Comprehensive Management Program Research Articles

Blood eosinophils levels in a Colombian cohort of biomass-and tobacco-related COPD patients.

Chronic obstructive pulmonary disease (COPD) is a major cause of illness and death among adults. In 2019, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy incorporated blood eosinophils as a biomarker to identify patients at increased risk of exacerbations which, with the history of exacerbations during the previous year, allows identification of patients who would benefit from anti-inflammatory treatment to reduce the risk of future exacerbations. The aim of this study was to describe demographic and clinical characteristics, eosinophil counts, and exacerbations in a cohort of COPD patients stratified by clinical phenotypes (non-exacerbator, frequent exacerbator, asthma-COPD overlap) in a Colombian cohort at 2600 meters above sea level. A descriptive analysis of a historical cohort of patients with a confirmed diagnosis of moderate to severe COPD (FEV1/FVC < 0.7 and at least one risk factor for COPD) from two specialized centers with comprehensive disease management programs was performed from January 2015 to March 2019. Data were extracted from medical records 1 year before and after the index date. 200 patients were included (GOLD B: 156, GOLD E: 44; 2023 GOLD classification); mean age was 77.9 (SD 7.9) years; 48% were women, and 52% had biomass exposure as a COPD risk factor. The mean FEV1/FVC was 53.4% (SD 9.8), with an FEV1 of 52.7% (20.7). No differences were observed between clinical phenotypes in terms of airflow limitation. The geometric mean of absolute blood eosinophils was 197.58 (SD 2.09) cells/μL (range 0 to 3,020). Mean blood eosinophil count was higher in patients with smoking history and frequent exacerbators. At least one moderate and one severe exacerbation occurred in the previous year in 44 and 8% of patients, respectively; during the follow-up year 152 exacerbations were registered, 122 (80%) moderate and 30 (20%) severe. The highest rate of exacerbations in the follow-up year occurred in the subgroup of patients with the frequent exacerbator phenotype and eosinophils ≥300 cells/μL. In this cohort, the frequency of biomass exposure as a risk factor is considerable. High blood eosinophil count was related to smoking, and to the frequent exacerbator phenotype.

Prioritization of control measures in leakage scenario using Hendershot theory and FBWM-TOPSIS.

Currently, there is increasing concern about the safety and leakage of process industries. Therefore, the present study aims to prioritize control measures before and after the leakage scenario by using the Hendershot theory and MCDM techniques. In this study, two proactive and reactive layers were selected before and after leakage of tanks, respectively. Then, criteria and alternatives were selected to perform fuzzy TOPSIS (FTOPSIS) and find the best alternative based on the literature review and Hendershot approach. The linear model of the fuzzy Best-Worst method (FBWM) was constructed and resolved using Lingo 17 software. Subsequently, criteria were assigned weights based on thorough calculations of the inconsistency rate. The weight of study experts was equal to 0.25. The results of FBWM showed that the reliability index with a weight of 0.3727 was ranked first and the inconsistency rate ([Formula: see text]) was calculated to be equal to 0.040. Inherent Safety Design (ISD) (0.899) and passive safety (0.767) also ranked first before and after tank leaks, respectively. Using the FBWM method leads to fewer pairwise comparisons and at the same time more stability. Although ISD and passive strategies are more valid and strict, elements of all strategies are necessary for a comprehensive process safety management program.

Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital

IntroductionThe intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. MethodsA retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. ResultsThe study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. ConclusionThis study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.

Chemical management in electronics manufacturing: Protecting worker health and the environment

In the realm of electronics manufacturing, the management of chemicals is paramount to safeguarding both worker health and environmental sustainability. This review delves into the strategies and challenges associated with chemical management within this industry. The utilization of various chemicals in electronics manufacturing processes presents potential hazards to both workers and the environment. From cleaning agents to solvents and fluxes, these substances pose risks ranging from acute toxicity to long-term health effects and environmental contamination. Effective chemical management strategies are therefore indispensable. This review discusses the proactive measures implemented by electronics manufacturers to mitigate these risks. It explores the adoption of alternative, less hazardous chemicals and the implementation of engineering controls to minimize exposure. Additionally, stringent protocols for handling, storage, and disposal are essential components of comprehensive chemical management programs. Furthermore, regulatory frameworks play a pivotal role in shaping chemical management practices within the electronics manufacturing sector. Compliance with local and international regulations such as REACH (Registration, Evaluation, Authorization, and Restriction of Chemicals) and RoHS (Restriction of Hazardous Substances) is imperative to ensure the safety of workers and the environment. However, despite these efforts, challenges persist. Balancing the need for innovation and productivity with chemical safety requirements remains a significant challenge for manufacturers. Additionally, global supply chain complexities add another layer of complexity to chemical management efforts. Effective chemical management in electronics manufacturing demands a multi-faceted approach encompassing technological innovation, regulatory compliance, and a commitment to worker health and environmental stewardship. By addressing these challenges collaboratively, the industry can strive towards safer and more sustainable practices.

