Careful Assessment Research Articles

How bereaved families conceptualise good care and communication in intensive care in South Australia

Since 2018, DonateLife South Australia and the Royal Adelaide Hospital (RAH) have collaborated to deliver routine family follow-up after bereavement in the intensive care unit (ICU). This follow-up includes a telephone interview that invites bereaved family members to comment on the quality of care and communication experienced in the ICU. To identify bereaved families’ experiences, including how they conceptualise good care and communication in intensive care, an analysis was conducted on all qualitative data collected during 118 interviews completed between 1 February 2018 and 30 May 2019. Reflexive thematic analysis was undertaken in an inductive and semantic way, with coding and theme generation being directed by the explicit content of the data, as conceptualised by Braun and Clarke. Initial codes were based on the interview questions, then additional codes were created during data analysis. Coding was informed by philosophical insights about concepts and the spirit of interpersonal engagement developed by Wittgenstein and Cordner, respectively. A concept map of the relationships observed between patterns of meaning in the data was created. Participants deeply appreciated staff providing them and their loved one with practical expressions of care and hospitality, however modest. These, along with staff sometimes crossing professional boundaries, expressed staff’s spirit of engagement, which in turn helped to maintain the patient’s dignity. Private space also helped to maintain the patient’s dignity, and it helped family to have enough time to say goodbye. Family not feeling rushed and being informed about their loved one dying also helped family to have enough time to say goodbye. Being informed depended on the quality of doctors’ communication. When family were not clearly informed, or had to wait long periods, they felt rushed and that they did not have enough time to say goodbye. Documents written to guide the assessment of intensive care comment on almost all of these matters, but the present study newly maps how they interact based on the extensive empirical evidence that it collected. Guidance documents should comment on giving staff scope to occasionally traverse a boundary, such as an institutional border or rule, to better support the patient and family, since families experience exceptionless practice insensitive to context as callous or disruptive of care.

Sclerostin and Cardiovascular Risk: Evaluating the Cardiovascular Safety of Romosozumab in Osteoporosis Treatment

Background/Objectives: Osteoporosis and cardiovascular disease (CVD) share common risk factors and pathophysiological mechanisms, raising concerns about the cardiovascular implications of sclerostin inhibition. Romosozumab, a monoclonal antibody that targets sclerostin, is effective in increasing bone mineral density (BMD) and reducing fracture risk. However, evidence suggests that sclerostin inhibition may adversely affect vascular calcification, potentially increasing the risk of myocardial infarction (MI) and stroke. Methods: This review synthesizes data from clinical trials, such as ARCH, BRIDGE, and FRAME, alongside genetic studies and observational analyses, to evaluate the cardiovascular safety of romosozumab. PubMed was searched for relevant studies published within the last five years. Studies addressing the relationship between romosozumab and cardiovascular outcomes were included, emphasizing both its efficacy in osteoporosis management and potential cardiovascular risks. Results: Romosozumab significantly improves BMD and reduces fracture risk in postmenopausal women and men with osteoporosis. However, clinical trials report an increased incidence of major adverse cardiovascular events (MACE), particularly in patients with pre-existing cardiovascular conditions such as chronic kidney disease (CKD), diabetes, or prior CVD. Genetic studies indicate that SOST gene variants may also influence cardiovascular outcomes. Conclusions: While romosozumab is an effective treatment for osteoporosis, careful cardiovascular risk assessment is crucial before initiating therapy, especially for high-risk populations. Long-term studies are needed to evaluate chronic safety. Future therapeutic strategies should aim to maintain bone health while minimizing cardiovascular risks, ensuring a balance between efficacy and safety in osteoporosis treatment.

Peripheral versus central vertigo

Dizziness and vertigo are common presentations in primary care, seen either acutely or chronically, with diverse causes including peripheral otological conditions, central neurological causes, systemic conditions, and psychological or functional causes. Symptoms vary widely, and can make diagnosis more challenging. Some causes are urgent (‘red flags’), requiring specialist referral or immediate treatment. This article guides clinical assessment, investigation, management and referrals in primary care.

