Gaps In Delivery Research Articles

Implementation and Integration of Sustainability in the Water Industry: A Systematic Literature Review

The changing stature of the environment and society, in general, necessitates a shift from the business-as-usual approaches to sustainable frameworks in the water industry. The industry’s reliance on conventional methods has created gaps in service delivery and the attainment of Sustainable Development Goals. Sustainable approaches have been implemented but are yet to reap any benefits for the foreseeable future. The flailing nature of the industry has created a need for the integration of sustainable initiatives such as the circular economy and Industry 4.0 technologies. A systematic review was conducted to determine the implementation and integration of sustainability in the water industry. The examination utilized the PRISMA framework to identify the best fit articles for inclusion. A total of 48 articles were identified that explored both the concepts of implementation and integration. The findings indicate that the circular economy initiatives will close the loops through the 6R model. Furthermore, the application of Industry 4.0 technologies such as artificial intelligence, IoT, and big data will increase the efficiency/performance of the industry. The paper has a favorable implication for society and the industry, as it recommends specific tools/interventions for sustainable water management.

When a baby is diagnosed at high risk of cerebral palsy: understanding and meeting parent need

Purpose To explore the experiences and needs of parents with an infant diagnosed at risk of cerebral palsy (CP) and to receive feedback on a new online support program (Parenting Acceptance and Commitment Therapy; PACT). Materials and methods Eleven parents from eight family dyads (8 mothers, 3 fathers) with infants under 24 months of age (age range 10–24 months) recently diagnosed as at risk of CP as well as fourteen clinicians participated in this qualitative study through interviews. Results Parents reported conflicting emotions and grief. Further, they reported that they wanted honesty, support and normalisation of their experiences from clinicians. Parents pointed to a gap in service delivery in terms of non-pathologising psychological support specific to their needs. Clinicians reported a lack of skills in supporting distressed parents. Parent feedback on PACT was positive, with parents receptive to the online delivery. Conclusions Parents want acceptance without pathologisation, honesty, and flexible support. Clinicians working with children at risk of CP need training in grief awareness and support for their own coping. Health services should consider building better parental support into their systems of care. IMPLICATIONS FOR REHABILITATION Parents want clinicians to be honest, supportive and to normalise their grief Clinicians in rehabilitation would benefit from up-skilling in grief support Parental support should be built into systems of care for children with cerebral palsy

Abstract 13846: Shared Curriculum Delivery Gaps Among Advanced Heart Failure and Transplant Cardiology Fellowship Programs

Introduction: Nearly 4,000 heart transplants and more than 5,000 LVAD implants were performed in the US in 2021. Medical care for these patients is performed by Advanced Heart Failure and Transplant Cardiology (AHFTC) physicians. Variations in faculty expertise and patient pathology exist between training programs, and some may be unable to provide a curriculum addressing all recommended competencies during the one-year-long fellowship. This study is a targeted needs assessment identifying gaps in curriculum delivery among US AHFTC fellowship programs. Methods: 50 medical knowledge competencies were selected from the 2017 ACC/AHA/HFSA/ISHLT/ACP Training Statement on Advanced Heart Failure and Transplant Cardiology. AHFTC fellowship programs were identified using the AMA’s FREIDA website. A survey was published on Qualtrics. An anonymous link was emailed to all program directors (PDs), while PDs and program coordinators (PCs) were asked to help distribute the survey to current fellows. Results: 17 PDs and 11 fellows completed the survey. The most common areas where little to no training was reported to be provided were: role of lung transplantation in patients with pulmonary arterial hypertension (68%), pathophysiology of cardiac dysfunction associated with portal hypertension (61%), and conditions that may impact mechanical circulatory support strategies in adult patients with congenital heart disease (58%). Respondents most requested a moderate to a significant amount of more training in the following areas: appropriate treatment of patients with each type of pulmonary hypertension (63%), pharmacology of medications available to treat pulmonary arterial hypertension (58%), and role of lung transplantation in patients with pulmonary arterial hypertension (53%). (The information reported is as of June 12, 2022. Data collection is ongoing.) Conclusions: Common gaps in curriculum delivery among US AHFTC fellowship programs appear to exist. The most desired area for additional instruction involves different aspects of the management of pulmonary hypertension. A focused centralized curriculum could be developed to teach these concepts, thereby better preparing AHFTC fellows to care for these types of patients in the future.

