Provincial Health Research Articles

Analisis Kandungan Borak pada Makanan di Sekitar UIN Sumatra Utara Kec. Medan Tuntungan

Students are an investment in the nation and the nation's next generation. Their growth and development will be optimal depending on providing nutrition with good and correct quality, quantity. By consuming good food and snacks, it is hoped that you can contribute adequate nutrition. Students are used to eating and snacks whose main menu is meatballs, junkfoot and modern food currently on campus and around campus. However, currently many foods and drinks contain additional ingredients such as preservatives, borax and others. Thus, it is necessary to study and research the borax content as well as qualitative analysis of the meatballs sold by traders around the UINSU Tuntungan campus. This type of research uses total sampling carried out by the UPT HEALTH LABORATORY of the North Sumatra Provincial Health Service. located on Jl. Willem Iskandar Pasar V (Jl. Balai Pom) using qualitative methods. The research results showed that from 6 samples of meatballs located around the UIN campus, it was proven that they did not contain borax. Based on the results of the analysis, it can be concluded that all meatball sellers located around the UIN Medan Tuntungan Campus have good knowledge and attitudes which are important factors in avoiding contamination by toxic substances and how to manage meatballs properly without the use of preservatives, especially borax. The meatball processing method at UIN and around UIN meets the requirements of the Minister of Health of the Republic of Indonesia 2015, Number: 722/Menkes/Per/IX/2015 regarding food, so students don't need to worry.

Ensuring diagnostic testing accuracy for patient care and public health- COVID-19 testing scale-up from an EQA provider's perspective.

In response to the coronavirus pandemic (COVID-19) and scale up of diagnostic testing, the Canadian Microbiology Proficiency Testing program created a new proficiency testing (PT) program for the molecular and antigen detection of SARS-CoV-2. The program was geared to point of care testing (POCT) sites located in each of the eight provincial Health Authorities across British Columbia, Canada, with the intention to monitor testing quality. The PT program consisted of 6 shipments in a year, each containing a set of 4 samples either positive for SARS-CoV-2 virus or negative. The program began with initial 23 sites enrolling in March 2021, expanding to >100 participants by December 2021. After the first two surveys, it was observed that testing performance (accuracy) was consistently acceptable for sites using nucleic acid technology (NAT), however performance by sites using rapid antigen detection (RAD) methods was poor, especially when testing the weakly positive samples. A root cause investigation of poor testing performance revealed gaps in the execution of testing methods and also in results interpretation. These quality issues were most commonly associated with new testers who lacked experience with diagnostic testing. Tester training and mentoring was reinforced as was retraining of personnel; sample processing instructions were modified, and a training video was also created for testing sites. As a result of these interventions, sites improved their testing accuracy and the performance of POCT sites using RAD methods came to more closely match the performance of sites utilizing NAT. Overall, the PT program was highly successfully and improved quality of testing in the province. This work demonstrates the critical value of an external quality assessment (EQA) partner towards improving patient and public health and safety, especially when testing is conducted outside of an accredited medical laboratory setting.

The Effect of Psychological Empowerment on Job Satisfaction: Regulatory role of generations X and Y

The objective of this study is to determine the moderator role of generation gap in the effect of psychological empowerment perception on job satisfaction. The population (N: 200) and sample (n=136) of the study consists of health professionals working in the Karaman Provincial Health Directorate, Türkiye. In the research data were collected with a questionnaire technique and the hypotheses were tested through the SPSS Macro Process program. The significance of the regulatory role (statistically) was calculated by the bootstrap test. As a result of the analyzes made, it was found that the moderator effect of psychological empowerment perception on job satisfaction differed between the X and Y generations. While the effect of the psychological empowerment perceptions of the X Generation employees on job satisfaction did not show a statistically significant difference, this effect was found to be statistically significant in the Y Generation employees. It has been found that generations have a moderator effect on the effect of psychological empowerment perceptions of health workers on job satisfaction (X and Y).

