Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised q...Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.展开更多
“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of res...“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of residents in care homes. Focus on Undernutrition （FoU）, a dietetic service delivered by dietetic assistants uses a multifaceted approach to undernutrition management. This study aims to evaluate FoU’s impact on undernutrition outcome measures in care homes; including FoU’s influence on weight change in residents “at risk” of undernutrition, and prevalence of undernutrition and pressure ulcers （PU）. Methods： A retrospective pragmatic service evaluation was undertaken using pseudonymised data collected over 13 years on weight, undernutrition risk and PU from long-stay residents’ notes before and six months after training （FoU）. Results： Analysis completed on 104 homes, 4,315 residents （71.3% female; mean stay 10.8 （1-278） months） in County Durham. Following FoU a significant difference was identified for： improved rate of weight change for “at risk” residents （p 〈 0.001）. Undernutrition risk significantly influenced weight change （low： B1.04 kg, E0.01 kg; moderate： B-1.79 kg, E-0.38 kg; high： B-0.83kg, E1.00 kg, Bp 〈 0.001, Ep = 0.001）. Reduced undernutrition prevalence （p 〈 0.001） from 32.7% to 29.1% residents “at risk” of undernutrition （moderate： B13.1%, E8.9%; high： B19.6%, E15.9%）. Nutrition screening significantly improved （B76.3%, E98.7%, p 〈 0.001）, reduced prevalence PU （51%, p 〈 0.001）. PU prevalence significantly increased with undernutrition severity at baseline （p 〈 0.001）, but not following FoU （p = 0.233） （low： B5%, E2.3%; moderate： B6.9%, E1.6%; high： B10.5%, E3.9%）. Odds of developing PU reduced 53% （OR： 0.47）. B：baseline; E：evaluation; OR： odds ratio. Conclusion： These results demonstrate dietetic assistants delivering FoU significantly improves weight, undernutrition and PU prevalence in care homes. Indicating FoU is an effective model for improving undernutrition outcomes, with the potential of reducing possible harm, such as PU in care homes.展开更多
BACKGROUND Prisoners are at risk of hepatitis C virus(HCV)infection,especially among the people who inject drugs(PWID).We implemented an outreach strategy in combination with universal mass screening and immediate ons...BACKGROUND Prisoners are at risk of hepatitis C virus(HCV)infection,especially among the people who inject drugs(PWID).We implemented an outreach strategy in combination with universal mass screening and immediate onsite treatment with a simplified pan-genotypic direct-acting antivirals(DAA)regimen,12 wk of sofosbuvir/velpatasvir,in a PWID-dominant prison in Taiwan.AIM To implement an outreach strategy in combination with universal mass screening and immediate onsite treatment with a simplified pan-genotypic DAA regimen in a PWID-dominant prison in Taiwan.METHODS HCV-viremic patients were recruited for onsite treatment program for HCV micro-elimination with a pangenotypic DAA regimen,12 wk of sofosbuvir/velpatasvir,from two cohorts in Penghu Prison,either identified by mass screen or in outpatient clinics,in September 2019.Another group of HCV-viremic patients identified sporadically in outpatient clinics before mass screening were enrolled as a control group.The primary endpoint was sustained virological response(SVR12,defined as undetectable HCV ribonucleic acid(RNA)12 wk after end-of-treatment).RESULTS A total of 212 HCV-viremic subjects were recruited for HCV micro-elimination campaign;91 patients treated with sofosbuvir/Ledipasvir or glecaprevir/pibrentasvir before mass screening were enrolled as a control.The HCV microelimination group had significantly lower proportion of diabetes,hypertension,hyperlipidemia,advanced fibrosis and chronic kidney diseases,but higher levels of HCV RNA.The SVR12 rate was comparable between the HCV microelimination and control groups,95.8%(203/212)vs 94.5%(86/91),respectively,in intent-to-treat analysis,and 100%(203/203)vs 98.9%(86/87),respectively,in perprotocol analysis.There was no virological failure,treatment discontinuation,and serious adverse event among sofosbuvir/velpatasvir-treated patients in the HCV micro-elimination group.CONCLUSION Outreach mass screening followed by immediate onsite treatment with a simplified pangenotypic DAA regimen,sofosbuvir/velpatasvir,provides successful strategies toward HCV micro-elimination among prisoners.展开更多
基金supported by Faculty of Medicine Siriraj Hospital,Mahidol University,Thailand(Grant No.[IO]R016233023).
文摘Objective:To identify healthcare managers’perspectives on the barriers to implementing cervical length screening to prevent preterm births.Methods:In PhaseⅠ,10 healthcare managers were interviewed.PhaseⅡcomprised questionnaire development and data validation.In PhaseⅢ,the questionnaire was administered to 40 participants,and responses were analyzed.Results:Their average related work experience was(21.0±7.2)years;39(97.5%)respondents also had healthcare management responsibilities at their respective hospitals.Most hospitals were reported to have enough obstetricians(31 cases,77.5%)and to be able to accurately perform cervical length measurements(22 cases,55.0%).However,no funding was allocated to universal cervical length screening(39 cases,97.5%).Most respondents believed that implementing universal screening,as per Ministry of Public Health policies,would prevent preterm births(28 cases,70.0%).Moreover,they suggested that hospital fees for cervical length measurements should be waived(34 cases,85.0%).Three main perceived barriers to universal screening at tertiary hospitals were identified.They were heavy obstetrician workloads(20 cases,50.0%);inadequate numbers of medical personnel(24 cases,60.0%);not believing that the screening test could prevent preterm birth(8 cases,20%)and lack of free drug support for preterm birth prevention in high-risk cases(29 cases,72.5%).Conclusions:The main obstacles to universal cervical length screening are heavy staff workloads and inadequate government funding for ultrasound scanning and hormone therapy.The healthcare managers do not believe that the universal cervical length screening can help to reduce preterm birth.
