined by implementing some form of clinical decision support (CDS) to guide clinicians in how to use and interpret personalized data; however, it is not yet clear which strategies are best suited for this purpose. In this study, we used implementation science to identify common strategies for applying provider-based CDS interventions across six genomic medicine clinical research projects funded by an NIH consortium. Each project’s strategies were elicited via a structured survey derived from a typology of implementation strategies, the Expert Recommendations for Implementing Change (ERIC), and follow-up interviews guided by both implementation strategy reporting criteria and a planning framework, RE-AIM, to obtain more detail about implementation strategies and desired outcomes. We found that, on average, the three pharmacogenomics implementation projects used more strategies than the disease-focused projects. Overall, projects had four implementation strategies in common; however, operationalization of each differed in accordance with each study’s implementation outcomes. These four common strategies may be important for precision medicine program implementation, and pharmacogenomics may require more integration into clinical care. Understanding how and why these strategies were successfully employed could be useful for others implementing genomic or precision medicine programs in different contexts.

scholarly journals Implementation of an Antimicrobial Stewardship Program in Five Colombian Hospitals in 2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s273-s273
Author(s):  
Christian Pallares ◽  
María Virginia Villegas Botero
Keyword(s):  
Infection Control ◽  
Antimicrobial Stewardship ◽  
Control Strategies ◽  
Education And Training ◽  
Public Hospitals ◽  
International Standards ◽  
International Consensus ◽  
Stewardship Program ◽  
And Training

Background: More than 50% of antibiotics used in hospitals are unnecessary or inappropriate. The antimicrobial stewardship programs (ASPs) are coordinated efforts to promote the rational and effective use of antibiotics including appropriate selection, dosage, administration, and duration of therapy. When an ASP integrates infection control strategies, it is possible to decrease the transmission of multidrug-resistant pathogens. Methods: In 2018, 5 Colombian hospitals were selected to implement an ASP. Private and public hospitals from different cities were included in the study, ranging from 200 to 700 beds. Our team, consisting of an infectious disease and hospital epidemiologist, visited each hospital to establish the baseline of their ASP program, to define the ASP outcomes according to each hospital’s needs, and to set goals for ASP outcomes in the following 6–12 months. Follow-up was scheduled every 2 months through Skype video conference. The baseline diagnosis or preintervention evaluation was done using a tool adapted from previous reports (ie, international consensus and The Joint Commission international standards). Documentation related to ASPs, such as microbiological profiles, antimicrobial guidelines (AMG) and indicators for the adherence to them as well as antimicrobial resistance (AMR) prevention through protocols, were written and/or updated. Prevention and infection control requirements and protocols were also updated, and cleaning and antiseptic policies were created. Training in rational use of antibiotic, infection control and prevention, and cleaning and disinfection were carried out with the healthcare workers in each institution. Results: Before the intervention, the development of the ASP according to the tool was 27% (range, 5%–47%). The lowest institutional scores were the item related to ASP feedback and reports (11% on average), followed by education and training (14%), defined ASP responsibilities (23%), ASP function according to priorities (26%), and AMR surveillance (27%). After the intervention, the ASP development increased to 57% (range, 39%–81%) in the hospitals. The highest scores achieved were for education and training (90%), surveillance (75%), and the activities of the infection control committee (70%). The items that made the greatest contribution to ASP development were the individual antibiogram, including the bacteria resistance profile, and the development of the AMG based on the local epidemiology in each hospital. Conclusions: The implementation of an ASP should include training and education as well as defining outcomes according to the hospital’s needs. Once the strategy is implemented, follow-up is key to achieving the goals.Funding: NoneDisclosures: None

Low Vision Services in an Agency: Structure and Philosophy

1975 ◽  
Vol 69 (6) ◽  
pp. 241-248
Author(s):  
Eleanor E. Faye ◽  
Clare M. Hood
Keyword(s):  
New York ◽  
Low Vision ◽  
Medical Director ◽  
The Other ◽  
Special Services ◽  
Full Discussion ◽  
Loan System ◽  
Training Services ◽  
And Training

The development and present structure of the comprehensive Low Vision Service of the New York Association for the Blind are used as the basis for a full discussion of the operation of such a clinical service, including its positive and negative features. The clinic is administered by a medical director and by an administrator who coordinates the work of a staff consisting of ophthalmologists, optometrists, low vision assistants, volunteers, registrar, and receptionist. A separate Optical Aids Service stocks low vision aids which it sells by prescription to clinics, doctors, and patients within and without the agency. Referrals for special services are made to the other departments of the agency. Also described are the low vision examination itself, follow-up and training services, and the aid loan system.

scholarly journals Effect of nutrition education by health professionals on pregnancy-specific nutrition knowledge and healthy dietary practice among pregnant women in Asmara, Eritrea: a quasi-experimental study

2021 ◽  
pp. bmjnph-2020-000159
Author(s):  
Lidia Ghirmai Teweldemedhin ◽  
Helen Gebretatyos Amanuel ◽  
Soliana Amanuel Berhe ◽  
Ghidey Gebreyohans ◽  
Zemenfes Tsige ◽  
...  
Keyword(s):  
Experimental Study ◽  
Pregnant Women ◽  
Nutrition Education ◽  
Health Professionals ◽  
Repeated Measures ◽  
Nutritional Knowledge ◽  
Dietary Practice ◽  
Quasi Experimental ◽  
Knowledge And Practice

