Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review.

BACKGROUND: Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences. There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so. METHODS: A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing. RESULTS: The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing. CONCLUSION: Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing.

UK guideline for the use of HIV post-exposure prophylaxis 2021.

We present the updated British Association for Sexual Health and HIV (BASHH) guidelines for post-exposure prophylaxis (PEP) to HIV following sexual exposures, occupational exposures and other nonoccupational exposures in the community. This serves as an update to the 2015 BASHH guideline on PEP following sexual exposures and the 2008 Expert Advisory Group on AIDS guidelines on HIV PEP. We aim to provide evidence-based guidance on best clinical practice in the provision, monitoring and support of PEP for the prevention of HIV acquisition following sexual, occupational and other nonoccupational exposures in the community. The guideline covers when to prescribe PEP, what antiretroviral agents to use and how to manage PEP. This includes (i) evidence of PEP efficacy; (ii) evidence relating to individual-level efficacy of antiretroviral therapy to prevent the sexual transmission of HIV; (iii) data on the detectable (transmissible) prevalence of HIV in specific populations; (iv) risk of HIV transmission following different types of sexual and occupational exposure; (v) baseline risk assessment; (vi) drug regimens and dosing schedules; (vii) monitoring PEP; (viii) baseline and follow-up blood-borne virus testing; (ix) the role of PEP within broader HIV prevention strategies, for example, HIV pre-exposure prophylaxis (PrEP). The guideline also covers special scenarios such as PEP in pregnancy, breastfeeding and chronic hepatitis B virus infection, and when PEP should be considered in people using HIV PrEP. The guidelines are aimed at clinical professionals directly involved in PEP provision and other stakeholders in the field. A proforma to assist PEP consultations is included. A public consultation process was undertaken prior to finalizing the recommendations.

Quotation errors related to the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study.

AIM: The aim of this study was to assess the accuracy of quotations of the Proximal Fracture of the Humerus Evaluation by Randomization (ProFHER) study in the published literature. METHODS: A literature search was performed from March 2015 to November 2019 to identify all papers that reference ProFHER since its publication. Full text articles were reviewed by two independent reviewers using a validated framework of assessing quotation errors. A kappa co-efficient was calculated to assess interobserver reliability of the reviewers. RESULTS: There were 260 individual ProFHER quoted references within the 138 included articles. We identified 35/260 quotation errors (13%). Of these, 10/35 (29%) were major quotation errors and 25/35 (71%) minor quotation errors. There was substantial interobserver agreement when errors were classified. Of the 10 major errors, six quotations were not substantiated by the results of ProFHER and three were unrelated to ProFHER. One paper contained a quotation error that contradicted the results of ProFHER. Of the 25 minor errors, 19 oversimplified or generalised the conclusions of ProFHER and six contained numerical or grammatical errors. CONCLUSION: The current study demonstrated substantial inaccuracies in quotations of the Proximal Fracture of the Humerus Evaluation by Randomization study. Vigilance is recommended when quoting the literature and reviewing submitted papers in order to prevent the perpetuation of misquoted data.

Quotation errors related to the Distal Radius Acute Fracture Fixation Trial paper.

Quotation error is an inaccuracy in the assertions made by authors when referencing another's work. This study aimed to assess the quotation errors in articles referencing the Distal Radius Acute Fracture Fixation Trial (DRAFFT). A literature search was performed to identify all citations of DRAFFT from 2014 to 2020. The relevant publications were assessed by two reviewers using a validated framework of error classification. There were 83 articles containing references to DRAFFT. There was substantial agreement between the two reviewers (Kappa coefficient 0.66). We found 22/83 (28%) of articles contained an error, with one article containing two errors. There were 12 major errors, which were not substantiated by, were unrelated to or contradicted the findings of DRAFFT, and 11 minor errors, including numerical inaccuracies, oversimplification or generalization. This study highlights that a significant number of articles inaccurately quote DRAFFT. Authors and journals should consider checking the accuracy of key referenced statements.

Point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review protocol.

OBJECTIVE: This review will explore how point-of-care tests for sexually transmitted infections have been implemented into health care systems in low- and middle-income countries, and the facilitators and barriers to implementation. INTRODUCTION: Sexually transmitted infections contribute to significant global morbidity. In low- and middle-income countries, syndromic management of sexually transmitted infections is recommended. However, due to the limitations of syndromic management, there is increasing interest in the potential for point-of-care tests to be incorporated into models of care for sexually transmitted infections in low-resource settings. It is therefore important to explore how point-of-care tests for sexually transmitted infections have been used in these settings previously, and the facilitators and barriers to implementation on a wider scale. INCLUSION CRITERIA: This scoping review will consider studies that explore the use of point-of-care-testing for chlamydia, gonorrhea, trichomoniasis, or syphilis, and how they are implemented into models of care in low- and middle-income countries. Study participants may be those receiving sexually transmitted infection testing or health care professionals providing testing. HIV testing will not be covered. Quantitative, qualitative, and mixed methods study designs, as well as review papers will be considered for inclusion. METHODS: The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews. The authors will search databases including MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, African Index Medicus, and the Cochrane library from 1998 onwards. Results will be screened by two independent reviewers and data extracted using a data extraction tool developed by the reviewers. Data will be presented both narratively and in tabular form.

Complications After Distal Biceps Tendon Repair: A Systematic Review.

