Changing practices in septorhinoplasty: the Irish experience

PURPOSE

Septorhinoplasty (SR) is one of the most complex surgical procedures of the head and neck. As an elective procedure aiming to enhance patient quality of life, it can be difficult to perform in single-payer healthcare systems due to capacity pressures from acute and oncological surgical demand. We aimed to review national trends in the practice of SR to inform future healthcare planning.

METHODS

This was a cross-sectional, population-based, longitudinal study of SR cases in Ireland's single-payer (public) healthcare system from 2005 to 2021. Time-series analysis using a linear regression model was performed to analyse trends by operation type, revision rates and length of stay. The impact of the COVID-19 pandemic and introduction of national surgical guidelines was analysed.

RESULTS

1952 SR were performed. Annual mean cases declined in both real (r = - 0.76, p < 0.01) and relative (r = - 0.87, p < 0.01) terms by 31% and 43%, respectively. Ambulatory SR, while initially rarely performed, increased to account for 55% of cases performed. The mean hospital length of stay declined significantly (r = - 0.84, p < 0.01) by 44%.

CONCLUSIONS

SR increasingly struggles to find its place in Ireland's public healthcare system. New changes in SR practices including the rapid growth of ambulatory surgery and shorter lengths of hospital stay indicate positive responses to the mounting pressures faced by healthcare systems.

An online survey of Malaysian long-term e-cigarette user perceptions

INTRODUCTION

The use of e-cigarettes (EC) has reached alarming proportions among Malaysians. On a national level, little is known about the profile and perceptions of Malaysian EC users. This study aimed to explore the prevalence of long-term EC usage and its associated factors among EC users in Malaysia.

METHODS

This nationwide online questionnaire survey was administered among 694 EC users across 13 states and 1 Federal Territory in Malaysia, between January and April 2018. A survey link was e-mailed to EC users that were recruited from an official national vape entity through their Facebook association page. We obtained information on respondents’ sociodemographic characteristics, smoking habits, long-term e-cigarette usage and perceptions of EC use. We estimated long-term EC user prevalence and fitted multivariate regression models to predict factors associated with long-term EC usage. Statistical significance was set at p<0.05.

RESULTS

Respondents were predominantly Malays (87.6%), aged >30 years (68.1%) and tertiary educated (71%). The majority were employed (93.1%) with a monthly household income of MYR 4000 or less (56.6%). About 84% were former smokers, while 10% were current smokers. The prevalence of long-term EC usage in this study was 82.3%. Most users believed that EC had helped them to cut down tobacco smoking (94.8%), reduced the urge to smoke (88.3%) and ultimately helped them to quit smoking (87.2%). Respondents aged >30 years and those who perceived that EC has helped them stop smoking were significantly more likely to be long-term EC users.

CONCLUSIONS

Most respondents engaged in EC use to quit smoking. They were more likely to be long-term EC users if they were older and perceived that EC has helped them to quit smoking. This information is valuable for targeted prevention, health promotion and policy regulations.

Conceptual Framework for Investigating and Influencing Adherence Behavior among HIV-Positive Populations: An Applied Social Cognition Model

Non-adherence remains a significant barrier to achieving successful HIV treatment outcomes. This review aimed to holistically examine the concept of adherence in the light of current research evidence and to provide a basic and adaptable conceptual framework for investigating and influencing adherence behavior among various HIV populations. We reviewed published journal articles and gray literature within the period from 2000 to 2017. A comprehensive search from major online databases and repositories such as PubMed, Scopus, Medline, Google Scholar, and Cochrane Database of Systematic Reviews was conducted using focused search terms that included "social cognition models" or "theories and models of health behavior change" or "behavior change in health psychology" or "theory-based interventions" or "behavioral frameworks" and "adherence behavior" or "medication adherence," and "HIV patients" or "HIV/AIDS." Only papers published in English were included in this study. We found varied and extensive literature evidence supporting the use of psychobehavioral models to promote conceptual understanding of adherence behavior among HIV-positive patients globally. We observed that certain approaches at investigating nonadherence worked better among certain populations and epidemics than others, largely because of contextual differences in barriers and burden of non-adherence among these populations. We synthesized the evidence and applied social cognition models in explaining and providing a basic, evidence-based and adaptable conceptual framework for investigating and influencing adherence behavior among HIV-positive populations around the world, regardless of geographical and HIV epidemiological context.

