Biomedical subjects

Mark Patrick

Publications and source records attributed to Mark Patrick.

4 recordsLinked to original sources

PubMed2006

Childhood death auditing to improve paediatric care.

AIM: Field-testing a paediatric mortality audit system at eight sites in South Africa to assess its feasibility, to collect local data on common causes of death in children under 5 y, and to determine health system failure, missed opportunities of intervention and substandard care (modifiable factors). METHODS: The study tested the Under-5 Healthcare Problem Identification Programme (U5PIP). The sites represent different levels of paediatric healthcare. STUDY PERIOD: 1 September 2003-31 August 2004. STUDY POPULATION: Under-5 patients admitted to study hospitals. CASES: Under-5 patients who died in study hospitals. RESULTS: In total, 1532 under-5 deaths occurred, representing a case-fatality rate of 7.8%. Main causes of death were lower respiratory tract infections (33%), gastroenteritis (15%) and septicaemia (12%). Sixty per cent of the deaths were HIV/AIDS related. Sixty-nine per cent of children who died were underweight. Administrative modifiable factors were present in 31% of deaths. Clinical personnel-related modifiable factors were detected in 26% at the clinic level and in 33-37% at the hospital level. CONCLUSION: The U5PIP is feasible for ongoing mortality reviews by paediatric teams as part of routine work. Information on common causes of death and modifiable factors in this study focus on the impact of HIV/AIDS, malnutrition and resource allocation, and can be used for interventions to improve paediatric healthcare.

Cause of Death↗

PubMed2005

Implementation of kangaroo mother care: a randomized trial of two outreach strategies.

AIM: To test whether a well-designed educational package on the implementation of kangaroo mother care (KMC) used on its own can be as effective in implementing KMC in a healthcare facility as the combination of a visiting facilitator used in conjunction with the package. SETTING: Thirty-four hospitals in KwaZulu-Natal Province, South Africa. METHOD: The hospitals were paired with respect to their geographical location and annual number of births at the facility. One hospital in each pair was randomly allocated to receive either the implementation package alone (group A) or the implementation package and visits from a facilitator (group B). Hospitals in group B received three facilitation visits. All hospitals were evaluated by a site visit 8 mo after launching the process and were scored by means of a progress-monitoring tool. OUTCOMES: Successful implementation was regarded as demonstrating evidence of practice (score>10) during the site visit. RESULTS: Group B scored significantly better than group A (p<0.05). All 17 hospitals in group B demonstrated evidence of practice, with the median score of the group being 15.44 (range 10.29-22.94). Twelve of the hospitals in group A demonstrated evidence of practice and the median score was 11.33 (range 1.08-21.13). CONCLUSION: Successful implementation was achieved in most of the hospitals irrespective of the strategy used. However, facilitation with an implementation package was clearly superior to using a package alone. Some sites do not need facilitation for successful implementation.

Allied Health Personnel↗

PubMed2005

Measuring implementation progress in kangaroo mother care.

AIM: To describe the development and testing of a monitoring model with quantitative indicators or progress markers that could measure the progress of individual hospitals in the implementation of kangaroo mother care (KMC). METHODS: Three qualitative data sets in the larger research programme on the implementation of KMC of the MRC Research Unit for Maternal and Infant Health Care Strategies in South Africa were used to develop a progress-monitoring model and an accompanying instrument. RESULTS: The model was conceptualized around three phases (pre-implementation, implementation and institutionalization) and six constructs depicting progress (awareness, adopting the concept, mobilization of resources, evidence of practice, evidence of routine and integration, sustainable practice). For each construct, indicators were developed for which data could be collected by means of the monitoring instrument used in a walk-through visit to a hospital. The instrument has been tested in 65 hospitals. CONCLUSION: The progress-monitoring model enables the quantification of individual hospitals' progress in the process of implementing KMC and an objective measurement of the effectiveness of different outreach strategies. The model also has potential to be adapted for measuring progress in other innovative healthcare interventions on a large scale.

Child Development↗

PubMed2002

Dopamine therapy for patients at risk of renal dysfunction following cardiac surgery: science or fiction?

OBJECTIVES: We aimed to evaluate the renoprotective role of renal-dose dopamine on cardiac surgical patients at high risk of postoperative renal dysfunction. The latter included older patients or those with pre-existing renal disease, elevated preoperative serum creatinine (Cr), poor ventricular function, hypertension, diabetes mellitus and unstable angina requiring intravenous therapy. METHODS: Fifty patients undergoing cardiopulmonary bypass (CPB) who fulfilled the entry criteria were prospectively randomized into two groups: Group 1 received a 'renal-dose' (3 microg kg(-1) min(-1)) dopamine infusion starting at anaesthetic induction for 48 h whilst saline infusion acted as placebo in Group 2. The anaesthetic and CPB regimes were standardized. Urinary excretion of retinol binding protein (RBP) indexed to Cr, an accurate and sensitive marker of early renal tubular damage, was assessed daily for 6 days. Additional outcome measures included daily fluid balance, blood urea and serum Cr. Statistical comparisons were made using ANOVA and Mann-Whitney U-test. RESULTS: No significant difference was found between the groups in their age, gender, preoperative NYHA class, ejection fraction, baseline serum Cr and duration of CPB and aortic cross-clamping. Renal replacement therapy was not required in any instance. Both groups demonstrated a similar and significant rise in urinary RBP throughout the study period. Dopamine-treated patients achieved more negative average fluid balance than those on placebo (5 vs. 229 ml, P<0.05). CONCLUSIONS: Renal-dose dopamine therapy failed to offer additional renoprotection to patients considered at increased risk of renal dysfunction after CPB.

Aged↗