@EARLI19 paper on Professional Learning in the health sector in developing countries by Koula Charitonos (Open University, UK) and Allison Littlejohn (University of Glasgow, UK)
The document discusses predictions for the future of laboratory medicine in 3 key areas:
1) Laboratory organization and staffing will consolidate into large regional centers and networks, with reduced numbers of laboratories and increased outsourcing. Staff will focus more on consultative services and quality control.
2) Automation and robotics will continue to increase to make laboratories more cost efficient, though they still have limitations, especially in specialized areas like microbiology.
3) Point-of-care testing is predicted to become more common, integrated into patient care, and allow for more home testing using portable devices. Genomics and proteomics are also expected to be the basis for many new diagnostic tests in the future.
Medical Laboratory Science provides laboratory information needed for disease diagnosis and treatment. It analyzes samples like blood, detects abnormal cells or enzymes, identifies bacteria, and detects genetic markers. Medical technologists determine normal/abnormal body fluid components, analyze blood samples, maintain supplies, prepare blood for transfusion, and assist medical teams. Skills include analytical thinking, time management, organization, communication, and attention to detail. Challenges include balancing integrity and turnaround time, cross-contamination, expensive equipment, quality assurance, lack of resources in developing countries, lack of regulations and support. Safety involves clearly labeling, segregating chemicals, wearing PPE, and properly handling waste.
The document describes the UK 100,000 Genomes Project, which aims to sequence 100,000 genomes from NHS patients by 2017. It will provide benefits to patients through new treatments and insights, contribute to the UK economy through commercial activity in genomics, and help integrate genomic medicine into clinical practice in the NHS. Genomics England was established to lead the project and work with partners including NHS England, 11 Genomic Medicine Centres, and commercial companies. The project involves genome sequencing, analysis, and returning results to clinicians to inform treatment.
Co-ordinated malaria research for better policy and practice: the role of res...ACT Consortium
Prof. David Schellenberg from the London School of Hygiene & Tropical Medicine presents on behalf of the ACT Consortium at the European Congress on Tropical Medicine and International Health in Basel, Switzerland, 8 September 2015
MicroGuide app, pop up uni, 1pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Shaun Cooley has extensive experience in clinical research and data management. He has worked on numerous clinical trials related to conditions such as PTSD, maternal immunology, neurology, and oncology. Currently he works as a research coordinator at a VA medical center, ensuring quality and compliance in clinical trials. He has also held positions as a biostatistician, laboratory contractor, and database manager. Cooley received his MPH in Epidemiology from USF and is currently a PhD candidate in nursing research at USF. He has expertise in statistical software programs including SAS and SPSS.
The Future of Laboratory Medicine: Understanding the New CoercionsCayeVerunque
The document discusses how laboratory medicine is undergoing major changes due to advances in technology and economic pressures. Laboratories provide various diagnostic tests and equipment that have evolved rapidly. It is important for laboratories to understand outcomes and quality management to contribute to improved patient care. Laboratories also need to better promote their interface with clinical practices by providing interpretive comments, using reflex testing, and conducting clinical audits to ensure high quality patient care and support multidisciplinary activities.
The document discusses predictions for the future of laboratory medicine in 3 key areas:
1) Laboratory organization and staffing will consolidate into large regional centers and networks, with reduced numbers of laboratories and increased outsourcing. Staff will focus more on consultative services and quality control.
2) Automation and robotics will continue to increase to make laboratories more cost efficient, though they still have limitations, especially in specialized areas like microbiology.
3) Point-of-care testing is predicted to become more common, integrated into patient care, and allow for more home testing using portable devices. Genomics and proteomics are also expected to be the basis for many new diagnostic tests in the future.
Medical Laboratory Science provides laboratory information needed for disease diagnosis and treatment. It analyzes samples like blood, detects abnormal cells or enzymes, identifies bacteria, and detects genetic markers. Medical technologists determine normal/abnormal body fluid components, analyze blood samples, maintain supplies, prepare blood for transfusion, and assist medical teams. Skills include analytical thinking, time management, organization, communication, and attention to detail. Challenges include balancing integrity and turnaround time, cross-contamination, expensive equipment, quality assurance, lack of resources in developing countries, lack of regulations and support. Safety involves clearly labeling, segregating chemicals, wearing PPE, and properly handling waste.
The document describes the UK 100,000 Genomes Project, which aims to sequence 100,000 genomes from NHS patients by 2017. It will provide benefits to patients through new treatments and insights, contribute to the UK economy through commercial activity in genomics, and help integrate genomic medicine into clinical practice in the NHS. Genomics England was established to lead the project and work with partners including NHS England, 11 Genomic Medicine Centres, and commercial companies. The project involves genome sequencing, analysis, and returning results to clinicians to inform treatment.
Co-ordinated malaria research for better policy and practice: the role of res...ACT Consortium
Prof. David Schellenberg from the London School of Hygiene & Tropical Medicine presents on behalf of the ACT Consortium at the European Congress on Tropical Medicine and International Health in Basel, Switzerland, 8 September 2015
MicroGuide app, pop up uni, 1pm, 3 september 2015NHS England
Expo is the most significant annual health and social care event in the calendar, uniting more NHS and care leaders, commissioners, clinicians, voluntary sector partners, innovators and media than any other health and care event.
Expo 15 returned to Manchester and was hosted once again by NHS England. Around 5000 people a day from health and care, the voluntary sector, local government, and industry joined together at Manchester Central Convention Centre for two packed days of speakers, workshops, exhibitions and professional development.
This year, Expo was more relevant and engaging than ever before, happening within the first 100 days of the new Government, and almost 12 months after the publication of the NHS Five Year Forward View. It was also a great opportunity to check on and learn from the progress of Greater Manchester as the area prepares to take over a £6 billion devolved health and social care budget, pledging to integrate hospital, community, primary and social care and vastly improve health and well-being.
More information is available online: www.expo.nhs.uk
Shaun Cooley has extensive experience in clinical research and data management. He has worked on numerous clinical trials related to conditions such as PTSD, maternal immunology, neurology, and oncology. Currently he works as a research coordinator at a VA medical center, ensuring quality and compliance in clinical trials. He has also held positions as a biostatistician, laboratory contractor, and database manager. Cooley received his MPH in Epidemiology from USF and is currently a PhD candidate in nursing research at USF. He has expertise in statistical software programs including SAS and SPSS.
The Future of Laboratory Medicine: Understanding the New CoercionsCayeVerunque
The document discusses how laboratory medicine is undergoing major changes due to advances in technology and economic pressures. Laboratories provide various diagnostic tests and equipment that have evolved rapidly. It is important for laboratories to understand outcomes and quality management to contribute to improved patient care. Laboratories also need to better promote their interface with clinical practices by providing interpretive comments, using reflex testing, and conducting clinical audits to ensure high quality patient care and support multidisciplinary activities.
Ronan Herlihy on Engaging Clinicians with data on their ordering practicesCirdan
The appropriate ordering project uses data extracted from Electronic Medical Record to create dashboards to inform and engage clinicians in ordering practices. This presentation looks at the techniques used to create answers for the clinicians questions and discusses the purpose behind 12 dashboards. It looks at the change management approaches and challenges.
The initial pilot project has been embraced by a number of local health districts in NSW and templates have been made available along with training tools.
Medical laboratory scientists analyze biological samples to help diagnose and treat patients. They perform complex tests using technology like microscopes and analyze the results of these tests, which account for 60-70% of patient diagnoses. Medical laboratory scientists work in hospitals, clinics, research institutions, and other settings. They must have a bachelor's degree in a science field as well as clinical training and certification. There is currently a shortage of these professionals, ensuring good job opportunities.
