Operational nursing managers' experiences of clinical supervision at a Johannesburg Hospital

Background: Clinical supervision is pivotal in supporting nurses in rendering quality, safe patient care. Therefore, it is essential to understand clinical supervision from operational nursing managers' context to define existing challenges and propose suitable recommendations. Objectives: This study aimed to explore and describe operational nursing managers' experiences of clinical supervision within the context of an academic hospital in Gauteng province and propose evidence-based practice recommendations to improve patient safety and the quality of clinical supervision. Method: An exploratory, sequential, mixed-method design was used and implemented over two phases to take advantage of the strengths of both the qualitative and quantitative research designs. Unstructured individual interviews were conducted to collect data in phase one, and an adapted Manchester Clinical Supervision Scale (MCSS) questionnaire was used to collect data in phase two. Results: Operational nursing managers work in stressful conditions and environments with a gross shortage of staff and tools of the trade while being expected to deliver high-quality and safe nursing care. Of the sampled respondents, 36% (n = 17) were dissatisfied with the supervision they received, while 64% (n = 30) were indifferent in the sense that they did not think it was adequate or inadequate. Conclusion: Clinical supervisors should be trained and supported in clinical supervision, with regular workshops on interpersonal relations. Contribution: A clearer understanding of clinical supervision within the hospital context and evidence-based practice recommendations to improve patient safety and the quality of clinical supervision.

A prehospital randomised controlled trial in South Africa: Challenges and lessons learnt

The incidence of cardiovascular disease and STEMI is on the rise in sub-Saharan Africa. Timely treatment is essential to reduce mortality. Internationally, prehospital 12 lead ECG telemetry has been proposed to reduce time to reperfusion. Its value in South Africa has not been established. The aim of this study was to determine the effect of prehospital 12 lead ECG telemetry on the PCI-times of STEMI patients in South Africa. A multicentre randomised controlled trial was attempted among adult patients with prehospital 12 lead ECG evidence of STEMI. Due to poor enrolment and small sample sizes, meaningful analyses could not be made. The challenges and lessons learnt from this attempt at Africa's first prehospital RCT are discussed. Challenges associated with conducting this RCT related to the healthcare landscape, resources, training of paramedics, rollout and randomisation, technology, consent and research culture. High quality evidence to guide prehospital emergency care practice is lacking both in Africa and the rest of the world. This is likely due to the difficulties with performing prehospital clinical trials. Every trial will be unique to the test intervention and setting of each study, but by considering some of the challenges and lessons learnt in the attempt at this trial, future studies might experience less difficulty. This may lead to a stronger evidence-base for prehospital emergency care

Adverse Drug Reaction Reporting by Doctors in a Developing Country: A Case Study from Ghana

Background: Spontaneous adverse drug reaction reporting is the most widely used and cost effective method of monitoring the safety of drugs. This method is heavily afflicted by underreporting by healthcare professionals. The study aims at assessing adverse drug reaction (ADR) reporting rate by doctors; knowledge of the reporting system and attitudes to SADR in the Greater Accra region. Methods: This was a cross sectional survey of 259 doctors randomly selected from 23 hospitals classified as government 199 (76.8); quasi-governmental 43(16.6) and private 17 (6.6) hospitals in the Greater Accra Region of Ghana. Data collection was by self-administered questionnaire from May 5; 2012- July 6; 2012. Descriptive statistics was used to describe the background characteristics of the doctors and the outcome measures like training and reasons for ADR reporting were summarized as frequencies and percentages. Results: One-third (27.4) of doctors surveyed had received previous training on drug safety monitoring and ADR reporting; training and knowledge of the reporting system was found to improve reporting. More than half 154 (59.5) of the doctors had seen a patient with suspected ADR in the past one year although only 31 (20) had reported it by completing the SADR reporting form. Doctors working in government hospitals were about 5 times more likely to report than those in private hospitals [OR=4.94; 95CI (1.55-15.69)]. Conclusion: Training and knowledge of the ADR reporting system were found to be associated with the likelihood of reporting an ADR. Most of the doctors had not previously received training on ADR reporting

Evaluation de la mobilite active des doigts par la cotation de la distance pulpo-palmaire exprimee en travers de doigts

L'evaluation de la mobilite des doigts est realisee classiquement par des methodes exigeant l'utilisation des instruments comme goniometre; latte graduee et autres. La disponibilite de ces instruments dans les structures medicales non specialisees et la competence des medecins praticiens generalistes a les utiliser correctement ne sont pas evidentes.Le but de la presente etude est de proposer une methode qui utilise les seuls doigts du patient comme outil de mesure; sans aucune intervention instrumentale.Quatre cents sujets de la population de Mbujimayi en R.D. Congo (196 de sexe masculin et 204 de sexe feminin) ont ete examines dans cette etude qui a consiste a mesurer la largeur des doigts et les angles des articulations des doigts a differents degres de flexion.Une echelle simple et pratique est proposee a l'issue de l'etude pour coter les differents degres de flexion des doigts

