Healthcare Corporation Research Articles

Use of electronic pharmacy transaction data and website development to assess antibiotic use in nursing homes

BackgroundIn 2017, the Centers for Medicare and Medicaid Services required all long-term care facilities, including nursing homes, to have an antibiotic stewardship program. Many nursing homes lack the resources, expertise, or infrastructure to track and analyze antibiotic use measures. Here, we demonstrate that pharmacy invoices are a viable source of data to track and report antibiotic use in nursing homes.MethodsThe dispensing pharmacy working with several nursing homes in the same healthcare corporation provided pharmacy invoices from 2014 to 2016 as files formatted as comma separated values. We aggregated these files by aligning elements into a consistent set of variables and assessed the completeness of data from each nursing home over time. Data cleaning involved removing rows that did not describe systemic medications, de-duplication, consolidating prescription refills, and removing prescriptions for insulin and opioids, which are medications that were not administered at a regular dose or schedule. After merging this cleaned invoice data to nursing home census data including bed days of care and publicly available data characterizing bed allocation for each nursing home, we used the resulting database to describe several antibiotic use metrics and generated an interactive website to permit further analysis.ResultsThe resultant database permitted assessment of the following antibiotic use metrics: days of antibiotic therapy, length of antibiotic therapy, rate of antibiotic starts, and the antibiotic spectrum index. Further, we created a template for summarizing data within a facility and comparing across facilities. https://sunahsong.shinyapps.io/USNursingHomes/.ConclusionsLack of resources and infrastructure contributes to challenges facing nursing homes as they develop antibiotic stewardship programs. Our experience with using pharmacy invoice data may serve as a useful approach for nursing homes to track and report antibiotic use.

Psychological and Coping Strategies Related to Home Isolation and Social Distancing in Children and Adolescents During the COVID-19 Pandemic: Cross-sectional Study.

BackgroundIn December 2019, a novel coronavirus called SARS-CoV-2 was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread due to human-to-human transmission, resulting in a global pandemic. Nearly every country, including Qatar, has established guidelines and regulations to limit the spread of the virus and to preserve public health. However, these procedures have been associated with negative effects on the psychological and intellectual well-being of individuals, including children and adolescents.ObjectiveThe objective of this study was to determine the psychological influence of home isolation and social distancing on children and adolescents during the COVID-19 pandemic in Qatar, and the strategies used to cope with these measures.MethodsThis cross-sectional study was undertaken using an online questionnaire administered through SMS text messaging. All home-isolated children and adolescents registered at the Primary Health Care Corporation aged 7-18 years were invited to participate in the study. Children and adolescents with intellectual disadvantages were excluded. A P value of .05 (two-tailed) was considered statistically significant.ResultsData were collected from 6608 participants from June 23 to July 18, 2020. Nearly all participants adhered to the official regulations during the period of home isolation and social distancing; however, 69.1% (n=4568) of parents believed their children were vulnerable to the virus compared to 25% (n=1652) who expressed they were not vulnerable at all. Higher levels of anger, depression, and general anxiety were prevalent among 1.3% (n=84), 3.9% (n=260), and 1.6% (n=104) of participants, respectively. The mean score for the emotional constructs anger and depression decreased with increased compliance with regulations (P=.04 and P=.11, respectively). The differences in mean score for all psychological and coping strategies used among participants across the 3 levels of vulnerability to SARS-CoV-2 were statistically significant. The mean score varied little with increasing reported vulnerability to the virus. This mild variation can make a difference when the sample size is large, as is the case in this study.ConclusionsScreening for psychological and social disruptions is important for the development of strategies by schools and health care providers to assess and monitor behavioral changes and negative psychological impact during post–COVID-19 reintegration. Participants experiencing higher levels of anxiety should be given more attention during reintegration and transitional phases in schools. Although electronic devices and social media platforms may have lowered anxiety levels in some cases, it is important to address how they are used and how content is tailored to children and adolescents. It is also important to maintain an active lifestyle for children and young persons, and encourage them not to neglect their physical health, as this promotes a better psychological state of mind.

