Survey Of Facilities Research Articles

Changes in health facility readiness for obstetric and neonatal care services in Nepal: an analysis of cross-sectional health facility survey data in 2015 and 2021

BackgroundNepal is committed to achieving the Sustainable Development Goal (SDG) 2030 target 3.1 of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. Along with increasing access to health facility (HF)-based delivery services, improving HF readiness is critically important. The majority of births in Nepal are normal low-risk births and most of them take place in public HFs, as does the majority of maternal deaths. This study aims to assess changes in HF readiness in Nepal between 2015 and 2021, notably, if HF readiness for providing high-quality services for normal low-risk deliveries improved; if the functionality of basic emergency obstetric and neonatal care (BEmONC) services increased; and if infection prevention and control improved.MethodsCross-sectional data from two nationally representative HF-based surveys in 2015 and 2021 were analyzed. This included 457 HFs in 2015 and 804 HFs in 2021, providing normal low-risk delivery services. Indices for HF readiness for normal low-risk delivery services, BEmONC service functionality, and infection prevention and control were computed. Independent sample T-test was used to measure changes over time. The results were stratified by public versus private HFs.ResultsDespite a statistically significant increase in the overall HF readiness index for normal low-risk delivery services, from 37.9% in 2015 to 43.7%, in 2021, HF readiness in 2021 remained inadequate. The availability of trained providers, essential medicines for mothers, and basic equipment and supplies was high, while that of essential medicines for newborns was moderate; availability of delivery care guidelines was low. BEmONC service functionality did not improve and remained below five percent facility coverage at both time points. In private HFs, readiness for good quality obstetrical care was higher than in public HFs at both time points. The infection prevention and control index improved over time; however, facility coverage in 2021 remained below ten percent.ConclusionsThe slow progress and sub-optimal readiness for normal, low-risk deliveries and infection prevention and control, along with declining and low BEmONC service functionality in 2021 is reflective of poor quality of care and provides some proximate explanation for the moderately high maternal mortality and the stagnation of neonatal mortality in Nepal. To reach the SDG 2030 target of reducing maternal deaths, Nepal must hasten its efforts to strengthen supply chain systems to enhance the availability and utilization of essential medicines, equipment, and supplies, along with guidelines, to bolster the human resource capacity, and to implement mechanisms to monitor quality of care. In general, the capacity of local governments to deliver basic healthcare services needs to be increased.

Hospital Resources and Practice Patterns for Congenital Cardiac Surgery in Pakistan: A Nationwide Status Report.

Objective: Low- and middle-income countries such as Pakistan bear the brunt of the global burden of congenital heart disease (CHD), This nationwide study assessed hospital resources and surgical practice patterns pertaining to CHD surgery across Pakistan. Methods: A nationwide hospital facility survey was conducted, targeting all health centers performing CHD surgery in Pakistan. Descriptive data analysis was performed, with categorical variables being presented as frequencies and percentages and continuous variables being reported as means and standard deviations. Results: Seventeen surgeons across 17 different centers participated in the study. Eight of 17 (47%) surgeons were under 45 years of age, while the rest were older than 45 years. More respondents were employed at public/government-owned hospitals (11/17, 65%) and at specialized cardiac centers (13/17, 76%), with a majority of centers reported as having a special ICU designated for congenital cardiac patients (11/17, 65%). With regard to operative volume, 7 of 17 (41%) centers reported more than 350 cases per year, with 7 of 17 reported >10 neonatal cases per year (6/12, 50%). Only one center reported national and international collaborations for research, most centers carrying out less than five research projects in a year. Conclusion: This study has identified key areas that require the attention of local administrative bodies as well as international organizations and societies. The existing centers in Pakistan are unable to meet the demands of the population, leaving a large number of untreated patients, especially for neonatal lesions.

