Awareness Of Guidelines Research Articles

S1001 Pattern of Dermatological Screening for Patients With Inflammatory Bowel Disease in Primary Care Clinics: A Tertiary Care Center Experience

Introduction: Skin cancer is one of the most common forms of cancer in the United States of America. Incidence of melanoma in patients diagnosed with Inflammatory Bowel Disease (IBD) had a reported 37% increase in risk of melanoma when compared to the general population. It was seen that IBD was associated with an increased risk of melanoma, independent of biologic therapy. According to preventative care guidelines, patients with IBD should undergo screening for melanoma independent of the use of biologic therapy. Methods: A random sample of patients were collected from a database within a tertiary care center. Patients were selected by having a confirmed diagnosis of Ulcerative Colitis (UC) or Crohn’s Disease (CD) and having an established relationship with an internal medicine resident or non-teaching internist clinic. General demographics, referral to Dermatology and specific department from where the referral was placed were collected, along with relevant clinical information including current and previous therapies for IBD. Results: A total of 109 patients met inclusion criteria. Of the 60 patients who were cared for at the resident teaching clinic, 14 were referred to dermatology. Referrals were mostly made by a consulting gastroenterologist (11 out of 14 referrals). Only 8 out of the 14 patients that were referred successfully followed through with a dermatology clinic. Of the 49 patients who were cared for at the non-teaching internist clinic, 8 were referred to dermatology, all of whom were referred by the consulting gastroenterologist. Six out of the 8 patients followed up with dermatology. In general, CD patients were significantly more likely to be referred to dermatology compared to UC patients (p< 0.05). Patients who are currently or were previously on biologic therapy were significantly more likely to be referred to dermatology compared to those who have no history of biologic use (p< 0.05). Conclusion: Based on this descriptive study, overall screening for dermatological cancers in the IBD at-risk population is low despite their care being provided at a tertiary care center with access to consultants. This signifies gaps of care and low adherence to practice guidelines. The limitations need to be further studied as we speculate that the reason for low adherence could include deficiency in awareness of guidelines among primary care clinics, gastroenterologist reliance on primary care for general health maintenance, and insufficient patient education regarding the risks of skin cancer.

Current Status of Korean Medicine Treatment for Post-acute COVID-19 Syndrome: A Survey of Korean Medicine Doctors

Background: The applicability of Korean medicine (KM) treatments for post-acute COVID-19 syndrome were investigated.Methods: A cross-sectional, web-based survey of Korean medical doctors (KMDs) was conducted in June 2022. The 25-item questionnaire comprised of five parts: basic characteristics, prescribed post-COVID-19 KM treatments, treatment effect in patients with post-acute COVID-19 syndrome, patient satisfaction, and awareness and utilization of the relevant KM Clinical Practice Guideline by the KMDs.Results: In total, 1,063 completed questionnaires were collected, and 822 were analyzed. The most common symptoms in patients with post-acute COVID-19 syndrome treated by KMDs was weakness and fatigue (84.3%). Herbal decoctions (39.2%) and herbal powder (not covered by medical insurance; 25.8%) were primarily used. Among the KMDs, 95% (n = 781) responded that KM treatments, particularly herbal decoctions (82.6%) and herbal powder (not covered by medical insurance; 46.8%), were effective. Overall, 92.6% (n = 761) of KMD participants answered that the patients were satisfied with KM treatments, mostly due to symptomatic improvement (60.8%). The primary reason for dissatisfaction was the burden of cost for patients (78.4%). The main reasons for low uptake of KM services by patients with post-acute COVID-19 syndrome were lack of publicity and administrative issues such as no health insurance coverage.Conclusion: KM is highly applicable for post-acute COVID-19 syndrome. Health policies supporting the use of KM for post-acute COVID-19 syndrome are recommended.

