Standard Policy Research Articles

The Impact on Authors and Editors of Introducing Data Availability Statements at Nature Journals

This article describes the adoption of a standard policy for the inclusion of data availability statements in all research articles published at the Nature family of journals, and the subsequent research which assessed the impacts that these policies had on authors, editors, and the availability of datasets. The key findings of this research project include the determination of average and median times required to add a data availability statement to an article; and a correlation between the way researchers make their data available, and the time required to add a data availability statement.

Management of severe bio-radiation dermatitis induced by radiotherapy and cetuximab in patients with head and neck cancer: emphasizing the role of calcium alginate dressings.

Severe bio-radiation dermatitis may develop in patients treated with concurrent radiotherapy and cetuximab for head and neck squamous cell carcinoma. The aim of our work was to report on the impact of a grade-specific management approach on treatment tolerability. Concomitant radiotherapy and cetuximab was prescribed for patients deemed ineligible for cisplatin-based chemoradiation. Since 2014, an advanced wound care nursing team was established in our clinic to implement a standardized policy for skin toxicity. A central role of calcium alginate dressings was defined in our management algorithm. The correlation between patient, disease, and treatment features with severe bio-radiation dermatitis and treatment tolerability was evaluated. Between 2007 and 2018, 51 patients were treated at our center with radiotherapy and cetuximab. The incidence of G3/G4 bio-radiation dermatitis was 43.1%. Comparing two consecutive cohorts of 26 and 25 patients treated before and after January 2014, respectively, the adoption of a grade-specific dermatitis management allowed to improve treatment tolerability. A mean radiation treatment interruption of 8.42days (SD, 6.73; 95% CI 5.7-11.1) was reduced to 0.86days (SD, 2.66; 95% CI - 0.28-2.02) in the more recent group (p < 0.0001). Mean relative dose intensity of cetuximab was also significantly higher (86.3% vs 74.5%, p = 0.0226). Routine involvement of an advanced wound care management team and early consideration for calcium alginate dressings in case of moist desquamation should be warranted to ensure high compliance to radiotherapy and cetuximab in patients with head and neck cancer.

The time-varying effect of monetary policy in China

ABSTRACTA sound understanding of monetary transmission mechanism is valuable because it helps the central bank to determine the proper course of monetary policy to balance growth and inflation. As China’s domestic financial markets deepen and develop further towards a market-based system, the country’s monetary policy instrument and transmission should continue to improve for managing economic conditions. Using a short-term key interest rate as standard monetary policy tool and time-varying parameter techniques, this study empirically demonstrates that China’s monetary policy framework is in the midst of transitioning to a market-based approach.

Identifying the Need for Good Practices in Health Technology Assessment: Summary of the ISPOR HTA Council Working Group Report on Good Practices in HTA

The systematic use of evidence to inform healthcare decisions, particularly health technology assessment (HTA), has gained increased recognition. HTA has become a standard policy tool for informing decision makers who must manage the entry and use of pharmaceuticals, medical devices, and other technologies (including complex interventions) within health systems, for example, through reimbursement and pricing. Despite increasing attention to HTA activities, there has been no attempt to comprehensively synthesize good practices or emerging good practices to support population-based decision-making in recent years. After the identification of some good practices through the release of the ISPOR Guidelines Index in 2013, the ISPOR HTA Council identified a need to more thoroughly review existing guidance. The purpose of this effort was to create a basis for capacity building, education, and improved consistency in approaches to HTA-informed decision-making. Our findings suggest that although many good practices have been developed in areas of assessment and some other key aspects of defining HTA processes, there are also many areas where good practices are lacking. This includes good practices in defining the organizational aspects of HTA, the use of deliberative processes, and measuring the impact of HTA. The extent to which these good practices are used and applied by HTA bodies is beyond the scope of this report, but may be of interest to future researchers.

