Comprehensive Care Center Research Articles

Self-management in Multiple Sclerosis (MS): Comparing Perceptions of Need Between People with MS, Carepartners, and MS Providers

<h3>Research Objectives</h3> People with Multiple Sclerosis (MS) face challenges managing complex symptoms and navigating daily life. Self-management interventions (SMIs) may help, but research is lacking on the perceived need for SMIs and how perceptions may differ between people with MS (PwMS), carepartners, and MS providers. This exploratory study: 1) determines the need for an MS SMI; 2) identifies similarities and differences in perceived need between PwMS, carepartners, and providers; and 3) generates ideas to inform future self-management research. <h3>Design</h3> A qualitative, exploratory study using focus group (FG) methodology with PwMS (3 FGs), carepartners (1 FG), and medical and rehabilitation MS providers (2 FGs). FGs were audio-recorded, transcribed, then analyzed using the Collaborative Qualitative Analysis approach. Setting: A comprehensive MS care center in urban, southern USA. <h3>Participants</h3> Participants represent a convenience sample of 16 PwMS, 4 carepartners, 6 medical providers, 10 rehabilitation providers. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> The FG moderator's guide included questions about: 1) priority MS symptoms; 2) barriers and facilitators to self-managing MS; 3) MS self-management strategies; 4) program and resource gaps. <h3>Results</h3> Results confirm that PwMS experience self-management challenges. PwMS and carepartner FGs revealed similar findings related to barriers and facilitators to self-managing MS and agreed that an SMI would be beneficial. While providers also agreed an MS SMI is needed, there were differences between groups in relation to barriers to self-management. Specifically, societal perceptions/stigma and the built environment were identified by PwMS as barriers, but not providers. PwMS also discussed the importance of alternative therapies and wellness activities, not discussed similarly by all provider types. <h3>Conclusions</h3> PwMS may benefit from SMIs. Obtaining input from PwMS, their carepartners and providers provides a holistic picture of the barriers to self-management that can inform content development. <h3>Author(s) Disclosures</h3> None.

Coordinating physiotherapy care for persons with haemophilia.

IntroductionPhysiotherapy is highly recommended for persons with haemophilia (PWH), to regain functioning after bleeding and to maintain functioning when dealing with haemophilic arthropathy. However, many PWH live too far from their Haemophilia Comprehensive Care Centre (HCCC) to receive regular treatment at their HCCC. Physiotherapists in primary care may have limited experience with a rare disease like haemophilia.AimTo explore experiences of stakeholders with primary care physiotherapy for PWH and develop recommendations to optimize physiotherapy care coordination.MethodsA RAND approach was used, consisting of a Delphi procedure with e‐mailed questionnaires and a consensus meeting. Included stakeholders were PWH, physiotherapists from HCCC's and primary care physiotherapists. HCCC physiotherapists approached patients from their centre and primary care physiotherapists from their network to fill in the questionnaires. Purposive sampling was used to select participants from the survey sample for the consensus meeting.ResultsNinety‐six primary care physiotherapists, 54 PWH and eight HCCC physiotherapists completed the questionnaire. Subsequently, four PWH, three primary care physiotherapists and four HCCC physiotherapists participated in the consensus meeting. The questionnaires yielded 33 recommendations, merged into a final list of 20 recommendations based on the consensus meeting. The final rank‐order consists of 13 recommendations prioritized by at least one stakeholder.ConclusionCommitment to a formal network is considered not feasible for a rare disease like haemophilia. Development of a practice guideline, easy‐accessible information and contact details, two‐way and open communication between HCCC and primary care and criteria to refer back to the HCCC are recommended.

