Validation and Reliability of Healthcare Workers' Knowledge, Attitude, and Practice Instrument for Uncomplicated Malaria by Rasch Measurement Model.

Background: This study assessed the validity and reliability of healthcare workers' knowledge, attitudes, and practices instrument for uncomplicated malaria (HKAPIUM) for evaluation of healthcare workers' knowledge, attitudes, and practices (KAP) on uncomplicated malaria management in primary healthcare (PHC) facilities in Plateau state, Nigeria. Methods: Relevant variables from literature, malaria treatment guidelines for Nigeria, and World Health Organization (WHO) were used to generate and present the items for the draft HKAPIUM scale, which was first screened by six experts before administered to 121 respondents who filled and returned immediately. The data were sorted and analyzed using Rasch measurement model (Bond & Fox software®). Results: The outcome of the initial screening showed high items content validity indices (I-CVI) (0.83-1.00) and high scale-CVI (S-CVI) {universal agreement (UA) within the experts (S-CVI/UA) (0.67-0.89) and the average CVI [S-CVI/Ave (0.94-0.98)]} for relevance, clarity, simplicity, and comprehensiveness. The Rasch analysis outputs showed good items' reliability for the three factors (KAP) > 0.9 with high separation index values of > 2.0; however person reliability were poor (< 0.6) which were confirmed by their low separation values. Goodness of fit statistics indicated nine items not fitting the model based on the suggested fit index values of 0.6 to 1.5, and ± 2 for mean square (MNSQ) and standardized Z-score (Zstds) respectively, and 0.3 to 0.7 for "point-measure correlation coefficients" (PTMEA Corr). Deletion of misfit items resulted in the items and persons' reliabilities falling above the minimum accepted limit of 0.6, with their separation values were all in the range of 1 and 2 which were acceptable. Similarly, fit index values for MNSQ infit and outfit, and Zstd parameters items in the new scale were all within the acceptable range of 0.6 to 1.5, and ±2 respectively, in addition to the positive PTMEA Corr as further confirmation of the items' fitness to the model. Conclusion: The reduction of 27-items draft HKAPIUM scale to 18 items was successful with good reliability and fitness to the model.

Spontaneous left anterior descending artery to right ventricular fistula.

We report a very unusual case of a spontaneously acquired left anterior descending to right ventricular fistula. We believe that this spontaneous occurrence was the result of hemodynamic changes that occurred between the first and second catheterizations.

Therapy for congestive heart failure in the late 20th century.

Ten to 15 years ago, the thrust of research in the treatment of congestive heart failure centered around finding new inotropic agents. While initially useful, these agents given chronically actually accelerated left ventricular failure and were associated with excess mortality. Recently, it has been learned that altering the body's response to heart failure is more beneficial compared to attempts to stimulate left ventricular inotropic function. Such altering of the neurohumoral responses to heart failure has been associated with improvements in both morbidity and mortality.

Coronary angioplasty and surgery for coronary artery disease.

Heart disease remains the most common cause of morbidity and mortality in the United States. During the 1970s until the early 1980s, patients with angina pectoris refractory to medical therapy could only consider bypass surgery to relieve their symptoms. Beginning in the early 1980s, coronary balloon angioplasty became an alternative to bypass surgery in those with single vessel coronary artery disease and failure to medical therapy. In the mid-1980s, patients with multi-vessel coronary artery disease also were seen to benefit from balloon angioplasty. Now in the 1990s, balloon angioplasty's success is being compared to coronary bypass with prospective randomized trials. While balloon angioplasty has become relatively easy to perform due to advances in balloon, wire, and guiding catheter technology, many new interventional devices such as atherectomy and laser, are now available. The explosion in technology reflects our inability to prevent atherosclerotic disease and also reveals that while we can improve a patient's lifestyle and in some situations improve mortality rate, atherosclerotic disease remains a disease for which we have no cure.

Coronary risk factors in type II diabetes: response to low-intensity aerobic exercise.

Patients with non-insulin-dependent diabetes are at greatly increased risk for coronary artery disease. Although exercise training has been shown to decrease risk factors, the presence of obesity, older age, and a sedentary lifestyle make a high-intensity exercise program an unrealistic choice of therapy. Therefore, we examined the effect of a low-to-moderate-intensity (mean 69 per cent of maximal heart rate) walking program on lipids, glucose, insulin, glycosylated hemoglobin and cardiovascular fitness. Nine women and seven men, mean age 56, were randomly assigned to a control or an exercise group which exercised three times per week for two months. Supervised exercise sessions consisted of 40-45 minutes of walking and/or slow jogging. Subjects continued on their usual diets. The trained group showed a significant improvement in VO2max from 1.65 to 1.95 L/min. Resting systolic blood pressure decreased from 141 to 130 mm Hg after training, and resting heart rate decreased from 88 to 81. Glycosylated hemoglobin decreased in the exercise group in seven or eight subjects and in only two of eight controls. Triglycerides decreased in the exercise group from 285 to 223 mg/dl. Body weight, total and HDL cholesterol, glucose, and insulin did not change in either group. These data indicate that a low-to-moderate level of aerobic training, independent of dietary changes, is an effective and feasible method of improving cardiovascular risk factors: physical fitness, systolic blood pressure, plasma triglycerides, and glycemic control in non-insulin-dependent diabetic subjects.