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Strategic adherence

Giovanni Ravasi, Beatriz Grinsztejn, Ricardo Baruch, Juan Vicente Guanira, Ricardo Luque, Carlos F Cáceres, Massimo Ghidinelli
INTRODUCTION: Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool...
2016: Journal of the International AIDS Society
Carlos F Cáceres, Annick Borquez, Jeffrey D Klausner, Rachel Baggaley, Chris Beyrer
BACKGROUND: In this article, we present recent evidence from studies focused on the implementation, effectiveness and cost-effectiveness of pre-exposure prophylaxis (PrEP) for HIV infection; discuss PrEP scale-up to date, including the observed levels of access and policy development; and elaborate on key emerging policy and research issues to consider for further scale-up, with a special focus on lower-middle income countries. DISCUSSION: The 2015 WHO Early Release Guidelines for HIV Treatment and Prevention reflect both scientific evidence and new policy perspectives...
2016: Journal of the International AIDS Society
Mahmoud Mohammad Yaseen, Mohammad Mahmoud Yaseen, Mohammad Ali Alqudah
Although available antiretroviral therapy (ART) has changed human immunodeficiency virus (HIV)-1 infection to a non-fatal chronic disease, the economic burden of lifelong therapy, severe adverse ART effects, daily ART adherence, and emergence of ART-resistant HIV-1 mutants require prospecting for alternative therapeutic modalities. Indeed, a growing body of evidence suggests that broadly neutralizing anti-HIV-1 antibodies (BNAbs) may offer one such feasible alternative. To evaluate their therapeutic potential in established HIV-1 infection, we sought to address recent advances in pre-clinical and clinical investigations in this area of HIV-1 research...
October 14, 2016: International Reviews of Immunology
Eirin N Ellensen, Torben Wisborg, Steinar Hunskaar, Erik Zakariassen
BACKGROUND: The Emergency Medical Communication Centre (EMCC) operators in Norway report using the Norwegian Index for Medical Emergency Assistance (Index), a criteria-based dispatch guideline, in about 75 % of medical emergency calls. The main purpose of a dispatch guideline is to assist the operator in securing a correct response as quickly as possible. The effect of using the guideline on EMCC response interval is as yet unknown. We wanted to ascertain an objective measure of guideline adherence, and explore a possible effect on emergency medical dispatch (EMD) response interval...
October 13, 2016: BMC Emergency Medicine
A M Hatcher, H Stöckl, N Christofides, N Woollett, C C Pallitto, C Garcia-Moreno, J M Turan
Prevention of mother-to-child transmission (PMTCT) can virtually eliminate HIV infection among infants, yet up to one-third of women miss PMTCT steps. Little is known about how partner dynamics such as intimate partner violence (IPV) influence pregnant and postpartum women's adherence to PMTCT. We conducted 32 qualitative interviews with HIV-positive pregnant and postpartum women in Johannesburg who experienced IPV. Trained researchers conducted in-depth interviews over the period of May 2014-Nov 2015 using narrative and social constructionist approaches...
November 2016: Social Science & Medicine
Sara Lodi, Shweta Sharma, Jens D Lundgren, Andrew N Phillips, Stephen R Cole, Roger Logan, Brian K Agan, Abdel Babiker, Hartwig Klinker, Haitao Chu, Matthew Law, James D Neaton, Miguel A Hernán
OBJECTIVE: The START trial found a lower risk of a composite clinical outcome in HIV-positive individuals assigned to immediate initiation of antiretroviral therapy (ART) compared with those assigned to deferred initiation. However, 30% of those assigned to deferred initiation started ART earlier than the protocol specified. To supplement the published intention-to-treat effect estimates, here we estimate the per-protocol effect of immediate versus deferred ART initiation in START. DESIGN: The START trial randomized 4685 HIV-positive participants with CD4 counts > 500 /mm to start ART immediately after randomization (immediate initiation group) or to wait until the CD4 count dropped below 350 cells/mm or an AIDS diagnosis (deferred initiation group)...