HIV Treatment Adherence - A Shared Burden for Patients, Health-Care Providers, and Other Stakeholders

Successful HIV treatment is contingent on sustained high levels of treatment adherence. Several barriers to optimal adherence have been documented. In this article, we first review the global burden of non-adherence among HIV/AIDS positive individuals on a public health scale. Second, we synthesized available evidence from different study designs and stratified across the European, African, and Asian literature to determine the factors influencing adherence to scheduled clinic appointments and medication non-adherence. Third, we discuss common measurement techniques that quantify the magnitude of non-adherence, their relative advantages and limitations in current practice. From January to May 2018, we reviewed guidelines, standard operating procedures, journal articles, and book chapters on treatment adherence among HIV patients receiving adherence to antiretroviral therapy (ART) globally. We searched PubMed, Medline, Google Scholar, and Cochrane Database of Systematic Reviews with the search terms "adherence," "adherence behavior," "medication adherence," and "HIV patients," or "HIV/AIDS," and "Antiretroviral Therapy" or "ART" or "ARVs" or "highly active ART " from 2000 to 2017. We also identified articles through searches of authors' files and previous research on HIV. We included only papers published in English in this review. We then generated a final list of reference on the basis of originality and the broad scope of this review. We found rich literature evidence of research findings and best practice recommendations on the importance of adherence in HIV/AIDS management, a general understanding of factors associated with non-adherence and approaches to investigating non-adherence behavior among different populations. We observed significant contextual differences exist with regard to barriers and burden of non-adherence among these populations.

Evaluation of standard diagnostic rapid test kits for malaria diagnosis among HIV patients in Kano, Nigeria

Background

Malaria diagnosis among HIV-positive patients is uncommon in Nigeria despite the high burden of both diseases.

Objectives

We evaluated the performance of a malaria rapid diagnostic test (MRDT) against blood smear microscopy (BSM) among HIV-positive patients in relation to anti-retroviral treatment (ART) status, CD4+ count, fever, cotrimoxazole prophylaxis and malaria density count.

Method

A cross-sectional study involving 1521 consenting randomly selected HIV-positive adults attending two ART clinics in Kano, Nigeria, between June 2015 and May 2016. Venous blood samples were collected for testing with MRDT, BSM, and CD4+ T cells count by cytometry. Biodata and other clinical details were extracted from patient folders into an Excel file, cleaned, validated, and exported for analysis into SPSS version 23.0. Sensitivity, specificity, predictive values of MRDT were compared with BSM with a 95% confidence interval.

Results

Malaria parasites were detected in 25.4% of enrollees by BSM and 16.4% by MRDT. Overall sensitivity of MRDT was 58% and specificity was 97%. Cotrimoxazole prophylaxis and fever status did not affect MRDT sensitivity and specificity. Unexpectedly, the sensitivity was highest at parasite density count of less than 500 cells/µL. At CD4+ T cells count over 500 cells/µL the sensitivity was higher (62.4%) compared to 56% at less than 500 cells/µL. In the non-ART group sensitivity was higher (65%) compared to those on ART (56%) but the specificity was similar. All differences were significant for all variables (p < 0.05).

Conclusion

Although the MRDT specificity was good, the sensitivity was poor, requiring further evaluation for use in malaria diagnosis among HIV-malaria co-infected persons in these settings.

Evaluating laboratory request forms submitted to haematology and blood transfusion departments at a hospital in Northwest Nigeria

Background

The laboratory request form (LRF) is a communication link between laboratories, requesting physicians and users of laboratory services. Inadequate information or errors arising from the process of filling out LRFs can significantly impact the quality of laboratory results and, ultimately, patient outcomes.

Objective

We assessed routinely-submitted LRFs to determine the degree of correctness, completeness and consistency.

Methods

LRFs submitted to the Department of Haematology (DH) and Blood Transfusion Services (BTS) of Aminu Kano Teaching Hospital in Kano, Nigeria, between October 2014 and December 2014, were evaluated for completion of all items on the forms. Performance in four quality indicator domains, including patient identifiers, test request details, laboratory details and physician details, was derived as a composite percentage.

Results

Of the 2084 LRFs evaluated, 999 were from DH and 1085 from BTS. Overall, LRF completeness was 89.5% for DH and 81.2% for BTS. Information on patient name, patient location and laboratory number were 100% complete for DH, whereas only patient name was 100% complete for BTS. Incomplete information was mostly encountered on BTS forms for physician’s signature (60.8%) and signature of laboratory receiver (63.5%). None of the DH and only 9.4% of BTS LRFs met all quality indicator indices.

Conclusion

The level of completion of LRFs from these two departments was suboptimal. This underscores the need to review and redesign the LRF, improve on training and communication between laboratory and clinical staff and review specimen rejection practices.