Secondary Healthcare Settings Research Articles

The Concept of Gynecologic Oncology Services in Jakarta Related to Academic Health System

An Academic Health System (AHS) is a system in partnership among universities and health care providers that focuses on education, training, service, and research. The final outcome of this partnership is to improve health status. Numerous countries have been using this system, since this system is proven to lead to better sustainable outcome.The vision of Faculty of Medicine, University of Indonesia (FMUI) is "to create infinite experience for all through Academic Health System". The third mission of FMUI is to integrate the AHS to Dr. CiptoMangunkusumo Hospital and its other affiliated hospitals.The division of Oncology Department of Obstetrics and Gynecology is a part of Academic Health System that is responsible to create the Gynecologic Oncology services in this system. We create the gynecologiconcology services in preventive approach from primary to tertiary prevention.The sister hospitals of FMUI’s including Dr. Cipto Manungunkusumo, Persahabatan, Fatmawati, Karawang, and Tangerang General Hospital. Ideally, we should have health provider partners from primary, DistrictHospital (Rumah Sakit Umum Kecamatan/RSUK and Rumah Sakit Umum Daerah/RSUD). Another partner in collaborative project of AHS is Organization of Health Care Professions, such as Indonesian Medical Association, Indonesian Obstetrics and Gynecology Society, and Indonesian Gynecologic Oncology Society, and nongovernmental organization such as Female Cancer Program, Indonesian Cancer Foundation and others are part of partnership in AHS. When talking about public health status, it is also necessary to talk about the role of government as the policy maker and The Social Warranty Institution (Badan Penyelenggara Jaminan Sosial Kesehatan, BPJS) as the public health care insurance regulator. Primary health care should be included in the AHS’s partnership members because primary prevention strategy should be conducted in primary health care.The example of this project is Cervical Cancer Surveilance as a pilot project. We would prepare the project in collaborative meeting with all partners to make proposal in gynecologic oncology services in primary,secondary, and tertiary health care, and finally Dr. Cipto Mangunkusumo Hospital as the national referral Hospital. The proposal should talk about concepts of education, training, service, and research. Primary health care can promote cervical prevention and early detection via visual inspection using acetic acid and Pap test.Cervical precancer lesion can be treated using cryotherapy in primary health care. In secondary health care setting, cervical precancer lesion until microinvasive cervical cancer (stage 1A1) can be treated. Invasive cervical cancer should be managed in tertiary health care. We are preparing concepts where all services should follow the Clinical Practice Guideline. All medical patient database should be recorded digitally as long term cohort data. By applying this system, we’ll have a large number of patients’ data from primary to tertiary health care.This is crucial, considering that the process of education, training, and research of medical students, residents, and fellows is the backbone of AHS in improving health care status.

Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review

ObjectivesTo identify features of programmes and approaches to make healthcare delivery in secondary healthcare settings more dementia-friendly, providing a context-relevant understanding of how interventions achieve outcomes for people living with...

A medication assessment tool to evaluate prescribers’ adherence to evidence-based guidelines in bipolar disorder

Background The goal of evidence-based clinical practice has led to an increased interest in the development of tools to measure adherence to national guidelines in different diseases. This aids in detecting and measuring inappropriate prescribing to specific patient groups by using quality standards extracted from evidence-based guidelines, and ultimately provide the basis of consistent standardized prescribing. Objective To design and validate a medication assessment tool to assess prescribers' adherence to international guideline recommendations in the management of bipolar disorder (MATBD). Setting Outpatient psychiatry clinic at a secondary healthcare setting in Kuwait. Method International guidelines concerned with the management of bipolar disorder were reviewed in order to develop MATBD. Face and content validity of the developed tool (MATBD) was performed with a research and expert group. A 4-point Likert scale was used to assess the expert group's level of agreement to individual criterion. Content validity ratio (CVR) was calculated for each criterion (n=54) and the content validity index (CVI) was calculated for each section (n=5) of the MATBD. Finally, feasibility testing was performed on 19 patient records to confirm the tool's fitness for purpose. Main Outcomes Measure Perceived relevance, utility, and clarity of individual criteria, and reliability of their application to clinical settings. Results Face validity and content validity were achieved with a research and expert group (n=14). Content validity ratio (CVR) was demonstrated for 54 criteria; criteria with a negative CVR were removed. This resulted in a draft MATBD comprising of 52 criteria (CVI: 0.814). Feasibility testing on 19 patients' records resulted in a final MATBD comprising of 49 criteria divided into 3 sections: initial assessment, acute management and monitoring. Conclusion A medication assessment tool was developed and validated to be used as a means of profiling potential opportunities for medication therapy management optimization, and improving therapeutic interventions regarding the management of bipolar disorder.

