Twelve months of implementation of health care performance‐based financing in Burkina Faso: A qualitative multiple case study

To improve health services' quantity and quality, African countries are increasingly engaging in performance‐based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post‐launch in late 2014. The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents. Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community‐based audits had yet been done. Distribution of bonuses varied from one centre to another. This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies.     

Azithromycin selectively reduces tumor necrosis factor alpha levels in cystic fibrosis airway epithelial cells

Azithromycin (AZM) ameliorates lung function in cystic fibrosis (CF) patients. This macrolide has been suggested to have anti-inflammatory properties as well as other effects potentially relevant for therapy of CF. In this study, we utilized three CF (IB3-1, 16HBE14o- AS3, and 2CFSMEo-) and two isogenic non-CF (C38 and 16HBE14o- S1) airway epithelial cell lines to investigate whether AZM could reduce tumor necrosis factor alpha (TNF-alpha) mRNA and protein levels by real-time quantitative PCR analysis and an enzyme-linked immunosorbent assay (ELISA), respectively. We studied the effects on the DNA binding of NF-kappaB and specificity protein 1 (Sp1) by an ELISA. Non-CF cells express significantly lower TNF-alpha mRNA and protein levels than an isogenic CF cell line. In CF cells, AZM treatment causes a 30% reduction of TNF-alpha mRNA levels (P < 0.05) and a 45% decrease in TNF-alpha secretion (P < 0.05), reaching approximately the levels of the untreated isogenic non-CF cells. In CF cells, NF-kappaB and Sp1 DNA binding activities were also significantly decreased (about 45 and 60%, respectively; P < 0.05) after AZM treatment. Josamycin, a macrolide lacking clinically described anti-inflammatory effects, was ineffective. Finally, AZM did not alter the mRNA expression levels of interleukin-6, a proinflammatory molecule not differentially expressed in CF and isogenic non-CF cells. The results of our study support the anti-inflammatory activities of this macrolide, since we show that AZM reduced the levels of TNF-alpha and propose inhibitions of NF-kappaB and Sp1 DNA binding as possible mechanisms of this effect.     

Role of transforming growth factor beta in rat bladder smooth muscle cell proliferation

Conditions associated with hypertrophy of the urinary bladder have repeatedly been associated with an increased urinary excretion of transforming growth factor (TGF) beta in both rats and patients. Because TGFbeta can have both growth-promoting and -inhibiting effects, we have studied its effects on cell growth and death in primary cultures of rat bladder smooth muscle cells. TGFbeta1, TGFbeta2, or TGFbeta3 did not cause apoptosis, but all three isoforms inhibited DNA synthesis with similar potency (EC(50) of approximately 0.1 ng/ml) and efficacy. Such inhibition was antagonized by a specific TGFbeta receptor antagonist and independent of the presence of serum. Mitogen-activated protein kinases (MAPKs) are involved in the control of cell growth, and all three TGFbeta isoforms inhibited activation of the extracellular signal-regulated kinase, c-Jun NH(2)-terminal kinase, and p38 MAPK subfamilies. Nevertheless, the inhibitory effects of the TGFbeta isoforms on DNA synthesis were not affected by presence of inhibitors of the three MAPK pathways. TGFbeta did not alter cell size as measured by flow cytometry or mitochondrial activity, an integrated measure of cell size and number. We conclude that our data do not support the hypothesis that TGFbeta is a mediator of rat bladder hypertrophy.     

The impact of social work environment, teamwork characteristics, burnout, and personal factors upon intent to leave among European nurses

OBJECTIVES: Europe's nursing shortage calls for more effective ways to recruit and retain nurses. This contribution aims to clarify whether and how social work environment, teamwork characteristics, burnout, and personal factors are associated with nurses' intent to leave (ITL). METHODS: Our sample comprises 28,561 hospital-based nurses from 10 European countries. Different occupational levels have been taken into account: qualified registered nurses (n = 18,594), specialized nurses (n = 3957), head nurses (n = 3256), and nursing aides and ancillary staff (n = 2754). RESULTS: Our outcomes indicate that ITL is quite prevalent across Europe, although we have found some differences across the countries depending on working conditions and economic situation. Quality of teamwork, interpersonal relationships, career development possibilities, uncertainty regarding treatment, and influence at work are associated with nurses' decision to leave the profession across Europe, notwithstanding some country-specific outcomes. A serious lack of quality of teamwork seems to be associated with a 5-fold risk of ITL in 7 countries. As far as personal factors are concerned, our data support the hypothesized importance of work-family conflicts, satisfaction with pay, and burnout. A high burnout score seems to be associated with 3 times the risk of ITL in 5 countries. CONCLUSIONS: To prevent premature leaving, it is important to expand nurses' expertise, to improve working processes through collaboration and multidisciplinary teamwork, and to develop team training approaches and ward design facilitating teamwork.     

Safety of same-day coronary angiography in patients undergoing elective valvular heart surgery

OBJECTIVE: To maximize patient convenience, we developed a protocol for coronary angiography the same day as elective valvular surgery. PATIENTS AND METHODS: We analyzed the medical records from a single surgical service of 226 consecutive patients who had undergone cardiac catheterization on the day of elective valvular repair or replacement between August 1, 2000, and August 30, 2004. The rates of renal failure (creatinine >2.0 mg/dL and 2 times the preoperative level), hemodialysis, continuous renal replacement therapy, and mortality were evaluated. RESULTS: Patients undergoing same-day angiography had a mean age of 65.6 plus-or-minus 12.1 years, and 33% were female. Of the study patients, 11.1% were diabetic, with a mean ejection fraction of 61% plus-or-minus 10%, and 28.3% had coronary artery disease severe enough to require bypass grafting. One patient died within 30 days of surgery; the overall mortality was 0.4%. Postoperatively, serum creatinine levels increased an average of 0.1 mg/dL (P<.001) in patients undergoing same-day coronary angiography. Four patients had transient renal failure (1.8%), 2 of whom required temporary hemodialysis. CONCLUSION: In properly selected patients, same-day coronary angiography is safe and has little impact on renal function. This protocol offers a simple way to reduce the number of hospital visits required by patients undergoing elective valvular surgery.     

