Magister Pharmaceuticae - MPharm / Tuberculosis and mv Tuberculosis (TB) is a major contributor to the disease burden in developing countries resulting in the deaths of approximately 2 million people a year. South Africa (SA) has one ( of the highest annual TB incidences with an estimate of 558 per 100 000 population (2003) and the situation shows no sign of abating. TB remains the most common opportunistic infection and cause of death amongst HIV- infected patients. Both TB and HIV treatment depends exclusively on multi-drug regimens that require close monitoring among health care professionals. With increasing workload due to staff shortage and high patient load, the quality of care in nurse-led primary care clinics may be compromised. Existing clinic staff may overlook drug-drug interactions, side effects and may not be aware of the consequences when a formulation is modified during multi-drug therapy administration. As the custodian of medicines, pharmacists are ideally placed to monitor therapy. Clinic-based training programs that are offered to nurses provide an opportunity to work alongside clinic staff and engage in patient-centered care where the pharmacotherapeutic the outcome of TB and HIV drug regimens could be closely monitored. XVll Aims The primary and secondary aims of the study were to: • Assess current practice patterns of TBIHIV at primary healthcare clinics in the Western Cape, • Assess the need for a clinic-based TBIHIV training among final year pharmacy students in UWC. http://uwc.ac.za Objectives To achieve the primary aim the researcher; 1. Conducted a baseline study at Ravensmead Community Health Centre(CHC) to assess current TBIHIV practice among HCP's and co-infected patients, 2. Assessed current practice patterns at Delft South ARV clinic and Elsies River TB clinic (pre-intervention), 3. Designed and implemented a clinic-based TBIHIV intervention tool for potential use by pharmacists at Delft South and Elsies River clinics (intervention phase), 4. Evaluated patient receptivity of the intervention tool amongst patients at Delft South and Elsies River clinics (post-intervention phase). XVlll To achieve the secondary aim the researcher; 5. Introduced a clinic-based training for seven final year pharmacy students, 6. Designed and administered an assessment to both control and experimental students, 7. Assessed scores between students who received the training (experimental group) with those who did not receive the training (control group). Results and discussion Findings from the baseline study indicate the need for the involvement of a trained pharmacist in TB and HIV management. Even though three-quarters (77.8%; 14) of the patients preferred receiving their TB information from the clinic nurse, almost two-thirds (63.2%; 12) of the patients believed that pharmacists assisted with their treatment provision. Patient data obtained from the clinic record card showed that almost two-thirds of the patients reported that they had experienced side effects (64.4%); the therapy of more than one-quarter (26.4%) showed drug-drug interactions and onset of adverse effects (1.1 %). Post-intervention, the data showed that patients' viewed the pharmacist's role more positively. Almost all responses (97.5%; 39) favored the services of a pharmacist in the clinic. In conclusion, findings from the post-intervention patient study underpin that a clinic-based role for the pharmacist is imminent. All seven (100%) of the experimental students passed the assessment and had scores in the range between 26 and 45 and more than three-quarters (78.4 %; 29) of the control students passed with marks within this range. Conclusion A trained pharmacist would be competent to work alongside nursing staff in optimizing care provision in the clinical management of TB and HIV in patients. The existing clinic-based TB/HIV program could be supplemented with theoretical concepts in the final year of undergraduate pharmacy training.

Influenza is a highly contagious respiratory virus that can cause very severe health complications in people, and can be especially dangerous for young children. The peak influenza season occurs in the winter months with February usually being the month with the highest number of reported infections. As the virus can cause serious illness, pediatric institutions during the winter months see a very large number of patients who have influenza or influenza related complications. Pediatric Emergency Departments (ED) similarly see a dramatic increase in the number of patients who visit the ED during the winter influenza season. Therefore, it is important that pediatric EDs develop ways to handle the increased patient population while still maintaining quality care to the rest of the ED. Thus, a novel influenza clinic run entirely by non-ED Nurse Practitioners (NP) was implemented into the operations of the ED as an annexed clinic in February 2013 during the winter influenza season. The clinic was beneficial in improving the average quality measures of the ED against similar days without the influenza clinic, lowering the average length of stay (LOS) by 24 minutes (13% decrease) and lowering the left without being seen rates (LWBS) by 1.35% (3 fewer patients on average). In addition, using NPs instead of higher cost physicians dramatically lowered the cost of the clinic by nearly half. While the influenza clinic was beneficial in lowering the average LOS and LWBS rates against similar days without the clinic the data did not reach statistical significance, perhaps due to the small amount of data available. The results, despite the statistical insignificance, show a promising future in addition of an NP run influenza clinic to handle the increased patient population during the winter influenza season.

