The study aimed to assess HIV stigma among healthcare workers in Sri Lanka. It found moderate levels of stigma, with scores ranging from 23-38% on a stigma index. Fear of HIV transmission contributed to stigma. Healthcare workers lacked comprehensive knowledge about HIV transmission and post-exposure protocols. The study recommends broad anti-stigma programs targeting healthcare workers and the general public, along with education on HIV facts and occupational safety protocols to reduce fear and discrimination.
1) The document discusses changing the safety culture of a hospital by focusing efforts on enhancing staff awareness of patient and staff safety and quality from 2008 to 2011.
2) Key elements in changing culture included setting direction by establishing a vision and values, implementing policies and infrastructure like a patient safety program, and engaging staff through workshops and leadership.
3) Data shows improvements in reported safety incidents from 2007 to 2011 and increases in teamwork and safety climate survey scores, indicating progress in changing the hospital's safety culture over time.
Micromeritics is the science involving the study of small particles in the few micron size range. Particle characteristics like size, shape, volume, and surface area can be determined. Techniques like optical microscopy, sieving, sedimentation, and conductivity methods are used to determine particle size and distributions. Derived properties of powders like bulk density, tapped density, angle of repose, and Carr's index provide information about powder flow and compressibility. Understanding micromeritics is important for applications like drug release, absorption, stability, and uniformity of drug products.
This document discusses characteristics of metacognition and effective teaching strategies. It also evaluates the strengths and weaknesses of a school library. Regarding metacognition, it notes the importance of thinking about one's own cognitive processes, self-regulation, reflection on strengths, weaknesses and learning strategies. Effective teachers are described as patient, flexible, concerned with student input and output, and attentive to student interests and needs. Regarding the library, strengths include availability of books, motivational materials, and a conducive environment, while weaknesses are the lack of systematic arrangement, distance from classrooms, small size, and lack of management.
Досвід Ресурсного центру для громадянського суспільства ГУРТ: забезпечення доступу до публічної інформації, розвиток спроможності і мережевої співпраці
Мар’яна Завійська, керівник напрямку «Суспільна експертиза» Ресурсного центру ГУРТ
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
1) The document discusses changing the safety culture of a hospital by focusing efforts on enhancing staff awareness of patient and staff safety and quality from 2008 to 2011.
2) Key elements in changing culture included setting direction by establishing a vision and values, implementing policies and infrastructure like a patient safety program, and engaging staff through workshops and leadership.
3) Data shows improvements in reported safety incidents from 2007 to 2011 and increases in teamwork and safety climate survey scores, indicating progress in changing the hospital's safety culture over time.
Micromeritics is the science involving the study of small particles in the few micron size range. Particle characteristics like size, shape, volume, and surface area can be determined. Techniques like optical microscopy, sieving, sedimentation, and conductivity methods are used to determine particle size and distributions. Derived properties of powders like bulk density, tapped density, angle of repose, and Carr's index provide information about powder flow and compressibility. Understanding micromeritics is important for applications like drug release, absorption, stability, and uniformity of drug products.
This document discusses characteristics of metacognition and effective teaching strategies. It also evaluates the strengths and weaknesses of a school library. Regarding metacognition, it notes the importance of thinking about one's own cognitive processes, self-regulation, reflection on strengths, weaknesses and learning strategies. Effective teachers are described as patient, flexible, concerned with student input and output, and attentive to student interests and needs. Regarding the library, strengths include availability of books, motivational materials, and a conducive environment, while weaknesses are the lack of systematic arrangement, distance from classrooms, small size, and lack of management.
Досвід Ресурсного центру для громадянського суспільства ГУРТ: забезпечення доступу до публічної інформації, розвиток спроможності і мережевої співпраці
Мар’яна Завійська, керівник напрямку «Суспільна експертиза» Ресурсного центру ГУРТ
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive function. Exercise causes chemical changes in the brain that may help protect against mental illness and improve symptoms.
Surimi based product Osakisuisan Fish CakeKeisuke Osaki
Osaki Suisan Co., Ltd is a seafood company founded in 1928 in Japan that specializes in surimi-based fish cakes. The company's former chairperson, Katsuichi Osaki, invented an imitation crab meat stick in 1974. Osaki Suisan uses a unique manufacturing method and original coloring technique to produce fish cakes that are springy, flexible, with no fishy smell. Their products have received awards and they sometimes provide samples to media for reviews. The fish cakes can be used in various dishes like tempura, sushi, soups, and more.
100 Ý Tưởng Bán Hàng Hay Nhất Mọi Thời Đại Ebook - Ken LangdonDuyệt Đoàn
100 Ý Tưởng Bán Hàng Hay Nhất Mọi Thời Đại
Rất nhiểu tình huống có thể xảy ra trong mối quan hệ giữa người bán hàng và khách hàng. Người bán hàng giỏi là người biết giải quyết các mối quan hệ đó một cách suôn sẻ nhất, khiến khách hàng haì lòng mà vẫn đem lại lợi nhuận cho mình cũng như công ty mình.
