Evaluating the use of educational videos to support the tuberculosis care cascade in remote Madagascar.

SETTING: Access to information about tuberculosis (TB) is vital to ensure timely diagnosis, treatment, and control among vulnerable communities. Improved approaches for distributing health education materials to remote populations are needed.OBJECTIVE: To evaluate the impact of two comprehensive video training curricula in improving patient, community member, and community health worker knowledge of TB in a remote area of Madagascar.DESIGN: A pre-test/post-test design was used to measure knowledge acquisition. Educational videos were short, culturally appropriate films presented at critical moments in the TB cascade of care.RESULTS: Of the total 146 participants, 86 (58.9%) improved their score on the post-test, 50 (34.2%) obtained the same score, and 10 (6.8%) received a worse score. A statistically significant difference was observed between the pre- and post-test scores, wherein scores increased by a median of 10.0% (interquartile range 0.0-20.0) after viewing the videos (P < 0.001). There was a significant difference between the number of correct answers on the pre-test and the number of correct answers on the post-test (P < 0.001).CONCLUSION: Educational videos were found to significantly improve TB knowledge among a low-literacy, remote population in Madagascar. Our findings suggest educational videos could be a powerful, low-cost, and sustainable tool to improve access to TB education materials globally.

High dietary intake of whole milk and full-fat dairy products does not exert hypotensive effects in adults with elevated blood pressure.

Regular consumption of low- and nonfat dairy products reduces blood pressure (BP) in adults with elevated BP. Currently, it is unknown if conventional full-fat dairy products exert similar hypotensive effects. We hypothesized that adding full-fat dairy products to the normal routine diet would reduce seated office and ambulatory BP (primary outcome) in adults with elevated BP when compared with a no dairy control. Using a randomized controlled crossover design, 60 adults with elevated systolic BP (systolic/diastolic BP: 120-159/<99 mm Hg) participated in a 4-week high-dairy (4 servings a day of full-fat dairy products + regular diet) and a 4-week no-dairy condition (plant-based food items + regular diet) separated by a 2-week washout period. Data were analyzed based on time, condition, and sex. Seated office systolic BP did not change significantly in either condition. There were no changes in systolic BP in male or female participants across either dietary period. Ambulatory (24-hour) systolic BP did not change significantly in the high-dairy (133 ±â€¯2 vs 131 ±â€¯1 mm Hg) or no-dairy conditions (132 ±â€¯2 vs 131 ±â€¯1 mm Hg). No significant changes were observed for diastolic BP or pulse pressure during condition for office or ambulatory measures. The solitary addition of full-fat dairy products to the normal routine diet does not exert hypotensive effects in adults with elevated BP when compared to the no-dairy control.

Analysis of a territorial approach to the delivery of nursing home care services based on historical data.

We analyze a territorial approach to deliver nursing homecare services to a territory public health. We present the case of the CSSS assigned to Côte-des-Neiges, Métro center and Parc Extension, specifically the case of the Côte-des-Neiges site (CLSC CDN), where a territorial approach is used since 1980. We first give an historical comparison of patient visits delivered in 1998-1999 and in 2002-2003. We follow with an in-depth analysis of the home services delivered in 2002-2003 to determine whether or not the territorial approach can well support the changing needs of the population. We conclude that the territorial approach to deliver homecare nursing services does not sufficiently support fluctuations in population needs for services. Not only is it difficult to predict these fluctuations, but it is difficult to accurately quantify the true needs for services since the availability of nursing services tends to determine the services actually delivered. In sectors of the territory where resources are more scarce (based on previous population needs analyses) or demand for services is greater, the result is work overload for the nursing staff. In addition, this results in service delivery inequities across the entire territory. Therefore, a more dynamic assignment of clients to the nurses based on each nurse's work load and case load rather than based on the geographic location of clients is worth the extra administrative time in case assignment to ensure a more equitable case load attribution between nurses as well as less inequities between clients in terms of service delivery considering their needs.

Scheduling emergency room physicians.