NovellusDx provides functional testing of cancer mutations to guide treatment decisions and avoid ineffective therapies. It analyzes mutations from next generation sequencing reports using a high-throughput clinical lab with proprietary technology. This identifies whether variants of unknown significance are driver mutations and which drugs they respond to or develop resistance against. A case study showed a BRAF variant was highly oncogenic but resistant to an ERBB2 inhibitor, and responded to a BRAF inhibitor instead, changing the optimal first-line treatment.
Paul Coplan, VP, Johnson & Johnson_mHealth IsraelLevi Shapiro
Pesentation, October 19th, 2021: What’s Next in RWE for Medical Devices: The Art of the Possible. Presented by Paul Coplan, ScD, MBA, FISPE, Vice President, Med Device Epidemiology and RWD Sciences, Johnson & Johnson; Adjunct Professor, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine; Fellow of the International Society of Pharmacoepidemiology
- Why RWE is Important for Medical Devices: Challenges with Clinical Trials of Medical Devices (Blinding, Surgeon skill/technique, Hospital process, Product modifications, Long term Follow up, Enrolment challenges)
- Types of Real-World Data Sources (Complaints like MAUDE, Eudramed and Company Databases, Hospital Databases, Electronic Health Records, Claims, Registries, Patient surveys, Surgeon surveys, PROs, Patient Preferences, wearables, sensors, social media, Surgical videos, device generated data, radiographic images)
- FDA CDRH Report on RWE Examples for Regulatory Decisions
- J&J Med Device Epidemiology & Real-World Data Sciences
- US National Evaluation System for Health Technology (NEST)
- RWE for Safety Assessments: Cobalt in Implants and at Work and Risk of Cancer
- Summary of Cobalt Exposure and All-Site Cancer Risk, by Study Type
- Comparative Effectiveness Studies Using RWE
- Summary
a. Use of RWE is important to benefit patients globally and enhance the safety and innovation of medical devices
b. Regulators are interested in using RWE for regulatory decisions but data quality and evidence needs to be regulatory grade
c. NEST has been a useful forum to advance the use of RWE for regulatory decisions in the US
d. RWE can be used for safety assessments, regulatory decisions, comparative effectiveness research, and R&D of products
Surrogate endpoints in global health research: still searching for killer app...SystemOne
1. The document discusses the use of surrogate endpoints in global health research instead of long-term clinical outcomes. It provides examples where interventions improved surrogate endpoints but did not improve mortality, such as a TB diagnostic test and a WHO childbirth checklist in India.
2. It argues that surrogate endpoints alone are not sufficient and global health interventions need to strengthen entire health systems to improve outcomes. Researchers should map how an intervention fits in the care pathway and evaluate multiple endpoints along the pathway.
3. The authors propose using implementation research to understand how interventions can be optimized depending on context and to lower unrealistic expectations of what innovations can achieve when introduced into suboptimal systems.
The role of medical technologists has changed dramatically over the last ten years. They have evolved from medical technologists to medical laboratory scientists and now molecular laboratory technologists working in COVID-19 laboratories using RT-PCR technology. Medical technologists now play a crucial role in disease detection by processing thousands of PCR tests daily to detect COVID-19 and monitor patient treatment. They work tirelessly around the clock as unsung heroes on the frontlines of the pandemic.
At the DayOne Experts even - Next Generation Clinical Trials, Lars G. Hemkens from University Hospital Basel shared his experience on how integrating data, that has been collected on a routine basis, into clinical trials will make a difference.
Apresentação Prime - INGLÊS - programa de triagem (10) ALTERAÇÕES1.ppt (1.103)Terra Vivos
Prime Diagnostics provides infectious disease screening programs for large populations. They offer automated testing equipment, technical assistance, sample collection kits, training, reagents, and a web-based results program. Their approach uses dried blood samples collected on filter paper, which allows for easy, non-invasive collection and transport of samples from remote areas without laboratory infrastructure. This methodology facilitates large-scale screening of populations to identify infectious diseases early and begin treatment or prevention efforts.
Dr. Jeff Bender - Companion Animal Antimicrobial StewardshipJohn Blue
Companion Animal Antimicrobial Stewardship - Dr. Jeff Bender, Co-Director for the Upper Midwest Agricultural Safety and Health Center and Professor College of Veterinary Medicine and School of Public Health at the University of Minnesota, Chair for the AVMA Task Force for Antimicrobial Stewardship in companion Animal Practice, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
This document outlines a research study to identify the medical devices most commonly causing injuries to hospital workers at Massachusetts Eye and Ear Infirmary and ways to prevent such injuries. The study will analyze injury data from 2009-2014 to determine which procedures and devices have the highest injury rates. The goal is to identify the most dangerous devices and see if safer alternatives exist. New safety strategies will then be developed and implemented based on the findings. The results will also be compared to state-level injury data and compiled into a central database for future reference.
Tomasz Sablinski from Transparency Life Sciences showed at the DayOne Expert event - Next Generation Clinical Trials ways to virtualize clinical trials or parts of them.
This document discusses value-based pricing and "innovative agreements" between the pan-Canadian Pharmaceutical Alliance (pCPA) and pharmaceutical manufacturers. It notes that performance-based agreements that tie the price of drugs to health outcomes present both challenges and opportunities. Challenges include implementing systems to track outcomes and determining which outcomes are measurable and attributable to the drug. Opportunities include structuring agreements for small patient populations and tying rebates to uncertainty in outcomes. The document argues that value-based pricing requires involvement from public drug plans, patients, and manufacturers to address these challenges and realize the opportunities.
The final protocol (v5.3). Notable changes include:
1) Confirmation of audit standard (Page 6).
2) Refinement of inclusion and exclusion criteria (Page 7)
3) Confirmation of audit status (Appendix C)
4) Refinement of required data fields (Page 19) including definitions (Pages 20-25)
Future Health Challenges: Developing Global Norms for Data and Results Sharin...ExternalEvents
http://www.fao.org/about/meetings/wgs-on-food-safety-management/en/
Future Health Challenges: Developing Global Norms for Data and Results Sharing during Public Health Emergencies. Presentation from the Technical Meeting on the impact of Whole Genome Sequencing (WGS) on food safety management and GMI-9, 23-25 May 2016, Rome, Italy.
The document discusses the role and activities of the UK National Screening Committee (UK NSC). It provides that the UK NSC sets policy for systematic population screening programs in the UK based on criteria for effectiveness, acceptability, and cost. The document outlines challenges facing the UK NSC, including governance, membership, defining screening programs, and evidence review processes. It also discusses recent approvals of new screening programs and evidence reviews currently underway.
This document provides an overview of operational research (OR). It discusses the history, definition, scope, phases and applications of OR. OR aims to apply scientific techniques to improve decision making and maximize benefits. It has been used extensively in public health to strengthen programs. Some examples of OR discussed are studies conducted by RNTCP to improve tuberculosis case detection and treatment. OR plays an important role in evaluating and improving health systems but faces challenges like limited funding and trained workforce.
This document outlines a proposal for a study on the knowledge, attitudes, and practices of nurses regarding the prevention of occupational hazards at two health care facilities in Abuja, Nigeria. The study aims to assess the nurses' level of knowledge, attitudes, and preventive practices. It will employ a descriptive research design and survey all 36 nurses at the sites using a questionnaire. The theoretical framework is Florence Nightingale's Environmental Theory. The proposal describes the research settings, population, instrument development and validation, data collection, and analysis methods. The goal is to understand how to better educate nurses and minimize workplace hazards.
