Factors associated with offering HIV testing to people aged ≥ 50 years: A qualitative study

Background Individuals aged ≥ 50 years continue to be disproportionately affected by late HIV diagnosis, which is associated with poorer health outcomes and onward transmission. Despite HIV testing guidelines and high acceptability of HIV testing among all patients, clinicians are less likely to offer a test to an older individual. The aim of this study was to identify clinician-related factors associated with offering HIV testing to patients aged ≥ 50 years. Methods Twenty clinicians who had been involved in the care of an older patient diagnosed late with HIV were interviewed. Results Thematic analysis identified seven factors associated with offering HIV testing to older people: knowledge, stigma, stereotyping and perception of risk, symptom attribution, discussing HIV with patients, consent procedures and practical issues. Conclusions Although some factors are not unique to older patients, some are unique to this group. Many clinicians lack up-to-date HIV-related knowledge, feel anxious discussing HIV with older patients and perceive asexuality in older age. In order to increase the offer of HIV testing to this group, we identified clinician-related barriers to test offer that need to be addressed.

Psychosocial Risk, Symptom Burden, and Concerns in Families Affected by Childhood Cancer

PURPOSE: The revised Psychosocial Assessment Tool (PATrev) is a common family-level risk-based screening tool for pediatric oncology that has gained support for its ability to predict, at diagnosis, the degree of psychosocial support a family may require throughout the treatment trajectory. However, ongoing screening for symptoms and concerns (e.g., feeling alone, understanding treatment) remain underutilized. Resource limitations necessitate triaging and intervention based on need and risk. Given the widespread use of the PATrev, we sought to explore the association between family psychosocial risk, symptom burden (as measured by the revised Edmonton Symptom Assessment System; ESAS-r), and concerns (as measured by the Canadian Problem Checklist; CPC). METHODS: Families (n = 85) with children between 2–18 years of age (M = 11.98, male: 62.4%) on or off treatment for cancer were recruited from the Alberta Children’s Hospital. One parent from each family completed the PATrev and the CPC. Participants 8–18 years of age completed the ESAS-r. RESULTS: Risk category (unviersal/low risk = 67.1%, targeted/intermediate risk = 21.1%, clinical/high risk = 5.9%), predicted symptom burden (F[2, 63.07] = 4.57, p = .014) and concerns (F[2, 80.08] = 16.34, p < .001), such that universal risk was associated with significantly lower symptom burden and fewer concerns. CONCLUSION: Family psychosocial risk is associated with cross-sectionally identified concerns and symptom burden, suggesting that resources might be prioritized for families with the greatest predicted need. Future research should evaluate the predictive validity of the PATrev to identify longitudinal concerns and symptom burden throughout the cancer trajectory.

Hyperprolactinaemia: audit of practice and new guidance

AimsHyperprolactinaemia is a problem secondary to antipsychotic use. Current management guidelines are heterogeneous and impractical. We aimed to assess coherence to common themes monitoring and intervention, reasons for failure, and to design new guidance for both general use Barnet, Enfield and Haringey Mental Health Trust (BEHMHT) and beyond.We hypothesised that performance would be poor and new guidance warranted.BackgroundHyperprolactinaemia is defined as blood prolactin of >530 miu/L in females and >424 miu/L in males, with 49.9% is due to medication. Several agents are deemed higher risk Symptom profiles and risk are idiosyncratic and there are adverse long-term outcomes. Treatment is based on symptom profile and severity and cause. Current guidance is trust specific or advised through The Maudlsey Prescribing Guidelines.Comprehensive and practical guidance reflecting front-line limitations is lacking. There is no clear delineation of a risk stratified pathway.MethodWe wished to ascertain data on surveillance, aetiology and signpost opportunities for service improvement. We also designed ‘risk strata’ to guide intervention.A random sample (n30) was selected from Enfield South Locality Team and data captured using local records. No ethical considerations were raised.A number of audit standards (95%) were developed based on previous guidance and agreed within the team and included frequency of monitoring, time to review and need for further referral.New guidance was developed based on results, MDT agreement and consultation with medical specialities.ResultData (n 30) showed predominant male bias to sample (66%) and average age of 48.87 yrs. Predominant diagnoses were Paranoid Schizophrenia (53.33%) and Schizoaffective disorder (33.33%.) Only 7/30 (23.33%) had undergone testing within the last year.Of those sampled, 2 (6.667%) had a new diagnoses of Hyperprolactinaemia, one on routine monitoring, one incidentally on admission to hospital. Both were on high risk agents. Both were reviewed and treated within one month. No audit standards were met, but no further referrals were required.Reasons for failure varied, but included loss to follow-up, no test requested or appointments missed.ConclusionBased on these data it was noted that monitoring was poor and reasons for failure varied. New Guidance was developed in response. The scope and validity of this guidance was agreed by MDT and awaits formal ratification.Re-audit will occur in 2020, and if successful the guidance submitted to other Trusts and RCPSYCH for national use.No financial interests to declare.