Resistance of Gastrointestinal Nematodes to Anthelmintics in Sheep Production in Zimbabwe

Introduction: Sheep play a crucial role in enhancing the socio-economic welfare of individuals in numerous nations. Within sub-Saharan Africa, productivity levels are hindered by various factors, such as prevalent diseases, inadequate nutrition, climate variations, predators, severe weather, as well as infestations of both external and internal parasites. The purpose of the present study was to assess the extent of anthelmintic resistance (AR) observed on a sheep farm operating for commercial purposes in Zimbabwe. Materials and methods: Forty female weaner Dorper sheep, averaging 43 kg in body weight, were selected from Ballineety commercial sheep farm in Mashonaland Central, Zimbabwe. These sheep were then divided into four groups of ten each, receiving different treatments including ivermectin, albendazole, levamisole, and no treatment as a control. Each treatment was administered according to the manufacturer’s recommendations. Pre-treatment faecal samples (day zero) and post-treatment (day 14) were collected and subjected to the Faecal Egg Count Reduction Test (FECRT). Anthelminthic resistance was suggested (AR) by the presence of faecal eggs after treatment. Results: All the drugs indicated a decrease in egg counts by less than 90%. The effectiveness of ivermectin, albendazole, and levamisole was measured at 58.5%, 70.1%, and 85.8% respectively. These findings indicate that nematodes have developed resistance to all treatments. The larval cultures of the samples before and after treatment indicated a significant presence of Haemonchus spp. in the pooled samples. In contrast, the quantities of Trichostrongylus spp. and Oesophagostomum spp. were low but present in all treatments. Cooperia spp. was recovered in post-treatment larval cultures of groups that received anthelmintic. The present study reports lower-than-expected efficacy for ivermectin, albendazole, and levamisole based on the reduction of egg excreted post-treatment. Conclusion: A common worms population in sheep are AR in the current study area. Therefore, comprehensive nematode management programs along with complementary eradication strategies are essential for sustainable sheep production.

Greater Than Sevenfold Return on Investment for a Comprehensive Patient Blood Management Program With Equivalent or Improved Outcomes.

Greater Than Sevenfold Return on Investment for a Comprehensive Patient Blood Management Program With Equivalent or Improved Outcomes.

A Comprehensive Patient Blood Management Program During Cardiopulmonary Bypass in Patients Over 60 Years of Age.

There is currently no consensus on the most appropriate blood transfusion strategy for older adults undergoing cardiovascular surgery. We aimed to investigate the potential benefits of the patient blood management (PBM) program specifically for advanced age patients, and to evaluate the relationship of age and PBM in cardiovascular surgery. We collected data from patients over 60 years old who underwent on-pump cardiovascular surgery. We compared transfusion and clinical outcomes between the pre-PBM and post-PBM groups using a propensity score matching method. Then, we conducted a subgroup analysis within the original cohort, specifically focusing on patients aged of 75 and above with multivariable adjusted models. Data of 9703 older adults were analyzed. Red blood cell (RBC) transfusion rates during cardiopulmonary bypass (CPB) (31.6% vs 13.1%, P<0.001), during the operation (50.8% vs 39.0%, P<0.001) and after the operation (5.6% vs 3.1%, P<0.001) were significantly reduced, and mortality and the risk of some adverse events were also reduced after the PBM. Subgroup analysis showed that there was no interaction between age and PBM, and advanced age (over age 75) did not modify the effect of PBM program in reducing RBC transfusion (Pinteraction=0.245), on mortality (Pinteration=0.829) and on certain complications. The comprehensive PBM program could reduce RBC transfusion without adverse outcomes in older patients undergoing CPB. Even patients over age 75 may benefit from a more stringent transfusion indication. Comprehensive blood conservation measures should be applied to optimize the blood management for older patients.

"MAMA's is like a second mom:" Client and Staff Experiences in a Comprehensive Social Risk Care Management Program Within a Perinatal Medical Home.

