Introduction Of Guidelines Research Articles

The Influence of Logistics Activity on Sustainable Performance of Air Cargo Business in Thailand

This research applies logistics management concepts to sustainable business operations in the context of air cargo businesses in Thailand. The study aims to understand how logistics activities impact the sustainable performance of air cargo businesses. The objectives of this study were to examine: 1) logistics activities in air cargo businesses in Thailand, and 2) the influence of logistics activities on the sustainable performance of the air cargo business. This study consists of descriptive research, utilzing a questionnaire for data collection. The sample consisted of 424 employees of air cargo businesses operating in Thailand. The findings reveal that all 9 logistics activities significantly influenced the sustainable performance of air cargo businesses in Thailand, in terms of economic, social, and environmental performance, where Customer Services and Support (CSS) had the highest average value with a mean value of 5.90 (S.D. = 0.723). Regarding the results of the study of influences, Facilities Site Selection, Warehousing, and Storage (FWS) was found to strongly impact Economic Performance (ECOP) with a β value of .740. Meanwhile, Reverse Logistics (RL) had the greatest impact on Social Performance (SOCP) with a β value of 0.843, and Transportation (TRAN) had the greatest influence on Environmental Performance (ENVP), with a β value of 0.749. The findings can support the introduction of business guidelines to enhance competitiveness and enable the achievement of sustainable success, offering encouragement for Thailand as a key air cargo hub for Southeast Asia. Moreover, the study can be used to enhance academic knowledge in the field of logistics and contribute to the future sustainable performance of the air cargo business.

Reintroduction of excluded food triggers as a crucial step in managing patients with food allergies

Introduction. Despite active research into the mechanisms of food allergies (FA), the main approach to managing patients with this condition remains the complete exclusion of causative allergens from the diet for a certain period. At the same time, the question of timely reintroduction of excluded food triggers into the diet is frequently raised, which is important both for maintaining oral tolerance and reducing the negative effects of long-term elimination diets, such as nutritional and eating behavior disorders, as well as financial burdens on families. However, clear recommendations on the reintroduction of previously excluded foods have not existed until recently. Regarding cow’s milk protein allergy (CMPA), such recommendations were provided in 2023 in the consensus document of the World Allergy Organization (WAO) — DRACMA.Aim. The aim of this review is to present current approaches to the reintroduction of food allergens into the diets of patients with food allergies and to evaluate various reintroduction protocols, including those used for cow’s milk protein allergy (CMPA).Material and methods. This review provides a concise summary of current approaches to reintroducing food allergens into the diet, covering both IgE-mediated and non-IgE-mediated forms of food allergy. The advantages of different patient management protocols are discussed, with special attention given to CMPA as one of the most common manifestations of FA in children.Results. An analysis of modern approaches has demonstrated that modern recommendations regarding the reintroduction of allergens, including those presented in the document of the World Allergological Organization — DRACMA for allergy to cow’s milk proteins, allow for a more personalized and safe approach to the reintroduction of allergens, which helps reduce risks and maintain food tolerance.Conclusions. The introduction of new guidelines for the reintroduction of food allergens is an important step in managing patients with food allergies. These recommendations provide a more personalized approach to treating food-allergic patients, including those with cow’s milk protein allergy, reducing the risks associated with reintroducing allergens into the diet. They also help to mitigate the negative effects of elimination diets and maintain oral tolerance in patients, which is particularly important for children with FA.

In-utero transfer, survival-focused care and survival to 28-days at 22-24 weeks’ gestation pre- and post- implementation of an extreme prematurity management guideline in Victoria, Australia

BackgroundCare for infants born at 22–24 weeks’ gestation varies globally, with an increasing willingness to provide survival-focused (‘active’) care for infants born at 22 weeks’ gestation in recent years. This...

Earlier routine induction of labor-Consequences on mother and child morbidity.

A growing number of birth interventions had led to a concern for potential health consequences. This study investigates the consequences of earlier routine labor induction. It exploits a natural experiment caused by the introduction of new Danish obstetric guidelines in 2011. Consequently, routine labor induction was moved forward from 14 to 10-13days past the expected due date (EDD) and extended antenatal surveillance was introduced from 7days past the EDD. Using administrative data, I find that affected mothers on average had a 9-11 percentage points (32%-38%) higher risk of being induced the following years. Yet, mother and child short- and medium-term morbidity were largely unaffected.

