Outcomes In Different Settings Research Articles

Radiomics for clinical decision support in radiation oncology

Radiomics is a promising tool for the development of quantitative biomarkers to support clinical decision-making. It has been shown to improve the prediction of response to treatment and outcome in different settings, particularly in the field of radiation oncology by optimising the dose delivery solutions and reducing the rate of radiation-induced side effects, leading to a fully personalised approach.Despite the promising results offered by radiomics at each of these stages, standardised methodologies, reproducibility and interpretability of results are still lacking, limiting the potential clinical impact of these tools.In this review, we briefly describe the principles of radiomics and the most relevant applications of radiomics at each stage of cancer management in the framework of radiation oncology. Furthermore, the integration of radiomics into clinical decision support systems is analysed, defining the challenges and offering possible solutions for translating radiomics into a clinically applicable tool.

Nature-based social interventions for people experiencing loneliness: the rationale and overview of the RECETAS project

ABSTRACT Loneliness is a major social concern with health consequences worldwide for populations across different demographic, cultural, social, economic, geographic, and environmental contexts. In March 2021, we launched Horizon 2020 European Commission-funded project, ‘Reimagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces (RECETAS)’ to reduce loneliness and promote health-related quality of life. In this paper, we present the project logic model, informed by stakeholder input, that aims to guide the initiative from its design and implementation to its evaluation in six cities across three continents, including Europe (Barcelona, Helsinki, Marseille, Prague), Australia (Melbourne), and South America (Cuenca). This model is being used to guide the implementation and evaluation of nature-based social prescribing interventions. Process and outcome measures will be used to compare outcomes in different settings and population contexts. The use of a logic model with stakeholder input ensures that the interventions are responsive to local needs, sustainable, and transferable to other geographic, social, economic, and cultural contexts. Knowledge translation will be central to maximising impacts on population health, civil society, and health and social systems in urban areas.

The Perioperative Pain Management Bundle is Feasible: Findings from the PAIN OUT Registry.

The quality of postoperative pain management is often poor. A 'bundle', a small set of evidence-based interventions, is associated with improved outcomes in different settings. We assessed whether staff caring for surgical patients could implement a 'Perioperative Pain Management Bundle' and whether this would be associated with improved multi-dimensional pain-related Patient-Reported-Outcomes (PROs). PAIN OUT, a perioperative pain registry, offers tools for auditing pain-related PROs and obtaining information about perioperative pain management during the first 24 hours after surgery. Staff from 10 hospitals in Serbia used this methodology to collect data at baseline. They then implemented the 'perioperative pain management bundle' into the clinical routine and collected another round of data. The bundle consists of four treatment elements: (1) a full daily dose of 1-2 non-opioid analgesics (e.g. paracetamol, NSAIDs); (2) at least one type of local/regional anesthesia; (3) pain assessment by staff; (4) offering patients information about pain management. The primary endpoint was a multi-dimensional pain composite score (PCS), evaluating pain intensity, interference and side-effects: It was compared between patients who received the full bundlevs.not. Implementation of the complete bundle was associated with a significant reduction in the PCS (P<0.001, small-medium effect size [ES]). When each treatment element was evaluated independently, non-opioid analgesics were associated with a higher PCS (i.e. poorer outcome; negligible ES); the other elements were associated with a lower PCS (all negligible-small ES). Individual PROs were consistently better in patients receiving the full bundle compared to 0-3 elements. The PCS was not associated with surgical discipline. We report findings from using a bundle approach for perioperative pain management in patients undergoing mixed surgical procedures. Future work will seek strategies to improve the effect. ClinicalTrials.gov identified NCT02083835.

