bluuebunny/crossref_metadata_2025_split huggingface dataset:
Education of Pharmacists in Ghana: evolving curriculum, context and practice in the journey from Dispensing Certificate to Doctor of Pharmacy Certificate.
Authors: Koduah Augustina , Kretchy Irene , Sekyi-Brown Reginald , Asiedu-Danso Michelle , Ohene-Agyei Thelma , Duwiejua Mahama 
Published: November 2020

Abstract
Background: Understanding the origin and evolution of education of pharmacists is important for practice and health system reforms. In Ghana, education of pharmacists started in the 1880s with the training of dispensers in a government hospital. Over the years, the curriculum and institutional arrangements changed and currently pharmacists are trained in universities. In this study we explored how and why education of pharmacists evolved in Ghana.Methods: We used a case study design to systematically describe education of pharmacists reforms. Data was collected from October 2018 and December 2019 through document review and in-depth interviews. The data was analysed based on institutional arrangements and contextual factors influencing reforms from the 1880s through 2012, when the Doctor of pharmacy programme was initiated in Ghana.Results: Reforms occurred around four main periods when institutional arrangements including the certificate awarded and expected roles were modified by educators and government. These are: (1) the Certificate of dispensing with dispenser-in-training and nurse-dispenser schemes (1880s to 1942), when dispensers were trained to assist doctors in dispensing or directly diagnosing and treating specific disease conditions. (2) the Diploma and Certificate of competency with the dispenser-in-training and pupil pharmacist schemes (1943 to 1960), where in addition to existing roles, pharmacists operated village dispensers. (3) the Bachelor of pharmacy degree (1961 to 2017), when pharmacists were trained mainly as medicines experts with a strong science base on all aspects of medicines from production, distribution and use; and over time with a gradual move to patient-oriented practice. (4) the Doctor of pharmacy degree (2012 to date), where in addition to existing roles, trainees are exposed to advance professional practice experiences. Important factors influencing the reforms included, health systems demands for village dispensaries and clinically oriented pharmacists, and harmonization with regional and international training and practice.Conclusion: Reasons influencing education of pharmacists reforms are context specific and are driven by historical experiences, national and international expectations as well as educators and regulators abilities to influence change. These reforms call for direct corresponding change in professional practice laws and regulation to enable pharmacists contribute fully to health care delivery in Ghana.
Virologic Response of Treatment Experienced HIV-infected Ugandan Children and Adolescents on NNRTI based first-line regimen, Previously Monitored without Viral Load
Authors: Ssemambo Phionah Kibalama , Nalubega-Mboowa Mary Gorrethy , Owora Arthur H. , Serunjogi Robert , Kironde Susan Kizito , Nakabuye Sarah , Ssozi Francis , Nannyonga Maria , Musoke Philippa , Barlow-Mosha Linda 
Published: November 2020

Abstract
Background: Many HIV-infected African children gained access to antiretroviral treatment (ART) through expansion of PEPFAR programs since 2004 and introduction of “Test and Treat” WHO guidelines in 2015. As ART access increases and children transition from adolescence to adulthood, treatment failure is inevitable. Viral load (VL) monitoring in Uganda was introduced in 2016 replacing clinical monitoring. However, there’s limited data on the comparative effectiveness of these two strategies among HIV-infected children in resource-limited settings (RLS).Methods: HIV-infected Ugandan children aged 1-12 years from HIV-care programs with >1 year of first-line ART using only immunologic and clinical criteria to monitor response to treatment were screened in 2010. Eligible children were stratified by VL ≤ 400 and >400 copies/ml randomized to clinical and immunological (control) versus clinical, immunological and VL monitoring to determine treatment failure with follow-up at 12, 24, 36, and 48 weeks. Plasma VL was analyzed retrospectively for controls. Mixed-effects logistic regression models were used to compare the prevalence of viral suppression between study arms and identify factors associated with viral suppression. Results: At baseline all children (n=142) were on NNRTI based ART (75% Nevirapine, 25% efavirenz). One third of ART-experienced children had detectable VL at baseline despite high CD4%. Median age was 6 years (interquartile range [IQR]: 5-9) and 43% were female. Overall, the odds of viral suppression were not different between study arms: (arm by week interaction, p=0.63), adjusted odds ratio [aOR]: 1.07; 95%CI: 0.53, 2.17, p=0.57) and did not change over time (aOR: 0 vs 24 week: 1.15; 95% CI: 0.91, 1.46, p=0.24 and 0 vs 48 weeks: 1.26; 95%CI: 0.92, 1.74, p=0.15). Longer duration of a child’s ART exposure was associated with lower odds of viral suppression (aOR: 0.61; 95% CI: 0.42, 0.87, p<.01). Only 13% (9/71) of children with virologic failure were switched to second-line ART, in spite of access to real-time VL.Conclusion: With increasing ART exposure, viral load monitoring is critical for early detection of treatment failure in RLS. Clinicians need to make timely informed decisions to switch failing children to second-line ART. Trial Registration: ClinicalTrials.gov NCT04489953, 28 Jul 2020. Retrospectively registered.
Preparing the healthcare workforce in South Africa for short-course rifampicin-resistant TB treatment: Inter-professional training and task-sharing considerations
Authors: Farley Jason E. , Ndjeka Norbert , Mlandu Khaya , Lowensen Kelly , Geiger Keri , Nguyen Yen , Budhathoki Chakra , Stamper Paul D 
Published: November 2020

