ABSTRACT
BACKGROUND: National specialty guidelines for HIV testing aim to increase diagnosis and reduce late presentation. An audit of new HIV diagnoses in Glasgow was performed to assess local performance against these guidelines and estimate the proportion of patients presenting who had previous missed opportunities for diagnosis. METHODS: A retrospective case note review of 339 patients diagnosed from September 2008 to September 2011 was performed. Documented past medical history was assessed for HIV clinical indicator conditions prior to HIV diagnosis and prior review by medical services. RESULTS: Ninety (26%) individuals had at least one documented clinical indicator condition prior to HIV diagnosis, of whom 80 had prior contact with at least one speciality. This group also had a lower mean nadir CD4 count (258 cells/cmm versus 393 cells/cmm, p = <0.005) and were more likely to be severely immunocompromised at diagnosis, with a CD4 count below 50 cells/cmm (31% versus 9%, p = <0.005). AIDS-defining illnesses were also more common (31% versus 8%, p ≤ 0.005) as was HIV-related mortality (p ≤ 0.005). CONCLUSION: Additional support and training are required to increase adherence to HIV-testing guidelines within primary and secondary care in order to prevent ongoing late presentation with both individual clinical and public health implications.
Subject(s)
Delayed Diagnosis , Guideline Adherence , HIV Infections/diagnosis , Mass Screening/organization & administration , Public Health , Adult , CD4 Lymphocyte Count , Female , HIV Infections/epidemiology , Health Policy , Humans , Male , Medical Audit , Practice Guidelines as Topic , Retrospective Studies , Scotland/epidemiologyABSTRACT
OBJECTIVE: To compare placement of IO lines using a traditional method with placement using a new device called the bone injection gun (BIG). METHODS: A prospective cross-over study was conducted to compare the time to line placement and ease of insertion for both traditional (Jamshidi) and BIG methods. EMT-P students and practicing paramedics provided information about their previous experience with IO line placement. They were assigned to establish an IO line in a pediatric leg mannequin using each technique, and rated the ease-of-use of each method. RESULTS: Thirty-eight participants (28 EMT-P students and 10 paramedics) completed both of the IO skills. Only two (5%) had ever placed an IO line in a patient previously. Time to placement of the IO device was faster in the BIG group (16.91 sec. vs. 11.93 sec., p = 0.02). There was no statistical difference in ease-of-use ratings between the methods (p = 0.816). Student times for establishing the IO line with the BIG device were faster than the times of the practicing paramedics (11. 18 sec. vs. 16.25 sec., p = 0.049). CONCLUSIONS: In the education setting, times to establishment of an IO line were similar using both the traditional method of insertion and the BIG device. Ratings of both the students and paramedics were similar with respect to each-of-use for both the methods.