Psychosocial Status of Healthcare Workers During the COVID-19 Pandemic.

This study aimed to determine the depression, anxiety, and stress levels of healthcare workers (HCWs) working actively in different health services during the pandemic. This cross-sectional study was conducted in Ankara at the Provincial Health Directorate Numune Campus between January and April 2022. The depression, anxiety, and stress levels of HCWs working actively in different health services during the pandemic were evaluated using the Depression, Anxiety and Stress Scale 21 (DASS-21). Univariate and multivariate linear regression analyses were performed to analyze the data. The study included 381 healthcare workers, 272 (71.4%) of whom were female. The mean age was 40.0±9.9 (21-63) years, and 44.9% (n=171) of the HCWs had a COVID-19 infection at some point. While 28.6% of HCWs needed psychological support before the pandemic, the rate increased to 36.2% during the pandemic (p<0.001). DASS-21 results showed that the frequency of depression was 31.0%, anxiety 47.2%, and stress 22.8% among participants during the pandemic. One out of three HCWs reported experiencing mental health problems. It is essential to improve the working conditions of HCWs to help them cope with the effects of the pandemic on their mental health and to provide psychosocial support.

Hospitalization Costs for Patients with Acute Appendicitis: An Update Using Real-World Data from a Large Province in China.

The aim of this study is to investigate the factors influencing hospitalization costs for patients diagnosed with acute appendicitis in China. We conducted a cross-sectional study using data from Provincial Health Statistics Support System Database from S Province in China. This dataset contained all hospital's electronic medical records from January 1, 2015 to December 31, 2018 including both public and private hospitals. The target population was identified based on the principal diagnosis of appendicitis (ICD-10: K35). To examine the impact of various factors on hospitalization costs, we conducted a multivariate linear regression analysis. Furthermore, we employed the Shapley value decomposition method to gain a more comprehensive understanding of the factors that influenced hospitalization costs and their respective levels of importance. Our study comprised 317,200 cases. During the period from 2015 to 2018, the average hospitalization expenses for patients with acute appendicitis were estimated at approximately 7014 RMB (1061 USD), which accounts for a considerable 12% of China's per capita GDP. The results of this study demonstrate a significant correlation between various factors, such as the patient's age, gender, marital status, occupation, payment method, number of complications, treatment method, hospital tier, and ownership, and the total hospitalization costs and subcomponents of hospitalization costs. Notably, the treatment method employed had the most substantial impact on hospitalization costs. To the best of knowledge, this is one of the first studies to investigate the hospitalization costs of acute appendicitis incorporating both patient-level and hospital-level covariates, using a large sample size. To reduce the costs associated with acute appendicitis in China, it is recommended to consider suitable treatment options and explore the option of receiving medical care at lower-tier and privately-owned healthcare facilities.

Clinical variables associated with late-onset thrombotic and cardiovascular events, after SARS-CoV-2 infection, in a cohort of patients from the first epidemic wave: an 18-month analysis on the “Surviving-COVID” cohort from Bergamo, Italy