BackgroundHealthy pregnancy and birth outcomes are greatly influenced by the intake of adequate and balanced nutrition. Pregnant women’s nutritional knowledge and practice have been identified as an important prerequisites for their proper nutritional intake. The antenatal period with the opportunities for regular contact with health professionals appears to be the ideal time and setting to institute the intervention which could maximise pregnant women’s outcome and that of their baby by motivating them to make nutritional changes.ObjectiveTo assess the effect of nutrition education on the appropriate nutritional knowledge and practice of pregnant women.MethodologyA facility-based single-group pre–post quasi-experimental study design was employed in five health facilities providing antenatal care (ANC) service in Asmara on 226 pregnant women. A predesigned and pretested questionnaire was used to collect data regarding nutritional knowledge via interview by trained data collectors during the pretest, immediate post-test and 6 weeks later. The practice was assessed at pre-intervention and 6 weeks later only. Repeated measures analysis of variance and paired t-test were used to make comparisons in knowledge and practice scores, respectively, using SPSS (V.22).ResultsTraining provided to pregnant women resulted in a significant increase on the mean scores of their knowledge from 29.01/47 (SE=0.35) pre-intervention to 42.73/47 (SE=0.24) immediate post-intervention. However, the score declined significantly from immediate after intervention to 6-week follow-up by 1.79 (SE=0.22). Although the score declined, knowledge at 6-week follow-up was still significantly greater than that of pre-intervention (p<0.0001). Health professionals (70.2%) were the primary source of information for pregnant women. The pregnancy-specific dietary practice score at 6-week follow-up (M=13.13/16, SE=0.09) was significantly higher than that of pre-intervention (M=12.55/16, SE=0.16). There was no significant interaction between the categories of demographic characteristics and change in practice and knowledge.ConclusionThis study has shown that the nutrition messages given to pregnant women by trained health professionals using a holistic approach in a sustained manner played a huge role in increasing their knowledge and in introducing positive dietary practices among them. Thus, ANC clinics must play a leading role in coordinating the effort of awareness creation regarding nutrition during pregnancy.

scholarly journals Using a 4K three-dimensional exoscope system (Vitom 3D) for mastoid surgery during the coronavirus disease 2019 pandemic

2021 ◽  
pp. 1-3
Author(s):  
M Ally ◽  
P Kullar ◽  
G Mochloulis ◽  
A Vijendren
Keyword(s):  
Residual Disease ◽  
Elective Surgery ◽  
Three Dimensional ◽  
Depth Of Field ◽  
High Definition ◽  
Microscopic Surgery ◽  
Lateral Skull Base ◽  
Mastoid Surgery ◽  
And Training

Abstract Objective Microscopic surgery is currently considered the ‘gold standard’ for middle-ear, mastoid and lateral skull base surgery. The coronavirus disease 2019 pandemic has made microscopic surgery more challenging to perform. This work aimed to demonstrate the feasibility of the Vitom 3D system, which integrates a high-definition (4K) view and three-dimensional technology for ear surgery, within the context of the pandemic. Method Combined approach tympanoplasty and ossiculoplasty were performed for cholesteatoma using the Vitom 3D system exclusively. Results Surgery was performed successfully. The patient made a good recovery, with no evidence of residual disease at follow up. The compact system has excellent depth of field, magnification and colour. It enables ergonomic work, improved work flow, and is ideal for teaching and training. Conclusion The Vitom 3D system is considered a revolutionary alternative to microscope-assisted surgery, particularly in light of coronavirus disease 2019. It allows delivery of safe otological surgery, which may aid in continuing elective surgery.

Walking for Better Outcomes and Recovery: The Effect of WALK-FOR in Preventing Hospital-Associated Functional Decline Among Older Adults

2019 ◽  
Vol 74 (10) ◽  
pp. 1664-1670 ◽  
Author(s):  
Yaniv Cohen ◽  
Anna Zisberg ◽  
Yehudit Chayat ◽  
Nurit Gur-Yaish ◽  
Efrat Gil ◽  
...  
Keyword(s):  
Older Adults ◽  
Group Intervention ◽  
Functional Decline ◽  
Intervention Group ◽  
Control Group ◽  
Community Mobility ◽  
Steps Per Day ◽  
Quasi Experimental ◽  
Activity Survey

Abstract Background In-hospital immobility of older adults is associated with hospital-associated functional decline (HAFD). This study examined the WALK-FOR program’s effects on HAFD prevention. Methods A quasi-experimental pre-post two-group (intervention group [IG] n = 188, control group [CG] n = 189) design was applied in two hospital internal medical units. On admission, patients reported pre-hospitalization functional status, which was assessed again at discharge and 1-month follow-up. Primary outcome was decline in basic activities of daily living (BADL), using the Modified Barthel Index. Secondary outcomes were decline in instrumental ADL (Lawton’s IADL scale) and community mobility (Yale Physical Activity Survey). All participants (75.1 ± 7 years old) were cognitively intact and ambulatory at admission. The WALK-FOR included a unit-tailored mobility program utilizing patient-and-staff education with a specific mobility goal (900 steps per day), measured by accelerometer. Results Decline in BADL occurred among 33% of the CG versus 23% of the IG (p = .02) at discharge, and among 43% of the CG versus 30% in the IG (p = .01) at 1-month follow-up. Similarly, 26% of the CG versus 15% of the IG declined in community mobility at 1-month follow-up (p = .01). Adjusted for major covariates, the intervention reduced the odds of decline in BADL by 41% (p = .05) at discharge and by 49% at 1-month follow-up (p = .01), and in community mobility by 63% (p = .02). There was no significant effect of the intervention on IADL decline (p = .19). Conclusions The WALK-FOR intervention is effective in reducing HAFD.

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