Continuous Adherence Research Articles

Influence of Health Literacy on Physical Activity and Sedentary Behaviors in Older Patients with Coronary Artery Disease

Background: Coronary artery disease is a chronic condition that requires continuous adherence to healthy behaviors. Adhering to physical activity and reducing prolonged sedentary behavior are important for the physical health of older patients with coronary artery disease (CAD). Health literacy is increasingly recognized as a key factor in secondary prevention for these patients. However, evidence regarding the associations among health literacy, physical activity, and sedentary behaviors for secondary prevention in older patients with coronary artery disease remains limited. Objectives: This study aimed to identify the prevalence of limited health literacy and the influence of health literacy on physical activity and sedentary behaviors in older patients with CAD. Methods: This study was a descriptive cross-sectional study conducted from May to December 2022 in South Korea. A total of 186 patients aged 65 and older diagnosed with coronary artery disease participated. Data on health literacy, physical activity, and sedentary behaviors were collected through self-reported questionnaires and electronic medical records. Results: The prevalence of limited health literacy in older patients was 66.7%. Hierarchical linear regression revealed that health literacy was a significant determinant of physical activity (β = −0.50, P < .001) and sedentary behaviors (β = 0.58, P < .001) after adjusting for confounding variables. Conclusions: Our main findings showed that health literacy can facilitate improvements in physical activity and sedentary behaviors. Health literacy can facilitate health decisions for secondary prevention in older patients with CAD. Thus, healthcare professionals should assess patient health literacy and illness severity when designing secondary prevention programs.

Effects of using a mobile application on pelvic floor training in women with stress urinary incontinence: A randomized controlled clinical study.

Urinary incontinence (UI) is defined as any involuntary loss of urine that causes negative impacts on women's lives. Pelvic floor muscle training (PFMT) is considered to be "level A" of scientific evidence in the treatment of UI. Despite its efficacy, it is known that the effect of PFMT may depend on continuous adherence. Therefore, healthcare professionals are looking for alternatives to improve adherence in their patients. Healthcare has been innovating through mobile device apps. Thus, the objective of this study was to verify the effects of PFMT with the use of a mobile device app in incontinent women. This was a controlled, randomized clinical trial that occurred remotely. A total of 104 women with stress UI and/or mixed incontinence, over 18 years old, literate, with preserved cognitive capacity, with internet access and a mobile device with the Android system, participated in this study. They were randomly divided into two groups: The App group and the Booklet group, which underwent a PFMT protocol guided by a mobile app and a booklet, respectively. Both groups received daily reminders to perform the exercises. Before and after 12 weeks of intervention, it was evaluated using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the King's Health Questionnaire (KHQ). Both groups showed improvements in the final ICIQ-SF score. However, superior results were shown for the Booklet group (App: pre: 11.5 [±3.8], post: 9.8 [±4.5]; Booklet: pre: 12.6 [±4.5], post: 7.4 [±4.3]; p = 0.03). It was concluded that PFMT, with the use of a mobile app, is capable of reducing UI and the impact of UI, but it is not superior to training with the use of booklet instructions.

Affecting factors and seasonal effects on the continuous positive airway pressure adherence of patients with obstructive sleep apnea

Continuous positive airway pressure (CPAP) is the preferred treatment for obstructive sleep apnea (OSA), but adherence remains challenging. This study identifies factors influencing CPAP adherence, including the impact of Korea's four distinct seasons. A retrospective study of 650 patients with OSA and prescribed with CPAP was conducted at a single institution from January 2018 to December 2020, and the patients' answers on various sleep questionnaires, demographic and polysomnographic data, and when and whether they returned the CPAP devices were collected and analyzed. The sample population was divided into when and whether the CPAP device was returned to the institution and the average daily use of the CPAP device. Results show that treatment failure is high in the first 12 weeks. Moreover, patients with more severe sleep apnea tended to have severe OSA-related clinical symptoms and are more likely to adhere to the treatment. In this study show that the seasons did not affect CPAP adherence because of indoor environmental factors. However, results show that other patient factors, such as BMI, AHI, RDI, daytime drowsiness, mood changes, and other OSA-related symptoms, have greater effects on CPAP adherence than seasonal change. Initial positive experience is important to adapt to the CPAP, and for this reason, more active intervention by sleep physicians during the initial CPAP adaptation is necessary.

