Knowledge Of Best Practices Research Articles

Knowledge and Practices of Students Regarding the Use of Face Masks to Limit the Spread of Coronavirus Disease (COVID-19)

Background and Objectives: Many countries are implementing face masks as part of their pandemic prevention strategies. Because the virus is so widespread, incorrect usage and disposal of masks can increase the transmission rate. The purpose of this study was to assess knowledge and practices of students in wearing facemask to prevent the spread of the new coronavirus (COVID-19). Methods: A cross-sectional descriptive study of 365 undergraduate students at Hawler Medical University was conducted from June 15th to October 15th, 2021. The data was gathered through direct interviews using a questionnaire that had been modified include demographic information, ten questions about knowledge, and 17 questions about practices for using surgical face masks to reduce COVID-19 exposure. Result: The result revealed that highest percentage of students were 18 to 20 years old (66.6%). Most of the participants in this study were female (59.5%). Participants demonstrated fair knowledge (N=218, 59.7%). Concerning the using surgical facemask to prevent the spread of COVID-19 and good practical knowledge (N=273, 74.8%). The highest levels of practical knowledge were related to wearing face masks in hospital premises to protect against COVID-19 (91.8%) and wearing masks in public spaces to protect against COVID-19 (87.1%). Conclusion: The studied students had a poor understanding of how to utilize face masks. Enhancing one’s knowledge and appropriate use of face masks takes time and effort. It is necessary to implement massive education campaigns at the level of Hawler Medical University to increase the proportion of knowledge about COVID-19 and stop its spread.

Fetal alcohol syndrome knowledge and risk behaviors among university students and community residents in Limpopo, South Africa

The Republic of South Africa has the highest documented fetal alcohol syndrome prevalence globally. In the Limpopo province, little is known about students’ or community members’ knowledge of fetal alcohol syndrome or fetal alcohol spectrum disorder rates and risk behaviors. The aim of this study was to characterize and compare knowledge about fetal alcohol syndrome and other fetal alcohol spectrum disorders and the related behaviors such as drinking among University of Venda students and local community residents in villages to inform educational efforts to prevent fetal alcohol syndrome. Participants ([Formula: see text]) were from the University of Venda and two villages, Maungani and Ha-Mangilasi, and completed an epidemiological survey about their characteristics, behaviors, and fetal alcohol spectrum disorder risks. We analyzed differences between the university students and community residents in fetal alcohol syndrome knowledge and the related risk behaviors. University students have heard of fetal alcohol syndrome (Fisher’s exact test p < .001), have seen warning labels about drinking during pregnancy (Fisher’s exact test p = .003), and were aware that a baby is born with birth defects if diagnosed with fetal alcohol syndrome (Fisher’s exact test p = .03) with more knowledge of fetal alcohol syndrome compared to community residents. Most respondents thought it was unacceptable to drink during pregnancy. Despite this, a substantial number of participants thought it was acceptable to have one drink after pregnancy recognition. There was little knowledge of best practices about alcohol consumption to prepare for pregnancy, or once recognized. We recommend an education campaign to raise awareness of fetal alcohol spectrum disorders across Limpopo, especially in smaller villages, and further research to determine demographic and experiential risk factors to aid in prevention efforts.

Knowledge, attitude and practice towards Hepatitis B infection of people in part of Jigawa State, Nigeria

This study analyzed Knowledge, Attitude/Perception and Practice of the people toward hepatitis B infection in four local governments of Ringim Emirate, Jigawa State. The data were obtained using questionnaire instrument and organized and processed in SPSS version 20 and analyzed using descriptive statistics and inferential statistics. The result shows that very few (4.9%) people showed good level of knowledge of the infection, and only very few (3.4%) show knowledge of good practice. The result also shows correlation coefficient of 0.917 indicated a positive correlation between knowledge scores. The findings also revealed that there is no statistically significant different between educational level and knowledge of Hepatitis B (p=.336). However, there is statistically significant difference, (p=.000) among other items of socio- demographic characteristics. The study suggested that public health education is needed to improve knowledge, attitude and practice on hepatitis B. Implementation of community mass media health education programme to raise the awareness and the knowledge about hepatitis B using all forms of media especially radios. Health care providers who are involved in the hepatitis control programme need to set schedule to provide education, increase awareness of contact case screening, early identifying and treating hepatitis infection especially hepatitis B. This will help to in prevention and controlling of the infection.

