Search Results for: GPG: Versione 5.6.2.1 (Aprile 2021)

This cross-sectional study measures trends in the use and cost of first-line biologic treatments for plaque psoriasis from 2007 to 2021.

Objective
To assess the appropriateness, acceptability and feasibility of implementing the Test-it PrCr Urinalysis Dipstick Test (LifeAssay Diagnostics, South Africa) in referral hospitals in Ghana.

Participants
96 healthcare professionals were trained on the protein-to-creatinine (PrCr) test, which was integrated into protocols alongside standard-of-care tests between November 2021 and April 2022. Test users completed questionnaires post training. Three focus group discussions (FGDs) and seven key informant interviews were conducted to evaluate test procedure comprehension, insights into training effectiveness, usability/user confidence, perceptions, attitudes towards the test and barriers and facilitators of use.

Results
High product usability, user confidence and satisfaction were reported. Staff perceived the test as easy to use and similar to current products. Misinterpretations of test results were less likely for strong results. Facilitators of use included effective trainings, sensitisation of the product and key stakeholder endorsement. Challenges impacting implementation feasibility included the short shelf life of test strips (3 months) after opening cannisters, the added complexity of the ratiometric result interpretation and the test’s lack of other parameters that are included in current products (eg, glucose, nitrate), limiting its broader clinical utility for antenatal care screening. All FGD participants agreed that the use of the PrCr test would not change current practices/protocols for dipstick use.

Conclusion
Although the Test-It PrCr test is easy to use and well accepted, key product attributes limit its implementation feasibility in this setting. It may be more appropriate for monitoring high-risk women in this context.

Objective
With the increasing prevalence of antimicrobial resistance (AMR), the rational use of antibiotics is crucial. This study aimed to evaluate the antibiotic use patterns and influencing factors of compliance in Shanxi Province Hospitals between 2015 and 2021 and provide data support for the management of antibiotics.

Design
This was a retrospective observational study of trends in antibiotic use and data reporting trends in the context of antimicrobial stewardship (AMS).

Data sources
The analysis involved annual antibiotic data from hospitals covered by China’s National Clinical Improvement System (NCIS). We obtained information on hospital characteristics (eg, city, a deidentified hospital code and hospital level) from Shanxi Provincial Pharmaceutical Quality Control Centre.

Eligibility criteria
Our study included Shanxi hospitals that reported annual antibiotic data to the NCIS system in any year between 2015 and 2021.

Results
The number of hospitals reporting antibiotic data has increased annually. Between 2015 and 2021, a total of 221 hospitals in 11 cities were analysed. The proportion of patients undergoing clean surgical procedures with prophylactic antibiotic prescriptions decreased from 45.08% to 40.0% between 2019 and 2021, with a compound annual growth rate (CAGR) of –5.80 (p=0.103). The intensity of antibiotic treatment among inpatients was from 42.00 to 39.70 daily defined dose between 2017 and 2021, with a CAGR of –1.40 (p=0.015). The proportion of inpatients with antibiotic prescriptions decreased from 51.42% to 47.14% between 2015 and 2021, with a CAGR of –1.44 (p

Objective
To investigate the association between initial discharge planning and transfers of inpatient care with discharge delay. To identify operational changes which could expedite discharge within the Discharge to Assess (D2A) model.

Design
Retrospective cohort study.

Setting
University Hospital Southampton National Health Service Foundation Trust (UHS).

Participants
All adults (≥18 years) who registered a hospital inpatient stay in UHS between 1 January 2021 and 31 December 2022 (n=258 051). After excluding inpatient stays without complete discharge planning data or key demographic/clinical information, 65 491 inpatient stays were included in the final analysis. Data included demographics, comorbidities, ward movements, care team handovers and discharge planning records.

Primary and secondary outcome measures
The primary outcome was discharge delay, defined as the number of days between the final estimated discharge date and the actual discharge date. For the purposes of OR analysis, discharge delay was modelled as a binary outcome: any delay ( >0 days) versus no delay. Logistic regression models were used to examine associations between initial discharge planning accuracy, the number of ward moves and the number of in-specialty handovers and the likelihood of discharge delay, adjusting for demographic and patient complexity factors.

Results
Out of 65 491 inpatient stays, 10 619 had an initial planned discharge pathway that was different from the final discharge pathway. 7790 of these inpatient stays (75.1%) recorded a discharge delay. In contrast, among the 54 872 inpatient stays where the initial and final pathway matched, 10 216 (18.6%) recorded a delay. Using logistic regression modelling a binary outcome (any discharge delay vs no delay), an inaccurate initial pathway was associated with significantly increased odds of delay (adjusted OR (aOR) 2.72, 95% CI 2.55 to 2.91). Each additional ward move (aOR 1.25, 95% CI 1.23 to 1.28) and each in-specialty handover (aOR 1.17, 95% CI 1.14 to 1.20) were also associated with higher odds of discharge delay.