Addressing persistent racial inequities in preterm birth requires innovative health care approaches. The Los Angeles County Maternity Assessment and Management Access Service Synergy Neighborhood program (MAMA's) is a perinatal medical home program designed to alleviate the impacts of chronic stress by addressing social determinants of health. It reduced odds of preterm birth rates in Black participants, yet it is unclear which program components most contributed to this reduction. This study seeks to understand the experiences of staff and clients within the MAMA's program to identify what factors decrease stress, how the program addresses racism and the challenges and opportunities of optimizing health during the COVID-19 pandemic. 21 staff and 34 clients completed semi-structured interviews from November 2020-December 2021. Separate interview guides for staff and clients explored experiences within the program, experiences during the COVID-19 pandemic, and how racism affects clients. Interviews were recorded and transcribed. Analysis used a phenomenologic framework. Coding was performed using grounded theory to identify themes. Analysis revealed six key themes: Stressors clients face, barriers for undocumented, Latina, and Spanish-speaking clients, exceptional care, emotional support, naming and responding to racism and discrimination, and impacts of COVID-19 pandemic. Staff and clients work together to address social needs in order to address chronic stress and racism in their lives, especially during the COVID-19 pandemic. Interviews revealed relationship building is a cornerstone of the program's success and plays a significant role in alleviating chronic stress in this population.

Comparative study of allopathy and ayurveda for treatment of diabetes mellitus

These days, one of the most prevalent non-communicable diseases is diabetes mellitus. It has an impact on people worldwide of all ages and their families, and it heavily strains national budgets and healthcare systems. In the short term, implementing a comprehensive healthcare management program for individuals with diabetes can result in significant improvements in clinical outcomes and costs. Millions of people throughout the world suffer from diabetes mellitus, a chronic metabolic illness. To avoid complications and enhance the quality of life for those with diabetes, management is crucial. The two main methods used to treat diabetes are Ayurveda, an ancient system of traditional medicine, and Allopathy, a conventional medical system. The purpose of this study is to compare and contrast these two methods for treating diabetes. The study includes a thorough analysis of the research on diabetes treatment in allopathy and ayurveda, as well as clinical studies and expert opinions.

Comprehensive Approach to Opioid Management in a Primary Care Network.

In response to the opioid epidemic, the Centers for Disease Control and Prevention released best practice recommendations for prescribing, yet adoption of these guidelines has been fragmented and frequently met with uncertainty by both patients and providers. This study aims to describe the development and implementation of a comprehensive approach to improving opioid stewardship in a large network of primary care providers. The authors developed a 3-tier approach to opioid management: (1) establishment and implementation of best practices for prescribing opioids, (2) development of a weaning process to decrease opioid doses when the risk outweighs benefits, and (3) support for patients when opioid use disorders were identified. Across 44 primary care practices caring for >223,000 patients, the total number of patients prescribed a chronic opioid decreased from 4848 patients in 2018 to 3106 patients in 2021, a decrease of 36% (P < 0.001). The percent of patients with a controlled substance agreement increased from 13% to 83% (P < 0.001) and the percent of patients completing an annual urine drug screen increased from 17% to 53% (P < 0.001). The number of patients coprescribed benzodiazepines decreased from 1261 patients at baseline to 834 at completion. A total of 6.5% of patients were referred for additional support from a certified alcohol and substance abuse counselor embedded within the program. Overall, the comprehensive opioid management program provided the necessary structure to support opioid prescribing and resulted in improved adherence to best practices, facilitated weaning of opioids when medically appropriate, and enhanced support for patients with opioid use disorders.

Analysis of a 5-year, evidenced-based, rational blood utilisation project in a South African regional hospital.

Blood products are a lifesaving but limited resource, particularly in resource-limited settings. Evidence-based transfusion criteria tailored to local hospitals have shown great promise in reducing costs, minimising shortages, and ameliorating the morbidity and mortality associated with liberal blood product usage. We implemented the "Saving Blood, Saving Lives" project to: promote responsible blood product use and reduce blood product ordering inefficiencies and expenditure. A comprehensive change management programme, preceded by 3 months of clinical department consultation and training, was implemented. A new evidence-based protocol for blood product utilisation was developed, together with an accountability form. This form was used in monthly audit meetings to refine policies, identify new problems, improve communication, and to drive hospital staff accountability and training. The primary measure of the programme's success was the change in the number of red cell concentrate units ordered. Project implementation required minimal time and no additional budget or staff. Annual red cell concentrate usage reduced from 7211 units in year one to 4077 units in year 5 (p < 0.001). Similar reductions were seen in freeze-dried plasma and platelet usage, as well as administrative costs. Total project saving, adjusted to baseline admission numbers, amounted to over R46 million ($2.5 million). As a change management programme centred the "Saving Blood, Saving Lives" project, was able to significantly reduce blood product-related administration and expenditure by implementing evidence-based transfusion criteria. The programme is simple, replicable and cost effective, making it ideally suited for use in resource-constrained environments.

