Quality Of Care Delivery Research Articles

Assessing the Feasibility of a Cancer Biomarker Testing Navigator in the Laboratory

Abstract Introduction/Objective Cancer biomarker testing is a crucial component of precision oncology, as it can guide medical treatment decisions with targeted therapies and immune checkpoint inhibitors. However, complex, fragmented, and inefficient operational processes involved in biomarker testing lead to delays, errors, and variability in testing. One potential solution is to introduce a novel role in the pathology laboratory: the cancer biomarker testing navigator (BTN). Methods/Case Report The American Society for Clinical Pathology (ASCP) conducted a mixed-methods project to assess the current state of biomarker testing operations and explore how a BTN may improve biomarker testing processes. ASCP conducted an online survey, focus groups, and worked with two hospital-based cancer centers on a feasibility pilot. Results (if a Case Study enter NA) Survey and focus group insights reveal several operational challenges around the biomarker testing process. 47 completed the survey and 16 participated in the focus groups. Participants report that biomarker test orders may be incorrect or incomplete. 37% of survey respondents experience delays preparing tissue samples for send-out cancer biomarker testing. 42% of survey respondents are unable to track the processing status of send-out tests. Excessive time is required to coordinate and facilitate send-out tests, especially when multiple reference laboratories are used since each has its own portal, requisition form, specimen requirements, etc. 87% agree they would benefit significantly from having a dedicated person to coordinate and manage cancer biomarker tests. The cancer centers that piloted this role found that they could catch and correct defects such as incorrect test ordered, incorrect specimen types marked on the test order, outdated requisition used, etc. The BTN also found instances where the test report was incomplete or had not been uploaded into the EHR. The BTN role could be justified by evaluating metrics such as task efficiency, workplace satisfaction in the lab, and levels of service satisfaction from oncologists. Patient care can be improved by reducing delays in testing and by reviewing other metrics of quality care delivery. Conclusion The BTN role in the laboratory is a novel solution for ensuring the proper collection and triage of pathology samples for biomarker testing. This role could serve as a liaison between the laboratory and ordering clinicians, provide collection and testing guidance, and help with benchmarking and quality measurement initiatives.

Perceived Importance of Types and Characteristics of Support to Informal Caregivers among Spouse Caregivers of Persons with Dementia in Sweden: A Cross-Sectional Questionnaire-Based Study.

Informal caregivers play a crucial role in the care of individuals with dementia, and their caregiving may significantly impact their own health and well-being. This cross-sectional survey study focuses on the perceived importance of various types and characteristics of formal support in a convenience sample of caregivers aged 65 years or older (N = 175) caring for a spouse with dementia. Participants completed a questionnaire containing 17 items describing different types of support and 12 items describing different characteristics of support, rating their importance. The questionnaire also contained questions on various caregiving-related factors. Principle components analysis (PCA) was carried out on the importance ratings, separately, on the types of support items and the characteristics of support items. Each PCA produced three components. For types of support, they were Proficiency and Opportunity, Supportive Structures, Flexible Counselling. For characteristics of support, they included Respectful and Competent, Timely Support, and Accessible and Acceptable. The three characteristics of the support components all had higher mean importance ratings than the three types of support components. The content of some components indicated that while spouse caregivers rate support for their caregiving needs as important, they may not always differentiate their own needs from those of their partner with dementia. The negative impact of caregiving was the factor most strongly and consistently associated with the components' importance ratings. This study emphasizes the need for health and social care providers to address the unique needs of spouse caregivers while simultaneously ensuring the delivery of quality care for individuals with dementia.

EP.07D.03 A Quality Improvement Initiative to Address Biomarker Testing and Quality of Care Delivery for Early-Stage NSCLC at 3 Cancer Centers in the US

EP.07D.03 A Quality Improvement Initiative to Address Biomarker Testing and Quality of Care Delivery for Early-Stage NSCLC at 3 Cancer Centers in the US

Impact of the Early Phase of the COVID-19 Pandemic on the Quality of Care for Colorectal and Anal Cancers at Comprehensive Cancer Centers on Two Continents.

