Entry Level Research Articles

Trends in attachment to a primary care provider in Ontario, 2008-2018: an interrupted time-series analysis.

Attachment to a regular primary care provider is associated with better health outcomes, but 15% of people in Canada lack a consistent source of ongoing primary care. We sought to evaluate trends in attachment to a primary care provider in Ontario in 2008-2018, through an equity lens and in relation to policy changes in implementation of payment reforms and team-based care. Using linked, population-level administrative data, we conducted a retrospective observational study to calculate rates of patients attached to a regular primary care provider from Apr. 1, 2008, to Mar. 31, 2019. We evaluated the association of patient characteristics and attachment in 2018 using sex-stratified, adjusted, multivariable logistic regression models and used segmented piecewise regression to evaluate changing trends before and after implementation of a policy that restricted physician entry to alternate models. Attachment increased from 80.5% (n = 10 352 385) in 2008 to 88.9% of the population (n = 12 537 172) in 2018, but was lower among people with low comorbidity, high residential instability, material deprivation, rural residence and recent immigrants. Inequities narrowed for recent immigrants, males and people with lower incomes over the study period, but disparities persisted for these groups. Attachment grew by 1.47% annually until 2014 (p < 0.0001), but was stagnant thereafter (annual percent change of 0.13, p = 0.16). Lack of sustained progress in attachment followed reduced levels of physician entry to alternate funding models. Although disparities narrowed for many groups over the study period, persistent gaps remained for immigrants and people with lower incomes; targeted interventions and policy changes are needed to address these persistent gaps.

Addressing the elephant in the room: Differentiating the AACN Essentials levels of competency within advanced practice.

While the 2021 AACN Essentials, "The Essentials: Core Competencies for Professional Nursing Education", provide a framework for educational preparation, academia is challenged to navigate through the muddy waters of competency attainment at the advanced level (L2). The aim of the new Essentials is to serve as a curriculum guide and provide a clear vision of the profession to community and stakeholders, while those within the profession struggle to thread this vision through redesign, specifically differentiating competency in L2 for master's and doctoral level preparation. This perspective article challenges educators to expand the definition of competency attainment to one of innovation based on the history and evolution of Doctor of Nursing Practice (DNP) education, competency-based education (CBE), and the achievement of milestones as advanced practice moves to entry level as DNP.

Exploring the Manager\'s Role beyond the Rule Book: Investigating the Influence of Managerial Emotional Intelligence and Individual Traits on Team Efficiency

Abstract: In most teams, the junior members constitute the primary workforce, while those in managerial positions are responsible for task allocation. Even individuals at the entry level have limited impact on contributions. The pivotal role falls upon mid-level employees, as their optimal performance is essential for the team's overall efficiency.

Designing a skills training pathway for the agricultural workforce from the employer perspective: skills micro-credentials from seasonal worker to supervisor

ABSTRACT Purpose To identify a skilled micro-credentialled training pathway for agricultural careers. Design/Methodology/Approach A survey consisting of open ended and Likert-type ratings questions regarding workforce skills requirements, training priorities and training delivery preferences was administered with 17 agricultural business managers and employers. Data were analysed to understand current workforce structures, compliance and training skills needs for workforce segments including: (a) seasonal workers, (b) entry level workers, and (c) supervisors. Findings Seventeen compliance and technical skills were identified as training priorities, and preferred approaches to training delivery included blended and on-the-job training, with formal accredited training preferred across all skills domains. Practical Implications Findings suggest that micro-credentials for these skills domains are of use for industry, with a skills development pathway for different workforce segments identified. Theoretical Implications It has been argued that micro-credentials may be a mechanism to improve the career motivations of workforce segments that traditionally do not engage in certificate or diploma level courses. The current research reports on an employer-identified need for this type of system, with further research required to explore employee perspectives. Originality/Value This research contributes a skills map that can be used to inform the design a micro-credentialled training pathway for the agricultural workforce.

Incidence and Factors Associated with Postspinal Headache in Obstetric Mothers Who Underwent Spinal Anesthesia from a Tertiary Hospital in Western Uganda: A Prospective Cohort Study.