Survival Outcomes and Care Equity among Patients with Advanced Breast Cancer in Auckland, New Zealand.

The Auckland Advanced Breast Cancer Review (AABC) was a review of patients diagnosed with advanced inoperable/metastatic breast cancer (ABC) within the Auckland region of New Zealand, commissioned in response to a Breast Cancer Registry report (BCFNZR) that showed poor and inequitable survival outcomes. The review was aimed at assessing equity of care and identifying healthcare delivery gaps for patients with ABC in the Auckland region. In this retrospective study, patients living within the Auckland region, diagnosed with ABC between the 1st January 2013 to the 31st December 2015 were identified from the Breast Cancer Registry. Data censorship date was 30th January 2019 to allow a minimum of 3 years of follow-up. Demographic, diagnostic, treatment, and survival data were extracted from electronic records for statistical analysis. Of the 388 patients that met inclusion criteria for this study, median overall survival (medOS) was 18.9 months in the total population, with no difference between patients with de novo metastatic disease (dnMBC -18.9 m) and recurrent metastatic disease (rMBC -18.7 m). No statistically significant differences in medOS was found amongst Maori (16.2 m), Pacific People (17.3 m), and NZ European (18.9 m) or when patients were stratified according domicile district health board. Median number of lines of systemic treatment was two, with similar treatment exposure between ethnic groups. While treatment uptake and survival outcomes were generally comparable across ethnicity and district health boards, dnMBC survival outcomes were considerably poorer than expected, earmarking this subset of patients with ABC for more in-depth research.

Examining the variations in the implementation of interventions to address stillbirth from the national to subnational levels: experiences from Uganda

BackgroundThe current global burden of stillbirth disproportionately affects regions such as sub-Saharan Africa, where Uganda is located. To respond to this burden, policies made at the national level were diffused from the centre and translated into service delivery at the district level, which is charged with implementation under the decentralization of health services arrangement. Variations emerge whenever policy recommendations are moved from national to subnational levels, with some aspects often lost along the way. Tools are available to facilitate knowledge of determinants of policy and innovation implementation within the healthcare system. However, the extent to which these have been applied to explain variations in implementation of interventions to address stillbirth reduction in Uganda remains scant. The aim of this article was to examine the variations in the implementation of interventions to address stillbirth from the national to the subnational levels in Uganda using the Consolidated Framework for Implementation Research (CFIR).MethodsThe study adopted a qualitative case study design. Data were collected from a purposively selected sample of key informants drawn from both the national and subnational levels. All interviews were conducted in English and transcribed verbatim. ATLAS.ti was used to guide the coding process, which used a codebook developed following the CFIR domains as codes and constructs as sub-codes. Analysis followed a content analysis technique.ResultsNational-level factors that favoured implementation of interventions to address stillbirth included the desire to comply with global norms, incentives to improve performance for stillbirth reduction indicators for better comparison with global peers, and clear policy alternatives as process implementation advanced by champions. Variations at the subnational level revealed aspirations to address service delivery gaps which fell within maternal health routine standard of care and ongoing health systems strengthening initiatives. Coalescing existing networks around maternal and child health was a key mobilization factor for advocacy and programming, with a promise that the set targets would be operationalized at the subnational level. The key champions were defined by their official roles within the district health systems, which enhanced accountability. Feedback and reflection were distinguished from the national to subnational through joint assemblies and formal audit reviews, respectively.ConclusionsA heavy influence of the global events directed national-level adaptation of interventions to address stillbirth. Implementation context at the subnational level led to local adaptation and translation of policy provisions from the national level to suit the context, which to a greater extent explains the variations in the final content of policy provisions delivered.

