Maximum Attainable Score Research Articles

Knowledge, attitudes and practices regarding medication splitting and crushing among the general public in Jordan: a cross-sectional study

BackgroundSplitting or crushing medications are used for dosage administration when a certain dose is not easily accessible. Understanding the splitting or crushing of medications is essential to guarantee safe medication...

Clinical Reasoning Skills Among Second-Phase Medical Students in West Bengal, India: An Exploratory Study.

Introduction Proper application of clinical reasoning skills is essential to reduce diagnostic and management errors. Explicit inclusion of training and assessment of clinical reasoning skills is the demand of time. The study intended to measure the clinical reasoning skills of second-phase undergraduate students in a medical college inWest Bengal, India, and its distribution across several individual variables. Methods The clinical reasoning skills of 105 undergraduate medical students were assessed in a cross-sectional exploratory study using key feature questions (KFQs) with the partial credit scoring system. Six case vignettes aligned to the core competencies in the subject of pharmacology, pathology, and microbiology were designed and validated by the subject material experts for this purpose. The responses of the participants were collected through Google Forms (Google, Mountain View, CA) after obtaining written informed consent. The scores obtained in all KFQs were added and expressed in percentage of the maximum attainable score. Results The mean (±SD) clinical reasoning score of the participants was 42.5 (±12.6). Only 29.6% of respondents scored ≥ 50. Students with higher subjective economic status (p-value = 0.01) and perceived autonomy (p-value < 0.001) were more likely to have higher clinical reasoning scores. The marks obtained in previous summative examinations were significantly correlated with clinical reasoning scores. Conclusion Average score < 50.0 and inability to score ≥ 50.0 by more than two-thirds of the participants reflected the deficit in the clinical reasoning skills of second-phase MBBSstudents. The association of clinical reasoning skills with economic status, autonomy, and previous academic performances needs further exploration.

Multi-criteria thermal resilience certification scheme for indoor built environments during heat waves

With climate change, the indoor built environment is expected to significantly influence the occupant's safety and well-being. A novel multi-criteria thermal resilience certification scheme for indoor built environments during extreme heat events is proposed in this paper. The certification scheme considers overheating, thermal comfort, heat stress, and hygrothermal discomfort in built environments. These criteria are quantified using key performance indicators like indoor overheating degree, hours of exceedance, wet-bulb globe temperature, and heat index, respectively. This scheme is developed based on existing best practices like standards, rating systems, and literature. The scheme is implemented on a benchmark building energy performance model for detached post-World War II dwellings in Belgium as a case study using weather data measured from the City of Brussels. The indoor overheating in the reference dwelling is assessed with a static threshold of 27 °C for the bedrooms and adaptive thresholds for other areas. The analysis found that the building performance is within the defined threshold levels throughout the heat wave duration for all criteria. Therefore, the reference dwelling got a maximum attainable score of four points and is rated five-star for thermal resilience during heat waves. The proposed certification scheme is intended as a standardized framework and highlights the need for further revisions in building performance policies and guidelines.

Evaluating patient experience to improve care in a specialist antenatal clinic for pregnancy after loss

In the United Kingdom, roughly 1 in 250 babies are stillborn each year. Most women who experience stillbirth become pregnant again – 80% within a year of loss. Presently, obstetric-led care is recommended; though there is a growing body of evidence to support provision of specialist services. The Rainbow Clinic is a specialist antenatal service providing care for pregnancies after loss incorporating clinical and psychological care. This study aimed to assess patient experience at the Rainbow Clinic and identify areas for clinical improvement. A 13-item questionnaire was distributed to pregnant women who attended the Rainbow Clinics at the Oxford Road and Wythenshawe sites of Saint Mary’s Hospital, Manchester, UK between July 2016 and June 2021. Descriptive statistics and unpaired t-test were used for quantitative data and summative content analysis for qualitative data. Four-hundred and fifty-six women completed the questionnaire. The mean patient experience score per quarter was stable with an average of 21.1 (± 3.0) for the five years, with a maximum attainable score of 25. The COVID-19 pandemic had no effect on patient experience at the Rainbow Clinic (pre-pandemic vs. during-pandemic: mean 21.2 v 21.3; p = 0.75). Free-text responses demonstrated women felt positively about the antenatal care received. Identified areas for improvement included “more awareness of the [Rainbow] sticker” to ensure women with previous loss are identified; increased publicity of the Rainbow Clinic services; developing more clinics at different locations to improve accessibility; and continuing specialist input into intrapartum care. Specialist antenatal care provided by the Rainbow Clinic was rated as of a high standard. Potential future improvements include sticker alterations (or other mechanisms to identify women who have experienced a previous loss) and develop increased awareness of the clinic in other institutions.

