Central Access Research Articles

Racial and ethnicassociations with comprehensive cancer center access and clinical trial enrollment for acute leukemia.

Clinical trial participation at Comprehensive Cancer Centers (CCC) is inequitable for minoritized racial and ethnic groups with acute leukemia. CCCs care for a high proportion of adults with acute leukemia. It is unclear if participation inequities are due to CCC access, post-access enrollment, or both. We conducted a retrospective cohort study of adults with acute leukemia (2010-2019) residing within Massachusetts, the designated catchment area of the Dana-Farber/Harvard Cancer Center (DF/HCC). Individuals were categorized as non-Hispanic Asian (NHA), Black (NHB), White (NHW), Hispanic White (HW), or Other. Decomposition analyses assessed covariate contributions to disparities in (1) access to DF/HCC care and (2) post-access enrollment. Of 3698 individuals with acute leukemia, 85.9% were NHW, 4.5% HW, 4.3% NHB, 3.7% NHA, and 1.3% Other. Access was lower for HW (age- and sex-adjusted OR = 0.64, 95% CI = 0.45 to 0.90) and reduced post-access enrollment for HW (aOR = 0.54, 95% CI =0.34 to 0.86) and NHB (aOR = 0.60, 95% CI = 0.39 to 0.92) compared to NHW. Payor and socioeconomic status (SES) accounted for 25.2% and 21.2% of the +1.1% absolute difference in HW access. Marital status and SES accounted for 8.0% and 7.0% of the -8.8% absolute disparity in HW enrollment; 76.4% of the disparity was unexplained. SES and marital status accounted for 8.2% and 7.1% of the -9.1% absolute disparity in NHB enrollment; 73.0% of the disparity was unexplained. A substantial proportion of racial and ethnic inequities in acute leukemia trial enrollment at CCCs are from post-access enrollment, the majority of which was not explained by sociodemographic factors.

Accessibility of Urban Tourism in Historical Areas: Analysis of UNESCO World Heritage Sites in Safranbolu

Expansion of cities with population growth leads to the differentiation of urban texture, negatively affecting the accessibility of tourism areas in historical regions. For this reason, there is a need to develop tourism areas that enable people to experience the areas of historical heritage. Sustainable urban development, which is also the theory of the study, has become an agenda for the protection and revitalization of historical areas in order to increase accessibility to tourism. The Safranbolu Protected Area, which is one of the oldest settlements with its traditional housing texture and which is included in the UNESCO World Heritage Sites List in Turkey, was chosen as the study area. In this study, the aim is to examine the accessibility of historical tourism centers, analyze the spatial configuration of the street texture in the city of Karabük and determine the features of the formation mechanism of the Safranbolu historical region. The research questions are based on the impact of (1) the accessibility of the street network on the formation mechanism of the urban architecture and (2) the shaping of urban tourism areas in historical cities. The space syntax method was used to examine the relationship between the building features of the Safranbolu Urban Protected Area and the formation features of the space. Within the scope of the study, the accessibility of the Safranbolu historical center was examined through the street texture that shapes the city form using data from Open Street Map. Segment and axial analyses were made based on the current street network data of the city. The key findings of the research revealed that the accessibility level of the city’s street network was practically effective in shaping the Safranbolu Urban Protected Area. It was theoretically found that the streets with a high global integration value in the city have an impact on the shaping of traditional architecture and constitute important routes for tourism in sustainable development. The findings serve as a reference for researchers in sustainable development, urban planners and local governments who will use it to test the methodology for understanding the street layout of the historical area and improving the experiential characteristics of the users.