Abstract
Background: Treatment for rifampicin-resistant Mycobacterium tuberculosis (RR-TB) is complex, however, shorter treatment, with newer antimicrobials are improving treatment outcomes. The South African National Department of Health (NDoH) recently accelerated the rollout of 9-month, all oral, RR-TB short-course regimens. We sought to evaluate an inter-professional training program using pre-test and post-test performance of Professional Nurses (PNs), Advanced Practice Professional Nurses (APPNs) and Medical Officers (MOs) to inform: a) training needs across cadres; b) knowledge performance, by cadres; and c) training differences in knowledge by nurse type. Methods: A 4-day didactic and case-based clinical decision support course for RR-TB regimens in South Africa (SA) was developed, reviewed and nationally accredited. Between February 2017 and July 2018, 12 training events were held. Clinicians who may initiate RR-TB treatment, specifically MOs and PN/APPNs with matched pre-post tests and demographic surveys were analyzed. Descriptive statistics are provided. Pre-post test evaluations included 25 evidence-based clinically related questions about RR-TB diagnosis, treatment, and care. Results: Participants (N=842) participated in testing, and matched evaluations were received for 800 (95.0%) training participants. Demographic data was available for 793 (99.13%) participants, of whom 762 (96.1%) were MOs, or nurses, either PN or APPNs. Average correct response pre-test and post-test scores were 61.7% (range 7-24 correct responses) and 85.9% (range 12-25), respectively. Overall, 95.8% (730/762) of participants demonstrated improved knowledge. PNs improved on average 25% (6.22 points) whereas MOs improved 10% (2.89 points) with better mean test scores on both pre- and post-test (p<0.000). APPNs performed the same as the MOs on post-test scores (p=NS). Conclusions: The inter-professional training program in short-course RR-TB treatment improved knowledge for participants. MOs had significantly greater pre-test scores. Of the nurses, APPNs outperformed other PNs, and performed equally to MOs on post-test scores, suggesting this advanced cadre of nurses might be the most appropriate to initiate and monitor treatment in close collaboration with MOs. All cadres of nurse reported the need for additional clinical training and mentoring prior to managing such patients.
Knowledge among the rural parents about the vaccinations and vaccination coverage of children in the first year of life in Papua New Guinea – analysis of data provided by Christian Health Services.
Authors: Gowin Ewelina , Kuzma Jerzy , Januszkiewicz-Lewandowska Danuta 
Published: November 2020