The early phase of the COVID-19 pandemic affected cancer care globally. Evaluating the impact of the pandemic on the quality of cancer care delivery is crucial for understanding how changes in care delivery may influence outcomes. Our study compared care delivered during the early phase of the pandemic with the same period in the previous year at two institutions across continents (Princess Margaret Cancer Center [PM] in Canada and A.C. Camargo Cancer Center [AC] in Brazil). Patients newly diagnosed with colorectal or anal cancer between February and December 2019 and the same period in 2020 were analyzed. Sociodemographic and clinical characteristics and performance of individual indicators within and between centers and between the peri-COVID-19 and control cohorts were tested using Cohen's h test to assess the standardized differences between the two groups. Among 925 patients, distinct effects of the early COVID-19 pandemic on oncology services were observed. AC experienced a 50% reduction in patient consultations (98 v 197) versus a 12.5% reduction at PM (294 v 336). Similarly, AC experienced a higher proportion of stage IV disease presentations (42.9% v 29.9%; P = .015) and an increase in treatment delay (61.9% v 9.7%; P < .001) compared with prepandemic. At PM, a 10% increase in treatment interruption (32.4% v 22.3%; P < .001) and a higher rate of discontinuation of radiotherapy (9.4% v 1.1%; P < .001) were observed during the pandemic. Postsurgical readmission rates increased in both AC (20.9% v 2.6%; P < .001) and PM (10.5% v 3.6%; P < .01). The early phase of the COVID-19 pandemic affected the quality of care delivery for colorectal and anal cancers at both centers. However, the magnitude of this impact was greater in Brazil.

How a Robust Community Clinical Practice Arm Can Support an Academic Health System’s Tripartite Mission

Natural tension exists between the community clinical practice arm and the academic clinical practice arm within a large academic health system (AHS). Disparate salary structures, overlapping geography, competition for patients, and inequitable application of standards and resources can all lead to suboptimal system performance, as each clinical practice works to maximize individual outcomes. These tensions can lead to unnecessary duplication of resources and wasting time and energy focusing on internal politics and competition rather than on addressing external competitive threats, such as the influence of venture capital, virtual services, and retail entrants into the clinical space. At the same time, the health care landscape continues to shift, as physician ownership of practices has fallen below 50%, creating both challenges and opportunities for health systems. This article describes how, over the last 15 years, UNC Health has built a robust community practice arm called UNC Physicians Network (UNCPN) alongside the academic department structure that fully supports UNC Health’s tripartite mission. The authors describe how a community arm within an AHS can expand its clinical footprint and harmonize research and teaching efforts to support the AHS mission in a community setting. To accomplish this harmonization, UNCPN identified three high-priority focus areas for intentional investment in collaboration between the community and academic arms: (1) partnering to increase community-based research; (2) growing internal capacity for learners; and (3) scaling care delivery quality and population health initiatives across a wide geography. These intentional efforts have allowed UNC Health to improve the performance of all AHS missions: research, education, and population-based clinical care. Specifically, the number of community clinics that were actively participating in research more than doubled, from 23 practices in 2019 to 49 in 2023. In association with the UNC Schools of Medicine and Nursing, for the last few years, approximately 65–70 preceptors have been committing as many as 23,000 hours to teaching about 95 students each academic year. In addition, during that same period, the percentage of School of Medicine student learners precepted nearly doubled in UNCPN adult clinics (Family Medicine and Internal Medicine) and increased by 50% in UNCPN pediatric clinics. As the number of UNCPN clinicians increased from 44 in 2010 to 697 in 2024, the number of primary care–empaneled patients grew from 200,000 in 2019 to more than 350,000 in 2024, with currently more than 540,000 patients in total, inclusive of primary and specialty care, which has allowed scaling of high-quality care, leading to top-tier performance in value-based contracts.

Translating potential germline findings from tumour profiling into routine clinical care.

