Bacteriological Identification among Patients Attending at Jimma University Veterinary Clinic

Findings of conducted study showed that the predominant bacteria in Jimma University Veterinary Clinic. Among predominant bacteria identified includes; Escherichia coli 46 (34.3%), Klebsiella 23(17.2%), followed by Staphylococcus aureus 40(29.9%) and Streptococcus spp 25(18.7%). Among 4 species of bacteria isolated, 2 were gram negative and 2 of them was gram positive bacteria. Among the antibiotic susceptibility test, Staphylococcus aureus showed the total resistant on penicillin while tetracycline showed to have the highest sensitivity. Escherichia coli showed the total resistant on gentamicin (100%). Veterinary Clinic is at risk of acquiring bacterial infections due to the presence of mentioned bacteria during this study. The big issue is that these infections resist to antibiotics used in treatment according to results of the study. Health care workers in Veterinary Clinic should improve hygiene to control clinic acquired infections and much attention should be done during diagnosis to improve treatment of patients.

Evaluation of Jadelle use in Teaching hospital in Niger Delta, Nigeria

Background: Jadelle (Norplant 2) is a levonorgestrel contraceptive implants that is safe, reversible, convenient, very effective and suitable for many women. Although it has numerous benefits, its use is still discontinued due to various reasons including side effects in the body of acceptors. Objective: To determine the prevalence rate, side effects, discontinuation rate and reasons for discontinuation of Jadelle at Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria. Methods: A retrospective study of 874 clients attending birth control clinic at the RSUTH from 1st January, 2015 – 31st December, 2019 was conducted. Their records were recovered from the clinic and studied. Data was extracted, coded and investigated using the statistical package for social sciences (SPSS) IBM version 25.0 (Armonk, NY). Results: Of 874 acceptors of contraceptives within the study period, one hundred and forty two used Jadelle giving an uptake rate of 16.2%. Jadelle use accounted for third most used contraceptive after implanon and intra uterine contraceptive device (IUCD) during the study period. The mean age was 32.9+4.21 years. Most age group was 30-34 years accounting for 57.8%. Age range was 20-48 years and most (81.7%) were multiparous. Christians accounted for 99.3% and 98.4% were married. All the clients had formal education. Thirty nine (27.5%) acceptors discontinued the use. Most were due to menorrhagia (33.3%) and desire for pregnancy (23.1%). Two unintended pregnancies occurred giving a Pearl index of 0.28 per 100 women-year. Conclusion: Jadelle is safe and effective. Menstrual abnormalities were the commonest side effects complained by the clients. Menstrual abnormalities and desire for pregnancy were the commonest reasons for discontinuation of Jadelle use.

Evaluating the Effects of Opioid Prescribing Policies on Patient Outcomes in a Safety-net Primary Care Clinic

Background After decades of liberal opioid prescribing, multiple efforts have been made to reduce reliance upon opioids in clinical care. Little is known about the effects of opioid prescribing policies on outcomes beyond opioid prescribing. Objective To evaluate the combined effects of multiple opioid prescribing policies implemented in a safety-net primary care clinic in San Francisco, CA, in 2013–2014. Design Retrospective cohort study and conditional difference-in-differences analysis of nonrandomized clinic-level policies. Patients 273 patients prescribed opioids for chronic non-cancer pain in 2013 at either the treated (n=151) or control clinic (n=122) recruited and interviewed in 2017–2018. Interventions Policies establishing standard protocols for dispensing opioid refills and conducting urine toxicology testing, and a new committee facilitating opioid treatment decisions for complex patient cases. Main Measures Opioid prescription (active prescription, mean dose in morphine milligram equivalents [MME]) from electronic medical charts, and heroin and opioid analgesics not prescribed to the patient (any use, use frequency) from a retrospective interview. Key Results The interventions were associated with a reduction in mean prescribed opioid dose in the first three post-policy years (year 1 conditional difference-in-differences estimate: −52.0 MME [95% confidence interval: −109.9, −10.6]; year 2: −106.2 MME [−195.0, −34.6]; year 3: −98.6 MME [−198.7, −23.9]; year 4: −72.6 MME [−160.4, 3.6]). Estimates suggest a possible positive association between the interventions and non-prescribed opioid analgesic use (year 3: 5.2 absolute percentage points [−0.1, 11.2]) and use frequency (year 3: 0.21 ordinal frequency scale points [0.00, 0.47]) in the third post-policy year. Conclusions Clinic-level opioid prescribing policies were associated with reduced dose, although the control clinic achieved similar reductions by the fourth post-policy year, and the policies may have been associated with increased non-prescribed opioid analgesic use. Clinicians should balance the urgency to reduce opioid prescribing with potential harms from rapid change.