A systematic scoping review of medicine availability and affordability in Africa

BackgroundThe most recent World Medicines Situation Report published in 2011 found substantial medicine availability and affordability challenges across WHO regions, including Africa. Since publication of the 2011 report, medicine availability and affordability has risen on the international agenda and was included in the Sustainable Development Goals as Target 3.8. While numerous medicine availability and affordability studies have been conducted in Africa since the last World Medicines Situation Report, there has not been a systematic analysis of the methods used in these studies, measures of medicine availability and affordability, categories of medicines studied, or geographic distribution. Filling this knowledge gap can help inform future medicine availability and affordability studies, design systems to monitor progress toward Sustainable Development Goal Target 3.8 in Africa and beyond, and inform policy and program decisions to improve medicine availability and affordability.MethodsWe conducted a systematic scoping review of studies assessing medicine availability or affordability conducted in the WHO Africa region published from 2009–2021.ResultsTwo hundred forty one articles met our eligibility criteria. 88% of the articles (213/241) reported descriptive studies, while 12% (28/241) reported interventional studies. Of the 198 studies measuring medicine availability, the most commonly used measure of medicine availability was whether a medicine was in stock on the date of a survey (124/198, 63%). We also identified multiple other availability methods and measures, including retrospective stock record reviews and self-reported medicine availability surveys. Of the 59 articles that included affordability measures, 32 (54%) compared the price of the medicine to the daily wage of the lowest paid government worker. Other affordability measures were patient self-reported affordability, capacity to pay measures, and comparing medicines prices with a population-level income standard (such as minimum wage, poverty line, or per capita income). The most commonly studied medicines were antiparasitic and anti-bacterial medicines. We did not identify studies in 22 out of 48 (46%) countries in the WHO Africa Region and more than half of the studies identified were conducted in Ethiopia, Kenya, Tanzania, and/or Uganda.ConclusionOur results revealed a wide range of medicine availability and affordability assessment methodologies and measures, including cross-sectional facility surveys, population surveys, and retrospective data analyses. Our review also indicated a need for greater focus on medicines for certain non-communicable diseases, greater geographic diversity of studies, and the need for more intervention studies to identify approaches to improve access to medicines in the region.

Working hours of full-time hospital physicians in Japan: a cross-sectional nationwide survey

BackgroundThe culture of excessively long overtime work in Japan has not been recently addressed. New legislation on working hours, including a limitation on maximum overtime work for physicians, will be enforced in 2024. This study was performed to elucidate the working conditions of full-time hospital physicians and discuss various policy implications.MethodsA facility survey and a physician survey regarding physicians’ working conditions were conducted in July 2022. The facility survey was sent to all hospitals in Japan, and the physician survey was sent to all physicians working at half of the hospitals. The physicians were asked to report their working hours from 11 to 17 July 2022. In addition to descriptive statistics, a multivariate logistic regression analysis on the factors that lead to long working hours was conducted.ResultsIn total, 11,466 full-time hospital physicians were included in the analysis. Full-time hospital physicians worked 50.1 h per week. They spent 45.6 h (90.9%) at the main hospital and 4.6 h (9.1%) performing side work. They spent 43.8 h (87.5%) on clinical work and 6.3 h (12.5%) on activities outside clinical work, such as research, teaching, and other activities. Neurosurgeons worked the longest hours, followed by surgeons and emergency medicine physicians. In total, 20.4% of physicians were estimated to exceed the annual overtime limit of 960 h, and 3.9% were estimated to exceed the limit of 1860 h. A total of 13.3% and 2.0% exceeded this level only at their primary hospital, after excluding hours performing side work. Logistic regression analysis showed that male, younger age, working at a university hospital, working in clinical areas of practice with long working hours, and undergoing specialty training were associated with long working hours after controlling for other factors.ConclusionsWith the approaching application of overtime regulations to physicians, a certain reduction in working hours has been observed. However, many physicians still work longer hours than the designated upper limit of overtime. Work reform must be further promoted by streamlining work and task-shifting while securing the functions of university hospitals such as research, education, and supporting healthcare in communities.

