Updated Policies Research Articles

The role and needs of teachers/schools in infection, prevention and control post covid-19

Abstract Introduction COVID-19 highlighted the importance of infection prevention and control (IPC) across all settings. As children are important transmitters of infection, teachers and schools play an important role in infection prevention. The aim of this study is to understand attitudes towards, and knowledge of IPC in schools post-Covid, and highlight any gaps in the training and resources needed. Methods An online survey of 1000 primary and secondary school teachers was carried out across England. Pearson’s chi-squared test, corrected for survey design, was used to test for differences in proportions across levels of categorical variables. Two qualitative workshops with eight head teachers were carried out to gather more in-depth information. Results 1000 teachers completed the survey across a range of teaching roles. Respondents reported that IPC measures are now less frequently implemented than during the pandemic. 71% of respondents say their role has changed since the pandemic, now having more responsibility for pupil health and hygiene; higher in primary versus secondary school teachers (31% v 25%; p < 0.05). 1/3 felt this change was permanent; 84% had no IPC training. Knowledge gaps were identified in the areas of IPC roles within schools, and IPC measures. 72% teachers claim they feel better prepared to deal with a public health outbreak compared to pre-pandemic, although 22% do not have an updated IPC policy; 35% had unmet needs. Conclusions Schools and teachers play a pivotal role in preventing the spread of communicable disease, highlighted during the COVID-19 pandemic. Teachers need, and more importantly want, more IPC training. Training and updated policies would support the educational workforce who feel their needs are not being met. Providing more streamlined, consistent, clear and concise information from trusted sources is required. Key messages • It is imperative to understand educators’ role in IPC in schools as they are key players in supporting local and national efforts to reduce the spread of infections. • Teachers desire further training with comprehensive information, and up-to-date policies to support their infection prevention and control efforts in educational settings.

Comprehensive insights into colistin and colistin resistance: updated regulations and policies on colistin usage and alternative strategies for mitigation and prevention of colistin resistance

Comprehensive insights into colistin and colistin resistance: updated regulations and policies on colistin usage and alternative strategies for mitigation and prevention of colistin resistance

At a glance: urinary catheterisation in males and females.

Urinary catheterisation is a crucial procedure in healthcare, requiring a thorough understanding of the anatomical and physiological differences between males and females to ensure safe and effective care. This guide explores the anatomy of the urinary system, detailing the kidneys, ureters, bladder, and urethra, and highlights key differences in catheterisation techniques for men and women. Emphasising evidence-based practices, it discusses recent advancements, such as antimicrobial catheters, and underscores the importance of comprehensive training and competency assessments for healthcare providers. Additionally, the guide advocates for patient-centred approaches, multidisciplinary collaboration, and adherence to updated policies to reduce complications such as catheter-associated urinary tract infections (CAUTIs). By integrating these critical evaluations and best practices, health professionals can enhance patient outcomes and maintain high standards of care in urinary catheterisation.

Promoting holistic and inclusive care for women: A call for updated health policies.

Promoting holistic and inclusive care for women: A call for updated health policies.

Comprehensive Benefits of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure With Reduced Ejection Fraction: A Literature Review.

Sodium-glucose cotransporter 2 (SGLT2) inhibitors, initially developed for type 2 diabetes, have emerged as a promising treatment for heart failure with reduced ejection fraction (HFrEF). They show significant cardiovascular benefits, including reduced cardiovascular mortality and heart failure hospitalizations. This review consolidates knowledge on the efficacy of SGLT2 inhibitors in HFrEF, focusing on their mechanisms of action, clinical benefits, and patient outcomes. To consolidate existing knowledge on the efficacy of SGLT2 inhibitors in reducing cardiovascular mortality in HFrEF, with an emphasis on pathophysiology, clinical benefits, and patient outcomes, major medical databases such as PubMed, Scopus, and Web of Science were reviewed, prioritizing research published from 2020 to 2024. Key studies and clinical trials, including DAPA-HF and EMPEROR-Reduced, were analyzed to understand the impacts of SGLT2 inhibitors on HFrEF management. The review highlights the multifaceted mechanisms by which SGLT2 inhibitors exert their cardiovascular benefits, including osmotic diuresis, natriuresis, improved myocardial energetics, and anti-inflammatory and antifibrotic effects. Clinical trials have consistently demonstrated significant reductions in cardiovascular mortality and hospitalizations among HFrEF patients treated with SGLT2 inhibitors. These benefits are observed across diverse demographic and clinical subgroups, indicating their broad applicability in clinical practice. SGLT2 inhibitors significantly advance HFrEF management, reducing cardiovascular mortality and hospitalizations. However, gaps remain in long-term outcomes, early diagnostic indicators, and mechanisms of action. Future research should address these gaps and explore personalized medicine to optimize treatment. Integrating SGLT2 inhibitors into standard HFrEF management guidelines, supported by updated policies and educational initiatives for healthcare providers, will be crucial to maximize their therapeutic potential and improve patient outcomes.