Wellness Program Within Primary Health Care: How to Avoid “No Show” to Planned Appointments? – A Patient-Centred Care Perspective

<strong>Background:</strong> Wellness program is a service provided by Primary Health Care Corporation (PHCC) to deliver an exercise program dedicated to patients with unhealthy lifestyle. Failing to cancel health care appointments in advance “no show” results in a vacant appointment slot that cannot be offered to other patients, which in turn will have an adverse impact on management plan and expected health outcome measures. <strong>Objectives:</strong> The purpose of this study is to implement a patient-centred care (PCC) program as an interventional approach to engage patients in changing behaviour and to encourage self-awareness to improve health status. Another aim of this study is to evaluate the effectiveness of an appointment reminder system (either short message service (SMS) or telephone call) on completion rate of the 12-week Wellness program. <strong>Methods:</strong> Amongst 112 patients, 50 participants (age: 49.9 ± 12.56 years; height: 1.61 ± 0.08 m; body mass: 75.06 ± 15 kg; body mass index (BMI): 28.66 ± 3.51 kg/m²) completed two surveys as part of the PCC program. The first survey was regarding the appointment reminder’s method preference. Accordingly, the demanded reminder system has been implemented as per patients’ preferences and then the rate of completion of the 12-weeks-wellness-program has been compared to the months preceding the intervention to demonstrate the effectiveness of this new reminder system. Towards the end of the study, a second survey on patients’ satisfaction level with regard the new reminder system has been completed. <strong>Results:</strong> The PCC program showed that majority of the patients were in favour of an appointment reminder system through SMS text message and telephone calls. Implementing this tool based on patient preference resulted in a high improvement of the completion rate of the Wellness program. <strong>Conclusions:</strong> This study provides insight on the efficacy of implementing a PCC program in Wellness Centre as well as the effectiveness of an appointment reminder system in improving the completion rate of Wellness program in a primary health care facility. Completing the Wellness program may lead to improved lifestyle behaviour and health outcomes by complying with international physical activity recommendations from the American College of Exercise Medicine (ACEM) and the World Health Organization (WHO).

Qualitative Focus Group Study Examining Perceptions of the Community's Important Health Issues, Health Care Needs and Perceived Barriers to Access Among Arabic Speaking Primary Care Clients in the State of Qatar.

ObjectiveThis study is a part of the Primary Health Care Corporation’s (PHCC) Health Needs Assessment (HNA) Initiative. It focuses on identifying perceptions of Arabic speaking primary care clients regarding community’s major health issues, their experiences in utilizing health services, and the barriers that limit their access to health care in the State of Qatar.Study Setting and DesignA total of 10 focus groups sessions were conducted at different PHCC’s health centers between October of 2019 and March of 2020. Sessions were distributed to cover all PHCC’s three geographical regions. Data were analyzed using thematic analysis.ParticipantsA total of 89 adult Arabic speaking individuals were recruited. Participants included were in the age groups (18–69), native Arabic speaker, and registered at one of the PHCC’s health centers with a valid health card at time of recruitment.ResultsAreas investigated included perceptions of the community’s health issues, needed health services, and perceived barriers to health care. Priority health issues identified were chronic non-communicable diseases, mental health, timely access to care, cultural competency of delivered services, and integration and coordination across health care settings and sectors. Participants were able to identify socioeconomic and environmental factors such as the need for health and wellness interventions at schools that affects the health of the individual and the community. The importance of raising the community’s awareness about health-related issues and availability of health services was highlighted by study participants.ConclusionCollecting qualitative data provides an opportunity to examine people’s perceptions, and motivations and engage the whole community. This process is very important for strategic planning of health services. The study attempts to fill the knowledge gap and should be linked to health policy and the development of socially and culturally appropriate health programs.

Qatar's Primary Health Care Medication Home Delivery Service: A Response Toward COVID-19.

