Provider Awareness Research Articles

P-1897. Quality Improvement Initiative: Quantifying and Reducing Anti-infective Pharmaceutical Waste at a Tertiary Care Pediatric Hospital

Abstract Background Pediatric hospitals have reported thousands of doses and dollars’ worth of waste from anti-infective drugs (anti-microbial, anti-fungal, anti-viral) every year. This has an environmental impact due to pharmaceutical waste incineration resulting in greenhouse gas emissions and contributes to drug shortages. Anti-infective drugs are prepared in advance for routine administration. When an order is modified or cancelled it cannot be used for another patient and gets discarded. The goal of this study was to calculate the anti-infective waste at our tertiary care pediatric hospital, to understand the key drivers and design education and QI interventions to reduce wasted doses.Figure 1:Fish bone diagram highlighting the reasons for waste Methods Pharmacy data for waste reviewed (06/2022-03/2024). The reasons for wasted doses determined by point prevalence review of 75 charts on a single hospital day. PDSA 1 included creation of additional batch processing timings. PDSA 2 included education of providers on teams with high amounts of wasted orders held in 02/2024. Pharmacy leaders reminded teams daily on rounds about stop dates.Figure 2:Key driver diagram Results Total waste - 79,525 doses at a cost of $407,072 were wasted due to order changes in 2023. Top wasted anti-infectives include ampicillin-sulbactam, cefepime, cefazolin, ceftriaxone, vancomycin, and piperacillin-tazobactam. PDSA 1 (Addition of batches for batch processing timing) & PDSA 2 (Provider education and awareness) showed significant reduction in waste per 1,000 doses as highlighted in figure 4.Figure 3:Reasons for waste on chart review of 75 patients Conclusion Education around medication waste was created through this QI Initiative and was well received. Using the data collected, IT and pharmacy workflow interventions are being developed and will be evaluated including standardized dosing, 48 hour hard-stops for sepsis rule outs.A key intervention we are currently working on (PDSA 3) is to reduce the time gap between discharge of the patient and when the orders are discontinued on the EMR (identified during chart review). For our hospital this time gap was found to be 6.5 hours which results in large amounts of waste. Calculating environmental impact & Green House Gas emissions from the pharmaceutical waste (by measuring weight in kg) is another impact assessment metric we are working on.Figure 4:Run-chart of baseline waste data with the two PDSA cyclesA decrease in the center line was observed following PDSA 1 that was sustained for greater than 6 months Disclosures All Authors: No reported disclosures

National Trends in Non-Accidental Pediatric Craniofacial Fractures Requiring Inpatient Admission.

Pediatric craniofacial trauma, particularly from non-accidental trauma (NAT), is a significant cause of injury with enduring physical and psychological impacts. This study analyzes demographic patterns, injury characteristics, and trends in NAT-related craniofacial injuries to inform early identification, intervention, and prevention efforts. Analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed for the years 2009 to 2019. Patients aged 0 to 17 with craniofacial injuries and a diagnosis of non-accidental trauma were identified based on current procedural codes; demographic and temporal trends were analyzed. Overall, 306,115 patients with craniofacial injuries and 20,540 patients with non-accidental trauma (NAT) were identified. Patients with NAT represented 2.6% of all craniofacial injuries, with a greater proportion of males affected. On average, 39% of all NAT cases involved a craniofacial injury. The most common injury patterns were intracranial (50.1%), superficial head injuries (37.7%), and craniofacial fractures (31.9%. Isolated facial fractures were rare, comprising <1% of all cases. Although the average in-hospital mortality was 6.78%, temporal analysis demonstrated significant reductions in in-hospital mortality and length of hospitalization (P<0.001). Pediatric craniofacial injuries from NAT remain a significant public health concern. However, the observed decrease in both hospitalization length and in-hospital deaths suggests improvements in early intervention and treatment outcomes. Continued efforts to refine diagnostic strategies, enhance provider awareness, and strengthen prevention initiatives are essential to mitigate the devastating impacts of NAT in the pediatric population.