Exploring Inclusion, Diversity, Equity, and Accessibility in the Built Environment: A Case Study

Continuous changes in society and the need for sustainable development demand updates in designing better built environments to respond to the variety of user needs. Notwithstanding the growing interest of research and the introduction of guidelines and standards on inclusion, diversity, equity, and accessibility, there are still several limitations in effectively and efficiently embedding such principles for the design of buildings and neighborhoods. Previous research demonstrated the critical need for innovative tools and methods to support professionals in designing responsive, inclusive spaces for an extended range of users. This article reports the results of a pilot study using the new IDEA Audit Tool for assessing how inclusion, diversity, equity, and accessibility are perceived by building occupants in a specific facility. The analysis of significant data provided by this study shows the challenges and highlights the benefits of the tool, including fostering an evidence-based decision-making process, speeding up the prioritization of critical design improvements, demonstrated through a six-month trial with a London-based inclusive design firm. The research-driven outcomes showcase the huge potential that the tool offers to improve the company strategy while evolving towards more inclusive, accessible spaces that foster diversity and equity, and has the potential to be replicated in several fields of action to raise awareness and improve the application of IDEA principles in all phases of the design process.

Optimizing Antibiotic Stewardship: Impact of Intravenous to Oral Conversion in General Medicine at a Tertiary Care Hospital

Antibiotics are used for the effective management of infectious diseases, a practice that is frequently misapplied nowadays. In order to monitor the conversion of IV to oral antibiotics, assess their rationality, and evaluate their effect on the length of hospital stays a prospective observational study was conducted. The study was divided into two phases; a baseline period of two months in which the antibiotics prescribed in the general medicine department were analysed. The intervention phase of four months consisted of the introduction of guidelines for IV to oral switch and conversion and analysis of IV to oral antibiotic conversion. The results revealed the majority of the participants were females and were from the age group 60 and above. A greater part of the study population had comorbidities, and the most common comorbidity was hypertension with type 2 diabetes mellitus. The conversion of IV to oral antibiotics was analysed for 159 patients and 79% of the antibiotics were converted and 21% were not. The most frequent type of conversion practice observed was switch therapy followed by step-down therapy and sequential therapy. The majority of the antibiotics were prescribed without a culture and sensitivity test. It was shown that the average length of hospital stay was 4.13 ± 1.5 days.

Corporate Governance and Capital Structure Decisions: Moderating Role of inside Ownership

This study empirically investigates the association between board attributes and capital structure decisions of non-financial listed firms in Bangladesh. This study also investigates how this association is shaped and moderated by the level of insider ownership. The current study takes 3096 firm-year observations of firms that are listed on the Dhaka Stock Exchange from 2004 to 2023. Multiple regression analysis on panel data was used, and pooled OLS was selected by resolving stationary issues. Moreover, this study used lagged variables and a GMM estimator to address endogeneity. The results show that both board size and board independence are more positively correlated with a firm’s leverage under conditions of a high level of inside ownership. On the other hand, without the moderating effect of inside ownership, gender diversity on the board does not have any significant impact on a firm’s leverage, and it turns into a positive association due to the moderating effect of inside ownership. This result is consistent with the existing theory and previous findings. After the introduction of corporate governance guidelines, the inside owners’ effect on board size and board independence became substantial, indicating that corporate governance guidelines with the moderating role of inside ownership play a significant role in capital structure decisions in Bangladeshi listed firms.

Impact of a national guideline for the management of peripheral arterial disease on revascularization rates in England: interrupted time series analysis.