September 6, 2016: AIDS
Liat Sorski, Lee Shaashua, Rivka Melamed, Pini Matzner, Shamgar Ben-Eliyahu
Marginating-hepatic (MH) leukocytes (leukocytes adhering to the sinusoids of the liver), were shown to exhibit unique composition and characteristics compared to leukocytes of other immune compartments. Specifically, evidence suggests a distinct pro- and anti-inflammatory profile of the MH-leukocyte population and higher cytotoxicity of liver-specific NK cells (namely, pit cells) compared to circulating or splenic immunocytes in both mice and rats. The method presented herein enables selective harvesting of MH leukocytes by forced perfusion of the liver in mice and rats...
2016: Journal of Visualized Experiments: JoVE
Deepika Gupta, Monica Sharma, Subendu Sarkar, B R Thapa, Anuradha Chakraborti
Enteroaggregative Escherichia coli (EAEC) is an important diarrhoeal pathogen causing diseases in multiple epidemiological and clinical settings. In developing countries like India, diarrhoeal diseases are one of the major killers among paediatric population and oddly, few studies are available from Indian paediatric population on the variability of EAEC virulence genes. In this study, we examined the distribution of plasmid and chromosomal-encoded virulence determinants in EAEC isolates, and analysed cytokines response generated against EAEC with specific aggregative adherence fimbriae (AAF) type in duodenal biopsies using in vitro organ culture (IVOC) mimicking in vivo conditions...
September 2016: FEMS Microbiology Letters
Leah L Zullig, Bradi B Granger, Hayden B Bosworth
THE PROBLEM: Nonadherence to prescription medications is a common and costly problem with multiple contributing factors, spanning the dimensions of individual behavior change, psychology, medicine, and health policy, among others. Addressing the problem of medication nonadherence requires strategic input from key experts in a number of fields. MEETING OF EXPERTS: The Medication Adherence Alliance is a group of key experts, predominately from the US, in the field of medication nonadherence...
2016: Patient Preference and Adherence
Tefera Kassahun, Hailay Gesesew, Lillian Mwanri, Tesfahun Eshetie
BACKGROUND: The provision of health education involving self-care and good adherence to medications has been acknowledged to be a cost effective strategy for improving quality of life of diabetes patients. We assessed levels of knowledge about type 2 diabetes mellitus (T2DM), self-care behaviours and adherence to medication among DM patients. METHODS: A facility based cross-sectional survey of 325 adults with T2DM patients attending Jimma University Teaching Hospital, Southwest Ethiopia was conducted...
2016: BMC Endocrine Disorders
Mathias Ried-Larsen, Reimar W Thomsen, Klara Berencsi, Cecilie F Brinkløv, Charlotte Brøns, Laura S Valentiner, Kristian Karstoft, Henning Langberg, Allan A Vaag, Bente K Pedersen, Jens S Nielsen
Promoting physical activity is a first-line choice of treatment for patients with type 2 diabetes (T2D). However, there is a need for more effective tools and technologies to facilitate structured lifestyle interventions and to ensure a better compliance, sustainability, and health benefits of exercise training in patients with T2D. The InterWalk initiative and its innovative application (app) for smartphones described in this study were developed by the Danish Centre for Strategic Research in T2D aiming at implementing, testing, and validating interval walking in patients with T2D in Denmark...
2016: Clinical Epidemiology
Mary Nowlan, Nikki Turner, Tomasz Kiedrzynski, Diana Murfitt, Nina Sawicki
In the past decade, pertussis has made a global resurgence, driving reconsideration of national immunisation schedules and vaccine usage. A workshop held by the Ministry of Health in 2015 discussed New Zealand's pertussis disease control strategies. Data were presented from current research into vaccine safety during pregnancy and the effectiveness of the immunisation schedule in preventing pertussis throughout childhood. The greatest burden of disease and mortality remains in infants under 1 year of age, especially infants too young to be immunised, those of Māori and Pacific ethnicity, and those living in deprivation...
2016: New Zealand Medical Journal
Daan Westra, Federica Angeli, Evelina Jatautaitė, Martin Carree, Dirk Ruwaard
INTRODUCTION: Medical specialists seem to increasingly work in- and be affiliated to- multiple organizations. We define this phenomenon as specialist sharing. This form of inter-organizational cooperation has received scant scholarly attention. We investigate the extent of- and motives behind- specialist sharing, in the price-competitive hospital market of the Netherlands. METHODS: A mixed-method was adopted. Social network analysis was used to quantitatively examine the extent of the phenomenon...