Study the Prevalence of Depression in Patients Attending Comprehensive Care Centre, Islamabad, Pakistan

Abstract: &#x0D; Depression is one of the most common neuropsychiatric complications of HIV disease, and this leads to worse HIV-related health outcomes. With 350 million people affected worldwide, rates of depression are roughly two times greater in people living with HIV than in the general population.&#x0D; Objective: Determine prevalence of depression in patients attending Comprehensive Care Centre Shifa international Hospital, Islamabad&#x0D; Design: Descriptive cross-sectional quantitative study. &#x0D; Settings: Shifa international Hospital, Islamabad Comprehensive Care Centre,&#x0D; Methods: This data is from a bigger study ‘prevalence of alcohol use disorders and depression in patients attending Comprehensive Care Centre (CCC). The study population consisted of PLWHA attending the CCC. Two hundred and seventy-two (N=272) participants from CCC attendants were recruited. All consenting male and female aged 18-65 years were interviewed using the researcher’s designed questioner to collect their socio-demographic characteristics. Fully completed questionnaires were entered into excel sheets and analyzed using the Statistical Package for Social Sciences (SPSS) Version 20. &#x0D; Results: The overall prevalence of depression was 23.8%, with mild depression at 9.7%, moderate depression at 10.4% and severe depression accounting for 3.7%, respectively. Depression was associated with alcohol use (p=0.024). A significant difference between depression and age where depression levels worsens as age advances; respondents in age category of 18-21 years had less or no depression compared to those in the age category of 33 years and above. We found an association between depression and employment. Those laid-off work (1/3), and the retired (15%) had more depression compared to the employed (11%) or self-employed 6%, with a P value of 0.55 (borderline). On multivariate analysis severity of depression (OR=5.5, 95% CI of OR [2.1 –14.3], p&lt;0.0001) was associated with male gender (OR=10, 95% CI of OR [3.6 –28.3], p&lt;0.0001).&#x0D; Conclusion: The study findings indicate a high prevalence of depressive symptoms in patients attending the CCC. There is need to set-up appropriate interventions and strategies to reduce the prevalence of mental health disorders into routine HIV clinical care and support.

Ssessing the performance of comprehensive health care centers in Aradan district based on the national accreditation model

ssessing the performance of comprehensive health care centers in Aradan district based on the national accreditation model

A cross-sectional study to assess quality of life in 2-18 years children and adolescent living with beta thalassemia major registered at comprehensive thalassemia care centre attached to tertiary care hospital in a metropolitan city

Background: Thalassemia is a serious inherited blood disorder. Children and adolescent living with thalassemia major require lifelong repeated blood transfusions and costly medicines for their survival. In India, β-thalassemia prevalence is 3-4%. Children are basic pillars of society although they are the most vulnerable part of society in view of nutrition, education and social life.Methods: Cross-sectional, observational study was conducted at comprehensive thalassemia care centre attached to tertiary care hospital in a metropolitan city. 76 children and adolescents living with beta thalassemia major aged between 2 to 18 years registered for blood transfusion were included.Results: The mean age of the study subjects was 13.81±6.71 years, 63.2% were males. Majority of study subjects belonged to Hindu religion. 46.3% study subjects were in primary school, 84.21% parents of study subjects gave the history of non-consangious marriage. 92.1% of the study subjects’ parents and their relatives were not aware of history of thalassemia in the family. Genetic counselling was offered to 71.1%. Age of onset of disease was 0-6 months amongst 64.5% of children. 53.9% children had B positive blood group. Total health summary score, emotional health summary score, social health summary score and psychosocial health summary score was better in age group 2-4 years. School health summary score was very low in all age groups.Conclusions: To improve the quality of life of children and adolescent living with beta thalassemia and to reduce catastrophic out pocket expenditure from parents of study subjects, there is need of developing comprehensive thalassemia care center at medical colleges/district hospitals for preventive and promotive health care of children and adolescents.