The COVID-19 pandemic has strained health care systems around the world. Pharmacists have made substantial contributions to the health care operations during the COVID-19 response. The Pharmacy Department at Qatar Primary Health Care Corporation (PHCC) acted proactively to ensure that all patients received their medications and their refilled prescriptions in time and without any disruption. The Medication Home Delivery Service was introduced and implemented for all Qatar residents to prevent unnecessary visits to health centers, minimize the spread of COVID-19 to vulnerable populations, especially those with multiple comorbidities, and protect health care workers from exposure to the virus. Moreover, several other precautionary measures were taken by the PHCC to ensure uninterrupted access to health care, including moving to a virtual health care delivery model. As of September 2020, the service had served around 64,213 patients since its launch in March 2020. In total, 70,357 medications were delivered and 69,092 (98.2%) medication packages were delivered successfully to patients, with an average of 450.8 medication packages delivered per month. Despite various challenges, the PHCC is considering continuing the Medication Home Delivery Service in the long term to continue with a more effective and efficient service for patients during the coming months and years.

КАКАЯ МОДЕЛЬ ФИНАНСИРОВАНИЯ ЗДРАВООХРАНЕНИЯ ЛУЧШЕ: БЮДЖЕТНАЯ ИЛИ СОЦИАЛЬНОГО СТРАХОВАНИЯ? О ЧЕМ СВИДЕТЕЛЬСТВУЕТ МЕЖДУНАРОДНЫЙ ОПЫТ?

In Russia disputes on the need to abandon Compulsory Health Insurance (CHI) and return to the tax-based financing are yet to subside. At present, after the statement of the President of the Russian Federation V. Putin about the possibility to establish a state health care corporation, discussions on the issue have only escalated. Purpose. To conduct a comparative assessment of the public health financing model impact on the access and structural characteristics of health care delivery in the developed countries. Material and methods. Assessment of the potential impact of public funding models on the health system performance is carried out by analyzing variations in the main indicators of financial access, health care uptake and health status of the population, achieved in the developed countries with different health financing models. Results. Health care expenditures in countries with CHI are higher than in countries with the tax-based financing model. In countries with CHI the share of administrative expenses is slightly higher than in countries with the tax-based financing system. The share of spending on preventive care is slightly higher in countries with the tax-based financing system. There is a slightly lower level of outpatient and inpatient care uptake in countries with the tax-based financing system compared to countries with CHI. The premature mortality rate in countries with CHI is slightly lower than in countries with the tax-based system. Conclusion. The obtained data indicate that there are no significant differences in the access and structural characteristics of medical care in the health care system of the developed countries with different financing models. The main difference remains the level of health expenditures. In countries with CHI, the level of health expenditures is higher than in countries with the tax-based financing, which is largely due to the existence of a separate source of funding. The level of administrative costs in countries with CHI is also higher than in countries with the tax-based system.

Comparison of the Diagnostic Value of Immunochromatography Kits in Corona Virus Disease 2019 Patients: A Prospective Pilot Study.

Introduction: The spread of coronavirus 2019 (COVID-19) is a serious problem all over the world. Several immunochromatography kits of the antibody for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been developed, but it is still unclear which kits have high diagnostic value. This study aims to evaluate the accuracy rate for antibody detection of each immunochromatography kit and reveal which kit has a high diagnostic value for antibody detection. Methods: This study was carried out between 1 August 2020 and 14 October 2020 at the Association of EISEIKAI Medical and Healthcare Corporation Minamitama Hospital. Patients diagnosed with COVID-19 and approximately 30 days after symptom onset were included as the positive group. The serum SARS-CoV-2 antibodies were analysed using seven immunochromatography kits. Results: Twenty samples (Positive group: 10 patients, Negative group: 10 healthy medical workers) were included in this study. The median age of the patients was 44 years, and the median duration from symptom onset was 30.5 days in the positive group. The accuracy rates for IgM/IgG detection were: 90.0%/100% in Kit A; 50.0%/95.0% in Kit B; 55.0%/65.0% in Kit C; 60.0%/55.0% in Kit D; 50.0%/80.0% in Kit E; 80.0%/90.0% in Kit F; and 90.0%/100% in Kit G. Conclusions: Our study showed that there is a variation of accuracy rates between immunochromatography kits for antibodies of SARS-CoV-2. COVID-19 IgG/IgM RAPID TEST CASSETTE (Hangzhou Biotest Biotech Co., Ltd., China) and Nadal COVID-19 IgG/IgM Rapid Test (BioServUK Ltd., UK: United Kingdom) have high accuracy rates for both IgM and IgG detection. Evidence from large population studies of immunochromatography kits is needed to clarify the details of diagnostic value for SARS-CoV-2.