P-515. Enhancing Sexual Wellness: A Novel Approach to Screening and Prevention in an Urban Health Center

Abstract Background The Family Health Centers at NYU Langone (FHC) is a network of Federally Qualified Health Centers that serves a largely marginalized, diverse, and low-income patient population in Brooklyn, NY. In 2023, the FHC provided care for over 112,000 patients, with 52% being on Medicaid or Medicare and 28% being uninsured. We identified 44 HBSAG positive patients as well as 25 newly diagnosed HIV patients. Patients as well as providers are often reluctant to have conversations around sexual health. Identifying risk factors for HIV, infectious hepatitis, and other infections is an area critical for providing excellent primary care to end the epidemic and curb Hep and STI rates. Methods The FHC had no standardized approach to collecting HIV and Hep B risk history being followed by providers. Our approach aimed to standardize risk screening processes while raising provider awareness of the significance of Hepatitis screening and HIV prevention. A Sexual Wellness Screening Tool was developed and integrated into the EPIC My Chart system. The screening tool is answered by patients ahead of an initial/annual appointment through the patient portal and updated annually. Patients with high-risk responses trigger an EPIC Best Practice Alert (BPA). The BPA recommends elements of care and prepopulates a Hepatitis B lab orders and/or referrals to the HIV prevention team. For provider buy-in and education, learning sessions were held across the network. Results During Q1 of 2024, 866 patients completed the tool, 525 patients screening positive for risk factors. Of the 525 patients, 88% reported having sex without a condom in the past 12 months. 65% of patients had multiple risk factors. All patients at risk, were offered testing, however 26 HBV tests were actually ordered and 5 completed. For HIV prevention, 26 referrals were generated and contacted by Prevention Navigators, leading to 2 patients beginning PrEP. Risk Responses Conclusion Having patients fill out the tool ahead of appointments allows for a provider to review the tool with the patient and can help guide the conversations patients and providers have; maximizing the finite time providers have with patients and empowering patients to have their questions answered. Continued education and laboratory process refinement are necessary to streamline the work. Disclosures All Authors: No reported disclosures

Investigating the Barriers to Adoption of Renewable Energy Systems in Residential Buildings in Kuwait

This study investigates the barriers to adopting renewable energy (RE) systems in residential buildings in Kuwait, with a focus on technical, financial, environmental, and social challenges. Through a structured survey administered to 217 respondents from varied demographics, the study highlights key obstacles such as high initial costs, limited awareness of service providers, environmental challenges, and social influences. Technical barriers, including maintenance complexities and insufficient skilled personnel, further hinder adoption. Despite acknowledging the benefits of RE systems, respondents express concerns over system reliability and compatibility with Kuwait's extreme climatic conditions, such as high temperatures and frequent dust storms. Financial constraints, particularly the lack of government incentives, exacerbate these challenges. Social factors, including community standards and peer influence, play a nuanced role, with public awareness campaigns identified as critical for fostering adoption. The findings emphasize the need for targeted awareness initiatives, financial incentives, and advanced technologies tailored to Kuwait’s climate. This study provides actionable insights for policymakers, developers, and stakeholders to address these barriers effectively and promote RE adoption. By overcoming these challenges, Kuwait can enhance its energy sustainability, contribute to global climate goals, and diversify its energy portfolio in alignment with sustainable development objectives.