Cross-Country Study of Institutionalizing Social Participation in Health Policymaking: A Realist Analysis

Strong evidence suggests that interventions based on community participation have a positive effect on a range of health outcomes in different settings. Community participation contributes significantly to the promotion of health at the local level, especially among the more disadvantaged groups of the society. The main goal of social participation mechanisms is to fill the gap between the views of the policymakers and the experiences and needs of the communities. An important point is that institutionalization of social participation in the development of health policies and its continuity over time are essential requirements. The question here is how participation should be institutionalized in the systems that have started this process. We conducted a realistic evaluation of a multicase study of public participation in health system policymaking. Countries including France, Chile, Iran, Thailand, and Tunisia were selected. The study objective was to determine interventions and mechanisms used by these countries for community participation in health policymaking and institutionalizing it. The data were extracted via a literature review for each country using a realistic approach analysis also known as context, intervention, mechanism, and outcome (CIMO) configurations. Thailand and France, which have applied a set of interventions such as supportive legislations, evidence production structures for informed decision making and interactions, accountability and transparency, and providing a context for development of civil society organizations, have succeeded in institutionalizing community participation in health policymaking. Iran, Tunisia, and Chile have been successful in this regard, but they are still far from institutionalizing community participation. Success in the institutionalization of participatory health governance requires a political will and commitment at the highest level in order to minimize the conflicts between economic and political interests of different stakeholders and to implement a set of interventions to maximize social participation in health policymaking.

Implementation of the national Getting it Right First Time orthopaedic programme in England: a qualitative case study analysis

ObjectiveTo describe the implementation and impact of the Getting it Right First Time (GIRFT) national orthopaedic improvement programme at the level of individual National Health Service (NHS) Trusts.DesignQualitative case studies...

Marital transition is associated with food insecurity, low dietary diversity, and overweight in a female population in rural Ghana

Research from high-income countries shows that marital transition affects individuals’ nutrition outcomes. Yet, little is known about its effect on women’s food security status and nutrition outcomes in Sub-Saharan Africa. Moreover, most published studies merge cohabitation and marriage into one category, but these statuses might have a distinct effect on nutrition outcomes in different settings. This study examined the association between the marital transition of women living in a rural district in Ghana and their food security status, minimum dietary diversity, and overweight (body mass index (BMI) ≥ 25 kg/m2). This analysis used representative data from women with a child less than 12 months from the Upper Manya Krobo District, which was collected for the 2014 baseline of the Nutrition Links project in 137 villages (clinicaltrials.gov NCT01985243). Women’s marital transition was assessed by merging their current and previous marital status into five categories: i) continuously married; ii) remarried; iii) cohabitating with a previous union; iv) cohabitating with no previous union; v) single (majority never previously married). The adjusted logistic regression showed that, compared to women who were continuously married, those cohabitating—with or without a previous union—and those who were single were more likely to be food insecure (aOR = 2.49; 95% CI [1.31, 4.72], aOR = 2.01; 95% CI [1.13, 3.58], and aOR = 1.85; 95% CI [1.02, 3.38], respectively). Women who were cohabitating—with or without a previous union—were more likely not to meet the minimum dietary diversity than those who were continuously married (aOR = 1.82; 95% CI [0.98, 3.38] and aOR = 1.78; 95% CI [1.01, 3.12], respectively). Finally, compared to the continuously married group, cohabitating women with no previous union were less likely to be overweight (aOR = 0.40; 95% CI [0.22, 0.74]). These results are consistent with previous publications that showed married women were wealthier and more overweight. Moreover, these results indicate that cohabitation affects nutrition-related outcomes differently compared to marriage in a sub-Saharan setting. More attention must be placed on better understanding the social aspects that link women’s marital transition to diet and nutrition outcomes. Key words: Marriage, marital status, food security, diet, overweight, women, Ghana, Africa

The Clinical Utility of Systemic Immune-Inflammation Index Supporting Charlson Comorbidity Index and CAPRA-S Score in Determining Survival after Radical Prostatectomy-A Single Centre Study.

