Local District Hospital Research Articles

“Maintain Professionalism”: Nurses’ Experiences in Caring for Patients with Malignant Fungating Wounds in Taiwan

ContextMalignant fungating wounds (MFWs) occur among 5%–15% of patients with terminal cancers, the uncontrollable symptoms result in serious psychosocial issues, thereby reducing the quality of life. Caring for MFWs impacts caregivers, including healthcare personnel. While existing studies are patient-focused, the impact of care experiences and associated support for nurses has not been examined. ObjectivesTo explore the experiences in caring for patients with MFWs among nurses in Taiwan. MethodsQualitative study with a phenomenological approach by thematic analysis was conducted with semi-structured interviews. About 15 nurses who cared for patients with MFWs at local district hospitals in Southern Taiwan. ResultsFour themes were identified to describe the phenomenon: (1) Fear of Unpredictability (2) Maintaining Professionalism (3) Feeling Helpless (4) Rationalizing the Negatives. The themes illustrated the distress of managing physical symptoms and highlighted how nurses strived to promote comfort for patients. Nurses felt helpless about the incurable nature of MFWs but found a way to suppress their feelings. ConclusionThe findings suggested the need for addressing the emotional well-being of nurses who take care of patients with MFWs. Future studies should identify effective coping strategies for nurses’ health when caring for this population.

The effect of hospital volunteering on empathy in nursing and medical students

BackgroundEmpathic care benefits patients and healthcare providers. There is evidence of self-reported empathy decline among students in healthcare education. Hospital volunteering could assist undergraduate healthcare students to develop empathetic relationships with patients. AimThe study aimed to investigate the feasibility and effect of a hospital volunteering intervention on the empathy levels of undergraduate nursing and medical students. It further aimed to explore their experience of the intervention and determine student-identified areas for patient safety improvements. DesignPre–post-intervention study SettingA large outer metropolitan hospital in New South Wales, Australia. ParticipantsTwenty-nine (n = 29) undergraduate nursing and medical students from an Australian university. MethodsStudents had an introductory experience of volunteering at their local district hospital through participation in the ‘Volunteer Taster Program’. The Jefferson Scale of Empathy-Health Professions Student questionnaire was used to measure student empathy scores pre and post program. Responses to open-ended questions were thematically analysed to evaluate student experiences and identify student-reported areas for patient safety improvements. ResultsTwenty-nine students (18 nursing, 11 medical) completed the program. Students had statistically significant improvements in post-intervention mean empathy scores 112.03 (95% CI 107.56, 116.5) to 117.38 (95% CI 113.76, 121.00) p < 0.001. Subgroup analysis identified a larger increase in empathy scores among medical students than nursing students. The thematic analysis revealed potential program benefits, including new perspectives of the patient experience, improved confidence in patient communication, a stronger professional identity, and a rewarding experience. Identified patient safety issues included concerns for patients’ emotional and physical well-being, and patient communication. ConclusionsThe Volunteer Taster Program is feasible and enabled nursing and medical students to connect with patients outside the sphere of clinical education. It appears to increase empathy levels in undergraduate students and could assist them to deliver empathetic, person-centred healthcare.

Clinical service delivery implications of the COVID-19 pandemic on people with Inflammatory bowel disease: a qualitative study

BackgroundDuring the COVID-19 pandemic, clinical services were severely disrupted, restricted, or withdrawn across the country. People living with Inflammatory Bowel Disease (IBD) – an auto-immune disorder for which medical treatment often results in immunosuppression, thus requiring regular monitoring—may have struggled to access clinical support. As part of a larger qualitative study, we investigated experiences of access to clinical services during the pandemic, and patient concerns about and preferences for services in the future.MethodsThis exploratory qualitative study used semi-structured interviews to explore participants’ experiences of clinical services across the UK during the pandemic. All data were collected remotely (March – May 2021) using online video-calling platforms or by telephone. Audio files were transcribed professionally and anonymised for analysis. Data were analysed using thematic analysis.ResultsOf the eight themes found across all data, four related specifically to accessing GP, local (district) hospital, and specialist (tertiary) referral services for IBD: 1) The Risk of Attending Hospital; 2) Missing Routine Monitoring or Treatment; 3) Accessing Care as Needed, and 4) Remote Access and The Future.ConclusionsOur findings support other studies reporting changes in use of health services, and concerns about future remote access methods. Maintenance of IBD services in some form is essential throughout crisis periods; newly diagnosed patients need additional support; future dependence on IBD services could be reduced through use of treatment / self-management plans. As the NHS digitalises it’s future services, the mode of appointment—remote (telephone, video call), or in-person – needs to be flexible and suit the patient.