Effectiveness of the nursing educational program upon nurse's knowledge and p...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
This document introduces the team and project for Media4Patient. The project aims to improve clinical trial enrollment through a new digital platform using social media and mobile technologies. It outlines challenges with patient recruitment such as many trials not reaching full enrollment and patients being unaware of clinical trial options. It then discusses stakeholders in clinical trials and viewpoints from different groups. Finally, it performs a PESTEL analysis to examine political, economic, technological, legal, environmental and socio-cultural factors affecting the project.
18
Annotated Bibliography
3164 words
Rough Draft on Infection Control
by
Submitted to
Semester
Date
Contact
Address
Phone
Email
Infection Control
2
Introduction of the Paper
Background
According to various reports by the Centers for Disease Control and Prevention, a significant number of lives are lost each passing year due to the spread of infections in hospitals that could otherwise have been prevented. 3 Therefore, effort geared towards understanding infection control plays a significant role in reducing the otherwise unnecessary loss of lives. Infection control entails the power to directly prevent or determine the spread of infections with the aim of avoiding it. 4 Indeed, the pathological state resulting from the invasion of the body by pathogenic microorganisms has far-reaching consequences. While so much has been done to prevent its spread, there is still a lot more to be done. This research paper intends to focus on Healthcare-associated Infections and how it can be prevented if not eliminated altogether.
Statement of the Problem
Healthcare-Associated Infections are a common occurrence in the modern healthcare setting resulting in huge financial losses and loss of lives. According to the Office of Disease Prevention and Healthcare Promotion (ODPHP), these are infections that patients contract while receiving treatment in a medical facility. Percival, Suleman, Vuotto & Donelli, (2015) pointed out that its prevalence is as a result of the employment of invasive devices and procedures meant to treat patients and to help them recover. 6 While most of them are accidental in nature, they still remain to be seen as accidents that could have been prevented. The US government, through the establishment of Healthy People 2020 and the U.S. Department of Health and Human Services (HHS) have taken a lead role in spreading the news on infection control. To that effect, recent research reveals that there could be a 70% reduction in infections by implementing existing prevention practices. This translates to a financial benefit estimated to be $31.5 billion in medical cost savings (ODPHP, 2019). Understanding these prevention measures should, therefore, be a priority to all healthcare practitioners. That is why this research study intends to shade more light on nosocomial infections. These are infections that occur within 48 hours upon admission into a hospital. They can also occur in three days of discharge or 30 days of operation. They affect one in every 10 patients admitted in a hospital. 5, 7
The rationale for addressing the issue
Addressing this issue is important to the health sector from a political, social as well as environmental perspective. As a matter of fact, its impact will be on a short term, interim basis and long term basis. Politically, health has always been a major subject of concern as it is used by voters to determine how best an administration has taken care of their needs. Establishing an infection contro.
Ronan Herlihy on Engaging Clinicians with data on their ordering practicesCirdan
The appropriate ordering project uses data extracted from Electronic Medical Record to create dashboards to inform and engage clinicians in ordering practices. This presentation looks at the techniques used to create answers for the clinicians questions and discusses the purpose behind 12 dashboards. It looks at the change management approaches and challenges.
The initial pilot project has been embraced by a number of local health districts in NSW and templates have been made available along with training tools.
Medical laboratory scientists analyze biological samples to help diagnose and treat patients. They perform complex tests using technology like microscopes and analyze the results of these tests, which account for 60-70% of patient diagnoses. Medical laboratory scientists work in hospitals, clinics, research institutions, and other settings. They must have a bachelor's degree in a science field as well as clinical training and certification. There is currently a shortage of these professionals, ensuring good job opportunities.
NovellusDx provides functional testing of cancer mutations to guide treatment decisions and avoid ineffective therapies. It analyzes mutations from next generation sequencing reports using a high-throughput clinical lab with proprietary technology. This identifies whether variants of unknown significance are driver mutations and which drugs they respond to or develop resistance against. A case study showed a BRAF variant was highly oncogenic but resistant to an ERBB2 inhibitor, and responded to a BRAF inhibitor instead, changing the optimal first-line treatment.
Paul Coplan, VP, Johnson & Johnson_mHealth IsraelLevi Shapiro
Pesentation, October 19th, 2021: What’s Next in RWE for Medical Devices: The Art of the Possible. Presented by Paul Coplan, ScD, MBA, FISPE, Vice President, Med Device Epidemiology and RWD Sciences, Johnson & Johnson; Adjunct Professor, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Perelman School of Medicine; Fellow of the International Society of Pharmacoepidemiology
- Why RWE is Important for Medical Devices: Challenges with Clinical Trials of Medical Devices (Blinding, Surgeon skill/technique, Hospital process, Product modifications, Long term Follow up, Enrolment challenges)
- Types of Real-World Data Sources (Complaints like MAUDE, Eudramed and Company Databases, Hospital Databases, Electronic Health Records, Claims, Registries, Patient surveys, Surgeon surveys, PROs, Patient Preferences, wearables, sensors, social media, Surgical videos, device generated data, radiographic images)
- FDA CDRH Report on RWE Examples for Regulatory Decisions
- J&J Med Device Epidemiology & Real-World Data Sciences
- US National Evaluation System for Health Technology (NEST)
- RWE for Safety Assessments: Cobalt in Implants and at Work and Risk of Cancer
- Summary of Cobalt Exposure and All-Site Cancer Risk, by Study Type
- Comparative Effectiveness Studies Using RWE
- Summary
a. Use of RWE is important to benefit patients globally and enhance the safety and innovation of medical devices
b. Regulators are interested in using RWE for regulatory decisions but data quality and evidence needs to be regulatory grade
c. NEST has been a useful forum to advance the use of RWE for regulatory decisions in the US
d. RWE can be used for safety assessments, regulatory decisions, comparative effectiveness research, and R&D of products
Surrogate endpoints in global health research: still searching for killer app...SystemOne
1. The document discusses the use of surrogate endpoints in global health research instead of long-term clinical outcomes. It provides examples where interventions improved surrogate endpoints but did not improve mortality, such as a TB diagnostic test and a WHO childbirth checklist in India.
2. It argues that surrogate endpoints alone are not sufficient and global health interventions need to strengthen entire health systems to improve outcomes. Researchers should map how an intervention fits in the care pathway and evaluate multiple endpoints along the pathway.
3. The authors propose using implementation research to understand how interventions can be optimized depending on context and to lower unrealistic expectations of what innovations can achieve when introduced into suboptimal systems.
The role of medical technologists has changed dramatically over the last ten years. They have evolved from medical technologists to medical laboratory scientists and now molecular laboratory technologists working in COVID-19 laboratories using RT-PCR technology. Medical technologists now play a crucial role in disease detection by processing thousands of PCR tests daily to detect COVID-19 and monitor patient treatment. They work tirelessly around the clock as unsung heroes on the frontlines of the pandemic.
At the DayOne Experts even - Next Generation Clinical Trials, Lars G. Hemkens from University Hospital Basel shared his experience on how integrating data, that has been collected on a routine basis, into clinical trials will make a difference.
Apresentação Prime - INGLÊS - programa de triagem (10) ALTERAÇÕES1.ppt (1.103)Terra Vivos
Prime Diagnostics provides infectious disease screening programs for large populations. They offer automated testing equipment, technical assistance, sample collection kits, training, reagents, and a web-based results program. Their approach uses dried blood samples collected on filter paper, which allows for easy, non-invasive collection and transport of samples from remote areas without laboratory infrastructure. This methodology facilitates large-scale screening of populations to identify infectious diseases early and begin treatment or prevention efforts.
