Set Of Guidelines Research Articles

A Qualitative Exploration of Moderating Factors Shaping Implementation Fidelity to Post-Abortion Care Guidelines in Chibombo District, Zambia

Abstract We sought to identify and describe modifying factors influencing adherence to the post-abortion care guidelines, as well as potential strategies to address them in rural health facilities of Chibombo District, Zambia. We used a qualitative descriptive approach, drawing on key informant interviews with program managers (n = 4) and in-depth interviews with post abortion care providers (n = 22). We adopted Carroll et al.‘s Framework for Implementation Fidelity which prescribes four categories of potential moderating factors that may shape adherence to post abortion care guidelines including comprehensiveness of policy description, facilitative implementation strategies, patient responsiveness, and quality of delivery. We analyzed the interview data using deductive thematic analysis. The study revealed shortcomings in the comprehensive description and dissemination of post abortion care guidelines, underscored by limited provider understanding and reference to them during practice, and delayed dissemination of any guideline changes or updates. Facilitative implementation strategies encompassed monitoring and supervision, technical and administrative support, documentation and audit, and community engagement. Inadequate provider training, inconsistent post abortion care drug supply, weak referral mechanisms and funding gaps affected the quality of delivery of post abortion care services. Lastly, patient responsiveness was affected by non-compliance to the guidelines and community reliance on self-treatment. There is a critical need for comprehensive training, supply chain improvements, and stronger health system support to ensure adherence to post-abortion care guidelines in rural settings. Such initiatives may have far-reaching implications for maternal health outcomes and general health equity.

Using Digital Integrated Community Case Management to Strengthen Protocol Adherence Over the Sick Child Recording Form for Under‐Five Children Referrals From Community to Higher Level Facilities in Malawi: Affordance Perspective

ABSTRACTAn effective referral system at the community level of healthcare for under‐five children manages health needs by fostering relationships across all levels of healthcare, enabling patients to receive the best possible care and, in the process, saving lives. However, identifying those who need urgent referral mostly depends on community health workers (CHWs) commitment, which some studies have found inadequate due to nonadherence to the integrated Community Case Management (iCCM) Protocol, a protocol aimed at reducing child mortality and morbidity. Studies have shown that employing mobile Health (mHealth) may circumvent some of the limitations of paper‐based iCCM protocol for patient referrals, which include assessment and treatment of under‐five children. Despite the known benefits of mHealth in supporting CHWs, studies analyzing how the affordance of digital iCCM may strengthen protocol adherence over paper‐based iCCM are lacking. Therefore, the purpose of this study is to analyze how the actualization of digital iCCM may strengthen protocol adherence over the SCRF, consequently, improving referrals from the community to the higher‐level facilities for specialized treatment. The data captured from interviews, focus groups, informal chats, observation and document analysis were transcribed and analyzed using thematic analysis. We found that the Sick Child Recording Form faces challenges due to nonadherence to set guidelines, resulting in misclassification, incorrect drug prescriptions, and consequently, delays in referring patients with acute symptoms to health facilities for specialized treatment. As a contribution, this paper offers a new perspective on the technological affordances of digital iCCM that strengthen protocol adherence in patients' referrals from the community to the higher‐level facilities that include assessment and treatment.

Barriers and enablers for implementation of clinical practice guidelines in maternity and neonatal settings: A rapid review.

Maternity and neonatal services are rapidly changing in Australia because of evolving needs of the community and patient population. Clinical practice guidelines focused on early interventions and prevention strategies can decrease risk for preventable negative health outcomes in this population. However, despite the existence of several clinical practice guidelines, their translation into practice remains problematic for healthcare services. To identify barriers and enablers for the implementation and adoption of clinical practice guidelines in maternal and neonatal settings. A rapid review was conducted according to Cochrane and World Health Organization guidelines. Systematic reviews, qualitative, quantitative and mixed-methods studies related to clinical guidelines in maternal and neonatal settings published in English Language between 2010 and 2023 meeting study eligibility criteria were identified using PubMed, Cochrane CENTRAL, EMBASE, and CINAHL databases. Forty-eight studies originating from 35 countries were reviewed, representing practice guidelines associated with maternal and neonatal care. Identified barriers and enablers aligned to five main themes related to the contextual level of impact: (i) healthcare system and systemic factors, (ii) patient and population, (iii) guidelines and standards, (iv) organisational capacity, and (v) health professional practice. Findings from this review shed light on the challenges and opportunities associated with introducing clinical practice guidelines in maternal and neonatal care settings. Implementation of guidelines into practice is complex, with different factors affecting their adoption and their use within healthcare settings. Addressing the multifaceted challenges associated with the implementation of clinical practice guidelines in maternal and neonatal care demands a comprehensive and collaborative strategy. Successful adoption of guidelines requires the involvement of stakeholders at all levels, supported by ongoing evaluation, feedback, and dedication to evidence-based practices.

