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Abstract Objective The study aims to explore the perceived outcomes of Medical Teaching Institution (MTI) reforms on autonomy and overall performance within tertiary healthcare institutions in Khyber Pakhtunkhwa (KP) province, Pakistan. Methodology A cross-sectional study was carried out from September 2023 to March 2024, involving interviews with frontline staff, administrative personnel, and senior management within MTI-affiliated institutions. The methodology employed, using both qualitative and quantitative data analysis techniques. Results The study showed that institutional staff members’ knowledge and understanding of the MTI changes differed. Some observed very minor adjustments, while others saw advances in hospital operations and service delivery. Administrative complexity, political meddling, and resource allocation problems were noted as challenges. Positive results were also observed, though, and they included improved infrastructure, possibilities for staff training, and decision-making procedures. Conclusion Despite significant improved, there are still challenges, such as inconsistent staff comprehension, mixed impacts on service delivery, resource allocation issues, and political meddling. Addressing these issues necessitates improved communication, continuous evaluation, and coordinated efforts to improve administrative systems and obtain consistent funding.

Objective: The study aims to explore the perceived outcomes of Medical Teaching Institution (MTI) reforms on autonomy and overall performance within tertiary healthcare institutions in Khyber Pakhtunkhwa (KP) province, Pakistan. Methodology: A cross-sectional study was carried out from September 2023 to March 2024, involving interviews with frontline staff, administrative personnel, and senior management within MTI-affiliated institutions. The methodology employed, using both qualitative and quantitative data analysis techniques. Results: The study showed that institutional staff members' knowledge and understanding of the MTI changes differed. Some observed very minor adjustments, while others saw advances in hospital operations and service delivery. Administrative complexity, political meddling, and resource allocation problems were noted as challenges. Positive results were also observed, though, and they included improved infrastructure, possibilities for staff training, and decision-making procedures. Conclusion: Despite significant improved, there are still challenges, such as inconsistent staff comprehension, mixed impacts on service delivery, resource allocation issues, and political meddling. Addressing these issues necessitates improved communication, continuous evaluation, and coordinated efforts to improve administrative systems and obtain consistent funding. [ABSTRACT FROM AUTHOR]

Objective: Third molar extraction is a common procedure with occasional complications. This study aimed to determine the incidence and types of complications in challenging lower third molar extractions and to identify complication risk factors in tertiary hospital patients. Material and methods: A retrospective cohort study was conducted on 354 patients who underwent unilateral lower third molar extraction during a 2-year period in 2018–2019 at Helsinki University Hospital. The outcome was the presence of a complication, and patient-related and operation-related variables served as determinants. Statistical analyses included Mann–Whitney U and Chi-squared tests, and binary logistic regression. Results: Complications occurred in 16.7% of patients. The most common complication was local infection (7.6%), followed by nerve injury (5.6%). The complication risk was 3.7-fold (95% confidence interval (CI) 1.97–6.77, p < 0.001) higher in extractions defined as demanding than in routine operative extraction. If the third molar was acutely infected, the complication risk increased 2.0-fold (95% CI 1.08–3.75, p = 0.027). Conclusions: Due to the high rate of complications in challenging extractions, scheduling a follow-up visit is important, and risk factors must be considered properly, especially in demanding extractions and in acutely infected third molars.

This study seeks to point out the different configurations of Health Care Networks in primary care (AB) and Hospital Care (AH), dimensioned based on coverage, quality, and resolvability characteristics in health macro-regions. Cross-sectional study used the cluster analysis and segmented 103 macro-regions into different profiles of coverage, quality and resolubility: group 1 (high coverage/AB and medium/AH; low quality AB-AH with high resolubility); group 2 (high coverage/AB and low/AH; low quality ABAH with medium resolubility) and group 3 (high coverage/AB and medium/AH; high quality ABAH with high resolubility). Coverage in AB was classified as high for 100% of the Brazilian population and in AH low to 9.70% and medium to 90.29%. Quality/AB-AH is low for 58.54% and high for 41.15%. Resolubility is high for 90.29% and medium for 9.70%. In Brazil, there is expansion of coverage with low quality/AB; shortage of hospital beds and low quality/HA with high resolution. However, in the Southeast and South, high AB-AH quality prevails. The structuring of health networks is still characterized by low resolution, demanding incentives for the governance of inter-federal arrangements. [ABSTRACT FROM AUTHOR]

Background: Despite a huge number of advancements in the medical field, periodontitis still remains one of the most prevalent oral diseases worldwide. Aim: Thus, the primary aim of our study was to evaluate the prevalence of periodontal diseases in patients reporting to the tertiary healthcare setup in Ranchi. Materials and Methods: Based on inclusion criteria, subjects aged 18–60 years were selected and a per forma was filled by the observer. The prevalence of periodontal disease was measured using the community periodontal index, simplified oral hygiene index, and stage of periodontitis. Results: Descriptive variables were assessed using frequency, percentage, mean, and standard deviations, while the categorical analysis was performed using the Chi-square tests. Conclusion: General awareness about periodontal health and regular dental visits should be given utmost importance among the rural populations of every developing country.