Dr. Jeff Bender - Companion Animal Antimicrobial StewardshipJohn Blue
Companion Animal Antimicrobial Stewardship - Dr. Jeff Bender, Co-Director for the Upper Midwest Agricultural Safety and Health Center and Professor College of Veterinary Medicine and School of Public Health at the University of Minnesota, Chair for the AVMA Task Force for Antimicrobial Stewardship in companion Animal Practice, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
This document outlines a research study to identify the medical devices most commonly causing injuries to hospital workers at Massachusetts Eye and Ear Infirmary and ways to prevent such injuries. The study will analyze injury data from 2009-2014 to determine which procedures and devices have the highest injury rates. The goal is to identify the most dangerous devices and see if safer alternatives exist. New safety strategies will then be developed and implemented based on the findings. The results will also be compared to state-level injury data and compiled into a central database for future reference.
Tomasz Sablinski from Transparency Life Sciences showed at the DayOne Expert event - Next Generation Clinical Trials ways to virtualize clinical trials or parts of them.
This document discusses value-based pricing and "innovative agreements" between the pan-Canadian Pharmaceutical Alliance (pCPA) and pharmaceutical manufacturers. It notes that performance-based agreements that tie the price of drugs to health outcomes present both challenges and opportunities. Challenges include implementing systems to track outcomes and determining which outcomes are measurable and attributable to the drug. Opportunities include structuring agreements for small patient populations and tying rebates to uncertainty in outcomes. The document argues that value-based pricing requires involvement from public drug plans, patients, and manufacturers to address these challenges and realize the opportunities.
The final protocol (v5.3). Notable changes include:
1) Confirmation of audit standard (Page 6).
2) Refinement of inclusion and exclusion criteria (Page 7)
3) Confirmation of audit status (Appendix C)
4) Refinement of required data fields (Page 19) including definitions (Pages 20-25)
Future Health Challenges: Developing Global Norms for Data and Results Sharin...ExternalEvents
http://www.fao.org/about/meetings/wgs-on-food-safety-management/en/
Future Health Challenges: Developing Global Norms for Data and Results Sharing during Public Health Emergencies. Presentation from the Technical Meeting on the impact of Whole Genome Sequencing (WGS) on food safety management and GMI-9, 23-25 May 2016, Rome, Italy.
The document discusses the role and activities of the UK National Screening Committee (UK NSC). It provides that the UK NSC sets policy for systematic population screening programs in the UK based on criteria for effectiveness, acceptability, and cost. The document outlines challenges facing the UK NSC, including governance, membership, defining screening programs, and evidence review processes. It also discusses recent approvals of new screening programs and evidence reviews currently underway.
This document provides an overview of operational research (OR). It discusses the history, definition, scope, phases and applications of OR. OR aims to apply scientific techniques to improve decision making and maximize benefits. It has been used extensively in public health to strengthen programs. Some examples of OR discussed are studies conducted by RNTCP to improve tuberculosis case detection and treatment. OR plays an important role in evaluating and improving health systems but faces challenges like limited funding and trained workforce.
This document outlines a proposal for a study on the knowledge, attitudes, and practices of nurses regarding the prevention of occupational hazards at two health care facilities in Abuja, Nigeria. The study aims to assess the nurses' level of knowledge, attitudes, and preventive practices. It will employ a descriptive research design and survey all 36 nurses at the sites using a questionnaire. The theoretical framework is Florence Nightingale's Environmental Theory. The proposal describes the research settings, population, instrument development and validation, data collection, and analysis methods. The goal is to understand how to better educate nurses and minimize workplace hazards.
Effectiveness of the nursing educational program upon nurse's knowledge and p...iosrjce
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care. Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice. The journal publishes original papers, reviews, special and general articles, case management etc.
This document introduces the team and project for Media4Patient. The project aims to improve clinical trial enrollment through a new digital platform using social media and mobile technologies. It outlines challenges with patient recruitment such as many trials not reaching full enrollment and patients being unaware of clinical trial options. It then discusses stakeholders in clinical trials and viewpoints from different groups. Finally, it performs a PESTEL analysis to examine political, economic, technological, legal, environmental and socio-cultural factors affecting the project.
18
Annotated Bibliography
3164 words
Rough Draft on Infection Control
by
Submitted to
Semester
Date
Contact
Address
Phone
Email
Infection Control
2
Introduction of the Paper
Background
According to various reports by the Centers for Disease Control and Prevention, a significant number of lives are lost each passing year due to the spread of infections in hospitals that could otherwise have been prevented. 3 Therefore, effort geared towards understanding infection control plays a significant role in reducing the otherwise unnecessary loss of lives. Infection control entails the power to directly prevent or determine the spread of infections with the aim of avoiding it. 4 Indeed, the pathological state resulting from the invasion of the body by pathogenic microorganisms has far-reaching consequences. While so much has been done to prevent its spread, there is still a lot more to be done. This research paper intends to focus on Healthcare-associated Infections and how it can be prevented if not eliminated altogether.
Statement of the Problem
Healthcare-Associated Infections are a common occurrence in the modern healthcare setting resulting in huge financial losses and loss of lives. According to the Office of Disease Prevention and Healthcare Promotion (ODPHP), these are infections that patients contract while receiving treatment in a medical facility. Percival, Suleman, Vuotto & Donelli, (2015) pointed out that its prevalence is as a result of the employment of invasive devices and procedures meant to treat patients and to help them recover. 6 While most of them are accidental in nature, they still remain to be seen as accidents that could have been prevented. The US government, through the establishment of Healthy People 2020 and the U.S. Department of Health and Human Services (HHS) have taken a lead role in spreading the news on infection control. To that effect, recent research reveals that there could be a 70% reduction in infections by implementing existing prevention practices. This translates to a financial benefit estimated to be $31.5 billion in medical cost savings (ODPHP, 2019). Understanding these prevention measures should, therefore, be a priority to all healthcare practitioners. That is why this research study intends to shade more light on nosocomial infections. These are infections that occur within 48 hours upon admission into a hospital. They can also occur in three days of discharge or 30 days of operation. They affect one in every 10 patients admitted in a hospital. 5, 7
The rationale for addressing the issue
Addressing this issue is important to the health sector from a political, social as well as environmental perspective. As a matter of fact, its impact will be on a short term, interim basis and long term basis. Politically, health has always been a major subject of concern as it is used by voters to determine how best an administration has taken care of their needs. Establishing an infection contro.
The document discusses the key role of diagnostics in addressing the challenge of antimicrobial resistance (AMR). It makes three key points:
1) AMR is a major threat as many infections are becoming increasingly difficult to treat due to drug-resistant bacteria. Without effective antibiotics, common infections and surgeries could become life-threatening.
2) Diagnostics are critical to appropriate antibiotic use by enabling rapid and precise diagnosis of whether a bacterial or viral infection is present and, if bacterial, determining the best antibiotic to use or avoid. This can help reduce unnecessary antibiotic prescribing.
3) The document outlines a vision for AMR diagnostics in the UK to ensure rapid diagnostic technologies are universally available to guide antibiotic
Final Year Project CHP 1& 2 CHENAI MAKOKO.docxChenaiMartha
The document proposes developing a model for early detection of layer bird diseases for layer poultry farmers. It discusses challenges small-scale farmers face in detecting diseases early due to limited access to veterinary support. Existing systems for disease detection include expert systems using certainty factors, deep learning models for detecting diseases from fecal images, and IoT-based frameworks. However, these systems either focus on expert diagnosis, rely on large datasets, or require specialized hardware. The proposed model aims to allow farmers to enter symptoms and receive recommendations to aid early disease detection.
