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BMC Geriatrics Jan 2023Postal screening has not previously been validated as a method for identifying fall and fracture risk in community-dwelling populations. We examined prognostic... (Randomized Controlled Trial)
Randomized Controlled Trial
Falls and fracture risk screening in primary care: update and validation of a postal screening tool for community dwelling older adults recruited to UK Prevention of Falls Injury Trial (PreFIT).
BACKGROUND
Postal screening has not previously been validated as a method for identifying fall and fracture risk in community-dwelling populations. We examined prognostic performance of a postal risk screener used in the UK Prevention of Falls Injury Trial (PreFIT; ISRCTN71002650), to predict any fall, recurrent falls, and fractures over 12 months. We tested whether adding variables would improve screener performance.
METHODS
Nine thousand eight hundred and eight community-dwelling participants, aged 70 years and older, and 63 general practices in the UK National Health Service (NHS) were included in a large, pragmatic cluster randomised trial comparing screen and treat fall prevention interventions. The short postal screener was sent to all participants in the trial intervention arms as an A4 sheet to be completed and returned to the GP (n = 6,580). The postal screener items were embedded in the baseline pre-randomisation postal questionnaire for all arms of the trial (n = 9,808). We assessed discrimination and calibration using area under the curve (AUC). We identified additional predictors using data from the control arm and applied these coefficients to internal validation models in the intervention arm participants. We used logistic regression to identify additional predictor variables.
FINDINGS
A total of 10,743 falls and 307 fractures were reported over 12 months. Over one third of participants 3,349/8,136 (41%) fell at least once over 12 month follow up. Response to the postal screener was high (5,779/6,580; 88%). Prediction models showed similar discriminatory ability in both control and intervention arms, with discrimination values for any fall AUC 0.67 (95% CI 0.65 to 0.68), and recurrent falls (AUC 0.71; 95% CI 0.69, 0.72) but poorer discrimination for fractures (AUC 0.60; 95% CI 0.56, 0.64). Additional predictor variables improved prediction of falls but had modest effect on fracture, where AUC rose to 0.71 (95% CI 0.67 to 0.74). Calibration slopes were very close to 1.
CONCLUSION
A short fall risk postal screener was acceptable for use in primary care but fall prediction was limited, although consistent with other tools. Fracture and fall prediction were only partially reliant on fall risk although were improved with the additional variables.
Topics: Aged; Aged, 80 and over; Humans; Fractures, Bone; Independent Living; Primary Health Care; State Medicine; United Kingdom
PubMed: 36690953
DOI: 10.1186/s12877-022-03649-5 -
BMJ Supportive & Palliative Care Jun 2021Providing care for our patients during the COVID-19 pandemic required a rapid shift to video consultations (VCs). A service evaluation was performed to capture hospice...
BACKGROUND
Providing care for our patients during the COVID-19 pandemic required a rapid shift to video consultations (VCs). A service evaluation was performed to capture hospice professionals' (HPs) and patients' experiences of VC.
METHODS
Online or postal surveys were sent to HPs and patients, who had participated in VC between March and July 2020, focusing on their experience and satisfaction with the service.
RESULTS
31 responses from HPs were received. 19 (61.3%) rated their experience of VC as good, despite 29 (93.5%) having no prior VC experience. One-third of HPs had undertaken potentially sensitive consultations, including resuscitation discussions. 23 (74.2%) undertook a VC that included a family member and 18 (58.1%) had included an external healthcare professional. 25 (80.6%) wanted to offer VC as an option going forward. Well-being staff successfully provided multiple group support sessions via video. 26 responses from patients (23) and carers (3) were received. 22 (84.6%) had access to a smartphone. 8 (30.8%) included a family member in their consultation. All patients/carers reported satisfaction with their VC, although 10 (38.5%) expressed a preference for face-to-face consultations. 22 (84.6%) patients would be happy to receive care via VC going forward and 21 (80.8%) stated they would recommend the use of VC to others.
CONCLUSION
Patients reported VC to be an acceptable way to receive support from a hospice service and HPs would like to continue to offer VC in the future. VC can be offered as an alternative to face-to-face consultations with the potential to continue and improve access to a wide range of hospice services.
PubMed: 34162580
DOI: 10.1136/bmjspcare-2020-002861 -
Proceedings of the National Academy of... Jan 2023
Topics: Animals; Viral Envelope; Postal Service; Zoonoses
PubMed: 36623201
DOI: 10.1073/pnas.2219962120 -
Health Expectations : An International... Feb 2023To involve health service users in health care and health research priority setting, different methods exist. Which method is most suitable under which circumstances is...
INTRODUCTION
To involve health service users in health care and health research priority setting, different methods exist. Which method is most suitable under which circumstances is unknown. We compared a postal Delphi survey and an in-person workshop to involve health service users in priority settings for rehabilitative care and research in Germany.
