Development Of Action Plan Research Articles

Collecting Multi-country Retrospective Antimicrobial Consumption and Use Data: Challenges and Experience.

Excessive or inappropriate antimicrobial use contributes to antimicrobial resistance, emphasizing the need to monitor and document the types and quantities of antibiotics used. Thus, data on antimicrobial consumption (AMC) and antimicrobial usage (AMU) are key in informing and promoting judicious use. Our study, conducted during 2019-2023, as part of the CAPTURA project, aimed to understand the state of data availability and quality for AMC and AMU monitoring in Asia. In this article, we describe the challenges and opportunities faced and provide examples of AMU and AMC analysis. World Health Organization (WHO) and country-tailored methodologies and tools were applied to collect retrospective data from 2016 to 2019 in Bangladesh, Bhutan, Laos, Nepal, Pakistan, Papua New Guinea, Sri Lanka, and Timor-Leste. The primary indicator for national AMC was total level of consumption, expressed as total defined daily doses (DDD) per 1000 inhabitants per day for the year or period of data collected. For facility AMC and AMU, the primary indicator was total DDD per admissions per day for the year or period of data collected. Although many countries faced infrastructural challenges in data collection and storage, we managed to collect and analyze AMC data from 6 countries and AMU data from 5. The primary indicators, and additional findings, were visualized to facilitate dissemination and promote the development of action plans. Looking ahead, it is crucial that future initiatives empower each country to establish surveillance infrastructures tailored to their unique contexts, ensuring sustainable progress in the fight against antimicrobial resistance.

Управління ризиками в контексті стратегії антикризового управління

It has been established that risk management in the context of an anti-crisis management strategy is an important aspect for ensuring the stability and success of an organization in the face of negative events and crisis situations. difficult conditions. It is emphasized that the development and justification of the company's anti-crisis strategy is an important stage of anti-crisis management. The stages that can be performed when developing and justifying an anti-crisis strategy are proposed: situation analysis, definition of goals and objectives, strategy selection, development of a detailed action plan, financial analysis and resources, strategy justification, implementation and control.

An ecological survey of Laro-limicolae in Northeastern Algeria

We conducted an inventory and characterization of Laro-limicolae settlement at three Ramsar sites located in Eastern Numidia (Lake Tonga, Lake Oubeira and El Mellah lagoon) between 2014 and 2016. We identified 27 species belonging to six families, dominated by Scolopacidae (10 sp.) and Laridae (9 sp.) followed by Charadriidae (4 sp.), Recurvirostridae (2 sp.) and for Glareolidae and Haematopodidae families (1 sp.) Inventoried species exhibited different phenological status: resident (26%), wintering (44%), migratory breeders (19%) and wintering/breeding (11%). Population analysis showed the presence of protected species such as black-tailed godwit and Northern lapwing. Bird counts showed monthly variations in total abundance and richness, peaking during winter. Highest numbers were recorded in January and lowest numbers in August. Analysis of diversity and equitability indices indicated that maximum values (H’ = 3.01 and E = 0.94) were noted at El Mellah lagoon in November and at Lake Oubeira in June. Our study provides recent and unpublished data on a group of birds that are little-documented for North Africa, particularly for Algeria. Our findings open the way for further, more detailed work on the subject, and may serve to develop action plans for the management and conservation of these bird populations and their habitats.

Emergency pharmacy workforce views and experience related to the provision of pharmaceutical care during mass gathering events: the FIFA World Cup Qatar 2022™ experience.

This study aimed to explore emergency pharmacy workforce perspectives and experiences in providing pharmaceutical care during mass gathering events (i.e., FIFA World Cup Qatar 2022™). A qualitative methodology was employed using focus groups discussions. Emergency pharmacists across Hamad Medical Corporation were invited to participate using a combination of purposive and snowball sampling. Focus groups were audio-recorded, transcribed verbatim, and validated. Inductive thematic analysis was undertaken to generate key themes and subthemes. Four focus groups were conducted which included 21 participants and generated five major themes. Whilst participants had mixed opinions in relation to their preparedness to practice during the World Cup, they perceived their experience as successful and smooth. The primary perceived facilitators were management support, mobile medical units, and high public health awareness. The main highlighted barriers were related to staff insufficiency, medications availability, and cultural and language challenges. Participants recommended pharmacist's role identification in mass gatherings, development of pharmacy action plan, and offering simulation training and pharmacy-specific training. Despite the perceived barriers, pharmacists reported positive views in relation to their experience in providing pharmaceutical care during mass gatherings. Future research should focus on the development of theory-driven action framework for pharmacy departments to adopt during mass gatherings.