Psychological Distress, Antipsychotic Medications and Cardiovascular Risk Factors Among Patients With Schizophrenia.

This study aims to assess the correlation between antipsychotic drug use, psychological distress and cardiovascular risk factors among patients with schizophrenia. A cross-sectional correlational design was used to obtain data from 143 patients with schizophrenia who were conveniently selected. Data were collected by assessing selected cardiovascular risk indicators blood pressure (BP), random blood sugar (RBS), body mass index (BMI), waist-to-height ratio (WtHR) and waist circumference (WC). A self-administered questionnaire was used to collect sociodemographic data, clinical history and the 18-item Psychological Stress Index for patients with schizophrenia. The use of antipsychotics was associated with increased cardiovascular risk factors including BP, BMI and WtHR. Atypical antipsychotic medications were associated with weight gain and obesity which increase the risk of diabetes and cardiovascular diseases. Age was significantly correlated with systolic BP (r = 0.31), diastolic BP (r = 0.30) and RBS (r = 0.26). Furthermore, significant correlations were found between the duration of diagnosis with systolic (r = 0.26) and diastolic (r = 0.21) BP. None of the correlations between stress and the other study variables were significant. Screening of antipsychotic side effects is needed in the early phases, and attention must be paid to the cardiovascular risk in patients with schizophrenia, particularly BP, glucose level and BMI. In addition, clinicians should be informed of this evidence to set guidelines for regular monitoring of metabolic parameters. STROBE guidelines were followed in this study. Actively involving patients in data collection, this study ensured that their voices were heard and their experiences were central to informing the research findings. In addition, involving patients in the study would enhance the relevance and applicability of the study's conclusions to real-world contexts, promoting patient-centered care and improved health outcomes for patients with schizophrenia.

Asian adult sleep medicine fellowship training curriculum: one curriculum, many contexts.

To develop a comprehensive Asian adult sleep medicine fellowship training curriculum to address the significant disparities in sleep medicine training across Asia, guided by the principle of "One Curriculum, Many Contexts," providing a standardized yet adaptable framework for sleep medicine education across the diverse healthcare landscapes of Asian countries. The curriculum development process involved a gap analysis, comprehensive literature review, and expert consensus through a modified RAND appropriateness method (RAM)/Delphi survey. The curriculum offers two flexible tracks: a one-year program (Track A) and a two-year program (Track B), accommodating varied educational pathways and healthcare system structures across Asia. Key features of the curriculum include detailed learning outcomes, competency-based educational content, and recommendations for teaching and learning activities. The assessment strategy incorporates summative and formative methods, with standard setting and program evaluation guidelines. The curriculum also provides recommendations for program accreditation, fellow-faculty ratios, and funding considerations. The Asian adult sleep medicine fellowship training curriculum provides a standardized yet adaptable framework for sleep medicine education across diverse Asian healthcare landscapes. By emphasizing flexibility and customization while maintaining high training standards, the curriculum aims to bridge the gap in sleep medicine training across Asia, ultimately improving the quality of sleep healthcare and patient outcomes throughout the region.

HSD72 Real World Evidence on Impact of Clinical Decision Support System (CDSS) Alerts on General Practitioners Adherence to the New Gastro-Oesophageal Reflux Disease Treatment Guidelines in German Primary Care Settings

HSD72 Real World Evidence on Impact of Clinical Decision Support System (CDSS) Alerts on General Practitioners Adherence to the New Gastro-Oesophageal Reflux Disease Treatment Guidelines in German Primary Care Settings

A Retrospective Audit of Osteoporosis Management Following Fragility Fractures in a Hospital Setting.

