This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descript...This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.展开更多
The need for early screening of the biopsychosocial vulnerability within primary care is clear in the literature, but there is disagreement on the definition and type of score to be used. Health is influenced by deter...The need for early screening of the biopsychosocial vulnerability within primary care is clear in the literature, but there is disagreement on the definition and type of score to be used. Health is influenced by determining not only biological, but also psychological and social. The aims of the study are research and evaluation tools to determine the biopsychosocial vulnerability and the creation of a flow-chart for the establishment of health and socio-personalized care programs, but based on scientific evidence. In our study we have built an original scale of assessment for the general medicine, which could simultaneously analyze the Bio-Psycho-Social aspect of patients. A group of GPs （general practitioners） have tested this tool on a group of complex patients. The results of the study show that a high score on our scale of assessment is not correlated with the age of a patient （R = 0.454）; instead there is a straight correlation between the high score and the number of GPs and patient contacts （R = 0.790） and a border-line significant correlation （R = 0.590） between high scores and hospital admissions and resources utilization. In conclusion, with our assessment scale we built a general medicine instrument, simple, integrated with primary care setting and tools, fast in use. In the research and validation phase we showed how this scale would be able to identify patients in need of more attention where there is a necessity to go from a Guideline and EBM-Based approach to a Personalized approach.展开更多
肉芽肿性多血管炎（granulomatosis with polyangiitis,GPA）是一种病因未明的罕见多系统自身免疫性疾病.其特征为坏死性肉芽肿性炎和免疫性中小血管炎,大部分患者以呼吸道病变为首发症状,容易误诊为肺结核.笔者报道2015年1月本院收治的...肉芽肿性多血管炎（granulomatosis with polyangiitis,GPA）是一种病因未明的罕见多系统自身免疫性疾病.其特征为坏死性肉芽肿性炎和免疫性中小血管炎,大部分患者以呼吸道病变为首发症状,容易误诊为肺结核.笔者报道2015年1月本院收治的1例以“发热、肺部阴影、单侧胸腔积液”为主要临床表现的患者,诊断为肺结核及结核性胸膜炎,经抗结核治疗无效,为明确诊断,笔者组织临床专家对患者的诊断及治疗进行了讨论.患者经肺活组织检查及检测c-ANCA阳性后,最终诊断为肉芽肿性多血管炎.展开更多
文摘This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.
文摘The need for early screening of the biopsychosocial vulnerability within primary care is clear in the literature, but there is disagreement on the definition and type of score to be used. Health is influenced by determining not only biological, but also psychological and social. The aims of the study are research and evaluation tools to determine the biopsychosocial vulnerability and the creation of a flow-chart for the establishment of health and socio-personalized care programs, but based on scientific evidence. In our study we have built an original scale of assessment for the general medicine, which could simultaneously analyze the Bio-Psycho-Social aspect of patients. A group of GPs （general practitioners） have tested this tool on a group of complex patients. The results of the study show that a high score on our scale of assessment is not correlated with the age of a patient （R = 0.454）; instead there is a straight correlation between the high score and the number of GPs and patient contacts （R = 0.790） and a border-line significant correlation （R = 0.590） between high scores and hospital admissions and resources utilization. In conclusion, with our assessment scale we built a general medicine instrument, simple, integrated with primary care setting and tools, fast in use. In the research and validation phase we showed how this scale would be able to identify patients in need of more attention where there is a necessity to go from a Guideline and EBM-Based approach to a Personalized approach.
文摘肉芽肿性多血管炎（granulomatosis with polyangiitis,GPA）是一种病因未明的罕见多系统自身免疫性疾病.其特征为坏死性肉芽肿性炎和免疫性中小血管炎,大部分患者以呼吸道病变为首发症状,容易误诊为肺结核.笔者报道2015年1月本院收治的1例以“发热、肺部阴影、单侧胸腔积液”为主要临床表现的患者,诊断为肺结核及结核性胸膜炎,经抗结核治疗无效,为明确诊断,笔者组织临床专家对患者的诊断及治疗进行了讨论.患者经肺活组织检查及检测c-ANCA阳性后,最终诊断为肉芽肿性多血管炎.