METHODS
One hundred and eighty-four former rehabilitants were randomly assigned to a postal Delphi survey (n = 152) or an in-person workshop (n = 32). Two hundred and seventy-six employees in rehabilitation were also invited to the Delphi Survey. The methodological comparison refers only to the sample of rehabilitants. Within each method, the participants agreed on the top 10 priorities for practice improvement and research in rehabilitative care. The priorities were compared descriptively. Participants' satisfaction was measured with the Public and Patient Engagement Evaluation Tool. The usability of both methods was compared based on the effort, time and material costs required for implementation.
RESULTS
Seventy-five former rehabilitants and 41 employees in rehabilitation completed both Delphi survey rounds. Eleven former rehabilitants participated in the in-person workshop. Priorities for practice improvement showed a high degree of overlap between both methods whereas research priorities differed greatly. Participants of the in-person workshop felt significantly better prepared, more listened to and more likely to feel that different views on the topics were discussed. Participants of the Delphi survey expressed difficulties in understanding all survey questions. The Delphi survey was more elaborate in preparation and implementation but caused lower material costs.
CONCLUSION
The differences in research priorities between the two methods could be due to the different samples, differences in the individual interests of participants or differences in the prioritization process. In-person workshops seem to be more appropriate for complex topics, where clarifications of questions and deeper discussions are needed. Delphi surveys seem to be more suitable for easily understandable topics, larger sample sizes and when fewer financial resources are available.
PATIENT OR PUBLIC CONTRIBUTION
The different study phases were supported by employees in rehabilitation and former rehabilitants (e.g., developing study documents, and interpreting results).
Topics: Humans; Delivery of Health Care; Health Priorities; Biomedical Research; Health Services; Health Facilities; Delphi Technique
PubMed: 36346143
DOI: 10.1111/hex.13646 -
Environmental Science & Technology Sep 2022The United States Postal Service (USPS) plans to purchase 165,000 next-generation delivery vehicles (NGDVs) between 2023 and 2032. The USPS submitted an environmental...
The United States Postal Service (USPS) plans to purchase 165,000 next-generation delivery vehicles (NGDVs) between 2023 and 2032. The USPS submitted an environmental impact statement (EIS) for two NGDV procurement scenarios: (1) 90% internal combustion engine vehicles (ICEVs) and 10% battery electric vehicles (BEVs) ("ICEV scenario") and (2) 100% BEVs ("BEV scenario"). To correct several significant deficiencies in the EIS, we conduct a cradle-to-grave life cycle greenhouse gas (GHG) assessment of these two scenarios. Our analysis improves upon the USPS's EIS by including vehicle production and end-of-life emissions, future grid decarbonization, and more accurate vehicle operating emissions. In our base case, we find that the ICEV and BEV scenarios would result in 15% greater and 8% fewer GHG emissions, respectively, than the USPS estimate. Favorable vehicle and grid development would result in 63% lower BEV scenario emissions than the USPS estimate. Consequently, we calculate a cumulative lifetime emission reduction of 57-82% (14.7-21.4 Mt COe) from procuring 100% BEVs instead of 10% BEVs, compared to the USPS's estimate of 10.3 Mt. Given the long NGDV lifetimes, committing to the ICEV scenario squanders an ideal use case for BEVs, jeopardizes meeting our climate goals, and forgoes potential climate and environmental justice co-benefits.
Topics: Animals; Greenhouse Effect; Greenhouse Gases; Life Cycle Stages; Motor Vehicles; Postal Service; Vehicle Emissions
PubMed: 36018721
DOI: 10.1021/acs.est.2c02520 -
Frontiers in Public Health 2022Despite the important role of testing as a measure against the COVID-19 pandemic, user perspectives on SARS-CoV-2 tests remain scarce, inhibiting an improvement of...
BACKGROUND
Despite the important role of testing as a measure against the COVID-19 pandemic, user perspectives on SARS-CoV-2 tests remain scarce, inhibiting an improvement of testing approaches. As the world enters the third year of the pandemic, more nuanced perspectives of testing, and opportunities to expand testing in a feasible and affordable manner merit consideration.
METHODS
Conducted amid the second pandemic wave (late 2020-early 2021) during and after a multi-arm trial evaluating SARS-CoV-2 surveillance strategies in the federal state Baden-Württemberg, Germany, this qualitative sub-study aimed to gain a deeper understanding of how test users and test rejectors perceived mail-in SARS-CoV-2 gargle tests. We conducted 67 semi-structured in-depth interviews (mean duration: 60 min) telephone or video call. Interviews were audio-recorded, transcribed verbatim and analyzed inductively using thematic analysis. The guided the findings' presentation.