Prevalence of post-acute sequelae of SARS-CoV-2 infection in people living with HIV: a systematic review with meta-analysis

Given the chronic immune activation and inflammatory milieu associated with Long COVID and HIV, we assessed the prevalence of Long COVID in adults living with HIV; and investigated whether adults living with HIV were associated with increased chance of developing Long COVID compared to adults living without HIV. In this systematic review and meta-analysis, we searched Medline, EMBASE, CINHAL, PubMed and CENTRAL from inception until June 14th, 2024, for observational studies that measured the prevalence of Long COVID in adults living with HIV and the odds of developing Long COVID following a SARS-CoV-2 infection in people living with HIV compared to people living without HIV. Reviews, case reports, randomised control trials and editorials were excluded. The search was conducted without language restrictions. We performed meta-analysis of proportions to synthesise prevalence estimates using logit transformation and a sensitivity analysis using mixed-effects logistic regression. We used random-effects meta-analyses to summarize the odds ratio (OR) of developing Long COVID in adults living with HIV compared to adults living without HIV and conducted a sensitivity analysis including only studies with covariate-adjusted estimates that was planned a-priori. We used ROBINS-E for the risk of bias assessment and GRADE to rate the certainty of evidence. We identified statistical heterogeneity using Cochran's Q test and quantified it using the I2 statistic. For the Q test, a P<0.10 was considered statistically significant. PROSPERO registration: CRD42024577616. Our search returned 831 results, of which 8 studies (4489 participants) were deemed eligible for inclusion in the systematic review and meta-analysis. The prevalence of Long COVID in adults with HIV was 43% (95% CI: 32-54%, 8 studies; 1227 participants; low certainty, I2<0.0001). The association of HIV status with Long COVID was inconclusive, with wide confidence intervals (OR: 1.16, 95% CI: 0.58-2.29; 4 studies; 3556 participants, low certainty, I2=0.013). When the analysis was restricted to studies reporting covariate-adjusted estimates, adults living with HIV were associated with a higher odds of Long COVID than those not living with HIV (OR: 2.21, 95% CI: 1.12-4.36; 2 studies; 374 participants, low certainty, I2=0.51). Current evidence indicates that the prevalence of Long COVID in adults living with HIV may be high, suggesting the need for increased awareness and education of healthcare providers and policy makers. Evidence on whether HIV positivity increases the risk of Long COVID is limited and inconclusive, highlighting a need for further research to clarify this potential association. None.

Implementing Findable, Accessible, Interoperable, Reusable (FAIR) Principles in Child and Adolescent Mental Health Research: Mixed Methods Approach.

The FAIR (Findable, Accessible, Interoperable, Reusable) data principles are a guideline to improve the reusability of data. However, properly implementing these principles is challenging due to a wide range of barriers. To further the field of FAIR data, this study aimed to systematically identify barriers regarding implementing the FAIR principles in the area of child and adolescent mental health research, define the most challenging barriers, and provide recommendations for these barriers. Three sources were used as input to identify barriers: (1) evaluation of the implementation process of the Observational Medical Outcomes Partnership Common Data Model by 3 data managers; (2) interviews with experts on mental health research, reusable health data, and data quality; and (3) a rapid literature review. All barriers were categorized according to type as described previously, the affected FAIR principle, a category to add detail about the origin of the barrier, and whether a barrier was mental health specific. The barriers were assessed and ranked on impact with the data managers using the Delphi method. Thirteen barriers were identified by the data managers, 7 were identified by the experts, and 30 barriers were extracted from the literature. This resulted in 45 unique barriers. The characteristics that were most assigned to the barriers were, respectively, external type (n=32/45; eg, organizational policy preventing the use of required software), tooling category (n=19/45; ie, software and databases), all FAIR principles (n=15/45), and not mental health specific (n=43/45). Consensus on ranking the scores of the barriers was reached after 2 rounds of the Delphi method. The most important recommendations to overcome the barriers are adding a FAIR data steward to the research team, accessible step-by-step guides, and ensuring sustainable funding for the implementation and long-term use of FAIR data. By systematically listing these barriers and providing recommendations, we intend to enhance the awareness of researchers and grant providers that making data FAIR demands specific expertise, available tooling, and proper investments.

Individual and clinical factors associated with patient acceptance of referrals to social services and community resources at a multi-purpose resource hub.