ImportancePopulation studies have recorded an increased, unexplained risk of post-acute cardiovascular and thrombotic events, up to 1 year after acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.ObjectivesTo search for clinical variables and biomarkers associated with late post-acute thrombotic and cardiovascular events after SARS-CoV-2 infection.DesignRetrospective cohort study.SettingThird-level referral hospital in Bergamo (Italy).ParticipantsAnalysis of an existing database of adult patients, who received care for SARS-CoV-2 infection at our institution between 20 February and 30 September 2020, followed up on a single date (“entry date”) at 3–6 months.ExposureInitial infection by SARS-CoV-2.Main outcomes and measuresPrimary outcome: occurrence, in the 18 months after entry date, of a composite endpoint, defined by the International Classification of Diseases—9th edition (ICD-9) codes for at least one of: cerebral/cardiac ischemia, venous/arterial thrombosis (any site), pulmonary embolism, cardiac arrhythmia, heart failure. Measures (as recorded on entry date): history of initial infection, symptoms, current medications, pulmonary function test, blood tests results, and semi-quantitative radiographic lung damage (BRIXIA score). Individual clinical data were matched to hospitalizations, voluntary vaccination against SARS-CoV-2 (according to regulations and product availability), and documented reinfections in the following 18 months, as recorded in the provincial Health Authority database. A multivariable Cox proportional hazard model (including vaccine doses as a time-dependent variable) was fitted, adjusting for potential confounders. We report associations as hazard ratios (HR) and 95% confidence intervals (CI).ResultsAmong 1,515 patients (948 men, 62.6%, median age 59; interquartile range: 50–69), we identified 84 endpoint events, occurring to 75 patients (5%): 30 arterial thromboses, 11 venous thromboses, 28 arrhythmic and 24 heart failure events. From a multivariable Cox model, we found the following significant associations with the outcome: previous occurrence of any outcome event, in the 18 months before infection (HR: 2.38; 95% CI: 1.23–4.62); BRIXIA score ≥ 3 (HR: 2.43; 95% CI: 1.30–4.55); neutrophils-to-lymphocytes ratio ≥ 3.3 (HR: 2.60; 95% CI: 1.43–4.72), and estimated glomerular filtration rate &amp;lt; 45 ml/min/1.73 m2 (HR: 3.84; 95% CI: 1.49–9.91).Conclusions and relevanceWe identified four clinical variables, associated with the occurrence of post-acute thrombotic and cardiovascular events, after SARS-CoV-2 infection. Further research is needed, to confirm these results.

When should DIY have a localized healthcare waste management system?

Purpose: The 2018 healthcare waste management crisis catalyzed a critical review of the concerns expressed by the Health Office (dinkes) and healthcare facilities regarding healthcare waste management in the Special Region of Yogyakarta (DIY). Due to this crisis, the Ministry of Health hired Universitas Gadjah Mada (UGM) to look into potential solutions and promote DIY government policy responses. This paper examines the management strategy during crisis times and possible alternative solutions.&#x0D; Methods: This paper uses focused group discussions reports involving separate groups of (1) environmental health officials from community health centers, (2) hospitals, (3) environment health officials of district health authorities, and (4) cross-sectoral province officials in the Yogyakarta Special Region. It is part of a project 'A case study of strengthening regional-based medical waste management model', fund from the Environmental Health Directorate, Directorate General of Public Health, Ministry of Health (Project KN 01.03/6.1/0198/2019).&#x0D; Result: A simulation of policy options based on health facility managers suggests that a province-based system is the most profitable in the long term for DIY, with several possible options. The national policy roadmap was considered inadequate to respond to DIY's urgent local needs. Furthermore, the series of meetings succeeded in forming an informal forum between health facilities, provincial health offices, and associations of hospital environmental sanitation experts, monitoring medical waste management.&#x0D; Conclusion: The 2018 medical waste management crisis led to the formulation of policy response choices tailored to the capacity of DIY. These choices considered the expenditures and legal sanctions faced by healthcare facilities and the economic value of a region-based waste system for local government authorities. This comprehensive approach highlights the importance of local capacity. It needs to shape effective and sustainable medical waste management policies, underscoring the necessity of region-specific strategies in the face of national health crises.

The causal configurations of provincial health policy innovation in China: an analysis of the food safety standard filing policy.

According to China's Food Safety Law of 2015, the filing of food safety enterprise standards is a policy innovation led by p9rovincial governments in China. However, there are significant differences in the development of the "Food Safety Enterprise Standard Filing Policy" between provincial governments across the country. This study aims to explore the internal mechanisms driving autonomous innovation by provincial governments in the absence of administrative pressure from the central government, to better understand the policy innovation mechanism in the Chinese context. Crispy Set Qualitative Comparative Analysis (csQCA) method is used to identify the innovation mechanism. This study found that provinces with good provincial economic resources and strong government capabilities are prone to policy innovation, and the influence of internal factors of provincial governments is stronger than that of external factors. When provincial economic resources and capacity are weak, endogenous factors in the province also help achieve proactive policy innovation by provincial governments. The research results reveal how provincial governments construct local policies in the absence of administrative pressure from the central government.

