scholarly journals Mass food challenges in a vacant COVID-19 stepdown facility: exceptional opportunity provides a model for the future

2021 ◽  
Author(s):  
Aideen Byrne ◽  
Juan Trujillo ◽  
John Fitzsimons ◽  
Muhammad Tariq ◽  
Robert Ghent ◽  
...  
Keyword(s):  
Healthcare Delivery ◽  
Food Challenge ◽  
Waiting List ◽  
Resuscitation Room ◽  
Clinical Nurse Specialists ◽  
Base Hospital ◽  
Key Stakeholders ◽  
Advanced Airway ◽  
Food Challenges ◽  
Conference Centre

Background: Internationally, the COVID-19 pandemic severely curtailed access to hospital facilities for those awaiting elective/semi elective procedures. For allergic children in Ireland, already waiting up to 4yr for an elective oral food challenge (OFC), the restrictions signified indefinite delay. At the time of the initiative there were approx 900 children on the Chidren’s Health Ireland(CHI) waiting list. In July 2020, a project was facilitated by short term(6wk) access to an empty COVID stepdown facility built, in a hotel conference centre, commandeered by the Health Service Executive Ireland(HSE). The aim was to the achieve rapid rollout of an off-site OFC service, delivering high throughput of long waiting patients, while aligning with hospital existing policies and quality standards, international allergy guidelines and national social distancing standards. Methods: The working group engaged key stakeholders to rapidly develop an offsite OFC facility. Consultant Paediatric Allergists, Consultant Paediatricians, trainees and Allergy Clinical Nurse Specialists were seconded from other duties. The facility was already equipped with hospital beds, bedside monitors(BP, Pulse, Oxygen saturation) bedside oxygen. All medication and supplies had to be brought from the base hospital. Daily onsite consultant anaesthetic cover was resourced and a resuscitation room equipped. Standardised food challenge protocols were created. Access to onsite hotel chef facilitated food preparation. A risk register was established. Results: After 6wks planning, the remote centre became operational on 7/9/20, with the capacity of 27 OFC/day. 474 challenges were commenced, 465 (98%) were completed, 9(2%) were inconclusive. 135(29.03%) OFC were positive, 25(5%) causing anaphylaxis. No child required advanced airway intervention. 8 children were transferred to the base hospital. The CHI allergy waiting list was reduced by almost 60% in only 24 days. Conclusions: OFCs remain a vital tool in the care of allergic children, with their cost saving and quality of life benefits negatively affected by delay in their delivery. This project has shown it is possible to have huge impacts on a waiting list efficiently, effectively and safely with good planning and staff buy in – even in a pandemic. Adoption of new, flexible and efficient models of service delivery will be important for healthcare delivery in the post-COVID-19 era.

The Food Challenge Risk Index: Predicting Positive Open Food Challenges to Milk, Egg, and Peanuts in Children

2005 ◽  
Vol 18 (2) ◽  
pp. 68-76 ◽  
Author(s):  
Shannon Kearney ◽  
Howard Israel ◽  
Kathleen Ververeli ◽  
Sharon Kimmel ◽  
Bernard Silverman ◽  
...  
Keyword(s):  
Risk Index ◽  
Food Challenge ◽  
Food Challenges

scholarly journals 299. “Where the Rubber Meets the Road”: Stakeholders’ Perspectives about the Current State of HCV Care Delivery in Massachusetts Jails

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S161-S162
Author(s):  
Alysse G Wurcel ◽  
Jessica Reyes ◽  
Julia Zubiago ◽  
Deirdre Burke ◽  
Tom Concannon ◽  
...  
Keyword(s):  
Public Health ◽  
Care Delivery ◽  
Mutual Recognition ◽  
Healthcare Delivery ◽  
Hiv Care ◽  
Structured Interviews ◽  
The Road ◽  
Transient Nature ◽  
Purposeful Sampling ◽  
Key Stakeholders

