Module 3
Counsellors
July 2017
Module 3: Counsellors. This module is for staff who counsel people as they consider PrEP or start taking PrEP and support them in coping with side-effects and adherence strategies. Those who counsel PrEP users may be lay, peer or professional counsellors and hea...lthcare workers, including nurses, clinical officers and doctors.
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Diabetes mellitus is one of the most common noncommunicable diseases worldwide. In the Eastern Mediterranean Region there has been a rapid increase in the incidence of diabetes mellitus and it is now the fourth leading cause of death. The increasing prevalence of diabetes mellitus, the emergence of ...diabetes complications as a cause of early morbidity and mortality, and the enormous and mounting burden on health care systems make diabetes a priority health concern. These guidelines provide up-to-date, reliable and balanced information for the prevention and care of diabetes mellitus in the Region. The information is evidence-based and clearly stated to facilitate the use of the guidelines in daily practice. They are intended to benefit physicians at primary, secondary and tertiary level, general practitioners, internists and family medicine specialists, clinical dieticians and nurses as well as policy-makers at ministries of health. They provide the information necessary for decision-making by health care providers and patients themselves about disease management in the most commonly encountered situations.
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The guide is organized into the major types of toxicities, the associated symp-toms, possible offending medications, and the suggested nursing assessments and interventions. Some symptoms (e.g. nausea) may be associated with a num-ber of underlying causes and may be mild, or a symptom of... a more serious medical situation requiring urgent attention. The pathophysiology for medica-tion-related fatigue and hypersalivation are unclear and these symptoms are not grouped under a specific type of toxicity. Additional information (comments) are provided for each toxicity to highlight relevant clinical information that may assist in management of side effects. Medications more strongly associated with the side effect appear in bold text. The appendices include tools nurses can use to more thoroughly assess patient complaints of pain, depression and neuropathy.
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In the current absence of vaccine for COVID-19, public health response target breaking the chain of infection by focusing on the mode of transmission. This paper summarizes current evidence-base around the transmission dynamics, pathogenic, and clinical features of COVID-19, to critically identify i...f there are any gaps in the current IPC guidelines.
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Patient-centred care (PCC) is a pillar of quality health services, where decision-making power is shared between the clinician and the patient. Although, this approach could be adopted with easiness in high income settings or in countries with unified health systems, in settings such as Peru, where ...universal access and other structural problems remain a challenge, the practice of PCC is not a priority. In Peru, research on PCC has been conducted for almost two decades, but this has not generated a need for development in academia, decision makers, health personnel or patients. Here, we give an overview of the road that PCC research has taken in Peru and the challenges that remain to translate it into clinical practice.
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La enfermedad de Chagas (ECha), resultado de la infección por el Trypanosoma cruzi, afecta varias poblaciones de las
zonas rurales de Suramérica y América Central. En los últimos años la enfermedad ha cobrado importancia epidemiológica no sólo porque se ha incrementado la detección de caso...s, sino por la presencia, en la infección crónica, de cardiopatía, patología de considerable gravedad clínica y cuya aparición aumenta el riesgo de incapacidad y reducción de la expectativa de vida.
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This brief summarizes current evidence and guidance for maintaining safe and effective care across the spectrum of maternal, newborn and infant care while protecting mother and child and health care providers during COVID-19. Furthermore, implications of the principle of “do no harm” are reviewe...d for maternal, newborn and infant care delivery during COVID-19, so that this information is conveniently and readily available to clinical and health system policy leaders and stakeholders in countries and communities. Additionally, considerations for safe oxygen delivery as well as key Infection Prevention and Control (IPC) measures at home and in healthcare facilities for pregnant women, newborns and children are described in detail in the brief.
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. Interim Guidelines. This interim guideline lays out some basic principles of optimal nutritional care for adults and paediatric patients during treatment and convalescence in Ebola treatment units, community care centres or to other centres where Ebola patients are receiving care and support. It h...ighlights the key clinical problems in patients affected by Ebola virus disease (EVD) that may interfere with their nutritional status and overall clinical support in the context of the current Ebola crisis, and summarizes their nutritional needs. It does not provide specific advice on fluid management in cases of vomiting, diarrhoea and dehydration or parenteral nutrition
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"Achieving, maintaining and improving accuracy, timeliness and reliability are major challenges for health laboratories. Countries worldwide committed themselves to build national capacities for the detection of, and response to, public health events of international concern when they decided to eng...age in the International Health Regulations implementation process. Only sound management of quality in health laboratories will enable countries to produce test results that the international community will trust in cases of international emergency. This handbook is intended to provide a comprehensive reference on Laboratory Quality Management System for all stakeholders in health laboratory processes, from management, to administration, to bench-work laboratorians. This handbook covers topics that are essential for quality management of a public health or clinical laboratory. They are based on both ISO 15189 and CLSI GP26-A3 documents"--Page 7.