Investigating inequalities in cancer staging and survival for adults with intellectual or developmental disabilities and cancer: A population-based study in Manitoba, Canada

BackgroundCancer is a leading cause of death among adults living with intellectual or developmental disabilities (IDD). However, few epidemiological studies exist worldwide quantifying inequalities in cancer stage at diagnosis and survival for people with IDD relative to those without IDD. MethodsA population-based, retrospective cohort study was conducted using provincial health and social administrative data in Manitoba, Canada. Adults (≥18 years) with a cancer diagnosis between 2004 and 2017 were included. Lifetime IDD was identified before the cancer diagnosis using an established algorithm. Modified Poisson regression with robust error variance was used to estimate the association between IDD status and metastatic cancer at diagnosis. Multivariable Cox proportional hazards analyses were used to the effect of IDD on overall survival following the cancer diagnosis. ResultsThe staging and prognosis cohorts included 62,886 (n = 473 with IDD) and 74,143 (n = 592 with IDD) cancer patients, respectively. People living with IDD were significantly more likely to be diagnosed with metastatic cancer and die following their cancer diagnosis compared to those without IDD (RR=1.20; 95 % CI 1.05–1.38; HR= 1.53; 95 % CI 1.38–1.71). Significant heterogeneity by sex was identified for cancer survival (p = 0.005). DiscussionPeople with IDD had more advanced cancer stage at diagnosis and worse survival relative to those without IDD. Identifying and developing strategies to address the factors responsible that contribute to these disparities is required for improving patient-centred cancer care for adults with IDD.

Politician’s childhood experience and government policies: Evidence from the Chinese Great Famine

We analyze the impact of a politician’s childhood experience on their policy choices. By exploiting exogenous variations in exposure to China’s Great Famine, we find that a provincial leader’s childhood experience of the famine significantly increases the share of government expenditure allocated to health care during his term. This effect is observed only for those who were aged under five during the famine and is not found among older cohorts. The impact is substantial: our back-of-the-envelope calculation indicates that an increase of one standard deviation in exposure to the famine can lead to an increase of roughly 7.84 billion RMB (equivalent to about 1.19 billion US Dollars) in annual provincial health care expenditure for a province with average government spending in 2017. We provide evidence suggesting that this effect may be driven by a politician’s personal experience of negative health outcomes due to the famine. Furthermore, we observe that China’s political promotion system, which favors economic growth, incentivizes provincial leaders to counterbalance increased health care spending by reducing funding for less visible public services, particularly cultural activities. Such strategic allocations ensure the continuity of other policy areas that are more influential in their political career.

Pendekatan Program Mother Smart Grounding (MSG) dalam Pencegahan Stunting pada Anak dan Modifikasi Makanan Sehat

The stunting rate in Indonesia is 21.6%. This figure is based on the results of the 2022 Indonesian Nutrition Status Survey (SSGI), the stunting rate decreased by 2.8% from 2021, while the government's target for 2024 is that the stunting rate in Indonesia is 14%, for this reason the government has made various efforts to meet the target. 2024. Based on data from the Jambi Provincial Health Service in 2018, for Jambi Province, the stunting prevalence rate was 30.1% with the highest percentage of stunting found in West Tanjung Jabung Regency (44%) and the lowest in Sarolangun Regency 18.8%, for Jambi City the figure Stunting incidence 26.2%. Catfish has important nutritional benefits in preventing stunting in toddlers. Apart from catfish containing high nutritional value, catfish is a type of fish that is easy to find and cheap. So the consumption of catfish is an effort to overcome stunting in toddlers that can be reached by both upper and lower classes of society. Apart from that, in efforts to overcome stunting, the community needs to be given an understanding of the importance of nutrition for toddlers and early childhood, namely by providing education to mothers of toddlers and early childhood with the Mother Smart Grounding (MSG) program at Mukti Tama Kindergarten, Jambi City, targeting mothers. Teachers of Mukti Tama Kindergarten students. Activities are carried out by: Lectures, Visual Presentations, group discussions. Results: an increase in the average knowledge of mothers and parents of Mukti Tama KB Kindergarten children with an average of 2.0. Conclusion: Most of the participants, 85%, responded very well to the material provided. There needs to be continuous health education activities in coordination between kindergartens and health workers holding the KIA program in the PKM Simpang Kawat work area.