文摘“Let them eat cake”： a retrospective service evaluation of Focus on Undernutrition in care homes. Introduction： Undernutrition is a major cause and consequence of poor health in older people, affecting 35% of residents in care homes. Focus on Undernutrition （FoU）, a dietetic service delivered by dietetic assistants uses a multifaceted approach to undernutrition management. This study aims to evaluate FoU’s impact on undernutrition outcome measures in care homes; including FoU’s influence on weight change in residents “at risk” of undernutrition, and prevalence of undernutrition and pressure ulcers （PU）. Methods： A retrospective pragmatic service evaluation was undertaken using pseudonymised data collected over 13 years on weight, undernutrition risk and PU from long-stay residents’ notes before and six months after training （FoU）. Results： Analysis completed on 104 homes, 4,315 residents （71.3% female; mean stay 10.8 （1-278） months） in County Durham. Following FoU a significant difference was identified for： improved rate of weight change for “at risk” residents （p 〈 0.001）. Undernutrition risk significantly influenced weight change （low： B1.04 kg, E0.01 kg; moderate： B-1.79 kg, E-0.38 kg; high： B-0.83kg, E1.00 kg, Bp 〈 0.001, Ep = 0.001）. Reduced undernutrition prevalence （p 〈 0.001） from 32.7% to 29.1% residents “at risk” of undernutrition （moderate： B13.1%, E8.9%; high： B19.6%, E15.9%）. Nutrition screening significantly improved （B76.3%, E98.7%, p 〈 0.001）, reduced prevalence PU （51%, p 〈 0.001）. PU prevalence significantly increased with undernutrition severity at baseline （p 〈 0.001）, but not following FoU （p = 0.233） （low： B5%, E2.3%; moderate： B6.9%, E1.6%; high： B10.5%, E3.9%）. Odds of developing PU reduced 53% （OR： 0.47）. B：baseline; E：evaluation; OR： odds ratio. Conclusion： These results demonstrate dietetic assistants delivering FoU significantly improves weight, undernutrition and PU prevalence in care homes. Indicating FoU is an effective model for improving undernutrition outcomes, with the potential of reducing possible harm, such as PU in care homes.
基金Supported by the Kaohsiung Medical University,No.108-2314-B-037-066 and No.DK107004and the Kaohsiung Medical University Hospital,No.KMUH-108-8R05,No.KMUH-DK109002 and No.KMUH-DK109005-1.
文摘BACKGROUND Prisoners are at risk of hepatitis C virus(HCV)infection,especially among the people who inject drugs(PWID).We implemented an outreach strategy in combination with universal mass screening and immediate onsite treatment with a simplified pan-genotypic direct-acting antivirals(DAA)regimen,12 wk of sofosbuvir/velpatasvir,in a PWID-dominant prison in Taiwan.AIM To implement an outreach strategy in combination with universal mass screening and immediate onsite treatment with a simplified pan-genotypic DAA regimen in a PWID-dominant prison in Taiwan.METHODS HCV-viremic patients were recruited for onsite treatment program for HCV micro-elimination with a pangenotypic DAA regimen,12 wk of sofosbuvir/velpatasvir,from two cohorts in Penghu Prison,either identified by mass screen or in outpatient clinics,in September 2019.Another group of HCV-viremic patients identified sporadically in outpatient clinics before mass screening were enrolled as a control group.The primary endpoint was sustained virological response(SVR12,defined as undetectable HCV ribonucleic acid(RNA)12 wk after end-of-treatment).RESULTS A total of 212 HCV-viremic subjects were recruited for HCV micro-elimination campaign;91 patients treated with sofosbuvir/Ledipasvir or glecaprevir/pibrentasvir before mass screening were enrolled as a control.The HCV microelimination group had significantly lower proportion of diabetes,hypertension,hyperlipidemia,advanced fibrosis and chronic kidney diseases,but higher levels of HCV RNA.The SVR12 rate was comparable between the HCV microelimination and control groups,95.8%(203/212)vs 94.5%(86/91),respectively,in intent-to-treat analysis,and 100%(203/203)vs 98.9%(86/87),respectively,in perprotocol analysis.There was no virological failure,treatment discontinuation,and serious adverse event among sofosbuvir/velpatasvir-treated patients in the HCV micro-elimination group.CONCLUSION Outreach mass screening followed by immediate onsite treatment with a simplified pangenotypic DAA regimen,sofosbuvir/velpatasvir,provides successful strategies toward HCV micro-elimination among prisoners.