Mejorar la evaluación en materia de transparencia a partir de la experiencia de la Ciudad de México

Este artículo explica cómo podría mejorarse la implementación de las disposiciones de las leyes sobre acceso a la información pública en los estados a la luz del caso de éxito en la Ciudad de México. Se utiliza como marco teórico una vertiente de la literatura sobre la implementación de políticas públicas, que postula que existe una mayor probabilidad de éxito cuando los cambios se realizan de manera gradual, pero sostenidos en el tiempo en lugar de modificaciones ambiciosas en plazos cortos. Se toma como caso de estudio a la Ciudad de México que, a lo largo de los años, ha tenido un desempeño consistente en la materia. Como método para la recolección de datos se utilizaron entrevistas semiestructuradas con 23 funcionarios de la Ciudad de México: comisionados, trabajadores del Instituto de Transparencia, Acceso a la Información Pública, Protección de Datos Personales y Rendición de Cuentas de la Ciudad de México (INFODF), y titulares de unidades de transparencia de dependencias. Se concluye que parte del éxito de la Ciudad de México se debe a que se han impulsado mejoras a los criterios de evaluación y políticas de estandarización de la información de manera gradual, pero incremental. Se propone establecer objetivos incrementales y razonables en las leyes para cumplirse en varios años con un enfoque de mejora continua.

IMPLEMENTATION OF EDUCATIONAL NATIONAL STANDARD POLICY ON THE OPERATION OF BASIC EDUCATION (Case Study in Wajo District, South Sulawesi)

&lt;em&gt;The background study of this research is to develop national education standards of the basic education. In this research study, the researcher tries to see and analyze the prevailing condition schools in the field of education. The goals of this research knowledge of the implementation of the National Education Standards policy and the determinant factors can support the implementation of National Education Standards policy on the implementation of National Standard School in Wajo Regency. The design of this research was descriptive qualitative research. The data for this research was collected through observation, interview, and documentation. The resulting analysis can be concluded as follows: First, the stages of implementation of the National Standard Primary School policy have not been implemented optimally because of overlapping. Second, the determinant factors that influence the implementation of the National Standard Primary School policy include resource support is still very limited, and third, less motivated elementary schools to get involved in the implementation of the National Standard Primary School policy, especially elementary schools in the standard category. In suggestion, good cooperation is needed with all parties and stakeholders in the implementation of the National Standard Primary School program through efforts to obtain common views and responsibilities towards Primary School development&lt;/em&gt;

Impact of Prior Cancer on Eligibility for Plasma Cell Disorder (PCD) Clinical Trials