Ridge preservation and augmentation using regenerative materials to enhance implant predictability and esthetics

Dentistry has entered an era in which patients no longer need to accept an edentulous or partially edentulous condition, or one in which their candidacy for tooth structure replacement (ie, implants with subsequent restoration) must be dismissed because of insufficient alveolar bone volume, height, or width. The supporting bone can be preserved at the time of tooth extraction, or augmented at the time of case presentation, using a variety of available regenerative materials. Among them are mineralized human allograft bone and collagen membranes that can be placed in combination with specific growth factor complexes and implant designs. This article reviews the challenges associated with adequately preserving or augmenting the alveolar bone after tooth extraction or loss and before implant placement. The research and benefits to support using allogenic bone graft and membrane materials for such procedures are detailed, and 3 clinical cases are presented to demonstrate the clinically successful incorporation of these materials with the host tissues.     

Prevalence of human papillomavirus in squamous cell carcinoma of the tongue

Oncogenic human papillomaviruses (HPVs) are important agents in the genesis of gynecological cancer, and have also been implied in the genesis of oral cancer. With the purpose of evaluating the relationship between HPV and squamous cell carcinoma (SCC) of the tongue, a case-control study was performed. Fifty white male patients who were smokers and had the histological diagnosis of SCC of the tongue were selected. The control group was composed of 10 matched patients with no clinical evidence of tongue lesions. Polymerase chain reaction (PCR) was used to detect the presence of HPV genome in fresh-frozen tissue specimens from SCC of the tongue margin. Thirty-seven patients (74%) had a positive PCR for oncogenic papillomavirus, and only 1 specimen (10%) of the control group was positive for nononcogenic papillomavirus. Based on the statistical analysis of this study there was a 25.6% higher risk for SCC of the tongue to harbor oncogenic HPV than the healthy control tongue tissue.     

The use of a wax bite wafer and a double computed tomography scan procedure to obtain a three-dimensional augmented virtual skull model

A detailed visualization of the interocclusal relationship is essential in a three-dimensional virtual planning setup for orthognathic and facial orthomorphic surgery. The purpose of this study was to introduce and evaluate the use of a wax bite wafer in combination with a double computed tomography (CT) scan procedure to augment the three-dimensional virtual model of the skull with a detailed dental surface. A total of 10 orthognathic patients were scanned after a standardized multislice CT scanning protocol with dose reduction with their wax bite wafer in place. Afterward, the impressions of the upper and lower arches and the wax bite wafer were scanned for each patient separately using a high-resolution standardized multislice CT scanning protocol. Accurate fitting of the virtual impressions on the wax bite wafer was done with surface matching using iterative closest points. Consecutively, automatic rigid point-based registration of the wax bite wafer on the patient scan was performed to implement the digital virtual dental arches into the patient's skull model (Maxilim, version 2.0; Medicim NV, St-Niklaas, Belgium). Probability error histograms showed errors of < or =0.16 mm (25% percentile), < or =0.31 mm (50% percentile), and < or =0.92 (90% percentile) for iterative closest point surface matching. The mean registration error for automatic point-based registration was 0.17 +/- 0.07 mm (range, 0.12-0.22 mm). The combination of the wax bite wafer with the double CT scan procedure allowed for the setup of an accurate three-dimensional virtual augmented model of the skull with detailed dental surface. However, from a clinical workload, data handling, and computational point of view, this method is too time-consuming to be introduced in the clinical routine.     

Specific magnetic bead based capture of genomic DNA from clinical samples: application to the detection of group B streptococci in vaginal/anal swabs

BACKGROUND: Group B streptococci (GBS) are a leading cause of sepsis and meningitis in newborns. We previously developed a rapid diagnostic system for GBS detection from vaginal/anal samples obtained from pregnant women during delivery. To facilitate the adaptation of this method for point-of-care testing, we have developed a specific and efficient GBS DNA capture method that is compatible with both PCR and nonamplification detection technologies. METHODS: Superparamagnetic beads were functionalized with oligonucleotide capture probes of different lengths and used to capture GBS genomic DNA (gDNA). A rapid extraction procedure was used to provide DNA from GBS cultures or vaginal/anal samples with added GBS. Hybridization reactions consisting of functionalized beads and target DNA in 30 muL of hybridization buffer were performed for 1 h at room temperature, followed by washing and resuspension in water. Captured DNA was then detected using quantitative PCR. RESULTS: A 25-mer capture probe allowed detection of 1000 genome copies of purified GBS DNA. The ability to detect GBS was improved by use of a 50-mer (100 copies) and a 70-mer capture probe (10 copies). Detection of approximately 1250 CFU/mL was achieved for diluted GBS broth culture and for vaginal/anal swab samples with added GBS. CONCLUSION: Oligonucleotide-functionalized superparamagnetic microbeads efficiently capture GBS gDNA from both bacterial cultures and vaginal/anal samples with added GBS. Efficiency of gDNA capture increases with oligonucleotide length. This technology could be combined with sample preparation and detection technologies in a microfluidic system to allow point-of-care testing for GBS.