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Since the Alma Ata Declaration of 1978, countries have varied in their progress towards establishing and sustaining comprehensive primary health care (PHC) and realizing its associated vision of ‘Health for All’. International health emergencies such as the coronavirus-19 (COVID-19) pandemic underscore the importance of PHC in underpinning health equity, including via access to routine essential services and emergency responsiveness. This review synthesizes the current state of knowledge about PHC impacts, implementation enablers and barriers, and knowledge gaps across the three main PHC components as conceptualized in the 2018 Astana Framework. A scoping review design was adopted to summarize evidence from a diverse body of literature with a modification to accommodate four discrete phases of searching, screening and eligibility assessment: a database search in PubMed for PHC-related literature reviews and multi-country analyses (Phase 1); a website search for key global PHC synthesis reports (Phase 2); targeted searches for peer-reviewed literature relating to specific components of PHC (Phase 3) and searches for emerging insights relating to PHC in the COVID-19 context (Phase 4). Evidence from 96 included papers were analysed across deductive themes corresponding to the three main components of PHC. Findings affirm that investments in PHC improve equity and access, healthcare performance, accountability of health systems and health outcomes. Key enablers of PHC implementation include equity-informed financing models, health system and governance frameworks that differentiate multi-sectoral PHC from more discrete service-focussed primary care, and governance mechanisms that strengthen linkages between policymakers, civil society, non-governmental organizations, community-based organizations and private sector entities. Although knowledge about, and experience in, PHC implementation continues to grow, critical knowledge gaps are evident, particularly relating to country-level, context-specific governance, financing, workforce, accountability and service coordination mechanisms. An agenda to guide future country-specific PHC research is outlined.

Force majeure clause is presented in various models, from the simple to the complex ones that contain comprehensive descriptions, provisions, and notifications set out in an agreement with the details of the consequences of force majeure events. Force majeure clause serves as a complementary core clause and a renegotiating tool for the parties in the case of any event occurring beyond their reasonable control, which is important enough not to be overlooked by business actors. The Covid-19 pandemic which is currently ongoing worldwide, which has been declared as a global pandemic by World Health Organization (WHO) on 11 March 2020, has had a huge impact on the social life and the world economy which is very unsettling for business people, banks, and the society in general. The research questions investigated in this study are: (i) What are the factors causing failures in the performance of contractual obligations? (ii) What is a comprehensive force majeure model clause for corporate transactions in Indonesia? This study employs the normative legal research method. A normative legal research is guided by the characteristics of the object of the research, yet remains limited by the expected outcome of the norms initially established. The theories applied in investigating the problems in this research are the will theory (wilstheorie), trust theory (vertrouwensttheorie), and statement theory (verklaringstheori). In this study, will be identified a comprehensive force majeure clause enables the party who experiences a force majeure event to waive some provisions in the contract agreement.

Objective Despite the fact that quality antenatal care is one of the essential aspects in maternal and child health care, the current perceived quality and associated factors of this service is not well acknowledged in Ethiopia. This study was therefore undertaken to assess focused antenatal care service utilization and associated factors in western Ethiopia. Result This study has measured the utilization of focused antenatal care services in terms of regularity of frequency of attendance, initiation time and completeness of the components. In about 19.8% of mothers attendance was irregular. While than three-fourths 330 (78.6%) started in the second trimester, and 42 (10%) of them commenced in the third trimester. The essential components of the services like counseling on nutrition, family planning, and HIV/AIDS were respectively missing in 1.9%, 8.3% and 7.4% of clients. Providing and receiving quality ANC was found to have emanated from different factors which were related to mothers, providers and facilities. Although the overall ANC utilization noticed deceivingly seems satisfactory, it was not fully comprehensive, focused and not to its current standard. Further efforts in terms of effective planning, monitoring and evaluation activities on the service are therefore strongly recommended.