Simple SummaryRadical treatment of prostate cancer (PCa) provides excellent oncological outcomes. However, curative treatment of primary PCa, as well as salvage treatment of biochemical recurrence after radical treatment, requires at least a 10-year life expectancy to be beneficial. To provide an accurate selection for active treatment, several tools evaluating individual life expectancy have been developed. Our retrospective study aimed to determine the utility of the systemic immune-inflammation index (SII) in predicting early survival when used as an adjunct to CAPRA-S and Charlson comorbidity index (CCI) scores in non-metastatic PCa. We confirmed the SII as an independent predictor of survival. We have also validated the SII as a supplement to scoring systems when stratifying the risk of early mortality. In the setting of patients that might require salvage treatment, supplementing comorbidity status with the SII provided accurate discrimination of survival. The SII seems then to be useful when estimating life expectancy in patients with non-metastatic PCa.The selection of candidates for the curative treatment of PCa requires a careful assessment of life expectancy. Recently, blood-count inflammatory markers have been introduced as prognosticators of oncological and non-oncological outcomes in different settings. This retrospective, monocentric study included 421 patients treated with radical prostatectomy (RP) for nonmetastatic PCa and aimed at determining the utility of a preoperative SII (neutrophil count × platelet count/lymphocyte count) in predicting survival after RP. Patients with high SIIs (≥900) presented significantly shorter survival (p = 0.02) and high SIIs constituted an independent predictor of overall survival [HR 2.54 (95%CI 1.24–5.21); p = 0.01] when adjusted for high (≥6) age-adjusted CCI (ACCI) [HR 2.75 (95%CI 1.27–5.95); p = 0.01] and high (≥6) CAPRA-S [HR 2.65 (95%CI 1.32–5.31); p = 0.006]. Patients with high scores (ACCI and/or CAPRA-S) and high SIIs were at the highest risk of death (p < 0.0001) with approximately a one-year survival loss during the first seven years after surgery. In subgroup of high CAPRA-S (≥6), patients with high ACCIs and high SIIs were at the highest risk of death (p <0.0001). Our study introduces the SII as a straightforward marker of mortality after RP that can be helpful in pre- and postoperative decision-making.

Antimicrobial Stewardship Interventions in Pediatric Oncology: A Systematic Review.

Antimicrobial stewardship programs represent efficacious measures for reducing antibiotic overuse and improving outcomes in different settings. Specific data on pediatric oncology are lacking. We conducted a systematic review on the PubMed and Trip databases according to the PRISMA guidelines, searching for reports regarding antimicrobial stewardship in pediatric oncology and hematology patients. The aim of the study was to summarize the present literature regarding the implementation of antimicrobial stewardship programs or initiatives in this particular population, and provide insights for future investigations. Nine papers were included in the qualitative analysis: three regarding antifungal interventions, five regarding antibacterial interventions, and one regarding both antifungal and antibacterial stewardship interventions. Variable strategies were reported among the included studies. Different parameters were used to evaluate the impact of these interventions, including days of therapy per 1000-patient-days, infections with resistant strains, safety analysis, and costs. We generally observed a reduction in the prescription of broad-spectrum antibiotics and an improved appropriateness, with reduced antibiotic-related side effects and no difference in infection-related mortality. Antibiotic stewardship programs or interventions are effective in reducing antibiotic consumption and improving outcomes in pediatric oncology hematology settings, although stewardship strategies differ substantially in different institutions. A standardized approach needs to be implemented in future studies in order to better elucidate the impact of stewardship programs in this category of patients.

Outcome Analysis of Intravenous Thrombolytic Therapy in Patients with Acute Ischaemic Stroke and its Association with Critical Time Intervals: An Ambispective Study