Cognitive assessment in acute care following traumatic brain injury: A scoping review of performance-based tests

It is recommended that the assessment of cognitive function by occupational therapists is best conducted by observing the performance of everyday tasks in real-life environments. Given the constraints of acute care settings, selecting the appropriate cognition assessment for patients with traumatic brain injury (TBI) can be challenging. A scoping review was used to explore the evidence for occupation-based assessments of cognition for use with patients with TBI and explore their clinical applicability for the acute setting. Assessments were included if they focused on performance-based tests using real-life or simulated activities of daily living (ADL) or instrumental ADL tasks. From 29 identified articles, 18 occupation-based assessments of cognition were reported for use in patients with TBI. They varied in terms of time and resources required to administer, complexity, and variety of assessments. This review highlights a range of assessments of cognitive function available to patients with TBI in acute care, which support occupational therapists to use an occupation-centered approach. Issues faced by occupational therapists assessing cognitive function in the acute care setting include time and environmental constraints. A small number of portable, contemporary, and performance-based assessments relevant to younger adults warrant further investigation to determine their feasibility for use in acute care.

Avaliação dos atributos dos serviços de Atenção Primária à Saúde na perspectiva dos profissionais de saúde

Objective: To assess the presence and extent of primary health care (PHC) attributes from the perspective of health professionals. Methods: This is an analytical cross-sectional study, carried out through the self-application of the Primary Care Assessment Tool (PCATool-Brasil) questionnaire, in the health professional’s version. General, essential and derived scores were assigned to each attribute. Results: General score indicated low performance for PHC. Essential attributes Ongoing care, Coordination of Services (information systems), Comprehensiveness (services available) and derived attributes (Family-centeredness and Community orientation) showed high orientation. Family Health Teams showed significantly higher scores in the attributes Ongoing care, Comprehensiveness (services provided) and Family-centeredness. Presence of specialization and residency in family health was positively associated with the attributes Ongoing care and Coordination of Services (integration of care). Conclusions: The study identified the presence and extension of the attributes, pointed out weaknesses, potentialities and possibilities for the services, both at the organizational level and as in the work process of the professionals. The qualification of professionals was associated with better results.

Inertial measurement unit signal-based machine learning methods for frailty assessment in geriatric health

Frailty is a geriatric syndrome that may result in poor health outcomes such as hospitalization, disability, psychological distress, and reduced life satisfaction, and it is also associated with higher healthcare costs. The aim of this study is to classify frailty in elders at an early stage (pre-frail) to lower the risk of frailty and, hence, improve the quality of life. The other two classes in the classification task are frail and robust (non-frail). To achieve this, a dataset based on gait was utilized, which was recorded by an Inertial Measurement Unit (IMU) sensor, including gyroscope and accelerometer data. In this study, two approaches were assessed: the first used advanced Deep Learning (DL) algorithms to analyze raw IMU signals, and the second used conventional Machine Learning (ML) methods with hand-crafted features. The DL model, i.e., InceptionTime, beat the other algorithms in the DL approach with a remarkable test accuracy of 98%. On the ML side, Random Forest reported the most successful ML method, which achieved a test accuracy of 63.3%. For a careful assessment of the models, other evaluation metrics like Precision, Recall, and F1-score were also evaluated. The evaluation of both approaches produces research benefits for the classification of frailty in older people and allows for the investigation of new areas, promoting deeper comprehension and well-informed decision-making, particularly in healthcare systems.

