Treatments for people living with schizophrenia in Sub-Saharan Africa: an adapted realist review.

AIM: To identify the treatments and interventions available and their impact on people living with schizophrenia in Sub-Saharan Africa. BACKGROUND: Help-seeking behaviour and the choice of treatment are largely influenced by socio-cultural factors and beliefs about the causes of mental illness. This review addresses the gap in knowledge regarding the treatment options available to people living with schizophrenia in Sub-Saharan Africa. DESIGN: Adapted realist literature review. DATA SOURCES: Electronic databases searched in June 2016 included PubMed, EMBASE, PsycINFO, ProQuest and CINAHL. REVIEW METHODS: The adapted realist review approach used to synthesize the published research involved identifying the review aim, searching and selecting relevant studies, extracting, iteratively analysing and synthesizing relevant data and reporting results. RESULTS: Forty studies from eight countries were reviewed. Most people were treated by both faith/traditional healers and modern psychiatry. Common treatments included antipsychotics, electroconvulsive therapy and psychosocial interventions. Few treatment options were available outside major centres, there was poor adherence to medication and families reported a high level of burden associated with caring for a relative. LIMITATIONS: Major limitations of this review were the lack of studies, variable quality and low level of evidence available from most countries from Sub-Saharan Africa and lack of generalizability. CONCLUSION: People living with schizophrenia in Sub-Saharan Africa were treated by faith, traditional healers and modern psychiatry, if at all. Further research is needed to better understand the local situation and the implications for caring for people from this region. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Mental health services in Sub-Saharan Africa are limited by fiscal shortages, lack of mental health services and qualified mental health professionals. This review provides evidence to inform nursing and healthcare policy, including recruiting and training mental health professionals and ensuring access to evidence-based, person-centred and culturally relevant mental health services within the primary care context.

Managing fistula-in-ano with ligation of the intersphincteric fistula tract procedure: the Western Hospital experience.

AIM: To review the preliminary results of the ligation of the intersphincteric fistula tract (LIFT) technique in treating complex anal fistulas at our hospital. METHOD: Between March and November 2010, patients with cryptoglandular anal fistulas were recruited prospectively from the colorectal clinic and treated using the LIFT procedure. A database was set up to collect information on demographics, past surgical treatments, fistula characteristics, MRI scan results, operative data and follow-up findings. The primary end-point measured was cure of the disease. The secondary end-point was the degree of postoperative continence. Preoperative and postoperative incontinence rates were recorded using Wexner's Incontinence Scale. RESULTS: Twenty-five patients (eight women and 17 men; median age, 40 years) underwent the LIFT procedure. Ten patients had recurrent fistulas and previous fistula surgery. The median operating time was 39 min. No intraoperative complications were documented. The median follow-up duration was 22 (3-43) weeks. Primary healing was observed in 17 (68.0%) patients and the median healing time was 6 weeks; one wound remained incompletely healed. Seven patients (28.0%) had disease recurrence presenting between 7 and 20 weeks postoperatively. No patients reported any incontinence postoperatively. CONCLUSION: The LIFT procedure has favourable healing rates with little or no risk of incontinence. This operation is safe and easy to learn. The early results from this pilot study show promise and affirm some of the findings of other researchers. These results will suggest opportunities to conduct further controlled studies comparing the LIFT procedure with standard therapies.

Time-domain soliton filter based on a semidissipative dual-core fiber.

We propose a time-domain dual-core fiber filter that greatly reduces soliton jitters and noise power in its application to ultrahigh-speed soliton communication systems. This filter is simply a dual-core fiber that has one core with negligible loss and the other with large loss.