Background Fragility fractures, often caused by osteoporosis, are a major public health concern among the growing population of the United Kingdom (UK). In addition to being a major source of illness and mortality, the rising incidence of osteoporosis places a heavy strain on healthcare systems if it is not adequately managed. In order to lower the risk of additional fractures, current guidelines place a strong emphasis on the timely evaluation and treatment of fragility fractures. Methods This retrospective audit was carried out in Warrington Hospital, UK, to examine the management of fragility fractures in patients aged 65 years and above across two cycles (January to March 2022 and April to May 2023, respectively). All data was obtained from electronic medical records, and management was assessed, including treatment with bisphosphonates, vitamin D, dual-energy X-ray absorptiometry (DEXA) scansand further referrals for metabolic bone clinics. Results The first cycle included 144 inpatients and showed significant under-utilization with only 16% receiving bisphosphonates treatment (23 inpatient prescriptions), low referrals for DEXA scan and metabolic bone clinics. Assessment and supplementation of vitamin D was also suboptimal. The second cycle of the audit reviewed 165 patients and showed minor improvement in bisphosphonates prescription, although post-discharge rates were low with around 80% of patients (104 of 131, as 34 patients were prescribed while inpatient) not receiving medications. The DEXA scans and metabolic bone clinic referrals also remained inadequate in the second cycle. Conclusions This audit highlighted the significant gap in the management of fragility fractures and persistent deficiencies in spite of robust guidelines and interventions set by various bodies. The implementation of treatment guidelines for osteoporotic patients at hospital level can help in timely initiation of antiresorptive therapy, DEXA scans and utilisation of metabolic bone clinics to optimise outcomes and reduce the burden on healthcare systems. There is a need for further research and education to improve this adherence to set guidelines and improve outcomes.

Identifying relevant diabetes and hypertension control management guidelines in primary healthcare and community settings in Indonesia: A Delphi survey.

The burden of non-communicable diseases (NCDs) in Indonesia is increasing, as evidenced by the latest Indonesian National Health Research, which shows an increase in diabetes prevalence, from 6.9% in 2013 to 10.9% in 2018, and hypertension, from 25.8% in 2013 to 34.1% in 2018. Hence, effective actions in community and primary health care (PHC) facility settings are necessary to tackle the burden of diabetes and hypertension, especially in low- and middle-income countries. The Indonesian government has issued numerous guidelines regarding NCDs. However, not all these guidelines can be applied to communities or PHCs. This study aimed to identify priority guidelines to support the community and PHC for NCD management using the Delphi survey method. These prioritized guidelines will serve as valuable resources for developing relevant, operational and comprehensive modules for community cadres and PHC staff involved in NCD management. The Delphi survey involved 25 experts and comprised three rounds using a questionnaire: 1) identification and assessment of guidelines, 2) assessment of the importance of guidelines, and 3) nomination of the three main priority guidelines. The results revealed three priority guidelines: NCD management guidelines, technical guidelines for Pos Pembinaan Terpadu (POSBINDU) NCDs, and integrated services for NCDs in PHC facilities. Additionally, priority guidelines were used to develop operational modules for community cadres and PHC staff in NCDs management. In conclusion, utilizing the Delphi method serves as a scientific approach to identify priority guidelines crucial for supporting the community and PHC in managing NCDs, particularly in countries with contexts similar to Indonesia.

Современные перспективные тренды профессиональной подготовки сотрудников уголовно-исполнительной системы в условиях цифровизации образования

The article examines the current promising trends in the professional training of employees of the penitentiary system. The conducted express review of modern aspects of professional training of employees of the penal enforcement system allows us to identify the following trends: the use of distance learning technologies, along with traditional training, and a competent combined version of their use and "necessary castling" in the textbook of academic disciplines; regular interactive interaction of subjects of the educational process through an electronic information and educational environment; the use of multimedia technologies as additional learning tools in modern education; additional classes with students on digital hygiene in interaction with various information systems and software products; the use of electronic textbooks, audio-visual aids and interactive courses as alternatives to traditional textbooks, teaching aids in printed form; the use of webinars as an effective form of interactive classes with students; the possibility of developing cognitive processes (attention, memory, thinking, etc.) in students through the use of intelligence simulators - on the example of professional training of psychologists of law enforcement agencies; personalized training. The relevance and discussion of relatively new concepts in modern education, psychology and pedagogy, which are designated as "digital engagement" and "digital professionalism", is noted. Today, the digital transformation of scientific and educational activities sets guidelines for the key areas of development of modern Russian education, taking into account the values for both students (students, cadets, employees of the penal correction system) and the state as a whole.