Deep Venous Stenting Improves Healing of Lower Extremity Venous Ulcers

Long standing, recalcitrant venous ulcers fail to heal despite standard compression therapy and wound care. Stenting of central veins has been reported to assist in venous ulcer healing. This study reports outcomes of deep venous stenting for central venous obstruction in patients with recalcitrant venous ulcers at a single comprehensive wound care center. A single center retrospective analysis was conducted of patients with CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) 6 disease that had undergone deep venous stenting in addition to wound care and compression therapy. Intra-operative details, wound healing, and stent patency rates were recorded. Stent patency and intra-operative details were compared between the healed and unhealed groups. Between 2010 and 2019, 15 patients met inclusion criteria (mean age: 63 years old, 12 males). Pre-operative mean wound area was 14.1 cm2 with mean wound duration of 30 months. 93% of patients healed the ulcers at mean healing time of 10.6 months. Wound recurrence rate was 57% with mean recurrence time of 14.8 months. Ten patients presented with an inferior vena cava (IVC) filter, 4 in the healed group and 6 in the unhealed group. The common iliac vein was stented in all patients. Extension into the IVC was required in 4, the common femoral vein in 11, and femoral vein in 2 patients. The average stent length was 190cm. During the follow-up period, primary patency rates in healed patients (mean follow-up time: 19.2 months) was 83% and 59% in the unhealed group (mean follow-up time: 36.6 months); secondary patency rates were 83% and 89%, respectively. In patients with recalcitrant venous ulcers with central venous obstruction, deep venous stenting resulted in a high rate of healing. However, a prolonged 10 month healing time was observed and despite high stent patency, wound recurrence rate was high.

FACTORS INFLUENCING HIV/AIDS CLIENT SATISFACTION AT COMPREHENSIVE CARE CENTRES IN WAJIR COUNTY, KENYA

Service delivery is one of the core pillars of health systems building blocks and client satisfaction is one of the parameters that is used to assess the status of services offered in an institution. This study investigated the factors that influence HIV/AIDS Client satisfaction at the Comprehensive Care Centre’s (CCCs) in Wajir County. Specific objectives were to assess the influence of availability of HIV/AIDS testing services, availability of HIV drugs, availability of care and support system and the availability of the institutional support towards HIV/AIDS at the CCCs on clients’ satisfaction. A descriptive cross-sectional study was employed where both quantitative and qualitative data were gathered through survey questionnaires and key informant interview guide. Out of the targeted 157 clients at the sub-County and county referral hospitals about 147 positively responded, leading to a 93.6% response rate. SPSS version 24 was used to code and analyze the collected data. Chi-square and Logistic regression analysis were done to determine the relationship between and among the variables. Bivariate analysis revealed a significant relationship between client satisfaction and predictor variables. The results indicated the probability of being satisfied with services in the Comprehensive Care Centre’s was 51.3 per cent higher for people who reported availability of HIV testing services and 56.9 per cent higher for people who reported accessibility of HIV care and social support. Based on the findings, the study’s policy recommendations are hospitals management needs to ensure sufficient HIV testing services are available and accessible to patients. Further, stakeholder collaboration with hospital management is recommended for strengthening service delivery at CCCs in Wajir County.

Comparative Assessment of Anxiety, Pain, and Discomfort During Rapid Maxillary Expansion Using Two Different Activation Protocols in Patients With Cleft Lip and Palate.

The aim of this study was to compare and assess the pain perception, anxiety, and discomfort between two different rapid maxillary expansion (RME) protocols in patients with unilateral cleft lip and palate (UCLP). This is a prospective study. The study was done in a comprehensive cleft care center. The sample included 26 patients between ages 6 and 9 years with a history of repaired UCLP. The patients were randomly allotted into 2 groups-Group A and Group B. Group A received 1 RME activation per day and Group B received 2 activations per day. The participants after RME activation completed a self-report questionnaire and ranked the pain and anxiety levels using Faces pain scale and Hamilton anxiety scale, respectively. The evaluation was done every day for 1 week. The Faces Pain Scale, Hamilton Anxiety Scale, and self-report questionnaires assessed the pain, anxiety, and discomfort experienced by the patients after 2 different types of RME activation protocols. Group B experienced significantly higher pain in the molars than Group A (P < .001). There was no significant difference between the 2 RME activation protocols regarding anxiety and jaw discomfort. Patients who received 2 activations per day experienced significantly higher levels of pain in the molars compared to the patients who received a single activation per day. There were no significant differences between the 2 activation protocols in terms of pain in the palate, tongue, anxiety, and jaw discomfort.

