Requirements for electronic laboratory reports according to the German guideline Rili-BAEK and ISO 15189

Objectives Legal regulations and guidelines such as the Guidelines of the German Medical Association for the Quality Assurance of Laboratory Medical Examinations (Rili-BAEK) and ISO 15189 apply to electronic laboratory reports. However, many laboratories struggle with practical implementation of these regulations and guidelines. Methods Laboratory and legal experts analyse the relevant guidelines and provide checklists and practical recommendations for implementation. Results Laboratories have less control over the display of electronic laboratory reports than over paper documents. However, an electronic report alone is legally sufficient and need not be accompanied by a paper copy. Rili-BAEK and ISO 15189 stipulate a set of minimum information in every report. The laboratory must verify that reports are transmitted and displayed correctly. To help laboratories do so, agreements between laboratories and the report recipients can clarify responsibilities. Conclusions Electronic laboratory reports can improve patient care, but laboratories need to verify their quality. Towards this end, Rili-BAEK and ISO 15189 set out helpful provisions.

Audit of therapeutic drug monitoring of ‘clozapine plasma levels’

AimsTo re audit the monitoring of Plasma Clozapine levels in Rehabilitation setting in CNTW Trust as per Trust Guidelines PGN on “Safe prescribing of Clozapine”.Objectives:To determine if1. The reason for a clozapine plasma level request is recorded.2. Results are recorded correctly.3. Appropriate action is taken and recorded when results are significant.BackgroundClozapine plasma level monitoring is useful when assessing adherence, adjusting the dose, monitoring the effects of changes in smoking habit, investigating clozapine side effects and when toxicity is suspected.An initial audit was carried out within the Trust in 2015 and the following recommendations were made:Check and record clozapine plasma levelAt baseline (a level should be taken once the patient has been on the target dose for at least a week)Annually.When clinically relevant to optimise therapy.An entry must be made in the patient's progress notes recording the reason of requesting the test.On receipt of results, the paper copy must be scanned & an entry made in progress notes.The clinician should comment on the significance of the results and propose an action plan.We re-audited compliance with the guidance in Rehabilitation (inpatients and community) by reviewing patient notes for a 2 year period of 2017–2018.MethodThe audit work involved a review of 31 case records of patients prescribed Clozapine whose last plasma level was taken between 2017–2018. Patient's details were identified from a randomly generated list by the Trust pharmacy.Result<50% compliance was seen with baseline, annual monitoring, reason for recording and proposed action plan by clinician.>50% compliance was seen with scanned results and levels checked when clinically relevant.No significant improvement from the previous audit except improvement in compliance with documentation of levels.ConclusionDissemination of Clozapine Key cards within teams.

Applying the AFIX Quality Improvement Model to Increase Adult Immunization in Wisconsin

Objectives Assessment, Feedback, Incentives, and eXchange (AFIX) is a quality improvement model used to increase childhood and adolescent immunization rates in the United States. We evaluated implementation of a similar quality improvement model to boost adult immunization rates. Methods During November 2016 through May 2017, adult immunization outreach specialists conducted 124 in-person visits to clinics in Wisconsin that immunize adults, submit immunization information to the Wisconsin Immunization Registry (WIR), and agreed to participate in adult AFIX. Outreach specialists ran immunization assessment reports using the WIR and showed a paper copy of the report during the visit. Health care providers were encouraged to implement at least 1 of 18 strategies (eg, reminder-and-recall intervention, giving adult immunization resources to patients) to increase adult immunization rates. Outreach specialists conducted follow-up with health care providers at 3, 6, and 9-18 months after the initial visit to encourage strategy implementation. We compared AFIX sites with control clinics on practice type, geographic location, and clinic size. Results Clinics that participated in adult AFIX had a significantly larger increase in median adult immunization rates for completion of the human papillomavirus vaccine series at the 9- to 18-month follow-up than control clinics did (10.4% vs 7.7%; P = .02). The median immunization rate for 13-valent pneumococcal conjugate vaccine/23-valent pneumococcal polysaccharide vaccine completed in series was higher, but not significantly so, among adult AFIX clinics than among control clinics (12.6% vs 10.7%; P = .18). Conclusions Adult AFIX resulted in increased awareness about adult immunization recommendations and may be a useful tool for increasing adult immunization rates.

Extending the Task-Technology Fit (TTF) Model to E-Textbook Usage by Students and Instructors

Companies produce increasing numbers of textbooks in electronic format (e-textbooks) for use by students and instructors. One would be remiss, however, to think that university bookstores are not filled with hard copies of textbooks; many students and instructors still insist on using traditional paper copy textbooks. Many models exist to explain the factors that influence whether users adopt new technologies. The majority of this research, however, focuses on a single user group or isolated new technologies in the academic domain, such as learning management systems or digital video tools. The study extends the Task-Technology Fit (TTF) model to explore how both students and instructors use e-textbooks. New items were added to existing constructs of access, task technology fit, and perceived ease of use. The authors propose a new model and test the impact of perceived ease of use, access to technology, and the task technology fit on performance by both students and instructors. The results of factor analysis and structural equation modeling are reported.