Mapping Prejudice: The Map Library as a Hub for Community Co-Creation and Social Change

The John R. Borchert Map Library was the ideal incubator for an experiment that has changed how a wide range of people are thinking about structural racism and the history of race in American urban environments. Mapping Prejudice used a cartographic visualization of racial covenants as the intellectual nexus of a project that transcended disciplinary boundaries and invited community members into cutting-edge research work. The Map Library provided the physical space, resources, and geospatial expertise necessary for community-driven mapping work. It also served as an intersectional hub necessary for this transformative research initiative, illustrating the synergies between map librarianship and other disciplines. The work depended on the unique contributions of the map librarian: project management; experience networking with researchers, campus departments, and community groups; and knowledge of best practices surrounding data management, curation, and reuse. This article explains how Mapping Prejudice changed academic scholarship and public understandings by engaging volunteers in meaningful research. It concludes by providing a description of future directions for this project and calls on librarians to lead more work of this kind. The example of Mapping Prejudice suggests ways that map librarians can be leading new modes of inclusive, equitable and community-responsive research.

Study on Protection and Utilization of Common Medicinal Plant Resources

This study deals with the ethno- medico- botany of plants species of Gandhinagar district, North Gujarat. Aim and Objective: The people live in remote areas and in villages which remain cut off from main cities and have to depend on local products for the primitive needs especially like food and medicines. The people are having knowledge about the uses of plants against various diseases. The villagers use the plants in a different illness in effective manners. Scientific investigations of use of herbal medicines would open new area of knowledge. Here, in this paper list of medicinal plants have been given, which are growing traditionally and utilizing through local health care system for a long time. Material Methods: The information of conservation, cultivation methods has been gathered and documented by visiting the local area, communities and farmers by interviewed them. The inputs are taken about traditional way of treatments for the common diseases. In this paper about 30 species have been acknowledge, which are being commercially extracted and traded. Most of the species are found wildly while some are farmed as per their season. Conclusion: Gandhinagar district is blessed with many of species of medicinal plants. The villagers are having good practical knowledge regarding herbal value of local species. The farmers are not getting proper market value for the medicinal plants and some time they do not get the return of their products timely and adequately. It is therefore, the pace of cultivating medicinal plants is very low which need to implement in the knowledge of common people.

Acceptability and Feasibility of a Return-to-Work Intervention for Posttreatment Breast Cancer Survivors: Protocol for a Co-design and Development Study.

BackgroundThe mortality rate from breast cancer has been declining for many years, and the population size of working-age survivors is steadily increasing. However, the recurrent side effects of cancer and its treatment can result in multiple disabilities and disruptions to day-to-day life, including work disruptions. Despite the existing knowledge of best practices regarding return to work (RTW) for breast cancer survivors, only a few interdisciplinary interventions have been developed to address the individualized needs and multiple challenges of breast cancer survivors, health care professionals, and employer and insurer representatives. Thus, it seems appropriate to develop RTW interventions collaboratively by using a co-design approach with these specific stakeholders.ObjectiveThis paper presents a protocol for developing and testing an innovative, interdisciplinary pilot intervention based on a co-design approach to better support RTW and job retention after breast cancer treatment.MethodsFirst, a participatory research approach will be used to develop the intervention in a co-design workshop with 12 to 20 participants, including people affected by cancer, employer and insurer representatives, and health care professionals. Next, a pilot intervention will be tested in a primary care setting with 6 to 8 women affected by breast cancer. The acceptability and feasibility of the pilot intervention will be pretested through semistructured interviews with participants, health care professionals, and involved patient partners. The transcribed data will undergo an iterative content analysis.ResultsThe first phase of the project—the co-design workshop—was completed in June 2021. The pilot test of the intervention will begin in spring 2022. The results from the test will be available in late 2022.ConclusionsThe project will offer novel data regarding the use of the co-design approach for the development of innovative, co-designed interventions. In addition, it will be possible to document the acceptability and feasibility of the pilot intervention with a primary care team. Depending on the results obtained, the intervention could be implemented on a larger scale.International Registered Report Identifier (IRRID)DERR1-10.2196/37009

Lessons From a Rapid Project Management Exercise in the Time of Pandemic: Methodology for a Global COVID-19 VIRUS Registry Database.