Opportunities for digitally-enabled personalization and decision support for pediatric growth hormone therapy.

Smart technologies and connected health are providing opportunities for improved healthcare for chronic conditions. Acceptance by healthcare professionals (HCPs) and patients is crucial for successful implementation. Evidence-based standards, technological infrastructure and regulatory processes are needed to integrate digital tools into clinical practice. Personal health records provide continuity and aid decision-making, while machine-learning algorithms may help in optimizing therapies and improving outcomes. Digital healthcare can negate geographical barriers, enabling patients in remote areas to access specialist endocrine expertise. We review available and developing digital tools to manage care for patients requiring growth hormone (GH) therapy for growth failure conditions. GH is most often administered via daily injections over several years; continuous adherence is necessary but may become insufficient. Future development and integration of electronic platforms for GH therapy requires involvement of all stakeholders in design-thinking approaches and human-factor testing. Growzen Connect is an innovative digital ecosystem designed to increase the management and monitoring of GH therapy, comprising the easypod device and connected mobile apps. It provides a real-time overview of a patient's therapy, including adherence and growth response, which aids decision-making by HCPs and empowers patients to engage in their therapy journey. Incorporating prediction models for adherence and growth in the ecosystem helps patients build treatment habits and allows issues to be addressed in a timely fashion. A connected ecosystem for GH therapy can enhance outcomes and empower patients, fostering a collaborative and patient-centered approach that is more proactive, beyond the traditional clinic-based approach.

Tracking continuous positive airway pressure adherence in obstructive sleep apnea patients before, during, and after the COVID-19 lockdown

Abstract: BACKGROUND: This study aimed to examine the impact of the COVID-19 lockdown on adherence to continuous positive airway pressure (CPAP) therapy among Saudi patients with obstructive sleep apnea (OSA). It also sought to assess the influence of demographic variables and comorbidities on CPAP adherence. METHODS: A prospective cohort study was conducted at the University Sleep Disorders Center at King Saud University Medical City. The study included 67 OSA patients who exclusively used CPAP for treatment across three distinct intervals prelockdown, during lockdown, and postlockdown. Adherence to CPAP therapy was objectively measured using “mask-on on-time monitoring” data from the CPAP machines. RESULTS: The study found a significant decrease in the number of days with CPAP usage during the lockdown period, which persisted postlockdown. Approximately half of the patients adhered to CPAP treatment throughout the three study intervals. The decrease in CPAP usage days during lockdown was particularly noticeable among patients younger than 50 and older than 65 years of age. The presence of comorbidities, body mass index, and sex did not significantly influence CPAP treatment adherence. CONCLUSION: The COVID-19 lockdown significantly impacted CPAP treatment adherence among OSA patients, with a decrease in adherence persisting postlockdown. This highlights the need for interventions to support CPAP adherence during challenging times such as a pandemic. Further research is needed to understand the long-term effects of the pandemic on CPAP therapy adherence.

Cardiac Effects of Renin-Angiotensin System Inhibitors in Nonproteinuric CKD.

In contrast to proteinuric chronic kidney disease (CKD), the relative cardioprotective benefits of antihypertensive medications in nonproteinuric CKD are unknown. We examined long-term cardiovascular outcomes and mortality in patients with nonproteinuric CKD treated with renin-angiotensin system inhibitors (RASIs) versus other antihypertensive medications. Among participants of the CRIC study (Chronic Renal Insufficiency Cohort) without proteinuria, we used intention-to-treat analyses with inverse probability of treatment weighting and Cox proportional hazards modeling to determine the association of RASIs versus other antihypertensive medications with a composite cardiovascular outcome (myocardial infarction, stroke, heart failure hospitalization, and death) and mortality. Secondary analyses included per-protocol analyses accounting for continuous adherence and time-updated analyses accounting for the proportion of time using RASIs during follow-up. A total of 2806 participants met the inclusion criteria. In the intention-to-treat analyses, RASIs versus other antihypertensive medications were not associated with an appreciable difference in cardiovascular events (adjusted hazard ratio [aHR], 0.94 [95% CI, 0.80-1.11]) or mortality (aHR, 1.06 [95% CI, 0.88-1.28]). In the per-protocol analyses, RASIs were associated with a lower risk of adverse cardiovascular events (aHR, 0.78 [95% CI, 0.63-0.97]) and mortality (aHR, 0.64 [95% CI, 0.48-0.85]). Similarly, in the time-updated analyses, a higher proportion of RASI use over time was associated with a lower mortality risk (aHR, 0.33 [95% CI, 0.14-0.86]). Among individuals with nonproteinuric CKD, after accounting for time-updated use, RASIs are associated with fewer cardiovascular events and a lower mortality risk compared with other antihypertensive medications. Patients with nonproteinuric CKD may benefit from prioritizing RASIs for hypertension management.

