Cross training of hospital pharmacy technicians.

Cross training is a job design method that can increase the efficiency and effectiveness of a hospital pharmacy department. Although employee satisfaction is often improved, some employees may fear that cross training makes them expendable. Good communication and employee participation are keys to successful implementation of a cross-training program. Methods of implementing cross-training programs and avoiding potential pitfalls are also described.

Dwindling family planning funds challenge Jamaica.

PIP: Changes in international financial support for family planning (FP) in Jamaica will impact on the quality, availability, method mix, and distribution of contraceptives. National government will have to increase costs for reproductive health needs, develop cost recovery systems, and find creative ways to shift care to the private sector. There are difficulties in shifting care to private physicians. Physicians have little training in reproductive medicine or family planning (FP), and there is little financial incentive. Counseling on FP is too time consuming at 45 minutes per patient, when curative care takes 15 minutes per patient. Physicians have reservations about the safe use of specific FP methods. Physicians also do not have access to current information on contraceptive technology and related medical questions; e.g., they lack knowledge about handling bleeding problems from patients use of Depo-Provera. 8% of women currently use Depo-Provera, compared to 2% using IUDs, 9% using condoms, 15% seeking female sterilization, and 20% using oral contraceptives. The average family size is low at 2.9 children. More than half of women of reproductive age use a family planning method. The government's immediate strategy is to promote long-term and permanent methods instead of short-term methods. The government is also working with professional associations to promote increasing involvement of private physicians in FP. The government departments of health and family planning have begun a pilot program to test the ability of non-nursing staff to counsel on sterilization. Future plans are to increase responsibilities of trained non-nursing staff to include counseling on other FP methods and to expand minilaparotomy to major hospitals other than Victoria Jubilee Hospital.^ieng

Reaching men: at work and in social settings.

PIP: Targeting men with the message of AIDS prevention is vital because men are the major sexual decision makers in developing countries; reaching them at work and social settings is an effective way to intervene. Men who work as truckers, police, miners and other migrant workers, soldiers and seamen are highly mobile, spend time away from home and are likely to engage in high risk behavior. A targeted intervention operated by the African Medical and Research Foundation (AMREF) with the assistance of AIDSTECH has trained peer educators, usually barmaids, bar owners and health workers, to talk to transport workers driving between Dar es Salaam, Tanzania and Zambia. Thousands of AIDS prevention posters, stickers and flyers, and 130,000 condoms per month have been distributed. KAP surveys have been conducted on the project by graduate students from University of Dar es Salaam. Condom distribution points were opened in offices of 2 major trucking companies, a fat in Tanzania where condoms are only supplied by medical outlets. AIDSTECH has also helped set up AIDS interventions for the Ghana Armed Forces, involving HIV testing, condom distribution and education. The military is a conducive milieu for communicating AIDS health messages because of the authoritarian structure.^ieng

Rubella: immunity and vaccination in schoolgirls.

Of 191 schoolgirls, 128 volunteered to take part in a feasibility study of serotesting before and after rubella vaccination, and all responded to RA 27/3 vaccine. Had the serum samples been taken by a fingerprick method the number of volunteers would probably have increased considerably. A change in policy for rubella vaccination to testing both before and after vaccination would cost no more than the existing policy, would ensure primary response, and would differentiate those women who were protected by the vaccine from those with antibody to wild virus.

Fetal damage after accidental polio vaccination of an immune mother.

Irreparable damage to the anterior horn cells of the cervical and thoracic cord was found in a 20-week-old fetus whose mother was immune to poliomyelitis before conceiving but who was inadvertently given oral polio vaccine at 18 weeks gestation. Polio neutralizing antibody titres in sera, taken before and after pregnancy, were identical and were at levels normally regarded as providing protection. Unsuccessful attempts were made to isolate poliovirus from extracts of fetal brain, lung, liver and placenta. Fluorescent antibody tests were performed on various levels of the central nervous system and on the left and right extensor forearm muscles. Specific positive fluorescence to poliovirus 2 and 3 antigens was detected at dorsal spinal cord level only. One positive result was seen with Coxsackie A9 antiserum and fresh guinea-pig complement in the inflammatory cells in the right extensor forearm muscles.This experience, as yet unexplained, underlines the importance of ensuring that women are not pregnant prior to oral polio vaccination.

Effect of rubella vaccination programme in schools on rubella immunity in a general practice population.

Between November 1979 and January 1980 all patients aged 13-21 years who attended a general practice in Glasgow were tested for their immunity against rubella (single radial haemolysis test). All of the women in the sample should have been vaccinated at 13 as part of the rubella vaccination programme, which began in Glasgow in 1971. The programme excludes boys. Of the 77 females and 64 male patients studied, nine (11.7%) and 10 (15.6%), respectively, were susceptible to the infection. For only 34 women was evidence of vaccination documented in the practice records, and three of those either had failed to seroconvert or had antibody below detectable values. Overall there was no significant differences between the proportion of men and women who were susceptible to the disease. The rubella vaccination programme had clearly failed to reduce the number of susceptible women in this practice. Hence the immune state of all girls should be checked at about 15 years of age, so that as many as possible may be rendered immune before they leave school.

Depression in rheumatoid arthritis.

We have examined 144 patients with rheumatoid arthritis and found a high prevalence of depression, which has not previously been reported.It is probable that good practitioners who see patients at home acquire a better understanding of the social and psychological aspects of such an illness. The presence of depression was statistically significant when associated with the articular index, the degree of functional impairment, and with dependence on others, but not with many other medical and social factors.

Early diagnosis of pregnancy in general practice.

The value of the signs and symptoms of pregnancy and of the pregnancy diagnostic test as predictors of pregnancy was estimated for 1,592 women seen in general practice. The presence of a sign or symptom alone is a poor pointer to a diagnosis of pregnancy. The combination of pairs of features improves the value, the best being breast signs combined with either the presence of signs of pregnancy on vaginal examination or a palpable fundus, both giving predictive values of 0.89. The pregnancy diagnostic test alone, however, had a predictive value of 0.91, a value of 1.00 indicating 100 per cent reliability.

The diagnosis of pregnancy in general practice.

In 1,631 pregnancies presenting to general practitioners, the reliability of three proprietary slide tests for the diagnosis of pregnancy was assessed both against the outcome and against the results of hospital tests done at the same time. When all patients were considered the reliability of such tests done in the surgery was 85 per cent against a 90 per cent for hospital tests and when only patients who were more than 42 days pregnant were included, the accuracy figure rose to 87 per cent in general practice and 91 per cent in hospital.The time delay before the results of the hospital test was assessed showed a mean of three days which is considered unacceptable if there are urgent clinical reasons for the test being done. The doctors participating listed their reasons for doing tests and in 54 per cent of cases urgent confirmation or otherwise of the pregnancy was considered essential by either doctor or patient. In the remaining 46 per cent this confirmation was considered simply helpful rather than essential. The study showed that the accuracy of the test, when delegated to a nurse, was acceptable and that in a proportion of three to one the participating doctors considered that the test was of value and worthwhile in patient care.

Health centre x-ray unit.

An analysis of the types and numbers of x-ray films requested in the first year of a health centre x-ray unit showed that chest films represented the largest proportion of these. The unit is most valuable when it is inmediately available to the patient and general practitioner at the time of consultation, and thus it should be open for at least five sessions per week. The likely referral rate for the health centre x-ray unit is 84 patients per 1,000 at risk, and a unit functioning for five sessions a week can examine 60 patients during that time. This minimum of five sessions would be fully used by a population of 30,000 patients. The running costs were found to be about the same as those of a hospital x-ray unit.