The goodness of machine-part groups in cellular manufacturing systems is evaluated by different measures available in the literature. The commonly known grouping efficiency measures will be discussed in this paper. None of these measures has the ability to evaluate the efficiency of block -diagonal system and sub-system at the same time. Moreover, sparsity of individual cells was not taken into consideration in these measures. In this paper, a new grouping measure called Comprehensive Grouping Efficacy (CGE) is proposed to overcome the drawbacks of these measures. CGE is tested against some problems from the literature and the results demonstrate the ability of this measure to be used as comprehensive grouping measure since four of the well-known measures are included in the CGE formula. The superiority of CGE is that it can be used to find the efficiency of block-diagonal form, the efficiency of sub-system, sparsity index and efficacy index at the same time, which will give the designer the opportunity to control the cell size. Without knowing the efficiency of sub-systems (individual cells), the system designer will not be able to control the cell size.

In low-income countries, a child diagnosed with cancer has an 80% chance of dying, while in high-income countries more than 80% survive the disease. In Colombia, a middle-income country, the government issued new legislation that promotes the generation of comprehensive care units; nevertheless, seven years after its expedition, no institution has been recognized as such by the Ministry of Health. The objective of this study was to characterize the current offer of oncological services for cancer care in children and to identify the institutions that can be constituted in Units of Comprehensive Care of Childhood Cancer in Colombia.descriptive study of secondary source, the Special Register of Health Providers of the Ministry of Health and Social Protection was consulted, in order to identify the institutions that had enabled hospitalization services of medium or high complexity, chemotherapy, specialized consultation, emergencies, oncological surgery, and radiotherapy or nuclear medicine. The information is reported in absolute frequencies.Seventy one institutions have hematology-oncology consultation, 39 institutions have chemotherapy and hospitalization services of medium or high complexity, and 18 have radiotherapy enabled. Only nine of the institutions include all the services that are necessary for comprehensive care.Colombia has a sufficient supply of services for the care of children with cancer. Only a minority are in institutions that have the capacity to guarantee the integrality of the attention.En los países de bajos ingresos un niño diagnosticado con cáncer tiene un 80% de probabilidad de morir mientras que en los países de ingresos altos más del 80% sobrevive a la enfermedad. En Colombia, un país de ingresos medios, el gobierno expidió una nueva legislación que promueve la generación de unidades de atención integral; sin embargo, siete años después de su expedición, ninguna Institución ha sido reconocida como tal por el Ministerio de Salud.Caracterizar la actual oferta de servicios oncológicos para atención de cáncer en niños e identificar las instituciones que podrían ser constituirse en Unidades de Atención Integral de Cáncer Infantil en Colombia.estudio descriptivo de fuente secundaria, se consultó el Registro Especial de Prestadores de Salud del Ministerio de Salud y Protección Social; identificando las instituciones que tenían habilitados servicio de hospitalización de mediana o alta complejidad, quimioterapia, consulta especializada, urgencias, cirugía oncológica, radioterapia o medicina nuclear. Se reporta la información en frecuencias absolutas.Setenta y una instituciones cuentan con consulta de hemato-Oncología, 39 instituciones tienen servicios de quimioterapia y hospitalización de mediana o alta complejidad y 18 tienen habilitada radioterapia. Solo nueve de las instituciones incluyen la totalidad de los servicios necesarios para la atención integral.Colombia cuenta con una oferta suficiente de servicios para atención de niños con cáncer. Solo una minoría se encuentra en Instituciones que tienen la capacidad de garantizar la integralidad de la atención.

β-thalassemia is one of the commonest monogenic disorders in India and Punjab is significantly impacted with an estimated 4700 patients with thalassemia major. Like several other states in India with a high prevalence of thalassemia, Punjab is confronted with the fact that the magnitude of the problem is poorly defined, and there is no clear roadmap for thalassemia control within the context of a National Thalassemia Control Program. There is a paucity of clinical research in the state of Punjab with respect to the incidence, prevalence, morbidity and mortality related to thalassemia, and this project is intended to generate exact data with regards to the above. This article looks at a “Project Rainbow”, a potential strategy by which the Central and Punjab Governments, NGOs, Parents-Patients Societies and Corporate Houses can work together to intervene at each stage of the thalassemia care giving process and reduce the burden of Thalassemia in Punjab.

