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To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community.
Cross-sectional quality-of-care study.
The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model.
LHW implementing treatment for uncomplicated SAM in the community.
Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for 60·0 % and 57·4 % of children, respectively. The appetite test was conducted correctly for 42·0 % of cases. Of all cases of SAM without complications assessed during the study, 68·0 % received the correct medical and nutrition treatment. The proportion of cases that received the correct medical and nutrition treatment and key counselling messages was 4·0 %.
This quality-of-care study supports existing evidence that LHW are able to identify uncomplicated SAM, and a majority can provide appropriate nutrition and medical treatment in the community. However, the findings also show that their ability to provide the complete package with an acceptable level of care is not assured. Additional evidence on the impact of supervision and training on the quality of SAM treatment and counselling provided by LHW to children with SAM is required. The study has also shown that, as in other sectors, it is essential that operational challenges are addressed in a timely manner and that implementers receive appropriate levels of support, if SAM is to be treated successfully in the community.
Bow leg (Figure 4.1) and knock knees are common referrals to children’s orthopaedic clinics. Most are physiological; however, pathological causes must be excluded (Table 4.1).
The leg alignment in the coronal plane (varus and valgus) undergoes a unique pattern of changes from birth until adulthood, as described by Salenius and Vankka . Most newborn babies have an average knee varus of 10°–15°. This begins to be corrected during the second year of life, reaching about 10° of valgus at around 4 years of age. The valgus alignment then gradually decreases, reaching the adult value (5° of valgus) around 8 years of age (see Figure 4.2). The standard deviation (SD) is 8° (more in the boys, 10°, and less in the girls, 7°).
Children with physiological genu varum and internal tibial torsion typically come to medical attention after the standing age (between 12 and 24 months), usually because of parental concern regarding the appearance of the legs, and these children have no other significant findings on clinical examination.
The first edition of this book has become essential reading for those preparing for postgraduate examinations in orthopaedics. Medical students and junior trainees had their own books to use. This is surprising as the same process of examination is used by all groups, the only differences being that the senior trainee should look more polished and should know more special tests. It was this realization that prompted us to come together with our many years’ experience of teaching clinical examination and to rewrite every chapter in a format that was uniform in style and in a sequence that could be used in examination situations or in clinical practice by all. Quick revision will become easier as each chapter ends with a summary of the examination technique. Another unique addition is that the illustrations also follow a sequence for quick visual revision. These illustrations are supplemented by numerous new clinical photographs. It is our hope that we have made this book even more user-friendly and an essential companion through your career in clinical practice.
Examination Techniques in Orthopaedics comprehensively covers the basic examination skills and important special tests needed to evaluate the adult and paediatric musculoskeletal system. Chapters are presented in an easy-to-read, memorable format, helping readers develop their own detailed framework for patient examination as well as promoting exam success. For this new edition, all of the chapters have been rewritten in a uniform style and a chapter on general principles has been added. Each chapter is illustrated by clinical photographs and photographs demonstrating the techniques on models, and includes a summary of techniques, which readers will find useful in exam preparation. The contributing authors are experienced in teaching clinical examination both in the hospital setting and on national courses, and furthermore, many are examiners with firsthand awareness of what candidates need to know. Invaluable reading for those taking undergraduate and postgraduate examinations, practising orthopaedic surgeons, physiotherapists, general practitioners, medical students and rheumatologists.
The purpose of this study was to identify the problems faced by ambulance drivers working in a conflict zone.
This study was conducted on ambulance drivers working for the four major hospitals in Kashmir, India. The drivers were interviewed and asked a series of 30 work-related questions. The individual interviews were conducted over a three-month period in the valley of Kashmir that was affected by continuous violence, strict curfew, and strikes.
A total of 35 ambulance drivers were interviewed. Drivers worked an average of 60 h/wk, and they drove an average of 160 km/d. Twenty-nine (83%) of the drivers experienced >1 threat of physical harm; 18 (54%) experienced physical assaults; and 31 (89%) reported evidence of psychological morbidity associated with their jobs.
The atmosphere of conflict on the streets of Kashmir impacted the ambulance drivers adversely, both physically as well as mentally. The stress faced by these professionals in conflict zones during their duty hours should be recognized, and corrective measures must be put in place.
Dhar SA, Dar TA, Wani SA, Hussain S, Wani ZA, Aazad S, Yaqoob S, Mansoor I, Ali MF, Ahmed M, Mumtaz I, Azhar I. In the line of duty: a study of ambulance drivers during the 2010 conflict in Kashmir. Prehosp Disaster Med. 2012;27(4):1-4.