Building and sustaining a culture of innovation in nursing Academics, Research, Policy, and Practice: Outcomes of the National Innovation Summit.

Healthcare in America faces multiple major challenges, highlighting the critical need for innovative solutions to systemic problems. Nursing is uniquely positioned to lead innovation in healthcare. Nurses represent the largest segment of the healthcare workforce, have the greatest exposure to system failures, and must develop workarounds and solutions for the numerous daily gaps in healthcare delivery. However, multiple barriers limit nurses' ability to engage in the essential work of innovating the future of healthcare. With the goal of bringing attention and urgent action to the need for innovation at all levels of nursing and healthcare, experts in innovation from The Ohio State University gathered nationally recognized nursing leaders in the format of an Innovation Summit to identify gaps in and barriers to innovation in healthcare along with solutions. Using a collaborative process, experts at the Summit identified and developed initial solutions to identified gaps and barriers to innovation across four key areas, which for the purpose of the Summit, we have designated four pillars: Academics, Research, Policy, and Practice. The experts believed that a focus on instilling innovation in all four pillars is necessary to improve healthcare and nursing which will ultimately improve the quality and safety of healthcare as well as population health outcomes. Over the next year, this expert panel of innovation leaders will continue to refine its recommendations and action plans to accelerate innovation in the nursing profession. This article describes the vision, process, and initial outcomes of this National Innovation Summit.

PSOR9 Presentation Time: 12:10 PM: Utilization of Brachytherapy Boost in Men with Unfavorable Intermediate Risk Prostate Cancer Treated with Radiation Plus Androgen Deprivation Therapy

<h3>Purpose</h3> Randomized data has shown a lower risk of recurrence with the addition of a brachytherapy (BT) boost in men with intermediate- and high-risk prostate cancer treated with external beam radiotherapy (EBRT) and concomitant androgen deprivation therapy (ADT). The inclusion of ADT with BT-based dose escalation is controversial, and professional guidelines support adding or excluding ADT for men with unfavorable intermediate risk prostate cancer treated with EBRT plus a BT boost. However, inclusion of ADT in men with intermediate risk prostate cancer may become more routine after results from RTOG 0815, and its impact on BT utilization in this population is unclear. Herein, we investigate the landscape of BT boost utilization in men with unfavorable intermediate risk prostate treated with EBRT and ADT in the United States. <h3>Materials and Methods</h3> Men ≥ 18 years diagnosed with clinical stage T1-2N0M0, PSA < 20, and Gleason grade group 3 prostate cancer between 2004-2017 were analyzed from the National Cancer Database. Those missing risk-stratification or treatment data were excluded. Eligible patients were grouped into the following cohorts based on primary radiation treatment modality: (i) EBRT alone or (ii) EBRT plus BT boost. EBRT monotherapy group received conventionally fractionated (1.8-2.0 Gy per fraction) ≥ 74 Gy or moderately hypofractionated (2.5-3.0 Gy per fraction) ≥ 60 Gy. EBRT plus BT boost group received conventionally fractionated ≥ 45 Gy or moderately hypofractionated ≥ 37.5 Gy, and either LDR or HDR BT. All patients received concomitant ADT. Cochran-Armitage was used to evaluate radiation modality treatment trends over time, and multivariable logistic regression was used to identify sociodemographic predictors of treatment. <h3>Results</h3> Among the eligible cohort, 46,490 (82%) were treated with EBRT alone and 10,236 (18%) were treated with EBRT plus BT boost. Median (range) age was 70 years (38-90). Between 2004 to 2017, there was a significant decline in annual use of a BT boost, from 24.5% in 2004 to 16.4% in 2017 (p<0.001). On MVA, Black race (adjusted OR 0.85, 95% CI 0.79-0.90, P<.0001), Medicaid insurance (aOR 0.67, 95% CI 0.57-0.78, P<.0001), and Charlson-Deyo comorbidity index > 1 (aOR 0.78, 95% CI 0.61-0.99, P=0.04) were associated with decreased odds of receiving a BT boost. Private insurance (aOR 1.11, 95% CI 1.05-1.18, P=.001), treatment at an academic institution (aOR 1.25, 95% CI 1.12-1.39, p<.0001), and Charlson-Deyo comorbidity index 0 (aOR 1.07, 95% CI 1.00-1.15, P=.04) were associated with increased odds of receiving a BT boost. <h3>Conclusions</h3> For men with unfavorable intermediate risk prostate cancer, utilization of a BT boost has significantly declined in the United States over the past two decades. Black and uninsured men have been at particularly high risk of undertreatment. Future studies aimed at identifying which men with intermediate-risk prostate cancer (e.g. based on genomic classifier or magnetic resonance imaging) derive the greatest oncologic benefit from a BT boost with EBRT and ADT is warranted to appropriately identify those who may be at risk of undertreatment with its exclusion. Additionally, future initiatives are needed to close the disparity gap in access and/or delivery of this efficacious treatment for Black and uninsured men, an overall undertreated population.

