Prognostic awareness and prognostic information preferences among advanced cancer patients in Kenya

Background: Cancer is the third leading cause of death in Kenya. Yet, little is known about prognostic awareness and preferences for prognostic information. Aim: To assess the prevalence of prognostic awareness and preference for prognostic information among advanced cancer patients in Kenya. Setting: Outpatient medical oncology and palliative care clinics and inpatient medical and surgical wards of Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya. Methods: The authors surveyed 207 adults with advanced solid cancers. The survey comprised validated measures developed for a multi-site study of end-of-life care in advanced cancer patients. Outcome variables included prognostic awareness and preference for prognostic information. Results: More than one-third of participants (36%) were unaware of their prognosis and most (67%) preferred not to receive prognostic information. Increased age (OR = 1.04, 95% CI: 1.02, 1.07) and education level (OR: 1.18, CI: 1.08, 1.30) were associated with a higher likelihood of preference to receive prognostic information, while increased symptom burden (OR= 0.94, CI: 0.90, 0.99) and higher perceived household income levels (lower-middle vs low: OR= 0.19; CI: 0.09, 0.44; and upper middle- or high vs low: OR= 0.22, CI: 0.09, 0.56) were associated with lower odds of preferring prognostic information. Conclusion: Results reveal low levels of prognostic awareness and little interest in receiving prognostic information among advanced cancer patients in Kenya. Contribution: Given the important role of prognostic awareness in providing patient-centred care, efforts to educate patients in Kenya on the value of this information should be a priority, especially among younger patients.

Knowledge and use of e-resources by medical researchers in Lagos State university college of medicine: A case study

Background: E-resources are one of the major sources of scientific information which provides the user with more precise and quick information. The completeness and quality of information accessible on electronic resources makes it dependable, reliable sources of information and knowledge production in the academic community. Information accessibility is pivotal in the health research environment as it helps in quick and effective response to challenges and complexities as they arise. However, the level of knowledge possessed by medical researchers in Lagos State University College of Medicine (LASUCOM) is important for teaching, learning and research. Hence, this study evaluated knowledge and use of e-resources by medical researchers in LASUCOM. Methods: The study adopted a descriptive research design. The population is 400 postgraduate students (MPH, resident doctors) and research scholars. The sample size is 200, representing 50% of the total population. Data were collected with the use of a structured questionnaire on knowledge and use of e-resources by the respondents. Frequency counts, percentages, mean, and standard deviation, were used reporting the data. Results: The results revealed the knowledge of medical researchers about electronic resources including journals (91.8%), books (89.4%), theses/dissertations (82.3%). Also, electronic resources were used for the purpose of obtaining current information (78.8%) and for academic /study purposes (78.8%). PubMed/MEDLINE (96.5%), PubMed Central (92.9%), African Journals Online (92.9%) were the most preferred electronic resources used by postgraduate and medical researchers in LASUCOM. Conclusion: The study concluded that librarians should be trained to support researchers in the research process. The study recommended that librarians should create awareness about electronic resources available and accessible in the library. Also, the library should provide adequate user education on database interface usage and optimal search skill techniques for retrieval of relevant information in the Medical Library.

Development of the African Digital Health Library (ADHL): Experience at the Medical Library, University of Ibadan, Nigeria

The African Digital Health Library, (ADHL) is a collaborative project involving five African institutions namely Bamako University of Science and Technology, Kenya Methodist University, Universities of Ibadan, Nairobi, Zambia, and Zimbabwe. The University of Ibadan Nigeria component of the ADHL (ADHL-UI) is described in this paper. Funded by the Office of Global AIDS Coordinator of the United States Department of State, the goal of ADHL-UI is to store, preserve, make accessible through an institutional repository, theses and dissertations by postgraduate students of the institution's College of Medicine. The ADHL-UI has over 1000 theses and dissertations accessible on the internet. Creation of the ADHL-UI, a repository of theses and dissertations in the Medical Library, University of Ibadan, is a major contribution to research development and preservation of institutional scholarly heritage. Effective use by students and faculty will help in reducing duplication of research efforts and create visibility for the authors and the institution.