Inclusion of Sex and Gender Differences in U.S. State Action Plans for Opioid Use and Opioid Use Disorder.

Background: States have developed action plans to address the "opioid crisis" over the past several years. While sex- and gender-based differences have been identified in complications of opioid use, risks of addiction to opioids, barriers to treatment of opioid use disorder, and associated stigma, it is unknown if or to what extent opioid plans consider or account for these differences. The objectives of this study were to analyze U.S. state opioid action plans and their inclusion of sex- and gender-specific concerns. Methods: A content analysis of 49 state plans was conducted in June 2020, assessing their inclusion of 14 variables covering provider education, pregnancy-related, and sex- or gender-based differences in opioid addiction and treatment. Results: Neonatal opioid withdrawal syndrome was the most common variable, noted in 57% of plans. Only 14% included pregnancy-related stigma, and 4% identified gender-specific stigma. Contraceptives and family-planning were included in 12% and 10% of plans, respectively. Two states included more than half of the variables and five plans made no mention of sex or gender differences. Conclusions: Few state plans contained sex- or gender-specific information, and those that did focused almost exclusively on childbearing, excluding other unique considerations of opioid-using-women of all ages. The results of this study could improve the care of women using opioids by informing the strategies of state agencies and impacting legislative efforts for prevention initiatives, substance use disorder treatment, and law enforcement programs.

Asthma in Pregnancy: A Critical Review of Impact, Management, and Outcomes.

Asthma is a common chronic respiratory condition that can significantly impact the health of pregnant women and their developing fetuses. This comprehensive review provides insights into the prevalence of asthma in pregnant women, the physiological changes during pregnancy, and the multifaceted impact of asthma on maternal and fetal health. It emphasizes the importance of proper asthma diagnosis, medication management, and the development of personalized asthma action plans during pregnancy. Lifestyle modifications, trigger avoidance, and stress reduction are essential to effective management. Healthcare providers are pivotal in educating, monitoring, and individualized care to ensure optimal asthma control. The review underscores the critical significance of managing asthma during pregnancy, as it improves maternal and fetal outcomes and potentially influences long-term health for both mother and child. Future directions in this field involve ongoing research, personalized treatment, early intervention, and precision medicine to enhance the understanding and care of asthma during pregnancy.

ДОСЛІДЖЕННЯ ВИКОРИСТАННЯ АЛЬТЕРНАТИВНИХ ВИДІВ ПАЛИВА НА ПОЛТАВЩИНІ

The possibilities of using energy-resource solid household waste, agricultural waste, logging waste from forestry enter-prises, green waste from landscaping and growing energy crops as alternative renewable fuels to meet the goals of small-scale heat and power generation in Poltava Oblast are investigated. To study this issue, the specialists from the Departments of Applied Ecology and Nature Management and Heat and Gas Supply, Ventilation and Heat Power En-gineering of National University "Yuri Kondratyuk Poltava Polytechnic" were invited to join the project and a new specialization "Renewable Heat and Power Engineering, Alternative Fuels and Environmental Protection" was opened in the specialty 183 "Environmental Protection Technologies". The problem was included in the strategic development plan of Poltava region and included in the development of the Action Plan for Sustainable Energy Development and Climate of Poltava City Territorial Community until 2030 in accordance with the European initiative "Covenant of Mayors for Climate and Energy". The assessment of the bioenergy potential may become a significant environmental and economic basis for improving the regional bioenergy sector in Poltava Oblast in the future. A complex of methods of system analysis and the method of data analysis has been applied to achieve the goal of the research. An analysis of modern international literary sources, an analysis of the morphological composition of municipal and green waste, and an analysis of the energy potential of plant biomass were reviewed. As a result of research, the scientific and applied task of using local energy resources at the level of each individual community of the Poltava region, taking into account ecological, economic and social development, has been formulated and substantiated. Ref. 10, figure. Keywords: energy security, environmental security, alternative fuels, renewable energy sources, energy crops, solid household waste, small-scale energy, environmental impact.

Non-Traditional Security Threats and NATO’s Response in the Contemporary Security Environment

Abstract This research paper emphasizes the importance of NATO’s adaptation to non-traditional threats in maintaining stability and security in the changing security environment. It highlights the need for NATO allies to prioritize the development of strategies and action plans that address emerging issues such as new technologies, energy security, climate change, hybrid threats, and cyber threats. The paper suggests that in order to effectively counter these non-traditional threats, NATO must remain current with the latest technological advancements. As such, the paper recommends that NATO allies develop new strategies and action plans without delay to counter these threats and ensure security. The relevance of NATO can only be ensured through its transformation and adaptation, which in turn makes its existence self-justified.

