Management of HIV and hepatitis B or C co-infection in 15 HIV treatment centres. Disparity between protocols and practice

2003 ◽  
Vol 14 (7) ◽  
pp. 469-472 ◽  
Author(s):  
M G Brook ◽  
K Jones ◽  
A W S Dale ◽  
R F Miller
Keyword(s):  
Hepatitis B ◽  
Highly Active Antiretroviral Therapy ◽  
Postal Survey ◽  
Hiv Treatment ◽  
Case Note ◽  
Clinical Practices ◽  
National Guidelines ◽  
Retrospective Case ◽  
Specific Therapy ◽  
Therapy Regimen

Our aim was to ascertain current guidelines and clinical practices prevalent in HIV treatment centres in the North Thames Region of England on the care of patients co-infected with HIV and hepatitis B or C. A self-completed postal survey of clinic guidelines and retrospective case-note reviews was performed. Fifteen of the 27 units completed the survey and generally had clinic guidelines consistent with current national guidelines. Stated policy was usually to screen HIV patients for hepatitis B virus (HBV) and hepatitis C virus (HCV) and to offer specific therapy for the hepatitis as well as the HIV. Many units were unable to contribute cases to the case-note review, probably through lack of case-identification, and therefore 11 units contributed 27 case-note reviews on HIV/HBV and five units contributed 11 case-note reviews on HIV/HCV. Fifty-six percent (25/45) of patients of HBV patients were HBeAg+ve and 88% (22/25) of these had received specific hepatitis B therapy although for 59% (13/22) this was with lamivudine as part of a highly active antiretroviral therapy regimen. None of the HIV/HCV patients had received or been referred for HCV-specific therapy. Testing for hepatitis A immunity in HBV or HCV patients with a view to vaccination was done in only 50% although 96% of HIV/HCV patients had been screened for HBV. There are significant differences between the clinics' intended and actual management of HIV and chronic viral hepatitis co-infection.

A Retrospective Analysis of Alcohol Intake and Management on the Medical Assessment Unit

2009 ◽  
Vol 8 (1) ◽  
pp. 43-47
Author(s):  
Sarah Hoye ◽  
◽  
Rebecca Boundy ◽  
Nicola Cooper ◽  
◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Clinical Management ◽  
Alcohol Intake ◽  
Case Note ◽  
National Guidelines ◽  
Medical Assessment ◽  
Retrospective Case ◽  
Assessment Unit ◽  
Current Impact

A retrospective case note analysis of 100 consecutive admissions to a Medical Assessment Unit to (a) review the current impact of alcohol, and (b) assess the quality of clinical management and adherence to local and national guidelines.

scholarly journals P14 Acute management of traumatic anterior shoulder dislocations during COVID-19: are we meeting published national standards for treatment during the pandemic?

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
Richard L Donovan ◽  
Amir Abdelmalek ◽  
Mark A A Crowther ◽  
Iain Packham ◽  
Richard Donovan
Keyword(s):  
Conscious Sedation ◽  
Care Pathway ◽  
Case Note ◽  
National Standards ◽  
Care Pathways ◽  
Acute Management ◽  
National Guidelines ◽  
Retrospective Case ◽  
Face To Face

Abstract Background BESS/BOA Patient Care Pathways provide national guidelines for acute management of traumatic anterior shoulder dislocations with respect to emergency reduction and clinic follow-up. COVID-19 posed challenges in terms of analgesia choice for reductions and altered follow-up arrangements. This study aimed to assess variance from the care pathway. Methodology We performed a retrospective case note analysis of all emergency presentations with acute traumatic anterior shoulder dislocations at the MTC in Bristol. We compared 01 Apr to 31 May in 2019 to the same period in 2020 to analyse the effects of the COVID-19 pandemic on the management of these injuries. Data parameters collated included examinations and imaging pre- and post-reduction, choice of analgesia, follow-up rates, referral to physiotherapy, and further imaging requested. Results We identified 32 patients in 2019, and 24 in 2020. Use of Entonox fell during the pandemic in favour of Penthrox. Use of conscious sedation (requiring full PPE) remained around 20%. Pre- and post-reduction orthogonal radiographs was near 100% in both cohorts. Referral to follow-up was 88% in 2019 but fell to 38% in 2020. Of those assessed in clinic during COVID-19, fewer were mobilised early or referred to outpatient physiotherapy compared to the previous year. Conclusions The acute management of anterior shoulder dislocations during the early COVID-19 pandemic faced two main challenges: choice of suitable analgesia whilst minimising AGPs; and limiting access to ’face-to-face’ follow-up to minimise hospital attendances. A key concern was a significant decrease in patient follow-up, thus limiting the access to optimal aftercare such as physiotherapy and further imaging.