The proportion of obstetric mothers reporting postspinal headache (PSH) in Uganda is high. The aim of this study is to determine the incidence and factors associated with postspinal headache among obstetric patients who underwent spinal anesthesia during cesarean section at a tertiary hospital in Western Uganda. A prospective cohort study was done on 274 consecutively enrolled obstetric patients at Fort Portal Regional Referral Hospital (FRRH) from August to November 2022. Pretested questionnaires were used to obtain the data needed for analysis. The data were entered into Microsoft Excel version 16, coded, and transported into SPSS version 22 for analysis. Descriptive statistics was used to determine the incidence of postspinal headache. Binary logistic regression was computed to obtain factors associated with postspinal headache. The overall incidence of postspinal headache was 38.3% (95% CI: 32.5-44.4). Factors with higher odds of developing postspinal headache included using cutting needle (aOR 3.206, 95% CI: 1.408-7.299, p=0.006), having a previous history of chronic headache (aOR 3.326, 95% CI: 1.409-7.85, p=0.006), having lost >1500 mls of blood intraoperatively (aOR 6.618, 95% CI: 1.582-27.687, p=0.010), initiation of ambulation >24 h after spinal anesthesia (aOR 2.346, 95% CI: 1.079-5.102, p=0.032), allowing 2-3 drops of cerebrospinal fluid (CSF) to fall (aOR 3.278, 95% CI: 1.263-8.510, p=0.015), undergoing 2 puncture attempts (aOR 7.765, 95% CI: 3.48-17.326, p ≤ 0.001), 3 puncture attempts (aOR 27.61, 95% CI: 7.671-99.377, p ≤ 0.001) and >3 puncture attempts (aOR 20.17, 95% CI: 1.614-155.635, p=0.004), those prescribed weak opioids (aOR 20.745, 95% CI: 2.964-145.212, p=0.002), nonsteroidal anti-inflammatory drug (NSAID) with nonopioids (aOR 6.104, 95% CI: 1.257-29.651, p=0.025), and NSAID with weak opioids (aOR 5.149, 95% CI: 1.047-25.326, p=0.044). Women with a body mass index (BMI) of 25-29.9 kg/m2 (aOR 0.471, 95% CI: 0.224-0.989, p=0.047) and a level of puncture entry at L3-4 (aOR 0.381, 95% CI: 0.167-0.868, p=0.022) had lower odds of developing PSH. The incidence of postspinal headache is still high as compared to the global range. This was significantly associated with needle design, amount of cerebro-spinal fluid lost, number of puncture attempts, body mass index, previous diagnosis with chronic headache, amount of intraoperative blood loss, time at start of ambulation, level of puncture entry, and class of analgesic prescribed. We recommend the use of a smaller gauge needle, preventing CSF loss, deliberate attempts to ensure successful puncture with fewer attempts, puncture attempts at L3-4, reducing intraoperative blood loss, earlier ambulation, and prescribing adequate analgesia to reduce the incidence of postspinal headache.

The implementation of English across the curriculum: An exploratory study of how South African educators teach writing in History lessons

AbstractIn 2013, as a strategy to enhance academic performance, the South African Department of Basic Education (DBE) published several English Across the Curriculum (EAC) manuals to guide in‐service teachers who did not have prior knowledge of how to integrate the teaching of content subjects with language learning. The DBE introduced the EAC strategy as a mandatory tool for strengthening the use of English as a Language of Learning and Teaching (LoLT) to address language as a barrier factor to academic success both in primary and high schools. However, in 2017, the DBE published a report showing that most content teachers were not using the EAC strategy. In view of the alarmingly poor academic performance in mostly public schools, the question in many people's minds has always been whether content teachers are using the EAC strategy. To understand this phenomenon, I conducted a qualitative study focused on four purposively selected Grade 8 Social Science educators teaching History (Grade 8 is an entry level to South African secondary schools). I collected data using non‐participant classroom observations and semi‐structured interviews, while inductive thematic analysis was used as an approach to analyse the data. The findings indicate that to teach writing in History, the participants used strategy‐focused instruction which includes vocabulary development and clustering activities as well as writing frames that encompass sentences and paragraphs. Importantly, the research adds to our knowledge of teaching of English to speakers of other languages in multilingual contexts when mandated by governments to change without appropriate support. The study highlights how this situation leads to deeper reflection where educators must encounter professional conflict and dilemmas to bring coherence to their teaching knowledge and experience.

