Diagnostic accuracy of an integrated respiratory guideline in identifying patients with respiratory symptoms requiring screening for pulmonary tuberculosis: a cross-sectional study.

Background: To evaluate the diagnostic accuracy of the integrated Practical Approach to Lung Health in South Africa (PALSA) guideline in identifying patients requiring bacteriological screening for tuberculosis (TB), and to determine which clinical features best predict suspected and bacteriologically-confirmed tuberculosis among patients with respiratory symptoms.

Methods: A prospective, cross-sectional study in which 1392 adult patients with cough and/or difficult breathing, attending a primary care facility in Cape Town, South Africa, were evaluated by a nurse using the guideline. The accuracy of a nurse using the guideline to identify TB suspects was compared to that of primary care physicians' diagnoses of (1) suspected TB, and (2) proven TB supported by clinical information and chest radiographs.

Surge capacity associated with restrictions on nonurgent hospital utilization and expected admissions during an influenza pandemic: lessons from the Toronto severe acute respiratory syndrome outbreak.

Background: Current influenza pandemic models predict a surge in influenza-related hospitalizations in affected jurisdictions. One proposed strategy to increase hospital surge capacity is to restrict elective hospitalizations, yet the degree to which this measure would meet the anticipated is unknown.

Objectives: To compare the reduction in hospitalizations resulting from widespread nonurgent hospital admission restrictions during the Toronto severe acute respiratory syndrome (SARS) outbreak with the expected increase in admissions resulting from an influenza pandemic in Toronto.

Designing theoretically-informed implementation interventions: fine in theory, but evidence of effectiveness in practice is needed.

The Improved Clinical Effectiveness through Behavioural Research Group (ICEBeRG) authors assert that a key weakness in implementation research is the unknown applicability of a given intervention outside its original site and problem, and suggest that use of explicit theory offers an effective solution. This assertion is problematic for three primary reasons. First, the presence of an underlying theory does not necessarily ease the task of judging the applicability of a piece of empirical evidence.

Knowledge translation and interprofessional collaboration: Where the rubber of evidence-based care hits the road of teamwork.

Knowledge-translation interventions and interprofessional education and collaboration interventions all aim at improving health care processes and outcomes. Knowledge-translation interventions attempt to increase evidence-based practice by a single professional group and thus may fail to take into account barriers from difficulties in interprofessional relations. Interprofessional education and collaboration interventions aim to improve interprofessional relations, which may in turn facilitate the work of knowledge translation and thus evidence-based practice.

Translating research into policy and practice in developing countries: a case study of magnesium sulphate for pre-eclampsia.

Background: The evidence base for improving reproductive health continues to grow. However, concerns remain that the translation of this evidence into appropriate policies is partial and slow. Little is known about the factors affecting the use of evidence by policy makers and clinicians, particularly in developing countries.

Effect of educational outreach to nurses on tuberculosis case detection and primary care of respiratory illness: pragmatic cluster randomised controlled trial.

Objectives: To develop and implement an educational outreach programme for the integrated case management of priority respiratory diseases (practical approach to lung health in South Africa; PALSA) and to evaluate its effects on respiratory care and detection of tuberculosis among adults attending primary care clinics.

Design: Pragmatic cluster randomised controlled trial, with clinics as the unit of randomisation.

Setting: 40 primary care clinics, staffed by nurse practitioners, in the Free State province, South Africa.

Effectiveness of pre-licensure interprofessional education and post-licensure collaborative interventions.

In this paper we scanned and summarized the empirical research evidence and found that the effects of pre-licensure interprofessional education on patient/client care are unknown. In contrast, for post-licensure collaboration interventions, there is a growing body of evidence suggesting positive effects on the delivery of care. The coverage of this latter evidence, however, is patchy, being especially weak in primary care.

Chest radiograph in acute respiratory infections in children.

Background: Chest radiography is widely used in children with acute lower respiratory infections, but the benefits are unknown.

Objectives: To assess the effects of chest radiography for children with acute lower respiratory infections.

Search Strategy: The searches were updated in November 2004.

Written parental consent in school-based HIV/AIDS prevention research.

