ABSTRACT
OBJECTIVES: HIV outcomes centre primarily around clinical markers with limited focus on patient-reported outcomes. With a global trend towards capturing the outcomes that matter most to patients, there is agreement that standardizing the definition of value in HIV care is key to their incorporation. This study aims to address the lack of routine, standardized data in HIV care. METHODS: An international working group (WG) of 37 experts and patients, and a steering group (SG) of 18 experts were convened from 14 countries. The project team (PT) identified outcomes by conducting a literature review, screening 1979 articles and reviewing the full texts of 547 of these articles. Semi-structured interviews and advisory groups were performed with the WG, SG and people living with HIV to add to the list of potentially relevant outcomes. The WG voted via a modified Delphi process - informed by six Zoom calls - to establish a core set of outcomes for use in clinical practice. RESULTS: From 156 identified outcomes, consensus was reached to include three patient-reported outcomes, four clinician-reported measures and one administratively reported outcome; standardized measures were included. The WG also reached agreement to measure 22 risk-adjustment variables. This outcome set can be applied to any person living with HIV aged > 18 years. CONCLUSIONS: Adoption of the HIV360 outcome set will enable healthcare providers to record, compare and integrate standardized metrics across treatment sites to drive quality improvement in HIV care.
Subject(s)
HIV Infections , Adult , Consensus , HIV Infections/therapy , Health Personnel , Humans , Outcome Assessment, Health Care , Patient Reported Outcome Measures , Treatment OutcomeABSTRACT
The effects of randomness, an unavoidable feature of intracellular environments, are observed at higher hierarchical levels of living matter organization, such as cells, tissues, and organisms. Additionally, the many compounds interacting as a well-orchestrated network of reactions increase the difficulties of assessing these systems using only experiments. This limitation indicates that elucidation of the dynamics of biological systems is a complex task that will benefit from the establishment of principles to help describe, categorize, and predict the behavior of these systems. The theoretical machinery already available, or ones to be discovered to help solve biological problems, might play an important role in these processes. Here, we demonstrate the application of theoretical tools by discussing some biological problems that we have approached mathematically: fluctuations in gene expression and cell proliferation in the context of loss of contact inhibition. We discuss the methods that have been employed to provide the reader with a biologically motivated phenomenological perspective of the use of theoretical methods. Finally, we end this review with a discussion of new research perspectives motivated by our results.
Subject(s)
Gene Expression Regulation, Neoplastic , Models, Biological , Neoplasms , Stochastic Processes , Humans , Neoplasms/genetics , Neoplasms/metabolism , Neoplasms/pathologyABSTRACT
The effects of randomness, an unavoidable feature of intracellular environments, are observed at higher hierarchical levels of living matter organization, such as cells, tissues, and organisms. Additionally, the many compounds interacting as a well-orchestrated network of reactions increase the difficulties of assessing these systems using only experiments. This limitation indicates that elucidation of the dynamics of biological systems is a complex task that will benefit from the establishment of principles to help describe, categorize, and predict the behavior of these systems. The theoretical machinery already available, or ones to be discovered to help solve biological problems, might play an important role in these processes. Here, we demonstrate the application of theoretical tools by discussing some biological problems that we have approached mathematically: fluctuations in gene expression and cell proliferation in the context of loss of contact inhibition. We discuss the methods that have been employed to provide the reader with a biologically motivated phenomenological perspective of the use of theoretical methods. Finally, we end this review with a discussion of new research perspectives motivated by our results.
Subject(s)
Humans , Gene Expression Regulation, Neoplastic , Stochastic Processes , Models, Biological , Neoplasms/genetics , Neoplasms/metabolism , Neoplasms/pathologyABSTRACT
From the aerial parts of Salvia occidentalis (Labiatae) a new diterpenoid with a rearranged neo-clerodane skeleton was isolated. This new compound was named salvioccidentalin and its structure was established by spectroscopic means. A probable biogenetic relationship with salvigenolide from S. fulgens and salvileucalin A and spiroleucantholide from Salvia leucantha is proposed.
Subject(s)
Diterpenes, Clerodane/chemistry , Diterpenes/chemistry , Salvia/chemistry , Humans , Medicine, Traditional , Molecular Structure , Nuclear Magnetic Resonance, BiomolecularABSTRACT
Relata a experiência de implementaçäo da Programaçäo/Orçamentaçäo Integrada (POI). Para tanto, apresenta aspectos históricos relativos ao modo de programaçäo e orçamentaçäo do Ministério da Previdência e Assistência Social e do Ministério da Saúde, mostrando como se desenvolveram as Açöes Integradas de Saúde, e como surgiram os SUDS (Sistemas Unificados e Descentralizados de Saúde) durante a Nova República.(MAM)
Subject(s)
Health Planning/trends , Public Policy , Public Health/history , Health Policy/history , BrazilABSTRACT
Descreve-se a conceituaçäo dada pelo Ministério da Saúde e pelo Instituto Nacional de Assistência Médica da Previdência Social - INAMPS, do Brasil, sobre Atençäo Primária à Saúde e a partir da qual, a estrutura de funcionamento de atendimento de serviços de saúde em geral, que visam em última instância, torná-los acessíveis à toda populaçäo em suas mais variadas necessidades (AVM)