This document outlines patient safety in healthcare facilities. It defines key terms like patient safety, psychological safety, and safety culture. It discusses the roles of the patient safety committee and the components of a patient safety plan. Specific patient safety issues in the intensive care unit are examined, like collaboration among ICU staff and common errors. International patient safety goals are provided, such as accurately identifying patients and reducing healthcare-associated infections. Root cause analysis is introduced as a way to investigate incidents and prevent future errors.
The Diagnostic & Testing virtual conference held on the 11th June 2020 was an inspiring event examining the role of both molecular and rapid diagnostics in tackling disease, infection and reducing the impact of COVID-19 within our communities and hospitals. The virtual conference explored how health professionals, academics and industry are driving diagnostic and testing usage within laboratories, pharmacies and community practice.
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The document proposes developing a system called the Layer Bird Vaccination Monitoring & Disease Detection System. This system would help small-scale layer poultry farmers in Zimbabwe track vaccinations, monitor treatments, and detect diseases early using data visualization and machine learning models. The system aims to address challenges small-scale farmers face like a lack of record keeping, monitoring of bird health, and limited access to veterinary support. It would allow farmers to enter bird symptom data and get recommendations to prevent losses from diseases.
Mr. Thomas J. Chapel - Measure that Make a Difference! WHY Measure and WHAT t...John Blue
Measure that Make a Difference! WHY Measure and WHAT to Measure! - Mr. Thomas J. Chapel, Chief Evaluation Officer, Centers for Disease Control and Prevention (CDC), from the 2015 NIAA Antibiotic Symposium - Stewardship: From Metrics to Management, November 3-5, 2015, Atlanta, Georgia, USA.
More presentations at http://swinecast.com/2015-niaa-symposium-antibiotics-stewardship-from-metrics-to-management
This document provides an overview of Good Clinical Practice (GCP) guidelines, including:
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- Requirements for ethics committees and special considerations for trials involving vulnerable groups.
- Guidelines address the design, conduct, monitoring, recording, analysis and reporting of clinical trials involving human subjects.
The Role of Patients & their Challenges in Clinical TrialsKathi Apostolidis
What are clinical trials
Myths about clinical trials
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Bernie Harrison - Australian Council Healthcare StandardsInforma Australia
The document discusses using targets to improve healthcare performance and patient safety. It notes that while modern medicine is advanced, healthcare systems still fail to meet their full potential due to issues like clinical practice variation and preventable medical errors. Targets have been implemented, like the 4-hour rule for emergency department wait times, but focusing only on targets can incentivize the wrong behaviors. True reliability and safety require a culture that learns from failures and embraces continuous improvement. High-reliability organizations exemplify principles like preoccupation with failure and deference to expertise. The goal should be zero preventable harm through reliable processes of care.
Accelerating the translation of medical research - 27 JuneInnovation Agency
Slides from the event focusing on translational research in Liverpool and North of England and why companies are establishing and growing operations in the region.
The infection control committee has several main functions:
1. Surveilling and preventing nosocomial infections through monitoring, investigating outbreaks, evaluating products, and developing infection control procedures.
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College Writing II Synthesis Essay Assignment Summer Semester 2017.docxclarebernice
College Writing II Synthesis Essay Assignment Summer Semester 2017
Directions:
For this assignment you will be writing a synthesis essay. A synthesis is a combination of two or more summaries and sources. In a synthesis essay you will have three paragraphs, an introduction, a synthesis and a conclusion.
In the introduction you will give background information about your topic. You will also include a thesis statement at the end of the introduction paragraph. The thesis statement should describe the goal of your synthesis. (informative or argumentative)
The second paragraph is the synthesis. You will combine two summaries of two different articles on the same topic. You will follow all summary guidelines for these two paragraphs. The synthesis will most likely either argue or inform the reader about the topic.
The conclusion paragraph should summarize the points of your essay and restate the general ideas.
For this essay you will read two research articles on a similar topic to the previous critical review essay as you can use this research in your inquiry paper. You will summarize both articles in two paragraphs and combine the paragraphs for your synthesis. In the synthesis you must include the main ideas of the articles and the author, title, and general idea in the first sentences.
This essay will be three pages long and the first draft and peer review are due June 15. You must turn them in hardcopy in class so you can do a peer review.
Running head: THESIS DRAFT 1
THESIS DRAFT 3Thesis Draft
Katelyn B. Rhodes
D40375299
DeVry University
Point-of-Care Testing (PoCT) has dramatically taken over the field of clinical laboratory testing since it’s introduction approximately 45 years ago. The technologies utilized in PoCT have been refined to deliver accurate and expedient test results and will become even more sensitive and accurate in order to dominate the field of clinical laboratory testing. Furthermore, there will be a dramatic increase in the volume of clinical testing performed outside of the laboratory. New and emerging PoCT technologies utilize sophisticated molecular techniques such as polymerase chain reaction to aid in the treatment of major health problems worldwide, such as sexually transmitted infections (John & Price, 2014).
Historic Timeline
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Technology in the mid-to-late 1990’s permitted analyzers to be much smaller so that they may be easily carried to the patient’s location. Computers also became more ...
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1. Prof Allison Littlejohn
University of Glasgow
Allison.littlejohn@Glasgow.ac,uk
@allisonl
Emerging directions in research on capacity
strengthening for drug-resistant infections in LMICs
Dr Koula Charitonos
Institute of Educational Technology,
The Open University UK
Koula.charitonos@open.ac.uk
@ch_koula
EARLI 2019
Aachen, Germany 12-16 August 2019
2. Professor Allison Littlejohn
Academic Director
Dr Koula Charitonos
Learning Advisor
Tim Seal
Senior Project Manager
Dr Heli Kaatrakoski
Researcher
Dr Rachel McMullan, Lecturer in Health Sciences, OU
Dr Alison Fox, Senior Lecturer in Education, OU
Gail Vardy, Co-ordinator, International Development Office, OU
Richard Dobson
Martin Hughes, Senior Project Manager, LDS, OU
Dr Ben Amos, Health Systems, Mott MacDonald
Dr Saba Mussavi, Epidemiologist, Health Systems Strengthening
4. UK aid programme, helping low and middle income countries to tackle
antimicrobial resistance (AMR).
The aim is to improve the surveillance of AMR and generate relevant data
that is shared nationally and globally.
https://www.flemingfund.org/
5. Source: LSHTM, 2018. AMR Surveillance in low- and middle-income settings. A roadmap for
participation in the global antimicrobial surveillance system (GLASS), p.21
AMR Surveillance Process
7. Design, Deliver and Evaluate Learning Events
to build capacity in AMR surveillance in LMICs
Develop a longer-term approach - topics, methods, modes of
delivery
for learning around AMR in LMICs for Year 2-Year 4
Develop understanding about the context
what skills and knowledge are needed, what does the environment look like, how lab
professionals in LMICs learn
Year 1 Objectives
Phase 2
Country visits Learning eventsExpert interviews
Phase 1 Phase 3
Event A Event B
8. What forms of professional learning change work in ways that support
global challenges?
What are the knowledge gaps?
9. • Interviews with n=23 ‘experts’ on AMR (in person, online)
• Members of the Technical Advisory Group of the Fleming Fund / DHSC (n=3)
• Members of staff at a research institution in a LMIC, leading a capacity programme
on AMR (n=2)
• Members of the Experts Advisory Group of the Management Agency leading the
implementation of the Fleming Fund (n=7);
• Members of staff of the Management Agency; (n=8) and
• Secondees from the UK DHSC in organisations such as World Health Organisation,
World Organisation for Animal Health (OIE) and Food and Agriculture Organisation
(FAO) (n=3)
• Average duration 50min, recorded & transcribed.