The Impact of Diagnostic Laparoscopy on Upstaging Patients with Siewert II and III Gastroesophageal Junction (GEJ) Cancer

BackgroundThe efficacy of routine diagnostic laparoscopy with cytologic evaluation for gastroesophageal junction (GEJ) cancer is variable with no set guidelines. We hypothesize that findings from diagnostic laparoscopy in Siewert II and III GEJ tumors may differ, where routine diagnostic laparoscopy with washings yields low upstaging results in Siewert II compared with Siewert III tumors.Patients and MethodsWe reviewed patients with Siewert II/III GEJ cancer from 2012 through 2022 within our integrated health system. Chi-squared, Fisher’s exact, and two-sample Wilcoxon rank-sum tests were utilized. The outcomes measured include likelihood of upstaging, cytology positivity, times to chemotherapy and surgery, and 5-year mortality using a multivariable Cox regression model.ResultsOf 265 patients with Siewert II diagnosis, 116 patients underwent a diagnostic laparoscopy while 149 patients did not. Median time to chemotherapy initiation and definitive surgery were increased among patients with diagnostic laparoscopy, with no difference observed in 5-year survival. For patients with Siewert II and III with a diagnostic laparoscopy, 5% of Siewert II were upstaged, compared with 17% of Siewert III (p = 0.025). Obtaining cytologic washings alone were less likely to be upstaged compared with receiving a biopsy with or without washings (5.2% vs. 17.3%, p = 0.039), and those with Siewert II were less likely than Siewert III to be upstaged after diagnostic laparoscopy (5.2% vs. 17.4%, p = 0.025).ConclusionsRoutine diagnostic laparoscopy yields a low upstaging rate in Siewert II GEJ adenocarcinomas (AC) while delaying treatment with no improvement on mortality. Expediting definitive surgery with selective biopsy in lieu of diagnostic laparoscopy may improve oncologic outcomes.

Development of a Human Factors Based Guideline to Support the Design, Evaluation and Continuous Improvement of Clinical Decision Support

ObjectiveTo develop a vendor-agnostic, Human Factors (HF) based guideline to guide the design, evaluation, and continuous improvement of clinical decision support (CDS). Participants and MethodsThe study utilized a two-phased iterative approach between June 2022 to June 2024. Phase 1 involved a search for relevant industry standards and literature, and consultation with multidisciplinary subject matter experts. Phase 2 involved a workshop with 30 healthcare and academic stakeholders to evaluate face validity and perceived usefulness of the initial section of the guideline. Participants were asked if the guideline met their expectations, to report on usefulness and ease of use, and to suggest areas for improvement. ResultsPhase 1 resulted in a compilation of accessible, best practice and context appropriate HF guidance for CDS design and optimization. The guideline supports users in determining whether use of CDS is appropriate, and if yes, CDS options and design guidance. During Phase 2, the guideline addressed 15 of participants’ 19 expectations for a CDS guideline. Participants said the guideline was helpful, comprehensive, easy to use, and provided step by step guidance, boundaries and transparency around CDS decisions. Participants recommended strengthening guidance around the need to understand system capabilities and the technical burden or complexity of CDS, and further guidance on how to approach CDS optimization using the guideline. ConclusionThe two phased iterative development and feedback process resulted in the development of a HF-informed guideline to provide consolidated, accessible and current best practice guidance on the appropriateness of CDS and CDS options, as well as designing, evaluating and continuously improving CDS. Future work will evaluate the impact and implementation of the guideline in real world settings.