BACKGROUND: Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Surgical repair restores flexion and supination strength, resulting in good functional outcome. The complication profile of each surgical approach and fixation technique has not been widely studied in the literature. PURPOSE: To report the rate of complications after repair of complete distal biceps ruptures, to classify them according to surgical approach and fixation technique, and to analyze risk factors and outcomes of the individual complications. STUDY DESIGN: Systematic review. METHODS: Studies published in English on primary repair of the distal biceps between January 1998 and January 2019 were identified. Data on complications were extracted and classified as major and minor for analysis. A quantitative synthesis of data was done to compare the complication rates between (1) limited anterior incision, extensile anterior incision, and double incision and (2) 4 fixation methods. RESULTS: Seventy-two articles including 3091 primary distal biceps repairs were identified. The overall complication rate was 25% (n = 774). The major complication rate was 4.6% (n = 144) and included a 1.6% (n = 51) rate of posterior interosseous nerve injury; 0.3% (n = 10), median nerve injury; 1.4% (n = 43), rerupture; and a 0.1% (n = 4), synostosis. Brachial artery injury, ulnar nerve injury, compartment syndrome, proximal radius fracture, and chronic regional pain syndrome occurred at a rate of <0.1% each. The majority of nerve injuries resolved with an expectant approach. The minor complication rate was 20.4% (n = 630). The most common complication was lateral cutaneous nerve injury (9.2%, n = 283). An extensile single incision was associated with a higher rate of superficial radial nerve injury when compared to limited single incision(6% vs 2.1%, P = .002). Limited anterior single incision technique had a higher rate of lateral antebrachial cutaneous nerve injury compared to extensile single incision. (9.7% vs 5.2%, P = .03). Synostosis occurred only with double incision. Fixation technique had no significant effect on rerupture rate and posterior interosseous nerve injury rate. CONCLUSION: This is the largest analysis of complications after distal biceps repair, indicating a major complication rate of 4.6%. This study provides valuable data with regard to the choice of technique, surgical approach, and rate of complications, which is essential for surgical planning and patient consent. REGISTRATION: CRD42017074066 (PROSPERO).

An open invitation to join HILJ [Journal] Club.

Journal clubs are an effective means to increase skills in handling evidence and support the continuing professional development of library and knowledge services workers. This editorial examines the progression of HILJ Club, an online journal club, from an idea to the launch of a dedicated platform. One article is selected per issue of the Health Information and Libraries Journal with an open discussion invited following a brief summary and reflections by a host. Participation in HILJ Club is growing. Future success is reliant on wider engagement, and an invitation is extended to join in the discussions or even host an edition.

Incidence of Medication-Related Harm in Older Adults After Hospital Discharge: A Systematic Review.

OBJECTIVES: To determine the incidence, severity, and preventability of and risk factors for medication-related harm (MRH) in community-dwelling older adults after hospital discharge. DESIGN: Systematic review. SETTING: A search of Medline, EMBASE, CINAHL, and the Cochrane Library was undertaken without time restrictions. PARTICIPANTS: Older adults (average age ≥65) participating in observational studies investigating postdischarge adverse drug reactions (ADRs) or adverse drug events (ADEs) within a defined follow-up period. MEASUREMENTS: One author screened abstracts of all articles to exclude obviously irrelevant articles. Two authors independently screened the remaining articles for inclusion. Two authors independently extracted data, including study characteristics, MRH incidence, and risk factors; a third reviewer critically appraised and verified the data. Disagreements were resolved through discussion. RESULTS: From 584 potentially relevant articles, 8 studies met our inclusion criteria: 5 North American and 3 European. Most of the included studies were of moderate quality. There was a wide range in MRH incidence, from 0.4% to 51.2% of participants, and 35% to 59% of MRH was preventable. MRH incidence within 30 days after discharge ranged from 167 to 500 events per 1,000 individuals discharged (17-51% of individuals). There is substantial methodological heterogeneity across multiple domains of the studies, including ADR and ADE definitions, characteristics of recruited populations, follow-up duration after discharge, and data collection. CONCLUSION: MRH is common after hospital discharge in older adults, but methodological inconsistencies between studies and a paucity of data on risk factors limits clear understanding of the epidemiology. There is a need for international consensus on conducting and reporting MRH studies. Data from large, multicenter studies examining a range of biopsychosocial risk factors could provide insight into this important area of safety.

An investigation into the feasibility of designing a framework for the quantitative evaluation of the Clinical Librarian service at an NHS Trust in Brighton, UK.

This feature presents research undertaken by Archana Deshmukh for her MA dissertation at the University of Brighton. She worked closely with Tom Roper, the Clinical Librarian at Brighton and Sussex University Hospitals NHS Trust, in a project to explore the feasibility of applying quantitative measures to evaluate the Clinical Librarian service. The investigation used an innovative participatory approach and the findings showed that although an exclusively quantitative approach to evaluation is not feasible, using a mixed methods approach is a way forward. Agreed outputs and outcomes could be embedded in a marketing plan, and the resulting framework could provide evidence to demonstrate overall impact. Archana graduated in July 2014, gaining a Distinction in the MA in Information Studies, and she is currently looking for work in the health information sector.

METRO taxonomy - progress report on assessment.

The Medical Education Taxonomy Research Organization (METRO) was formed to map and create terms to comprehensively describe the processes, procedures and concepts of medical education. The terms will be used in a variety of purposes, such as describing content for retrieval from e-learning environments, indexing literature in databases, and extracting and exchanging data for research, such as for BEME systematic reviews. METRO has now completed an extensive set of descriptors for assessment, which are freely available at http://metro2.blogspot.com. The organization welcomes the response and participation of all medical education professionals.