Challenges faced by parents of children with learning disabilities in Opuwo, Namibia

Background: Parenting children with learning disabilities requires a high level of knowledge and access to resources, information and services.In developing countries, however, these resources and services are not always available. Parents in Namibia, a developing country, therefore face challenges addressing children's learning and other developmental disabilities, including challenges related to preventative and supportive interventions.Objective: This research focuses on challenges faced by parents as they parent children with learning disabilities in Opuwo, Namibia. Method: In-depth interviews were conducted with eight parents regarding the challenges they face in parenting their children with learning disabilities. Thematic analysis enabled the researchers to identify, analyse and report on themes that emerged from the qualitative interview data.Results: Analysis of the interviews indicated that some participants had only a vague understanding of learning disabilities, as they did not have access to essential knowledge about this phenomenon. They also lacked an awareness of the availability of programmes, services and policies meant to benefit their children with learning disabilities. Participants voiced that they, their children with learning disabilities and community members have stereotypes and prejudices regarding learning disabilities. In this study, most of the children with learning disabilities were raised by single, unemployed parents who seemed to have access to less support from external sources than married couples parenting children with learning disabilities. These single parents are usually not married and because of lack of financial support from the other parent, the majority of them indicated that they struggle to meet the financial and material needs of their children.Conclusion: The researchers concluded that the participants in this study experience a range of challenges in parenting their children with learning disabilities. The main challenges emanate from financial instability, as well as lack of knowledge regarding services and programmes for children with learning disabilities. This lack of knowledge on the part of participants could indicate poor policy education by policy implementers at grass-roots level

Contextual hybrid-based recommendation of PUBMED articles

Background:The amount of information at the medical field has been growing day by day. Also new medical articles about the preoccupied disease are published each day and the updated information is very required for physicians. Consequently,the appropriate information in the appropriate moment is very suitable for physicians, and this is the challenge contributed in this research work. Methods:Our goal is to recommend documents deemed relevant to doctors, moreover, regarding the context of using of an Electronic Medical RecordsEMR. The principle is to extract the context of this usage: illness, Age ..., searching on the contents of documents and taking into account the rate of vote documents. For experiment and evaluation, we have used 100 articles randomly selected from PUBMEDabout cardiology. In addition, we have developed a system that extracts the context of EMRat the moment of exploration. The extracted context is used with users rating bythe recommender system to select and rank the recommended articles for physicians in the same moment of use.Results:The first result of this research work is the smart interaction between users and the software system by introducing the context of use. In addition, another important result is the reuse of user's appreciation for additional dynamicity and intelligibility. Conclusion: The developed system offers the physician an appropriate recommendation of pertinent PUBMED articles. The developed system augments the relevancy of the recommendation by analyzing the contents of the articles and introducing a collaborative method

Socio-demographic variables as predictors of accessibility, utilization, and preference for reproductive health information sources among undergraduate students in Nigerian universities

This study examined socio-demographic variables as predictors of accessibility, utilization and preference for reproductive health information sources among undergraduate students in Nigerian universities. The study adopted a survey research design. A sample of 2615 undergraduate students was drawn from six conventional federal universities in the six geopolitical zones in Nigeria. Data were collected using the questionnaire. Of the 2615 copies of questionnaire distributed, 1615 usable copies of the questionnaire were returned, giving 62% return rate. Result of Regression analysis revealed that the seven independent variables jointly predicted accessibility to reproductive health information sources, utilization of reproductive health information sources, preference for reproductive health information sources and knowledge of reproductive health among undergraduate students. The study concluded that strategies aimed at the provision of access to reproductive health information to young people may be more effective if their socio-demographic characteristics are factored into such interventions.

Health promotion through herb information: a special discussion of GEGEMU herb in yoruba setting of Nigeria

Gegemu herb (Datura Stramonium) is a plant that is common in the environment. It is a cosmopolitan weed of word wide distribution. It is found in many countries. The herb is widely available and dominates the surroundings of houses in Yoruba land. However, only few people know about its uses, toxicity and hazards. This paper is a review on Gegemu herb, the toxic effects of the plant and the various uses in Yoruba land. The paper recommendations that information about gegemu should be made known to the public through print and other mass media, Librarians should make efforts to communicate indigenous knowledge and herb information to the community and Researchers on health sciences and pharmacology are urged to further study this plant for the benefits of mankind. Keywords: Gegemu Herb, Datura Stramonium, Herb Information, Health Promotion.