Adaptation and reorganisation of primary care facility during COVID-19 pandemic: a perspective from primary health care corporation, Qatar

The COVID-19 pandemic has brought unprecedented challenges to healthcare systems across the world. It has had a devastating impact on peoples’ health, well-being and livelihood, crippling the economy, aviation, travel, hospitality and various other sectors. In order to curb its impact various governments had to take drastic measures to deal with this crisis. In Qatar, the major healthcare providers led by the MOPH responded swiftly by implementing major changes. They developed infrastructure, revisited public health policies, modified their operations and functioning which helped to cope with this evolving public health emergency. This paper reviews how a small health center in Qatar had to adapt its services, infrastructure and pathways to the changing needs and demands in a timely fashion leading to improved patient care and helping to contain the outbreak in both patients and staff alike. It also evaluates how Primary health care corporation at an organization level paved the transition in every aspect to ensure efficient and safe delivery of primary care services to everyone. As the world is preparing to overcome the pandemic, the paper highlights the value of teamwork in responding to the adversity by creating innovative ways of working and how good leadership can have a positive influence on healthcare and society in general.

Estimating point prevalence of COVID-19 in Qatar's primary care registered population: an RT-PCR drive-through study protocol.

BackgroundThe first COVID-19 cases in Qatar were reported on 29 February 2020. As the epidemic progresses, essential epidemiological information is needed to facilitate monitoring of COVID-19 in the population and plan the pandemic response in Qatar.AimThe primary aim of this cross-sectional study is to estimate the point prevalence of COVID-19 in Qatar’s primary care registered population.Design & settingA cross-sectional study design will be utilised. One publicly funded health centre from each of three geographical regions in Qatar will be identified as a study location and set up to facilitate a drive-through for the study.MethodPrimary Health Care Corporation (PHCC) is publicly funded and the largest primary care provider in Qatar. The study will include randomly selected individuals from the full list of PHCC's registered population on its electronic medical records system. The sample selection will be done using a proportional to size sampling technique stratified by age, sex, and nationality representative of the overall PHCC-registered population. Considering the total population registered in PHCC, a sample of 2080 is proposed. A questionnaire will be administered to collect sociodemographic information, and nasal and throat swab samples will be taken. Data will be analysed to report overall symptomatic and asymptomatic point prevalence of COVID-19.ConclusionThis study, with the help of a randomly selected representative sample from Qatar’s primary care registered population, will provide results that can be applied to the entire population. This study design will closely represent a real-world scenario of the outbreak and is likely to provide important data to guide COVID-19 pandemic planning and response in Qatar.

Nine SARS-CoV-2 Positive Pregnant Women and Their Infant Delivery Outcomes

There are scientific reports from around the world describing the cases of COVID-19. This is a case series reporting outcomes of deliveries from nine mothers with positive SARS-CoV-2 testing at Healthcare Corporation of America hospitals in the United States from January to April 2020. Thirty-three percent of the women had cesarean sections. There was only one preterm birth and that infant did have low birth weight and low Apgar scores at one and five minutes. Seven of the nine infants were tested for SARS-CoV-2 and all results were negative. As the COVID-19 pandemic continues across the globe and at a high rate in the United States, more research will be needed to determine the outcomes for pregnant women and their offspring, both at birth and in the future.