Coexistence of Giant Hydatid Cyst and Hepatocellular Carci-noma: A Case Report and Literature Review

From a global perspective, hepatocellular carcinoma (HCC) and hydatid cyst disease are both common; however, the endemic and zoonotic nature of hydatid cysts (due to Echinococcus larvae) makes the simultaneous detection of the two conditions a rare occurrence. In this case report, in a 43-year-old male patient, we aim to draw attention to the potential coexistence of HCC and liver hydatid cysts by presenting a case in which HCC tissue was detected in the cyst wall—removed by emergency surgery due to cyst perforation. Hydatid lesions in the liver may exhibit tumor-like growth characteristics. Consequently, identifying a hydatid cyst concomitant with HCC can be challenging, particularly when HCC has developed within the cystic structure. Careful assessment of resected tissues and detailed diagnostic approaches can facilitate the identification of such cases, even if the risk of HCC in patients with hydatid cysts is marginal. It may be advisable to suggest periodic monitoring with HCC-related markers and liver imaging methods.

Psychometric Validation of Sheffield Profile for Assessment and Referral to Care (SPARC) in Korean Cancer Patients.

Identifying the palliative care needs of patients with advanced cancer is important for maintaining quality of life and timely transition to palliative care. We aimed to validate the Korean Sheffield Profile for Assessment and Referral for Care (K-SPARC) in such patients and establish its psychometric properties, including reliability, validity, and responsiveness to change. We used the forward-back translated version of SPARC, which was verified through a pilot study, to assess the palliative care needs of patients with advanced cancer. Reliability was evaluated by internal consistency using Cronbach's alpha coefficients and test-retest reliability. Criterion validity was analyzed against other questionnaires, including the Korean versions of the Functional Assessment of Cancer Therapy-General (FACT-G Korean) and Korean versions of the Edmonton Symptom Assessment System (K-ESAS). Factor analysis was used to assess construct validity. Two hundred fifty-nine patients were included from 2019 to 2022. Forty-nine percent of all patients were women, and the median age was 63 years. Cronbach's alpha coefficient (range, 0.642-0.903) and test-retest reliability (range, 0.574-0.749) indicated acceptable reliability. The correlation coefficients between K-SPARC and FACT-G Korean suggested significant criterion validity. The correlation coefficients for the physical, social, emotional, and functional domains were 0.701, 0.249, 0.718, and 0.511, respectively (p-value <0.001, all). Factor analysis demonstrated satisfactory construct validity of the tool. This study demonstrated the utility of K-SPARC as an evaluation tool for providing palliative care to patients with advanced cancer through psychometric validation; the tool had good internal consistency, reliability, and acceptable validity.

ENHANCEMENT OF PRIMARY CARE ASSESSMENT TOOL (PCAT): A SCOPING REVIEW

Background: Strengthening the quality of primary health care is one way to improve public health. For this reason, an appropriate primary care assessment tool (PCAT) is necessary to evaluate and improve primary health care. Objective: This study aims to provide an overview of the development of primary care assessment tools. Methods: The study was conducted through a scoping review of articles written in English that were published in the PubMed, Scopus, Science Direct, and Semantic Scholar databases from 2010 to 2023. Results: A total of 10 selected articles describe the development of primary care assessment tools, namely PCAT Malawi, Vietnam PCAT-PE, Vietnam PCAT-AE, CR-PCAT (China), PCAT-TI (Tibet), UG-PCAT (Uganda), PCAT-C (China), PCAT-Facility (Spain), KS-PCAT (Standard Korean), PCAT-10 (Spain), and Colombia PCAT. Each tool has a different development focus according to the context of each country. Conclusion: This study provides an overview of the development of PCAT. In general, the development of PCAT in each country demonstrates different characteristics. The selection of a health service assessment tool must align with the needs of the element or aspect to develop. Keywords: primary care assessment tool, PCAT development, primary health care assessment, PCAT modification.