Pemanfaatan Limbah Kulit Jeruk Manis (Citrus Sinensis) Sebagai Obat Nyamuk Liquid Elektrik Yang Aman dan Ramah Lingkungan Di Desa Borisallo Kec Parangloe Kabupaten Gowa

DHF cases in Indonesia in 2014 showed that there were 10 provinces in Indonesia that had the highest dengue cases and one of them was South Sulawesi Province (7). Based on data from the South Sulawesi Provincial Health Service, there were 2,166 people suffering from dengue fever from January to May 2020. 19 of them died. And the most in Gowa Regency were 6 people. Borisallo Village, Parangloe District, is one of the villages supported by the Indonesian Muslim University. We chose this location as a service partner area because dengue cases in Gowa Regency, based on the 2019 South Sulawesi Provincial Health Service Profile, were the 2nd highest area with dengue cases after Pangkep Regency, namely 474 sufferers. Then in 2020 Gowa Regency was the area with the most dengue cases, namely 457 people. The aim of this service is to improve cadres' skills in making their own mosquito repellent from natural ingredients that are safe and environmentally friendly, increase cadres' knowledge about the dangers of chemical mosquito repellent, increase cadres' knowledge in making preventive efforts against diseases transmitted by mosquito vectors. The solutions offered include training in making electric liquid mosquito repellent from sweet orange peel, providing education regarding the dangers of chemical mosquito repellent for health, providing education on preventive efforts to prevent diseases transmitted by mosquito vectors. &#x0D;

Maternal and birth outcomes in pregnant people with and without HIV in the Western Cape, South Africa.

We evaluated associations of HIV and antiretroviral therapy (ART) with birth and maternal outcomes at a province-wide-level in the Western Cape, South Africa, in a recent cohort before dolutegravir-based first-line ART implementation. This retrospective cohort study included pregnant people delivering in 2018-2019 with data in the Western Cape Provincial Health Data Centre which integrates individual-level data on all public sector patients from multiple electronic platforms using unique identifiers. Adverse birth outcomes (stillbirth, low birth weight (LBW), very LBW (VLBW)) and maternal outcomes (early and late pregnancy-related deaths, early and late hospitalizations) were compared by HIV/ART status and adjusted prevalence ratios (aPRs) calculated using log-binomial regression. Overall 171,960 pregnant people and their singleton newborns were included, 19% (N = 32 015) identified with HIV. Amongst pregnant people with HIV (PPHIV), 60% (N = 19 157) were on ART preconception, 29% (N = 9276) initiated ART during pregnancy and 11% (N = 3582) had no ART. Adjusted for maternal age, multiparity, hypertensive disorders and residential district, stillbirths were higher only for PPHIV not on ART [aPR 1.31 (95%CI 1.04-1.66)] compared to those without HIV. However, LBW and VLBW were higher among all PPHIV, with aPRs of 1.11-1.22 for LBW and 1.14-1.54 for VLBW. Pregnancy-initiated ART was associated with early pregnancy-related death (aPR 3.21; 95%CI 1.55-6.65), and HIV with or without ART was associated with late pregnancy-related death (aPRs 7.89-9.01). Even in the universal ART era, PPHIV experienced higher rates of LBW and VLBW newborns, and higher late pregnancy-related death regardless of ART status than pregnant people without HIV.

