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Baldwin Martensen posted an update 6 months, 3 weeks ago
A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.
A health system response to domestic violence against women is a global priority. However, little is known about how these health system interventions work in low-and-middle-income countries where there are greater structural barriers. Studies have failed to explore how context-intervention interactions affect implementation processes. Healthcare Responding to Violence and Abuse aimed to strengthen the primary healthcare response to domestic violence in occupied Palestinian territory. We explored the adaptive work that participants engaged in to negotiate contextual constraints.
The qualitative study involved 18 participants at two primary health care clinics and included five women patients, seven primary health care providers, two clinic case managers, two Ministry of Health based gender-based violence focal points and two domestic violence trainers. Semi-structured interviews were used to elicit participants’ experiences of engaging with HERA, challenges encountered and how these were negotiated. Data ergent feature of the intervention was the ability of the clinic case managers to improvise their role.
Flexible use of ENPT helped to surface practices the providers and women patients engaged in to make HERA workable. The findings have implications for the transferability of evidenced based interventions on health system response to violence against women in diverse contexts, and how HERA can be sustained in the long-term.
Flexible use of ENPT helped to surface practices the providers and women patients engaged in to make HERA workable. The findings have implications for the transferability of evidenced based interventions on health system response to violence against women in diverse contexts, and how HERA can be sustained in the long-term.
Most people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care, including older people and people living with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice, or none.
A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p < 0.001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p = 0.006) than single practice attendees.
Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. selleck chemical Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
The effect of low systolic blood pressure and its subsequent postoperative outcome during esophagectomy for esophageal cancer is not well studied.
A prospective study was conducted and data were collected on patients who underwent esophagectomy and esophagogastric anastomosis for esophageal cancer. Intraoperative hypotension (IOH), defined as systolic blood pressure (SBP) < 90mm Hg lasting more than 5min, was recorded. Patients’ 30days post-operative composite outcome of mortality, anastomotic leak, and prolonged hospital stay were analyzed as outcome variables.
A total of 54 patients underwent esophagectomy for esophageal cancer during the study period. The mean age was 54years. The mean duration of the surgery was 208min. Intraoperative mean low SBP was 80mmHg while the lowest record was 55mmHg. IOH occurred in 51% (n = 29) of patients. Anastomotic leak occurred in 7% (n = 4) (OR 1.2, 95% CI 0.26-6.3; p = 0.76). In-hospital mortality was 5% (n = 3) (OR 1.44, 95% CI 0.22-9.3; p = 0.7) and 33% (n = 1p = 0.76). In-hospital mortality was 5% (n = 3) (OR 1.44, 95% CI 0.22-9.3; p = 0.7) and 33% (n = 18) had prolonged hospital stay (OR 0.53, 95% CI 0.14-1.9; p = 0.34). The overall anastomotic leak rate was 13% (n = 7). Multivariate analysis (logistic regression model) showed SBP less then 90 mmHg for more than 5 min was not significantly associated either with individual or composite outcomes of mortality, anastomotic leak, and prolonged hospital stay (AOR 1.06, 95% CI 0.98-1.14; p = 0.16) CONCLUSION In patients undergoing esophagectomy for esophageal cancer, a systolic blood pressure less then 90 mm Hg for greater than 5 min during surgery has no significant statistical association with composite adverse outcomes of mortality, anastomotic leak, and prolonged hospital stay.
Oral diseases are common and widespread around the world. The most common oral diseases are preventable, and early onset is reversible. Myanmar faces many challenges in rendering oral health services, because approximately 70% of the total population resides in rural areas. These relate to the availability and accessibility of oral health services. Therefore, oral health education is one key element to prevent oral diseases and to promote oral health.
A quasi-experimental study was carried out at Basic Education Middle Schools in rural areas of Magway Township to study the effectiveness of oral health education on the knowledge and behavior of 8- to 10-year-old school children. A total of 220 school children, 110 from intervention schools and 110 from control schools, participated in this study from 2015 to 2017. Data were collected before and after intervention in the two groups by using a self-administered questionnaire. Tooth brushing method data were collected by direct observation with a checklist. Oral health education was provided at eight weekly intervals for 1year.
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