Evaluation of continuous positive airway pressure adherence and its contributing factors

BackgroundContinuous positive airway pressure (CPAP) adherence may vary based on the study design and country. ObjectivesTo investigate long-term CPAP adherence and elucidate associated factors. MethodsA multicenter retrospective observational cohort study was conducted over two years. The study included patients diagnosed with obstructive sleep apnea who were prescribed CPAP (n = 1261). Adherence was assessed for 90 days and 365 days. Centers for Medicare and Medicaid Services (CMS) criteria (≥4 h/night on ≥70 % of nights) and research adherence criteria (≥4 h/night during the observational period) were used. Factors influencing CPAP adherence (CMS criteria) during 90 and 365 days were also evaluated. Continuous variables were categorized into low, middle, and high classes, and logistic regression analysis with interaction was performed. ResultsCPAP adherence to CMS criteria for 90 and 365 days was 45.6 % and 44.7 %, respectively, whereas adherence to research criteria was 57.0 % and 54.1 %, respectively. Middle age, high age, and high apnea ratio independently increased CPAP adherence. Conversely, a high rapid eye movement apnea-hypopnea index ratio decreased CPAP adherence. Although high body mass index (BMI) had no independent effect on adherence, its interaction with high 3 % oxygen desaturation index increased 90-day CPAP adherence. However, high BMI decreased 90-day CPAP adherence in males. The interaction between middle age and high BMI was associated with decreased CPAP adherence over 365 days. ConclusionsAdherence to CPAP in real-world settings is modest. Various factors influence CPAP adherence. BMI may exert varied effects on CPAP adherence depending on the accompanying factors.

Insights into Hospitalized Children with Urinary Tract Infections: Epidemiology and Antimicrobial Resistance Patterns in Israel-A Single Center Study.

Background: The escalating resistance of uropathogens in pediatric febrile urinary tract infection (F-UTI) is a global concern. This study examined changing trends in F-UTI epidemiology and resistance patterns among Israeli pediatric inpatients over a decade. Methods: Demographic, clinical, and laboratory data for children between 3 months and 18 years old with febrile UTI from 2010 to 2021 were retrieved from electronic medical records. Results: A total of 761 cases of F-UTI were identified (702 females, mean age 43 months). Escherichia coli was the most common pathogen (85.9%), followed by Pseudomonas aeruginosa (3.5%) and Klebsiella pneumoniae (3.4%). Compared with the non-complicated UTI group, the complicated UTI group had significantly higher rates of Pseudomonas aeruginosa (5.3% vs. 1.0%, p = 0.002) and Klebsiella pneumoniae (4.6% vs. 1.6%, p = 0.03). Antibiotic resistance analysis revealed significant differences between the groups: resistance to cephalexin was higher in the complicated UTI group (19.3%) compared with the non-complicated UTI group (13.4%, p = 0.03). Notably, relatively low resistance rates were observed for ceftriaxone (4.4%) and gentamicin (6.0%). Over time, a significant decreasing trend in resistance to ampicillin was observed (slope = -0.0193, p = 0.011). No significant trends were found for trimethoprim-sulfamethoxazole, cephalexin, amoxicillin-clavulanic acid, ceftriaxone, and cefuroxime. Conclusions: Significant differences in pathogen distribution and resistance patterns between complicated UTI and non-complicated UTI groups highlight the need for continuous resistance monitoring and adherence to local guidelines. For the treatment of severe community F-UTI, ceftriaxone could be a reasonable option for first-onset F-UTI. Further studies are needed to implement antibiotic stewardship and optimize usage.