This paper introduces the problem of scheduling emergency room physicians. We interviewed physicians from six hospitals in the greater Montreal, Canada area, in order to understand the emergency room scheduling problem. Extracting the real scheduling problem is difficult because physician working conditions are based on informal mutual cooperation which is usually not documented. We present the characteristics of the scheduling problem and the scheduling techniques currently used in the six emergency rooms we analyzed. Using the scheduling problems of Charles-Lemoyne Hospital and the Jewish General Hospital, we show how to modify a hospital's existing scheduling rules to develop techniques which produce better schedules and reduce the time needed to build them.

Suicidal ideation and self-determination in institutionalized elderly.

The right to self-determination is central to the current debate on rational suicide in old age. The goal of this exploratory study was to assess the presence of self-determination in suicidal institutionalized elderly persons. Eleven elderly persons with serious suicidal ideations were matched according to age, sex, and civil status with 11 nonsuicidal persons. The results indicated that suicidal persons did not differ from nonsuicidal persons in level of self-determination. There was, however, a significant difference between groups on the social subscale. Suicidal elderly persons did not seem to take others into account when making a decision or taking action. The results are discussed from a suicide-prevention perspective.

The public health care planning problem: a case study using geographic information systems.

We address the problem of designing new networks for the delivery of public health care services in the United States. The paper is based on a case study design conducted with the Fulton County Health Department (Atlanta, GA). The research contribution this paper makes is twofold. First, it presents a planning methodology to deliver health care services through a mix of fixed health centers, satellite facilities, and mobile facilities. Second, it gives insights on how to use geographic information systems to design new health care service networks.

Improving on-time performance in health care organizations: a case study.

In this paper, we propose a strategy to build a measurement system that helps improve on-time performance in health care organizations. We analyze the measurement system for monitoring the performance of daily start times of first surgeries in a U.S. hospital. Although surgeons appear to be the main cause of delay, efforts to improve their on-time performance alone are not sufficient to improve on-time performance for first surgeries. Therefore, working on the main source of delay to improve performance, as the Pareto principle suggests, does not always work in the health care context. Rather, we found that ameliorating the hospital's overall on-time performance achieves the desired result of improving surgeons' performance through a snowball effect (a self-reinforcing effect) and, consequently, the on-time performance for first surgeries also improves.

A cluster of bloodstream infections and pyrogenic reactions among hemodialysis patients traced to dialysis machine waste-handling option units.

From June 17 through November 15, 1995, ten episodes of Enterobacter cloacae bloodstream infection and three pyrogenic reactions occurred in patients at a hospital-based hemodialysis center. In a case-control study limited to events occurring during October 1-31, 1995, seven dialysis sessions resulting in E. cloacae bacteremia or pyrogenic reaction without bacteremia were compared with 241 randomly selected control sessions. Dialysis machines were examined, dialysis fluid and equipment were cultured, and E. cloacae isolates were genotyped by pulsed-field gel electrophoresis. Each dialysis machine had a waste-handling option (WHO) through which dialyzer-priming fluid was discarded before each dialysis session; in 7 of 11 machines, one-way check valves designed to prevent backflow from the WHO into patient bloodlines were dysfunctional. In the case-control study, case sessions were more frequent when machines with >/=1 dysfunctional check valves were used. E. cloacae with identical pulsed-field gel electrophoresis patterns were isolated from case patients, dialysis fluid, station drains, and WHO units. Our investigation shows that bloodstream infections and pyrogenic reactions were caused by backflow from contaminated dialysis machine WHO units into patient bloodlines. The outbreak was terminated when WHO use was discontinued, check valves were replaced, and dialysis machine disinfection was enhanced.

Personal goals and subjective well-being in later life.

With a sentence completion technique, 708 elderly participants (65 to 90 years of age) expressed 15,027 personal aspirations. These goals were classified according to their motivational content in ten major categories and their relationships with various aspects of subjective well-being were studied. Two goal profiles emerged from this analysis. Aspirations centered on self-preservation were associated with poor self-rated physical health, being burden by difficulties, lack of meaning to life, dissatisfaction with life, and negative expectations for the future. Aspirations of self-development and interest in the well-being of others were associated with feelings of well-being in later life. Development of meaningful personal goals was discussed as as a new intervention approach with the elders.