A review of Peyronie's disease insurance coverage.

Peyronie's disease (PD) is a fibroproliferative disorder that causes an abnormal curve of the penis resulting in pain, discomfort, and erectile dysfunction with management options including correctional surgery, penile external/internal devices, shock wave therapy (SWT), intralesional Verapamil (IV), and collagenase Clostridium histolyticum injections. To investigate the insurance coverage of these treatment options. The authors performed a cross-sectional analysis of the top US insurance policies for coverage of PD. Companies were chosen based on their market share and enrollment. Their policies were identified through a Web-based search and telephone interviews, and the companies' medical necessity criteria were defined. The online policies were then re-examined for interval change 3 years later. There are significant discrepancies for in coverage for the different modalities of Peyronie's treatment. Of the 100 companies examined, only 54% of companies had a policy that directly addressed the treatment coverage for PD. The most covered treatment was CCH injections with 37 companies providing unanimous coverage (n = 37, 100%). Within this category, all companies required a palpable plaque as a requirement. Additionally, external/internal devices were unanimous covered by 18 companies (n = 18, 100%). Surgical treatment was covered by eight companies with six companies denying coverage (n = 8 vs. n = 6, 57.1% vs. 42.9%). IV was covered by two companies. The least covered treatment option was SWT which was universally denied by 19 companies (n = 19, 100%). Insurance coverage of PD should be aligned with current medical literature to better increase access to care. This study is limited by the updated policies of insurance companies and future applicability. Additionally, this study assumes that a written policy will provide coverage and may overestimate the actual extent of coverage. Finally, this study only addressed some of the common treatment options of PD and did not expand on all possible treatment options. Differing rates for modalities of treatment may present a barrier for patients to receive individualized and adequate treatment for PD.

Divide and Save: A Critical Care Air Transport Team Case With Prolonged Field Care

ABSTRACT Critical care air transport teams (CCATTs) specialize in providing intensive medical and postoperative resuscitative care during air evacuations. In a 2014 mission, a seasoned CCATT was urgently deployed to evacuate 6 American service members with gunshot wounds. Despite only having 2 hours of premission preparation and no further injury or treatment details, CCATT secured additional equipment, medications, and blood supply. Upon arrival to a foreign nonmilitary hospital, they discovered that American ground commanders had lost trust in local medical capabilities. One patient experienced prolonged extremity tourniquet time and surgical delay. This led to acute renal failure, preventing immediate evacuation without continuous renal replacement therapy (CRRT). Deviating from the standard procedure, the CCATT obtained permission to split their team. The CCATT nurse attended 5 stabilized patients during unregulated critical care air transport with plans to swiftly return with CRRT equipment for the critical sixth patient. The physician and respiratory therapist remained at the foreign hospital for 2 days to provide prolonged field care. This case demonstrates the evolving mission scope of CCATT, which may encompass ground triage, prolonged field care, unregulated movement, and atypical CCATT equipment such as CRRT, occasionally necessitating a split team construct. To adapt to these evolving needs, updated policies and training now incorporate these diverse CCATT concepts, emphasizing the importance of flexibility in en route critical care missions.