105 Background: Tumor molecular profiling (TMP) provides an opportunity to identify heritable cancer predisposition. Molecular Screening and Therapeutics Study (MoST) (8000 patients, 2016-23) and Cancer Screening Program (CaSP) (23000 patients, 2023-25) are Australian research programs providing TMP for therapy matching in advanced cancer. Matched germline testing is resource-inefficient and is not performed . An integrated approach between TMP and cancer genetics is needed to improve familial cancer outcomes through prevention and early detection. Methods: In MoST, potential germline variants (PGV) in actionable cancer genes were investigated in blood DNA in a research setting. Positive cases were informed, and a genetics review for clinical testing recommended. In CaSP, germline follow-up recommendations are included in the Molecular Oncology Board (MOB) Report based on decision algorithms to inform clinicians of PGV needing clinical assessment. Cancer genetics clinics in Australia were surveyed regarding preferences for the return of genetic information from tumor profiling. A centralised precision care clinic was launched in March 2024 to investigate the implementation of returning PGV information from tumor-only profiling. Results: In MoST, 38% (140/367) of PGVs tested were positive in blood DNA. Of these, 44% were identified in the highest actionability genes: BRCA1, BRCA2, PALB2, Lynch Syndrome. The validation and return of results process was unsatisfactory; it was resource-heavy, timeframes were extended, DNA was sometimes unavailable, and communicating information to non-participating relatives of deceased participants was challenging due to a lack of established pathways. The systems design in CaSP has allowed the study to manage higher volume without a net increase in germline workforce. To date, 2372 patients have completed profiling with 173 MOB recommendations for PGV validations. Fifty-four cancer genetics staff nationally responded to the survey. Many (61%) were concerned about the increased uptake of TMP without a workforce to match germline testing demand (97%) and lack of funding assigned in a universal healthcare system (70%) being main concerns. Most (82%) supported a centralised service anticipating improved efficiency gain (71%), equity of access (77%) and streamlining of processes (71%). The stakeholders voiced a consistently high (&gt;50%) demand for information regarding PGV in lower actionability genes. MOB recommendations were adapted to reflect 3 tiers of actionability The centralised clinic has reviewed 21 patients nationally to test 23 highest actionability variants. The average referral to review time is 2 weeks. Conclusions: Precision oncology can play a role in familial cancer prevention. Deliberate collaboration and integration between precision research and relevant specialised care can lead to resource-optimised, equitable delivery of quality care.

Current type 2 diabetes guidelines: Individualized treatment and how to make the most of metformin.

Evidence-based guidelines provide the premise for the delivery of quality care to preserve health and prevent disabilities and premature death. The systematic gathering of observational, mechanistic and experimental data contributes to the hierarchy of evidence used to guide clinical practice. In the field of diabetes, metformin was discovered more than 100 years ago, and with 60 years of clinical use, it has stood the test of time regarding its value in the prevention and management of type 2 diabetes. Although some guidelines have challenged the role of metformin as the first-line glucose-lowering drug, it is important to point out that the cardiovascular-renal protective effects of sodium-glucose co-transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists were gathered from patients with type 2 diabetes, the majority of whom were treated with metformin. Most national, regional and international guidelines recommend metformin as a foundation therapy with emphasis on avoidance of therapeutic inertia and early attainment of multiple treatment goals. Moreover, real-world evidence has confirmed the glucose-lowering and cardiovascular-renal benefits of metformin accompanied by an extremely low risk of lactic acidosis. In patients with type 2 diabetes and advanced chronic kidney disease (estimated glomerular filtration rate 15-30 mL/min/1.73m2), metformin discontinuation was associated with an increased risk of cardiovascular-renal events compared with metformin persistence. Meanwhile, it is understood that microbiota, nutrients and metformin can interact through the gut-brain-kidney axis to modulate homeostasis of bioactive molecules, systemic inflammation and energy metabolism. While these biological changes contribute to the multisystem effects of metformin, they may also explain the gastrointestinal side effects and vitamin B12 deficiency associated with metformin intolerance. By understanding the interactions between metformin, foods and microbiota, healthcare professionals are in a better position to optimize the use of metformin and mitigate potential side effects. The United Kingdom Prospective Diabetes Study and the Da Qing Diabetes Prevention Program commenced 40 years ago provided the first evidence that type 2 diabetes is preventable and treatable. To drive real-world impact fromthis evidence, payors, practitioners and planners need to co-design and implement an integrated, data-driven, metformin-based programme to detect people with undiagnosed diabetes and prediabetes (intermediate hyperglycaemia), notably impaired glucose tolerance, for early intervention. The systematic data collection will create real-world evidence to bring out the best of metformin and make healthcare sustainable, affordable and accessible.