A national guideline on peripheral arterial disease management in England was issued in August 2012. The impact on revascularization rates was examined and variation with socioeconomic deprivation assessed. Annual hospital admissions for England over 10 years (2008-2009 to 2017-2018) were examined using interrupted time series analysis. A pragmatic approach was used to classify admissions for revascularization into moderate and severe categories. There were 309 839 admissions (56% for moderate peripheral arterial disease), with an overall annual admission rate for revascularization of 86 per 100 000 population aged 25+ years. The rate for moderate peripheral arterial disease marginally increased by 0.29 per 100 000 per year (95% c.i. -0.22 to 0.80) from 2008-2009 to 2012-2013. Following guideline introduction, this rate decreased. The equivalent for severe peripheral arterial disease increased by 1.33 per 100 000 (0.78 to 1.88). Following guideline introduction, this rate plateaued. The change in rate (slope) for moderate peripheral arterial disease of -2.81 per 100 000 per year (-3.52 to -2.10) after guideline introduction was greater than the change in rate for severe peripheral arterial disease of -1.95 per 100 000 per year (-2.73 to -1.17). For moderate peripheral arterial disease, the annual rate in the most socioeconomically deprived category was 15.6 per 100 000 lower in 2017-2018 compared with 2012-2013 (24.3% decrease). The impact progressively diminished with decreasing deprivation. In the least deprived category, the reduction was 5.2 per 100 000 (12.9% decrease). For severe peripheral arterial disease, the decrease was 1.2 per 100 000 (3.1% reduction) with no consistent variation in relation to deprivation. Introduction of the national peripheral arterial disease management guideline in England was associated with a reduction in admission rates for revascularization, especially for moderate peripheral arterial disease, with greater reduction in rates for moderate peripheral arterial disease in more socioeconomically deprived areas. Association, however, does not necessarily imply causation and alternative explanations cannot be ruled out.

An Institutional Febrile Neutropenia Protocol Improved the Antibacterial Treatment and Encouraged the Development of a Computerized Clinical Decision Support System.

We investigated the influence of a local guideline on the quality of febrile neutropenia (FN) management and the applicability of a computerized decision support system (CDSS) using real-life data. The study included 227 FN patients between April 2016 and January 2019. The primary outcome measure was the achievement of a 20% increase in the rate of appropriate empirical treatment of FN in bacteremic patients. The compatibility of the CDSS (the development of which was completed in November 2021) with local protocols was tested using standard patient scenarios and empirical antibiotic recommendations for bacteremic FN patients. In total, 91 patients were evaluated before (P1: between April 2016 and May 2017) and 136 after (P2: between May 2017 and January 2019) the guideline's release (May 2017). The demographic characteristics were similar. Appropriate empirical antibacterial treatment was achieved in 58.3% of P1 and 88.1% of P2 patients (p = 0.006). The need for escalation of antibacterial treatment was significantly lower in P2 (49.5% vs. 35.3%; p = 0.03). In P2, the performance of the CDSS and consulting physicians was similar (CDSS 88.8% vs. physician 88.83%; p = 1) regarding appropriate empirical antibacterial treatment. The introduction of the local guideline improved the appropriateness of initial empirical treatment and reduced escalation rates in FN patients. The high rate of compliance of the CDSS with the local guideline-based decisions in P2 highlights the usefulness of the CDSS for these patients.

Utilization of telemedicine services of institute of national importance in the western region of INDIA: A mixed-method study.

Telemedicine has emerged as a crucial healthcare tool, especially during the COVID-19 pandemic, offering risk-free contactless communication between physicians and patients. In India, the introduction of official guidelines in 2019 and initiatives like the "e-Sanjeevani" national teleconsultation portal have accelerated telemedicine's adoption. However, the utilization and satisfaction levels of telemedicine services in Institutes of National Importance (INI) remain underexplored. This mixed-method study aims to describe the utilization of telemedicine services at the All India Institute of Medical Sciences (AIIMS), Rajkot, an INI in western India, and assess patients' satisfaction with these services. Data was collected from patients availing telemedicine services through the e-Sanjeevani portal at AIIMS Rajkot between February and December 2022. Quantitative analysis included patient demographics, specialty attended, location, call duration, and wrong call rates. Qualitative analysis involved interviews with patients to assess their experiences and satisfaction levels. Statistical analyses were performed using SPSS for quantitative data and Atlas Ti for qualitative data. A total of 12,442 doctor-to-doctor and 7,876 patient-to-doctor consultations were recorded, with a diverse age distribution (21-40 years, 45.4%). Most patients were from medical specialties, with general medicine, Pulmonary Medicine, and Dermatology being the highest. The data revealed a wide geographic distribution, with over 70% of cases from more than 200 kilometers away. Despite some challenges, including a 38.2% wrong call rate, the telemedicine services were well-received, with 96% of respondents reporting overall satisfaction. Telemedicine services at AIIMS Rajkot have shown high user satisfaction and accessibility, highlighting their potential in improving healthcare delivery and access, particularly in remote areas. However, efforts to enhance digital literacy and address challenges are necessary for further optimization of telemedicine services.