Our goal for this study was to evaluate the comprehensiveness of nuclear medicine (NM) residency websites from the USA and Canada. The authors searched all the existing NM residency programs as listed in the Fellowship and Residency Electronic Interactive Database and the Canadian Residency Matching Service. We analyzed each website for the presence or absence of 44 elements previously identified as important considerations for medical students applying to residency. We compared criteria prevalence between regions and program size using t-tests and analysis of variance. Our results showed that, of 47 NM residencies, 9 did not have a dedicated website, leaving a total of 38 websites available for evaluation. The individual websites in the USA had a mean of 15 of 44 elements sought; in contrast, Canadian programs had 26 of 44 elements sought. The most common elements included contact e-mail, mailing address, and comprehensive faculty listings. Information about resident hometown, academic interests, and extracurricular interests was only included in 3% of the websites. Only 3% of websites included case description and 11% included rotation schedule. Courses attended were included in 5%, educational resources in 8%, and resident education was included in 5% of the websites. In conclusion, about one in five NM residency programs do not have a publicly available website. The websites that do exist are incomprehensive, containing an average of only 32% of elements sought for the USA programs and 41% of elements sought in Canadian programs. Residency program websites are an important tool in recruiting medical students. Addressing the lack of available websites as well as the gap in content of the websites that does exist may improve recruitment of students to NM residency programs.

A major motivation for bifacial photovoltaics (PV) is an expected additional energy yield, compared to monofacial panels, due to the two-sided light sensitivity. The potential for an improved module power output and energy yield was repeatedly demonstrated by simulations [1-8], measurements on stand-alone modules [9-14] or installations [15-19] in various orientations. However, uncertainties concerning the actual output of projected systems still deter possible investors. Even in the PV community, the real quantitative benefit due to bifaciality and the best-suited technical concepts are still under discussion [20-22], as reflected by numerous publications dealing with these topics.

Introduction the aim of this study was to design an approach to improving care for frail older patients in hospital services where comprehensive geriatric assessment (CGA) was not part of the clinical tradition. Methods the intervention was based on the principles of CGA, using quality improvement methodology to embed care processes. Qualitative methods and coproduction were used to inform development of the intervention, which was directed towards the health care professionals involved in peri-operative/surgical cancer care pathways in two large UK teaching hospitals. A formative, qualitative evaluation was undertaken; data collection and analysis were guided by normalisation process theory. Results the clinicians involved agreed to use the toolkit, identifying potential benefits including improved surgical decision making and delivery of interventions pre-operatively. However, sites concluded that pre-operative assessment was not the best place for CGA, and at the end of the 12-month trial, implementation was still nascent. Efforts competed against the dominance of national time-limited targets, and concerns relating to patients’ immediate treatment and recovery. Some participants involved in the peri-operative pathway felt that CGA required ongoing specialist input from geriatricians, but it was not clear that this was sustainable. Conclusions clinical toolkits designed to empower non-geriatric teams to deliver CGA were received with initial enthusiasm, but did not fully achieve their stated aims due to the need for an extended period of service development with geriatrician support, competing priorities, and divergent views about appropriate professional domains.

Internal guidance signs are critical for the normal operation of a comprehensive passenger transportation hub. In the present paper, the procedures, methods and restrictions on the development of guidance sign locations are summarized in terms of the planning and design method of guidance signs and an evaluation of guidance sign service manuals after a sorting and analysis of relevant literature. The results show that the existing location model fails to quantitatively describe the behavior characteristics of massive passenger flows and results in the spatial planning and design of guidance signage being inaccessible for many in mass passenger transit and spatial topological networks resulting from 3D hub architecture make the constraint conditions of location models more complex. Sophisticated guidance signs and location models responding to behavioral characteristics and spatial topological networks will be a trend of interest in the optimal layout of future comprehensive passenger transportation hubs.