Background Up to 30% of children have constipation at some stage in their life. Although often short-lived, in one-third of children it progresses to chronic functional constipation, potentially with overflow incontinence. Optimal management strategies remain unclear. Objective To determine the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation, and understand how they can best be implemented. Methods Key stakeholders, comprising two parents of children with chronic functional constipation, two adults who experienced childhood chronic functional constipation and four health professional/continence experts, contributed throughout the research. We conducted pragmatic mixed-method reviews. For all reviews, included studies focused on any interventions/strategies, delivered in any setting, to improve any outcomes in children (0–18 years) with a clinical diagnosis of chronic functional constipation (excluding studies of diagnosis/assessment) included. Dual reviewers applied inclusion criteria and assessed risk of bias. One reviewer extracted data, checked by a second reviewer. Scoping review: We systematically searched electronic databases (including Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature) (January 2011 to March 2020) and grey literature, including studies (any design) reporting any intervention/strategy. Data were coded, tabulated and mapped. Research quality was not evaluated. Systematic reviews of the evidence of effectiveness: For each different intervention, we included existing systematic reviews judged to be low risk of bias (using the Risk of Bias Assessment Tool for Systematic Reviews), updating any meta-analyses with new randomised controlled trials. Where there was no existing low risk of bias systematic reviews, we included randomised controlled trials and other primary studies. The risk of bias was judged using design-specific tools. Evidence was synthesised narratively, and a process of considered judgement was used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic synthesis: Included studies (any design, English-language) detailed intervention-related costs. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit, and reporting quality evaluated using the consensus health economic criteria checklist. Systematic review of implementation factors: Included studies reported data relating to implementation barriers or facilitators. Using a best-fit framework synthesis approach, factors were synthesised around the consolidated framework for implementation research domains. Results Stakeholders prioritised outcomes, developed a model which informed evidence synthesis and identified evidence gaps. Scoping review 651 studies, including 190 randomised controlled trials and 236 primary studies, conservatively reported 48 interventions/intervention combinations. Effectiveness systematic reviews studies explored service delivery models (n = 15); interventions delivered by families/carers (n = 32), wider children’s workforce (n = 21), continence teams (n = 31) and specialist consultant-led teams (n = 42); complementary therapies (n = 15); and psychosocial interventions (n = 4). One intervention (probiotics) had moderate-quality evidence; all others had low to very-low-quality evidence. Thirty-one studies reported evidence relating to cost or resource use; data were insufficient to support generalisable conclusions. One hundred and six studies described implementation barriers and facilitators. Conclusions Management of childhood chronic functional constipation is complex. The available evidence remains limited, with small, poorly conducted and reported studies. Many evidence gaps were identified. Treatment recommendations within current clinical guidelines remain largely unchanged, but there is a need for research to move away from considering effectiveness of single interventions. Clinical care and future studies must consider the individual characteristics of children. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information. Plain language summary Between 5% and 30% of children experience constipation at some stage. In one-third of these children, this progresses to chronic functional constipation. Chronic functional constipation affects more children with additional needs. We aimed to find and bring together published information about treatments for chronic functional constipation, to help establish best treatments and treatment combinations. We did not cover assessment or diagnosis of chronic functional constipation. This project was guided by a ‘stakeholder group’, including parents of children with constipation, people who experienced constipation as children, and healthcare professionals/continence experts. We carried out a ‘scoping review’ and a series of ‘systematic reviews’. Our ‘scoping review’ provides an overall picture of research about treatments, with 651 studies describing 48 treatments. This helps identify important evidence gaps. ‘Systematic reviews’ are robust methods of bringing together and interpreting research evidence. Our stakeholder group decided to structure our systematic reviews to reflect who delivered the interventions. We brought together evidence about how well treatments worked when delivered by families/carers (32 studies), the wider children’s workforce (e.g. general practitioner, health visitor) (21 studies), continence teams (31 studies) or specialist consultant-led teams (42 studies). We also considered complementary therapies (15 studies) and behavioural strategies (4 studies). Care is affected by what is done and how it is done. We brought together evidence about different models of delivering care (15 studies), barriers and facilitators to implementation of treatments (106 studies) and costs (31 studies). Quality of evidence was mainly low to very low. Despite numerous studies, there was often insufficient information to support generalisable conclusions. Our findings generally agreed with current clinical guidelines. Management of childhood chronic functional constipation should be child-centred, multifaceted and adapted according to the individual child, their needs, the situation in which they live and the health-care setting in which they are looked after. Research is needed to address our identified evidence gaps. Scientific summary Background Chronic functional constipation (CFC) in childhood is common; it is estimated to affect 5–30% of school-aged children, becoming chronic in around one-third of cases. CFC has negative effects on quality of life (QoL) of children, families and carers, with increasing impact as the child gets older. Although rarely life-threatening, CFC is an unpleasant and distressing condition, associated with a wide range of complications, including physical discomfort, missed school, poor school performance, social isolation and reduced involvement in group activities. More than a third of children with CFC will present clinically with behavioural problems as a result of the constipation. The healthcare costs of childhood CFC are significant. Treatments are usually directed at symptom control since limited diagnostics mean no underlying cause is identified in more than 95% of cases, thus limiting ability to stratify treatments. There are a number of different interventions available for the management of CFC; however, the optimal strategy for combining and implementing interventions for individual circumstances remain unclear. National Institute for Health and Care Research (NIHR) commissioned this work to address the question: ‘What are the most effective interventions, and combinations and sequences of interventions, for childhood chronic functional constipation (CFC), and how can they best be implemented?’ Objectives Specific research questions (RQs) answered by this project were: RQ1: What is the current evidence relating to management strategies for childhood CFC? (Scoping review). RQ2: What are the most effective childhood CFC strategies and combinations of strategies in relation to outcomes of importance to stakeholders and/or cost to the patient/NHS? [Systematic review (SR) of evidence of effectiveness and cost effectiveness]. RQ3: What factors are associated with implementation success or failure of childhood CFC strategies and combinations of strategies for different subgroups? (SR of factors affecting implementation). RQ4: What are the evidence gaps in childhood CFC management strategies? Design We conducted a three-stage pragmatic mixed-method study. In stage 1, we completed a broad, comprehensive scoping review. In stage 2, we conducted focused SRs evaluating effectiveness, cost effectiveness and factors affecting implementation. In stage 3, we integrated findings, generating interactive evidence maps, exploring complementarity between our findings and published clinical guidelines, and identifying evidence gaps. Methods Patient and public involvement Stakeholder involvement was central to our project. We formed a stakeholder group (SG) from across the UK, comprising people with lived experience of childhood CFC, parents of children with CFC, healthcare professionals and representatives of relevant charities. We adhered to key principles for research co-production. The SG provided continuous project oversight and completed specific activities. These activities included development of an intervention taxonomy and logic model, agreement on outcomes for the review, identifying evidence gaps and reaching consensus on clinical implications. Scoping review Our scoping review was based on a systematic search of several electronic databases including medical literature analysis and retrieval system online (MEDLINE), excerpta medica database (EMBASE) and Cumulative Index to Nursing and Allied Health Literature (CINAHL; January 2011 to March 2020), as well as searches of grey literature, contacting experts and forward citation tracking. We included papers, regardless of study design, which investigated, reported or discussed any strategy, delivered in any setting, aimed at improving any outcomes in children (aged 0–18 years) with a clinical diagnosis of CFC. We did not include studies of assessment/diagnosis. We included studies involving children with or without additional needs but excluded those with a recognisable cause of constipation such as anorectal malformation, Hirschsprung’s disease, intestinal nerve abnormalities, metabolic or endocrine causes. Eligible abstracts and full texts were independently reviewed by two reviewers. Data were extracted by one reviewer and cross-checked by a second. Two reviewers independently applied descriptive codes to categorise the type of study, aim/focus of the study, outcomes, types of interventions/intervention combinations, and availability of data relating to effectiveness, economics or implementation factors. In keeping with scoping review methodology, we did not formally assess research quality. Data were summarised within an evidence gap map. Systematic reviews of evidence of effectiveness For our SRs of evidence of effectiveness, we considered all studies identified in the scoping review and ‘tagged’ them as studies of effectiveness. We included any studies investigating effectiveness of any intervention, or combination of interventions, aimed at improving outcomes in children with CFC. Informed by our stakeholders, we grouped studies according to whether the intervention was one that would be delivered by families/carers (‘Level 0’), the wider children’s workforce (e.g. general practitioner, health visitor) (‘Level 1’), continence teams (‘Level 2’) or specialist consultant-led teams (‘Level 3’). We also considered different models of service delivery, and complementary and psychosocial