Experiences reporting on mental illness and suicide: Findings from interviews with Australian news professionals

Improvements in the quality of news portrayals of mental illness and suicide can be attributed to the introduction of media guidelines, particularly the Mindframe guidelines in Australia. However, based on reports about problematic media content, there remains scope for improvement. This study sought to further investigate the experiences of Australian news media professionals in reporting on mental illness and suicide, including their experiences of using the Mindframe guidelines and developing news stories about people with lived experience. We conducted semi-structured interviews with 12 media professionals, including junior reporters, senior reporters, and news editors. Media professionals had an average of 10.1 years’ (SD = 9.4) experience and represented a range of work experiences. Three key themes were generated from participant responses about their experiences reporting on mental illness and suicide: 1. Awareness of responsible reporting guidelines and how to proactively increase this; 2. Newsroom processes, values and subjectivity in applying guidelines; and 3. The importance and challenge in sharing lived experience stories, and improving support for covering these stories. Further resources and education are needed across newsrooms and universities to increase awareness and use of the Mindframe guidelines, and ultimately improve the quality of Australian media portrayals of mental illness and suicide. Editors and managers should be targeted with this training to best influence organisational change. Media professionals require additional preparation and support to develop lived experience stories, particularly in working with people bereaved by suicide to ensure this is a safe engagement for both parties.

Impact of new antifungal medications on onychomycosis prescriptions and costs in Japan: A nationwide claims database study.

Onychomycosis, a fungal nail infection, is a common dermatological condition in Japan, with a prevalence of approximately 5%-10%. Despite the introduction of new antifungal medications and updated treatment guidelines published in 2019, data on real-world prescription trends and the associated medical costs are limited. This study aimed to investigate the prescription patterns and medical costs of topical and oral antifungal medications for onychomycosis in Japan from fiscal years 2014 to 2021 using the National Database of Health Insurance Claims and Specific Health Checkups of Japan Open Data. We analyzed the annual prescription volumes and medical costs of four antifungal medications: efinaconazole, luliconazole, fosravuconazole, and terbinafine. The prescription volume of efinaconazole, a topical medication launched in 2014, rapidly increased and dominated the market share. Fosravuconazole, an oral medication introduced in 2018, showed an increasing trend, coinciding with a decline in efinaconazole prescriptions. Terbinafine, a well-established oral medication, experienced a substantial decrease in prescription volume. The sex- and age-adjusted prescription volume per 100 000 population was higher among older adults, particularly for efinaconazole. The total medical costs for onychomycosis treatment more than doubled in fiscal year 2015 compared with that for 2014, mainly driven by efinaconazole prescriptions, and exceeded 30 billion Japanese yen in fiscal years 2019-2021. The costs slightly decreased in fiscal years 2020 and 2021, possibly due to the introduction of fosravuconazole. The predominance of topical prescriptions, especially in older adults, raises concerns regarding adherence to the Japanese guidelines that recommend oral antifungals as the first-line treatment for onychomycosis. The substantial increase in medical costs also highlights the economic burden of onychomycosis and the need for cost-effective treatment strategies. This study provides valuable insights into the real-world prescription trends and medical costs of onychomycosis treatment in Japan, suggesting an opportunity to assess potential gaps between guideline recommendations and clinical practice.