Knowledge of abortion legality among health facility staff in Ghana.

Abortion has been legal for multiple indications in Ghana since 1985, and efforts have been made to expand the availability of safe abortion care in the years since. However clandestine, and potentially unsafe, abortions remain common, suggesting numerous barriers to access persist; one possible barrier is poor knowledge of the abortion law among those working in health facilities. Our study aimed to identify levels of legal knowledge among health facility staff across Ghana. Data for this paper are drawn from a nationally representative cross-sectional health facility survey conducted in 2018; our analytic sample includes 340 facilities that provide induced abortion and/or postabortion care (PAC). The survey collected data on provision of abortion and PAC, as well as knowledge of abortion legality and recommendations for reducing unsafe abortion. We used descriptive statistics to examine levels of knowledge and recommendations, and logistic regression to assess associations with individual and facility characteristics. Comprehensive knowledge of the legal indications for abortion was low among health facility staff; just 6% identified all legal indications, and the majority (83%) underestimated the number of conditions under which abortion is legal. Knowledge was higher for more restrictive indications, such as a woman's life being at risk, which was identified by 72% of respondents, than more broadly interpretable indications, such as mental health, identified by 29%. Respondents in facilities providing both induced abortion and PAC had better knowledge of several legal indications than those in facilities providing PAC only. Health facility staff have significant gaps in their knowledge of abortion legality. Knowledge of the law among this population is highly important for ensuring that abortion care is made available to the fullest extent of the law. Efforts are needed to improve knowledge of the law among providers and facility staff, particularly for indications with broad interpretability.

Community-based assessment for infant, under-5 child and maternal mortality in tribal population of Himachal Pradesh, India

Introduction: Infant and child mortality rates are sensitive indicators of health services of any community. Tribal populations remain a disadvantaged group among other communities and the indicator of their accessibility and availability of health services is the infant and maternal mortality rates.Objectives: To assess reliable estimates and causes for the child (less than five year of age) mortality rate and maternal mortality ratio (MMR) of tribal population of Himachal Pradesh, and the maternal and child health services and facilities available in their health institutionsMethods: A community-based surveillance study was conducted in 2019-20 on the deaths of all children (less than five year of age) and maternal deaths in the entire population of two tribal districts i.e., Kinnaur and Lahau l & Spiti, and of two tribal blocks of Chamba District in the state of Himachal Pradesh. Sub-centres (SC) remained under the study for a period of one year. Verbal autopsies were conducted to ascertain the cause of death by community workers under the supervision of project staff. In addition, a cross-sectional facility survey was conducted, Health institution data were gathered using a pre-tested structured schedule adapted from the National Health Mission Facility Assessment Tool.Results: Majority (85%) of the SCs were functioning in Kinnaur District and 66% at Lahaul & Spiti District. In the latter district, the labour room was functional at primary health center (PHC). Civil and district hospitals were preferred for delivery while SC and PHC were preferred for preventive services. The infant mortality rate (IMR) of all districts was 24 per 1000 live births (LB). Most of the deaths were in post neonatal period (62%). Birth asphyxia and pneumonia were major causes. The 1-5-year mortality rate was 1 per 1000 LB, which was only reported from the district of Chamba. There were zero maternal mortalities during the survey period.Conclusions & Recommendations: The IMR in tribal districts was higher than the state average. Most deaths were due to birth asphyxia, hence indicates the importance of labour room preparedness at PHCs in these hard-to-reach areas.