therapies. For each different intervention, we adopted a hierarchical, step-wise approach to inclusion of different study designs. If there was a comprehensive SR, judged to be low risk of bias (ROB) [using risk of bias assessment tool for systematic reviews (ROBIS) criteria, assessed by two independent reviewers], this was also included. Where we included a SR, we also included any randomised controlled trials (RCTs) published after the date of the search in the review. Where there was no SR, we included RCTs and other primary studies of intervention effectiveness. Data were extracted on study methods, participant characteristics, intervention characteristics [using template for intervention description and replication (TIDieR) framework], outcomes and key findings. ROB was judged using tools appropriate to the study design [e.g. Cochrane ROB tool for RCTs, critical appraisals skills programme (CASP) tools for cohort studies, Joanna Briggs Institute (JBI) tools for qualitative evidence, Ways of Evaluating Important and Relevant Data (WEIRD) tool for other study designs]. Relevant meta-analyses within included SRs were updated with any new RCTs following the methods reported in the SR. A narrative synthesis of evidence of effectiveness for each intervention, delivered within ‘level’ 0 to 3 was presented, with a process of considered judgement used to judge certainty in the evidence as high, moderate, low, very low or insufficient evidence. Economic evaluation For our SR of economic studies, we considered any economic evidence identified in our scoping review and conducted additional searching of electronic databases and citation tracking following best practice guidance. We included all types of study detailing costs related to interventions aimed at children with CFC that were published in English, regardless of study design. One reviewer extracted data, including details of economic evaluations, and these were checked by a second reviewer. Studies were categorised as cost-consequence, cost-effectiveness, cost-utility or cost-benefit and their quality evaluated using the consensus health economic criteria (CHEC) checklist, and data were brought together into a narrative synthesis. Systematic review of factors affecting implementation For our SR of factors affecting implementation, we included studies which were identified in the scoping review as explicitly reporting data relating to key participant variables, barriers, facilitators, equity factors and adherence. One reviewer systematically identified, extracted and coded [using the consolidated framework for implementation research (CFIR)] barriers and facilitators, and a second reviewer checked this. We used a best fit framework synthesis approach combining deductive and inductive thematic approaches to identify barriers and facilitators. Data were brought together in a narrative synthesis organised around the CFIR domains. Integration of findings Our integration of findings from the SRs was informed by decisions taken by our stakeholders, including development of a logic model. We explored agreements between our findings and recommendations within previously published guidelines. We brought our findings together within interactive evidence maps, and systematically identified evidence gaps. Results The scoping review included 651 studies, including 190 RCTs and 236 primary studies. Forty-eight interventions (or combinations of interventions) were reported. Studies were mainly conducted in high-income countries; no studies from low-income countries were identified. The most frequently reported interventions were delivered by carers, prior to healthcare professional involvement (22%); these were primarily lifestyle interventions focused on diet. The least frequently reported were psychosocial interventions (3%). Children were recruited from a variety of settings including hospitals, clinical outpatients, and other community settings. Interventions were generally delivered face to face either at home or within a variety of hospital settings such as the emergency department. Interventions were rarely delivered in education settings (e.g. school-based settings) (n = 5) or residential care/looked after population (n = 1) settings. The most frequently reported outcome measurement was defaecation frequency, which was reported in one-third of studies within the scoping review. School attendance or absenteeism was the least frequently reported outcome (n = 8 studies). Our SRs of effectiveness included 32 studies (including 2 SRs) which explored effectiveness of interventions delivered by families/carers (‘Level 0’); 21 studies (including 2 SRs) which explored effectiveness of interventions delivered by wider children’s workforce (‘Level 1’); 31 studies (including 1 SR) which explored effectiveness of interventions delivered by continence teams (‘Level 2’); 42 studies (no SRs) which explored effectiveness of interventions delivered by specialist consultant-led teams (‘Level 3’); 15 studies (no SRs) which explored effectiveness of different models of service delivery; 15 studies (2 SRs) which explored effectiveness of complementary therapies; and 4 studies (1 SR) which explored effectiveness of psychosocial interventions. Interventions for which there was some evidence of potential benefit included, within Level 0: a trial of cows’ milk-free diet, educational interventions for parents, selenium supplements. Within Level 1: laxatives, physical exercise focused on pelvic floor muscle, combined pharmacological, diet and behaviour programme. Within Level 2: combined oral and enema therapy, transanal irrigation, biofeedback (for children with abnormal defaecation dynamics), combined treatment programmes. Within Level 3: botulinum toxin, antegrade continence enema (ACE)/Malone antegrade continence enema (MACE), sacral modulation. Models of care delivery which may be beneficial included nurse-led clinics, an algorithm, or care pathway, used in primary care settings, specialist (Level 2) services and web-based information, following an appointment with a specialist. Complementary therapies for which there was some evidence of effectiveness included: connective tissue manipulation (CTM) for children with cerebral palsy (CP), and some herbal/traditional medicines. There was some evidence in favour of behavioural therapy. Interventions which evidence suggests may not be beneficial include, probiotics, additional dietary fibre, increased fluid intake and biofeedback (for children with normal defaecation dynamics). Evidence relating to probiotics was judged to be moderate quality, but for all other interventions was considered low to very low quality. There was insufficient evidence to support conclusions relating to several other interventions. We identified 31 studies which reported some evidence relating to cost or resource use, of which 20 were cost-of-illness studies. Fewer than 30% of the studies employed a formal economic evaluation study design. Most studies were poorly reported with limited details. Data included in this review were insufficient to support any generalisable conclusions relating to cost or resource use. One hundred and six studies described multiple barriers and facilitators across the five domains of the CFIR framework. The most commonly reported factors related to ‘successfulness’ of an intervention included; whether the intervention was adaptable, flexible and offered an advantage over an alternative solution; understanding the tension for change (i.e. why clinicians and families felt that the changes were needed now); the taboo nature of constipation and the reluctance of children, families, healthcare professionals and wider society to openly engage in discussion about constipation; a lack of understanding of what children and their families need; self-efficacy, coupled with individual knowledge and beliefs; and engagement of champions to support children. Research gaps were identified through evidence maps and stakeholder discussions. Key topics considered priorities for future research relate to recognition of CFC; information provision; diet; laxatives and combinations of laxatives; behavioural therapy and psychological support. Future research studies should address what works for which individual child, and when, including children with and without additional needs. Research to explore the optimal delivery of services, including identification of key components and features of effective teams and criteria for referring children from one ‘level’ to the next, is needed. Conclusions We conducted a comprehensive review of all evidence relating to interventions, and combinations of interventions, for children with CFC. The finding from our review are generally in agreement with the current guideline recommendations, where recommendations exist. A significant proportion of interventions for which we found evidence had not been addressed within current guidelines. This project has highlighted that research in this field often does not adhere to recognised standards for conduct and reporting or consider the complexities of interventions for CFC. We found no evidence which gave us high certainty in the findings; and we only had moderate certainty relating to one intervention (probiotics, with evidence demonstrating that probiotics may not have any beneficial – or harmful – effect). Our certainty about all other findings was low to very low or, in many cases, we judged that the evidence was insufficient to support any generalised conclusions. The current evidence base rarely measured outcomes deemed of highest priority to children and families, and many studies failed to describe the complex nature of the treatments that a child may be receiving. This limits the conclusions that can be made from the current evidence. Further, the limitations within the evidence base reduce confidence in recommendations and create a barrier to implementation of best practice, impairing progress in efforts to improve outcomes for this group of children. Our findings do not indicate that changes are necessarily needed to the treatment recommendations within current clinical guidelines. However, management of childhood CFC is complex, and there is no simple ‘one size fits all’ approach. Clinical care and future studies must consider the individual characteristics of each child with constipation, and the context – or environment – within which they live. Key goals of successful management of CFC should be early recognition of symptoms and delivery of interventions by families/carers, achieved by providing children and families/carers with effective education and support from members of the wider children’s workforce (primary care services). Development, evaluation and implementation of strategies to enhance the delivery of services focused on individualised care, combining lifestyle and behavioural strategies with laxatives are a priority. To avoid further research waste, it is essential that future research addresses the questions which are of the highest priority to key stakeholders and has the highest possible standards of conduct and reporting. Future research studies should address what works for which individual child, and when, including children with and without additional needs. Future research into any interventions for childhood CFC should take into account relevant evidence relating to the development and evaluation of complex interventions. Study registration This study is registered as PROSPERO CRD42019159008. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 128470) and is published in full in Health Technology Assessment; Vol. 28, No. 5. See the NIHR Funding and Awards website for further award information.