European principles of care for women and girls with inherited bleeding disorders

Despite increasing awareness of issues faced by women and girls with inherited BDs (WGBD), standards of care are lacking, with disparities in diagnosis and treatment for WGBD across Europe. We aimed to develop practical principles of care (PoC) to promote standardization of care for WGBD within European Haemophilia Treatment and Comprehensive Care Centres (HTC/CCCs). The co-creation process, supported by the European Association for Haemophilia and Allied Disorders, consisted of four multidisciplinary meetings with health care providers (HCPs) experienced in WGBD care, and European Haemophilia Consortium representatives, combined with broad patient and HCP consultations in the European haemophilia community. Relevant medical societies outside Europe were contacted for confirmation. We developed ten PoC for WGBD, stressing the importance and benefits of a centralized, multidisciplinary, comprehensive, family-centred approach to support and manage WGBD during all life stages. These PoC emphasise the right to equitable access and quality of care for all people with BDs, irrespective of gender. Multiple medical societies outside Europe also confirmed their support for endorsement. Ten PoC for WGBD evolved from an iterative process among stakeholders, supported by relevant medical societies worldwide. These PoC can serve as a benchmark for diagnosis and comprehensive multidisciplinary management of WGBD, and improve awareness of their unique challenges. They offer a framework to guide HTC/CCCs in providing equitable care for all WGBD, both in their own services and in other healthcare settings. Implementation of these principles aims to positively impact the health, wellbeing and quality of life for WGBD.

Pseudoexfoliation Syndrome and Associated Factors Among Adults at Gondar University Comprehensive Specialized Hospital Tertiary Eye Care and Training Center: A Cross-Sectional Study.

BackgroundPseudoexfoliation syndrome is an age-related disorder characterized by the deposition of a distinct fibrillar extracellular material in various tissues and organs of the body. Glaucoma and cataract are the consistently reported clinical consequences of Pseudoexfoliation syndrome on the eye. This study aimed to estimate the proportion of pseudo-exfoliation syndrome and associated factors in Gondar university comprehensive specialized hospital tertiary eye care and training center.Methods and MaterialsInstitution-based cross-sectional study was conducted from January to March 2019 at Gondar university comprehensive specialized hospital tertiary eye care and training center among 295 patients. Consecutive 295 participants aged above 40 years were involved in the study. A structured questionnaire and ocular examination were used to collect the data. Data were entered into EPI-INFO 3.5.1 and exported to SPSS version 20 for analysis. Factors associated with pseudoexfoliation syndrome were ascertained by chi-square and independent t-test. Statistical significance was considered when p-value <0.05.ResultsA total of 295 adults participated in the study with a response rate of 92.8%. The median (±IQR) age of study respondents was 64(±9) years and 67.8% were males. The proportion pseudoexfoliation syndrome was 34.6% [95% CI: 29.2–40.7%]. The mean IOP and mean age were significantly higher among patients with pseudoexfoliation syndrome. Age, sex, high IOP, glaucoma, outdoor work, and rural residence were significantly associated with the proportion of pseudoexfoliation syndrome.ConclusionThe proportion of pseudoexfoliation syndrome among participants aged ≥40 years was high. Age, sex, high IOP, glaucoma, outdoor work, and rural residence were factors having a significant association with the proportion of pseudoexfoliation syndrome.