▪History of prior cancer is a widespread exclusion criterion in cancer trials. Up to 80% of NCI-sponsored and 80% of industry-sponsored lung cancer trials exclude patients with a prior cancer. We suspect this exclusion is commonly applied in other cancer trials, although no definitive data exist. Prior cancer is especially common among older patients and those with certain cancer types. Among patients >65 years, 15.1% overall have prior cancer. In Multiple Myeloma, the most common plasma cell disorder (PCD), prevalence of prior cancer is as high as 17.4%. Examining the prior cancer exclusion criterion is important because the number of US cancer survivors is large and rapidly growing. Arbitrarily excluding cancer survivors from trials is not evidence-based and exclusion presumably arises from assumptions that higher mortality of patients with prior cancer could hinder study conduct and bias trial outcomes. However, few data exist to support this assumption of higher mortality. In fact, we demonstrated that lung cancer patients with a prior cancer have similar or lower mortality risk, compared to those without prior cancer.In this abstract, we reviewed prior cancer related eligibility criteria in three of the most common PCD (Multiple Myeloma, Amyloidosis and Waldenström Macroglobulinemia) clinical trials sponsored or endorsed by 5 major Co-Operative groups in North America (Table 1). We use descriptive statistics (n, %) and Fisher's exact tests to describe characteristics of trials with and without exclusion criteria. Of 33 trials, 26 (79%) excluded patients with prior cancer as follows - active cancer (12%), within 2-3 years of PCD diagnosis (9%), or within 5 years of PCD diagnosis (55%). Many trials had exceptions to prior cancer exclusion. Specifically, 67% of trials allowed non-melanoma skin cancer, 58% allowed in-situ cervical cancer, 12% allowed early stage prostate cancer.Table 2 shows the association between clinical trial characteristics and prior cancer exclusion. There was no association between prior cancer exclusion and phase of study, transplant studies, or survival end point. Exclusion criteria varied across year of activation (p=0.01); for example, 75% of studies activated 1990-1999 excluded prior cancer, compared to 100% of studies activated after 2010. Type of PCD was marginally associated with exclusion criteria (p=0.08); 74% of Multiple Myeloma trials excluded patients with prior cancer compared to 100% of the Amyloidosis and Waldenström Macroglobulinemia trials.Conclusion:A substantial proportion of potential participants may be excluded from PCD clinical trials because of a history of prior cancer. This practice impacts accrual, generalizability, and fair access to cutting-edge treatments and the highest level of clinical care. As treatment outcomes for other cancers continue to improve, it is likely that the prevalence of multiple primary cancers will increase. This exclusion criterion is applied widely across studies, including more than two-thirds of those with non-survival endpoints. Our study is the first to examine the prevalence and potential impact of prior cancer exclusion in PCD clinical trials. Using population-based cancer registry data, we plan to undertake further research to understand the appropriateness and ramifications of this standard exclusion policy in PCD cancer trials. [Display omitted] DisclosuresCollins:Agios: Research Funding; Bristol Myers Squibb: Research Funding; Celgene Corporation: Research Funding; Arog Pharmaceuticals: Research Funding. Devine:Kiadis Pharma: Consultancy. Usmani:Amgen, BMS, Celgene, Janssen, Merck, Pharmacyclics,Sanofi, Seattle Genetics, Takeda: Research Funding; Abbvie, Amgen, Celgene, Genmab, Merck, MundiPharma, Janssen, Seattle Genetics: Consultancy. Anderson:Amgen: Speakers Bureau; Takeda: Speakers Bureau; Celgene: Speakers Bureau. Kumar:Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees; Roche: Research Funding; AbbVie: Membership on an entity's Board of Directors or advisory committees, Research Funding; AbbVie: Membership on an entity's Board of Directors or advisory committees, Research Funding; Merck: Membership on an entity's Board of Directors or advisory committees, Research Funding; Oncopeptides: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; KITE: Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Membership on an entity's Board of Directors or advisory committees, Research Funding; KITE: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees, Research Funding.

Transfusion Practices Among Hematology/Oncology Healthcare Professionals

Introduction/Background:There are no evidence-based guidelines for optimal transfusion practices for patients undergoing chemotherapy and stem cell transplant. There are minimal low-quality studies regarding transfusion thresholds as well as the efficacy of pre-transfusion medications (to reduce febrile non-hemolytic transfusion reactions) for these patients. To pursue a prospective quality improvement study, it is important to know the current transfusion standards used by practitioners regarding: 1) transfusion thresholds for platelets and red blood cells and 2) routine use of pre medications prior to transfusions. Additional research questions included differences in the above standards by region or by pediatrics vs. adult providers.Study Design and Methods:Expedited IRB approval was obtained. We conducted a REDCap survey from 3/1/18-4/12/18 targeting hematology oncology providers of both pediatric and adult providers. The survey was emailed through multiple databases with members form several countries that included both adult and pediatric hematology/oncology practitioners.Results:One hundred and nineteen hematology/oncology practitioners completed the survey: 94 attending physicians, 19 fellows and 6 nurse practitioners. Most respondents practiced in United States (90 %, 107/119), the rest practiced in Canada, India, Italy and Iran. The majority of participants were pediatric hematology/oncology providers (84 %, 100/119). Of the remaining providers 10 treated only adults and 9 treated both adults and children. The vast majority (97%, 115/119) of participants did not utilize a standard policy for premedication prior to red blood cell transfusions. Similarly, 95 % (111/117) or participants made individual decisions on premedication with platelet transfusions rather than using an institutional policy. When asked about the threshold to transfuse blood products, 71% (75/105) of those who treated patients undergoing chemotherapy said they would transfuse red blood cells when patients had a hemoglobin of</= 7 g/dL, and 79% (82/104) would transfuse platelets when patients had a platelet count <10 K/mL. Practitioners treating bone marrow transplant (BMT) patients had more variability and used higher transfusion thresholds. Fifty-two percent (33/64) of them would transfuse red blood cells for patients undergoing BMT with a higher threshold of hemoglobin of 8 g/dL while only 36% used the lower threshold of 7 g/dL. Similarly, for platelet transfusions for patients undergoing BMT, 47% (31/66) would use a 20K/mL threshold, and 45% would transfuse platelets at a threshold of 10 K/mL.Conclusion:There is currently no routine practice of utilizing pre-medications prior to transfusions of red blood cells or platelets. Instead, practitioners surveyed indicated a preference for individualizing the use of pre-medications only if patients had a previous transfusion reaction. As the use of these medications is not evidence-based, additional studies are needed to determine their efficacy. Transfusion thresholds are relatively consistent among providers with the majority aiming for more liberal thresholds in patients undergoing chemotherapy and more conservative for those undergoing BMT. More studies are needed to evaluate the risks and benefits of using different transfusion thresholds. [Display omitted] DisclosuresKanter:Sancilio: Research Funding; ASH: Membership on an entity's Board of Directors or advisory committees; NHLBI: Membership on an entity's Board of Directors or advisory committees, Research Funding; bluebird bio: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Global Blood Therapeutics: Research Funding; Apopharma: Research Funding; AstraZeneca: Membership on an entity's Board of Directors or advisory committees; Pfizer: Research Funding.