Introduction: The cervix is the lower cylindrical part of the Uterus which projects into the vagina. The cervix despite being a small part, is home to numerous disease conditions, including both neoplastic and non-neoplastic ones. Important among these conditions are Inflammatory conditions like Chronic cervicitis along with premalignant and malignant conditions like CIN and SCC. Most cervical cancers are caused by HPV, an oncogenic virus. The main objective of our study is to analyze the histopathological spectrum of different types of cervical lesions, both neoplastic and non-neoplastic. Methodology: A retrospective study was done on 380 hysterectomy specimens and cervical biopsies that were submitted to the Department of Pathology, Nalanda Medical College and Hospital, Patna from May 2022 to July 2023. Detailed histopathological assessment of various lesions of the cervix was done, including both non-neoplastic as well as neoplastic. Results: Out of 380 cases that were taken into consideration, 340 (89.5%) had non-neoplastic lesions, and 40 (10.5%) had neoplastic lesions. 241 cases (63.4%) were that of Chronic non-specific cervicitis. Other non-neoplastic lesions were Chronic papillary endocervicitis, endocervical polyps, squamous metaplasia, and nabothian cysts. Nearly 14 cases (3.7%) were that of CIN 1, 10 (2.6%) had CIN 2, 3 (0.8%) had CIN 3, and 11 (2.9%) had SCC. 43 years was the mean age of the women with preinvasive lesions. The mean age of patients with SCC was 49.2 years. Conclusion: Chronic non-specific cervicitis was the most common disease condition affecting the cervix, comprising 63.4% of total cases. Neoplasms comprised 10.5% of all cervical lesions. Accurate histopathological diagnosis may help in the reduction of complications caused by chronic cervicitis. The accurate and timely diagnosis of premalignant conditions by histopathology may help in preventing disease progression and avoiding more invasive surgeries thereby reducing morbidity and improving their quality of life.

