Adolescents living with HIV (ALWH) who transition from pediatric to adult care face several challenges that increase their risk of experiencing treatment interruptions and being lost to HIV care with ...resultant increased morbidity and mortality. To date, few studies have examined their outcomes post-healthcare transition (HCT), precluding the development and dissemination of evidence-based interventions aimed at retaining ALWH in HIV care both during and after HCT. We conducted a systematic review to synthesize the outcomes of ALWH post-HCT to provide suggestions for future directions.
We systematically searched several electronic databases through October 2019 using keywords for HIV, HCT and ALWH. We categorized studies by target population, country (i.e., upper-high income and low-middle income), study design (i.e., descriptive, mixed methods, quantitative), outcomes measured, and follow-up period.
A total of 24 studies met inclusion criteria. Studies were categorized according to the following HCT outcomes: retention in HIV care post-HCT (n = 13), changes in CD4+ count and viral load post-HCT (n = 16), and mortality among ALWH post-HCT (n = 7). Most studies (n = 11) examining retention in HIV care indicated that more than 70% of ALWH were retained in care 1-2 years post-HCT while the remaining studies (n = 2) reported retention rates less than 55%. While studies indicated that CD4+ counts and viral loads tended to worsen during the first few years post-HCT, these differences were often not statistically significant. Among all ALWH who transitioned to adult care, a small proportion died within their first seven years post-HCT. Among qualitative studies, common themes included transition readiness (n = 6), provider-patient relationship in the adult clinic setting (n = 6), and concern about the adult clinic setting (n = 4).
Transition outcomes were poorest for ALWH with unsuppressed viremia pre-HCT, suggesting that this subgroup of ALWH may need greater support from their treatment teams and caregivers during and post-HCT to improve clinical outcomes.
Background Patients with end-stage renal disease (ESRD) receiving dialysis have poor health-related quality of life. Physical symptoms are highly prevalent among dialysis-dependent patients and play ...important roles in health-related quality of life. A range of symptom assessment tools have been used in dialysis-dependent patients, but there has been no previous systematic assessment of the existing symptom measures’ content, validity, and reliability. Study Design Systematic review of the literature. Settings & Population Patients with ESRD on maintenance dialysis therapy. Selection Criteria for Studies Instruments with 3 or more physical symptoms previously used in dialysis-dependent patients and evidence of validity or reliability testing. Intervention Patient-reported physical symptom assessment instrument. Outcomes Instrument symptom-related content, validity, and reliability. Results From 3,148 screened abstracts, 89 full-text articles were eligible for review. After article exclusion and further article identification by reference reviews, 58 articles on 23 symptom assessment instruments with documented reliability or validity testing were identified. Of the assessment instruments, 43.5% were generic and 56.5% were ESRD specific. Symptoms most frequently assessed were fatigue, shortness of breath, insomnia, nausea and vomiting, and appetite. Instruments varied widely in respondent time burden, recall period, and symptom attributes. Few instruments considered recall periods less than 2 weeks and few assessed a range of symptom attributes. Psychometric testing was completed for congruent validity (70%), known-group validity (25%), responsiveness (30%), internal consistency (78%), and test-retest reliability (65%). Content validity was assessed in dialysis populations in 57% of the 23 instruments. Limitations Consideration of physical symptoms only and exclusion of single symptom–focused instruments. Conclusions The number of available instruments focused exclusively on physical symptoms in dialysis patients is limited. Few symptom-containing instruments have short recall periods, assess diverse symptom attributes, and have undergone comprehensive psychometric testing. Improved symptom-focused assessment tools are needed to improve symptom evaluation and symptom responsiveness to intervention among dialysis-dependent patients.
Disclosure of parental human immunodeficiency virus (HIV) infection to their children remains a difficult process for parents living with HIV (PLWH). In order to identify the best strategies to ...facilitate parental HIV disclosure, it is necessary to examine the efficacy of existing interventions designed to help PLWH parents with the disclosure process to their children.
To systematically review the efficacy of interventions designed to assist PLWH disclose their HIV status to their children.
We conducted a systematic review and narrative synthesis of interventions designed to assist PLWH disclose their HIV status to their children. MEDLINE/PubMed, PsycINFO, Embase, Global Health, and Web of Science were searched.
Studies were eligible for inclusion if they evaluated an intervention for parental HIV disclosure. Five studies published between 2001 and 2015 met the inclusion criteria. The interventions were conducted in South Africa, China, and the United States. Three of the studies used two-arm randomized controlled trials, in which the intervention group was given enhanced care while the control group received standard care. Four of the five studies included a theoretically informed intervention and three were limited to mothers. Results showed that four of the interventions increased parental HIV disclosure.