Rất nhiều cuốn sách đã nói đến mối quan hệ "thắng - thắng" trong kinh doanh cũng như ký kết hợp đồng, có nghĩa là ai cũng hài lòng, cảm thấy mình thắng lợi khi mua - bán một móm hàng và điều này còn rõ nét hơn trong cuốn sách 100 ý Tưởng Bán Hàng Hay Nhất Mọi Thời Đại - Tác giả Ken Langdon, một nhà quản lý thành công, một chuyên gia tư vấn đào tạo bán hàng và cũng là tác giả của rất nhiều cuốn sách về quản lý, marketing, kế toán rất nổi tiếng
This document discusses the relationship between the built environment and public health. It provides statistics showing that driving is associated with negative health outcomes, while walking and biking are beneficial. Rates of obesity, diabetes, and other chronic diseases have increased as communities have been designed primarily for automobiles. Redesigning cities and neighborhoods to encourage physical activity, such as by building light rail systems and removing freeways, can significantly improve health. The built environment is now recognized as a major determinant of public health.
El documento presenta un diagrama de tres sectores de la economía - primario, secundario y terciario - y los subsectores que componen cada uno. El sector primario incluye la agricultura, ganadería y pesca. El sector secundario se compone de la industria y construcción. El sector terciario está formado por el turismo.
This document provides a collection of clinical case studies for self-learning in clinical medicine. It includes 13 case studies with relevant patient histories, examination findings, test results and radiological images. Learners are asked to examine the information and materials provided to make diagnoses and identify any abnormalities. The goal is to enhance clinical reasoning skills through active engagement with real medical cases.
A claim for quantum meruit seeks payment for work where the price was not agreed upon. It can be based in contract or restitution. For a contract-based claim, terms of payment will be implied if the contract is silent on price or expressly agrees to reasonable payment. A restitution claim seeks payment to prevent unjust enrichment. A quantum meruit claim will not succeed if a contract governs the situation. A letter of intent or agreement without a price may not create a binding contract if essential terms are missing or the intent to contract is unclear. Carrying out work alone does not create a contract.
We share here a peek into the enormity of work we contribute to the various parameters of design-which initiate humbled pride in us. We look forward to your generous feedback. 'Feedbacks' provide us with platforms to express interactive energies -yours & ours. We are an alive legacy of design & some of our immortal stories are told here.
The document discusses distance education and defines key terms. It notes that distance education is formal instruction that does not require in-person interaction due to constraints of time and location, while distance learning does not necessitate synchronous interaction. The history section briefly outlines an early technology, the Hansen Writing Ball, and a modern technology, virtual classrooms that use video conferencing software like Adobe Connect.
This document discusses developing a balanced leadership style through understanding one's "grit and grace" model of influence. It explains that over-relying on either a gritty, assertive style or a gracious, supportive style can lead to problems. Leaders need to pay attention to developing balance so they can influence effectively in different situations. The document provides tips on gaining self-awareness of one's natural style preferences and learning to draw from both grit and grace approaches.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help boost feelings of calmness, happiness and focus.
Immersive research uses online qualitative methods to capture consumer behaviors and experiences in context. It incorporates activities to explore experiences rather than just asking questions. Mobile devices can be used to have participants capture experiences in the moment. When using mobile, keep activities short, use a record then reflect method, and set clear expectations. For a successful project, planning is key, get involved with participants, and engage clients throughout.
This document discusses trees and their parts, leaves, and fruit. It mentions different types of trees found alone or in forests. It also shows people interacting with trees by sleeping under them, taking shelter in their shade, or picking fruit from them.
This presentation discusses healthcare worker safety issues. It covers topics like blood and body fluid exposure, personal protective equipment, immunizations, safe equipment use, isolation precautions, sharp injuries, and post-exposure prophylaxis. Data showed that nurses comprised the largest percentage of workers injured. The presentation calls for greater accountability, education, surveillance, and use of safety devices to protect healthcare workers.
Nurse Maude provides community nursing services in Christchurch, New Zealand. They operate a specialist wound care service from two clinics. In 2009, they began using an electronic health record (EHR) system integrated with a wound measurement tool. An audit found that while the EHR captured data on 562 patients, some data was missing due to technical and organizational issues. Recommendations included improving training, equipment, and standardizing the data collected in the EHR.
Surimi based product Osakisuisan Fish CakeKeisuke Osaki
Osaki Suisan Co., Ltd is a seafood company founded in 1928 in Japan that specializes in surimi-based fish cakes. The company's former chairperson, Katsuichi Osaki, invented an imitation crab meat stick in 1974. Osaki Suisan uses a unique manufacturing method and original coloring technique to produce fish cakes that are springy, flexible, with no fishy smell. Their products have received awards and they sometimes provide samples to media for reviews. The fish cakes can be used in various dishes like tempura, sushi, soups, and more.
100 Ý Tưởng Bán Hàng Hay Nhất Mọi Thời Đại Ebook - Ken LangdonDuyệt Đoàn
100 Ý Tưởng Bán Hàng Hay Nhất Mọi Thời Đại
Rất nhiểu tình huống có thể xảy ra trong mối quan hệ giữa người bán hàng và khách hàng. Người bán hàng giỏi là người biết giải quyết các mối quan hệ đó một cách suôn sẻ nhất, khiến khách hàng haì lòng mà vẫn đem lại lợi nhuận cho mình cũng như công ty mình.