WHEN OLDER ADULTS GOT TRAUMATIC INJURY: EFFECTS OF CASE MANAGEMENT

Abstract Case management can improve patient outcomes from the acute to rehabilitation phase after traumatic injury. However, a lack of evidence on effects of case management in older patients with traumatic injury makes it difficult to translate research findings into practice. The study was to examine the effects of a case management intervention on illness perception, coping strategies used, and quality of life in older patients with traumatic injury across a 9-month span after hospital discharge. A 4-wave longitudinal, experimental design was used in older patients with traumatic injury hospitalized at a regional hospital in Taiwan. Subjects were randomly assigned to case management (experimental) or usual care (control) group. The intervention started during hospitalization and ended with a phone follow-up two weeks post discharge. Illness perception and/or coping strategies used along with health-related quality of life were measured at baseline, 3, 6 and 9 months after discharge. Generalized estimating equations were used for analysis. Findings showed significant differences of illness perceptions at 3 and 6 months as well as coping strategies used at 6 and 9 months after discharge between the two groups. However, no significant difference on quality of life over time between the two groups was found. While case management appears to help older patients with traumatic injury decrease illness perception and better cope with their injury, it does not significantly improve their quality of life nine months after discharge. It is recommended that healthcare professionals develop a comprehensive long-term case management program for older patients with traumatic injury.

Planning and design of three USACE New York District projects

The United States Army Corps of Engineers (USACE) New York District (NYD) has had a tremendous impact on an approximately $6 billion comprehensive coastal storm risk management program in the last 10 years since Hurricane Sandy caused significant damage in the New York (NY) and New Jersey (NJ) area. There was 2013- 2014 emergency repair and restoration to existing beach nourishment and navigation projects, but also USACE NYD accomplished the planning and design for multiple coastal storm risk management projects in the NY and NJ area. Of those projects, specific coastal risk reduction features are described for the Sea Bright to Manasquan, NJ; East Rockaway Inlet to Rockaway Inlet, NY; and Montauk Point Lighthouse Stabilization, NY. The planning and design for these projects exemplifies resilience principles and planned adaptability to withstand the challenges of the dynamic coastal environment. The USACE NYD is faced with numerous challenges such as environmental restrictions, politics, real estate, sea level change, etc.; the magnitude of coastal planning, design and construction that has occurred over these past 10 years for the NYD studies and projects demonstrates the fortitude of collaboration combined with current and innovative engineering principles.

Current status of heart failure management in Vietnam

Heart failure is a growing public health issue with high mortality and hospitalization rates. Comprehensive management programs are needed to improve outcomes and reduce costs. In Vietnam, there are gaps in guideline-directed medical therapy, lack of a multidisciplinary approach, inadequate patient education, and poor continuity from inpatient to outpatient care. However, management programs are evolving with 29 hospitals having established programs. Initial results show improved use of medications, reduced hospitalizations and mortality, and better quality of life in some programs. Challenges remain around resources, costs, patient diversity, and lack of standardization. Standardization initiatives like EuroHeart are working to define common data sets and care standards internationally. Effective programs require optimized hospital treatment, comprehensive discharge planning, structured follow up, and patient selfmanagement support. Further government support, healthcare professional training, public education, research, and regional collaborations are needed to advance heart failure care in Vietnam.

Symptom clusters in breast cancer survivors with and without type 2 diabetes over the cancer trajectory

ObjectiveThis study aimed to investigate symptoms and symptom clusters in breast cancer survivors (BCS) with and without type 2 diabetes across three crucial periods during the cancer trajectory (0-6 months, 12-18 months, and 24-30 months) post-initial chemotherapy. MethodsEight common symptoms in both BCS and individuals with diabetes were identified through natural language processing of electronic health records from January 2007 to December 2018. Exploratory factor analysis was employed to discern symptom clusters, evaluating their stability, consistency, and clinical relevance. ResultsAmong the 4601 BCS in the study, 19.7% (n = 905) had a diabetes diagnosis. Gastrointestinal symptoms and fatigue were prevalent in both groups. While BCS in both groups exhibited an equal number of clusters, the composition of these clusters differed. Symptom clusters varied over time between BCS with and without diabetes. BCS with diabetes demonstrated less stability (repeated clusters) and consistency (same individual symptoms comprising clusters) than their counterparts without diabetes. This suggests that BCS with diabetes may experience distinct symptom clusters at pivotal points in the cancer treatment trajectory. ConclusionsHealthcare providers must be attentive to BCS with diabetes throughout the cancer trajectory, considering intensified and/or unique profiles of symptoms and symptom clusters. Interdisciplinary cancer survivorship models are essential for effective diabetes management in BCS. Implementing a comprehensive diabetes management program throughout the cancer trajectory could alleviate symptoms and symptom clusters, ultimately enhancing health outcomes and potentially reducing healthcare resource utilization.