Abstract
BackgroundThis analysis aimed to assess rural parents' knowledge about the diseases prevented by vaccinations and establish vaccination coverage in PNG. MethodsKnowledge on vaccinations was checked through a standard questionnaire (five open questions). We analyzed data on vaccination coverage from 2016 to 2018 from all Catholic health facilities. Analyzed vaccinations were the pentavalent vaccine (DTaP-HiB-HepB) and measles vaccine given in the first year of life. Coverage was calculated based on the number of vaccines used compared to the number of eligible children.Analysed vaccinations were the pentavalent vaccine (DTaP-HiB-HepB) and measles vaccine given in the first year of life.Results56 parents, including 52 mothers and four fathers, participated in the interview. Many parents (46%) understood that the vaccine prevents diseases. During the analyzed period, a total of 25,502 doses of measles vaccine was given, 31,428 children were vaccinated with the pentavalent vaccine. In 2016, the coverage rate for the measles vaccine was 26.6% and 33.4% for the pentavalent vaccine. In 2017, the coverage rate for measles and pentavalent vaccines was 12.5% and 16.6%, respectively. There were significant differences in immunization coverage between provinces. A decreasing trend in the number of administered vaccinations was observed.ConclusionThe results of this analysis demonstrate that in PNG, the majority of children are not fully immunised. There are big differences in the vaccination coverage between provinces. As protection from diseases is low, there is a very high risk of an outbreak of the vaccine-preventable disease in the community.Delivery of vaccinations in PNG encounters many barriers from access to healthcare services to natural disasters and inter-tribial conflicts.Trial registration NA
A Real-Time PCR Assay for Rapid Identification of Inducible and Acquired Clarithromycin Resistance in Mycobacterium abscessus
Authors: Sharma Meenu Kaushal , La Yanni , Janella Debra , Soualhine Hafid 
Published: November 2020

Abstract
Background: Mycobacterium abscessus is a rapidly growing mycobacteria involved in severe infections of the lung, skin, or soft tissue. Macrolides such as clarithromycin are the recommended first line drugs for treatment of M. abscessus infections. However, M. abscessus has dual mechanisms of resistance to macrolides, making treatment by macrolides difficult. A functional erm(41) gene confers for inducible resistance while acquired mutations on the 23S rRNA rrl gene confer for constitutive resistance. Methods: We have developed a real-time PCR assay to detect both inducible and acquired resistance to clarithromycin, and compared the results to traditional erm(41) and rrl sequencing and phenotypic susceptibility testing using Sensititre™ plates. Results: Of the total 126 M. abscessus isolates tested, truncated erm(41) was found in 23/126 (18.3%) of the samples, 27/126 (21.4%) had a T28C mutation in erm(41), and 2/126 (1.6%) had an acquired A2058C mutation in rrl. The phenotypic results correlated with the expected sequencing results in 121/126 samples (96%). Phenotypic testing compared to real-time PCR resolved 2 of these discrepancies by showing the existence of both erm(41) alleles in the isolates that sequencing missed. One culture was found to be mixed with two M. abscessus subsp. as per hsp65 sequencing and 2 isolates had discordance between molecular and phenotypic results. It was presumed that 3 isolates showed discrepancy between sequencing and real-time PCR, but one culture was mixed and other 2 detected both alleles by real-time PCR leading to 100% concordance when compared to sequencing. Conclusion: In conclusion, real-time PCR is more accurate for detection of both acquired and induced clarithromycin resistance, specifically when mixed genic profiles are present in a sample.
Observational study of compliance with infection control practices among healthcare workers in subsidized and private residential care homes
Authors: Au Jessie Kit Ling , Suen Lorna Kwai Ping , Lam Simon Ching 
Published: November 2020

Abstract
Background: The elderly population in Hong Kong is rapidly growing, and the need for residential care homes (RCHs) is increasing. The risk of being infected with micro-organisms increases among the frail and the vulnerable elderly population as their immunity system begins to deteriorate. Furthermore, the residents in RCHs are at high risk of healthcare-associated infections (HAIs) due to the confined living environments and individual co-morbidities. In relation to this, infection control practice (ICP) is considered a crucial and effective approach in preventing HAIs. This study aimed to observe the daily ICP of healthcare workers in RCH settings.Methods: An observational study was conducted to observe daily ICP among healthcare workers in private and subsidized RCHs. Each RCH was separated into different units based on the location (common area and bedroom area) and nature of residents for successive days. The ICP episodes were observed until 200 opportunities in each unit. The ICP episodes were recorded by an electronic tool called “eRub,” which is an ICP checklist based on international guidelines.Results: The most frequent observed ICP episodes were hand hygiene (n=1053), the use of gloves (n=1053) and respiratory protection (n=1053). The overall compliance of hand hygiene was poor, with only 15% of participants performing this during the “five moments for hand hygiene.” Furthermore, the observations showed that 77.9% improperly performed the use of gloves, and 31.8% failed to wear a mask during the care provision for the elderly. However, the results showed that most healthcare workers can wear the mask in a proper way when they should. Generally, the personal care workers were the worst in terms of hand hygiene and use of gloves compared with the other types of healthcare workers. Conclusions: Despite the fact that the practice of hand hygiene, the use of gloves, and respiratory protection were the important elements of ICP, overall compliance to these elements was still poor. Personal care workers had the most frequent contact with the residents, but they had the worst compliance rate. Hence, continued monitoring and training among healthcare workers is needed, particularly personal care workers, in this healthcare service setting.
Splenic Infarction and Infectious Diseases in Korea
Authors: Im Jae Hyoung , Chung Moon-Hyun , Lee Hye-Jin , Kwon Hea Yoon , Baek JiHyeon , Jang Ji-Hun , Lee Jin-Soo 
Published: November 2020