SELF-ASSESSMENT OF KNOWLEDGE OF EMERGENCY MEDICAL SERVICES SYSTEM EMPLOYEES ON NEW PSYCHOACTIVE SUBSTANCES – CURRENT STATUS AND DEVELOPMENT PROSPECTS

Aim: To examine the level of knowledge on new psychoactive substances (NPS) among health care profesionals (HCPs) working within the Emergency Medical Services (EMS) system in Poland, and to assess how they would like to improve it. Material and methods: The study involved 602 HCPs working within the EMS system and was carried out using a survey questionnaire. Both online and paper-copy surveys were utilized. The collected data were statistically analyzed using the STATISTICA 12.5PL computer program (StatSoft, Inc., USA). Results: Most responders perceived themselves as having a “sufficient” (49%) or a “weak” level (40.5%) of knowledge of NPS, while only 10.5% as “good”. The Internet was a main source of information on NPS. In the 4-year period covered by the study, only less than 22% of HCPs took part in any training courses on NPS. Most participants expressed a need to learn more about “pharmacological treatment”, “legal provisions” and “qualification for hospital treatment”. Conclusions: An inadequacy in essential knowledge of NPS by HCPs working within the EMS system highlights the need for education on these novel molecules.

The Matrix: Connecting Time and Space in archaeological stratigraphic records and archives

The records of archaeological stratigraphic data and the relationships between stratigraphic units are fundamental to understanding the overall cohesiveness of the archaeological archive of an excavation. The information about individual units of excavation identified on sites with complex stratigraphy is most often held in the site database records and stratigraphic matrix diagrams, usually documenting relationships based on the laws of stratigraphic superposition and the Harris matrix conventions (Harris 1979). However, once the matrix diagram has been used to record the information during excavation, there is far less consistency in how those stratigraphic records, and any associated phasing information, are finally deposited in the archives. For that valuable data to be successfully identified and re-used (particularly if the rest of the data is in a database), the stratigraphic and phasing data needs to be in a format that can be interrogated as part of the database. In practice, often only a (paper) copy of the matrix diagrams make the archive. This means that the critical temporal and spatio-temporal relationships upon which the phasing of sites is built, cannot usually be interrogated or (re)used without lengthy and wasteful re-keying of that data into another version of the database. The stratigraphic, sequencing and temporal information held in a matrix is fundamental in further studies of the site records and in working out how the site may relate to other excavated sites of similar or related dates and phases. This article will suggest ways in which the stratigraphic data from excavations and the reasoning processes carried out in subsequent analysis could be better managed, to make matrices (re)useable as part of a more integrated digital archive. This article examines how conceptual reference modelling, particularly using temporal relationships, can be used to explore these issues and how associated technologies could enable semantically-enriched deductions about the spatio-temporal and purely temporal relationships that fundamentally link archaeological data together. It will also consider where further work is needed both to deal with analysis of spatial or temporal records and to enhance Bayesian chronological modelling and associated temporal reasoning, and how this may form the basis for new linkages between archaeological information across space-time.

Barriers to caring for survivors of childhood cancer: Primary care providers’ and oncologists’ perspectives.

e19194 Background: Advances in treatment have resulted in a growing population of childhood cancer survivors. As most survivors will develop at least one late effect from treatment, it is important to continue to monitor their health. The incidence of late effects increases with age and often are not clinically apparent until decades after cancer treatment. The Institute of Medicine has recommended models of care delivery that include collaboration between oncologists and primary care physicians (PCP). Thus, we explored PCP and pediatric oncologists’ perceptions and experiences with survivors of childhood cancer in primary care. Methods: Recruitment of primary care physicians occurred utilizing the state Board of Medicine listings. A link and a paper copy of the survey were supplied via mail to approximately 3,000 pediatricians. Pediatric oncologists from a large Midwestern hospital completed the survey via email. Results: A total of 197 participants (19 oncologists/ 178 PCPs) completed the survey. The response rate was 95% for oncologists and 6% for PCPs. Although most PCPs (76%, n=134) had cared for a childhood cancer survivor, some respondents (16%, n=8) reported an unwillingness to care for a survivor. Using a ten-point scale, PCPs mean comfort level in caring for survivors of pediatric cancer was 5.78 ( SD= 2.37). PCPs identified the following barriers: limited knowledge of late effects (64%; n=114), lack of communication with oncologist (47%; n=83), and comfort level (38%; n=67). Nearly all oncologists (86%, n=19) reported referring patients to PCPs. Oncologists typically (83%, n=15) referred patients within the first year after treatment. Overall, oncologists were comfortable referring survivors to a PCP ( M=7.5; SD=1.97) and over half were satisfied with the PCP’s care of survivors (57%, n=12). Years in practice and sex of the oncologist were unrelated to comfort level referring to PCP. Conclusions: Barriers faced by PCPs in caring for survivors illustrate a need for increased education and communication between PCPs and oncologists. Attention to these concerns may improve follow-up care and comfort in the referral process.