Reimagining Healthcare Delivery: Enhancing Patient-Centric Services in Pakistan Public Hospitals

Background: The study explored the allied health services provided by Karachi public hospitals. Patient engagement, treatment quality, digital marketing efficacy, accessibility, patterns of usage, and satisfaction with health outcomes were the primary areas of interest. With the potential to improve patient experiences and health outcomes, the findings offered recommendations to enhance patient-centered care, service accessibility, and communication strategies. Methodology: This cross-sectional study focused on the health outcomes in public healthcare facilities. Stratified random sampling and Smart Partial Least Squares (PLS) analysis were used to examine the associations among the variables. The sample-to-variable ratio determined a sample size of 410 for executing Smart PLS regression and correlation analysis. Results: The study found a robust correlation between factor loadings and demographic traits. Positive relationships between patient utilization, service accessibility, the efficacy of digital marketing, and the quality of care were revealed. Further, the moderation analysis highlighted that empathy was critical in determining patient happiness. The model fit indices showed a good fit, with some minor differences amongst models. The structural equation model results confirmed the crucial role of patient engagement, care quality, and service accessibility in influencing patient utilization. Conclusion: The study emphasized that patient-provider relationships and moderating factors like empathy helped serve the patients better and positively. These findings underline the significance of holistic methods in promoting patient-centric care delivery and eventually improving healthcare. Keywords: Digital Marketing Effectiveness, Patient Engagement, Quality of Care Delivery, Service Accessibility and Convenience.

Urologic oncology considerations in transgender and gender diverse patients.

This review delves into the pressing issue of urologic oncology considerations within the transgender and gender-diverse (TGD) community. With estimates suggesting that TGD individuals constitute 0.3 to 0.5% of adults worldwide, and this number steadily rising, our review examines the barriers that impede the delivery of excellent quality care, particularly in the context of cancer diagnosis and treatment. Recent findings highlight disparities in cancer screening, diagnosis, and treatment access for TGD individuals. These challenges are compounded by a dearth of research and the failure of healthcare systems to account for gender identity and its nuances in data collection. Main themes in the literature include the impact of gender-affirming hormone therapy and surgery on cancer risk, challenges in prostate cancer screening and management, and considerations pertinent to testicular and other urological cancers in TGD patients. The implications for clinical practice and research are profound and emphasize the need for multidisciplinary approaches that cater to the unique healthcare needs of TGD individuals. This includes comprehensive strategies for inclusive and accurate data collection, alongside the development of evidence-based guidelines for cancer screening and management tailored specifically to this population.

Assessment of the response to kidney patients' needs in disaster-stricken Syria.

The major fighting activities in the Syrian conflict have subsided, but the country continues to deal with significant political, economic, and psychosocial consequences that gravely impact the healthcare system, including the care of patients with kidney disease. The purpose of this manuscript is to review some of the problems faced by kidney patients in postconflict Syria and their available and proposed remedies. Many challenges, such as unfair, poorly planned, and poorly organized distribution of resources, suboptimal quality-monitoring infrastructure, psychosocial barriers, and workforce shortages, impede the delivery of quality care and negatively impact outcomes. The negative impact of these problems is not uniform and tends to affect certain areas more than others because of geopolitical factors imposed by the conflict. After prolonged conflicts, healthcare resources remain limited for prolonged periods, leading to inadequate care, poor outcomes, and worsening inequities. Involvement of the international community and expatriate nephrologists is essential to guide care delivery and improve outcomes. The lessons learned from the Syrian conflict apply to many limited resources and disaster situations.