Abstract Background HCV is highly prevalent in criminal-justice involved populations (CJIP). Nationally, the operationalization of guideline-driven HCV care (including testing and treatment) for CJIP has been challenging, prompting this study to understand barriers and facilitators. Methods We used purposeful sampling strategies to recruit key stakeholders including people who are incarcerated, clinicians providing care in jail, clinicians providing care outside of jail, corrections administrators, and representatives of industry, public health and public policy. Semi-structured interviews were performed in Spanish or English, based on preference of participant. Written notes were used to capture details from interviews in jails and interviews outside of jail were recorded. People interviewed outside of jail were offered a stipend. Interviews were coded and analyzed with a compare and consensus approach. Results Of 120 people, 49 (41%) people agreed to be interviewed in each of the stakeholder categories including 21 men who were incarcerated (mean age 32 [IQR 25, 39], 60% non-White). Barriers to HCV care delivery included (1) Fragmented healthcare delivery because of transient nature of CJIP (2) Frustration and disempowerment experienced by people incarcerated in jail and (3) Heterogeneous views on stakeholders responsible for providing and financing HCV care in jails. Facilitators to HCV care delivery included (1) Incarcerated population’s interested in HCV care for public and personal health and (2) An existing strong public health infrastructure in place supporting HIV care delivery. Conclusion Understanding various stakeholders’ views of barriers to HCV care in jails is a necessary first step to building improved care pathways. Mutual recognition may help to focus limited administrative and fiscal resources on HCV care for this transient population. Disclosures All authors: No reported disclosures.

scholarly journals Home care workers caring for adults with heart failure need better access to training and technology: A role for implementation science

2020 ◽  
Vol 4 (3) ◽  
pp. 224-228 ◽  
Author(s):  
Madeline R. Sterling ◽  
Nicola Dell ◽  
Emily Tseng ◽  
Fabian Okeke ◽  
Jacklyn Cho ◽  
...  
Keyword(s):  
Heart Failure ◽  
Home Care ◽  
Implementation Science ◽  
Care Home ◽  
Healthcare Delivery ◽  
Home Healthcare ◽  
Healthcare Team ◽  
Key Stakeholders ◽  
Care Workers ◽  
Home Care Workers

AbstractAlthough highly involved in heart failure (HF) patients’ care, home care workers (HCWs) lack HF training and are poorly integrated into the healthcare team. For its potential to address these challenges, we examined the role of technology among HCWs caring for HF patients. We conducted 38 interviews with key stakeholders. Overall, four themes emerged. Participants reported that technology is critical for HF care, but existing systems are outdated and ineffective. HCWs also have limited access to electronic resources. Technology, training, and principles of implementation science can be leveraged to improve HCWs’ experience in caring for HF patients and home healthcare delivery.

scholarly journals Oral food challenge to wheat: a near-fatal anaphylaxis and review of 93 food challenges in children

2013 ◽  
Vol 6 ◽  
pp. 14 ◽  
Author(s):  
Antonella Cianferoni ◽  
Karishma Khullar ◽  
Rushani Saltzman ◽  
Joel Fiedler ◽  
Jackie P Garrett ◽  
...  
Keyword(s):  
Food Challenge ◽  
Oral Food Challenge ◽  
Food Challenges ◽  
Fatal Anaphylaxis

scholarly journals Detection of Salivary Tryptase Levels in Children following Oral Food Challenges

2021 ◽  
pp. 1-4
Author(s):  
Wouter W. de Weger ◽  
Vibeke M. Bruinenberg ◽  
Evelien M. van der Lek ◽  
Jeroen H. Gerrits ◽  
Lidy van Lente ◽  
...  
Keyword(s):  
Food Allergy ◽  
Limit Of Detection ◽  
Food Challenge ◽  
Oral Food Challenge ◽  
Potential Association ◽  
The Mean ◽  
Food Challenges ◽  
Assay Precision ◽  
Objective Marker ◽  
Time Point