Background and Objectives: Thrombocytopenia affects 5-10% of pregnant women and the postpartum period. Thrombocytopenia is described as a platelet count that is lower than the lower limit of normal. Normal pregnancy causes a physiologic decrease in platelet count. The reason for this physiological decline is unknown. Material and Methods: Women attending antenatal OPD at Govt Medical College, Srikakulam from November 2021 to November 2022 with platelet count less than 150X109/L, regardless of gestational age, were included in this observational study. Thrombocytopenia was identified in 384 pregnant women out of 3500 who were tested on their first antenatal appointment. Results: 384 women with low platelet count were followed up on till birth and the outcome was evaluated. 42 ladies were not followed up on. Around 52% of the women were between the ages of 21 and 25, and the majority of them had moderate thrombocytopenia. 76.02% of patients were delivered at term, while 47.95% were delivered vaginally. During treatment, 42 women required ICU admission, and the overall death rate was about 4.97%. Conclusion: Around 52% of the women were between the ages of 21 and 25, and the majority of them had moderate thrombocytopenia. 76.02% of patients were delivered at term, while 47.95% were delivered vaginally. During treatment, 42 women required ICU admission, and the overall death rate was about 4.97%. [ABSTRACT FROM AUTHOR]

Background: Despite a huge number of advancements in the medical field, periodontitis still remains one of the most prevalent oral diseases worldwide. Aim: Thus, the primary aim of our study was to evaluate the prevalence of periodontal diseases in patients reporting to the tertiary healthcare setup in Ranchi. Materials and Methods: Based on inclusion criteria, subjects aged 18–60 years were selected and a per forma was filled by the observer. The prevalence of periodontal disease was measured using the community periodontal index, simplified oral hygiene index, and stage of periodontitis. Results: Descriptive variables were assessed using frequency, percentage, mean, and standard deviations, while the categorical analysis was performed using the Chi-square tests. Conclusion: General awareness about periodontal health and regular dental visits should be given utmost importance among the rural populations of every developing country. [ABSTRACT FROM AUTHOR]

Multiprofessional Health Residency Programs were created to further align health training with the needs of the population and, through an emphasis on teamwork, have been contributing to the consolidation of the Brazilian Unified Health System. The present study sought to understand the perceptions of a group of multiprofessional residents in Hospital Care about interdisciplinarity and interprofessionality within the scope of teamwork. This is a qualitative study that had the participation of 29 multiprofessional residents in the 'Hospital Care' area of concentration, all female (six psychologists, six social workers, six nurses, six physiotherapists and five nutritionists). Data were collected by means of a semi-structured interview script. The corpus was subjected to thematic content analysis. Most of the participants: (1) reported that their first contact with the notion of interdisciplinarity occurred when they were in college, which led to them assimilating it as a synonym for joint action, and (2) claimed to have no knowledge of the notion of interprofessionality, but valued the horizontalization of relations between health professionals. Additionally, important conditions concerning both interdisciplinarity and interprofessionality were not emphasized by the participants. Further studies on the subject are needed, due to its importance for public health. [ABSTRACT FROM AUTHOR]

Introduction: COVID-19, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has reached pandemic proportions worldwide, persisting over time. In this context, this study aims to analyze the factors associated with mortality in hospitalized patients with COVID-19 in a third-level hospital in the Lambayeque region. Material and metodo: A retrospective cohort study was conducted on patients diagnosed with COVID-19, hospitalized at the National Hospital Almanzor Aguinaga Asenjo (HNAAA) during the months of March to September 2020. Results: Forty patients admitted to the Intensive Care Unit (ICU) were examined, of whom twenty-two required mechanical ventilation (MV). Overall mortality in the ICU was 68.7%, while mortality among patients who required mechanical ventilation was 91.6%. A statistical association was found between death and vital signs on admission to the ICU, as well as with the waiting time for admission. The probability of survival at 2 and 7 days was 90.1% and 45.5%, respectively. Conclusions: In this cohort, a mortality rate of 68.7% was observed in the ICU, with a survival rate of 45.5% at 7 days and less than 10% at 18 days. No associations were found between survival and any of the variables of interest. [ABSTRACT FROM AUTHOR]

Background: It is difficult to ascertain reliably the overall incidence and prevalence of the various cutaneous infections in different parts of the world because studies of one region of the country may not be a true representation of the overall disease pattern of that country; furthermore, incidence and prevalence figures may only will be representative of the population sampling, which may have associated risk factors for infection. Most of the studies done in this field are dealt with adults or with a specific clinical form of dermatophytosis. Only few surveys were performed in pediatric age group. Aim: To study clinical presentation of superficial dermatophytic infection in paediatric patients in tertiary health care centre. Methods: It is an observational type of study. The present study was conducted in Department of Dermatology, Rajshree Medical & Research Institute, Bareilly, from 1st march 2021 to 28th February 2022. Results: Majority of the study population belonged to 11-15 years (48.7%) followed by 15-18 years (24.1%), 0-5 years (16.6%) and 5-10 years (10.6%). The mean age of the study population was 9.16±4.241 (0-18) years. There were 47.7% males and 52.3% females. Itching was present among most of the patients that is 226 patients had this complaint (95.3%). The most commonly affected sites was Groin (47.2%) followed by Trunk (29.9%), buttocks (29.1%), upper limbs (24.0%), Face (6.7%), Scalp (4.6%), lower limbs (4.6%) and Nails (0.4%). The predominant lesion type was Plaque (43.5%) followed by Others like Pustules, erosions, excoriation, crusting (29.5%), Plaque with papules (16.5%), Plaque, Others (4.6%), Papules, Others (4.6%) and Macule being the least lesion type (1.3%). The most common lesion feature found in most of the study group was discoloration (94.1%). The most common diagnosis was T. corporis (29.1%) followed by T. corporis+ T. cruris (28.3%), T. cruris (22.4%). Limitations: The study was an observational study done at the first visit of the patient in OPD with no follow-up. This was major limitation of the study, since the further change of course of presentation was not noted. Also the patients undergoing any other treatment with dermatophytosis were not studied. Conclusion: Total 237 patients of superficial dermatophytosis were included in the study, out of which mean age was 9.16 ± 4.241 with female predominance (52.3%). Maximum patients were from middle school (48.9%) corresponding to age and belonged to middle class (70.5%) socioeconomic status. Common presenting complaints were itching (95.3%), affected site was groin (47.2%) and annular plaque was predominant type of lesion. The most common made in our study was T. Cruris (47.2%). More studies should be carried out in future on large scale so that this study can be corroborated to evidence. Along with that, alternation in dosage for pediatric age group should be studied. [ABSTRACT FROM AUTHOR]

Objective : To explore the potential of gatekeeping for specialized consultations and patient care via remote interactions with family physicians. Methods: This cross-sectional study was conducted at a tertiary hospital between November 2020 and December 2021, when specialized consultations were canceled due to the COVID-19 pandemic. Patients who were evaluated for remote consultation with family physicians were included. Remote consultations were done by a family physician team facilitated through the TelessaúdeRS-UFRGS service. The primary outcome was potential patients eligible for discharge from specialty ambulatory to primary care. Data Sources and Analytic Sample : Data were collected from hospital records. Candidates for remote consult included stable health conditions, indicating the absence of acute or decompensated symptoms as reported in the consult request via the online platform, absence of necessity for any medical procedures or scheduled surgeries, and absence of time-sensitive situations. The prevalence of the outcome was estimated at a corresponding 95% confidence interval. The chi-square test compared the outcome according to COVID-19 mortality waves and specialty groups. Results : At the outset, 2,429 consultations were assessed against the study's eligibility criteria. Among these, 2,160 consultations were included, of whom 776 were candidates for family physician team consultation. Subsequently, the remote family physicians team conducted 557 (23% of the original sample) consultations. Overall, 10% (95% CI: 9-11) had the potential to be discharged from specialty care. Patients' age was linked to discharged likelihood. Prevalence rates varied across specialty groups (highest in surgical patients) and COVID-19 waves (highest in the second wave). Conclusions : This study, conducted within a tertiary hospital's specialty outpatient clinic, highlights the potential of remote consultations with a family physician team in identifying cases suitable for management in primary care settings. Our findings demonstrate that 10% of cases assessed through remote consultations exhibited potential for primary care management.