Cost-effectiveness analysis of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective.

This study assessed the cost-effectiveness of continuous positive airway pressure treatment for obstructive sleep apnea in Singapore from a health system perspective. The analysis evaluated a 5-year care pathway using a Markov model, considering per-patient costs of treatment, health system cost savings of obstructive sleep apnea and attributed conditions, the effectiveness measured in disability-adjusted life years with a discount rate of 3% and a weighted 5-year continuous positive airway pressure adherence of 74.1% from Singapore studies. Per-patient costs of treatment were from a large public hospital in Singapore. Efficacy of continuous positive airway pressure treatment, health system costs and disability-adjusted life years were obtained from literature; costs are in US dollars. We conducted probabilistic sensitivity analysis, one-way sensitivity analysis and what-if analysis. Based on a willingness-to-pay threshold of US $50,000 per disability-adjusted life year in USA, continuous positive airway pressure therapy was highly cost-effective, with an incremental cost-effectiveness ratio of $13,822 per disability-adjusted life year averted. Compared with the annual total costs of $856 for patients with continuous positive airway pressure treatment diagnosed by an inpatient sleep study, the total costs for those diagnosed by a home sleep test were $625, resulting in a remarkable 27% reduction per patient per year. One-way sensitivity analysis indicated that costs of treatment, effectiveness of continuous positive airway pressure treatment and adherence had a higher impact on the cost-effectiveness of continuous positive airway pressure therapy. The what-if analysis suggested that for continuous positive airway pressure treatment to be cost-effective, adherence rate should be at least 16.1%. These findings provide valuable insights for policymakers in making informed decisions on funding diagnosis and continuous positive airway pressure therapy within Singapore's healthcare system.

Multidimensional prediction of continuous positive airway pressure adherence

ObjectiveContinuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA). Unsatisfactory adherence to CPAP is an important clinical issue to resolve. Cluster analysis is a powerful tool to distinguish subgroups in a multidimensional fashion. This study aimed to investigate the use of cluster analysis for predicting CPAP adherence using clinical polysomnographic (PSG) parameters and patient characteristics. Patients/methodsParticipants of this multicenter observational study were 1133 patients with OSA who were newly diagnosed and implemented CPAP. Ward's method of cluster analysis was applied to in-laboratory diagnostic PSG parameters and patient characteristics. CPAP adherence was assessed during 90- and 365-day periods after CPAP initiation in each cluster. We adopted the Centers for Medicare and Medicaid Services criterion for CPAP adherence, i.e., CPAP use ≥4 h per night for 70 % or more of the observation period. Logistic regression analysis was performed to stratify clusters according to CPAP adherence. ResultsFive clusters were identified through cluster analysis. Clustering was significantly associated with CPAP adherence at 90- and 365-day periods after CPAP initiation. Logistic regression revealed that the cluster with features including apnea predominant sleep-disordered breathing, high apnea-hypopnea index, and relatively older age demonstrated the highest CPAP adherence. ConclusionCluster analysis revealed hidden connections using patient characteristics and PSG parameters to successfully identify patients more likely to adhere to CPAP for 90 days and up to 365 days. When prescribing CPAP, it is possible to identify patients with OSA who are more likely to be non-adherent.