<b><i>Background:</i></b> Oral food challenge (OFC) is commonly used to diagnose food allergy. This test is time and resource intensive, and conclusions are not always unequivocal as this relies on the interpretation of symptoms. Therefore, an objective marker would improve the accuracy of the diagnostic workup of food allergy. <b><i>Objectives:</i></b> The aim of this study was to investigate whether tryptase can be detected in saliva of children following OFC. <b><i>Method:</i></b> Children from 3 to 18 years of age were eligible for inclusion if an OFC for peanut or tree nut had been recommended. Saliva samples were collected prior to the first dose and 5, 10, and 15 min following the last administered dose during OFC. Assay precision, spike-and-recovery, and assessment of lower limit of detection of the tryptase immunoassay were examined before analysis of tryptase in saliva was performed. <b><i>Results:</i></b> A total of 30 children were included (median age 8 years, 63.3% male, 53.3% positive OFC outcome). Tryptase was detected in saliva samples. The mean of the change in baseline tryptase value to each saliva collecting time point was significantly different in patients with a positive OFC outcome compared to a negative outcome (<i>p</i> &#x3c; 0.01). <b><i>Conclusions:</i></b> This study showed that tryptase can be detected in saliva of children following OFC. Increased levels of tryptase compared to baseline were found if the OFC outcome was positive, suggesting that measuring tryptase in saliva may be useful in the diagnosis of food allergy. Further research is needed to evaluate the potential association between tryptase levels and symptoms.

Use of emergency backup resources during open food challenges at a pediatric tertiary care center

2020 ◽  
Author(s):  
Samantha Knox ◽  
Jaclyn Bjelac ◽  
Wei Liu ◽  
Brian Schroer
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Diagnostic Testing ◽  
Cleveland Clinic ◽  
Food Challenge ◽  
Patients Âgés ◽  
History Of ◽  
Children And Young Adults ◽  
Food Challenges ◽  
Grade 3

Background: Oral food challenge (OFC) remains the criterion standard diagnostic procedure for food allergy. Althoughthe need for OFCs has increased, some allergists may not perform them due to the risk for adverse events and lack of backupresources.Objective: The study aimed to elucidate the frequency of reactions in which emergency backup resources were used andreported on various challenge outcomes at a tertiary pediatric hospital.Methods: We retrospectively reviewed children and young adults (ages, 0–21 years) who completed OFCs in 2013–2018 at Cleveland Clinic Children’s Hospital. Demographics, atopic history, culprit food, reaction history, and diagnostic testing as well as challenge details and outcomes were collected and analyzed.Results: A total of 1269 challenges of 812 unique patients ages 5 months to 21 years were reviewed. More than half of challenges were performed in patients with a history of a reaction and positive testing result before challenge. The foods with the highest proportion of allergic outcomes were egg, sesame, and baked egg. More than one-third of challenge reactions were grade 3 or 4 anaphylaxis when using a food-induced anaphylaxis grading scale. Epinephrine was used for reactions in 7.2% of all challenges. Reactions in five challenges (0.4%) prompted utilization of backup emergency resources.Conclusion: On review of nearly 1300 OFCs, emergency backup resources were rarely used, despite a large proportion ofmoderate-to-severe reactions. The need for backup resources during food challenges is rare, which suggests that most typicalallergy offices are able to treat OFC reactions.

An Online Dual-Certification Program in Advanced Practice Nursing and Nursing Education

2008 ◽  
Vol 19 (1) ◽  
pp. 59-65
Author(s):  
Arleen M. Stahl ◽  
Margaret L. Lewandowski ◽  
Maria A. Connolly
Keyword(s):  
Nursing Education ◽  
Nurse Educators ◽  
Healthcare Delivery ◽  
Advanced Practice Nursing ◽  
Full Time ◽  
Certification Program ◽  
Clinical Nurse ◽  
Clinical Nurse Specialists ◽  
Dual Certification ◽  
Faculty Shortages