Quality of hemodialysis water: a 7-year multicenter study.

Since dialysis was introduced 30 years ago, constant progress in technology permitted shortening the length of hemodialysis (HD) sessions. Through growing concerns about the inadequacy of tap water for dialysate production, hospitals soon opted for water treatment systems dedicated to HD. Nonetheless, persistent bacterial contamination and the occurrence of pyrogenic reactions were reported in some HD centers. Several factors contributing to this situation were identified. After the introduction of highly permeable synthetic membranes in the late 1970s, microbiologic problems reappeared. Thus, in 1977, the Centers for Disease Control and Prevention (CDC) issued proposed guidelines for HD water quality, followed in 1981 by an American National Standard for HD water, issued by the Association for the Advancement of Medical Instrumentation (AAMI). This Standard was also followed in Canada up to 1986, at which time a National Standard for Canada was released by the Canadian Standards Association (CSA). This prompted the Laboratoire de santé publique du Québec (LSPQ) to implement in the Province of Québec a voluntary HD water quality monitoring program. All 36 HD centers in the Province agreed to participate. The program was launched in February 1987. Water was sampled monthly for bacteria over a 7-year period (February 1987 to January 1994), and every 3 months for pyrogen and chemicals. Participation was more than 95%. Bacteriologic samples were processed in duplicate on heterotrophic plate count agar by the pour plate technique. Incubation was for 48 +/- 3 hours at 35 +/- 0.5 degrees C, and the colonies were counted on a Quebec colony counter (New Brunswick Scientific Co, New Brunswick, NJ). Pyrogen determinations were made using the limulus amebocyte lysate (LAL) test on 1:20 sample dilution by the gel-clot method. Chemical elements were measured by inductively coupled plasma emission, graphite furnace absorption, conductivity, ultraviolet light absorption, or colorimetry. Only fully treated HD water samples were selected from the 11,000 water samples received. Of the 5,820 samples retained for this study, 3,547 were for bacterial, 1,112 for pyrogen, and 1,161 for chemical analyses. Overall compliance to the CSA Standard was 70% for bacteria, 56% for pyrogen, and 86% for chemistry. The performance of different types of water treatments were compared and discussed; the best overall compliance was obtained by reverse osmosis combined with deionization (RO + DI). The type of water treatment that proved most popular was RO alone, which was used by 22 HD centers (61%).(ABSTRACT TRUNCATED AT 400 WORDS)

[Attitude of nursing personnel towards patients with AIDS: impact of an awareness program]. / Attitudes du personnel soignant à l'égard des personnes atteintes du SIDA: impact d'un programme de sensibilisation.

The goal of this study was to evaluate the impact of an awareness program aimed at experienced personnel and personnel in training who provide healthcare services to patients with AIDS. The purpose of the program was to prepare healthcare staff psychically in working with patients. Six groups of approximately ten people each watched a video showing a nurse stating her concerns about AIDS. After the video, people were encouraged to express their own emotions regarding the disease and people suffering from it. Other participants making up a control group did not attend the discussion. All subjects (N = 124) completed questionnaires on their attitudes and knowledge about AIDS before and after the discussion. Results show an improvement of attitudes with respect to homosexuality, as well as a better understanding of AIDS. However, these observations do not seem to correspond with a more favourable attitude towards AIDS patients. An analysis of these discussions reveals that there is a conflict between the will to help patients and the feeling of shame when faced with the difficulty of showing empathy. As a result, the authors recommend that training programs aimed at healthcare personnel be geared to alleviate this conflict.

[Chronic obstructions of the left main and right coronary arteries]. / Occlusions chroniques du tronc coronaire gauche et de la coronaire droite.

The authors report a case of chronic occlusion of the left main coronary associated with occlusion of the second segment of the right coronary artery documented at coronary angiography carried out for effort angina without previous infarction. Myocardial perfusion was preserved mainly by a marginal branch of the right coronary arising immediately before the occluded second segment and by a small branch of the left main coronary artery.