Analysis of the National Formulary Drug Supply Chain with Its Availability in the Pharmacy Installation of the Government General Hospital (RSUD) Dr. Sitanala Tangerang City

This study explores the pharmaceutical supply chain management of the National Formulary at RSUP Dr. Sitanala in Tangerang City, aiming to identify obstacles to drug availability and formulate effective and efficient solutions. Acknowledging quality healthcare as a fundamental human right and a critical investment for a nation's future, this research emphasizes the importance of high-quality healthcare services. These services encompass not only treatment but also health promotion and disease prevention through the adoption of clean and healthy living habits. Drug availability is a major pillar in the provision of quality healthcare services. Effective and efficient management of the pharmaceutical supply chain, particularly regarding National Formulary drugs, is crucial in ensuring the availability of medications at healthcare facilities. This research employs a comprehensive analysis of the supply chain processes at RSUP Dr. Sitanala, examining stages such as drug selection, demand planning, procurement, receipt, storage, distribution, drug control, therapy monitoring, prescription preparation, drug dispensation, and medication administration. The study's methodology involves a case study approach, integrating theoretical management principles and interdisciplinary pharmacy management with compliance to regulations, as outlined in Permenkes No. 76 of 2016. Findings from RSUP Dr. Sitanala indicate that the hospital's pharmaceutical management practices align with contemporary health and pharmacy management theories, emphasizing structured systems, stringent verification, and effective interprofessional communication to ensure medication safety and efficacy. The study identifies challenges in information technology and interdisciplinary coordination as areas needing improvement. Nonetheless, a commitment to continuous improvement and adherence to regulatory standards reflects RSUP Dr. Sitanala's dedication to enhancing the quality of pharmaceutical management and healthcare services. The implications of this research extend beyond RSUP Dr. Sitanala, offering valuable recommendations for improving drug supply chain management in other healthcare institutions in Indonesia. By enhancing access to and the quality of healthcare services, this study contributes to the broader goal of achieving the highest possible level of health for individuals, reflecting the perspective of human rights and investment in the nation's future health.

A Novel Technique for the Optimization of Energy Cost Management and Operation of Microgrids Inspired from the Behavior of Egyptian Stray Dogs

Managing costs in microgrids presents a formidable challenge due to the intricate blend of renewable and non-renewable energy sources that underpin their power generation. Ensuring seamless integration of microgrids with the national grid is pivotal for continuous load demand satisfaction and adherence to liberalized energy market mandates. To address this challenge, this paper introduces a new optimization technique for the Cost Management and Operation System (CMOS) of multi-source microgrids through a smart management unit. The cornerstone of this unit is the Egyptian Stray Dog Optimization (ESDO) algorithm, meticulously designed to optimize operational costs in line with load demands, energy cost dynamics, and generation proficiencies. Rigorous testing of the proposed system was conducted on a multi-resource microgrid using MATLAB, encompassing various operational scenarios. The simulation outcomes consistently highlighted the unit’s capability to achieve optimal cost-efficiency. Comparative analysis with other optimization techniques, particularly Particle Swarm Optimization (PSO), demonstrated the superior performance of the Egyptian Stray Dog algorithm, underscoring its potential as a leading solution in this domain.

Implementation of cardiac enhanced recovery after surgery at Lausanne University Hospital, our roadbook to certification.

Enhanced recovery after surgery (ERAS) is a multidisciplinary, patient-centred approach aimed at expediting recovery, improving clinical outcomes, and reducing healthcare costs. Initially developed for colorectal surgery, ERAS principles have been successfully applied across various surgical specialties, including cardiac surgery. This study outlines the implementation and certification process of the ERAS program in a tertiary cardiac surgical centre within the Heart-Vessel Department at Lausanne University Hospital. The implementation involved forming a multidisciplinary team, including cardiac surgeons, anaesthesiologists, intensivists, a cardiologist, clinical nurse specialists and physiotherapists. The ERAS nurse coordinator played a central role in organizing meetings, promoting the program, developing protocols, and collecting data. The certification process required adherence to ERAS guidelines, structured training and external evaluation. Key phases included pre-ERAS data collection, protocol dissemination, inclusion of the 1st patients, followed by analysis and full implementation. Achieving certification required maintaining a compliance rate of over 70% with established protocols. The process involved overcoming various barriers, such as inconsistent practices and the need for multidisciplinary collaboration. In this paper, we provide some solutions to these challenges, including team education, regular meetings and continuous feedback loops. Preliminary data from the initial cohort showed improvements in early mobilization, opioid use, respiratory complications and shorter hospital stays. The successful implementation of the ERAS program at our institution demonstrates the feasibility and benefits of a structured, multidisciplinary approach in cardiac surgery. Continuous self-assessment and adherence to guidelines are essential for sustained improvement in patient outcomes and healthcare efficiency.

