Implementation and Knowledge of the Clinical Practice Guide for Palliative Care in the Ecuadorian Primary Care Level

Ecuador assumed the commitment of including Palliative Care (PC) in its health policies. In 2014, the Ministry of Public Health (Ministerio de Salud Pública, MSP) approved the Clinical Practice Guide for Palliative Care (Guía de Práctica Clínica sobre Cuidados Paliativos, GPCCP), with application at the national level, as a mandatory internal regulation in all institutions belonging to the National Health System. In 2021, there is no evidence about the degree of implementation. The objective was to evaluate the implementation (I) of the GPCCP guide and the knowledge (C) of the health personnel working in the Zone 7 Health Centers (HCs). This is a cross-sectional, descriptive, and prospective study. A total of 292 professionals were interviewed: managers (38), physicians (150), and nurses (104). Three surveys based on the GPCCP guide were elaborated: one for the implementation, which was applied to the individuals in charge, and the others to assess the health professionals’ knowledge. The SPSS program was used, version 25. In the three groups, more than half of the participants had no training in PC, 91.2% of the HCs have the GPCCP guide, there is PC medical history (MH) in 38.2%, and morphine is used in 14.7%. The implementation of the GPCCP guide was inadequate in 52.9% of the cases. Only 25% treat the agony symptoms and 30%, delirium; 4.4% acknowledge the use of morphine in dyspnea, and 13.3% identify the subcutaneous route as the first choice for hydration at the end-of-life phase. Strategies to implement the GPCCP guide and to improve the health personnel’s knowledge must be implemented in Zone 7 centers.

COVID-19 among Healthcare Workers: A Prospective Serological-Epidemiological Cohort Study in a Standard Care Hospital in Rural Germany

Healthcare workers (HCW) play a vital role in the SARS-CoV-2 pandemic control. The aim of this study was to assess the prevalence of SARS-CoV-2 antibodies and the risk of COVID-19 infections in a cohort of HCW from four different risk groups (from intensive care unit to administration) of a hospital of a primary care level in rural Germany. The outcomes were monthly measures of antibody seroprevalence over a period of 6 months. Overall, a seroprevalence of 13.41% was determined, with significantly higher prevalence rates among HCW working in areas with more frequent contact to confirmed or suspected cases (30.30%, p = 0.003). The group specific differences in the risk of infection from COVID-19 were detected, as HCW groups with frequent exposure seemed to have an increased risk (RR = 3.18, p = 0.02; CI95 1.09–9.24). The findings contribute to the epidemiological understanding of the virus spread in an unvaccinated population group, which is highly relevant for the pandemic management.

Pengabdian Kepada Masyarakat Dengan Asuhan Kebidanan Pada Pasien Retensio Placentadi Puskesmas Pembantu Golodukal, Kecamatan Langke Rembong, Kabupaten Manggarai

ABSTRAK Setiap wanita akan melalui proses kehamilan, persalinan, nifas hal tersebut merupakan proses yang fisiologis. Selama menjalani proses tersebut kemungkinan terjadi masalah kesehatan yang dapat menimbulkan kesakitan bahkan kematian baik pada ibu dan bayi. Tujuan kegiatan ini untuk mempelajari dan memahami asuhan kebidanan pada ibu hamil, bersalin, nifas, neonates dan KB secara komprehensif. Metode yang digunakan adalah metode penelitian kualitatif deskriptif dengan pendekatan studi kasus tujuh langkah varney. Tehnik pengambilan data melalui wawancara, observasi langsung dan studi dokumen rekam medic. Analisa data dilakukan secara deskriptif berdasarkan tujuh langkah varney. Hasil kegiatan ini adalah Ny. M.G.L umur 26 tahun, G2P1A0, ibu bersalin dengan retensio placenta dan penatalaksanaan manual placenta sesuai standar SOP di tingkat pelayanan primer, nifas normal, BBL normal dan ibu menggunakan KB suntik 3 bulanan. Kata kunci : Asuhan kehamilan, bersalin, Retensio Placenta. ABSTRACT Every woman will go through a process of pregnancy, childbirth, childbirth, this is a physiological process. During this process, there may be health problems that can cause pain and even death to both mother and baby. The purpose of this activity is to learn and understand midwifery care for pregnant women, childbirth, postpartum, neonates, and family planning in a comprehensive manner. The method used is the descriptive qualitative research method with a seven-step Varney case study approach. Data collection techniques through interviews, direct observation, and study of medic record documents. The data analysis was done descriptively based on the seven Varney steps. The result of this activity is Mrs. M.G.L, 26 years old, G2P1A0, a mother giving birth with retained placenta and manual management of the placenta according to SOP standards at the primary care level, normal postpartum, normal LBW, and the mother uses 3-monthly injection contraceptives. Key words: Pregnancy care, childbirth, Retensio Placenta