Epidemiological and Clinical Observations of Gonococcal Infections in Women and Prevention Strategies

Neisseria gonorrhoeae is rapidly developing antimicrobial resistance. There is an urgent need for an effective gonococcal vaccine. In this study we examined epidemiological and clinical factors associated with gonorrhea in a cohort of women exposed to men with gonococcal urethritis attending the National Center for STD Control clinic in Nanjing, China, to understand the natural history and the risk factors for gonorrhea in this vulnerable population. This analysis will help identify the best target populations for vaccination, which is essential information for the development of vaccine strategies. We observed that 75% of the women in our cohort yielded a N. gonorrhoeae positive culture (infected women) and reported multiple sexual exposures to their infected partner. Infected women were younger than exposed but uninfected women. Contrary to the general belief that gonorrhea is asymptomatic in most women, 68% of the infected women acknowledged symptoms during their STD clinic visit, and overt inflammatory responses were detected upon medical examination in 88% of subjects. Other sexually transmitted infections were detected in 85% of subjects. This study confirmed that N. gonorrhoeae infections are underdiagnosed in women and, consequentially, untreated. Thus, our analysis reinforces the need to establish strategies for gonococcal prevention through the determination of the target population for a gonococcal vaccine.

Birth Control, Border Control

Betty Mary Goetting opened the first birth control clinic on the U.S.-Mexico border in 1937. The rhetoric she used to advocate for contraception in El Paso, Texas, paralleled eugenic trends in the birth control movement nationwide, focused on curbing fertility rates among those considered of poor mind and body. Where previous studies focus on the urban North, this borderlands case study places the birth control movement’s attention to overpopulation within the context of immigration restrictions at the U.S.-Mexico border. Goetting’s birth control campaigns, supported by the movement’s pioneer Margaret Sanger, targeted Mexican-origin women as part of a larger process that sought to protect the body politic from non-white immigrants while simultaneously exploiting their labor. Despite Catholic backlash against birth control and the racist rhetoric of Anglo birth control advocates, Mexican-origin women enthusiastically visited the El Paso birth control clinic. Given the dearth of health care afforded working-class, Mexican-origin women at this time, hundreds of women used the clinic’s services for their own purposes—reminding us that birth control movements offer a paradox of coercion and choice.

Perception of social stigma among patients attending a filariasis morbidity control clinic in South India

Background: The psychological and social stigma associated with lymphatic filariasis can adversely affect productivity and quality of life. This study was carried out to assess the perception of social stigma among patients with lymphatic filariasis.Methods: A hospital based cross sectional study was done on 30 subjects with lymphatic filariasis who attended a filariasis morbidity control clinic in Tamil Nadu. Data was collected using a locally adopted, pilot tested interviewer administered questionnaire derived from explanatory model interview catalogue community stigma scale (EMIC-CSS). Patients were categorized into none, mild, moderate and severe levels of social stigma based on their responses for questions related to stigma assessment. Data was analyzed using Epi-Info. Quantitative variables were presented as mean with standard deviation. Qualitative variables were presented as frequency with proportion. Results: Majority of the study subjects were males (60%), Hindu by religion (73.3%) and belonged to nuclear family (73.3%). The mean age (±SD) was 47 (±10.9) years. 66.7% of subjects were aged between 46-50 years. Majority (60%) of subjects had mild stigma. 13% had moderate while 3% had severe stigma. 23% of subjects had no stigma. Conclusions: 87% of this study subjects had perceived the social stigma towards lymphatic filariasis. Hence, apart from prevention and treatment measures for filariasis, importance has to be given in context of reducing social stigma towards the disease.