Early-Stage Lung Cancer in the Era of Lung Cancer Screening: Veterans Health Administration Outperforms Other Insurance Models

BackgroundLung cancer screening guidelines were introduced in the United States in 2013, with variable implementation. This study evaluated temporal diagnostic trends in non-small cell lung cancer (NSCLC) diagnosis since the introduction of these guidelines. MethodsThis retrospective cohort analysis used data from the Veterans Administration Corporate Data Warehouse and the National Cancer Database. We evaluated temporal trends in the distribution of NSCLC stage at the time of diagnosis along with differences based on insurance coverage type, including uninsured, privately insured, Medicare, Medicaid, and Veterans Affairs (VA) coverage, with adjustment for clinically relevant variables. ResultsAmong 1,450,965 patients diagnosed from 2006 to 2020, the proportion of NSCLC cases diagnosed at stage I increased in all insurance groups by 12.74%, 2%, 0.25%, and 2.57% for the VA, Medicare, private insurance, and Medicaid, respectively. If all insurance systems achieved the unadjusted stage distribution seen in the Veterans Health Administration, an additional 45,684 patients would be diagnosed with stage I NSCLC and 65,933 fewer patients would be diagnosed with stage IV disease. ConclusionsFor patients with any form of insurance, there has been an increase in the proportion of early-stage NSCLC (stage I and II) and a corresponding decrease in the proportion of stage III and IV since the introduction of national lung cancer screening guidelines. As the largest integrated single-payer health care system in the United States, the VA dramatically outperforms other insurance types, perhaps attributable to universal coverage and robust lung cancer screening programs.

Evaluation of a Risk Screening Checklist for Venous Thromboembolism Prophylaxis in a Women and Newborn Hospital.

The venous thromboembolism (VTE) risk screening forms were developed to allow for recording identified risk factors for VTE including thrombophilia, history of VTE, postpartum hemorrhage, and cesarean delivery, and documentation of specific actions taken to mitigate these risks and reduce complications due to VTE. Compliance with hospital guidelines in assessing VTE risk and appropriate prescribing of thromboprophylaxis was evaluated prior to the introduction of VTE risk screening forms (March 2022). Efficacy of the new VTE risk screening forms was also assessed (April 2023). Patient discharge summaries and patient medical records including medication charts were used to review the documentation of VTE risk assessments and details of thromboprophylaxis prescribing. Of 74 postnatal patients, 37.8% had VTE risk assessment documented prior to the introduction of VTE risk screening forms. Of 37 patients identified to be at moderate to high risk of VTE requiring pharmacological prophylaxis, 70.3% (n = 26) were appropriately prescribed pharmacological prophylaxis. After the risk screening forms were introduced, a total of 67 antenatal, postnatal, and gynecologic patients were studied. Of these, 32.8% (n = 22) of patients had all required fields completed appropriately. When using the forms, 26.9% (n = 7) of postnatal and 88% (n = 22) of gynecological patients were rated as medium or high risk, and all received medical review within 24 hours. Pharmacological prophylaxis was indicated in 88% (n = 22) of gynecological, 43.8% (n = 7) of antenatal, and 38.5% (n = 10) of postnatal patients, and all were appropriately prescribed. The guideline review and introduction of VTE risk screening forms was valuable to provide guidance in the risk assessment for VTE and to identify patients requiring prophylaxis.

COMPLIANCE WITH THE SUSPECTED CAUDA EQUINA SYNDROME (CES) PATHWAY IN BETSI CADWALADR UNIVERSITY HEALTH BOARD (BCUHB) WEST: A RETROSPECTIVE AUDIT AGAINST NATIONAL STANDARDS

ObjectiveGuidelines published by the British Association of Spine Surgeons (BASS) and Society of British Neurological Surgeons (SBNS) recommend urgent MRI imaging and intervention in individuals suspected of having CES. The need for an evidence based protocol is driven by a lack of 24/7 MRI services and centralisation of neurosurgery to tertiary centres, compounded by CES's significant medico-legal implications. We conducted an audit to evaluate the pathway for suspected CES in BCUHB West between 2018 and 2021.MethodsA retrospective audit of patients managed for suspected CES between 01/11/2018 and 01/05/2021 was performed, using the SBNS/BASS guidelines as the standard.ResultsA total of 252 patients received an emergency MRI for suspected CES between 2018 and 2021. 99% of patients were scanned in compliance with SBNS/BASS standards. Radiological evidence of CES was found in 18% of patients. 33% of emergency scans were performed by out-of-hours services. 4% of patients had repeated scans within the same 6-month period. The majority of referrals originated from Orthopaedics surgeons (78%), or staff in the Emergency Department (8%). 92% of ambulatory patients were not admitted to hospital. During the peak of the COVID-19 pandemic, referrals increased from 2.5 to 3.5 per week.ConclusionSBNS/BASS standards were largely met, avoiding life changing disability and medico-legal consequences. The department should continue to follow SBNS/BASS guidance on the management of individuals with suspected CES. Challenges regarding the use of repeated scans should be addressed to avoid unnecessary costs. Introduction of new early recognition guidelines and Same Day Emergency Care (SDEC) has likely driven an increase in suspected CES referrals, and subsequent MRI demand. This audit should be utilised as an ongoing tool to ensure best practice continues, and to implement simple measures which may improve compliance with the pathway.