Continual learning framework for a multicenter study with an application to electrocardiogram

Deep learning has been increasingly utilized in the medical field and achieved many goals. Since the size of data dominates the performance of deep learning, several medical institutions are conducting joint research to obtain as much data as possible. However, sharing data is usually prohibited owing to the risk of privacy invasion. Federated learning is a reasonable idea to train distributed multicenter data without direct access; however, a central server to merge and distribute models is needed, which is expensive and hardly approved due to various legal regulations. This paper proposes a continual learning framework for a multicenter study, which does not require a central server and can prevent catastrophic forgetting of previously trained knowledge. The proposed framework contains the continual learning method selection process, assuming that a single method is not omnipotent for all involved datasets in a real-world setting and that there could be a proper method to be selected for specific data. We utilized the fake data based on a generative adversarial network to evaluate methods prospectively, not ex post facto. We used four independent electrocardiogram datasets for a multicenter study and trained the arrhythmia detection model. Our proposed framework was evaluated against supervised and federated learning methods, as well as finetuning approaches that do not include any regulation to preserve previous knowledge. Even without a central server and access to the past data, our framework achieved stable performance (AUROC 0.897) across all involved datasets, achieving comparable performance to federated learning (AUROC 0.901).

Managing End of Life Care for the Critically Ill: A Novel Program to Deliver Bedside Critical Care Without Transfer to the Intensive Care Unit

Background: Navigating medical care at the end of life can be a challenging experience for patients. There are also significant resource burdens, including intensive care unit (ICU) admissions, accompanying terminal illness. For actively dying patients, developing a care plan based on patient goals and delivering care at the bedside can enhance patient well-being, avoid inappropriate transfers or interventions, and improve resource management. Methods: The Rapid Response Team (RRT) is an around the clock intensivist service that responds to all acutely decompensating patients in our hospital. Through the Appropriate Care Escalation (ACE) program, the RRT intensivist identifies amongst decompensating patients, terminally ill individuals for whom prognosis is extremely poor irrespective of available interventions. These patients receive discussions about goals of care, code status, and management options. They receive care on a dedicated stepdown unit without escalation to the ICU. If aligned with patient goals, care plans incorporate critical care interventions including ventilator and vasopressor therapy. Results: Over 5 years, RRT identified 413 terminally ill patients under the ACE program to continue end of life care on the stepdown unit. Following discussions of goals, 60.8% of patients requested DNR/DNI, 30.9% were full code, and 8.5% requested DNR/OK-TO-INTUBATE status. At discharge, 82.1% of ACE patients expired compared to 23% of all RRT consultations. Patients received 233 critical care procedures at bedside including intubations, central access catheters and bronchoscopy. Conclusion: The ACE program helped identify, in real time, actively dying, terminally ill patients, establish patient goals, and expand critical care services outside the ICU.

Influence of gastric residual assessment in preterm neonates on time to achieve enteral feeding (the GRASS trial)—Multi-centre, assessor-blinded randomised clinical trial

PurposeGastric residual measurement is routinely performed in premature infants prior to feeding despite a lack of evidence of benefit. We aimed to evaluate if the exclusion of routine gastric residual measurement and evaluation has an impact on the time taken to achieve full enteral feeding in preterm neonates.MethodsInternational multi-centre randomised controlled trial. Clinically stable, appropriate for gestational age infants between 26+0 and 30+6 weeks of gestation and less than 1.5 kg birth weight were eligible. Infants were randomised to the intervention arm (no monitoring of gastric aspirates) or control arm (routine care). Primary outcome was the achievement of enteral feeds of 100 ml/kg/day by day 5 of life.ResultsNinety-five infants were recruited with 88 included in an intention-to-treat analysis, 45 in the intervention arm and 43 in the control arm. There was no imbalance in baseline characteristics. Thirty-three (73.3%) infants in the intervention group and 32 infants (74.4%) in the control group reached full feeds by day 5 of life (p = 0.91) with no difference in median time to full feeds. There were no statistically significant differences in survival or the major morbidities of prematurity. Conclusion: There was no difference in time to attainment of enteral feeds of 100 ml/kg/day in premature infants when gastric residuals were not monitored. In the absence of a clinical benefit to routine monitoring, it may be appropriate to discontinue this practice and only monitor residuals when clinical concern of feeding intolerance or gastrointestinal pathology arises in this group of patients.Trial registration: NCT03111329—https://clinicaltrials.gov/. Registered 06/04/2017.What is Known:• Previous randomized trials have shown little benefit to the performance of routine assessment of gastric residuals in preterm infants. Despite this, they continue to be performed due to concerns from observational data regarding development of NEC. Meta-analysis to date has failed to answer the question regarding NEC.What is New:• In very low birth weight infants who are fed using modern feeding practice of faster feed advancement, to minimize use of central access and parenteral nutrition, exclusion of routine checks of gastric residuals did not increase the proportion of infants reaching full enteral feeds by day 5. No harm was seen when residual checks were not performed.• In the absence of a clinical benefit to the routine performance of gastric residuals in very low birth weight infants, it may be appropriate to discontinue their use and instead check residuals when clinical concern of pathology arises.