Mapping of Anatomic Variants of the Proximal Vertebral Artery in Relation to Embryology.

Variations in the origins and courses of the vertebral arteries are relatively rare but may be clinically meaningful. We hypothesize a relationship between variant origins of the vertebral arteries and their levels of entry to the foramina transversaria. In this retrospective study of CT angiograms, we document the frequency and types of vertebral artery variants, correlating origins with levels of entry to the foramina transversaria. Vertebral artery variants were observed in 18.7% of a sample of 460 CT angiograms of the neck. Right-sided variants were less common than left (44.2% versus 68.6%, with 12.8% bilateral) and more common than previously thought. The most common variant on both sides was a variant origin proximal to the normal vertebral artery origin and entry at C5. Most right vertebral arteries originating within 2 cm of the origin of the right subclavian artery and left vertebral arteries originating between the left common carotid and subclavian arteries were "high-entry" variants. Most "low-entry" variants, entering at C7, took origin from the arch just distal to the left subclavian artery or at a common origin with the costocervical trunk. Multiple origins or accessory vertebral arteries were also described, and each moiety followed the same rules described for single origins. A map of vertebral artery origins mirrored the map of aortic arch embryology. Vertebral artery variants follow certain well-defined patterns that correlate with the embryology of the aortic arch and great vessels.

Implementing a quality improvement initiative for private healthcare facilities to achieve accreditation: experience from India

BackgroundThe Manyata program is a quality improvement initiative for private healthcare facilities in India which provided maternity care services. Under this initiative, technical assistance was provided to selected facilities in the states of Uttar Pradesh, Jharkhand and Maharashtra which were interested in obtaining ‘entry level certification’ under the National Accreditation Board for Hospitals and Healthcare Providers (NABH) for provision of quality services. This paper describes the change in quality at those Manyata-supported facilities when assessed by the NABH standards of care.MethodsTwenty-eight private-sector facilities underwent NABH assessments in the three states from August 2017 to February 2019. Baseline assessment (by program staff) and NABH assessment (by NABH assessors) findings were compared to assess the change in quality of care as per NABH standards of care. The reported performance gaps from NABH assessments were then also classified by thematic areas and suggested corrective actions based on program implementation experience.ResultsThe overall adherence to NABH standards of care improved from 9% in the baseline assessment to 80% in the NABH assessment. A total of 831 performance gaps were identified by the NABH assessments, of which documentation issues accounted for a majority (70%), followed by training (19%). Most performance gaps could be corrected either by revising existing documentation or creating new documentation (62%), or by orienting facility staff on various protocols (35%).ConclusionWhile the adherence of facilities to the NABH standards of care improved considerably, certain performance gaps remained, which were primarily related to documentation of facility policies and protocols and training of staff, and required corrective actions for the facilities to achieve NABH entry level certification.

Computer aided derivation of vehicle modules and functions from use cases in order to create user orientated vehicle interior concepts

Trends such as autonomous driving, non-driving related activities and digitalisation are contributing to a revolution in vehicle concept design. An aspect of this is the consideration of future use cases in shaping vehicle architectures. Future user scenarios can help identify relevant use cases, from which the user needs and system requirements can be derived. The derived requirements need to be matched to vehicle functions and architectural modules that can fulfil them. However, the optimal combination of functions and modules can be difficult to identify due to the numerous possibilities. The aim of this paper is to apply a matrix-based methodology that enables the systematic matching of requirements to vehicle functions and/or modules, as well as the identification of an ideal module/function combination for all the considered requirements. An example is presented that considers a requirement specification that has been derived from predetermined user needs. The requirements are matched to suitable functions/modules and the best possible combinations are determined using the proposed matrix-based methodology. Two optimal combinations are selected, one for a vehicle in the entry level segment and the other for a premium vehicle. The results indicate it is possible to determine an optimal combination for both vehicle segments considered, as well as the substantial influence the rating parameters have on the end result. Lastly, it is shown how the results can be applied by concept designers in order to draft tailored, user-orientated interior concepts.

