Enhancing Chemotherapy Capabilities in Rural Hospitals: Implementation of a Telechemotherapy Model (QReCS) in North Queensland, Australia

Introduction: The Queensland Remote Chemotherapy Supervision (QReCS) model enables rural nurses to administer chemotherapy in smaller rural towns under supervision by health professionals from larger centers using telehealth. Its implementation began in North Queensland, Australia (population, 650,000), in 2014 between two regional cancer centers (Townsville and Cairns as primary sites) and six rural sites (125 to 1,000 kilometers from primary sites). Our study examined the implementation processes, feasibility, and safety of this model. Methods: Details of implementation and patients’ clinical details for the period of 2014 to 2016 for descriptive analysis were extracted from telechemotherapy project notes and oncology information systems of North Queensland, respectively. Results: After a successful pilot study in Townsville Cancer Centre, statewide rural and cancer networks of Queensland Health, in collaboration with clinicians and managers across the state of Queensland, developed the QReCS model and a guide for operationalizing it. QReCS was implemented at six sites from 2014 to 2016. Main enablers across North Queensland included collaboration among clinicians and managers, availability of common electronic medical records, funding from Queensland Health, and installation of telehealth infrastructure by statewide telehealth services. Main barriers included turnover of senior management and nursing staff at two rural towns. Sixty-two patients received 327 cycles of low- to medium-risk chemotherapy agents. Rates of treatment delays, adverse events, and hospital admissions were similar to those in face-to-face care. Conclusion: Implementation of the QReCS model across a large geographic region is feasible with acceptable safety profiles. Leadership by and collaboration among clinicians and managers, adequacy of resources and common governance are key enablers.

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Sex disparities in cardiovascular health metrics among rural-dwelling older adults in China: a population-based study

BMC Geriatrics ◽

10.1186/s12877-021-02116-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiaolei Han ◽

Ziying Jiang ◽

Yuanjing Li ◽

Yongxiang Wang ◽

Yajun Liang ◽

...

Keyword(s):

Older Adults ◽

Rural Communities ◽

Cardiovascular Health ◽

Rural China ◽

Descriptive Analysis ◽

Population Based ◽

Baseline Survey ◽

Chinese Older Adults ◽

Face To Face ◽

Sex Disparities

Abstract Background Cardiovascular health (CVH) metrics among Chinese older adults are poorly understood. We investigated sex disparities in CVH metrics and their management among rural-dwelling older adults in China. Methods This community-based study included 5026 participants (age ≥ 65 years; 57.2% women) in the baseline survey of a multimodal intervention study in rural China. In March–September 2018, data were collected through face-to-face interviews, clinical examinations, and laboratory tests. We defined six CVH metrics (three behavioral factors—smoking, body mass index, and physical activity; three biological factors—blood pressure, total cholesterol, and blood glucose) following the modified American Heart Association’s recommendations. We performed descriptive analysis separately for men and women. Results Of all participants, only 0.8% achieved ideal levels in all six CVH metrics. Men were more likely than women to have ideal levels in all CVH metrics but smoking. Women had higher prevalence of ideal global (9.7% vs. 7.8%) and behavioral (18.3% vs. 9.5%) CVH metrics (p < 0.001), whereas men had higher prevalence of ideal biological CVH metrics (5.4% vs. 3.5%, p < 0.001). The prevalence of ideal global and behavioral CVH metrics increased with age in both women and men (p for trend< 0.001). Women were more likely to be aware of their hypertension and diabetes, and to receive antihypertensive treatment, while men were more likely to achieve the goal of high cholesterol treatment (p < 0.05). Conclusions The CVH metrics among older adults living in the rural communities in China are characterized by an extremely low proportion of optimal global CVH metrics and distinct sex differences, alongside poor management of major biological risk factors. Trial registration ChiCTR1800017758 (Aug 13, 2018).