Abstract TMP41: Mapping Accessibility Differences of Acute Stroke Centers in the United States

Background: One of the keys to mitigating adverse outcomes of an ischemic or hemorrhagic stroke is timely access to a stroke center. Every minute of a large vessel occlusion results in the mean loss rate of 2 million neurons. Every 20-minute reduction in time to reperfusion increases disability-free lifespan by 3 months. For intracerebral hemorrhage, early intensive blood pressure lowering within 2 hours of onset improved outcomes . For aneurysmal subarachnoid hemorrhage, more than one-third of rebleeds occur within 3 hours. Accessibility of acute stroke centers varies drastically across the United States, both between states and between localities. There is a need to characterize accessibility not only based on the population and distance to the nearest center but also using average travel time per area. Methods: To understand the accessibility of the 2,446 stroke centers in the US we performed geospatial mapping by combining distance and average travel time as part of an interactive map. The map can be used to visually identify regions lacking timely access to a stroke center. Through linking highly granular demographic and socio-economic census data, we can better understand populations effected by long travel times. To identify the nearest stroke center for every census tract in the US, the distance between centroids and the KNN algorithm was used. By adding the average commute times of the counties that intersected the straight line, travel time to the nearest stroke center was estimated. Results: Approximately 45 million people live over 90 minutes away from a stroke center. Increasing stroke center access should be prioritized for populations over 1.5 hours from the nearest stroke center. The map highlights regions of particular concern with 2.5 - 4+ hour travel times (Fig. 1). Conclusion: We demonstrate that accessibility differences of stroke centers can be better understood using an interactive map. Our map highlights regions and populations in need of a stroke center.

Mortality in Women with Coronary Artery Disease in Paraná State, Brazil: A Bayesian Spatiotemporal Analysis.

Mortality resulting from coronary artery disease (CAD) among women is a complex issue influenced by many factors that encompass not only biological distinctions but also sociocultural, economic, and healthcare-related components. Understanding these factors is crucial to enhance healthcare provisions. Therefore, this study seeks to identify the social and clinical variables related to the risk of mortality caused by CAD in women aged 50 to 79 years old in Paraná state, Brazil, between 2010 and 2019. This is an ecological study based on secondary data sourced from E-Gestor, IPARDES, and DATASUS. We developed a model that integrates both raw and standardized coronary artery disease (CAD) mortality rates, along with sociodemographic and healthcare service variables. We employed Bayesian spatiotemporal analysis with Markov Chain Monte Carlo simulations to assess the relative risk of CAD mortality, focusing specifically on women across the state of Paraná. A total of 14,603 deaths from CAD occurred between 2010 and 2019. Overall, temporal analysis indicates that the risk of CAD mortality decreased by around 22.6% between 2010 (RR of 1.06) and 2019 (RR of 0.82). This decline was most prominent after 2014. The exercise stress testing rate, accessibility of cardiology centers, and IPARDES municipal performance index contributed to the reduction of CAD mortality by approximately 4%, 8%, and 34%, respectively. However, locally, regions in the Central-West, Central-South, Central-East, and Southern regions of the Central-North parts of the state exhibited risks higher-than-expected. In the last decade, CAD-related deaths among women in Paraná state decreased. This was influenced by more exercise stress testing, better access to cardiology centers, improved municipal performance index. Yet, elevated risks of deaths persist in certain regions due to medical disparities and varying municipal development. Therefore, prioritizing strategies to enhance women's access to cardiovascular healthcare in less developed regions is crucial.