Reduction in Transplantation Activity without Impairment in Outcomes in the Covid-19 Era- Data from the Sarah Cannon Blood Cancer Network (SCBCN)

BackgroundThe Covid-19 pandemic has profoundly disrupted healthcare operations for vulnerable transplant and cell therapy patients. The Sarah Cannon Blood Cancer Network (SCBCN) comprises six Healthcare Corporation of America hospitals that have been certified based upon defined metrics of infrastructure, staffing, processes and volume. The SCBCN actively coordinated a response by integrating information from the framework of federal, state, network, hospital and individual transplant programs. Dynamic standards were developed taking into account operational aspects (such as PPE conservation, staffing, isolation policy, etc.), external regulations, and input from professional societies in order to balance the needs for life-saving therapy while reducing the likelihood of adverse consequences. In this study, we describe the impact of the Covid-19 across our network on transplant and cell therapy activity as well as the outcomes of the patients who were treated.MethodsData was integrated from electronic health records and a center survey questionnaire. The period of observation (defined as Covid era) was from March 15, 2020 to June 15th, 2020 to allow sufficient time for analysis of early outcomes. Transplant and cell therapy data from the prior 12 months was used as a comparator.Results:Within the SCBCN there was a decrease in overall transplant and cell therapy activity in the Covid era. Autologous transplantation was mainly diminished, particularly in the first 2 months. There was no significant impact on allogeneic or CAR-T therapy volumes. For allogeneic transplantation, there was a modest reduction in marrow grafts (11% to 8%) and a significant increase in cryopreservation (16% to 79%, P<0.001). The time to neutrophil and platelet engraftment in the Covid era were similar to those in the prior year. Day +30 survival in the Covid era for allogeneic, autologous, and CAR-T therapy were 95%, 99% and 100%, respectively. Including historically transplanted patients, centers reported a total of 22 patients who contracted proven Covid19, at a median duration of 4 years (range 3-2634 days) post infusion. There were 9-auto, 12-allo, and 1-CAR-T recipients, and two died. Of the two deaths, one 70-year old recipient died from Covid19 after first testing positive at day+3 after autologous transplantation, and another 68-year old recipient tested positive at day+464 after autologous transplantation but died with refractory lymphoma.Conclusions:We describe a deliberate and coordinated reduction in transplant and cell therapy activity across our network compared to the prior year. For those patients who were selectively transplanted during the Covid19 pandemic, outcomes were not impaired. Our analysis will be updated at the time of presentation with data covering the Covid era from July-Oct '20.FigureDisclosuresBachier:Sanofi: Speakers Bureau; AlloVir: Honoraria; CRISPR: Honoraria; Juno Therapeutics, a Bristol-Myers Squibb Company: Honoraria. Kambhampati:AbbVie: Other: Investigator in AbbVie-sponsored clinical trials.. McSweeney:Kite, a Gilead Company: Consultancy, Honoraria, Research Funding, Speakers Bureau; Fred Hutchinson: Patents & Royalties; Colorado Blood Cancer Institute: Current Employment. Ramakrishnan:Amgen: Membership on an entity’s Board of Directors or advisory committees; Takeda: Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Cigna: Honoraria. Safah:Verastem: Honoraria; Astellas: Speakers Bureau; Amgen: Honoraria; Janssen: Speakers Bureau.

Impact of Liver Injury in COVID-19 Patients: Single-center Retrospective Cohort Analysis.