Test-retest reliability of the questionnaire on the screening of sleep disorders

Sleep is a vital component for maintaining good physical and mental health. When sleep is disordered, it can adversely affect an individual's mental and physical wellbeing. Although a variety of single specific disorder measurements are available for specialized clinicians use across the globe, to date, there are no proper screening instruments available for screening multiple sleep disorders at the primary care level. The purpose of this study is to determine the test-retest reliability of the sleep disorder screening questionnaire (SDSQ) for detecting multiple sleep disorders among the Mongolian population. A total of 366 university students were recruited for participation. SDSQ was administrated to all participants on two occasions two weeks apart. The test-retest reliability intra-class correlation (ICC) and Cronbach's alpha of the SDSQ were calculated. The sample consisted of 194 (53%) females, and 172 (47%) males, with a mean age of 21.6. Observed test-retest reliability was ranged from 0.53 to 0.81. The SDSQ was found to have excellent internal consistency with an alpha=0.950. The external validity of SDSQ revealed strong test-retest reliability in the current study population. The discriminant and convergent validity studies are required for the further improvement of the construct of the SDSQ.

Patient-Pathway Analysis of Tuberculosis Services in Cameroon

In Cameroon, in 2019, tuberculosis (TB) treatment coverage was estimated at 53%, indicating that almost half of all people sick with TB were not diagnosed or linked to care. To inform strategies to improve access to TB services, we conducted an evaluation of the alignment between patient-initiated care-seeking behavior and spatial and institutional allocation of TB services. Data sources included the Cameroon Demographic and Health Survey (2018), the Health Facility List (2017), and routinely collected TB surveillance data. Data visualization was performed in Tableau and QGIS. The pathway analysis showed that only an estimated 9% of people attended a health facility providing TB services at initial care-seeking, with access varying from <3% to 16% across the ten regions of the country. While 72% of government and 56% of private hospitals (Level 2 facilities) provide TB services, most Cameroonians (87%) initially chose primary care (Level 1) or informal private sector sites (Level 0) without TB services. The gaps were greatest in regions with the highest prevalence of poverty, a significant determinant for TB. These results indicate that access may be improved by expanding TB services at both public and private facilities across the country, prioritizing regions with the greatest gaps.

Palliative care integration indicators: an European regional analysis

ObjectiveTo estimate the capacity of European countries to integrate palliative care (PC) into their health systems through PC service provision for patients of all ages, with different care needs and diseases, in various settings and by a range of providers.MethodsSecondary analysis of survey data from 51 countries with 22 indicators explored the integration of available PC resources for children, for patients of all ages, at the primary care level, for oncology and cardiac patients, and in long-term care facilities. We also measured volunteer participation. Results were quantified, converted into weighted subscores by area and combined into a single ‘Integration Capacity Score (ICS)’ for each country.ResultsThirty-eight countries reported 543 specialised paediatric PC services. One-third of all surveyed countries reported 20% or more of patients with PC needs at the primary care level. Twenty-four countries have a total of 155 designated centres that integrate oncology and PC. Eight countries were pioneering cardiology services that integrate PC. Eight reported a volunteer workforce of over 1000 and 12 had policies regulating PC provision and interventions in long-term care facilities. Across all indicators, 39 countries (76%) score from low to very low integration capacity, 8 (16%) score at an intermediate level, and 4 (8%; the Netherlands, UK, Germany and Switzerland) report a high-level integration of PC into their health systems.ConclusionVariable progress according to these indicators shows that most European countries are still in the process of integrating PC into their health systems.

The Prevalence of Potentially Inappropriate Prescribing in the Elderly at the Primary Care Level in Kazakhstan

BACKGROUND: These potentially inappropriate prescribing is associated with the development of undesired medical reactions in elderly patients, and increase the frequency of hospitalizations, the number of aggravations and the cost of treatment. All of these adverse events are preventable. For detection of PIP and to prevent the adverse drug reactions (ADRs) in elderly patients, it is necessary to screen for potentially inappropriate prescribing. AIM: The aim of the study is to study the prevalence of PIP and the factors associated with these prescriptions at the level primary link in Kazakhstan. METHODS: A prospective descriptive study was carried out at the primary care level, in five clinics in Kazakhstan. The study involved 205 patients over 65 years old who received regular outpatient treatment for chronic diseases. Patients’ current diagnoses and prescription medicines were reviewed and the STOPP and START tools applied. RESULT: The prevalence of PIP in terms of STOPP criteria was 54% (114 patients). In general, we have identified 181 cases of PIP. The most commonly prescribed PIP were moxonidine (20%), glimeperide (16.5%), and PPI (20%). The prevalence of prescribing omissions in terms of START criteria was 22% (48 patients). Overall 66 cases of prescribing omissions were identified. The most commonly prescribed omissions were statins (6%) and ACE inhibitors (4%). Comparative analysis revealed a statistically significant effect of polymorbidity on the prevalence of PIP (p < 0.001) and number of prescribed medicines on the prevalence of PIP (p < 0.05). We have found a statistically significant effect of age on the presence of prescribing omissions of patients. (p < 0.001) CONCLUSION: Our results showed a high prevalence of potentially inappropriate prescribing at the primary care level in Kazakhstan. Screening tools should be incorporated into the everyday practice of primary care doctors.