The diagnosis and surgical management of pulmonary sequestration in adults: a case series from a single centre in the UK

Pulmonary sequestration (PS) is a rare congenital malformation where extrapulmonary lung tissue receives systemic blood supply from an anomalous branch directly from the thoracic or abdominal aorta. Whilst non-malignant, it can often present with similar symptoms as lung cancer. We present a retrospective review of 8 consecutive adult patients undergoing surgical management for PS within a single centre in the UK. Of our cohort, 62.5% had never smoked. PS in the right lung was seen in 62.5% of cases. Anomalous branches of the pulmonary artery, pulmonary vein or coeliac axis supplied 37.5% of the PS seen in our cohort, and 12.5% did not have a radiologically identifiable blood supply. Techniques varied from thoracotomy (n = 4), video-assisted thoracoscopic surgery (VATS) (n = 3) to robotic resection (n = 1) with no intra-operative or post-operative complications reported within hospital. The mean length of stay was 2 days. The post-operative mortality rate was 12.5%; one patient had died following the robotic resection of the mass of pneumonia in the local district hospital 26 days post-operatively after being discharged. No other complications nor recurrence was recorded over the follow-up period. Where pulmonary masses receive blood supply from anomalous branches of the pulmonary vein and coeliac axis, diagnoses of PS should be considered. The clinical feasibility of discharge in 2 days with no symptom recurrence should undergo further investigation with a larger sample size.

The importance of "time to surgery" in the management of lumbar disc herniation in patients without progressive neurological deficits.

Prolonged sciatica symptoms may result in disability and consequently, absence from work for a longer period. Up to 10% of patients may need surgery but it is difficult to predict and determine which of these patients would improve spontaneously in comparison to those who might benefit from discectomy surgery. We aimed to determine if delay in the "time to surgery" (TTS) has any adverse effects on the patient reported outcome measures (PROMs). Eighty-seven patients after exclusions were selected consecutively. PROMs were comprised of pre-operative, six weeks and six months post-operative back and leg pain visual analogue scores (VAS) and Oswestry disability index (ODI). The differences between these scores were correlated with TTS. Minimal clinically important difference (MCID) of 30% improvement for ODI scores and 33% for VAS scores from baseline were considered as significant improvement. Patients were grouped into TTS less than 6 months and TTS greater than 6 months from referral to TTS. The longest TTS was 18 months. Statistical analysis was done using JASP (Version 0.14.0) [computer software]. The TTS was on average 22.5 weeks. MCID for the leg pain VAS was achieved in 90.2% patients with TTS <6 months and in 80.8% with TTS ≥6 months. The MCID for ODI was achieved in 60.7% with TTS <6 months and in 42.0% with TTS ≥6 months. The MCID for back pain VAS was achieved in 73.8% with TTS <6 months and in 50.0% of patients with TTS ≥6 months. Those who achieved the MCID in ODI score between the two groups were analysed using chi-square test with P=0.115. Those who achieved the MCID in VAS leg pain score between the two groups were analysed using chi-square test with P=0.227. No statistical difference was found in ODI and VAS for leg for patients with TTS before or after 6 months. Lumbar discectomies had a positive impact on patient's pain and function in our local district hospital. Delayed surgery of ≥6 months did not cause statistically significant worse outcomes. In the absence of worsening neurological deficit, it may be the wrong approach to define a value for the TTS.

Nurses' perspectives of pain assessment and management in dementia care in hospital.