Objectives: We examined the process of obtaining "active," written parental consent for a school-based HIV/AIDS prevention project in a South African high school by investigating (1) parental consent form return rates, (2) parents' recall and knowledge of the research, and (3) the extent to which this consent procedure represented parents' wishes about their child's involvement in the research.

Methods: This cross-sectional descriptive study comprised interviews with parents of children in grades eight and nine in a poor, periurban settlement in Cape Town.

Results: Within 2 weeks, 94% of 258 parents responded to a letter requesting written consent and of those, 93% consented, but subsequent interviews showed that 65% remembered seeing the consent form.

Lay health worker intervention with choice of DOT superior to standard TB care for farm dwellers in South Africa: a cluster randomised control trial.

Setting: Farms in the Boland health district, Western Cape Province, South Africa.

Objective: To evaluate the effect of lay health workers (LHWs) on tuberculosis (TB) control among permanent farm workers and farm dwellers in an area with particularly high TB prevalence.

Design: Pragmatic, unblinded cluster randomised control trial.

Staff training and ambulatory tuberculosis treatment outcomes: a cluster randomized controlled trial in South Africa.

Objective: To assess whether adding a training intervention for clinic staff to the usual DOTS strategy (the internationally recommended control strategy for tuberculosis (TB)) would affect the outcomes of TB treatment in primary care clinics with treatment success rates below 70%.

Methods: A cluster randomized controlled trial was conducted from July 1996 to July 2000 in nurse-managed ambulatory primary care clinics in Cape Town, South Africa. Clinics with successful TB treatment completion rates of less than 70% and annual adult pulmonary TB loads of more than 40 patients per year were randomly assigned to either the intervention (n = 12) or control (n = 12) groups.

Lay health workers in primary and community health care.

Background: Lay health workers (LHWs) are widely used to provide care for a broad range of health issues. However, little is known about the effectiveness of LHW interventions.

Objectives: To assess the effects of LHW interventions in primary and community health care on health care behaviours, patients' health and wellbeing, and patients' satisfaction with care.

Changing professional practice in tuberculosis care: an educational intervention.

Aim: This paper describes the development and implementation of an experiential, participatory in-service education programme focusing on patient-centeredness, problem-solving and critical reflection for primary providers delivering care to tuberculosis patients in South Africa.

Background: Tuberculosis is a major contributor to the disease burden in developing countries. In South Africa, approximately 90% of tuberculosis patients are managed by nurses at the primary level.

Gender disparity amongst TB suspects and new TB patients according to data recorded at the South African Institute of Medical Research laboratory for the Western Cape Region of South Africa.

Objective: To describe the sex and age distribution of sputum submission and smear positivity in the Western Cape Province of South Africa.

Method: Laboratory registers of the South African Institute of Medical Research were examined retrospectively for the year 1999.

Results: Male tuberculosis (TB) suspects outnumbered females by 1.

DOTS for temporary workers in the agricultural sector. An exploratory study in tuberculosis case detection.

Introduction: This study was conducted in the Boland health district of the Cape Winelands of South Africa where there is a high tuberculosis incidence and prevalence. A survey conducted on 211 farms in the study district during 1998, reported that 65% (n = 9042) of all workers on these farms, were temporarily employed. Temporary farm workers live in communities either within or the outskirts of the boundaries of the Boland health district, from where they are transported to work daily.

Health systems research training enhances workplace research skills: a qualitative evaluation.

Introduction: In-service education is a widely used means of enhancing the skills of health service providers, for example, in undertaking research. However, the transfer of skills acquired during an education course to the workplace is seldom evaluated. The objectives of this study were to assess learner, teacher, and health service manager perceptions of the usefulness, in the work setting, of skills taught on a health systems research education course in South Africa and to assess the extent to which the course stimulated awareness and development of health systems research in the work setting.

Systematic reviews of the effectiveness of quality improvement strategies and programmes.

Systematic reviews provide the best evidence on the effectiveness of healthcare interventions including quality improvement strategies. The methods of systematic review of individual patient randomised trials of healthcare interventions are well developed. We discuss methodological and practice issues that need to be considered when undertaking systematic reviews of quality improvement strategies including developing a review protocol, identifying and screening evidence sources, quality assessment and data abstraction, analytical methods, reporting systematic reviews, and appraising systematic reviews.