RESULTS
Respondents generally described gargle sampling as simple and comfortable. However, individual perceptions of the testing method and its feasibility varied widely from disgusting and complicated to simple and brilliant. Self-sampling was appreciated for lowering infection risks during testing, but also considered more complex. Gargle-sampling increased participants' self-efficacy to sample correctly. Communication (first contact, quantity and content of information, reminders, support system) and trust (in the study, its institutional affiliation and test method) decisively influenced the intervention's acceptability.
CONCLUSION
User-driven insights on how to streamline testing include: consider communication, first impressions of tests and information as key for successful mail-in testing; pay attention to the role of mutual trust between those taking and administering tests; implement gargle self-sampling as a pleasant alternative to swab testing; offer multiple test methods to increase test up-take.
Topics: Humans; COVID-19; Emotions; Pandemics; Postal Service; SARS-CoV-2; Implementation Science; Specimen Handling
PubMed: 36684995
DOI: 10.3389/fpubh.2022.1024525 -
Cureus Aug 2020Introduction We have been using telemedicine in the management of hyperthyroidism since 2010. Although telemedicine has been used in different areas of healthcare...
Introduction We have been using telemedicine in the management of hyperthyroidism since 2010. Although telemedicine has been used in different areas of healthcare management for several years, its importance was highlighted during the current coronavirus (COVID-19) pandemic. The aim of this survey was to assess patient satisfaction with the use of telemedicine in the management of hyperthyroidism. Materials and methods A postal survey was administered to all patients who had received at least one telemedicine session during the months January to May 2020 for the management of hyperthyroidism. Patients were asked to respond to nine statements using the five-point Likert scale. A suggestion box was included for comments and suggestions for improvement. Results There were 106 patients (26 males vs 80 females) with an average age of 53 years who received one to three calls over a five-month study period. A total of 65 respondents returned completed survey forms (61.3% response rate). Approximately 97% of respondents were satisfied with the overall quality of service provided during the use of telemedicine in the management of hyperthyroidism. The telemedicine service was time saving and met their needs. Approximately 14% of respondents were undecided about whether telemedicine was as good as the traditional face-to-face consultation. The respondents also made useful comments and suggestions concerning the provision of adequate time slots, occasional face-to-face appointments, and the introduction of text messaging and emailing to the telemedicine service. Conclusions This survey has demonstrated that the use of telemedicine in the management of hyperthyroidism is desirable to a majority of patients, as long as adequate time slots are dedicated to the telemedicine sessions and patients are reassured of the availability of face-to-face consultation sessions. Regular patient feedback is necessary to perfect the use of telemedicine in a patient-centered healthcare service.
PubMed: 32832308
DOI: 10.7759/cureus.9859 -
Journal of the International AIDS... Oct 2021The advent of COVID-19 has put pressure on health systems as they implement measures to reduce the risk of transmission to people living with HIV (PLHIV) and healthcare...
Distribution of antiretroviral therapy through private pharmacies and postal courier services during COVID-19 in Botswana: acceptability and reach of two out-of-facility individual differentiated service delivery models.
INTRODUCTION
The advent of COVID-19 has put pressure on health systems as they implement measures to reduce the risk of transmission to people living with HIV (PLHIV) and healthcare workers. For two out-of-facility individual differentiated service delivery (DSD) models, we assessed acceptability of antiretroviral therapy (ART) distribution through private pharmacies and reach of home delivery of ART through courier services during the COVID-19 pandemic in Botswana.
METHODS
From 24 July to 24 August 2020, we conducted exit interviews with PLHIV receiving ART from 10 high-volume public facilities in Gaborone, and mapped and conducted an online survey with private pharmacies to assess willingness and capacity to dispense ART to PLHIV enrolled in the Botswana national ART program. We piloted ART home delivery from September 2020 to January 2021 in Gaborone and Kweneng East districts for PLHIV accessing ART at two Tebelopele Wellness Clinics. We used cascade analysis to measure the enrolment and eventual reach (percentage of those reached amongst those who are eligible) of ART home delivery.
RESULTS
Sixty-one PLHIV and 42 private pharmacies participated. Of the PLHIV interviewed, 37 (61%) indicated willingness to access ART from private pharmacies and pay BWP50 (∼US$4) per refill for a maximum of two refills per year. All private pharmacies surveyed were willing to provide ART, and 26 (62%) would charge a dispensing fee (range = BWP50-100; ∼US$4-8) per refill. All pharmacies operated 12 h/day, 6 days/week and on public holidays. In the home delivery pilot, 650 PLHIV were due for refills, 69.5% (n = 452) of whom were eligible for home delivery. Of these, 361 were successfully offered home delivery and 303 enrolled (enrolment = 83.9%: female = 87.2%, male = 77.8%, p = 0.013). A total of 276 deliveries were made, a reach of 61%.
