14,230 research outputs found

    Mobility and Clinic Switching Among Postpartum Women Considered Lost to HIV Care in South Africa.

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    This version is the Accepted Manuscript, and was published in final edited form as: J Acquir Immune Defic Syndr. 2017 April 01; 74(4): 383–389. doi:10.1097/QAI.0000000000001284OBJECTIVE: Retention in HIV care, particularly among postpartum women, is a challenge to national antiretroviral therapy programs. Retention estimates may be underestimated because of unreported transfers. We explored mobility and clinic switching among patients considered lost to follow-up (LTFU). DESIGN: Observational cohort study. METHODS: Of 788 women initiating antiretroviral therapy during pregnancy at 6 public clinics in Johannesburg, South Africa, 300 (38.1%) were LTFU (no visit ≥3 months). We manually searched for these women in the South African National Health Laboratory Services database to assess continuity of HIV care. We used geographic information system tools to map mobility to new facilities. RESULTS: Over one-third (37.6%) of women showed evidence of continued HIV care after LTFU. Of these, 67.0% continued care in the same province as the origin clinic. Compared with those who traveled outside of the province for care, these same-province "clinic shoppers" stayed out-of-care longer {median 373 days [interquartile range (IQR): 175-790] vs. 175.5 days (IQR: 74-371)} and had a lower CD4 cell count on re-entry [median 327 cells/μL (IQR: 196-576) vs. 493 cells/μL (IQR: 213-557). When considering all women with additional evidence of care as engaged in care, cohort LTFU dropped from 38.1% to 25.0%. CONCLUSION: We found evidence of continued care after LTFU and identified local and national clinic mobility among postpartum women. Laboratory records do not show all clinic visits and manual matching may have been under- or overestimated. A national health database linked to a unique identifier is necessary to improve reporting and patient care among highly mobile populations

    Emerging priorities for HIV service delivery

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    Nathan Ford and co-authors discuss global priorities in the provision of HIV prevention and treatment services

    The Effect of Complete Integration of HIV and TB Services on Time to Initiation of Antiretroviral Therapy: A Before-After Study.

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    Studies have shown that early ART initiation in TB/HIV co-infected patients lowers mortality. One way to implement earlier ART commencement could be through integration of TB and HIV services, a more efficient model of care than separate, vertical programs. We present a model of full TB/HIV integration and estimate its effect on time to initiation of ART

    Effect of Remote Fetal Monitoring in an Inpatient Obstetrical Unit: A retrospective review

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    Electronic Fetal Monitoring (EFM) has been used as a tool for inpatient obstetrical care in the United States since the 1980\u27s. The litigious nature of our society has caused much emphasis to be placed upon EFM use and interpretation; however, little evolution has occurred in monitoring techniques. The review of relevant literature found a significant gap in knowledge in regards to research of the current monitoring practice. Therefore, this study was aimed to look at the effect of remote monitoring, like the practice currently used in telemetry, on inpatient obstetrical care. The study used a retrospective review to look at three components including: reaction time of nurses, overall quality of tracing, and the Apgar score of the neonates. Study participants were selected at random from two groups, one prior to implementation of a remote monitoring protocol and one after implementation. All three components improved from the control group to the experimental group, yet only nurse reaction time was found to be statistically significant; therefore, additional research on this subject matter may be warranted. If valid, the impact of these findings is significant because they suggest the potential benefit of a new standard in care. Therefore, more research on the use of remote monitoring techniques is needed along with more data to determine the overall effectiveness in improving obstetrical care

    3D-Wound Imaging: Precise, Consistent, and Efficient

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    Background: The most common method of obtaining wound measurements is the hand-ruler method. Studies show that the hand-ruler method results in the most inaccurate measurements with the lowest interrater reliability. Studies also show that using 3D-wound imaging yields the most accurate measurements with the best interrater reliability. 3D-wound imaging technology also increases efficiency by allowing users to obtain images and document assessments using one device at the bedside. Purpose: The purpose of this project is to make the process of assessing wounds more efficient by decreasing the time spent on photographing, measuring, and documenting wound assessments by implementing the use of 3D-wound imaging technology and software. Methods: Prior to the implementation of the 3D-wound technology, a baseline time of completing skin rounds assessments of wounds including imaging, measuring, and documentation was obtained via questionnaire asking nurses the average time they have experienced in completing all skin rounds duties including imaging, assessing, and documenting wounds. During implementation of 3D-wound imaging, start and end times were obtained through the 3D-wound software reporting dashboard. Other information collected included the number of wounds and number of patients that were seen. Post implementation data was analyzed 2-months after implementation. Evaluation/Results: After 2 months, the results showed a decrease in time to image wounds, conduct a full assessment and complete documentation by an average of 4.73 hours or 59%. Implementation of 3D-wound technology also allowed for realignment of the skin rounds team and decrease the number nursing personnel required on the team. Implications for Practice: Streamlining the process of wound assessment and documentation by implementing the use of 3D-wound imaging technology can be rolled out to the entire hospital, including outpatient clinics. A more widespread use of the technology can lead to decreased man-hours across the facility and therefore decreased costs. Conclusion: Future studies can show how clinicians use the accurate data provided by the 3D-wound imaging device in making treatment decisions which can ultimately lead to faster healing and decreased hospital bed days

    Closing the loop in child TB contact management: completion of TB preventive therapy outcomes in western Kenya

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    SETTING: Children especially those \u3c 5 years of age exposed to pulmonary tuberculosis (TB) are at a high risk of severe TB disease and death. Isoniazid preventive therapy (IPT) has been shown to decrease disease progression by up to 90%. Kenya, a high TB burden country experiences numerous operational challenges that limit implementation of TB preventive services. IPT completion in child contacts is not routinely reported in Kenya. OBJECTIVE: This study aims to review the child contact management (CCM) cascade and present IPT outcomes across 10 clinics in western Kenya. DESIGN: A retrospective chart review of programmatic data of a TB Reach-funded active, clinic-based CCM strategy. RESULTS: Of 553 child contacts screened, 231 (42%) were reported symptomatic. 74 (13%) of the child contacts were diagnosed with active TB disease. Of those eligible for IPT, 427 (90%) initiated IPT according to TB REACH project data while 249 (58%) were recorded in the IPT register with 49 (11%) recorded as a transfer to other facilities. Of the 249 recorded in the IPT register, 205 (82%) were documented to complete therapy (48% of project initiation children). CONCLUSION: Our evaluation shows gaps in the routine CCM care cascade related to completeness of documentation that require further programmatic monitoring and evaluation to improve CCM outcomes
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