Meta Analysis: Relationship of Tuberculosis Patient Contact, Density And Ventilation Area With Tuberculosis Events

Tuberculosis is one of 10 causes of death in the world. In 2018 TB sufferers in Indonesia reached 840 thousand people, the third-highest figure in the world after India and China. The purpose of this study was to analyze the relationship between contact with tuberculosis patients, occupancy density and ventilation area with tuberculosis’ incidence. This study used meta-analysis, the articles’ sources were from Google Scholar, PubMed and DOAJ published from 2011-2020. There were 12 articles that met the conditions for contact-free variables with tuberculosis patients, 12 articles of occupancy density, and 10 articles of ventilation area variable. The results were contacting with tuberculosis patients had 5.93 times more of getting tuberculosis compared to people who had no contact with tuberculosis patients, people who lived in densely populated areas were 2.41 times more getting tuberculosis compared to people living in occupancy that is not crowded, people who live in dwellings with a non-standard ventilation area were 2.14 times more getting tuberculosis when compared to people who live in an area where the ventilation area meets the standard. The conclusion of this study is tuberculosis patient contact, occupancy density, and ventilation area with the incidence of tuberculosis have a significant relationship.

Professional decision making with digitalisation of patient contacts in a medical advice setting: a qualitative study of a pilot project with a chat programme in Sweden

ObjectivesPatient e-services are increasingly launched globally to make healthcare more efficient and digitalised. One area that is digitalised is medical advice, where patients asynchronously chat with nurses and physicians, with patients having filled in a form with predefined questions before the chat. This study aimed to explore how occupational professionalism and the possibility of professional judgement are affected when clinical patient contact is digitalised. The study’s overall question concerns whether and how the scope of the healthcare staff’s professional judgement and occupational professionalism are affected by digitalisation.Design and settingA qualitative study of healthcare professionals working in a pilot project with a chat programme for patients in a medical advice setting in Sweden.Participants and analysisContextual inquiries and 17 interviews with nurses (n=9) and physicians (n=8). The interviews were thematically analysed. The analysis was inductive and based on theories of decision making.ResultsThree themes emerged: (1) Predefined questions to patients not tailored for healthcare professionals’ work, (2) reduced trust in written communication and (3) reduced opportunity to obtain information through chat communication.ConclusionsThe results indicate that asynchronous chat with patients might reduce the opportunity for nurses and physicians to obtain and use professional knowledge and discretionary decision making. Furthermore, the system’s design increases uncertainty in assessments and decision making, which reduces the range of occupational professionalism.

European consensus on patient contact shielding

Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.

The role of community pharmacists in immunisation: a national cross-sectional study

Background Austrian pharmacists are not authorised to administer immunisations, and evidence about their willingness to immunise is lacking. Aim The aim of this study is to investigate Austrian community pharmacists’ willingness to administer immunisations in the future. Method This study is designed as a cross-sectional online survey based on the theoretical domains framework (TDF). The validated and piloted questionnaire obtained ethical approval by Robert Gordon University. Outcome measures included pharmacists’ willingness to immunise, service requirements, barriers and education needs. Results The questionnaire was sent out to 3086 community pharmacists of which 380 responses were included in the final analysis (12.3%). Willingness to administer immunisations after appropriate training and legislative regulation was stated by 82.6% (n = 314) of participants. It was demonstrated that pharmacists willing to immunise were significantly younger than their counterpart (38 [IQR 31–49] years vs. 45 [IQR 37.5–54] years; OR 1.06; 1.03–1.09, 95% CI; p < 0.001). ‘Legal liability’ was considered the most critical barrier to service implementation, ‘seeing blood’ and ‘close patient contact’ as least critical. Pharmacists not willing to immunise showed a higher probability to evaluate personnel resources (OR 2.98; 1.35–6.58, 95% CI; p = 0.007), close patient contact (OR 2.79; 1.46–5.34, 95% CI; p = 0.002) and management of side effects (OR 2.62; 1.21–5.67, 95% CI; p = 0.015) as (highly) critical. The majority assessed the ‘right timing for training’ to be after the foundation training with a 2-yearly renewal. Conclusion Austrian community pharmacists show a strong willingness to administer immunisations while highlighting important requirements and barriers towards service implementation.