Energy consumption assessment and economic analysis of a novel sustainable electro-machining auxiliary system

In contrast to traditional machining methods, electro-machining presents a new opportunity for treating materials that are problematic for conventional approaches. While gaining increasing prominence in the manufacturing industry, electro-machining is marked by heightened energy consumption and reduced operational efficiency. A comprehensive survey of electro-machining manufacturing facilities has identified two pivotal factors influencing energy consumption and efficiency enhancements: 1) determining optimal electrical parameters for electro-machining during the production planning stage, and 2) timely adjustment of electro-machining parameters throughout the production stage. To address these two challenges, an innovative model-based electro-machining auxiliary system has been introduced for the surveillance and optimization of the machining process. The system aims to curtail energy consumption, enhance machining efficiency, and fortify economic viability, all while maintaining machining quality. Notably, the system demonstrates adaptability in deriving optimized electrical parameters tailored to diverse processing conditions. Energy consumption evaluation and techno-economic analysis, employing primary industry data, were conducted to compare the energy efficiency and economic performance of the machining process with the new auxiliary system against the conventional approach. The foremost outcome of adopting the new auxiliary system is a substantial reduction in energy usage; from an economic standpoint, the analysis shows that the cost of machining a single workpiece is reduced by 27.75%; the energy efficiency analysis reveals a 27.75% decrease in energy consumption per unit area, accompanied by an approximately 30% increase in machining efficiency. The proposed approach has demonstrated significant practical value for the sustainable development of the electro-machining process.

THE ASSOCIATION OF COVID-19 OUTBREAKS AND OTHER FACTORS WITH NURSING HOME RESIDENTS’ QUALITY OF LIFE

Abstract Nursing home (NH) residents’ Quality of life (QoL) is an important goal of care. However, it is understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, care aide emotional exhaustion, and lack of resident access to geriatric professionals were associated with NH residents’ QoL. In this cross-sectional study (Jul-Dec 2021), we purposefully selected 9 NHs in Alberta, Canada based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). Using a validated questionnaire (DEMQOL-CH), we assessed dementia-specific QoL of 689 residents from 18 care units through video-based interviews with care aides. Independent variables included COVID-19 outbreak in the NH in the last 2 weeks (health authority records), proportion of care aides on a care unit with high emotional exhaustion scores (9-item short form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit characteristics (validated facility and care unit surveys), and resident covariates (Resident Assessment Instrument – Minimum Data Set 2.0). COVID-19 outbreaks within two weeks of the data collection (β=0.189, 95% confidence interval [CI]: 0.058;0.320), higher proportions of emotionally exhausted care aides on a care unit (β=0.681, 95%CI: 0.246;1.115) and lack of access to geriatric professionals (β=0.216, 95%CI: 0.003;0.428) were significantly associated with poorer resident QoL. Policies aimed at reducing infection outbreaks, better supporting care staff, and increasing access to geriatric specialists, may help to mitigate negative effects of COVID-19 NH residents’ QoL.

COVID-19 AND THE CARE OF ASSISTED LIVING RESIDENTS: THE COVCARES PROGRAM OF RESEARCH

Abstract This presentation describes the goals, design and methods of the COVID-19 and the Care of Assisted living Residents (COVCARES) program of research. Our goals were to address critical knowledge gaps related to how COVID-19 impacted assisted living (AL) residents, family/friend caregivers, and homes, and to compare how outcomes differed between AL and nursing homes (NH). Partnering closely with provincial Alzheimer Societies, family caregiver advocates, and health policy decision makers, we conducted two interconnected studies: The first was a prospective cohort study, surveying family/friend caregivers of AL residents and directors of care of AL homes in the Canadian provinces of Alberta and British Columbia twice (10/2020–04/2021 and 07/2021–09/2021). 673 caregivers and 104 AL homes responded to our first survey. Of those, 386 caregivers and 78 AL homes submitted a second survey. The second was a population-based retrospective cohort study (01/2017–12/2021), using clinical and health administrative data of all AL and NH residents in Alberta. Data included Resident Assessment Instrument (RAI) records, acute care and emergency department admission data, prescription medications, data on COVID-19 infections, and vital statistics of 23,355 AL residents and 41,583 NH residents. Analyzing each of the aforementioned data sets individually, and linking family and facility surveys, as well as resident and facility survey data, we provide unique insights into the impacts of the COVID-19 pandemic on AL settings. The presentations in this symposium will share selected key findings from our program of research.

