scholarly journals Nurse-led PrEP-RN clinic: a prospective cohort study exploring task-Shifting HIV prevention to public health nurses

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e040817
Author(s):  
Patrick O'Byrne ◽  
Amanda Vandyk ◽  
Lauren Orser ◽  
Marlene Haines
Keyword(s):  
Public Health ◽  
Cohort Study ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Secondary Outcome ◽  
Bivariate Analysis ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Risk Criteria

ObjectiveTo report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service.DesignThis was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained.SettingThis study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada.ParticipantsOf all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN).Primary and secondary outcome measuresUptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN.Findings69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period.ConclusionsNurse-led PrEP is an appropriate strategy for PrEP delivery.

Triple site sexually transmitted infection testing as a crucial component of surveillance for men who have sex with men: A prospective cohort study

2021 ◽  
pp. 095646242110474
Author(s):  
Roy Zucker ◽  
Michael Gaisa ◽  
Keith Sigel ◽  
Ilan Singer ◽  
Amos Adler ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Study Groups ◽  
Sexual Risk Taking ◽  
Syphilis Infection ◽  
Transmitted Infection ◽  
Sexually Transmitted ◽  
Crucial Component ◽  
Sex With Men

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are common among men who have sex with men (MSM). Many oropharyngeal and anorectal infections remain asymptomatic. We aimed to evaluate triple-site screening following PrEP introduction. We enrolled a prospective cohort study including 210 asymptomatic MSM during 2019–2020, analyzed by groups: HIV positive (HIV+), HIV−uninfected using PrEP (HIV−/PrEP+), or HIV-uninfected not using PrEP (HIV−/PrEP−). A self-administered questionnaire captured demographic information and sexual risk-taking behaviors. CT/NG testing results were compared between study groups and predictors of infection were evaluated. We included 59 HIV+, 70 HIV−/PrEP+, and 81 HIV−/PrEP− subjects. 30% ( n = 62) of participants tested positive for CT/NG. HIV−/PrEP+ group had highest proportion of infections ( n = 33, 47%) followed by HIV−/PrEP− ( n = 16, 22%) and HIV+ ( n=13, 20%; p < .001). Importantly, 98% (80/82) of pharyngeal/anorectal CT/NG infections were missed in genitourinary tract screening alone. PrEP use and previous syphilis infection were the strongest risk factor for CT/NG. Extra-genital asymptomatic CT/NG infections were prevalent among MSM. These data highlight the importance of routine extra-genital CT/NG testing in asymptomatic sexually active MSM. The study describes the consequences for three-site testing lack of implementation in the PrEP era.

scholarly journals Prophylactic Tranexamic acid usage in Prevention of Post-Partum Hemorrhage a Prospective Cohort Study

2019 ◽  
Author(s):  
Seifeldin Sadek ◽  
Arnold M Mahesan ◽  
Hadi Ramadan ◽  
Nimra Dad ◽  
Vani Movva ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Blood Loss ◽  
Tranexamic Acid ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Post Partum ◽  
Secondary Outcome ◽  
Post Partum Hemorrhage ◽  
Estimated Blood Loss

Abstract Background Post-partum hemorrhage (PPH) is the leading cause of obstetric morbidity and mortality around the world. Prophylactic administration of tranexamic acid (TXA) in patients at risk for PPH is aimed at reducing estimated blood loss (EBL). Method This was a prospective cohort study. Patients at high risk of PPH were given 1000mg of TXA intravenously at cord clamping after delivery of the baby, and compared with high PPH risk controls who did not receive TXA. Both cesarean section deliveries (CD) and vaginal deliveries (VD) were included. The primary outcome was postpartum hemorrhage, and the secondary outcome was calculated estimated blood loss (cEBL). Results Between January 2017 and May 2017, 101 patients at high risk for PPH were enrolled. Fifty one received TXA and 50 did not. There were 20 cases of PPH in the TXA group compared with 30 cases in the control group (OR 0.43, 95% CI, NNT=5). The average cEBL for VD and CD were significantly lower in the patients who received TXA compared with controls: 561ml ±336ml compared with 841ml ±462ml (p=0.0006) for VD and 658ml ±294mL compared with 1024ml ±276 for CD (p=0.0007). Conclusions Intravenous TXA may be used as prophylaxis for PPH in obstetric patients at high risk.

scholarly journals Can delirium research activity impact on routine delirium recognition? A prospective cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e023386 ◽  
Author(s):  
Carly Welch ◽  
Thomas A Jackson
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
University Teaching ◽  
Secondary Outcome ◽  
Research Activity ◽  
Statistical Manual ◽  
Diagnostic And Statistical Manual ◽  
Improve Patient ◽  
Discharge Summaries