Feasibility for cage farming in Africa: The case of the Kenyan part of Lake Victoria

AbstractFish catches in Lake Victoria have been on the decline, while demand for fish has been increasing because of rapid human population growth and awareness of the health benefits of fish. This decline is attributed to socioeconomic activities around the lake and climate change effects. To bridge the gap, cage culture has presented itself as a new socioeconomic frontier with good prospects for income in Lake Victoria, besides conserving declining wild fish stocks. However, these cages are greatly influencing the biodiversity of the lake both negative and positive. The study adopted a descriptive survey research where a total of 200 cage fish farmers were targeted. A sample of 60 fish farmers was selected using purposive and simple random sampling methods. Interview schedules and self-administered questionnaires were the main tools for data collection. Both primary and secondary data were collected and analyzed using Statistical Package for Social Sciences. The results were: the majority of cage fish farmers were male (87%) while the female was 13%, with a majority (75%) of the secondary and tertiary level of education. The beach management units and fish farmers were responsible for siting of cages. The fish farmers experienced several challenges including high cost of feeds leading to the use of poor quality feeds that sink and increase eutrophication, which enhances the growth of algae and water hyacinth in the lake. Overstocking leads to the emergence of diseases and fish kills, and fish theft resulting in economic loss. Most (80%) of respondents were not aware of policy guidelines on cage culture in Lake Victoria, while (75%) were not aware if cage culture was promoting climate change effects in Lake Victoria. This paper recommends the government to create awareness of policy guidelines on cage fish farming.

S1365 Improving Screening and Vaccination Rate for Hepatitis B in Veterans Affair Primary Care Population: A Quality Improvement Study

Introduction: According to Advisory Committee on Immunization Practices (ACIP), acute infection with Hepatitis B virus (HBV) is rising among adults 40 years and older. Hepatitis B (HepB) vaccines have long demonstrated safety and efficacy for decades, however less than a third of U.S. adults reported being vaccinated against HBV in 2018. In 2022, ACIP updated its recommendation and advised vaccinating all adults aged 19-59 and those 60 years and older with risk factors; adults 60 years and older without known risk factors may also be vaccinated. Our project aims to improve HBV screening and vaccination rate among Veterans Affairs (VA) primary care clinic patient population. Methods: Data was collected from pre-intervention (October – December 2021) and post-intervention (March – May 2022); all patients seen in clinic during these months were included. Patients were considered immune against HBV from vaccination if they have positive anti-HBsAg; and susceptible to infection if hepatitis panel negative. Interventions include educating each resident group regarding update in vaccination guideline and hepatitis panel interpretation. Reminder poster regarding HBV vaccine was placed in each clinic room. In addition, reminder for checking HepB status was developed and embedded in VA electronic medical record (EMR) system, which will show up at the end of each visit. (Figure) Results: In the pre-intervention period from October to December 2021, a total of 1242 veterans were seen in primary care clinic. 532 veterans were screened for immunity in the past with 378 veterans noted to have no immunity against hepatitis B. Out of 378 non-immune veterans, only 35 patients were vaccinated against HepB. (Table) In the post-intervention period from March to May 2022, 1174 veterans were seen. 689 veterans were screened for immunity and 402 have no immunity against HBV on hepatitis panel; 123 veterans received HepB vaccine during clinic visit, which is more than 20% increase compared to prior. Conclusion: Our data suggest that HBV vaccination rate was suboptimal among veteran population. A low-cost intervention along with the help of technology could be beneficial in integrating new vaccination guideline in VA standard of care. Our project strikes to encourage clinicians to bear the responsibility and offer the vaccine to adult patients proactively, rather than wait for patients to request for it. The goal of this project is to increase awareness of new vaccination guideline and reach for full vaccination rate among veteran population. Table 1. - Data gathered from pre-intervention and post-intervention period. Pre-Intervention (October to December 2021) Post-Intervention (March to May 2022) Total veterans seen in clinic 1242 1174 Veterans that were screened for Hepatitis B 532 out of 1242 (42.8%) 689 out of 1174 (58.7%) Screened veterans found to have no immunity against Hepatitis B 378 out of 532 (71%) 402 out of 689 (58.3%) Veterans without HepB immunity that received HepB vaccine 35 out of 378 (9%) 123 out of 402 (30.6%) Figure 1.: Example of electronic reminder that was developed and embedded in VA electronic medical record system. The reminder will show up at the end of each clinic visit, which will ask physicians to check veterans' hepatitis B status and offer vaccine if appropriate.

Variation of implant use in A1 and A2 trochanteric hip fractures : a study from the National Hip Fracture Database of England and Wales.