• Experience spanning multiple countries, including: Vietnam, Malawi,
Cambodia, Philippines, Pakistan, Mali, Tanzania, Ghana, Uganda, Nepal,
India, Laos, Kenya, Bhutan, New Zealand, Myanmar, Zimbabwe, UK.
Phase 1 Participants
10. to establish a reliable and credible AMR surveillance
system in the facility (e.g. hospital, animal facility)
ACTIVITY SYSTEMS
Local system (facility level)
National system
(country level)
Regional system
(district / region level)
Global system
(across countries)
to operationalise a functioning
surveillance system in the
country
to establish AMR surveillance
networks in the districts /
regions
to establish GLASS guidelines
across countries
11. “there's quite a lot of other donors involved in this area. And it's an up and
coming subject. So people are investing, and taking up, and taking up the
resources of a very limited number of people. So you have to be careful to
pitch programmes at the right level for each country because the
absorptive capacity of the countries…has been limited…”
[AMR Community / Expert, P3)
1. Growing awareness of AMR as an emerging
global challenge
12. “And that’s [One Health] been a big thing, again for our own team [Fleming
Fund / Management Agency] to understand, and then for countries to
understand. Because everybody from WHO, and the tripartite, DH, Mott,
and to some extent on the ground uses the words One Health, and
understands that One Health is important for antibiotic resistance, but
without really understanding how to achieve that” [AMR Community /
Expert, P23]
2. AMR is a multi-disease and multi-sectoral challenge
13. “most of the procurement agency in countries base their choice of reagent based on
cost. And so, they will select re-agents that are unfit to provide good quality testing.
And this is because there is a disconnection between the finance ministry and the
technical people, even from the country. And so, these systemic issues like quality is not
restricted to train lab technicians, to do good testing. They know that they need good
reagents, but they don't have these reagents, because the national procurement
agency is not supporting [purchase of] this reagent because they cost too much
initially…And there is all this economic value chain that is not taken into consideration
by the finance ministry" (P5)
3. AMR Surveillance is an outcome of well-functioning
lab networks
14. 4. AMR Surveillance relies on Good Practice
“…you know, antibiotic prescribing was a very easy task when I
was a young physician because we had a lot of antibiotics and
every antibiotic was working on most bacteria. So, it was very
easy. Now it's very, very complicated in many instances,
because we have bacteria on which very few antibiotics which
are working. And depending on the patient, you have strictly to
use this one or this one, at that dose or this dose. And very
often, it's a great help for the clinicians to have the advice of
the microbiologist to choose the right antibiotic […]” [AMR
Community / Experts, P18]
15. “The first one is to report it to the clinician and tell him, well, you have to use antibiotic
X or Y and not antibiotic Z to treat your patient…The second use is to tell a clinician
every year, during the past year, we have isolated, I don't know, 564 bacteria of that
type in your department…To give them the statistics. Which will help them to use this
data in what we call an empiric manner… and so you can adapt your empirical
treatment using the retrospective data…. And the third use of the data is to gather all
the information from hospitals or health centres… and to have a global picture in the
country of the susceptibility pattern of each type of bacteria. And so the leaders and
the people that make the public health policy… will take specific measures against
bacteria X” [P18]
5. AMR Surveillance requires data flow across local,
national and global systems
16. “The second major issue is about trust…If you go to a UK hospital with a suspicion of
infection, immediately, you will be taking a number of samples depending on the type
of infection. And these samples will go to the lab, and the clinicians will use the result
to treat you because they trust the results from the lab. In many, many places in
developing countries, this does not happen because first, the clinician do not do the
sampling. Very often, they do not do the sampling, because… they don't trust the result
of the lab. And if they don't trust the results of the lab, they don't do the test because
they know that they will not use the result…They don't send test, so the lab has very
little tests to perform, and so they are not very good at performing tests and they are
not very good at giving good results. And so it doesn't work” [P18]
6. AMR surveillance requires trust and openness
among professionals
17. “it all comes back to resourcing: if you are a lab technician working in a poorly
resourced lab…you will still feel undervalued and under-represented…” [P22].
“[difficult to] technically assess precisely the results of the susceptibility…It’s extremely
difficult technically to say bacteria X is susceptible to antibiotic Z, but not to antibiotics
A and B” [P18].
7. AMR surveillance relies on motivated and skilful
professionals
18. Key knowledge and skills needs by AMR experts
Ref Priority areas / Category name
1 Diagnostics Stewardship
2 Good Laboratory Practice
3 Foundations in Microbiology
4 Molecular Advanced Microbiology
5 Data Use & Interpretation for diagnosis in Clinical and Vet Services
6 Data Use & interpretation for Public Health Policy
7 Communication, Collaboration & Advocacy
8 Surveillance System Planning & Implementation
9 One Health Multisectoral
19. 1. Target learning events for groups of people with specific job roles.
2. Design learning events that encourage collaborative work.
3. Expand beyond traditional ways of working, where clinicians and labs are
disconnected and not engaging in direct, two-way communication.
4. Learning and capacity building has to maintain focus on new practices and be
accompanied by a restructuring of work.
5. A capacity strengthening programme that only looks at achieving
advancement of knowledge and skills will not bring desirable change.
Capacity strengthening for drug-resistant infections
in LMICs: key recommendations
20. Professor Allison Littlejohn
Academic Director
Dr Koula Charitonos
Learning Advisor
Tim Seal
Senior Project Manager
Dr Heli Kaatrakoski
Researcher
Koula.charitonos@open.ac.uk
@ch_koula
Allison.littlejohn@Glasgow.ac.uk
@allisonl
21. Categories /
Who says?
DS GLP FM MAM DICV DUP CCA SSPI OH
Policy Makers
(n=3)
1 1 1 - 1 - 2 - -
AMR
Community/
Experts (n=20)
4 8 11 1 12 6 13 7 3
Total 5 9 12 1 13 6 15 7 3
The number of experts expressing what needs to be learnt (N=23)
DS=Diagnostics Stewardship; GLP= Good Laboratory Practice; FM= Foundations in Microbiology; MAM=Molecular Advanced
Microbiology; DUCV= Data Use & Interpretation for diagnosis in Clinical and Vet Services; DUPH=Data Use & interpretation for
Public Health Policy, CCA=Communication, Collaboration & Advocacy; SSPI=Surveillance System Planning & Implementation;
OH=One Health Multisectoral
22. Who should learn per category?
DS=Diagnostics Stewardship; GLP= Good Laboratory Practice; FM= Foundations in Microbiology; MAM=Molecular Advanced Microbiology;
DUCV= Data Use & Interpretation for diagnosis in Clinical and Vet Services; DUPH=Data Use & interpretation for Public Health Policy,
CCA=Communication, Collaboration & Advocacy; SSPI=Surveillance System Planning & Implementation; OH=One Health Multisectoral
Categories /
Target groups
DS GLP FM MAM DICV DUP CCA SSPI OH
1. Lab Professionals x x x x x x x x x
2. Senior Lab Professionals x x x x x x x x
3. Clinical Services Professionals x x x x x x x
4. Vet Services Professionals x x x x x
5. Senior Management staff in
Clinical services
x x x x x x
6. Senior Management in Vet
Services
x x x x
7. Policy maker x x x x x
8. AMR Community / Experts x x x x x
9. Clinical and Veterinary services
clients
x
10. The Public x
23. Roles / target groups who should be working together per identified categories
DS=Diagnostics Stewardship; GLP= Good Laboratory Practice; FM= Foundations in Microbiology; MAM=Molecular Advanced Microbiology;
DUCV= Data Use & Interpretation for diagnosis in Clinical and Vet Services; DUPH=Data Use & interpretation for Public Health Policy,
CCA=Communication, Collaboration & Advocacy; SSPI=Surveillance System Planning & Implementation; OH=One Health Multisectoral
24. Event B: Foundations in
Microbiology
• Lab Professionals, Senior Lab Professionals.