Introduction: Intravenous thrombolytic therapy has become the standard of care in patients with acute ischaemic stroke. The success of this therapy depends on achieving the shortest time between the onset of stroke and reperfusion. Many clinical tasks like neurological assessment, imaging and its interpretation, exclusion of contraindications and informed consent must be taken care of, prior to administration of thrombolytic therapy. As this is a time sensitive intervention, it may have variable outcomes in different settings. Aim: To evaluate the immediate and 90-day neurological outcome of the patients who had received intravenous thrombolytic therapy in acute ischaemic stroke and to evaluate its association with stipulated critical time intervals. Materials and Methods: This was an ambispective observational study conducted for a period of 18 months (April 2018-October 2019) in the Emergency Department of Pushpagiri Institute of Medical Sciences, Thiruvalla, a tertiary care hospital in central Kerala, India. For the prospective arm of the study, data were collected from the patients who came to the Emergency Department with acute ischaemic stroke in the window period (three hours) or in the extended window period (3 to 4.5 hours). Onset to door time, door to imaging time, door to needle time and onset to needle time were assessed and recorded. National Institute of Health Stroke Scale (NIHSS) score at presentation and at 24 hours post-thrombolysis was noted. Magnetic Resonance Imaging (MRI)/ Computed Tomography (CT) brain report 24 hours post-thrombolysis was followed-up. The functional outcome at 90 days was assessed using Modified Rankin Scale (MRS) score. For the retrospective arm of the study, the relevant data were collected from the hospital records and the patients were followed-up. The association between the stipulated critical time intervals and 24 hours post-thrombolysis NIHSS score, as well as MRS score at 90 days were calculated using the statistical analysis tool STATA v.14. Statistical comparisons were performed between subgroups using the Chi-square test, Fisher’s exact test, Wilcoxon signedrank test, and Mann-Whitney U-test as indicated for dichotomous or continuous variables. For all statistical analyses, a p-value of &lt;0.05 was taken as statistically significant. Results: Of the total 110 patients, 105 patients (95.5%) reached the hospital within three hours (window period), and five patients (5%) reached within 4.5 hours (extended window period). A total of 58 patients (52.7%) received thrombolytic treatment within three hours and 52 patients (47.3%) within 4.5 hours. After 24 hours of thrombolysis, improvement in neurological function, as defined by an improvement in NIHSS score by 4 or more was found in 73 patients (66.4%). At 90 days follow-up, 76 patients (69.1%) became functionally independent with an MRS score of 0-2. There was a significant association between NIHSS score 24- hours post-thrombolysis and the functional outcome at 90 days. Of the various stipulated critical time intervals, a significant association was seen only with onset-to-door time and NIHSS score 24 hours post-thrombolysis. Conclusion: 69.1% of the patients who have received intravenous thrombolytic therapy for acute ischaemic stroke in this study have shown favourable functional outcome at 90 days. The NIHSS score 24 hours post-thrombolysis compared to baseline is a good predictor of the neurological outcome at 90 days.

Role of platelet-rich plasma in maxillofacial surgery

Platelet-rich plasma (PRP) has been reported as an efficacious modality that can enhance the process of wound healing and tissue regeneration and has been validated in different medical settings, including cardiovascular surgery, otolaryngology, head and neck surgery, and maxillofacial surgery. In dental and oral surgery settings, PRP has been reported as an efficacious approach with favorable outcomes in different settings. Some of these procedures include surgical repair of the alveolar cleft, mandibular reconstruction, ablative surgical procedures, placement of osseointegrated implants, periodontal plastic surgery, and management of infrabony periodontal defects. In the present study, we aim to discuss the role and mechanisms that PRP plays in the settings of maxillofacial surgery based on evidence from the relevant studies in the literature. Evidence indicates the wide acceptance of the modality, which has been proven to increase the rate of wound healing and reduce the frequency of pain and swelling. The administration of PRP has been reported to dispense with the need for invasive approaches that might be furtherly associated with complications and different morbidities. However, in most of the favorable events where the PRP administration of was associated with enhanced outcomes, the modality was used in combination with another therapeutic approach. Therefore, further research is needed to validate the efficacy of the modality in the different settings.