We describe the implementation of a comprehensive HIV stigma-reduction and wellness-enhancement community intervention that focused on people living with HIV (PLWH), as well as people living close to them (PLC) from six designated groups. A holistic multiple case study design was used in urban and rural settings in the North West Province, South Africa. Purposive voluntary sampling was used to recruit the PLWH group; snowball sampling was used for the PLCs. Data were analyzed by means of open coding and text document analysis. The comprehensive nature of the intervention ensured enhancement in relationships in all groups. The increase in knowledge about stigma, coping with it, and improved relationships led to PLWH feeling less stigmatized and more willing to disclose. PLCs became aware of their stigmatizing behaviors and were empowered to lead stigma reduction in their communities. Many community members were reached through these initiatives.

Purpose : determine the status of implementation of computer programs in physical education of students of Dnipropetrovsk region and the need for automated monitoring systems components of the physical condition of schoolchildren. Material : This survey was attended by 21 physical education teacher: teacher-trainers - 19.05%, with the highest category of teachers - 33.3%, with the first - 23.8%, in the second - 19.05%, professionals - 4.8%. Found that 90.5% of employees feel the need to create an automated system for complete monitoring of the physical condition of students grades 1-11 for the introduction of a differentiated approach in physical education of students. Conclusions . The study results give reason to believe it expedient to establish a comprehensive program of monitoring the physical condition of students based on physical development, functional and physical preparedness depending on features weighty growth indicators., Цель : определить состояние внедрения компьютерных программ в систему физического воспитания школьников Днепропетровской области и потребности в автоматизированных системах контроля компонентов физического состояния школьников. Материал : в анкетировании принял участие 21 учитель физической культуры: учителей-методистов - 19,05%, учителей с высшей категорией - 33,3%, с первой - 23,8%, со второй - 19,05%, специалистов - 4,8%. Установлено, что 90,5% специалистов считают необходимым создание автоматизированной системы комплексного контроля физического состояния школьников 1-11 классов для внедрения дифференцированного подхода в физическом воспитании школьников. Выводы . Результаты исследования дают основание считать целесообразным создание программы комплексного мониторинга физического состояния учеников с учетом физического развития, функциональной и физической подготовленности в зависимости от особенностей весо-ростовых показателей., Мета : визначити стан впровадження комп'ютерних програм у систему фізичного виховання школярів Дніпропетровської області та потреби в автоматизованих системах контролю компонентів фізичного стану школярів. Матеріал : в анкетуванні взяв участь 21 вчитель фізичної культури, зокрема вчителів-методистів - 19,05 %, вчителів з вищою категорією - 33,3 %, з першою - 23,8 %, з другою - 19,05 %, спеціалістів - 4,8 %. За результатами анкетування, 90,5 % фахівців вважають необхідним створення автоматизованої системи комплексного контролю фізичного стану школярів 1-11 класів для впровадження диференційованого підходу у фізичному вихованні школярів. Висновки . Результати дослідження дають підставу вважати доцільним створення програми комплексного моніторингу фізичного стану учнів 1-11 класів з урахуванням фізичного розвитку, функціональної та фізичної підготовленості залежно від особливостей масо-зростових показників школярів.