Social reintegration of fistula survivors in North Central Nigeria: A case for rehabilitation

Obstetric fistula remains one of the neglected forms of chronic maternal morbidity that occurs mainly in low- and middle-income countries. We explored the rehabilitation and reintegration experiences of 15 fistula survivors in North Central Nigeria. We employed a qualitative research design, guided by Constructivist Worldview, involving narrative interviewing technique in conducting in-depth interviews. Key benefits of rehabilitation reported by the participants included socioeconomic-financial empowerment and autonomy, improved social status, and freedom from self-isolation. Additionally, participants experienced positive psychological effects, such as increased self-worth and self-confidence. However, prolonged recovery periods and stigmatization issues were noted as barriers to successful reintegration post rehabilitation. On the other hand, the presence of family and community support, along with the resolution of stigma, were found to be facilitators of social reintegration. Considering the holistic benefits of rehabilitation, we recommend implementing a comprehensive care management program for fistula survivors to facilitate successful social reintegration.

Evidence from a Smoking Management Service in a University Teaching Hospital in Dublin, Ireland monitored by repeat surveys, 1997–2022

St Vincent’s University Hospital (SVUH) has a comprehensive smoking management programme and since 1997 has conducted periodic surveys of inpatients, outpatients, staff and visitors to establish prevalence of smoking and associated attitudes towards the hospital’s smoke-free campus policy pioneered in 2009. We report trends and describe also the online community stop smoking course (SSC) developed more recently in response to COVID-19. A questionnaire examining attitudes and smoking status was administered by census surveys of inpatients, quota or random sub-sample surveys of staff, and quota surveys with outpatients and visitors in the time period of 1997–2018. Chi square test for trend was used. Smoking rates declined in all groups but significantly so in outpatients (19.5% vs. 10%; p < 0.01), visitors (27.4% vs. 9.5%; p < 0.0001) and staff (30.0% vs. 10.8%; p < 0.0001). Use of E-Cigarettes was low in all cohorts. Rates of smoking were borderline higher in inpatients eligible by income for state-funded General Medical Services (33.2% vs 26.8%, p = 0.099). Support for and awareness of the ban increased over time. Demographic and quit data was compared between participants of in-person or online SSC. The online courses were successful with a maintenance of quit rates (End of Course: 54.7% vs. 55.0%, 1 Month: 50.4% vs. 54.0%, 3 Month: 19.8% vs. 22.5%). While the hospital community’s smoking prevalence has decreased over time and attitudes to the smoking ban have been increasingly positive, the campus is not without difficulties in keeping it smoke-free. We continue to advocate for hospital staff support in enacting this flagship initiative.

139-OR: An Obesity-centric Approach With and Without Antiobesity Medications Compared with the Usual-Care Approach to Management of Patients with Obesity and Type 2 Diabetes in an Employer Setting—A Pragmatic Randomized Controlled Trial (EMPOWER-T2D)

