• Oh Miranda posted an update 2 months ago

    Tuberculosis preventive treatment (TPT) is a critical intervention to reduce TB mortality among people living with HIV (PLHIV). To facilitate scale-up of TPT among PLHIV, the Nigeria Ministry of Health and the US Centers for Disease Control and Prevention (CDC) Nigeria, supported by US President’s Emergency Plan for AIDS Relief (PEPFAR) implementing partners (IPs), launched a TPT-focused technical assistance strategy in high-volume antiretroviral treatment (ART) sites during 2018.

    Nigeria has an estimated 1.9 million PLHIV, representing the second largest national burden of PLHIV in the world, and an estimated 53% of PLHIV are on ART.

    In 50 high-volume ART sites, we assessed readiness for TPT scale-up through use of a standardized tool across five areas clinical training, community education, patient management, commodities and logistics management, and recording and reporting. We deployed a site-level continuous quality improvement strategy to facilitate TPT scale-up. IPs rapidly disseminated best pracprovement approach allowed each site to design a specific plan to achieve desired TPT scale-up, and best practices were implemented concurrently at other, smaller sites. The approach could assist scale-up of TPT among PLHIV in other countries.

    Pre-exposure prophylaxis (PrEP) is only effective in preventing new HIV infections when taken consistently. In clinical practice, asking a patient about their adherence (self-report) is the predominant method of assessing adherence to PrEP. Though inexpensive and noninvasive, self-report is subject to social desirability and recall biases. Several clinical trials demonstrate a discrepancy between self-reported adherence and biomarker-based recent adherence. PI3K activator Less is known about the accuracy of self-report in real-world clinical settings. This brief report addresses this knowledge gap and describes the concordance between self-reported adherence and biomarker-based adherence in real-world clinical settings.

    A Liquid Chromatography-Mass Spectrometry (LC-MS/MS) urine test for Tenofovir was developed and used clinically to detect recent non-adherence (no dose in at least 48 hours) for each individual. Two clinics’ standard operating procedures recommend utilization of the urine-based adherence test for patientd PrEP regimen. These findings suggest that objective adherence monitoring can be used clinically to enable providers to identify non-adherent patients and allocate support services accordingly.

    Utilization of biomarker-based adherence monitoring at these two clinics resulted in 564 additional patients receiving enhanced adherence support who otherwise would not have been identified as non-adherent to their prescribed PrEP regimen. These findings suggest that objective adherence monitoring can be used clinically to enable providers to identify non-adherent patients and allocate support services accordingly.

    Oxford-III unicompartmental knee replacements (UKRs) are among the most commonly used prostheses to treat isolated medial compartment osteoarthritis (OA). However, the best mode of implant fixation for primary UKRs remains a source of debate. The hypothesis of this study was that the biologically superior fixation of uncemented Oxford-III primary UKRs would translate into a lower revision rate when compared with cemented Oxford-III primary UKRs used to treat isolated medial compartment OA.

    Data on all Oxford-III primary UKRs (n = 8,733) completed for isolated medial compartment OA from January 2000 to December 2018 were obtained from the New Zealand Joint Registry (NZJR). Revision rates were documented for each fixation type and analyzed for associations with patient sex and age at surgery. A multivariate Cox proportional-hazards analysis was completed to determine if type of fixation was an independent risk factor for revision of Oxford-III UKRs.

    Statistical analysis revealed a >1.8-fold greater revmplete description of levels of evidence.

    Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

    The efficacy of commercially available antibiotic-loaded bone cement (ABC) in preventing infection in total knee arthroplasty (TKA) is unclear. We sought to determine the effectiveness of commercially available ABC in reducing the risk of infection following TKA, both overall and among 3 subgroups of patients with a higher risk of infection (diabetes, body mass index ≥35 kg/m, and American Society of Anesthesiologists classification ≥3), and to evaluate the association between the use of ABC and the risks of aseptic revision and revision for aseptic loosening.

    The Kaiser Permanente Total Joint Replacement Registry was utilized to evaluate 87,018 primary cemented TKAs performed from 2008 to 2016. The primary outcome was time to infection (90-day deep infection or septic revision). Reduced infection risk with ABC relative to regular cement was tested with use of propensity-score-weighted Cox proportional-hazards models with superiority and noninferiority testing. All analyses were replicated for each of thecomplete description of levels of evidence.

    Protecting healthcare workers is an essential component of a successful response to the COVID-19 pandemic. The resource intensive nature of infectious disease protection, budgetary constraints, and global shortages of personal protective equipment (PPE) make this a daunting task. Practical, easily implemented strategies for healthcare workers (HCW) protection are needed.

    We cross-reference the “Systems, Space, Staff, and Stuff” paradigm from disaster management and the “Hierarchy of Controls” approach to infection prevention from the Center for Disease Control and Prevention (CDC) to generate a narrative overview of worker protection strategies relevant to COVID-19.

    Alternative types of PPE, management of hazards, and reorganizing how people work can optimize HCWs protection.

    A comprehensive PPE strategy can utilize the “systems, space, staff, stuff” paradigm of disaster management to identify new or underutilized solutions to HCWs protection.

    A comprehensive PPE strategy can utilize the “systems, space, staff, stuff” paradigm of disaster management to identify new or underutilized solutions to HCWs protection.

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