Active citizen workshop for building capacities of the young people in villages around the Borobudur Temple

The Borobudur Temple is one of Indonesia’s tourist destinations, which has long been famous among local and foreign tourists. The Indonesian government has even designated the Borobudur compound as a super-priority tourist destination. However, the existence of the Borobudur Temple has not had much effect on the welfare of the people who live in the surrounding villages. This community service activity was conducted to build the capacities of young people in some villages around the Borobudur Temple area. This activity aimed to improve the soft skills of young people. More specifically, it was designed to guide them to be aware of themselves and their communities, gain the skills to communicate with others, identify and map the potentials and challenges in their communities, and develop action plans for their communities. This program was carried out in the form of a workshop, adapting the active citizen modules developed by the British Council. The participants claimed that this workshop was useful for them, especially in making them more confident, helping them realize their existence, increasing their ability to communicate with others and build networks with people from different backgrounds, enhancing their understanding of their community and environments, and raising their motivation in making positive social changes.

Elaborating ESG Of TESLA Based on Information

Sustainable development is now a hot topic in the world. In view of the serious problems in environment, society, financial market and other aspects, international organization, countries and even enterprises around the world have put forward ESG and other sustainable development action plans, so that human beings can develop sustainably. Therefore, the research theme of this paper is Tesla's ESG performance in 2022 The research method of this paper is as follows: Firstly, massive data about Tesla's ESG in 2022 and ESG of other three companies are collected, and then the ESG of Tesla company is analyzed and the ESG form of Tesla company is compared with that of other three typical companies. This paper draws a conclusion on the defects and advantages of Tesla's 2022 ESG and their differences between other companies ESG, which provides valuable reference materials for future scholars studying Tesla ESG and the whole situation of world range companies ESG.

Key Findings from a Transformative Quality Improvement Initiative on Advancing CAR T-Cell Treatment in Non-Hodgkin Lymphoma

Background Chimeric antigen receptor (CAR) T-cell therapy can transform outcomes for eligible patients with relapsed/refractory non-Hodgkin lymphoma (NHL). However, community-based care teams face challenges, including identifying eligible patients and coordinating referral and care, hindering integration into clinical practice. PRIME conducted a quality improvement (QI) initiative to better understand the challenges community oncology teams encounter in coordinating CAR T-cell therapy for patients with NHL and to bridge the gap between tertiary referral centers and large CAR T-cell centers. Methods This QI initiative included baseline provider surveys (n = 60), pre- and post-surveys of providers (n = 55) participating in team-based audit-feedback (AF) sessions (Table 1) and 90-day follow-up surveys. Survey questions were designed to evaluate practice patterns, challenges, and barriers to providing CAR T cell therapy to NHL patients. Care teams from each clinic, along with a CAR T-cell expert from the regional academic center and nationally renowned expert NHL CAR T-cell physician, participated in AF sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Results Provider Surveys: Providers' top reported challenges managing patients with NHL were individualizing treatment plans (33%), patient nonadherence/lack of follow-up (23%), and patient health literacy (20%). Specific barriers to using CAR T-cell therapy included identifying patients eligible for treatment (45%), gaining approval from the insurance company (40%), and transferring the patient to a CAR T-cell center for infusion (27%). When asked about clinical practices, 48% of providers reported discussing novel therapies for NHL in detail with their patients, and 51% of providers often or always refer eligible patients for CAR T-cell therapy. While 45% of providers rated the level of collaboration/communication between CAR T-cell centers and oncology clinics as very good/excellent, more than half felt it could be better, citing insufficient sharing of patient information (38%), and lack of expertise in CAR T-cell administration among clinic staff (18%) as common challenges. Small Group AF Sessions: HCPs participating in the A/F sessions reported key challenges of treatment with CAR T-cell therapy as gaining approval from insurance companies (33%), managing patients post-treatment (26%), and identifying patients eligible for treatment (22%) (Figure 1).Improvement in very high/high confidence were noted in identifying eligible patients for CAR T-cell therapy (51% to 84%) and managing adverse/late effects of CAR T-cell therapy in patients with NHL (46% to 85%). Action plans outlined to achieve CAR T-Cell therapy goals included: increase efforts to facilitate timely patient referrals for CAR T-cell therapy, improve communication between referral centers and CAR T-cell therapy performing centers, and enhance patient knowledge and expand supportive care discussions for CAR T-cell therapy. Follow-up Surveys: In 90-day follow up surveys (n = 12), 92% of respondents reported good/very good/excellent communication and collaboration between CAR T-cell centers and oncology clinics. Additionally, 75% report improved identification of eligible patients for CAR T-cell therapy. Despite these improvements, clinics top challenge of gaining approval from the insurance company for CAR T-cell therapy (33%) persists. Conclusions Through this QI initiative, clinical teams created and implemented action plans to close gaps in identifying eligible patients, coordinating CAR T-cell therapy referral and approval, and providing counseling and obtaining consent among hematology/oncology team members. Following the initiative, meaningful confidence gains were noted in identifying eligible patients for CAR T-cell therapy and managing adverse/late effects of treatment. Action plans developed by HCPs following this QI initiative, will be addressed in future initiatives to support evidence-based integration of CAR T-cell therapies into NHL care to optimize patient outcomes. Study Sponsor Statement The study reported in this abstract was funded by an independent educational grant from Bristol Myers Squibb, who had no role in the study design, execution, analysis, or reporting.