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The association between opening a short stay paediatric assessment unit and trends in short stay hospital admissions

BMC Health Services Research ◽

10.1186/s12913-021-06541-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Steve Turner ◽

Edwin-Amalraj Raja

Keyword(s):

Hospital Admissions ◽

Geographic Region ◽

Health Board ◽

Short Stay ◽

Emergency Admissions ◽

Inpatient Ward ◽

Assessment Unit ◽

Stay Hospital ◽

Clinical Referral ◽

Health Boards

Abstract Background Many inpatient facilities in Scotland have opened short stay paediatric assessment units (SSPAU) which are clinical areas separate from the usual inpatient ward area and these are where most short stay (also called zero day) admissions are accommodated. Here we describe the effect of opening short stay paediatric assessment units (SSPAU) on the proportion of zero day admissions relative to all emergency admissions. Methods Details of all emergency medical paediatric admissions to Scottish hospitals between 2000 and 2013 were obtained, including the number of zero day admissions per month and health board (i.e. geographic region). The month and year that an SSPAU opened in each health board was provided by local clinicians. Results SSPAUs opened in 7 health boards, between 2004 and 2012. Health boards with an SSPAU had a slower rise in zero day admissions compared to those without SSPAU (0.6% per month [95% CI 0.04, 0.09]. Across all 7 health boards, opening an SSPAU was associated with a 13% [95% CI 10, 15] increase in the proportion of zero day admissions. When considered individually, zero day admissions rose in four health boards after their SSPAU opened, were unchanged in one and fell in two health boards. Independent of SSPAUs opening, there was an increase in the proportion of all admissions which were zero day admissions (0.1% per month), and this accelerated after SSPAUs opened. Conclusion Opening an SSPAU has heterogeneous outcomes on the proportion of zero day admissions in different settings. Zero day admissions could be reduced in some health boards by understanding differences in clinical referral pathways between health boards with contrasting trends in zero day admissions after their SSPAU opens.

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An Ecological Exploration of Facilitators to Participation in a Mosque-Based Physical Activity Program for South Asian Muslim Women

Journal of Physical Activity and Health ◽

10.1123/jpah.2017-0312 ◽

2018 ◽

Vol 15 (9) ◽

pp. 671-678 ◽

Cited By ~ 3

Author(s):

Munira Abdulwasi ◽

Meena Bhardwaj ◽

Yuka Nakamura ◽

Maha Zawi ◽

Jennifer Price ◽

...

Keyword(s):

Physical Activity ◽

South Asian ◽

Local Community ◽

Physical Activity Intervention ◽

Descriptive Analysis ◽

Community Setting ◽

Muslim Women ◽

Face To Face ◽

Physical Activity Interventions ◽

Semistructured Interviews

Background: This descriptive qualitative study informed by an ecological framework explored factors influencing South Asian Muslim women’s decisions to participate in a mosque-based physical activity intervention.Methods: Individual, face-to-face, semistructured interviews were conducted in English, Hindi, or Urdu with 12 South Asian Muslim women at their home or mosque in Ontario, Canada. All interviews were audio-recorded, transcribed verbatim and managed, sorted, and analyzed for themes through a process of descriptive analysis.Results: The participants described as follows: (1) intrapersonal facilitators, which included their feelings, beliefs, and motivations to continue with this intervention; (2) interpersonal facilitators detailing the support that they had received from others during the intervention; and (3) environmental facilitators, which highlighted convenience and access to physical activity opportunities in a local community setting.Conclusion: This intervention displayed how South Asian Muslim women were motivated to continue with the mosque-based physical activity intervention due to interpersonal, intrapersonal, and environmental facilitators. The findings can be used to increase further understanding of how mosques may provide culturally and religiously sensitive contexts for physical activity interventions for South Asian Muslim women.

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Algorithms for Individual Prediction of COVID-19 infection and Hospitalization among Symptomatic patients based on health data (Preprint)

10.2196/preprints.29504 ◽

2021 ◽

Author(s):

Rossella Murtas ◽

Nuccia Morici ◽

Chiara Cogliati ◽

Massimo Puoti ◽

Barbara Omazzi ◽

...

Keyword(s):