Patients with A1 and A2 trochanteric hip fractures represent a substantial proportion of trauma caseload, and national guidelines recommend that sliding hip screws (SHS) should be used for these injuries. Despite this, intramedullary nails (IMNs) are routinely implanted in many hospitals, at extra cost and with unproven patient outcome benefit. We have used data from the National Hip Fracture Database (NHFD) to examine the use of SHS and IMN for A1 and A2 hip fractures at a national level, and to define the cost implications of management decisions that run counter to national guidelines. We used the NHFD to identify all operations for fixation of trochanteric fractures in England and Wales between 1 January 2021 and 31 December 2021. A uniform price band from each of three hip fracture implant manufacturers was used to set cost implications alongside variation in implant use. We identified 18,156 A1 and A2 trochanteric hip fractures in 162 centres. Of these, 13,483 (74.3%) underwent SHS fixation, 2,352 (13.0%) were managed with short IMN, and 2,321 (12.8%) were managed with long IMN. Total cost of IMN added up to £1.89 million in 2021, and the clinical justification for this is unclear since rates of IMN use varied from 0% to 97% in different centres. Most trochanteric hip fractures are managed with SHS, in keeping with national guidelines. There is considerable variance between hospitals for implant choice, despite the lack of evidence for clinical benefit and cost-effectiveness of more expensive nailing systems. This suggests either a lack of awareness of national guidelines or a choice not to follow them. We encourage provider units to reassess their practice if outwith the national norm. Funding bodies should examine implant use closely in this population to prevent resource waste at a time of considerable health austerity.Cite this article: Bone Jt Open2022;3(10):741-745.

Diagnosis and referral of musculoskeletal tumors

Musculoskeletal tumors are uncommon. However, the true burden of all bone and soft tissue tumors of extremities is underestimated. Usually, the diagnosis of sarcomas is missed or delayed. Therefore, an adequate clinical and radiological assessment, along with the awareness and application of simple guidelines for referral to a specialized center, are of utmost importance. These are critical steps for an appropriate diagnosis and treatment of sarcomas, improving their prognosis.

Fostering Oral Chemotherapy Understanding and Safety (FOCUS) Project: Interventions for improving knowledge and compliance with national safety standards.

370 Background: Oral chemotherapy drugs are not always subject to the same safety standards as intravenous chemotherapy. Variability in safety practices can cause gaps in care, creating a need for continuous review of this process. This quality improvement (QI) project sought to improve provider and staff general knowledge on oral chemotherapy and on national safety standards through an educational intervention and to evaluate the implementation of an electronic medical record (EMR) integrated chemotherapy documentation template geared towards improving compliance with national safety standards pertinent to oral treatment. Methods: We used a pre/post-test design to compare knowledge following an educational session. A 15-question test covering national guidelines and safety standards relevant to oral chemotherapy were used to evaluate base knowledge before and after the session. We compared pre and post-test scores using paired t-tests. Then, a chemotherapy documentation template was developed in the EMR. The medical records of 44 patients at the center were reviewed four months before and 44 patients one month after the template’s introduction and documentation compliance was assessed using 24 national chemotherapy administration safety standards from the American Society of Clinical Oncology (ASCO) Quality Oncology Practice Initiative and the 2016 ASCO/Oncology Nursing Society Chemotherapy Administration Safety Standards. Comparison of compliance rates were performed using independent t-tests. Results: A total of 65 providers and staff participated in the educational session and completed both the pre and post-test. There was a statistical significance in knowledge gained from pre-test to post-test (p value of &lt; 0.001). Additionally, from the 88 charts reviewed, there was a statistical improvement in compliance with national safety standards (p value of &lt; 0.001). The participants (n = 29) also scored the documentation template as above average indicating overall ease of use and feasibility for continued use. Conclusions: This QI initiative improved provider knowledge and compliance with oral chemotherapy national safety standards. As a result, more centers should focus efforts on awareness and utilization of established national safety guidelines; critical to addressing the disparities in practice. Additionally, having a standardized workflow that prompts documentation within the EMR and discussion of the national standards is key to quality and safe practice.