Market reactions to ECB policy innovations: A cross-country analysis

Regulators have been paying increasing attention to governing and steering market fluctuations, with their role in shaping the economic cycle being ever more crucial. The combined effect of the financial and sovereign debt crises, as well as the approach to the zero lower bound, has made actions even more pressing, forcing the European Central Bank to resort to unconventional instruments to revive the economies and counter deflationary pressures. By using a combined event study and panel regression methodology, we investigate whether European Monetary Union equity markets react heterogeneously to standard and non-standard European Central Bank policy innovations. Our results show that conventional policies unevenly affect financial indices in the Eurozone and, hence, are bound to generate asymmetries that reflect on real economies, while unconventional measures, albeit with different intensities, exercise a homogeneous pressure on all markets. Our evidence highlights the beneficial impact of unconventional measures and suggests that they can play a useful role even in non-crisis times.

Analysis of policy implementation of local public service agency in hospital

Background: The level of public satisfaction with public hospital services is still quite low, with almost more than 50% complaining about the services it receives. The demand for hospital service quality, the government imposed the policy of local public service agency (LPSA) in the hospital. This study aimed to analyze the implementation of LPSA policy.Methods: This research was a descriptive research with qualitative approach. This research was conducted in Dr Rasidin Hospital in Padang, during July to October 2017. Key informants were chosen by purposive sampling as many as five people who understand about LPSA policy. Data were collected through indept interview, document review, and observation. Qualitative data were analyzed by thematic analysis.Results: The result of the research showed that the implementation of LPSA policy from policy standard has been run well, has a sufficient and adequate resources. Disposition of executives were positive in support of this policy to service activities. Communication has not spread evenly across all employees, only revolving around employees who directly handle the local public service agency. The bureaucratic structure was clear.Conclusions: Implementation of public service agency policies has worked well in terms of the standard policy, disposition, resources, communications, bureaucratic structure.

Lean Production, Izzat and Industrial Conflict in the Indian Auto Sector: A Case Study

The purpose of this article is to highlight the role that Izzat played in the unfolding industrial disputation that emerged at the Toyota plant in Bangalore between 1999 and 2007. Isolated instances contributed to a build-up of employee and community resentment at what was perceived as an attack on Izzat. Behind the events is the attempt to transpose Japanese “lean production and management systems” into an Indian subsidiary where local industrial and cultural conditions were not suitable for the imposition of such practices from headquarters to a subsidiary. The result of the analysis contributes to the understanding of workplace industrial relations (IR) in India and the centrality of Izzat. Within India, the significance of trade unions; the respect of employees; the importance of family and community; the importance of seniority; and the role of respect and honour are factors that multinationals often fail to understand in the design and implementation of their production and HRM systems. The study contributes to the debate over the transferability of standardized HRM policies and practices. MNEs should play a proactive role in supporting the employees of subsidiaries to adjust to and accommodate new paradigms in workplace industrial relations. The aggressive production and HRM practices at the Toyota plant were not compatible with the norms and cultural institutions of the Indian workforce. One of the key implications of this research is that foreign production, organizational and industrial relations systems and practices cannot be transplanted into host-country environments without the due recognition of key cultural conditions, notably Izzat in India.