CONCLUSIONS
Providing ART through private pharmacies and home delivery was acceptable in Botswana during COVID-19. Surveyed pharmacies were willing and able to dispense ART to PLHIV attending public sector facilities for free or for a nominal fee. Additionally, using courier services for ART home delivery is a novel and viable model in countries with a reliable courier service like Botswana and should be scaled up, particularly in urban areas.
Topics: Botswana; COVID-19; Female; HIV Infections; Humans; Male; Pandemics; Pharmacies; SARS-CoV-2
PubMed: 34713589
DOI: 10.1002/jia2.25814 -
The Australian & New Zealand Journal of... Aug 2021Post-partum follow up testing of women with gestational diabetes mellitus (GDM) is important. All women, and their family doctors, receive written reminders. There are...
BACKGROUND
Post-partum follow up testing of women with gestational diabetes mellitus (GDM) is important. All women, and their family doctors, receive written reminders. There are no recent major Australian reviews of the efficacy and compliance with this advice conducted in an ethnically representative population and using the current diagnostic criteria.
AIM
The aim was to examine a cohort of women with recently diagnosed GDM and a completed pregnancy to determine what proportion had been tested and what were the difficulties in having testing carried out.
METHODS
Women who were diagnosed with gestational diabetes and attended the Diabetes Service in 2017 were followed up in 2019. Attempted contact was made using an unidentified land line, an identifiable mobile phone and a postal survey. Compliance with testing advice was the major parameter considered.
RESULTS
There were 714 women with GDM, 75 were excluded: 64 after pass one and 11 after pass two. In total, only 339/639 (53.1%) could be contacted. Of these women, 334 agreed to be surveyed; 207 (62.0%) had a post-partum test. Of the 127 women who had not had a test, 113 agreed to have an HbA1c. Only 13/113 (11.5%) had this done within a month.
CONCLUSION
Contacting women, even within a short time after the pregnancy, is difficult. The number of post-partum tests carried out is suboptimal. Written advice to all women and their doctors does not appear to be working. A review of the cost effectiveness of this approach and development of new methods may be worthwhile.
Topics: Australia; Diabetes Mellitus, Type 2; Diabetes, Gestational; Female; Glucose Tolerance Test; Humans; Postpartum Period; Pregnancy
PubMed: 33506501
DOI: 10.1111/ajo.13312 -
Sexually Transmitted Infections May 2021We comparatively evaluated two HIV and syphilis blood sampling kits (dried blood spot (DBS) and mini tube (MT)) as part of an online STI postal sampling service that... (Comparative Study)
Comparative Study
Are all blood-based postal sampling kits the same? A comparative service evaluation of the performance of dried blood spot and mini tube sample collection systems for postal HIV and syphilis testing.
OBJECTIVES
We comparatively evaluated two HIV and syphilis blood sampling kits (dried blood spot (DBS) and mini tube (MT)) as part of an online STI postal sampling service that included tests for chlamydia and gonorrhoea. We aimed to see how the blood collection systems compared regarding sample return rates and result rates. Additionally, we aimed to observe differences in false-positive results and describe a request-to-result ratio (RRR)-the required number of kit requests needed to obtain one successful result.
METHODS
We reviewed data from an online postal STI kit requesting service for a client transitioning from MT to DBS blood collection systems. We described service user baseline characteristics and compared kit requests, kit and blood sample return rates, and the successful resulting rates for HIV and syphilis for MT and DBS. Pearson's χ and Fisher's exact test were used to determine statistical differences, and statistical formulae were applied to produce CIs for differences in proportions.
RESULTS
5670 STI postal kit requests from a Midlands region were reviewed from 6 September 2016-2 January 2019 (1515 MT and 4155 DBS). Baseline characteristics between the two groups were comparable (68.0% female, 74.0% white British and 87.5% heterosexual, median age 26 years). Successful processing rates for DBS were 94.6% and 54.4% for MT (p<0.001) with a percentage difference of 40.2% (95% CI 36.9% to 43.4%). The RRR for MT was 2.9 cf. 1.6 for DBS. False-positive results for MT samples were 5.2% (HIV) and 0.4% (syphilis), and those for DBS were 0.4% (HIV) and 0.0% (syphilis).
CONCLUSIONS
This comparative analysis demonstrated the superior successful processing rates for postal DBS collection systems compared with MT. Reasons for this included insufficient volumes, high false-positive rates and degradation of blood quality in MT samples. A postal sampling service using DBS to screen for HIV, syphilis and other blood-borne viruses could be a viable alternative.
Topics: Adult; Blood Specimen Collection; Dried Blood Spot Testing; False Positive Reactions; Female; HIV Infections; Humans; Male; Syphilis; Syphilis Serodiagnosis; Young Adult
PubMed: 33214322
DOI: 10.1136/sextrans-2020-054692