Conclusions
This study finds a strong association between inaccurate initial discharge plans and inpatient transfers of care with discharge delay, after controlling for patient complexity and acuity. This highlights the need to consider how initial plans and inpatient transfers affect discharge planning. Given the lead times for organising onward care, operational inefficiencies are most impactful for patients eventually discharged on pathways with higher planning complexity.

Objective
The aim of this study was to compare in-hospital mortality across waves in patients without and with a ceiling of care at hospital admission.

Design
A multicentre prospective cohort study.

Setting
Five tertiary hospitals in Catalonia, Spain, during four waves of the COVID-19 pandemic. Data from the first wave embraced from March to April 2020, second wave from October to November 2020, third wave from January to February 2021 and fourth wave from July to August 2021.

Participants
All consecutive adult subjects (older than 18 years old) admitted to any of the five aforementioned centres. All subjects had a confirmed SARS-CoV-2 infection (with a positive PCR test or antigen test) and an overnight hospital stay. Ceiling of care defined as the highest level of care that a patient will receive during medical treatment was assessed at hospital admission for all patients.

Primary measure
In-hospital mortality.

Results
A total of 3982 hospitalised patients without ceiling of care and 1831 hospitalised patients with ceiling of care were included in the analysis. The adjusted ORs of in-hospital mortality in the second wave were 0.57 (95% CI 0.40 to 0.80), in the third 0.56 (95% CI 0.37 to 0.84) and in the fourth 0.34 (95% CI 0.21 to 0.56) compared with the first wave in subjects without ceiling of care. The adjusted OR was significantly lower in the fourth (0.38, 95% CI 0.25 to 0.58) wave compared with the first wave in subjects with ceiling of care.

Conclusions
In patients without ceiling of care, mortality decreased over time, suggesting better disease knowledge and management. In ceiling of care, only fourth wave patients were less likely to die than first wave patients. In a future infectious disease pandemic, it will be a challenge to improve the management of patients with ceiling of care.

Objective
To evaluate the user experience of the joint National Institute of Health and Care Excellence (NICE)/Keele University Shared Decision Making (SDM) learning package.

Design
A qualitative study using online semistructured interviews. Data were analysed using open coding followed by the construction of themes.

Setting
Participants were recruited and interviewed online via Microsoft Teams.

Participants
Healthcare professionals who had used the NICE SDM learning package and provided contact details between June 2021 and April 2022 were eligible to be contacted.

Intervention
The online learning package developed to support the implementation of the NICE SDM guideline.

Findings
12 participants from a variety of different professional backgrounds were interviewed and reported that the learning package was easy to use and the different formats for presenting the information were engaging. The package was available in discrete sections—‘bitesize’ chunks—which allowed the participants to fit their learning around their busy schedules. The package included virtual patients (VPs) which allowed users to practice their SDM skills and put the learning into practice. The VPs also stimulated reflection on current performance and a shift in approach to SDM in practice. Suggestions were made by participants to improve the usability and accessibility of the learning package.

Conclusion
The NICE SDM learning package was viewed favourably by the participants. The bitesize structure and interactivity were key positive elements. Many participants suggested that they had made changes to their practice as a result of using the package.

Introduction
Postbariatric hypoglycaemia (PBH) is a complex medical condition with a significant impact on patients’ quality of life. The underlying mechanisms remain to be elucidated. We have shown that food ingestion increases IL-1β and subsequently stimulates insulin secretion. We therefore hypothesised that overactivation of the IL-1β pathway could lead to PBH by promoting excessive insulin secretion after a meal. In a proof-of-concept study, we have shown that acute treatment with the IL-1 receptor antagonist anakinra can attenuate PBH after a single liquid mixed meal. This study aims to validate this therapeutic approach over a longer period of time using the long-acting anti-IL-1β antibody canakinumab.

Methods and analysis
In this prospective, randomised, double-blind, placebo-controlled, multicentre trial, we plan to enrol 62 adult patients after bariatric surgery with frequent, postprandial hypoglycaemia (ie,

Objectives
Our study was designed to assess whether paired normal-tumour testing increased access to targeted therapy, clinical trials and influenced cancer screening recommendations given to patients and their families.

Design
Prospective cohort study.

Setting
Academic cancer centre in the Pacific Northwest region of the USA.

