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This study explored the perceived value, role and reported use of clinical guidelines by clinicians in urban paediatric and maternity hospital settings, and the effect of current implementation strategies on clinician attitudes, knowledge and behaviour. A total of 63 clinicians from 7 paediatric and maternity hospitals in Kabul, Afghanistan participated in structured focus groups; content analysis methodology was used for identification and analysis of key themes. Seven sets of guidelines, protocols or standards were identified (including 5 WHO-endorsed guidelines). However, most are failing to achieve high levels of use. Factors associated with guideline use included: clinician involvement in guideline development; multidisciplinary training; demonstrable results; and positive clinician perceptions regarding guideline quality and contextual appropriateness. Implementation activities should fulfil 3 major objectives: promote guideline awareness and access; stimulate motivation among clinical guideline users; and actively facilitate adherence to guidelines.

This study explored the perceived value, role and reported use of clinical guidelines by clinicians in urban paediatric and maternity hospital settings, and the effect of current implementation strategies on clinician attitudes, knowledge and behaviour. A total of 63 clinicians from 7 paediatric and maternity hospitals in Kabul, Afghanistan participated in structured focus groups; content analysis methodology was used for identification and analysis of key themes. Seven sets of guidelines, protocols or standards were identified (including 5 WHO-endorsed guidelines). However, most are failing to achieve high levels of use. Factors associated with guideline use included: clinician involvement in guideline development; multidisciplinary training; demonstrable results; and positive clinician perceptions regarding guideline quality and contextual appropriateness. Implementation activities should fulfil 3 major objectives: promote guideline awareness and access; stimulate motivation among clinical guideline users; and actively facilitate adherence to guidelines.

The global community must advocate to sustain midwifery training and services in Afghanistan, says Sabera Turkmani

Afghanistan has made important strides in healthcare delivery and outcomes despite political instability, but withdrawal of international funding threatens progress and system collapse, write Sabera Turkmani and Sheena Currie

During previous Taliban control (1996-2001), maternal and newborn health outcomes were among the worst globally, with maternal mortality ratios estimated at 1600 per 100 000 live births and an infant mortality rate of 90 per 1000 live births in 2000.12 Women faced extreme restrictions, which contributed to high levels of illiteracy and inaccessibility of reproductive, maternal, and newborn health services, including no skilled birth attendants for most women. Between 2000 and 2017, Afghanistan was one of the countries to achieve at least a 50% reduction in its maternal mortality ratio and an increase of over 15% of births attended by midwives, nurses, or in health facilities.5 By 2019, the infant mortality rate was 47 per 1000 live births—almost halved from rates observed in 2000.2 Central to these achievements was the scaling up of midwifery in Afghanistan.6 Midwifery education was identified as a key strategy to improving maternal and newborn health, and by 2010 it was expanded to 34 provinces aiming to increase women’s access to trained midwives, particularly in rural and remote areas. By 2017, the maternal mortality ratio had dropped to 638 per 100 000 live births—a huge improvement, yet still among the 10 highest maternal mortality ratios globally.8 The situation remained fragile, with the health system reliant on financial and technical support from international donors, increased attacks on health facilities in recent years, and deteriorating security.9 Additionally, the covid-19 pandemic is thought to have led to a 14% decline in perinatal outpatient appointments.10 Thus far, the newly-formed Taliban government appears to be enforcing restrictions on the public life of women and girls.

Abstract Objectives Management of colorectal cancer warrants mutational analysis of KRAS/NRAS when considering anti–epidermal growth factor receptor therapy and BRAF testing for prognostic stratification. In this multicenter study, we compared a fully integrated, cartridge-based system to standard-of-care assays used by participating laboratories. Methods Twenty laboratories enrolled 874 colorectal cancer cases between November 2017 and December 2018. Testing was performed on the Idylla automated system (Biocartis) using the KRAS and NRAS-BRAF cartridges (research use only) and results compared with in-house standard-of-care testing methods. Results There were sufficient data on 780 cases to measure turnaround time compared with standard assays. In-house polymerase chain reaction (PCR) had an average testing turnaround time of 5.6 days, send-out PCR of 22.5 days, in-house Sanger sequencing of 14.7 days, send-out Sanger of 17.8 days, in-house next-generation sequencing (NGS) of 12.5 days, and send-out NGS of 20.0 days. Standard testing had an average turnaround time of 11 days. Idylla average time to results was 4.9 days with a range of 0.4 to 13.5 days. Conclusions The described cartridge-based system offers rapid and reliable testing of clinically actionable mutation in colorectal cancer specimens directly from formalin-fixed, paraffin-embedded tissue sections. Its simplicity and ease of use compared with other molecular techniques make it suitable for routine clinical laboratory testing.