• 8-week OU OpenLearn course ‘Understanding
antibiotic resistance’
• Focus on Bhutan
• Objectives:
appreciate the issues surrounding antibiotic
resistance
know about the challenges in developing new
antibiotics
know about alternative approaches to tackling
infectious diseases.
Two pilot events
Event A: Data Use and
Interpretation
• Lab professionals, Senior Lab Professionals,
(Senior) Clinical Services Professionals, (Senior)
Vet Services Professionals
• (Perhaps) existing resources on data use and
interpretation with additional learning and
assessment developed in order to provide a
more contextualised response.
• Objectives:
Understand basic interpretation / analysis
Identify how to apply this to your needs
How data can be used to support your work
Develop a plan to implement data use in practice
Engage in knowledge sharing to support change in
practice, challenges / successes
25. Phase 2 Country visits
Phase
2
To identify existing courses training on AMR available in the countries; tensions and contradictions in the
surveillance system and to map knowledge gaps and work practices among lab professionals
1x Meeting with 12 members of the AMR Committee
6x Lab visits and Lab Tours
25x Individual interviews
1x group interview
Meetings: 1x Chief Laboratory Officer & 1x Medical Superintended
6x Meetings with AMR Committee
3x Lab Visits and Lab tours
21x individual interviews
4x Meetings with members of the AMR Platform
2x meetings with staff in Ghana Health Services
4x Lab Visits and Lab tours
14x Individual interviews
26. Phase 2 Country visits
Professional Roles Country 1 Country
2
Country
3
Laboratory
Professionals
9 10 5
Senior Laboratory
Professionals
10 4 2
Clinical Services
Professionals
1 - -
Senior Management
Staff in Clinical Services
1 - 1
Policymaker 3 6 4
AMR Community /
Expert
1 1 2
Total 25 21 14
Editor's Notes
Collaboration with International Development Office & IET
Work with Mott & Department of Health
The increasing use of antimicrobials worldwide has been associated with a global increase in Drug-Resistance Infections, which threatens to return clinical therapies to the pre-antibiotic era.
At present, DRIs are estimated to account for 50,000 deaths each year in Europe and the USA alone
by 2050 it is estimated that DRIs will account for 10 million • deaths per year worldwide posing an economic and biosecurity threat.
(LSHTM Roadmap)
The rise of antimicrobial resistance (AMR) poses a threat to our ability to treat common and life-threatening infections on a global scale.
Identifying the emergence of AMR requires strengthening of surveillance for AMR, particularly in low and middle-income countries (LMICs) where the burden of infection is higher and health systems are least able to respond.
In response to this global challenge, DHSC established the fleming Fund. 265million pounds investments on public health systems in 24 countries.
Throughout the five years countries, 24 in total will become involved in the programme. Our work is in 3 of these countries, all three in different stages in this process.
Focus is on LMICs – situation there is highly dependent on how well the health system in each country functions.
Focus is not only on Human Health – instead they are underpinned by a ‘One health approach’ where sectors come together, human health, animal health, agriculture & environment.
One of the key concepts in the Fleming Fund and also within our work is the idea of an AMR surveillance system that is functioning at global, national, regional and local level.
These systems are not really established in LMICs. They are in infancy. Fleming fund is aiming to create these systems.
This representation here shows this process and core activities happening in the system.
it includes ‘patient’ and activity that is happening in this system by various professionals, such as clinicians and laboratory staff.
Laboratories play a big role in this process. However, they are at the margins of the medical profession, usually not much valued and staff there not well recognised. Little is known about how to offer laboratory capacity strengthening in ways that bring about effective change.
We viewed the laboratory as a key learning setting in the system. Knowledge-intensive workplace
A key decision we made in early stages of the project was that we will focus on professionals in the laboratory and we wanted to understand bit more about their roles and what do they do in their everyday work. And how they see themselves fitting into the surveillance system.
There’s a mandate by WHO for lab people to comply and establish knowledge on a framework developed by WHO and develop skills on doing tests and generating data and documenting this data.
We were looking to unpack characteristics of this environment – what are the prominent work practices related to AMR; who are the people who are working in the labs; what are existing learning practices? How does the use of technology look like? What motivates these professionals?
But of course they are not working alone. It’s a system where there are lots of interdependencies, lots of actors, global and local players, donors, complex work practice, and of course as we are talking about LMICs a completely different context.
So this was some background information
I’ll move on to explain what we were set to do in this first year and how we went about doing it.
We are about to complete Year 1. In this presentation we are
A central question guiding our inquiry was:
Data was gathered between April and June 2018 during a series of face-to-face and online interviews with experts in AMR (total n=23).
Interviews were guided by a semi-structured instrument previously validated during studies of self-regulated, professional learning (see Appendix A). It is noted that these experts had expertise on health systems research and AMR in multiple countries across the world.
Note: the majority of the experts had experience in human health systems (due to the nature of the provided contacts) and this might have been reflected in their views.
In parallel to this activity, Phase 1 further included a review of learning resources on AMR, including but not limited to online courses, videos, frameworks and reports. The main objective was to gain a better understanding of the AMR landscape and document the range of existing resources in order to map these resources against the identified needs that would emerged from the interviews with experts and professionals in countries.
In our analysis we drew on the tradition of socio-cultural and cultural-historical theories and the work by Engeström (1987) to analyse learning and development in the context of their changing work environments
A central system is the one at the facility level involving various actors. We viewed the work of laboratory professionals as a form of collective activity system complemented and extended with models of multiple interconnected activity systems.
There is a wider global system that can be seen as an activity system itself led by WHO and UN agencies. Interconnected with:
- National systems as a distinct activity system having the object of….
- There are also district/regional systems …
Looking at these systems, in the analysis of the data generated through the interviews with AMR Community / Experts (n=23), we were interested in tracing the challenges/tensions that professionals in heath settings face when navigating a changing environment where they have to change their own practice to accommodate the new practice of ‘surveillance’. The analysis supported identification of tensions between elements of the AMR system, either at the global level or at the country level or local level. The analysis also surfaces potential future dilemmas associated with implementing a capacity strengthening programme. The following section in the presentation highlights key tensions that emerged through the Phase 1 interviews.
The CHAT framework provided a means of analysing work and learning through identification of tensions and contradictions in context of organisational transformation. As a ‘dialectical’ theory, it views human relationships as interwoven with multiple contradictions, and conceptualises learning as a dynamic and non-linear process.
First two findings, related to nature of the challenge
The recent emergence of AMR as a global challenge is perceived as the main reason that the general lack awareness of the problem of AMR. This is also the reason why professionals working in public health facilities have limited knowledge about AMR and is considered by some as the reason why there has been limited mobilisation of resources to tackle AMR within health systems and to the lack of regulation around the use of antibiotics in LMICs.
an environment that is ‘dynamic’ and ‘fluid’, careful navigation and co-ordination is needed.
This quote highlights specific vested interests and competing concerns / priorities. Within, for example, Ministries / departments / donors that influence the resources available (e.g. funding). The above quote also signals that a likely outcome is a sense of fatigue among the various groups that these stakeholders are targeting.
How are global challenges recognised? eg how to the vested interests and competing concerns / priorities mediate the recognition of AMR as a global challenge and prioritisation of it in work? How does it become central to what professionals do?