Emerging evidence suggests that bi-directional communication and referral pathways, when employed strategically, can lead to favorable health outcomes by connecting patients with complex, multi-faceted health and social needs to appropriate services and resources. However, despite these benefits, patient acceptance of referrals via these pathways remains suboptimal. In this study, we describe individual and clinical factors associated with patient acceptance of these referrals. We extracted individual-level demographic and clinical data for patients referred primarily from a large safety-net health system to a multi-purpose resource hub co-located on the campus of its largest hospital, for the period October 2019 to June 2023. Descriptive statistics, Chi-square analyses, and multinomial regression modeling were performed to examine these data. Of 1865 patients in the study sample, 54.2% accepted a referral, 27.4% were lost to follow-up, and 18.4% declined. Most patients who accepted referrals were female (67.1%), Latino (81.5%), and had hypertension and/or prediabetes or diabetes (84.1%). In modeling analyses, those who accepted referrals tended to be female, and were referred from primary care clinics; many were referred for multiple service/resource categories. We found associations between patient acceptance of referrals and gender and source of referral. Drawing upon these results as well as experience implementing these systems, we propose several practical strategies for increasing successful referrals, including identifying and addressing barriers for patients who declined or were lost to follow-up; using standardized screening tools to routinely assess for multi-faceted health and social needs; increasing provider awareness about the benefits and functioning of these pathways; and monitoring progress so mid-course adjustments can be made when necessary.

Impact of multi-modal learning workshop on awareness and knowledge of health care providers about waste management in India

Hospital waste management is crucial in preventing needle stick injuries and exposure to hazards. Adequate knowledge, appropriate safety measure, and methods of handling the wastes are more important in waste management. : The objective of this project is to study the impact of multi-modal training workshops in improving the knowledge and awareness on biomedical waste management among healthcare workers.An eight-hour onsite training workshop was conducted in Ahmedabad, Kolkata, Indore, and Hyderabad from July to September 2023. A validated pre and post-test questionnaire was used to assess the impact of the workshop. At the end of each workshop, responses were analyzed to study the effectiveness of the workshop and to do a gap analysis on the areas that require strategic learning. Analysis was conducted on data aggregated using the Chi-square test.In the above analysis, the pre-test scoring of these participants was 66%. After the workshop, the post-test scoring was 83% with a significant improvement (p &amp;#60; 0.0001). The pre-test and post-test scores in individual regions were 63% and 78% at Ahmedabad, 71% and 86% at Kolkata, 60% and 86% at Indore, and 68% and 83% at Hyderabad respectively.In healthcare facilities, training plays a key role in preventing health hazards for both employees and patients. Training must involve different types of learning methods tailored to the needs and capability of understanding of the participants. The effectiveness of training must be measured using appropriate tools to study the impact of the learning methods.

"Share the Fear": Communication Concerns of Parents With Cancer With Dependents and Coparents: A Qualitative Needs Assessment Study.

The estimated 1.6 million adults in the United States with cancer who also have dependents face unique challenges given the profound impact of cancer on their families, such as increased psychological distress, decreased quality of life, and altered family functioning. Unfortunately, little is known about the mutual cancer-related communication concerns from the perspectives of the parents with cancer or the coparents. Coparents care for the patient and dependents until they reach adulthood (eg, unmarried, divorced, stepparent, and/or same-sex partnerships). To understand the mutual cancer-related communication concerns from the perspectives of parents with cancer and the coparents and intervention delivery preferences. Fifteen parents with cancer and 15 coparents were recruited to participate in semistructured interviews between October 2022 and September 2023 within an academic medical center in Midwestern states. Interviews were conducted via Zoom. The data were analyzed through Charmaz's inductive grounded theory approach. Parents with cancer and the coparents desire communication assistance with each other about discussing the cancer diagnosis with dependents, end-of-life planning, managing finances, and addressing mental health concerns and emotions. The majority of participants reported interest in a virtually delivered intervention. Findings from this study provide a mutual understanding of cancer-related communication concerns from the perspectives of parents with cancer and the coparents. These findings provide awareness for providers and the foundation to inform a web-based communication intervention about cancer-related concerns to promote family resiliency in this population, which provides a resource for providers to utilize.