Introduction : Care of chronic disease and, as part of it, care of complex chronic patients (CCPs) is one of the main challenges for our health system. The “2011-2015 Health Plan for Catalonia” establishes a new model for the prevention and care of chronic disease, based on better detection of patients and on a transversal, multidisciplinary care model. Complex chronic patients in Catalonia are defined as patients with the combination of comorbidity criteria, a record of use of resources and risk criteria. Hospital Plato has a catchment population of 143,000 inhabitants. It is estimated that complex chronic patients represent between 3.5% and 5% of the population, meaning that the target population is estimated to be between 5,000 and 7,150 patients. In our centre, a Comprehensive Care Model for CCPs and patients with Advanced Chronic Disease centered on the process was established in 2012. The stages of the project were carefully designed. Description : In the development of the comprehensive care plan for complex chronic patients the following actions were carried out: - Constitution of the Reference Group in Care to Patients with advanced diseases and palliative needs. - Creation and appointment of the position of the Case Manager Nurse. - Constitution of the Territorial Complex Chronic Patient Project Group. - Preparation and design of the territorial care routes for Heart Failure and Chronic Obstructive Pulmonary Disease. - Internal training by the Reference Group in Care to Complex Chronic Patients, with the methodological support of the Qualy Observatory. - Training stays at other hospitals by the professionals belonging to the Reference Group in Care to Complex Chronic Patients. - Identification of CCPs by markers in the Shared Medical Record of Catalonia, accessible to all the health professionals in the community, in Primary Health Care as well as Hospital Care. - Design of two operational objectives as part of the Hospital's Strategic Plan: o To consolidate the internal and territorial actions of Complex Chronic Patients o A study to create a Complex Chronic Patient Unit This latter objective culminated with the creation of the Complex Chronic Patient Unit in 2014, with 12 beds, which has led to the sectorising of these patients. The objectives of the unit are to improve the health results, maintain the quality of life and at the same time decrease high-cost services such as urgent hospital admissions, maintaining the continuum of care. With this objective in mind, attendance at the daily multidisciplinary meeting by the Case Management Nurse, the social worker, the pharmacist and, since May 2015, by the Case Management Nurse in Primary Health Care was planned, in addition to the complete care team of the unit. Results : Patients dealt with at the CCP units since its creation to date: - By the Case Management Nurse 612 - By the Social Worker: 235 A study was carried out during a one-year period to compare the health results of these patients with those defined in the Chronicity Prevention and Care Programme with the following results: 421 patients were attended with an average age of 84.91 years (SD 8.94), of whom 56% were women. Health results: - Average stay 7.78 days (standard - Rate of readmissions at 30 days 8.31 (standard - Return to previous dispositive 68% (standard 70-80%), - Transfer to a partner health centre 11% (standard - Death 10.96% (standard Conclusions : The comprehensive care given to complex chronic patients requires a continuum of care. It must include all the health professionals both in primary care as well as in hospital care. This approach results in an improvement in the quality of care with good health results when compared to those previously defined.

Background: Although epidemiological research demonstrates that there is an association between lifestyle factors and risk of breast cancer recurrence, progression of disease, and mortality, no comprehensive lifestyle change clinical trials have been conducted to determine if changing multiple risk factors leads to changes in biobehavioral processes and clinical outcomes in women with breast cancer. This article describes the design, feasibility, adherence to the intervention and data collection, and patient experience of a comprehensive lifestyle change clinical trial (CompLife). Methods: CompLife is a randomized, controlled trial of a multiple-behavior intervention focusing on diet, exercise, and mind-body practice along with behavioral counseling to support change. The initial exposure to the intervention takes place during the 4 to 6 weeks of radiotherapy (XRT) for women with stage III breast cancer and then across the subsequent 12 months. The intervention group will have 42 hours of in-person lifestyle counseling during XRT (7-10 hours a week) followed by up to 30 hours of counseling via video connection for the subsequent 12 months (weekly sessions for 6 months and then monthly for 6 months). The primary outcome is disease-free survival. Multiple secondary outcomes are being evaluated, including: (1) biological pathways; (2) overall survival; (3) patient-reported outcomes; (4) dietary patterns/fitness levels, anthropometrics, and body composition; and (5) economic outcomes. Qualitative data of the patient experience in the trial is collected from exit interviews, concluding remarks, direct email correspondences, and web postings from patients. Results: Fifty-five patients have been recruited and randomized to the trial to date. Accrual of eligible patients is high (72%) and dropout rates extremely low (5%). Attendance to the in-person sessions is high (95% attending greater than 80% of sessions) as well as to the 30 hours of video counseling (88% attending more than 70% of sessions). Adherence to components of the behavior change intervention is high and compliance with the intensive amount of data collection is exceptional. Qualitative data collected from the participants reveals testimonials supporting the importance of the comprehensive nature of intervention, especially the mind-body/mindfulness component and social support, and meaningful lifestyle transformations. Conclusion: Conducting a comprehensive, multicomponent, lifestyle change clinical trial for women with breast was feasible and collection of biobehavioral outcomes successful. Adherence to behavior change was high and patient experience was overwhelmingly positive.

