Background: Appropriate sample requesting, collecting and timely dispatch to the appropriate laboratory is essential in establishing diagnosis of pathologies with lesions. Much time and effort may be wasted if this is...Background: Appropriate sample requesting, collecting and timely dispatch to the appropriate laboratory is essential in establishing diagnosis of pathologies with lesions. Much time and effort may be wasted if this is not done according to certain standards. We conducted this study to assess the route of lymph node samples from requests to reaching the laboratories. Methods: We conducted an audit over a period from 4th June until 10th Aug 2023. Data for all the procedures performed over this period on lymph node samples (was entered into and analysed using Excel. Results: A total of eighteen samples for sixteen patients were obtained during this period. Median age of the patients was 34 years (19 - 73) with a M:F ratio of 5:11. Among the IR samples, nine samples were from the neck, three from inguinal area and one from axilla. Seven samples (53.8%) were tru-cut biopsies, six samples (46.15%) were FNA. All samples were sent to the pathology laboratory fixed in formalin. Samples for TB were sent only for five cases (31.25%) and for only two cases (12.5%) were samples sent for bacterial culture. For the OR samples, none were sent for either bacterial culture or TB. Overall, eight patients (50%) were not investigated for any infectious etiologies like brucella, toxoplasmosis, CMV, EBV plus other possible causes. Repeat sampling was required for 25% of patients (within and out of the audit period). Conclusions: to avoid delays in making diagnoses, it is paramount to consider infectious etiologies as possible diagnosis for lymphadenopathy and request appropriate investigations. This requires liaising with infectious diseases/clinical microbiology experts to guide regarding types of samples, types of media and timely dispatch to the correct laboratory.展开更多
Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and fnancing. Different tools have been developed, incl...Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and fnancing. Different tools have been developed, includ-ing incident analysis, health technology assessment and clinical audit. The clinical audit consist of mea-suring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine in order to identify the changes needed to improve the quality of care. In particular, patients suffering from chronic renal diseases, present many problems that have been set as topics for clinical audit projects, such as hypertension, anaemia and mineral metabolism management. Although the results of these studies have been encouraging, demonstrating the ef-fectiveness of audit, overall the present evidence is not clearly in favour of clinical audit. These findings call attention to the need to further studies to validate this methodology in different operating scenarios. This review examines the principle of clinical audit, focusing on experiences performed in nephrology settings.展开更多
The REFLECT Psychological Services Audit Framework was developed to address critical gaps in the evaluation of mental health services, primarily within Employee Assistance Programmes (EAPs) and psychological services....The REFLECT Psychological Services Audit Framework was developed to address critical gaps in the evaluation of mental health services, primarily within Employee Assistance Programmes (EAPs) and psychological services. This study aims to assess the framework’s impact on clinical outcomes, financial oversight, staff well-being, and risk management. A mixed-methods approach was employed, combining quantitative data—including paired t-tests, regression analysis, and Chi-square tests—with qualitative insights from semi-structured interviews and focus groups. Quantitative data were collected across 10 EAPs, evaluating 100 clients using the PHQ-9 and GAD-7 scales for depression and anxiety, respectively, and 50 staff members using the Maslach Burnout Inventory (MBI). Financial data included budget allocation efficiency and cost-effectiveness metrics. Risk management was assessed through safeguarding incidents and incident reporting time. Results revealed significant improvements across all key domains: client mental health outcomes (PHQ-9 and GAD-7 scores significantly reduced, p [1] offers a comprehensive, evidence-based tool for improving service quality, financial efficiency, and clinician support in psychological services.展开更多
BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study i...BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study is a clinical audit of the recording and management of CHD risk factors.It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology(ESC).Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate.Azerbaijan is a country in the South Caucasus,a region at a very high risk for CVD.AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku(Azerbaijan).METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021.Information on demographics,risk factors,physical and laboratory data,and medications was collected using a standard questionnaire in consecutive patients aged≥18 years with established CHD during outpatient visits.Data from 687 patients(mean age 59.6±9.58 years;24.9%female)were included in the study.RESULTS Only 15.1%of participants were involved in cardiac rehabilitation programs.The rate of uncontrolled risk factors was high:Systolic blood pressure(BP)(SBP)(54.6%),low-density lipoprotein cholesterol(LDL-C)(86.8%),diabetes mellitus(DM)(60.6%),as well as overweight(66.6%)and obesity(25%).In addition,significant differences in the prevalence and control of some risk factors[smoking,body mass index(BMI),waist circumference,blood glucose(BG),and SBP]between female and male participants were found.The cardiovascular health index score(CHIS)was calculated from the six risk factors:Non-or ex-smoker,BMI<25 kg/m2,moderate/vigorous physical activity,controlled BP(<140/90 mmHg;140/80 mmHg for patients with DM),controlled LDL-C(<70 mg/dL),and controlled BG(glycohemoglobin<7%or BG<126 mg/dL).Good,intermediate,and poor categories of CHIS were identified in 6%,58.3%,and 35.7%of patients,respectively(without statistical differences between female and male patients).CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and,in particular,the control rate of BP,are insufficient.Given the fact that patients with different comorbid pathologies are at a very high risk,this is of great importance in the management of such patients.This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures,especially in the regions at a high risk for CVD.A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.展开更多