Institutionalising guideline development in a new universal healthcare system: a study in Cyprus

Abstract Issue Guideline development is a lengthy and diligent process that involves the assessment and interpretation of evidence by a committee. Whilst the implementation of high quality healthcare guidelines ensures consistency and quality in healthcare delivery, many countries worldwide, including Cyprus, lack the capacity and resources to develop de novo guidelines. Description of the problem Guidelines developed by internationally recognised organisations, such as NICE, are a valuable resource for countries like Cyprus. The collaboration between NICE and the newly established healthcare system in Cyprus introduced a process for guideline institutionalisation, taking advantage of existing human resources and building guideline development capability in Cyprus. Results This process involved recruiting local professionals to form a guideline secretariat. The secretariat, supported by NICE, is responsible for overseeing the guideline development process including technical expert committee (TEC) recruitment and stakeholder consultation. The TEC contextualise an existing NICE guidelines to reflect local considerations. NICE provides quality assurance to ensure changes are contextual in nature and consistent with the underpinning evidence. Despite initial challenges, getting stakeholder buy-in and engaging healthcare professionals in the TEC, one contextualised guideline has been produced and two others are at the final stage. Lessons Guideline contextualisation is an efficient and sustainable way of building guideline development capability to institutionalize guidelines in settings with limited capacity. Key messages • De-novo guideline development is time consuming and demanding and many countries require an alternative process for producing locally relevant guidelines, capitalising on existing resources. • Support by an established organisation ensures quality, is less resource intensive, and builds capability for the sustainability of the process.

Vocational Education Administration, Bilateral System under the Office of the Vocational Education Commission Kalasin Province

Background and Aims: Vocational education administration Dual system of educational institutions under the Office of the Vocational Education Commission. It is a professional education arrangement that arises from an agreement between an educational institution and a business establishment. The main objective is to develop and train professional skills for students. To prepare for future work the objectives of this research are to study the following: (1) Level of administration of vocational education, dual system, of vocational education in Kalasin Province. According to the standards for managing vocational education in the dual system of the Vocational Education Commission. To assess the quality and efficiency of operations at the operational level. 2) Compare the level of vocational education administration in the dual system of vocational education in Kalasin Province. To find differences in management in various areas and the use of various approaches to develop educational quality. (3) Study guidelines for promoting or developing the administration of vocational education, a dual system, of educational institutions under the Office of the Vocational Education Commission, Kalasin Province. To suggest ways to improve and develop educational administration to be more efficient. Methodology: In this research the sample group used was a total of 196 people. The research tool was a questionnaire with a 5-level rating scale, which had a confidence value of 0.81 and an internal consistency (IOC) in the range of 0.6-1.00. This questionnaire was designed to inquire about the administration of vocational education. Dual system of educational institutions under the Kalasin Provincial Vocational Education Institute. For data analysis use basic statistics, including frequency, percentage, mean, standard deviation and statistical tests used to compare differences, including t-test and F-test. Results: The results of the research found that: (1) Vocational education administration overall, it was at a high level. (2) Results of comparative analysis of opinions regarding vocational education administration classified by position, educational level, and size of educational institution found that there was no difference. (3) Guidelines for developing vocational education administration It is necessary to be supported and encouraged to be able to develop and adapt to the changes in today's industrial world. The various areas that should be developed include: 1) Quality of graduates: They must have knowledge and abilities that are accepted by the industry. 2) Curriculum development: Curriculum should be developed together with entrepreneurs and other stakeholders. 3) Measurement and evaluation: An effective measurement and evaluation system should be developed. 4) Cooperation between Educational institutions and business establishments: There should be strong relationships and cooperation in developing students. Conclusion: Vocational education administration Dual system of educational institutions under the Office of the Vocational Education Commission Kalasin Province. It is necessary to strengthen cooperation between educational institutions and enterprises. By giving the private sector an opportunity to participate in setting criteria and guidelines in various areas to be clear and consistent with the needs of the labor market. In this regard, there should be an effective evaluation process in order for management to be systematic and produce good results.

Adherence to IMCI guidelines for key symptoms in Ethiopian children: A 2021-2022 national service provision survey.

