University College Hospital (UCH) is a teaching hospital in the Fitzrovia area of the London Borough of Camden, England. The hospital, which was founded as the North London Hospital in 1834, is closely associated with University College London (UCL), whose main campus is situated next door. The hospital is part of the University College London Hospitals NHS Foundation TrustThe hospital is on the south side of Euston Road and its tower faces Euston Square tube station on the east side. Warren Street tube station lies immediately west and the major Euston terminus station is beyond 200 metres east, just beyond Euston Square Gardens.
BACKGROUND:Improving comfort during and after surgery is a key concern for anaesthetists and other clinicians. With the inclusion of patient and public involvement, we undertook a Delphi consensus process to update previously recommended endpoints to be used in clinical trials evaluating treatments aiming to improve patient comfort after surgery. METHODS:We undertook a systematic review to identify domains and outcome measures of patient comfort used in perioperative studies. Focus groups, workshops, and a multi-round Delphi consensus process that included clinician-researchers and a patient experience and consumer group updated a recommended list of standardised endpoints focused on patient comfort. Consensus was defined as a median item score of 7 or greater and at least 70% of responses achieving a score of 7 or greater on a 9-point Likert scale. Additional ratings were done to determine validity, reliability, feasibility, and patient-centredness. Qualitative analyses were undertaken to identify themes. RESULTS:Response rates for each of the Delphi rounds were 100%. A final list of eight defined endpoints was identified: supplementary analgesic use, subjective analgesic effectiveness, pain intensity (at rest, during movement, and at 12, 24, and 72 h), postoperative nausea and vomiting (PONV, at 0-6 h, at 6-24 h, and overall), postdischarge nausea and vomiting (PDNV), severe PONV, quality of recovery (QoR-15), and time to mobilisation. All endpoints were assessed as valid, reliable, and feasible measures of patient comfort and were considered patient-centred. Patient and public involvement highlighted the importance of clear communication and shared decision-making to enhance comfort through the surgical journey. CONCLUSIONS:We recommend that at least some of these standardised endpoints be included as outcome measures in clinical trials assessing patient comfort and pain after surgery. SYSTEMATIC REVIEW PROTOCOL:Open Science Framework (10.17605/OSF.IO/DJQFE).
Background:Mental health problems are a barrier to the well-being of youth living with HIV. Many youth living with HIV in Nigeria face peculiar biopsychosocial vulnerabilities that predispose them to mental health problems including depression and substance use. In addition to improving treatment outcomes like medication adherence and linkage to care, peer engagement has shown some promise in improving the social and emotional well-being of this population. Mobile health (mHealth) interventions like SMS text messaging medication reminders may also contribute to better outcomes in youth living with HIV. Emerging evidence suggests that combination interventions may be more effective than single interventions in improving key HIV testing and treatment outcomes among youth in Nigeria. Objective:This study aims to explore the impact of Intensive Combination Approach to Rollback the Epidemic in Nigerian Adolescents (iCARE Nigeria) study-an mHealth and peer navigation intervention primarily aimed at medication adherence and viral suppression-on depressive symptoms and substance use among youth living with HIV in Nigeria. Methods:A single-arm clinical trial was conducted at the Infectious Disease Institute, College of Medicine, University of Ibadan, Nigeria- primarily to improve medication adherence and viral suppression among youth living with HIV attending its HIV clinic. The intervention combined peer navigation and daily, 2-way, text message medication reminders delivered over a period of 48 weeks. Participants were screened at baseline and follow-up visits (24 and 48 weeks) for depression and substance use using standardized measures. Paired t tests and McNemar tests were used to investigate the change in depressive symptoms and the change in the proportion of participants reporting substance use over time, respectively. Results:All 40 enrolled participants (n=20, 50% male; mean age 19.9 y, SD 2.5 y) completed baseline and follow-up visits at week 24, while 37 (92.5%) participants completed the week 48 visit. Compared with baseline, there were significantly fewer self-reported depressive symptoms observed at 48 weeks (mean 2.89 vs 2.08; t36=2.04, 95% CI 0.006-1.615) but not at 24 weeks (mean 2.89 vs 2.62; t36=0.47, 95% CI -0.74 to 1.44). There were fewer self-reports of substance use at weeks 24 and 48 when compared to baseline, but these were not statistically significant (odds ratio [OR] ∞, 95% CI 0.189-∞ and OR 3.0, 95% CI 0.24-157.49, respectively). Conclusions:These findings suggest a statistically significant reduction in depressive symptoms among youth living with HIV over the 48-week intervention period that may be due to the iCARE Nigeria intervention. However, given limitations such as low levels of depressive symptoms at baseline, small sample size, and the lack of a control group, future studies such as the randomized stepped wedge evaluation of the iCARE intervention are needed to provide better insights into these exploratory findings.
BACKGROUND:Antimicrobial resistance (AMR) is a major global health threat, but there is scarcity of laboratory surveillance data linked to clinical information to determine burden and inform interventions, especially from low-income and middle-income countries. The ACORN2 study sought to address this through prospective case-based surveillance in 19 hospitals across Africa and Asia to characterise drug-resistant infections by origin, clinical syndrome, patient age, outcome, and geographical location. METHODS:Patients were enrolled on selected wards and clinical data were collected daily for community-acquired infections (CAIs). Point prevalence surveys for hospital-acquired infections (HAIs) were conducted weekly. Mortality was assessed at discharge and after 28 days. Linked microbiology data were extracted from local laboratory databases. Primary descriptive analyses focused on WHO Global Antimicrobial Resistance and Use Surveillance System pathogen (target organism) bloodstream infections (BSIs). Comparisons were adjusted for clustering by site using random effects models. FINDINGS:Over 31 months, 41 907 infections were characterised from 41 032 admissions. Two-thirds were children (19 351; 47·2%) or neonates (6649; 16·2%). There were marked differences in pathogen incidence and antibiotic resistance when clinical infections were stratified by patient age category and infection origin (CAI/HAI). The highest rates of target organism AMR BSI were third-generation cephalosporin-resistant (3GC-R) Escherichia coli (718·56/100 000 blood cultured infection episodes), meticillin-resistant Staphylococcus aureus (586·89/100 000 blood cultured infection episodes), and 3GC-R Klebsiella pneumoniae (364·92/100 000 blood cultured infection episodes). In-hospital mortality was 13·1% (166/1265) in patients with target organism BSI versus 6·2% (1357/21 845) in those with negative blood cultures, p<0·0001. INTERPRETATION:ACORN2 has shown practical implementation of collecting linked clinical-laboratory AMR data in low-income and middle-income countries and identified a significant burden of WHO GLASS BSI. Adoption of the ACORN2 approach at scale might enhance use of diagnostic microbiology and improve the volume of clinical data included in national and global AMR surveillance datasets. FUNDING:Wellcome.