A Canadian Commentary on the NKF-ASN Task Force Recommendations on Reassessing the Inclusion of Race in Diagnosing Kidney Disease

In 2021, a committee was commissioned by the Canadian Society of Nephrology (CSN) to comment on the 2021 National Kidney Foundation (NKF)- American Society of Nephrology (ASN) Task Force recommendations on the use of race in glomerular filtration rate (GFR) estimating equations. The committee met on numerous occasions and agreed on several recommendations. However, the committee did not achieve unanimity, with a minority group disagreeing with the scope of the commentary. As a result, this report presents the viewpoint of the majority members. We endorsed many of the recommendations from the NKF-ASN Task Force, most importantly that race should be removed from the eGFR creatinine-based equation. We recommend an immediate implementation of the new CKD-EPI equation (2021), which does not discriminate among any group while maintaining precision. Additionally, we recommend that Canadian laboratories and provincial kidney organizations advocate for increased testing and access to cystatin C as the combination of cystatin C and creatinine in revised equations leads to more precise estimates. Lastly, we recommend that future research studies evaluating the implementation of the new equations and changes to screening, diagnosis, and management across provincial health programs be prioritized in Canada.

Time trends in preeclampsia and gestational diabetes in Denmark and Alberta, Canada, 2005-2018-A population-based cohort study.

Preeclampsia and gestational diabetes mellitus share risk factors such as obesity and increased maternal age, which have become more prevalent in recent decades. We examined changes in the prevalence of preeclampsia and gestational diabetes between 2005 and 2018 in Denmark and Alberta, Canada, and investigated whether the observed trends can be explained by changes in maternal age, parity, multiple pregnancy, comorbidity, and body mass index (BMI) over time. This study was a register-based cohort study conducted using data from the Danish National Health Registers and the provincial health registers of Alberta, Canada. We included in the study cohort all pregnancies in 2005-2018 resulting in live-born infants and used binomial regression to estimate mean annual increases in the prevalence of preeclampsia and gestational diabetes in the two populations across the study period, adjusted for maternal characteristics. The study cohorts included 846 127 (Denmark) and 706 728 (Alberta) pregnancies. The prevalence of preeclampsia increased over the study period in Denmark (2.5% to 2.9%) and Alberta (1.7% to 2.5%), with mean annual increases of 0.03 (95% confidence interval [CI] 0.02-0.04) and 0.06 (95% CI 0.05-0.07) percentage points, respectively. The prevalence of gestational diabetes also increased in Denmark (1.9% to 4.6%) and Alberta (3.9% to 9.2%), with average annual increases of 0.20 (95% CI 0.19-0.21) and 0.44 (95% CI 0.42-0.45) percentage points. Changes in the distributions of maternal age and BMI contributed to increases in the prevalence of both conditions but could not explain them entirely. The prevalence of both preeclampsia and gestational diabetes increased significantly from 2005 to 2018, which portends future increases in chronic disease rates among affected women. Increasing demand for long-term follow up and care will amplify the existing pressure on healthcare systems.

HUBUNGAN PERILAKU SISWA SEKOLAH DASAR DENGAN KEJADIAN DEMAM BERDARAH DENGUE (DBD) DI KECAMATAN DOLOK BATU NANGGAR KABUPATEN SIMALUNGUN TAHUN 2023