Pharmacists' Attitudes and Role in Diabetes Management in Kuwait

Objectives: The objectives of this study were to measure pharmacists' attitudes toward management of diabetes, identify current levels of pharmacy service provided to patients with diabetes, and identify barriers for further provision of diabetes-related services. Subjects and Methods: A descriptive, cross-sectional study was conducted on a sample of 198 pharmacists working in primary and secondary health care settings in one health region of Kuwait using a pretested self-administered questionnaire. Descriptive statistics, correlations, and comparative analysis were performed. Results: The response rate was 84.4% (n = 168). Respondents had overall positive attitudes toward management of diabetes. Pharmacists regularly provided their patients with counseling on the appropriate time to administer their medications; however, services related to hypoglycemia and management of comorbid diseases were rarely provided. A negative correlation was found between the positive overall diabetes-related attitudes and pharmacists' involvement in providing the following diabetes-related services: glucose monitoring (r = -0.25, p = 0.001), comorbid disease management (r = -0.243, p = 0.001), and healthy living choices (r = -0.237, p = 0.002). The perception that some physicians and patients have of pharmacists as dispensers only was identified as the most important barrier to providing diabetes-related services. Conclusion: Pharmacists have positive diabetes-related attitudes; however, they provide limited diabetes-related services to their patients. Barriers to provision of pharmacy services to patients with diabetes should be addressed to enable optimum patient care delivery.

Time to question diabetes self-management support for Arabic-speaking migrants: exploring a new model of care.

The objective of this study was to explore a new model for diabetes self-management support in Arabic-speaking migrants. Two qualitative methods were used: face-to-face semi-structured individual interviews and focus groups. Interviews were audio-taped, transcribed verbatim and coded thematically. Arabic-speaking migrants with Type 2 diabetes were recruited from several primary, secondary and tertiary healthcare settings in metropolitan Melbourne, Australia. These settings were purposefully selected to obtain a diverse group of participants. Data collection continued until saturation was reached. This is the first study that involved members of Arabic-speaking communities in Australia in a formal process of consumer and public involvement to inform research design and recruitment in order to provide evidence for a new model of diabetes self-management for Arabic-speaking migrants. No self-management support was offered to Arabic-speaking migrants beyond the initial diagnosis period. Significant knowledge gaps and skills deficits in all self-management domains were evident. The provision of tailored self-management support was considered crucial. When asked about preferred structure and delivery modalities, a strong preference was reported for face-to-face storytelling interactions over telephone- or internet-based interventions. Gender-specific group education and self-management support sessions delivered by Arabic-speaking diabetes health professionals, lay peers or social workers trained in diabetes self-management were highly regarded. A patient and public involvement approach allows genuine engagement with Arabic-speaking migrants with diabetes. There is urgent need for a new model for self-management support among Arabic-speaking migrants. Findings yielded new recommendations for diabetes health professionals working with these migrant communities to support behaviour change.

Bladder and bowel dysfunctions in 1748 children referred to pelvic physiotherapy: clinical characteristics and locomotor problems in primary, secondary, and tertiary healthcare settings

