Quality of HIV Care and Mortality Rates in HIV-Infected Patients

Abstract Background: Nigeria contributes significantly to the global burden of HIV, Hepatitis B and C infections, either singly or in combinations, despite progress in HIV care regionally and globally. Although some limited data on mono infection of HIV, Hepatitis B and C virus infections do exists, that of dual and triplex infections, including seroconversion and mother-to-child transmission (MTCT) rates necessary for planning to address the scourge of infections in pregnancy are not available.Objectives: To determine the seroprevalence, rate of new infections, MTCT of dual and triple infections of HIV, Hepatitis B and C viruses and associated factors, among pregnant women in Nigeria. Method: A multicenter prospective cohort study will be conducted in six tertiary health facilities randomly selected from the six geopolitical zones of Nigeria. All eligible pregnant women are to be tested at enrollment after informed consent for HIV, Hepatitis B and C infections. While those positive for at least two of the infections in any combination will be enrolled into the study and followed up to 6 weeks post-delivery, those negative for the three infections or positive for only one of the infections at enrolment will be retested at delivery using a rapid diagnostic test. On enrolment into the study relevant information, will be obtained, and laboratory test of CD4 count, liver function test and full blood counts, and prenatal ultrasonography will also be obtained/performed. Management of mother-newborns pairs will be according to appropriate national guidelines. All exposed newborns will be tested for HIV, HBV or HCV infection at birth and 6 weeks using PCR technique. The study data will be documented on the study case record forms. Data will be managed with SPSS for windows version 23. Ethical approval was obtained from National Health Research Ethics Committee (NHREC) (NHREC/01/01/2007-23/01/2020).Conclusion: Pregnant women with multiple of HIV, HBV and C infections are at increased risk of hepatotoxicity, maternal and perinatal morbidity and mortality. Additionally, infected pregnant women transmit the virus to their unborn baby even when asymptomatic. Children born with any of the infection have significantly poorer quality of life and lower five-year survival rate. Unfortunately, the seroconversion and MTCT rates of dual or triplex infections among pregnant women in Nigeria have not been studied making planning for prevention and subsequent elimination of the viruses difficult. The study is expected to fill this knowledge gaps. Nigeria joining the rest of the world to eliminate the triple infection among children rest on the availability of adequate and reliable data generated from appropriately designed, powered study using representative population sample. The establishment of the three-in-one study of prevalence, rate of new infection, rate and risk factor for MTCT of dual and triple infection of HIV, Hepatitis B and C viruses among pregnant women in Nigeria is urgently needed for policy development and planning for the improvement of the quality of life of mothers and the elimination of childhood triplex infection.

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Value-Based HIV Care: A Method to Improve Quality of HIV Care.

10.21203/rs.3.rs-117180/v1 ◽

2020 ◽

Author(s):

Guido van den berk ◽

Daoud Ait Moha ◽

Janneke Stalenhoef ◽

Marie-Jose Kleene ◽

Narda van der Meche ◽

...

Keyword(s):

Quality Of Life ◽

Care Delivery ◽

Population Level ◽

Care Quality ◽

Hiv Care ◽

First Year ◽

Outcome Indicators ◽

Number Of Patients ◽

Care Path

Abstract Background : To support our goal of providing optimal HIV care to our patients, we started applying the value-based health care principle to the HIV care that we offer in our HIV center, measuring relevant health outcomes and costs to allow continuous implementation of improvements (Value-Based HIV Care; VBHiC). Methods : In line with the principles of Michael Porter, our approach consisted of the following steps: 1) Organizing into integrated practice units / describing the HIV care path; 2) Defining an HIV outcome indicator set; 3) Building an enabling information technology platform; 4) Integrating care delivery across separate facilities; 5) Moving to bundled payments for care cycles and 6) Expanding excellent services and interventions for improvement across geographic boundaries. Results : The following set of 9 outcome indicators was developed: undetectable HIV load within the first year of care; quality of life within the first year of care; mortality within the first year of care; retention in care; therapy effectiveness; therapy tolerance; cardiovascular risk; quality of life for every subsequent year and overall annual mortality. These indicators, which were evaluated retrospectively, are shown in figures 1-5. Collection of the underlying data started in January 2016. The HIV care path was also integrated into the electronic file system. Creation of the ability to monitor outcome indicators at patient level, population level and process level allowed us to implement a quality cycle (plan-do-study-act). Conclusion : Our Value-Based HIV Care approach facilitated structured evaluation of parameters that are of value to the patient. It also boosted the quality of the HIV care that we provide and allowed us to increase the number of patients to whom we can offer high quality HIV care.

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Survival and quality of life following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma

International Journal of Cancer Research & Therapy ◽

10.33140/ijcrt.06.02.07 ◽

2021 ◽

Vol 6 (2) ◽

Keyword(s):

Quality Of Life ◽

Pancreatic Ductal Adenocarcinoma ◽

Short Review ◽

Mortality Rates ◽

Ductal Adenocarcinoma ◽

Term Survival ◽

Long Term Survival ◽

Dismal Prognosis

Pancreatic ductal adenocarcinoma (PDAC) most commonly affects the head of the pancreas. This condition has a dismal prognosis. Patients with early disease may be candidates for pancreaticoduodenectomy (PD). This is a high-risk operation which is associated with considerable morbidity. Whilst perioperative mortality rates have fallen in recent times, the risk remains significant and long-term survival is poor, even in those who make an uncomplicated recovery. Furthermore, PD is known to affect quality of life (QoL) negatively. Most studies suggest it takes up to six months before a patient’s QoL returns to baseline. This is a considerable amount of time for a patient who is unlikely to achieve long-term survival. This short review discusses the recent literature surrounding mortality rates, long-term survival and QoL following PD for PDAC. A comprehensive understanding of these topics will allow clinicians and patients to consider the risks and benefits before surgical resection is considered.

