A cross-sectional survey assessing clinicians' perspectives towards redesigning the surveillance model for head and neck cancer: can we do better?

BACKGROUND: Service delivery of post-treatment surveillance in head and neck cancer (HNC) varies across institutions in Australia. To better understand current practices and develop protocols that maximize service capacity or incorporate emerging technologies, especially in under-resourced regional and remote communities, it is important to obtain the perspectives of clinicians that regularly manage patients with HNC. DESIGN: This cross-sectional study utilized an online survey distributed via email to specialists recruited from HNC-associated networks across Australia. The survey captured information on current practices and explored clinician perspectives towards re-designing the current surveillance model to incorporate telehealth or patient-reported outcome measures (PROMs). Quantitative data was analyzed using descriptive statistics while open-ended survey comments were analyzed using a content analysis approach. RESULTS: Forty participants completed the survey (25 surgeons, 9 medical oncologists, 5 radiation oncologists and 1 oral medicine specialist). Most clinicians used either institution-specific guidelines (44%) or National Comprehensive Cancer Network guidelines (39%), with the remaining 17% using surveillance intervals based on patient symptoms. Following treatment, 53% of participants imaged patients only when there was clinical suspicion of recurrence or new symptoms. Planned surveillance imaging was conducted at 6 or 12-monthly intervals based on the HNC subtype. Fifty-seven percent of clinicians were open to redesigning the surveillance model, specifically in low-risk patients who did not require nasoendoscopic examination. Seventy-one percent had concerns regarding the feasibility of telehealth appointments, citing disparities in digital health equity. Additionally, 61% felt PROMs are currently underutilized and were open to incorporating HNC-specific PROMS into surveillance. Open-ended responses indicated that within the current surveillance model, "fragmented service provision" and "administration issues" were significantly impacting on timing of care. CONCLUSION: Surveyed HNC clinicians feel that current post-treatment surveillance can be fragmented and potentially lead to delayed care. They are open to incorporating PROMS to assist in surveillance scheduling, especially in low-risk patients.

Temporal changes in the positivity rate of common enteric viruses among paediatric admissions in coastal Kenya, during the COVID-19 pandemic, 2019-2022.

BACKGROUND: The non-pharmaceutical interventions (NPIs) implemented to curb the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) early in the coronavirus disease 2019 (COVID-19) pandemic, substantially disrupted the activity of other respiratory viruses. However, there is limited data from low-and-middle income countries (LMICs) to determine whether these NPIs also impacted the transmission of common enteric viruses. Here, we investigated the changes in the positivity rate of five enteric viruses among hospitalised children who presented with diarrhoea to a referral hospital in coastal Kenya, during COVID-19 pandemic period. METHODS: A total of 870 stool samples from children under 13 years of age admitted to Kilifi County Hospital between January 2019, and December 2022 were screened for rotavirus group A (RVA), norovirus genogroup II (GII), astrovirus, sapovirus, and adenovirus type F40/41 using real-time reverse-transcription polymerase chain reaction. The proportions positive across the four years were compared using the chi-squared test statistic. RESULTS: One or more of the five virus targets were detected in 282 (32.4%) cases. A reduction in the positivity rate of RVA cases was observed from 2019 (12.1%, 95% confidence interval (CI) 8.7-16.2%) to 2020 (1.7%, 95% CI 0.2-6.0%; p < 0.001). However, in the 2022, RVA positivity rate rebounded to 23.5% (95% CI 18.2%-29.4%). For norovirus GII, the positivity rate fluctuated over the four years with its highest positivity rate observed in 2020 (16.2%; 95% C.I, 10.0-24.1%). No astrovirus cases were detected in 2020 and 2021, but the positivity rate in 2022 was similar to that in 2019 (3.1% (95% CI 1.5%-5.7%) vs. 3.3% (95% CI 1.4-6.5%)). A higher case fatality rate was observed in 2021 (9.0%) compared to the 2019 (3.2%), 2020 (6.8%) and 2022 (2.1%) (p < 0.001). CONCLUSION: Our study finds that in 2020 the transmission of common enteric viruses, especially RVA and astrovirus, in Kilifi Kenya may have been disrupted due to the COVID-19 NPIs. After 2020, local enteric virus transmission patterns appeared to return to pre-pandemic levels coinciding with the removal of most of the government COVID-19 NPIs.

Managing Chronic otitis media with Effusion in Children with non-Syndromic Cleft Palate: Short-Term Ventilation Tubes Versus Surveillance.

OBJECTIVE: To compare the effectiveness of short-term ventilation tubes compared to surveillance on conductive hearing loss in children with non-syndromic orofacial clefting involving the muscular palate. INTRODUCTION: Chronic otitis media with effusion is a common finding in children with cleft palate. The accepted convention is insertion of short-term ventilation tubes at the time of palate repair, but some centres are choosing conservative management. Each approach has its advantages but there is currently no consensus on the most appropriate management in children with non-syndromic cleft palate. INCLUSION CRITERIA: Children <18 years with cleft lip and palate, or isolated cleft palate, not associated with a genetic syndrome, who have been diagnosed with chronic otitis media with effusion. METHODS: A systematic search of MEDLINE, CINAHL, Embase and Scopus databases was conducted. Grey literature searches were conducted through Central Register of Controlled Trials, Clinicaltrials.gov and ProQuest. Two reviewers screened the studies, conducted critical appraisal, assessed the methodological quality, and extracted the data. Where possible, studies were pooled in statistical meta-analysis with heterogeneity being assessed using the standard Chi-squared and I2 tests. RESULTS: Four studies met the inclusion criteria but were of low quality with a moderate risk of bias. Only data on hearing thresholds could be pooled for analysis which found no statistically significant difference. Other outcomes were presented in narrative form. Certainty of evidence for all outcomes was deemed low to very low using GRADE criteria. CONCLUSIONS: No definitive conclusions can be drawn regarding most effective management at improving conductive hearing loss. Missing data and inconsistent reporting of outcomes limited capacity for pooled analysis.