The aims of this study are to evaluate in a pragmatic cross-sectional study, the clinical characteristics of childhood bladder and/or bowel dysfunctions (CBBD) and locomotor problems in the primary through tertiary health care setting. It was hypothesized that problems would increase, going from primary to tertiary healthcare. Data were retrieved from patient-records of children (1–16 years) presenting with CBBD and visiting pelvic physiotherapists. Prevalence’s of dysfunctions were compared between healthcare settings and gender using ANOVA and chi-square test. Agreement between physicians’ diagnoses and parent-reported symptoms was evaluated (Cohen’s Kappa). One thousand seventy hundred forty-eight children (mean age 7.7 years [SD 2.9], 48.9% boys) were included. Daytime urinary incontinence (P = 0.039) and enuresis (P < 0.001) were more diagnosed in primary healthcare, whereas constipation (P < 0.001) and abdominal pain (P = 0.009) increased from primary to tertiary healthcare. All parent-reported symptoms occurred more frequently than indicated by the physicians. Poor agreement between physicians’ diagnoses and parent-reported symptoms was found (k = 0.16). Locomotor problems prevailed in all healthcare settings, motor skills (P = 0.041) and core stability (P = 0.015) significantly more in tertiary healthcare.Conclusions: Constipation and abdominal pain (physicians’ diagnoses) and the parent-reported symptoms hard stools and bloating increased from primary to tertiary healthcare. Discrepancies exist between the prevalence’s of physicians’ diagnoses and parent-reported symptoms. Locomotor problems predominate in all healthcare settings.What is Known:• Childhood bladder and/or bowel dysfunctions (CCBD) are common.• Particularly tertiary healthcare characteristics of CBBD are availableWhat is New:• Characteristics of CBBD referred to pelvic physiotherapy are comparable in primary, secondary, and tertiary healthcare settings.• Concomitant CBBD appeared to be more prevalent than earlier reported.• Discrepancies exist between referring physicians’ diagnoses and parent-reported symptoms.

Perceptions of patients, significant others and health professionals of the role of significant others in programs for chronic non-malignant pain patients: a systematic review protocol.

The objective of this review is to identify and synthesize the perceptions of patients, significant others and health professionals regarding the role of significant others in chronic pain programs or healthcare regimens that target patients with chronic non-malignant pain. More specifically, the objective is to identify the role of significant others in chronic pain programs and healthcare regimens for adult patients with chronic non-malignant pain in primary, secondary or tertiary healthcare settings.

Types of health care facilities and the quality of primary care: a study of characteristics and experiences of Chinese patients in Guangdong Province, China.

BackgroundIn China, most people tend to use hospitals rather than health centers for their primary care generally due to the perception that quality of care provided in the hospital setting is superior to that provided at the health centers. No studies have been conducted in China to compare the quality of primary care provided at different health care settings. The purpose of this study is to compare the quality of primary care provided in different types of health care facilities in China.MethodsA cross-sectional survey with patients was conducted in Guangdong province of China, using the validated Chinese Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and 10 domains of primary care quality for patients in tertiary, secondary, and primary health care settings. Multivariate analyses were used to assess the association between types of facility and quality of primary care attributes while controlling for sociodemographic and health care characteristics.ResultsThe final number of respondents was 864 including 161 from county hospitals, 190 from rural community health centers (CHCs), 164 from tertiary hospitals, 80 from secondary hospitals, and 269 from urban CHCs. Type of health care facilities was significantly associated with total PCAT score and domain scores. CHC was associated with higher total PCAT score and scores for first contact-access, ongoing care, comprehensiveness-services available, and community orientation than secondary and/or tertiary hospitals, after controlling for patients’ demographic and health characteristics. Higher PCAT score was associated with greater satisfaction with primary care received. CHC patients were more likely to report satisfactory experiences compared to patients from secondary and tertiary facilities.ConclusionsThe study demonstrated that CHCs provided better quality primary care when compared with secondary and tertiary health care facilities, justifying CHCs as a model of primary care delivery.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1604-2) contains supplementary material, which is available to authorized users.

Patients' Preference for Integrating Homoeopathy Services within the Secondary Health Care Settings in India: The Part 3 (PPIH-3) Study.