An Analysis of Value Capture Instruments

Value capture means capturing in some way the value of an investment in public infrastructure. Value capture methods include five forms of property-related taxes: a tax on land value uplift, a broad-based land tax, selective land tax, property taxes and transaction taxes. They may also include three forms of user charges: developer charges, consumer charges and sale of development rights. The paper assesses these options against three standard policy objectives of efficiency, equity and practicality. The paper finds that all three main forms of user charges meet these criteria. Special area land and property taxes may be appropriate in limited cases. Pure betterment taxes on land value uplift are rarely practical.

Practical Applications of Standard and Behavioral Life-Cycle Theories and Public Policy

In Standard and Behavioral Life-Cycle Theories and Public Policy, from the Fall 2017 issue of The Journal of Retirement, author Meir Statman, a professor of finance at Santa Clara University, contrasts two different approaches to understanding how people think about saving and spending over their lifetimes. Standard life-cycle theory assumes a smooth, conflict-free approach toward money. In contrast, behavioral life-cycle theory allows for a range of utilitarian, expressive, and emotional attitudes. People can benefit from third-party assistance by financial advisors and public policy to come up with a balanced plan. TOPICS:Retirement, in wealth management, social security, legal/regulatory/public policy

Sustainable Development Goals and the Role of Standards

표준은 지속가능개발목표를 달성하는 데 중요한 역할을 할 수 있는 기반이 되는 사회 제도이며한 사회의 질서 확립에 기여하고, 비효율성을 줄여서 사회나 산업의 발전에 중요한 역할을 한다. 따라서 표준체계의 확립은 개발도상국 발전에도 토대가 된다. 특히 경제적인 측면에서 개발도상국의 제조 기업들이 국제 산업 가치사슬에 진입하기 위해서는 국제 수준의 환경, 품질 표준 및 인증을 획득하거나, 제품 품질을 담보할 수 있는 표준 및 인증 시스템을 개발하는 것이 필요하다. 이를 돕기 위해 무역원조(Aid for Trade)에서 표준 부문 원조의 중요성이 증가하고 있다. 또한 국제표준화기구들도 SDGs 달성에 기여하기 위해 다양한 노력을 경주하고 있다. 이런 배경에서, SDGs의 달성에 표준이 어떤 역할을 할 수 있을 것인가는 표준 및 표준화 연구의 지평을 넓히고, 새로운 표준 정책 아젠다를 발굴하는 데 기여할 수 있는 의미있는 연구 주제다. 또한 국내외를 통틀어 SDGs의 달성에 표준화가 기여했고, 또 기여할 수 있는 다양한 주제와 방식, 그리고 그 함의를 심도 있게 다룬 연구들은 아직 미미한 상황에서 국제사회의 주요 의제에 대응하기 위한 다양한 시각을 점검할 수 있다는 점에서 그 시의성 또한 높다. 기존에 연구되던 표준 및 표준화의 연구 주제를 SDGs의 틀 속에서 새롭게 해석하거나, 혹은 SDGs의 목표들 중에서 표준화를 새로운 문제해결의 방식으로서 적용해 보는 시도들은 우리사회의 지속가능한 전환을 위한 토대 역할을 할 것으로 판단된다.The Sustainable Development Goals (SDGs), announced at the UN General Assembly in 2015 under the consensus of the world leaders, are a new international agenda that is expected to play a role in standardization and standardization. Sustainable development means development that allows the present generation to meet the needs of future generations without compromising their ability to meet their needs (Brundtland, 1987) Emphasize the balance between the three pillars of social development, environmental sustainability and economic growth. The SDGs thus define the 17 challenges and 169 goals that the international community will face today and address specific implementation measures to achieve them over the next 15 years to 2030. In this context, what role the standard can play in achieving SDGs is a meaningful research topic that can broaden the horizons of standard and standardization research and contribute to the discovery of a new standard policy agenda. In addition, standardization has contributed to the achievement of the SDGs at home and abroad, and the various themes and methods that can contribute to and the implications of the implications are still under investigation. ), The timing is also high. Attempts to reinterpret the research topics of existing standards and standardization in the framework of SDGs, or to apply standardization among the goals of SDGs as a new problem solving method, serve as the foundation for the sustainable transition of our society.