Enhanced Scheduling Support to Improve Continuity of Care in a Resident Training Clinic

ABSTRACT Background Clinical continuity is recognized as a driver of satisfaction for patients and physicians. Greater continuity may positively affect trainee decisions to enter primary care. Maintaining clinical continuity remains a challenge in residency clinics. Objective We determined whether enhanced scheduling support was associated with improvement in internal medicine resident continuity with patients. Methods This study was conducted from June 2017 to December 2018. In the intervention clinic, a single scheduling staff member (ratio of 10 residents to 1 scheduler) was colocated within the clinical space, allowing the scheduler to participate in clinical discussions and direct communication with physicians regarding future appointments. In the comparison clinic, scheduling staff (19:1 ratio) were located at a remote front desk area and relied on patient reports or electronic health record orders to identify appointment needs and arrange follow-up appointments. The main outcome of the intervention was resident continuity, calculated using the continuity for physician formula. Results During the study period, mean resident continuity was 23% (range 13%–37%) in the comparison clinic (57 residents) and 54% (range 38%–66%) in the intervention clinic (10 residents). Resident continuity was significantly higher in the intervention clinic compared with the traditional control clinic for every quarter measured (P < .001 for all comparisons). Conclusions Enhancing scheduling support through colocation and a lower resident to scheduler ratios was associated with significantly higher rates of resident continuity compared with a traditional front desk model, with results sustained over 18 months.

Opioid stewardship: implementing a proactive, pharmacist-led intervention for patients coprescribed opioids and benzodiazepines at an urban academic primary care centre

In 2017, almost 4000 Canadians died from opioid-related causes. Coadministration of opioids and benzodiazepines is a risk factor for overdose. Few studies have evaluated leveraging pharmacists to address opioid-benzodiazepine coprescribing. Our aim was to develop and test a role for pharmacists as opioid stewards, to reduce opioid and benzodiazepine doses in coprescribed patients. We conducted Plan-Do-Study-Act cycles between November 2017 and May 2018 across two primary care centre clinics. A third clinic acted as a control. Our intervention included a pharmacist: (1) identifying patients through medical record queries; (2) developing care plans; (3) discussing recommendations with physicians and (4) discussing implementing recommendations. We refined the intervention according to patient and physician feedback. At the intervention clinics, the number of patients with pharmacist developed care plans increased from less than 20% at baseline to over 60% postintervention. There was also a fourfold increase in the number of patients with an active opioid taper. At the control clinic, the number of patients with pharmacist developed care plans remained relatively stable at less than 20%. The number of patients with active opioid tapers remained zero. At the intervention clinics, mean daily opioid dose decreased 11% from 50.5 milligrams morphine equivalent (MME) to 44.7 MME. At the control clinic, it increased 15% from 62.3 MME to 71.4 MME. The number of patients with a benzodiazepine taper remained relatively stable at both the intervention and control clinics at less than 20%. At the intervention clinics, mean daily benzodiazepine dose decreased 8% from 9.9 milligrams diazepam equivalent (MDE) to 9.3 MDE. At the control clinic, it decreased 4% from 10.8 MDE to 10.4 MDE. A proactive, pharmacist-led intervention for coprescribed patients increased opioid tapers and decreased opioid and benzodiazepine doses. Future work will help us understand whether sustaining the intervention ultimately reduces rates of opioid-benzodiazepine coprescribing.

Effect of Combined Oral Contraception on Coagulation Profiles in Women Attending Fertility Control Clinic in Baqubah City- Iraq

