Flu fighters: Flu vaccine administrations in pediatric hematology oncology patients.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 131-131
Author(s):  
Mehgan Beverley ◽  
Patricia Lorenz ◽  
Joel Kaplan ◽  
Nicole Turner
Keyword(s):  
Influenza Infection ◽  
Target Population ◽  
Time Frame ◽  
Control Limit ◽  
Similar Time ◽  
Pediatric Hematology ◽  
Flow Maps ◽  
Phone Calls ◽  
Flu Vaccine ◽  
The Impact

131 Background: Influenza is a serious virus that affects millions of people every year. The CDC and AAP recommend all people starting 6 months of age get a yearly flu vaccine, especially the immunocompromised. Children receiving chemotherapy for cancer treatment are at heightened risk of severe influenza infection and resulting complications. (Goossen et al., 2013). Methods: An interdisciplinary team used the Model for Improvement with an aim statement, current and ideal process flow maps, and annotated run charts to monitor the impact of changes. Change ideas were tested via small-cycle PDSAs. Successful strategies included development of a flu form, targeting patients with pre-visit planning and phone calls, and escalation to physician intervention. Results: A p shewhart chart analyzed the percentage of target population receiving vaccines weekly. The goal was to vaccinate 95% of patients with leukemia or neuro-oncology on active chemotherapy who were older than 6 months of age without medical contraindications. At baseline, upper control limit (UCL) was 6%, mean was 2% and lower control limit (LCL) was 0%. After testing changes, the percentage of flu vaccines improved (special cause variation) to UCL 100%, mean 95%, LCL 87%. The goal was met and sustained through the end of 2018 flu season. This QI project also improved flu vaccinations given to all our patients as compared to the 2016/2017 flu season. During the 2016/2017 flu season, 295 flu vaccines were given. During the 2017/2018 flu season, 457 flu vaccines were given in a similar time frame, i.e. an increase of 155%. In addition to improving care delivered to our target population, this work facilitated greater distribution of flu vaccine to all at-risk populations in our clinic. Conclusions: This project shows a comprehensive and effective approach to reducing the risk of a serious health threat for some of our most vulnerable patients. By developing a well-defined process, standardizing messaging, and using data to inform next steps, our team surpassed benchmarks established by some of the best cancer care specialists in the country. The processes established here can be applied widely, offering hope that future flu seasons could be less devastating to vulnerable populations.

scholarly journals The Influence of Age on the Likelihood of Catheter-Free Fistula Use in Hemodialysis Patients

2019 ◽  
Vol 6 ◽  
pp. 205435811986194
Author(s):  
Farah Ladak ◽  
Pietro Ravani ◽  
Matthew J. Oliver ◽  
Fareed Kamar ◽  
Alix Clarke ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Time Frame ◽  
Health Sciences ◽  
Hemodialysis Patients ◽  
Age Group ◽  
Similar Time ◽  
Median Percentage ◽  
The Impact ◽  
Dialysis Time

Background: Clinical practice guidelines recommend arteriovenous fistulas as the preferred form of vascular access for hemodialysis. However, some studies have suggested that older age is associated with poorer fistula outcomes. Objective: We assessed the impact of age on the outcomes of fistula creation and access-related procedures. Design: This was a prospective cohort study using data collected as part of the Dialysis Measurement Analysis and Reporting (DMAR) system. Setting: Participating Canadian dialysis programs, including Southern Alberta Renal Program, Manitoba Renal Program, Sunnybrook Health Sciences Centre (Toronto, Ontario), London Health Sciences Centre (London, Ontario), and The Ottawa Hospital (Ottawa, Ontario). Patients: Incident hemodialysis patients aged 18 years and older who started dialysis between January 1, 2004, and May 31, 2012. Measurements: The primary outcome was the proportion of all first fistula attempts that resulted in catheter-free fistula use, defined as independent use of a fistula for hemodialysis (ie, no catheter in place). Secondary outcomes included the time to catheter-free fistula use among patients with a fistula creation attempt, total number of days of catheter-free fistula use, and the proportion of a patient’s hemodialysis career spent with an independently functioning fistula (ie, catheter-free fistula use). Methods: We compared patient characteristics by age group, using t tests or Wilcoxon rank sum tests, and chi-square or Fisher exact tests, as appropriate. Logistic and fractional logistic regression were used to estimate the odds of achieving catheter-free fistula use by age group and the proportion of dialysis time spent catheter-free, respectively. Results: A total of 1091 patients met our inclusion criteria (567 age ≥ 65; 524 age < 65). Only 57% of first fistula attempts resulted in catheter-free fistula use irrespective of age (adjusted odds ratio [OR]≥65vs<65: 1.01; P = .93). The median time from hemodialysis start to catheter-free use of the first fistula did not differ by age when grouped into fistulas attempted pre- and post-dialysis initiation. The adjusted rates of access-related procedures were comparable (incidence rate ratio [IRR]≥65vs<65: 0.95; P = .32). The median percentage of follow-up time spent catheter-free was similar and low in patients who attempted fistulas (<65 years: 19% vs ≥65 years: 21%; P = .85). Limitations: The relatively short follow-up time may have underestimated the benefits of fistula creation and the observational study design precludes inferences about causality. Conclusions: In our study, older patients who underwent a fistula attempt were just as likely as younger patients to achieve catheter-free fistula use, within a similar time frame, and while requiring a similar number of access procedures. However, the minority of dialysis time was spent catheter-free.