Introduction: Comprehensive correct HIV/AIDS knowledge (CCAK) is defined as correctly identify the two major ways of preventing the sexual transmission of HIV, and reject the most common misconceptions about HIV transmission. There are limited studies on this topic in Sudan. In this study we investigated the Comprehensive correct HIV/AIDS knowledge among Universities students. Methods: A cross-sectional analytic study was conducted among 556 students from two universities in 2014. Data were collected by using the self-administered pre-tested structured questionnaire. Chi-square was used for testing the significance and P. Value of ≥ 0.05 is considered as statistically significant. Results: The majority (97.1%) of study subjects have heard about a disease called HIV/AIDS, while only 28.6% of them knew anyone who is infected with AIDS in the local community. Minority (13.8%) of students had CCAK however, males showed a better level of CCAK than females (OR = 2.77) with high significant statistical differences (P. Value = 0.001). Conclusion: Poor rate of CCAK among university students is noticed, especially among females. Almost half of students did not know preventive measures of HIV, nearly two thirds had misconception, about one third did not know the mode of transmission of HIV. Pan African Medical Journal 2016; 24

Toward revitalizing the Nation’s primary medical care system, the Agency for Health Research & Quality (AHRQ) stated that new foundational measures must be crafted for achieving high-quality, accessible, efficient health care for all Americans. The efficiency of medical care is viewed along two dimensions: first, we must continue to pursue translational research; and second, we must translate research to optimize effectiveness in specific clinical settings. It is increasingly evident that the efficiency of both translational processes is critical to the revitalization of health care, and that it rests on the practical functionality of the nexus among three cardinal entities: the researcher, the clinician, and the patient. A novel model has evolved that encapsulates this notion, and that proposes the advanced pri-mary care “medical home”, more commonly referred to as the “patient-centered medical home” (PCMH). It is a promising model for transforming the organization and delivery of primary medical care, because it is not simply a place per se, but it is a function-ing unit that delivers medical care along the fundamental principles of being patient-centered, comprehensive, coordinated, and accessible. It is energized by translational research, and its principal aim and ultimate goal is translational effectiveness. The PCMH is a model that works well within the priorities set by the American Recovery and Reinvestment Act of 2009, and the Health Care Reform Act of 2010. However, while dentistry has a clearly defined place in both Acts, the PCMH is designed for medical and nursing care. A parallel model of the “patient-centered dental home” (PCDH) must be realized.

