A critical analysis of discovery health's claims-based risk adjustment of mortality rates in South African private sector hospitals

In 2019, Discovery Health published a risk adjustment model to determine standardised mortality rates across South African private hospital systems, with the aim of contributing towards quality improvement in the private healthcare sector. However, the model suffers from limitations due to its design and its reliance on administrative data. The publication's aim of facilitating transparency is unfortunately undermined by shortcomings in reporting. When designing a risk prediction model, patient-proximate variables with a sound theoretical or proven association with the outcome of interest should be used. The addition of key condition-specific clinical data points at the time of hospital admission will dramatically improve model performance. Performance could be further improved by using summary risk prediction scores such as the EUROSCORE II for coronary artery bypass graft surgery or the GRACE risk score for acute coronary syndrome. In general, model reporting should conform to published reporting standards, and attempts should be made to test model validity by using sensitivity analyses. In particular, the limitations of machine learning prediction models should be understood, and these models should be appropriately developed, evaluated and reported.

Satisfaction with pharmacy services and its relationships with the control of selected chronic diseases / La satisfacción con los servicios de farmacia y sus relaciones con el control de enfermedades crónicas seleccionadas

OBJECTIVE: To assess the level of satisfaction with pharmacy services and whether satisfaction/dissatisfaction had any effect on two common chronic diseases. Proper control of chronic diseases requires a management regime which includes promotive, preventive, curative and rehabilitative services through primary, secondary and tertiary preventive intervention measures and a wide range of support services. METHODS: A cross-sectional descriptive study with both quantitative and qualitative components was designed to collect data from among all diabetic and hypertensive patients (n = 150) attending 3 health centres in the parish of St Thomas on the days that data were being collected. The questionnaires were interviewer administered. Qualitative data were obtained from focus group discussions which explored themes related to the objectives. RESULTS: Though there was overall satisfaction with the pharmacy services studied, the level of control ofthe two diseases was unsatisfactory. There was no relationship between hypertension control and satisfaction with pharmacy services while the relationship with diabetes mellitus control was limited to a very weak negative association with the rating of the pharmacists' instructions on how to take the prescribed medications. CONCLUSION: "Satisfactory Pharmacy Services " could be improved by the employment of additional staff, improvement in how drugs are stocked, greater availability of generic drugs and more utilization ofhealth cards.

OBJETIVO: Evaluar el nivel de satisfacción con los servicios de farmacia, e investigar si la satisfacción o la insatisfacción tienen algún efecto en dos enfermedades crónicas comunes. El control apropiado de las enfermedades crónicas requiere un régimen de tratamiento que incluye servicios promovedores, preventivos, curativos y rehabilitadores a través de medidas de intervención preventiva primaria, secundaria y terciaria, así como una amplia variedad de servicios de apoyo. MÉTODOS: Se diseñó un estudio descriptivo transversal con componentes cuantitativos y cualitativos, a fin de recopilar datos de entre todos los pacientes diabéticos e hipertensos (n = 150) que asistían a 3 centros de salud en el distrito de Saint Thomas en los días en que se recogían los datos. Las encuestas fueron aplicadas por el entrevistado. Se obtuvieron datos cualitativos de discusiones de grupo focal, en las que se exploraban temas relacionados con los objetivos. RESULTADOS: Aunque había satisfacción global con los servicios de farmacia estudiados, el nivel de control de las dos enfermedades fue poco satisfactorio. No había ninguna relación entre el control de la hipertensión y la satisfacción con los servicios de farmacia, en tanto que la relación con el control de la diabetes mellitus se limitó a una asociación negativa muy débil con la evaluación de las instrucciones de los farmacéuticos sobre cómo tomar los medicamentos prescritos. CONCLUSIÓN: "Los Servicios Satisfactorios de Farmacia"podrían mejorar mediante la introducción de personal adicional, el mejoramiento en cuanto a cómo organizar el almacén de medicamentos, mayor disponibilidad mayor de medicamentos genéricos, y más utilización de tarjetas de salud.

Perceptions of Door-to-Door HIV Counselling and Testing in Botswana

Prevalence of HIV infection in Botswana is among the highest in the world; at 23.9 of 15 - 49-year-olds. Most HIV testing is conducted in voluntary counselling and testing centres or medical settings. Improved access to testing is urgently needed. This qualitative study assessed and documented community perceptions about the concept of door-to-door HIV counselling and rapid testing in two of the highest-prevalence districts of Botswana. Community members associated many positive benefits with home-based; door-to-door HIV testing; including convenience; confidentiality; capacity to increase the number of people tested; and opportunities to increase knowledge of HIV transmission; prevention and care through provision of correct information to households. Community members also saw the intervention as increasing opportunities to engage and influence family members and to role model positive behaviours. Participants also perceived social risks and dangers associated with home-based testing including the potential for conflict; coercion; stigma; and psychological distress within households. Community members emphasised the need for individual and community preparation; including procedures to protect confidentiality; provisions for psychological and social support; and links to appropriate services for HIV-positive persons

Utility of the Malayalam translation of the 7- minute screen for Alzheimer's disease risk in an Indian community.