Advancing Care of Patients with Sickle Cell Disease through a Transformative Quality Improvement Initiative

Background Managing sickle cell disease (SCD) and its associated complications requires specialized knowledge often limited in primary and emergency care settings. Despite the availability of guideline recommendations and an expanding therapeutic landscape, hematologists experience challenges in managing sickle cell pain and implementing multidisciplinary care coordination that improves morbidity, overall disease management, and quality of life. To improve SCD care, we conducted a quality improvement (QI) study, bringing together healthcare professionals (HCPs) from established SCD centers to assess current practice patterns and develop strategies to overcome barriers to acute pain management and transitions of care for patients with SCD. Methods This QI initiative is comprised of baseline surveys (n = 115), pre- and post-surveys (n = 71) from the small-group, team-based audit-feedback (AF) sessions (Table 1), and 90-day follow-up surveys of HCPs from the four enrolled centers. Survey questions were designed to assess knowledge, confidence, and experiences managing acute pain, transitioning care, and keeping up with the latest clinical evidence and guideline recommendations for SCD. Care teams from each clinic, along with a nationally renowned expert SCD physician, participated in audit and feedback sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Results Baseline surveys results revealed providers' top challenge encountered in managing patients with SCD as managing acute complications (40%) (Figure 1). Gaps were observed in clinicians reporting high/very high confidence in their ability to adequately manage SCD patients' acute pain episodes (51%), align clinical practices with evidence-based SCD guidelines (44%), and coordinate transitions of care (33%). Furthermore, baseline surveys showed only 19% of providers reported they are very/extremely satisfied with their current process for transitioning patients, noting top challenges in patient's difficulty navigating the adult healthcare system (47%) and deficiency of providers caring for patients with SCD near me (26%). Following participation in the AF sessions, clinicians indicated gains in high/very high confidence in their ability to adequately manage an acute pain episode for a patient with SCD (52% to 69%) and ability to coordinate transitions of care for patients with SCD (44% to 56%). During the AF sessions, Care teams set goals to improve provider education, appropriate acute care management of SCD and patient engagement. Action plans to achieve these goals include sharing the action plan with additional clinical team members (47%), collaborating among clinical teams to improve pain management plans for patients with SCD (39%) and improving patient education about SCD (31%). In 90-day follow up surveys, 75% of clinics reported improvements in acute pain management and transitions of care for patients with SCD. Furthermore, the top 3 areas of most improvement at the time of follow-up were enhancing sickle cell education provided to patients (75%), supporting teenage and young adult patients in independently managing their own care (50%), and coordinating meetings with local adult sickle cell providers and teenage/young adult patients and families (50%). Conclusions Through this QI initiative, clinical teams identified barriers to optimal SCD care, creating and implementing specific action plans to increasing knowledge of SCD and evidence-based therapies, optimizing transitions of care and improving acute pain management. While meaningful confidence and action plan gains were demonstrated, these data underscore clinical practice gaps to address in future initiatives to support safe, effective, and evidence-based processes for managing SCD to prevent complications and optimize outcomes and quality of life. Study Sponsor Statement The study reported in this abstract was funded by educational grants from Vertex Pharmaceuticals Incorporated and Agios Pharmaceuticals, Inc. The grantors had no role in the study design, execution, analysis, or reporting.

Optimizing Management of AML: Insights from a Community-Based Quality Improvement Initiative