Audit and feedback strategies: study protocol and preliminary results from the EASY-NET project

Abstract Background In Italy there is evidence of a large variability in health care services and health outcomes. This multi-regional project is funded on Ministry of Health and Health Regional Authorities (code NET-2016-02364191). The aims are: 1) To test the effectiveness of Audit and Feedback (A&amp;F) interventions in improving health professional practices and patients' outcomes in different settings using both a quantitative and a qualitative approach. 2) To examine factors that may explain variations in the effectiveness of A&amp;F. 3) To evaluate the impact of A&amp;F in reducing avoidable differences in access to effective health care interventions in socioeconomically disadvantaged populations. Methods In the 7 participating Regions (about 33 million inhabitants) experimental study designs have been implemented in different clinical areas (e.g. before-after controlled study, cluster randomized trial): in Lazio emergency care and chronic diseases care, in Friuli Venezia Giulia emergency care, in Piemonte oncology care, in Emilia Romagna chronic disease care, in Lombardia cardiovascular care, in Calabria deliveries and maternal health, in Sicilia emergency care. The effectiveness of different types of A&amp;F are compared in term of outcomes using health information system databases. Results Preliminary results show large heterogeneity in developing and conducting A&amp;F, in term of team project composition, type of intervention, clinicians' behavior to be changed, outcomes indicators, professionals involved, structure and timing of data reporting, actions to be implemented after the intervention. Limited awareness and interest of clinicians in A&amp;F interventions was found. Conclusions The project represents a unique opportunity to explore how A&amp;F interventions could be better designed. Different A&amp;F strategies will be compared in term of clinical outcomes. The identification of barriers/facilitating factors will supply knowledge on mechanisms and tools to enhance A&amp;F effectiveness. Key messages The project supports providers in reducing gap between knowledge and practice. The project promotes culture of interprofessional collaboration as a key point for high quality care.

Return on Safety Training

Firms devote significant resources to safety-training programs with the aim to mitigate financial loss due to safety incidents and create customer value. From both practical and theoretical perspectives, it is important to know (1) whether safety-training programs mitigate financial loss, so that senior management can maintain the support for them, and (2) whether safety-training programs contribute to firm sales so firms can use them as a critical marketing lever to communicate value to customers. Yet, there is a lack of empirical evidence on the return on safety-training programs. The authors establish a consistent set of links between safety-training programs and financial outcomes in different settings across three studies. Study 1 shows that a 10-percentage-point increase in safety-training completion mitigates financial loss by 6% to 13% using safety reports from 1,199 locations of a business-to-business oilfield services company. Study 2 shows that firms emphasizing safety training in their Form 10-Ks are associated with 4% to 15% higher sales among 8,824 publicly traded companies between 1998 and 2018. Study 3 finds a positive association between safety investments and sales among 4,236 workplaces based on a national survey in South Korea. These effects are more pronounced among smaller locations, firms, and workplaces, suggesting that firms need to tailor safety-training programs to maximize their financial return.

Survival of Hospitalized COVID-19 Patients in Northern Italy: A Population-Based Cohort Study by the ITA-COVID-19 Network.

IntroductionCOVID-19 case fatality rate in hospitalized patients varies across countries and studies. Reliable estimates, specific for age, sex, and comorbidities, are needed to monitor the epidemic, to compare the outcome in different settings, and to correctly design trials for COVID-19 interventions. The aim of this study was to provide population-based survival curves of hospitalized COVID-19 patients.Materials and MethodsA cohort study was conducted in three areas of Northern Italy, heavily affected by SARS-CoV-2 infection (Lombardy and Veneto Regions, and Reggio Emilia province), using a loco-regional COVID-19 surveillance system, linked to hospital discharge databases. We included all patients testing positive for SARS-CoV-2 RNA by RT-PCR on nasopharyngeal/throat swab samples who were hospitalized from 21 February to 21 April 2020. Kaplan–Meier survival estimates were calculated at 14 and 30 days for death in any setting, stratifying by age, sex, and the Charlson Index.ResultsOverall, 42,926 hospitalized COVID-19 patients were identified. Patients’ median age was 69 years (IQR: 57–79), 62.6% were males, and 6.0% had a Charlson Index ≥3. Survival curves showed that 22.0% (95% CI 21.6–22.4) of patients died within 14 days and 27.6% (95% CI 27.2–28.1) within 30 days from hospitalization. Survival was higher in younger patients and in females. The negative impact of comorbidities on survival was more pronounced in younger age groups.ConclusionThe high fatality rate observed in the study (28% at 30 days) suggests that studies should focus on death as primary endpoint during a follow-up of at least one month.