THE REAL TIME HIGH PRECISION CRIMINAL FACE RECOGNITION FOR ATM SECURITY IN DEEP LEARNING

The proposed ATM security system, utilizing composable deep face recognition, emphasizes user protection during transactions with a specific focus on eye retina accuracy. In the event of a potential threat identified through real-time face detection and tracking, an automatic alert is initiated. Prioritizing precision, the system employs advanced face detection algorithms for accurate location and tracking, even in dynamic scenarios. A down sampling technique ensures efficient processing of facial data, crucial for meticulous identification in crowded ATM locations. The integration of a face tracking ID unit enhances accuracy, providing continuous monitoring and persistence in identification, particularly focusing on the distinctive patterns in the eye retina. The scoring method, rooted in face tracking and embedding distance, significantly elevates user identification reliability, minimizing the risk of false positives, especially in criminal identification based on unique eye retina features. In response to potential threats, the system promptly generates automatic alerts and dispatches secure emails to relevant entities, including the affected card user, the respective bank, and cybersecurity authorities. These emails include comprehensive information, such as a high-precision image of the detected criminal's face, detailed facial recognition data, and a thorough summary of their known criminal history. This accuracy-driven and retina focused approach enhances safety, emphasizing continuous refinement and adherence to privacy and ethical considerations during implementation. KEYWORDS: Crime prevention, down-sampling, face recognition.

Understanding patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease in Mulago and Kiruddu hospitals, Uganda, a qualitative study.

In 2016, Uganda added Hydroxyurea (HU) to the list of essential drugs to treat sickle cell disease SCD. However, Hydroxyurea utilization has been low for several countries in sub-Saharan Africa. This study examined patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease in Mulago and Kiruddu hospitals, in Uganda. To understand the patient-related barriers to hydroxyurea use among adolescent and adult patients with sickle cell disease, we conducted a parallel convergent mixed methods study at outpatient departments of two national referral hospitals in Uganda from October 2022 to January 2023. The cross-sectional mixed-methods study employed both quantitative and qualitative methods. We collected survey data from a systematic sample of 259 participants and conducted individual interviews with a purposive sample of 40 participants (20 adolescents or their caregivers and 20 adult patients with SCD) and interviewed them individually on their knowledge, perceptions, barriers, and facilitators of HU utilization. Descriptive data were analyzed using Stata 16, whereas qualitative data were analyzed thematically using an inductive approach supported by NVivo 12 software. We triangulated data to determine the concordance of qualitative and quantitative data. The study enrolled 40 participants for qualitative interviews and 259 patients for quantitative, with an average age of 16, over half being female, 46% having secondary education, and 96% unmarried. The prevalence of HU use was 78%. The study identified three themes as follows: Patient barriers at the individual including Inadequate knowledge about HU, Persistent pain, Poor adherence to HU, Poor communication with health care workers, and Psychosocial and emotional challenges. At the facility level, long queues and poor quality of care, drug-related side effects that affect HU, and drug stock-outs were reported. Myths, rumors, and misconceptions about HU, and gender-related barriers were reported to affect HU utilization at a community level. Facilitators for the use of HU and recommendations for improvement. Facilitators included perceived benefits, long duration on HU, information sharing by healthcare workers, availability of complementary drugs, confirmation of diagnosis, and availability of medication at public health facilities or private pharmacies. Patients suggested continuous adherence support, encouragement from healthcare workers, sensitization about benefits and risks, a peer-to-peer approach, and financial support for adolescents and women to start businesses to resolve financial problems. Implementing the use of HU has been challenging in Uganda and needs improvement. Facilitators to hydroxyurea use have been highlighted, though Patient-identified barriers at individual, facility, and community levels that need to be resolved. The experiences and insights shared by our participants provide invaluable guidance for increasing the uptake of HU. Further studies are needed to establish validated instruments to assess patients' pain communication and adherence to the HU regimen.