The aim of the diploma thesis is to prepare documentation for construction. The building is partially basement and in terms of building physics is designed as a building with almost zero energy consumption. For the purpose of the work is chosen multifunctional object, which consists of veterinary clinic and shop with pet supplies. The building land is located in the cadastral area of Brno-Královo Pole in a built-up area designated for mixed areas of trade and services on a relatively flat plot no. 4800/28 on Edisonova Street. The new building is located on the southeast side of the property, which is followed by parking from the northwest side. The purpose, appearance and volume of the building do not interfere in any way with the character of the territory. Veterinary clinic is partially basement with two floors. In the basement is a technical background for the whole multifunctional building. On the first floor is a waiting room with a reception and two examination rooms, an office and a changing room for employees. On the floor are specialized workplaces, X-ray, ultrasonographic, otoscopic, laboratory and operating room together with hospitalization for animals. The shop with pet supplies is designed as a single storey, consisting of a sale area with a warehouse and facilities for employees. The southeast facade is covered with expanded metal. The construction system of the building is wall-mounted, made of ceramic bricks for thin-layer mortar. Ceiling constructions are designed from large-area filigree panels. The roof is vegetational.

Diploma thesis Veterinary Clinic is compiled in the form of project documentation. The building is situated in the township Vladislav. The building will be made from POROTHERM blocks with ventilated facade with the mineral heat insulation. The ceilings will be made from POROTHERM and SPIROLL.The building has flat roof. The project emphasizes disposition, static, fire safety, acoustic, energy savings and user safety solutions. The building has two floors, second one is receding. On the first floor there are two consulting rooms with shared waiting room, x-ray, laboratory, two operating rooms, post-op care and technical background. On the second floor there is a room for doctors, room for nurses, living room, kitchen and dressing room. The thesis includes specializations – Building services - ventilation and sanitary.

Medical male circumcision prevalence in Lesotho remains at 23% even though efforts are made to encourage men to be circumcised. The purpose of this study was to explore and describe perceptions of men regarding male circumcision in a hospital in Morija, Lesotho and make recommendations on how to promote uptake of medical male circumcision. A descriptive, explorative and contextual qualitative design was used. In-depth, unstructured individual interviews were conducted on ten (10) uncircumcised men who were selected via purposive sampling. The findings revealed that men’s perceptions on circumcision can be classified under the following themes: perceived health beliefs of men about circumcision, perceived community-held beliefs about circumcision, men’s knowledge regarding circumcision, and perceived misconceptions about circumcision. It is recommended that knowledge on circumcision be reinforced and negative perceptions be corrected with the multi-sectoral approach to promote uptake of circumcision services. / Health Studies / M.A. (Public health)

The aim of this study has been to establish an understanding for the approach and working methods used by Swedish counsellors employed at youth clinics, with a focus on detecting as well as supporting adolescent girls who have experienced violence in couple relationships. The method used was of qualitative form and involved interviews with six counsellors working at different youth clinics across Sweden. The material was analyzed with a qualitative analysis as method and with help of empowerment as a theoretical concept. Results have shown that routine questions to adolescents are crucial part in the working method in regards of detecting violence. Furthermore, have the results shown that violence is not a primary cause for help seeking among adolescent girls, thereby creating a challenge for the counsellors to discover. The most common cause reported have been psychosomatic symptoms which can be linked to being exposed to violence. The essay depicts several ways in which adolescent girls who are victims of partner violence can be supported. This includes talking about the current as well as the desired direction the relationship should take. Strengthening the girl’s network of friends and family is another vital point. Lastly, providing information to the client about her bodily and legal rights to help her setting boundaries to unacceptable behavior in a relationship.