Dengue hemorrhagic fever is an infectious disease that can cause extraordinary events (KLB). Dengue Hemorrhagic Fever spreads in Southeast Asia. Western Pacific &amp; Caribbean. Indonesia is an endemic region that has spread to all corners of the country. According to the North Sumatra Provincial Health Ministry, the number of dengue hemorrhagic fever (DHF) sufferers in the region between January and September 2022 was 5,270 cases. According to the Simalungun District Health Office, in December 2022 there were 999 cases of dengue fever and 13 deaths in Simalungun. The results of the initial study of student behavior are still not enough to eradicate mosquito nests (PSN). This type of research is a quantitative study with an analytic observation study design using cross-sectional methods. This research was conducted in the elementary school area 091690 Serbelawan. The population in this study were elementary school students in Dolok Batu Nanggar Elementary School. In this study the analysis used the chi-square or chi-square formula (x2). . The results showed that there was a relationship between the behavior of throwing garbage and the incidence of DHF at the level of p = 0.045, namely &lt;α = 0.05. There is a relationship between the behavior of draining the bathtub and the incidence of DHF at the level of p = 0.020, namely &lt;α = 0.05. There is no relationship between the use of anti-mosquito lotion and the incidence of DHF at the level of p=0.684, namely &lt;α = 0.05. It is suggested to the head of the Puskesmas to develop health education about the dangers of dengue fever mosquitoes.

Organ Donation in Canadian PICUs: A Cross-Sectional Survey, 2021-2022.

To understand contemporary pediatric organ donation programs in Canadian PICUs, including: policies and practices, data collection and reporting, and system and process barriers. A cross-sectional survey carried out 2021-2022. Canadian PICUs affiliated with a donor physician network. Pediatric intensivists identified as the donation program lead, or most knowledgeable about donation for their institution. A 19-item survey was developed through collaboration with stakeholders from the organ donation and transplantation community within Canada. Domains and items were generated and reduced iteratively during an in-person workshop. Pretesting and pilot testing were completed to ensure readability, flow, clinical sensibility, and construct validity. Fifteen of 16 (94%) invited Canadian PICUs from seven provinces completed the survey representing 88% (15/18) of all noncardiac Canadian PICUs. Surveys were completed between June 2021 and September 2022. All units support donation after death by neurologic criteria (DNC); 14 of 15 indicated donation policies were in place and 1 of 15 indicated no policy but the ability to facilitate donation. Thirteen of 15 units (87%) support donation after death by circulatory criteria (DCC) with policies in place, with 11 of 13 of these indicating routine support of donation opportunities. The majority (13/15) of units identified a donation champion. Of the 16 identified champions across these centers, 13 were physicians and were registered nurses or nurse practitioners. Eight of 13 units (62%) with donation champions had positions supported financially, of which 5 units came from the Organ Donation Organization and the other 3 came from the provincial health authority. Finally, only 3 of 15 PICU donation programs have a pediatric donation committee with family involvement. Variability exists in identification (including determination of death practices), referral, and approach for donation between units. Although all Canadian PICUs support donation after DNC donation, and most support donation after DCC, variability exists in the identification, referral, and approach of potential donors. There is a notable lack of family involvement in pediatric donation programs. There are many opportunities for standardization of PICU donation programs which may result in improved rates of pediatric organ donation in Canada.

The necessity of healthcare supply chain resilience for crisis preparedness.

Prior to and during the COVID-19 pandemic, Canadian provincial health systems and governments did not sufficiently consider healthcare supply chain in their crisis preparedness plans, leading to an exposed and vulnerable healthcare system. There have been many opportunities to learn from past Canadian and global crises, which have emphasized the importance of healthcare supply chain resilience in providing essential care to patients; however, considerations of healthcare supply chain resilience remain a significant gap in preparedness planning. Illustrated through the Canadian response to COVID-19 pandemic, this article will explore how healthcare supply chain resilience should be a necessary consideration in any crisis preparedness plans. Further, without this consideration of healthcare supply chain resilience, it is the person (the patient and healthcare worker), and especially vulnerable populations, that are most put at risk in the event of a future crisis.