Use of Handheld Ultrasound to Estimate Right Atrial Pressure in a Pulmonary Hypertension Clinic

Rationale: Point-of-care ultrasonography is an invaluable asset for inpatient decision-making. Whether handheld ultrasound can be used in the outpatient management of pulmonary hypertension is unknown. Objectives: We investigated whether a handheld ultrasound estimate of right atrial pressure correlates with B-type natriuretic peptide (BNP) and clinical outcome over time in outpatients with pulmonary hypertension. Methods: This prospective study included outpatients in a Pulmonary Hypertension Comprehensive Care Center clinic who had a same-day BNP concentration. We used a handheld ultrasound to measure inferior vena cava size and collapsibility, which were used to estimate right atrial pressure (eRAP) and categorize it as normal, intermediate, or high. Correlation analysis was used to compare these ultrasound measurements with BNP at baseline and over time. Cox regression was used to determine whether these measurements were associated with time to clinical worsening. Results: Ninety patients (60% Group 1 pulmonary hypertension) were enrolled. Patients with an intermediate or high eRAP category at baseline had higher BNP concentrations than patients with normal eRAP. For every transition in eRAP category (e.g., from normal to intermediate) between clinic visits, BNP changed by an average of 155 pg/ml (95% confidence interval [CI], 84-227). Higher baseline eRAP category was independently associated with more than twofold increased risk for clinical worsening (hazard ratio, 2.44; 95% CI, 1.47-4.07). Conclusions: Right atrial pressure estimated by portable handheld ultrasound correlates with BNP at baseline and serially over time. Furthermore, eRAP is independently associated with clinical worsening. The use of portable handheld ultrasound to estimate right atrial pressure should be considered in pulmonary hypertension clinics. Clinical trial registered at clinicaltrials.gov (NCT02873039).

Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers.

Study Registration https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022837,DRKS00022837.BackgroundIntensified oncological treatment for advanced cancer patients at the end-of-life has been specified as aggressiveness of care (AOC) and increased over the past decades. The aims of this study were to 1) determine the frequency of AOC in Central Europe, and 2) investigate differences in mental health outcomes in bereaved caregivers depending on whether the decedent had experienced AOC or not.Materials and methodsWe conducted a cross-sectional study in a large tertiary comprehensive cancer care center in Germany. Bereaved caregivers provided information about (a) treatment within the last month of life of the deceased cancer patient and (b) their own mental health status, i.e., decision regret, complicated grief, depression, and anxiety. After multiple imputation of missing data, differences in mental health outcomes between AOC-caregivers and non-AOC-caregivers were analyzed in a multivariate analysis of variances.ResultsWe enrolled 298 bereaved caregivers of deceased cancer patients. AOC occurred in 30.9% of all patients. In their last month of life, 20.0% of all patients started a new chemotherapy regimen, and 13.8% received ICU-treatment. We found differences in mental health outcomes between bereaved AOC- and non-AOC-caregivers. Bereaved AOC caregivers experienced significantly more decision regret compared to non-AOC caregivers (Cohen’s d = 0.49, 95% CI [0.23, 0.76]).ConclusionAOC occurs frequently in European health care and is associated with poorer mental health outcomes in bereaved caregivers. Future cohort studies should substantiate these findings and explore specific trajectories related to AOC. Notwithstanding, shared-decision making at end-of-life should increasingly account for both patients’ and caregivers’ preferences.

Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary Hospital in Kenya

Background: Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure.&#x0D; Objective: To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya.&#x0D; Methodology: A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet.&#x0D; Results: A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load &lt;1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load &gt; 1000 copies/ ml p&lt;0.012.&#x0D; Conclusion: The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years).&#x0D; Keywords: Adolescents; HIV; Kenya; virologic suppression; young adults.

Prevalence of common mental disorders and associated factors among adults with Glaucoma attending University of Gondar comprehensive specialized hospital tertiary eye care and training center, Northwest, Ethiopia 2020.