Hand Hygiene Evaluation Using Two Different Evaluation Tools and Hand Contamination of Veterinary Healthcare Workers in a Swiss Companion Animal Clinic

Hand hygiene (HH) is the most important measure to prevent nosocomial infections. HH compliance in companion animal clinics has been reported to be poor. The present study compared an online application with the WHO evaluation form to assess the WHO five moments of HH in a Swiss companion animal clinic. In 202 hand swabs from 87 staff members, total viable count (TVC) before and after patient contact was evaluated and the swabs were tested for selected antimicrobial resistant microorganisms of public health importance. HH compliance (95% confidence interval) was 36.6% (33.8–39.5%) and was similar when assessed with the two evaluation tools. HH differed between hospital areas (p = 0.0035) and HH indications (p < 0.0001). Gloves were worn in 22.0% (18.0–26.6%) of HH observations and were indicated in 37.2% (27.3–48.3%) of these observations. Mean TVC before patient contact was lower (0.52 log CFU/cm2) than after patient contact (1.02 log CFU/cm2) but was similar before patient contact on gloved and ungloved hands. Three hand swabs (1.5% (0.4–4.3%)) were positive for methicillin-resistant Staphylococcus aureus. Gloving should not be regarded as a substitute for HH. Overall, HH in companion animal medicine should urgently be fostered.

Technicians and Dentists: A catch 22 situation?

Dental technicians who regularly receive poor quality impressions and records are often faced with professional and ethical concerns as to how to handle the situation. They may choose to complete the task to the best of their abilities. Other options are to alter the casts to try to improve the situation and then complete the prescription, contact the dentist and discuss the issue, contactthe patient, contact the medical aid, report the practitioner to the HPCSA, or refuse to do the work. Their latter actions have potentially negative implications for them, and will certainly sour working relationships. At worst, they may lose the dentist’s support. This paper explores ways in which dentists and techniciains can foster collegial and mutually beneficial relationships from early on in their careers. This will not only promote better communication, and improve the quality of work produced by them, but it will also serve the best interests of their patients and the profession as a whole.

SP4.1.7 Colorectal Cancer: Pathway Disruptions as a Result of COVID-19

Aims COVID-19 has impacted diagnosis and treatment of colorectal cancer. Efforts to minimise patient contact have caused delays in cancer pathways, generating a potential risk to patient care. We aim to identify the pandemic effect on colorectal referral pathways. Methods All cancer referrals during March-June 2020 were reviewed to obtain information on the timeline and planning of investigation and treatment. The data was compared to evidence from the same referral period in 2019. Results 681 referrals were received during March-June 2020, compared to 1032 in 2019, indicating a 34% decrease. The majority of patients were reviewed in telephone clinic (76.2%) rather than physical appointments (15.4%). Although the commonest mode of investigation was endoscopy(46.2%), there was increased use of CT scan(35.8%). 114(17.1%) patients were not investigated, of which 40(35.1%) declined investigation, primarily due to COVID-19 apprehension. 6 patients were re-referred and 67(58.8%) were removed from the pathway for unknown reasons. 1 patient was subsequently admitted as an emergency. There were 44 new diagnoses of colorectal cancer based on MDT discussion, of which 14(31.8%) breached the investigation and 20(45.5%) the treatment date. 18 underwent curative surgery compared to 47 in the same period in 2019, indicating 61.7% less operative activity. Conclusions COVID-19 has changed surgical practice, forcing alternative clinic, investigation and treatment methods. Disruption of colorectal pathways is causing reduced referrals, investigation delays and less surgical activity. Delayed presentation with advanced disease may deprive the opportunity of treatment with curative intent.

EP.TU.369Straight to Test (STT) vs. Traditional Colorectal Target Investigations Pathway - A Local Audit

Aims The STT pathway was borne out of the National Cancer Strategy 2015 and faster diagnosis standard to rule in, or out, cancer within 28 days of referral. We aimed to review local target standard of practice, including comparison of STT vs Traditional pathways towards reaching the national standards. Methods The Somerset Database for all target referrals to the department was accessed. We chose October 2019 as a period unaffected by COVID-19. Time to investigation, results and treatment were reviewed. SPSS v.16 was used to perform an unpaired T-test of Traditional vs. STT time to diagnosis. Results 212 patients were referred for target investigations. 53 declined, DNA-ed or were unfit. 159 proceeded to investigations of which 7 cancers were diagnosed: 4 colorectal, 1 gastric and 2 lung. Time to diagnosis averaged 45.8 days and only 47/159 (29.6%) had their definitive diagnosis in 28 days. 52 patients were streamed to STT and 107 traditional pathways. STT patients were diagnosed at 36.3 days (95% CI 28.1-44.6) and traditional patients 50.5 days (95% CI 45.4-55.7) (P = 0.005). Cancer treatment was received median day 59 (range 27-189) and 4/7 received this within 62 days. Conclusion Target investigations have low pick up rates of cancers with ever increasing referrals. Our centre did not meet aspirational national targets of time to treatment or diagnosis, although STT patients were diagnosed significantly faster. With COVID-19, rationalisation of patient contact with maintained diagnosis rates must be strategised. Stricter FIT testing with risk stratification and STT expansion is one strategy.