Interoceptive Awareness Among the General Public in Saudi Arabia: A Cross-Sectional Study.

Background Interoception refers to the cognitive process of perceiving internal bodily states. This encompasses various physiological indicators, including heart rate fluctuations, stomach distention, internal temperature, hydration levels, sensory input from free nerve terminals in the fascia and muscles, as well as hormonal, stretch, and pain receptors. This study aimed to examine the interoceptive awareness among the general public in Saudi Arabia. Methods A cross-sectional online survey was undertaken in Saudi Arabia to investigate the level of interoceptive awareness within the overall population of the country in October 2023. This research used a previously developed questionnaire named the Multidimensional Assessment of Interoceptive Awareness, version 2 (MAIA-2). In a binary logistic regression analysis, the mean interoceptive awareness score of the participants was utilized as the dummy variable to determine the variables that influence interoceptive awareness. Results A total of 814 participants were involved in this study. Overall, the study participants demonstrated a marginal level of interoceptive awareness with a mean score of 94.3 (standard deviation (SD): 29.3) out of 185 (representing 51.0% of the maximum attainable score). The mean interoceptive score was not consistent across different subscales and ranged between 37.7% and 63.3%. The highest mean interoceptive score was observed for the Trusting subscale (9.5 (SD: 4.5) out of 15) (representing 63.3% of the maximum attainable score for this subscale). The lowest mean interoceptive score was observed for the Not-Distracting subscale (11.3 (SD: 6.9) out of 30) (representing 37.7% of the maximum attainable score for this subscale). Binary logistic regression analysis did not identify any statistically significant difference in the likelihood of having a higher level of interoceptive awareness among the participants based on their demographic characteristics (p>0.05). Conclusion The participants in our research demonstrated a modest degree of interoceptive awareness. The study's results suggest that the participants demonstrated a heightened inclination towards internal experiences rather than being attentive to their bodily sensations. Further investigation is required to examine interoceptive awareness across various cohorts.

Evaluation of Pharmacology and Pathophysiology Knowledge of Epilepsy among Senior Pharmacy Students: A Single Center Experience.

Background and Objectives: Epilepsy is a chronic disease that causes substantial morbidity and mortality. Pharmacists represent an integral role in managing patients with epilepsy. The aim of this study was to evaluate the level of knowledge about the pharmacology and pathophysiology of epilepsy among senior pharmacy students. Materials and Methods: Cross-sectional study using a designed questionnaire to measure the pharmacological and physiological knowledge of senior pharmacy students regarding epilepsy who are studying at Umm Al-Qura University, Makkah, Saudi Arabia, from August to October 2022. Results: A total of 211 senior clinical pharmacy students responded to the questionnaire. The majority of the respondents were 4th year pharmacy students. The numbers of female and male participants were equal (106 and 105 students, respectively). The participants represented an acceptable level of knowledge about the pathophysiology aspects of epilepsy, with a mean total score of 6.22 ± 1.9 out of a maximum score of 10. The respondents reported that epilepsy could be due to genetic predisposition combined with environmental conditions (80.1%) or brain stroke (17.1%). Regarding the respondent knowledge about the pharmacology of epilepsy, the total score was 4.6 ± 2.1 (maximum attainable score: 9). Conclusions: The majority of pharmacy students had knowledge about the pathophysiology concept of the disease; however, low knowledge was shown by the respondents regarding the pharmacology of epilepsy. Thus, there is a need to identify better strategies to improve students' education.

