Client-Centered Adherence Counseling with Adherence Measurement Feedback to Support Use of the Dapivirine Ring in MTN-025 (The HOPE Study).

Fostering adherence and open communication about adherence challenges is key to harnessing the potential of biomedical HIV prevention products. We describe the counseling intervention and objective adherence measure feedback process implemented to support adherence to the dapivirine vaginal ring among participants in four sub-Saharan countries and present findings on the counselors' likeability and acceptability of the intervention. Most counselors (N = 42; 86%) liked Options counseling "very much" and during in-depth interviews (N = 22), reported that the intervention reshaped their adherence counselling approach by emphasizing understanding participants' experiences using the ring, which facilitated open discussion of adherence challenges. Counselors found that reframing residual drug level (RDL) discussions from the "adherence" to "protection" perspective encouraged adherence among consistent users and facilitated decisions to switch to a different HIV prevention approach among infrequent users. Among counselors, 24% said participants "liked it very much" while 26% said that participants "liked it a little" possibly due to two main complaints: perceived repetitiousness of sessions and variability in the RDL assay, which at times resulted in unexpected low RDLs.

RESUMEN: Fomentar la adherencia y la comunicación abierta sobre los desafíos con la adherencia es clave para aprovechar el potencial de los productos biomédicos de prevención del VIH. Describimos la intervención de consejería y el proceso de compartir los resultados de medidas objetivas de adherencia con participantes en cuatro países subsaharianos para apoyar la adherencia al anillo vaginal de dapivirine y presentamos los resultados sobre la agradabilidad y la aceptabilidad de la intervención a los consejeros. A la mayoría de los consejeros (N=42; 86%) "les gustó mucho" la consejería quienes, durante entrevistas en profundidad (N=22) y reportaron que la intervención cambió su aproximación a la consejería sobre la adherencia. Se enfocaban más en comprender la experiencia de uso del anillo entre las participantes, lo cual facilitaba una conversación abierta sobre posibles desafíos a la adherencia. Los consejeros encontraron que cambiar el enfoque de "adherencia" a "protección" en las conversaciones sobre los niveles residuos de drogas fomentaba la adherencia entre las mujeres que usaban el anillo consistentemente y facilitaba la decisión de cambiar a otro método de prevención del VIH entre las mujeres que lo usaban con poca frecuencia. Entre los consejeros, 24% dijeron que a las participantes "les gustó mucho" la consejería y 26% que a las participantes "les gustó un poco". Es posible que esto se deba a dos quejas principales: la percepción de que las sesiones sean repetitivas y la variabilidad en el ensayo de los niveles residuos de drogas, lo cual a veces resultaba en niveles bajos inesperados.

Factors affecting success rate of Advanced Trauma Life Support (ATLS) courses.

BACKGROUND: The aim of the present study was to define the factors that affect passing the assessments for successful completion of the Advanced Trauma Life Support (ATLS) Provider Courses in the United Arab Emirates (UAE). METHODS: The ATLS Provider Course has been taught in three medical centers in the UAE since 2004. A total of 1,041 doctors completed the course during the period 2004-2010. A special protocol was designed to enter data accrued for each course, participants' demographics, and assessments, including the final results. Direct logistic regression was performed to define factors affecting success in multiple choice questions (MCQ) and in the practical initial assessment station exam. The studied variables included the year, the course site, speciality, level of practice, and pre-test score. RESULTS: The majority of participants were surgeons (33.2 %), followed by Emergency Medicine physicians (27.3 %). The logistic regression model showed that having a low pre-test score (p < 0.0001) and being a family medicine practitioner (p < 0.0001) increased the likelihood of failing the MCQ exam. The chance of passing the end of course practical exam increased with time (p = 0.002). A low pre-test score (p < 0.0001) and being examined in site A (p = 0.04) increased the chance of failing in the initial assessment exam. The pass rate for the ATLS exam significantly increased after adoption of the interactive approach to teaching. CONCLUSIONS: Prior knowledge and preparation is essential to passing the ATLS exam. Doctors who deal clinically with all aspects of airway, breathing, and circulation of the ATLS course are more likely to pass the MCQ exam in our setting, followed by those who usually manage only the circulation or disability aspects of ATLS. It is possible that the interactive approach to teaching ATLS has improved the overall ATLS success rate.

Impact of a satellite laboratory on turnaround times for the emergency department.

BACKGROUND: Prolonged laboratory turnaround time (TAT) contributes to prolonged length of stay in emergency departments (EDs). The TAT of laboratory test results is a common key performance indicator by which clinicians and regulatory bodies evaluate laboratory performance. Establishing satellite laboratories in EDs staffed by laboratory technologists is one approach towards reducing TAT. METHODS: TAT data were collected for three time intervals: (a) sampling time to time samples received in the laboratory (transportation time), (b) sample received in the laboratory until results were available for viewing on the laboratory information system monitor or collection by ED staff (within laboratory TAT), and (c) sampling to availability of results (total TAT, e.g., a+b). The target was to achieve a median within laboratory TAT of 45 min for samples received from the ED. RESULTS: The median transportation times for samples to be delivered to the central and satellite laboratory were 22 min and 1 min, respectively (p<0.0001). The median within laboratory TATs were 45 [95% confidence interval (CI) 43-49] and 34 (95% CI 33-35) min for the central and satellite laboratories, respectively (p<0.001). CONCLUSIONS: A satellite laboratory in the ED can significantly reduce laboratory TAT.