High Risk ◽

Prediction Models ◽

Hospital Admissions ◽

Health Data ◽

Low Risk ◽

Risk Prediction Models ◽

Predictive Algorithms ◽

Medium Risk ◽

Risk Patients ◽

At Home

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has generated a huge strain on the health care system worldwide. The metropolitan area of Milan, Italy was one of the most hit area in the world. OBJECTIVE Robust risk prediction models are needed to stratify individual patient risk for public health purposes METHODS Two predictive algorithms were implemented in order to foresee the probability of being a COVID-19 patient and the risk of being hospitalized. The predictive model for COVID-19 positivity was developed in 61.956 symptomatic patients, whereas the model for COVID-19 hospitalization was developed in 36.834 COVID-19 positive patients. Exposures considered were age, gender, comorbidities and symptoms associated with COVID-19 (vomiting, cough, fever, diarrhoea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnoea). RESULTS The predictive models showed a good fit for predicting COVID-19 disease [AUC 72.6% (95% CI 71.6%-73.5%)] and hospitalization [AUC 79.8% (95% CI 78.6%-81%)]. Using these results, 118,804 patients with COVID-19 from October 25 to December 11, 2020 were stratified into low, medium and high risk for COVID-19 severity. Among the overall population, 67.030 (56%) were classified as low-risk, 43.886 (37%) medium-risk, and 7.888 (7%) high-risk, with 89% of the overall population being assisted at home, 9% hospitalized, and 2% dead. Among those assisted at home, most people (60%) were classified as low risk, whereas only 4% were classified at high risk. According to ordinal logistic regression, the OR of being hospitalised or dead was 5.0 (95% CI 4.6-5.4) in high-risk patients and 2.7 (95% CI 2.6-2.9) in medium-risk patients, as compared to low-risk patients. CONCLUSIONS A simple monitoring system, based on primary care datasets with linkage to COVID-19 testing results, hospital admissions data and death records may assist in proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic.

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Analisis Hukum Islam dan Undang-Undang No. 11 Tahun 2008 tentang Informasi dan Transaksi Elektronik terhadap Jual Beli Data Supplier di Agen Fashion

Prosiding Hukum Ekonomi Syariah ◽

10.29313/syariah.v0i0.20536 ◽

2020 ◽

pp. 75

Author(s):

Nur'aeni Nasifah ◽

Siska Lis Sulistiani ◽

Yayat Rahmat Hidayat

Keyword(s):

Data Collection ◽

Qualitative Method ◽

Islamic Law ◽

Descriptive Analysis ◽

Secondary Data ◽

Point Of View ◽

Supplementary Data ◽

Literature Study ◽

Face To Face

Abstract. Sale and purchase is transaction that often done by individual or group because there is a transfer of ownership between goods and assets. In practice, sale and purchase is not only done by face to face but also can be done online, as in the case of the sale and purchase of suppliers data at Agen Fashion. This study aims to find out how the transaction practice is and how Islamic law and ITE Law point of view are, whether it is accordance to the laws or not. This research uses qualitative method with normative juridical approach and literature study. The main sources in this study are secondary data that support this research, such as Alquran, Hadith, and the ITE Law. The interviews as data collection techniques are conducted as supplementary data. The analytical method used is descriptive analysis. The results of this study are the transaction is not accordance with the terms of sale and purchase in Islamic law because there is a lack of clarity (gharar) on the quality of the object and is not accordance as well as the clause no. 9 of the ITE Law because the seller did not explain the object completely.Keywords: Sale and Purchase, Islamic Law, ITE Law, GhararAbstrak. Jual beli merupakan bentuk transaksi yang sering dilakukan oleh tiap individu atau kelompok karena dalam jual beli terdapat perpindahan kepemilikan antara barang dan harta untuk memenuhi kebutuhan hidup. Pada praktiknya, jual beli tidak hanya dilakukan secara bertatap muka melainkan dapat dilakukan secara online, seperti halnya pada jual beli data supplier di Agen Fashion. Penelitian ini bertujuan untuk mengetahui bagaimana praktik jual beli data supplier di Agen Fashion serta bagaimana hukum Islam dan Undang-Undang No. 11 Tahun 2008 Tentang Informasi dan Transaksi Elektronik memandang praktik jual beli data supplier tersebut, apakah telah sesuai dengan hukum yang menjadi pisau analisis dalam penelitian ini atau belum. Penelitian ini menggunakan metode kualitatif dengan pendekatan yuridis normatif dan studi kepustakaan. Sumber utama dalam penelitian ini adalah data sekunder yang mendukung penelitian ini, yaitu Alquran, Hadis, dan UU ITE. Sedangkan teknik pengumpulan data berupa wawancara dilakukan sebagai data pelengkap. Metode analisis yang digunakan yaitu descriptive analysis. Hasil dari penelitian ini adalah transaksi yang terjadi di Agen Fashion tidak sesuai dengan syarat jual beli dalam hukum Islam karena terdapat ketidakjelasan (gharar) pada kualitas objek transaksi, dan tidak sesuai dengan Pasal 9 dalam UU ITE karena pelaku usaha tidak menjelaskan secara lengkap terkait objek yang ditawarkan.Kata Kunci: Jual Beli, Hukum Islam, UU ITE, Gharar

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A simple descriptive analysis of hospital admissions’ progress: a case study of the Greatest Public Gene- ral Hospital, Athens, Greece