Experiences of Registered Nurses with Regard to Accessing Health Information at the Point-of-Care via Mobile Computing Devices

Background: The volume of health information necessary to provide competent health care today has become overwhelming. Mobile computing devices are fast becoming an essential clinical tool for accessing health information at the point-of-care of patients.Objectives: This study explored and described how registered nurses experienced accessing information at the point-of-care via mobile computing devices (MCDs).Method: A qualitative; exploratory; descriptive and contextual design was used. Ten in-depth interviews were conducted with purposively sampled registered nurses employed by a state hospital in the Nelson Mandela Bay Municipality (NMBM). Interviews were recorded; transcribed verbatim and analysed using Tesch's data analysis technique. Ethical principles were adhered to throughout the study. Guba's model of trustworthiness was used to confirm integrity of the study. Results: Four themes emerged which revealed that the registered nurses benefited from the training they received by enabling them to develop; and improve; their computer literacy levels. Emphasis was placed on the benefits that the accessed information had for educational purposes for patients and the public; for colleagues and students. Furthermore the ability to access information at the point-of-care was considered by registered nurses as valuable to improve patient care because of the wide range of accurate and readily accessible information available via the mobile computing device. Conclusion: The registered nurses in this study felt that being able to access information at the point-of-care increased their confidence and facilitated the provision of quality care because it assisted them in being accurate and sure of what they were doing

Access to Information and Decision Making on Teenage Pregnancy Prevention by Females in Tshwane

Background: The increase in the number of teenage pregnancies and its negative consequences has encouraged various researchers to explore the possible causes of teenage pregnancy. Findings from previously-conducted research have indicated different preventable factors that predispose female teenagers to pregnancy; such as staff attitudes and the lack of information resulting from poor access to health facilities.Objective: To explore and describe access to information and decision making on teenage pregnancy prevention by females using a primary healthcare clinic in Tshwane; South Africa.Method: In this study; the researchers used a descriptive qualitative and exploratory research design to explore and describe the verbal reports regarding prevention of teenage pregnancy by females using a primary healthcare clinic in Tshwane; South Africa. Face-to-face semistructured interviews were conducted with 15 female participants aged between 15 and 26; who had been pregnant once or more during their teens.Results: Two themes emerged; namely; access to information and decision making by female teenagers. Five categories that emerged were: access to information on pregnancy prevention; ignoring of provided information; the use of alternative medicine with hormonal contraception; personal reasons for use and non-use of contraception; and decisions made by teenagers to not fall pregnant. Females in this study fell pregnant in their teens; even though they had access to information.Conclusion: Given the complexity of this problem; female teenagers should use their families as primary sources of information for reproductive health promotion and educational institutions should build on this to aid the prevention of teenage pregnancy

Human resources in health research institutions in sub-Saharan African countries: results of a questionnaire-based survey

Objective To describe the current status of institutional facilities and the supporting research infrastructure of surveyed health research institutions in Africa; including information on communication technologies and connectivity; library resources; and laboratory operations and resources. Design A structured questionnaire was used to solicit information on institutional facilities at health research institutions. Setting Health research institutions in 42 sub-Saharan African countries. Participants Key informants from 847 health research institutions. Main outcome measures The availability of laboratory; information and communication; and library facilities in health research institutions. Results Less than half of the respondent health research institutions had computer laboratories (49); network computers (50) and information technology support (38). More than two-thirds (67) had a library. Electronic subscriptions to international journals were observed to be very low; with an average of three subscriptions per institution. Almost two-thirds of the surveyed institutions (69) reported having laboratories; about half of which (55) were accredited nationally. Linkages and research collaborations were generally weak; particularly those with other laboratories in the Region. Challenges included financial and human resource constraints and the inability to communicate effectively with partners. Conclusions Health research institutions in the Region have insufficient access to essential facilities such as laboratories; libraries; computers and the Internet to generate; access and share information

Reasons for inpatients not to seek clarity at Dr George Mukhari Academic Hospital, Pretoria

Background: Healthcare practitioners should provide patients with information regarding their clinical conditions. Patients should also feel free to seek clarity on information provided. However; not all patients seek this clarity. Objectives: To explore the reasons inpatients gave for not seeking clarity on information that was received but not understood. Methods: This was a qualitative arm of a larger study; titled 'Are inpatients aware of the admission reasons and management plans of their clinical conditions? A survey at a tertiary hospital in South Africa'; conducted in 2010. Of the 264 inpatients who participated in the larger study; we extracted the unstructured responses from those participants (n = 152) who had indicated in the questionnaire that there was information they had not understood during their encounter with healthcare practitioners; but that they had nonetheless not sought clarity.Data were analysed thematically. Results: Themes that emerged were that inpatients did not ask for clarity as they perceived healthcare practitioners to be 'too busy'; aloof; non-communicators and sometimes uncertain about patients' conditions. Some inpatients had unquestioning trust in healthcare practitioners;whilst others had experiences of bad treatment. Inpatients had poor self-esteem; incapacitating clinical conditions; fear of bad news and prior knowledge of their clinical conditions. Some inpatients stated that they had no reason for not seeking clarity. Conclusion: The reasons for not seeking clarity were based on patients' experiences with the healthcare practitioners and their perceptions of the latter and of themselves. A programme should be developed in order to educate inpatients on effective communication with their healthcare practitioners