Abstract Background Violence against women is a serious public health concern, and is highly prevalent globally, including in India. Health-care providers [HCPs] can play an important role in addressing and reducing negative consequences of violence against women. We implemented a pre-post intervention study of HCP training in three tertiary care facilities in Maharashtra, India. Methods The study used a pre-post intervention design with assessment of HCPs’ (n = 201) knowledge, attitudes, perceived preparedness and practice at three time points: before training, after training and at 6 months follow- up. Results Total median score of knowledge about common signs and symptoms of violence (8.89 vs, 10.00), attitudes towards acceptability of violence (9.05 vs. 10.00), individual (6.74 vs. 10.00) and system level preparedness (6.11 vs. 8.14) improved from pre to post- training. The generalized estimating equation [GEE] model, adjusted for age, sex, site and department, showed an improvement in knowledge, attitudes and preparedness post- training. The change from pre to 6 months follow- up was not significant for attitude. Conclusions This package of interventions, including training of HCPs, improved HCPs’ knowledge, attitudes and practices, yet changes in attitudes and preparedness did not sustain over time. This study indicates feasibility and positive influence of a multi-component intervention to improve HCP readiness to respond to violence against women in a low-resource setting. Future phases of intervention development include adapting this intervention package for primary and secondary health facilities in this context, and future research should assess these interventions using a rigorous experimental design. Finally, these results can be used to advocate for multi-layered, systems-based approaches to strengthening health response to violence against women.

Objective: to analyze the occurrence of verbal aggression and factors associated with the phenomenon against health workers. Method: mixed study, sequential explanatory, developed from 2016 to 2019, with 647 health service workers from the West and Far West regions of Santa Catarina. The Survey Questionnaire Workplace Violence in the Health Sector and semi-structured interviews were used. Inferential and thematic statistical analyzes were carried out, respectively. Results: of the participants, 307 (47.4%) reported having suffered at least one episode of verbal aggression. This event was associated with the role of the worker, physical contact with the patient, recognition at work, and concern about violence at work. The testimonies point out the impacts on the health of workers and the fragility of the conducts after the episodes. Conclusion: verbal aggression is a typical violence of public health services, with victims who have a common profile and institutions with difficulty in managing this problem. [ABSTRACT FROM AUTHOR]

Abstract Background This study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System’s primary and tertiary health care centers within a local population. Methods This was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%). Results In the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered. Conclusions Our results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients.

Introduction Recently, many public and private sector institutions and hospitals have installed biometric fingerprint devices for attendance purposes. This step is taking us toward modernization but biometric devices have their cons and pros; if not sterilized at regular intervals, then it may be a potent cause of transmission of various infections. Many studies have reported the presence of coagulase-negative Staphylococcus aureus (CONS), methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli , Pseudomonas , and others. Aim To study the pattern of bacterial flora and the effect of disinfection on fingerprinting biometric devices at a tertiary care health facility.  Materials and methods A total of 138 biometric devices were used, out of which 105 were frequently (at least 50 uses per day) used and functional. So, 105 samples were collected on day zero (baseline), of which 43 and 62 were from clinical and non-clinical groups, respectively. The devices were disinfected with isopropyl alcohol (w/v 70%) and subsequent samples were taken on day 1 (after 24 hours) and day 7. The samples were collected and transported to the microbiology lab for culture and incubation. Statistical analysis was performed using SPSS software version 25 (IBM Corp., Armonk, NY) employing chi-square, Cochran's Q test, and post hoc test. A p-value ≤0.05 at a 95% confidence interval was considered to be statistically significant. Results At baseline (day 0), bacterial growth was observed in 13 (38%) devices from the clinical group and 10 (20%) from the non-clinical group. After disinfection with 70% isopropyl alcohol, bacterial growth was reduced by 83% on day 1 but increased by 82% on day 7. These changes were statistically significant (p ≤ 0.05). Conclusion The present study concluded the definite presence of bacterial flora on the biometric fingerprint devices which are prone to carry and transmit microorganisms indirectly from person to person. The surface of biometric fingerprinting devices should be disinfected daily. If not possible, it should be done on an average of every third day to control and minimize the transmission of microorganisms., Competing Interests: Human subjects: All authors have confirmed that this study did not involve human participants or tissue. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Chauhan et al.)

ABSTRACT OBJECTIVE To analyze mortality and associated factors in a series of gastroschisis at birth in the state of Rio de Janeiro in a 10-year period (2005 to 2014). METHOD A retrospective cohort study, which related the databases of the Live Births Information System and the Mortality Information System by probabilistic linkage. Final database was constructed in two stages: preparation of the two initial databases and establishment of relationships between them. RESULTS Preterm newborns and those with low birthweight had higher risk of death, with statistical significance (p = 0.03 and p = 0.006, respectively). Regarding place of birth, although death frequency was higher in maternity units than in general hospitals (p = 0.04; OR = 0.5; 95%CI 0.3–1.0), it was observed that a unit characterized as a general hospital had a high birth frequency (61.2%). Furthermore, the comparative analysis of the risk of death between this unit and others showed a 7.5 higher risk of death in general hospitals and 3.2 higher in maternity units, with statistical significance (p < 0.001). Moreover, births in level II intensive care units had 3.9 times more risk of death compared with level III (p < 0.001). CONCLUSION This study foments the discussion of two possible strategies in the treatment of gastroschisis in newborns. First, the centralization of care in tertiary units, enabling malformation care to be analyzed in a more detailed and standardized manner. Second, and perhaps more feasible, the elaboration of clinical guidelines to standardize immediate care for gastroschisis in babies born outside tertiary centers, as well as the standardization of their transportation until arrival at the tertiary center.