High Quality of Care Delivery Improves Patient Satisfaction and Quality of Life Outcomes After Breast Augmentation.

Breast augmentation is one of the most common aesthetic procedures worldwide. Most studies have focused on evaluating the outcome with validated patient-reported outcome measures (PROMs) and factors that may influence them. However, the influence of care delivery, which can be measured with patient-reported experience measures (PREMs), is rarely considered in studies of breast augmentation patients. In this study we aimed to evaluate the associations between PREMs and PROMs in patients who underwent breast augmentation. A multicenter cohort study was conducted in breast augmentation patients. Patients completed PREMs, including items such as communication between physician and patient, expectation management, welcome, and hygiene, and the BREAST-Q PROM (satisfaction with breasts and psychosocial, physical, and sexual well-being) preoperatively and 6 months postoperatively. Regression analyses were performed to investigate the associations between PREMs and PROMs. Overall, 329 patients were included between 2018 and 2022. Univariate regression analysis showed a positive association between PREM and PROM scales. The feeling of being heard (B = -38.39 and B = -18.90), the opportunity to ask questions (B = -9.21), and trust in their physician (B = -39.08) had the highest association with change in the 4 BREAST-Q scales. The multivariable regression analysis showed that the variance in PROMs related to changes in PREMs (19%) was little influenced by patient characteristics (1%). Patient outcomes are more positive after breast augmentation when patients feel they are being heard, have the opportunity to ask questions, and have trust in their physician. Future studies should be targeted at optimizing patient-reported experience to investigate whether this improves patient-reported outcomes.

Early warning tools and clinician 'agency' for strengthening safety culture: An integrative review.

Identify and analyse literature investigating nurses' and midwives' use of early warning tools during the care of adult inpatients. An integrative literature review. Whittemore and Knafl's (2005) framework guided this integrative review. PubMed, CINAHL, EMCARE and Google Scholar were systematically searched. The authors assessed the methodological quality of 21 papers meeting inclusion criteria and thematically analysed key data. Three main themes were identified, each with further sub-themes. Early warning tools operate within various systems and cultural contexts. However, their potential for improved patient safety may be hindered. Protocols influencing tool usage may make nurses and midwives distanced from patients and their expertise. For early warning tools to enhance patient safety, assessing their integration into practice is crucial to maximizing effectiveness. This review emphasizes the importance of integrating human relationships with early warning tools for patient safety. This integrative literature review does not include patient or public input. Adapting early warning tools to balance standardization for safety and efficiency and promoting nurses' and midwives' expertise and autonomy is required to optimize delivery of quality care and uphold patient safety. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used.

Patient-Perceived Quality Assessment in Orthopedics and Traumatology Departments during COVID-19 Pandemic.

The COVID-19 pandemic has led to significant disruptions in various healthcare systems. In Romania, the elective procedures in the orthopedic and traumatology specialty were one of the most affected. The study aims to investigate the influence of the COVID-19 pandemic on patient perceptions of quality in these departments. Standardized assessment tools were used, which consist of satisfaction questionnaires addressed to patients in order to assess the quality of health services in orthopedics and traumatology departments. Thus, a retrospective study was conducted using satisfaction questionnaires addressed to patients admitted to the orthopedics and traumatology departments of the County Clinical Emergency Hospital Bihor between January 2019 and December 2022. Eight reports, based on 746 questionnaires conducted during the studied period, were evaluated. To gauge patient satisfaction, Likert scales featuring five response options were used. A total of 627 questionnaires were valid, the exclusion criteria being incomplete questionnaires (the patients did not respond on all questions, n = 119). Four domains were analyzed: demographic data, hotel conditions, quality of medical care, and overall satisfaction. Demographic data highlight that patients exhibited an equitable distribution across residences, with 50.2% hailing from urban locales, while 53.5% (n = 333) were female. Regarding the overall impression, in 2020, there was a decline in the top rating of 5 compared to 2019, dropping to just 45.10% from 53.45%. Scores of 4 increased to 41.83%, while scores of 3 stayed under 8.5%. Scores of 2 and 1 were negligible. In 2021 and 2022, we can observe a sustained increase in the number of patients who awarded 5 points for overall impression and a decrease in the number of patients who awarded 4 points compared to previous years. The maximum difference between 2020 and 2021 and the period before and after this period was 27.24% (p-value < 0.001). The results indicate that while overall impressions of the hospital remained positive throughout the studied period, there were notable fluctuations in satisfaction levels during the pandemic. Patient satisfaction with attending physicians dipped in 2020 from 86.70% to 77.78% but recovered by 2022. The same trend can be observed with nurses and caregivers, as well as hotel services, during this period. These findings underscore the importance of addressing patient concerns and improving the quality of care delivery, particularly during times of crisis.