Tetracycline Resistance Genes of Ureaplasmas

There is limited information in the medical setting on antimicrobial susceptibilities and resistance development in ureaplasmas. The study investigated tetracycline and doxycycline resistance in clinical isolates of Ureaplasma parvum and Ureaplasma urealyticum. Culture with species PCR confirmatory techniques were applied to 191 endocervical specimens collected during the period January-March 2006. MIC determinations were performed by microbroth dilution with tetM resistance and int-Tn genes characterised employing PCR and sequencing. Sixty-six Ureaplasma cultures (35 U. parvum; 9 U. urealyticum; 22 U. parvum + U. urealyticum) were obtained. On screening the Ureaplasma cultures; tetM gene regions were demonstrated from both tetracycline-susceptible and -resistant ureaplasmas. Seven isolates [U. parvum (6); U. urealyticum (1)] were resistant to tetracycline with dual doxycycline resistance observed in three strains. Int-Tn gene characterisation of the seven tetracycline-resistant strains revealed three types were present indicating transposons from different origins had integrated into Ureaplasma genomes. TetM sequences of five tetracycline-resistant strains were seen to be highly mosaic in structure. The finding of transposon and/or tetM regions in all Ureaplasma cultures investigated with or without full expression of tetracycline resistance; in conjunction with tetM and int-Tn gene mosaic/diversity; verifies that ureaplasmas undergo extensive genetic exchange of transposon/resistance genes with concomitant genomic remodelling

Identification of Sources from which Doctors in the Private Sector Obtain Information on HIV and AIDS

Background: Doctors need to constantly update their knowledge and obtain information in order to practise high-quality medicine. Antiretroviral drugs have been available only since around 1996; therefore many of the doctors who were trained prior to 1996 would not have received any formal training in the management of HIV and AIDS patients. Where doctors source their general medical knowledge has been established; but little is known about where doctors source information on HIV/AIDS. This study investigated where private sector doctors from the eThekwini Metro obtain information on HIV and AIDS for patient management. Methods: A descriptive cross-sectional study among 133 private general practitioners (GPs) and 33 specialist doctors in the eThekwini Metro of KwaZulu-Natal; South Africa; was conducted with the use of questionnaires. The questionnaires were analysed using SPSS version 15. A p value of 0.05 was considered statistically significant. Results: The majority of the doctors (92.4) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME); textbooks; pharmaceutical representatives; workshops; colleagues and conferences were identified as other sources of information; while only 35.7of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9versus 72.7; p 0.05) and conferences (48.6versus 78.8; p 0.05) as sources of HIV information. More than 90of doctors reported that CME courses contributed to better management of HIV and AIDS patients.) obtained information on HIV and AIDS from journals. Continuing Medical Education (CME); textbooks; pharmaceutical representatives; workshops; colleagues and conferences were identified as other sources of information; while only 35.7of doctors were found to use the internet for information. GPs and specialists differed significantly with regard to their reliance on colleagues (52.9versus 72.7; p 0.05) and conferences (48.6versus 78.8; p 0.05) as sources of HIV information. More than 90of doctors reported that CME courses contributed to better management of HIV and AIDS patients. Conclusion: Private sector doctors in the eThekwini Metro obtain information on HIV from reliable sources in order to have up-to-date knowledge on the management of HIV-infected patients

The Internationalisation of South African Medical Research; 1975-2005

South Africa's record in the production of scientific knowledge in medicine is remarkable; but attempts have yet to be made to examine its distinctive characteristics. This is critical to the understanding of its nature; trends and the directions which it is taking today. Using the publication records extracted from the Science Citation Index (SCI) of the ISI Web of Science for a 3-decade period from 1975 to 2005; with 5-year windows; I have examined the salient characteristics of medical research in South Africa in terms of; (1) the number of publications; (2) type of publications (sole/co-authored); (3) collaboration (domestic/international); (4) affiliation sector of authors and collaborators; (5) regional origin of collaborators; (6) publication outlets and (7) citations; in comparison with `all subjects' covered in the database concerned. This analysis shows that the contribution of medical publications to the total output of South African scholars is shrinking (25in 1980 to 8in 2000). Papers produced in collaboration are growing in number (increased by 17during 1975-2005). While domestic collaboration declined by 24; international collaboration grew from 4of total papers in 1975 to 48in 2005. South African medical researchers now publish more in foreign-originated journals (from 20in 1975 to 75in 2005) than in local journals and work mostly in universities; hospitals and research institutes; they collaborate with overseas partners from as many as 56 countries. Significantly; collaboration with Western European partners has increased 45-fold from 1975-2005. This study showed that a marked degree of internationalisation (measured in terms of international collaboration; publications in foreign journals and the number of citations) of South African medical research is taking place and that this trend is likely to continue in the future