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As countries aim to progress towards the Sustainable Development Goals (SDGs) and achieving universal health coverage, health inequities driven by racial discrimination and intersecting factors remain pervasive. Inequities experienced by indigenous peoples as well as people of African descent, Roma ...and other ethnic minorities are of concern globally; they are unjust, preventable and remediable.
Health systems themselves are important determinants of health and health equity. They can perpetuate health inequities by reflecting structural racism and discriminatory practices of wider society. For instance, systemic racism, implicit bias, misinformed clinical practice, or discrimination by health professionals contributes to health inequities. However, health systems can also be a leading force for tackling the inequities faced by populations experiencing racial discrimination.
Primary health care (PHC) is the essential strategy for reorientating health systems and societies to become healthier, equitable, effective and sustainable. In 2018, on the 40th anniversary of the Declaration of Alma-Ata, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) renewed the emphasis on PHC with their strategy,
WHO outlines 14 strategic and operational levers for policy-makers to strengthen PHC. Within each lever, there are multiple potential entry points for targeted actions to address racial discrimination, foster intercultural care, and reduce health inequities experienced by indigenous peoples as well as people of African descent, Roma and other ethnic minorities.
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The International Classification of Functioning, Disability and Health, known more commonly as ICF, provides a standard language and framework for the description of health and health-related states. Like the first version published by the World Health Organization for trial purposes in 1980, ICF is... a multipurpose classification intended for a wide range of uses in different sectors. It is a classification of health and health-related domains -- domains that help us to describe changes in body function and structure, what a person with a health condition can do in a standard environment (their level of capacity), as well as what they actually do in their usual environment (their level of performance).
These domains are classified from body, individual and societal perspectives by means of two lists: a list of body functions and structure, and a list of domains of activity and participation. In ICF, the term functioning refers to all body functions, activities and participation, while disability is similarly an umbrella term for impairments, activity limitations and participation restrictions. ICF also lists environmental factors that interact with all these components.
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Interim guidance, 6 October 2021
Direct detection of SARS-CoV-2 viral proteins (antigens) in nasal swabs and other respiratory secretions using lateral flow immunoassays (also known as rapid diagnostic tests, RDTs) offers a faster and less expensive method to test for SARS-CoV-2 than the reference ...method, nucleic acid amplification tests (NAATs). This interim guidance offers recommendations on the priority uses of antigen-detecting rapid diagnostic tests (Ag-RDTs) in specific populations and settings, including (i) for primary case detection in symptomatic individuals suspected to be infected and asymptomatic individuals at high risk of COVID-19, (ii) for contact tracing, (iii) during outbreak investigations and (iv) to monitor trends of disease incidence in communities. Ag-RDTs meeting minimum performance requirements can be used outside of clinical and laboratory settings, including in communities, by trained operators in accordance with instructions. The guidance additionally provides recommendations on implementation, product selection and storage.
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The NICE guideline "Hypertension in Adults: Diagnosis and Management" outlines recommendations for diagnosing and managing hypertension in adults over 18, including those with type 2 diabetes. It emphasizes accurate blood pressure measurement, recommending ambulatory or home monitoring to confirm di...agnosis. Cardiovascular risk and target organ damage should be assessed, considering age, lifestyle, and other conditions. Initial treatment focuses on lifestyle changes such as diet, exercise, and smoking cessation, with medication advised for stage 1 hypertension at high cardiovascular risk or stage 2 hypertension. Regular monitoring and treatment adjustments are recommended to maintain target blood pressure levels, with specific guidance for people over 80 and those with additional conditions like diabetes or kidney disease. The guideline aims to reduce risks of heart attack, stroke, and other complications, supporting evidence-based treatment decisions in clinical practice.
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As the global community aims to fulfill its commitments to the UN Sustainable Development Goals, and the achievement of universal health coverage, dozens of countries have committed to the expansion of community health workers (CHWs) as the front line of their healthcare systems [1, 2]. Robust resea...rch demonstrates CHWs improve access to care, reduce maternal, newborn, and child mortality, improve clinical outcomes for chronic diseases, and prevent disease outbreaks [3].