Land-use change, no-net-loss policies, and effects on carbon dioxide removals

BackgroundCarbon dioxide removal from the atmosphere (CDR) is a critical component of strategies for restricting global warming to 1.5°C and is expected to come largely from the sequestration of carbon in vegetation. Because CDR rates have been declining in the United States, in part due to land use changes, policy proposals are focused on altering land uses, through afforestation, avoided deforestation, and no-net-loss strategies. Estimating policy effects requires a careful assessment of how land uses interact with forest conditions to determine future CDR.ResultsWe evaluate how alternative specifications of land use-forest condition interactions in the United States affect projections of CDR using a model that mirrors land sector net emission inventories generated by the US government (EPA). Without land use change, CDR declines from 0.826 GT/yr in 2017 to 0.596 GT/yr in 2062 (28%) due to forest aging and disturbances. For a land use scenario that extends recent rates of change, we compare CDR estimated based on net changes in land use (Net Change model) and estimates that separately account for the distinct CDR implications of forest losses and forest gains (Component Change model). The Net Change model, a common specification, underestimates the CDR losses of land use by about 56% when compared with the Component Change models. We also estimate per hectare CDR losses from deforestation and gains from afforestation and find that afforestation gains lag deforestation losses in every ecological province in the US.ConclusionsNet Change approaches substantially underestimate the impact of land use change on CDR and should be avoided. Component Change models highlight that avoided deforestation may provide up to twice the CDR benefits as increased afforestation—though preference for one policy over the other would require a cost assessment. The disparities in the CDR impacts of afforestation and deforestation indicate that no-net-loss policies could mitigate some CDR losses but would lead to overall declines in CDR for our 45-year time horizon. Over a much longer period afforestation could capture more of the losses from deforestation but at a timeframe inconsistent with most climate change policy efforts.

The appearance of scalp high-frequency oscillations is associated with poor seizure control in pediatric epilepsy patients.

Epilepsy treatment with anti-seizure medications (ASMs) is based on careful assessment of the balance between the likelihood of further seizures and the risk of side effects of treatment. However, there is currently no established biomarker to ascertain seizure control status with ASMs. High-frequency oscillations (HFOs), transient bursts of EEG activity with frequencies beyond 80 Hz, are a new and promising noninvasive epilepsy biomarker. We compared the risk of scalp HFO appearance between pediatric patients with good and poor seizure control by treatment with ASMs. A total of 72 epilepsy patients (aged 0-18 years, 39 males) with good and poor seizure control with ASMs participated in this study. We applied a validated automated detector to determine HFO and spike. We calculated the odds ratios (ORs) for scalp HFO and spike appearance according to seizure control status by multiple logistic regression analysis. Scalp HFO was seen more commonly and with a significantly higher detection rate in patients with poor seizure control as compared with patients with good seizure control for both ripple and fast ripple. These significant associations were found for both focal and generalized epilepsy. The ORs for scalp HFO appearance adjusted for confounding factors were significantly higher in patients with poor seizure control compared to those with good seizure control (ripple: OR [95% CI] = 11.91 [2.21-64.30], p = 0.004; fast ripple: 4.98 [1.03-24.09], p = 0.046). There were no significant associations between spike appearance and seizure control status. We found an increased risk of scalp HFO appearance in patients with poor seizure control. The results of this study support that scalp HFO is associated with patients having frequent seizures after treatment in both ripple and fast ripple. This study analyzed scalp high-frequency oscillations and spikes in pediatric patients with various types of epilepsy who were being treated using ASMs. The results showed that an increased risk of scalp HFO appearance was observed in patients with poor seizure control compared to those with good seizure control. These findings were observed in both the ripple (80-250 Hz) and fast ripple (250-500 Hz) bands. The scalp HFO is associated with patients having frequent seizures after treatment in both ripple and fast ripple.