Abstract
Background The spleen contains immune cells and exhibits a pattern of infarction different from other organs; as such, splenic infarction (SI) may provide important clues to infection. However, the nature of the relationship between SI and infectious disease(s) is not well understood. Accordingly, this retrospective study investigated the relationship between SI and infection. Methods Hospital records of patients with SI, who visited Inha University Hospital (Incheon, Republic of Korea) between January 2008 and December 2018, were reviewed. Patient data regarding clinical presentation, causative pathogens, risk factors, and radiological findings were collected and analyzed.Results Of 353 patients with SI, 101 with infectious conditions were enrolled in this study, and their data were analyzed to identify associations between SI and infection. Ten patients were diagnosed with infective endocarditis (IE), and 26 exhibited bacteremia without IE. Twenty-seven patients experienced systemic infection due to miscellaneous causes (negative result on conventional automated blood culture), including the following intracellular organisms: parasites (malaria [n =12], babesiosis [n =1]); bacteria (scrub typhus [n =5]); viruses (Epstein–Barr [n =1], cytomegalovirus [n =1]); and unidentified pathogen[s] (n =7). Splenomegaly was more common among patients with miscellaneous systemic infection; infarction involving other organs was rare. Thirty-eight patients had localized infections (e.g., respiratory, intra-abdominal, or skin and soft tissue infection), and most (35 of 38) had other risk factors for SI. Conclusions In this study, various infectious conditions were found to be associated with SI, and intracellular organisms were the most common causative pathogens. Further studies are needed to examine other possible etiologies and the underlying pathophysiological mechanisms.
Increase in foreign body and harmful substance ingestion and associated complications in children: a retrospective study of 1199 cases from 2005 to 2017
Authors: Speidel Arne Jorma , Woelfle Lena , Mayer Benjamin , Posovszky Carsten 
Published: November 2020

Abstract
Background: Children with a history of caustic or foreign body ingestion (FBI) seem to be presenting more frequently to emergency departments. This study aims to elucidate the clinical presentation, diagnostic procedures, and complications associated with the ingestion of on different object categories over a 13-year time period. Methods: A structured retrospective data analysis of patients who presented in between January 2005 and December 2017 to the University Medical Centre Ulm was performed. Patients up to 17 years of age with food impaction or foreign body or harmful substance ingestion were included by selection of the corresponding International Statistical Classification of Diseases and Related Health Problems (ICD10-GM) codes. Descriptive statistics, parametric or non-parametric tests, and linear regression analysis were performed.Result: In total, 1199 patients were analysed; the mean age was 3.3 years (SD 3.12; range 7 days to 16 years), the male to female ratio was 1.15:1, and 194 (16.2%) were hospitalized. The number of patients seen annually increased from 66 in 2005 to 119 in 2017, with a rise in percentage of all emergency patients from 0.82% in 2010 to 1.34% in 2017. The majority of patients (n=619) had no symptoms, and 244 out of 580 symptomatic patients complained of retching or vomiting. Most frequently, ingested objects were coins (18.8%). Radiopaque objects accounted for 47.6%, and sharp objects accounted for 10.5% of the ingested foreign bodies, both of which were significantly more often ingested by girls (p<0.001 for both). Button battery ingestion was recorded for 63 patients with a significant annual increase (R2=0.57; b=0.753; p=0.003). The annual rate of complications also increased significantly (R2=0.42; b=0.647; p=0.017).Conclusion: We found an alarming increase in the number of children who presented to our emergency department with FBI and associated complications. A standardized diagnostic and therapeutic approach may reduce and prevent serious complications. Further preventive measures within the home environment are needed to stop this trend.
Specific Dynamic Variations in the Peripheral Blood Lymphocyte Subsets in COVID-19 and Severe Influenza A Patients: A Retrospective Observational Study
Authors: Qian Fang , Gao Guiju , Song Yangzi , Xu Yanli , Wang Aibin , Wang Sa , Yiwei Hao , Chen Meiling , Ma Xiaoyang , Zhao Tianwei , Guo Xiaodi , Chen Zhihai , Zhang Fujie 
Published: November 2020