Physicians' Knowledge of Abdominal Compartment Syndrome and Intra-Abdominal Hypertension in Saudi Arabia: An Online Cross-Sectional Survey Study.

To determine physicians' knowledge of abdominal compartment syndrome and intra-abdominal hypertension in Saudi Arabia. A cross-sectional online survey study was conducted on physicians in Saudi Arabia between March and August 2022. A previously developed questionnaire was adapted and used in this study. The survey instrument investigated the knowledge and management of intra-abdominal hypertension and abdominal compartment syndrome among physicians. Logistic regression was used to identify predictors of being knowledgeable about abdominal compartment syndrome and intra-abdominal hypertension. A total of 266 physicians participated in this study. Around one-fifth (21.8%) the study participants were ICU physicians and 25.0% reported that they practice internal medicine. Intra-abdominal hypertension (IAH) and the impact of increased intra-abdominal pressure (IAP) on organ function were terms that the majority of research participants (70.3%) reportedthey were familiar with. A similar percentage (73.7%) reported that they are familiar with abdominal compartment syndrome (ACS). Around 43.0% of the study participants reported that they do not know how to measure IAP. The most frequently reported (13.5%) intervention in the treatment of IAH and ACS was the use of inotropes or vasopressors. The study participants showed a weak level of knowledge of ACS and IAH with a median score of 3.00 (IQR: 5.00-2.00), which represents 27.3% of the maximum attainable score. Physicians working at hospitals with 20-50 ICU beds were 41.0% (odds ratio: 0.59 (CI: 0.37-0.96)) less likely to be knowledgeable about intra-abdominal hypertension and abdominal compartment syndrome (p≤0.05). Physicians demonstrated a low level of IAP and ACS knowledge. To increase the safety of medical practices and enhance clinical outcomes for patients, awareness should be raised about the proper diagnosis and managementof IAP and ACS. Future research should focus on developing effective educational strategies to improve physicians' understanding of IAP and ACS.

Button batteries in the ear, nose and throat: a novel survey of knowledge of UK advanced nurse practitioners

Button battery (BB) impaction in the ear, nose and throat can result in significant morbidity. Advanced nurse practitioners (ANPs) are increasingly responsible for initial patient assessment and prompt escalation to otolaryngologists for definitive management. Our novel national study aimed to assess ANPs' knowledge with respect to the assessment and management of patients with BBs in the ear, nose and throat. A national 13-point survey was disseminated among ANPs over a 2-week period. Knowledge was assessed through eight multiple choice questions with a maximum attainable score of 21. A total of 242 responses were analysed. Knowledge deficits were identified in all domains (mean overall score 8.5/21), including presenting clinical features, preliminary investigations and intervention strategies. The overwhelming majority of respondents (97%; n=234) advocated for further training. A need for further education has been highlighted by this surveyed cohort of ANPs. Implementation of standardised protocols, virtual resources and simulation platforms may address knowledge deficits.

Awareness and Readiness To Implement the Pradhan Mantri Jan Arogya Yojana: A Cross-Sectional Study Among Healthcare Workers of a Tertiary Care Hospital in Eastern India.

BackgroundThe Indian government announced "Ayushman Bharat" for a New India 2022 during the 2018-19 parliament budget sessions, which includes the national health protection scheme presently known as "Pradhan Mantri Jan Arogya Yojana (PMJAY)" to facilitate access to secondary and tertiary healthcare services. This study aimed to see how well healthcare workers (HCWs) understood the PMJAY and how prepared they were to administer it.Materials and methodsWith an anticipated sample size of 411, this hospital-based analytical, cross-sectional study was done among treating faculty, resident doctors, and nursing officers as study participants. Participants completed a self-administered, pre-tested, semi-structured questionnaire to determine their level of awareness and readiness to adopt PMJAY. SPSS Version 22 software (SPSS Inc., Chicago, IL, USA) was used to analyze the data.ResultsThe overall mean (SD) awareness score and mean readiness score among HCWs were found to be 5.52 (1.82) and 18.49 (4.5), respectively. There was a significantly high awareness score among doctors compared to nursing officers. The relation between awareness score and readiness score showed a weak positive significant correlation (r=0.174, p=0.001). The linear regression model demonstrated an increase of 0.432 units in readiness for every unit increase in awareness score.ConclusionThe doctor's mean awareness score was little over half of the maximum attainable score. Faculty members were more aware of the scheme than the residents and nursing officers. The readiness to implement PMJAY improves as the awareness grows. Frequent workshops on PMJAY for stakeholders are required for better readiness.