Indian patients' preference for integrated homoeopathy services remains underresearched. Two earlier surveys revealed favorable attitude toward and satisfaction from integrated services. The objectives of this study were to examine knowledge, attitudes, and practice of homoeopathy and to evaluate preference toward its integration into secondary-level health care. A cross-sectional survey was conducted during May to October 2015 among 659 adult patients visiting randomly selected secondary-level conventional health care setups in Kolkata, Mumbai, Kottayam, and New Delhi (India) using a self-administered 24-item questionnaire in 4 local vernaculars (Bengali, Marathi, Malayalam, and Hindi). Knowledge and practice scores were compromised; attitude scores toward integration and legal regulation were high. Respondents were uncertain regarding side effects of homoeopathy and concurrent use and interactions with conventional medicines. A total of 82.40% (95% confidence interval = 79.23, 85.19) of the participants were in favor of integrating homoeopathy services. Preference was significantly higher in Delhi and lower in Kottayam. Probable strategic measures for further development of integrated models are discussed.

Effects of a nurse-coordinated prevention programme on health-related quality of life and depression in patients with an acute coronary syndrome: results from the RESPONSE randomised controlled trial.

BackgroundImprovement of health-related quality of life (HRQOL) is an important goal in preventive cardiology. HRQOL is also related to depressive symptoms, which represent a common co-morbidity and risk factor in patients with an acute coronary syndrome (ACS). Comprehensive nurse-coordinated prevention programmes (NCPP) in secondary care have been shown to reduce cardiovascular risk, however their effects on HRQOL and depressive symptoms have not been evaluated. We therefore investigated HRQOL and depressive symptoms in a secondary analysis in the RESPONSE trial, evaluating the effect of a NCPP on cardiovascular risk.MethodsRESPONSE was a multicentre (n = 11) randomised controlled trial in ACS-patients in secondary and tertiary healthcare settings evaluating a NCPP. The intervention consisted of four outpatient nurse clinic visits in the first 6 months after the index event, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care. The control group received usual care only. The outcome was change in HRQOL as measured by the MacNew questionnaire and change in depressive symptoms as measured by Beck’s Depression Inventory (BDI) questionnaire at 12-months follow-up relative to baseline.ResultsOf 754 patients randomised, 615 were analysed for HRQOL; 120 for depressive symptoms. At baseline, HRQOL was 5.17 (SD 1.09) and 5.20 (SD1.04) (scale range 1.0 to 7.0) in the intervention and control group, respectively. At 12 months follow-up, HRQOL increased by 0.57 (SD 0.89) in the intervention group as compared with 0.42 (SD 0.90) in the control group (p = 0.03). This increase was observed across all relevant subscales. The BDI decreased by 1.9 in the intervention group as compared with 0.03 in the control group (p = 0.03) (scale range 1.0 to 63).ConclusionParticipation in a NCPP is associated with a modest but statistically significant increase in HRQOL, and a decrease of depressive symptoms, both of which are highly relevant to patients. A reduction in depressive symptoms may in addition contribute to a reduction in the overall risk of recurrent events.Trial registrationDutch trials register: NTR1290. Registered 24 April 2008.

Patient Satisfaction and Experiences towards Paramedical Services in a Secondary Care Referral Healthcare Setting of India

Patient Satisfaction and Experiences towards Paramedical Services in a Secondary Care Referral Healthcare Setting of India

The epidemiology of self-harm in a UK-wide primary care patient cohort, 2001-2013.

BackgroundMost of the research conducted on people who harm themselves has been undertaken in secondary healthcare settings. Little is known about the frequency of self-harm in primary care patient populations. This is the first study to describe the epidemiology of self-harm presentations to primary care using broadly representative national data from across the United Kingdom (UK).MethodsUsing the Clinical Practice Research Datalink (CPRD), we calculated directly standardised rates of incidence and annual presentation during 2001–2013. Rates were compared by gender and age and across the nations of the UK, and also by degree of socioeconomic deprivation measured ecologically at general practice level.ResultsWe found significantly elevated rates in females vs. males for incidence (rate ratio - RR, 1.45, 95 % confidence interval - CI, 1.42-1.47) and for annual presentation (RR 1.56, CI 1.54–1.58). An increasing trend over time in incidence was apparent for males (P < 0.001) but not females (P = 0.08), and both genders exhibited rising temporal trends in presentation rates (P < 0.001). We observed a decreasing gradient of risk with increasing age and markedly elevated risk for females in the youngest age group (aged 15–24 years vs. all other females: RR 3.75, CI 3.67–3.83). Increasing presentation rates over time were observed for males across all age bands (P < 0.001). We found higher rates when comparing Northern Ireland, Scotland, and Wales with England, and increasing rates of presentation over time for all four nations. We also observed higher rates with increasing levels of deprivation - most vs. least deprived male patients: RR 2.17, CI 2.10–2.25.ConclusionsIncorporating data from primary care yields a more comprehensive quantification of the health burden of self-harm. These novel findings may be useful in informing public health programmes and the targeting of high-risk groups toward the ultimate goal of lowering risk of self-harm repetition and premature death in this population.