BackgroundThe rapid emergence of the COVID-19 pandemic globally collapsed health care organizations worldwide. Incomplete knowledge of best practices, progression of disease, and its impact could result in fallible care. Data on symptoms and advancement of the SARS-CoV-2 virus leading to critical care admission have not been captured or communicated well between international organizations experiencing the same impact from the virus. This led to the expedited need for establishing international communication and data collection on the critical care patients admitted with COVID-19.ObjectiveDeveloping a global registry to collect patient data in the critical care setting was imperative with the goal of analyzing and ameliorating outcomes.MethodsA prospective, observational global registry database was put together to record extensive deidentified clinical information for patients hospitalized with COVID-19.ResultsProject management was crucial for prompt implementation of the registry for synchronization, improving efficiency, increasing innovation, and fostering global collaboration for valuable data collection. The Society of Critical Care Medicine Discovery VIRUS (Viral Infection and Respiratory Illness Universal Study): COVID-19 Registry would compile data for crucial longitudinal outcomes for disease, treatment, and research. The agile project management approach expedited establishing the registry in 15 days and submission of institutional review board agreement for 250 participating sites. There has been enrollment of sites every month with a total of 306 sites from 28 countries and 64,114 patients enrolled (as of June 7, 2021).ConclusionsThis protocol addresses project management lessons in a time of crises which can be a precept for rapid project management for a large-scale health care data registry. We aim to discuss the approach and methodology for establishing the registry, the challenges faced, and the factors contributing to successful outcomes.Trial RegistrationClinicalTrials.gov NCT04323787; https://clinicaltrials.gov/ct2/show/NCT04323787

Identifying and managing psoriasis-associated comorbidities: the IMPACT research programme

BackgroundPsoriasis is a common, lifelong inflammatory skin disease, the severity of which can range from limited disease involving a small body surface area to extensive skin involvement. It is associated with high levels of physical and psychosocial disability and a range of comorbidities, including cardiovascular disease, and it is currently incurable.ObjectivesTo (1) confirm which patients with psoriasis are at highest risk of developing additional long-term conditions and identify service use and costs to patient, (2) apply knowledge about risk of comorbid disease to the development of targeted screening services to reduce risk of further disease, (3) learn how patients with psoriasis cope with their condition and about their views of service provision, (4) identify the barriers to provision of best care for patients with psoriasis and (5) develop patient self-management resources and staff training packages to improve the lives of people with psoriasis.DesignMixed methods including two systematic reviews, one population cohort study, one primary care screening study, one discrete choice study, four qualitative studies and three mixed-methodology studies.SettingPrimary care, secondary care and online surveys.ParticipantsPeople with psoriasis and health-care professionals who manage patients with psoriasis.ResultsPrevalence rates for psoriasis vary by geographical location. Incidence in the UK was estimated to be between 1.30% and 2.60%. Knowledge about the cost-effectiveness of therapies is limited because high-quality clinical comparisons of interventions have not been done or involve short-term follow-up. After adjusting for known cardiovascular risk factors, psoriasis (including severe forms) was not found to be an independent risk factor for major cardiovascular events; however, co-occurrence of inflammatory arthritis was a risk factor. Traditional risk factors were high in patients with psoriasis. Large numbers of patients with suboptimal management of known risk factors were found by screening patients in primary care. Risk information was seldom discussed with patients as part of screening consultations, meaning that a traditional screening approach may not be effective in reducing comorbidities associated with psoriasis. Gaps in training of health-care practitioners to manage psoriasis effectively were identified, including knowledge about risk factors for comorbidities and methods of facilitating behavioural change. Theory-based, high-design-quality patient materials broadened patient understanding of psoriasis and self-management. A 1-day training course based on motivational interviewing principles was effective in increasing practitioner knowledge and changing consultation styles. The primary economic analysis indicated a high level of uncertainty. Sensitivity analysis indicated some situations when the interventions may be cost-effective. The interventions need to be assessed for long-term (cost-)effectiveness.LimitationsThe duration of patient follow-up in the study of cardiovascular disease was relatively short; as a result, future studies with longer follow-up are recommended.ConclusionsRecognition of the nature of the psoriasis and its impact, knowledge of best practice and guideline use are all limited in those most likely to provide care for the majority of patients. Patients and practitioners are likely to benefit from the provision of appropriate support and/or training that broadens understanding of psoriasis as a complex condition and incorporates support for appropriate health behaviour change. Both interventions were feasible and acceptable to patients and practitioners. Cost-effectiveness remains to be explored.Future workPatient support materials have been created for patients and NHS providers. A 1-day training programme with training materials for dermatologists, specialist nurses and primary care practitioners has been designed. Spin-off research projects include a national study of responses to psoriasis therapy and a global study of the prevalence and incidence of psoriasis. A new clinical service is being developed locally based on the key findings of the Identification and Management of Psoriasis Associated ComorbidiTy (IMPACT) programme.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 10, No. 3. See the NIHR Journals Library website for further project information.