Abstract 26: Regional Inequities in Access to Stroke Facilities in India - Estimating Travel Distance and Times for Thrombolysis and Thrombectomy

Introduction: Stroke is a global health concern, with its impact more pronounced in low- and middle-income countries like India. The access to acute stroke treatments, especially intravenour thrombolysis and mechanical thrombectomy, is limited. This research dives into the regional variations in the distribution and accessibility of stroke centers in India. Methods: Data on stroke centers, including those capable of intravenous thrombolysis (IVT) and endovascular treatment (EVT), was gathered from pertinent medication and device providers and geocoded. We estimated driving distances and travel durations between population centers and their proximate IVT and EVT stroke facilities using Google Distance Matrix API, which provided gross estimations. We then compared the estimates across different zones to look at regional disparities in access to stroke facilities. Results: Of the 566 IVT-capable centers spread across 26 states/UTs, 361 (63%) were equipped for EVT. The average stroke centres per million (SCPM) population was 0.41 and 0.26 for IVT-C and EVT-C, respectively. Majority of stroke centres were located in the south zone (>35%), followed by the western and central zones, while the north, east and northeast zones collectively accounted for just 15% of stroke facilities. Median travel distances to IVT and EVT centers were 114 km and 140 km, respectively. Median travel durations to access IVT and EVT facilities stood at 3.04 and 3.46 hours, respectively. The median duration in the south zone for IVT-C and EVT-C centers was 2 and 2.5 Conclusions: The findings of this gross estimations a comprehensive view of stroke care infrastructure in India, highlighting significant regional disparities. The substantial travel times and distinct inconsistencies in stroke care facility availability underscore the need for strategic policy interventions and focused interventions, particularly in underserved regions.

Vascular Access Team Central Line Dressing Changes to Reduce Infection Risk: A Focused Two-Person Approach in High-Risk Patients.

Due to low compliance by bedside nursing with a central line-associated bloodstream infection (CLABSI) prevention bundle and increased CLABSI rates, a mandatory re-education initiative at a 1200-bed university-affiliated hospital was undertaken. Despite this, 2 units, housing high-risk immunocompromised patients, continued to experience increased CLABSI rates. A quality improvement before-after project design in these units replaced bedside nursing staff with 2 nurses from the vascular access team (VAT) to perform central vascular access device (CVAD) dressing changes routinely every 7 days or earlier if needed. The VAT consistently followed the bundled components, including use of chlorhexidine gluconate (CHG)-impregnated dressings on all patients unless an allergy was identified. In this case, a non-CHG transparent semipermeable membrane dressing was used. There were 884 patients with 14 211 CVAD days in the preimplementation period and 1136 patients with 14 225 CVAD days during the postimplementation period. The VAT saw 602 (53.0%) of the 1136 patients, performing at least 1 dressing change in 98% of the patients (n = 589). The combined CLABSI rate for the 2 units decreased from 2.53 per 1000 CVAD days preintervention to 1.62 per 1000 CVAD days postintervention. The estimated incidence rate ratio (IRR) for the intervention was 0.639, a 36.1% reduction in monthly CLABSI rates during the postimplementation period.

Implementing a 4% EDTA Central Catheter Locking Solution as a Quality Improvement Project in a Large Canadian Hospital.

Oncology and critical care patients often require central vascular access devices (CVADs), which can make them prone to central line-associated bloodstream infections (CLABSIs) and thrombotic occlusions. According to the literature, CLABSIs are rampant and increased by 63% during the COVID-19 pandemic, highlighting the need for innovative interventions. Four percent ethylenediaminetetraacetic acid (4% EDTA) is an antimicrobial locking solution that reduces CLABSIs, thrombotic occlusions, and biofilm. This retrospective pre-post quality improvement project determined if 4% EDTA could improve patient safety by decreasing CLABSIs and central catheter occlusions. This was implemented in all adult cancer and critical care units at a regional cancer hospital and center. Before implementing 4% EDTA, there were 36 CLABSI cases in 16months (27 annualized). After implementation, there were 6 cases in 6months (12 annualized), showing a statistically significant decrease of 59% in CLABSIs per 1000 catheter days. However, there was no significant difference in occlusions (alteplase use). Eighty-eight percent of patients had either a positive or neutral outlook, while most nurses reported needing 4% EDTA to be available in prefilled syringes. The pandemic and nursing shortages may have influenced the results; hence, randomized controlled trials are needed to establish a causal relationship between 4% EDTA and CLABSIs and occlusions.

