METHODS: This is an international, multicenter, observational, prospective cohort study of patients admitted with acute ischemic stroke secondary to ICAS to stroke centers in six Asian countries. Stroke due to ICAS was diagnosed when there was a ≥50% intracranial large artery stenosis ipslateral to a non-lacunar infarct, without significant ipsilateral extracranial stenosis, cardiac cause or other mechanism found for the stroke. Data were collected on patient demographics, vascular risk factors, stroke location, and severity. Outcomes of interest were stroke recurrence and mortality at 12-month follow-up.
RESULTS: A total of 356 patients were recruited. Mean age was 62.7 ± 13.8 years, and 39.9% were females. Mean NIHSS on admission was 9 ± 8, with majority of patients having mild (39.3%) or moderate (37.9%) strokes. Stroke recurrence was 6.7% (95% CI: 4.4-9.9%) while mortality rate was 13.2% (95% CI: 9.9-17.2%) within 1 year. The risk of stroke recurrence was associated with increasing age (odds ratio [OR]: 1.04, 95% CI: 1-1.06, p = 0.05) and hypertension (OR: 3.23, 95% CI: 1.09-9.61, p = 0.035). Mortality was associated with age (OR: 1.05, 95% CI: 1.01-1.08, p = 0.006) and NIHSS (OR: 1.12, 95% CI: 1.07-1.17, p < 0.001).
CONCLUSIONS: This multicenter Asian study demonstrates a high risk of stroke recurrence and mortality among patients with acute stroke due to ICAS. They are associated with age (both), as well as hypertension (for recurrence) and NIHSS (for mortality). Better treatment modalities are needed to reduce the frequency of adverse outcomes in symptomatic ICAS.
METHODS: A systematic literature search was conducted using PubMed, Virtual Health Library, Web of Science, Scopus, Science Direct, and Embase. Article screening was independently performed by two reviewers. Studies assessing pharmacy students' knowledge of HIV prophylaxis were included. Data were extracted and organized into two categories: study characteristics (author, year, country, objectives, design, sample size, duration, and outcomes) and instrument characteristics (authors, year, country, instrument name, objective, description, type of assessment, mode of assessment, validation processes, and experimental phase).
RESULTS: Eight studies were identified, including one from Malaysia and seven from the United States, involving 1,797 students. All studies employed cross-sectional designs, and only one assessed knowledge retention through an intervention. Eight assessment instruments were identified: six focused on PrEP, one on PEP, and one on both. Some studies demonstrated substantial knowledge and confidence in PrEP, but significant gaps were found in PEP awareness, access to prophylaxis, and familiarity with prescribing guidelines.
CONCLUSIONS: There is a notable shortage of assessment tools for PEP. Further research is needed to develop validated instruments that measure knowledge and address educational gaps. Longitudinal studies with pre- and post-tests are crucial to evaluate educational interventions and enhance pharmacy students' preparedness for HIV prophylaxis.
METHODS: This prospective study utilized the direct observation technique where the preparation and administration of 222 intravenous medications were observed in the EDs of two hospitals in Malaysia. Information on medication preparation, administration, and other procedures was recorded. Error rates were calculated, and multivariable logistic regression was conducted to identify factors contributing to intravenous MAEs.
RESULTS: MAEs were detected in 83.3% (185/222) of the observed medications affecting 86.7% (124/143) patients. Among these, a total of 240 MAEs were identified, with the most common being wrong rate of administration (55.8%), wrong preparation technique (20.8%), and omission error (11.7%). Alimentary tract and metabolism medications accounted for the highest proportion of MAEs (52.0%), followed by anti-infective medications (21.7%) and nervous system medications (15.4%). Excluding wrong time errors reduced the error rate to 80.2% (178/222). Nonverbal orders and inadequate or absence of labelling were significantly associated with MAEs, while factors such as the complexity of preparations, working shift, experience, and high-alert medications showed no significant associations.
CONCLUSION: The study highlighted a high prevalence of intravenous MAEs in EDs. Nonverbal orders and inadequacy in labelling of medications were significant contributing factors to MAEs in the ED. Implementing an admixture labelling policy, comprehensive training programmes, strict enforcement of existing guidelines and protocols through regular audits, establishing nonpunitive error reporting system, and technological solutions where financially feasible are crucial for mitigating these errors to promote patient safety.
OBJECTIVE: To identify how to improve surveillance of movement behaviours, from the perspective of experts.
METHODS: This Delphi Study involved 62 experts from the SUNRISE International Study of Movement Behaviours in the Early Years and Active Healthy Kids Global Alliance (AHKGA). Two survey rounds were used, with items categorised under: (1) funding, (2) capacity building, (3) methods, and (4) other issues (e.g., policymaker awareness of relevant WHO Guidelines and Strategies). Expert participants ranked 40 items on a five-point Likert scale from 'extremely' to 'not at all' important. Consensus was defined as > 70% rating of 'extremely' or 'very' important.
RESULTS: We received 62 responses to round 1 of the survey and 59 to round 2. There was consensus for most items. The two highest rated round 2 items in each category were the following; for funding (1) it was greater funding for surveillance and public funding of surveillance; for capacity building (2) it was increased human capacity for surveillance (e.g. knowledge, skills) and regional or global partnerships to support national surveillance; for methods (3) it was standard protocols for surveillance measures and improved measurement method for screen time; and for other issues (4) it was greater awareness of physical activity guidelines and strategies from WHO and greater awareness of the importance of surveillance for NCD prevention. We generally found no significant differences in priorities between low-middle-income (n = 29) and high-income countries (n = 30) or between SUNRISE (n = 20), AHKGA (n = 26) or both (n = 13) initiatives. There was a lack of agreement on using private funding for surveillance or surveillance research.
CONCLUSIONS: This study provides a prioritised and international consensus list of actions required to improve surveillance of movement behaviours in children and adolescents globally.
METHODS: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the final consensus statements.
RESULTS: A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include consensus on managing patients with sepsis outside a designated critical care area, triggers for escalating clinical management and criteria for safe transfer to another facility. The experts agreed on the following: in the absence of serum lactate, clinical parameters such as altered mental status, capillary refill time and urine output may be used to guide resuscitation; special considerations regarding the volume of fluid used for resuscitation, especially in tropical infections, including the use of simple tests to assess fluid responsiveness when facilities for advanced hemodynamic monitoring are limited; use of Ringer's lactate or Hartmann's solution as balanced salt solutions; epinephrine when norepinephrine or vasopressin are unavailable; and the administration of vasopressors via a peripheral vein if central venous access is unavailable or not feasible. Similarly, where facilities for investigation are unavailable, there was consensus for empirical antimicrobial administration without delay when sepsis was strongly suspected, as was the empirical use of antiparasitic agents in patients with suspicion of parasitic infections.
CONCLUSION: Using a Delphi method, international experts reached consensus to generate expert clinical practice statements providing guidance to clinicians worldwide on the management of sepsis in resource-limited settings. These statements complement existing guidelines where evidence is lacking and add relevant aspects of sepsis management that are not addressed by current international guidelines. Future studies are needed to assess the effects of these practice statements and address remaining uncertainties.