Background: Alzheimer's disease (AD) is suspected to be currently under-diagnosed in India, thus the need for a brief, effective screening test for the condition. Aims: We aimed to test the Malayalam translation of the 7-Minute Screen (7MS) for detecting those at high risk for AD and to report on the subscores used to derive the Alzheimer's risk score. Setting and Design: This study was performed in Kerala State amongst young university students and elders in residential care homes. Materials and Methods: Two hundred and eighty-two volunteers were tested, 178 young controls (aged 20-29) and 104 literate elders, (55-92 years). None were clinically diagnosed with AD. Statistical Analyses: Elders and controls were assessed as High or Low AD Risk with the published 7MS algorithm. Performance was compared between groups with ANOVA. Results: The algorithm estimated high (n = 61/104) or low (n = 40/104) AD risk in the elderly. Significant differences were found between controls, low- and high-risk groups on all four components of the screen (Orientation: F = 131.1, Enhanced Cued Recall: F = 23.4, Clock Drawing: F = 65.1, Verbal Fluency: F = 15.7, P P Conclusions: The 7MS may be a useful screening test for cognitive impairment in India. Suggestions are given for revising the 'risk algorithm' for more appropriate AD risk assessment in this population.

An international review of tobacco smoking among medical students.

We conducted a systematic international review of tobacco smoking habits among medical students. Particular attention was paid to countries where smoking rates have been historically well-documented in local journals, but were less often included in larger international review articles. The methodology involved a search of relevant medical subject headings, after which the reference lists of journal papers were also examined to find additional publications. A total of 66 manuscripts met the inclusion criteria. The most common countries previously studied included India, the United States, Australia, Japan, Pakistan, Turkey and the United Kingdom. Overall, our review suggests that the prevalence of smoking among medical students varies widely amongst different countries and also between male and female students within the same areas. Consistently low smoking rates were found in Australia and the United States, while generally high rates were reported in Spain and Turkey. Given their important future role as exemplars, more effective measures to help reduce tobacco smoking among medical students are clearly needed worldwide.

Nuestra experiencia en resección de metástasis pulmonares de carcinoma colorrectal / Our experience in resection of pulmonary metastases of rectocolonic carcinoma

Antecedentes y Objetivos: La metastasectomía pulmonar es un procedimiento aceptado para tratamiento de lsa metástasis (Mts) pulmonares del carcinoma colorrectal. Los pacientes no tratados presentan supervivencia a 5 años por debajo del 5%. No existe actualmente quimioterapia efectiva. Se relata en la bibliografía internacional una supervivencia actuarial de 20-40% con carciroma colorrectal con/sin resección previa de secundarismo hepático. Lugar de aplicación: Hospital privado universitario. Diseño: Modelo retrospectivo. Método: Se analizan 40 pacientes, estudiándose la supervivencia según diferentes criterios. La metastasectomía fue indicada en casos de: tumor primario controlado, ausencia de Mts extratorácicas y condición clínica favorable. Se incluyeron sólo los pacientes con resección completa de las Mts. Todos ellos fueron evaluados previamente para recidiva local o compromiso sistémico del cáncer primario. Resultados: La supervivencia actuarial a 5 años de toda la población desde la metastasectomía pulmonar fue 37,9%. Factores como: edad, sexo, tamaño y número de metástasis, intervalo libre de enfermedad, metastesectomía hepática previa y nivel preoperatorio de CEA no influyeron significatimente en los resultados. Conclusión: Una bien seleccionada población de pacientes con Mts pulmonares de carcinoma colorrectal de beneficia claramente con la resección quirúrgica de las mismas por toracotomía.

Intraspinal synovial cysts: a retrospective study.

BACKGROUND: We report the clinical presentation, radiographic studies, intraoperative findings, histopathological analysis, and post-treatment outcome in 26 patients diagnosed with spinal synovial cysts (SSCs). AIMS: To describe the clinical presentation, radiographic studies, operative findings, and postoperative follow-up in 26 patients with SSCs. SETTINGS AND DESIGN: The study was retrospective in design, involving chart review. Individual patient data was tabulated and patterns were recognized. MATERIALS AND METHODS: The charts for 26 patients who underwent surgical extirpation of SSC between April 1993 and October 2002 were retrospectively reviewed. Specifically, initial clinical presentation, pertinent radiographs (X-rays, magnetic resonance imaging, computed tomography), intraoperative findings, histopathology, and postoperative follow-up were noted. Statistical Analysis Used: Patient data was tabulated and analyzed for patterns in demographics, symptoms and histopathology. RESULTS: SSCs were more common in females than males (17:9 ratio). Presenting symptoms were back pain with radiculopathy in 13 (50%), radicular pain in the absence of back pain in 10 (38%), and back pain without radicular pain in three (11%). In addition, 17 patients (65%) had sensory deficit, and 9 (35%) had motor deficit. Most SSCs occurred at the lumbar (19/26) or lumbosacral (5/26) regions, with only 2 (2/26) in the thoracic region. One patient had bilateral SSC at the L4-5 level. Intraoperatively, each cyst was located adjacent to a degenerated facet joint. These lesions could grossly be identified intraoperatively and histopathological confirmation was achieved in all the cases. CONCLUSIONS: SSCs are important lesions to consider in the differential diagnosis of lumbar epidural masses and surgical resection leads to significant improvement in the majority of cases.