160 A CLOSED-LOOP AUDIT EXAMINING THE USE OF PROPHYLACTIC ANTI-COAGULATION IN OLDER ADULTS ADMITTED TO A SPECIALIST GERIATRIC SERVICE

Abstract Background Guidelines recommend prescription of Prophylactic Anticoagulation (PA) to all hospitalized older adults unless a contraindication exits. In many cases this does not happen at the time of admission increasing the risk of thromboembolic events. We aimed to assess the use of PA across the medicine for the geriatric service of a level 3 hospital (average daily census of service 120) then use quality improvement to achieve our goal of 95% prescription of prophylactic anticoagulation when appropriate. Methods Medication kardexes and clinical notes were reviewed to collect variables including age, length of stay, creatinine clearance, weight, mobility status, use and dose of antithrombotic medications and documentation of reason if not prescribed. Following initial data collection, cause and effect analysis was performed to identify reasons for under-prescription and small tests of change were conducted across 4 PDSA cycles before data collection was repeated. Results Initial data collection revealed that only 80% of older adults admitted to the service were receiving prophylactic anticoagulation. Cause and effect analysis identified many reasons for failure to prescribe PA including inadequate history taking, lack of clinician education and training, poor documentation, lack of handover between clinicians, failure to complete medication reconciliation on admission and lack of pharmacy support on some wards. Each of these contributory factors were addressed in turn. After a month of QI activities prescription of PA improved to 83% and by 3 months 98.1% (104/106) of patients were receiving PA with only 2 patients for whom PA was not prescribed without clear documentation of the reason. Conclusion Sustained quality improvement resulted in a culture change across our service improving rates of appropriate prescription of PA and raising the quality of care delivered to older adults. This model of quality improvement is now being replicated across our department to address other gaps in service delivery.

Multidisciplinary Model of Cervical Cancer Management in Botswana: Benchmarking the Care Cascade to Identify the Impact of Delays