Complications following bilateral simultaneous versus staged total knee arthroplasty in the Japanese population: a propensity-matched case-control study

Although bilateral simultaneous total knee arthroplasty (BSTKA) is an effective treatment for bilateral knee osteoarthritis, safety concerns and lack of precise patient selection criteria persist. This study aimed to determine the differences in perioperative parameters and complication rates between BSTKA and staged TKA in the Japanese population. We retrospectively reviewed 531 patients who underwent BSTKA or staged TKA between 2012 and 2021. Propensity score matching, performed on a 1:1 nearest neighbor basis for age, BMI, diagnosis, ASA score, and age-adjusted Charlson Comorbidity Index, yielded matched cohorts of 94 patients (188 knees) for each group. Outcome measures included operative time, perioperative blood loss, length of hospital stay, and nonmechanical complications after surgery. The BSTKA group had a shorter median operative time and hospital stay (111 min and 16 days) than the staged TKA group (159 min and 33 days) (p < 0.001). Overall complication rates were higher in the BSTKA group than in the staged TKA group (26% vs. 13%, p = 0.026), with anemia requiring transfusion being the most common. Cardiovascular complications were more frequent in the BSTKA group (4.3% vs. 0%, p = 0.043). These findings emphasize the importance of careful patient selection and risk assessment when considering BSTKA.

Tradeoffs When Building and Running Cohort and Patient-Level Markov Simulation Models

The choice of health care modeling approaches is driven by trade-offs between various modeling techniques. This study evaluates cohort (CH) versus patient-level (PL) Markov modeling techniques within a cost-effectiveness analysis framework to understand the practical decisions analysts face. Both the CH and PL models were constructed using identical datasets and similar assumptions. Each model included eight health states to capture disease severity and symptom types and allowed switching from first-line to second-line treatment. We assessed model outcomes and performance using various quantitative and qualitative techniques. The CH and PL models yielded very similar base case results; only minor differences in functionality and outcome consistency were detected. The CH model offered greater stability and easier parameter testing, while the PL model provided superior flexibility for structural adjustments and detailed patient pathway and subgroup analysis. However, the PL model required substantially more computational time for sensitivity analyses and more technical skills to understand and interpret patient pathways and model results. CH modeling faced more challenges when extensive structural changes were initiated. Choosing between CH and PL modeling techniques involves the careful assessment of trade-offs between the need for a flexible and informed model and the optimization of human and computational resources.

Congenital Anterior Urethral Obstruction: A Case Series

Congenital Anterior Urethral Diverticulum (CAUD) and Anterior Urethral Valve (AUV) are rare but well-described causes of urinary obstruction in male children. The clinical presentation can range from isolated poor urinary stream with normal bladder and upper tracts to severe obstructive uropathy with renal failure. In the present case series, six children with anterior urethral obstruction managed between June 2014 and June 2024 were retrospectively identified. Age at presentation, clinical features, investigations, management and long-term follow-up were studied. The age at presentation ranged from newborn to seven years. Severe disease, as evidenced by progressive renal failure, was present in 1 of the 6 children (16.6%). One child had undergone foetal intervention by valve ablation but had progressive renal failure on follow-up. Three children (50%) underwent diverticulum excision with urethroplasty, of which one child developed a postoperative urethrocutaneous fistula. One child with AUV had a dorsal urethral fold causing obstruction, unlike the ventral pathology observed in the other children. CAUD and AUV are rare yet important causes of obstructive uropathy. Careful assessment is crucial for making the correct diagnosis. Temporary diversion may be essential when cystoscopy or primary repair is not feasible or in cases of urosepsis.

Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) in Benign Gynaecology: A Systematic Review of Adnexal, Myomectomy and Prolapse Procedures.