Optimizing dispatch for a concentrated solar power tower

Concentrating solar power (CSP) systems employ a sophisticated thermal receiver, power cycle, and a heliostat field, comprised of thousands of mirrors spread over hundreds of acres of land, and are most cost-effective with relatively large quantities of energy storage which can be scheduled for dispatch. We exercise an existing optimization model that maximizes revenue over a year-long time horizon, solved using a standard 48-h look-ahead policy at hourly fidelity on a CSP system under development in California. The system employs molten salt power tower technology with a 150 MWe (net) turbine, eight hours of thermal storage at full load, and a solar field that provides 1.75 times the rated turbine thermal power. The model considers system configuration and interoperability aspects, such as storage tank size, production capacities, and ramp rates, and determines decisions that expedite financing, permitting, and plant design. Relative to results achieved via industry practice, the existing optimization model reduces the number of power cycle (i.e., turbine) start-up events by 86.4%, thereby improving net revenue by more than 8.5% annually; this corresponds to an approximately $140 M increase in net revenue over the lifetime of the plant, taking a step towards advancing the long-term economic viability of large-scale renewable energy systems. Sensitivity analysis on uncertain parameter values provides insight regarding those values that influence profit most significantly.

Ongoing professional practice evaluation: An infrastructure for accountability.

239 Background: As a national network of five hospitals treating patients fighting complex cancers, continuous monitoring of clinical staff competence is a priority. Recognizing an opportunity for an enhanced structure for ongoing professional practice evaluation (OPPE), a process mandated by The Joint Commission, the network set out to create heightened accountability, reliability and understanding of the review of performance data. Methods: Two work groups were established. The first was charged with the selection of meaningful specialty specific measures applicable to the oncology patient population. The second tasked to leverage resources expended using existing software and limiting the need for manual intervention. This group was responsible for creation and implementation of a consistent workflow with defined roles for physicians, medical staff operations and quality reviewers. Results: Over 50 subspecialties were mapped to over 250 selected metrics, with overlap when applicable to more than one specialty. A standard network-wide policy was approved by each center’s medical executive team. A workflow was clearly defined to include responsibilities associated with (pre-review) analyst role, service chief and credential committee. The use of the network’s reporting tool was standardized for OPPE as well as additional sources of quality data identified outside of the tool as needed, specifically for low volume and non-patient facing providers. A review calendar was created to guide the process on a rolling basis. Lastly, an OPPE Toolkit was created to govern and educate on the process that includes a pocket guide, Q&amp;A, and on-boarding materials for physicians to understand their data relevant to metrics for which they are accountable. Conclusions: This systemic and timely evaluation of practitioner specific data supports improvement of practitioner performance and provides objective information for credentialing and privileging decisions across the network. Physicians’ visibility into their own data has increased. Automating the majority of efforts associated with OPPE has reduced the time associated with fulfilling this external requirement and resulted in full compliance.