Knowledge, Attitudes, and Practices towards COVID-19 Pandemic among Residents of the Jharkhand State, India: An Online Survey

Background: People's adherence to control measures is imperative in the fight against COVID-19. The present study was done to evaluate knowledge, attitudes, and practices towards COVID-19 among residents of Jharkhand and to assist the government in deciding further course of action during the COVID-19 outbreak.&#x0D; Methods: This study was an online cross-sectional survey. The link to the questionnaire was displayed on the official website of Rajendra Institute of Medical Sciences, Ranchi, National Health Mission, Jharkhand, official website of all districts under Jharkhand state administration, Integrated Disease Surveillance Programme and Information &amp; Public Relations department. Participation of residents in the survey was extensively propagated using mass media mainly local television networks, radio channels and newspapers.&#x0D; Results: A total of 4683 responses were received from all districts of Jharkhand. The majority of the participants were young adults (47.5%) and the number of male participants was more than the females (81.4%). The mean correct knowledge score for participants of this study was 10.73+2.2 (maximum attainable score was 14) while the mean practice score for the participants was 4.5+0.69 (maximum attainable score was 5). The knowledge score of the participants was significantly associated with their age, education status and economic class (p&lt;0.0001). The participants largely held an optimistic attitude and healthy practices towards COVID-19. Conclusion: Participants had a positive attitude but were also logically worried and uncertain about the near future. Adequate knowledge of participants was visible in their practices. There was however a gap across age groups, gender, literacy and income levels which should be addressed in future campaigns.

Awareness, Views, Perceptions, and Beliefs of Pharmacy Interns Regarding Digital Health in Saudi Arabia: Cross-sectional Study

BackgroundDigital health technologies and apps are rapidly advancing in recent years. It is expected to have more roles in transforming the health care system in this era of digital services. However, limited research is available regarding delivering digital health education in pharmacy and the pharmacy students’ perspectives on digital health. ObjectiveThis study aims to assess pharmacy interns’ awareness of digital health apps in Saudi Arabia and their views regarding the coverage of digital health in the education of pharmacists. In addition, we assessed the interns’ perceptions and beliefs about the concepts, benefits, and implementation of digital health in practice settings. MethodsA cross-sectional study using a web-based survey was conducted among pharmacy interns at Unaizah College of Pharmacy, Qassim University, Saudi Arabia. An invitation with a link to the web-based survey was sent to all interns registered at the college between January and March 2021. ResultsA total of 68 out of 77 interns registered in the internship year participated in this study, giving a response rate of 88%. The mean total score for pharmacy interns’ awareness of digital health apps in Saudi Arabia was 5.66 (SD 1.74; maximum attainable score=7). The awareness with different apps ranged from 97% (66/68) for the Tawakkalna app to 65% (44/68) for the Ministry of Health 937 call center. The mean total score for attitude and beliefs toward concepts and benefits of telehealth and telemedicine apps was 58.25 (SD 10.44; maximum attainable score=75). In this regard, 84% (57/68) of the interns believed that telehealth could enhance the quality of care, 71% (48/68) believed that it could help effectively provide patient counseling, and 69% (47/68) believed it could improve patients’ adherence to therapy. In this study, 41% (28/68) believed that the current coverage of digital health in the curriculum was average, whereas only 18% (12/68) believed it was high or very high coverage. Moreover, only 38% (26/68) attended additional educational activities related to digital health. Consequently, the majority (43/68, 63%) were of the opinion that there is a high or very high need to educate and train pharmacists in the field of digital health. ConclusionsOverall, the interns showed good awareness of common digital health apps in Saudi Arabia. Moreover, the majority of the interns had positive perceptions and beliefs about the concepts, benefits, and implementation of digital health. However, the findings showed that there is still scope for improvement in some areas. Moreover, most interns indicated that there is a need for more education and training in the field of digital health. Consequently, early exposure to content related to digital health and pharmacy informatics is an important step to help in the wide use of these technologies in the graduates’ future careers.