Journal of Hospital Administration ◽

10.5430/jha.v1n1p36 ◽

2012 ◽

Vol 1 (1) ◽

pp. 36 ◽

Cited By ~ 1

Author(s):

Zoe Boutsioli

Keyword(s):

Public Hospital ◽

Hospital Admissions ◽

Descriptive Analysis ◽

Total Hospital ◽

Emergency Admissions ◽

Time Period ◽

It Department ◽

The Mean ◽

In The Beginning

This paper studies the progress of hospital admissions over the time period 1995-2005 for the largest Greek general public hospital. Daily admissions data, disaggregated into elective and emergency were collected from the IT Department of the hospital. Great seasonality for hospital admissions was found. They reduce during weekends, the summer months and official holidays. Emergency admissions are at their peak in the beginning of the week and decline afterwards. During weekends, emergency admissions decrease by 25%. The majority of hospital elective admissions enter into the hospital from Monday to Thursday. During Friday and weekends, elective hospital admissions fall sharply, by 63%. However, on Sunday, they slightly increase. The mean number of total hospital admissions increased by 17% from 1995 to 2005. This increase in total admissions results from the significant increase of elective admissions (by 56%) and not from the emergency admissions that fell by 17%.

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P1747Reducing the delay from first medical contact to reperfusion in patients with acute myocardial infarction in metropolitan and adjacent rural areas: data from a regional myocardial infarction registry

European Heart Journal ◽

10.1093/eurheartj/ehz748.0501 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Stockburger ◽

L Bruch ◽

I Jacob ◽

A Kuehne ◽

H H Minden ◽

...

Keyword(s):

Myocardial Infarction ◽

Symptom Onset ◽

Rural Areas ◽

Intervention Program ◽

Hospital Treatment ◽

Optimal Care ◽

Treatment Delays ◽

Learning Platform ◽

Rural Sites ◽

The City

Abstract Background Time from symptom onset to reperfusion in STEMI patients has been described to depend on a fast and valid pre-hospital STEMI diagnosis which not only decreases pre-hospital, but also in-hospital treatment delays. A publicly funded, prospective joint intervention program (QS-Notfall) has been initiated within our regional myocardial infarction (MI) registry (B2HIR) between hospitals and emergency medical services (EMS). The objective of the program is to reduce care delays of MI patients by supporting emergency care personnel in diagnosing STEMI trough real-time telemedical ECG counselling and by introducing a respective e-learning platform: “STEMI recognition made easy!” Methods Comprehensive baseline data on pre-hospital and in-hospital care have been collected from EMS and hospital records of all 1927 STEMI diagnosed patients with symptom onset <24 hours at 24 hospitals (with metropolitan and rural location) in 2016. The dataset reported here delineates the situation before the implementation of systematic ECG-related interventions. Results Pre-hospital phase: Mode of hospital admission of STEMI patients comprised physician-escorted EMS (60%), EMS w/o an escorting physician (10%) in the city, referral by a primary care physician (10%), and self-presentation to the emergency department (14%). Some patients were primarily admitted to a non-PCI-capable hospital and underwent secondary transfer to a PCI-capable hospital. The respective percentages were found to differ between the metropolitan (4%) and rural areas (17%), Treatment delays Time from symptom onset to arrival of the EMS took 33min (median) in the city and 38 min in rural areas. Time between EMS arrival and ECG recording was 16 min and did not differ between metropolitan and rural sites. The delay from ECG recording to arrival at the hospital was 32 min in the city and 44 min at rural sites. Door to balloon time was similar (63 min) at both regions. Time delay from symptom onset to reperfusion for STEMI patients without physician escorted EMS was up to 370 min and differed according to the admission mode. Shortest care Patients, who alarmed the EMS and were cared for by physician escorted EMS, were brought to a PCI-capable hospital, and were directly admitted to the cath-lab, bypassing the emergency room, attained a delay from symptom onset to ECG recording of 48 min in the city and 37 min at rural areas. The delay from ECG recording to reperfusion was 67 min at urban sites and 77 min at rural sites in these fastest-treated patients. At metropolitan and rural sites 18,5% and 11% of patients belonged to this group, respectively. Conclusion This pre-interventional baseline dataset shows that guideline-prescribed care delays are attainable for patients with acute MI. But the proportion of patients with optimal care delays is small and needs to be increased considerably, which is the objective of our ongoing joint intervention QS-Notfall program. Acknowledgement/Funding Innovation Fonds, Ministry of Health, Germany