Management of Renal Disease: utility of a joint HIV-renal clinic

Although there has been a decrease in the incidence of HIV-associated nephropathy, the incidence of chronic kidney disease (CKD) is increasing in patients attending HIV clinics. Traditional risk factors for CKD, including diabetes, hypertension and coinfection with hepatitis C virus, are overrepresented in this population, making it difficult to distinguish the contribution of HIV infection 1. HIV-infected patients are at risk of renal dysfunction caused by HIV and by antiretroviral treatment (ART) toxicity. In particular, tenofovir disoproxil fumarate (TDF) has been associated with proximal renal tubular dysfunction 2. In 2014 locally in Brighton we had a cohort of 2150 HIV-infected patients, 90% of whom were on ART with 910 of 1935 (47.0%) on regimens including TDF. In addition to using a written protocol for monitoring renal function in patients on antiretrovirals (ARVs) and a standardized operating policy for investigation of abnormal blood tests and urinalysis, we run a ‘one-stop shop’ HIV-renal specialist clinic with an HIV physician and renal physician working together seeing referrals from the general HIV clinic. This study aimed to investigate the utility of this clinic and to describe renal disease in this cohort. We reviewed all patient records of patients seen in a specialist HIV-renal clinic between 2012 and 2014. Demographics, HIV history, number of visits, the indication for referral and outcome information were collected using a standardized proforma. Sixty-five patients, with a median age of 51 years (28–88 years) and a median duration of HIV infection of 163 months (20–335 months), were seen. Forty-two were taking TDF for a mean of 55.8 months (9–122 months). A total of 42 of 65 patients were reviewed once with a median number of visits of 1 (1–4). There were 98 appointments, 54 of which were virtual. The did-not-attend (DNA) rate was 11.4%. Referred patients were categorized as having: proteinuria on TDF (38 of 65 patients; 59%), proteinuria not on TDF (12 of 65 patients; 18%) and raised creatinine without proteinuria (15 of 65 patients; 23%). Of the 38 patients on TDF with proteinuria, five (13.2%) had TDF toxicity diagnosed and TDF was discontinued immediately, and 27 continued with close monitoring with a further seven subsequently discontinuing; the total number discontinuing was 12 of 38 (32%). Addition or up-titration of medications for poorly controlled hypertension was the commonest intervention overall in the joint HIV-renal clinic (23 of 65 patients; 35.4%), in particular in the non-TDF proteinuria group (eight of 12 patients; 66.7%). Renal calculi were a frequent contributor to renal dysfunction and four of 65 patients (6%) had a new glomerular diagnosis after undergoing renal biopsy [two had focal segmental glomerulosclerosis, one had immunoglobulin A (IgA) nephropathy and one had glomerulonephritis with granulomata]. In four patients (6%), the creatinine rise was attributed to nonsteroidal anti-inflammatory drug (NSAID), creatine or protein supplement usage. TDF toxicity was the commonest reason for referral but only a minority of referred patients (13.2%) needed to discontinue immediately. Optimizing blood pressure control was the most frequent outcome, suggesting that this is an underappreciated priority among HIV physicians.

Rethinking the Patient Education Council Format to Increase Efficiency

The Patient, Family, and Community Education Council (PEC) at a major medical center restructured its organizational format to enable it to operate more efficiently. Work groups from members of the PEC were created, based on the council’s goals, and charged with different responsibilities related to patient education. The work groups work independently and meet to report on their progress at the PEC monthly meeting. As new patient materials are developed, a Patient Communications specialist works with the PEC to ensure that approved materials comply with the institution’s standard policy prior to publication.

Integrated health system strengthening can generate rapid population impacts that can be replicated: lessons from Rwanda to Madagascar

At the turn of the century, the Millennium Development Goals (MDGs) set targets to dramatically improve human welfare by 2015. These ambitious aims included reducing extreme poverty by 50%, under-5...

A study on prescribing pattern of antibiotics in paediatric outpatient department at a multispeciality hospital nellore

In our study antibiotics are prescribed to paediatric patients based on empirical therapy without performing any sensitivity tests. Collaborative (Physician, Pharmacist, Microbiologist) research can be helpful, in addition to get a clear understanding of need for microbiological tests, pharmacist intervention and physician good judgment in clinical situation. Exact identification of disease and its management gives an important aspect of patient care which is important in paediatric patients. Prescriber should minimize the empirical therapy as much as possible. To limit or reduce the antibiotic prescribing all necessary references, Standard Treatment Guidelines (STG) and antibiotic prescribing policies should be provided by the hospitals. Physician should refer to STG for minimal prescribing of antibiotics. Specific effective interventions should be developed to reduce the inappropriate antimicrobial prescription. All diabetes mellitus patient treated in the Inpatient department of General medicine and Nephrology department during March-August 2014 were monitored, collect relevant data and entered into the data sheet. Based on the inclusion and exclusion criteria of the protocol approved by the IEC, patients belonging to the age group 40-70 of both sex were selected and enrolled for the study.