Abstract only Background: Delays in endovascular therapy can lead to worse outcomes in stroke patients. Interfacility delays when transferring patients to thrombectomy-capable hospitals are common. ...We sought to identify causes of such delays and create a standardized transfer process to improve transfer times. Methods: A 15-hospital system formed a multidisciplinary team to assess the current state of DIDO processes from data on previous transfers, evaluate current transfer algorithms, and analyze baseline performance. Individual hospital transfer algorithms were compared. Results: Data was analyzed for 47 patients transferred from 12 facilities to thrombectomy-capable centers from June 2017 to July 2018 who received ischemic stroke treatment. 71% were from a metro area within 50 miles of a thrombectomy-capable hospital and 29% were from outside the metro area, up to 400 miles away. 80% were transported by air by 9 different agencies. DIDO times were: 27% less than 90 min; 27% 90 to 120 min; 44% greater than 120 min. There was minimal opportunity for improvement based on: day of week, NIHSS, and treatment with alteplase. Areas for improvement include: timeliness of door to CT (x-=13 vs 35 min), time to CT read (x-=8 vs 16 min), time to alteplase (x-=48 vs 115 min), and time to transfer (x-=125 vs 148 min), time from arrival to consult with thrombectomy capable centers (x-= 53 vs 86 min), time from consult to dispatch (x-=19 vs 26 min), and time of transfer agency on scene (x-=22 vs 37 min) for metro vs rural hospitals. Conclusions: Identified causes of delays include decision to transfer and initiation of dispatch to coordinate transport. A difference in timeliness initial diagnosis and treatment of patients outside metro areas was identified. Last known well (LKW) to arrival for transferred patients revealed a need to educate sending facilities on the expanded treatment windows- only 3 patients had a LKW to arrival time greater than 4.5 hours.
HIV-related internalized stigma remains a major contributor to challenges experienced when accessing and providing HIV diagnosis, care and treatment services. It is a key barrier to effective ...prevention, treatment and care programs. This study investigated experiences of internalized stigma among people living with HIV in Malawi.
A participatory cross-sectional study design of participants from eight districts across the three administrative regions of Malawi. Data were collected using Key Informant Interviews (n = 22), Focus Group Discussions (n = 4) and life-stories (n = 10). NVIVO 12 software was used for coding applying both deductive and inductive techniques. Health Stigma and Discrimination Framework was used as a theoretical and analytical framework during data analysis.
Overt forms of stigma and discrimination were more recognizable to people living with HIV while latent forms, including internalized stigma, remained less identifiable and with limited approaches for mitigation. In this context, manifest forms of HIV-related stigma intersected with latent forms of stigma as people living with HIV often experienced both forms of stigma concurrently. The youths, HIV mixed-status couples and individuals newly initiated on ART were more susceptible to internalized stigma due to their lack of coping mechanism, unavailability of mitigation structures, and lack of information. Broadly, people living with HIV found it difficult to identify and describe internalized stigma and this affected their ability to recognize it and determine an appropriate course of action to deal with it.
Understanding the experiences of internalized stigma is key to developing targeted and context specific innovative solutions to this health problem.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Introduction HIV-related internalized stigma remains a major contributor to challenges experienced when accessing and providing HIV diagnosis, care and treatment services. It is a key barrier to ...effective prevention, treatment and care programs. This study investigated experiences of internalized stigma among people living with HIV in Malawi. Methodology A participatory cross-sectional study design of participants from eight districts across the three administrative regions of Malawi. Data were collected using Key Informant Interviews (n = 22), Focus Group Discussions (n = 4) and life-stories (n = 10). NVIVO 12 software was used for coding applying both deductive and inductive techniques. Health Stigma and Discrimination Framework was used as a theoretical and analytical framework during data analysis. Results Overt forms of stigma and discrimination were more recognizable to people living with HIV while latent forms, including internalized stigma, remained less identifiable and with limited approaches for mitigation. In this context, manifest forms of HIV-related stigma intersected with latent forms of stigma as people living with HIV often experienced both forms of stigma concurrently. The youths, HIV mixed-status couples and individuals newly initiated on ART were more susceptible to internalized stigma due to their lack of coping mechanism, unavailability of mitigation structures, and lack of information. Broadly, people living with HIV found it difficult to identify and describe internalized stigma and this affected their ability to recognize it and determine an appropriate course of action to deal with it. Conclusion Understanding the experiences of internalized stigma is key to developing targeted and context specific innovative solutions to this health problem.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Nalaganje filtrov
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