Predicting possible distribution of rice leaf roller (Cnaphalocrocis medinalis) under climate change scenarios using MaxEnt model in China

The relationship between climate conditions and pest life is a key determinant of their distribution. Cnaphalocrocis medinalis Guenee, a major rice pest, exhibits outbreaks and its distribution patterns closely linked to meteorological factors. By using 244 actual distribution and occurrence data of C. medinalis along with 8 bioclimatic data, and employing the MaxEnt model and ArcGIS, combined with the latest SSPs climate scenario data, this study evaluated the risk region distribution status in the current period and predicted changes in China from 2040 to 2100. The results indicate that an overall increase in the risk area for C. medinalis, particularly under SSP245 scenario during 2040–2060. While Low-risk areas are expected to decrease, Medium and High-risk areas are projected to increase significantly, with worsening pest infestations anticipated in southern Hubei, eastern Hunan, most of Jiangxi, central Fujian, northern Guangdong, and southern Jiangsu. Regions such as central Liaoning are expected to reach the minimum survival standard for C. medinalis in future, leading to the northward shift in risk areas. Difference plots highlighted areas of increased and decreased suitability, providing actionable insights for policymakers. Regions with increased suitability align with the predicted northward shift of many agricultural pests, necessitating enhanced monitoring, specific pest control measures, and updated agricultural policies to address changing risk profiles. Additionally, the centroid analysis showed a northwest shift direction in future, primarily located at the junction of Shaoyang City and Loudi City, situated around 27–28 °N degrees north latitude and 111–113 °E. The study underscores the significant impact of climate change on the distribution of rice leaf roller, providing valuable insights for agricultural planning and management. The northward and westward expansion of risk areas necessitates adaptive strategies to mitigate potential impacts on agriculture. Enhanced monitoring, integrated pest management, and the development of pest-resistant crops are essential for addressing future challenges posed by climate change.

A Bibliometric Study of Publications and Citations in the Field of Digital Economy

The evolution of the digital economy has been characterized by an increasing trend in academic publications from 1996 to 2024, reflecting its growing importance and widespread implications across various sectors. This study analyzes the publication trends using bibliometric data, revealing significant growth in research outputs, particularly in the past decade. The implications of this growth are profound for both the business sector and policymakers, as they adapt to technological advancements and shifting market dynamics. The analysis not only highlights the sectors' responses to these changes but also underscores the need for updated policies to support digital infrastructure, ensure data privacy, and promote digital inclusivity. The study further discusses how this burgeoning research can guide strategic decisions in technology adoption and policy formulation.

Proceedings of the 2024 Transplant AI Symposium.

With recent advancements in deep learning (DL) techniques, the use of artificial intelligence (AI) has become increasingly prevalent in all fields. Currently valued at 9.01 billion USD, it is a rapidly growing market, projected to increase by 40% per annum. There has been great interest in how AI could transform the practice of medicine, with the potential to improve all healthcare spheres from workflow management, accessibility, and cost efficiency to enhanced diagnostics with improved prognostic accuracy, allowing the practice of precision medicine. The applicability of AI is particularly promising for transplant medicine, in which it can help navigate the complex interplay of a myriad of variables and improve patient care. However, caution must be exercised when developing DL models, ensuring they are trained with large, reliable, and diverse datasets to minimize bias and increase generalizability. There must be transparency in the methodology and extensive validation of the model, including randomized controlled trials to demonstrate performance and cultivate trust among physicians and patients. Furthermore, there is a need to regulate this rapidly evolving field, with updated policies for the governance of AI-based technologies. Taking this in consideration, we summarize the latest transplant AI developments from the Ajmera Transplant Center's inaugural symposium.

Stop the Line: Interventions to Prevent Retained Surgical Items.

The surgical team works collaboratively to prevent the occurrence of retained surgical items (RSIs). The purpose of this quality improvement project was to increase compliance with facility policies and improve teamwork skills to prevent the occurrence of RSIs. The project team implemented an evidence-based communication protocol, updated hospital network policies, introduced just-in-time job aids, and facilitated leader support through a daily huddle to address identified practice gaps. The TeamSTEPPS Teamwork Attitudes Questionnaire was used to measure the change in staff members' attitudes about teamwork before and after project implementation. Additional process and outcome measures included the number of near misses and actual RSIs, compliance with the daily huddle, and completion of the communication training. Results included improved perceived teamwork attitude scores and zero reports of actual RSI events over 7.5weeks.