The Health Services Provision Assessment in Ethiopia (SPA-ET) is a survey that generates data on the availability and quality of health services in Ethiopia. Despite the presence of integrated management of childhood illness guidelines in healthcare settings, there has been inadequate exploration or assessment of how effectively and consistently health professionals follow the guidelines. This study aims to identify factors influencing healthcare worker adherence to the integrated management of childhood illness guidelines to identify spatial clusters. The data for this study were gathered from the Service Provision Assessment (SPA) survey in Ethiopia, which was conducted nationwide from August 11, 2021, to February 4, 2022. It included a total of 788 health professionals who assessed sick children experiencing at least one of the three main childhood illness symptoms: fever, cough, or diarrhea. We employed STATA version 16 for data analysis, utilizing cross-tabulations to explore relationships between variables and logistic regression modeling to identify factors influencing adherence. To account for the hierarchical structure of the health survey data, we employed multilevel logistic regression. Model selection was based on comparison parameters including the Bayesian Information Criterion (BIC) and Akaike Information Criterion (AIC). We computed adjusted odds ratios with 95% confidence intervals, and statistical significance was determined at a significance level of p < 0.05. The rate of adherence to the integrated management of childhood illness guideline was 33% (95% CI: 29.70%, 36.26%). The analysis revealed several factors influencing adherence to IMCI protocols. child's age (being ≥24 months) [aOR = 0.66, 95% CI: (0.45, 0.87)], facility type (health center) [aOR = 2.61, 95% CI: (1.84, 3.37)], place of residency (being rural) [aOR = 0.54, 95% CI: (0.38, 0.77)], and care provider's qualification (health officer) [aOR = 1.71, 95% CI: (1.18, 2.48)] were all statistically significant. Moreover, the primary cluster is situated in the west Oromia region, with a central focus at coordinates (7.982108 N, 36.203355 E) and extends to a radius of 78.28 km. This study confirms a low adherence rate (33%) among health professionals in Ethiopia to the IMCI guideline for assessing the three main symptoms of sick children. The study identified child's age, facility type, academic qualification, and place of residence as crucial factors correlated with adherence rate. Furthermore, 5 secondary clusters (hotspot areas) were identified using SaTScan software. To address the higher protocol refusal, interventional plan needs to be based on academic qualification of care provider, facility type, age of child and place of residency. Moreover, interventions to reduce non-adherence to IMCI guidelines should be location-tailored based on identified hotspot areas to restore guidelines adherence equality.

A unified longitudinal trajectory dataset for automated vehicle

Automated Vehicles (AVs) promise significant advances in transportation. Critical to these improvements is understanding AVs’ longitudinal behavior, relying heavily on real-world trajectory data. Existing open-source trajectory datasets of AV, however, often fall short in refinement, reliability, and completeness, hindering effective performance metrics analysis and model development. This study addresses these challenges by creating a Unified longitudinal trajectory dataset for AVs (Ultra-AV) to analyze their microscopic longitudinal driving behaviors. This dataset compiles data from 14 distinct sources, encompassing various AV types, test sites, and experiment scenarios. We established a three-step data processing: 1. extraction of longitudinal trajectory data, 2. general data cleaning, and 3. data-specific cleaning to obtain the longitudinal trajectory data and car-following trajectory data. The validity of the processed data is affirmed through performance evaluations across safety, mobility, stability, and sustainability, along with an analysis of the relationships between variables in car-following models. Our work not only furnishes researchers with standardized data and metrics for longitudinal AV behavior studies but also sets guidelines for data collection and model development.

Canine epilepsy/seizure occurrence in primary care and referral populations: a look into the epidemiology across countries.

Epilepsy is a common neurological condition in dogs. Analysis of primary care populations across countries can provide a more complete understanding of the epidemiology of this condition and provide context for spectrum of care discussions. This narrative literature review was aimed at understanding canine epilepsy/seizure prevalence in primary care populations, and changes in occurrence across geography, culture, and socioeconomic status. There are few studies to give insight into the true general population of epileptic canines and there is inconsistency in the literature regarding the standards applied for epilepsy diagnosis across primary care and referral practices. Therefore, the future focus should be on more epidemiological research in primary care and mixed populations, more veterinary education to standardize use of medical guidelines in primary care settings, and increased awareness of the benefits of having pet insurance to mitigate the potentially substantial cost of care for dogs with epilepsy.

