Leveraging routine data in impact evaluation: Understanding data systems in primary healthcare prior to a matched cluster-randomised evaluation of adherence guidelines in South Africa.

BACKGROUND: An essential part of providing high-quality patient care and a means of efficiently conducting research studies relies upon high-quality routinely collected medical information. OBJECTIVES: To describe the registers, paper records and databases used in a sample of primary healthcare clinics in South Africa (SA) with the view to conduct an impact evaluation using routine data. METHODS: Between October 2015 and December 2015, we collected information on the presence, quality and completeness of registers, clinical stationery and databases at 24 public health facilities in SA. We describe each register and type of clinical stationery we encountered, their primary uses, and the quality of completion. We also mapped the ideal flow of data through a site to better understand how its data collection works. RESULTS: We identified 13 registers (9 standard, 4 non-standard), 5 types of stationery and 4 databases as sources of medical information within a site. Not all clinics used all the standardised registers, and in those that did, registers were kept in various degrees of completeness: a common problem was inconsistent recording of folder numbers. The quality of patient stationery was generally high, with only the chronic patient record being considered of varied quality. The TIER.Net database had high-quality information on key variables, but national identification (ID) number was incompletely captured (42% complete). Very few evaluation sites used electronic data collection systems for conditions other than HIV/AIDS. CONCLUSION: Registers, databases and clinical stationery were not implemented or completed consistently across the 24 evaluation sites. For those considering using routinely collected data for research and evaluation purposes, we would recommend a thorough review of clinic data collection systems for both quality and completeness before considering them to be a reliable data source.

Avaliação eletrocardiográfica em cães submetidos à pneumonectomia direita / Electrocardiographic evaluation in dogs subjected to pneumonectomy right

O propósito das ressecções pulmonares em cães e gatos, quer sejam por lobectomia ou pneumonectomia, é a cura ou paliação de processos broncopulmonares sempre que os meios conservadores de tratamento clínico sejam considerados ineficientes. Tendo em vista as significativas alterações resultantes da pneumonectomia, novos estudos experimentais devem ser feitos para avaliar as vantagens dessa intervenção cirúrgica e determinar a maneira como aplicá-la com segurança. O presente estudo tem como objetivo avaliar as alterações eletrocardiográficas em dez cães adultos de ambos os sexos, sem raça definida, com 10-30 kg, submetidos à pneumonectomia direita. Foram avaliados diariamente os parâmetros clínicos de cada cão e as alterações em todas as derivações do eletrocardiograma. Todos os cães apresentaram um bom desenlace pós-operatório. Apenas um cão apresentou alteração de relevância clínica, um caso de complexos ventriculares prematuros, possivelmente decorrente da parada cardiorrespiratória, que foi revertido com sucesso. Houve diminuição da amplitude dos complexos QRS nos primeiros 14 dias, retornado ao normal após 60 dias de pós-operatório.

The purpose for using lobectomy or pneumonectomy in dogs and cats, is to cure or palliate of bronchopulmonary diseases whenever conservative clinical treatment proves ineffective. Considering the marked changes caused by pneumonectomy, new experimental studies have to be done to assess the advantages of this surgical intervention allow its performance without any risk. The aim of the current study was to evaluate the electrocardiographic alterations in ten adult mongrel dogs of both sexes with between 10 and 30 Kg that were submitted to right pneumonectomy. The clinical parameters of the dogs were evaluated in a daily basis and the alterations in every electrocardiogram derivation were recorded. All dogs presented a good post-operative outcome. In most cases there were no electrocardiographic alterations; when these alterations were observed they were of no clinical significance and included premature ventricular complexes in one dog, most likely resulting from a cardiorespiratory arrest that was reverted to successfully, and a decreased width in the QRS complex amplitude on the first 0-14 days post surgery which returned to normal after sixty days post surgery.