scholarly journals 197 Acute Management of Traumatic Anterior Shoulder Dislocations During COVID-19: Are We Meeting Published National Standards for Treatment During the Pandemic?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Donovan ◽  
A Abdelmalek ◽  
M Crowther ◽  
I Packham
Keyword(s):  
Conscious Sedation ◽  
Care Pathway ◽  
Case Note ◽  
National Standards ◽  
Care Pathways ◽  
Acute Management ◽  
National Guidelines ◽  
Retrospective Case ◽  
Face To Face

Abstract Background BESS/BOA Patient Care Pathways provide national guidelines for acute management of traumatic anterior shoulder dislocations with respect to emergency reduction and clinic follow-up. COVID-19 posed challenges in terms of analgesia choice for reductions and altered follow-up arrangements. This study aimed to assess variance from the care pathway. Method We performed a retrospective case note analysis of all emergency presentations with acute traumatic anterior shoulder dislocations at the MTC in Bristol from 01/04/2019-31/05/2019 to the same period in 2020 to analyse the effects of COVID-19 on management of these injuries. Results We identified 32 patients in 2019, and 24 in 2020. Entonox usage fell, in favour of Penthrox. Use of conscious sedation (requiring full PPE) remained around 20%. Pre- and post-reduction imaging was near 100% throughout. Referral to follow-up was 88% in 2019 but 38% in 2020. Those assessed in clinic during COVID-19, fewer were mobilised early or referred to outpatient physiotherapy compared to 2019. Conclusions Acute management of anterior shoulder dislocations during COVID-19 was challenged by choice of suitable analgesia that limits AGPs, and limiting access to ’face-to-face’ follow-up. A key concern was a significant decrease in patient follow-up, thus limiting the access to optimal aftercare such as physiotherapy and further imaging.

31 A multi-site retrospective case note review for clinical practices of constipation in specialist palliative care settings

2018 ◽  
Vol 8 (3) ◽  
pp. 371.2-371
Author(s):  
S McIlfatrick ◽  
DHL Muldrew ◽  
E Carduff ◽  
M Clarke ◽  
J Coast ◽  
...  
Keyword(s):  
Palliative Care ◽  
Clinical Practice ◽  
Advanced Cancer ◽  
Management Strategies ◽  
Case Note ◽  
Specialist Palliative Care ◽  
Clinical Practices ◽  
Retrospective Case ◽  
Pharmacological Management ◽  
Case Note Review

BackgroundConstipation is a common symptom for patients receiving palliative care. Whilst national clinical guidelines are available on the management of constipation for people with advanced cancer in specialist palliative care (SPC) settings questions exist around clinical practice and the extent to which the guidelines are implemented in practice. This study examine current clinical practice for management of constipation for patients with advanced cancer in SPC settings.MethodsA multi-site retrospective case-note review was conducted consisting of 150 patient case-notes from three SPC units across the United Kingdom between August 2016 and May 2017. Descriptive statistics were used to compare clinical practices to national policy guidelines for constipation.ResultsA physical exam and bowel history was recorded for 109 patients (73%). Whilst the Bristol Stool Chart was used frequently across sites (96%) involvement of the multidisciplinary team varied. Almost a third of patient charts (27%) recorded no evidence of non-pharmacological management strategies. Pharmacological management was recorded frequently with sodium docusate or senna as the preferred laxatives across all sites however 33% of patient charts recorded no information on the titration of laxatives. There were no consistent management strategies recorded for opioid induced constipation or bowel obstructionConclusionAssessment and management of constipation in SPC settings is highly variable. Variations in assessment; limited use of non-pharmacological and preventative strategies and absence of consistent strategies for opioid induced constipation or bowel obstruction are evident. Further education is needed to equip HCPs with the necessary knowledge and skills to assess and manage constipation.References. Friedrichsen M, Erichsen E. The lived experience of constipation in cancer patients in palliative hospital-based home care. Int J Palliat Nurs [Internet] 2004;10(7):321–5. Available from: http://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl?=13576321&A?N=13991056&h=XKMF4r08srZuhDY0j7C95oLLyYKNHUcvoeEuhyXNnsIM2BI%2BEhmcY1pPP%2BN1pvrMzQ9Bn9b5j45X6WzyBRydEA%3D%3D&crl=c [Accessed: 21 August 2017]. Gilbert EH, et al. Chart reviews in emergency medicine research: Where are the methods?Annals of Emergency Medicine1996;27(3):305–8. Available at: http://www.ncbi.nlm.nih.gov/pubmed/8599488 [Accessed: 17 May 2018]. National Clinical Effectiveness Committee. Management of constipation in adult patients receiving palliative care national clinical guideline No. 10November 2015.. Tvistholm N, Munch L, Danielsen AK. Constipation is casting a shadow over everyday life? A systematic review on older people’s experience of living with constipation [Internet]. Journal of Clinical Nursing2017;26:902–14. Available from: http://doi.wiley.com/10.1111/jocn.13422 [Accessed: 21 August 2017]. Wickson-griffiths A, et al.Revisiting retrospective chart review: An evaluation of nursing home palliative and end-of-life care research. Palliative Medicine Care2014;1(2):8. Available at: www.symbiosisonlinepublishing.com [Accessed: 23 November 2017]