Background:In 2012,the Ugandan Government declared an epidemic of Nodding Syndrome(NS)in the Northern districts of Gulu,Kitgum,Lamwo and Pader.Treatment guidelines were developed and NS treatment centres were establis...Background:In 2012,the Ugandan Government declared an epidemic of Nodding Syndrome(NS)in the Northern districts of Gulu,Kitgum,Lamwo and Pader.Treatment guidelines were developed and NS treatment centres were established to provide symptomatic control and rehabilitation.However,a wide gap remained between the predefined care standards and the quality of routine care provided to those affected.This study is to qualitatively assess adherence to accepted clinical care standards for NS;identify gaps in the care of affected children and offer Clinical Support Supervision(CSS)to Primary Health Care(PHC)staff at the treatment centres;and identify psychosocial challenges faced by affected children and their caregivers.Methods:This case study was carried out in the districts of Gulu,Kitgum,Lamwo and Pader in Uganda from September to December in 2015.Employing the 5-stage approach of Clinical Audit,data were collected through direct observations and interviews with PHC providers working in public and private-not-for-profit health facilities,as well as with caregivers and political leaders.The qualitative data was analysed using Seidel model of data processing.Results:Clinical Audit and CSS revealed poor adherence to treatment guidelines.Many affected children had suboptimal NS management resulting in poor seizure control and complications including severe burns.Root causes of these outcomes were frequent antiepileptic drugs stock outs,migration of health workers from their work stations and psychosocial issues.There was hardly any specialized multidisciplinary team(MDT)to provide for the complex rehabilitation needs of the patients and a task shifting model with inadequate support supervision was employed,leading to loss of skills learnt.Reported psychosocial and psychosexual issues associated with NS included early pregnancies,public display of sexual behaviours and child abuse.Conclusions:Despite involvement of relevant MDT members in the development of multidisciplinary NS guidelines,multidisciplinary care was not implemented in practice.There is urgent need to review the NS clinical guidelines.Quarterly CSS and consistent anticonvulsant medication are needed at health facilities in affected communities.Implementation of the existing policies and programs to deal with the psychosocial and psychosexual issues that affect children with NS and other chronic conditions is needed.展开更多
文摘Background: Appropriate sample requesting, collecting and timely dispatch to the appropriate laboratory is essential in establishing diagnosis of pathologies with lesions. Much time and effort may be wasted if this is not done according to certain standards. We conducted this study to assess the route of lymph node samples from requests to reaching the laboratories. Methods: We conducted an audit over a period from 4th June until 10th Aug 2023. Data for all the procedures performed over this period on lymph node samples (was entered into and analysed using Excel. Results: A total of eighteen samples for sixteen patients were obtained during this period. Median age of the patients was 34 years (19 - 73) with a M:F ratio of 5:11. Among the IR samples, nine samples were from the neck, three from inguinal area and one from axilla. Seven samples (53.8%) were tru-cut biopsies, six samples (46.15%) were FNA. All samples were sent to the pathology laboratory fixed in formalin. Samples for TB were sent only for five cases (31.25%) and for only two cases (12.5%) were samples sent for bacterial culture. For the OR samples, none were sent for either bacterial culture or TB. Overall, eight patients (50%) were not investigated for any infectious etiologies like brucella, toxoplasmosis, CMV, EBV plus other possible causes. Repeat sampling was required for 25% of patients (within and out of the audit period). Conclusions: to avoid delays in making diagnoses, it is paramount to consider infectious etiologies as possible diagnosis for lymphadenopathy and request appropriate investigations. This requires liaising with infectious diseases/clinical microbiology experts to guide regarding types of samples, types of media and timely dispatch to the correct laboratory.
文摘Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and fnancing. Different tools have been developed, includ-ing incident analysis, health technology assessment and clinical audit. The clinical audit consist of mea-suring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine in order to identify the changes needed to improve the quality of care. In particular, patients suffering from chronic renal diseases, present many problems that have been set as topics for clinical audit projects, such as hypertension, anaemia and mineral metabolism management. Although the results of these studies have been encouraging, demonstrating the ef-fectiveness of audit, overall the present evidence is not clearly in favour of clinical audit. These findings call attention to the need to further studies to validate this methodology in different operating scenarios. This review examines the principle of clinical audit, focusing on experiences performed in nephrology settings.
文摘The REFLECT Psychological Services Audit Framework was developed to address critical gaps in the evaluation of mental health services, primarily within Employee Assistance Programmes (EAPs) and psychological services. This study aims to assess the framework’s impact on clinical outcomes, financial oversight, staff well-being, and risk management. A mixed-methods approach was employed, combining quantitative data—including paired t-tests, regression analysis, and Chi-square tests—with qualitative insights from semi-structured interviews and focus groups. Quantitative data were collected across 10 EAPs, evaluating 100 clients using the PHQ-9 and GAD-7 scales for depression and anxiety, respectively, and 50 staff members using the Maslach Burnout Inventory (MBI). Financial data included budget allocation efficiency and cost-effectiveness metrics. Risk management was assessed through safeguarding incidents and incident reporting time. Results revealed significant improvements across all key domains: client mental health outcomes (PHQ-9 and GAD-7 scores significantly reduced, p [1] offers a comprehensive, evidence-based tool for improving service quality, financial efficiency, and clinician support in psychological services.