Implementation of antimicrobial stewardship interventions recommended by national toolkits in primary and secondary healthcare sectors in England: TARGET and Start Smart Then Focus.

To assess and compare the implementation of antimicrobial stewardship (AMS) interventions recommended within the national AMS toolkits, TARGET and Start Smart Then Focus, in English primary and secondary healthcare settings in 2014, to determine the prevalence of cross-sector engagement to drive AMS interventions and to propose next steps to improve implementation of AMS. Electronic surveys were circulated to all 211 clinical commissioning groups (CCGs; primary sector) and to 146 (out of the 159) acute trusts (secondary sector) in England. Response rates were 39% and 63% for the primary and secondary sectors, respectively. The majority of CCGs and acute trusts reported reviewing national AMS toolkits formally or informally (60% and 87%, respectively). However, only 13% of CCGs and 46% of acute trusts had developed an action plan for the implementation of these toolkits. Only 5% of CCGs had antimicrobial pharmacists in post; however, the role of specialist antimicrobial pharmacists continued to remain embedded within acute trusts, with 83% of responding trusts having an antimicrobial pharmacist at a senior grade. The majority of healthcare organizations review national AMS toolkits; however, implementation of the toolkits, through the development of action plans to deliver AMS interventions, requires improvement. For the first time, we report the extent of cross-sector and multidisciplinary collaboration to deliver AMS interventions in both primary and secondary care sectors in England. Results highlight that further qualitative and quantitative work is required to explore mutual benefits and promote best practice. Antimicrobial pharmacists remain leaders for implementing AMS interventions across both primary and secondary healthcare sectors.

Characteristics of patients requesting for tooth extraction in a Nigerian secondary health-care setting

Introduction: Patient desire or preference has been documented as one of the reasons for tooth extraction, but the affected patients have not been properly characterized. The objective of this study was to determine the characteristics of patients requesting for tooth extraction in a Nigerian secondary health-care setting. Materials and Methods: This study was a prospective study of patients attending the Dental Clinic of Central Hospital, Benin City, Edo State, Nigeria. An interviewer-administered questionnaire which elicited information on age, gender, educational status, dental attendance pattern, tooth extraction experience or that of close relative or friend, reasons for tooth extraction request, and awareness of tooth restoration options was the data collection tool. Data analysis was done using the IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA) and P < 0.05 was considered statistically significant. Results: A total of 137 patients aged between 17 and 65 years that met the inclusion criterion were studied. The majority of the patients who requested for tooth extraction were males, aged between 26 years and 65 years, had tertiary education, and had previously visited the dental clinic. A total of 48.9% and 62.0% of the participants had previous tooth extractions and had relatives that have undergone tooth extractions, respectively. Dental visit pattern was significantly associated with tooth extraction experience. The leading reason for requesting for tooth extraction was a permanent stoppage of pain. Age and gender were not significantly associated with the reasons for requesting tooth extraction. Conclusion: Data from this study revealed that adult patients of both genders, varying ages, educational attainments, and dental attendance patterns requested for tooth extraction in the studied Nigerian secondary health-care setting, and their leading reason for the request was a permanent stoppage of pain.