August 2016: Social Science & Medicine
William Goossen
The selection, implementation, and certification of electronic health records (EHR) could benefit from the required use of one of the established clinical model approaches. For the lifelong record of data about individuals, issues arise about the permanence and preservation of data during or even beyond a lifetime. Current EHR do not fully adhere to pertinent standards for clinical data, where it is known for some 20 plus years that standardization of health data is a cornerstone for patient safety, interoperability, data retrieval for various purposes and the lifelong preservation of such data...
2016: Studies in Health Technology and Informatics
Jordan E Pinsker, Amy Kraus, Danielle Gianferante, Benjamen E Schoenberg, Satbir K Singh, Hallie Ortiz, Eyal Dassau, David Kerr
OBJECTIVES: People with type 1 diabetes are at risk for early- and late-onset hypoglycemia following exercise. Reducing this risk may be possible with strategic modifications in carbohydrate intake and insulin use. We examined the exercise preparations and management techniques used by individuals with type 1 diabetes before and after physical activity and sought to determine whether use of differing diabetes technologies affects these health-related behaviours. METHODS: We studied 502 adults from the Type 1 Diabetes Exchange's online patient community, Glu, who had completed an online survey focused on diabetes self-management and exercise...
May 17, 2016: Canadian Journal of Diabetes
Malin Andre, Hedvig Gröndal, Eva-Lena Strandberg, Annika Brorsson, Katarina Hedin
BACKGROUND: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines...
2016: BMC Family Practice
Moi Lin Ling, Anucha Apisarnthanarak, Namita Jaggi, Glenys Harrington, Keita Morikane, Le Thi Anh Thu, Patricia Ching, Victoria Villanueva, Zhiyong Zong, Jae Sim Jeong, Chun-Ming Lee
This document is an executive summary of the APSIC Guide for Prevention of Central Line Associated Bloodstream Infections (CLABSI). It describes key evidence-based care components of the Central Line Insertion and Maintenance Bundles and its implementation using the quality improvement methodology, namely the Plan-Do-Study-Act (PDSA) methodology involving multidisciplinary process and stakeholders. Monitoring of improvement over time with timely feedback to stakeholders is a key component to ensure the success of implementing best practices...
2016: Antimicrobial Resistance and Infection Control
Saeed Al Shemeili, Susan Klein, Alison Strath, Saleh Fares, Derek Stewart
RATIONALE AND AIM: The structures and processes around the management of medicines for elderly, hospitalized patients are ill defined. This study aimed to determine consensus related to strategic and operational approaches in the United Arab Emirates. METHODS: A modified Delphi technique, consensus study with first round statements developed from systematic reviews related to medicines management. Normalization process theory and the theoretical domains framework were applied in the construction of statements, organized into key elements of medicines management: guidelines for medicines management, medicines reconciliation, medicines selection, prescribing and review, medicines adherence, medicines counselling, health professional training and evaluation research...
October 2016: Journal of Evaluation in Clinical Practice
Lee Shaashua, Liat Sorski, Rivka Melamed, Shamgar Ben-Eliyahu
Marginating-pulmonary (MP) leukocytes are leukocytes that adhere to the inner endothelium of the lung capillaries. MP-leukocytes were shown to exhibit unique composition and characteristics compared to leukocytes of other immune compartments. Evidence suggests higher cytotoxicity of natural killer cells, and a distinct pro- and anti-inflammatory profile of the MP-leukocyte population compared to circulating or splenic immunocytes. The method presented herein enables selective harvesting of MP-leukocytes by forced perfusion of the lungs in either mice or rats...
2016: Journal of Visualized Experiments: JoVE
Joseph D Tucker, Adam Gilbertson, Ying-Ru Lo, Marco Vitória
BACKGROUND: Curing HIV is a new strategic priority for several major AIDS organizations. In step with this new priority, HIV cure research and related programs are advancing in low, middle, and high-income country settings. This HIV cure momentum may influence existing HIV programs and research priorities. DISCUSSION: Despite the early stage of ongoing HIV cure efforts, these changes have directly influenced HIV research funding priorities, pilot programs, and HIV messaging...
2016: BMC Infectious Diseases
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