Regeringen vill ge pengar till läkemedelsbolag för att skynda på utvecklingen av antibiotika som står emot motståndskraftiga bakterier köpa antibiotika Svenska materialet kan bli alternativ till antibiotika.
Microsoft word - imai_profile.doc
IMAI stands for Integrated Management of Adolescent and Adult Illness, and is a
training package that has been developed by the World Health Organization. It has been
implemented extensively in African and Asian countries. Karur is one of the first two districts selected for implementation in India, following country-specific adaptation by
WHO. Adapted materials have also been translated into Tamil. SAATHII is
implementing this training project based on the APAC-VHS model of mainstreaming
care and support, which it had piloted earlier in Salem district.
The World Health Organization has coordinated the development of the IMAI guidelines
and training materials. The simplified WHO standardized guidelines are for ARV therapy
within the context of primary health care, based at first-level health facilities or in district
clinics. IMAI provides tools (standardized guidelines and standard training packages to
teach these guidelines) for rapid country adaptation and use in their efforts to achieve the
3x5 goals. The modules cover chronic HIV care including ARV therapy, acute care
(including the management of opportunistic infections and when to suspect HIV, linking
to testing and counselling), palliative care (symptom management at home), and general
principles of good chronic care (to support the health system transition from acute to
The WHO IMAI guidelines and training packages support the rapid expansion of access
to ART by supporting the shifts of key tasks to multi-purpose health workers at first-level
facilities located in the community (health centres and clinics). By preparing nurses and
clinical aids to provide acute care to adults, many opportunistic infections can be treated
and the patient stabilized for ARV treatment without referral to district clinic.
Management of patients near their home is important for equity and to achieve high
There are clear advantages to standardized and simplified evidence-based guidelines and
training materials when attempting to go to scale while preserving quality. Standardized
guidelines describe the competencies that form the basis for certification.
The target audience for the guidelines is first-level facility health workers who work in a
district outpatient clinic or in peripheral health centres and clinics, in rural or urban areas,
in low resource settings. These simplified guidelines will allow shifting key tasks from
doctors to nurses, medical aids and other first level facilities in clinical management of
ARV treatment and in the management of opportunistic infections in preparation for
ART. The patient education, psychosocial support, and adherence preparation and
support has been designed for implementation by lay providers. Most of the increase in
human resources for ARV treatment will be from PLHA and other community members
who both join clinical teams and support treatment and other care in the community.
At the district level, the nurses and lay providers following the IMAI guidelines would
work in a clinical team with the doctor or clinical officer who would be also be guided by
other WHO ART guidelines for senior clinicians. In peripheral health centres and clinics,
the nurses and lay providers would need to stay in communication with these same more
senior clinicians, by referral and back-referral and communication by cell phone or other
1. Acute care (including opportunistic infections, when to suspect and test for HIV, prevention)
Acute care presents a syndromic approach to the most common adult illnesses including
most opportunistic infections. Clear instructions are provided so the health worker knows
which patients can be managed at the first-level facility and which require referral to the
district hospital or further assessment by a more senior clinician. Preparing first-level
facility health workers to treat the common, less severe opportunistic infections will
allow them to stabilize many clinical stage 3 and 4 patients prior to ARV therapy without
2. Chronic HIV care with antiretroviral treatment
This module includes patient education, psychosocial support, prevention for positives,
clinical staging, prophylaxis (INH, cotrimoxazole, fluconazole), preparation for ARV
treatment then clinical monitoring, response to side effects, adherence preparation and
support, management of chronic problems, and data collection based on a simple
treatment card. The Chronic HIV Care with ARV Therapy effectively integrates HIV
care and prevention, increasing the potential for preventive interventions. The broader
uptake of preventive interventions is essential for HIV control.
3. General principles of good chronic care
IMAI supports the introduction of an effective approach to chronic care (including a team
approach, patient partnership, inclusion of “expert patients”/peer support staff on the
clinical team, and effective adherence support). This approach could permit rapid
expansion of human resources for HIV care while providing the skills and clinic capacity
for effective management of other chronic illnesses. A short module describes the
General Principles of Good Chronic Care. These principles are used in the Chronic HIV
4. Palliative care: symptom management and end-of-life care
The module covers management of symptoms during acute or chronic illness, education
of the patient, family and community caregiver to provide care at home, using the
Caregiver Booklet; and end-of-life care. Symptom management is very important in
patients on ARV treatment. In order to expand access to palliative care, this approach
assumes that most of the care will be given by the patient’s family with back-up by multi-
purpose health workers at first- level facilities. This module covers palliative care in both
The Caregiver Booklet
The Caregiver Booklet is designed to be used by health workers to educate family
members and other caregivers and then given to them to use as a reference at home.
These are interim guidelines released for country adaptation and use to help with the
emergency scale-up of antiretroviral therapy (ART) in resource-limited settings. These
interim guidelines will be revised soon based on early implementation experience. Please
send comments and suggestions to : [email protected].
16-18 April 2006 Cairo, Egypt The Cairo Regional Centre for International Commercial Arbitration (CRCICA) organized in collaboration with the Egyptian State Council the seminar of "Arbitration in Disputes Arising out of International Administrative Contracts" during the period from 16 to 18 April 2006 in Cairo, Egypt. The program was divided into six sessions scheduled over thr
Roll No. Total No. of Questions : 13] [Total No. of Pages : 02 Paper ID [A0307] (Please fill this Paper ID in OMR Sheet) B.Sc. IT/DCA (203/402) (S05) (LE) (N) (Sem. - 2nd/4th) WEB.TECHNOLOGIES - I Time : 03 Hours Maximum Marks : 75 Instruction to Candidates: Section - A is Compulsory . Attempt any Nine questions from Section - B. Section - A Q1) (15 × 2 =