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Cryptosporidiosis in Harare, Zimbabwe.

OBJECTIVE: To determine the prevalence of Cryptosporidium parvum in diarrhoeal patients. DESIGN: This was a laboratory-based cross sectional study on cryptosporidiosis in diarrhoeal patients. SETTING: Department of Medical Laboratory Sciences, College of Health Sciences in Harare, Zimbabwe. SUBJECTS: People of all ages with diarrhoea presenting at primary level health centres in Harare. MAIN OUTCOME MEASURES: Patient's age, laboratory results. RESULTS: Cryptosporidium parvum was the commonest enteric pathogen and was detected in 5.8% of the 500 diarrhoeal patients of all ages followed by Shigella species (3.8%) and Salmonella species (2.0%). The highest detection rate of C. parvum oocysts was observed in children less than five years old (11.2%) followed by children between six and 10 years old (6.3%) and then the 31 to 40 year age group (5.9%). CONCLUSIONS: Cryptosporidiosis affects people of all ages in Harare but is more common in children, particularly those under five years. The C. parvum oocysts should be looked for routinely in diarrhoeal stool specimens particularly those from children less than five years since C. parvum may be one of the causative agents of diarrhoea in this age group.

AIDS-Related Opportunistic Infections↗

A study for the production of containers used in the diagnosis and prevention of infection.

OBJECTIVES: 1. To study the need of containers used in the diagnosis and prevention of infection. 2. To produce the containers, 3. To test the practicability of the product. MATERIAL AND METHOD: - The study on the need of the containers was done by questionnaires answered by nurses and microbiology laboratory technicians in 56 hospitals. - The containers were produced by the researchers who later had them tested for their practicability by nurses and technicians in the same hospitals. - The study was done during 2002-2004. RESULTS: Fifty-six hospitals were enrolled by stratified random sampling. Questionnaires were responded by 424 nurses and 35 microbiology laboratory technicians. Sputum trap, body fluid and feces containers and needle disposal box were studied and the need for commercial products was 31.1%, 31.1%, 32.3% and 99.5% respectively. Sixteen percent to 58.5% of these containers were bought and 14.3% to 68.6% were home-made. Sputum trap, body fluid and feces containers, and needle disposal boxes were produced and tested by 400 nurses and 32 laboratory technicians. The products were evaluated as satisfactory in 59.4% to 80.0%. The lid of the needle disposal box designed as saw tooth was not convenient for use and was later modified to various slits. The costs of the containers produced were 1.3% to 29.8% of available commercial products. CONCLUSION: Sputum trap, body fluid and feces containers and needle disposal boxes of reasonable prices were needed in Thailand. These containers could be produced locally and were much cheaper than available commercial ones.

Containment of Biohazards↗

[Contribution of medical technologists in team medical care of diabetics].

For the effective treatment of diabetic mellitus (DM), patients are encouraged to self-manage their disease according to the doctor's instructions and advice from certified diabetes educators (CDE) and other comedical staff. Therefore, the cooperation of medical staff consisting of a doctor, CDE, nurse, pharmacist, dietitian, and medical technologist is important for DM education. Medical technologists licensed for CDE (MT-CDE) have been participating in the DM education team in Kobe University Hospital since 2000. MT-CDE are in charge of classes for medical tests, guidance for self-monitoring of blood glucose and teaching how to read the fluctuation graph of the blood glucose level in the education program for hospitalized DM patients. MT-CDEs teach at the bedside how to read the results of medical tests during the first few days of hospitalization using pamphlets for medical tests. The pamphlets are made comprehensible for patients by using graphics and photographs as much as possible. It is important to create a friendly atmosphere and answer frank questions from patients, since they often feel stress when having medical tests at the early stage of hospitalization. This process of questions and answers promotes their understanding of medical tests, and seems to reduce their anxiety about having tests. We repeatedly evaluate their level of understanding during hospitalization. By showing them the fluctuation graph of the glucose level, patients can easily understand the status of their DM. When prescriptions are written on the graph, their therapeutic effects are more comprehensible for the patients. The items written on the graph are chosen to meet the level of understanding of each patient to promote their motivation. In summary, the introduction of MT-CDE has been successful in the education program for DM patients in our hospital. We plan to utilize the skills and knowledge of MT-CDE more in our program so that our DM education program will help patients cope with life with DM.

Blood Glucose Self-Monitoring↗

[Role of medical technologists in the infection control team].

The infection control team (ICT) plays important roles in many different aspects of infection control. They include (1) surveillance for hospital-acquired infection, (2) developing the infection control manual, (3) checking that the manual is followed correctly, (4) giving information about the isolation of microorganisms in the hospital, (5) educating and instructing medical staff, etc. Many data have been accumulated on a database in the microbiology laboratory. Bacterial samples are also examined in the microbiological laboratory therefore medical technologists will be the first to notice hospital-acquired infection. Offering prompt information, obtained by surveillance or routine work, greatly contributes to infection control. Furthermore, a 24hr system for the microbiological laboratory may prevent occupational infection of health care workers. The role of the medical technologist in ICT is thus important. To prevent outbreaks of infection, the regional network is also important for the collection of information about the pathogen and the susceptibility of antimicrobial agents in the region. The medical technologist should participate in and communicate with this network. As mentioned above, the inclusion of medical technologists in infection control practice is essential. To participate in the ICT, medical technologists need to have communication skills, and be recognized by other team members as an essential member.