<h3>Purpose/Objective(s)</h3> Timely access to and completion of radiation therapy (RT) are crucial for optimizing clinical outcomes of patients with locally advanced cervical cancer. The cascade of cancer care comprises the steps between initial presentation and treatment initiation. It is unknown which of these steps if any contribute to delay and downstream survival. Multi-disciplinary management has been shown to enhance the likelihood of successful care coordination and delivery across this cascade, but when implemented in limited resource settings it is unknown if multi-disciplinary management initiatives can adequately identify care delivery gaps. This study sought to examine care delivery metrics and outcomes from a newly established multi-disciplinary team clinic (MDT) in a limited resource setting. The analysis benchmarked the timing of steps between diagnosis and RT initiation in patients with locally advanced cervical cancer in Botswana to determine if delay impacted survival. <h3>Materials/Methods</h3> Between January 2016 and July 2018, 230 patients with biopsy-proven cervical cancer were enrolled in Gaborone, Botswana and followed until November 2019. The number of days between biopsy, pathology, MDT consult, RT consult, simulation, and treatment start were calculated based on dates of care delivery. The association of delay with survival was evaluated using the Kaplan-Meier estimates and multivariable Cox proportional hazards models. <h3>Results</h3> After diagnosis, 187 (81.3%) patients ultimately received treatment. Times between various steps of the care cascade are detailed in Table 1. Untreated patients had a median of one-month additional delay between biopsy and pathology result (57 vs. 25 days, p=0.003). Univariate analysis showed patients treated with curative intent (EQD2 >65 Gy) had worse overall survival when delay between simulation and RT start was > 12 days (p=0.048). Median survival was 2 vs. 4.6 years for patients with and without delay >12 days, respectively. This association trended toward but did not meet statistical significance on multivariate analysis after controlling for HIV status and stage (HR 2.35, 95% CI 0.95 – 5.85, P=0.07). HIV status was not associated with delay at any point. <h3>Conclusion</h3> Treatment delay exists in all steps of the care cascade for patients with cervical cancer in Botswana. Delay of >12 days between radiation simulation and initiation was found to negatively impact survival in patients treated with curative intent. This study also demonstrates the feasibility of utilizing the resources of an MDT care model to quantify care delivery benchmarks in a low-resource setting, resulting in identification of actionable targets to improve care delivery and outcomes.

Palestinian Dependence on External Health Services: De-development as a Tool of Dispossession

Abstract Through multiple mechanisms, armed conflict degrades and destroys health systems, leaving significant gaps in care delivery that lead to worse health outcomes. Civilian populations are often left at the mercy of multiple stakeholders to attain health care. Often, they are unable to meet their needs within their own territory. This has been documented as the case throughout the occupied Palestinian territories for decades. In this paper, I argue that the destruction and de-development of the Palestinian health system is not just a side effect of conflict, but is part of a broader effort of dispossession, disconnecting Palestinians from their land and from each other. I focus on the multiple ways Palestinians are forced to depend on external actors to seek needed care due to the limitations of blockade and occupation, the drivers of these pathways, and the outcomes of this dependence. Lastly, I provide recommendations for refocusing health efforts internally.

Social Model Hospice Homes: Bridging the Gap in End-of-Life Care Delivery.

Background: People prefer to die at home, if given a choice. However, data show that less than half of hospice patients get to do so, as many lack the social resources needed for end-of-life (EOL) care to be supported at home. The Social Model Hospice Home (SMHh) is an emerging model of care and offers an option for individuals whose EOL care cannot be fully supported by their available social network. An SMHh is a community-supported home staffed with round the clock caregivers dedicated to closing this social gap in EOL care delivery. Objective: This study aimed to enhance and clarify the reasons for successful outcomes of the SMHh concept. Methods: This study used a qualitative descriptive approach. Twenty-three semistructured interviews were conducted with the participants. Located throughout North America, participants consisted of staff, volunteers, guests, family members of previous guests, board members, and administrators of SMHh programs. Results: Over the course of the study, five major themes were developed: (1) physical attributes of the home, (2) volunteer base, (3) attention to detail, (4) structure of accountability, and (5) practice of compassionate honesty. These themes reveal the beginning of an explanatory theory of why the SMHh concept can support the delivery of effective, high-quality EOL care. Conclusions: The result of this study substantiates SMHh as a viable alternative to traditional in-home or institution-based EOL care. As the SMHh movement develops, more research is needed to explore and understand how this emerging model of care can be implemented on a larger scale.

A call to action; national survey of teaching radiology curriculum to medical students.