Knowledge and Attitude of Pharmacy Students toward People with Mental Illnesses and Help-Seeking: A Cross-Sectional Study from Saudi Arabia

People with mental illnesses (MIs) face several challenges in addition to their disease. People’s negative views of those with MIs impact patients’ decisions to seek professional help. The aims of this study were to assess pharmacy students’ attitudes toward people with MIs and seeking help for mental health, as well as their knowledge about the causes of MIs. A cross-sectional survey was conducted on pharmacy students at Unaizah College of Pharmacy, Qassim University, Saudi Arabia. Out of the 460 distributed questionnaires, 330 complete questionnaires were received, giving a response rate of 71.7%. Overall, the mean total score for attitude towards people with MIs was 60.16 ± 10.48 (maximum attainable score: 105). In this study, 51.12% believed that people with MIs are more likely to harm others than a person without MIs and 66.9% mentioned that they did not trust the work of a mentally ill person as part of their work team. However, only 35.45% believed that it is difficult for mentally ill individuals to follow social rules. In terms of attitudes toward help-seeking, the mean total score of was 12.83 ± 3.16 out of the maximum score of 25. In addition, the mean total score for knowledge about causes of mental illness was 2.92 ± 1.76 out of the maximum score of 8. The participants reported that MIs could be due to genetic inheritance (56%), substance abuse (54.5%), or brain disease (66.1%). The findings showed that there are some negative attitudes toward people with MIs and negative attitudes towards seeking help for mental health. In addition, some misconceptions about the causes of MIs are prevalent. Consequently, the incorporation of more topics concerning mental health in pharmacy curricula could help improve the awareness of and knowledge about mental health.

Knowledge, Attitude and Practice About Coronavirus Disease (COVID-19) Pandemic and Its Psychological Impact on Students and Their Studies: A Cross-Sectional Study Among Pharmacy Students in Saudi Arabia.

BackgroundIndividuals’ knowledge, attitude and practice towards preventive and precautionary measures of COVID-19 are essential to control the spread of the disease. Consequently, the aims of the study were to evaluate knowledge, attitude and practice of pharmacy students towards the pandemic and to assess its psychological impact on them to provide future guidance.MethodsA cross-sectional, questionnaire-based study was conducted via a web-based survey in May 2020. All pharmacy students enrolled at Unaizah College of Pharmacy, Qassim University, were invited to take part in the study.ResultsA total of 232 out of 460 students took part in the study, giving a response rate of 50.43%. The mean total knowledge score was 9.87 ± 2.04 (maximum attainable score, 12). The majority of the participants (n=163; 70.3%) believed COVID-19 is a health threat to their community in the early months of the pandemic. Moreover, the majority (93%) also believed that the lockdown at the beginning of the pandemic was necessary to contain the pandemic. Encouragingly, 86.6% reported that they did not go to any crowded places during the pandemic with more female students avoiding crowded places compared to male students (91.6% versus 78.7%, respectively, P = 0.005). The majority (91%) also reported that they were following the strategies recommended by the authorities to prevent the spread of the virus. Encouragingly, 54.3% reported that the pandemic either had no effect or just a limited effect on their studies. However, 38.5% reported that they always felt or frequently felt nervous or anxious during the pandemic.ConclusionThe study showed that pharmacy students had good knowledge as well as positive attitudes and good practices towards COVID-19 and the preventive measures. However, during the early months, the pandemic did have a negative psychological impact on a number of students. Consequently, proactive psychological and social support services to the students should be considered during the current and future pandemics. In addition, it is important to consider and proactively address key issues that could cause stress and anxiety among students when shifting to distance learning and assessments.