Vaginal natural orifice transluminal endoscopic surgery (vNOTES) is utilised for gynaecological procedures globally, however evidence to support its application aside from hysterectomy is lacking. A systematic review to determine feasibility and safety profile of vNOTES for benign gynaecology was conducted. A literature search of MEDLINE, EMBASE, CINAHL, SCOPUS and CENTRAL was conducted, including all types of studies reporting vNOTES for gynaecological indications. After excluding cases with concurrent hysterectomy, the review focuses on procedures for benign indications and oncological procedures are reported separately. Patient characteristics and perioperative outcomes were reported, with pooled analysis for sufficiently powered categories. 54 articles were analysed, including 7 comparative studies (n=439) and 1 RCT (n=34), reporting 2469 cases of vNOTES, including adnexal (tubal and/or ovarian) (43 articles, n=2261), myomectomy (10 articles, n=136) and prolapse repair (6 articles, n=72) in predominantly premenopausal women with BMI<30kg/m2 on pooled analysis. The overall conversion rate was low (1.38%, n=34) with procedure specific conversion rates of 0.45-6.8% for adnexal procedures, 1.47% for myomectomy and none reported for prolapse repair. Overall complication rates were low (3.44%, n=85) with no associated mortality. Five (0.20%) adhesion-related rectal injuries at colpotomy were noted, all repaired intraoperatively without long-term sequelae. vNOTES appears feasible based on limited evidence, for uterine-sparing gynaecological indications, despite a notable rate of rectal injury at colpotomy. There is a negligible risk of rectal injury observed at conventional laparoscopy and robotically assisted surgery, but similar rate of entry-related gastrointestinal injury. This may be due to the learning-curve or suboptimal case selection, necessitating careful training, assessment, and appropriate patient selection. Surgeons should continue registering prospective vNOTES cases via iNOTESs, to evaluate emerging perioperative trends with global uptake of this novel technique.

Retinacular Plication for the Treatment of Posterior Tibial Tendon Impingement in Total Ankle Replacement—A Technique Tip

Total ankle replacement has become the standard treatment for end-stage ankle osteoarthritis, but complications like posterior tibial tendon impingement can occur, affecting long-term success. The presented technique involves reinforcing retinacular tissues around the tendon to create a protective barrier between the tendon and prosthetic components. The procedure is discussed in detail, emphasizing careful assessment, surgical steps, and considerations for tensioning. While this technique offers a novel solution to soft tissue impingement, its limitations and the need for long-term outcomes assessment are acknowledged. In conclusion, retinacular plication may help address posterior tibial tendon impingement after total ankle replacement, but meticulous surgical technique and patient-specific planning are essential for favorable results. Level of Evidence: Level Ⅴ.

Pediatric Anterior Cruciate Ligament Tears.

Anterior cruciate ligament (ACL) tears have become an increasingly prevalent problem in pediatric patients due to increased youth sports participation and early sports specialization. A high index of suspicion should be utilized for any young patient with an acute knee injury and an associated effusion or difficulty bearing weight. A thorough work-up should be performed that includes a careful assessment of growth remaining and concomitant injuries. While nonoperative management may be a consideration for select cases, most patients will benefit from early surgical management. ACL deficiency or delayed reconstruction can lead to early chondral degeneration and risk for further injury to the cartilage and menisci. The goal of ACL reconstruction is to create a stable knee and prevent secondary chondral or meniscal injury. Physeal-sparing and physeal-respecting transphyseal techniques have been developed that allow for safe and successful ligament reconstruction while minimizing the risk of growth arrest. Younger patients have a higher risk of reinjury and require a longer recovery period for a full return to sports than their older counterparts. Even though there have been advances in the safe and successful treatment of ACL tears in pediatric patients, it remains a devastating physical and psychological injury, and increased efforts should be made at prevention. Injury prevention programs have been shown to reduce the risk of ACL tears, and it is important to increase awareness and utilization of prevention strategies.

Evaluating the Impact of Precipitation, Temperature, and Topological Factors on Flood Severity in Myanmar: A Data-Driven Analysis

Abstract: This study really takes a look at the perplexing connection between precipitation, temperature, and the effect of floods in Myanmar, zeroing in on how these natural elements impact the quantity of individual people impacted by flood catastrophes. Through an itemized investigation of climate information and flood influence reports from different districts, we find that high precipitation levels don't be guaranteed to correspond with expanded flood harm. A few locales experience serious flooding in spite of having lower precipitation, showing that variables past precipitation, for example, geography and soil conditions, assume a huge part in flood weakness. This exploration features the requirement for complete appraisals of these ecological variables in regions encountering destroying floods, implying that districts with lower precipitation yet critical flood effects ought to go through careful topological assessments to all the more likely illuminate flood risk the executives techniques.