文摘BACKGROUND Effective management of major cardiovascular risk factors is of great importance to reduce mortality from cardiovascular disease(CVD).The Survey of Risk Factors in Coronary Heart Disease(SURF CHD)II study is a clinical audit of the recording and management of CHD risk factors.It was developed in collaboration with the European Association of Preventive Cardiology and the European Society of Cardiology(ESC).Previous studies have shown that control of major cardiovascular risk factors in patients with established atherosclerotic CVD is generally inadequate.Azerbaijan is a country in the South Caucasus,a region at a very high risk for CVD.AIM To assess adherence to ESC recommendations for secondary prevention of CVD based on the measurement of both modifiable major risk factors and their therapeutic management in patients with confirmed CHD at different hospitals in Baku(Azerbaijan).METHODS Six tertiary health care centers participated in the SURF CHD II study between 2019 and 2021.Information on demographics,risk factors,physical and laboratory data,and medications was collected using a standard questionnaire in consecutive patients aged≥18 years with established CHD during outpatient visits.Data from 687 patients(mean age 59.6±9.58 years;24.9%female)were included in the study.RESULTS Only 15.1%of participants were involved in cardiac rehabilitation programs.The rate of uncontrolled risk factors was high:Systolic blood pressure(BP)(SBP)(54.6%),low-density lipoprotein cholesterol(LDL-C)(86.8%),diabetes mellitus(DM)(60.6%),as well as overweight(66.6%)and obesity(25%).In addition,significant differences in the prevalence and control of some risk factors[smoking,body mass index(BMI),waist circumference,blood glucose(BG),and SBP]between female and male participants were found.The cardiovascular health index score(CHIS)was calculated from the six risk factors:Non-or ex-smoker,BMI<25 kg/m2,moderate/vigorous physical activity,controlled BP(<140/90 mmHg;140/80 mmHg for patients with DM),controlled LDL-C(<70 mg/dL),and controlled BG(glycohemoglobin<7%or BG<126 mg/dL).Good,intermediate,and poor categories of CHIS were identified in 6%,58.3%,and 35.7%of patients,respectively(without statistical differences between female and male patients).CONCLUSION Implementation of the current ESC recommendations for CHD secondary prevention and,in particular,the control rate of BP,are insufficient.Given the fact that patients with different comorbid pathologies are at a very high risk,this is of great importance in the management of such patients.This should be taken into account by healthcare organizers when planning secondary prevention activities and public health protection measures,especially in the regions at a high risk for CVD.A wide range of educational products based on the Clinical Practice Guidelines should be used to improve the adherence of healthcare professionals and patients to the management of CVD risk factors.
文摘Background:In 2012,the Ugandan Government declared an epidemic of Nodding Syndrome(NS)in the Northern districts of Gulu,Kitgum,Lamwo and Pader.Treatment guidelines were developed and NS treatment centres were established to provide symptomatic control and rehabilitation.However,a wide gap remained between the predefined care standards and the quality of routine care provided to those affected.This study is to qualitatively assess adherence to accepted clinical care standards for NS;identify gaps in the care of affected children and offer Clinical Support Supervision(CSS)to Primary Health Care(PHC)staff at the treatment centres;and identify psychosocial challenges faced by affected children and their caregivers.Methods:This case study was carried out in the districts of Gulu,Kitgum,Lamwo and Pader in Uganda from September to December in 2015.Employing the 5-stage approach of Clinical Audit,data were collected through direct observations and interviews with PHC providers working in public and private-not-for-profit health facilities,as well as with caregivers and political leaders.The qualitative data was analysed using Seidel model of data processing.Results:Clinical Audit and CSS revealed poor adherence to treatment guidelines.Many affected children had suboptimal NS management resulting in poor seizure control and complications including severe burns.Root causes of these outcomes were frequent antiepileptic drugs stock outs,migration of health workers from their work stations and psychosocial issues.There was hardly any specialized multidisciplinary team(MDT)to provide for the complex rehabilitation needs of the patients and a task shifting model with inadequate support supervision was employed,leading to loss of skills learnt.Reported psychosocial and psychosexual issues associated with NS included early pregnancies,public display of sexual behaviours and child abuse.Conclusions:Despite involvement of relevant MDT members in the development of multidisciplinary NS guidelines,multidisciplinary care was not implemented in practice.There is urgent need to review the NS clinical guidelines.Quarterly CSS and consistent anticonvulsant medication are needed at health facilities in affected communities.Implementation of the existing policies and programs to deal with the psychosocial and psychosexual issues that affect children with NS and other chronic conditions is needed.