Covid-19 Pandemi Sürecinde Sağlıklı Çocuk Takibi ve Kronik Hastalık Kontrollerinin Sürekliliği ve Pandeminin Poliklinik Başvurularına Erken ve Geç Dönemdeki Etkisinin Karşılaştırılması

Aim: Pandemic disrupted health care access in many centers all around the world. CDC recommended that seperating pandemic and non-pandemic hospitals, prioritizing emergency visits, postponing elective operations and, where possible, converting outpatient visits to telehealth calls. In this period, well-child checkups were cancelled and routine childhood vaccination was interrupted. We aimed to evaluate the impact of pandemic on the routine immunization schedule, neonatal screening program, chronic disease follow ups and outpatient clinic visits. 
 Material and Method: In total, 401 children and their parents were included in this study and patient population of interest was children of routine immunization age. Outpatient visit features and compliance with the childhood vaccination and neonatal screening program before and during the pandemic were asked. 
 Results: Compared to 2021, there was a significant increase in both the number of patients with upper respiratory tract infection symptoms and their hospital admissions. While the rates of hospital admissions increased in 2022 in those with diarrhea, almost all of the patients with lower respiratory tract infection symptoms stated that they applied to the hospital in both periods. It was observed that routine vaccination and newborn screening programs were carried out successfully during the pandemic process in Turkey. It was found that chronic disease follow-ups of children were interrupted in 2021. 
 Conclusion: This study has shown how the 3 major components of health system (outpatient clinic visits, well child check-ups and chronic disease follow-ups) were affected at different times of the pandemic in Turkey. Successful management in childhood vaccinations and neonatal screening program should also be ensured in chronic disease follow-up bythe separation of pandemic and non-pandemic hospitals. Showing the strengths and weaknesses of strategies implemented in health system during the pandemic guides the measures to be taken for similar situations that may occur in the future.

Priority populations’ experiences of the accessibility and inclusion of recreation centres: a qualitative study

BackgroundAlthough the health benefits of physical activity are well documented, certain priority populations are often disproportionately insufficiently active and at higher risk of poor health. Recreation centres have the potential to provide accessible and supportive environments for physical activity for all. However, little is known about priority populations’ experiences of these venues and their views of how accessibility and inclusion can be optimised. This study aimed to gain in-depth insights of recreation centre experiences and potential strategies for improving inclusion and accessibility amongst priority populations (women, older adults, ethnic minorities, persons living with disabilities/additional needs, individuals identifying as LGBTQIA+, low socio-economic position).MethodsThis qualitative study (2021–2022) involved 18 semi-structured individual interviews with adult priority population users of recreation centres (50% 65 + years, 61.2% female) in one Melbourne municipality. Participants were asked to discuss their positive and negative experiences at the centres and to identify strategies for enhancing accessibility and inclusion. Interviews were audio-recorded and transcribed verbatim. Content analysis was performed for data analysis.ResultsWhile many participants had positive views of the facilities and programs at the centres, as they met their needs, they also had suggestions for improving accessibility and inclusion. Similarly, most participants were happy with the communications, felt included, and perceived the culture positively. Those who did not feel included at the centres offered many potential strategies for changing the culture, modifying communications (e.g., signage), and establishing partnerships for better access and inclusion.ConclusionsThe present study adds to essential knowledge concerning priority populations’ experiences of recreation centres. For recreation facilities that were generally perceived as having positive inclusion and accessibility, the findings nonetheless highlighted suggestions for further enhancement. These strategies may be useful more broadly for improving accessibility and inclusion, thereby promoting physical activity and ultimately health for all.