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Medical Resources and Suicide Prevention

Perceptual and Motor Skills ◽

10.2466/pms.1992.75.3f.1254 ◽

1992 ◽

Vol 75 (3_suppl) ◽

pp. 1254-1254

Author(s):

David Lester

Keyword(s):

Infant Mortality ◽

Medical Care ◽

Suicide Prevention ◽

Mortality Rates ◽

Homicide Rates ◽

Medical Resources ◽

Suicide Rates ◽

American States ◽

Quality Of Medical Care

Infant mortality rates, a measure of the quality of medical care, was associated with homicide rates, but not suicide rates, over nations and over the American states.

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Abstract WP330: Process Measures and Outcomes in Defuse 3 Trial by Day and Week Time Patterns

Stroke ◽

10.1161/str.51.suppl_1.wp330 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Michael Mlynash ◽

Maarten G Lansberg ◽

Stephanie Kemp ◽

Soren Christensen ◽

Michael P Marks ◽

...

Keyword(s):

Arrival Time ◽

Stroke Care ◽

Mortality Rates ◽

Temporal Variations ◽

Time Of Day ◽

Process Measures ◽

Time Period ◽

Time Patterns ◽

Time Of Admission

Introduction: Several studies identified temporal variations in stroke care and suggested that quality of care declines during off-hours and on weekends. Methods: We specified 2 time definitions: a) 8-hour blocks: night (midnight – 7:59), day (8:00 – 15:59), evening (16:00-23:59); b) weekday vs. weekend. We compared process measures and outcomes of the EVT-treated DEFUSE 3 patients based on these definitions. To assign patients to time-blocks, we used date and time of admission to hospital that performed EVT. Results: 92 patients were randomized to EVT treatment: 30% arrived to the treating hospital at night, 49% at day, 21% at evening. Mean age by arrival time 71±14, 70±12, 63±15 (p=0.09); NIHSS 17±5, 15±6, 15±8 (p=0.40); female 39%, 51%, 63% (p=0.27). Weekend admission occurred in 21%. Weekday vs weekend mean age 68±14 vs 72±11 (p=0.19); female 53% vs 37% (p=0.20), higher weekend NIHSS 15±6 vs 18±6 (p=0.04). Onset to arrival at the EVT center varied by time of day: (hrs:mins) 7:04±2:43 night, 8:05±3:01 day, 4:51±2:30 evening, p<0.001. However, day admissions tended to be wake-up/not witnessed strokes more often: 76% vs. 47% evening and 64% night, p=0.09. Transfer times for 57 transfer patients were similar: mean 3:06, 3:09, 3:38. Time from arrival at the treating hospital to groin puncture varied by presenting times: 2:28±1:11 night, 1:45±0:46 day, 2:36±2:32 evening (p=0.02). Time-metrics for weekday vs weekend were similar. Rates of successful reperfusion, 90-day mRS and mRS=0-2 did not differ by time of day or week. There was higher 90-day mortality (32% vs 10%, p=0.02) and in-hospital mortality (21% vs. 4%, p=0.03) on weekend. Symptomatic ICH also occurred more commonly in weekend admits (21% vs 3%, p=0.01). However, after adjustment for age and NIHSS, presenting on weekend was not independently associated with mortality, p=0.13. Conclusions: DEFUSE 3 patients admitted during the day had the longest time from last known well to arrival at the study site due to the high percentage of wake-up strokes admitted during this time period, however, these patients had the shortest arrival to groin puncture times. Although mortality rates were higher for patients who presented on weekends, this may be explained by the fact that these patients were older and had higher NIHSS.

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Constipation and faecal incontinence

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0145 ◽

2017 ◽

pp. 1123-1128

Author(s):

Philippe Chassagne ◽

Frédéric Roca

Keyword(s):

Quality Of Life ◽

Faecal Incontinence ◽

Mortality Rates ◽

Geriatric Syndromes ◽

Faecal Impaction ◽

Detailed History ◽

Digestive Disorder ◽

Digestive Disorders ◽

Functional Digestive Disorders

Constipation and faecal incontinence are the two main functional digestive disorders reported by old people. Prevalence increases with age and predominantly affects women. Both are associated with poorer quality of life. Clinical assessment of constipation including a detailed history is the best approach to identify features suggesting abnormal transit or evacuation problems. As for many geriatric syndromes, medication related effects should always be considered. Faecal incontinence is a marker of disability assessed by most activities of daily living (ADL) scales. In severe cases, faecal incontinence is also associated with high mortality rates. The main risk factor for transient faecal incontinence is the coexistence of a functional digestive disorder such as constipation (especially with faecal impaction) or diarrhoea. These two conditions must be identified since they can be improved by specific therapeutic programmes, which are usually multidimensional and multiprofessional.

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