IntroductionClinical governance outlines duties and responsibilities as well as indicators of the actions towards best possible patient outcomes. However, evidence of outcomes on clinical governance interventions is limited in South Africa. This study determined knowledge of clinical staff about the existence of clinical governance protocols/tools that are utilised in selected South African hospitals.MethodsA cross-sectional study conducted among randomly sampled clinical staff at Nelson Mandela Academic (NMAH), St Elizabeth in the Eastern Cape Province and, Rob Ferreira (RFH) and Themba Hospitals in the Mpumalanga Province of South Africa. A self-administered survey questionnaire was used to collect demographic information and quality improvement protocols/tools in existence at the hospitals. Data were captured in Excel spreadsheet and analysed with STATA. Knowledge was generated based on the staff member’s score for the 12 questions assessed.ResultsA total of 720 participants were recruited of which 377 gave consent to participate. Overall, 8.5% (32/377) of the participants got none or only one correct out of the 12 protocols/tools; and 65.5% (247/377) got between two and five correct. The median knowledge scores were 41.7% (interquartile range (IQR) = 16.7%) in three of the hospitals and 33.3% (IQR = 16.7%) at NMAH (p-value = 0.002). Factors associated with good knowledge included more than five years of experience, being a professional nurse compared to other nurses, not working at NMAH as well as being a medical doctor or pharmacist compared to other staff. Overall, 74.0% (279/377) of the respondents scored below 50%; this was 84.4% (92/109) at NMAH and 66.3% (55/83) at RFH and this difference was statistically significant (p-value = 0.017).ConclusionDespite clinical governance implementation, there was low knowledge of clinical governance protocols/tools among clinical staff. Therefore, providing more effective, relevant training workshops with an emphasis on importance of local ownership of the concept of clinical governance, by both management and clinical staff is of great importance.

BackgroundIntestinal schistosomiasis caused by Schistosoma mansoni continues to be a significant public health problem in Ethiopia. This study investigated the prevalence and intensity of S.mansoni infection, and contributing factors in Alamata district of Tigray Region, Northern Ethiopia.MethodsA community-based cross-sectional study was conducted and 1762 participants were enrolled from five clusters in Alamata district. A questionnaire was used to collect socio-demographic data and risk factors. Stool samples were examined using Kato-katz technique to determine the prevalence and intensity of infection. The data were analyzed using SPSS version 25. Median, inter quartile range (IQR), mean, frequency, and percentage were used to descriptively summarize data. The Wilcoxon Mann–Whitney and Kruskal-Wallis tests were used to compare the differences in mean rank of egg load between different groups. Bivariate and multivariable logistic regression models were used to investigate the association between the odds of being infected with S.mansoni and the different socio-demographic and other factors. The strength of these associations was reported using odds ratio with corresponding 95% confidence intervals, and a P-value below 5% was used to report statistical significance.ResultsOut of 1762 residents included in the study 941 (53.4%) were females. The age varied from 5–80 years, with a median age of 25 years (IQR = 27), the overall prevalence of S.mansoni was 21.5% with males accounting for 26% (204/821) of the infections. The proportion of infection was higher among the age groups of 15–19 and 20–29 years at 32.7% and 33.1%, respectively. The mean egg count among the infected study participants was 146.82 eggs per gram of feces (epg) ± (243.17 SD). Factors significantly associated with increased odds of infection were living in Waja cluster (AOR:8.9; 95% CI, 3.5–23.2; P< 0.001); being in the age groups 10–14 (AOR:6.0, 95% CI: 3.1–11.7, P

Participants’ responses on protocols and practices in their hospitals.

Implemented in Microsoft Excel. Obtained from www.sportsci.org in August 2019. (XLS)

Staff knowledge of policies or practices that were available within their hospitals.

BackgroundHypertension (HTN) affects over a billion people worldwide, with most cases in low- and middle-income countries (LMICs) where awareness and control remain low. In Pakistan, general practitioners (GPs) are usually the initial contact for hypertensive patients. Through the Train the Trainer (TTT) initiative, a group of consultant cardiologists were trained as master trainers to conduct training for GPs across Pakistan. This study aimed to assess the effectiveness of the TTT initiative regarding knowledge of GPs about the diagnosis and management of HTN.MethodsThis study included 540 GPs from all over Pakistan. Participants attended HTN training workshops run by Master Trainers under the TTT model and completed a structured online questionnaire in relation to knowledge of HTN before and 1–3 months after training. Knowledge scores were derived from correct responses for 19 items.ResultsPre-training GPs demonstrated low HTN knowledge scores with a median of 26.3 [IQR: 15.8–36.8] and 92% scoring less than 50. In contrast, post-training medians increased significantly to 42.1 [IQR: 31.6–63.2], with 38.5% of GPs achieving moderate or high knowledge scores ≥50 (p 

Bivariable associations of knowledge on protocols/practices in their hospitals.

BackgroundEnvenoming by Bothrops lanceolatus, a viperid endemic to Martinique an island in the Lesser Antilles, induces a unique clinical manifestation, i.e., thrombosis. Pathophysiological signaling leading to thrombotic events remains poorly understood. Among others, proposed mechanisms include increased expression of multimerized forms of von Willebrand factor (VWF). Prothrombotic effects of VWF are regulated by ADAMTS13, a metalloprotease which cleaves VWF multimers. Whether ADAMTS13 activity is reduced in B. lanceolatus envenoming has not been previously investigated.Methodology/Principal FindingsADAMTS13 activity was evaluated via chromogenic assay in experimental and clinical studies. Human plasma with known ADAMTS13 activities (0.70 IU/mL) was incubated with increasing doses of B. lanceolatus venom. Incubation with B. lanceolatus venom (concentrations 10–1000 ng/mL) induced a dose-dependent reduction of ADAMTS13 activity. In our series of 46 patients bitten by B. lanceolatus snake, ADAMTS13 activity was determined at admission before antivenom therapy. In these patients, the median plasmatic ADAMTS13 activity was 94% (IQR: 78–122%). Ten patients (22%) displayed ADAMTS13 activity less than 75%. Compared with patients with normal ADAMTS13 activity (n = 36), those with moderately low ADAMTS13 activity (n = 10) were older, had a lower platelet count, and displayed increased concentrations of creatine kinase, fibrinogen and C-reactive protein. Multivariate linear regression retained only grade severity of envenoming as independent predictor of increase length of hospital stay, while reduced ADAMTS13 activity and increased C-reactive protein levels bordered on statistical significance.Conclusions/SignificanceFor the first time, our study provided evidence suggesting that ADAMTS13 activity is reduced in experimental B. lanceolatus venom exposure and patients with B. lanceolatus envenoming. Thanks to its role on the VWF regulation, it is suggested that reduced ADAMTS13 activity can increase the risk of thrombosis in B. lanceolatus envenoming by favoring the circulation of prothrombotic VWF multimers. Low ADAMTS13 activity was associated with increased length of stay in envenomed patients.