Measuring the Accessibility and Capacity Sufficiency of Private and Public Health Centers in the Istanbul Metropolitan Area

Measuring the Accessibility and Capacity Sufficiency of Private and Public Health Centers in the Istanbul Metropolitan Area

PERCUTANEOUS TRANSLUMINAL ANGIOPLASTY IN SUBCLAVIAN VEIN STENOSIS CAUSED BY CENTRAL VENOUS CATHETERIZATION FOR HEMODIALYSIS ACCESS IN CHRONIC KIDNEY DISEASE PATIENTS

Introduction: The increased of central vein access for hemodialysis in chronic kidney disease patients has led to increase of side effect in clinically relevant stenosis of subclavian vein. One of therapeutic options to solve stenosis of subclavian vein is endovascular treatment Percutaneous Transluminal Angioplasty (PTA) . Objectives: To show our experience in treating subclavian vein stenosis using Endovacular treatment Percutaneous Transluminal Angioplasty (PTA). Materials and Methods: A retrospective study in 62 chronic kidney disease patients who undergo hemodyalisis with stenosis of subclavian vein treated with PTA in 3 hospitals in Surabaya from October 2017-October 2020 with range age 18-70 years was conducted . Results: We performed PTA for subclavian vein stenosis in 62 cases. Partial stenosis was found in 35 cases and total occlusion in 27 cases. For 27 total occlusion cases, 19 cases can still be opened, but 8 cases can’t be opened or recanalization and we drop out these patient. 54 cases (87%) were good and 8 cases (13%) can’t be open. The result of PTA in treating stenosis of subclavian vein was good. The result of reduced in arm swelling and using doppler USG follow up are 100%(54/54) after 1 month, 100%(54/54) after 3 months, 90.7% (49/54) after 6 months. Conclusion: Percutaneous Transluminal Angioplasty (PTA) is effective in treating subclavian vein stenosis reliefe its symptomps. The patency rate is 90.7% after 6 months post procedure of PTA.

Nutritional status and its relationship with COVID-19 prognosis in hemodialysis patients.

Introduction: among the groups more affected by the COVID-19 pandemic were patients undergoing chronic hemodialysis (HD) treatment due to their comorbidities, advanced age, impaired innate and adaptive immune function, and increased nutritional risk due to their underlying inflammatory state. All of these factors contribute to a higher risk of severe complications and worse outcomes compared to the general population when infected with SARS-CoV-2. Objective: the objective of this study was to describe the nutritional characteristics of and their potential association with the prognosis of COVID-19 in patients undergoing chronic HD treatment. Method: a descriptive, retrospective, observational design. All cases of COVID-19 in patients undergoing chronic treatment at the Hemodialysis Unit of Hospital de Manises, Valencia, Spain, from the start of the pandemic to before vaccination were included. Results: for that, 189 patients were studied, who received chronic HD treatment in the hospital unit, 22 patients were diagnosed with COVID-19 (12 %) in that period. The mean age was 71 years, 10 were women, the Charlson index was 6.59 points, diabetes mellitus 10, vintage HD 51.6 months, 2 patients had previously received a currently non-functioning kidney transplant, 16 had arteriovenous fistula as vascular access, and 6 had central vascular access. The mean dialysis session time was 220.14 minutes and the initial value of the single dose of the Kt/V pool was 1.7. 16 patients had body composition measurement, a strong association (p < 0.05) was identified between mortality and BMI, as well as mortality and FTI. Furthermore, the differences between deceased and surviving groups in the serum levels of various variables related to nutritional status were analyzed, finding significant differences with p < 0.05 in the value of triglycerides and ferritin. Conclusions: higher body mass index and higher body fat content, along with lower baseline levels of triglycerides and ferritin, were significantly associated with higher COVID-19 mortality in patients on chronic hemodialysis. These findings suggest that the initial nutritional status of these patients can significantly influence the prognosis of SARS-CoV-2 infection.

Transradial Approach to Coronary Interventions in Central Nepal

Background The transradial approach (TRA) has gained popularity worldwide and it is the preferred access in many cardiac centers in Nepal. The aim of this study is to document single operator experience with TRA and its complications. Results A total of 214 patients were included with 114(53.27%) males and 100(46.73%) females. The mean age was (62.51 ± 12.47) years. The total transradial success rate was 88.78% for Coronary interventions. The crossover rate from radial to femoral access was 11.22%. The primary causes for crossover were severe tortuosity of the aorta and brachiocephalic trunk, radial artery spasm, puncture failure, and radial loop. Conclusions TRA is safe and can be applied in the majority of cases. The routine assessment of dual hand circulation before TRA might not be necessary.