Association between infertility and incident onset of systemic autoimmune rheumatic disease after childbirth: a population-based cohort study.

What is the association between infertility with or without fertility treatment and incident onset of systemic autoimmune rheumatic disease (SARD) among women who give birth? Women who experienced infertility but did not use fertility treatment had a higher incidence of SARD up to 9 years after delivery than those who did not experience infertility, even after accounting for their higher rates of preeclampsia, spontaneous preterm birth, and stillbirth. Infertility is increasingly common and is an under-appreciated risk marker for chronic diseases in women. Despite several studies documenting abnormal immune activity in women with infertility, little is known about the association between infertility and incidence of autoimmune diseases such as SARD which disproportionately develops in reproductive-aged women. This population-based cohort study using linked administrative data for all of ON, Canada, 2012-2021 and included 568053 singleton births among 465078 women aged 18-50 years without known pre-existing SARD. The exposures were: (i) no infertility with unassisted conception (referent [88.0% of the cohort]); (ii) infertility without fertility treatment (9.2%); (iii) infertility with non-invasive fertility treatment (ovulation induction or intrauterine insemination [1.4%]); and (iv) infertility with invasive fertility treatment (IVF or ICSI [1.4%]). SARD was identified by a validated algorithm based on diagnostic codes at two physician visits, one rheumatologist visit, or one hospitalization and measured from the index delivery date, with censoring at death, loss of health insurance, or study end of 31 March 2021. Marginal structural Cox proportional hazards models generated hazard ratios (HR) and 95% CIs representing total effects adjusted for sociodemographic characteristics, comorbidities, and smoking, and controlled direct effects additionally accounting for adverse pregnancy outcomes. The median (IQR) duration of follow-up was 6.5 (4-9) years. The incidence rate of SARD was 9.3 per 10000 person-years in women without infertility, 12.5 per 10000 person-years in those with infertility and no fertility treatment, 10.9 per 10000 person-years following non-invasive fertility treatment, and 10.9 per 10000 person-years after invasive fertility treatment. Infertility without treatment was associated with an elevated risk of SARD, even after accounting for adverse pregnancy outcomes (controlled direct effect HR 1.25, 95% CI 1.12-1.40). Neither non-invasive (total effect HR 1.06, 95% CI 0.79-1.42) nor invasive (total effect HR 0.97, 95% CI 0.69-1.36) fertility treatments were associated with SARD. Exposure and outcome misclassification is possible as this study used published algorithms in health administrative data with unknown or imperfect sensitivity and specificity. Data on individual-level social and lifestyle factors and underlying causes of infertility were not available and thus were not included in the analysis. Infertility in the absence of fertility treatment may be an important risk marker for SARD in women who give birth. Greater health provider awareness of SARD symptoms and related gynaecological issues that may be present in women with infertility could facilitate earlier detection and treatment of SARD during the reproductive years. This research was funded by the Canadian Institutes of Health Research through a Banting Postdoctoral Fellowship to N.V.S. and Canada Research Chair to H.K.B. (2019-00158) and was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Long-Term Care. The analyses, conclusions, opinions, and statements expressed herein are solely those of the authors and do not reflect those of the funding organizations; no endorsement is intended or should be inferred. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. M.Y.C. has consulted for Celltrion, Werfen, Organon, MitogenDx, AstraZeneca, Mallinckrodt Canada Inc, and Glaxo Smith Kline. All other authors have no conflicts of interest. N/A.

