​Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite

Mammalian bite wounds are a very common clinical problem across the world. Systematic reviews have been conducted to address the role of education in preventing dog bite injuries in adolescents and children (Duperrex 2009) and antibiotic prophylaxis for mammalian bites (Medeiros 2001). However local wound management, one of the most important aspects in management of mammalian bites has not been evaluated by systematic reviews. The issue of primary closure versus delayed closure for non-bite traumatic wounds has been studied previously (Eliya-Masamba 2013), but this systematic review did not include mammalian bites. The issue of primary closure of animal bites remains controversial (Garbutt 2004), and a systematic review in this regard will help to make an objective assessment of this important question, and enable evidence-based clinical decision-making and guideline development.

A Cochrane Review on this is being conducted by Dr. Soumyadeep B and his colleagues. The protocol for the same has been published and is available here  (Open Access in India by ICMR grant )

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Health and beyond…strategies for a better India: using the “prison window” to reach disadvantaged groups in primary care

…Politicians, policy makers and the general public in India are prejudiced by the traditional notion that “sinners deserve neither mercy nor money.” Owing to this mind-set policy makers tend to allocate the resources “as per law” rather than “as per needs.” Even this is provided only after significant lobbying by pressure groups like human/prison rights activists. Sadly the media too presents prison health as a human rights issue and not an issue of public health concern. The very fact that almost all prisoners return back to the community makes it imperative to link prison health with the public health system and bring them under the coverage of primary health care. Policy makers as well as the general public need to understand that the prison and the community are at continuum. The much needed overhaul of the prison health system by linking it with public health cannot be achieved without a sustained campaign aimed at changing these dogmas. Historical data from nations which have separate health systems for prisons clearly indicate very poor quality of services. …Read the full article published at Journal of Family Medicine & Primary Care here.(Click: Open Access)

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Are interventions to reduce sitting at workplace effective?

It is common for family physicians in developing nations like India to encounter patients whose profession demands sedentary lifestyle. Such patients present with back problems, obesity, cardiovascular diseases and diabetes and ask doctors for advice on how to decrease sitting. Workplaces need to address this issue by inculcating strategies to decrease sitting and improve health of their employees. Occupational physicians too need to suggest evidence-based strategies to employers. This article provides an evidence based summary about what interventions are actually effective for decreasing sitting at workplace.

Read the full Evidence Summary , published at Journal of Family Medicine and Primary Care here. (Open Access)

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The battle of interpreting research results to specific audiences

Originally posted on Nordic-EBM:

Klingons3

Evidence-based medicine has been called “cookbook medicine” by some of its more vocal critics. This implies that evil faceless organisations like Cochrane aim to turn all healthcare workers into mindless automatons who blindly follow dictums derived solely from scientific evidence. I hope it doesn’t surprise many in that this has never been the aim of Cochrane, or EBM in general, nor will it ever be. EBM, or EBP if you prefer the term ‘practice’ rather than the more vague ‘medicine’, is a belief system that rests on three pillars (cf. five in Islam). The EBM pillars are: 1) best available scientific evidence (i.e. the purview of Cochrane and yours truly), 2) clinical experience and 3) patient preferences and values. So, the main gist is that evidence doesn’t matter – no matter how scientific – if we don’t have a clinician at hand to interpret it for the benefit of…

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Introducing the start of Cochrane infographics

Originally posted on visually cochrane:

Let’s begin at the beginning

Infographics in Cochrane – what’s that supposed to mean? Well, it’s an idea. I could claim it as my own but I’m sure that there are many others who have had similar Heureka-moments years ago. For example, see this poster presented in Hyderabad. Also infographics as a whole have been around for centuries already. Especially when it comes to health issues, one has to mention Florence Nightingale’s elegant creation depicting causes of death in the Crimean war. So I stay well clear of declaring any originality in that department. What then is all the fuss about? My idea, or vision, or inspiring mental itch if you will, is that it would be really cool to have a visual format for presenting results of Cochrane reviews, something like an intuitive pictorial Plain Language Summary. As there aren’t ready off-the-shelf solutions, it is up…

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Guest column : Doctor ‘scarcity’ a crisis of numbers or leadership? #UHC

Originally posted on Apothecurry:

Dr Raman KumarA recent article in the Indian Express reported statistics from India’s National Health Mission to highlight what it called “a debilitating shortage” of health specialists in the country. In doing so, it only reaffirmed what several experts, committees, and policy wonks have said all along: India needs more doctors.

For the longest time, India’s healthcare problem has been defined as one of numbers. Doctor demand outstrips supply, we are told. The accent has been on creating supply (predominantly in the private sector) to address this perceived shortage. I use the word “perceived” because the problem does not lie in numbers alone. What India faces is a full-blown leadership crisis caused by the systematic undermining of primary care physicians and the disproportionate clout wielded by super specialists in medical regulation against the backdrop of a lacklustre public health system.