Family child care home providers' self-reported nutrition and physical activity practices, self-efficacy, barriers and knowledge: baseline findings from happy healthy homes.

Describe nutrition and physical activity practices, nutrition self-efficacy and barriers and food programme knowledge within Family Child Care Homes (FCCH) and differences by staffing. Baseline, cross-sectional analyses of the Happy Healthy Homes randomised trial (NCT03560050). FCCH in Oklahoma, USA. FCCH providers (n 49, 100 % women, 30·6 % Non-Hispanic Black, 2·0 % Hispanic, 4·1 % American Indian/Alaska Native, 51·0 % Non-Hispanic white, 44·2 ± 14·2 years of age. 53·1 % had additional staff) self-reported nutrition and physical activity practices and policies, nutrition self-efficacy and barriers and food programme knowledge. Differences between providers with and without additional staff were adjusted for multiple comparisons (P < 0·01). The prevalence of meeting all nutrition and physical activity best practices ranged from 0·0-43·8 % to 4·1-16·7 %, respectively. Average nutrition and physical activity scores were 3·2 ± 0·3 and 3·0 ± 0·5 (max 4·0), respectively. Sum nutrition and physical activity scores were 137·5 ± 12·6 (max 172·0) and 48·4 ± 7·5 (max 64·0), respectively. Providers reported high nutrition self-efficacy and few barriers. The majority of providers (73·9-84·7 %) felt that they could meet food programme best practices; however, knowledge of food programme best practices was lower than anticipated (median 63-67 % accuracy). More providers with additional staff had higher self-efficacy in family-style meal service than did those who did not (P = 0·006). Providers had high self-efficacy in meeting nutrition best practices and reported few barriers. While providers were successfully meeting some individual best practices, few met all. Few differences were observed between FCCH providers with and without additional staff. FCCH providers need additional nutrition training on implementation of best practices.

Physical therapists' knowledge and implementation of best practices in the outpatient physiotherapy department during the COVID-19 pandemic: A cross-sectional study.

Physiotherapists (PTs) play an important role in the well-being and physical rehabilitation of patients with long term health problems. It is important that PTs follow recommended practices that minimize the transmission of SARS-CoV-2 infection in providing Outpatient Physiotherapy services. The aim of this study was to assess the knowledge of COVID-19 among the PTs and evaluate the state of implementation of best practices in Outpatient Physiotherapy to prevent SARS-CoV-2 infections during the ongoing pandemic. A self-administered online questionnaire consisting of three sections, including section one on demographic information, section two on evaluating knowledge about SARS-CoV-2 and section three on implementing best practices as a survey tool for collecting data from PTs working in Lahore and Faisalabad in Punjab, Pakistan. A total of 216 completed surveys were received. Correct responses to different questions devised to test the participants' knowledge of SARS-CoV-2 varied from 58.3% to 99%. The implementation of best practices to prevent the infection transmission in the Outpatient Physiotherapy ranged from 22.7% to 92.1% for different domains. The age of the PTs and OPD setting were associated significantly with the PTs' knowledge of COVID-19 and also with the state of implementation of recommended practices to prevent SARS-CoV-2 infections in the Outpatient Physiotherapy (p < .05). The majority of the PTs, particularly those working in the clinic setting, possessed a good knowledge of COVID-19 and implemented best practices in their Outpatient Physiotherapy at a good level. However, efforts should be directed towards further improving the knowledge of PTs and ensuring implementation of best practices in Outpatient Physiotherapy, particularly in government and private hospitals.