Educating nurses for the healthcare delivery workforce is stymied as qualified applicants to nursing programs are being turned away. Although applications to baccalaureate programs have increased, between 41 683 and 147 000 undergraduate and graduate applicants were turned away from nursing education programs in 2005 due largely to shortages of nursing faculty. In this article, the evidence-based rationale for the development of a dual-certification program for the preparation of clinical nurse specialists and nurse educators is described. Because faculty shortages are nationwide, we developed the program to be delivered, in its entirety, online. Standardized data collection methods for evaluating student progress and their achievement of competencies expected of clinical nurse specialists and nurse educators are provided. The program may be a model for preparing clinically competent nurse educators who prefer practice settings to full-time faculty positions.

Oral food challenges in clinical practice: a missing element of food allergy diagnosis in Russia

2021 ◽  
Vol 17 (4) ◽  
pp. 19-29
Author(s):  
Daria M. Levina ◽  
Ilya A. Korsunskiy ◽  
Daniel B. Munblit
Keyword(s):  
Food Allergy ◽  
Russian Federation ◽  
Food Challenge ◽  
Clinical History ◽  
Allergy Diagnosis ◽  
Laboratory Test Results ◽  
The World ◽  
Life Threatening ◽  
Food Challenges ◽  
Food Allergy Diagnosis

Food allergy is one of the most prevalent allergic conditions, causing reduction in patient quality of life. It is linked with high levels of anxiety due to potential life-threatening reactions, and high economic burden for a healthcare system. Food allergy affects approximately 5 to 10% of children around the world. In Russian Federation the diagnosis of food allergy is primarily based on clinical history, laboratory test results, examination and elimination of suspected food. Meanwhile oral food challenge (OFC) is considered a gold standard of food allergy diagnosis by most of professional bodies nationally and internationally. OFC is a diagnostic procedure involving administration of a causative allergen in gradually increasing amount under a close medical supervision. The method is safe, highly specific and sensitive and is widely used around the world for more than 45 years. The main goals of OFC include food allergy diagnosis and presence of tolerance evaluation, which may result in diet expansion. OFC may also help establishing both, reaction severity and dose needed to elicit reaction, which may further assist with alleviation of patients anxiety. In this paper we discuss existing approaches to the diagnosis of food allergy in Russian Federation and review available recommendations on OFC outlined in international guidelines.

scholarly journals Development of Family Medicine training in Botswana: Views of key stakeholders in Ngamiland

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Radiance M. Ogundipe ◽  
Robert Mash
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Healthcare Delivery ◽  
Family Physicians ◽  
Training Programme ◽  
Holistic Health ◽  
District Health ◽  
Key Stakeholders ◽  
Quality Of Primary Care ◽  
Personal Welfare

Background: Family Medicine training commenced in Botswana in 2011, and Maun was one of the two sites chosen as a training complex. If it is to be successful there has to be investment in the training programme by all stakeholders in healthcare delivery in the district.Aim: The aim of the study was to explore the attitudes of stakeholders to initiation of Family Medicine training and their perspectives on the future roles of family physicians in Ngami district, Botswana.Setting: Maun and the surrounding Ngami subdistrict of Botswana.Methods: Thirteen in-depth interviews were conducted with purposively selected key stakeholders in the district health services. Data were recorded, transcribed and analysed using the framework method.Results: Participants welcomed the development of Family Medicine training in Maun and expect that this will result in improved quality of primary care. Participants expect the registrars and family physicians to provide holistic health care that is of higher quality and expertise than currently experienced, relevant research into the health needs of the community, and reduced need for referrals. Inadequate personal welfare facilities, erratic ancillary support services and an inadequate complement of mentors and supervisors for the programme were some of the gaps and challenges highlighted by participants.Conclusion: Family Medicine training is welcomed by stakeholders in Ngamiland. With proper planning introduction of the family physician in the district is expected to result in improvement of primary care. 

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