Optimizing Long COVID Outcomes: An Interdisciplinary Survey of U.S. Rehabilitation Providers

Purpose: Clinical practice guidelines (CPGs) can optimize Long COVID rehabilitation outcomes; however, an understanding of the target condition and available resources influence the adoption of CPGs. This study explored rehabilitation provider's awareness of Long COVID and their use of associated CPGs within the United States. Methods: A cross-sectional sample of 300 rehabilitation providers (100 physical therapists, 100 occupational therapists, 100 speech-language pathologists) were randomly selected from the state with the highest prevalence of Long COVID within each of the 9 U.S. geographic divisions. A total of 2700 participants were invited to complete a survey exploring their awareness of Long COVID and use of CPGs. Results: Surveys were received from 299 providers (11.6% response rate) across all identified states and disciplines. Most (70.2%) reported awareness of Long COVID symptomatology. Few were aware of relevant CPGs (12.7%) or used them (7.4%) in practice. Although 39.8% reported awareness of symptom exacerbation triggers, only 8.3% knew of associated screening tools. Similar trends were noted when responses were limited to those who treat Long COVID. Nearly all respondents (88.2%) believed that Long COVID will persist in the rehabilitation community. Conclusion: Rehabilitation providers perceive that they are aware of Long COVID symptomatology, although there is a lack of awareness and application of relevant CPGs across disciplines. Discrepancies between providers' perceived and actual understanding of Long COVID rehabilitation likely exist that can impede outcomes if evidence-based resources are underused. Interdisciplinary initiatives to enhance evidence translation to rehabilitation are needed to optimize Long COVID practice.

Deaf culture awareness among physicians and advanced practice providers in the emergency department: A multicenter study.

In areas with a large Deaf/hard-of-hearing (DHH) population, emergency medicine (EM) providers may benefit from cultural awareness training as this has been shown to foster delivery of more equitable care in other minority populations. Rochester, New York, has been touted to be the home to the largest per-capita DHH population in the United States. Given the large local DHH community and DHH professionals working in Rochester, University of Rochester (UR) providers likely have higher exposure to DHH people than most other EM providers in the United States. All UR providers receive annual institutional cultural sensitivity e-training that includes information about the DHH community. In addition to the e-training, the UR EM residents also receive a workshop during intern year and recurrent DHH culture education throughout their residency. The purpose of this study was to measure impact of preexisting cultural sensitivity training and higher DHH person exposure on DHH cultural awareness in UR providers compared to non-UR EM providers who may have lower DHH person exposure and culture training. In this cross-sectional study, a survey on DHH cultural awareness was distributed to UR and Emergency Research Network in the Empire State (ERNIES) emergency departments. As surrogates for cultural awareness, the survey evaluated providers' exposure, knowledge, comfort, and attitudes to Deaf culture. Descriptive statistics were employed to characterize the sample. Bivariate analysis was performed to compare UR provider responses to others using chi-square and Fisher's exact testing. Of 83 recruited participants, 75 providers completed the survey, and 53/75 (71%) responders were from UR. While high percentages of UR and non-UR participants reported seeing DHH patients recently (98% vs. 96%, respectively), one-third (24/75) of all participants reported having no experience or training on Deaf culture. Compared to only 10% of other providers, one-third of UR providers were better able to identify cultural nuances within the DHH community (p = 0.01). UR providers were significantly less comfortable communicating with Deaf patients via lipreading, which is typically an unreliable/unsafe mode of communication (11% vs. 69%, p = 0.002). When knowledge was assessed, UR providers better identified Deaf patient rights in a clinical setting (89% vs. 77%, p = 0.002). Also, all trainees had significantly higher scores on questions related to Deaf culture compared to all advance practice providers and attendings (mean scores 6.86 vs. 6.06 and 6, respectively, p = 0.03). EM providers with high exposure to DHH people and DHH culture training are more comfortable with and able to better identify nuances of Deaf culture. Additionally, EM providers with DHH culture training are less comfortable communicating using lipreading with DHH patients suggesting increased awareness of a common, yet ineffective and inaccurate, communication pitfall with this population. The study suggests that implementing Deaf culture education in areas with a large DHH population may enhance cultural awareness and comfort of future providers in caring for Deaf patients.