STRATEGIES USED BY OHIO’S NURSING HOMES TO RETAIN CERTIFIED NURSING ASSISTANTS: DO THEY WORK?

Abstract A low retention rate of certified nursing assistants (CNA) in nursing homes (NHs) is a known problem; it drives up facilities’ operating costs and negatively impacts the quality of care provided. The COVID-19 pandemic exacerbated this problem and left facilities scrambling to retain workers. Using data from the 2021 Ohio Biennial Survey of Long-Term Care Facilities, this study examines strategies implemented by facilities to improve retention of their CNAs. Facilities have tried to implement a variety of workplace environment changes such as allowing staff teams to manage schedule and financial benefit strategies such as longevity wage increase to improve their CNA retention. The statewide average NH retention rate was 64% for CNAs ranging between 0 and 100%. Three groups were constructed from the retention data: high or rate of 75% or higher (N = 220), medium or between 50% and 75% (N = 254), and low or under 50% (N = 145). We found that a higher proportion of low-retention facilities implemented most of these strategies compared to facilities with high and medium CNA retention rates. At the same time, we found that a higher proportion of administrators in the high retention group knew all their CNAs by name compared to the low-retention group (50.0% vs 41.7%). These findings suggest that environmental and financial strategies may not have much of an impact on retention rates, but making people feel respected and appreciated could.

WHAT DO NURSING HOMES RECEIVING HIGH COMPLAINTS GOT TO DO WITH RESIDENTS’ QUALITY OF LIFE?

Abstract Residents’ quality of life is important to understand nursing home (NH) quality. Official complaints are another NH quality indicator. However, little research has examined the two quality measures together. To fill this gap, this study aims to investigate the association between resident satisfaction and NH complaints. 2018–2019 complaints data from the Ohio Department of Health, 2017 Ohio Biennial Survey of Long-Term Care Facilities, and 2017 Ohio Nursing Home Resident Satisfaction Survey were merged (N=629). Eight outcome variables were used: overall resident satisfaction score and seven individual domain scores. They range from 0 (low) to 100 (high). For independent variables, we labeled NHs received 6 or more complaints per 100 residents in both 2018 and 2019 as ‘high complaint repeaters.’ Multiple linear regression was conducted. There is a statistically significant relationship between official complaints and resident satisfaction. High complaint repeaters had lower overall satisfaction score by 1.48 (p < .01); lower moving in score by 2.16 (p < .01); lower spending time score by 1.30 (p < .05); lower caregivers score by 1.20 (p < .05); lower meals and dining score by 2.18 (p < .05); lower environment score by 1.13 (p < .05); and lower facility culture score by 2.14 (p < .01) than non-high complaint repeaters. However, there is no association between complaints and care and services domain score. State policy makers need to consistently monitor high complaint repeaters and support them to reduce complaints. Also, providers should allocate resources and design strategies to improve residents’ experiences.

ANALYSIS OF OHIO’S ASSISTED LIVING DIRECT CARE WORKFORCE

Abstract Direct care workers (DCWs) in Ohio’s licensed residential care facilities (RCFs) provide the most assistance with activities of daily living to individuals with disabilities. DCWs include medication aides, personal care aides, and nurse aides. In 2017, 41% of Ohio AL administrators reported high DCW recruitment issues and 36% high DCW retention problems (8+ on 10-point scale). Understanding how RCFs with no or little recruitment/retention challenges compare to other RCFs on strategies used, training hours, wages, benefits, resident composition, and RCF characteristics can identify potential strategies to increase recruitment/retention. This study uses the 2019 Ohio Biennial Survey of Long-Term Care Facilities (n=540 RCFs) to compare RCF strategies to recruit and retain DCWs by measures of recruitment/retention problem-severity and their 3-year retention rates among full-time (FT) and part-time (PT) DCWs. In 2019, 65% of Ohio RCF administrators reported recruitment issues at the median or greater (8+). Similarly, 62% of RCFs experienced retention issues at the median or more (7+). On average, 37% of FT DCWs worked in the RCF for 3 years or more and 21% among PT DCWs (ranges: 0%-100%). 28.24% of RCFs reported high 3-year retention among FT DCWs (60-100%) and 26.51% reported high 3-year retention among their PT DCWs (30%-100%). RCFs with less serious recruitment challenges report providing more hours of training for newly employed DCWs before they provide resident care (34.54 vs. 29.60, t=-2.7, p<.01). Individual retention strategies did not show relationships with high retention. Results indicate pervasive challenges with DCW retention and recruitment that require new approaches.