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Impact of multiple concurrent central lines on central-line–associated bloodstream infection rates

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.180 ◽

2019 ◽

Vol 40 (9) ◽

pp. 1019-1023 ◽

Cited By ~ 2

Author(s):

Jesse Couk ◽

Sheri Chernetsky Tejedor ◽

James P. Steinberg ◽

Chad Robichaux ◽

Jesse T. Jacob

Keyword(s):

Bloodstream Infection ◽

Hospital Admissions ◽

Pay For Performance ◽

Descriptive Analysis ◽

Cohort Analysis ◽

Severity Of Illness ◽

Central Line ◽

Central Lines ◽

Academic Medical ◽

Retrospective Cohort Analysis

AbstractBackground:The current methodology for calculating central-line–associated bloodstream infection (CLABSI) rates, used for pay-for-performance measures, does not account for multiple concurrent central lines.Objective:To compare CLABSI rates using standard National Healthcare Safety Network (NHSN) denominators to rates accounting for multiple concurrent central lines.Design:Descriptive analysis and retrospective cohort analysis.Methods:We identified all adult patients with central lines at 2 academic medical centers over an 18-month period. CLABSI rates were calculated for intensive care units (ICUs) and non-ICUs using the standard NHSN methodology and denominator (a patient could only have 1 central-line day for a given patient day) and a modified denominator (number of central lines in 1 patient in 1 day count as number of line days). We also compared characteristics of patients with and without multiple concurrent central lines.Results:Among 18,521 hospital admissions, there were 156,574 central-line days and 239 CLABSIs (ICU, 105; non-ICU, 134). Our modified denominator reduced CLABSI rates by 25% in ICUs (1.95 vs 1.47 per 1,000 line days) and 6% (1.30 vs 1.22 per 1,000 line days) in non-ICUs. Patients with multiple concurrent central lines were more likely to be in an ICU, to have a longer admission, to have a dialysis catheter, and to have a CLABSI.Conclusions:Using the number of central lines as the denominator decreased CLABSI rates in ICUs by 25%. The presence of multiple concurrent central lines may be a marker of severity of illness. The risk of CLABSI per lumen of a central line is similar in ICUs compared to wards.

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Practice Patterns of Dentist Anesthesiologists in North America

Anesthesia Progress ◽

10.2344/anpr-64-04-11 ◽

2018 ◽

Vol 65 (1) ◽

pp. 9-15 ◽

Cited By ~ 1

Author(s):

Andrew S. Young ◽

Michael W. Fischer ◽

Nicholas S. Lang ◽

Matthew R. Cooke

Keyword(s):

North America ◽

Practice Patterns ◽

Descriptive Analysis ◽

Maxillofacial Surgery ◽

Pediatric Dentistry ◽

Geographic Region ◽

Oral And Maxillofacial Surgery ◽

Total Response Rate ◽

Multiple Regions ◽

American Society

This study provides trends in the discipline of dental anesthesiology. A questionnaire-based survey was sent to 338 members of the American Society of Dentist Anesthesiologists to evaluate practice patterns. One focus of the study was modality of sedation/anesthesia used for dentistry in North America. Age, gender, years in practice, and geographic region of practice were also obtained. Data gathered from the returned questionnaires were entered into an Excel spreadsheet and then imported into JMP Statistical Discovery Software (v12.2 Pro) for descriptive analysis. A total of 112 surveys were completed electronically and 102 surveys were returned via post, for a total response rate of 63.3% (N = 214). Data from this survey suggested a wide variation of therapeutic practices among dentist anesthesiologists in North America. Of the surveyed dentist anesthesiologists, 58.7% (SE = 4.2%) practice as mobile providers, 32.2% (SE = 3.1%) provide care in an academic environment, and 27.7% (SE = 2.8%) function as operator/anesthetists. The majority of anesthesia is provided for pediatric dentistry (47.0%, SE = 4.2%), oral and maxillofacial surgery (18.5%, SE = 3.9%), and special needs (16.7%, SE = 3.6%). Open-airway (58.7%, SE = 5.5%) sedation/anesthesia was the preferred modality of delivery, compared with the use of advanced airway (41.3%, SE = 4.6%). The demographics show diverse practice patterns of dentist anesthesiologists in multiple regions of the continent. Despite concerns regarding specialty recognition, reimbursement difficulties, and competition from alternative anesthesia providers, the overall perceptions of dentist anesthesiologists and the future of the field seem largely favorable.

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