Body Size Remains the Major Source of Sex Disparity Despite Updated Liver Transplant Allocation Policies.

Efforts to address US liver transplant (LT) access inequities continue, yet disparities linked to candidate traits persist. Analyzing national registry data pre- and post-Acuity Circle (AC) policy, our study assessed the impact of low body surface area (BSA) on LT waitlist mortality. The outcomes of LT candidates listed in the pre-AC era (n = 39 227) and post-AC (n = 38 443) were compared for patients with low BSA (22.9% pre-AC and 23.3% post-AC). Fine-Gray competing risk models highlighted that candidates with low BSA had a lower likelihood of LT both pre-AC (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.92-0.95) and post-AC (HR 0.96; 95% CI, 0.94-0.98), with minimal improvement in waitlist mortality/dropout risk from pre-AC (HR 1.15; 95% CI, 1.09-1.21) to post-AC (HR 1.13; 95% CI, 1.06-1.19). Findings were mostly reaffirmed by Cox regression models incorporating the trajectory of Model for End-stage Liver Disease (MELD) scores as time-dependent covariates. Regions 3, 5, and 7 showed notable LT waitlist disparities among low BSA patients post-AC policy. Causal mediation analysis revealed that low BSA and the difference between MELD-sodium and MELD 3.0 (MELD_D, as a proxy for the potential impact of the introduction of MELD 3.0) largely explained the sex disparity in AC allocation (percent mediated 90.4). LT waitlist disparities for female candidates persist, largely mediated by small body size. Although MELD 3.0 may reduce some disparities, further body size adjustments for in allocation models are justified.

Telehealth in Urology Beyond COVID-19

Introduction: Implementation of telehealth (TH) accelerated during the COVID-19 pandemic and has become a vital part of health care delivery. As we move toward the post-COVID-19 era, clinical practice has demonstrated a need for updated policies and quality improvement to solidify the role of TH in the urology care setting. The AUA Census data were used to explore trends, benefits, and barriers to urology TH implementation. Methods: The AUA Workforce Workgroup and Telehealth Taskforce analyzed data from the 2019-2022 AUA Census. Pertinent variables included utilization, patient satisfaction, care settings, quality, and diagnoses amenable to TH. Results: Pre-COVID-19 TH utilization increased from 11.9% to 81% during and after the COVID-19 pandemic. TH is predominately used in metropolitan academic centers, with usage increasing from 12.8% to 83% in these areas during the pandemic. Usage also increased in non-metropolitan areas from 3.8% to 61.2%. Overall, 76.7% reported increased ease of scheduling follow-ups, 62% ease of ordering tests, and 69.5% ease of accessing patient data in favor of audio visits vs in-person visits. TH utilization increased from 42.4% to 65% for initial visits and 66.8% to 82% for follow-up visits. Over 80% of practicing urologists younger than 54 years desire the use of telemedicine for follow-up visits. TH increased patient access to care by 51.6%, and 54% of urologists expressed desire to continue using or increase utilization of TH. The top 3 barriers of patient’s ability to receive telemedicine were 67.6% noting lack of knowledge in using patient portal/software needed for telemedicine visits, 49.6% had lack of adequate conferencing tools, and 43.9% lacked high-speed internet service to enable video visits. In total, 53.4% of urologists would absolutely or probably increase usage if payment parity of TH was comparable with that of in-office E/M services. Conclusion: TH implementation accelerated during the COVID-19 era. In the post-COVID-19 era, TH continues to be important across multiple areas including patient and physician satisfaction and increasing access to care, particularly in rural areas. Barriers exist, especially concerning payment parity, and could be eliminated through advocacy for policy updates and standardization of technology.