Bacteria↗

[Role of a medical technologist in a nutrition support team].

The nutrition support team (NST) in our hospital not only develops clinical nutritional methods in inpatients but also performs the entire nutritional management including nutritional prescription in consultation with the physician in charge. In NST activity, clinical technologists have opportunities to report information on laboratory examination values obtained in daily work and make proposals. These opportunities are useful not only for enhancing the awareness of technologists who have focused on specific duties but also for training medical technologists. We hope that medical technologists participate in NST activity as full medical staff members in many institutions.

Humans↗

Ubiquitous computing in shared-care environments.

In light of future challenges, such as growing numbers of elderly, increase in chronic diseases, insufficient health care budgets and problems with staff recruitment for the health-care sector, information and communication technology (ICT) becomes a possible means to meet these challenges. Organizational changes such as the decentralization of the health-care system lead to a shift from in-hospital to both advanced and basic home health care. Advanced medical technologies provide solutions for distant home care in form of specialist consultations and home monitoring. Furthermore, the shift towards home health care will increase mobile work and the establishment of shared care teams which require ICT-based solutions that support ubiquitous information access and cooperative work. Clinical documentation and decision support systems are the main ICT-based solutions of interest in the context of ubiquitous computing for shared care environments. This paper therefore describes the prerequisites for clinical documentation and decision support at the point of care, the impact of mobility on the documentation process, and how the introduction of ICT-based solutions will influence organizations and people. Furthermore, the role of dentistry in shared-care environments is discussed and illustrated in the form of a future scenario.

Computer Systems↗

Protocol for the evaluation of automated blood coagulation instruments (coagulometers) for determination of the international normalised ratio.

Results of prothrombin time tests for the control of oral anticoagulant therapy, when using automated blood coagulation instruments (coagulometers), may not be the same as those obtained when using manual methods, and variation in coagulometer performance may affect clinical interpretation of data. The haematology advisory committee of the Institute of Medical Laboratory Sciences has recommended that coagulometers should be used for determination of prothrombin times only if it can be demonstrated that the results are valid when compared with those of a standardised manual method. A protocol for the evaluation of coagulometers, and details of the procedures, are given in this report, the main emphasis of which is on the assessment of instruments for determination of the International Normalised Ratio. Guidelines are also provided for the general use of machines of this type and for the assessment of safety. The principles of the protocol are applicable to other automated tests of blood coagulation.

Autoanalysis↗

Hospital management strategies for fixed-price payment.

The Medicare prospective payment system and pressures from business to change hospital financing demand new management strategies. This article explores specific steps hospital administrators can take to enable their institutions to cope effectively under prospective payment and new market conditions.

Diagnosis-Related Groups↗

The power to reduce the cost of technology.

Technology has been made the scapegoat for the increasing cost of health care. Government action in the form of congressional legislation, administrative regulations, funded research, health care payments, etc., has been an important contributing factor in this increasing cost. Microcomputer/microprocessor-based systems such as MUMPS, PROMIS, COSTAR, GeMSAEC, and ASPECT have underutilized potential for producing economies of scale. Quantitative comparative cost data should be developed by every government-sponsored study or project to forcefully prove that more technology results in lowered costs.

Clinical Laboratory Techniques↗

Allied health applicant pools and employment opportunities--1987.

This study sought information relative to student capacity and enrollment, quality of applicants, numbers in the applicant pool, and program directors' estimates of the job market and salaries, as well as overall impressions of their respective professions in six allied health disciplines: medical technology, physical therapy, radiologic technology, occupational therapy, dietetics/nutrition, and medical record administration. Of 105 four-year colleges and universities surveyed, 252 programmatic responses were received from 83 institutions (79% response rate). Generally, the status of these six allied health professions appeared very good, with a 2 to 1 overall ratio of applicants to graduates, and an almost 6 to 1 ratio in physical therapy. The average GPA for incoming allied health students was 3.01. Job opportunities were considered plentiful, and 93% of program directors rated the overall outlook for their respective professions as good to excellent. However, there were four areas that program officials may wish to examine more closely: excessive length of some professional programs, numbers of minorities in the institutions surveyed, entry-level salaries for several professions, and a somewhat less positive atmosphere in medical technology as compared to the other five disciplines.

Allied Health Personnel↗

A Minority Health Careers Exposure Program.

The University of Tennessee-Memphis (UT-M) Health Careers Exposure Program was initiated in response to the complaint of minority college students that basic medical science laboratories and clinical centers at private and state-supported health-science organizations in Tennessee were inaccessible to them as career-motivating, summer work experiences. The preceptor-apprentice relationship was the means utilized to expose and stimulate minority college students to enter health careers in this study. The formal activity was usually conducted for eight to ten weeks of summer vacation in the basic science and clinical facilities on the UT-M campus.A survey of the current career activities of former apprentices suggests that direct exposure of academically talented, minority college students to health careers is a factor that increases the number entering the health professions.

Black or African American↗