Background There has been groundbreaking progress in the molecular diagnosis, risk stratification, and treatment landscape for acute myeloid leukemia (AML), allowing providers to tailor a personalized therapy approach for individual patients. Despite these advances, many barriers to optimal AML treatment exist in integrating targeted therapies, selecting guideline-aligned treatments and managing adverse events. To address these challenges, we conducted a quality improvement (QI) study in community oncology clinics to assess current practice patterns and develop strategies to overcome barriers to optimal care for patients with AML. Methods The QI initiative comprised baseline provider surveys and pre- and post-surveys of providers participating in small-group, team-based audit-feedback (AF) sessions. Survey questions were designed to assess knowledge, confidence, and experiences with targeted therapies for AML. Care teams from each clinic, along with an expert AML physician, participated in AF sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Between 1/2022-6/2022, 104 hematology/oncology providers completed baseline surveys and 54 care team members from the enrolled clinics participated in the AF sessions (Table 1). Results Provider Surveys: Providers' top reported challenges encountered in managing patients with AML were individualizing treatment plans (33%) and supportive care counseling (21%). Moreover, the most challenging issue encountered in selecting therapies for patients with AML was selecting optimal therapies for individual patients (27%). Factors considered most important in treatment decision-making, in addition to clinical guidelines, included effects on quality of life (51%) and treatment effectiveness (51%). Additionally, top parameters guiding treatment decision-making include age (63%) and karyotype/molecular abnormalities (60%). Clinicians reported the most difficulty in managing myelosuppression (34%) associated with novel AML therapies. When asked their top barriers to engaging patients with AML in shared decision-making, providers reported patient's low health literacy (29%) and not enough time to engage in SDM (25%). AF Sessions: Providers participating in the small group AF sessions reported testing for and interpreting results of molecular and genetic features (30%) and individualizing treatment plans (28%) as top challenges. Following the AF session, clinicians reported improvements in high/very high confidence in their ability to select guideline-aligned treatment for patients with AML (70% to 96%) and ability to manage adverse effects of novel AML treatments (76% to 96%). Care teams also set goals to improve individualized treatment plans and adverse event management, stay up to date with clinical guidelines and knowledge of novel therapies, and increase multidisciplinary collaborative care for patients with AML. Action plans to achieve these goals include enhancing knowledge of clinical evidence for new and emerging therapies for AML and developing personalized treatment plans incorporating patient-specific factors and preferences (Figure 1). Conclusions Through this QI initiative, clinical teams identified barriers to optimal AML care and created and implemented specific action plans focused on increasing knowledge of AML therapies, optimizing personalized treatment plans and improving adverse events management. Meaningful confidence gains were observed in aligning treatment plans to guideline recommendations and managing adverse effects of treatment. These data underscore clinical practice gaps to address in future initiatives to support safe, effective, and evidence-based integration of targeted therapies into AML care to optimize patient outcomes. Study Sponsor Statement The study reported in this abstract was funded by educational grants from AbbVie, Inc. and Astellas. The grantors had no role in the study design, execution, analysis, or reporting.

Accelerating the Adoption of New and Emerging Therapies for DLBCL: A Community-Based Quality Improvement Initiative

Background Remarkable progress has been made in the treatment and management of DLBCL. With a rapidly evolving landscape and novel treatment options, support is needed for community oncologists to guide integration of the latest safety and efficacy data into existing treatment planning. In this quality improvement (QI) initiative, we undertook an innovative practice transformation model bringing together providers from 4 community-based oncology clinics to assess current practice patterns and develop strategies to overcome barriers to optimal care for patients with relapsed/refractory DLBCL. Methods Between 8/2022-11/2022, 75 hematology/oncology clinicians completed surveys designed to evaluate practice patterns, challenges, and barriers to patient-centered care (Table 1). HCP cohorts within each oncology clinic participated in 1-hour live small-group audit-feedback (AF) sessions in which the teams reviewed the survey data, reflected on their own practice patterns and developed action plans to close identified DLBCL care gaps. Additional surveys conducted before and after the AF sessions evaluated changes in participants' knowledge and confidence in delivering quality care. Results Baseline Provider Surveys: HCPs reported identifying when patients have shifted to a more progressive disease course (31%) and selecting optimal therapies for individual patients (20%) as the biggest challenges in selecting therapies for DLBCL patients. The most challenging issues in managing DLBCL patients were supportive care counseling (28%) and recognizing and managing adverse events (20%). In addition to clinical guidelines, the other factors HCPs identified as most important for treatment decision-making for patients with DLBCL were the effects on quality of life (53%) and treatment effectiveness (48%). In terms of confidence, 23% reported very high confidence in the team's ability to stay up-to-date with new data on DLBCL treatment advances, and 29% reported very high confidence in aligning their clinical practices with evidence-based DLBCL guidelines. When asked about discussing novel treatment options with patients, 8% do not discuss, while 36% briefly discussed, and 56% discussed in detail. Moreover, 36% of HCPs reported low/very low confidence in identifying patients eligible for treatment with novel therapies, and 43% had low/very low confidence in navigating access to incorporate novel therapies into individual DLBCL treatment plans. To improve DLBCL care, only 3% of HCPs felt completely educated on the management of DLBCL, with 44% wanting to improve efficiency and ease of obtaining insurance approval for novel therapies and 44% seeking education on identifying patients eligible for newer therapies. Small-Group AF Sessions: In assessing HCPs' knowledge impact, only 35% correctly selected T-cell as the other targeted cell, in addition to tumor cells, for the mechanism of bispecific antibodies in DLBCL (Figure 1). Although this was improved compared to the 26% correct prior to the activity, more education is needed to close this knowledge gap. HCPs plan to address the following challenges: employing strategies to better identify and manage adverse events of novel therapies for DLBCL (79%), enhancing knowledge of clinical evidence for new and emerging therapies for DLBCL (71%), and developing personalized treatment plans incorporating patient-specific factors and preferences (68%). To achieve these goals, HCPs committed to improve patient communication and education, expand treatment access, engage patients by working to understand patient-specific considerations related to cellular therapies, and to educate and train staff in managing adverse events. Conclusions Barriers to providing patient-centered care in DLBCL identified in this QI initiative include staying up-to-date with novel therapies, recognizing and managing adverse events, and identifying patients eligible for novel therapies. After participating in this QI initiative, HCPs developed action plans to address the identified gaps and reported meaningful confidence gains in delivering DLBCL care. Practice gaps uncovered in this initiative can inform future QI programs. Study Sponsor Statement The study reported in this abstract was funded by an independent educational grant from Genmab US, Inc. and Kite Pharma, Inc. The grantors had no role in the study design, execution, analysis, or reporting.