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Interview with HIFA Country Representative of the Year 2014 : Didier Demassosso , Cameroon

Didier Demassosso from Cameroon has won the  HIFA Country Representative of the Year 2014 . An interview with him by Isabelle

Isabelle – What is the role of a HIFA representative and what activities you have undertaken in relation to this?

Didier – A HIFA representative must allow a maximum of people to know, adhere to the idea of HIFA and make them participate in the online discussion forum of HIFA.He/she should promote the HIFA everywhere. I have talked about the HIFA to my university teachers, my colleagues in psychology, psychiatrists, decision-makers, psychology student, and physicians. I have promoted during the promotion of mental health in Cameroon in 2014 and early 2015. I have also promoted the HIFA in an advocacy manner in my blog (http: // www .ictandkulture.blogspot.com).

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Didier Demassosso, Cameroon – HIFA Country Representative of Year Award 2014

Isabelle – What have been the contributions of HIFA for yourself, your organization, your country?
Didier – HIFA gave me a lot and still does till today. I have always been very sensitive to information as a tool for personal development. As a clinical psychologist at the end of his training and guidance counsellor, being a HIFA representative has been a way to use my skills pragmatically and evaluate them in a new area for me.

I can say that I do a bit of health communication and education for health ever since I am a HIFA representative. I have never as much set into perspective all my skills until now . It is not enough to be a representative of the HIFA; one most have a passion for health and management of information and knowledge referring to it. One must be able to mobilize a large amount of knowledge to solve information-related problems physicians, the layman,researcher, and policy makers ask. It is important to remember that I work in a context where the concept of “health literacy” is not included as a priority. Now I have a very clear vision of my professional carrier of my strengths and weaknesses at the professional level.
As a student in the Psychology Department of the University of Yaoundé I, I talked about the HIFA to my teachers and my classmates. A good amount of them are now member of HIFA. It is true that I have not extended my representative activities across the Cameroonian territory. This is an important goal this year. Nevertheless,
policymakers, important authorities of Cameroon are members of the HIFA. I’m sure
they now understand the importance of health care related information. For example, I had the support of Dr. Laure Menguene, Psychiatrist and Chief of Department of the Sub-Directorate for the Promotion of Mental Health and Psychiatry of The Ministry of Public Health. She allowed the HIFA I can say to be a friend of the Promotion of Mental Health in Cameroon. I could through her collaboration speak about the HIFA during coordination meetings of the Sub-Directorate for the Promotion of Mental Health and Psychiatry in the presence of clinical psychologists, former mental patients, psychiatrists, nurse specializing in Mental Health and theologian. I am seen to approach other makers, and researchers in the field of health to allow greater awareness and to be sensitive to information in health and health care.
Isabelle – What are the benefits, opportunities and challenges as HIFA representative of your country?
Didier – Being a HIFA representative, I could easily be listened by major research
organizations I approached, I can name EMERALD. I also felt I was listened by
foundations, and even Cameroonian authorities. Thanks to this position I could be
“empowered” to do important things for my country. However, as a HIFA representative for Cameroon, I am only a volunteer member yet with the responsibility to Promote the HIFA. I receive as benefits related to my membership,access to a significant amount of resources, links to scientific information in the field of health and related sectors. I also have the advantage and the opportunity to be in contact and collaborate with WHO authorities such as you Isabelle, I’m very honoured (smiles).
Despite the benefits and opportunities of the HIFA in terms of networking and developing my skills, I have many logistical difficulties. The internet is still not
readily accessible and affordable in Cameroon despite progress since some time. I
would have liked to use the internet to the maximum because many Cameroonians
are more and more online. But I cannot. Besides, participating in HIFA online discussions really helps in sharing and knowledge building and yet requires regular online presence that requires access to the Internet. I also find it very difficult to
improve the communication on the promotion of HIFA. I have attended and organized many conferences where the HIFA could have been visible if there were adequate communicational supports. In the school where I work I will like to have posters or any other material that may have a wider communication impact. Finally,the Cameroonian context even if it is fond of information is hardly interested in scientific information and its consumption. This is perhaps because there is no real communication and dissemination of research results. I am very interested in the dissemination of research products as part of changing attitudes. Valid information can truly make a difference. In brief, I believe that promoting HIFA can only be done by also promoting the concept of “health literacy”!

Join HIFA for free at http://www.hifa2015.org/

Conflicts of Interest : Dr. Soumyadeep Bhaumik had won the HIFA Country Representative of the Year Award previously

Dr Neil Pakenham-Walsh  HIFA Coordinator with a plaque mentioning the importance of HIFA

Dr Neil Pakenham-Walsh HIFA Coordinator with a plaque mentioning the importance of HIFA

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