Perceptions of the Availability and Effectiveness of HIV/AIDS Awareness and Intervention Programmes by People with Disabilities in Uganda

The World Health Organization has recommended collaborative activities between TB and HIV programmes with routine counselling and testing for HIV among TB patients in order to improve the uptake of HIV services. We carried out qualitative research interviews with 21 TB patients in four selected TB and HIV/AIDS treatment centres in the Northwest Region of Cameroon to explore the facilitators and barriers to HIV testing. The desire to be healthy and live longer from knowing one's status inspired by the anticipated support from loved ones; faith in a supreme being; influence and trust in the medical authority; encouraged HIV testing. Men also demonstrated their masculinity by testing; thus portraying themselves as positive role models for other men. Meanwhile; the overwhelming burden of facing both TB and HIV simultaneously; influenced by the fear of disclosure of results; harmful gender norms and practices; fear of stigma and discrimination; and misconceptions surrounding HIV/AIDS deterred HIV testing. However; as a result of conflicting emotional experiences regarding to test or not to test; the decision-making process was not straightforward and this complex process needs to be acknowledged by health care providers when advocating for routine HIV testing among TB patients

Access and use of medicines information sources by physicians in public hospitals in Uganda: a cross-sectional survey

Background :Rational and cost-effective prescription of medicines requires up-to-date and readily accessible medicines information. There are several studies on availability and access to medicines information sources, but have been conducted only in high-income countries. Objective:To assess medicines information sources accessed by physicians in public hospitals in Uganda, and physicians' opinion on establishment of a medicines information centre in the country. Methods:A cross-sectional survey including 369 physicians from six district, six regional and two university hospitals. Data was collected using a semi-structured self-administered questionnaire.Results :Response rate was 91%. This included 31, 136 and 168 physicians from the district, regional and university hospitals, respectively. In the district hospitals the source of medicines information reported to be most available was colleagues (100%), while in the regional and university hospitals it was literature from pharmaceutical companies (98%) and hard copy of research publications (99%) respectively. The most frequently used source in the district and regional hospitals was National Standard Treatment Guideline (90% and 73% respectively), and colleagues in university hospitals (89%). Accessibility problems with reported available sources were commonest with research publications in medical journals, both hard copy and through the internet, MIMS, pharmacists and pharmacologists. Need for a medicines information centre was indicated by 80% of the respondents.Conclusion : Majority of the physicians in public hospitals in Uganda have limited access to unbiased drug information. Therefore, there is need to assess the feasibility of establishing a drug information centre, and then assess its use during a trial period

Information and its value to health workers in rural Uganda: a qualitative perspective

A study was conducted in 1998/99 to investigate the accessibility and use of information by health workers in rural Uganda. Data were collected qualitatively using semi-structured interviews. As a qualitative study; it focussed in-depth on a relatively small sample of health workers selected purposefully. Different categories of health workers were interviewed. Data were analysed using a grounded theory approach. In this paper; two main categories that emerged from the data will be discussed; namely: value of information and constraints. Information was valuable in clinical work; information dissemination; decision making; administration and detection. Constraints to effective information used included the quality and relevance of the information as well as difficulties of sometimes putting theory into practice. Finally; the concepts that emerged from the analysis of the use of information pointed directly to the information needs of the health workers studied; which shows that information was valuable in meeting those needs. Some implications of the study and areas for further research are highlighted

Access to health information through partnerships: problems and benefits

Even though in Africa have limited resources for their work; many of them have made innovative and committed efforts to deal with the problems they face; by creating partnerships with other libraries in the region and beyond; and with international agencies that are concerned with information transfer and health promotion. Library partnerships have indeed served several purposes in Africa. However; the greatest challenge facing African libraries today is to keep the partnerships alive and growing. This paper is a series of reflections on the nature and history of partnerships between Universities in Africa and others elsewhere; with a particular focus on those that the Albert cook Medical Library at Makerere University has participated in