Undiagnosed, uncomplicated foreign body in abdominal cavity – A case of medical negligence

When a retained surgical foreign body occurs, it poses significant risks to patients, potentially resulting in life-threatening complications. This paper presents the case report of dead body of a female of about 32 years of age brought for medicolegal post-mortem examination with a history of sudden death. Internal examinations revealed adhesion present around the right ovary, right fallopian tube, ceacum, omentum and large intestine with 100 ml free fluid in abdominal cavity. On careful blunt dissection of adhesion, a gauze piece was observed in the abdomen cavity that too is having firmly adherent to the surrounding organs. On removing it was of size 29 × 15 cm, yellowish - white in color. This underscores the need for continuous vigilance and adherence to established counting procedures throughout the surgical process to minimize the risk of such adverse events. Excellent communication among surgeons, nurses, and anesthetists during the procedure is key to success.

Reducing Improper and Missed Peri-Procedure Antibiotics Prescriptions in a Regional Oncology Centre.

Background In the realm of oncology care, patients undergoing invasive procedures are particularly vulnerable to infections due to their compromised immune systems. Antibiotics play a pivotal role in preventing such infections. However, inappropriate or missed administration of peri-procedure antibiotics poses a significant risk in the form of treatment complications, contributing to antibiotic resistanceand increased healthcare costs. Methods The study was a two-cycle, closed-loop quality improvement project utilizing both retrospective and prospective data analysis of peri-procedure antibiotics prescription in a regional oncology centre. Two audit cycles were carried out in total; the first cycle was carried out in November 2023 where six-week data were collected retrospectively. As a result, formal and informal teaching sessions about the importance of correct peri-procedure antibiotics and the availability of complete institutional peri-procedure antibiotics guidelines in clinical areas were ensured. The second cycle was carried out prospectively for two weeks in January 2024. Patients were included if they underwent selected procedures performed by interventional radiology or gastroenterology while the patients operated on by the general surgeons and any day case procedures were excluded. Results We identified a total of 82 interventional procedures during the first cycle that fulfilled the inclusion criteria. Six out of 82 patients (7.3%) did not receive the correct peri-procedural antibiotics as per hospital antibiotics guidelines. A prospective two-week data after implementing the change revealed that 25 patients had documented interventional procedures done during this period using electronic patient records. Out of 25 patients, only one patient (4%) did not receive the peri-procedural antibiotics as per guidelines. We were able to demonstrate increased adherence to the peri-procedural guidelines (from 93% to 96%) during the two cycles. However, this change was not statistically significant (p = 0.50). Conclusion By educating and engaging healthcare professionals in adhering to evidence-based guidelines and best practices, we have observed notable, although statistically significant improvement in peri-procedure antibiotics prescription practices. Continued educational efforts and reinforcement strategies will be vital in further improvements over time. By providing ongoing support and resources, healthcare providers can be empowered to consistently make informed decisions regarding peri-procedure antibiotic administration. This commitment to maintaining high standards of antibiotic prescribing practices is expected to result in improved patient outcomes, including reduced rates of surgical site infections and antibiotic resistance. It is imperative to recognize the critical role that accurate peri-procedure antibiotic prescriptions play in patient safety and overall healthcare quality. By fostering a culture of continuous improvement and adherence to established guidelines, we can ensure that patients receive optimal care while minimizing the risks associated with antibiotic overuse or misuse.

0544 The Impact of Telemedicine on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea Patients

0544 The Impact of Telemedicine on Continuous Positive Airway Pressure Adherence in Obstructive Sleep Apnea Patients

Does continuous glucose monitoring influence adherence to time-restricted eating?