Participants
Patients newly diagnosed between 01 January 2021 and 31 December 2022 with cancers of the oesophagus, gastro-oesophageal junction and stomach (CEGEJS) were included. All other cancer diagnoses such as head and neck, duodenal and lower gastrointestinal tract cancers were excluded.

Intervention
Paired germline and tumour genetic test within 90 days of new patient visit.

Primary outcome measures
Number of targeted therapies received (or not) when eligible, follow-up treatment data and number of inherited predispositions to cancers identified. No secondary outcome measures.

Results
Of 42 patients, 32 (76.2%) were eligible for at least one targeted therapy. 19 patients received immunotherapy, when 16 had a biomarker predicting immunotherapy benefit, and benefit of immunotherapy was unclear for 3. Another 11 did not have this biomarker, and 6 of them received immunotherapy. Six pathogenic variants were identified in four high-risk genes. By 01 January 2024, 18 patients (42.9%) had died of complications of cancer.

Conclusion
More than 75% of patients who received tumour testing were eligible for a targeted therapy regardless of their stage at diagnosis, emphasising the need to expand access to testing with staging workup to improve survival outcomes. Six families received personalised screening recommendations, thanks to this study.

Background
The COVID-19 outbreak at the end of 2019 severely impacted global healthcare systems, especially primary healthcare services. This paper aimed to identify the implications derived from the strengths and weaknesses observed in Iran’s primary healthcare (PHC) programmes during the pandemic.

Methods
This was a qualitative study conducted in 2021. 13 semistructured interviews were held with Iranian healthcare policymakers and executive managers, selected via snowball sampling, using the World Health Organization’s analytical framework. Finally, a thematic analysis was conducted on the interview data.

Results
The thematic analysis of the findings yielded five major themes: revision of healthcare financing, redefining education and research in primary healthcare, redefinition of primary healthcare, development of a new model for family medicine, and community engagement.

Conclusion
Addressing vertical inequality in Iran’s healthcare system was delineated to be crucial. Meanwhile, multiple strategies including enhancing family physicians’ knowledge and skills, decentralising decision-making, empowering them and involving communities in healthcare planning were presented to improve PHC and family medicine. Further empirical research is needed.

Introduction
Adolescents’ experiences (10–19 years-old) with tuberculosis (TB) remain poorly understood. Descriptions of adolescent TB experiences, particularly how they interact with the health system, are scarce. We aimed to understand adolescents’ experiences of TB health services in the Western Cape, South Africa. We focused on how TB services were aided or hindered through interactions with healthcare providers and health system processes.

Methods
Teen TB, an observational study in Cape Town, enrolled 50 newly diagnosed adolescents with multidrug-resistant and drug-susceptible TB. A subset of 20 was selected for serial qualitative data collection, with 19 completing all tasks between December 2020 and September 2021. 52 interviews were conducted and thematically analysed using a case descriptive process for experiences across the TB care cascade.

Findings
Adolescents criticised the difficulties and delays they encountered in obtaining an accurate TB diagnosis. Initial misdiagnoses and delayed TB diagnoses were reported, despite seeking help from multiple healthcare providers at different facilities. Adolescents questioned whether the financial, social and emotional costs of TB care outweighed the costs of delaying treatment initiation and adherence. Adolescents reported that the treatment regimen, adherence support processes and interactions with the health system posed significant challenges to maintaining adherence. Encouragingly, however, most adolescents reported being well treated and cared for by health workers.

Conclusion
Our study shows that adolescents experience challenges throughout their TB treatment journeys. More adolescent-focused research is needed to tailor treatment and healthcare processes to their needs.

Objectives
(1) Identify the processes, staff time and labour costs associated with non-attendance at two physiotherapy outpatient clinics using time-driven activity-based costing; (2) estimate labour cost-burden of non-attendance response scenarios.

Design
A six-step time-driven activity-based costing method was used, including scenario analyses.

Setting
Two tertiary hospital outpatient clinics.

Participants
Clinic non-attendance rates were determined from digital administrative records for participating clinics. Interviews and iterative discussions were conducted with 15 administrative and clinical staff to establish process maps and key parameters.

Primary and secondary outcome measures
The primary outcome was health service labour cost associated with clinic non-attendance. Four key work processes were identified and costed (2023, A$).

Results
Clinic non-attendance rates for the 2018–2021 period were 8% (Clinic 1) and 10% (Clinic 2). Complex triaging cases constituted greater costs than simple triaging cases. Projected annual costs of non-attendance were as high as A$114 827 for a single clinic. The most expensive referral and response scenario was internal referral with non-attendance that was converted to a telephone appointment (mean cost of A$113/appointment).