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Background: Settings based approach for health promotion at workplaces is surveillance of employees for CVD risk factors, which will help to estimate the prevalence of CVD risk factors and monitor CVD risks among the employees. It was planned to calculate the prevalence of CVD risk factors among group C employees of tertiary care hospital in south India. Materials and Methods: A hospital based cross-sectional survey was conducted among 324 group C employees aged ≥18 years as per the WHO "STEP wise approach to surveillance of non-communicable diseases" (STEPS) methodology. Standardized international protocols were used to measure behavioural risk characteristics (smoking, alcohol consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, waist circumference, height and blood pressure). Multivariate analysis was done to know the factors, which carry independent risk of hypertension. Risk factor profiling of the employees was done using WHO/ISH risk prediction chart to estimate the 10 year risk of a fatal or nonfatal major cardiovascular events (myocardial infarction or stroke), according to age, gender, blood pressure, smoking status and presence or absence of self-reported status of diabetes mellitus. Data entry was done using Epi-data version 4.4.2.1. Data cleaning and analysis was done using Statistical Package of Social Sciences (SPSS) version 20. Results: Mean age in years was 34.3 (±8.26) and men contributed 79.3% of study participants. Prevalence of major cardiovascular risk factors was as follows: Current smokers 25.3% men, regular alcohol intake 29.01% between men, overweight (≥23 kg/m2) 26.4%, central obesity 16%, hypertension 13.7% and a past history of diabetes mellitus 15.6%. Almost 3/4th of the participants were following unhealthy diet and living sedentary life style. The relationship between sociodemographic factors and selected risk factors of CVD (tobacco use, alcohol use, unhealthy diet and physical activity) was found significant associated with gender, age, educational status and years of work experience. Around four percent participants had a >10% risk of developing CVD in next 10 years. Conclusion: The prevalence of CVD risk factors is high in the sample population. Employee health and wellness program must be regulated and implemented in the institute, to overcome the burden of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Saúde Pública is the property of Faculdade de Educacao da Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Rehabilitation / Rehabilitacija is the property of University Rehabilitation Institute, Republic of Slovenia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Early initiation of antiretroviral therapy (ART) during acute HIV infection is associated with favourable clinical and epidemiological outcomes. Barriers to prompt treatment initiation limit the benefits of universal access to ART in Mexico. We sought to create an algorithm for the immediate detection and treatment of patients with acute HIV infection. Methods: A nationwide cohort of patients with acute HIV infection was created in 2015. In order to identify cases and treat them promptly at our centre, an interdisciplinary group coordinated through an instant‐messaging tool using smart phones was established. When a probable case was detected, a discussion was initiated to confirm the diagnosis and facilitate the administrative processes to initiate ART as soon as possible. We compared time to ART initiation with that in a comparison group of patients with chronic HIV infection enrolled during the same period (May 2015 to February 2017) through routine care, using survival analysis estimators and log‐rank tests. Results: We recruited 29 patients with acute HIV infection. The median time to ART initiation was 2 days in these patients, in contrast to 21 days for patients with chronic infection. There were no significant differences in the percentages of patients engaged in care, on treatment or virologically suppressed at 1 year of follow‐up. Conclusions: Implementing immediate ART initiation programmes is feasible in Mexico, in spite of the substantial administrative barriers that exist in the country. More extensive replication of this model in other centres and in patients with chronic infection is warranted to evaluate its effect on the continuum of care. [ABSTRACT FROM AUTHOR]

Background: Government of India flagged off a very big health scheme for poor in the name of 'Ayushman Bharat' (AB) with a huge increase in medical cover for poorer section of the society from Sep 2018. This covers secondary and tertiary hospitalization care to approximately 40% of the population. Objectives: As the scheme involves huge financial outlay, this paper attempts to evaluate performance and understand whether the core objectives are met on the lines of Universal Health. Methods: A exhaustive survey of related literatures and published data on the official web site of AB is made. Results: The scheme is reasonably successful in providing financial relief but need to look at areas concerning quality delivery. Conclusions: With the larger objective of 'Universal Health', the beneficiaries list need to be reviewed. The scheme should look at bringing down the out of pocket expenses. [ABSTRACT FROM AUTHOR]

Background: Time duration between symptom onset and treatment in acute coronary syndrome (ACS) is important in determining survival outcomes. This study aimed to determine the extent of delays that occur in the pathway to seeking specific treatment among ACS patients and to explore the associated factors. Materials and Methods: This cross‑sectional study was conducted in the emergency department of a tertiary care hospital in Madurai, Tamil Nadu, India, among patients with ACS. Aquestionnaire was used to collect information on demographic details, clinical features, time duration, and health system‑related factors. The time delay at various levels was expressed as median and interquartile range (IQR). Nonparametric tests were applied to test for statistical differences in subgroups. Results: Among 232 ACS patients, the median (IQR) delay from symptom onset to decision‑making was 30 min (10, 240), from decision‑making to arriving at the first facility was 30 min (15, 45), and from decision‑making to receiving specific treatment was 23.3 h (1, 170). Nearly 91% of the patients contacted private health facilities first and only 21.1% received any specific treatment at the first facility they contacted. The two most common reasons for referral from a lower level health facility were lack of infrastructure and lack of a specialist. Conclusions: Significant delays occurred in the pathway to receiving specific treatment for ACS, especially due to delays in decision‑making and number of facilities contacted in the initial period not being able to provide specific treatment. Private health facilities are more sought after for emergency care of ACS. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJETIVO: investigar o conhecimento e aplicação da Política Nacional de Humanização por fonoaudiólogos de um hospital público de Belo Horizonte. MÉTODO: trata-se de um estudo qualitativo que teve como instrumento de coleta de dados um formulário elaborado pelas pesquisadoras. A amostra foi composta por 25 fonoaudiólogas de um hospital público. Foi realizada análise quantitativa das questões de caracterização da amostra e análise quanti-qualitativa de conteúdo na qual foram identificadas e elencadas as categorias de análise e a frequência de ocorrência dos conteúdos e expressões para as questões discursivas. RESULTADOS: na análise quantitativa, percebeu-se que 68% das fonoaudiólogas eram formadas há mais de cinco anos; 88% tinham pós-graduação; 56% atuavam na área de Audiologia; 52% atuavam também em instituições privadas e 60% referiram conhecer a PNH. Na análise qualitativa, as necessidades/demandas apontadas para garantia do atendimento humanizado constaram dos eixos temáticos gestão e organização dos serviços de saúde, instrumentalização do trabalhador da saúde, multiprofissional e intersetorial, além do respeito às demandas e direitos do usuário. CONCLUSÃO: o conceito de humanização apresentado pelas fonoaudiólogas está em consonância com o descrito na PNH. E quanto aos eixos para garantia da atenção humanizada tomando com referência a instituição, o usuário e o profissional, as entrevistadas citaram parcialmente os princípios da Política Nacional de Humanização.PURPOSE: to investigate speech therapists knowledge and application as for the National Policy of Humanization (NPH) in a public hospital in Belo Horizonte METHOD: it is a qualitative and qualitative study. With 25 speech therapists answering a self-applicable questionnaire, used as instrument for data collection, elaborated by the authors. A quantitative analysis was carried through on the questions referring to sample characterization and also a qualitative analysis of the content, through which the categories of analysis were identified and ranked, as well as contents' frequency as for the occurrence and expressions being used. RESULTS: it was possible to perceive in the quantitative analysis that 68% of speech therapists had been graduated for more than five years; 88% were post-graduated; 52% also acted in private institutions and 60% declared being familiar with NPH. In the qualitative analysis, content was organized in the following categories: service organization; instruments used for professionals and team training; management of multi professional and inter-sector works. CONCLUSION: in what concerns the concept of humanization presented by the speech therapists, it is in consonance with what has been described in the National Politic of Humanization. About the criteria needed in order to guarantee a humanized assistance taking as reference the institution, the user and the professional, the interviewed subjects partially cited the principles of the National Policy of Humanization.