The risk of preterm delivery after appendectomy during pregnancy is higher in the face of a negative appendectomy

BackgroundReported outcomes after appendectomy during pregnancy remain inconclusive, and the risk for preterm delivery is not necessarily procedure-related. MethodsThis retrospective cohort study included 185 pregnant women who underwent appendectomy during pregnancy and gave birth between 2005 and 2022, compared using a 3:1 ratio to 555 parturients who did not undergo surgery. clinical, obstetrical and neonatal outcomes were analyzed. ResultsLaparoscopic appendectomy was the most common procedure (117/185; 63.2 ​%) whereas 68/185 (36.8 ​%) had open appendectomy. Pathological findings revealed that 141/185 cases (76.2 ​%) had an inflamed appendix, while 44/185 (23.8 ​%) were classified as having a “white appendix” (negative appendectomy).Preterm delivery occurred more frequently in the appendectomy group [22/185 (11.9 ​%) vs 30/555 (5.4 ​%), p ​= ​0.003] with even higher incidence in negative appendectomies compared to inflamed appendix cases [9/44 (20.5 ​%) vs 13/141 (9.2 ​%), p ​= ​0.044]. Multivariate analysis identified appendectomy (but not an inflamed appendix) as the sole significant risk factor for preterm birth (odds ratio 2.3, CI 1.26–4.15, p ​= ​0.006). ConclusionPreterm delivery correlates with negative appendectomies. Careful assessment is essential to avoid unnecessary surgical interventions during pregnancy.

Evaluating compliance with quality indicators of HIV and AIDS clinical care and analyzing those associated with mortality in the Democratic Republic of Congo

BackgroundSince human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) infection have been identified, significant improvements have been made concerning its diagnosis and treatment. Few contributions have been made in the area of quality indicators in the Democratic Republic of Congo (DRC). To address this gap, a recent study conducted in the said area in 2023 resulted in the development of a comprehensive list of 88 indicators for assessing the quality of clinical care for HIV and AIDS. Out of these, 66 were identified as a core set of quality indicators for the assessment of HIV and AIDS clinical care. The aim of this study was to evaluate compliance with these quality indicators and determine those that are associated with mortality among people living with HIV and AIDS (PLWHA) in the DRC.MethodsA retrospective cohort study was conducted at Panzi Hospital in Bukavu, South Kivu province of the DRC. The study population included PLWHA adult patients who were followed for a period of five years at the antiretroviral (ARV) clinic from January 2017 to December 2021. Descriptive analysis was performed to evaluate essential characteristics, and inferential statistics were performed including a multivariable logistic regression analysis performed to assess the association between selected clinical care indicators and PLWHA mortality, to estimate the odds ratios of mortality based on various factors, and to control for confounding variables.ResultsA total of 884 PLWHA were included. The level of compliance with the quality indicators was 78.79%. In the multivariate analysis, the quality-of-care indicators associated with mortality in the follow-up PLWHA on treatment were items 12 (Late diagnosis of HIV infection in specialized care), 24 (Assessment of resistance in cases of virologic failure), and 38 (Evaluation of Cardiac risk). Other factors associated with mortality were male sex, lower CD4 (< 500mm3) and high viral load (> 50 copies/ml).ConclusionThe level of compliance with the indicators was moderate. Some quality indicators were associated with mortality. These indicators are associated with delayed diagnosis of HIV infection, assessment of resistances in case of virologic failure, and evaluation of cardiac risk. Addressing gaps in adherence to these quality of care indicators (clinical care standards) could potentially reduce mortality rates and enhance the overall management of HIV and AIDS, particularly at Panzi Hospital in Bukavu, South Kivu Province, and in general in the DRC.