HOW A CLINICAL ANTIMICROBIAL STEWARDSHIP TEAM COULD IMPROVE ANTIBIOTIC USE AT A CHILDREN'S HOSPITAL

Aim The Department of Health have published guidelines which provide an outline for evidence-based Antimicrobial Stewardship (AMS) in secondary healthcare settings.1 The guidance states antimicrobials should not be started without clinical evidence of a bacterial infection and that all patients should be reviewed at 48 hours to make a clear plan of action; the “Antimicrobial Prescribing Decision”. The aim of this audit is to establish how often the 48 hour review takes place at our centre, and to evaluate the appropriateness of the decisions made at 48 hours, and estimate the impact of establishing a dedicated AMS team on patient care. Methods Data collection took place from Jan to May 2013. Ten wards (mix of medical and surgical) were visited on five occasions over that period. Information was collected from patients prescribed IV antibiotics for 48 hours or longer, and included basic demographic data, diagnosis, antibiotic prescribed and dose, and whether a 48 hour review had taken place. The data was reviewed by a virtual AMS team (Infectious Diseases (ID) consultant and ID pharmacist) and each patient underwent a 48 hour “Antimicrobial Prescribing Decision”, which was compared to the clinical decision. In addition the team assessed the eligibility for the patient for Outpatient Parenteral Antimicrobial Therapy (OPAT). Results Of the 533 patients screened, 78 (15%) had been prescribed antibiotics for more than 48 hours. The most common indications for IV antibiotics were pneumonia, sepsis and surgical prophylaxis. The most frequent antimicrobials were cefuroxime and cefotaxime. The AMS team found that they would have stopped or switched IV antibiotics to oral at 48 hours in 36% of cases when they had actually been continued, this was most common for patients receiving IV antibiotics for pneumonia, UTI and surgical prophylaxis. Six out of 78 patients were found to be eligible for OPAT at the time of review. Conclusions This audit demonstrated that a systematic 48 hours review by a dedicated antimicrobial stewardship team could improve adherence with the Department of Health “Start Smart Then Focus” guidance1 and improve patient care by stopping antibiotics early or switching to oral therapy. This study also estimates that combining this systematic review at 48 hours with an improved OPAT service could save 1800 bed days per year locally.

Standardizing bio-medical waste management to improve occupational safety of the healthcare workers at a secondary healthcare setting in Bangladesh

Standardizing bio-medical waste management to improve occupational safety of the healthcare workers at a secondary healthcare setting in Bangladesh

Cardiovascular disease mortality and years of life lost attributable to non-optimal systolic blood pressure and hypertension in northeastern Iran.

High blood pressure is the second most important risk factor of cardiovascular diseases (CVDs) in Iran. It is imperative to estimate the burden of CVDs that can be averted if high blood pressure is controlled at the population level. The aim of the current study was to estimate the avertable CVD mortality in the setting of Golestan Cohort Study (GCS). Over 50,000 participants were recruited and followed for a median of 7 years. The exposures of interest in this study were non-optimal systolic blood pressure (SBP) and hypertension measured at baseline. Deaths by cause have been precisely recorded. The Population Attributable Fraction (PAF) of deaths and Years of Life Lost (YLLs) due to CVDs attributable to exposures of interest were calculated. Overall, 223 deaths due to ischemic heart disease (IHD), 207 deaths due to cerebrovascular accidents (CVA), and 460 deaths due to all CVDs could be averted if the SBP of all subjects in the study were optimal. Similarly, 5,560 YLLs due to IHD, 4,771 YLLs due to CVA, and 11,135 YLLs due to CVDs could be prevented if SBP were optimal. In all age groups, the avertable deaths and YLLs were higher due to IHD compared with CVA. Deaths and YLLs attributable to non-optimal SBP in women were less than men. A very large proportion of CVD deaths can be averted if blood pressure is controlled in Iran. Effective interventions in primary and secondary health care setting are mandatory to be implemented as early as possible.

Prevalence of undiagnosed HIV infection among dental patients in a Nigerian secondary healthcare facility.