Objective: Among patients with T2D and obesity, determine the effect of combining anti-obesity medications (AOM) with a comprehensive employer-based weight management program [obesity-centric approach (OCA) + AOM] compared with OCA alone, or usual care (UC) on weight and HbA1c. Methods: A 1-year open-label, randomized, pragmatic clinical trial was conducted at the Cleveland Clinic (CC). Participants were adults with T2D (HbA1c &amp;gt;7.5%) and BMI ≥ 30 kg/m2 enrolled in the CC Employee Health Plan. Participants were randomized 1:1:1 to OCA+ AOM, OCA alone, or UC. Participants in the OCA+AOM group initiated treatment with 1 of 5 US FDA-approved AOMs according to standard practice. Linear mixed effect models were conducted for analysis. Results: A total of 74 participants were randomized (24 OCA+AOM, 26 OCA, and 24 UC). Participants were predominantly female (59%), median age 53.5 (47, 60) years, 68% Caucasian, with baseline median BMI and HbA1c of 37.4 (34.2, 42.7) and 8.8% (7.9, 10.4), respectively. At 1 year, patients that received UC, OCA alone, and OCA + AOM had their mean % weight change (90% confidence interval, CI) by -4.48% (-6.52 to -2.45), -6.68% (-8.71 to -4.65), and -8.74% (-10.64 to -6.74) and mean HbA1c change (90% CI) by -1.65% (-2.09 to -1.22), -2.22% (-2.65 to -1.79), and -2.18% (-2.61 to -1.74), respectively. Only OCA + AOM treatment was found to be non-inferior (P=0.004) to UC approach in weight loss change. OCA + AOM treatment was also found to be superior to UC approach in weight loss change (P=0.022). OCA+AOM and OCA alone were non-inferior to usual-care in HbA1c change (P &amp;lt;0.05), but neither was superior (P&amp;gt;0.05). Conclusion: An OCA +AOM approach to T2D treatment was associated with additional weight loss with non-inferior A1C reductions vs. UC. Larger long-term studies evaluating obesity-focused approaches to T2D management are needed. Disclosure K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck &amp; Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck &amp; Co., Inc., Novo Nordisk. B.Rogen: None. J.F.Bena: None. H.Xiao: None. G.Barnard: None. E.Borukh: None. S.Peechakara: None. M.L.Griebeler: None. B.Burguera: Research Support; Novo Nordisk.

Stories women tell: Exploring lived experiences with natural disasters in the coastal and upland communities of Sagñay, Camarines Sur

This phenomenological inquiry explored women’s lived experiences from the coastal and upland communities of Sagñay, Camarines Sur, Philippines. Data sources were transcripts of in-depth individual interviews and focus group discussions. Findings suggest that women are vulnerable to disasters due to their socio-economic and geographic conditions, as reflected in the four emerging central themes of psychological, economic, and physical distress; women’s roles in the domestic disaster phases; coping strategies, and the need for long-term and comprehensive disaster management programs. Coping strategies applied before, during, and after disasters have helped them survive disaster effects to a certain extent. However, they cannot escape the constant exposure to environmental hazards as long as there are geographic and socio-economic barriers. Hence, women’s high vulnerability to disasters is confirmed positively, as revealed in their shared narratives. Implications to policies in Disaster Risk Reduction and Management (DRRM) include strengthening mechanisms to increase their involvement in the DRRM stages and increasing their resilience and those of their communities through sustainable programs and activities.

A Study on The Presence of Legionella pneumophila in Hospital Water Samples from Eastern Turkey

Objective: Legionnaires' disease is a fatal form of pneumonia brought on by an infection mostly caused by the 60 different species of Legionella pneumophila. Legionnaires' illness is caused by Legionella spp.-contaminated water systems. In this work, we sought to analyze Legionella species, serogroups (SG), and contamination in the water sources of hospitals in five regions in eastern Turkey.&#x0D; Methods: Between January 2017 and December 2018, a total of 1008 samples were examined, including 2 cooling towers, 62 hot water tanks, 104 cold water tanks, and 840 faucet shower heads. Samples were collected by the standard culture method L. pneumophila SG 1, it was analyzed for L. pneumophila SG 2-16 and Legionella spp. The samples were inoculated into BCYE and GVPC medium, and the colonies were assessed using a latex agglutination test, followed by species- and serotype-level identifications.&#x0D; Results: In our study, a total of 1008 water samples were examined, of which 35.31% (356) belonged to 2017, while 64.68% (652) belonged to 2018. 83.33% of the water samples were taken from faucets and shower heads, 10.32% from the cold water tank, 6.15% from the hot water tank, and 0.2% from the cooling tower, and the highest positivity rate was observed in the hot water tank with 12.60%. 7.04% (71) of the samples were positive, and 16.9% (12) of the positive samples were L. pneumophila SG 1, 77.46% (55) L. pneumophila SG 2-14 was detected, while 5.63% (4) were nonpneumophila (Legionella spp) it has been determined as.&#x0D; Conclusions: Legionella disease remains a significant public health threat. The water tanks of hospitals and hotels should be investigated more thoroughly, the necessary disinfection procedures should be carried out frequently. All hospitals should have water management policies, and towns and large buildings should establish comprehensive water system management programs that decrease Legionella growth and transmission. To enhance prevention measures and clinical diagnosis, we also need quicker ways of detecting Legionella in water systems and clinical samples.