Effect of Pharmacist Email Alerts on Concurrent Prescribing of Opioids and Benzodiazepines by Prescribers and Primary Care Managers

Policy makers have sought to discourage concurrent prescribing of opioids and benzodiazepines (coprescribing) because it is associated with overdose. Email alerts sent by pharmacists may reduce coprescribing, but this intervention lacks randomized evidence. To investigate whether pharmacist emails to practitioners caring for patients who recently received opioids and benzodiazepines reduce coprescribing of these medications. Randomized clinical trial (intention to treat) conducted in 2019-2021 of patients and their practitioners (prescribers and primary care managers) in the National Capital Region of the Military Health System. Participants were 2237 patients who were recently coprescribed opioids and benzodiazepines. These patients had 789 practitioners eligible for emails. Patients were randomized to email alerts to their practitioners or as-usual care. Clinical pharmacists sent the email alert. Messages were standardized and designed to facilitate coordination between practitioners, increase awareness of guidelines, and provide action steps and resources. The primary outcomes were patients' days received of opioids, benzodiazepines, and concurrent opioids and benzodiazepines during the 90 days following enrollment evaluated using 1-sided hypothesis tests. Secondary outcomes included total prescribing of opioids and benzodiazepines by patients' practitioners, including to patients outside the study, to test for broader outcomes on their prescribing. Of 2237 patients, 1187 were assigned to treatment and 1050 to control; 1275 (57%) were women. Patients received a mean (SD) of 31 (44) days of opioids and 33 (34) days of benzodiazepines in the 90 days before enrollment. There were no detected differences in the primary end points, including patients' receipt of opioids (adjusted difference, 1.1 days; 95% CI, -∞ to 3.0; P = .81), benzodiazepines (adjusted difference, -0.6 days; 95% CI, -∞ to 1.4; P = .30), and opioids and benzodiazepines together (adjusted difference, -0.1 days; 95% CI, -∞ to 0.7; P = .41). Of 789 practitioners, 429 were considered the treatment group, 325 were considered controls, and 35 were excluded. There were no detected differences in practitioners' total prescribing of opioids, benzodiazepines, or both drug classes together. In this randomized clinical trial of pharmacist emails to practitioners, email alerts failed to detectably reduce coprescribing, highlighting the value of alternative approaches. Combining randomization with quality improvement activities may help stakeholders seeking evidence-based interventions to encourage guideline-concordant care. ClinicalTrials.gov Identifier: NCT03887247.

UK Doctors Delivering Physical Activity Advice: What Are the Challenges and Possible Solutions? A Qualitative Study.

Despite strategies to enable Health Care Professionals (HCPs) to give physical activity (PA) advice to patients, this appears to be rarely done in consultations. The aims of the present study were to gain an understanding of doctors’ awareness of current PA guidelines and to explore their opinions on barriers and solutions. A qualitative approach using semi-structured interviews was adopted. This study included 15 doctors currently working in the UK’s National Health Service (NHS). A thematic analysis approach was used to analyse the transcripts. Four themes and twelve sub-themes were deciphered. Intrinsic factors limiting the delivery of PA advice included a lack of knowledge of PA guidelines and PA being an afterthought. Barriers to delivering PA guidance included a lack of PA education, time pressures, and patient engagement. Solutions included staff training, incorporating PA into undergraduate training, and encouraging staff to be physically active. Methods to optimise PA guidance included individualised PA advice, local exercise services and schemes, utilising online and visual resources, and motivational interviewing. This study provides an updated insight into doctors’ opinions on barriers and solutions to discussing PA with patients. It is clear that further work is needed to ensure greater awareness of PA guidelines amongst clinicians.

Remote infection control assessments in long-term care facilities during COVID-19 pandemic in Texas, 2020