Global health systems strengthening: FIGO's strategic view on reducing maternal and newborn mortality worldwide.

To demonstrate that successful health systems strengthening (HSS) projects have addressed disparities and inequities in maternal and perinatal care in low-income countries. A comprehensive literature review covered the period between 1980 and 2022, focusing on successful HSS interventions within health systems' seven core components that improved maternal and perinatal care. The findings highlight the importance of integrating quality interventions into robust health systems, as this has been shown to reduce maternal and newborn mortality. However, several challenges, including service delivery gaps, poor data use, and funding deficits, continue to hinder the delivery of quality care. To improve maternal and newborn health outcomes, a comprehensive HSS strategy is essential, which should include infrastructure enhancement, workforce skill development, access to essential medicines, and active community engagement. Effective health systems, leadership, and community engagement are crucial for a comprehensive HSS approach to catalyze progress toward universal health coverage and global improvements in maternal and newborn health.

Palliative Care Clinicians' Views on Metrics for Successful Specialist Palliative Care Delivery in the ICU

ContextA quarter of palliative care (PC) clinicians’ consultations are now requested from the intensive care unit (ICU). Despite this high usage, a standardized set of quality metrics for PC delivery in the ICU does not exist. ObjectivesTo explore PC clinicians’ views on how to best measure quality of care delivery in their role as a consultant in the ICU setting. MethodsSecondary analysis of a parent dataset consisting of qualitative data from semi-structured interviews exploring ways to optimize PC clinicians’ role in the ICU. Nineteen participants were recruited across five academic medical centers in the US. Participants included PC physicians (n = 14), nurse practitioners (n = 2), and social workers (n = 3). Thematic analysis with an inductive approach was used to generate themes. ResultsWe identified two central themes: difficulties in measuring PC quality in the ICU (theme 1) and tension between the role of PC and metrics (theme 2). Theme 1 had two subthemes related to logistical challenges in measuring outcomes and PC clinicians’ preference for metrics that incorporate subjective feedback from patients, family members, and the primary ICU team. Theme 2 described how PC clinicians often felt a disconnect between the goal of meeting a metric and their goals in delivering high-quality clinical care. ConclusionOur findings provide insight into PC clinician perspectives on quality metrics and identify major barriers that need to be addressed to successfully implement quality measurement in the ICU setting.

An IoT Intelligent Approach for Safety and Efficiency of Robotic Medicine Delivery in Hospitals