Coronavirus disease 2019 (COVID-19) continues to pose a global public health threat. The pandemic overstretched already weak health systems in low- and low-middle-income countries, including Ethiopia. There is a paucity of studies on the impact of COVID-19 on antenatal care access, uptake, and provision in Ethiopia. This study examines the impact of COVID-19 on antenatal care provision in the Sidama region, Ethiopia. A concurrent mixed-methods study was conducted between 14 February and 10 May 2022 at 15 public hospitals in the Sidama region. An interrupted times series design was applied for a quantitative study, which included data from all pregnant women who attended antenatal care before COVID-19 (12 months, March 2019 to February 2020) and during COVID-19 (six months, March to August 2020) at 15 public hospitals in the region. The total numbers in the antenatal care 1 cohort (at least one antenatal care contact) and antenatal care 4 cohort (at least four antenatal care contacts) were 15,150 and 5,850, respectively, forming a combined final dataset of 21,000 women. Routinely collected monthly data were derived from the hospitals' health management information system and imported into Stata version 17 for analysis. The mean monthly incidence rate ratio of antenatal care uptake was calculated using a Poisson regression model with a 95% confidence interval. Simultaneously, an exploratory study design was conducted for qualitative using in-depth interviews to explore maternity care providers' perceptions of the impact of COVID-19 on antenatal care access, uptake, and provision. Qualitative data were thematically analysed. The quantitative and qualitative findings were then integrated using the joint display technique. Our findings indicate a significant monthly decrease of 0.7% in antenatal care 1 and 1.8% in antenatal care 4 during the first six months of the pandemic. A lack of medical supplies, fear of contracting COVID-19, inadequate personal protective equipment, discrimination against those attending the hospital, and the absence of antenatal care guidelines for care provision, COVID-19 vaccine hesitancy and long waiting times for ANC led to disrupted access, uptake, and provision of antenatal care during COVID-19. Our findings demonstrate that the COVID-19 pandemic affected antenatal care access, uptake, and provision in the study area from March to August 2020. To mitigate disrupted antenatal care access, uptake and provision, antenatal care clinics should be equipped with medical supplies. It is crucial to maintain rapport between the community and maternity care providers and provide training for maternity care providers regarding the adapted/adopted guidelines during COVID-19 at the hospital grassroots level for use in the current and future pandemics. Pregnant women should have timely access to maternity care providers in order to maintain at least a minimum standard of care in current and future pandemics.

Delayed reactions after facial hyaluronic acid injection are relatively rare complications. Their cause may be infectious or immune-mediated in origin, and their outbreak can be triggered, for example, by an influenza-like illness. To describe potential adverse event of influenza like illness following dermal filler injection. We report fourteen unusual cases of delayed hypersensitivity reaction to several brands of hyaluronic acid dermal filler following influenza like illness. Increasing evidence implicates influenza infection in the pathogenesis of late onset filler reaction. Although there is a low risk of late onset adverse reaction with hyaluronic acid fillers, injecting physicians must be aware of the possible filler reaction following the influenza infection.

Today, elite athletes form an important social group, and the non-sport facets of their lives matter as much as their sports performances. However, there has been little empirical research on the lifestyles of elite athletes. Therefore, this study aimed to develop knowledge about the Iranian elite athletes’ lifestyle. The study was conducted with a qualitative approach in two phases. Glaserian grounded theory was used in the first phase, and thematic analysis was used in the second phase. Participants of the first phase included 19 sports experts, such as sports sociologists, sports psychologists, and sports coaches, who were selected by purposive and snowball sampling methods for holding unstructured in-depth interviews. The data were simultaneously analyzed using a set of open, theoretical, selective coding and memos. The codes were grouped into three different categories with different natures. The emerged theory advanced our understanding of the lifestyle shaping structures of elite athletes, lifestyle indicators, and even professionalization of their lifestyles. According to the results, the Iranian elite athletes’ lifestyles include indicators, such as professional mindset, competencies, life vision, financial literacy, responsibility, consumption, leisure, personal issues, and religious behavior. Subjects of the second phase were 44 Iranian athletes in the national levels who participated voluntarily in the study. The data were analyzed by thematic analysis method, and lifestyles typologies were identified. Based on results, five dominant lifestyles among the Iranian elite athletes were identified: consumerist, easy going, socially useful, profit-oriented, and professional. Finally, the features of each lifestyle were discussed.