ObjectiveTo assess if ongoing delirium research activity within an acute admissions unit impacts on prevalent delirium recognition.DesignProspective cohort study.SettingSingle-site tertiary university teaching hospital.Participants125 patients with delirium, as diagnosed by an expert using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition reference criteria, were recruited to a prospective cohort study investigating use of informant tools to detect unrecognised dementia. This study evaluated recognition of delirium and documentation of delirium by medical staff.InterventionsThe main study followed an observational design; the intervention discussed was the implementation of this study itself.Primary and secondary outcome measuresThe primary outcome was recognition of delirium by the admitting medical team prior to study diagnosis. Secondary outcomes included recording of or description of delirium in discharge summaries, and factors which may be associated with unrecognised delirium.ResultsDelirium recognition improved between the first half (48%) and second half (71%) of recruitment (p=0.01). There was no difference in recording of delirium or description of delirium in the text of discharge summaries.ConclusionDelirium research activity can improve recognition of delirium. This has the potential to improve patient outcomes.

scholarly journals Coagulation screening tests in high risk neonates: a prospective cohort study.

1992 ◽  
Vol 67 (10 Spec No) ◽  
pp. 1196-1197 ◽  
Author(s):  
B K Schmidt ◽  
P Vegh ◽  
M Andrew ◽  
M Johnston
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Screening Tests

scholarly journals Effect of H. pylori Eradication on the Long-Term Incidence of Recurrent Ulcer Bleeding in High-Risk Aspirin Users: A 10-Year Prospective Cohort Study

2011 ◽  
Vol 140 (5) ◽  
pp. S-173-S-174 ◽  
Author(s):  
Francis K.L. Chan ◽  
Jessica Ching ◽  
Bing-yee Suen ◽  
Yee Kit Tse ◽  
Justin C. Wu ◽  
...  
Keyword(s):  
Cohort Study ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Ulcer Bleeding ◽  
Recurrent Ulcer ◽  
H Pylori

scholarly journals P0154BLOOD PRESSURE CONTROL IN ELDERLY PATIENTS WITH HEART FAILURE AND MORTALITY RISK: A POPULATION-BASED PROSPECTIVE COHORT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Antonios Douros ◽  
Alice Schneider ◽  
Dörte Huscher ◽  
Natalie Ebert ◽  
Nina Mielke ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
High Risk ◽  
Elderly Patients ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Antihypertensive Drugs ◽  
Population Based ◽  
Vulnerable Population ◽  
All Cause Mortality

Abstract Background and Aims Current guidelines on the management of heart failure (HF) recommend control of blood pressure (BP) in elderly patients. However, the exact treatment goals in this vulnerable population are unclear. Thus, our population-based prospective cohort study aimed to assess whether BP values &lt;140/90 mmHg are associated with a decreased risk of cardiovascular (CV) death and all-cause mortality in HF patients ≥70 years. Method The study included participants of the Berlin Initiative Study (BIS), all ≥70 years, who were treated with antihypertensive drugs and had a diagnosis of HF (ICD-10 codes: I11.0, I13.0, I13.2, I50.x) at baseline. The study period was from 2009 to 2017. Demographics, lifestyle factors, medications, and comorbidities were assessed in face-to-face interviews and from linked administrative healthcare data. Outcomes were adjudicated using death certificates and hospital discharge notes. Cox proportional hazards models yielded crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of CV death and all-cause mortality associated with normalized BP (systolic BP &lt;140 mmHg and diastolic BP &lt;90 mmHg) compared with non-normalized BP (systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg) in patients with HF. In sensitivity analyses we restricted to high-risk HF patients (≥80 years or with previous CV events). We also repeated the analyses in patients without HF to assess a potential effect modification. Results Among 1623 BIS participants treated with antihypertensive drugs at baseline, 544 (33.5%) had a diagnosis of HF. Of those, 255 (46.9%) showed normalized BP and 289 (53.1%) had non-normalized values. Mean age (standard deviation [SD]) was 82.8 (6.8) years (45.4% female). Selected patient characteristics are shown in the Table. Median (interquartile range) duration of follow-up was 6.7 (4.1-7.3) years. Compared with non-normalized BP, normalized BP was associated with a numerically increased risk of CV death (HR, 1.40; 95% CI, 0.90-2.17) and all-cause mortality (HR, 1.28; 95% CI, 0.96-1.71) in patients with HF. The associations were more pronounced or reached statistical significance when restricting to HF patients ≥80 years (CV death: HR, 1.54; 95% CI, 0.94-2.53 / all-cause mortality: HR, 1.56; 95% CI, 1.11-2.18) or HF patients with previous CV events (CV death: HR, 1.65; 95% CI, 0.83-3.29 / all-cause mortality: HR, 1.33; 95% CI, 0.85-2.07) (Figure). The effect estimates in patients without HF were comparable to those with HF (CV death: HR, 1.18; 95% CI, 0.78-1.78; p for interaction, 0.695 / all-cause mortality: HR, 1.20; 95% CI, 0.93-1.54; p for interaction, 0.604). Conclusion Our study suggests that normalized BP does not decrease the risk of CV death or all-cause mortality in elderly patients with HF and it could even increase the risk especially in high-risk subgroups. Thus, individualized benefit-risk assessment is required for the pharmacotherapy of HF in this vulnerable population.

