Point of care testing for hepatitis C in the priority settings of mental health, prisons and drug & alcohol facilities - the PROMPt Study.

BACKGROUND: A barrier to hepatitis C virus (HCV) cure is conventional testing. The aim of this study was to evaluate the effect of HCV antibody and RNA point-of-care-testing (POCT) on testing rates, linkage to care, treatment and acceptability of testing in three priority settings in Australia. METHODS: Participants were enrolled in an interventional cohort study at a reception prison, inpatient mental health service (MHS), and inpatient alcohol and other drug (AOD) unit-between October 2020 and December 2021. HCV POCT was performed using SD Bioline HCV antibody fingerstick test and a reflexive Xpert® HCV Viral Load Fingerstick test using capillary blood samples. A retrospective audit of HCV testing and treatment data was performed at each site for the preceding 12-month period to generate a historical control. RESULTS: 1,549 participants received a HCV antibody test with 17% (264/1,549) receiving a positive result, of which 21% (55/264) tested HCV RNA positive. Across all settings the rate of testing per year significantly increased between the historical controls and the study intervention period by three-fold (RR:2.57 95% CI: 2.32, 2.85) for HCV antibody testing and four-fold (RR:1.62; 95% CI:1.31, 2.01) for RNA testing. Treatment uptake was higher during the POCT intervention (86%, 47/55; P=0.010) compared to the historical controls (61%, 27/44). CONCLUSIONS: This study demonstrated across three settings that the use of HCV antibody and RNA POCT increased testing rates, treatment uptake linkage to care. The testing model was highly acceptable for most participants. CLINICAL TRIAL REGISTRATION: ACTRN-12621001578897.

Evaluation of the impact of assistive artificial intelligence on ultrasound scanning for regional anaesthesia.

BACKGROUND: Ultrasound-guided regional anaesthesia relies on the visualisation of key landmark, target, and safety structures on ultrasound. However, this can be challenging, particularly for inexperienced practitioners. Artificial intelligence (AI) is increasingly being applied to medical image interpretation, including ultrasound. In this exploratory study, we evaluated ultrasound scanning performance by non-experts in ultrasound-guided regional anaesthesia, with and without the use of an assistive AI device. METHODS: Twenty-one anaesthetists, all non-experts in ultrasound-guided regional anaesthesia, underwent a standardised teaching session in ultrasound scanning for six peripheral nerve blocks. All then performed a scan for each block; half of the scans were performed with AI assistance and half without. Experts assessed acquisition of the correct block view and correct identification of sono-anatomical structures on each view. Participants reported scan confidence, experts provided a global rating score of scan performance, and scans were timed. RESULTS: Experts assessed 126 ultrasound scans. Participants acquired the correct block view in 56/62 (90.3%) scans with the device compared with 47/62 (75.1%) without (P=0.031, two data points lost). Correct identification of sono-anatomical structures on the view was 188/212 (88.8%) with the device compared with 161/208 (77.4%) without (P=0.002). There was no significant overall difference in participant confidence, expert global performance score, or scan time. CONCLUSIONS: Use of an assistive AI device was associated with improved ultrasound image acquisition and interpretation. Such technology holds potential to augment performance of ultrasound scanning for regional anaesthesia by non-experts, potentially expanding patient access to these techniques. CLINICAL TRIAL REGISTRATION: NCT05156099.

Improving rib fracture management in Morriston hospital: using QI to develop an erector spinae plane catheter service.

INTRODUCTION: Trauma audit research network (TARN) data for 2018 indicated that we admitted 100 patients with chest wall injuries in our District General Hospital (DGH). Our own retrospective audit of pain team referrals confirmed long length of stay (median 14 days), with 59% requiring level 2/3 care and 11% mortality risk. We noticed that Regional anaesthesia was offered to less than 25% of patients despite 63% reporting severe pain and decided to introduce an erector spinae plane (ESP) catheter service for rib fractures. Our aims were to reduce length of stay and pain scores. METHODS: We set up an email alert system, where TARN data collectors notified us when patients were admitted through the emergency department with rib fractures. Using a secure social media app (Whatsapp), we organised a group of regional anaesthetists who were willing to provide an ESP service. Process mapping and driver diagrams helped to streamline the service. RESULTS: Mean length of hospital stay was reduced from 10 to 7 days after introduction of the service with significant reduction in variability. Mean pain scores improved from 8.9/10 to 5/10 with an average improvement of pain score of 2.78 points on a numerical scale out of 10. (n=9) CONCLUSIONS: This service improvement relied on a team of hospital clinicians who agreed to provide an extra pain service for patients with rib fracture. The reduction in LOS may be explained by improved respiratory physiology with ESP catheter placement. The ability to deep breathe, cough and engage in physiotherapy treatment are important factors in recovering from rib fractures. The small reduction in pain scores may be explained by the presence of other injuries. Ongoing improvements in training should improve reliability of catheter placement and reduce practitioner variation.