BackgroundThe Texas Department of State Health Services (DSHS) Healthcare Safety Unit (HCSU) conducts remote infection control assessments (tele-ICARs) in long-term care facilities (LTCFs) to evaluate COVID-19 infection prevention and control (IPC) knowledge and practices using a standardized assessment tool. Tele-ICARs are used to gauge different IPC measures specific to SARS-CoV-2 and are either proactive––conducted prior to identified cases––or responsive to an outbreak, which is defined as a new SARS-CoV-2 infection in any staff or any facility-onset infection in a resident. State and local partners use findings from the assessments to aid LTCFs by providing targeted and timely resources and support to mitigate identified gaps.MethodsData from tele-ICARs conducted between March 1 and October 30, 2020 were analyzed to assess major gaps across LTCF types. A major gap was defined as 10% or more of facilities not satisfying a specific IPC measure, excluding missing data. Gaps were also assessed by tele-ICAR type: proactive or responsive. Fisher's exact tests and univariate logistic regression were used to characterize significant associations between major IPC gaps and LTCF or tele-ICAR type.ResultsDSHS conducted tele-ICARs in 438 LTCFs in Texas during 8 months; 191 were nursing homes/skilled nursing facilities (NH/SNFs), 206 were assisted living facilities (ALFs) and 41 were other settings. Of the assessments, 264 were proactive and 174 responsive. Major gaps identified were: (1) 22% did not have a preference for alcohol-based hand sanitizer (ABHS) over soap and water; (2) 18.1% were not aware of the contact time for disinfectants in use; (3) 17.9% had not stopped resident communal dining; (4) 16.8% did not audit hand hygiene and PPE compliance; and (5) 11.8% had not stopped inter-facility group activities and extra-facility field trips. When restricting analyses to proactive tele-ICARs, one additional gap was identified: 11.1% of facilities lacked a dedicated space to care for or cohort residents with confirmed SARS-CoV-2 infection. Significantly more ALFs than NH/SNFs had not suspended resident communal dining (P < .001) nor identified a dedicated space to cohort residents with confirmed SARS-CoV-2 infection (P < .001). Significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR reported a preference for ABHS over soap and water (P = .008) and reported suspending communal dining (P < .001) and group activities (P < .001). Also, significantly more LTCFs that received a responsive ICAR compared to a proactive ICAR had identified a dedicated space to cohort residents with confirmed SARS-CoV-2 (P = .009).ConclusionsIncreased facility education and awareness of federal and state guidelines for group activities and communal dining is warranted in Texas, emphasizing the importance of social distancing for preventing the transmission of SARS-CoV-2 in LTCFs, particularly ALFs. CDC recommendations for ABHS versus hand washing should be emphasized, as well as the importance of monitoring and auditing HCP hand hygiene and PPE compliance. Facilities may benefit from additional education and resources about disinfection, to ensure proper selection of disinfectants and understanding of the contact time required for efficacy. Analysis by tele-ICAR type suggests facilities may benefit from identifying space for dedicated COVID-19 units in advance of an outbreak in their facility. Conducting tele-ICARs in LTCFs enables public health agencies to provide direct and individualized feedback to facilities and identify state-wide opportunities for effective interventions in response to SARS-CoV-2.

Associations between Parent Attitudes and on- and off-Screen Behaviours of Preschool Children in Singapore.

The research aims were to examine the relationships between parent and child digital media use and to describe the characteristics of the top and bottom quartiles of child digital media use in meeting the 24 h integrated guidelines for sleep, physical activity, and sedentary behaviour. Parent-reported on- and off-screen habits and quality of life of children were collected from 1481 parents of preschool children aged 2–5 years in 2019. Significant relationships were detected between parent and child digital media use (weekday, r = 0.274; weekend, r = 0.421, p < 0.05) with no sex difference in daily child digital media use (p > 0.05). Age of first exposure to fixed screens, daily digital media use, and physical play durations were significantly different between heavy (child-TQ) and light (child-BQ) child users of digital media (p < 0.05). Parental perceived importance of child digital media use and parental awareness and practice of guidelines for child digital media use differed significantly between parents of child-TQs and parents of child-BQs (p < 0.05). The number of 24 h movement guidelines met between child-TQs and child-BQs differed (p < 0.05). Parents voiced serious concerns for child digital media use, including addiction (75–76%), poor eyesight (73%), access to inappropriate content (73–74%), a lack of parent–child interaction (65%), poor sleep (49–55%), and a lack of physical activity (55–59%), but these findings did not translate to parental enforcement of the guidelines. Parent education on how to get the best digital media use outcomes for preschool children is recommended.

Physician- and patient-reported barriers to hepatocellular carcinoma surveillance: A nationwide survey.