Interprofessional collaboration and communication to facilitate implementation of cognitive rehabilitation in persons with brain injury

ABSTRACT Cognitive rehabilitation encompasses therapeutic services directed at improving cognitive functioning and functional abilities in individuals with brain injury. The term cognitive rehabilitation, however, is often broadly defined, and interventions delivered by individual disciplines may vary in their conceptualizations. This paper, written by an interprofessional collaborative group of speech-language pathologists and rehabilitation psychologists/ neuropsychologists identifies challenges in interprofessional rehabilitation of cognitive problems as well as solutions for addressing those challenges. Specifically, the challenge of defining elements of cognitive rehabilitation is addressed with a recommendation for interprofessional training and development of a shared perspective; the problem of “siloed” care is addressed by recommendations for consistent and considerable efforts at interprofessional communication, use of shared language and emphasis on health literacy; and the challenge of access to collaborative care is addressed with the recommendation to increase utilization of telerehabilitation interventions. Our goal is to empower clinicians to not only turn to evidence-based practice to address patient needs, but to go further in implementing the evidence base by facilitating true collaborative interdisciplinary services via improved knowledge of best practice, and advocacy avenues within systems of care. Such an approach will maximize the ability of rehabilitation professionals to provide meaningful, person-centered interventions that will maximize patient outcomes.

A Case for Using Electronic Health Record Data in the Evaluation of Produce Prescription Programs.

Produce prescription programs within clinical care settings can address food insecurity by offering financial incentives through “prescriptions” for fruits and vegetables to eligible patients. The electronic health record (EHR) holds potential as a strategy to examine the relationship between these projects and participant outcomes, but no studies address EHR extraction for programmatic evaluations. We interviewed representatives of 9 grantees of the U.S. Department of Agriculture’s Gus Schumacher Nutrition Incentive Grant Program’s Produce Prescription Projects (GusNIP PPR) to understand their experiences with and capacity for utilizing EHR for evaluation. Five grantees planned to use EHR data, with 3 main strategies: reporting aggregate data from health clinics, contracting with external/third party evaluators, and accessing individual-level data. However, utilizing EHRs was prohibitive for others due to insufficient knowledge, training and/or staff capacity; lack of familiarity with the Institutional Review Board process; or was inappropriate for select target populations. Policy support for produce prescription programs requires a robust evidence base, deep knowledge of best practices, and an understanding of expected health outcomes. These insights can be most efficiently and meaningfully achieved with EHR data, which will require increased financial support and technical assistance for project operators.

Prevalence of Physical Activity Requirements Among US Colleges/Universities Participating in the American College Health Association-National College Health Assessment II.

Physical activity requirements (PAR; ie, courses required for graduation) have been proposed as a policy solution for increasing undergraduate physical activity. This study aimed to report prevalence of PAR among US colleges/universities participating in the American College Health Association-National College Health Assessment (ACHA-NCHA) and to understand whether these requirements were associated with campus characteristics. Data from the American College Health Association-National College Health Assessment II serial cross-sectional survey (2015–2019) were merged with researcher coded variables (2019): binary PAR status, nature of PAR (activity-based, conceptual, or combination), and number of courses required to fulfill the PAR. Logistic regression determined whether campus characteristics were associated with PAR in 2019. Nonparametric tests examined differences in nature and number of PAR courses. Of 379 schools, 59 (15.6%) had PAR, with 36 (61.0%) having activity-based PAR and 23 (39.0%) having a combination. Compared to public and four-year schools, private (OR=3.47 [1.77, 6.80]) and two-year schools (OR=6.55 [2.21, 19.45]) had significantly increased odds of having PAR. Private schools required significantly more PAR courses compared to public schools (2.42 vs. 1.73, P=.005). PAR were less prevalent in this sample than reported historically, indicating need for campus leadership attention to this issue. Research is needed to understand what barriers exist to implementing and maintaining PAR on college/university campuses, particularly among public and four-year schools. Understanding health promotion practices among ACHA member schools, which have made leadership commitments to promote student health, can provide greater knowledge of PAR barriers and best practices in schools across the United States and globally.

