BACKGROUND: Voluntary counseling and testing (VCT) continues to play a critical role in HIV prevention care and treatment. In recent years different modalities of VCT have been implemented including clinic- mobile- and home-based testing and counseling. This review assesses the effects of all VCT types on HIV-related risk behaviors in low- and middle-income countries. OBJECTIVES: The primary objective of this review is to systematically review the literature examining the efficacy of VCT in changing HIV-related risk behaviors in developing countries across various populations. SEARCH METHODS: Five electronic databases - PubMed Excerpta Medica Database (EMBASE) PsycINFO Sociological Abstracts and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) - were searched using predetermined key words and phrases. Hand-searching was conducted in four key journals including AIDS AIDS and Behavior AIDS Education and Prevention and AIDS Care; the tables of contents of these four journals during the included time period were individually screened for relevant articles. The reference lists of all articles included in the review were screened to identify any additional studies; this process was iterated until no additional articles were found. SELECTION CRITERIA: To be included in the review eligible studies had to meet the following inclusion criteria: 1) Take place in a low- or middle-income country as defined by the World Bank 2) Published in a peer-reviewed journal between January 1 1990 and July 6 2010 3) Involve client-initiated VCT including pre-test counseling HIV-testing and post-test counseling and 4) Use a pre/post or multi-arm design that compares individuals before and after receiving VCT or individuals who received VCT to those who did not and 5) Report results pertaining to behavioral psychological biological or social HIV-related outcomes. DATA COLLECTION AND ANALYSIS: All citations were initially screened and all relevant citations were independently screened by two reviewers to assess eligibility. For all included studies data were extracted by two team members working independently using a standardized form. Differences were resolved through consensus or discussion with the study coordinator when necessary. Study rigor was assessed using an eight point quality score and through the Cochrane Collaborations Risk of Bias Assessment Tool. Outcomes comparable across studies including condom use and number of sex partners were meta-analyzed using random effects models. With respect to both meta-analyses data were included from multi-arm studies and from pre/post studies if adequate data were provided. Other outcomes including HIV-incidence STI incidence/prevalence and positive and negative life events were synthesized qualitatively. For meta-analysis all outcomes were converted to the standard metric of the odds ratio. If an outcome could not be converted to an odds ratio the study was excluded from analysis. MAIN RESULTS: An initial search yielded 2808 citations. After excluding studies failing to meet the inclusion criteria 19 were deemed eligible for inclusion. Of these studies two presented duplicate data and were removed. The remaining 17 studies were included in the qualitative synthesis and 8 studies were meta-analyzed. Twelve studies offered clinic-based VCT 3 were employment-based 1 involved mobile VCT and 1 provided home-based VCT. In meta-analysis the odds of reporting increased number of sexual partners were reduced when comparing participants who received VCT to those who did not unadjusted random effects pooled OR= 0.69 (95% CI: 0.53-0.90 p=0.007). When stratified by serostatus these results only remained significant for those who tested HIV-positive. There was an insignificant increase in the odds of condom use/protected sex among participants who received VCT compared to those who did not unadjusted random effects pooled OR=1.39 (95% CI: 0.97-1.99 p=0.076). When stratified by HIV status this effect became significant among HIV-positive participants random effects pooled OR= 3.24 (95% CI: 2.29-4.58 p<0.001). AUTHORS CONCLUSIONS: These findings add to growing evidence that VCT can change HIV-related sexual risk behaviors thereby reducing HIV-related risk and confirming its importance as an HIV prevention strategy. To maximize the effectiveness of VCT more studies should be conducted to understand which modalities and counseling strategies produce significant reductions in risky behaviors and lead to the greatest uptake of VCT.

/pdf/voluntary-counseling-and-testing-vct-for-changing-hiv-4pu6twmuht.pdf

Voluntary counseling and testing (VCT) for changing HIV-related risk behavior in developing countries

Analysis of hospital costs: a manual for managers , Analysis of hospital costs: a manual for managers , کتابخانه مرکزی دانشگاه علوم پزشکی تهران

https://people.brandeis.edu/~shepard/w-manual.PDF

Analysis of Hospital Costs: A Manual for Managers

1 Clinical teaching.- 2 Foundations of clinical teaching and learning.- 3 Learning in the laboratory.- 4 The briefing: preparing students for clinical practice.- 5 Learning through clinical practice.- 6 Debriefing: reflecting on practice.- 7 From student to nurse.

Clinical Teaching in Nursing

Background and objectives: The diagnosis of hypertension among hemodialysis patients by predialysis or postdialysis blood pressure (BP) recordings is imprecise and biased and has poor test-retest reliability. The use of intradialytic BP measurements to diagnose hypertension is unknown. Design, setting, participants, & measurements: A diagnostic-test study was done with interdialytic ambulatory BP as reference standard. Index BP recordings tested were: predialysis (method 1), postdialysis (method 2), intradialytic (method 3), intradialytic including predialyis and postdialysis (method 4), and the average of predialysis and postdialysis (method 5). Each index BP was recorded over six consecutive dialysis treatments. Results: There were differences among index BP measurements in reproducibility, bias, precision, and accuracy. Method 4 was the most reproducible (intraclass correlation coefficient = 0.70 for systolic and diastolic BP). All 5 measurement methods overestimated 44-h ambulatory systolic BP. Methods 2, 3, or 4 overestimated ambulatory systolic BP by only a small amount. Method 4 was the most precise and accurate. For diagnosis of hypertension, BP cut-point by method 4 of 135/75 mmHg, had a sensitivity of 90.4% and specificity of 75.9% for systolic BP (area under ROC curve 0.90). Median cut-off systolic BP of 140 mmHg from a single dialysis provides approximately 80% sensitivity and 80% specificity in diagnosing systolic hypertension; a median cut-off diastolic BP of 80 mmHg provides approximately 75% sensitivity and 75% specificity in diagnosing diastolic hypertension. Conclusions: Consideration of intradialytic BP measurements together with predialysis and postdialysis BP measurements improves the reproducibility, bias, precision, and accuracy of BP measurement compared with predialysis or postdialysis measurements.

Diagnosing hypertension by intradialytic blood pressure recordings.

https://onlinelibrary.wiley.com/doi/pdf/10.4073/csr.2013.9

Technical and Vocational Education and Training (TVET) Interventions to Improve the Employability and Employment of Young People in Low- and Middle-Income Countries: A Systematic Review

Ruth V. Matheney

Papers

Pre- and Post-

Pre- and post--conferences for students.

New Directions in Patient-Centered Nursing

How Does the Psychiatric Nursing Affiliation Fail

Fundamentals of patientcentered nursing