Loss of consciousness, collapse and associated driving restrictions: a retrospective case note review – an important reminder regarding driving restrictions

2017 ◽  
Vol 62 (2) ◽  
pp. 43-47
Author(s):  
Adam Williamson ◽  
Scott Muir
Keyword(s):  
Media Coverage ◽  
Case Note ◽  
Loss Of Consciousness ◽  
Fitness To Drive ◽  
National Guidelines ◽  
Retrospective Case ◽  
High Profile ◽  
Driving Restrictions ◽  
Medical Standards ◽  
Case Note Review

Background and aims National guidelines outlining medical standards for fitness to drive are provided by The Driver and Vehicle Licensing Agency. We aimed to establish whether patients presenting with collapse or loss of consciousness received documented advice regarding driving restrictions, if appropriate for their working diagnosis. Methods and results A retrospective case note review was undertaken over a four-month period for emergency patients clinically coded as seizure/convulsion (R568) and collapse/syncope (R55X); 163 patients had a primary or working diagnosis on discharge that suggested driving status and restrictions could have been reviewed. Six groupings of diagnoses were noted, and variation was seen amongst documentation for each. Current driving status was documented for 32 patients, and 34 had restriction advice documented; 73% (119 patients) had further investigations or clinic review planned. Conclusion Documentation of driving status and restrictions is poor. This audit serves to remind clinicians of the importance of considering driving status when discharging patients who have presented with collapse or loss of consciousness. Recent high-profile media coverage regarding medical driving restrictions, both locally and nationally, have emphasised the need for knowledge of The Driver and Vehicle Licensing Agency guidance.

scholarly journals FRI0116 COMPARABLE EFFICACY AND SAFETY OF TWO REGIMENS OF RHEUMATOID ARTHRITIS TREATMENT WITH TOFACITINIB: DATA FROM RUSSIAN NATIONAL REGISTRY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 639-639
Author(s):  
A. Babaeva ◽  
E. Kalinina ◽  
E. Nasonov ◽  
V. Mazurov ◽  
G. Lukina ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Therapy Group ◽  
Target Therapy ◽  
Combined Therapy ◽  
National Registry ◽  
Comparable Efficacy ◽  
Efficacy And Safety ◽  
National Guidelines ◽  
Therapy Regimen ◽  
Conventional Dmards