Coronavirus disease 2019 (COVID-19) has become a serious threat to global public health. Unfortunately, to date, there are no specific vaccines or targeted drugs, and the number of patients with positivity for systemic acute respiratory syndrome-novel coronavirus-2 infection is growing worldwide.1 Patients with COVID-19 may be at risk for liver injury, but the mechanism and clinical significance of injury remains unclear. Proposed mechanisms include direct virus-induced insults, immune-mediated damage (due to excessive inflammatory response), and drug-induced injury. COVID-19-related liver dysfunction is now gaining widespread attention; however, liver injury’s impact on the outcome of COVID-19 patients is not clearly understood. We have evaluated the impact of liver insults on the hospitalization outcome of COVID-19 patients admitted to a suburban New York safety-net hospital and would like to share our preliminary results in a Letter to the Editor instead of an Original Article for rapid dissemination to the worldwide audience. In our retrospective, unmatched, single-center analysis, we have identified the first 639 confirmed COVID-19 patients (ages ≥18 years) admitted to our facility from March 2020 to May 2020. Elevated liver-related enzymes [serum alanine aminotransferase (commonly referred to as ALT) >40 U/L, aspartate aminotransferase (commonly referred to as AST) >40 U/L, or alkaline phosphatase (commonly referred to as ALP) >120] were used to stratify patients with or without liver injury. The primary outcome was all-cause in-hospital mortality; other in-patient outcomes, including cardiac arrest, acute respiratory distress syndrome, arrhythmia, shock, and intubation rate, were also measured. The Pearson’s chi-square test and Student’s t-test were used for evaluating categorical and continuous variables, respectively. A two-step hierarchical multivariate regression model was performed to assess the risk of in-patient mortality and other hospitalization outcomes after adjusting for baseline characteristics and comorbidities. All statistical analyses were performed using SPSS® Corp. Version 22 (Armonk, NY, USA). This analysis was approved by the Institutional Review Board (IRB) of Nassau Health Care Corporation (NHCC) at Nassau University Medical Center (NUMC), under IRB reference # 20-277. Out of the total 639 COVID-19 patients, 476 (74.5%) [mean age of 58.89±15.61 years, 63.0% male] had evidence of liver injury. COVID-19 liver injury cohorts had statistically significant higher rates of all cause in-patient mortality [35.5% vs. 22.7%; adjusted odds ratio (aOR): 2.84; 95% confidence interval (CI): 1.71-4.71; p<0.001). COVID-19 liver injury was observed more often in our Hispanic patient population (38.2%). The COVID-19 liver injury group showed higher risk of other in-patient outcomes, such as cardiac arrest (26.1% vs. 14.1%; aOR: 2.65; 95% CI: 1.52-4.59; p≤0.001), requirement of intubation (30% vs. 14.7%; aOR: 2.87; 95% CI: 1.70-4.85; p<0.001), acute respiratory distress syndrome (43.1% vs. 30.7%; aOR: 1.89; 95% CI: 1.23-2.91; p=0.004), arrhythmia (5.2% vs. 0.6%; aOR: 3.16; 95% CI: 0.95-10.33; p=0.05) and shock (15% vs. 2.8%; aOR: 2.06; 95% CI: 1.15-3.70; p=0.016) compared to COVID-19 patients without evidence of liver injury (Tables 1 and ​and22). Table 1. Baseline characteristics of COVID-19 hospitalizations with vs. without liver injury Variable With liver injury, n=476 (74.5%) Without liver injury, n=163 (25.5%) p* Age in years at admission Mean age±standard deviation 58.89±15.61 61.92±17.32 0.038 Sex 0.041 Male 63.0% 54.0% Female 37.0% 46.0% Race 0.26 White 22.1% 21.5% African American 24.6% 30.7% Hispanic 38.2% 30.7% Asian or Pacific Islander 2.9% 6.1% Other 11.1% 9.8% Insurance status 0.23 Uninsured/self-pay 16.0% 16.0% Medicare/Medicaid 40.1% 45.4% Private insurance 41.8% 34.4% Unknown 1.9% 4.3% Comorbidities Alcohol abuse 14.9% 10.4% 0.268 Asthma/COPD 10.5% 11.0% 0.713 HIV/AIDS 1.1% 1.8% 0.789 Congestive heart failure 4.8% 8.6% 0.247 Diabetes mellitus 34.5% 43.6% 0.078 OSA/OHS 1.9% 0.6% 0.521 Hypertension 50.6% 58.9% 0.221 Malignancy 5.0% 3.7% 0.321 Chronic kidney disease 7.6% 15.3% 0.010 Coronary artery disease 8.0% 14.1% 0.05 In- hospital Outcomes All cause in-hospital mortality 35.5% 22.7% <0.001 Cardiac arrest 26.1% 14.1% <0.001 Intubation 30% 14.7% <0.001 ARDS 43.1% 30.7% 0.004 Arrhythmias 5.2% 0.6% 0.05 Shock 15% 2.8% 0.016 Open in a separate window *p≤0.05 at 95% confidence interval indicates statistical significance. Abbreviations: ARDS, acute respiratory response syndrome; COPD, chronic obstructive pulmonary disease; OSA/OHS, obstructive sleep apnea/obesity hypoventilation syndrome; HIV/AIDS, human immunodeficiency virus/acquired immunodeficiency syndrome.

