High variability in the measurement of HIV primary prevention activities and outcomes.

INTRODUCTION: While there is a global consensus on monitoring Human Immunodeficiency Virus (HIV) treatment progress, there has been less attention to the degree of consistency of the measurement of HIV prevention programmes-and the global prevention response is not on-track to achieve 2020 goals. In this paper, we assess the degree of variability in primary prevention indicators selected by national strategic plans (NSPs) and global stakeholder monitoring and evaluation (M&E) strategies. METHODS: We obtained the most recent NSPs from low and middle income Joint United Nations Programme on HIV/AIDS (UNAIDS) Fast-Track countries, and M&E documents from The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund), President's Emergency Plan for AIDS Relief (PEPFAR), UNAIDS, the Global HIV Prevention Coalition and the World Health Organization (WHO). We extracted HIV primary prevention indicators from each document, standardized and aggregated them by age/ sex, categorized indicators by topic, and evaluated the frequency of matched indicators between countries and stakeholders. Data were collected between February and April of 2019. RESULTS: Twenty-one NSPs and five global stakeholder documents were assessed; 736 primary prevention indicators were identified; 284 remained following standardization and aggregation. NSPs contained from 3 to 48 primary prevention indicators, with an average of 23; categories included: HIV education and outreach (17.6%), testing (17.3%) and condom use (16.2%). Of unique national indicators, only 34% was shared between two or more countries. Sixty-nine per cent was applied in a single country only. 56% of NSP indicators did not appear in any global stakeholder document. Conversely, 42% of global indicators did not appear in any surveyed NSPs. Within global indicators, 63% was only measured by one global body, and no single indicator was measured by all five. CONCLUSIONS: These analyses reveal a lack of consensus both between and within countries' and global stakeholders' measurement of HIV prevention. Though some variability is expected, these findings point to a need to refocus attention on achieving greater consensus on a global measurement framework for HIV prevention

The Borodin Quartet (image)

http://deepblue.lib.umich.edu/bitstream/2027.42/61051/1/2601.pd

30 day mortality in adult palliative radiotherapy - A retrospective population based study of 14,972 treatment episodes

Background: 30-day mortality (30DM) has been suggested as a clinical indicator of the avoidance of harm in palliative radiotherapy within the NHS, but no large-scale population-based studies exist. This large retrospective cohort study aims to investigate the factors that influence 30DM following palliative radiotherapy and consider its value as a clinical indicator. Methods: All radiotherapy episodes delivered in a large UK cancer centre between January 2004 and April 2011 were analysed. Patterns of palliative radiotherapy, 30DM and the variables affecting 30DM were assessed. The impact of these variables was assessed using logistic regression. Results: 14,972 palliative episodes were analysed. 6334 (42.3%) treatments were delivered to bone metastases, 2356 (15 7%) to the chest for lung cancer and 915 (5.7%) to the brain. Median treatment time was 1 day (IQR 1–7). Overall 30DM was 12.3%. Factors having a significant impact upon 30DM were sex, primary diagnosis, treatment site and fractionation schedule (p < 0.01). Conclusion: This is the first large-scale description of 30-day mortality for unselected adult palliative radiotherapy treatments. The observed differences in early mortality by fractionation support the use of this measure in assessing clinical decision making in palliative radiotherapy and require further study in other centres and health care systems

Defining Surgical Quality in Gastric Cancer: A RAND/UCLA Appropriateness Study

National Health ServiceUniv Toronto, Dept Surg, Toronto, ON, CanadaUniv Toronto, Dept Med, Toronto, ON, CanadaInst Clin Effectiveness Studies, Toronto, ON, CanadaSunnybrook Res Inst, Toronto, ON, CanadaDalhousie Univ, Dept Surg, Halifax, NS B3H 4H2, CanadaUniv Calgary, Dept Surg, Calgary, AB, CanadaMaimonides Hosp, Dept Surg, Brooklyn, NY 11219 USAMem Sloan Kettering Canc Ctr, Dept Surg, New York, NY 10021 USAUniversidade Federal de São Paulo, São Paulo, BrazilBrown Univ, Dept Surg, Providence, RI 02912 USAOhio State Univ, Dept Med, Columbus, OH 43210 USAOhio State Univ, Dept Pharmacol, Columbus, OH 43210 USARoyal Marsden Hosp, Dept Med, Sutton, Surrey, EnglandUniv Texas MD Anderson Canc Ctr, Dept Radiat Oncol, Houston, TX 77030 USAUniv Texas MD Anderson Canc Ctr, Dept Surg Oncol, Houston, TX 77030 USAYonsei Univ, Coll Med, Dept Surg, Seoul, South KoreaUniv Chicago, Dept Surg, Chicago, IL 60637 USACanc Inst Hosp, Dept Surg, Tokyo, JapanLeiden Univ, Med Ctr, Dept Surg, Leiden, NetherlandsUniv Michigan Hlth Syst, Dept Surg, Ann Arbor, MI USAUniversidade Federal de São Paulo, São Paulo, BrazilWeb of Scienc