Learning a palliative care approach during the COVID-19 pandemic: A case study in an Infectious Diseases Unit.

BACKGROUND: Hospital palliative care is an essential part of the COVID-19 response, but relevant data are lacking. The recent literature underscores the need to implement protocols for symptom control and the training of non-specialists by palliative care teams. AIM: The aim of the study was to describe a palliative care unit's consultation and assistance intervention at the request of an Infectious Diseases Unit during the COVID-19 pandemic, determining what changes needed to be made in delivering palliative care. DESIGN: This is a single holistic case study design using data triangulation, for example, audio recordings of team meetings and field notes. SETTING/PARTICIPANTS: This study was conducted in the Palliative Care Unit of the AUSL-IRCCS hospital of Reggio Emilia, which has no designated beds, consulting with the Infectious Diseases Unit of the same hospital. RESULTS: A total of 9 physicians and 22 nurses of the Infectious Diseases Unit and two physicians of the Palliative Care Unit participated in the study.Our Palliative Care Unit developed a feasible 18-day multicomponent consultation intervention. Three macro themes were identified: (1) new answers to new needs, (2) symptom relief and decision-making process, and (3) educational and training issues. CONCLUSION: From the perspective of palliative care, some changes in usual care needed to be made. These included breaking bad news, patients' use of communication devices, the limited time available for the delivery of care, managing death necessarily only inside the hospital, and relationships with families.

Health care workers' knowledge and attitude towards TB patients under Direct Observation of Treatment in Plateau state Nigeria, 2011.

INTRODUCTION: Tuberculosis (TB) is a public health problem in Nigeria. Adherence to the total duration of treatment is critical to cure the patients. We explored the knowledge of the health care workers on management of TB patients including their perceived reasons for patient non adherence to treatment to develop strategies to improve the quality of the TB control service in the state. METHODS: We conducted a cross sectional study. We used self administered questionnaire to extract information from the health workers on their trainings for TB control, knowledge of the control services, patients' education including prevention of defaulting from treatment. We conducted focus group discussion with the health care workers. We performed descriptive analysis using epiInfo software. RESULTS: Of the 76 respondents 41 (53.9%) were female, 39.9% were community health extension workers, 26.3% were nurses/midwifes 30.3% lacked training on management of TB patient. Only 43.4% knew when to take action on patients who miss their drugs in the intensive phase, 30.3% and 35.5% knew defaults among category 1 and category 2 in the continuation phases of treatment respectively. They identified side effects of drugs (80%), daily clinic attendance (76.3%), health workers attitude (73.4%) and lack of knowledge on duration of treatment (71.1%) including their unfriendly attitudes towards the patients as the major barriers to patients' adherence to treatment. CONCLUSION: Lack of knowledge of the health care workers on management of TB patients and poor interpersonal relation and communication with patients have negative effect on patients' adherence to the long duration of TB treatment.

Interventions for educating traditional healers about STD and HIV medicine.

BACKGROUND: For the treatment of HIV/AIDS, individuals may consult traditional healers because they possess a shared sociocultural background, meet the needs and expectations of the patients, and pay special attention to social and spiritual matters. Various intervention strategies have been adopted to educate traditional healers in various aspects of Western medicine, with a particular focus on HIV/AIDS. OBJECTIVES: To evaluate the effectiveness of interventions for educating traditional healers in the fundamentals of sexually transmitted infection (STI) and HIV medicine. SEARCH STRATEGY: We searched the Cochrane Register of Controlled Trials, Pubmed, Embase, Gatway and AIDSearch from the period of 1980 to 2008. We also handsearched the reference lists of the retrieved articles, located conference proceedings of international conferences related to AIDS studies and contacted key personnel and organizations working in HIV/AIDS intervention programs in developing countries. SELECTION CRITERIA: All intervention studies using a controlled design that have evaluated the effect of educational interventions on any one of the outcome measures specified were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed the eligibility of potentially relevant studies and extracted data from and assessed study quality of included studies. A meta-analysis of study outcomes was not possible given the small number of included studies and the heterogeneity in methodological designs and outcome measures. MAIN RESULTS: We included two studies (one RCT and one CBA study) in this review (n = 311). Both of these studies indicated that a training workshop increased the knowledge about HIV/AIDS of traditional healers. With regards to behaviour change, Peltzer 2006 detected a significant difference in traditional healers' reports of managing their patients; however, there was no evidence of a reduction of HIV/STI risk behaviours and referral practices, as assessed by self-report. The study by Poudyal 2003 did not assess this outcome. AUTHORS' CONCLUSIONS: Two studies met the inclusion criteria for this review. Although these studies reported some positive outcomes, the few studies and methodological heterogeneity limits the conclusions that can be drawn about the effectiveness of HIV training programs aimed at traditional healers. More rigorous studies (i.e. those employing rigorous randomisation procedures, reliable outcome measures and larger sample sizes) are needed to provide better evidence of the impact of HIV training programs aimed at traditional healers.