Atrial fibrillation: review of the European Society of Cardiology guidelines and national guidelines 2020

The review presents the key provisions of the recommendations of the Russian society of cardiology and the guidelines of the European society of cardiology for the diagnosis and treatment of atrial fibrillation (AF), updated in 2020. The recommendations clearly state the requirements for atrial fibrillation diagnosis verification, and propose an approach to the formation of a complex characteristic of the disease in four positions, which is designated as 4S-AF (Stroke risk, Symptom severity, Severity of AF burden, Substrate severity). The authors analyzed the strategy "CC To ABC" (Confirm AF, Characterize AF, Treat AF: the ABC pathway) proposed by European experts, the issues of modern terminology and requirements for verifying the diagnosis of AF, complex characteristics of the disease and stratification of the risk of stroke and bleeding, a new ABC approach in the treatment of AF, where A is anticoagulant prevention of thromboembolic complications, B is the control of symptoms of the disease and C is the detection and treatment of comorbid pathology. The General principles that have changed in comparison with the previous versions of guidelines of 2016 on the initiation and tactics of anticoagulant therapy, pharmacological and non-drug cardioversion, catheter ablation in patients with AF, affecting the prognosis and outcomes in patients with AF, are outlined. It is emphasized that the pattern of atrial fibrillation (first diagnosed, paroxysmal, persistent, long-term persistent, permanent) should not determine the indications for anticoagulant prevention. The solution to this issue is determined by the level of risk according to the CHA2DS2-VASc scale. The introduction of the considered methods of diagnosis and treatment of AF into clinical practice will optimize the burden on the health care system and reduce the costs associated with the burden of AF.

Which scores should use cardiologist to predict outcomes in patients with nonvalvular atrial fibrillation?

Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia Management of patients with atrial fibrillation (AF) includes anticoagulation for prevention of stroke and systemic embolism, improvement of AF-related symptoms by rate or rhythm control, and treatment for cardiovascular and other comorbidities. The structured characterization of AF should address four AF-related domains, that is, stroke risk, symptom severity, AF burden (type of AF, number and duration of episodes, etc.), and substrate severity. Various scores, i.e.CHA 2 DS 2 -VASc (stroke risk), HAS-BLED (bleeding risk), EHRA (severity of AF-related symptoms), and 2MACE (risk of cardiovascular events), can be used to estimate the risk of outcomes and for treatment decisions. Noteworthy, bleeding risk assessment using HAS-BLED score focuses attention on modifiable risk factors that should be managed to improve safety of anticoagulation, whereas a high bleeding risk score should not lead to withholding oral anticoagulants. New clini- cal and biomarker-based risk scores were developed. However, their potential advantages over existing scores should be confirmed in clinical studies.

Enterprise Architecture within the Process of Permanent Change

Permanent changes that happen within the external surroundings of an enterprise, respectively within the macro-environment, significantly influence its efficiency and behaviour. The framework for these changes is made up by Enterprise Architecture (EA). Impacts of these changes are distinct in both, the internal environment of an enterprise as well as in its mid-environment, being of dynamic nature, and their elimination is a basic assumption of keeping the enterprise's competitiveness. The article focuses on analysing the macro-environment factors' influence on the changes in enterprise EA from the perspective of their sector differentiation. Tests have been carried out both ways – for chosen macro-environment factors, as well as macro-environment areas as a whole. The research survey was carried out on a file of 456 enterprises from the whole of the Czech Republic, out of which the production and industry sectors included 187 enterprises, and the service sector 255 enterprises. Pearson's chi-quadrate test was used as a statistical method. At the same moment, macro-environment factor prediction was tested, respectively the importance attached by top managers to the individual macro-environment factors in the future. Research results have proven a significant sector differentiation from the perspective of macroenvironment factors' impact on EA, while a greater influence of these factors has been indicated mainly in the service sector. It may be assumed that top managers begin to prove a risk symptom caused by a change in the economic cycle.

Adolescent psychosis risk symptoms predicting persistent psychiatric service use: A 7-year follow-up study

Background:We investigated whether psychosis risk symptoms predicted psychiatric service use using seven-year register follow-up data.Methods:Our sample included 715 adolescents aged 15–18, referred to psychiatric care for the first time. Psychosis risk symptoms were assessed with the Prodromal Questionnaire (PQ) at the beginning of the treatment. We assessed the power of the overall PQ as well as its positive, negative, general, and disorganized psychosis risk symptom factors in predicting prolonged service use. Baseline psychiatric diagnoses (grouped into 7 categories) were controlled for. Based on both inpatient and outpatient psychiatric treatment after baseline, adolescents were divided into three groups of brief, intermittent, and persistent service use.Results:Stronger symptoms on any PQ factor as well as the presence of a mood disorder predicted prolonged service use. All of the PQ factors remained significant predictors when adjusted for baseline mood disorder and multimorbidity.Conclusions:In a prospective follow-up of a large sample using comprehensive mental health records, our findings indicate that assessing psychosis risk symptoms in clinical adolescent settings at the beginning of treatment could predict long-term need for care beyond diagnostic information. Our findings replicate the previous findings that positive psychosis risk symptoms are unspecific markers of severity of psychopathology. Also psychosis risk symptoms of the negative, disorganization, and general clusters are approximately as strongly associated with prolonged psychiatric service use in the upcoming years.