Hepatocellular carcinoma (HCC) surveillance rates are suboptimal. We aimed to identify HCC surveillance barriers from both physician's and patient's perspectives and assess the effectiveness of physician education using social networks. A nationwide survey with 513 physicians and another single-center survey with 315 HCC-risk patients were conducted. Barriers to suboptimal surveillance were identified using univariate and multivariate logistic regression analysis. We educated 143 physicians by sending brief notes on HCC surveillance guidelines via social networks and re-evaluated their knowledge after 60 days using t test. Surveys showed 458 (86.3%), 254 (47.8%), and 225 (42.4%) physicians recommended surveillance in patients with cirrhosis, at-risk hepatitis B virus, and hepatitis C virus infection, respectively. Only 228 (42.9%) and 241 (38.0%) respondents adhered to recommended surveillance tools and interval, respectively. The main surveillance barriers among physicians were the lack of knowledge and resource limitations. The lack of a doctor's prescription was identified as a major barrier by patient' perspectives (odds ratio 1.4, 95% CI: 1.1-1.8, P = .024). Education via social networks enhanced physicians' knowledge, with pre- and post-education scores for guideline awareness of 63.0% versus 84.3% (P < .001) and for surveillance indication and tools of 40.0% versus 63.0% (P = .001), and 42.0% versus 59.3% (P = .015), respectively. Physicians' knowledge gap is a primary barrier for adherence to HCC surveillance protocols. Brief education via social networks shows effectiveness at increasing physicians' knowledge of HCC surveillance.

Awareness And Knowledge Of The 2018 Physical Activity Guidelines Among US Adults

The Physical Activity Guidelines for Americans, second edition was released in 2018 and recommends adults do ≥150 minutes/week of moderate-intensity equivalent aerobic physical activity preferably spread out over a week (adult aerobic guideline). Assessing awareness and knowledge of the guideline is important for monitoring public understanding of physical activity and health. PURPOSE: To describe prevalence and correlates of reported awareness and knowledge of the aerobic guideline among US adults. METHODS: National data from the 2019 FallStyles survey were analyzed. Adults (n=3471) who reported seeing, hearing, or reading anything about governmental physical activity guidelines in the last year were considered aware of the guidelines. Adults who selected “150 minutes spread out over a week” when asked about the minimum amount of moderate-intensity physical activity the government recommends for substantial health benefits were considered knowledgeable of the adult aerobic guideline. Weighted prevalence and adjusted odds ratios from logistic regression models were estimated. RESULTS: Overall, 9.2% of adults reported being aware of the guidelines and 2.9% knew the aerobic guideline, though 27.5% selected “30 minutes/day, ≥5 days/week,” which is one way to meet the guideline. After adjusting for covariates, the odds of awareness were higher with older age, higher education level, and among married adults (bivariate differences by income no longer significant). Adults who were aware of the guidelines had higher odds of knowing the guideline (bivariate differences by education, income, and meeting the guideline no longer significant).CONCLUSION: One year after the physical activity guidelines were released, few US adults were aware of them, even fewer knew the adult aerobic guideline, and disparities exist. Overall more messaging and equitable outreach on physical activity may benefit the public’s understanding of physical activity and health.

P01-17 Promotion of health-enhancing physical activity in Europe: a cross-sectional study among 536 sports associations

BackgroundSports associations may play an important role in the promotion of health-enhancing physical activity (HEPA) in Europe. However, no recent findings on their commitment to HEPA promotion are available. Therefore, we aimed to determine the level and correlates of the commitment of European sports associations to HEPA promotion.MethodsRepresentatives of 1717 sports associations from 36 countries were invited to take part in a survey conducted within the Sports Club for Health (SCforH) 2015-17 project, and 536 (31%) agreed to participate. The participants were asked about their organisation's awareness of SCforH guidelines and its commitment (0-10) to the promotion of: elite sports; health-enhancing sports; health-enhancing exercise, and other types of HEPA. An overall HEPA promotion score was calculated as the arithmetic mean of the latter three. A multiple regression analysis was conducted with the overall HEPA promotion score as the outcome variable and organisation type (“national association of a specific sport” as the reference group [ref], “European sports federation”, “national umbrella sports organisation”, “national Olympic committee”, “national sport-for-all organisation”), headquarters in an EU member state (“no” [ref], “yes”), region of Europe (“Western” [ref], “Central-Eastern”, “Northern”, “Southern”), commitment to elite sports (“low” [ref], “medium”, “high”), and awareness of SCforH guidelines (“no” [ref], “yes”) as explanatory variables.ResultsThe commitment to HEPA promotion was low (score: 0-3) in 32.1% (95% confidence interval [CI]: 28.1, 36.0), medium (4-6) in 39.7% (95% CI: 35.6, 43.9), and high (7-10) in 28.2% (95% CI: 24.4, 32.0) of sports associations. Being a national sport-for-all organisation (β = 1.68; 95% CI: 0.74, 2.62; p > 0.001), national Olympic committee (β = 1.48; 95% CI: 0.41, 2.55; p = 0.007), located in Central-Eastern Europe (β = 0.56; 95% CI: 0.01, 1.12; p = 0.047), and aware of the SCforH guidelines (β = 0.86; 95% CI: 0.35, 1.37; p > 0.001) was associated with greater commitment to HEPA promotion.ConclusionRelatively low commitment of European sports associations to HEPA promotion may be increased by raising awareness of the SCforH guidelines and by considering national sport-for-all organisations, national Olympic committees, and organisations in Central-Eastern Europe as role-models in this endeavour.

