Defining Key Performance Indicators for the California COVID-19 Exposure Notification System (CA Notify).

OBJECTIVES: Toward common methods for system monitoring and evaluation, we proposed a key performance indicator framework and discussed lessons learned while implementing a statewide exposure notification (EN) system in California during the COVID-19 epidemic. MATERIALS AND METHODS: California deployed the Google Apple Exposure Notification framework, branded CA Notify, on December 10, 2020, to supplement traditional COVID-19 contact tracing programs. For system evaluation, we defined 6 key performance indicators: adoption, retention, sharing of unique codes, identification of potential contacts, behavior change, and impact. We aggregated and analyzed data from December 10, 2020, to July 1, 2021, in compliance with the CA Notify privacy policy. RESULTS: We estimated CA Notify adoption at nearly 11 million smartphone activations during the study period. Among 1 654 201 CA Notify users who received a positive test result for SARS-CoV-2, 446 634 (27%) shared their unique code, leading to ENs for other CA Notify users who were in close proximity to the SARS-CoV-2-positive individual. We identified at least 122 970 CA Notify users as contacts through this process. Contact identification occurred a median of 4 days after symptom onset or specimen collection date of the user who received a positive test result for SARS-CoV-2. PRACTICE IMPLICATIONS: Smartphone-based EN systems are promising new tools to supplement traditional contact tracing and public health interventions, particularly when efficient scaling is not feasible for other approaches. Methods to collect and interpret appropriate measures of system performance must be refined while maintaining trust and privacy.

Gaps in Chlamydia Treatment Within California Family Planning Clinics: Are Patients Filling Prescriptions?

BACKGROUND: Compared with receiving medication dispensed in a health center, patients receiving prescriptions must take additional steps for treatment. Few clinics have protocols for ensuring prescriptions are filled. This study evaluated prescription fill rates for chlamydia treatment based on claims data in California Title X clinics and examined fill rates by patient demographics and clinic type. METHODS: We collected treatment information during Title X site audits for a convenience sample of patients with a positive chlamydia test between January 2008 and March 2013. We categorized patients as receiving treatment on-site versus via prescription and matched prescriptions to pharmacy billing claims within 90 days of test date. We examined treatment rates by patient age, gender, and race/ethnicity, and by clinic type, and assessed the median time to treatment. RESULTS: Among 790 patients diagnosed with chlamydia across 79 clinics, 65% (n = 513) were treated on-site and 33% (n = 260) via prescription; 17 (2%) did not have treatment information. Sixty-seven percent of prescriptions had confirmed receipt of treatment. Prescription fill rates were lower for patients age 18 years and younger (47% vs. 71%, P < 0.01) and for patients attending federally qualified health centers compared with stand-alone family planning clinics (63% vs. 88%, P < 0.01). Median time to treatment was similar for patients treated on-site (5 days) or via prescription (4 days). CONCLUSIONS: Delays in chlamydia treatment increase risk of complications and ongoing transmission. Providing medications on-site can improve treatment rates, especially among younger patients. These insights can inform clinic treatment protocols and efforts to improve quality of chlamydia care.

Revision total hip arthroplasty for ceramic head fracture: a long-term follow-up.

The results of revision total hip arthroplasty (THA) for ceramic head fracture have generally been disappointing, largely due to third body wear after incomplete synovectomy. We have followed 8 patients who sustained ceramic head fractures and were subsequently revised to a metal-on-polyethylene articulation. There were no revisions for osteolysis or aseptic loosening at a mean follow-up of 10.5 years. The yearly wear rates of each of 5 of these THAs after revision were compared with 6 matched metal-on-polyethylene THAs; there were no significant differences in wear rates. Greater than 10-year survivorship with a metal-on-polyethylene bearing couple is possible after revision THA for a ceramic head fracture if a complete and thorough synovectomy can be performed. Our technique of synovectomy will be described.

Controlling pain after total hip and knee arthroplasty using a multimodal protocol with local periarticular injections: a prospective randomized study.

In this prospective randomized study, patients undergoing total hip (THA) or knee arthroplasty (TKA) were randomized to either a study group receiving periarticular injections or a control group receiving patient-controlled analgesia with or without femoral nerve block (TKA patients). All patients received a comprehensive multimodal perioperative protocol. Pain, recovery of functional milestones, and overall satisfaction were assessed. The THA study group demonstrated significantly lower average pain scores and higher overall satisfaction than the control group. There was no significant difference in pain scores between the study and control groups in the TKA cohort. Both study groups demonstrated lower narcotic usage and side effects as well as improved early functional recovery. Periarticular injection with a multimodal protocol was shown to safely provide excellent pain control and functional recovery and can be substituted for conventional pain control modalities.

Detection of Chlamydia trachomatis by nucleic acid amplification testing: our evaluation suggests that CDC-recommended approaches for confirmatory testing are ill-advised.

We evaluated three CDC-suggested approaches for confirming positive nucleic acid amplification tests (NAATs) for Chlamydia trachomatis: (i) repeat the original test on the original specimen, (ii) retest the original specimen with a different test, and (iii) perform a different test on a duplicate specimen. For approach 1, specimens (genital swabs or first-catch urine [FCU]) initially positive by the Abbott LCx Probe System Chlamydia trachomatis Assay (LCx; Abbott Laboratories), the APTIMA Combo 2 Assay (AC2; Gen-Probe Inc.), the Amplicor CT/NG Assay (PCR; Roche Diagnostics Corp.), or the BD ProbeTec ET System C. trachomatis amplified-DNA assay (SDA; Becton Dickinson Diagnostic Systems) were retested by the same NAAT. In several evaluations, multiple efforts were made to confirm the original positive result. For approach 2, specimens initially positive by SDA and the Hybrid Capture 2 CT-ID DNA Test (HC2; Digene Corp.) were retested by different NAATs (SDA, PCR, AC2, and the APTIMA assay for C. trachomatis [ACT]). For approach 3, duplicate male urethral or cervical swabs were tested by SDA or by both AC2 and ACT. FCU specimens were tested by all three tests. We found that 84 to 98% of SDA, LCx, PCR, and AC2 positive results were confirmed by a repeat test and that 89 to 99% of SDA and AC2 and 93% of HC2 positive results were confirmed by different NAATs, but that some NAATs cannot be used to confirm other NAATs. The use of repeat testing did not confirm 11% of C. trachomatis SDA positive results that could be confirmed by more extensive testing. Doing more testing confirms more positive results; >90% of all positive NAATs could be confirmed.