Rất nhiều cuốn sách đã nói đến mối quan hệ "thắng - thắng" trong kinh doanh cũng như ký kết hợp đồng, có nghĩa là ai cũng hài lòng, cảm thấy mình thắng lợi khi mua - bán một móm hàng và điều này còn rõ nét hơn trong cuốn sách 100 ý Tưởng Bán Hàng Hay Nhất Mọi Thời Đại - Tác giả Ken Langdon, một nhà quản lý thành công, một chuyên gia tư vấn đào tạo bán hàng và cũng là tác giả của rất nhiều cuốn sách về quản lý, marketing, kế toán rất nổi tiếng
This document discusses the relationship between the built environment and public health. It provides statistics showing that driving is associated with negative health outcomes, while walking and biking are beneficial. Rates of obesity, diabetes, and other chronic diseases have increased as communities have been designed primarily for automobiles. Redesigning cities and neighborhoods to encourage physical activity, such as by building light rail systems and removing freeways, can significantly improve health. The built environment is now recognized as a major determinant of public health.
El documento presenta un diagrama de tres sectores de la economía - primario, secundario y terciario - y los subsectores que componen cada uno. El sector primario incluye la agricultura, ganadería y pesca. El sector secundario se compone de la industria y construcción. El sector terciario está formado por el turismo.
This document provides a collection of clinical case studies for self-learning in clinical medicine. It includes 13 case studies with relevant patient histories, examination findings, test results and radiological images. Learners are asked to examine the information and materials provided to make diagnoses and identify any abnormalities. The goal is to enhance clinical reasoning skills through active engagement with real medical cases.
A claim for quantum meruit seeks payment for work where the price was not agreed upon. It can be based in contract or restitution. For a contract-based claim, terms of payment will be implied if the contract is silent on price or expressly agrees to reasonable payment. A restitution claim seeks payment to prevent unjust enrichment. A quantum meruit claim will not succeed if a contract governs the situation. A letter of intent or agreement without a price may not create a binding contract if essential terms are missing or the intent to contract is unclear. Carrying out work alone does not create a contract.
We share here a peek into the enormity of work we contribute to the various parameters of design-which initiate humbled pride in us. We look forward to your generous feedback. 'Feedbacks' provide us with platforms to express interactive energies -yours & ours. We are an alive legacy of design & some of our immortal stories are told here.
The document discusses distance education and defines key terms. It notes that distance education is formal instruction that does not require in-person interaction due to constraints of time and location, while distance learning does not necessitate synchronous interaction. The history section briefly outlines an early technology, the Hansen Writing Ball, and a modern technology, virtual classrooms that use video conferencing software like Adobe Connect.
This document discusses developing a balanced leadership style through understanding one's "grit and grace" model of influence. It explains that over-relying on either a gritty, assertive style or a gracious, supportive style can lead to problems. Leaders need to pay attention to developing balance so they can influence effectively in different situations. The document provides tips on gaining self-awareness of one's natural style preferences and learning to draw from both grit and grace approaches.
The document discusses the benefits of exercise for mental health. Regular physical activity can help reduce anxiety and depression and improve mood and cognitive functioning. Exercise causes chemical changes in the brain that may help boost feelings of calmness, happiness and focus.
Immersive research uses online qualitative methods to capture consumer behaviors and experiences in context. It incorporates activities to explore experiences rather than just asking questions. Mobile devices can be used to have participants capture experiences in the moment. When using mobile, keep activities short, use a record then reflect method, and set clear expectations. For a successful project, planning is key, get involved with participants, and engage clients throughout.
This document discusses trees and their parts, leaves, and fruit. It mentions different types of trees found alone or in forests. It also shows people interacting with trees by sleeping under them, taking shelter in their shade, or picking fruit from them.
This presentation discusses healthcare worker safety issues. It covers topics like blood and body fluid exposure, personal protective equipment, immunizations, safe equipment use, isolation precautions, sharp injuries, and post-exposure prophylaxis. Data showed that nurses comprised the largest percentage of workers injured. The presentation calls for greater accountability, education, surveillance, and use of safety devices to protect healthcare workers.
Nurse Maude provides community nursing services in Christchurch, New Zealand. They operate a specialist wound care service from two clinics. In 2009, they began using an electronic health record (EHR) system integrated with a wound measurement tool. An audit found that while the EHR captured data on 562 patients, some data was missing due to technical and organizational issues. Recommendations included improving training, equipment, and standardizing the data collected in the EHR.
Chunhee Bok - Korea - Wednesday 30 - Oral Presentations Misc. Dincucai_isodp
The document contains several charts and graphs showing trends in acceptance of brain death and organ donation in Korea over time. The charts show acceptance has increased from the 1990s to 2010 according to several studies. Additional charts and graphs show regional differences in organ procurement coordinator staffing and the number of education visits to hospitals over time. Final charts examine attitudes toward organ donation among medical professionals, finding neurosurgeons have more positive views while ICU nurses have more negative or unsure views.