To explore nurses' perspectives and generate recommendations for nursing practice of pain assessment and management in dementia care in a hospital setting. Semi-structured face-to-face interviews were conducted with nurses who had experience in dementia care from two care units of a regional hospital. Data were analysed using six phases of reflexive thematic analysis. Eight nurses from two inpatient units of a local district hospital were interviewed. Five themes were identified: (1) ways of understanding, (2) practicality of pain assessment tools, (3) usefulness of pain scores, (4) analgesia use and (5) limitations to practice. Nurses perceived pain tools did not sufficiently help to assess pain in people with dementia, and adaptation was often needed when scoring pain. Overuse of analgesia, trial-and-error practice and delayed prescriptions for analgesia limited pain management effectiveness for people with dementia during hospitalisation. Pain tools are preferably used as a complementary method in addition to nurses' intuitional judgement. Reporting pain via scores requires a more complete narrative description from the source of pain reports to allow clinicians to accurately report a persons' pain. Clinicians must minimise trial-and-error practice in analgesia by conducting comprehensive pain assessments. Health-care organisations need to foster timely collaboration between clinicians to support nurses' practice limitations for effective analgesia administration in dementia care.

Health System Costs of a Breast Cancer Early Diagnosis Program in a Rural District of Rwanda

PURPOSE Low-and-middle-income countries require information about effective and pragmatic strategies to facilitate earlier breast cancer diagnoses. A Breast Cancer Early Detection (BCED) program training health workers and establishing breast clinics in Burera District, Rwanda was associated with increased evaluation of breast symptoms and higher incidence of early-stage breast cancer. We examined the program's cost from the health system perspective. METHODS The BCED program's first phase started in 2015 and included seven health centers (HCs) and Butaro Cancer Center of Excellence (BCCOE), the cancer referral center at Butaro Hospital. Patient volume and diagnoses from 2015 to 2017 were abstracted from existing databases. We retrospectively reviewed administrative data to identify start-up and ongoing operational costs. Using Time-Driven Activity-Based Costing, clinical costs per patient visit were estimated based on HC and BCCOE visits for breast health care observed in 2021. RESULTS Over the first 2 years, there were 1,010 HC visits for breast symptoms, 210 referrals to BCCOE, and 10 breast cancers diagnosed. The BCED program's total cost was $119,511, comprising of start-up costs ($36,917), recurring operational costs ($67,711) and clinical costs ($14,883). Clinical breast assessment (CBA) at HCs cost $3.27/visit. At BCCOE, CBA-only visits cost $13.47, CBA/ultrasound cost $14.79, and CBA/ultrasound/biopsy cost $147.81. Overall, the clinical cost per breast cancer diagnosed was $1,488. The primary cost drivers were personnel at HCs (55%) and biopsy supplies at BCCOE (46%). In other districts, patients must go to their local HC and district hospital before referral to BCCOE, adding about $14.00/patient. CONCLUSION The BCED program's cost at HCs was modest, similar to other outpatient HC services. Hospital-level care was more expensive and requiring multiple visits for biopsies increased costs. Start-up and operational costs could be reduced by using local trainers and virtual/mobile mentorship. For scalability in other districts, decentralizing ultrasound and/or biopsies to district hospitals could reduce costs.

A case of atmospheric electricity injury. Clinical observation

Objective. The world statistics on lightning strike outcomes reveals 6000 to 24000 human deaths annually. The lightning strike regular mortality is 20–30% with two thirds of survivors having serious complications and long lasting consequences. Every third person struck by lightning bears skin damage.Clinical observation. The man, 27 years old, was traumatized after the lightning struck into his forehead area. A contused-lacerated wound of soft tissues was diagnosed. The patient was taken to the local district hospital for primary care. 20 days after receiving the injury, he turned to the Saratov Regional Clinical Center for Combustio- logy, where he underwent autodermoplasty of the defect in the integument of the skull.Discussion. Direct lightning strike is technically a result of the immediate contact of the injured with the atmospheric electricity. It comprises no more than 5% all lightning strike cases. The outcome is often lethal as the electrical discharge received is the highest.Conclusion. Autodermotransplanting is advantageous in the replacement of damaged skin integument, inclu- ding that caused by atmospheric electricity. In such situations adequate first aid treatment, timely transportation, staged medical treatment, specialized stationary treatment, proper surgical treatment, and post-operative care are important.

The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa.

