|
| ||
|
|
||
Case Load (case + load)
Selected AbstractsBritish HIV Association (BHIVA) national cohort outcomes audit of patients commencing antiretrovirals from naïveHIV MEDICINE, Issue 6 2009E Street Objectives The aim of this work was to audit the extent to which routine HIV care in the UK conforms with British HIV Association (BHIVA) guidelines and specifically the proportion of patients starting highly active antiretroviral therapy (HAART) who achieve the outcome of virological suppression below 50 HIV-1 RNA copies/mL within 6 months. Methods A prospective cohort review of adults with HIV infection who started antiretroviral therapy (ART) for the first time between April and September 2006 was carried out using structured questionnaire forms. Results A total of 1170 adults from 122 clinical sites participated in the review. Of these patients, 699 (59.7%) started ART at CD4 counts <200 cells/,L and 193 (16.5%) had not been tested for HIV drug resistance. Excluding patients with valid reasons for stopping short-term ART, 795 (73.5%) of 1081 patients had an undetectable viral load (VL) at follow-up. Detectable VL was strongly associated with pretreatment CD4 count below 50 cells/,L and pretreatment VL above 100 000 copies/mL, and was not associated with clinic location or case load. About a quarter of patients did not have a VL measurement during the first 6 weeks after starting ART. Conclusions The majority of patients who initiated ART at sites participating in this UK national audit were managed within the BHIVA guidelines and achieved virological suppression below 50 copies/mL around 6 months after commencing treatment. Poor VL outcomes were associated with very low CD4 cell count and/or high VL at baseline but not with clinic case load or location. There is an urgent need to diagnose patients at an earlier stage of their HIV disease. [source] Development of a client-generated health outcome measure for community nursingAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 5 2000Rhonda Griffiths Objective:To develop a client-generated outcome measure for use in community nursing. Method:Participants for the study were identified from the case load of community health nurses, from a nursing home service and from residents of a retirement village. All participants had a diagnosis of venous leg ulcer (VLU) and/or type 2 diabetes. Preliminary development of the measure involved focus groups of community clients and health professionals, and pilot testing of an existing quality of life (QoL) measure, the Patient-Generated Index. The resulting Client-Generated Index was tested for reliability and validity. Results:The Pearson's correlation coefficient between administration of the CGI at T1 and T2 was 0.526 (n=51; p=0.0001). The CGI correlated significantly with four of eight dimensions of the SF-36, and with pain as a clinical marker for VLU r=0.54 (p=0.001). Overall, participants with VLU reported a lower QoL (mean CGI score 2.8) compared to those with diabetes (mean CGI score 4.1). Conclusions:The CGI was developed to measure outcomes in community health settings. Some measures of its reliability and validity are demonstrated and further research is needed to validate the instrument using other client groups. Implications:If routine assessment and evaluation is to contribute to measures of outcome, the instruments need to be concise and acceptable to health care providers. The CGI has all these properties. [source] Care co-ordination and key worker schemes for disabled children: results of a UK-wide surveyCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2004V. Greco Abstract Aim To investigate the prevalence and nature of care co-ordination and key worker services for disabled children and their families. Methods Postal survey of 225 Children with Disabilities Teams across the UK. Results Out of 159 questionnaires returned (70%), 35 (22%) reported having a care co-ordination scheme, with 30 (19%) of these providing key workers for families. The majority had multiagency and parent involvement in setting up and overseeing the schemes. However, multiagency funding was less common and funding for many schemes was short term. Different models of key working were apparent. Five schemes employed full-time key workers. In 21 schemes, professionals key worked with a few families as part of a larger case load, and in three schemes, both types of key workers were employed. Most schemes provided initial or ongoing training for key workers, but a few provided neither of these. Discussion The proportion of areas having care co-ordination or key worker services is consistent with findings on research with parents of disabled children, which reports that less than one-third of families have a key worker. The extent of multiagency involvement in planning and overseeing the operation of the service was positive but joint funding was more problematic. There was considerable variation in service models and as