Francesca Torriani, M.D., of UC San Diego Owen Clinicm, presents "Update on International CFAR Grant on Tuberculosis and HIV Screening in Healthcare Workers at Maputo Central Hospital in Mozambique" at AIDS Clinical Rounds
This document summarizes data from 136 palliative care patients seen by the Palliative Care Quality Network between November 8-9, 2012. Key findings include:
- The average age of patients was 74 years old and over half were female. Most referrals came from medical/surgical units and were for symptom management, pain management, or advance care planning.
- Cancer was the most common primary diagnosis. Documentation of goals of care and code status varied between hospitals. Multidisciplinary teams including nurses, doctors, and social workers provided consultations.
- Pain, anxiety, and dyspnea were the most common initial symptoms. Symptoms improved for most patients within 24 hours of the palliative care consultation
1. The study assessed the knowledge, attitude, and practices of nurses regarding care of people living with HIV/AIDS before and after an education intervention at BPKIHS hospital in Nepal.
2. A training program was developed and provided to nurses based on their pre-test knowledge. It covered epidemiology, symptoms, transmission, treatment, nursing care, and services available.
3. Post-training, the nurses demonstrated significantly improved knowledge in areas like modes of transmission, symptoms, testing, treatment, and services available indicating the effectiveness of the training program in increasing nurses' capacity to care for PLWHA.
EVALUATION OF PSYCHOSOCIAL FACTORS INFLUENCING HEALTHCARE PROFESSIONAL ACCEPT...HTAi Bilbao 2012
EVALUATION OF PSYCHOSOCIAL FACTORS INFLUENCING HEALTHCARE PROFESSIONAL ACCEPTANCE OF TELEMONITORING FOR CHRONIC PATIENTS
Estibalitz Orruño1, Marie-Pierre Gagnon2-3, José Asua4, Eva Reviriego1
1 Basque Office for Health Technology Assessment (Osteba), Department of Health and Consumer Affairs, Basque Government, Vitoria-Gasteiz, Spain.
2 Faculty of Nursing Sciences, Université Laval, Québec, Canada.
3 Research Centre of the Centre Hospitalier Universitaire de Québec, Québec, Canada.
4 Direction of Knowledge Management and Evaluation, Department of Health and Consumer Affairs, Basque Government, Vitoria-Gasteiz, Spain.
The REAL Registry & The MATRIX Trial document summarizes findings from the REAL Registry, which analyzed data from over 11,000 STEMI patients undergoing primary percutaneous coronary intervention (pPCI) from 2003 to 2009 in Italy. Key findings include:
- Trans-radial access for pPCI was associated with lower rates of major bleeding or vascular complications compared to trans-femoral access.
- All-cause mortality was lower in patients undergoing trans-radial pPCI compared to trans-femoral after propensity score matching, with a 26% relative risk reduction.
- When excluding shock patients, trans-radial access was associated with a 30% lower all-cause mortality compared to trans-fem
1) The document analyzes tuberculosis treatment outcomes in Dharwad district, India from 2010-2011 based on records from the Revised National Tuberculosis Control Program (RNTCP).
2) It finds that while case detection has increased, sputum conversion and cure rates remain below targets, ranging from 85-88% versus the goal of over 90%.
3) Cure rates varied between tuberculosis units within the district, with Kalghatgi achieving the highest and Kundgol the lowest.
4) Overall the district's cure rate was lower than the state and national averages, indicating room for improvement in tuberculosis management and control.
Perception On OSH anagement Among Hospital Staff & Nurses In SSHD by Dr Nelbo...Moon Girl
1) The study examined nurses' perceptions of occupational safety and health management in Sabah state hospitals.
2) Training and competence received the highest rating, while safety incidents received the lowest.
3) Overall perceptions of safety satisfaction and feedback were above average, indicating nurses were relatively satisfied with OSH management. High training scores reflected emphasis on safety training.
This document discusses a case of tuberculosis (TB) transmission among healthcare workers in Thailand. It presents the case of a nurse with active TB who had been in contact with her roommate and other OR nurses. The document examines whether this was a result of human error or system error. It explores options for post-exposure management, including contact tracing and preventive treatment. It also discusses developing TB infection control interventions in resource-limited settings through measures like administrative controls, environmental controls, and respiratory protection.
A survey was conducted of 76 technology users at Huntington Hospital. The majority were nurses (42.1%) or classified as "other" (30.3%). The most commonly used devices were desktop computers (52.6%) and laptops (40.8%). 42.1% said they would consider purchasing a new device in the next 3 months, with smartphones/tablets being the most popular choice (53.3%). While 57.9% did not use mobile devices for hospital resources, the most accessed were Meditech (45.5%) and SharePoint (33.3%) via mobile. A majority (64.5%) were interested in a technology user group, with the best days being Tues
IPOS10 - T178 Implementation of a Screening Programme for Cancer Related Dist...Alex J Mitchell
Implementation of a Screening Programme for Cancer Related Distress: Part II - Does Screening Aid Clinicians' Communication, Judgement or Accuracy of Anxiety and Depression
This document discusses the management of diffuse gliomas and outlines the workflow for stereotactic radiosurgery (SRS) and stereotactic body radiation therapy (SBRT). It covers topics such as target delineation, motion management, dose prescription, plan evaluation, quality assurance, and the importance of education. Strict immobilization and minimizing errors are emphasized for SRS and SBRT. Various motion management systems and techniques for different tumor sites are presented. Metrics for evaluating plan quality like coverage, conformity, homogeneity and dose to organs-at-risk are defined. The document stresses the need to balance optimal target coverage while restricting dose to nearby organs.