This short report describes three family physicians (FP)-led clinical governance interventions to strengthen the care access and coordination in an urban district hospital in Cape Town, South Africa. The actual experiences and their effects on health services are captured here. The report also describes a range of interventions from enhanced access to timely computer tomographic scans to determine definitive care, to creating a local referral forum between levels of care, which resulted in a renewed appreciation for the scope of services and illness burden managed by the district health system and to the establishment of an onsite echocardiology service at the local district hospital to enhance the identified burden of disease of the local community. Each of these interventions were planned and implemented based on local data in partnership with the team members at the different levels of care. By applying an inclusive and distributed leadership style as informed by care access to scarce resources was better coordinated for the local communities served. The importance of the building trusting relationships between FPs and referral hospital colleagues cannot be overemphasised. Family physicians should be integrated and collaborated in the clinical governance platforms across levels of care. The FP’s roles as primary care consultant and clinical governance leader are pivotal in enhancing service delivery efficiency and in providing quality healthcare.

Expanding the epidemiological understanding of hepatitis C in South Africa: Perspectives from a patient cohort in a rural town

The epidemiology of hepatitis C virus (HCV) in the general population of South Africa (SA) is incompletely understood. A high HCV prevalence in key populations is known, but data are limited in terms of a broader understanding of transmission risks in our general population.To investigate a patient cohort with HCV infection clustering in a rural SA town, in order to identify possible HCV transmission risks, virological characteristics, phylogenetic data and treatment outcomes.A cluster of patients with positive HCV serology, previously identified from laboratory records, were contacted by a local district hospital and offered confirmatory testing for HCV viraemia where needed. Those with confirmed HCV RNA were invited to a local hospital visit, where relevant demographic information was recorded, clinical assessment performed and a confidential questionnaire administered. HCV population-based sequencing was performed on HCV NS3/4A, NS5A and NS5B using polymerase chain reaction-specific or M13 universal primers, and sequences were aligned using BioEdit 7.2.5. Phylogenetic trees were constructed. Clinical assessments included liver fibrosis determination with FibroScan (cut-off ≥12.5 kPa = F4). Patients were offered treatment, and sustained virological response (SVR) was confirmed by undetectable HCV RNA at least 12 weeks after the end of treatment.Twenty-one patients, all from the same town, median (interquartile range (IQR)) age 64 (59 - 70) years, 57% female, were evaluated. Of these, 24% (n=5) were HIV co-infected, stable on antiretrovirals. The median (IQR) alanine aminotransferase level was 51 (31 - 89) U/L, with fibrosis distribution including 29% F1, 29% F2, 9% F3 and 33% F4 METAVIR fibrosis. Virologically, two genotypes were observed: 62% (n=13) genotype (GT) 1b and 38% (n=8) GT5a. No patient had ever used injecting drugs, 14% (n=3) had received blood products before 1992, and 9.5% (n=2) had undergone traditional healer-administered scarification. All (n=21) reported attendance at a single primary care clinic in the past, with most (n=20) recalling having received parenteral therapies at the clinic. Phylogenetic analysis of the HCV NS5A and NS5B regions confirmed GT1b and GT5a genotypes and formed two separate clusters within their respective genotypes, suggesting a common source for each genotype infection. Most patients received treatment with sofosbuvir/daclatasvir, 1 was treated with sofosbuvir/velpatasvir, and 1 was re-treated with sofosbuvir/velpatasvir/voxilaprevir. Per protocol SVR was 95%, with the non-SVR patient successfully re-treated.Data from a rural town cluster of patients suggest parenteral medical exposure as the probable common source of hepatitis C transmission risk. The cohort was of older age with a significant number having advanced fibrosis or cirrhosis, suggesting HCV acquisition in the distant past. Using a simplified care approach, treatment outcomes were very good.

Evaluation of Hepatitis C Virus Core Antigen Assay in a Resource-Limited Setting in Pakistan.