Abstract
Background:Both COVID-19 and influenza A contribute to increased mortality among the elderly and those with existing comorbidities. Changes in the underlying immune mechanisms determine patient prognosis. This study aimed to analyze the role of lymphocyte subsets in the immunopathogenesisof COVID-19 and severe influenza A, and examined the clinical significance of their alterations in the prognosis and recovery duration.Methods:By retrospectively reviewing of patients in four groups (healthy controls, severe influenza A, non-severe COVID-19 and severe COVID-19) who were admitted to Ditan hospital between 2018 to 2020, we performed flow cytometric analysis and compared the absolute counts of leukocytes, lymphocytes, and lymphocyte subsets of the patients at different time points (weeks 1- 4).Results:We reviewed the patients’ data of 94 healthy blood donors, 80 Non-severe-COVID-19, 19 Severe-COVID-19 and 37 severe influenza A. We found total lymphocytes (0.81 ×109/L vs 1.74 ×109/L, P = 0.001; 0.87 ×109/L vs 1.74 ×109/L, P < 0.0001, respectively) and lymphocyte subsets (T cells, CD4+ and CD8+ T cell subsets) of severe COVID-19 and severe influenza A patients to be significantly lower than those of healthy donors at early infection stages. Further, significant dynamic variations were observed at different time points (weeks 1–4).Conclusions:Our study suggests the plausible role of lymphocyte subsets in disease progression, which in turn affects prognosis and recovery duration in patients with severe COVID-19 and influenza A.
Association between haematological parameters and sickle cell genotypes in children with Plasmodium falciparum malaria residents in Kisumu County in western Kenya
Authors: Kosiyo Paul , Otieno Walter , Gitaka Jesse , Munde Elly O. , Ouma Collins 
Published: November 2020

Abstract
Background: Sickle cell disease (SCD) is a monogenic disorder due to point mutation in the β-globin gene resulting in substitution of Valine for Glutamic acid. The SCD is prevalent in P. falciparum endemic regions such as western Kenya. Carriage of different sickle cell genotypes may influence haematological parameter during malaria. Children resident in malaria holoendemic regions suffer more from malaria-related complications and this is moderated by the presence of the SCD. In the current study, we determined the association between sickle cell genotypes and haematological parameters in children with P. falciparum malaria resident in Kisumu County in Western Kenya.Methodology: Children (n=217, aged 1-192 months) with acute febrile condition were recruited at Jaramogi Oginga Odinga Teaching and Referral Hospital. Chi-square (c2) analysis was used to determine differences between proportions. Differences in haematological parameters were compared across groups using Kruskal Wallis test and between groups using Mann Whitney U test. Multivariate logistic regression analysis controlling for infection status was used to determine the association between sickle cell genotypes and haematological parameters.Results: Using HbAA as the reference group, multivariate logistic regression analysis revealed that carriage of HbSS was associated with reduced haemoglobin [OR=0.310, 95% CI=0.101-0.956, P=0.041], reduced haematocrit [OR=0.318, 95% CI=0.128-0.793, P=0.014], reduced RBC count [OR=0.124, 95% CI=0.045-0.337, P=0.001], reduced MCHC [OR=0.325, 95% CI=0.118-0.892, P=0.029], increased leucocytosis [OR=9.283, 95% CI=3.167-27.210, P=0.001] and reduced monocytosis [OR=0.319, 95% CI=0.123-0.830, P=0.019]. However, carriage of HbAS was only associated with increased micro-platelets [OR=3.629, 95% CI=1.291-8.276, P=0.012].Conclusion: Results show that carriage of HbSS in children influence the levels of haemoglobin, haematocrit, RBC, MCHC, WBC and Monocytes. Therefore prior knowledge of HbSS should be considered to improve clinical management of haematological alterations during malaria in children.