Personalized Medicine: The Dawn of a New Era in Healthcare

The landscape of healthcare is transforming with the advent of personalized medicine, an approach that alters medical treatment to each individual's specific characteristics. This paradigm shift is driven by advancements in genomics, molecular biology, and bioinformatics, which have developed a deeper understanding of the genetic and molecular basis of diseases. This new healthcare model is based on precision and individualization, aiming to provide customized healthcare with medical decisions and treatments by considering variability in genes, environment and lifestyle of an individual patient and offer accurate diagnosis, better treatments and prevention plans. The accomplishment of the Human Genome Project in 2003 was a significant advancement in genomics that provided blueprints of the human genome [1]. Rapid progress in genomic sequencing technologies makes it feasible and cost effective. Advanced sequencing techniques including next-generation sequencing allow a detailed analysis of genetic makeup to locate mutations and genetic predispositions for better treatment decisions. Cancer is caused by genetic heterogeneity and has benefited greatly from genomic insights. Molecular profiling of tumor cells allows the identification of specific genetic mutations involved in cancer pathogenesis. Targeted therapies can then be designed to inhibit these specific molecular pathways, leading to more effective and less toxic treatments compared to traditional chemotherapy. For example, in breast cancer the identification of Human epidermal growth factor receptor 2 (HER2) mutations has led to the development of HER2-targeted therapies to improve treatment [2]. Besides oncology, personalized medicine is making progress in other fields. In cardiology, genetic testing allows identification of patients who are at risk of getting inherited cardiovascular diseases. In pharmacology, pharmacogenomics, the study of correlation between genes and immune response of an individual to drugs helps in designing most effective drugs with the least side effects for each patient. In infectious diseases, genomic sequencing of pathogenic microbes can lead to development of appropriate antimicrobial drugs to prevent outbreaks. Despite its progress, the implementation of personalized medicine is facing several challenges. The utilization of genomic data in clinical workflows demands significant changes to healthcare setting and training with concerns about data privacy, equal access to diverse populations and the ethical implications of genetic information. Currently, the universal unavailability of sophisticated bioinformatics tools to interpret complex genomic data is also a challenge. Researchers and policymakers must work in to set guidelines and standards for safe use of personalized medicine. Therefore, personalized medicine is a promising tool, which has revolutionized diagnosis, treatment, and prevention in traditional medicine. Using genomics and molecular biology, we can develop a more precise, predictive, and personalized approach to medicine. This exciting frontier must be navigated with the ultimate goal of improving patient outcomes.

High-dose colistin pharmacokinetics in critically ill patients receiving continuous renal replacement therapy

BackgroundColistin, administered as intravenous colistimethate (CMS), is still used in the critical care setting and current guidelines recommend high dosage CMS in patients undergoing continuous renal replacement therapy (CRRT). Due to the paucity of real-life data, we aimed to describe colistin pharmacokinetic/pharmacodynamic (PK/PD) profile in a cohort of critically ill patients with infections due to carbapenem-resistant (CR) bacteria undergoing CRRT.ResultsAll consecutive patients admitted to three Intensive Care Units (ICUs) of a large metropolitan University Hospital, treated with colistin for at least 48 h at the dosage of 6.75 MUI q12, after 9 MIU loading dose, and undergoing CRRT were included. After the seventh dose, patients underwent blood serial sampling during a time frame of 24 h. We included 20 patients, who had CR-Acinetobacter baumannii ventilator-associated pneumonia and were characterized by a median SAPS II and SOFA score of 41 [34.5–59.3] and 9 [6.7–11], respectively. Fifteen patients died during ICU stay and six recovered renal function. Median peak and trough colistin concentrations were 16.6 mcg/mL [14.8–20.6] and 3.9 mcg/mL [3.3–4.4], respectively. Median area under the time–concentration curve (AUC0 − 24) and average steady-state concentration (Css, avg) were 193.9 mcg h/mL [170.6–208.6] and 8.07 mcg/mL [7.1–8.7]. Probability of target attainment of colistin pharmacodynamics according to the fAUC0 − 24/MIC target ≥ 12 was 100% for MIC ≤ 2 mcg/mL and 85% for MIC = 4 mcg/ML, although exceeding the toxicity limit of Css, avg 3–4 mcg/mL.ConclusionsIn critically ill patients with CR infections undergoing CRRT, recommended CMS dosage resulted in colistin plasmatic levels above bacterial MIC90, but exceeding the safety Css, avg. limit.Trial registrationThis trial was registered in ClinicalTrials.gov on 23/07/2021 with the ID NCT04995133 (https//clinicaltrials.gov/study/NCT04995133).