Bakgrund: Generellt genomförs operationer på en operationssal med anpassade förutsättningar samtsterila och aseptiska förhållanden. Syftet är att bibehålla den rekommenderade mikrobiologiskarenhetsgraden i luften och förebygga postoperativa infektioner. Bakteriebärande partiklar i luften kanuttryckas i colony forming units per kubikmeter (CFU/m³). Mindre operationer genomförs även påmottagningsrum men det saknas kunskap om CFU/m³ i dessa vårdmiljöer. Syfte: Syftet var att jämföra CFU/m³ i en operationssal och ett mottagningsrum vid polikliniskaoperationer samt kartlägga faktorer som kan påverka CFU/m³. Metod: Studien är en icke-experimentell tvärsnittsstudie med kvantitativ metod och observationer avkvalitativa data. Totalt genomfördes 20 aktiva luftmätningar under pågående operationer, varav tio ien operationssal samt tio i ett mottagningsrum. Data analyserades med deskriptiv och analytiskstatistik. För att beskriva skillnader mellan de två grupperna valdes det icke parametriska MannWhitney U test samt Spearman's rangkorrelation för analys av samband mellan CFU/m³ och övrigavariabler. Multivariabel regression användes för att undersöka vilka av variablerna som hade enoberoende effekt på CFU-värdet.Resultat: Av 20 aktiva luftmätningar påvisades ett högre CFU/m³ (p <0,001) och en högrerumstemperatur (p <0,001) i mottagningsrum jämförelsevis med operationssal. Vårdmiljön hade enoberoende effekt på CFU-värdet (p <0,05). Variablerna antal personer och antal dörröppningar bidroginte signifikant till regressionsmodellen. Slutsats: Följande studie kan konstatera att CFU/m³ var högre i mottagningsrummet än ioperationssalen. Huruvida CFU-värdet har en klinisk betydelse för postoperativa infektioner eftermindre polikliniska operationer i mottagningsrum behöver undersökas i framtida forskning. / Bakgrund: Verksamheten utförs i allmänhet i en operationssal med anpassade förhållanden, samt sterila och aseptiska förhållanden. Att upprätthålla mikrobiologisk renhet i luften är ett sätt att förhindra infektioner på operationsstället (SSI). Luftburna bakteriepartiklar uttrycks i kolonibildande ledningar per kubikmeter (CFU/m³). Mindre kirurgiska ingrepp utförs också i klinikbaserade procedurrum men det saknas kunskap om nivåerna av CFU/m³. Syfte: Syftet var att jämföra CFU/m³ i en operationssal med ett klinikbaserat ingrepp som utförde kirurgiska ingrepp och undersöka faktorer som kan påverka CFU/m³. Metoder: En ickeexperimental tvärsnittsstudie med en kvantitativ metod och observation av kvalificerade data utfördes. Totalt genomfördes 20 aktiva luftprovtagningar under mindre kirurgiska ingrepp, tio i varje driftsmiljö. Data analyserades med beskrivande och analytisk statistik. Mann-Whitney U-test tillämpades för att jämföra de två grupperna. Spearmans rank-korrelationmeasured korrelationen och flera regressionsanalys användes för att förstå effekterna av två eller flera oberoende variabler på CFU/m³. Resultat: En högre CFU/m³ (p<0,001) och en rumstemperatur (p<0,001) upptäcktes i klinikenbaserade procedurrummet jämfört med operationssalen. Driftsmiljön hade en oberoende på CFU/m³ (s<0,05). Variabler som antal personer och dörröppningar bidrog inte obetydligt. Slutsatser: Denna studie kan fastställa att CFU/m³ var högre i den klinik-baserade förfarandet roomversus operationssalen. Ytterligare forskning behövs för att undersöka om CFU/m³ har en klinisk betydelse för SSI i klinikbaserade procedurrum.

Diabetes is the 7th leading cause of death in the United States and is the main cause of chronic kidney failure, nontraumatic limb amputations, blindness, myocardial infarction, and stroke. Many patients with diabetes do not meet goals for at least 1 control measure of blood sugar, blood pressure, or cholesterol. The purpose of the project was to implement a template for documentation--a toolkit for patient care management-to improve blood glucose and blood pressure levels in a rural health clinic in central Texas for 33 patients with diabetes during a 6- to 8-week timeframe. The practice-focused question asked whether management of patients with diabetes would be improved if documentation on a standard template were used by all providers at the site. Models used in this doctoral project included the chronic care model and the Institute for Healthcare Improvement breakthrough series collaborative model. Sources of evidence included published outcomes and research from a systematic review of the literature, archival and operational data collected from the rural health clinic, and evidence from the project. Glycosalated hemoglobin levels improved from a mean of 8.9 mg to 7.6 mg in 31 of 33 participants (t = 2.684, 30 df, p = .012). Systolic and diastolic blood pressures were reduced slightly, but changes were not statistically significant. Potential implications for positive change in nursing practice include improvements in clinical management, implementation of evidence-based practice, and improved outcomes for patients with diabetes. Incorporating evidence-based practice provides scientific justification for actions that will improve clinical outcomes for patients, which leads to healthier patients, families, and communities and contributes to positive social change.

No description available.

Abstract Introduction: Obesity amongst children is a major health problem. At the outpatient paediatric clinic at Södertälje hospital in Region Stockholm, there is a large and well-established treatment model against childhood obesity. During spring 2020 all elective care in Region Stockholm, including visits to the obesity team, was cancelled for 3 months due to relocation of health care professionals because of the Covid-19 pandemic. Aim: To investigate whether the first wave of the Covid-19 pandemic affected the outcome of childhood obesity treatment at one outpatient paediatric clinic in Region Stockholm. Methods: A retrospective controlled cohort study comparing two groups regarding results of first year of obesity treatment for children. One group had their first year of treatment during the first wave of the Covid-19 pandemic and the control group before the pandemic. Data was retrieved from BORIS and complemented by a review of medical records. Results: Mean change in BMI SDS after one year of treatment in the Covid group was -0.10 units and in the control group -0.11 (ns). In the Covid group more patients quit the treatment programme and had a smaller number of visits to a nurse compared to controls. Conclusion: This study showed no difference in outcome regarding change in BMI SDS. However, it seems that the cancellation of visits might have affected the number of children lost to follow-up. Therefore, clinics should consider “digi-physical” care (e.g., via telephone, videocalls or other media) to secure the child and parents motivation and participation in the obesity treatment programme.