PurposeThis study aimed to assess the prevalence of common mental disorders and associated factors among adults with glaucoma at Gondar university comprehensive specialized hospital tertiary eye care and training center. Glaucoma predisposes patients to common mental problems and leads to wasteful, costly and inefficient use of medical services and complications of the diagnoses. So, determining the level and factors associated with common mental disorders among glaucoma patient would help to improve and integrate comprehensive ophthalmic services which address common mental disorder in a follow-up visit.MethodsAn institution-based cross-sectional study was conducted on 495 glaucoma patients selected by using systematic random sampling. Data were collected through face-to-face interview and chart review. Self-reported questionnaire (SRQ-20) was used to assess the presence of common mental disorders. Binary logistic regression analysis was done to identify factors associated with common mental disorders. Variables with P<0.05 were considered as factors significantly associated with common mental disorders.ResultFour hundred sixty-eight patients were included in this study with a response rate of 94.54%. The mean age of the participant was 58 ± 14.11 years. The prevalence of common mental disorders was found to be 29.5% (95% CI 25.4–33.3). Female sex (AOR = 3.79, 95% CI: 1.66–8.62) (p-value = 0.001), average monthly income of less than 1200 birr (AOR = 6.05 95% CI: 2.26–16.22) (p-value = 0.001), poor level of social support (AOR = 17.39 95% CI: 7.79–38.82) (p-value = 0.001), moderate and high risk of alcohol use (AOR = 10.42 95%CI: 2.74–39.54) (p-value = 0.001), presence of chronic medical illness (AOR = 3.85 95% CI: 2.07–7.16) (p-value = 0.001), receiving both drug and surgical treatment (AOR = 2.50, 95%CI: 1.30–4.83) (p-value = 0.006) and presence of systemic carbonic anhydrase inhibitors use (AOR = 3.16, 95%CI: 1.65–6.06) (p-value = 0.001) were significantly associated with increased level of common mental disorders.ConclusionSignificant numbers of glaucoma patients have CMD and found significantly associated with socio-economic, ocular and systemic clinical factors. Therefore, the integration of psychosocial care into the current treatment of patients with glaucoma would have a significant advantage to help these patients.

Screening for Cognitive Dysfunction Using the Rowland Universal Dementia Assessment Scale in Adults With Sickle Cell Disease

Adults with sickle cell disease (SCD) disproportionally experience early cognitive decline; however, guidance on the optimal screening strategy for cognitive dysfunction is lacking, and several available tools are biased by language, educational level, socioeconomic status, and race/ethnicity. The Rowland Universal Dementia Assessment Scale (RUDAS) was specifically designed for cognitive screening in multicultural populations. To ascertain the prevalence of suspected dementia in adults with SCD using the RUDAS, and to identify whether age, sex, educational level, several biological variables, and SCD complications were associated with RUDAS scores. This multicenter, bilingual, cross-sectional study was conducted in 2 SCD comprehensive care centers in Canada (Centre Hospitalier de l'Université Montréal in Montréal and University Health Network in Toronto). Participants were adults aged 18 years or older and were enrolled in the study between July 1, 2018, and July 30, 2019. All outpatients were eligible and offered study participation, unless they had an acute medical condition that required inpatient care or they were unable to follow study instructions. The RUDAS was administered by trained personnel in either French or English, according to the patient's language preference. A questionnaire on social determinants of health was also administered, and participants underwent screening for anxiety and depression. Proportion of participants with RUDAS scores that were suggestive of dementia and the RUDAS score. Any score lower than 23 points was suggestive of dementia, a score between 23 and 27 points indicated a possible association with mild neurocognitive disorder, and a score higher than 27 points was normal. A total of 252 adult patients with SCD were included (136 women [54.0%]; mean [range] age, 34.8 [18-75] years). Overall, 29 patients (11.5%) had RUDAS scores that were suggestive of dementia, and this proportion increased with age (15 [8.7%] in the 18-39 years age group, 10 [14.5%] in the 40-59 years age group, and 4 [36.4%] in the ≥60 years age group). The RUDAS scores were not associated with sex, language, SCD genotype, and SCD complications. The highest level of education was significantly associated with the RUDAS score; however, the association was small (η2 = 0.02; 95% CI, 0.00-0.07; P = .02). In a multivariable analysis, lower glomerular filtration rate (r = 0.40; 95% CI, 0.29-0.50; P < .001) and increasing age (r = -0.37; 95% CI, -0.47 to -0.26; P < .001), but not SCD genotype or disease severity, were associated with lower RUDAS scores. This study found that using the RUDAS revealed a high prevalence of suspected dementia in adult patients with SCD that was associated with worsening kidney function and age. Cognition should be screened in all adult patients with SCD, regardless of age, disease severity, and SCD genotype; further validation of the RUDAS is ongoing.