Background: Use of oral contraception has been associated with an increased abnormalities of lipid and carbohydrate metabolism as well as hemostatic variables at baseline (increased plasma levels of factor VII, factor X, fibrinogen and of D-dimers).Objectives: To evaluate the effect of oral contraceptive pills (combined pills) on coagulation tests,prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen level.Patients and methods: This is a descriptive cross sectional study which was conducted in fertility control clinic in Al-Batool Teaching Hospital for Maternity and Children in Baqubah city, during the period from December 2015 to October 2016. Eighty eight women were enrolled in this study according to inclusion criteria, 63 women were use contraceptive pills(study group) and other 25 females not taken these pills (control group), prothrombin time, activated partial thromboplastin time and fibrinogen level measured by using the coagulometer instrument.Results: The mean age was 29.89 and 30.89 years for all participants (subject and control) it was (range 20-45). The results of cases revealed that PT= 12.89 seconds, APTT= 30.45 seconds, and fibrinogen level= 2.18 g/l while the results of control group revealed that PT= 11.92 seconds, APTT= 29.85 seconds and fibrinogen level= 2.24 g/l. Overall no significant variations were noticed in these parameters with P value > 0.05 also no significant changes were noticed between age groups, duration of oral contraceptives and some clinical parameters.Conclusion: Effect of combined oral contraceptives use on prothrombin time, activated partial thromboplastin time and fibrinogen levels are minor compared with control group. تأثير وسائل منع الحمل عن طريق الفم على عوامل التخثر في النساء المتواجدات في عيادة تنظيم الأسرة في مدينة بعقوبة, العراق أ.م.د سوسن طالب سلمان أ.م.د اريج عطية حسين م.د. رغد كامل سعدي الخلاصة: الخلفيةالدراسة: يرتبط استخدام وسائل منع الحمل عن طريق الفم مع زيادة نسبة الدهون في الدم والتمثيل الغذائي للكربوهيدرات وكذلك عوامل التخثر بما في ذلك زيادة مستويات العامل السابع في البلازما، عامل X، الفيبرينوجين و D-dimer الهدف من الدراسة: لتقييم تأثير حبوب منع الحمل عن طريق الفم على عوامل التخثروهي وقت البروثرومبين، تنشيط وقت ثرومبوبلاستين الجزئي، ومستوى الفيبرينوجين. المرضى وطرق العمل: دراسة وصفية مقطعية أجريت في عيادة تنظيم الأسرة في مستشفى البتول التعليمي للأمومة والطفولة في مدينة بعقوبة، خلال الفترة من كانون الاول 2015 إلى تشرين الاول 2016. تم اختيار ثمان وثمانون امرأةكمتطوعين وفقا إلى معاييرالاشتراك بالبحث، اخذت عينات الدم من 63 امرأة كانت تستخدم حبوب منع الحمل و 25 أنثى أخرى لم تأخذ موانع الحمل ، وتم اختيارها واعتبارها السيطرة في فئة عمرية معينة. وقت البروثرومبين ، تنشيط وقت ثرومبوبلاستين الجزئي ومستوى الفيبرينوجين قيست باستخدام أداة كواغلوميتتر. النتائج: كان متوسط العمر 29.89 و 30.89 سنة لجميع المشاركين (مستخدمي موانع الحمل والسيطرة) كان (المدى 20-48). اظهرت نتائج الحالات ان وقت البروثرومبين(PT) = 12.89 ثانية، تنشيط وقت ثرومبوبلاستين الجزئي(APTT) = 30.45 ثانية، ومستوى الفيبرينوجين = 2.18 جم / لتر في حين كشفت نتائج مجموعة السيطرة ان PT = 11.92 ثانية، APTT = 29.85 ثانية ومستوى الفيبرينوجين = 2.24 جم / لتر. وبشكل عام لم تلاحظ أي اختلافات معنوية في هذه المعاملات مع قيمة P> 0.05كما لم تلاحظ أي تغيرات معنوية بين الفئات العمرية ومدة وسائل منع الحمل الفموية وبعض المتغيرات السريرية في حين لاحظ فرق كبير مع مؤشر كتلة الجسم. الاستنتاج: تأثير وسائل منع الحمل عن طريق الفم على مستويات وقتالبروثرومبين،تنشيطوقتثرومبوبلاستينالجزئي،ومستوىالفيبرينوجين كانت طفيفة مقارنة مع مجموعة السيطرة. الكلمات المفتاحية: وسائل منع الحمل عن طريق الفم، هرمون الاستروجين، بروجيستاجين، تجلط الدم، تخثر الدم