428. Assessing the Confidence, Knowledge and Preferences of Hospital Staff with Regards to Personal Protective Equipment (PPE) Practices During the COVID-19 Pandemic

BackgroundEffective use of personal protective equipment (PPE) by hospital staff is critical to prevent transmission of COVID-19. This study examines hospital staff confidence in and knowledge of effective PPE use, and their preferences for learning about PPE practices.MethodsThree isolation precautions signs were created for use in the care of those with or under investigation for COVID-19 infection: first, a special respiratory precautions sign designed by infection control; and next, two signs outlining proper donning and doffing practices – one created internally with the support of health literacy, and another developed with a design firm (IDEO) using principles of human-centered design (Figure 1). All signs were used for ≥ 10 weeks prior to distribution of a questionnaire (REDCap) to clinical and non-clinical hospital staff. Those who had not worked on hospital units during the pandemic (after March 15, 2020) were excluded. The 38-item survey was sent by supervisors over email between July 14-31, 2020, and examined demographics, confidence in and knowledge of PPE best practices, and preferences for each precaution sign with regards to trustworthiness, ease of following, informative content, and clarity of image/layout. Responses were reported using descriptive statistics. A non-parametric test of trends compared staff preferences across signs. Logistic regression examined the association between answering all knowledge-based questions correctly and staff role and confidence in PPE practices (Stata). ResultsOf the 531 respondents, 461 were eligible for inclusion. The majority were female, white, and not high risk for COVID-19 (Table 1). Most were confident about PPE use, correctly answered questions examining knowledge of PPE best practices, and found PPE signage helpful (Table 2). Staff preferred the professionally designed sign for informative content (p< 0.01) and clear imagery/layout (p=0.01) (Table 3). Confidence in PPE practices and physician or nurse roles were associated with answering all knowledge-based questions correctly (p< 0.001 and p=0.04, respectively). ConclusionIn a convenience sample of hospital staff, most were confident and knowledgeable about PPE use, found PPE signage helpful, and preferred professionally designed signs.Disclosures All Authors: No reported disclosures

Teaching From Afar: Development of a Telemedicine Curriculum for Healthcare Workers in Global Settings.

The Stanford Department of Emergency Medicine joined forces with Digital Medic to create educational materials to teach global healthcare providers how to evaluate patients via telemedicine in the setting of COVID-19. Users then asked for additional education on best practices surrounding the use of telemedicine as a communication medium. Here, we describe our experience in the creation of this additional module and provide some basic feedback received from end-users. We scripted, filmed, and edited a video module for this application over the course of 14 weeks. It was subsequently deployed as part of the larger COVID-19 educational program. To date, the course has had over 28,000 participants. Each was asked to take a pre- and post-test to assess the knowledge of telemedicine best practices before and after the video module; 19,412 elected to take the pre-test and 19,364 took the post-test with overall scores of 84% and 95%, respectively. Anecdotal feedback has been positive. Telemedicine systems have proliferated rapidly around the world, but best practices for physician-to-patient interactions have not been similarly disseminated. We conclude that video modules can be used to fill this educational need quickly and economically.

Benchmarking for accountability on obesity prevention: evaluation of the Healthy Food Environment Policy Index (Food-EPI) in Australia (2016-2020).