The diagnosis of Hepatitis C virus (HCV) infection can be challenging due to its cost and a lack of access to centralized testing. There is an urgent need to develop simplified HCV testing algorithms. The aim of this study was to evaluate the performance characteristics of a Hepatitis C core antigen (HCVcAg) assay in a decentralized, resource-limited setting. This is a descriptive cross-sectional study from a highly endemic area of Karachi, Pakistan. Between October 2019 and July 2020, subjects aged 12 years and above who screened positive for HCV antibodies were simultaneously tested for HCV RNA (Xpert HCV Viral Load, GeneXpert® IV, Cepheid, France) and HCVcAg (ARCHITECT HCV Ag assay, Abbott® Diagnostics) to confirm active HCV infection. An Abbott ARCHITECT® i1000SR Immunoassay Analyser was installed at a local district hospital as a point-of-care (POC) facility for HCVcAg testing, while samples for HCV RNA were tested in a central lab. Two hundred individuals (mean age 46.4 ± 14.5 years, 71.5% females), who screened positive for HCV antibody, were included in the study. HCV RNA was detected in 128 (64.0%) while HCVcAg was reactive in 119 (59.5%) cases. Performance of the Immunoassay Analyser was excellent with a higher throughput and quicker readout value compared to the GeneXpert System. The sensitivity and specificity of HCVcAg (≥10 fmol/L) at HCV RNA thresholds of ≥12 was 99.1% (95% CI: 95–100%) and 87.6% (95%CI: 78.4–94%). A strong agreement was observed between the HCVcAg assay and HCV RNA. The ARCHITECT HCV Ag assay showed high sensitivity and specificity compared to HCV RNA in a decentralized, resource-limited setting. It can therefore be used as a confirmatory test in HCV elimination programs, particularly for low-income countries such as Pakistan.

Chronic Disease in the Community (CDCom) Program: Hypertension and non-communicable disease care by village health workers in rural Uganda.

BackgroundAlthough hypertension, the largest modifiable risk factor in the global burden of disease, is prevalent in sub-Saharan Africa, rates of awareness and control are low. Since 2011 village health workers (VHWs) in Kisoro district, Uganda have been providing non-communicable disease (NCD) care as part of the Chronic Disease in the Community (CDCom) Program. The VHWs screen for hypertension and other NCDs as part of a door-to-door biannual health census, and, under the supervision of health professionals from the local district hospital, also serve as the primary providers at monthly village-based NCD clinics.Objective/MethodsWe describe the operation of CDCom, a 10-year comprehensive program employing VHWs to screen and manage hypertension and other NCDs at a community level. Using program records we also report hypertension prevalence in the community, program costs, and results of a cost-saving strategy to address frequent medication stockouts.Results/ConclusionsOf 4283 people ages 30–69 screened for hypertension, 22% had a blood pressure (BP) ≥140/90 and 5% had a BP ≥ 160/100. All 163 people with SBP ≥170 during door-to-door screening were referred for evaluation in CDCom, of which 91 (59%) had repeated BP ≥170 and were enrolled in treatment. Of 761 patients enrolled in CDCom, 413 patients are being treated for hypertension and 68% of these had their most recent blood pressure below the treatment target. We find: 1) The difference in hypertension prevalence between this rural, agricultural population and national rates mirrors a rural-urban divide in many countries in sub-Saharan Africa. 2) VHWs are able to not only screen patients for hypertension, but also to manage their disease in monthly village-based clinics. 3) Mid-level providers at a local district hospital NCD clinic and faculty from an academic center provide institutional support to VHWs, stream-line referrals for complicated patients and facilitate provider education at all levels of care. 4) Selective stepdown of medication doses for patients with controlled hypertension is a safe, cost-saving strategy that partially addresses frequent stockouts of government-supplied medications and patient inability to pay. 5) CDCom, free for village members, operates at a modest cost of 0.20 USD per villager per year. We expect that our data-informed analysis of the program will benefit other groups attempting to decentralize chronic disease care in rural communities of low-income regions worldwide.

Comparative Analysis of Rural Health Demographics in 2 East African Communities During Medical Camps: Volunteers' Perspectives'.