yet, little is known about whether or how such variations relate to outcomes for children and families. Further research will investigate these issues. [source] Mechanical bowel preparation and antibiotic prophylaxis in colorectal surgery: use by and opinions of Spanish surgeonsCOLORECTAL DISEASE, Issue 1 2009J. V. Roig Abstract Objective, Antibiotic prophylaxis (AP) and mechanical bowel preparation (MBP) previous to surgery have classically been regarded as important in colorectal surgery. The latter has recently been questioned. We evaluated opinion of Spanish surgeons about the use of these measures. Method, E-mail survey among all members of Spanish Coloproctologic Associations. Results, Of 413 participants in the survey, 131 (31.7%) responded; 87% of surgeons used cathartics (70%), enemas (2%) or both (28%) for MBP. MBP was used 60% in right colon surgery, 90% in left colon and 99% in rectal surgery. Surgeons with more case load or those who specialized in colorectal surgery used significantly less MBP; 60% of the surgeons thought that MBP made surgery easier and reduced contamination; 35% thought that it decreased wound infection (WI) and 17% thought that it prevented anastomotic leaks. For 77%, it was regarded as useful or very useful. AP was used by 99.3% of surgeons including systemic alone in 86.2% and combined with oral in 16.8%. The first dose was given 2 h before surgery by 20.2% of the surgeons, at the anaesthetic induction by 78.3% and postoperatively by 1.5%; 43% used single dose only, 44.5% extended to 24 h and 12.5% for two or more days; 95% thought that AP reduced WI and 96% considered that it was useful. Conclusion, There is general agreement on AP. MBP remained a common practice among Spanish colorectal surgeons except for right colonic resection. Surgeons with more case load and specialization used it significantly less. [source] C4d in pediatric renal allograft biopsies: A marker for negative outcome in steroid-resistant rejectionPEDIATRIC TRANSPLANTATION, Issue 4 2006Regina Vargha Abstract:, Recently, deposition of C4d, reflecting complement activation via the classical pathway, has been established as marker of antibody-mediated rejection. As C4d can be detected in paraffin sections, it allows for retrospective analysis in populations with low case loads, such as in pediatric transplantation. In this study we re-evaluated consecutive renal transplant biopsies obtained since 1990 in 36 children (18 boys, 18 girls) who had received their allograft (nine living, 27 cadaveric) at an age of 10.12±4.4 yr. Clinical indications for biopsy were 16 acute steroid resistant rejections (ASRs), 11 chronic rejections and nine other diagnoses. Overall, C4d deposition was found in nine cases (25%), eight of them with diagnosed ASR. Six out of these eight allografts were lost during 36 months of clinical follow-up, a significantly higher rate than in C4d-negative biopsies (p<0.05). C4d status therefore turned out to be an excellent predictor for inferior graft survival following ASR. None of the other histopathologic markers were sensitive for humoral rejections. In conclusion, the high prevalence of C4d-positive staining in ASR demonstrates the importance of the humoral part of the immune system in pediatric transplantation. The worse outcome of C4d-positive rejections despite massive immunosuppressive therapy clearly indicates the need for innovative therapies in this high-risk population. [source] Merit, Management, and Neutral Competence: Lessons from the U.S. Merit Systems Protection Board, FY 1988,FY 1997PUBLIC ADMINISTRATION REVIEW, Issue 2 2000William F. West Despite the centrality of merit principles to governance in the United States over the past century, scant empirical research examines linkages between institutions, and outcomes in the implementation of merit system protections. We argue that the fate of merit principles depends, at a minimum, on two influences that may compete with neutral competence. The first is partisan responsiveness by counter bureaucracies charged with holding agencies accountable to merit principles. The second influence is the sacrifice of merit in the interest of managerial rerogatives at the agency level. This exploratory study assesses both of these influences within the federal government. Our data consist of personal interviews, analyses of U.S. Merit System Protection Board (MSPB) processes, case loads, and decisions between fiscal years 1988 and 1997, and a brief case study of the Justice Department. We find that the MSPB is largely the neutral and competent agency that Congress intended to create when it enacted the Civil Service Reform Act of 1978. Less positively, our analysis also reveals that federal agencies vary in how well their personnel actions fare with the MSPB. This finding is especially germane to reinventing-government reforms that decentralize personnel management to agencies or to line operators within agencies. [source] | ||||||||||