How is surgical antibiotic prophylaxis prescribed for open reduction internal fixation procedures by Australian orthopaedic surgeons?

How is surgical antibiotic prophylaxis prescribed for open reduction internal fixation procedures by Australian orthopaedic surgeons?

S04-5 Development of the Sports Club for Health (SCforH) online learning tool

BackgroundIn 2019, the European Commission provided funding of nearly 400 thousand Euro for the third round of the Sports Club for Health (SCforH) project. The objective of this project is to increase participation in sport and HEPA in the European Union by encouraging sports clubs and associations to implement SCforH principles in their activities. To achieve the objective of the project, in this study we aimed to develop a SCforH online learning tool.MethodsThrough a comprehensive literature search and consultations with the stakeholders in the area of sport, we created a list of examples of good practice in implementing SCforH initiatives and other related HEPA promotion practices in the sports context. The list was used to inform the development of the SCforH online learning tool. The SCforH online learning tool was developed through a consultation process including 15 experts in the area of sport and health.ResultsThe SCforH online learning tool includes: a participation consent form; a module for setting learning objectives, textual, pictorial, and video learning materials; interactive learning exercises; in-course quizzes and self-assessment modules; a link to the database of SCforH initiatives and other related practices in the European Union; links to other available online materials for those who want to know more; a module for the assessment of acquired knowledge; a participant feedback module; an optional survey including questions relevant for the evaluation of SCforH activities.ConclusionsThe SCforH online learning tool will enable the realisation of other aims of the current SCforH project, in particular, raising the awareness of the SCforH guidelines among: European sports clubs; sport associations; HEPA promoters; policymakers; and students of physical education, sport science, and public health.

317 Preoperative Fasting in Adults – A Quality Improvement Project at Macclesfield District General Hospital

Abstract Aim Our primary endpoint was to evaluate staff awareness of preoperative fasting guidelines. Our secondary endpoint was to evaluate patient preoperative fasting times. Method Data were collected using online close-ended survey questions from surgical ward nurses and healthcare assistants before and after implementing a multimodal campaign to raise awareness. Data were collected for patient fasting times before and after the same interventions. Interventions: Results Staff: Our interventions increased staff awareness of preoperative fasting guidelines for food by 20.6% (from 50% to 70.6%) and for clear fluids by 28.8% (30% to 58.8%). Patients Average preoperative fasting times for food before and after intervention were 12.7 and 12 hours respectively (p=0.736). For clear fluids, average fasting times before and after intervention were 6.2 hours and 4.5 hours (p=0.415). Conclusions Staff were generally unaware of the guidelines and viewed preoperative fasting solely as a safeguard against aspiration, causing adoption of a risk-averse attitude. The benefits of adequate hydration and nutritional support before surgery were overlooked. Our interventions helped raise awareness in the short term. For our next cycle, we plan to assess the efficacy of implementing long-lasting changes such as local trust guidelines and improved staff training to drive a change in attitude and awareness of preoperative fasting.

Understanding Primary Care Providers' Experience with Lifestyle Behavior Change Recommendations and Programs to Prevent Chronic Disease.