Co-creation and priority setting for applied and implementation research in One Health: Improving capacities in public and animal health systems in Kenya.

Background: The Kenyan government has successfully been implementing sector specific and multisectoral projects aligned to the Global Health Security Agenda (GHSA). For operational readiness and to enhance the effective planning and implementation of Global Health Security Programs (GHSP) at national and subnational level, there is an urgent need for stakeholders' engagement process to seek input in identifying challenges, prioritise activities for field implementation, and identify applied research and development questions, that should be addressed in the next five years. Methods: The modified Child Health and Nutrition Research Initiative (CHNRI) method was used to identify global health security related priorities for multisectoral implementation in Kenya. Subject matter experts from human, animal and environmental health sectors at national and subnational level contributed to predefined research questions from a number of sources and activities for consideration for implementation using a One Health approach. Sixty-two experts scored the 193 questions based on five pre-defined criteria: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Data resulting from this process was then analysed in a Microsoft Excel spreadsheet to determine the research priorities and experts' agreements. Results: Among the priority activities identified for implementation research were; strengthening One Health governance and legal frameworks; integration of ecosystem health into One Health programming; strengthening disease reporting, integrated data collection, information sharing and joint outbreak response; socio-anthropological and gender-based approaches in improving risk and behavioural change communication and community engagement; and one health workforce development. In addition, the potentials to invest in collaborative predictive risk modelling to enhance epidemic intelligence systems, while strengthening the One Health approach in the food safety incident and emergency response plans are feasible. Interpretation: Successful multisectoral implementation of global health security program in Kenya calls for a whole of society approach that will harness community and private sector knowledge to build preparedness and response capacities while targeting neglected and marginalised populations. This research provides a framework that is worth emulating for cost-effective planning and implementation of overarching One Health programs.

A retrospective review of spontaneous epistaxis outcomes for patients on novel oral anticoagulants compared to antiplatelets and warfarin.

AIMS: The incidence of epistaxis-related admissions amongst elderly patients is rising due to the increasing use of anticoagulants and antiplatelet agents. This retrospective study evaluates the differences in outcomes for patients on warfarin, novel anticoagulants (NOACs) and antiplatelets over two different time periods. METHODOLOGY: Retrospective case-control study with data from patients admitted with epistaxis through the Flinders Medical Centre Emergency Department in the first six months of 2013 and compared to the same period in 2018. The latter coincides with integration of NOACs into Australian prescribing practices. Included participants were ≥50 years with spontaneous epistaxis which coincides with peak incidence in adults. Exclusion criteria were epistaxis due to trauma, intrinsic coagulopathy, or recent post-surgery. Linear regression and binary logistic regression models were the statistical methods used. RESULTS: Data from 85 patients were analysed for length of stay (LOS), readmission rates and method of haemostasis. In 2013, 41 patients were included compared to 44 in 2018, suggesting a 7% increase in admissions rates but this was not statistically significant (p = 0.96). The proportion of patients admitted with epistaxis while taking an anticoagulant or antiplatelet agent increased from 66% in 2013 to 93% in 2018. Thirty six percent of patients in 2018 were taking NOACs, however, LOS was 2 times shorter (mean ratio = 2.08 days, 95% CI: 1.03, 4.19). Seven percent of patients in 2018 had bleeding requiring surgery or interventional radiology, compared to 12% in 2013, but this was not statistically significant. There was no statistically significant difference in readmission rates (p = 0.82) or intervention required (p = 0.74) between the two time periods. CONCLUSIONS: Epistaxis admissions at our institution have increased since the introduction of NOACs. However, most patients can be managed successfully with intranasal packing and cautery alone. NOACs are not associated with increased rated of invasive haemostatic measures and patients have a shorter LOS.

Effectiveness of ventilation tube insertion for conductive hearing loss in children with chronic otitis media with effusion and non-syndromic cleft palate: a systematic review protocol.

OBJECTIVE: This review will investigate the efficacy of ventilation tube insertion versus non-surgical options in the management of chronic otitis media with effusion in children with non-syndromic cleft palate by assessing the degree of conductive hearing loss. INTRODUCTION: Chronic otitis media with effusion is common in children with cleft palate due to associated eustachian tube dysfunction. It can lead to impaired hearing and can hinder speech and language development. The main treatment options are drainage of effusion with ventilation tubes, surveillance, or amplification with hearing aids. Each of these approaches has its advantages but there is currently no consensus on the most appropriate management in children with cleft palate. INCLUSION CRITERIA: Eligible studies will include children (<18 years) with cleft palate not associated with a genetic syndrome, diagnosed with chronic otitis media with effusion, who have undergone insertion of ventilation tubes compared with either surveillance or amplification with hearing aids. METHODS: A comprehensive search of MEDLINE, CINAHL, Embase, and Scopus will be conducted to find published literature. Gray literature searches will be conducted through the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, and ProQuest Dissertations and Theses Global. Two reviewers will screen studies, conduct critical appraisal of eligible studies, assess the methodological quality, and extract the data. Where possible, studies will be pooled in statistical meta-analysis, with heterogeneity of data being assessed using the standard χ 2 and I2 tests. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021255861.