HIV stigma remains high globally. Although there is a selection of HIV stigma reduction interventions discussed in the literature, there is a paucity of research about the effectiveness of these interventions. This study aimed at gaining a deeper understanding of the experiences of people living with HIV (PLWH) and people living close to them from six designated groups during and after having undergone a comprehensive HIV stigma reduction community intervention in both an urban and a rural setting. Attention was focused on their expressed experiences of the workshop and projects executed. A qualitative interpretive description approach was used. PLWH as participants were selected through purposive voluntary sampling and through snowball sampling for the people living close to them. Recruitment was from both urban and rural settings in the North West Province, South Africa. Data collection was via in-depth interviews with 23 PLWH and 60 people living close to them from specific designated groups. The data were thematically analysed through manual open coding. The results from the urban and rural settings were pooled, as there were no noteworthy differences in the themes between them. The results indicated that there was an increase in knowledge in all the groups, as well as experiences of enhanced relationships and of being equipped with leadership skills in order to go out into the community and being part of HIV stigma reduction actions. The intervention in its comprehensive nature was found to have been successful and promising for future use in reducing HIV stigma.Keywords: community, comprehensive, HIV, intervention, stigmaLa stigmatisation lie´e au VIH est re´pandue dans le monde. Bien que la documentation sur le sujet aborde un ensemble d’interventions en faveur de sa re´duction, les recherches sur l’efficacite´ de telles interventions restent limite´es. Cette e´tude vise donc a` mieux comprendre l’expe´rience des personnes vivant avec le VIH (PVVIH) et de leur entourage dans six groupes se´lectionne´s pendant et apre`s une intervention communautaire globale de re´duction de la stigmatisation lie´e au VIH, en milieu urbain et rural. L’on a accorde´ une attention particulie`re aux expe´riences partage´es sur l’atelier et les projets entrepris. Une approche de description qualitative et interpre´tative a e´te´ adopte´e. Les PVVIH participantes ont e´te´ se´lectionne´es graˆce a` un e´chantillonnage dirige´ et volontaire, et un e´chantillon boule de neige pour l’entourage. Les personnes recrute´es provenaient de milieux urbains et ruraux de la province du Nord-Ouest, Afrique du Sud. La collecte de donne´es s’est faite par des entretiens approfondis avec 23 PVVIH et 60 personnes de leur entourage, toutes issues de groupes spe´cifiques de´signe´s. Les donne´es ont e´te´ analyse´es the´matiquement par codage ouvert et manuel. Les re´sultats des milieux urbains et ruraux ont ensuite e´te´ regroupe´s car il ne semblait pas y avoir de diffe´rence remarquable entre les the`mes souleve´s dans les deux milieux. Dans tous les groupes, les re´sultats indiquaient un accroissement des connaissances, de l’ame´lioration des relations, et des compe´tences de leadership pour prendre part a` la vie communautaire et participer aux activite´s de re´duction de la stigmatisation. La re´ussite de la nature globale de l’intervention est prometteuse pour les activite´s futures de re´duction de la stigmatisation du VIH.Mots-cle´s: communaute´, global(e), VIH, intervention, stigmatisation

Introduction The implementation of telehealth into the delivery of chronic conditions management within Hywel Dda Health Board has provided an opportunity to enhance close working relationships with Carmarthenshire County Council’s well-established telecare team. The responsibilities of the telecare team were initially limited to the installation and removal of telehealth devices in patients’ homes and training on its use but as the use of telehealth has widened, an increasing number of non-clinical tasks, several of which were previously undertaken by clinical staff, have been delegated to members of the telecare team and linked to the monitoring centre. In addition, all the tasks associated with managing and administering the patients on the telehealth system backend are undertaken by the chronic conditions management administrative support team within the Health Board. Aims and objectives This presentation will describe our experience of bringing together clinical and non-clinical staff from two separate organisations to deliver a more appropriate, comprehensive and timely telehealth service to patients. It will explain how strong working relationships have developed, the importance of a clear understanding of different roles within the team and the need for building trust and confidence in colleagues, resulting in the clinical nurse specialists ‘letting go’ and responding to change that supports effective monitoring and still providing quality care. We will report on the lessons learned during the process, from both staff groups’ perspectives and the patient’s perspective, as tasks previously undertaken by clinicians have shifted to non-clinical staff. Results Our current approach to telehealth has evolved into a model which ensures that the specialist nursing team are able to focus solely on delivering quality clinical care enabled and supported by telehealth where appropriate. All the non-clinical tasks are now undertaken by the telecare team staff and chronic conditions management administrative support and include: Installing devices in patients’ homes and providing education and training First-line monitoring/triage of uploaded patient data Escalation of clinical alerts to nursing team by Telephone Resolving technical alerts and missing uploads/data Provision of refresher training to patients as required (telephone-based or face-to-face) Responding to patient or nurse-reported technical problems, including battery/faulty device replacement Providing advice on home set-up e.g., recommending changes System administrator, patient administration and management function of backend The results of patient and staff questionnaires seeking feedback on our model will be given together with an economic evaluation comparing the current approach, which utilises telecare and specialist staff to deliver the service compared to the previous delivery model using specialist nursing staff only. We will also show that through embedding telehealth into a well-established community specialist nursing service has the following impact and outcomes: Patients to take more responsibility for their day-to-day care Nurses to monitor patients remotely and contact those who need support reducing the number if inappropriate home visits Reducing travelling for the nursing service Improving relationships between patient and nurse Supporting carers Conclusions We have embedded our telehealth service into existing service models which have now been enhanced utilising a partnership approach and ensuring the best use of the skills and expertise, across the organisations involved. This has been a key factor in developing an efficient, effective and sustainable approach.