National Survey of the Bone Densitometry Evaluation Process Within an Integrated Healthcare System

Background: To assess the current state of bone mineral density evaluation services via dual energy x-ray absorptiometry (DXA) provided to Veterans with fracture risk through the development and administration of a nationwide survey of facilities in the Veterans Health Administration.Methodology: The Bone Densitometry Survey was developed by convening a Work Group of individuals with expertise in bone densitometry and engaging the Work Group in an iterative drafting and revision process. Once completed, the survey was beta tested, administered through REDCap, and sent via e-mail to points of contact at 178 VHA facilities.Results: Facility response rate was 31 % (56/178). Most DXA centers reported positively to markers of readiness for their bone densitometers: less than 10 years old (n=35; 63 %); in “excellent” or “good” condition (n=44; 78 %, 32 % and 46 %, respectively); and perform phantom calibration (n=43; 77 %). Forty-one DXA centers (73 %) use intake processes that have been shown to reduce errors. Thirty-seven DXA centers (66 %) reported their technologists receive specialized training in DXA, while 14 (25 %) indicated they receive accredited training. Seventeen DXA centers (30 %) reported performing routine precision assessment.Conclusions: Many DXA centers reported using practices that meet minimal standards for DXA reporting and preparation; however, the lack of standardization, even within an integrated healthcare system, indicates an opportunity for quality improvement to ensure consistent high quality bone mineral density evaluation of Veterans.

Monitoring the Family Health Centres in Kerala, India: Findings from a facility survey.

Kerala, a south Indian state, has often been cited globally as a model for better health outcomes at low cost but faces unique challenges in achieving Universal Health Coverage (UHC). To propel the efforts in achieving UHC, the Government of Kerala announced the "Aardram" health reform initiative, emphasising improving the quality of primary care service delivery. The reforms started in 2017, and in the first stage, 170 of 848 Primary Health Centres (PHCs) were upgraded to Family Health Centres (FHCs). The facilities were provided with additional doctors, nurses, and paramedical staff; the working hours were extended, and the range of services offered increased. In support of these processes, we carried out a facility assessment to assess differences between upgraded FHCs and existing PHCs. We conducted a facility-based cross-sectional assessment in eight primary care facilities of Kerala, FHC (N=4) and PHCs (N=4) from June to October 2019. A structured questionnaire covering utilisation and coverage of selected priority services for various populations and health outcome data was filled out by health staff to report data for the financial year 2018-19. Data were analysed in Microsoft Excel spreadsheets for easy analysis and replication by state stakeholders. Coverage indicators such as full antenatal care and full immunization coverage were not appreciably different in FHCs as compared to PHCs. However, key reform-related differences were observed. On average, FHCs had 0.8 medical officers and one staff nurse per 10,000 population, whereas PHCs had 0.7 medical officers and less than 0.4 staff nurses per 10,000 population, even as the size of populations served by these human resources varied greatly across both types of facilities. The number of outpatient department visits per 10,000 population annually was 11,343 persons in FHCs and 9,580 persons in PHCs. FHCs also provided additional services such as screening for depression and chronic obstructive pulmonary disorders. Aardram primary healthcare reforms are still in their early days and appear to be associated with improved service coverage at the institutional level. However, some patterns are uneven: reforms should be carefully documented, and population-level impacts monitored over time.