Radiology and medical imaging are important yet often an underrepresented facet of medical education. Notably, there is concern among radiologists that students do not receive enough radiology exposure and that they struggle to interpret image findings on entering residency. Therefore, this survey aims to identify how medical students perceive the radiology curriculum and to determine gaps in delivery. Students were recruited from United States (US) medical schools and given a 21-question survey assessing their perception of the radiology curriculum as well as asking about their confidence levels regarding medical imaging. The inclusion criteria were age >18 and enrolled in US medical school. The surveys were completed in April-July 2020 by students across the US. Objective parameters were measured as percentage correct, while subjective parameters used a 4-point Likert scale. A total of 472 medical students across 31 medical schools completed the surveys with a response rate of 69%. Responses represented all class years within medical schools and showed equal distribution among the future career plans. Students responded that didactic lectures were the most common teaching method and that radiologists were their primary teachers during preclinical education. Students were unfamiliar with the American College of Radiology appropriateness criteria with 65% responding they had never heard of it and 33% reporting that they have heard of it but never used it. In assessing students' perceptions of radiology education, 72% of students responded that they received too little, and 28% of students responded, "Just right." <1% of students responded that there was "Too much" radiology in their curriculum. Radiologists are increasing their educational representation in medical school curricula. Despite this, radiology continues to be under-represented with students desiring more exposure to medical imaging. Integrating the student's perceptions with existing curricula suggests that efforts should focus on increasing awareness of which studies are appropriate and teaching students how to systematically interpret an image.

Strengthening maternal nutrition counselling during routine health services: a gap analysis to guide country programmes.

The WHO recommends counselling on healthy eating, weight gain, and physical activity during antenatal care (ANC) and postnatal care (PNC), yet advice and information are often not tailored to women's nutritional needs and contexts. The purpose of the gap analysis was to identify key elements related to the provision of maternal nutrition counselling during routine health contacts and provide programme considerations to strengthen quality service delivery. A search of PubMed, Cochrane Library, CINAHL Plus and Scopus databases was conducted to retrieve studies from January 2010 to December 2021. Using inclusion criteria, quantitative, qualitative and mixed methods studies were included in the final gap analysis. Low-, middle- and high-income country contexts. Following application of gap analysis criteria, thirty-seven articles from sixteen countries were included in the analysis. Gaps in delivery of maternal nutrition counselling include provider capacity building, frequency, content and delivery platforms. Globally, counselling on appropriate weight gain during pregnancy is often not delivered with the desired content nor quality, while targeted counselling to overweight and obese women was provided in several high-income country contexts. Delivery of maternal nutrition counselling through multiple delivery platforms demonstrated improvements in maternal diet and/or weight gain during pregnancy. Strengthening the integration of maternal nutrition counselling into pre- and in-service curricula, routine health provider training, supportive supervision and provider mentoring is needed. Future efforts may consider generating global and regional weight gain guidelines and incorporating maternal nutrition counselling indicators as part of quality-of-care ANC/PNC standards and routine health systems.

Quality gaps in care delivery among emerging adults with type 1 diabetes: A retrospective cohort study.

Quality gaps in care delivery among emerging adults with type 1 diabetes: A retrospective cohort study.

What’s missing? Diagnostic workup for breast cancer in Sudan.

110 Background: In Sudan, healthcare access may limit diagnostic workup for breast cancer. This study evaluates the relationship between geography and ethnicity and completeness of documentation of diagnostic workup (staging and receptor testing) in Sudan. Methods: This retrospective study used data abstracted from patients with breast cancer receiving cancer care at Sudan’s largest cancer center (Radiation and Isotopes Center Khartoum [RICK]) in 2017. The patient’s age at diagnosis, sex, breast cancer stage, ethnic subgroup (further categorized as Arab and non-Arab), regions of origin and residence (Central, Northeastern, Western, and Khartoum [where RICK is located]), and receptor status from pathology reports were abstracted from paper medical records. Complete diagnostic workup was defined as having both receptor testing and staging. Descriptive statistics were calculated using frequencies and percentages for categorical variables and median and interquartile range (IQR) for continuous variables. Odds ratios (OR) and 95% confidence intervals (CI) were estimated to evaluate complete diagnostic workup on ethnic group, origin, and residence using binomial logistic regression models (excluding non-Sudanese patients and those with missing demographics). Results: Of 240 patients included, 237 were female, median age was 53 (IQR 43-62). Most often patients were Arab (68%), originated from Northeastern and Khartoum regions (both 28%) and lived in the Khartoum region (53%). Overall, 49% patients were missing receptor testing and/or staging, with modest differences by geographic region and ethnicity (Table). In adjusted analyses, non-Arab patients had similar odds of having complete diagnostic workup when compared to Arab patients (OR 1.22; 95% CI 0.70-2.10). Patients originating from and residing in regions outside the Khartoum region had similar odds of complete diagnostic workup when compared to patients originating from and residing in the Khartoum region. Conclusions: Almost half of breast cancer patients had incomplete diagnostic workup, regardless of region of origin, region of residence, and ethnic group. This highlights a substantial systems-based quality gap in care delivery, warranting efforts to improve completeness in diagnostic workup for all patients with breast cancer in Sudan.[Table: see text]