Perspectives of Infectious Disease Physicians on Bartonella quintana Cases, United States, 2014-2024.

In a US survey of infectious disease specialists, 61 respondents reported seeing >1 Bartonella quintana infection during 2014-2024. Diagnostic challenges included limited healthcare provider awareness, inadequate testing, and inconsistent healthcare access among affected populations. Early recognition of B. quintana infections is needed to improve outcomes among affected populations.

Severe and Fatal Rocky Mountain Spotted Fever After Exposure in Tecate, Mexico - California, July 2023-January 2024.

Rocky Mountain spotted fever (RMSF) is a tickborne disease endemic in areas of the Americas. Persistent high incidence of the disease exists in northern Mexico, perpetuated by local populations of brown dog ticks (Rhipicephalus sanguineus sensu lato) and free-roaming dogs. Six cases of RMSF caused by Rickettsia rickettsii, including three deaths, were reported to the California Department of Public Health during July 2023-January 2024. All six patients were eventually determined to have had exposure to R. rickettsii in Tecate, Mexico, a municipality on the U.S. border that had not been previously described as a high-risk RMSF area. Identification and reporting of the cases were complicated by challenges in diagnosis. The serious nature of the disease and delays in initiating appropriate treatment can result in life-threatening consequences. Epidemiologic collaborations among local, state, federal, and international public health agencies were essential to identifying Tecate as the location of exposure. Further collaborations will be important for directing future prevention measures. Increased health care provider awareness of RMSF is critical on both sides of the border to facilitate earlier diagnosis and initiation of appropriate treatment.

Updated guidelines on HIV post-exposure prophylaxis: continued efforts towards increased accessibility.

HIV transmission is ongoing in both high- and low-resource settings. Post-exposure prophylaxis (PEP) remains an important tool in preventing HIV; however, PEP is significantly underutilized. The multitude of barriers to PEP implementation include low patient and provider awareness and acceptability, limited access to treatment and prevention services, and high rates of stigma. The World Health Organization (WHO) recently released updated guidance on the delivery of HIV PEP. This commentary aims to highlight the salient changes, evaluate how such recommendations can overcome the existing barriers to PEP implementation and discuss strategies needed to put the updated guidance into practice. The 2024 WHO PEP guidelines continue a trend towards increasing access to PEP. Most notably, the WHO now provides strong recommendations that: (1) PEP be delivered in community settings (e.g. pharmacies, police stations and online platforms), and (2) PEP delivery and monitoring be done via task sharing involving non-specialist health workers (e.g. pharmacists or community health workers). The guidelines also emphasize that the PEP encounter is an important educable moment whereby a transition to pre-exposure prophylaxis among individuals at continued risk for HIV infection should be discussed. The decentralization of PEP delivery has the potential to overcome numerous barriers to PEP implementation, reduce time to initiation and support adherence with the 28-day course. To translate the recommendations into delivery programmes, however, much more work is needed. Detailed templates can help overcome the heterogeneity of both the community settings in which PEP can now be provided and the populations (e.g. survivors of sexual assault, healthcare workers, sex workers, etc.) among whom PEP may be indicated. Training of the workforce will be essential, which should include, as emphasized by the WHO, training in trauma-based care. Novel formulations of and delivery mechanisms for PEP are also emerging, and how such iterations can synergize with decentralized PEP delivery programmes remains to be seen. The updated WHO PEP guidelines make major strides towards increasing access to PEP. Realization of such aims will require ongoing evaluation and support given the heterogeneity in who benefits most from PEP.

Increasing resuscitation status-related goals of care discussions for older adults with severe mental illness in a Canadian mental health setting: a retrospective study

BackgroundOlder adults with severe mental illness, including advanced dementia (AD), within geriatric admission units (GAU) often prioritise comfort care, avoiding life-prolonging procedures including cardiopulmonary resuscitation (CPR). Pre-2019, hospital policy lacked...

