Integrated clinical and quality improvement coaching in Son La Province, Vietnam: a model of building public sector capacity for sustainable HIV care delivery.

BACKGROUND: The global scale-up of antiretroviral therapy included extensive training and onsite support to build the capacity of HIV health care workers. However, traditional efforts aimed at strengthening knowledge and skills often are not successful at improving gaps in the key health systems required for sustaining high quality care. METHODS: We trained and mentored existing staff of the Son La provincial health department and provincial HIV clinic to work as a provincial coaching team (PCT) to provide integrated coaching in clinical HIV skills and quality improvement (QI) to the HIV clinics in the province. Nine core indicators were measured through chart extraction by clinic and provincial staff at baseline and at 6 month intervals thereafter. Coaching from the team to each of the clinics, in both QI and clinical skills, was guided by results of performance measurements, gap analyses, and resulting QI plans. RESULTS: After 18 months, the PCT had successfully spread QI activities, and was independently providing regular coaching to the provincial general hospital clinic and six of the eight district clinics in the province. The frequency and type of coaching was determined by performance measurement results. Clinics completed a mean of five QI projects. Quality of HIV care was improved throughout all clinics with significant increases in seven of the indicators. Overall both the PCT activities and clinic performance were sustained after integration of the model into the Vietnam National QI Program. CONCLUSIONS: We successfully built capacity of a team of public sector health care workers to provide integrated coaching in both clinical skills and QI across a province. The PCT is a feasible and effective model to spread and sustain quality activities and improve HIV care services in a decentralized rural setting.

Red light cameras: do they change driver behavior and reduce accidents?

BACKGROUND: : Installation of red light cameras (RLC) at intersections associated with a high number of traffic accidents are currently in use to reduce the number of traffic collisions. The primary objective of this study was to evaluate the sustained effect of RLC on driver behavior. The secondary objective was to evaluate the number of collisions before and after RLC implementation. METHODS: : For the primary objective, an 8-month prospective observational study after installation of RLC in September 2007 was undertaken at the intersection with the highest incidence of traffic accidents in the State of Louisiana. For the secondary objective, collision occurrences were collected 10 months before and after RLC installation. The mean number of citations was calculated by month, and the statistical significance of trend was obtained from a linear regression model across the study period and by t test to compare before and after citations were issued. The number of traffic collisions was compared using chi. RESULTS: : During the initial 30 days, 2,428 violations per week were recorded, whereas in the subsequent 30 days, there were 534 citations per week issued (p < 0.001). After eight months, the number of citations was reduced to an average of 356 citations per week (p < 0.01). Mean number of citations decreased significantly during implementation of RLC. Three drivers received more than one citation. Although there was a trend in reduction of collisions from 122 to 97 before and after RLC, this did not reach statistical significance; p = 0.18. CONCLUSION: : A significant and sustained reduction in the number of citations occurred as driving behavior was modified. Despite reducing the number of cars entering this intersection during a red light, RLC do not seem to prevent traffic collisions at this monitored intersection. Alternative means of injury prevention must be investigated.

The association between women's health information use and health care visits.

OBJECTIVE: To determine the effect of the type of information sources used on health services use. METHODS: Population-based random-digit dialing survey of 498 women, between December 1999 and January 2000, on use of health information sources and health visits. RESULTS: After adjustment for sociodemographic and medical factors, use of print health media and computer-based resources was associated with 1.9 and 1.6 more visits, respectively compared to non-use (Regression coefficients 1.9; [95% confidence interval {CI} 0.1, 3.7] and 1.6; [95% CI 0.3, 3.0]). CONCLUSIONS: Print health media and computer-based sources are associated with a higher number of health care visits.

ACAM2000 clonal Vero cell culture vaccinia virus (New York City Board of Health strain)--a second-generation smallpox vaccine for biological defense.

The threat of smallpox as a biological weapon has spurred efforts to create stockpiles of vaccine for emergency preparedness. In lieu of preparing vaccine in animal skin (the original method), we cloned vaccinia virus (New York City Board of Health strain, Dryvax by plaque purification and amplified the clone in cell culture. The overarching goal was to produce a modern vaccine that was equivalent to the currently licensed Dryvax in its preclinical and clinical properties, and could thus reliably protect humans against smallpox. A variety of clones were evaluated, and many were unacceptably virulent in animal models. One clonal virus (ACAM1000) was selected and produced at clinical grade in MRC-5 human diploid cells. ACAM1000 was comparable to Dryvax in immunogenicity and protective activity but was less neurovirulent for mice and nonhuman primates. To meet requirements for large quantities of vaccine after the events of September 11th 2001, the ACAM1000 master virus seed was used to prepare vaccine (designated ACAM2000) at large scale in Vero cells under serum-free conditions. The genomes of ACAM1000 and ACAM2000 had identical nucleotide sequences, and the vaccines had comparable biological phenotypes. ACAM1000 and ACAM2000 were evaluated in three Phase 1 clinical trials. The vaccines produced major cutaneous reactions and evoked neutralizing antibody and cell-mediated immune responses in the vast majority of subjects and had a reactogenicity profile similar to that of Dryvax.