In this paper, we introduce an IoT-based robotic medicine delivery system designed to boost safety and efficiency in hospital settings. This IoT-embedded robotic system integrates advanced sensors such as proximity, temperature, pressure, pulse rate, etc., sensors for ensuring real-time health and environmental monitoring behind this system. The robot is connected to a centralised controller, enabling healthcare workers to monitor patients using a cloud-based system. . Our robotic system moves about with the support of both line follower and LiDAR scanning technology for environmental safety and proximity detection. Experimental results show that the robotic system was able to navigate static obstacles and dynamically move away from the mobile entities within its reach without touching them. Besides, the proposed robotic system was able to reach the bed at the right time under normal operating conditions, which shows the efficiency of this approach in real-time settings. Patient feedback suggests that patients are very happy about the system, in terms of its usefulness, trustworthiness, and to their suprise to be taken care of by a robot. Overall, our study shows the potential of the proposed robotic system in streamlining the existing medicine delivery process in hospitals. It can potentially improve various aspects including safety, efficiency, patient compliance, and quality of care delivery. The promising results suggest further studies for incorporating advanced features and for ensuring compliance with regulatory requirements. Additional studies are to be conducted to further improve the proposed sensor-based robotic medicine delivery system, to facilitate its adoption in hospitals.

The impact of leadership style in team-based primary care - staff satisfaction and motivation.

Leadership styles, beliefs, and behaviours are an important and critical component to the delivery of quality care in any primary care organisation. The human resource crisis in health care has resulted in greater investments in team-based care; however, some leaders may not have experience working in team-based settings. To explore what leadership characteristics, styles, and behaviours were most conducive to employee satisfaction, motivation, and delivery of care in a team-based primary care setting. A qualitative study involving 16 community health centre (CHC) staff from six CHCs across Ontario, Canada. Thematic analysis of qualitative interviews using a framework based on transformational leadership (TL) theory. The following three themes emerged from our findings as having a noticeable impact on staff motivation, morale, delivery of care, and client outcomes: transparent and open communication; opportunities to collaborate in decision making; and staff recognition and appreciation. The results of our study indicate it is critical that leaders adopt leadership styles and approaches in which every team member is informed, heard, and appreciated. This study described the leadership styles and characteristics that lead to improved employee satisfaction, motivation, and morale in a team-based primary care setting, and the impact this could and does have on quality and delivery of care. Future research is needed to better understand the impact of leadership in a variety of roles within a team-based environment, specifically in a multidisciplinary setting.

The causes of negative countertransference in its cultural aspect among psychiatric residents in Tunisia

IntroductionNegative countertransference in psychiatry refers to the therapist’s unfavorable emotional reactions to the patient, such as anger and frustration, which can hinder the therapeutic relationship and the client’s progress. This is why it is imperative to study the causes of this negative counter-transference, such as cultural causes, to ensure effective treatment, appropriate care and better comfort for psychiatry residents during their professional practice.ObjectivesTo study the cultural causes of negative countertransference among psychiatric residents in Tunisia and their coping behavior.MethodsThis cross-sectional study was carried out among Tunisian residents working in psychiatric departments, using a questionnaire deployed via Google Forms.Results The study involved 26 residents with 23 females. The average age was 27.57 years with extremes ranging from 26 to 32. The participants were family doctors practicing in psychiatric wards (26.9%), first year psychiatry residents (15.4%), second year psychiatry residents (23.1%), third year psychiatry residents (19.2%), fourth year psychiatry residents (11.5%) and child psychiatry residents (3.8%). The majority of residents admitted having had a negative transference towards a patient (88.5%). The level of frustration felt by residents during this counter-transference on a scale of 100 varied from 1 to 100 with an average of 61.9. Substance abuse was the primary cause in 52.17% of cases. The second cause was the patient’s ideology, with a percentage equal to 43.47%. The same percentage of 17.39% was for traditions, socio-economic level and membership of a particular political group. In 82.6% of cases, residents tried to analyze this counter-transference and 65.2% of them managed to deal with their frustration. The feeling of guilt was experienced by 56.52% of practitioners and the same number of residents tried to avoid the patient. Among the participants, 43.47% discussed this difficulty with their supervising physician and only 4 residents asked to change patients.Conclusions In conclusion, our study identified the cultural causes of negative countertransference in Tunisian psychiatry residents, including substance abuse, ideology, traditions, socio-economic level and politics. Understanding these causes is essential to resident training but also to the delivery of quality care in psychiatry. By integrating this knowledge into training, we can help residents recognize and manage negative countertransference, in order to improve the quality of care they provide to their patients.Disclosure of InterestNone Declared