A Quality Improvement Project to Increase Adolescent Vaping Capture and Provider Awareness of Use

A Quality Improvement Project to Increase Adolescent Vaping Capture and Provider Awareness of Use

Conceptual Framework for Community-Based Prevention of Brown Dog Tick-Associated Rocky Mountain Spotted Fever.

Rocky Mountain spotted fever (RMSF) is a severe tickborne disease that can reach epidemic proportions in communities with certain social and ecologic risk factors. In some areas, the case-fatality rate of brown dog tick-associated RMSF is up to 50%. Because of the spread of brown dog tick-associated RMSF in the southwestern United States and northern Mexico, the disease has the potential to emerge and become endemic in other communities that have large populations of free-roaming dogs, brown dog ticks, limited resources, and low provider awareness of the disease. By using a One Health approach, interdisciplinary teams can identify communities at risk and prevent severe or fatal RMSF in humans before cases occur. We have developed a conceptual framework for RMSF prevention to enable communities to identify their RMSF risk level and implement prevention and control strategies.

Health Behavior Frameworks Describing HPV Vaccine Uptake in Adults: A Scoping Review

Human papillomavirus (HPV) is the most prevalent sexually transmitted disease in the United States, and it has been shown to cause a number of different cancers, namely cervical. Fortunately, there is a highly efficacious vaccine that is available to adolescents and adults up to age 45. Vaccination rates in adults have increased over the years but are still low, especially in men. There is a need to understand HPV vaccine-seeking behaviors in adults to better address their concerns, beliefs, and barriers. The purpose of this scoping review is to provide a synthesis of the current literature on health behavior frameworks that have been used to describe HPV vaccine uptake in adults. This review also covers the socioeconomic barriers of adults getting the vaccine. For this review, 33 articles were found and included. The theory of planned behavior, health belief model, and social cognitive theory were the most commonly seen frameworks in the literature. Theoretical constructs that significantly predicted HPV vaccine behavior across the included studies were social norms, attitudes, perceived behavioral control, perceived benefits, perceived susceptibility, perceived severity, perceived barriers, and self-efficacy. Major socioeconomic factors that were described were provider recommendation, knowledge, age, gender, race, awareness, and marital status. This information is critical for public health efforts to better target the adult population with HPV vaccine information and awareness. It is also necessary for providers to better understand patients and their potential barriers to getting the HPV vaccine.

Factors influencing healthcare access for persons with disabilities in Kakamega County, Kenya during COVID-19: A qualitative study

INTRODUCTION Access to healthcare for persons with disabilities is an indicator of the overall effectiveness of the healthcare system in terms of equity, accessibility and the right to health. This study explores factors affecting access to healthcare among persons with disabilities in Kakamega County in the context of COVID-19. MATERIALS AND METHODS Materials used in this study are part of a larger study that looked at access to healthcare and its effect on the quality of life of persons with disabilities in Kakamega County. In this paper, we present data generated from the qualitative component of the study that comprised 7 focus group discussions, 15 in-depth interviews, and 8 key informants who provided contextual information on health services for persons with disabilities. Data was coded and analysed thematically. RESULTS The study established key barriers to healthcare access for persons with disabilities during the COVID-19 pandemic period ranging from availability, affordability, discrimination, accommodation, assistive devices, and appropriateness of healthcare. In addition, the results show that these obstacles are not limited to the pandemic, but represent everyday challenges that persons with disability experience; but were exacerbated during the pandemic. CONCLUSION AND RECOMMENDATIONS This study highlights the need for disability-friendly infrastructure in healthcare facilities, subsidized medical costs, and the provision of assistive technologies to improve healthcare access for persons with disabilities. We also recommend increasing community and provider awareness of disability rights, enforcing existing laws and policies, and ensuring equal employment opportunities to support full social participation for individuals with disabilities.