Students’ Perceptions of the Digital Access Centres at the University of South Africa

This paper sought to investigate the accessibility of Digital Access Centres as a resource for Unisa Students needing to access services away from campus. The Digital Access Centres are available in open-distance e-learning institutions like Unisa in a quest to reach students. Unisa regional computer labs are always fully packed with students queuing to access the computers to access online platforms to write and submit assignments. Students are also expected to use Digital Access Centres to access support services instead of travelling long distances to regional offices or campuses. This study investigated UNISA students’ perceptions and knowledge of Digital Access Centres. A qualitative research methodology was used. Data was generated through semi-structured interviews with thirteen students. The sample was drawn from a population of students who visit computer labs at the Gauteng Regional Service Centre. The data collected revealed that students do not know about Digital Access Centres despite information being available on myUnisa and myChoice brochures. The findings also revealed that few students are accessing Digital Access Centres, and those who visited the centres, indicated that the centres are not fully operational and struggle with connectivity.

Overview of Patient Safety Culture with the AHRQ Model at General Hospital

A healthy latrine coverage rate of 100% is the goal for the Krueng Sabee Health Center's access to proper sanitation program of the 11 villages in the Krueng Sabee Health Center's service area, 4 villages (36.36%) have access to healthy latrines, while 7 villages (63.64%) do not. The latrine ownership rate at the center is 36.36%, but this figure is still short of the target. Sampling approach used in combination study (mixed methodologies research) 95 samples were randomly selected using quantitative techniques, while 9 informants were chosen using qualitative techniques. Logistic regression tests were used to examine quantitative data on a univariate, bivariate, and multivariate basis. data that has been transformed into a qualitative form for presentation and conclusion-making. Quantitative research results: Logistic regression test results: education level OR= 3,452, income level OR= 80,695, knowledge OR= 4,717, attitude OR= 43,982 and social culture OR= 0.647, income level is the dominant independent variable that influences family latrine ownership with the OR value = 80,695. The results of the qualitative analysis show that the majority of families do not have toilets, due to low income levels. Conclusion: level of education, attitudes, social culture towards ownership. Interview results play an active role in providing information, counseling and explaining the importance of family latrine ownership. Village officials who facilitate support for latrine ownership allocate data on assistance for latrine construction in limited quantities. It is recommended that the Health Service evaluate and integrate related programs in increasing latrine coverage in its working areas.

Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization.

Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere's formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization.

Analysis of Efforts to Achieve Performance-Based Capitation Indicators Talang Banjar Public Health Center

Introduction: Performance-Based Capitation Policy is an effort to ensure FKTP performance to improve satisfaction, service quality and cost efficiency. Preliminary study, the capitation payment of the Talang Banjar Public Health Center in 2022 is only 88% with the achievement of AK 64.93 per mile, RRNS 2.12%, and RPPT 0.55%. Objective: This study aims to analyze efforts to achieve KBK indicators at Talang Banjar Public Health Center based on input and process aspects. Method: This research is qualitative research with a descriptive approach with data collection using observation, document review and in-depth interviews with 15 informants who were selected by purposive sampling. Result and Discussion: The results show that the achievement of KBK Public Health Center indicators is influenced by available inputs, namely health human resources, infrastructure, funds, and methods. The process aspect shows obstacles to achieving contact number indicators, namely difficulties in Public Health Center accessibility, promotional and preventive efforts that are not optimal, as well as reporting healthy visits, non-specialist referral indicators are influenced by the behavior of patients who want to be referred and the availability of medical devices, while controlled prolanist indicators are influenced by the difficulty of routine monitoring of officers to participants. Conclusion: A thorough evaluation is needed from BPJS Kesehatan, Dinas Kesehatan and Public Health Center leaders to identify problems that arise in achieving performance indicators as an effort to ensure the quality of service to NHI participants