scholarly journals EFFECT OF USAGE OF DERIVATIVE FINANCIAL INSTRUMENTS ON FINANCIAL PERFORMANCE OF NON-FINANCIAL FIRMS

2018 ◽  
Vol 3 (2) ◽  
pp. 1
Author(s):  
Mercelline Nafula Waswa ◽  
Dr. Joshua Matanda Wepukhulu
Keyword(s):  
Risk Management ◽  
Financial Performance ◽  
Financial Risk ◽  
Financial Structure ◽  
Target Population ◽  
Time Frame ◽  
Annual Reports ◽  
Unique Contribution ◽  
Financial Firms ◽  
The Impact

Purpose: The purpose of this study is to examine the effect of derivative financial instrument utilization on the financial performance of non-financial firms recorded at the Nairobi Securities Exchange. The objectives that guided this study are to assess the impact of use of derivatives in risk management on financial performance of non-financial firms listed on the Nairobi Securities Exchange (NSE). Methodology: The study embraced the regression model. A census of all the 47 non-financial firms listed at the NSE as at December 2017 constituted the target population where only 11 listed non-financial firms were financial derivative instruments users. The study utilized qualitative and quantitative research techniques especially the utilization of descriptive research design. The data for this study was collected using questionnaires, audited financial statements and annual reports of individual firms for the multi year time frame covering 2013-2017 (the two years comprehensive). Results: The study discovered that greater part of the firms (66.67%) utilizes Forwards, 22.22% utilize Swaps and 11.11% utilize Futures and Options for financial risk management. From the study the outcomes were as per the following: presence of debt in the financial structure of the non-financial firms listed at the NSE does not influence its financial performance as estimated by return on assets (ROA), use of derivatives in efficiency in trading influences the financial performance of the firms, use of derivatives in price stabilization is statistically significant and utilization of derivatives in price discovery does not influence the financial performance of the firms. By and large, the performance of the recorded non-financial firms at the NSE amid the time of study was 8.13 with a standard deviation of 10.67. Unique contribution to Theory, Practice and Policy: The study recommended that firms should combine both debt and equity in their financial structure. It is therefore incumbent on firms’ managers and financial advisors to continuously study the market and advice on the appropriateness of the proportions of the various sources of finance based on market circumstances at any given time.

Addicted to PBS? CBT can fix that: commentary on improving the adoption of PBS and ABA using diffusion of innovations

2018 ◽  
Vol 23 (4) ◽  
pp. 187-191
Author(s):  
Jonathan Mason
Keyword(s):  
Diffusion Of Innovations ◽  
Design Methodology ◽  
Time Frame ◽  
Behaviour Therapy ◽  
Similar Time ◽  
Content Type ◽  
Effective Interventions ◽  
Cognitive Behaviour ◽  
Positive Behaviour Support ◽  
The Impact

Purpose The purpose of this paper is to provide a commentary to Hayward, Poed and McKay-Brown’s article by expanding upon some of the reasons for the apparent dominance of Positive Behaviour Support (PBS). Design/methodology/approach The commentary notes the rise and dominance of Cognitive behaviour therapy (CBT) over a similar time frame, and uses both this and ideas from the literature to examine the reasons for, advantages and consequences of PBS’s dominance. Findings The paper identifies three overlapping reasons for the comparable rise of PBS and CBT, and examines the impact that their dominance has had on attempts to manage quality, improve outcomes and train staff. Originality/value Establishing the reasons for the success of a theoretical approach can assist with the development of other effective interventions.