WP4.1 - Costs of acute appendicitis in COVID-19 pandemic period: a cohort study

Abstract Aims During COVID 19 pandemic, aerosol generating procedures were deemed high risk for patients &amp; staff. NHS England set guidelines on appendicitis management, thus acute appendictomy rates were reduced. Aim of study is to assess cost implications of appendicitis management at a single centre. Methods Cohort study carried out from Mar'2020 to Jan'2024. Descriptive demography &amp; post-operative outcomes were evaluated in appendicitis in COVID19, post-COVID19 appendicitis were controls. Costing calculated using the standardised NHS cost ledger for resources, procurement and services Results COVID (n = 306) Post COVID (n = 446) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 35.2 38.0 47.9 &amp;lt; 0.0005 Sex(M : F) 155 : 151 216 : 230 19 : 26 NS BMI(kg/m2) 25.4 25.8 26.5 NS GP 49 162 A &amp; E 257 284 WCC(x109/L) 12.5 13.1 6.5 &amp;lt; 0.0001 CRP(mg/L) 67.2 70.9 3.4 &amp;lt; 0.0001 Conservative(n) 148 87 0 &amp;lt; 0.0001 Surgery(n) 158 359 45 &amp;lt; 0.0001 Open(n) 6 2 0 NS Lap(n) 300 444 45 &amp;lt; 0.0001 ASA(median) 2 1 2 NS Uncomplicated 178 170 42 &amp;lt; 0.0001 Complicated 128 276 3 &amp;lt; 0.0001 Clinical 0 21 USS scan 89 113 CT scan 334 312 Op time(mins) 72.8 75.9 74.4 NS LOS(days)(med) 2 2 0 &amp;lt; 0.0001 IP AB(days) 2 2 0 &amp;lt; 0.0001 Post-op AB(days) 5 3 0 &amp;lt; 0.0001 Appendix HPA(mm) Length 66.8 66.5 55.7 &amp;lt; 0.005 Diameter 11.5 11.1 9.9 NS Cost(£) 2160 4422 1046 &amp;lt; 0.0001 Conclusion Clinically &amp; radiologically grading of appendicitis (uncomplicated or complicated) has allowed safe conservative management (antibiotic therapy). Non surgical management is cheaper for index admission, but there are additional costs &amp; workload.

Autonomy of Regulatory Authority to Effectively Provide Regulatory Services in Tanzania: A Case Study of LATRA

The establishment of regulatory authorities is geared towards regulating or stabilizing the market economy through fostering fair competition and setting guidelines that safeguard consumers and nurture the private sector. The study was generally geared to assess the autonomy of regulatory authorities to effectively provide regulatory services in Tanzania, taking the case study of the Land Transport Regulatory Authority (LATRA). This study was guided by four specific objectives, namely: to determine the ability of LATRA to effectively provide regulatory services in Tanzania; to assess institutional frameworks that influence LATRA to effectively provide regulatory services in Tanzania; to assess legal frameworks that influence LATRA to effectively provide regulatory services in Tanzania; and to explore challenges facing LATRA to effectively provide regulatory services in Tanzania. Transportation, SERVIQUAL, and agency theories were used to support this study. LATRA was used as the case study, targeting a population of 123, among which were LATRA employees as regulatory authorities, the Tanzania Bus Owners Association (TABOA) as service providers, and commuters on public transport as service users. The researcher employed simple random sampling and purposive sampling procedures to get a sample size of 55 respondents from the targeted population. The study used an interview schedule guide and a questionnaire to obtain data from the field. The data were analysed using the Statistical Package for Social Sciences (SPSS). The study found that LATRA has been providing various regulatory services, such as the issuance and cancellation of public transport permits and licenses, reviewing and setting rates and charges, and also imposing sanctions on entities that contravene regulation policies and laws. The current institutional framework affects the smooth functioning of LATRA and its ability to effectively provide its regulatory services. This is due to LATRA’s administrative incapacity, poor management support, and financial independence, which affect its autonomy to effectively provide regulatory services. The smooth functioning of LATRA is hindered by political interference, limited administrative competencies, limited transparency, the use of the Tanzania Police Force (TPF) to deal with regulatory issues, the invisible hand of the Tanzanian government in LATRA’s daily operation, as well as LATRA’s institutional and legal frameworks, which reduce the practical aspect of LATRA's autonomy in discharging regulatory functions. The study further recommended that the LATRA policy, institutional framework, and legal framework should be overhauled or repaired in order to remove or reduce political interference in LATRA operations, which affects the autonomy of LATRA.