Despite broad agreement on the need for comprehensive policy action to improve the healthiness of food environments, implementation of recommended policies has been slow and fragmented. Benchmarking is increasingly being used to strengthen accountability for action. However, there have been few evaluations of benchmarking and accountability initiatives to understand their contribution to policy change. This study aimed to evaluate the impact of the Healthy Food Environment Policy Index (Food-EPI) Australia initiative (2016-2020) that assessed Australian governments on their progress in implementing recommended policies for improving food environments. A convergent mixed methods approach was employed incorporating data from online surveys (conducted in 2017 and 2020) and in-depth semi-structured interviews (conducted in 2020). Data were analysed against a pre-defined logic model. Australia. Interviews: twenty stakeholders (sixteen government, four non-government). Online surveys: fifty-three non-government stakeholders (52 % response rate) in 2017; thirty-four non-government stakeholders (36 % response rate) in 2020. The Food-EPI process involved extensive engagement with government officials and the broader public health community across Australia. Food-EPI Australia was found to support policy processes, including as a tool to increase knowledge of good practice, as a process for collaboration and as an authoritative reference to support policy decisions and advocacy strategies. Key stakeholders involved in the Food-EPI Australia process viewed it as a valuable initiative that should be repeated to maximise its value as an accountability mechanism. The highly collaborative nature of the initiative was seen as a key strength that could inform design of other benchmarking processes.

Improving hospital-based point-of-care ultrasound cleaning practices using targeted interventions: a pre\u2013post study

BackgroundPoint-of-care ultrasound (POCUS) devices are becoming more widely used in healthcare and have the potential to act as fomites. The objective of this project was to study the thoroughness of cleaning of POCUS machines before and after a quality improvement initiative. We designed a mixed-methods, pre/post study which took place over the course of one year at a university-affiliated health center. Cleaning rates of four ultrasound machines used by hospital medicine and critical care medicine services were evaluated using fluorescent marking. Interventions targeted physicians’ knowledge of best practices and improved access to cleaning supplies. Pre- and post-intervention cleaning rates were compared using a generalized linear model. The impact of the corona virus disease of 2019 (COVID-19) pandemic on baseline cleaning rates was also evaluated. Physicians’ attitudes and knowledge of cleaning practices were evaluated via unpaired pre/post surveys.ResultsThere was significant improvement in thoroughness of cleaning following intervention (pre 0.62, SE 0.05; post 0.89, SE 0.07), p < 0.0001). There was no difference in baseline cleaning rates before (0.63, SE 0.09) and after (0.61, SE 0.1) the onset of the COVID-19 pandemic (p = 0.78). Post-intervention surveying found improved understanding of guideline-based cleaning practice, better performance on knowledge-based questions, and fewer reported barriers to machine cleaning.ConclusionThoroughness of cleaning of POCUS machines can be improved with practical interventions that target knowledge and access to cleaning supplies.

1644 Trainee Perspective in Sarcoma Care

AimSoft tissue sarcomas (STS) are rare and aggressive tumours. Appropriate multidisciplinary management requires robust knowledge of best practice and understanding of current guidelines. Plastic surgery trainees must therefore be proficient in the assessment, investigation, and treatment of patients with STS. We aimed to evaluate trainee education, confidence, and competence in managing patients with STS.MethodAll plastic surgery trainees in Wales completed an online questionnaire and written assessment. This was designed by the lead for STS and TPD. Formal training, knowledge of national guidelines and excision margins for different types of STS and skin cancer was assessed using short answer questions. A five-point Likert scale was used to assess trainee confidence in STS and skin cancer management and follow-up. Volume and type of teaching in sarcoma and skin cancer was also quantified.ResultsTrainees received less sarcoma training and were less confident in STS assessment and follow-up, in comparison to skin cancer. More senior trainees or those with formal sarcoma training were more confident in skin cancer management (mean confidence rating 4.4 vs 2.2) and performed better in the written assessment of excision margins (mean score 100% vs 61.45%)ConclusionsTrainees receive less training in sarcoma with a significant impact on their competence and confidence in sarcoma care. We believe this is consistent across the United Kingdom as evidenced by just two sarcoma webinars held during the COVID-19 pandemic. Formal national evaluation of sarcoma teaching should be carried out to inform ongoing efforts to improve educational resources on this important topic for trainees.

Experiences of Transgender and Gender Nonbinary Patients in the Emergency Department and Recommendations for Health Care Policy, Education, and Practice.