Coming-of-Age Cinema in New Zealand

2017 ◽  
Author(s):  
Alistair Fox
Keyword(s):  
Coming Of Age ◽  
Belief Systems ◽  
Time Frame ◽  
New Wave ◽  
Art Cinema ◽  
Literary Sources ◽  
French New Wave ◽  
Significant Phenomenon ◽  
The Impact ◽  
New Zealanders

This book investigates the coming-of-age genre as a significant phenomenon in New Zealand’s national cinema, tracing its development from the 1970s to the present day. A preliminary chapter identifies the characteristics of the coming-of-age film as a genre, tracing its evolution and the influence of the French New Wave and European Art Cinema, and speculating on the role of the genre in the output of national cinemas. Through case studies of fifteen significant films, including The God Boy, Sleeping Dogs, The Scarecrow, Vigil, Mauri, An Angel at My Table, Heavenly Creatures, Once Were Warriors, Rain, Whale Rider, In My Father’s Den, 50 Ways of Saying Fabulous, Boy, Mahana, and Hunt for the Wilderpeople, subsequent chapters examine thematic preoccupations of filmmakers such as the impact of repressive belief systems and social codes, the experience of cultural dislocation, the expression of a Māori perspective through an indigenous “Fourth Cinema,” bicultural relationships, and issues of sexual identity, arguing that these films provide a unique insight into the cultural formation of New Zealanders. Given that the majority of films are adaptations of literary sources, the book also explores the dialogue each film conducts with the nation’s literature, showing how the time frame of each film is updated in a way that allows these films to be considered as a register of important cultural shifts that have occurred as New Zealanders have sought to discover their emerging national identity.

The Impact of Mobile Gadget in EFL Learning: Perceptions of EFL Undergraduates

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Imam - Fauzi
Keyword(s):  
Self Report ◽  
Fourth Generation ◽  
Learning Activity ◽  
Advanced Country ◽  
Innovative Methods ◽  
Phone Calls ◽  
Teachers And Students ◽  
Efl Students ◽  
The Impact ◽  
Efl Learning

AbstractMost of young people are enthusiasticin having the most recent mobile gadgets just to boast among their peers. They likely utilize them to make phone calls, take pictures, listen to songs, watch videos, or surf the internet access for learning or just entertainment. In a technologically advanced country like Indonesia, the third and fourth generation (3G, 4G) mobile devices are available at affordable prices, and people of all streams find it necessary to own a mobile gadget for connecting and communicating.  Moreover, it has become a common trend among undergraduates to carry a mobile gadget to the classroom as well.In this paper, the researcher emphasize the potential of mobile gadgets as a learning tool for students and have incorporated them into the learning environment.The present study examines the application of mobile gadgetin EFL learning and investigates the perceptions of EFL students about mobile gadget in learning activity.  A field study was conducted on thirty undergraduatestudents majoring in accounting study Serang Raya University.  The methodology of data collection included a self-report for students and teachers’ and students’ questionnaire. Findings of the research are significant for EFL teachers and researchers for introducing innovative methods and helpful materials for the English classroom.Keywords: Mobile gadget, students’ perception, teachers’ perception..

scholarly journals Evaluation of the online-based self-help programme “Selfapy” in patients with unipolar depression: study protocol for a randomized, blinded parallel group dismantling study

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rico Krämer ◽  
Stephan Köhler
Keyword(s):  
Depressive Symptoms ◽  
Depression Scale ◽  
Drop Out ◽  
Control Group ◽  
Hamilton Depression Scale ◽  
Online Interventions ◽  
Phone Calls ◽  
Self Help ◽  
Low Threshold ◽  
The Impact