Antibiotic Use Among Residents Receiving Skilled Nursing Care in 29 U.S. Nursing Homes.

Data describing antibiotic use in U.S. nursing homes remain limited. We report antibiotic use among skilled nursing facility residents from 29 U.S. nursing homes and assessed correlations between antibiotics prescribed to residents in skilled care and nursing home characteristics. Retrospective cohort study. Twenty-nine U.S. nursing homes in the same healthcare corporation. Residents receiving skilled care in 2016. We used pharmacy invoice and nursing home census data to calculate the days of antibiotic therapy per 1,000 days of skilled care (1,000 DOSC), the rate of antibiotic starts per 1,000 DOSC, the length of antibiotic therapy, and the average antibiotic spectrum index. We also assessed correlations between antibiotic use and nursing home characteristics. Antibiotics accounted for an average of 9.6% (±0.6%) of systemic medications prescribed among residents receiving skilled care. On average, 26.8% (±2.9%) of antibiotics were intravenous. Fluoroquinolones were prescribed at the highest rates (19% across all facilities), followed by beta-lactam/beta-lactamase inhibitors (11%), first- and second-generation cephalosporins, sulfonamides, and oral tetracyclines (each at 9%). Both the proportion of residents using enrolled in Medicare and number of unique prescribers responsible for systemic prescriptions positively correlated with the rate of antibiotic starts. Our study demonstrates that pharmacy invoices represent a useful and preexisting source of data for assessing antibiotic prescriptions among individuals receiving skilled nursing care. The correlation between the number of unique prescribers and antibiotic starts suggests that prescribers are central to efforts to improve antibiotic use in nursing homes.

Evaluation of the use of Floseal®, a topical hemostatic agent, in cardiothoracic surgery

Introduction: Achieving haemostasis is critical in surgical procedures. Surgical bleeding is associated with an increased risk of mortality and morbidity with consequences at both clinical and organizational level, and with significant economic implications. In addition to conventional methods for controlling intraoperative bleeding, many topical adjunctive hemostatic products are available; among them Floseal® (Baxter Healthcare Corporation), a gelatin-based hemostatic matrix.&#x0D; The aim of this study is to provide an updated systematic literature review of Floseal® in cardiac surgery and estimate its associated economic impact in an Italian hospital.&#x0D; Methods: A literature search was conducted in MEDLINE and the Cochrane Library over the period 2013-2016 to identify new publications related to Floseal® in cardiac surgery, in addition to those already included in the systematic review of Echave et al. Furthermore, we investigated the economic impact of the use of Floseal® adapting the model elaborated by Tackett et al. to the Italian NHS. Four new studies were selected.&#x0D; Results: High variability in surgical procedures, choice of hemostatic products compared to Floseal® and outcome definition is confirmed. Clinical, organizational, and economics endpoints were investigated. A cost-consequence analysis estimated relevant savings. A scenario analysis, despite showing a high variability in patient level savings (€ 441-2.831), confirmed economic advantages associated with Floseal®.&#x0D; Discussion: Results support prior research both in terms of heterogeneity of evidence on the effectiveness of Floseal® in cardiac surgery and cost implications. The use of Floseal® achieves substantial cost savings in a hypothetical Italian hospital with a cardiac surgery unit.

Casey-Fink Graduate Experience Survey for Nurses and Preceptors in the Kingdom of Saudi Arabia

Background: Preceptors play an essential role in supporting new nurses during the transitional period in professional roles. Moreover, graduate nurses experience several challenges during their transitional role from students to professional nurses, despite the considerable relationship between nurses and preceptors.Purpose: The study aims to evaluate the relationship between the experiences of nurses using Casey-Fink Graduate Nurse Experience Survey and the number of preceptors in Saudi hospitals.Methods: A cross-sectional study design was adopted, and Casey-Fink Graduate Nurse Experience Survey was used to collect data from 84 newly graduated nurses. Descriptive and regression analysis was used for data analysis.Results: Results showed that there was no statistically significant relationship between the responses of 5 factors of the Casey-Fink Graduate experience survey and the number of preceptors. Based on the survey, (33.8%) had to stress whereas significant causes of stress were student loans (41.9%), personal relationships (13.5%), living situation (27%), and finances (10.8%).Conclusion: No statistically significant relationship was found between variables including; support, patient safety, communication/leadership, professional satisfaction, and job satisfaction. The significance of preceptorship programs should be considered by the primary health care corporation to support and prepare preceptors of newly graduated and recruited nurses.