Study I examined associations between promoter methylation of 10 tumor suppressor genes (e.g. RASSF1A, GSTP1) in breast tumor tissue and prognosis in a population-based cohort of breast cancer patients followed for 8 years. Methylation of certain genes like GSTP1 and TWIST1 were associated with increased breast cancer mortality. Patients with more methylated genes had higher mortality, with a 41% increased risk of breast cancer death for each additional methylated gene. Overall, DNA methylation shows potential as a prognostic biomarker for breast cancer outcomes.
This document analyzes dosimetric parameters associated with acute toxicity in breast irradiation using 3D conformal radiation therapy (3DCRT). It found that a breast planning target volume (PTV) exceeding 1150 ml was associated with a 7.7 times higher risk of grade 2 or 3 acute toxicity, regardless of other dosimetric factors. 107 breast cancer patients treated with 3DCRT were analyzed, and mean PTV volume was 777 ml. Larger PTV volume was the only factor correlated with increased acute toxicity in multivariate analysis.
1) FNAC is a simple, safe, and minimally invasive outpatient procedure that provides a reliable diagnosis of thyroid nodules and goiters, avoiding unnecessary diagnostic surgery.
2) A study of 221 patients found that FNAC accurately diagnosed 92.3% of cases as benign and 2.3% as malignant. Histological examination of tissue from the 76 patients who underwent surgery confirmed the FNAC diagnoses in 94.7% of cases.
3) FNAC is a reliable first-line investigation for patients presenting with thyroid abnormalities that can help clinicians make an early and accurate diagnosis to guide appropriate treatment.
Lecture: Final current needs on portfolio development Dr Ajith Karawita
The document discusses the purpose and contents of a professional portfolio. A professional portfolio is an organized collection of work samples, accomplishments, skills, experiences, and qualifications that demonstrates an individual's talents and abilities. It can be used to assess professional development, support career transitions, and showcase qualifications for potential employers or educational opportunities. When preparing a portfolio, individuals should consider including sections that highlight their personal information, values, goals, accomplishments, skills, education, references, and work samples along with reflective statements. The portfolio allows individuals to curate the best representation of themselves and their qualifications for different opportunities and audiences.
HIV stigma and discrimination reduction tool "welcome2care"Dr Ajith Karawita
Welcome2care is an HIV stigma reduction intervention for healthcare workers. It is a two day workshop with lecture discussions and activities. Activities are based on the concept of peer pressure on changing attitudes.
Measuring HIV stigma and discrimination in healthcare settingsDr Ajith Karawita
The study aimed to quantify the level of stigma among healthcare workers against people living with HIV in Sri Lanka. A survey of 832 healthcare workers from six major hospitals found stigma index scores ranging from 36-40, indicating significant levels of HIV-related stigma. Doctors and nurses had a median score of 39, while other medical staff such as technicians and attendants had slightly lower scores ranging from 36-38. These findings demonstrate that discriminatory attitudes towards people living with HIV are prevalent among healthcare workers in Sri Lanka, creating barriers to accessing HIV prevention, treatment, and support services.
Sri lankan experience on reduction of hiv stigma and discrimination among hea...Dr Ajith Karawita
The presentation did in the 11th ICAAP in the Satellite session 08 (Hall G) on Getting to Zero Discrimination in Healthcare Setting in Asia organized by International Labour Organization (ILO)
11th ICAAP was held in the Queen Sirikith Convention Centre, Bangkok, Thailand from 18-22 November 2013.
The document discusses indexing of biomedical literature. It begins with background information on what constitutes an article and the concept of publishing. It then defines what a citation is, including citation contents, styles, and identifiers. It also discusses referencing methods and plagiarism. The document then describes cataloging and indexing, including major indexing services like PubMed and Index Medicus provided by the National Library of Medicine.
This document discusses concepts related to disease screening and HIV testing models. It provides an overview of screening criteria and benefits and potential adverse effects. Voluntary counseling and testing (VCT) is described as an active case finding strategy and entry point to HIV care. Key aspects of VCT include pre-test counseling to assess risk and provide information, post-test counseling that depends on results, and the overall goal of helping clients gain knowledge and adopt protective behaviors. Special populations for VCT and various service delivery settings are also reviewed.
Cardiac failure, cyanotic heart disease
D. Liver disease – cirrhosis of liver
E. Inflammatory bowel disease
F. Miscellaneous – cystic fibrosis, rheumatoid arthritis,
thyroid disorders, chronic renal failure
Grading of finger clubbing
1. Early clubbing – angle between nailbed and finger < 180 degrees
2. Moderate clubbing – angle between 180-200 degrees
3. Marked clubbing – angle > 200 degrees
Clubbing is usually bilateral and symmetric. It is graded by measuring the angle between nailbed and finger using a protractor.