The effects of background noise on cognitive performance during a 70 hour simulation of conditions aboard the International Space Station.

A total of twenty-five subjects were cloistered for a period of 70 hours, five at a time, in a hyperbaric chamber modified to simulate the conditions aboard the International Space Station (ISS). A recording of 72 dBA background noise from the ISS service module was used to simulate noise conditions on the ISS. Two groups experienced the background noise throughout the experiment, two other groups experienced the noise only during the day, and one control group was cloistered in a quiet environment. All subjects completed a battery of cognitive tests nine times throughout the experiment. The data showed little or no effect of noise on reasoning, perceptual decision-making, memory, vigilance, mood, or subjective indices of fatigue. Our results suggest that the level of noise on the space station should not affect cognitive performance, at least over a period of several days.

Chikungunya infection--an emerging disease in Malaysia.

Many countries neighboring Malaysia have reported human infections by chikungunya virus, a mosquito-borne togavirus belonging to the genus Alphavirus. However, although there is serological evidence of its presence in Malaysia, chikungunya virus has not been known to be associated with clinical illness in the country. An outbreak of chikungunya virus occurred in Klang, Malaysia, between December 1998 and February 1999. The majority of the cases were in adults and the clinical presentation was similar to classical chikungunya infections. Malaysia is heavily dependent on migrant workers from countries where chikungunya is endemic. It is speculated that the virus has been re-introduced into the country through the movement of these workers.

Tubo-ovarian abscess after tubal ligation

Tubo-ovarian abscess usually results from ascending infection of the lower genital tract. In a few cases it can occur as a result of direct contamination at the time of tubal sterilization. We describe a case that presented seven years after post partum tubal sterilization, showing both acute and chronic components.

Oncocercosis en Colombia? una revaluación del foco de López de Micay / Onchocerciasis in Colombia? Follow-up of the in López of Micay focus

En 1965 se describió el primer foco de oncocercosis humana en Colombia en López de Micay, en la costa pacífica. Doce años después, una visita de seguimiento mostró que la prevalencia de infección había disminuído del 15 al 7,5 por ciento. Ya que no se volviron a reportar pacientes, se consideró extinguido el foco hasta 1989, cuando un niño con queratitis ocular fue remitido al Hospital Universitario de Cali. Se confirmó el diagnóstico de oncocercosis con una biopsia de piel. En julio de 1989 se hizo una visita al área y se tomaron muestras a 170 personas. La prevalencia de infección detectada por biopsia de piel fue de 4,1 por ciento (7/170). Se detectaron microfilarias (mf) en piel en 10 por ciento de los hombres muestreados y 0,9 por ciento de las mujeres. La microfilarodermia varió entre 0,5 mf por miligramo de piel y 47mf/mg y estaba directamente relacionada con la edad. No se encontraron nódulos subcutáneos palpables ni alteraciones dérmicas atribuibles al parásito en ningún paciente. Dos pacientes presentaron cambios oculares: queratitis bilateral y degeneración de la retina, respectivamente. Durante la visita, la actividad de los simúlidos fue muy baja y no se intentaron capturas. Es probable que la transmisión ocurra en sitios río arriba, donde la actividad de los vectores es mayor. Con la construcción de vías de acceso y una planta hidroeléctrica se espera un aumento de la población no inmmune en área. Cabe preguntar, cúal será el impacto de esta población susceptible sobre este foco hopoendémico

An outbreak of influenza a in the highlands of Papua New Guinea.

In December 1982 and the early months of 1983, there was increased reporting of influenza-like illness from hospitals and health centres across the highlands region of Papua New Guinea. During this period, which fell in the highland wet season, influenza A viruses were isolated in routine surveillance specimens from a population of monitored children in the Goroka area in the Eastern Highlands. Influenza A viruses were also isolated in the investigation of a nearby rural outbreak of influenza-like illness. Samples of viruses isolated in these investigations were serotyped as most resembling the A/Philippines/2/82 strain. The contribution of these findings to the epidemiology of influenza in tropical countries, the role of influenza in the pathogenesis of pneumonia and possible interactions with bacteria and porcine influenza strains was discussed.