Association between nutritional status of Filipino preschool children and participation in government programmes at the household and individual levels

Introduction: Health and nutrition interventions in developing countries have been linked to better thriving and survival of children. Identifying programmes with significant effect on the nutritional status of Filipino preschool children may aid in identifying impactful interventions in addressing malnutrition. This study evaluated the association between nutritional status of preschool children and government programme participation based on the 2018 Expanded National Nutrition Survey (ENNS) results. Methods: Secondary data analysis of 12,949 preschool children was performed from the 2018 ENNS. The selected data included socioeconomic, anthropometric, and self-reported household-level and individual-level government programme participation. Chi-square test for association and multiple logistic regression were conducted using Stata version 16. Results: Participation in immunisation programme, growth monitoring, household food production, and awareness and usage of iodised salt were negatively associated with at least one type of undernutrition. Consequently, participation in deworming programme was positively associated with both underweight and stunting. Regression analysis showed that preschool children who underwent growth monitoring were less likely to be stunted (OR=0.58), while those who underwent newborn screening were less likely to be underweight (OR=0.53) and stunted (OR=0.62). On the contrary, dewormed children were more likely to be stunted (OR=1.63) and those from 4Ps households were more likely to be wasted (OR=2.24). Conclusion: There is a need to re-evaluate programme strategies to maximise the benefits provided. Programmes showing significant associations with nutritional status including immunisation, growth monitoring, deworming, household food production, and awareness and usage of iodised salt should be continued and sustained with updated policies.

The Development and Implementation of the Fast-Pace Assessment Framework and Tiered Analgesic Orders for Opioid Optimization

BackgroundWithin the context of the opioid epidemic, changes needed to be made in the prescription and administration of analgesics. The purpose of this paper is to describe the development and implementation of a project that utilized a holistic pain assessment framework and introduced new order sets to guide the integration of nonopioid, opioid, and co-analgesics in a quaternary care medical center. MethodsAn interdisciplinary team updated policies and procedures for pain assessment and opioid administration and created new analgesic order sets for both adult and pediatric patients. Following requisite approvals, these order sets were integrated into the electronic health record. Education of clinicians, patients, and caregivers was provided to facilitate implementation of these new clinical practices. ResultsPrescribers’ levels of adherence with the use of the pain order sets ranged from 80% to 90% and no adverse effects were reported. Education of nursing staff was incorporated into hospital orientation. Ongoing evaluations are providing insights into how the new policies and procedures can be optimized to ensure reliable, safe, and effective pain management. ConclusionsSince the implementation of the opioid optimization project, adherence with the tiered, multimodal approach to analgesic prescribing is high. Next steps include both qualitative and quantitative evaluations of the benefits and challenges associated with this practice change. For example, systems will be developed to monitor nurses’ adherence with the implementation of the pain order sets and the use of both pharmacologic and nonpharmacologic pain management interventions.

Sustainable Coastal Tourism Practices in Aklan: Bases for Policy Recommendations

Aklan, one of the provinces in the Philippines, is known for its beautiful white beaches. Among its municipalities, Buruanga stands out with its immaculate white sand. This study examined the current state of coastal tourism, identified challenges and opportunities, and proposed policy recommendations for the effective implementation of sustainable practices in Aklan, Philippines. The research, conducted through a quantitative descriptive correlational design, involved 30 stakeholders, including resort owners, tourists, resort workers, municipal tourism officers, and local government officials. Data were collected using a researcher-made questionnaire and interviews. Findings revealed positive implementation of sustainable practices, particularly in policies, operations and management, socio-cultural aspects, products and services, and facilities. However, challenges persisted, such as changing existing practices and waste management. Despite these challenges, opportunities existed, including existing infrastructure and collaboration between stakeholders. Recommendations emphasized the need for strengthened waste management systems, updated policies, increased awareness campaigns, and community involvement. The study underscored a commitment to sustainable practices in Buruanga's coastal areas while identifying areas for improvement. Addressing these weaknesses can leverage existing strengths, contributing to a more environmentally responsible and economically viable tourism industry. Through its findings and recommendations, this research sought to inform policymakers, stakeholders, and communities, fostering sustainable tourism development in Buruanga, Aklan, and beyond.

Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system

Abstract Objective: Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, including enhancing communication, provider engagement, accountability, and transparency in reporting to achieve long-term improvements. Design: Quality improvement with multiple levels of interventions Setting: A health system in northern Ohio with 21 affiliated hospitals across 16 counties. Patients: Adult patients admitted to the hospital between June 2020 and June 2023. Methods: A broad set of quality improvement (QI) strategies was developed by an interdisciplinary team and guided by the Fractal Management System framework to ensure accountability, communication, and alignment across teams and facilities. Key drivers were indwelling urinary catheter (IUC) alternatives, insertion, maintenance, removal, and smart diagnostics. The main outcome measures were standardized infection ratios (SIR) and standardized utilization ratio (SUR), comparing period 1 (P1, June 2020 to December 2021) and period 2 (P2, January 2022 to June 2023). Results: Enhanced communication and management played crucial roles in minimizing IUC placement. Updated policies and protocols, coupled with clear guidelines and decision support tools, facilitated effective urinary management. Performance tracking and visual management boards provided real-time insights, while collaborative efforts, including staff huddles and multidisciplinary teamwork, ensured consistent adherence to best practices. Conclusions: A systemwide QI initiative focused on enhanced communication, management, and collaboration contributed to improved SIR and reduced CAUTI rates across multiple hospitals, highlighting the impact of strong communication and proactive management in healthcare settings.

Key findings from the 2023 'ACT NOW on Global HIV Migration, Mobility and Health Equity' community forum.

Background People living with HIV continue to face laws, policies, and practices that impact their potential for travel and migration. These laws include: mandatory HIV testing and involuntary disclosure of HIV; lack of access to affordable HIV-related health care, treatment and counselling during the migration process; deportation of foreign nationals living with HIV; and restrictions on the length of stays. Methods HIV migration laws were the topic of a half-day community forum held as part of the 12th International AIDS Society Conference on HIV Science held in Brisbane, Australia, in July 2023. Over 150 delegates attended and, after a series of presentations, delegates were invited to participate in structured, facilitated conversations about issues related to policy, health and law concerning migration of people living with HIV. In this paper, we report on key themes from those discussions and identify areas for ongoing investigation. Results Advocates recommended the removal of unfair and unjust migration laws and policies that contribute to HIV stigma and discrimination; updated migration policies that reflect the current context and cost of biomedical approaches to HIV management and prevention; expanded and equitable access to HIV-related care regardless of migration or residency status; and the development of advocacy networks to promote changes to migration policies. Conclusions Laws limiting the migration of people living with HIV actively discourage individuals from seeking HIV testing, treatment and care. Ultimately, restrictive migration laws and policies undermine global efforts to end AIDS as a public health concern and to virtually eliminate HIV transmission by 2030.

Evaluation of School Wellness Policies in Low-Income California Districts After the 2016 USDA Final Rule.

Districts with federal nutrition programs must have an updated local school wellness policy (LSWP) to promote nutrition, physical activity, and student wellness. This study evaluates factors associated with LSWP quality among low-income districts. In 2018, we collected LSWPs from websites of 200 randomly selected, county-stratified, low-income-serving California public districts. Multivariable linear regression assessed associations between district characteristics, model LSWP use (national, state, none), and adoption date on policy quality. On the WellSAT 3.0 scale of 0-100, mean (95% CI) comprehensiveness was 65.0 (63.2-66.7) and strength was 37.3 (35.3-39.2). Nearly verbatim adoption of model LSWPs was high(68.5% state model, 13.0% a national model). Half were adopted before mandated updates. District size (≥1000 students) and national model LSWP adoption were associated with higher comprehensive scores. National model LSWP adoption was associated with higher strength scores in updated policies compared with those not updated. LSWPs have improved school food and activity environments, but district engagement in LSWP is low. Integration into education frameworks that reduce learning barriers could provide synergy for re-engagement. High adoption of model policies and low update compliance indicate little district engagement in LSWP. Mixed methods studies of districts with high-quality LSWP are needed.

Digital Twins and Its Security Issues and Implications

A digital twin is a digital or virtual copy of physical assets or products. It has the virtual and real world by collecting real-time data from the sensors which are installed in the devices. The collected data is either locally decentralized or centrally stored in cloud. Then the data is evaluated and simulated in virtual copy of the assets. After revising the information from stimulation the parameters are applied to real assets and we can predict current and future conditions in both design and operational environment. Also these are the next big thing in fourth industrial revolution for the development of new products and process. Because of vast amount of data used and the risk this poses to sensitive system data. To overcome these. The key enabling technology for digital twins data analytics and IoT must follow the updated security policies, and data sharing based on Distributed Ledger Technology can help to overcome the challenges in sharing data.