Assessment of grassroot level health care service delivery system in a community development block of Haryana: A cross sectional study.

Health-care service delivery is one of the components of six building blocks of World Health Organization Health System Framework. In order to monitor the progress of health-care service delivery, it is necessary to monitor its dimensions. The current study aimed to assess the health-care service delivery at the lowest health-care delivery post in Haryana. In this cross-sectional observational study conducted in 17 randomly selected subcenters of Block Shahzadpur, Haryana, from July 2019 to March 2020, an Evaluation Framework was developed to monitor health-care service delivery through its three parameters, namely, service delivery, service provision, and facility assessment. The pretested, semi-structured tools were designed on Epi collect online (version 5) application using the available validated tools. The mean service delivery score for antenatal care assessment, postnatal care assessment, and immunization is 74.9 (78.9%), 24.7 (98.6%), and 40.2 (87.3%), respectively, with an overall score of 139.8 (84.2%). The mean service provision score as assessed by patients and their caregivers through exit interview on five elements was 97%. The mean total score for facility assessment parameter was 81.7 (86.9%). The overall health service delivery score calculated by adding scores of all three parameters was 318.4 (maximum attainable score = 360, 88.4%). A good correlation was observed between individual parameters with total score, indicating higher performance of health-care delivery system. The future studies should focus on understanding the gaps at grassroot level and lay down the dashboard indicators for objectively evaluating health-care delivery system.

Measuring hope amongst Tanzanian women who participate in microfinance: An evaluation of the Snyder hope scale

ABSTRACTMeasuring hope reliably and accurately remains an important research objective, not least in less prosperous settings where ‘holding on to hope’ may be critically important in the struggle against adverse life conditions. The State Hope Scale was designed for use in the US. Despite reported application in diverse cultures and using translations the scale has not been extensively validated outside US populations. This study contributes to a larger project exploring the measurement of hope and provides a critique of Snyder’s scale as used in a Tanzanian female population of 1021 urban microfinance participants. We evaluate the scale’s validity through assessment of the empirical distribution of scores, item response profiles, internal consistency and discriminatory ability. Participants mostly scored very high and many reached very near the maximum attainable score. Hardly any endorsed the negative half of the response scale. Several problems are discussed including poor discrimination and strong evidence of acquiescence response bias. We also found little association of the scale scores with hypothesised correlates of hope. Future improvements on the measurement of hope are recommended, especially in studies outside the narrow Western context in which the scale was devised.

2657. Clinical Prediction Tool for Multidrug-Resistant Organisms Among Deceased Donors at the Time of Donor Evaluation

BackgroundTransplant guidelines recommend exercising caution when considering organs that may be infected or colonized with multidrug-resistant organisms (MDROs) and treating the organ recipient with perioperative antibiotics active against the donor MDRO. Unfortunately, donor MDROs are often identified only after transplantation. We developed a clinical prediction tool to stratify donors’ MDRO risk at the time of donor evaluation.MethodsA retrospective cohort study was conducted at four transplant centers in Philadelphia between January1, 2015 and June 30, 2016. All deceased organ donors who donated ≥1 organ to one of the centers were included. Multivariate logistic regression was used to determine predictors of donor MDROs, including methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci, extended-spectrum cephalosporin-resistant (ESC-R) or carbapenem-resistant Enterobacteriaceae, multidrug-resistant (MDR) P. aeruginosa, or MDR Acinetobacter species. Manual forward selection was utilized to maximize the area under the receiver operating characteristic curve (AUC). A scoring system was developed based on the odds ratios for each covariate. Internal validity was assessed using the Hosmer–Lemeshow statistic, specificity, and negative predictive value (NPV).ResultsOf 440 total donors, 62 (14%) grew MDROs on culture. The majority were MRSA (40) or ESC-R Enterobacteriaceae (20). The most parsimonious model that predicted donor MDROs included: a terminal hospitalization ≥ 7 days (1 point), ≥ 2 antibiotics administered during the terminal hospitalization (1 point), receipt of extracorporeal membrane oxygenation (ECMO) (1 point), and presence of opacities on donor chest imaging concerning for lower respiratory tract infection (2 points). With this scoring system, the maximum attainable score is 5; any donor with a score of ≥ 2 points would be considered high risk for an MDRO, with an AUC of 0.71, specificity of 99%, and NPV of 86%. The Hosmer–Lemeshow P = 0.68.ConclusionThe risk of an MDRO among deceased organ donors can be predicted using the above scoring system. This tool will inform decisions about organ utilization and perioperative prophylaxis for solid-organ transplant recipients. Disclosures All authors: No reported disclosures.