This document provides clinical materials for self-learning in clinical medicine. It contains 14 case studies with imaging and test results. Each case asks the reader to identify findings, make diagnoses, and suggest management. The materials were prepared by Dr. Ajith Karawita for discussion and are available to further learning in clinical medicine. Feedback can be provided by email.
This document provides clinical materials for self-learning in clinical medicine. It was prepared by Dr. Ajith Karawita and contains acknowledgements, instructions for use, and 12 case studies with associated radiological images and reports. The case studies cover a range of topics in clinical medicine and are intended to allow the reader to examine each case, analyze the findings, and suggest a diagnosis and treatment plan.
This document provides clinical materials for self-learning in clinical medicine. It includes 12 clinical cases with descriptions, examination findings, imaging results, and summaries. The objective is to examine each case carefully and analyze the findings to aid in learning. Suggestions and feedback can be provided to the author via email. The author acknowledges and thanks the patients, teachers, and colleagues who contributed to developing this resource.
This document provides clinical materials for self-learning in clinical medicine. It contains 19 case studies presented as images and descriptions. Each case asks the reader to examine the images, describe any abnormalities, and provide interpretations or suggestions for management. The cases cover a wide range of organ systems and medical conditions commonly seen in clinical practice.
This Lecture was delivered in the First Sri Lanka National Consultation Meeting on MSM, HIV and Sexual Health, 18th – 21st November 2009
Organised and conducted by Companions on a Journey and Naz Foundation International.
Presentation at Sri Lanka college of venereologists 2011Dr Ajith Karawita
This document summarizes a study that mapped and estimated the sizes of female sex worker (FSW) and men who have sex with men (MSM) populations in Anuradhapura District, Sri Lanka. The study used a geographic mapping methodology involving key informant interviews (Level 1) to identify hot spots, which were then validated (Level 2). Final estimates were 1,138 FSWs and 729 MSM in the district. The study aimed to provide data to help plan HIV prevention programs for these most-at-risk populations.
Presentation done at the Programme Science Symposium in International Union Against Sexually Transmitted Infection (IUSTI), 12th IUSTI World Congress, New Delhi
The National STD/AIDS Control Programme is Sri Lanka's leading agency for sexual health promotion and the prevention, control, and treatment of STIs including HIV/AIDS. It operates 29 full-time STD clinics and 21 branch clinics across the country. The Programme's strategic focus areas include prevention through interventions targeting most-at-risk populations, care and treatment through 28 ART centers, and strategic information management. It works in collaboration with various government agencies, private partners, and civil society organizations to achieve its mission of quality sexual health services for a healthier nation.
Mapping of MARPs and strategic planning was conducted in Sri Lanka to estimate the size and distribution of key populations at high risk of HIV. The mapping identified over 1,900 female sex worker spots and 900 MSM spots across four districts. National estimates of 41,285 female sex workers and 32,796 MSM were then extrapolated. The data generated hotspot maps and will inform targeted HIV prevention by facilitating intervention planning, resource allocation, and monitoring and evaluation of coverage and impact.
Lecture at EPISEA 2010 conference gaps in stragegic information on MARPs 24…Dr Ajith Karawita
This document discusses gaps in strategic information on most-at-risk populations (MARPs) in Sri Lanka. There is a lack of population size estimates and mapping of MARPs at the district level. Data on MARPs is also inadequate for HIV surveillance and estimates. It is difficult to obtain probability samples for surveillance and studies of MARPs due to their mobile nature. There is also insufficient expertise for MARP studies given Sri Lanka's low-level HIV epidemic status.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
2. General Objective
• To ascertain the HIV knowledge, attitudes and
level of stigma & discrimination towards
people living with HIV among healthcare
workers, in selected healthcare settings in
Colombo.
3. Specific Objective
1. To assess the level of stigma among healthcare
providers towards PLHIV
2. To describe the knowledge and general attitudes
towards PLHIV
3. To describe the knowledge and practices related to
standard precaution
4. Study Setting
National Hospital of Sri Lanka De Soysa Maternity Hospital Lady Ridgeway Hospital for Children
Castle Street Hospital for Women National STD/AIDS Control Programme Hospital, Angoda
Base
6. Sampling technique and sample size
Institutions:
1. NHSL, 2. DMH, 3. CSHW, 4. LRH, 5. • Quota sampling was done
CSTDC, 6. BH(Angoda) considering the relative
Category of staff:
1. DOCs, 2. NOs, 3. MLTs, 4. ATs, 5. LAs
proportions of healthcare
workers.
