Concomitant HIV infection in newly diagnosed multiple myeloma patients is hard to recognise and should be tested for routinely in areas of high endemicity

Background. Over the past three decades much has changed in the treatment and outcomes of patients suffering concurrently from both multiple myeloma (MM) and HIV. While the prevalence of MM appears to be higher in HIV-positive individuals than in those who are uninfected, early recognition of patients suffering from both diseases is difficult and little information is available on their demographics and clinical presentation.Objective. To compare the presenting features of HIV-positive patients diagnosed with MM with those of HIV-negative patients.Methods. A single-centre, retrospective cohort study included 16 HIV-positive and 73 HIV-negative patients diagnosed with MM, in order to compare variables related to the clinical presentation of both conditions.Results. HIV-positive patients presented with MM at a significantly younger age, and had fewer osteolytic lesions, less renal impairment and lower neutrophil counts. Disease stage, gender, pathological fractures, bone marrow plasmacytosis, plasmacytomas and lymphocyte counts were comparable, emphasising the difficulty of identifying these patients. The HIV-positive patients had relatively high CD4 counts and a low prevalence of abnormal Freelite kappa/lambda ratios. All HIV-positive patients presented with paraproteins of the immunoglobulin G (IgG) type, implying a possible relationship between MM and an IgG response to HIV antigens.Conclusions. On the basis of our findings and literature on the treatment of both diseases, we suggest that HIV be tested for routinely in younger MM patients, especially in areas with a high prevalence of HIV. The integration of our results into the sparse knowledge on the role of HIV infection-related MM provides possible new insights into the interaction between these diseases

Effects of service-wide support on regularity of alcohol screening of clients in Australian Aboriginal and Torres Strait Islander Community Controlled Health Services: a cluster randomised trial

Background: We have previously shown that service-wide support can increase the odds of alcohol screening in any 2-month period in a cluster randomized trial of service-wide support to Aboriginal and Torres Strait Islander Community Controlled Health Services (ACCHS). Here we report an exploratory analysis on whether the resulting pattern of screening was appropriate. Aim: we assess whether that increase in screening was associated with: (i) increased frst-time screening, (ii) increased annual screening, (iii) whether frequently screened clients fell into one of four risk categories as defned by national guidelines. Methods: Setting and participants: 22 ACCHS; randomized to receive the support model in the treatment (‘earlysupport’) arm over 24-months or to the waitlist control arm. Intervention: eight-component support, including training, sharing of experience, audit-and-feedback and resource support. Analysis: records of clients with visits before and after start of implementation were included. Multilevel logistic modelling was used to compare (i) the odds of previously unscreened clients receiving an AUDIT-C screen, (ii) odds of clients being screened with AUDIT-C at least once annually. We describe the characteristics of a sub-cohort of clients who received four or more screens annually, including if they were in a high-risk category. Results: Of the original trial sample, 43,054 met inclusion criteria, accounting for 81.7% of the screening events in the overall trial. The support did not signifcantly increase the odds of frst-time screening (OR =1.33, 95% CI 0.81–2.18, p =0.25) or of annual screening (OR =0.99, 95% CI 0.42–2.37, p=0.98). Screening more than once annually occurred in 6240 clients. Of the 841 clients with four or more screens annually, over 50% did not fall into a high-risk category. Females were overrepresented. More males than females fell into high-risk categories. Conclusion: The signifcant increase in odds of screening observed in the main trial did not translate to signifcant improvement in frst-time or annual screening following implementation of support. This appeared to be due to some clients being screened more frequently than annually, while more than half remained unscreened. Further strategies to improve alcohol screening should focus on appropriate screening regularity as well as overall rates, to ensure clinically useful information about alcohol consumption. Trial Registration ACTRN12618001892202, retrospectively registered 16 November 2018 https://anzctr.org.au/Trial/ Registration/TrialReview.aspx?ACTRN=12618001892202.Monika Dzidowska, Jacques E. Raubenheimer, Timothy A. Dobbins, K. S. Kylie Lee, Noel Hayman, Julia Vnuk, Paul Haber, and Katherine M. Conigrav

Critical Factors Underpinning the e-CRM Activities of SMEs

Small and medium-sized enterprises (SMEs) are vital components of our economies, but many struggle to perform the marketing prescribed theoretically for large organisations. In practice, marketing is performed in SMEs through an intrinsic customer orientation, which exhibits striking resemblances to customer relationship management (CRM) theory. A quantitative approach was adopted to provide broad understanding and classification to the under-researched area of e-CRM in SMEs. Exploratory factor analysis uncovered eight distinct yet inter-related factors underpinning the practices and processes of e-CRM in SMEs. Findings show that SMEs are performing e-CRM to varying extents, reaping a range of performance benefits and facing a range of challenges. It is true that SMEs are not adopting e-CRM per se, as described in the large organisation-biased literature, but they are adopting relatively simple IBTs to improve their customer communication and information management capabilities and thus to create competitive advantage in their own strategic way. From a theoretical perspective, this study has shed significant light on what is driving SMEs’ e-CRM activities, thus providing long-awaited theoretical support for a practical reality. From a managerial perspective, the study has delineated eight principal issues that require attention if e-CRM is to be implemented successfully in SME