1588. Clinical Prediction Tool for Extended-Spectrum Β Lactamase-Producing Enterobacteriaceae as the Etiology of Bacteremia in Solid Organ Transplant Recipients

BackgroundMultidrug-resistant Gram-negative bacterial infections have emerged as a significant cause of morbidity among solid-organ transplant (SOT) recipients, leading to challenges in selection of empiric antibiotic therapy. As such, we developed a predictive tool to determine whether these patients are high or low risk for extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (EB) bacteremia at the time of positive blood culture.MethodsAll SOT recipients admitted to the Hospital of the University of Pennsylvania with blood cultures positive for EB between January 2007 and July 2016 were included in the source cohort. Multivariate logistic regression was used to determine predictors of ESBL-EB bacteremia. Manual forward selection was utilized to maximize area under the receiver operating characteristic curve (AUC), with sequential addition of covariates until achieving an AUC increase of <1%. A scoring system was developed based on the adjusted odds ratios for each covariate. Interval validity was assessed using the Hosmer-Lemeshow statistic, sensitivity, specificity, and the bootstrapping technique.ResultsOver the study period, there were 287 SOT recipients admitted with an EB bacteremia, of which 51 were due to an ESBL-producing organism. The final model that predicted presentation with ESBL-EB bacteremia included: identification of an ESBL-EB on culture in the previous 12 months, trimethoprim-sulfamethoxazole exposure in the prior 6 months, receipt of a kidney transplant, and fluoroquinolone exposure in the prior 6 months. This model achieved an AUC of 0.85, sensitivity of 54.9%, specificity of 96.6%, and Hosmer–Lemeshow statistic of 0.26 (Figure 1). Based on the adjusted odds ratios for each factor, scores of +3, +1, −1, and +1 were assigned to each covariate, respectively. With this scoring system, the maximum attainable score was 5, with any score of ≥3 deemed to be predictive of ESBL-EB bacteremia. After bootstrapping, the adjusted AUC remained at 0.85.ConclusionThe presence of ESBL-EB organism as the etiology of bacteremia in SOT recipients can be predicted using the above scoring system. This tool will inform judicious empiric antibiotic use in this population at the time of positive blood culture. Disclosures All authors: No reported disclosures.

Harvesting procedures, welfare and shelf life of ungutted and gutted shortfin pompano (Trachinotus falcatus) stored in ice