Health systems capacity for epilepsy care in Uganda: A survey of health facilities in Western Uganda

Health systems capacity for epilepsy care in Uganda: A survey of health facilities in Western Uganda

The Capacity of HIV Care Facilities to Implement Strategies Recommended by the Ending the HIV Epidemic-The Medical Monitoring Project Facility Survey.

Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic (EHE) activities. U.S HIV care facilities. We analyzed 2021 survey data from a census of 514 facilities providing care to a national probability sample of U.S. adults with HIV. We present weighted estimates of facility characteristics, services, and policies, and estimates of the proportion of all U.S. HIV patients attending these facilities. Among HIV care facilities, 37% were private practices, 72% were in areas with population > 1 million, and 21% had over 1000 HIV patients. Most provided preexposure prophylaxis (PrEP, 83%) and postexposure prophylaxis (PEP, 84%). Over 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/STI transmission risk reduction counseling (89%); fewer had on-site access to substance use disorders treatment (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. Results indicate some strengths that support EHE-recommended strategies among HIV care facilities, such as high availability of PrEP/PEP, as well as areas for improvement, such as provision of staff anti-stigma trainings and adherence supports.

2194. Implementation of the CDC’s Core Elements of Antibiotic Stewardship: A Survey of Long-Term Care Facilities During the COVID-19 Pandemic

Abstract Background Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) is funded by the Nebraska DHHS to assist healthcare facilities with improving their antimicrobial stewardship programs (ASP). ASAP conducted a survey during the COVID-19 pandemic to learn about implementation of the CDC core elements (CE) of antibiotic stewardship in long-term care facilities (LTCF). Methods An online self-assessment survey of CE was created and hosted on the ASAP website. A link to the survey was shared with LTCF through ASAP’s email distribution lists, webinars, and other meetings. Data were summarized using descriptive statistics. Results 54 of 196 licensed LTCF in Nebraska responded to the survey between 05/2021 to 12/2022. Of these, 26 (48%) had all 7 CE with reporting and education being the least likely CE to be met (Tables 1 and 2). Half (50%) of LTCF did not have a signed leadership statement of support for ASP. ASP leadership responsibility was often shared across multiple positions (physicians, directors or assistant directors of nursing [DON/ADON], pharmacists, and infection preventionists), but DON/ADON were most commonly accountable (69%). Consultant pharmacists were the most commonly identified ASP experts (74%) available to LTCF. Only 57% of LTCF reported successfully implementing at least one infection-specific intervention to improve antibiotic use (AU); addressing UTIs was the most commonly identified intervention (31%). Almost a quarter (22%) of LTCF did not monitor rates of C. difficile infection, and about a third (30%) did not track antibiotic-resistant (AR) organisms. While 78% of LTCF provided educational resources to their nursing staff on AR and opportunities to improve AU, only 48% provided these resources to their clinical providers. Out of 26 LTCF reporting areas of antibiotic misuse at their facility, 88% agreed that ASP could help address the issue. For 24 LTCF that reported barriers to starting or improving ASP, prescriber resistance and lack of time were the most commonly identified barriers (28% and 13%). Conclusion Implementation of the CE remains low in LTCF and was likely further impacted by the COVID-19 pandemic. The findings highlight the challenges to implementing ASP in LTCF along with opportunities for improvement. Disclosures Trevor C. Van Schooneveld, MD, FSHEA, FACP, AN2 Therapeutics: Grant/Research Support|Biomeriuex: Advisor/Consultant|Biomeriuex: Grant/Research Support|Insmed: Grant/Research Support|Thermo-Fischer: Honoraria Scott J. Bergman, PharmD, bioMerieux, Inc.: Honoraria Muhammad Salman Ashraf, MBBS, Merck & Co. Inc: Board Member|Merck & Co. Inc: Grant/Research Support

