Bowral and District Hospital is an acute care public hospital servicing the Southern Highlands region in New South Wales, Australia. The hospital is centrally located in the town of Bowral and is the only hospital operated outside the Sydney metropolitan area by the South Western Sydney Local Health District.
The World Health Organization recommended enhanced adherence counselling (EAC) sessions among people with HIV on ART with persistent viremia (viral load > 1000 copies/ml). There have been variations on the impact of EAC on viral load suppression (VLS) and it is unclear whether completing three sessions as recommended by country’s HIV treatment guidelines is superior to those who had less than three sessions. We summarized pooled estimates of EAC linkage, completion rate, VLS and compared impact of EAC linkage, EAC completion on VLS among people with HIV in Africa. Through systematic review, PubMed, Embase, Cochrane CENTRAL and clinicaltrials.gov were searched for articles published between January 2016 and December 2022. Participants who attended three EAC sessions were considered to have completed and VLS was defined as HIV-RNA < 1000 copies/ml. Using random effects models, we computed pooled prevalence estimates with a 95
To determine the prevalence of ischiofemoral impingement (IFI) in young patients evaluated for joint-preserving hip surgery and investigate its associations with osseous deformities and intra-articular pathologies. Retrospective study of 256 hips (224 patients, mean age 34 years) that were examined with radiographs and MR arthrography for hip pain. Quadratus femoris muscle edema was used to indicate IFI and measurements of ischiofemoral space were performed. Imaging analysis assessed cam deformity, femoral torsion, neck-shaft angle, ischial angle, acetabular coverage-/ version, and chondro-labral pathology. Prevalence of MRI findings consistent with IFI was calculated and univariate- and multivariate logistic regression identified associations between IFI and hip deformities. Quadratus femoris muscle edema consistent with IFI was present in 9
To develop evidence-based guidelines for the prevention, identification, and management of growth failure in infants under 6 months (U6M), ensuring early detection and intervention to improve health outcomes. Growth failure in the first 6 months of life significantly increases the risk of acute malnutrition and stunting in later childhood. Unlike older children, management in this age group prioritizes establishing exclusive breastfeeding and addressing feeding challenges. There are no standardized guidelines for identifying and managing growth failure in this vulnerable population. A national consultative committee of experts was convened to formulate these guidelines. The committee conducted extensive discussions, dividing key areas among six working groups. The process included four virtual and one in-person meeting between August and October 2024. A draft guideline was developed, reviewed, and approved by all committee members. Early growth failure is a significant public health concern. Timely identification of at-risk infants through mother-infant dyad assessments during routine health visits is essential. Weight-for-age is the most reliable anthropometric indicator for recognizing at-risk infants U6M. The term “infant at risk of poor growth and development” is recommended to identify at-risk infants needing intensified support. Community-based interventions should support at-risk infants without medical complications, while those with complications need facility-based care with skilled lactation support. Severely wasted infants require close monitoring for hypothermia, hypoglycemia, and sepsis. Establishing exclusive breastfeeding should be prioritized in all cases, and when not feasible, F-100D (Catch-up D) should be used to ensure safe nutritional rehabilitation while minimizing renal solute load.
Surfactant (SRT) therapy is well-established for respiratory distress syndrome (RDS) in very preterm infants, but its effectiveness in late preterms (≥ 34 weeks’ gestation) is less defined. We evaluated post-SRT oxygenation responses in late preterm infants in relation to pulmonary comorbidities. In this multicenter prospective cohort, 350 late preterm infants received SRT according to European RDS guidelines. Pulmonary comorbidities—including persistent pulmonary hypertension (PPHN), meconium aspiration, air leaks, pulmonary hemorrhage, and pneumonia—were documented. Oxygen saturation to inspired oxygen ratios (S/F ratios) were recorded over 48 h. A good response was defined as a ≥ 50
Kerala reports one of the highest case fatality rates and high prevalence of comorbidities and risk factors among persons with tuberculosis (PwTB). We developed a comprehensive care model (CCp-K) focusing on triaging persons with tuberculosis for severe illness, uncontrolled diabetes, alcohol and nicotine dependence at diagnosis, and ensuring inpatient care and follow-up. In the pre-implementation phase, we explored the barriers, facilitators, and perceived suggestions in the design and implementation of CCp-K from various interest holders for sustainable implementation. We conducted an interest holder mapping and using the Power-Interest matrix of Mendelow, we purposively selected key interest holders at the district and state level. In-depth interviews were conducted using an interview guide by trained interviewers until data saturation was achieved. The audio recordings were transcribed, translated, and analysed using a framework-guided thematic analysis approach. Twelve interest holders participated in the interview, which included nine men and three women. The interviews lasted for a mean duration of 74 min (SD = 22). A total of 33 codes were generated and categorized under five themes: (i) perception on TB deaths (ii) relevance of CCp-K differentiated TB care model, (iii) perceived feasibility and enablers of implementing CCp-K, (iv) perceived barriers, and (v) perceived suggestions for the model and its delivery. The interest holders perceived that while delayed diagnosis contributes to TB mortality, the CCp-K model can bridge critical gaps in post-diagnosis care, particularly through early triaging and comorbidity management to reduce TB deaths. The robust healthcare infrastructure of Kerala, local governments and community involvement, and cross-adaptation opportunities from previous successful models were perceived as facilitators. The lack of nodal treatment centres, stigma among healthcare workers, social vulnerability, and competing priorities were perceived as major barriers. The interest holders perceived the CCp-K model to be relevant and feasible. However, Kerala should overcome the barriers of inadequate inpatient referral centers by establishing designated TB care facilities, leveraging existing collaboration with private partnerships, and strengthening the social support system.