Advancing Collaboration across the Multiple Myeloma Treatment Journey from Oncology Clinic to CAR T-Cell Center: A Paired Center Transformative Quality Improvement Initiative

Background Treating patients with multiple myeloma (MM) is a complex endeavor that requires effective clinical decision-making from a team of specialists and supporting clinicians. Additionally, treatment with chimeric antigen receptor (CAR) T-cell therapy presents unique challenges, requiring communication and collaboration between the oncology clinic and CAR T-cell treatment centers. To improve collaborative MM care, we conducted a quality improvement (QI) study, bringing together community and academic oncology centers to assess current practice patterns and develop strategies to overcome barriers in the treatment of patients with MM across the continuum of care. Methods This QI initiative is comprised of baseline provider surveys (Community n = 21; Academic n = 18) and pre- and post-surveys of providers (n = 31) participating in small-group, team-based audit-feedback (AF) sessions (Table 1). Survey questions were designed to assess knowledge, confidence, and experiences in keeping up with the latest clinical evidence and guideline recommendations and collaboration and communication practices between centers. Care teams from each clinic, along with a nationally renowned expert MM physician, participated in audit and feedback sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Results Provider Surveys: When asked their top challenge encountered in managing patients with MM, community-based providers reported keeping up with clinical evidence for new and emerging therapies (48%), whereas academic-based providers reported knowing how to optimally sequence therapies (50%). Further differences between community and academic clinicians were evident in their self-reported confidence in their ability to stay up-to-date with new data on CAR T-cell therapies and other MM treatment (high/very high confidence: 84% academic; 24% community; p < .001), ability to align clinical practices with evidence-based guidelines (high/very high confidence: 72% academic; 34% community; p = .018), and ability to sequence lines of therapy and differentiate between novel therapies for MM (high/very high confidence: 72% academic; 29% community; p = .007). Despite these differences, care teams from both settings reported low percentages of eligible patients have received CAR T-cell therapy for MM, citing patient resistance, cost and difficulty gaining insurance approval as top barriers (Figure 1). When asked to rate the level of communication and collaboration between academic and community centers, 44% of academic providers and 35% of community providers rated very good/excellent. The top barrier among providers not indicating very good/excellent communication from both settings was lack of time for our clinic's staff to communicate. AF Sessions: Providers participating in the small group AF sessions reported gaining access to newer therapies (55%) as their biggest challenge regarding MM management. Clinicians indicated gains in moderate/high/very high confidence in their ability to align treatment decisions with guidelines and clinical evidence for MM (78% to 92%) and ability to sequence treatment options across multiple lines of therapy for patients with MM (80% to 100%). Care teams set goals to enhance knowledge of clinical efficacy and safety of new and emerging therapies for MM. Action plans to achieve these goals include developing a hematology disease specific tumor board to collaborate on patient care plans, further train designated staff members focused on CAR T-cell/MM, discuss relevant new data to improve the team's confidence in therapy sequencing and early referrals to CAR T-cell centers. Conclusions Through this QI initiative, clinical teams identified barriers to optimal MM care, creating and implementing specific action plans to increase knowledge of current and emerging therapies for MM to enhance individualized treatment plans. While meaningful confidence gains were demonstrated, these data underscore clinical practice gaps to address in future initiatives to support evidence-based, collaborative care plans for patients with MM. Study Sponsor Statement The study reported in this abstract was funded by educational grants from Bristol Myers Squibb. The grantors had no role in the study design, execution, analysis, or reporting.