Understanding integrated HPV testing and treatment of pre-cancerous cervical cancer in Burkina Faso, Cote d’Ivoire, Guatemala and Philippines: study protocol

BackgroundMany low- and-middle-income countries are disproportionately burdened by cervical cancer, resulting in high morbidity and mortality. HPV-DNA testing coupled with treatment with thermal ablation is a recommended screening and precancer treatment strategy, but not enough is known about how this can be effectively implemented in the context of integrated services. The (Scale Up Cervical Cancer Elimination by Secondary prevention Strategy, (SUCCESS) project is conducting a study to understand this approach, integrated into existing women’s health services in Burkina Faso, Cote d’Ivoire, Guatemala, and the Philippines (2020–2024).MethodsA hybrid effectiveness-implementation type III mixed-methods observational study design is used to assess feasibility, acceptability, and costs of integrated service delivery in 10 sites per country, selected considering urban/rural location, facility level, onsite/offsite laboratories, and health services type. In each country, a sample size of 2227 women aged 25–49 years will be enrolled with about 20% being women living with HIV. The primary outcome is proportion of HPV positive women completing precancer treatment, if eligible, within three months of screening. Data collection and analysis includes; facility and client exit surveys, key informant and client interviews, registries and project records extractions, and costing data analysis. Analysis includes descriptive statistics, context description, thematic analysis, and document analysis. Quantitative analyses will be stratified by participant’s HIV status.DiscussionRecruitment of study participants started in April 2022 (Burkina Faso and Côte d’Ivoire) and August 2022 (Guatemala and the Philippines). Enrolment targets for women screened, client exit, in-depth and key informant interviews conducted were reached in Burkina Faso and Cote d’Ivoire in November 2022. Guatemala and Philippines are expected to complete enrolment by June 2023. Follow-up of study Participants 12-months post-treatment is ongoing and is expected to be completed for all countries by August 2024. In LMICs, integrating cervical cancer secondary prevention services into other health services will likely require specific rather than incidental recruitment of women for screening. Reconfiguration of laboratory infrastructure and planning for sample management must be made well in advance to meet induced demand for screening.Trail Registration ClinicalTrials.Gov ID: NCT05133661 (24/11/2021).

Measurement of Neutron Leakage and Facility Survey of a Newly Commissioned Quadruple Photon Energy Medical Linear Accelerator Using a Neutron Survey Meter

Measurement of Neutron Leakage and Facility Survey of a Newly Commissioned Quadruple Photon Energy Medical Linear Accelerator Using a Neutron Survey Meter

Integral Field Spectroscopy of 13 Tidal Disruption Event Hosts from the Zwicky Transient Facility Survey

The host galaxies of tidal disruption events (TDEs) have been shown to possess peculiar properties, including high central light concentrations, unusual star formation histories, and “green” colors. The ubiquity of these large-scale galaxy characteristics among TDE host populations suggests that they may serve to boost the TDE rate in such galaxies by influencing the nuclear stellar dynamics. We present the first population study of integral field spectroscopy for 13 TDE host galaxies across all spectral classes and X-ray brightnesses with the purpose of investigating their large-scale properties. We derive the black hole masses via stellar kinematics (i.e., the M–σ relation) and find masses in the range , with a distribution dominated by black holes with M BH ∼ 106 M ⊙. We find one object with M BH ≳ 108 M ⊙, above the “Hills mass”, which if the disrupted star was of solar type, allows a lower limit of a ≳ 0.16 to be placed on its spin, lending further support to the proposed connection between featureless TDEs and jetted TDEs. We also explore the level of rotational support in the TDE hosts, quantified by (V/σ) e , a parameter that has been shown to correlate with the stellar age and may explain the peculiar host-galaxy preferences of TDEs. We find that the TDE hosts exhibit a broad range in (V/σ) e following a similar distribution as E + A galaxies, which have been shown to be overrepresented among TDE host populations.