This article is protected by copyright. All rights reserved.Issues addressed The new National Cervical Screening Program (NCSP) has recently been implemented. Little research is available on women's attitudes towards the program. This study aims to quantitatively assess Australian women's understanding and attitudes towards the new guidelines and their barriers to screening. Method Authors designed a cross-sectional survey which was piloted and distributed as a waiting room survey to eligible women who attended a private general practice in North Queensland. Results Of the respondents, 53.8% had accurate knowledge of the new NCSP. Most participants (75.8%) believed they were not provided sufficient information about the NCSP and 60.2% wished to receive this information from their general practitioner. The screening test itself remains an issue, with embarrassment and discomfort listed as the most common barriers to screening. Conclusion Many women do not have accurate knowledge of the new NCSP. Further health promotion in this area is warranted, where the general practitioner may play a key role. SO WHAT? While the new NCSP will lead to further reduction in cervical cancer mortality, it appears from the data that women did not fully understand cervical cancer and its screening. This suggests the need for further health education to women about updated screening guidelines.In the last few months, an unprecedented number of laboratory tests for coronavirus disease 2019 (COVID-19) have been developed at a remarkable speed. With the rapid adoption of these tests into clinical practice, combined with the widespread publicity they received, questions arose related to the different types of tests, their utility, performance, and regulatory approval status. The aim of this publication is to provide a general landscape of laboratory testing for COVID-19 and offer a historical and regulatory perspective associated with them. Specifically, we aim to elaborate on the regulatory complexities of diagnostic testing in the United States and its implications to the present outbreak, as well as provide a synopsis of laboratory tests that have been developed for COVID-19. We will first address the detection of severe acute respiratory syndrome-coronavirus 2 directly by either nucleic acid amplification tests or by the detection of the viral protein for active infections. Subsequently, we will provide an overview of serological tests that can aid not only in diagnosis but additionally help to identify prior infections and potential immunity.For centuries it has been humankind's instinct to cover the mouth and nose when coughing or sneezing. Common sense would dictate this instinctively reduces the dispersion of aerosol and droplets and thus the spread of contact and airborne infections.Background & aims In 2016, Médecins Sans Frontières established the first general population Hepatitis C virus (HCV) screening and treatment site in Cambodia, offering free direct-acting antiviral (DAA) treatment. This study analysed the cost-effectiveness of this intervention. Methods Costs, quality adjusted life years (QALYs) and cost-effectiveness of the intervention were projected with a Markov model over a lifetime horizon, discounted at 3%/year. Patient-level resource-use and outcome data, treatment costs, costs of HCV-related healthcare and EQ-5D-5L health states were collected from an observational cohort study evaluating the effectiveness of DAA treatment under full and simplified models of care compared to no treatment; other model parameters were derived from literature. Incremental cost-effectiveness ratios (cost/QALY gained) were compared to an opportunity cost-based willingness-to-pay threshold for Cambodia ($248/QALY). Results The total cost of testing and treatment per patient for the full model of care was $925(IQR $668-1631), reducing to $376(IQR $344-422) for the simplified model of care. EQ-5D-5L values varied by fibrosis stage decompensated cirrhosis had the lowest value, values increased during and following treatment. The simplified model of care was cost saving compared to no treatment, while the full model of care, although cost-effective compared to no treatment ($187/QALY), cost an additional $14 485/QALY compared to the simplified model, above the willingness-to-pay threshold for Cambodia. This result is robust to variation in parameters. Conclusions The simplified model of care was cost saving compared to no treatment, emphasizing the importance of simplifying pathways of care for improving access to HCV treatment in low-resource settings.Objectives To show safety and efficacy of subcutaneous (sc) methotrexate (MTX) compared to oral MTX, alternative disease-modifying anti-rheumatic drugs (DMARD) monotherapy, and combinations (biologic monotherapy, conventional and biologic combination groups) in routine clinical practice. Methods Clinical and laboratory data were retrospectively analysed for rheumatology clinic attendances at a large North-East England hospital trust between January 2014-January 2018. Adverse and stop event rates (transaminitis [serum alanine aminotransferase >80U/l] or neutropenia [neutrophils less then 2.0x109 /l]) were calculated, adjusted for duration of DMARD exposure. Results 8394 patients received DMARDs 2093 oral MTX; 949 sc MTX. Median (Interquartile range - IQR) oral MTX dose was 15 (10-20) mg, and sc MTX was 20 (15-25) mg (p less then 0.0001). Continuation rates were higher for sc MTX when adjusted for follow-up duration (RR=1.54, 95% CI 1.40-1.70; p less then 0.0001). 2382 patients experienced 4358 adverse events (1711 transaminitis, 2647 neutropenia). Significantly fewer adverse events were observed for sc MTX monotherapy versus biologic and combination DMARD therapies (p less then 0.01). Compared to oral MTX, sc MTX was associated with a non-significant trend to lower rates of neutropenia, but only slightly higher rate of transaminitis (RR=1.26, 95% CI 1.07-1.48; p=0.006) despite significantly higher doses. Conclusions Subcutaneous MTX is safe in routine practice. find more This is the largest study yet reported and provides observational data that sc MTX is continued longer and better tolerated compared to other therapy groups, especially oral MTX.find more
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