Introduction
Tuberculosis is a major health problem in Lusaka, Zambia, where 16% of the people of productive age was infected with HIV. DOTS coverage is 100% with 81% case detection and 73% cure rate.Following the spread of HIV infection, the number of tuberculosis patients has been increasing. Within this context, the HIV/AIDS and TB Control Project established a model external quality assessment (EQA) system for AFB microscopy service at peripheral laboratories.This study aims to show importance of EQA in quality NTP laboratory system.
Methods
All 22 diagnostic centers in Lusaka during the period from July 2003 to September 2005 were evaluated following internationally recognized guidelines. Sample slides were taken randomly from among slides read at peripheral diagnostic centers and were blindly rechecked by controllers at the quality assurance (QA) center. Quality of smear preparation was also assessed.
Results and Discussions
Between 2003 and 2005, major reading errors (discrepancy: two reading scales and over) found by controllers decreased from 5% of sample slides to 0.7%, and minor errors (one scale discrepancy) from 3.4% to 0.3%. The number of diagnostic centers without any errors was only 3 at the beginning of study and this number increased to 17 at the end. Quality of smear preparation such as thickness, size and evenness also improved based on international standards. These results highlighted the effectiveness of the quality assurance system (blinded rechecking of sample slides and effective feedback with frequent visits to peripheral diagnostic centers) in terms of maintaining the proficiency of AFB microscopy service. EQA system should be expanded in the areas where both HIV and TB prevalence is high. The effective implementation of EQA service in the NTP is the essential factor for the success of DOTS strategy and may contribute ultimately to prevent new tuberculosis infection among persons, including HIV-infected.

Purpose: To investigate the present situation and to explore future problems in bereavement care. Methods: A questionnaire survey was mailed to approximately 1,000 home-visit nursing stations throughout Japan. Results: A total of 296 (29.8%) valid responses were returned. Of the responding stations, 6.1% answered that they “positively perform” bereavement care, 73.1% “perform [it] when necessary,” and 20.7% “seldom perform” bereavement care. A total of 91.4% of the responding stations provided bereavement care by visiting nurses after a patient’s death. A total of 73.6% of the responding stations always performed care in the form of appreciation for their efforts. A total of 32.4% of the responding stations contacted related organizations to request that the organizations watch bereaved family members who suffered from dementia but lived alone. Reasons for not contacting related organizations included not knowing which organization to contact (17.5% of the responding stations). Conclusion: Approximately 90% of the responding stations provided bereavement care by visiting nurses after the patient’s death, with emotional support as the main activity. Visiting nurses were asked to acquire abilities: 1) to provide bereaved families with information about health and welfare services that could be used in addition to long-term care insurance to rebuild their lives, 2) to ascertain which bereaved families would need continuous support, and 3) to assign these bereaved families to relevant organizations.

Purpose: To elucidate the problems recognized by visiting nurses when local communities support the bereaved families of users of home-visit nursing stations. Methods: A questionnaire survey was mailed to approximately 1,000 home-visit nursing stations throughout Japan. Results: We then analyzed 211 free descriptions and extracted 8 problems, including “Grief care is difficult to continue because it is a voluntary activity,” “It is insufficient in assessing bereaved families and I don’t know the social resources to introduce to bereaved families,” “I am reluctant to be involved with bereaved families,” “Because of the Act on the Protection of Personal Information, it is difficult to support bereaved families,” and “A formal & informal support for bereaved families has not been established.” Conclusion: No system has been established for grief care in Japan and grief care does not generate a profit; therefore, visiting nurses felt limited in their ability to be continuously involved in grief care, although they were concerned about the situations of bereaved families. This study indicated future tasks that home-visit nursing stations that perform grief care for the bereaved families of their users and home-visit nursing stations that request this care be provided by community general support centers should be evaluated in terms of medical remuneration points.