The findings suggest that parental HIV disclosure interventions are successful in assisting parents with the disclosure process and can be adapted in different cultural context. Future parental HIV disclosure interventions should include fathers in order to assist men with parental HIV disclosure.
Interpersonal continuity has been shown to play an essential role in primary care's salutary effects. Amid 2 decades of rapid evolution in the health care payment model, we sought to summarize the ...range of peer-reviewed literature relating continuity to health care costs and use, information critical to assessing the need for continuity measurement in value-based payment design.
After comprehensively reviewing prior continuity literature, we used a combination of established medical subject headings (MeSH) and key words to search PubMed, Embase, and Scopus for articles published between 2002 and 2022 on "continuity of care" and "continuity of patient care," and payor-relevant outcomes, including cost of care, health care costs, cost of health care, total cost of care, utilization, ambulatory care-sensitive conditions, and hospitalizations for these conditions. We limited our search to primary care key words, MeSH terms, and other controlled vocabulary, including primary care, primary health care, family medicine, family practice, pediatrics, and internal medicine.
Our search yielded 83 articles describing studies that were published between 2002 and 2022. Of these, 18 studies having a total of 18 unique outcomes examined the association between continuity and health care costs, and 79 studies having a total of 142 unique outcomes assessed the association between continuity and health care use. Interpersonal continuity was associated with significantly lower costs or more favorable use for 109 of the 160 outcomes.
Interpersonal continuity today remains significantly associated with lower health care costs and more appropriate use. Further research is needed to disaggregate these associations at the clinician, team, practice, and system levels, but continuity assessment is clearly important to designing value-based payment for primary care.
Objective To estimate the frequency with which results of large randomized clinical trials registered with ClinicalTrials.gov are not available to the public.Design Cross sectional analysisSetting ...Trials with at least 500 participants that were prospectively registered with ClinicalTrials.gov and completed prior to January 2009.Data sources PubMed, Google Scholar, and Embase were searched to identify published manuscripts containing trial results. The final literature search occurred in November 2012. Registry entries for unpublished trials were reviewed to determine whether results for these studies were available in the ClinicalTrials.gov results database.Main outcome measures The frequency of non-publication of trial results and, among unpublished studies, the frequency with which results are unavailable in the ClinicalTrials.gov database.Results Of 585 registered trials, 171 (29%) remained unpublished. These 171 unpublished trials had an estimated total enrollment of 299 763 study participants. The median time between study completion and the final literature search was 60 months for unpublished trials. Non-publication was more common among trials that received industry funding (150/468, 32%) than those that did not (21/117, 18%), P=0.003. Of the 171 unpublished trials, 133 (78%) had no results available in ClinicalTrials.gov.Conclusions Among this group of large clinical trials, non-publication of results was common and the availability of results in the ClinicalTrials.gov database was limited. A substantial number of study participants were exposed to the risks of trial participation without the societal benefits that accompany the dissemination of trial results.
Immunogenicity from seasonal inactivated influenza vaccine (IIV) remains suboptimal in solid organ transplant recipients (SOTR). We conducted a systematic review that compared the safety and ...immunogenicity of non-standard influenza vaccination strategies to single dose IIV in SOTR. Booster dose(s) and possibly high dose (HD) influenza vaccination strategies appear to hold promise for improving vaccination immunogenicity in SOTR. Administration of intradermal and MF59-adjuvanted trivalent IIV (IIV3) did not improve vaccine immunogenicity compared to single dose intramuscular IIV. Alternative vaccine strategies were generally well-tolerated; a higher frequency of injection site reactions and systemic adverse events were noted in SOTR who received HD, intradermal or adjuvanted IIV3 and HD IIV3 respectively. Allograft rejection rates were similar in both groups. SOTR should continue to receive standard dose IIV annually in accordance to current recommendations pending future studies to determine the optimal timing, frequency and dose(s) of IIV using the booster dose strategy.
Co-streaming classes have enabled library staff to extend open classes to distance education students and other users. Student evaluations showed that the model could be improved. Two areas required ...attention: audio problems experienced by online participants and staff teaching methods. Staff tested equipment and adjusted software configuration to improve user experience. Staff training increased familiarity with specialized teaching techniques and troubleshooting procedures. Technology testing and staff training were completed, and best practices were developed and applied. Class evaluations indicate improvements in classroom experience. Future plans include expanding co-streaming to more classes and on-going data collection, evaluation, and improvement of classes.
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