A comparative Hygienic Evaluation of Balance of Lipid Components in the Diet of Medical University Students

INTRODUCTION: A balanced diet provides the optimal level of metabolism and is one of key modifiable factors of the primary prophylaxis of chronic non-infectious diseases. Excess of the common fat in the diet is the most common alimentary imbalance in nutrition of the population.&#x0D; AIM: A comparative characteristics of the level of the alimentary intake and of the main alimentary sources of lipid components in medical university students.&#x0D; MATERIALS AND METHODS: For quantification of entry of lipid components, the method of triple 24-hour reproduction was used. The data on actual nutrition were acquired and analyzed using a specialized questionnaire developed for the given study.&#x0D; RESULTS: A comparative analysis of levels of intake of the common fat, saturated and polyunsaturated fatty acids did not identify any statistically significant differences in women and men in both groups the main sources of the common fat and saturated fatty acids were hard cheese, milk chocolate, sausage products, chicken eggs, butter and mayonnaise. The main contribution to the required level of polyunsaturated fatty acids, irrespective of gender, were made by sunflower oil, fish, mayonnaise, nuts, seeds, pizza and olive oil.&#x0D; CONCLUSION: The level of intake of common fat with the diet exceeds the physiological demand in 95.3% of women and 94.8% of men. A share of saturated fatty acids made more than 10% of the energy value in 92% of female respondents and in 94% of male respondents, which is associated with the excessive quantity of the sources of hidden fat in the diet of students of the two comparison groups, such as hard cheese, milk chocolate and sausage products. In 45% of students, owing to the presence of oils, fish, mayonnaise and nuts in their diet, the level of entry of polyunsaturated fatty acids met the physiological demand.

An Evidence Based Rationale for Health and Wellness Coaching as a Complementary Certification in Undergraduate Health Education.

Health and wellness coaching (HWC) is an effective intervention for many chronic lifestyle diseases. Chronic diseases represent a majority of our severe national healthcare burden. Yet, HWC certification programs vary in delivery method and degree awarded. The purpose of this paper is to provide an evidence based rationale for HWC as a complementary area of study to non-licensure granting, undergraduate health degrees in higher education. A comprehensive review of the literature related to the efficacy of HWC was completed. In addition, the national program directory was mined for descriptive data for approved HWC programs. Given the growing body of support for HWC as an effective intervention, we recommend that institutions deliver HWC curricula as an academic minor for undergraduate students in non-licensure granting health-related degrees to position graduates for entry level careers in HWC. Evidence from the successful deployment of an undergraduate program in HWC supports our contention that HWC be delivered as an academic minor in support of lifestyle health and wellness education. In doing so, the field can offer HWC in a way that is widely accessible to the undergraduate population, while providing a mechanism for direct employment as a professional health and wellness coach.

A Hitchhiker's Guide to Problem Selection in Carbohydrate Synthesis.

Oligosaccharides are ubiquitous in molecular biology and are used for functions ranging from governing protein folding to intercellular communication. Perhaps paradoxically, the exact role of the glycan in most of these settings is not well understood. One reason for this contradiction concerns the fact that carbohydrates often appear in heterogeneous form in nature. These mixtures complicate the isolation of pure material and characterization of structure-activity relationships. As a result, a major bottleneck in glycoscience research is the synthesis and modification of pure materials. While synthetic and chemoenzymatic methods have enabled access to homogeneous tool compounds, a central problem, particularly for newer synthetic chemists, is the matter of problem selection. This outlook aims to provide an entry level overview of fundamental principles in carbohydrate chemistry with an eye toward enabling solutions to frontier challenges.

