Considering community care in public health responses: A national study regarding palliative care during a prolonged coronavirus disease 2019 lockdown.

OBJECTIVE: To describe changes in palliative care characteristics, utilisation and outcomes in Victoria during a period of enhanced public health management and a prolonged lockdown due to coronavirus disease 2019. METHODS: A national retrospective cohort study with palliative care service setting comparisons in Victoria and other mainland states was conducted. RESULTS: Analysis of 48 non-Victorian services (n=53,428 patients) and 20 Victorian services (n=31,125 patients) showed that for community services, patient volume, average length of stay, functional dependency and the proportion of admissions in a deteriorating phase increased during the lockdown in Victoria, yet little changed in comparator states. Regarding inpatient services, the management of family/carer problems remained constant in comparator states, yet substantial fluctuations in outcomes in Victoria were observed. CONCLUSIONS: As health systems adapt to changing circumstances during the pandemic, the ability to upscale community services is critical. Addressing the implications of shifting inpatient care to the community needs attention. IMPLICATIONS FOR PUBLIC HEALTH: Our study highlights the need to ensure community care providers are adequately considered within public health management responses. 'Joined up' policy and implementation across care settings are essential, especially as major barriers to infection control and increased utilisation may be evident in the community during the coronavirus disease 2019 pandemic.

Addressing the attitudes of service providers: increasing access to professional midwifery care in Nepal.

Increasing access to professional care during labour and delivery is the central strategy in Nepal's commitment to reducing its maternal mortality ratio. This paper outlines a number of complementary interventions used by the Nepal Safer Motherhood Project to address the negative attitudes prevalent among service providers, which is a contributing factor to the under-utilization of the health-care services. The perspectives of the community and the service providers are presented, with a discussion of the importance of effective communication, the establishment of positive relationships and a demonstration of the critical role of local ownership and involvement in bringing about a positive change.

Community based maternal and child health care in Nepal: self-reported performance of Maternal and Child Health Workers.

The performance of a sample of 112 refresher trained Maternal and Child Health Workers (MCHW) was assessed over a nine-month period, using a self-reporting questionnaire. The findings show that the MCHWs are providing obstetric services, including antenatal care, birth attendance and postnatal and newborn care, at community level and identifying complications for referral, but their productivity levels are very low, particularly in the remote hill areas, where they are most needed. In order to increase their effectiveness, greater emphasis needs to be placed on the creation of an enabling environment, both in terms of professional support and recognition at community level. This requires more technical and logistical backup and the promotion of greater awareness amongst women and their families about the importance of midwifery care and skilled birth attendance.

Stimulating policy debate on blood transfusion services through the work of an emergency obstetric care project in Nepal.

PURPOSE: To improve the quality and accessibility of emergency obstetric care (EmOC) at district level. METHODS: As the availability of safe and reliable blood transfusion services is a critical component of EmOC, financial and management support was provided to the blood transfusion service centers in the 3 project's Phase 1 districts. EVALUATION: An evaluation after 3 years showed that, with modest financial outlays and the development of supportive district level partnerships, substantial improvements in quality and management of services had been achieved. The evaluation also identified limitations imposed by lack of legal frameworks and central support; although the Nepal Red Cross Society has a government mandate to supply the national blood needs, the operating procedures and guidelines have no legal base. The evaluation report was widely circulated, and the findings used in national policy discussions. RESULTS: Following this a task force was commissioned to develop a legal policy framework to ensure standardized quality blood services with defined management and monitoring roles and responsibilities.

The evolution of a quality of care approach for improving emergency obstetric care in rural hospitals in Nepal.

We describe the iterative process of developing a locally-appropriate quality of care approach and its role in emergency obstetric care (EmOC) programming in Nepal. We describe the context of maternal health issues in Nepal, the rationale for developing a quality of care approach within a model to improve EmOC, and outline the outcomes and catalytic effects of the process. The lessons learned during the development of this approach are detailed. The program developed and implemented a quality of care approach at three district hospitals in Nepal. This resulted in improvements in the structure, process and outcomes of EmOC in these institutions. The process also resulted in improved understanding of quality of care approaches on both local and national levels and the creation of a Nepalese quality of care evaluation framework for maternity services. While the theoretical concept of quality of care is difficult to translate into a concrete approach, we used a process in rural hospitals in Nepal that created highly motivated teams and improved the overall functioning of these hospitals.

Evolution of the postabortion care program in Nepal: the contribution of a national Safe Motherhood Project.

The objective of this review is to present the findings and lessons learned over the first 4 years (1999-2002) of implementation of postabortion care (PAC) services outside of major urban centers in Nepal, where a significant proportion of services are provided by nurses. The contributions made by a national Safe Motherhood project to the establishment of the National Postabortion Care Program including the promotion of nurse providers within an integrated program of emergency obstetric care services are highlighted. Clinical competency assessments and service utilization data from three district hospital-based postabortion service sites supported by the Nepal Safer Motherhood Project are analyzed. The relationship between the findings of this assessment and two previous assessments, one covering two districts and one nationwide, are discussed. This review found that nurses are at least as competent as physicians in providing postabortion care services. The inclusion of postabortion care into the emergency treatment of obstetric complications provided the environment needed for successful introduction of nurse-led PAC services. Competency-based training of nurse providers is the key to making life-saving postabortion care services accessible and affordable in Nepal. Ensuring that these nurse providers are able to implement services requires strategic planning, careful advocacy and support from physician colleagues as well as the presence of adequate infrastructure and equipment. The successful introduction of postabortion care services into three district hospitals also offering emergency obstetric care provides an example of how a nurse-led service can be integrated into an emergency obstetric care support project. The project's learning has influenced national policy on the expansion of the postabortion care program throughout Nepal.

Comparison of N95 disposable filtering facepiece fits using bitrex qualitative and TSI Portacount quantitative fit testing.

As a means of evaluating the use of denatonium benzoate (bitrex) as a qualitative fit test agent with filtering facepiece respirators, the bitrex qualitative and TSI Protacount(R) quantitative fit-test methods were compared using N95 filtering facepieces. Seventy-nine paired tests (trial) were performed. Detection of bitrex during a qualitative fit test or measurement of a fit factor of <100 during a quantitative fit test constituted a failure. Qualitative and quantitative methods were performed using identical test protocols. Data were analyzed using pass/fail criteria, and matched-pair analysis methods were applied. The results of this study indicate that the use of bitrex during qualitative fit testing of N95 disposable filtering facepieces results in an increase in failure and/or rejection in cases where a TSI Portacount (plus N95 companion accessory) quantitatively establishes an acceptable fit.

Multiplexed permanent and real time holographic recording in photorefractive BSO.

We report permanent hologram recording in crystals of photorefractive bismuth silicon oxide using reversible photochromic effects. At a recording wavelength of 488 nm, exposures of several minutes produce areas of faint discoloration in which the permanent hologram is stored. The normal photorefractive behavior is unaffected, however, permitting spatial multiplexing of both real time and permanent holograms. Experimental results and characteristics of this permanent recording in combination with the photorefractive process are presented.

Applications of Multiplexed real time permanent holographic recording in photorefractive BSO.

Photochromic effects in crystals of photorefractive bismuth silicon oxide have been used for the recording of permanent holograms. The combination of this permanent recording with the usual photorefractive real time recording has revealed some novel techniques in information processing and interferometry. These are based on the possibilities of multiplexing two distinct holographic gratings having identical grating wave vectors within the same crystal volume. Techniques ranging from image synthesis and logic operations to holographic interferometry and all-optical switching are demonstrated.