scholarly journals Meniscal tear outcome Study (METRO Study): a study protocol for a multicentre prospective cohort study exploring the factors which affect outcomes in patients with a meniscal tear

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038681
Author(s):  
Imran Ahmed ◽  
Mike Bowes ◽  
Charles E Hutchinson ◽  
Nicholas Parsons ◽  
Sophie Staniszewska ◽  
...  
Keyword(s):  
Cohort Study ◽  
Research Ethics ◽  
Outcome Measures ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Meniscal Tear ◽  
Ethics Committee ◽  
Secondary Outcome ◽  
Research Ethics Committee ◽  
Baseline Characteristics

IntroductionThis study is designed to explore the baseline characteristics of patients under 55 years of age with a meniscal tear, and to describe the relationship between the baseline characteristics and patient-reported outcome measures (PROMs) over 12 months. Research has highlighted the need for a trial to investigate the effectiveness of arthroscopic meniscectomy in younger patients. Before this trial, we need to understand the patient population in greater detail.Methods and analysisThis is a multicentre prospective cohort study. Participants aged between 18 and 55 years with an MRI confirmed meniscal tear are eligible for inclusion. Baseline characteristics including age, body mass index, gender, PROMs duration of symptoms and MRI will be collected. The primary outcome measure is the Western Ontario Meniscal Evaluation Tool at 12 months. Secondary outcome measures will include PROMs such as EQ5D, Knee Injury and Osteoarthritis Outcome Score and patient global impression of change score at 3, 6 and 12 months.Ethics and disseminationThe study obtained approval from the National Research Ethics Committee West Midlands—Black Country research ethics committee (19/WM/0079) on 12 April 2019. The study is sponsored by the University of Warwick. The results will be disseminated via peer-reviewed publication.Trial registration numberUHCW R&D Reference: IA428119. University of Warwick Sponsor ID: SC.08/18–19

scholarly journals Adherence to childhood cancer treatment: a prospective cohort study from Northern Vietnam

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e026863
Author(s):  
Bui Ngoc Lan ◽  
Anders Castor ◽  
Thomas Wiebe ◽  
Jacek Toporski ◽  
Christian Moëll ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cancer Treatment ◽  
Childhood Cancer ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Cox Model ◽  
Secondary Outcome ◽  
Northern Vietnam ◽  
Family Decision ◽  
Treatment Abandonment

ObjectivesGlobal incidence and attention to childhood cancer is increasing and treatment abandonment is a major cause of treatment failure in low- and middle-income countries. The purpose of this study was to gain an understanding of factors contributing to non-adherence to treatment.DesignA prospective cohort study with 2 year follow-up of incidence, family-reported motives and risk factors.SettingThe largest tertiary paediatric oncology centre in Northern Vietnam.ParticipantsAll children offered curative cancer treatment, from January 2008 to December 2009.Primary and secondary outcome measuresFamily decision to start treatment was analysed with multivariable logistic regression, and family decision to continue treatment was analysed with a multivariable Cox model. This assessment of non-adherence is thereby methodologically consistent with the accepted definitions and recommended practices for evaluation of treatment abandonment.ResultsAmong 731 consecutively admitted patients, 677 were eligible for treatment and were followed for a maximum 2 years. Almost half the parents chose to decline curative care (45.5%), either before (35.2%) or during (10.3%) the course of treatment. Most parents reported perceived poor prognosis as the main reason for non-adherence, followed by financial constraints and traditional medicine preference. The odds of starting treatment increased throughout the study-period (OR 1.04 per month (1.01 to 1.07), p=0.002), and were independently associated with prognosis (OR 0.51 (0.41 to 0.64), p=<0.0001) and travel distance to hospital (OR 0.998 per km (0.996 to 0.999), p=0.004). The results also suggest that adherence to initiated treatment was significantly higher among boys than girls (HR 1.69 (1.05 to 2.73), p=0.03).ConclusionsNon-adherence influenced the prognosis of childhood cancer, and was associated with cultural and local perceptions of cancer and the economic power of the affected families. Prevention of abandonment is a prerequisite for successful cancer care, and a crucial early step in quality improvements to care for all children with cancer.

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