The role of socio-economic factors responsible for non-compliance of directly observed treatment short-course among tuberculosis patients

Introduction: Tuberculosis has gone out of control in many parts of world. The therapeutic regimens given under direct observation as recommended by world Health Organization have been shown to be highly effective for both preventing and treating tuberculosis but poor compliance to anti-tuberculosis medication (ATT) is a major barrier to its global controls. Objectives: The role of socio-economic factors responsible for non-compliance of directly observed treatment short-course (DOTS) among Tuberculosis Patients. Materials and Methods: Cross sectional study, interviewed using a set of questionnaire. Participants were enrolled at DOTS centre of Lala Ram Sarup Institute of tuberculosis and Respiratory disease New Delhi, India. Patients who interrupted treatment for more than 2 months consecutively were classified as non-compliance cases. T-test was used for comparing the means of the control and case groups. Results: Majority of study population (45%) was in age group of 31 -45 years, which is the productive age. 85 % noncompliant patients believed anti TB drugs to be bad and 15 % accepted as good for them. Similarly 87 % believed to stop ATT very prematurely as soon as symptoms disappear while 13 % believed to continue as per DOTS volunteer advice. The study revealed that the non-compliance of DOTS was significantly high among those who were less educated, unskilled worker, low family income and upper lower class family. Conclusion: In Delhi region, the treatment of Tuberculosis was good and did not have much involvement of socio-economical role in the non-compliance of treatment. But still major hurdle is the inadequate education, occupation, and income

Shared decision making and experiences of patients with long-term conditions : has anything changed?

Background Medication problems among patients with long-term conditions (LTCs) are well documented. Measures to support LTC management include: medicine optimisation services by community pharmacists such as the Medicine Use Review (MUR) service in England, implementation of shared decision making (SDM), and the availability of rapid access clinics in primary care. This study aimed to investigate the experience of patients with LTCs about SDM including medication counselling and their awareness of community pharmacy medication review services. Methods A mixed research method with a purposive sampling strategy to recruit patients was used. The quantitative phase involved two surveys, each requiring a sample size of 319. The first was related to SDM experience and the second to medication counselling at discharge. Patients were recruited from medical wards at St. George’s and Croydon University Hospitals.The qualitative phase involved semi-structured interviews with 18 respiratory patients attending a community rapid access clinic. Interviews were audio-recorded and transcribed verbatim. Thematic analysis using inductive/deductive approaches was employed. Survey results were analysed using descriptive statistics. Results The response rate for surveys 1 and 2 survey was 79% (n = 357/450) and 68.5% (240/350) respectively. Survey 1 showed that although 70% of patients had changes made to their medications, only 40% were consulted about them and two-thirds (62.2%) wanted to be involved in SDM. In survey 2, 37.5% of patients thought that medication counselling could be improved. Most patients (88.8%) were interested in receiving the MUR service; however 83% were not aware of it. The majority (57.9%) were interested in receiving their discharge medications from community pharmacies. The interviews generated three themes; lack of patient-centered care and SDM, minimal medication counselling provided and lack of awareness about the MUR service. Conclusion Although patients wanted to take part in SDM, yet SDM and medication counselling are not optimally provided. Patients were interested in the MUR service; however there was lack of awareness and referral for this service. The results propose community pharmacy as a new care pathway for medication supply and counselling post discharge. This promotes a change of health policy whereby community-based services are used to enhance the performance of acute hospitals

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Enhancing communication adaptability between payment card processing networks

Financial organizations communicate with each other using ISO 8583 or its derivatives to complete the request and response cycle of card originated transactions originated from an ATM, POS, or the web. ISO 8583 is a broad standard. Its implementations slightly vary due to the flexibility available within the standard. This paper discusses the problem of adaptability of communication between payment card transaction processing entities due to this flexibility. We first provide an overview of different variations in ISO 8583 implementations and identify the interoperability issue based on our industry experience. We then propose a solution and suggest a way to standardize different implementations so that one organization can communicate with another without or with minimal changes in software. The suggestion is based on the exchange of meta data indicating how the target system is interpreting the header fields during the communication process.Finally, we discuss the benefits of the solution in which the vendors could not only avail the customization flexibility provided by ISO8583 but also ensure that their implementation of the standard is interoperable with others. This reduces the cost of interconnectivity with other partners when a network wants to expands its busines

Sputum smear positivity at two months in previously untreated pulmonary tuberculosis patients

Background and Objectives: In pulmonary tuberculosis, bacteriological status at two months affects subsequent treatment and prognosis. The effect on treatment outcome and risk factors for sputum conversion at two months treatment in previously untreated pulmonary tuberculosis (PTB) patients was studied in the following report. Methods: A 1:1 case-control study was performed from June 2006 to February 2008 on patients in the Revised National Tuberculosis Control Program in a tertiary level institute in Delhi, India. Patients with previously untreated PTB with sputum smear positive at 2 months of treatment (cases) were compared with those who achieved conversion (controls). Results: In 74 cases and 74 controls, independent risk factors for sputum smear positive at two months were: illness for >2 months, presence of cavity or extensive disease on chest X-ray, and interruption in intensive phase of treatment. Patients with smear positive at 2 or 3 months of treatment were more likely to fail or default from treatment. Aforesaid factors were also associated with sputum culture positive status at 2 months in univariate analysis. Patients who interrupted treatment ≥3 times in the first two months were more likely to be culture positive at two months and had a higher rate of default and failure. Conclusions: Illness for more than 2 months, presence of cavity or extensive disease on chest X-ray, and interruption in intensive phase of treatment are independent risk factors for sputum smear positivity at two months, which in turn is associated with poor treatment outcomes. Patients with these factors merit special attention under the national program