Development of Hemagglutinin-Neuraminidase Homologous Peptides as Novel Promising Therapeutic Agents Against Peste des Petits Ruminants Virus.

The lack of specific antiviral therapy and complications associated with the existing peste des petits ruminants (PPR) vaccines accentuates the search of novel antiviral blocking agents in order to curtail the PPR infection at initial level. The synthetic hemagglutinin-neuraminidase (HN) homologous peptides may compete with the natural HN protein of PPR virus for binding to signaling lymphocytic activation molecule (SLAM) receptor, consequently, may disrupt peste des petits ruminants virus (PPRV) at entry level. Therefore, insilico analysis, synthesis, purification and subsequent characterization of HN homologous peptides were conducted in this study. The HN homologous peptides were synthesized by means of solid phase chemistry and were purified by reversed-phase-high performance liquid chromatography. The mass as well as sequence of HN homologous peptides were assessed by mass spectroscopy while its secondary structure was elucidated by circular dichroism spectroscopy. The binding (interaction) efficacy of HN homologous peptides with PPRV antibodies was assessed via indirect enzyme linked immunosorbent assay, visual detection test (red wine to purple), bathochromic shift under UV-Vis spectrophotometry and lateral flow immunochromatographic strip test. The antiviral properties and cytotoxicity of these peptides were also assessed in B95a cell line with changes in cytopathic effect and titer of PPRV (Sungri/96). The presence of green fluorescein isothiocyanate over the B95a cell surface pointed towards the binding of HN homologous peptides with surface SLAM receptor. Moreover, the intact beta sheet configuration in water and lower cytotoxicity [cytotoxic concentration 50 (CC50) > 1000µg/ml] of these peptides signifies its in vivo use. Among HN homologous peptides, the binding efficacy and antiviral properties of pep A was relatively high in comparison to pep B and Pep ppr peptides. The prerequisite concentration of HN homologous peptides (pep A = 12.5µg/ml; pep B = 25µg/ml; pep ppr = 25µg/ml) to exemplify its antiviral effect was much lower than its CC50 level. Hence, this study signifies the therapeutic potential of synthetic HN homologous peptides.

Trends among Institutional Animal Care and Use Committees and Animal Resource Programs for Providing Oversight and Animal Care during the (COVID)-19 Pandemic and Beyond.

To assess the impact of the COVID-19 pandemic on facility oversight and animal care at 2 y after declaration of the pandemic, we distributed a comprehensive survey to targeted groups within the broader animal research community in early 2022. A total of 265 surveys were returned (161 responses to IACUC questions, 193 responses to animal resource program [ARP] questions, and 89 responses to both). IACUC questions focused on the use of virtual interactions for IACUC activities and on remote work for IACUC support staff during and after the pandemic. ARP questions focused on remote work arrangements, altered work schedules, personnel shortages, and operational changes made during and after the pandemic. Results indicate that IACUCs readily adopted remote work options for staff and virtual meetings, changes that are now largely viewed as permanent, and are using modified methods for postapproval monitoring (PAM), while largely rejecting virtual semiannual facility inspections. This pattern reflects available guidance for virtual IACUC meetings, whereas new guidance for virtual semiannual facility inspections might have caused confusion and regulatory compliance concerns. Remote work options were available for some ARP staff, depending on job responsibilities, but were mostly eliminated by 2 y after the start of the pandemic. ARP staff expressed a strong desire for continued in-person presence of supervisors; this preference was not expressed by IACUC staff. Based on the timing of the survey (April 2022), substantial disruptions in the labor market had resulted in a considerable number of job openings and lack of entry level staff. Long-term assessment of effects on compliance and IACUC engagement would be useful given the widespread use of virtual IACUC meetings and other changes related to institutional and programmatic adoption of remote work options in ARPs.

