BackgroundThe need for research-based knowledge to inform health policy formulation and implementation is a chronic global concern impacting health systems functioning and impeding the provision of quality healthcare for all. This paper provides a systematic overview of the literature on knowledge translation (KT) strategies employed by health system researchers and policy-makers in African countries.MethodsEvidence mapping methodology was adapted from the social and health sciences literature and used to generate a schema of KT strategies, outcomes, facilitators and barriers. Four reference databases were searched using defined criteria. Studies were screened and a searchable database containing 62 eligible studies was compiled using Microsoft Access. Frequency and thematic analysis were used to report study characteristics and to establish the final evidence map. Focus was placed on KT in policy formulation processes in order to better manage the diversity of available literature.ResultsThe KT literature in African countries is widely distributed, problematically diverse and growing. Significant disparities exist between reports on KT in different countries, and there are many settings without published evidence of local KT characteristics. Commonly reported KT strategies include policy briefs, capacity-building workshops and policy dialogues. Barriers affecting researchers and policy-makers include insufficient skills and capacity to conduct KT activities, time constraints and a lack of resources. Availability of quality locally relevant research was the most reported facilitator. Limited KT outcomes reflect persisting difficulties in outcome identification and reporting.ConclusionThis study has identified substantial geographical gaps in knowledge and evidenced the need to boost local research capacities on KT practices in low- and middle-income countries. Evidence mapping is also shown to be a useful approach that can assist local decision-making to enhance KT in policy and practice.Electronic supplementary materialThe online version of this article (10.1186/s12961-019-0419-0) contains supplementary material, which is available to authorized users.

BackgroundCancer screening programs hold much potential for reducing the cervical cancer disease burden in developing countries. The aim of this study was to determine the feasibility of mobile health (mHealth) phone technology to improve management and follow-up of clients with cervical cancer precursor lesions.MethodsA sequential mixed methods design was employed for this study. Quantitative data was collected using a cross-sectional survey of 364 women eligible for a Pap smear at public sector health services in Cape Town, South Africa. Information was collected on socio-demographic status; cell phone ownership and patterns of use; knowledge of cervical cancer prevention; and interest in Pap smear results and appointment reminders via SMS-text messages. Descriptive statistics, crude bivariate comparisons and logistic regression models were employed to analyze survey results. Qualitative data was collected through 10 in-depth interviews with primary health care providers and managers involved in cervical cancer screening. Four focus group discussions with 27 women attending a tertiary level colposcopy clinic were also conducted. Themes related to loss of mobile phones, privacy and confidentiality, interest in receiving SMS-text messages, text language and clinic-based management of a SMS system are discussed. Thematic analyses of qualitative data complemented quantitative findings.ResultsPhone ownership amongst surveyed women was 98% with phones mostly used for calls and short message service (SMS) functions. Over half (58%) of women reported loss/theft of mobile phones. Overall, there was interest in SMS interventions for receiving Pap smear results and appointment reminders. Reasons for interest, articulated by both providers and clients, included convenience, cost and time-saving benefits and benefits of not taking time off work. However, concerns were expressed around confidentiality of SMS messages, loss/theft of mobile phones, receiving negative results via SMS and accessibility/clarity of language used to convey messages. Responsibility for the management of a clinic-based SMS system was also raised.ConclusionsResults indicated interest and potential for mHealth interventions in improving follow-up and management of clients with abnormal Pap smears. Health system and privacy issues will need to be addressed for mHealth to achieve this potential. Next steps include piloting of specific SMS messages to test feasibility and acceptability in this setting.

SummaryA prospective 5-year survival study of 900 patients, aged 65 years and over, undergoing a general surgical procedure. demonstrated that following an initial high mortality rate the survival of the group as a whole approached that of an age-matched population. Non-elective admissions, age 75 years and over, ASA grade 4 5 and major surgery were associated with a high early mortality. Mortality associated with malignancy extended over 1 year. The study reinforces the conclusion that age alone should be no bar to surgery and anaesthesia, endorses the findings of the National Conjidential Enquiry into Peri-operative deaths and emphasises the need to re-examine the provision of anaesthetic and surgical services in District General Hospitals. The henefts of elective admission in the very old are highlighted, along with the potential for extension of day case surgery. Key wordsAge factors. Anaesthesia; geriatric. Surgery.Many changes have occurred in surgical and anaesthetic practice over the past 20 years, with a growing number of operations of increasing complexity being undertaken in older and often less fit, patients [I]. While much is known about the early postoperative outcome of elderly general surgical patients, little has been published on their long-term survival since the two studies of Andersen and Ostberg [2, 31 more than two decades ago. This present study has, therefore, been undertaken to establish the trends of long-term survival in general surgical patients aged 65 years and over and to identify those factors of importance in predicting outcome. Patients and methodsThe Maelor Hospital, Wrexham, is a District General Hospital which at the time of the study served a population of 228 000 of whom 14.3% were aged 65 years and over. As described in a previous prospective study of hospital outcome [4], a detailed pre-operative questionnaire was completed by the surgeons and anaesthetists involved in the care of each patient aged 65 years and over, who underwent a general surgical operation during the 12 month period from May 1985. These included urological operations but excluded endoscopic investigations of the gastro-intestinal tract [4]. Orthopaedic and trauma cases were not included. In addition to general medical information, the ASA status of each patient was established pre-operatively .Three years after surgery an interim personal questionnaire was sent to those patients discharged from hospital who were not known to have subsequently died. This was accompanied by a letter explaining the reasons for the request and apologising should the patient be then deceased. If replies were not received, further enquiries to ascertain survival were undertaken using the general practitioners, the Family Practitioner Service, the local Registrar of Births and Deaths, the NHS Central Register at Southport and the office of Population Censuses and Surveys, London. A further follow up was undertaken 5 years postoperatively.

This article discusses the findings of an audit to assess the improved outcomes of a systematic approach to training nurses working in an emergency assessment area (EAA) to conduct dysphagia screening for patients who have had a stroke. The investment in training has reduced the time patients wait for dysphagia screening from 35 hours to less than one hour. As a result of this audit dysphagia screening competencies have been established.

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