Assessment of the Need, Demand, and Access to Mental Health Care Services by Nursing Staff in Dispensaries Within Mombasa County, Kenya

Mental health and well-being are crucial for a fulfilling life. Work related stress negatively impacts health care providers' professionalism, quality of care delivery, efficiency, and overall quality of life. It is important to identify and mitigate these work-related risk factors to protect the mental health well-being of healthcare workers. The aim of this study was to assess the provision, demand and awareness of need for mental health care services amongst nursing care staff stationed in dispensaries within Mombasa County, Kenya. This is a cross-sectional study that targeted nurses at the dispensary level, facility in-charges, and County health personnel. Quantitative data was collected using GAD-7 to measure anxiety, PHQ 9 to measure depression and PCL 5 to measure PTSD. Qualitative data was collected through IDI and key informant interviews with the facility in charges and the Sub-County County nurse officials. Quantitative data was analyzed descriptively while qualitative data was analyzed following Creswell six steps. The research discovered the proportion of nurses in Mombasa County affected by PTSD severe anxiety and severe depression as 12.6%, 22.6% and 3.2% respectively. These conditions have their origin in work and personal matters with work-related matters being the main contributors. Fear of stigmatization from colleagues and the community negatively affected care seeking behavior. Nine county facilities offered mental health services although understaffed with only 9 specialized staff. The county has made some investment in mental health service provision, this investment is however focused on service provision to the general public as opposed to health care workers.

Survival Among Patients With High-Risk Gastrointestinal Cancers During the COVID-19 Pandemic

Prior reports demonstrated that patients with cancer experienced worse outcomes from pandemic-related stressors and COVID-19 infection. Patients with certain malignant neoplasms, such as high-risk gastrointestinal (HRGI) cancers, may have been particularly affected. To evaluate disruptions in care and outcomes among patients with HRGI cancers during the COVID-19 pandemic, assessing for signs of long-term changes in populations and survival. This retrospective cohort study used data from the National Cancer Database to identify patients with HRGI cancer (esophageal, gastric, primary liver, or pancreatic) diagnosed between January 1, 2018, and December 31, 2020. Data were analyzed between August 23 and September 4, 2023. Trends in monthly new cases and proportions by stage in 2020 were compared with the prior 2 years. Kaplan-Meier curves and Cox regression were used to assess 1-year mortality in 2020 compared with 2018 to 2019. Proportional monthly trends and multivariable logistic regression were used to evaluate 30-day and 90-day mortality in 2020 compared with prior years. Of the 156 937 patients included in this study, 54 994 (35.0%) were aged 60 to 69 years and 100 050 (63.8%) were men. There was a substantial decrease in newly diagnosed HRGI cancers in March to May 2020, which returned to prepandemic levels by July 2020. For stage, there was a proportional decrease in the diagnosis of stage I (-3.9%) and stage II (-2.3%) disease, with an increase in stage IV disease (7.1%) during the early months of the pandemic. Despite a slight decrease in 1-year survival rates in 2020 (50.7% in 2018 and 2019 vs 47.4% in 2020), survival curves remained unchanged between years (all P > .05). After adjusting for confounders, diagnosis in 2020 was not associated with increased 1-year mortality compared with 2018 to 2019 (hazard ratio, 0.99; 95% CI, 0.97-1.01). The rates of 30-day (2.1% in 2018, 2.0% in 2019, and 2.1% in 2020) and 90-day (4.3% in 2018, 4.4% in 2019, and 4.6% in 2020) operative mortality also remained similar. In this retrospective cohort study, a period of underdiagnosis and increase in stage IV disease was observed for HRGI cancers during the pandemic; however, there was no change in 1-year survival or operative mortality. These results demonstrate the risks associated with gaps in care and the tremendous efforts of the cancer community to ensure quality care delivery during the pandemic. Future research should investigate long-term survival changes among all cancer types as additional follow-up data are accrued.