1234 Optimising Vitamin D and Calcium Management in Thyroidectomy Patients

Abstract Aim The study aimed to investigate the causes of temporary postoperative hypocalcemia and strategies for correction. Objectives included assessing the impact of preoperative trust guidelines on detecting and managing Vitamin D deficiency in thyroidectomy patients and analyzing its correlation with postoperative hypocalcemia at Northampton General Hospital. Method A three-cycle audit analyzed 16, 12, and 8 cases, respectively, encompassing total and completion thyroidectomies at NGH. Collaborative development of standardized trust guidelines involved the ENT Team, Endocrinology, and Pharmacists. Data collection covered various parameters, and departmental teachings were conducted to educate the team on the new guidelines. Results Thyroidectomy indications included Graves's disease, large Multinodular Goitre, and malignancy. In the third cycle, all patients underwent preoperative Vitamin D checks, aligning postoperative hypocalcemia with the national range. Our interventions increased preoperative Vitamin D checks from 56% to 100%, reducing deficiency from 25% to 0%. Postoperative hypocalcemia decreased from 56% in Cycle 1 to 8.3% in Cycle 2 and 12.5% in Cycle 3. Long-term hypoparathyroidism dropped to 0% in Cycle 3, with no correlation between surgeon technique or indication and postoperative hypocalcemia. Conclusions The introduction of preoperative guidelines significantly enhanced Vitamin D deficiency detection, substantially reducing postoperative hypocalcemia. This underscores the positive impact of standardized protocols on patient care. Future efforts involve re-auditing with the involvement of junior doctors to ensure continuous enhancement in clinical practice.

Reducing the harm associated in treating hyperkalaemia with insulin and dextrose

Inpatient treatment of hyperkalaemia with insulin and dextrose can be complicated by iatrogenic hypoglycaemia. We sought to assess the incidence of hypoglycaemia in hospitalised patients with renal disease and assess the impact of the introduction of a local guideline incorporating the use of sodium zirconium cyclosilicate (SZC) for patients with moderate hyperkalaemia. After establishing a significant burden of hypoglycaemia in the initial observation period, a requirement for hourly capillary blood glucose monitoring (for up to 6 h) following the administration of insulin for hyperkalaemia was incorporated into the guidelines. The two-fold introduction of SZC alongside changes in patient care after the administration of insulin/dextrose resulted in more appropriate use of insulin/dextrose, as well as a significant (73%) reduction in the iatrogenic burden of hypoglycaemia (P = 0.04).

Comparative review of vasectomy guidelines and novel vasal occlusion techniques.

Vasectomy is the most commonly performed urologic procedure in the United States and is a highly effective form of male contraception. The introduction of guidelines by urological societies has standardized vasectomy care. Providers should be awadre of the rationale behind these guidelines, as well as key differences among them. While few major changes to vasectomy technique have been adopted over the past 40 years, new, reversible vasal occlusive technologies may affect delivery of male contraceptive care in the future. Here, we perform a comparative review of vasectomy guidelines from six urological societies worldwide. In addition, we report on the status of several experimental vasal occlusion methods that may be available in the next decade.