AMR as a multi-disease and multi-sectoral challenge that involves farming and agriculture, the environment, human health and animal health systems. Hence AMR must be dealt with through collaborative and multi-sectoral approaches, while maintaining a focus on the local, regional, national, and global levels.
Therefore, collaborative forms of work and learning across boundaries are required to ease this tension. A consequence is that different groups (acting as silos) that have been designed to work separately (e.g. Human Health systems, Animal Health systems) now have to work together. This requires a number of architectural or organisational changes, but it is not clear how these can be actuated.
An example is the One Health perspective that underpins AMR work. Whilst the focus is on protecting human health, this cannot be achieved without a strong One Health component with linkages between animal and human health disciplines at the country level. Many interviewees pointed to a ‘design challenge’. The Fleming Fund has to work towards facilitating the One Health. However, this work takes place in an environment where there is limited awareness about the One Health perspective, which creates a tension in terms of how to operationalise this perspective – as illustrated in the quote.
Responsibility for new/ emerging areas tends to be distributed across existing ‘mature’ domains / organisations and the need to create new collaborations/ partnerships. This issue leads to the issue in slides 17 & 18 – that a well functioning solution (ie surveillance) and good practice requires new collaborations/ partnerships and ways of working, which, in turn, requires new roles, rules and division of labour.
Responsibility for new/ emerging areas tends to be distributed across existing ‘mature’ domains / organisations and the need to create new collaborations/ partnerships and new work practices.
This issue leads to the issue in slides 17 & 18 – that a well functioning solution (ie surveillance) and good practice requires new collaborations/ partnerships and ways of working, which, in turn, requires new roles, rules and division of labour.
One of the key mandates of the Fleming Fund is to establish and support AMR surveillance networks within the countries. Depending on the country, a network may already be in place, or may be developed as part of the capacity-building process.
The interviews suggested that the speed and extent to which AMR surveillance can be strengthened depends on the functioning of these networks and the resources available, including funding and human resources and it heavily relies on policy commitment.
In most LMICs countries there is existing laboratory capacity, yet the scale varies substantially, not only across countries, but also within the country itself. E.g. labs in rural settings differ from urban areas,
the capacity and expertise in AMR reference labs is different from sentinel sites,
only a few labs are accredited,
AMR surveillance for human health is better developed than for animal health.
A number of systemic issues were raised during the interviews, such as the infrastructure (i.e. power supply, equipment, lack of capacity to use the equipment), quality (i.e. quality control, quality assurance) but also the procurement process within the public health system in LMICs
AMR is usually made worse by ingrained professional practices. Several examples of entrenched practice were described, such as the pharmacist who sells antibiotics over-the-counter without a prescription, the farmer who uses antibiotics in agriculture and very frequently references to the clinician who prescribes antibiotics without sufficient data.
‘Prescribing practice’ very frequently used as examples of bad practice. Clinicians were perceived as not making use of lab-diagnostics to treat patients, and, instead, relying on empirical diagnosis. Evidence in the interviews pointed to “no culture of reliance amongst clinicians for using laboratory services as part of their day to day clerical work” [P13] and, instead, relying on empirical diagnosis.
This might be because of: 1. the lab service is not available, reliable, or timely, or 2. clinicians are not trained in interpreting the data and results and 3. in some facilities patients having to pay for lab tests, hence the cost of treatment may have been increased.
new collaboration and ways of working are necessary
Such new rules/ roles/ wow lay the foundation to enable the ‘flow’ of data - as a key object of work. In other words – its not simple about the ‘diffusion of knowledge to ‘plug the knowledge gap’ but its also necessary to establish the right conditions for people to work together and exchange data objects in an effective way.
In most LMICs there is no systematic way of collecting and reporting these data. There are few standardised procedures and standardisation of reporting systems and data sharing and comparability with other countries is not yet possible. Links between clinical data, samples and clinical outcomes are not usually made, while any data that is available often is generated by externally funded research projects.
Three different visions of data use within a surveillance system were articulated:
- good quality data from the labs is shared within a facility with clinicians or vets to support diagnosis, prophylaxis and treatment at an individual level.
Data is also made available in aggregated forms beyond the local facility and is shared with district and national facilities to support treatment guidelines and public health policy nationally.
Data is shared in global systems
Trust is critical to create these conditions for effective working.
specific ‘norms’ within AMR systems, one of which was expressed as ‘lack of trust’ of clinicians in terms of the results generated by the laboratories
This tension originates from the hierarchical structures within health systems. One interviewee noted that “the clinical staff and laboratory staff often don't talk to each other very much…”
This lack of trust influences the ways in which the microbiology labs operate.
One issue is that LMICs laboratories are usually run by people without a medical background, and this is sometimes perceived by clinicians as problematic, also because lab professionals cannot give advice on what antibiotics should be used.
almost all the interviewees referred to the same issue: lab professionals do not have the technical expertise needed to perform bacterial susceptibility testing.
inadequate and sometimes non-existent training as another factor contributing to the poor functioning of AMR surveillance systems.
concern about low retention rates of laboratory professionals, low salaries and poor motivation.
The fact that labs operate in low-resource environments, where often lab managers/heads of units cannot commit extra resources to AMR surveillance, were also seen as detrimental. You have labs with 3 people, one working on malaria, one on HIV and one of tuberculosis.
We needed to find practical next steps and here’s what we did ie provide learning events that don’t simply disseminate knowledge but start to support the conditions specified in slides 15-21).
In bold are the three top according to the experts. We mapped these against specific roles.
Whilst ‘Foundations in Microbiology’ is a well-established domain in the field. But not the other two:
The importance of developing communication, collaboration and advocacy skills across roles in the surveillance system. This category does not look at subject specific skills, such as in the category ‘Foundations in Microbiology’ but it underpins effective surveillance practice because surveillance activity involves numerous processes, interfaces and handoffs across different professional groups with varying levels of educational and professional training, and instances where critical information must be accurately communicated - across professionals, ranks, settings, teams and sectors. Where professionals are not communicating effectively, patient/public health safety is at risk and errors are likely to occur. Experts highlighted the need to bring clinicians and lab professionals together.
Data Use & Interpretation for diagnosis - highlights the importance of data flow across local, national and global systems as discussed earlier. This gap in knowledge on how to use data might be due to the fact that AMR surveillance systems are not yet mature in LMICs. It might be because no specific roles have been created to use and interpret data, or because professionals who have this role have not yet acquired specialised skills, do not feel ownership of specific tasks or are not sufficiently supported in the performance of this activity.
We recognise the difficulties in supporting the restructure of workplaces in ways that support effective learning and are trying to find ways to design learning events that move beyond what we traditionally think of as ‘learning’ or ‘education’ to ways of encouraging genuine advancement of working conditions in ways that help solve global challenges.
These gaps cannot be dealt with in isolation.
Should consider hierarchical and organisational structures at the local facility level.
The roles of professionals who are close to the patient or animal should be reviewed or created to ensure their practice enables effective sampling and data use.
But there is also a need to clarify what knowledge and competencies are required for sampling and data use and interpretation to be performed adequately at the local level.
We have to reconsider roles within the health-care/AMR workforce, as well as the knowledge, skills and practices that are appropriate for workforce strengthening programmes.
A capacity strengthening programme that only looks at achieving advancement of knowledge and skills will not bring desirable change. Review / Create roles at the local level for this activity to take place in an effective way and professionals to feel supported.
Clarify / Review what knowledge and competencies are required for new practice to be performed adequately at the local level.
Engaged with number of roles – diverse – interested not to talk just to senior people
Talked to almost 100 people (and approx. 85 are structured interviews)