Objective To assess the effects of a comprehensive intervention (staff training, equipment, internal clinical audits, cost sharing system, patients–providers meetings) in improving cesarean delivery access and quality in an urban district of Burkina Faso. Methods We conducted a before-after study in the health district sector 30 in Ouagadougou between 2003 and 2006. We measured cesarean delivery quality (accessibility, diagnosis, procedure, postoperative follow-up) and maternal and neonatal health in 1371 sections. Results The number of cesarean deliveries performed increased each year, from 42 in 2003 to 630 in 2006. This increase happened without increase in maternal and perinatal post-cesarean mortality (respectively 1.1% and 3.6% in 2006). The cesarean delivery rate for women of the district increased from 1.9% to 3.3% of expected births between 2003 and 2005. Conclusion To improve access to quality cesarean delivery, we have shown that it was necessary to have a systemic approach combining technical, operational, sociocultural, and political factors.

Cleft lip and palate (CLP) is one of the most prevalent congenital craniofacial deformities. CLP may result in impairments that stigmatize the individual and have an impact on health, emotions, and social interactions. This article describes the comprehensive orthodontic approach in the treatment of unilateral cleft of the lip and the palate. It also emphasizes the importance of orthodontic intervention to improve the facial esthetics in CLP patients. The treatment planning procedures and the results are presented below.

Introduction: The information regarding therapeutically relevant genomic alterations in small cell lung cancer (SCLC) is not well developed. We analyzed the SCLC genome using an integrative approach to stratify the targetable alterations. Methods: We performed whole exon sequencing (n = 51) and copy number analysis (n =47) on surgically resected tumors and matched normal tissue samples from treatment-naive Japanese SCLC patients. Results: The demographics of the 51 patients included in this study were as follows: median age, 67 years (range, 42-86 years); female, 9 (18%); history of smoking, 50 (98%); and pathological stage I/II/III/ IV, 28/13/9/1, respectively. The average number of nonsynonymous mutations was 209 (range, 41-639; standard deviation, 130). We repeatedly confirmed the high prevalence of inactivating mutations in TP53 and RB1, and the amplification of MYC family members. In addition, genetic alterations in the PI3K/AKT/mTOR pathway were detected in 36% of the tumors: PIK3CA, 6%; PTEN, 4%; AKT2, 9%; AKT3, 4%; RICTOR, 9%; and mTOR, 4%. Furthermore, the indi- vidual changes in this pathway were mutually exclusive. Importantly, the SCLC cells harboring active PIK3CA mutations were potentially targetable with currently available PI3K inhibitors. Conclusions: The PI3K/AKT/mTOR pathway is distinguishable in SCLC genomic alterations. Therefore, a sequencing-based compre- hensive analysis could stratify SCLC patients by potential therapeu- tic targets.

Letter concerning the services of a member of the State Board of Education for the San Pete teachers' institute meetings.