Objective:To determine the prevalence of undiagnosed HIV infection among patients attending the Dental Clinic of General Hospital Minna, Niger State, Nigeria.Materials and Methods:The study was a prospective study of 1080 dental patients of General Hospital Minna.Results:Out of the 1080 patients counseled, only 200 gave consent to participate in the study. Of the 200 participants, 8 tested positive for HIV, giving a prevalence of 4.0%. Females and participants in the sixth and fifth decades of life were found to have higher prevalence of undiagnosed HIV. Corpers and traders had higher prevalence of undiagnosed HIV. Participants with periodontal complaints (bleeding gums and shaking teeth) also had higher prevalence of undiagnosed HIV. The proportion of participants that reported having knowledge about the actual existence, risk factors, and prevention of HIV/AIDS was high. The proportion of participants who expressed willingness to receive more information on HIV-related issues was high.Conclusion:One out of 25 patients attending this secondary healthcare setting for dental services had undiagnosed HIV infection. This highlights the need for the establishment of voluntary counseling and testing (VCT) unit in the dental clinics and also re-emphasizes the strict compliance of standard precaution in dental practices.

Evaluation of Cwm Taf Health Board's knee-joint care programme a year from its completion: a professional-led dietetic and exercise intervention for obese patients with knee osteoarthritis

BackgroundThe National Institute for Health and Care Excellence recommends that weight loss and exercise are a core part of treatment for osteoarthritis. The delivery of these services within the National Health Service is by physiotherapists and dietitians in the secondary health-care setting. This feasibility study for obese patients with knee osteoarthritis was led by registered exercise professionals with the aim of assessing the potential for widespread use within the community. Methods81 patients met the inclusion criteria (body-mass index [BMI] >30 kg/m2 and radiological evidence of knee osteoarthritis) and were invited to participate through various routes (National Exercise Referral Scheme exclusion criteria were used). The intervention was a 16-week programme containing 1 h of exercise twice a week and 1 h a week of dietary advice. Primary outcome measures were Oxford knee score, quality of life (EQ-5D and EQ visual analogue scale [EQ-VAS]), and function (6-min walk test and 30 s sit to stand test). Outcome data were collected at week 16 and at 1 year after completion by the same exercise professionals. Student's t tests were used for statistical analysis. FindingsThe intervention started in January, 2013. 27 patients attended initial assessment and 18 finished the 16-week intervention. All 18 patients were white (nine men, mean age 59·7 years [SD 5·11], range 50–68), and had a starting BMI of 38·9 kg/m2 (SD 8·01). 14 patients completed 1-year follow-up (seven men, mean age 62·6 years [3·74], 53–69) and had a BMI of 33·34 kg/m2 (SD 5·08) at 1 year. At 1-year follow-up, significant changes were seen in the 30 s sit to stand test (mean change 3·6 repetitions, 95% CI 1·2 −5·96; p<0·0001) compared with baseline. Non-significant improvements were also seen in this time period for Oxford knee score (mean change 3·4, −4·97 to 11·7) and 6-min walk test (54·9 m, −51·4 to 161·3). InterpretationStatistically significant changes in 30 s sit to stand scores require investigation on a larger scale. Limitations include small sample size and lack of a control group. Sessions were run during working hours and no clear referral pathway was set up. Evening classes would allow working patients to participate, and incorporation of referral pathways within existing National Health Service structures would allow the programme to run at capacity. A larger study should advertise exit routes from the programme to enable long term success. FundingCwm Taf Health Board.

Adoption of Integrated Healthcare Information System in Nairobi County: Kenyatta National Hospital versus Mater Hospital

Health care information systems are aimed at facilitating the smooth running and interoperability of the health care delivery processes to ensure efficiency and effectiveness; however, the complexity, heterogeneity and diversity of the health care sector especially in Kenya poses serious challenges especially in relation to integration of the systems. There is a large disconnect between the public and private health care delivery systems characterized by fragmentation of services, locally within hospitals (among primary, secondary and tertiary health care settings) and across different health care centers. This research is aimed at examining the adoption of integrated healthcare information system in Nairobi County; Kenyatta National Hospital represents the public sector and The Mater Hospital the private sector. A sample size of 100 users on information system from the two hospitals picked from the primary secondary and tertiary levels were selected and questionnaires administered to them. Data was analyzed through descriptive statistics with the aid of SPSS. The results of the study indicated that there was a huge disparity between healthcare information system adoption in the public and private sectors with the private sector’s adoption being at an advanced stage. The major barriers to adoption including social political barriers, financial constraints and technical/technological barriers also presented.