Conclusion
Non-attendance rates at participating clinics were at the lower end of values reported in prior literature; however, substantial healthcare resource waste was still evident. Findings highlighted the extent to which non-attendance at scheduled clinic appointments may not only impact patients’ welfare through lost treatment opportunity, but also carry substantial opportunity cost from wasted hospital resources that could have been allocated to other referred patients. Establishing the effectiveness and cost-effectiveness of interventions to reduce non-attendance remains a priority.

Introduction
Statins are among the most widely used drugs. While they are effective for primary and secondary prevention of cardiovascular (CV) disease in middle-aged subjects, their benefits for prevention in older adults (aged ≥70 years) without CV disease are uncertain, particularly for those with multimorbidity. Statin side effects and drug interactions are common in older patients and may negatively impact quality of life. To date, the only randomised controlled trial (RCT) investigating statin discontinuation in older adults has demonstrated no difference in survival but did note a small improvement in quality of life for those who discontinued statins. However, this trial exclusively enrolled patients with a life expectancy

Background
Recent studies showed an increase in neuroendocrine neoplasms, especially for the digestive tract. Several risk factors have been suggested to explain this increase, including a family history of cancer, tobacco smoking, alcohol consumption and metabolic disorders such as diabetes and obesity. Another risk factor may be depressive disorders, which could increase the risk of neuroendocrine neoplasms either directly or mediated through associated risk behaviours and/or antidepressant medication. Here, we outline the design of our study to identify the risk factors for neuroendocrine neoplasms in Germany.

Methods and analysis
A case–control study of the resident population of Bavaria, the second most populous federal state in Germany, based on a record linkage of data from the Bavarian Cancer Registry and data from the Bavarian Association of Statutory Health Insurance Accredited Physicians. Cases have a diagnosis of a malignant neuroendocrine neoplasm, either of the bronchopulmonary system or the gastroenteropancreatic system, in the period from 2021 to 2023. Controls are sampled from the non-cases and matched on sex, birth year (in 5-year intervals) and time of diagnosis (by calendar quarter). Risk factor prevalence of cases and controls is assessed on the basis of assured outpatient diagnoses, that is, diagnoses documented in at least 2 out of 4 consecutive quarters in the 16 quarters preceding the diagnosis of a neuroendocrine neoplasm. The analysis uses conditional logistic regression to estimate ORs and 95% CIs.

Ethics and dissemination
This study protocol was approved by the Ethics Committee of the Bavarian State Chamber of Physicians (reference number: 24008). Approval by the supervisory authority has been obtained from the Bavarian State Ministry of Health, Care, and Prevention (reference number: G35h-A1080-2023/20-2) and also the Bavarian Data Protection Commissioner stated to have no concerns after presentation of the study protocol (reference number: DSB/7-692/1-275). The results of the case–control study will be presented at national as well as international conferences and be published in the form of scientific articles in peer-reviewed journals.

Trial registration number
NCT06282016.

Introduction
Breast cancer is the most common form of cancer in women. A considerable number of women with breast cancer who have been treated with chemotherapy subsequently develop neurological symptoms such as concentration and memory difficulties (also known as ‘chemobrain’). Currently, there are no validated therapeutic approaches available to treat these symptoms. Cognitive training holds the potential to counteract cognitive impairment. Combining cognitive training with concurrent transcranial direct current stimulation (tDCS) could enhance and maintain the effects of this training, potentially providing a new approach to treat post-chemotherapy subjective cognitive impairment (PCSCI). With this study, we aim to investigate the effects of multi-session tDCS over the left dorsolateral prefrontal cortex in combination with cognitive training on cognition and quality of life in women with PCSCI.

Methods and analysis
The Neuromod-PCSCI trial is a monocentric, randomised, double-blind, placebo-controlled study. Fifty-two women with PCSCI after breast cancer therapy will receive a 3-week tDCS-assisted cognitive training with anodal tDCS over the left dorsolateral prefrontal cortex (target intervention), compared with cognitive training plus sham tDCS (control intervention). Cognitive training will consist of a letter updating task. Primary outcome will be the performance in an untrained task (n-back task) after training. In addition, feasibility, safety and tolerability, as well as quality of life and performance in additional untrained tasks will be investigated. A follow-up visit will be performed 1 month after intervention to assess possible long-term effects. In an exploratory approach, structural and functional MRI will be acquired before the intervention and at post-intervention to identify possible neural predictors for successful intervention.

Ethics and dissemination
Ethical approval was granted by the ethics committee of the University Medicine Greifswald (BB236/20). Results will be available through publications in peer-reviewed journals and presentations at national and international conferences.

Trial registration number
ClinicalTrials.gov; NCT04817566, registered on 26 March 2021.