Scaling up the availability of tobacco dependence treatment training: leveraging the experience of King Hussein Cancer Center to create new training hubs

Background and challenges to implementation Despite their proven value, tobacco dependence treatment (TDT) services are short in the Eastern Mediterranean Region (EMR) partly due to the lack of expertise among healthcare providers (HCPs). Since training is a proven strategy to avail TDT, King Hussein Cancer Center (KHCC) trained 2,000 HCPs in EMR (between 2011 and 2016). However, centralization meant limited training capacity, calling for scaling up. Intervention or response KHCC collaborated with institutions in Oman, Egypt, Tunisia, and Morocco to build sustainable evidence-based local training hubs. The collaborating institutions host and manage the hubs. (1) In each country, needs were assessed to inform identification of target audiences, program design, and selection of HCPs to serve as trainers; and relevant system-level barriers and facilitators were scanned. (2) KHCC shared its evidence-based training curriculum with hubs for translation and necessary customization. (3) KHCC held training of trainers (ToT) workshops, observed trainers in action, and provided feedback. The ToT workshops provided an opportunity for the group of trainers to reflect on barriers and plan action for a TDT-supporting environment. Results and lessons learnt 84 HCPs were engaged as trainers (all non-smokers and mostly clinicians). Results from two rounds of semi-annual post-ToT online follow up indicate trainer engagement (Table 1). Respondents report the need for strengthened TDT clinical experience as a barrier to engaging in training, and administrative issues and shortage of medications as barriers to practice. Table 1: Results from long-term follow up of hub trainers (self-reports)   Percentage of trainers …   … practicing TDT … offering TDT training through workshops … offering on-the-job TDT training … interacting with fellow trainers from their own country … interacting with fellow trainers from other countries Results of first semi-annual follow up (response rate 40%) 80% 36% 42% 41% 6% Results of second semi-annual follow up (response rate 25%) 81% 25% 39% 62% 19% [Table 1] Within the first year of launching, the hubs offered 8 training workshops through their local trainers (almost double KHCC's historical capacity of 4.5 workshops). Hubs also report miscellaneous TDT awareness activities, and TDT advocacy work. Conclusions and key recommendations Our program succeeded in expanding the availability of TDT training and in building a network of trainers/advocates. Yet, hubs need to strengthen their advocacy role to address barriers holding them from achieving full potential, such as those preventing some trainers from engaging in training

EFFECT OF NEBULIZED COLISTIN ON THE VENTILATOR CIRCUIT: A PROSPECTIVE PILOT CASE-CONTROL STUDY FROM A SINGLE CANCER CENTER

Nebulized colistin (NC) is used for the treatment of pneumonia due to multidrug-resistant Gram-negative bacteria. In this one-year case-control study, our objective was to evaluate the effect of NC on the ventilator circuit (VC) components. The case group consisted of 25 mechanically-ventilated patients who received NC, while the control group was 25 mechanically-ventilated patients who did not receive NC. Respiratory therapists inspected the VC every 4 hrs and whenever a ventilator alarm was reported. The VC component was changed if the alarm did not subside after necessary measures were performed. Patients from both groups were treated at the adult ICU in King Hussein Cancer Center (KHCC). In the case group, 22(88%) patients required changing at least one of the circuit components (flow sensor, exhalation membrane, or nebulizer kit). The median number of changes (range) per patient of the flow sensor, exhalation membrane, and nebulizer kit were: 2(1-3), 2(1-6), and 1(1-2), respectively. Large amounts of white crystals, which resembled the colistin powder, were reported on the replaced VC components. The flow sensor was changed in 2 control patients, but white crystals were absent. Crystals obtained from one case subject were confirmed to be colistin by chromatographic mass spectroscopy. Further studies are needed to evaluate the effect of crystal formation on the efficacy of NC and clinical outcomes