Pediatric blood cultures—turning up the volume: a before and after intervention study

The major determinant of blood culture (BC) diagnostic performance is blood volume, and pediatric sample volumes are frequently low. We aimed to assess BC volumes in our institution, design an intervention to increase volumes, and assess its impact. All pediatric BCs submitted over a 7-month period to the microbiology laboratory in a university hospital (including emergency department, pediatric ward, and neonatal unit) were included. A pre-intervention period assessed current practice. A multi-faceted intervention (education, guideline introduction, active feedback strategies) was collaboratively designed by all stakeholders. Impact was assessed in a post-intervention period. The main outcome measures included the percentage of samples adequately filled using three measures of sample adequacy (1) manufacturer-recommended minimum validated volume—> 0.5 ml, (2) manufacturer-recommended optimal minimum volume—> 1.0 ml, (3) newly introduced age-specific recommendations. Three hundred ninety-eight pre-intervention and 388 post-intervention samples were included. Initial volumes were low but increased significantly post-intervention (median 0.77 ml vs. 1.52 ml), with multivariable regression analysis estimating volumes increased 89% post-intervention. There were significant increases in all measures of volume adequacy, including an increase in age-appropriate filling (20.4–53.1%), with less improvement in those aged > 3 years. Overall, 68.4% of pathogens were from adequately filled cultures, while 76% of contaminants were from inadequately filled cultures. A pathogen was detected in a higher proportion of adequately filled than inadequately filled cultures (9.4% vs. 2.2%, p < 0.001). Conclusion: Blood volume impacts BC sensitivity, with lower volumes yielding fewer pathogens and more contaminants. Focused intervention can significantly improve volumes to improve diagnostic performance.What is Known:• Blood volume is the major determinant of blood culture positivity, and yet pediatric blood culture volumes are frequently low, resulting in missed pathogens and increased contamination.What is New:• Adequately filled (for age) blood cultures have a pathogen detection rate three times higher than inadequately filled blood cultures.• This interventional study shows that collaboratively designed multi-modal interventions including focus on accurate volume measurement can lead to significant increases in blood volumes and improve blood culture diagnostic performance.

Changes in access to viral load testing, incidence rates of viral load suppression and rebound following the introduction of the 'universal test and treat' guidelines in Cameroon: A retrospective follow-up analysis.

Cameroon adopted and started implementing in 2016, the 'universal test and treat' (UTT) guidelines to fast-track progress towards the 95-95-95 ambitious targets to end the HIV epidemic. Achieving the third 95 (viral load suppression) is the most desirable target in HIV care. We aimed to evaluate the effectiveness of this novel approach on access to viral load testing (VLT), viral suppression (VLS), and viral load rebound (VLR). A retrospective cohort study was conducted at The Nkongsamba Regional Hospital to compare VLT outcomes between the pre-UTT (2002 to 2015) and the post-UTT (2016 to 2020) periods. We used a data extraction form to collect routine data on adult patients living with HIV. We measured uptake levels of the first and serial VLT and compared the incidence rates of VLS (VL<1000 copies/ml) and viral load rebound (VLR) before and after introducing the UTT approach using Kaplan Meier plots and log-rank tests. Cox regression was used to screen for factors independently associated with VLS and VLR events between the guideline periods. Access to initial VLT increased significantly from 6.11% to 25.56% at 6 months and from 12.00% to 73.75% at 12 months before and after introducing the UTT guidelines respectively. After a total observation time at risk of 17001.63 person-months, the UTT group achieved an incidence rate of 90.36 VLS per 1000 person-months, four-fold higher than the 21.71 VLS per 1000 person-months observed in the pre-UTT group (p<0.0001). After adjusting for confounding, the VLS rate was about 6-fold higher in the UTT group than in the pre-UTT group (adjusted Hazard Rate (aHR) = 5.81 (95% confidence interval (95%CI): 4.43-7.60). The incidence of VLR increased from 12.60 (95%CI: 9.50-16.72) to 19.11 (95%CI: 14.22-25.67) per 1000 person-months before and after the introduction of UTT guidelines respectively. After adjusting, VLR was more than twice as high in the UTT group than in the pre-UTT group (aHR = 2.32, 95%CI: 1.30-4.13). Increased access to initial VLT and higher rates of VLS have been observed but there are concerns that the suppressed viral load may not be durable since the introduction of the UTT policy in this setting.