A139 CANADIAN GASTROENTEROLOGY CAREER PATHWAY EXPERIENCES: A GENDER DIVIDE UNDER EXAMINATION

Background The number of Canadian gastroenterologists has been on the rise in the last 20 years but female representation has stayed disproportionately low (30%). Gastroenterology has remained a male dominated subspecialty despite research showing as early as 1990’s that systemic gender-based barriers exist. Aims To determine whether GI career profiles differ between male and female gastroenterologists and understand barriers to career advancement related to gender in order to help shape future interventions to counteract these issues. Methods A 51-question survey was disseminated to gastroenterologists practicing in Canada. Using provincial College of Physicians and Surgeons websites, an electronic survey was sent to GIs with email addresses and a paper copy to those with fax numbers. The Canadian Association of Gastroenterology sent our survey link in their September 2019 membership email. The survey included questions pertaining to personal, professional, financial and practice characteristics of participants. Data was analyzed using SAS statistical program, and descriptive analysis with 95% confidence intervals was used to compare proportions of men and women. Nonparametric tests were used for continuous data. Qualitative thematic analysis was applied for short answer responses. Results Total 98 responses received (14.7% response rate) with 35% female respondents. Majority had adult, urban practices (86%) but males reported significantly more endoscopy time (42% v. 30%) vs. females who spent more time on research (23% v. 10%). Men were more likely to be married and have children than females. Women were more likely to not only have to choose between their marriage and their career, but more chose marriage compared to men specifically taking time off for maternity or childcare needs. Men were more likely to leave childcare predominantly to their spouse whereas women were more likely to share responsibility of childcare with spouse and hired help. Even after adjusting for age, males earned a significantly higher income than females (&gt;$100,000 difference). 40% of men reported a salary over $600,000, compared to only 4% of women. Several gender-based biases were cited by females during their staff GI career: receiving less recognition for their work, challenging relationships with senior colleagues and support staff, inferior promotion opportunity, more difficulty publishing research and having their competency challenged by peers. Conclusions This survey shows that there are still many differences in the Canadian GI career pathway experience based on gender. Female GIs are disproportionately negatively affected in their clinical and academic practices, renumeration and work-life balance. Understanding these disparities is the first step towards remedying gender inequality in GI workplace culture. Funding Agencies None

Development of Grease Resistant Packaging Paper Using Cellulose Nanocrystals and Sodium Alginate

A biodegradable packaging paper with excellent grease resistance was produced using cellulose nanocrystals and sodium alginate. This study aims to reduce the porosity of paper by filling the pores with cellulose nanocrystals and using sodium alginate as a binder. Different types of papers, including filter paper, copy paper, and supercalendered paper, were used. Pure cellulose nanocrystals and cellulose nanocrystals/sodium alginate solutions at different concentrations and ratios (2:8, 5:5, and 9:1 by weight ratio) were applied to papers by coating and impregnation techniques. The resulting papers were then characterized with atomic force microscopy and scanning electron microscopy for the surface morphology. The grease barrier and the mechanical property were investigated in accordance with TAPPI standards. The results demonstrated that the copy paper coated with 2:8 of cellulose nanocrystals/sodium alginate showed excellent grease barrier properties. Within 48 h of the test period for grease to penetrate the coated paper, almost 100% of the grease barrier was achieved when the coating weight was set at 4 g/m2. The roughness of the paper surface significantly decreased, thereby resisting the penetration of oil from one side to another. Moreover, the mechanical property of both cellulose nanocrystals- and cellulose nanocrystals/sodium alginate-coated papers was improved due to the addition of cellulose nanocrystals as a reinforced filler.

Pre-service Teachers' Willingness to Engage in Inclusive Teaching: An Explanatory Model

In this article, we report on a study that sought to examine the willingness of pre-service teachers to apply the inclusion policy for students with disability. The study considered the Theory of Planned Behavior (Ajzen, 1985, 1991) as a means to explain the willingness of pre-service teachers in general and of the subgroups to engage in inclusive teaching. Participants were 580 pre-service teachers enrolled in various types of programs in three different teacher education colleges in Israel. They completed a paper copy questionnaire with 55 items. It was constructed according to Theory of Planned Behavior (TBP) guidelines. It was found that the model, based on the TPB, explains the degree of willingness of pre-service teachers to engage in inclusive teaching. It emerges that attitudes toward inclusion, perceptions of social norms regarding inclusion, and a sense of the competence of pre-service teachers to teach inclusive classes explain most of the variance in the willingness to engage in inclusive teaching and serves as leading factors manifesting this willingness. The discussion is focused on the need to increase pre-service teachers' willingness by using this model.