Estimated Population: 5898
Category Sample size
Doctors 130
Nursing officers 205
MLTs 92
Attendants 154
Labourers 251
Total 832
Sample: 832 (14.1%)
7. Ethical considerations
• Informed consent
• Voluntary
participation/Autonomy
• Confidentiality
• Data security
• Ethical clearance was taken
from the ethics committee of
the faculty of Medicine,
University of Peradeniya
9. Age distribution
Mean age of the sample was 41 years (SD, 10.6 years)
Range 38-41.7 years
Category of staff Mean age N SD
Doctors 41.73 130 9.737
Nursing staff 39.93 205 10.559
MLTs 38.51 91 9.744
Attendants 48.35 147 6.150
Labourers 38.06 246 11.454
Total 41.01 819 10.612
10. Distribution of the sample by category of staff
Over half of the sample is represented by the Nursing staff
(24.6%) and hospital labourers (30.2%)
Category of staff Frequency Percent Cumulative Percent
Doctors 130 15.6 15.6
Nursing staff 205 24.6 40.3
MLTs 92 11.1 51.3
Attendants 154 18.5 69.8
Labourers 251 30.2 100.0
Total 832 100.0
11. Experience as a healthcare worker
Average years of experience was 15 years
Category of staff Mean years Standard Deviation (Months)
Doctors 13.10 9.7069
Nursing staff 15.70 10.9271
MLTs 13.13 10.0739
Attendants 22.67 6.1455
Labourers 11.06 9.0230
Total 14.90 10.1572
12. Provision of care to an HIV patient
Have you ever provided care to an HIV patient
100
90 85.9
80 Yes No Don't know
70 66.7 67.8
60.9
60
Percent
49.8
50 43.3
40
30.5
30
18.6 18.5
20 14.7 13.7 10.9 8.6
10 6.9
3.3
0
Doctors Nursers MLTs (N=92) Attendants Labourers
(N=129) (N=205) (N=151) (N=245)
13. Cause of Stigma & Discrimination
Fear of HIV transmission by type of contact
with people living with HIV/AIDS
14. Fear of HIV transmission by type of contact
Labourers Attendants MLTs Nurses Doctors
Giving
inj/drip 34.1
53.5
72.7
Dressing 62.3
wounds 41
60.8
32.7
Touching 28.5
40
saliva 23.4
35.4
12
Touching 11.7
14.3
sweat 4.9
6.2
0 10 20 30 40 50 60 70 80
Percent
15. Fear of HIV transmission by type of contact
Giving injec/drip Dressing wounds Touching saliva Touching sweat
Labourers 72.7
32.7
12
Attendants 62.3
28.5
11.7
MLTs 40
14.3
34.1
Nurses 41
23.4
4.9
53.5
Doctors 60.8
35.4
6.2
0 20 40 60 80
Percent
16. Cause of Stigma & Discrimination
Morality related attitudes towards
PLHIV
17. Morality Related Attitudes towards PLHIV
Labourers Attendants MLTs Nurses Doctors
I feel ashamed if someone in my family 69.7
72.7
44
infected 35.1
44.2
74.5
79.2
I feel ashamed if I was infected 50.5
47.3
55.4
30.8
45.8
It is the FSWs who spread the disease 33
23.4
40
Promiscuous men are the once that 62.4
70.8
58.9
spread the disease 52.2
55
51
61.2
Ashamed of themselves 13.2
5.4
6.2
66.9
69.9
Punishment for bad behaviours 35.2
26.3
16.2
11.6
13
Karume/punishment from God 11
2
6.2
0 20 40 60 80 100
Percent
19. In the past 12 months have you seen the following happen in your health facility
because a client was known to have or was suspected of having HIV/AIDS
Labourers Attendants MLTs Nurses Doctors
HCWs gossiping about the patient's HIV 10.1
6.5
46.2
status 27.3
41.5
Testing the patient without patient's 31.1
36.8
18.9
consent 29.8
22.3
22.8
Pass on the patient to to others 22.9
15.4
10.2
18.5
Use of latex gloves unnecessarily for 27.1
32
29.7
performing external examinations 30.7
30
Requiring some patients to be tested for 63.7
64.7
63.7
HIV before scheduling surgeries 66.3
56.2
Extra precausions being takenin the 73.6
82.2
67
sterilization of instruments used for HIV… 74.6
57.7
Receiving less care/attention than other 12.4
11.7
11
patients 12.2
13.1
0 20 40 60 80 100
Percent
21. 21-Item Stigma index
• Twenty-one item stigma Index used in this study to measure the level of
HIV stigma among healthcare workers.
• Scoring was done on a three-point Likert scale (agree, can’t say, disagree)
ranging from 1 to 3 with the score of 21 as minimum and 63 as the
maximum score
• The scoring was done according to the responses on the statements in the
21-item stigma scale.