Disparities of Self-compassion and Job Satisfaction across Decision-Making Styles among Filipino Workers

Self-compassion and job satisfaction of Filipino workers across their decision-making styles are constructs of the present study being presented in the field of work. This paper aimed to identify the decision-making style; describe and measure the degree of self-compassion and job satisfaction; and determine the difference in self-compassion and job satisfaction across decision-making styles among respondents. The General Decision-making Styles Questionnaire (GDSQ), Self-compassion Scale, and Job Satisfaction Survey were administered to 359 respondents who aged from 28-60 years old, regardless of gender, across different companies in Calabarzon. The respondents were employees from entry level positions, supervisors, as well as executive level positions. Results have shown that rational, intuitive, dependent, avoidant, spontaneous, and dependent were the decision-making styles among respondents. The degree of self-compassion was at a high level (M=142.78, SD=21.16), while the degree of job satisfaction showed respondents’ ambivalence towards their job (M=3.51, SD=0.46). The Multivariate Analysis of Variance (MANOVA) confirmed a significant difference (Fobt= 5.054**, p of 0.0001) in the self-compassion and job satisfaction across decision-making styles among Filipino workers and was validated by Fisher’s LSD as a post hoc test. Outcomes of the study is recommended as a basis in proposing intervention programs in human resource management and industrial psychology. Mixed-method research is recommended to strengthen the concepts of self-compassion and related variables in this study.

Comparing Visitor Perceptions, Characteristics, and Support for Management Actions before and during a Pilot Timed Entry System at Arches National Park

Over the past decade, many national park units in the United States broke visitation records. Arches National Park (UT, USA) is no exception. Between 2011 and 2021, visitation increased 74%. As part of considering management options to address the issues from sustained and concentrated visitation, Arches implemented a pilot timed entry system from 3 April to 3 October 2022. This article compares visitor perceptions, characteristics, and support for management actions before and during the pilot timed entry system using data from visitor intercept surveys. Findings suggest visitors experience quality improved across the park and on hiking trails during the pilot timed entry system. Visitor characteristics were extremely similar, and there were no differences in local residency, group size, vehicle occupancy, race, ethnicity, first time visitation, education level, or household income. Visitors were more likely to plan for the trip further in advance and were less likely to re-enter the park during the pilot timed entry system. Lastly, visitors demonstrated more support for timed entry and lower levels of support for expanding parking, site specific reservations, and temporary closures during the pilot timed entry system. These results reflect unique insights for managers considering managed access systems like timed entry to sustainably manage visitor use in parks and protected areas.

Tikanga and the Law

This paper is based on the transcript from a presentation given at the New Zealand Asian Lawyers Wānanga on Tikanga and the Law given on 3 May 2023. This paper offers one of many explanations of tikanga and is an entry level introduction only to a complex kaupapa. This paper traverses briefly a proposed three-part model of recognition of tikanga. The first part of the model is a methodology of engagement. The second part is the notion of kaitiaki as a controlling principle. The third part is tikanga-enabling processes. The last two steps of the methodology are covered briefly due to time restraints.&#x0D; Keywords: tikanga; normative system; recognition; methodology of engagement; tikanga-enabling processes; common law.

Relative age effect

The aim of this study was to examine relative age effect (RAE) on distinctive variables and age groups in recreational football. Participants (N = 79,249) included male (n = 63,540) and female (n = 15,709) players aged 2 to 12 years. Data were gathered through an official database containing all licensed players in Denmark. Birthdate distributions were split by age category, sex, club size, year group size, and birth quarter (Q1 = January to March, Q4 = October to December). RAEs were calculated using chi-square analysis. Significant RAEs existed in all age categories (except females in U6 and below). The effect was most pronounced at the entry level among both males and females. Club size was not associated with RAEs, but were shown in smaller and midsized year groups, but were absent in larger year groups. The results of this study show that RAEs are present from early sport participation.

Assessment of Readiness Toward Flipped Learning Among Novice Nursing Students on Fundamental Nursing Care in Puducherry, South India.