To support the operationalization of quality CHW program design and implementation, USAID, UNICEF, the Community Health Impact Coalition, and Initiatives Inc. have updated and adapted the Community Health Worker Assessment and Improvement Matrix (CHW AIM) Program Functionality Matrix [12]. This tool can be used to identify design and implementation gaps in both small- and national-scale CHW programs, and close gaps in policy and practice.
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Overuse of antimicrobial agents occurs globally in both community and hospital settings. Misuse of antibiotics can lead to a variety of adverse outcomes, including the development of antimicrobial resistanceand increased cost of hospitalization. This issuehas been particularly problematic in de...veloping countries, where antibiotic-management programs rarely exist and where antibiotics can be purchased without aprescription. In Thailand, the rate of antibiotic resistance among gram-positive and gram-negative or-ganisms has increased significantly over the past decade. These findings provide compelling evidence ofthe need for more-rational use of antimicrobial agents in Thailand.
Clinical Infectious Diseases2006; 42:768–752006 by the Infectious Diseases Society of America.
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In many low- and middle-income countries, there is a wide gap between evidencebased recommendations and current practice. Treatment of major CVD risk factors remains suboptimal, and only a minority of patients who are treated reach their target levels for blood pressure, blood sugar and blood choles...terol.
In other areas, overtreatment can occur with the use of non-evidence-based
protocols. The aim of using standard treatment protocols is to improve the quality
of clinical care, reduce clinical variability and simplify the treatment options,
particularly in primary health care. Standard treatment protocols can be developed by preparing new national treatment guidelines or by adapting or adopting international guidelines.
The Evidence-based protocols module uses hypertension and diabetes screening
and treatment as an entry point to control cardiovascular risk factors, prevent target organ damage, and reduce premature morbidity and mortality. A comprehensive risk- based approach for integrated management of hypertension, diabetes, and high cholesterol is included in the Risk-based CVD management module.
This module includes clinical practice points and sample protocols for:
1. hypertension detection and treatment
2. type 2 diabetes detection and treatment
3. identifying basic emergencies – care and referral.
HEARTS emphasizes adaptation, dissemination, and use of a standardized set of
simple clinical-management protocols, which should be drug- and dose-specific,
and include a core set of medications. The simpler the protocols and management tools, the more likely they are to be used correctly, and the higher the likelihood that a programme will achieve its goals.
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One of the main aims of the WHO Global Initiative for Childhood Cancer and the CureAll Americas framework is to strengthen centers of excellence and promote the training of the health workforce, especially pediatric oncology nurses, specialized in nursing care for children and adolescents with cance...r and their families. These health personnel provide compassionate, non traumatic, complex, continuous, ethical, conscious patient- and family-centered care in order to meet the physical, emotional, psychosocial, and cultural needs of the people involved. This publication is aimed at health administration teams, hospital management teams, and professional pediatric oncology nursing groups. Its objective is to identify, systematize, and consolidate available evidence on the scope of pediatric oncology nursing practice in Latin America and the Caribbean based on core competencies, in order to incorporate them into clinical practice, teaching, and research. The preparation process included a systematic review aimed at finding the best evidence on this subject. Patient- and family centered care and the conceptual model of competencies for teenagers and young adults with cancer, developed by the Teenage Cancer Trust with the support of the Royal College of Nursing, were the theoretical foundations supporting the systematization of recommendations.
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The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the... disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
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The pharmacological management of asthma has changed considerably in recent decades, as it has come to be understood that it is a complex, heterogeneous disease with different phenotypes and endotypes. It is now clear that the goal of asthma treatment should be to achieve and maintain control of the... disease, as well as to minimize the risks (of exacerbations, disease instability, accelerated loss of lung function, and adverse treatment effects). That requires an approach that is personalized in terms of the pharmacological treatment, patient education, written action plan, training in correct inhaler use, and review of the inhaler technique at each office visit. A panel of 22 pulmonologists was invited to perform a critical review of recent evidence of pharmacological treatment of asthma and to prepare this set of recommendations, a treatment guide tailored to use in Brazil. The topics or questions related to the most significant changes in concepts, and consequently in the management of asthma in clinical practice, were chosen by a panel of experts. To formulate these recommendations, we asked each expert to perform a critical review of a topic or to respond to a question, on the basis of evidence in the literature. In a second phase, three experts discussed and structured all texts submitted by the others. That was followed by a third phase, in which all of the experts reviewed and discussed each recommendation. These recommendations, which are intended for physicians involved in the treatment of asthma, apply to asthma patients of all ages.
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