Stigmatizing Non Stigmatizing
statement statement
Agree 3 1
Disagree 1 3
Cant say 2 2
• Higher score on the index denotes a higher level of stigma
22. HIV Stigma Index among Healthcare workers
Stigma Index by category of staff
Stigma Scale (22-63)
Laboures, 36.9
Attendants, 37.3
MLTs, 37.1
Nursing Officers, 31.6
Doctors, 33.4
21 24 27 30 33 36 39 42 45 48 51 54 57 60 63
Stigma Scale (21-63)
24. Knowledge on HIV transmission
Labourers Attendants MLTs Nurses Doctors
4.8
Can a person get HIV by sharing a meal with 2.6
0
someone who infected 2
4.6
16
Can a person get HIV infection from 7.8
3.3
mosquito bites 3.4
3.8
73.3
Can a healthy looking person have HIV 78.6
91.2
infection 93.7
98.5
88
Can the risk of HIV be reduced by using 92.9
92.3
condoms 92.6
94.6
92
Can the risk of HIV be reduced by having sex 93.5
97.8
with only one faithful, uninfected partner 94.1
94.6
0 20 40 60 80 100
Percent
28. Knowledge on post-exposure management of
needle prick injuries
Labourers Attendants MLTs Nurses Doctors
Report to infection 79.3
81.2
82.4
control staff 92.2
80
58.2
59.7
Report to head 67
79
52.3
13.5
11
Dress the wound 9.9
23.9
13.1
35.1
44.8
Squeeze/Bleed wounds 63.7
62.9
32
Clean wound with 49
40.9
61.5
sntiseptics 56.1
59.2
Wash with soap and 49.4
57.1
69.2
water 89.3
70.8
0 20 40 60 80 100
Percent
29. Under what circumstances should a healthcare
worker seek PEP
Labourers Attendants MLTs Nurses Doctors
21.1
HIV positive blood contact 26.6
33
with intact skin 22.9
22.5
48.6
Any blood contact with 51.9
52.7
non-intact skin 61.5
51.9
47.4
Any blood contact with 52.6
57.1
mucous membranes 55.1
56.6
71.6
Needle stic injury from an 77.3
90.1
HIV patient 89.8
90.7
45
47.4
Any needle stick injury 46.2
48.8
33.3
0 20 40 60 80 100
Percent
30. What should be done to prevent HIV
transmission to Healthcare workers
31. In your opinion, what should be done to prevent HIV
transmission to HCWs in hospital setting
Labourers Attendants MLTs Nurses Doctors
HIV patients should have a separate 27.5
23.4
22 26.2 40.7
healthcare institution
Assume that every pt has HIV and always 63.3
63.6 90.196.1
take precausions 77.7
2.4
1.9
Do not accept HIV pt's to hospitals 1 4.4
4.6
15.9
18.8
Supply enough PEP 45.4 53.8 64.6
Inform all hospital workers about HIV pt's 34.440.2
31.9
21.527.8
30.7 40.3
Have enough clean running water to wash 54.9 62.4
55.4
Wear special protections when touching HIV 57
65.9 74
pt's 64.6 71.2
20.7
24
Test every patient for HIV 18 24.2
7.7
35.1 42.9
Supply enough gloves 66.3 73.178
0 20 40 60 80 100
Percent
32. Conclusions and Recommendations (1 of 5)
• Results showed that about 23%-38% stigma level
among healthcare workers
• Prevailing level of HIV stigma and discrimination
among HCWs is a reflection of the situation in the
society. Therefore, fighting against HIV stigma
and discrimination should not be confined to
healthcare settings. It should be a broad
approach which should include PLHIV, healthcare
workers and general population as whole.
33. Conclusions and Recommendations (2 of 5)
• Fear of HIV transmission is one of the reasons for
stigmatizing patients with HIV. It has been
observed to be prevalent among all the
categories of staff.
• Morality related attitudes are not uncommon
among HCWs which is also a cause of stigma
• stigma cannot be eliminated, but discriminatory
actions can be eliminated within the healthcare
settings (Target - zero discrimination by 2015)
34. Conclusions and Recommendations (3 of 5)
• It is difficult to expect respectful, stigma free
behaviours among HCWs unless they are specially
trained to deal with an HIV positive patients
• Most of the time doctors are missing in lot of training
interventions. This study showed the importance of
inclusion of all the categories of staff for better results
• Although HCWs have the responsibility to adhere to
standard precautions and equal rights for treatment
care and support, decision makers in the healthcare
system should also have the responsibility to make
prevention supplies and PEP available.
35. Conclusions and Recommendations (4 of 5)
• Healthcare providers are not free of
misperceptions, misconceptions and
judgemental attitudes towards PLHIV which
persist in society at large, and need to be
addressed
36. Conclusions and Recommendations (5 of 5)
Healthcare providers should have their own
rights to be protected from HIV and ways of
upholding their rights
BUT
without denying the rights of PLHIV
39. Acknowledgement
Principal Investigator: Dr. D Ajith Karawita
Co-investigators: Dr. KAM Ariyaratne, Dr. Manoji Gunathilake
Contributors
Prof. A Pathmeswaran, Dr. Sujatha Samarakoon, Dr. S. Benaragama, , Dr. Sunera
Fernando, Mr Hans Billimoria, Mrs Sherine Rodrigo
UN Agencies: Dr. Indira hettiarachchi, Ms. Swairee Rupasinghe, Dr. Dayanath
Ranatunge
AIDS Foundation of Lanka: Dr. Palitha Abeykoon, Dr. Sarojini Perera
We would like to acknowledge the support extended by the National STD/AIDS
Control Programme, National Hospital of Sri Lanka (NHSL), De Soysa Maternity
Hospital (DMH), Lady Ridgeway Hospital for Children (LRH), Castle Street Hospital
for Women (CSHW) and Base Hospital Angoda (Infectious Disease Hospital)
Most importantly we, would like to thank all the healthcare workers who
participated in the research
Dr. Darshani Wijewickrama and Dr Sathya Herath for translations
Ms Nimali Magammana, Sister Chandrani Kumari Rajakarune, Nalaka Gamage, RW
Bandara, Ms. Wasanthi Rajapakse, Ms. Anoma for data collection and data entry.