Transgender and gender nonbinary (trans/NB) individuals face many barriers to accessing health care in the United States due to systemic and clinician discrimination. Such experiences can lead to avoidance or delays in seeking care. These issues are relevant for emergency department (ED) clinicians and staff because trans/NB patients may use the ED in times of crisis. The purpose of this study was to qualitatively explore experiences of trans/NB individuals accessing health care in the ED and provide recommendations for improvements. This study involved semi-structured qualitative interviews with nine trans/NB individuals living in Arkansas about their experiences when visiting local EDs. Interviews revealed four main themes: 1) system and structural issues; 2) interactions with clinicians/staff influence care received; 3) perceptions of clinician knowledge and education about trans/NB health; and 4) impact on future health and health care access. Participants recommended education for current and future ED clinicians and staff to improve knowledge of best practices for trans/NB health care. Recommendations were also made to improve ED policy for inclusive and affirming intake processes, intake forms, and electronic health record (EHR) documentation, including documentation and use of patients' chosen name and pronouns. The negative experiences and discrimination reported by trans/NB patients in ED visits underscores the importance of improving ED clinician knowledge of gender-affirming care practices, ED intake policies and practices, and EHR documentation in EDs.

Providers' Knowledge of Diagnosis and Treatment Best Practices for Acute Myocardial Infarction (AMI): Evidence from India Using Clinical Vignettes

Research ObjectiveCardiovascular diseases (CVDs) are a leading cause of death worldwide, and 80% of CVD deaths occur in low‐ and middle‐income countries (LMICs). The Global Burden of Disease Study estimates that CVDs contribute 28·1% of total deaths in India. Acute Myocardial Infarctions (AMI) make up a large share of these deaths. Early diagnosis and correct treatment of AMI is critical to preventing CVD‐related deaths. This study aims to assess the competence of primary care providers in India to diagnose and treat AMI and examine differences between public and private sector providers.Study DesignWe conducted a cross‐sectional study of healthcare providers' knowledge of diagnosis and treatment for AMI. Data collection took place in Odisha, one of the poorest states in India, from August 2019 to March 2020. Using data from vignette‐based interviews with primary care providers in the public and private sectors, we assessed providers' knowledge of best practices in clinical care. The public sector providers within this study included physicians at government‐run primary health centers, and the private sector providers were engaged in solo‐practice, irrespective of medical qualifications. The vignette‐responses were evaluated against standard treatment guidelines (STGs) for AMI at the primary care level.Population Studied110 primary care providers working in Odisha, India a state with ~47 million people, of which 32.5% earn &lt; $1.90/day and ~ 60% belong to indigenous or vulnerable social groups.Principal FindingsOverall, providers demonstrated low levels of knowledge: only 67.27% diagnosed AMI correctly, and 0% recommended the correct treatment as per STGs. Providers seldom asked key diagnostic questions such as family and medical history (6.36% of cases) and the nature of the chest pain (10.91%) or results from diagnostic tests like ECG and EKG (30%), lipid profile (1.82%), or angiograms (3.64%). Private sector providers showed higher competence in making a correct diagnosis than public providers (difference of 32.73 percentage points). In line with STGs, 82.43% of providers referred AMI cases to hospitals, with more private than public providers making these referrals. 55.41% of providers prescribed at least one correct drug (in combination with unnecessary drugs). More private providers prescribed at least one correct drug than public sector providers. 44.74% of public providers prescribed only unnecessary drugs, without a single medicine recommended for angina.ConclusionsHealthcare providers in Odisha, India, have low levels of knowledge regarding AMI diagnosis and treatment, with public providers showing lower competence than private providers.Implications for Policy or PracticeOur findings indicate strikingly poor quality of care for AMI at the primary care level. The widespread misdiagnosis of AMI, the prescription of unnecessary drugs, and a lack of appropriate referral raise concerns for India's efforts to address rising rates of CVD. Our findings suggest addressing CVD in LMIC contexts is complex and requires improving the baseline knowledge of providers in both public and private sectors; which may be particularly relevant in contexts with little de facto regulation.Primary Funding SourceBill and Melinda Gates Foundation.