Background:Current EULAR and national guidelines recommend use of synthetic target drug Tofacitinib (TOFA) for active rheumatoid arthritis (RA) treatment in case of resistance or intolerance to metotrexate (MTX) or other conventional DMARDs. Two treatment regimens are approved: TOFA mono-therapy and combination with conventional DMARD, preferably with MTX.Objectives:Aim of presented study was to compare efficacy and safety of TOFA given in two regimens: as mono-therapy and in combination with MTX.Methods:We analyzed data from Russian national registry of RA. 450 patients (pts) treated with TOFA in dose 10 mg daily have been enrolled in this investigation. Among them 169 pts have composed TOFA mono-therapy group (mono) and 281 pts treated with TOFA plus MTX have been included in combo-therapy group (combo). Period of treatment varied from 6 months to 3 years and even more. Treatment efficacy was evaluated on the basis of clinical and laboratory indices of RA activity: CDAI, SDAI, DAS28, HAQ, GPA (general pain assessment), TJC, SJC, CRP, ESR monthly during first 6 months, than in 1,2,3 years and after 3 year period of treatment.Results:There were no significant differences in pts demographic characteristic and disease longevity and/or severity in two separated groups. Majority of baseline indices were identical in these groups aside from SDAI, CRP (were higher in combo-group) and HAQ (was higher in mono-group). Pts monitoring have shown dramatically decrease of all used indices during the first several months of therapy in both groups. Moreover all clinical and laboratory parameters after 6-months treatment were comparable in mono- and combo- groups. Positive dynamics remained during further 3-year period in both groups. Significant differences between baseline and ultimate data after 3 year course therapy were revealed in CDAI, SDAI, DAS28, HAQ, GPA, TJC, SJC, CRP, ESR in both groups. In particular DAS28 index decreased from 5.38±0.08 to 2.88±0.07 (p<0.05) in mono-group and from 5.54±0.09 to 3.40±0.21 (p<0.05) in combo-group. Along with this comparing of endpoints in two analyzed groups have shown that levels of CDAI, SDAI, GPA were significant higher in combo-group than in mono-group (p<0.05). Adverse effects were registered in 4.73% pts from mono-group and in 4.98% pts from combo-group (p>0.05). Spectrum of adverse reactions was similar in compared groups: respiratory infection (in 2.96% and 3.36% cases respectively) and herpes infection (in 0.59% and 0.71% cases, respectively) were registered predominantly.Conclusion:Data gained from National RA registry have demonstrated that treatment with TOFA in mono-therapy regimen has the comparable efficacy with regimen of combined therapy, included MTX and TOFA. Safety of both regimens can be qualified as good. Obtained results confirm high efficacy and safety of target therapy with TOFA and prove the recommendation for use it in different regimens – mono-therapy or combination with MTX.References:[1]Smolen JS, et al. Ann Rheum Dis. 2017;0:1–18. doi:10.1136/annrheumdis-2016-210715[2]Boyle DL, et al. Ann Rheum Dis. 2015;74:1311-1316. doi:10.1136/annrheumdis-2014-206028Disclosure of Interests:Aida Babaeva: None declared, Elena Kalinina: None declared, Evgeny Nasonov Speakers bureau: Lilly, AbbVie, Pfizer, Biocad, R-Pharm, V Mazurov: None declared, Galina Lukina Speakers bureau: Novartis, Pfizer, UCB, Abbvie, Biocad, MSD, Roche, Antonina Davydova: None declared, Irina Semizarova: None declared, Olga Slyusar: None declared, Tatyana Rasevich: None declared, Ruzana Samigullina: None declared, Diana Abdulganieva: None declared

On the stability of a mathematical model for HIV(AIDS) - cancer dynamics

2021 ◽  
Vol 8 (4) ◽  
pp. 783-796
Author(s):  
H. W. Salih ◽  
◽  
A. Nachaoui ◽  
Keyword(s):  
Mathematical Model ◽  
Highly Active Antiretroviral Therapy ◽  
Lyapunov Method ◽  
Equilibrium Points ◽  
Hiv Treatment ◽  
Biochemical Processes ◽  
Highly Active ◽  
Biological Phenomena ◽  
The Stability ◽  
The Impact

In this work, we study an impulsive mathematical model proposed by Chavez et al. [1] to describe the dynamics of cancer growth and HIV infection, when chemotherapy and HIV treatment are combined. To better understand these complex biological phenomena, we study the stability of equilibrium points. To do this, we construct an appropriate Lyapunov function for the first equilibrium point while the indirect Lyapunov method is used for the second one. None of the equilibrium points obtained allow us to study the stability of the chemotherapeutic dynamics, we then propose a bifurcation of the model and make a study of the bifurcated system which contributes to a better understanding of the underlying biochemical processes which govern this highly active antiretroviral therapy. This shows that this mathematical model is sufficiently realistic to formulate the impact of this treatment.

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