CBR3 V244M is associated with LVEF reduction in breast cancer patients treated with doxorubicin

BackgroundThe CBR3 V244M single nucleotide polymorphism has been linked to the risk of anthracycline-related cardiomyopathy in survivors of childhood cancer. There have been limited prospective studies examining the impact of CBR3 V244M on the risk for anthracycline-related cardiotoxicity in adult cohorts.ObjectivesThis study evaluated the presence of associations between CBR3 V244M genotype status and changes in echocardiographic parameters in breast cancer patients undergoing doxorubicin treatment.MethodsWe recruited 155 patients with breast cancer receiving treatment with doxorubicin (DOX) at Roswell Park Comprehensive Care Center (Buffalo, NY) to a prospective single arm observational pharmacogenetic study. Patients were genotyped for the CBR3 V244M variant. 92 patients received an echocardiogram at baseline (t0 month) and at 6 months (t6 months) of follow up after DOX treatment. Apical two-chamber and four-chamber echocardiographic images were used to calculate volumes and left ventricular ejection fraction (LVEF) using Simpson’s biplane rule by investigators blinded to all patient data. Volumetric indices were evaluated by normalizing the cardiac volumes to the body surface area (BSA).ResultsBreast cancer patients with CBR3 GG and AG genotypes both experienced a statistically significant reduction in LVEF at 6 months following initiation of DOX treatment for breast cancer compared with their pre-DOX baseline study. Patients homozygous for the CBR3 V244M G allele (CBR3 V244) exhibited a further statistically significant decrease in LVEF at 6 months following DOX therapy in comparison with patients with heterozygous AG genotype. We found no differences in age, pre-existing cardiac diseases associated with myocardial injury, cumulative DOX dose, or concurrent use of cardioprotective medication between CBR3 genotype groups.ConclusionsCBR3 V244M genotype status is associated with changes in echocardiographic parameters suggestive of early anthracycline-related cardiomyopathy in subjects undergoing chemotherapy for breast cancer.

Association of blood culture with carbapenem use in pyogenic liver abscess: a two-center retrospective study

BackgroundHighly empiric use of carbapenem in pyogenic liver abscess (PLA) is widespread problem. However, few studies have examined the association between blood culture and carbapenem use in patients with PLA in China. Thus, we conducted this observational study.MethodsThe data of patients diagnosed with PLA at two comprehensive tertiary care centers from 2014 to 2020 were retrospectively collected. Demographic and clinical data were analyzed, and univariate and multivariate analyses were performed to investigate the association between blood culture and carbapenem use. Subgroup analysis was conducted to explore whether the effect is different in sepsis.ResultsBlood culture was performed in 110 (46.0%) patients, of whom 44 (40.0%) patients had positive results for bacterial culture. Extended-spectrum beta-lactamase (ESBL)-positive blood culture isolates were detected in 8 (7.3%) patients. The positivity rate of blood culture in sepsis was higher than in non-sepsis (58.1% vs. 32.9%, P = 0.015). Fewer patients who had a blood culture received carbapenem treatment in comparison to patients without blood culture (19.1% vs. 31.8%, P = 0.026). Multivariate analysis showed that blood culture was independently associated with less carbapenem exposure (adjusted odds ratio [OR] = 0.33, 95% confidence interval [CI]: 0.16–0.68, P = 0.003), and this effect remained significant in the sepsis subgroup (adjusted OR = 0.17, 95% CI: 0.05–0.53, P = 0.002).ConclusionBlood culture had a high positivity rate and was associated with less carbapenem use in PLA, especially those who developed sepsis. More attention should be paid to performing early blood culture and less carbapenem use in PLA.

Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary hospital in Kenya.

Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure. To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya. A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet. A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load <1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load > 1000 copies/ml p<0.012. The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years).

Health care professionals\u2019 attitudes towards youth-friendly sexual and reproductive health services in Jordan: a cross-sectional study of physicians, midwives and nurses

BackgroundYouth-friendly sexual and reproductive health (SRH) services are thought to make such services for adolescents more accessible and acceptable; however, provider attitudes may still present an important barrier. Improving youth SRH service utilization has been recognized as a national priority in Jordan; however, existing services remain underutilized. Previous studies found that youth perceive SRH services to be inadequate and that providers are not supportive of their needs. The purpose of this study is measure provider attitudes towards youth-friendly SRH services and explore their variation according to individual characteristics among health care professionals in Jordan.MethodsWe measured provider attitudes towards youth-friendly SRH services using a scale that was developed and validated in Jordan. The scale consists of three subscales: (1) Attitudes towards SRH information and services offered to youth, (2) Norms and personal beliefs, and (3) Attitudes towards the policy and clinical environment. Possible scores range between 1 and 4, with higher scores reflecting more youth-friendly attitudes. Physicians, midwives and nurses working at either primary health centers, comprehensive care centers, or women’s and children’s health centers where services to adolescents are or should be offered were recruited from four governorates in Jordan using a two-stage, cluster sampling scheme. Differences in attitudes were assessed using simple and multivariable linear regression analysis.ResultsThe sample consisted of 510 providers from four governorates in Jordan. The mean provider score on the full scale was 2.7, with a range of 2.0 to 3.8. On Subscales 1 and 2, physicians exhibited significantly more youth-friendly attitudes than nurses by scoring 0.17 points higher than nurses on Subscale 1 (95% CI: 0.02–0.32; p < 0.05) in adjusted analyses. Providers who had been previously trained in SRH issues scored 0.10 points higher (95% CI: 0.00—0.20; p < 0.05) than those who had not on Subscale 3. No differences were found according to provider characteristics on Subscale 2. Providers exhibited the lowest scores related to items referencing youth sexual behavior.ConclusionsProvider attitudes towards youth-friendly SRH service delivery highlight context-specific, cultural concerns. The limited variation in attitudes related to norms and personal beliefs may be a reflection that such beliefs are deeply held across Jordanian society. Last, as past training on SRH was significantly associated with higher scores, our results suggest opportunity for intervention to improve providers’ confidence and knowledge.

Organizational Strategies for Providing Cancer Palliative Care to Many.

Hospitals and healthcare organizations are today operating in an extremely competitive environment, with increasing pressure to improve quality while reducing costs. In responding to this dynamic situation, transformation of any organization requires the will to organize delivery around the needs of patients. Providing palliative care to the many who require it needs the value agenda to be formulated based on mutually reinforcing components. Here we present an overview of the framework for a palliative care department in a comprehensive cancer center, which includes different levels that are embedded within a comprehensive system. Detailed information on each level is presented, followed by a discussion of quality of care, as an integrating theme for the framework. The chapter concludes by detailing the benefits that a comprehensive cancer palliative care center provides to a country's healthcare efforts through service, education, research, and advocacy.