Federalization of Agriculture Sector: Issues and Challenges

The research examines the current issues and challenges of sectoral restructuring and assesses local governments' performance in agricultural service delivery at the local level under the federal system in Nepal. This study was conducted using a mixed method during 2019-2021 in three local governments at the local, Karnali Province, and federal levels. Qualitative methods such as KIIs, FGDs and field observations were used to analyze the issues and gaps in functions, institutions and policies in the agriculture sector under the federal system. Whilst qualitative methods and an empirical survey among 300 farming households were conducted to assess local governments' performance in agricultural service provisions. The qualitative data were analyzed using the thematic analysis method, and the quantitative data were analyzed using descriptive statistics such as frequency and percentage. Findings revealed that functional overlap, duplication and lack of coordination between the three tiers of the government as major issues in sectoral restructuring. Farming household surveys revealed that local governments are effective in the timely delivery of agricultural services. However, farmers indicated their lower level of agreement on the capacity of the local staff, policies, institutional mechanisms, participatory process in planning and financial resource allocation for agricultural services. The performance of these three local governments on agricultural service delivery was affected by leadership priority and commitment, local policies, local staff capacity, resource allocation and external support. Overlapping and duplication in service delivery roles, weak local capacity, higher conditionality of intergovernmental sectoral fiscal transfer and less priority of local governments in financial resource prioritization are current issues and gaps in agricultural service delivery. The findings suggest the demarcation of the roles and responsibilities between the three tiers of the government, strengthening local capacities and revisiting local governments' institutional arrangement for effective agricultural service delivery under the federal system.

Increasing research to address cancer care disparities in an NCI-sponsored community oncology network.

176 Background: Improving the delivery and outcomes of cancer care should be informed by research that aims to reduce disparities among underserved populations and those underrepresented in clinical studies. The NCI Community Oncology Research Program (NCORP), a community-based clinical trials network, conducts such research. In this analysis, we aimed to identify opportunities to develop a robust program of disparities-relevant cancer care delivery research (CCDR). Methods: We reviewed NCORP CCDR studies approved between August 2014-May 2022. Any study with at least one aim addressing care delivery in NIH-health disparity or underrepresented populations was deemed disparities-relevant. Studies were categorized as: primary if they were focused exclusively on cancer disparities within populations of interest; secondary if they had a disparities-related aim in a broader study; and exploratory if the aim assessed differences by race, ethnicity, income, insurance status, or practice-level characteristics. For each CCDR protocol, study and disparities-related characteristics were abstracted by two reviewers, who resolved any disagreements by discussion. Descriptive statistics are summarized. Results: Of 23 CCDR studies, a majority had at least one disparities-relevant aim: 4 primary, 3 secondary, and 10 exploratory. Studies with primary and secondary aims focused on racial/ethnic minorities, rural residents, older adults, adolescent/young adults and socioeconomically disadvantaged populations. Cancer care delivery gaps addressed by these studies included shared decision making, guideline adherence, case management, healthcare expenditures, and healthcare accessibility. Most studies focused on patients undergoing active treatment and included multilevel interventions. Only one of the disparities-relevant studies was available to non-English speaking patients. Conclusions: The inclusion of disparities-relevant aims in most of the care delivery studies is encouraging. The fact that most studies with a primary or secondary aim included an intervention demonstrates strong interest in generating evidence that will support improved cancer care delivery. Studies also addressed several distinct disparity populations across a range of care delivery gaps. These results represent opportunities for targeted network efforts to increase the disparities research portfolio and may inform strategies to optimize equitable care delivery that meets the needs of diverse cancer patient/survivor populations.