Malawian and Zambian governments have made efforts to improve healthcare for rural dwellers but possible differences or similarities in health demographics may inform targeted interventions and volunteers may have a greater role to play in improving health outcomes.Aims and ObjectivesTo compare of basic health and social demographics observed during 4-day medical camps in 2 rural communities in Zambia and Malawi to determine any significant differences or similarities.MethodAbout 12 and 10 local and international volunteers at medical camps (at a temporary rural health post or community hall) in rural Zambia and Malawi respectively treated 488 patients in total, with basic health and social demographic data collected and results analyzed.ResultsThe mean age of patients seen in Malawi and Zambia were 34.5 and 38.9 years respectively, with 39% and 40% of patients in Malawi and Zambia respectively being within the 18 to 44 years age group, and mostly females (59.7% in Malawi and 65.7% in Zambia). Most were non-infectious diseases (97.3% in Zambia, 95% in Malawi), mostly musculoskeletal (17.0% in Malawi and 30.5% in Zambia), while medications prescribed were mostly analgesics (35.7% in Malawi and 29.9% in Zambia). Only a small proportion of patients were referred to local secondary facilities or district hospitals, 51 (28.7%) in Malawi and 59 (19.9%) in Zambia respectively. Chi square test shows a significant difference (P < .001) in diseases in both countries, but there was no statistically significant difference between the mean age of patients seen in both countries, using the independent t-test (P = .365).ConclusionThis study highlights statistically significant demographic differences between the 2 communities and possible reasons for these, and how volunteers’ roles in rural healthcare in the East African communities could be further evaluated.

Incidence of recreational sports-related sudden cardiac arrest in participants over age 12 in a general African population

BackgroundThe incidence of sports-related sudden cardiac arrest (SrSCA) in sub-Saharan Africa is unknown.ObjectiveTo determine the incidence of sudden cardiac arrest (SCA) in non-competitive athletes in an urban population of Cameroon,...

Nurses' perception of the multidisciplinary team approach of care for adolescent mothers and their children in Ugu, KwaZulu-Natal.

BackgroundAdolescent childbearing has numerous consequences on maternal health, child health and the well-being of society. Because of the high-risk nature of adolescent pregnancy, a multidisciplinary team (MDT) approach is recommended to achieve satisfactory pregnancy outcomes.AimThe aim of this study was to explore nurses’ perceptions of the MDT approach in the continuum of care for adolescent mothers and their children.SettingThe study was conducted in a local district hospital in Ugu, KwaZulu-Natal.MethodsAn explorative and descriptive qualitative study design was used. The first author and hospital staff (clinical midwives and the clinical manager of obstetrics and gynaecology) collaborated on the development of the focus group discussion (FGD) guide to explore nurses’ perception of the MDT approach of care for adolescent mothers and their children. A total of three FGDs were conducted. Data were analysed using thematic analysis.ResultsSix overarching themes emerged from the data analysis which included professional benefits of adopting the MDT approach of care for adolescent mothers and their children, barriers to the multidisciplinary collaboration, clinical benefits of adopting the MDT approach of care for parenting adolescent mothers, problems and needs of adolescent mothers, and nurses’ reasons regarding their willingness to participate in a multidisciplinary collaboration in the care of parenting adolescent mothers.ConclusionIn the opinion of nurses, the MDT approach of care for adolescent mothers and their children is an important strategy to improve maternal and child health outcomes. This study has important implications for the design of an intervention.

Outcomes of percutaneous endoscopic gastrostomy, percutaneous endoscopic gastropexy gastrostomy and radiologically inserted gastrostomy in patients at a district general hospital in 2016

Enteral tube feeding has proven to be safe and effective for patients requiring assisted feeding in the long term. There are various methods of tube insertion, namely: Percutaneous Endoscopic Gastrostomy (PEG), Percutaneous Endoscopic Gastropexy Gastrostomy (PEGG) and Radiologically Inserted Gastrostomy (RIG). The guidelines released by the British Society of Gastroenterologists1 in 2010, formulated after the 2004 National Confidential Enquiry into Patient Outcome and Death (NCEPOD)2 after gastrostomy were adopted in our trust. Following that we had observed an improvement in the 30-day mortality rate compared to earlier published data and we had reported the findings in our 2016 study at BAPEN. The purpose of this study is to evaluate and compare patient outcomes in 2016 post gastrostomy procedures with our previous findings in our local district hospital trust. The following were considered: procedure type, waiting time, sex, complications, mortality at 30 days, and mortality after 1 year.

Point-of-care tests for syphilis and yaws in a low-income setting - A qualitative study of healthcare worker and patient experiences.