Prescribing lifestyle behavior change is a recommended strategy for both primary and secondary prevention of disease. Programs that support and encourage lifestyle behavior change are available to patients but are underutilized. The purpose of this study was to understand primary care providers (PCPs) experiences and barriers they experience with referring patients to lifestyle behavior change programs at one academic health care system. In-depth semi-structured interviews were conducted with 7 academic PCPs between November 2020 and January 2021. Qualitative analysis identified major themes. Four themes emerged: (1) guideline awareness and adherence, (2) barriers to lifestyle behavior change recommendations, (3) provider role with respect to lifestyle behavior change recommendations, and (4) suggestions to improve utilization of behavior change support. Specific strategies for improvement include revising referral process, educating providers about programs already offered, integrating a team-based approach, and systemizing healthy lifestyle behaviors interventions. The lessons identified through this study highlight the need for systematic prioritization of lifestyle behavior change to decrease certain barriers that providers face when attempting to integrate lifestyle change consistently into their practice.

Identifying barriers and facilitators to routine preoperative frailty assessment: a qualitative interview study.

Preoperative frailty assessment is recommended by multiple practice guidelines and may improve outcomes, but it is not routinely performed. The barriers and facilitators of routine preoperative frailty assessment have not been formally assessed. Our objective was to perform a theory-guided evaluation of barriers and facilitators to preoperative frailty assessment. This was a research ethics board-approved qualitative study involving physicians who perform preoperative assessment (consultant and resident anesthesiologists and consultant surgeons). Semistructured interviews were conducted by a trained research assistant informed by the Theoretical Domains Framework to identify barriers and facilitators to frailty assessment. Interview transcripts were independently coded by two research assistants to identify specific beliefs relevant to each theoretical domain. We interviewed 28 clinicians (nine consultant anesthesiologists, nine consultant surgeons, and ten anesthesiology residents). Six domains (Knowledge [100%], Social Influences [96%], Social Professional Role and Identity [96%], Beliefs about Capabilities [93%], Goals [93%], and Intentions [93%]) were identified by > 90% of respondents. The most common barriers identified were prioritization of other aspects of assessment (e.g., cardio/respiratory) and a lack of awareness of evidence and guidelines supporting frailty assessment. The most common facilitators were a high degree of familiarity with frailty, recognition of the importance of frailty assessment, and strong intentions to perform frailty assessment. Barriers and facilitators to preoperative frailty assessment are multidimensional, but generally consistent across different types of perioperative physicians. Knowledge of barriers and facilitators can guide development of evidence-based strategies to increase frailty assessment.

Guideline Awareness Disparities in Plastic Surgery: A Survey of American Society of Plastic Surgeons.

Background:The American Society of Plastic Surgeons (ASPS) clinical practice guidelines were constructed to help direct evidence-based surgical management in plastic surgery. Societal member awareness of the recommendations for breast reconstruction has yet to be studied among ASPS members.Methods:Univariate and multivariate analyses were performed using electronic survey data from 243 ASPS members. Characteristics, including respondent demographics, practice distribution, and geographic locations, were correlated to the awareness of autologous and expander/implant-based reconstruction guidelines.Results:Of the respondents, 52% and 35.7% reported awareness for autologous breast reconstruction and expander/implant-based reconstruction guidelines, respectively. Surgeons who performed more general and autologous breast reconstruction were more likely to be aware of autologous breast reconstruction and expander/implant-based guidelines (P = 0.0034 and 0.032). Autologous breast reconstruction guideline awareness was geographically disparate (P = 0.031), with greater awareness in the Northeast (OR, 4.5; 95% CI, 1.63–12.53; P = 0.01) and Southwest (OR, 3.91; 95% CI, 1.18–13.83; P = 0.01). Respondents with larger practice percentages of breast reconstruction and those with higher annual academic meeting attendance reported greater awareness of expander/implant-based guidelines (P = 0.044 and 0.040). Meeting attendance (OR, 2.14; 95% CI, 1.15–8.91; P = 0.022) and practice-based (OR, 3.14; 95% CI, 1.52–8.91; P = 0.027) awareness disparities were also appreciated on multivariate analysis.Conclusions:Guideline awareness in plastic surgery varies by practice composition and geography. These findings can be used to help inform more targeted educational and implementation strategies in breast reconstruction.Clinical Question/Level of Evidence:Quality Improvement/Level IV