Can You Hear Us Now? Equity in Global Advocacy for Palliative Care.

Evidence-based advocacy underpins the sustainable delivery of quality, publicly guaranteed, and universally available palliative care. More than 60 million people in low- and middle-income countries (LMICs) have no or extremely limited access to either palliative care services or essential palliative care medicines (e.g., opioids) on the World Health Organization Model List. Indeed, only 12% of the global palliative care need is currently being met. Palliative care advocacy works to bring this global public health inequity to light. Despite their expertise, palliative care practitioners in LMICs are rarely invited to health policymaking tables - even in their own countries - and are underrepresented in the academic literature produced largely in the high-income world. In this paper, palliative care experts from Bangladesh, Colombia, Egypt, Sudan, Uganda, and Zambia affiliated with the International Association for Hospice &amp; Palliative Care Advocacy Focal Point Program articulate the urgent need for evidence-based advocacy, focusing on significant barriers such as urban/rural divides, cancer-centeredness, service delivery gaps, opioid formulary limitations, public policy, and education deficits. Their advocacy is situated in the context of an emerging global health narrative that stipulates palliative care provision as an ethical obligation of all health systems. To support advocacy efforts, palliative care evaluation and indicator data should assess the extent to which LMIC practitioners lead and participate in global and regional advocacy. This goal entails investment in transnational advocacy initiatives, research investments in palliative care access and cost-effective models in LMICs, and capacity building for a global community of practice to capture the attention of policymakers at all levels of health system governance.

Assistive technologies during and after the COVID-19 pandemic

PurposeThis paper aims to review the literature on assistive technologies (AT) during the COVID-19 pandemic and afterward, in libraries globally, as portrayed on blogs, wikis and the internet.Design/methodology/approachReports from blogs, internet sources and databases during the pandemic in 2019 up to July 2022 are examined and findings highlighted the trends in the use of AT within that period.FindingsAT were not readily available in libraries, archives and museums during the lockdown. Some institutions made emergency contingency provisions to loan out equipment. Online resources were made available over time, however. In aftermath of the pandemic, there is a concerted effort to bridge the gaps in service delivery to the clientele that need AT and plan for possible future emergencies.Originality/valueThis paper presents an overview of the trends in the use of AT during and after the COVID-19 pandemic globally.

A Review of COVID-19 Response Challenges in Ethiopia.

Background: The COVID-19 pandemic has positioned fragile healthcare systems in low-income countries under pressure, leading to critical gaps in service delivery. The pandemic response demands the healthcare system to be resilient and continue provision of healthcare services. This review is aimed at describing the healthcare response challenges during the pandemic in Ethiopia. Methodology: Eligible studies dealing with challenges of the healthcare system in response to the COVID-19 pandemic in Ethiopia were included. The six World Health Organization (WHO) healthcare system building blocks were used to categorize healthcare challenges. PubMed ProQuest, databases were searched, and results were summarized using systematic review synthesis. Results: Financial constraints led to a shortage of mechanical ventilators. Furthermore, the pandemic hindered the capacity to avail full packages of personal protective equipment in health facilities and intensive care capacity. The pandemic also affected the delivery of maternal, child and new-born services, prevention, and treatment of childhood illness, including immunization services. Conclusions: The COVID-19 pandemic posed various challenges to the performance of the healthcare system in Ethiopia. It is recommended that policy makers and stakeholders enhance pandemic preparedness and strengthen response capacity by considering the six WHO healthcare system building blocks.