Partnering to Educate Nurses in Long-Term Care

Despite a 2008 national call to retool a health care workforce for an aging America, the geriatrics-trained workforce is declining while the U.S. population continues to age. Formalized academic-practice partnerships between long-term care facilities and schools of nursing are one response to strengthening the work-force caring for older adults. This article details the activities of an intentional, synergistic, 3-year partnership between National HealthCare Corporation (NHC) and University of Alabama at Birmingham (UAB) School of Nursing. The partnership focused on providing continuing education and leadership development for NHC nurses while also providing nursing faculty with access to clinicians and patients in long-term care for the purposes of education, research, and quality improvement. The ultimate goal for both partners was improved patient outcomes. [J Contin Educ Nurs. 2020;51(2):75-81.].

Model of Transition from a Primary Health Care Provider to a Community Service Hub during COVID-19 Pandemic at Primary Health Care Corporation in Qatar

The novel Coronavirus Disease (COVID-19) has tested healthcare system’s ability to respond to major incidents. Healthcare facilities found themselves in a situation where they needed to adjust their operations rapidly if they were to contain the spread of the virus.

Executive Coaching Outcome Research in a Field Setting: A Near-Randomized Controlled Trial Study in a Global Healthcare Corporation

Executive coaching is widely used as a tool to develop leaders and organizations. However, despite the popularity of coaching, the effect of coaching on relevant leadership performance measures rem...

Association between body mass index (BMI) percentile and asthma in children of 5–12 years old: A case–control study using electronic medical records in Primary Health Care Corporation, Qatar 2016–2017

ABSTRACT Background: Over the last several decades, obesity and asthma prevalence have risen among children. The increase in overweight and obesity has been associated with an increased risk of asthma in children. Most epidemiological studies have proposed that a high body mass index (BMI) at infancy and early childhood increases the risk of asthma in children. A recently adopted electronic recording system for health service encounters in Primary Health Care Corporation of Qatar has provided a convenient opportunity to assess the possible link between asthma and obesity in children aged 5–12 years. Objectives: To calculate the prevalence rate of overweight and obesity among asthmatic children aged 5–12 years using primary health care centers during 2016–2017. To measure the strength of the association between BMI and asthma in children aged 5–12 years after adjusting for age, gender, and nationality. Methodology: This was a case–control study on the electronic health records of children aged 5–12 years who visited one of the primary health care centers during the two-year study period (2016–2017). A total of 9889 children with a diagnosis of asthma and valid BMI measurements were included in the case group, and an identical number of children who visited the health care centers for other reasons and had valid BMI measurements were randomly enrolled in the control group. Results: The prevalence of obesity (BMI-for-age Z-score &gt;2) was significantly higher among asthmatics (24.9%) compared with non-asthmatic controls (17.7%). Asthma significantly increased the risk of being obese by 41% in bivariate analysis. The calculated risk estimate for the association between asthma and obesity increased to 70% after adjusting for the confounding effect of age, gender, and nationality. Conclusions: The present observational study based on a large sample of 5 to 12-year-old children documented a strong association between asthma and obesity (BMI-for-age Z-score 2 or above). This positive association between asthma and high BMI was stronger among older children, females, and Qatari nationals.

Effect of prepregnancy maternal BMI on adverse pregnancy and neonatal outcomes: results from a retrospective cohort study of a multiethnic population in Qatar

BackgroundGiven the small number of studies on the topic, we aimed to identify the impact of prepregnancy maternal body mass index (BMI) on adverse pregnancy outcomes (POs) in a low-risk,...