Background This study aimed to assess the readiness towardflipped learning (FL)among novice nursing students in fundamental nursing care in Puducherry, South India. Methodology A cross-sectional descriptive study was conducted among 176 first-year B.Sc. Nursing students from threeprivate nursing colleges by purposive sampling technique. In theory and practical classes, the students were taught fundamental nursing procedures such as oral medication, intramuscular injection, peripheral intravenous cannulation, and nasogastric tube feeding as FL. The study was conducted from November 2021 to March 2022. The responses were collected using the Nursing Students'Readiness for Flipped Classroom(NSR-FC) scale with four domains such as personal, technological, environmental, and pedagogical readiness. Pearson correlation and chi-square tests were used to analyze data by incorporating IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp.,Armonk, NY, USA). Results Among 176 nursing students, 73.9% were aged between 17 and 19 years, the majority (76.7%) were females, and 98% of them used mobile phones to access online FL content. Of the novice nursing students, 69.88% agreed, 27.84% strongly agreed, and 2.27% were in a neutral state for readiness to adopt FL in their nursing curriculum with a mean (standard deviation, SD) value of 77.02 (6.27). Among the four domains of readiness, a positive correlation was found between personal with technological readiness (P= 0.001; r=0.446)and pedagogical with personal readiness (P= 0.003; r= 0.223).Statistically, a significant association was found between students' readiness towardFL with the occupation of the head of the family, gadgets used to access the FL materials, and Wi-Fi/internet availability in the institutions with a P-value <0.05. Conclusions The study showed highly positive readiness for FL among nursing students in nursing subjects. It can be leveraged with educational institutions' environmental and technological support by properly utilizing mobile devices, computer laboratories, and access to the internet/Wi-Fi for students from their entry level to enhance FL.

Barriers to HIV-associated lymphoma diagnosis in Soweto, South Africa: A nurse's perspective.

e18727 Background: Delayed diagnosis of aggressive lymphoma in people living with HIV (PLWH) in South Africa is an emerging public health crisis due in part to PLWH living longer on antiretroviral therapy. The main driver of this delay has been shown to occur during the healthcare-practitioner interval that represents the time from presentation to the healthcare center until a diagnosis is confirmed. We set out to explore the barriers contributing to the prolonged healthcare-practitioner interval during the diagnosis of aggressive B-cell lymphoma in PLWH. We provide a nurse perspective, often the first contact a patient will have within the public healthcare sector in Soweto, South Africa. Methods: We conducted a total of nine qualitative in-depth interviews (IDIs) between May-August 2022 with nurses at four public healthcare clinics in Soweto, South Africa. Eligible participants were purposively sampled provided that they had at least 5 years’ experience working with PLWH. All IDI’s were conducted by an experienced, multi-lingual qualitative researcher in a private room at the respective clinic. A semi-structured interview guide was developed to explore the following topics: provider experience in the healthcare system, experience with taking care of PLWH and experience in distinguishing lymphoma from tuberculosis (TB). The interviews lasted on average 67 minutes and were conducted in the participants preferred local language and/or English. IDIs were audio-recorded, transcribed verbatim, and entered into NVIVO for framework data analysis mapped onto a socio-ecological model exploring barriers at the institutional level. Results: Majority of participants were female (7/9; 78%) with a median age of 39 years. Two nurses held enrolled nurse qualifications (entry level) and 7 nurses held professional qualifications with a median of 10 years’ experience in healthcare. Participants report fundamental barriers that occur at the health system level including limited knowledge about lymphoma by providers; structural limitations at the clinic including staffing shortages and limited resources; poor referral/triage process for lymphoma; and lack of continuity in patient care. In contrast, a clear referral process for TB diagnosis and treatment was noted by the nurses. Nurses perceived that patient level barriers that result in advanced stage cancer presentations include use of alternative and traditional medicine. Conclusions: A clear distinction between referral and triage of suspected TB vs lymphoma diagnoses emerged. Nurses perceive that utilization of traditional medicine by patients results in advanced stage cancer diagnoses. Interviews with lymphoma patients are ongoing and interviews with providers at the TB clinics and with traditional healers in the region are planned to better understand the role that these barriers play in delayed lymphoma diagnosis in South Africa.