Addressing community readiness to promote physical activity in older adults in Germany.

Community-based approaches are promising to promote physical activity in old age. The community readiness (CR) model offers a structured approach to assess community capacities to address a certain health topic before and after implementing an intervention. The objective of this study is to assess whether community-based capacity building for physical activity among the elderly has a lasting effect on CR. Four communities (two sub-urban and two urban) in Northwestern Germany were randomly assigned to either intervention or control group. CR was assessed at three time points (2015, 2018 and 2020) by interviewing local key informants (n = 129). Community capacity building was carried out in the two intervention communities after baseline assessment and included the development and implementation of a local physical activity action plan for elderly. Overall CR scores were calculated and random effects regression analysis was performed to analyze group-by-time interaction. At baseline, the overall CR score was 4.62 (standard deviation (SD) = 0.51) indicating that communities were in the preplanning stage of CR. CR scores in the intervention communities did not significantly increase at follow-up assessments compared to control communities [2018: 4.82, coefficient -0.03, 95% confidence interval (CI) (-0.80; 0.73); 2020: 4.54, coefficient 0.19, 95% CI: (-0.59; 0.97)]. The process evaluation indicated several factors facilitating a successful cooperation with community stakeholders. These included building on existing networks, using a structured approach for developing and implementing a local physical activity action plan for older adults, providing financial support for implementing activities and linking activities to existing community events.

Identification of drivers and affecting factors in the future of Persian medicine: The cross-impact analysis method

IntroductionPersian medicine is a holistic medical school with deep roots. It has a high educational, research, and therapeutic capacity and has been the focus of Iran's general health policies in recent years. Futures studies aid policymakers and health managers in creating normative scenarios and developing action plans using various techniques. This study aimed to identify important drivers and factors that affect the future of the Persian medicine system. MethodThis qualitative research was conducted with a futures studies approach, using the Cross-Impact Analysis (CIA) in three main steps. The first and second steps were conducted using interviews and focus group discussions. In the first step, 15 semi-structured interviews were conducted with Persian medicine experts to identify all factors affecting the future of Persian medicine. In the second step, we held three focus group discussions with 9 interviewees from step one with national-level influence to determine the influence and dependence of each factor. The third step was performed using the matrix CIA and MICMAC to identify the key factors affecting the future of Persian medicine. ResultsSixty five variables affecting the future of Persian medicine were identified, 36 related to the health system, and 29 to external factors. Factors such as globalization, knowledge-based economy, the spread of non-communicable and chronic diseases, as well as people's views and attitudes towards Persian medicine, are considered key drivers and variables that will affect the future of the Persian medicine system. The Iranian development plans as a two-dimensional and risk factor are crucial in establishing Persian medicine. ConclusionThe future of the Persian medicine system is relatively stable. The pattern of the Iranian development plans is considered the most important two-faceted factor as a risk factor in the establishment of the Persian medicine system. It is suggested that the position of the Persian medicine system in the Iranian development plans be made more prominent.

Researchers join forces to conserve red colobus (Piliocolobus badius temminckii) in West Africa.

The recent development of the Red Colobus Conservation Action Plan has spurred momentum to promote site-based conservation of red colobus while forging partnerships among researchers and building local capacity. Communities for Red Colobus (C4RC) is a community-centered conservation organization in The Gambia, West Africa, that aims to protect Temminck's red colobus (Piliocolobus badius temminckii) while advancing opportunities for local people. We highlight the inception and initial development of C4RC with its educational and ranger teams and describe how local and international collaborations have positively impacted the organization through training and mentoring programs. This conservation program has the potential to become sustainable with plans for continued ecological monitoring, reforestation efforts, use of alternative methods of cooking, and the expansion of ecotourism. We hope that the dissemination of project information through Gambian broadcast and social media channels and wider community outreach activities will improve perceptions and conservation of primates and inspire the development of other red colobus initiatives at suitable forest sites based on the C4RC model of community-based conservation.