Stereospecific anti SE2' fluorination of allenylsilanes: synthesis of enantioenriched propargylic fluorides.

The electrophilic fluorodesilylation of enantioenriched allenylsilanes proceeds with efficient transfer of chirality. The silylation-fluorination of propargylic alcohols occurs with overall retention of stereochemistry, a result consistent with a stereospecific anti S(E)2' mechanism for the fluorination step.

Cambridge Health's outreach earns alliance an AHA NOVA Award.

Cambridge Health Alliance, (CHA), Somerville, Mass., has been named for one of the five NOVA Awards given this year by the American Hospital Association. It is recognized for leading a program to improve community health by extending help to low-income and uninsured children and adults, as well as to the chronically ill and racial and ethnic minorities.

Vermont hospital's web site focuses on valuable healthcare information.

Brattleboro Memorial Hospital's web site celebrates a century of caring in the region of Brattleboro, Vt. The web site, bmhvt.org, is loaded with information, including a local links page that enables site visitors to hook up with the Brattleboro Chamber of Commerce, the Area Health Education Council, Lifeline Personal Response Service, and more.

Medical City introduces new magazine for Dallas community.

Medical City, Dallas, launches a quarterly magazine titled, IN: Mind Body Life, as the final phase in its two-year branding campaign. In search of a unique style, the hospital worked with American Airlines' publishing house, AAP Custom.

Thought about annual reports.

Editor Tom Rees shares the observations of other experts on the subject of creating your annual report.

Web site offers evidence hospital is county's most preferred hospital.

We review the recently-renovated web site for Bridgeport Hospital, Bridgeport, Conn., or "Fairfield County's Most Preferred Hospital." The site, www.bridgeporthospital.com, offers a wide-ranging selection of links to afford its readers plentiful information about its various specialties, special events, and available physicians.

Hospitals target-marketing wound centers to build profit statements.

Wound care centers add to the hospital's' profits as well as serving as a marketing vehicle for other services. Learn how the program is promoted by Shawnee Mission Medical Center, Shawnee Mission, Kan., Stamford Hospital, Stamford, Conn., and Good Samaritan Hospital, Suffern, N.Y.

Detroit's Henry Ford Health System awarded Foster G. McGaw Prize.

Henry Ford Health System, Detroit, is named winner of the prestigious Foster G. McGaw Prize for excellence in community service. The organization received 100,000 dollars from the sponsors, the American Hospital Association, The Baxter International Foundation and the Cardinal Health Foundation.

Publicist's advice: hire a PR firm before you need one.

Tom Rees, self-confessed former PR representative for the University of Colorado Health Sciences Center, addresses the value healthcare organizations can find in public relations consultation.

Press kit leads to wide, consistent coverage of Parma Hospital honor.

At Parma Community General Hospital, Parma, Ohio, a press kit was created to recognize the hospital's designation as Ohio's number one hospital for joint replacement surgery. If you're proud of your press kit, we hope you'll consider sending it to us for this new feature.

Media Monday tip sheet builds Spartanburg's media relations.

Media Monday is published weekly and sent to area newsrooms by the Spartanburg Regional Healthcare System, Spartanburg, S.C. The news and feature tip sheet was started in 1998 in order to disperse a lot of information with a limited number of staff.

Press kit kicks off new branding.

A smartly produced press kit resulted in unprecedented news coverage when Denver's Porter Adventist Hospital recently unveiled plans for an extensive 80 million dollars redevelopment. A news conference was held to announce this plan, along with the opening of the hospital's new emergency department. The overall effort is part of the new branding strategy of the 75-year-old hospital.

Virginia Hospital Center web site filled with relevant information.

The web site of Virginia Hospital Center, Arlington, Va., provides a preview of the facility's 150 million dollars hospital grand opening along with a wide range of healthcare conditions and services.

Medical group forges information link with television station web site.

Methodist Medical Group, Peoria, Ill, has entered into an interesting partnership with the local WEEK-TV to provide timely informative health related information. Through the WEEK web site, members of the public have access to a variety of locally produced health related articles by clicking on the MedWatch tab at www.week.com. Viewers can request specific topics of interest by e-mail.