Background In Turkey, a mandatory referral system is not used. Caregivers, for their children, present directly to health-care providers at all levels. This allows patients to present directly to university hospitals. In this study, reasons for university hospital-treatment seeking by caregivers for child health problems is discussed. Methods This was a cross-sectional descriptive study at Dokuz Eylul University Faculty of Medicine, Izmir, Turkey, of 235 caregivers whose children were admitted to the outpatient clinic of the General Pediatrics Department between 4 and 11 April 2013. They completed a questionnaire on demographic data and reasons for presentation to the university hospital. Mann-Whitney U-test was used to compare group means, and Pearson chi-squared test for ratios between groups. P <0.05 was considered to be statistically significant. Results A total of 54.5% of participants lived far from the hospital. The most frequent complaints involved the respiratory tract, among which the most frequent complaint was cough. Time from symptom onset to presentation was ≥7 days in 58.3% of patients, and 48.9% had never presented to another institution. The most common reason for choosing the university hospital was the availability of the necessary tests (88.1%). Conclusions Despite common use of primary health-care systems, with regard to tertiary hospital presentation, the most important factors for preferring tertiary hospital presentation were caregiver trust in tertiary hospital resources for diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Faced with the usual cold relationships established in the pediatric intensive care units (PICU) between the health personnel and the families of hospitalized children, some physicians of the Pablo Tobon Uribe hospital, aiming for an improvement in the communication, developed a strategy that promoted assertive dialogue and listening, after implementing a "Patient and Family-Focused Care" model. The experience systematization methodology allowed for a reflective analysis of the testimonials collected during the multiple encounters between the health personnel and 820 relatives. Results, in terms of learning, evidence an integral attention involving the family as the subject of care, raising awareness on the psychological repercussions implied by the experience of staying in the PICU, and encouraged a critical reflection from the health personnel regarding the attention offered to the families of the patients during the daily clinical practice. [ABSTRACT FROM AUTHOR]

Screening is used by the emergency services to identify the most urgent or potentially more serious cases, ensuring that they receive preferential treatment relative to less urgent cases. This study describes the experience of a nursing academic during a voluntary placement at a public hospital in Minas Gerais. After prior contact with the nurse in charge, permission was obtained to undertake a supervised internship lasting 45 days in the risk assessment section. During this period, the academic conducted an updated bibliographic review on this topic and on the perception of the duties of the nursing professional. During the placement, it was recognized that there was a clear need for the nurse to possess scientific and technical expertise in order to obtain a correct classification, using both the Canadian and Manchester protocols. The astuteness of the professional in producing a case history concerning the pathology is crucial for the correct processing of the patient, based on identifying the complexity of the problem and prioritization of attendance. The results of the work showed that the extension activity provided a valuable educational experience. The importance of risk classification was demonstrated, together with the dynamics of the operational circumstances, the facilitating factors, and the challenges that remained to be overcome. This confirmed the importance and benefits of the nursing academic acquiring new knowledge and experiences, complementing his range of teaching and learning. [ABSTRACT FROM AUTHOR]

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Objectives: To study the effect of providing tertiary (specialized) health care for type 2 diabetic patients to meet the WHO and ADA standards and glycemic targets. Method: Six months, Jan. – Jun. 2010, cohort study was conducted on 600 adult diabetics who registered in the National Diabetes Center (NDC) / Al-Mustansiriya University, Baghdad – Iraq. They were followed for 3- 6 months; each time patients were examined physically and their blood pressure, height, weight and BMI were measured. Fasting blood samples were taken from all patients to test the FPG, HbA1c, T.Chol, TG, HDL and LDL. Results: Patients’ age was 52.85±15.56 year and the male/female ratio was 1.01, the median duration of disease was 7 years and their BMI was 28.80 ± 13.02 kg/m2. Patients’ achievement during study period, of glycemic and cardiovascular risk factors, meet the targets of ADA, NHANES and NCEP/ATP III Guidelines of FPG, PPG, HbA1c, T.Chol, TG, LDL, HDL, systolic and diastolic blood pressure by 26.74%, 29.09%, 32.78%, 61.0%, 60.86%, 76.19%, 74.35%, 52.54% and 62.50% respectively. Conclusions: We concluded that tertiary health service can help to meet the international guidelines and recommended targets for type 2 diabetes. Improving quality and coverage of tertiary health services may help in achieve and sustain targets; and afterward close adhering to the WHO and ADA standards and glycemic targets. Abbreviations: BMI=Body Mass Index, FPG= Fasting Plasma Glucose, PPG = post prandial plasma glucose, HbA1c =glycated hemoglobin, T.Chol. = total cholesterol, TG = Triglyceride, LDL = low-density lipoprotein, HDL = high-density lipoprotein, ADA= American Diabetes Association, NHANES = National Health and Nutrition Examination Survey, NCEP/ATP III = National Cholesterol Education Program/Adult Treatment Panel