Abstract Background Patients with mild to moderate depressive symptoms can have limited access to regular treatment; to ensure appropriate care, low-threshold treatment is needed. Effective online interventions could increase the supply of low-threshold treatment. Further research is needed to evaluate the effectiveness of online interventions. This study aims to evaluate the online-based self-help programme “Selfapy” on a sample of depressive subjects and compares the impact of the programme’s unaccompanied version with its therapeutic accompanied version. Methods A sample of 400 subjects that have a mild to severe depressive episode (Becks Depression Inventory - II and Hamilton Depression Scale) will be used. Subjects are randomly assigned to immediate access to an unaccompanied course (no support from psychologist via weekly phone calls), immediate access to an accompanied course (support from a psychologist via weekly phone calls) or a waiting list control group (access to the intervention after 24 weeks). The intervention will last for a period of 12 weeks. Depressive symptoms as a primary parameter, as well as various secondary parameters, such as life satisfaction, therapeutic relationships, social activation, self-esteem, attitudes towards Internet interventions and drop-out rates, are recorded at four different points in time: at baseline (T1), 6 weeks after the start of the intervention (T2), 12 weeks after the start of the intervention (T3) and 3 months after completion of the treatment follow-up (T4). Conclusion This randomized and controlled, blinded study will make use of a “dismantled” approach to adequately compare the accompanied and unaccompanied versions of the intervention. Positive and meaningful results are expected that could influence the acceptance and implementation of online interventions. Trial registration German Clinical Trials Register DRKS00017191. Registered on 14 June 2019

scholarly journals POS1189 THE IMPACT OF TELEMEDICINE AND COVID-19 ON A TERTIARY RHEUMATOLOGY SERVICE: A RETROSPECTIVE AUDIT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 876-877
Author(s):  
W. Zhu ◽  
T. De Silva ◽  
L. Eades ◽  
S. Morton ◽  
S. Ayoub ◽  
...  
Keyword(s):  
Immunosuppressive Therapy ◽  
Univariate Analysis ◽  
Diagnostic Delay ◽  
Cohort Differences ◽  
Phone Calls ◽  
Retrospective Audit ◽  
Common Diagnosis ◽  
Significant Difference ◽  
The Impact

Background:Telemedicine was widely utilised to complement face-to-face (F2F) care in 2020 during the COVID-19 pandemic, but the impact of this on patient care is poorly understood.Objectives:To investigate the impact of telemedicine during COVID-19 on outpatient rheumatology services.Methods:We retrospectively audited patient electronic medical records from rheumatology outpatient clinics in an urban tertiary rheumatology centre between April-May 2020 (telemedicine cohort) and April-May 2019 (comparator cohort). Differences in age, sex, primary diagnosis, medications, and proportion of new/review appointments were assessed using Mann-Whitney U and Chi-square tests. Univariate analysis was used to estimate associations between telemedicine usage and the ability to assign a diagnosis in patients without a prior rheumatological diagnosis, the frequency of changes to immunosuppression, subsequent F2F review, planned admissions or procedures, follow-up phone calls, and time to next appointment.Results:3,040 outpatient appointments were audited: 1,443 from 2019 and 1,597 from 2020. There was no statistically significant difference in the age, sex, proportion of new/review appointments, or frequency of immunosuppression use between the cohorts. Inflammatory arthritis (IA) was a more common diagnosis in the 2020 cohort (35.1% vs 31%, p=0.024). 96.7% (n=1,444) of patients seen in the 2020 cohort were reviewed via telemedicine. In patients without an existing rheumatological diagnosis, the odds of making a diagnosis at the appointment were significantly lower in 2020 (28.6% vs 57.4%; OR 0.30 [95% CI 0.16-0.53]; p<0.001). Clinicians were also less likely to change immunosuppressive therapy in 2020 (22.6% vs 27.4%; OR 0.78 [95% CI 0.65-0.92]; p=0.004). This was mostly driven by less de-escalation in therapy (10% vs 12.6%; OR 0.75 [95% CI 0.59-0.95]; p=0.019) as there was no statistically significant difference in the escalation or switching of immunosuppressive therapies. There was no significant difference in frequency of follow-up phone calls, however, patients seen in 2020 required earlier follow-up appointments (p<0.001). There was also no difference in unplanned rheumatological presentations but significantly fewer planned admissions and procedures in 2020 (1% vs 2.6%, p=0.002). Appointment non-attendance reduced in 2020 to 6.5% from 10.9% in 2019 (OR 0.57 [95% CI 0.44-0.74]; p<0.001), however the odds of discharging a patient from care were significantly lower in 2020 (3.9% vs 6%; OR 0.64 [95% CI 0.46-0.89]; p=0.008), although there was no significance when patients who failed to attend were excluded. Amongst patients seen via telemedicine in 2020, a subsequent F2F appointment was required in 9.4%. The predictors of needing a F2F review were being a new patient (OR 6.28 [95% CI 4.10-9.64]; p<0.001), not having a prior rheumatological diagnosis (OR 18.43 [95% CI: 2.35-144.63]; p=0.006), or having a diagnosis of IA (OR 2.85 [95% CI: 1.40-5.80]; p=0.004) or connective tissue disease (OR 3.22 [95% CI: 1.11-9.32]; p=0.031).Conclusion:Most patients in the 2020 cohort were seen via telemedicine. Telemedicine use during the COVID-19 pandemic was associated with reduced clinic non-attendance, but with diagnostic delay, reduced likelihood of changing existing immunosuppressive therapy, earlier requirement for review, and lower likelihood of discharge. While the effects of telemedicine cannot be differentiated from changes in practice related to other aspects of the pandemic, they suggest that telemedicine may have a negative impact on the timeliness of management of rheumatology patients.Disclosure of Interests:None declared.