Shortfin pompano (Trachinotus falcatus) were harvested from a floating cage culture. Handling stress (blood pH, white muscle pH, and rigor mortis) and welfare (“eye roll”) were determined for two harvesting methods: (i) batch netting and transfer to ice-slurry where the fish were killed and chilled (commercial method) and, (ii) transfer of fish to a tub immersed in the cage before it was lifted onto a barge where the fish were euthanised by an AQUI-S™ overdose. Half of the ice-slurry fish were gutted. All fish were subsequently stored for 18 d in ice for assessment of freshness (total bacterial counts, TBC and Quality Index Method, QIM) as well as skin and eye color. A modified QIM scheme for European sea bass was used with demerit points ranging from 0 to 18. Due to excessive swimming during crowding, both ice-slurry and AQUI-S™ fish were harvested in an exhausted condition. Upon sampling, none of the fish exhibited “eye roll”, indicating they were either unconscious or dead. Since the ice-slurry fish were not stunned immediately, the welfare of the fish might have been compromised. During rapid chilling, the fish developed cloudy eyes. The asset of using AQUI-S™ was possibly better fish welfare during the stunning and euthanising phase since exposure to ice-slurry was associated with escape swimming behaviour and slow death. Shortly after harvesting there were some significant differences between harvesting methods in terms of skin color. They were, however, largely offset by storage for one day. Only a few minor changes in skin color took place during further storage. Changes in eye color were more prominent than for skin. After storage for more than a week, the TBCs of gutted fish were significantly higher compared with ungutted fish (P <0.05). AQUI-S™ fish (ungutted) exhibited the lowest TBCs for about the first two weeks indicating exposure to the anesthetic reduced bacterial growth. After 18 d, none of fish from all treatments had yet reached the generally accepted spoilage level of 7 log cfu g−1. At this point, the fish had not reached the maximum attainable QI score of 18. High linear correlations (R ≥ 0.972, P < 0.001) were achieved for development of QI during ice storage where the ungutted and AQUI-S™ treatments were practically similar. The modified QIM scheme was considered suitable for pompano. The shelf life was tentatively considered to be approximately 18 d, although this should to be verified by other, supplementary methods. To prolong shelf life, it is recommended that pompano is not gutted before they are subjected to chilled storage.

INSTITUTION EFFICIENCY VERSUS THE LEVEL OF DEVELOPMENT OF LOCAL GOVERNMENTS (A STUDY AT THE LEVEL OF POLAND’S REGIONAL DIVISION)

As the socio-economic reality is growing increasingly complex, the role of local governments in the management of events and processes occurring in local communities gains importance. Considering the fact that the basic task of local authorities is to stimulate the growth and development of a given local entity, an analysis was undertaken to the aim of assessing the relationship between the level of local development and the institutional efficiency of local self-governments and vice versa, in a regional approach (NUTS 2). To achieve this aim, mixed data were analysed, that is raw data (acquired via survey from 1,220 municipalities) and secondary data (from the database of the Local Data Bank). The efficiency of local governments was measured with an aggregate factor EFF, while the level of development was assessed with the DEV measure. The results indicate that the local governments did rather poorly in terms of both efficiency and development. In both cases, the mean value of the applied synthetic measures reached no more than 30% of the maximum attainable score. The basic tools in the research were correlation and regression analysis. Both procedures demonstrated the presence of a relationship between the two analysed categories (r = 0.365). Moreover, the analysis of regression showed that the impact of developmental processes on the improvement of efficiency of local governments was stronger that the influence of improved efficiency on developmental processes occurring in the analysed municipalities.

Stigma towards mental illness: A hospital-based cross-sectional study among caregivers in West Bengal.

Stigma among caregivers of people with mental illness has a serious impact on the disease outcome and lives of people with mental illness as well as other family members. The objectives of this study were (i) To determine the level of self-perceived stigma toward mental illness, (ii) To measure perception to it among caregivers of people with mental illness, and (iii) To identify the factors associated with self-perceived stigma of caregivers. In this cross-sectional study, a structured interview was conducted among 200 caregivers of people with mental illness in the psychiatry outpatient department of a tertiary care hospital in West Bengal, India. Stigma and perception regarding mental illness were assessed with a validated 12-item Explanatory Model Interview Catalogue and 20-item perception scale, respectively. Information on their sociodemographic characteristics was also collected. Average stigma score (53.3 ± 13.2) was higher than 50% of maximum attainable score. Caregivers of higher age, female gender, low income, higher education, manual job, rural residence, and those who are single or widowed scored higher in stigma scale. Caregivers with female gender (P = 0.007) and rural residence (P = 0.01) were more likely to have stigma while the perception score was negatively associated (P < 0.001) with stigma score. The study highlighted that health-care providers can play a pivotal role to address caregivers' stigma in order to alleviate its effect on the course of illness and improve family life.