IntroductionThe human treponematoses comprise venereal syphilis and the three non-venereal or endemic treponematoses yaws, bejel, and pinta. Serological assays remain the most common diagnostic method for all treponemal infections.Point-of-care tests (POCTs) for syphilis and yaws allow testing without further development of infrastructure in populations where routine laboratory facilities are not available. Alongside the test’s performance characteristics assessed through diagnostic evaluation, it is important to consider broader issues when rolling out a POCT. Experience with malaria POCT roll-out in sub-Saharan Africa has demonstrated that both healthcare worker and patient beliefs may play a major role in shaping the real-world use of POCTs. We conducted a qualitative study evaluating healthcare worker and patient perceptions of using a syphilis/yaws POCT in clinics in the East Malaita region of Malaita province in the Solomon Islands. Prior to the study serology was only routinely available at the local district hospital.MethodsThe POCT was deployed in the outpatient and ante-natal departments of a district hospital and four rural health clinics served by the hospital. Each site was provided with training and an SOP on the performance, interpretation and recording of results. Treatment for those testing positive was provided, in line with Solomon Islands Ministry of Health and Medical Services’ guidelines for syphilis and yaws respectively. Alongside the implementation of the POCT we facilitated semi-structured interviews with both nurses and patients to explore individuals’ experiences and beliefs in relation to use of the POCT.Results and discussionFour main themes emerged in the interviews: 1) training and ease of performing the test; 2) time taken and ability to fit the test into a clinical workflow; 3) perceived reliability and trustworthiness of the test; and 4) level of the health care system the test was most usefully deployed. Many healthcare workers related their experience with the POCT to their experience using similar tests for malaria. Although the test was considered to take a relatively long time to perform the benefits of improved access to testing were considered positive by most healthcare workers. Qualitative data is needed to help inform better training packages to support the implementation of POCT in low-resource settings.

Sport-related sudden cardiac arrest in black African non-competitive athletes: Incidence in a general population of Cameroon

Incidence estimates of sudden cardiac arrest (SCA) in athletes living in sub-Saharan Africa (SSA) are unknown. Over 12 months, the household administrative office and health community committee within neighbourhoods in two health areas of Douala (Cameroon) registered all deaths among 86,188 inhabitants aged under 18 years. As part of an extended multi-source surveillance system, all sport fields, the Emergency Medical Service (EMS), local medical examiners and district hospital mortuaries were also surveyed. Whereas two physicians investigated every natural death, two cardiologists reviewed all unexpected natural deaths. There were 288 all-cause deaths and 27 (9.4%) were SCD. The crude incidence rate was 31.3 [95% confidence interval (CI): 20.3–40.6]/100,000 person–years. The age-standardized rate by the African standard population was 33.6 (95% CI: 22.4–44.9)/100,000 person–years. Death occurred at night in 37% of cases, including 11% of patients who died while asleep. Out-of-hospital SCA occurred in 63% of cases, 55.5% of which occurred at home. Of the 88.9% cases of witnessed CA, 63% occurred in the presence of a family member and cardiopulmonary resuscitation was attempted only in 3.7%. While running, death occurred in 1 (3.7%) non-competitive female athlete aged 35 years. Sport-related SCA in this African population claimed an annual incidence of 1.15 cases per 100,000 person–years, which is in accordance with reported rates in the literature. Long-term cohort studies in many African countries are warranted to better understand incidence estimates of SCA in black athletes.

Auditing stillbirths at Lower Umfolozi War Memorial Regional Hospital: A 12-month review.