Comparison of Prostatic Volume Measured with Abdominal Ultrasound and Prostatic Weight Determined after Open Enucleation Performed in Gondar University Hospital; Ethiopia

Objective: To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Patients and Methods: Between April 2002 and October 2006; 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department; Cairo; Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type; stage; grade and gross features in addition to lymph node involvement were particularly noted. Results: Bilharzial bladder pathology (lesions or ova) was present in 105 (70.9) of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma (TCC) in 84 (56.7); squamous cell carcinoma (SCC) in 51 (34.5); adenocarcinoma in 9 (6.1) and anaplastic tumor in 4 (2.7) of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23; pT3 in 70.9and pT4a involving the prostate or seminal vesicles in 6.1. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 (48.6) and high grade in 76 (51.4) specimens. Regional lymph node involvement was detected in 31 (20.9) specimens irrespective of bilharzial infestation. Conclusion: Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3; low-grade SCC and commonly appears as an ulcerative; bulky; fungating or verrucous mass. On the other hand; bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation

Mandatory HIV Testing and Uptake of Ante-Natal Services in a Primary Health Care Centre in South-South Nigeria

Background: The Nigeria's national policy on HIV/AIDS did not allow for mandatory HIV testing. But several health institutions in Nigeria insist on an HIV test before certain services are given. Fears have been expressed that such mandatory HIV testing might lead to poorer uptake of associated services. Aim: To assess the impact of mandatory HIV testing on the uptake of ante-natal services in a primary health centre located in Obrikom - a semi-urban community in south-south Nigeria. Method: A cross-sectional study was carried out; using the ante-natal records of the primary health centre. The HIV testing procedure of the health centre was clearly established using in-depth interview of staff; and exit interview of women attending the ante-natal clinic. A four-year (October; 2002 to September; 2006) review of the ante-natal records of the health center was then carried out to coincide with the period; two years before; and two years after the introduction of Mandatory HIV testing in the health centre. Results: The health centre had a total of 281 new antenatal registrations during the study period; out of which; only 75 (26.69) were registered two years after the introduction of the policy. This is a significant reduction (p-value 0.001); when compared to the number that registered before the introduction of the policy. There is also a significant decrease in the number of antenatal visits (p-value 0.05); the number of visits decreased from a total of 840 visits; and an average quarterly visits of 105 (s.d 19.94) before the implementation of the policy; to 394 visits and an average quarterly visits of 44.75 (s.d 15.1). Conclusion: Mandatory HIV testing can lead to a significant decrease in the uptake of associated health care services. Efforts should be made to discourage it

Structured observations of hygiene behaviours in Burkina Faso: validity, variability, and utility

The use of observation techniques has been promoted for the study of hygiene practices; however, questions still remain about the validity and repeatability of such techniques. In this article we compare data on hygiene behaviours obtained from questionnaires with data obtained using a structured observation approach and examine the repeatability of structured observations of behaviours and spot observations of environmental conditions. Poor agreement between questionnaire responses and observations was found for child defecation and stool disposal practices (kappa statistic: 0.25 and 0.28, respectively). There was evidence of over-reporting of "good" behaviours (P < 0.0001). Repeated observations of child defecation and stool disposal behaviours showed better agreement (kappa statistic: 0.76 and 0.62, respectively) based on small sample sizes. These findings suggest that our questionnaire data are less valid than data obtained by direct observation. However, different approaches to questioning may be less prone to over-reporting of "good" behaviours than our approach. Further research into the validity of different forms of question is warranted. Behaviours and conditions related to hygiene vary. Observations may be useful in determining the frequency of different behaviours/conditions in the community. However, individual practices may be too variable to assign individuals to exposed and non-exposed groups for the purpose of identifying links with health outcomes. Further studies on the variability of behaviours and the repeatability of observations are therefore needed

Availability; provision and use of drugs: exemplary research protocol; research results and their implementation

This is the first in a five-volume series published by the Joint HSR Project. It deals with problems in availability; provision and use of essential drugs and discusses four studies on this issue; which were carried out in four different countries: Ghana; Malawi; Mauritius and Zambia. Part One contains the exemplary research protocol based on the study done in Mauritius. Parts Two to Four involve all four country studies and discuss the methodologies used; results; recommendations and their implementation respectively. The series should enable other researchers in developing their own studies on availability; provision and use of drugs

Factors associated with maternal mortality

This is the second in five-volume series published by the Joint HSR Project. It deals with factors associated with maternal mortality and discusses four studies on this issue which were carried out in four different countries: Tanzania; Malawi; Zambia and Namibia. The volume comprises four parts: Part One contains an exemplary research protocol for a case-control study on maternal mortality; based on the study done in Malawi. Parts Two to Four involve all four studies and discuss the different methodologies used in each study; their results; and the recommendations and their implementation respectively. This volumes should enable other researchers in developing their own studies on maternal mortality; and to address this problem both at health facilities as well as in communities