Obesity is a significant health issue in Aotearoa; effective and pragmatic strategies to facilitate weight loss are urgently required. Growing recognition of the circadian rhythm’s impact on metabolism has popularised diets like time-restricted eating (TRE)(1). The 16:8 TRE method involves limiting food intake to an 8-hour daily eating window and can lead to weight loss without other substantial changes to diet(2). Nonetheless, TRE requires accountability and tolerating hunger for short periods. Continuous glucose monitors (CGM) are small wearable biofeedback devices that measure interstitial glucose levels scanned via smartphones. By providing immediate feedback on the physiological effects of eating and fasting, CGM use may promote adherence to TRE(3). This pilot study aimed to 1) investigate how CGM affects adherence to TRE and 2) assess the feasibility of CGM use while undertaking TRE. This two-arm randomised controlled trial enrolled healthy adults from Dunedin, assigning them to TRE-only or TRE+CGM groups for 14 days. Successful adherence to TRE was defined a priori as maintaining an 8-hour eating window on 80% of days. CGM feasibility was defined a priori as scanning the glucose monitor thrice daily on 80% of days. Secondary outcomes included well-being, anthropometry, glucose levels, and overall TRE and CGM experiences via semi-structured interviews. Twenty-two participants were randomised into two groups: TRE-only (n = 11) and TRE+CGM (n = 11, with n = 2 excluded from analysis post-randomisation for medical reasons). Participants had a diverse range of ethnicities, the mean age was 32 (+/-14.9) years, and 55% were female. The TRE+CGM group adhered to the 8-hour eating window for an average of 10.0 days (range 2-14) compared with 8.6 days (range 2-14) in the TRE-only group. Both groups had similar mean eating window durations of 8.1 hours. Five (56%) participants in the TRE+CGM group achieved the a priori criteria for TRE adherence, compared to 3 (27%) in the TRE-only group. Participants in the TRE+CGM group performed an average of 8.2 (+/-5.6) daily scans, with n = 7 (78%) of participants meeting the a priori CGM feasibility criteria. Neither group reported consistent adverse psychological impacts in DASS-21 and WHO-5 scores. Interviews highlighted that CGM increased hunger tolerance during fasting as participants felt reassured by their normal glucose levels. CGM aided TRE accountability by acting as a biological tracker of food intake. Participants reported that TRE led to improved energy and self-efficacy, a more productive daily routine, and healthier food choices. Promisingly, 72% of participants would use CGM and undertake TRE in future. This study demonstrates that using CGM while undertaking TRE is feasible and can improve adherence by enhancing hunger tolerance and accountability. Overall, participants experienced increased awareness of eating habits and physiological mechanisms. Over the longer term, this simple and synergistic approach may be a helpful weight loss strategy.

Implementation of Contractor Safety Management System (CSMS) PT. Waskita Karya on Rigid Pavement Subcontractor

Purpose: This study aims to evaluate the application of Contractor Safety Management System (CSMS) and its compatibility between the administrative stage and implementation in construction projects, particularly focusing on the Kutanegara region in Indonesia. Recognizing the prevalence of work accidents and delays attributed to discrepancies in CSMS, the research seeks to assess the alignment between CSMS policies and their execution in the field. Methods: The research adopts a descriptive qualitative approach to evaluate the application of CSMS. Data collection employs triangulation, combining observation, interviews, and documentation review. Key informants, including main and supporting stakeholders, are selected through purposive sampling techniques to provide insights into CSMS implementation and its effectiveness in ensuring workplace safety and compliance. Results and Discussion: The evaluation of CSMS application reveals inconsistencies between administrative policies and their implementation in the field. Specifically, discrepancies are identified in the installation of vision, mission, and policy statements (16%), K3 signs and smoking bans (42%), warning signs and evacuation directions (53%), and the management of electrical panels and Lock Out Tag Out (LOTO) procedures (37%). While these inconsistencies are categorized as minor, they highlight the need for continuous improvement and alignment between CSMS policies and practices to mitigate work accidents and delays effectively. Implications of the Research: The findings of this study have implications for construction project management and safety practices, emphasizing the importance of aligning CSMS policies with on-site implementation to enhance workplace safety and efficiency. By identifying discrepancies and areas for improvement in CSMS application, the research provides insights into strategies for enhancing safety protocols and reducing the risk of work accidents and delays in construction projects. Originality/Value: This study contributes to the existing literature by addressing the gap in research regarding the alignment between CSMS policies and their implementation in construction projects, particularly in the Indonesian context. By employing a qualitative approach and triangulating multiple data sources, the research offers valuable insights into the effectiveness of CSMS in ensuring workplace safety and compliance. The findings underscore the importance of continuous improvement and adherence to safety protocols in construction projects, ultimately enhancing the overall quality and efficiency of project delivery.