Pre-rehabilitation sense of coherence as a predictor of symptom change after rehabilitation.

Sense of coherence (SOC) constitutes the key component of salutogenesis theory. It reflects individuals' confidence that their environment is comprehensible and manageable and that their lives are meaningful. Research demonstrates a strong cross-sectional relationship between SOC and mental health. However, little is known about SOC's temporal stability and its potential to predict changes in psychopathological symptom severity in different settings. The goal of the current study was to address this gap. The sample of the two-wave longitudinal study consists of 294 patients receiving inpatient psychotherapeutic (and psychopharmacological) treatment for various psychological disorders at a German psychosomatic rehabilitation clinic. SOC (Antonovsky, Social Science & Medicine, 1993, 36, 725-733) and outcome measures (i.e., general mental health problems, depression and anxiety symptoms) were assessed within two days of arrival and at the end of rehabilitation (week 5/6). SOC was significantly enhanced after treatment whereas psychopathological symptoms were significantly reduced. Regression analyses revealed that pre-treatment SOC was a significant negative predictor of post-treatment symptom severity for all outcome measures even after controlling for pre-treatment symptoms. The current findings provide first evidence that SOC is a significant unique predictor of symptom change. Future studies need to further investigate longitudinal associations between SOC and mental health outcomes in different settings.

Pharmacy students' intentions to utilize pharmacoeconomics, pharmacoepidemiology, and health outcomes in future jobs

IntroductionThe objectives of this study were to explore factors associated with pharmacy students' intentions to utilize health outcomes by: (1) understanding opinions on health outcomes, (2) understanding the likelihood of using health outcomes in different settings, and (3) predicting pharmacy students' intentions to utilize health outcomes in future jobs. MethodsThis study surveyed second-year pharmacy students over two years. The survey contained four components: the theory of planned behavior, opinions on health outcomes, the likelihood of using health outcomes in different settings, and demographics. To predict pharmacy students' intentions to utilize health outcomes in future jobs, a multiple linear regression model was used with behavioral intention as the dependent variable. ResultsOf the 376 second-year pharmacy students surveyed, 229 responded (60.90%). Pharmacy students had a positive attitude (mean: 0.77, SD: 0.16), high level of subjective norm (mean: 0.75, SD: 0.18), high level of perceived behavioral control (mean: 0.74, SD: 0.15), and high level of behavioral intention (mean: 0.74, SD: 0.21). They thought health outcomes were important for their future jobs (mean: 0.76, SD: 0.22), and equally important as other courses in the doctor of pharmacy curriculum (mean: 0.49, SD: 0.23). Significant predictors of utilizing health outcomes in future jobs were attitude (0.21; 95% CI: 0.03, 0.40), subjective norm (0.38; 95% CI: 0.23, 0.54), and perceived behavioral control (0.45, 95% CI: 0.27, 0.63). ConclusionsThe second-year pharmacy students in the program studied had positive opinions and expressed high likelihood of applying their health outcomes knowledge and skill after graduation.

An insider view on the World Symposium on Pulmonary Hypertension

An insider view on the World Symposium on Pulmonary Hypertension

Patient-Centered Preference Assessment to Improve Satisfaction With Care Among Patients With Localized Prostate Cancer: A Randomized Controlled Trial.