scholarly journals POS0774 INFLUENZA INFECTION AS A TRIGGER FOR SYSTEMIC LUPUS ERYTHEMATOSUS FLARES RESULTING IN HOSPITALIZATION

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 641.1-641
Author(s):  
Y. B. Joo ◽  
Y. J. Park
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Confidence Interval ◽  
Lupus Erythematosus ◽  
Influenza Infection ◽  
Age Groups ◽  
Case Series ◽  
Incidence Rates ◽  
Systemic Lupus ◽  
Control Interval ◽  
The Impact

Background:Infections have been associated with a higher risk of systemic lupus erythematosus (SLE) flares, but the impact of influenza infection on SLE flares has not been evaluated.Objectives:We evaluated the association between influenza infection and SLE flares resulting in hospitalization.Methods:SLE flares resulting in hospitalization and influenza cases were ascertained from the Korean national healthcare insurance database (2014-2018). We used a self-controlled case series design. We defined the risk interval as the first 7 days after the influenza index date and the control interval was defined as all other times during the observation period of each year. We estimated the incidence rates of SLE flares resulting in hospitalization during the risk interval and control interval and compared them using a Poisson regression model.Results:We identified 1,624 influenza infections among the 1,455 patients with SLE. Among those, there were 98 flares in 79 patients with SLE. The incidence ratio (IR) for flares during the risk interval as compared with the control interval was 25.75 (95% confidence interval 17.63 – 37.59). This significantly increased the IRs for flares during the risk interval in both women (IR 27.65) and men (IR 15.30), all age groups (IR 17.00 – 37.84), with and without immunosuppressive agent (IR 24.29 and 28.45, respectively), and with and without prior respiratory diseases (IR 21.86 and 26.82, respectively).Conclusion:We found significant association between influenza infection and SLE flares resulting in hospitalization. Influenza infection has to be considered as a risk factor for flares in all SLE patients regardless of age, sex, medications, and comorbidities.References:[1]Kwong, J. C. et al. Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. N Engl J Med 2018:378;345-353.Table 1.Incidence ratios for SLE flares resulting in hospitalization after influenza infectionRisk intervalIncidence ratio95% CIDuring risk interval for 7 days / control interval25.7517.63 – 37.59Days 1-3 / control interval21.8114.71 – 32.35Days 4-7 / control interval7.563.69 – 15.47SLE, systemic lupus erythematosus; CI, confidence intervalDisclosure of Interests:None declared

Big data and artificial intelligence for health system sustainability: The case of Veneto Region

2021 ◽  
pp. 31-52
Author(s):  
Grazia Dicuonzo ◽  
Francesca Donofrio ◽  
Antonio Fusco ◽  
Vittorio Dell’Atti
Keyword(s):  
Artificial Intelligence ◽  
Big Data ◽  
Healthcare System ◽  
Care Delivery ◽  
Research Question ◽  
Health Agency ◽  
Time Frame ◽  
Structured Interviews ◽  
Case Study Methodology ◽  
The Impact

This paper investigates the digitalization challenges facing the Italian healthcare system. The aim of the paper is to support healthcare organizations as they take advantage of the potential of big data and artificial intelligence (AI) to promote sustainable healthcare systems. Both the development of innovative processes in the management of health care activities and the introduction of healthcare forecasting systems are valuable resources for clinical and care activities and enable a more efficient use of inputs in essential-level care delivery. By examining an innovative project developed by the Regional Social Health Agency (ARSS) of Veneto, this study analyses the impact of big data and AI on the sustainability of a healthcare system. In order to answer the research question, we used a case study methodology. We conducted semi-structured interviews with key members of the organizational group involved in the case. The results show that the implementation of AI algorithms based on big data in healthcare both improves the interpretation and processing of data, and reduces the time frame necessary for clinical processes, having a positive effect on sustainability.

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