Although the total number of stillbirths worldwide was estimated at 2.6 million in 2009, there is currently a dearth of literature on stillbirths in developing countries and rural settings, where the majority of such births occur. The 'Hands Up' Mortality and Morbidity Extraction Tool (HUMMET), developed at Lower Umfolozi War Memorial Regional Hospital (LUWMRH) in 2010, outlines a systematic approach to summarising individual cases of adverse perinatal outcomes. To depict the HUMMET form by describing the detailed demographic and obstetric profile of patients who delivered a stillborn infant at LUWMRH, as well as risk factors associated with these stillbirths between 1 April 2014 and 31 March 2015. The findings add to a global initiative advanced by the Lancet series on stillbirths, aimed at raising awareness of stillbirth statistics in low- and middle-income countries. A total of 310 detailed stillbirth case summaries of 305 patients were collected during the study period, representing 90% of the total number of stillborn infants delivered at LUWMRH. A retrospective audit of the HUMMET forms was conducted and the cases were further summarised in a Microsoft Excel spreadsheet that allowed for a univariate analysis of the variables. The stillbirth rate at LUWMRH is much higher than that at other regional hospitals owing to the number of at-risk referrals and emergency cases from surrounding clinics and district hospitals. Referrals were from local clinics (49%) and district hospitals (45%), 35% of stillbirths were due to abruptio placentae and a large proportion were associated with gestational hypertension, pre-eclampsia and/or eclampsia. Avoidable factors were predominantly a late patient response to reduced fetal movements and delays in transfer to hospital. Twenty percent of stillbirths were associated with inappropriate monitoring or management of the obstetric condition at the district hospital. The HUMMET form provides a systematic approach to analysing cases of perinatal morbidity and mortality in line with the requirements of the Perinatal Problem Identification Programme database, but provides more details on the circumstances and contributing factors. A repeat audit is recommended to determine whether interventions have been effective.

Impact of Climate Change on Health From the Perspective of Catholic Relief Services.

Albeit on a much larger scale, climate change reminds me of how I felt in March 2014 when I heard about the first case of Ebola virus disease (EVD) in Guinea. Having spent many years in West Africa, I could only begin to imagine the breadth of destruction it would have on the lives of thousands. At the early stage of the EVD outbreak, the world struggled to respond appropriately because we had never experienced such a large outbreak of this disease. Climate change feels the same way, except that we have much better advance knowledge that if the world does not make drastic changes immediately, climate change will have a devastating health effect on countries across the globe.For more than seven decades, Catholic Relief Services (CRS) has responded to both sudden-onset or short-term and slow-onset or long-term emergencies, as a result of both natural disasters and conflict. In 2015, we worked in 101 countries and reached more than 100 million people. Our programing in agriculture, health, and emergency response-our three main areas of intervention-engages a wide range of partners, from civil society and governments to private companies and universities, working with community health workers as well as local health facility and district hospital staff and Ministry of Health representatives. While climate change has an impact on many areas of human health, this commentary is grounded in my expertise in mosquito-borne diseases.The Problem or Challenge From a Public Health Point of ViewFrom a public health perspective, change in the climate means changes in precipitation levels, which may cause flooding and impact health and nonhealth sectors alike. For instance, flooded lands make it difficult or impossible for farmers to cultivate their land, which in turn means reduced nutritious foods for families, affecting the health of pregnant women and children, among others. Flooding also means an upsurge in water-borne diseases and an increase in standing water, which forms a perfect breeding ground for mosquitos, thereby increasing vector-borne diseases such as malaria and Zika.Rising temperatures also means the (re)introduction of malaria in what are currently malaria-free areas. Conversely, this could also mean that there might no longer be malaria in current areas. However, the likelihood of the former could have a dramatic negative effect on the loss of human life and the health burden to humans. This would lead to a rise in malaria epidemics, since such communities would not have acquired natural immunity from the ongoing presence of the malaria parasite (and perhaps would not have the knowledge to prevent malaria) and would be hit with the disease just as hard as foreigners traveling to malaria-endemic countries. In countries with less developed health systems than those in Europe or the United States, this could unfortunately mean many lives lost.In CRS, we see climate change as undermining our investment in supporting national malaria control programs in developing countries to prevent and control malaria activities, such as seasonal malaria chemoprevention, which aims to eliminate malaria from a specific geographic area by providing prophylactic drugs to children 3 to 59 months of age. In addition, in the last few months of 2015, areas as diverse as India and Zimbabwe have struggled with sudden outbreaks of dengue fever, a disease also transmitted by a mosquito. This might forecast the rise of a broad spectrum of vector-borne diseases in the near future, just like we have recently seen with the Zika virus.The Solution From an International Nongovernmental Organization Point of ViewClimate change jeopardizes health for millions, and in turn will affect the way international agencies such as CRS respond to its effects. Since CRS works across sectors that include health and water management, we can contribute to reducing the negative health impacts caused by climate change and in mitigating the impact of climate change on the environment and agriculture and therefore livelihoods. …