To study the effectiveness of the Patient Preferences for Prostate Cancer Care (PreProCare) intervention in improving the primary outcome of satisfaction with care and secondary outcomes of satisfaction with decision, decision regret, and treatment choice among patients with localized prostate cancer. In this multicenter randomized controlled study, we randomly assigned patients with localized prostate cancer to the PreProCare intervention or usual care. Outcomes were satisfaction with care, satisfaction with decision, decision regret, and treatment choice. Assessments were performed at baseline and at 3, 6, 12, and 24 months, and were analyzed using repeated measures. We compared treatment choice across intervention groups by prostate cancer risk categories. Between January 2014 and March 2015, 743 patients with localized prostate cancer were recruited and randomly assigned to receive PreProCare (n = 372) or usual care (n = 371). For the general satisfaction subscale, improvement at 24 months from baseline was significantly different between groups (P < .001). For the intervention group, mean scores at 24 months improved by 0.44 (SE, 0.06; P < .001) from baseline. This improvement was 0.5 standard deviation, which was clinically significant. The proportion reporting satisfaction with decision and no regret increased over time and was higher for the intervention group, compared with the usual care group at 24 months (P < .05). Among low-risk patients, a higher proportion of the intervention group was receiving active surveillance, compared with the usual care group (P < .001). Our patient-centered PreProCare intervention improved satisfaction with care, satisfaction with decision, reduced regrets, and aligned treatment choice with risk category. The majority of our participants had a high income, with implications for generalizability. Additional studies can evaluate the effectiveness of PreProCare as a mechanism for improving clinical and patient-reported outcomes in different settings.

Doxycycline for outpatient-treated acute exacerbations of COPD: does it offers any additional value?

Despite its accepted role, a number of controversies persist regarding the use of antibiotics for exacerbations of chronic obstructive pulmonary disease (COPD). The adequate selection of patients, the identification of biomarkers for treatment response, the adequacy to disease and exacerbation severities or the short-term impact on the exacerbation outcome in different settings remain some of the aspects under current debate (1,2). One specific topic that warrants investigation is the potential long-term impact of antibiotic prescription during exacerbations, specifically on the prevention of subsequent exacerbations. The question about whether a specific treatment during the exacerbation can have an impact on the long term preventing future acute episodes is intriguing. Beyond the potential rationale behind, the topic results to be not easy to face, since a number of factors associated with subsequent exacerbations or with re-admissions after an index event are well-known (3).

Short-term treatment outcomes of children starting antiretroviral therapy in the intensive care unit, general medical wards and outpatient HIV clinics at Red Cross War Memorial Children's Hospital, Cape Town, South Africa: A retrospective cohort study.

Many HIV-infected children are initiated on antiretroviral therapy (ART) during hospitalisation in South Africa (SA). No published data on these outcomes exist. To assess the short-term outcomes of children initiated on ART in the intensive care unit (ICU), general medical wards (GMWs) and outpatient HIV clinics (OHCs) at Red Cross War Memorial Children's Hospital (RCWMCH), Cape Town, SA. We conducted a retrospective cohort study of HIV-infected children aged <13 years commenced on first-line ART between January 2008 and December 2011. Outcomes included death, virological suppression and changes in CD4 count. Kaplan-Meier estimates, multivariate Cox proportional hazard ratios and logistic regression were used to estimate outcomes at 6 months. One hundred and six children were commenced on ART in the ICU, 509 in the GMWs and 127 in the OHCs; 65.7% of all children were <12 months old. Of children qualifying for rapid ART initiation according to the 2013 national treatment guidelines, 182 (24.9%) started therapy within 7 days of diagnosis. Overall mortality was 6.4% (95% confidence interval (CI) 4.9 - 8.4). Of children remaining in care at RCWMCH, 51.0% achieved a CD4 percentage ≥25% and 62.3% a viral load ≤50 copies/mL 6 months after ART initiation. Mortality was higher in the ICU cohort (13.2%) than in the GMW and OHC cohorts (5.5% and 3.9%, respectively, log-rank p=0.004). Predictors of mortality included moderate underweight (adjusted hazard ratio (aHR) 2.4; 95% CI 1.1 - 5.2), severe underweight (aHR 3.2; 95% CI 1.6 - 6.5), absence of caregiver counselling sessions (aHR 2.9; 95% CI 1.4 - 6.0) and ART initiation in the ICU (aHR 2.6; 95% CI 1.4 - 4.9). These results highlight the importance of understanding the context in which children initiate ART, when comparing outcomes in different settings.

CP-104 Optimisation of drug treatments by pharmacists in nursing homes

BackgroundOptimising drug treatment is an essential part of caring for older people. Due to the comorbidity and frailty of this population, pharmacologic treatment should be individualised and reviewed to ensure...