Improving global health security through implementation of the National Action Plan for Health Security in Sierra Leone, 2018–2021: lessons from the field

BackgroundAll countries are required to implement International Health Regulations (IHR) through development and implementation of multi-year National Action Plans for Health Security (NAPHS). IHR implementation requires annual operational planning which involves several tools such as NAPHS, State Party Annual Report (SPAR), Joint External Evaluation (JEE) and WHO IHR Benchmarks tool. Sierra Leone has successfully improved IHR capacities across the years through successful annual operational planning using the above tools. We conducted a study to document and share the country’s unique approach to implementation of NAPHS.MethodsThis was an observational study where the process of implementing and monitoring NAPHS in Sierra Leone was observed at the national level from 2018 to 2021. Data was obtained through review and analysis of NAPHS annual operational plans, quarterly review reports and annual IHR assessment reports. Available data was supplemented by information from key informants. Qualitative data was captured as notes and analysed for various themes while quantitative data was analyzed mainly for means and proportions.ResultsThe overall national IHR Joint External Evaluation self-assessment score for human health improved from 44% in 2018 to 51% in 2019 and 57% in 2020. The score for the animal sector improved from 32% in 2018 to 43% in 2019 and 52% in 2020. A new JEE tool with new indicators was used in 2021 and the score for both human and animal sectors declined slightly to 51%. Key enablers of success included strong political commitment, whole-of-government approach, annual assessments using JEE tool, annual operational planning using WHO IHR Benchmarks tool and real time online monitoring of progress. Key challenges included disruption created by COVID-19 response, poor health infrastructure, low funding and inadequate health workforce.ConclusionIHR annual operational planning and implementation using evidence-based data and tools can facilitate strengthening of IHR capacity and should be encouraged.

Optimizing the Integration of Genetic Testing in AML Care in Community Practice: Insights from a Quality Improvement Initiative

Background The treatment landscape for acute myeloid leukemia (AML) is rapidly evolving, and with many of the more recently FDA approved treatments being targeted therapies, timely and actionable molecular and cytogenetic testing is critical to the management of AML patients. However, many challenges and barriers to optimal testing workflows impede clinicians' ability to integrate genetic testing in treatment decision-making. To improve quality care related to genetic testing in AML, we conducted a quality improvement (QI) study focused on evidence-based integration of genetic testing into routine practice for AML patients in community oncology clinics. Methods This QI initiative is comprised of baseline (N = 72) and follow-up provider surveys, and pre- and post-surveys of providers participating in small-group, team-based audit-feedback (AF) sessions across 5 community clinics. Survey questions were designed to assess knowledge, confidence, and experiences with genetic testing in AML. Care teams from each clinic, along with an expert AML oncologist and a hematopathologist, participated in AF sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Results Provider Surveys: Providers top reported challenges encountered with integrating genetic testing into routine practice include determining whether to begin treatment prior to receipt of genetic testing result (56%)and applying genetic testing results to treatment decision-making (29%). For patients with AML, 70% of providers stated they were likely to start treatment prior to receiving testing results. When asked to report routine molecular testing practice patterns, 72% of providers reported testing for FLT3 mutations, 62% for IDH1/2 mutations, 65% for TP53 mutations, and 63% for NPM1 mutations; with further suboptimal reported practices in the use of NGS panels (58%; average turnaround time 15 days) and PCR (52%; average turnaround time 8 days). Overall, providers reported a 56% satisfaction rate with the processes implemented in the clinic related to sample preparation, timely review, and turnaround time of molecular diagnostics testing reports. AF Sessions: Providers participating in the AF sessions also reported determining whether to begin treatment prior to receipt of molecular testing results, long turnaround times and deciding on the appropriate molecular tests as top barriers to integrating testing in routine AML care. Clinicians reported improvements in high/very high confidence in their ability to select appropriate genetic tests to order for patients with AML (35% to 50%) and select targeted therapies based on genetic test results for AML patients (34% to 59%). Care teams set goals to improve turnaround times and testing workflows with pathology partners, as well as to maximize opportunities for patients to receive AML therapies for their specific mutation profile. Action plans to achieve these goals include improve team skills in choosing guideline-based genetic testing methods and targeted therapies and collaborate among clinical teams to improve ordering workflow and diagnostic sample preparation for genetic testing. Follow-Up Surveys: In 90-day follow up surveys, 100% of clinic champions reported upshifts in patients with targetable driver mutations receiving guideline-recommended treatment based on genetic testing results, and 4/5 clinics reported improved selection of guideline-recommended genetic testing prior to treatment initiation for AML patients. Conclusions Through this QI initiative, clinical teams identified barriers to integrating genetic testing into routine AML care, creating and implementing action plans to optimize genetic testing workflows and guideline-recommended targeted therapy selection. While meaningful confidence and action plan gains were demonstrated, these data underscore clinical practice gaps to address in future initiatives to support the integration of evidence-based genetic testing into AML care, including integrated education sessions with clinicians and pathologists. Study Sponsor Statement The study reported in this abstract was funded by independent educational grants from AbbVie, Inc. and Astellas Pharma Global Development, Inc., who had no role in the study design, execution, analysis, or reporting.