Real World Experience of Ibrutinib in an Ethnically Diverse Canadian Community Hospital

Chronic Lymphocytic Leukemia (CLL) is an indolent lymphoproliferative disorder commonly managed in community centers. Ibrutinib revolutionized the management of patients with CLL (2). Ibrutinib was initially considered an easy to administer, well tolerated oral medication with excellent efficacy. It was the first clinically available Bruton's Tyrosine Kinase (BTK) inhibitor widely used to treat CLL (3). Recently there have been concerns about cardiovascular toxicities leading to the use of alternative BTK inhibitors (5). Where alternative BTK inhibitors are available these toxicity concerns have led to a decline in the use of ibrutinib to treat CLL. The population served is ethnically diverse consisting of 52% South East Asian with a significant population of African origin. We suspected that the concerns regarding Ibrutinib toxicity were not seen in our patient population prompting a retrospective review of our experience. Ibrutinib therapy A total of 106 CLL patients treated with Ibrutinib were identified from which data was extracted. The mean age was 63.4 years. Patients with CLL treated with Ibrutinib from 2014 to 2021 were identified using OPIS and Meditech and data was extracted manually. Table 1 60% of patient received their initial drug funding through compassionate access, 2% via private insurance and the remaining 38% through the provincial health system. The majority of patients who received funding through compassionate access were eventually transitioned to the provincial health system for drug funding. Toxicity and outcomes Table 2 81% of treated patients never required a dose adjustment of Ibrutinib. The majority of dose reductions were of a temporary nature. We were unable to obtain accurate response data in our retrospective review. 82 of the 106 patients continue on ibrutinib therapy. It is presumed that these patients continue to benefit from therapy without disease progression although response data details were poorly recorded in the medical record. Conclusions There is a lack of data of community real world experience with Ibrutinib particularly in the Canadian setting. Community centers generally are lacking in information technology required to do retrospective audits. Our data shows that ibrutinib therapy for CLL is a reasonable and effective option with good tolerability in a patient population with high cardiovascular risk. The data is limited by the retrospective data collection. The efficacy of therapy is likely comparable to that of the published literature. These data suggest that the tolerability of Ibrutinib therapy seems better than that of the published literature (1) with a low incidence of atrial fibrillation, dose adjustments and low drug discontinuation rate. Of note Richter's transformation was also uncommon in our patient population. This is particularly of interest as our study did capture patients in the early days of ibrutinib therapy when there were concerns that Richter's transformation was more common than seen today. Many of the patients who were treated with ibrutinib would not have received the drug today because of cardiovascular concerns (4). At that time, it was the only available oral targeted agent for the treatment of chronic lymphocytic leukemia. Other agents such as Venetoclax, Acalabrutinib, Zanubrutinib and novel combinations were unavailable at that time or were not funded. These lack of options likely contribute to the persistence of Ibrutinib therapy in our patients. These data suggest that ibrutinib can be used in a high cardiovascular risk population with good efficacy and tolerability. 1.Alloucjery, M., Tomowiak, C., Lombard, T., &amp; et al. (2021). Safety Profile of Ibrutinib: An Analysis of the WHO Pharmacovigilance Database. Front Pharmacology, 12:769315. 2.Byrd, J. C., Brown, J. R., O'Brien, S., &amp; et al. (2014). Ibrutinib versus ofatumumab in previously treated chronic lymphoid leukemia. NEJM, 371(3):213-223. 3.Byrd, J. C., Furman, R. R., &amp; Coutre, S. S. (2013). Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia. NEJM, 369(1):32-42. 4.Lovell, A. R., Jammal, N., &amp; Bose, P. (2022). Selecting the optimal BTK inhibitor therapy in CLL: rationale and practical considerations. Therapueltic Advances in Hematology, 13:1177/20406207221116577. 5.Salem, J. E., Manouchehri, A., &amp; Bretagne, M. (2019). Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia. J Am Coll Cardiol, 74:1667-1678.

Cohort profile: recruitment and retention in a prospective cohort of Canadian healthcare workers during the COVID-19 pandemic

PurposeHealthcare workers were recruited early in 2020 to chart effects on their health as the COVID-19 pandemic evolved. The aim was to identify modifiable workplace risk factors for infection and...