Routine application of high-performance liquid chromatography for identification of mycobacteria.

Mycolic acid analysis by high-performance liquid chromatography (HPLC) was introduced in our laboratory as the routine technique for identifying all clinical isolates of mycobacteria referred to us. HPLC identified 96.1% of the 1,103 strains analyzed, whereas the biochemical procedures and/or the commercial DNA probes identified 98.3% of strains, for an overall agreement of 94.4%. Compared with the probes, there was 100% specificity and 98.9% sensitivity for Mycobacterium tuberculosis identification. HPLC allowed early detection and identification of the rare mycobacterial species M. haemophilum, M. malmoense, M. shimoidei, and M. fallax as well as uncharacteristic strains of M. simiae. After 18 months of routine use, HPLC proved to be reliable, easy to perform, rapid, and less costly than other identification methods.

Evaluation of a mechanical/chemical infectious waste disposal system.

OBJECTIVES: The mechanical/chemical infectious waste disposal system (IWDS), model Z-5000 HC, manufactured by Medical SafeTEC Inc. (Indianapolis, Indiana) was evaluated for its ability to disinfect biomedical waste. METHODS: The IWDS was operated with a sodium hypochlorite solution and tested with loads consisting of microbial cultures and blood. During and after processing, samples of liquid, milled solid waste, and leachate were collected to determine the efficacy of disinfection and the chemical by-products released. An inactivation factor was calculated. Aerosol emission was studied. All tests were done in triplicate. RESULTS: Our results showed the expected level of disinfection (inactivation factor greater than or equal to 5 log10) for all tests carried out with Bacillus subtilis, Enterococcus faecalis, Candida albicans, and Serratia marcescens, and for most of the tests with Mycobacterium fortuitum and bacteriophages OX174 and f2. Further tests performed in the absence of blood resulted in an inactivation factor greater than or equal to 5 log10 for all tests with M fortuitum, but not for those of the milled solids with bacteriophage f2. Aerosols were found to escape the apparatus when the IWDS was operated in the absence of chlorine. The liquid effluent contained an average of 17,600, and 15 mg/l of free chlorine, chloramines, and trihalomethanes (THM), respectively. The air effluent contained 1.1 mg/m3 of total chlorine and 1.4 micrograms/m3 of THM. CONCLUSIONS: Under our study conditions and except for certain tests with bacteriophage f2, the IWDS reduced the microbial populations tested by a factor of 5 log10. The aerosol dispersion problem remains to be solved, and the significance of the chemical by-products released will require further investigation.

Motivational goal objects in later life.

With a sentence completion technique, 708 elderly participants (64 to 90 years of age) expressed 15,020 personal aspirations. These goals were classified according to their motivational content in ten major categories and their relationships with different sociodemographic variables were studied. Two goal profiles emerge from this analysis. Aspirations centered on self-preservation are associated with very old age, functional impairment, lower S.E.S. and education, being alone or institutionalized. Aspirations of self-development and interpersonal relationships are associated with younger age, physical autonomy, higher S.E.S. and education, being married or living at home. Development of meaningful personal goals are discussed as a mean of intervention with elderly individuals.

Performance characteristics of two bioassays and high-performance liquid chromatography for determination of flucytosine in serum.

We compared the accuracy and precision of two microbiological methods and one high-pressure liquid chromatography (HPLC) procedure used to measure the concentrations of flucytosine in serum. On the basis of an analysis of six standards, all methods were judged reliable within acceptable limits for clinical use. With the biological methods, a slight loss of linearity was observed in the 75- to 100-micrograms/ml range. Compared with the bioassays, the HPLC method did not present linearity problems and was more precise and accurate in the critical zone of 100 micrograms/ml. On average, results obtained with patient sera containing 50 to 100 micrograms of flucytosine per ml were 10.6% higher with the HPLC method than with the bioassays. Standards for the biological assays may be prepared in serum or water.