Explore the vast range of titles available.

Introduction and ObjectivesIntrapulmonary right-to-left shunts (RLS) are an important clinical concern in individuals with Hereditary Hemorrhagic Telangiectasia (HHT). Along with respiratory symptoms like dyspnea, serious neurological complications can arise including ischemic strokes and brain abscess. HHT is an autosomal dominant genetic disorder characterized by arteriovenous malformations (AVMs), with pulmonary AVMs (PAVMs) being a common manifestation that contributes to intrapulmonary shunting. Screening for PAVMs is important in HHT to prevent risks of paradoxical embolization, appropriate management and rarely death from pulmonary hemorrhage. Agitated saline contrast echocardiography (‘bubble echo studies’) are done through HHT Centers to identify RLS and grading the same when present, and are recommended through the International HHT Guidelines. Western Canada has a large rural/remote population, and therefore satellite HHT clinics by health jurisdiction and associated echo labs performing these studies have been recommended to improve access to care and hopefully maintain quality of RLS assessments. This policy study aimed to assess the written policies governing bubble echo techniques and protocols in use within accredited echo labs across the province of Alberta, Canada.MethodsWe conducted an observational cross-sectional study at a single time point (as of July 15, 2024) to evaluate the practices and protocols used in echocardiographic assessments for RLS to screen individuals with HHT - working with the provincial accreditation body, the College of Physicians and Surgeons of Alberta (CPSA). All CPSA-accredited adult echo lab facilities were contacted (telephone/email/in-person). Policy data was collected on the proportion of CPSA-accredited labs specifically performing shunt assessments, including review of available written policies for the shunt assessment protocols.ResultsA total of 62 CPSA-accredited adult echocardiography facilities were reviewed, of which only 12 reported performing bubble echo studies for RLS assessment. The policy review of the participating echo labs revealed notable variations in the saline injection techniques and the grading scales/criteria used for shunt evaluation in bubble echo studies.Abstract P287 Table 1Comparison of shunt assessment protocols across accredited echo labsConclusionCurrent accreditation criteria in Alberta and other health jurisdictions do not mandate a standardized protocol for bubble echo shunt assessments. Considering a standardized protocol could reduce variability between labs and allow for more reliable comparisons over time.

PurposeAccurate and reproducible quantification of ventricular function is essential for serial monitoring and management of complex congenital patients. Systemic right ventricular functional analysis can be challenging. We sought to investigate visual grading and quantification in systemic right ventricles with transthoracic echo and CMR and impact of training and experience on reproducibility.Methods10 anonymous apical ‘4-chamber’ transthoracic (Epic, Phillips) images, duplicated twice, were viewed by 20 participants of varying experience and accreditation and 10 anonymous ‘4-chamber’ CMR (1.5 T Avanto, Siemens) HLA images of the same patients, duplicated twice, were analysed by 12 participants. Participants were asked to provide an overall visual grading of systemic RV function, an ‘eyeball’ estimate of systemic RV function and a judgement of image quality (%). Experience and accreditation were noted.Results10 patients, 6 female, mean age 28 years, range 20–48 years: 8 patients with single ventricle (Fontan), 1 atrial switch (Senning) and 1 ccTGA. 16 echo viewers were accredited, 5 regularly performing congenital echo and 6 CMR viewers were accredited. CMR image quality ranged between 50–100% and echo image quality between 15–90%. Repeat blinded visual estimates by the same observer were in agreement between 45–100% in echo and 25–83% with CMR with less reproducibility in those observers without CMR accreditation.ConclusionVisual grading and quantification of complex congenital heart disease is difficult with limited reproducibility. There is a variation in visual grading by observers, particularly in CMR.Formal quantification by experienced congenital imagers is recommended to optimise reliability of serial measurements with both echo and CMR

BackgroundThe Pulmonary Rehabilitation Services Accreditation Scheme (PRSAS), hosted by the Royal College of Physicians (RCP), was launched in April 2018 to improve the quality of UK pulmonary rehabilitation services. Participating services work to an accreditation pathway which involves self-assessment and quality improvement against the standards. Accredited services submit evidence annually to demonstrate maintenance to the standards and have a 5-yearly on-site assessment. The aim of this analysis was to explore the experiences of accredited services.MethodsA mixed method survey was sent to current accredited services (2024) to record experiences of the service accreditation journey and to explore impact, barriers and facilitators to completing the accreditation process. A descriptive analysis was undertaken with content analysis for qualitative content.ResultsAt the time of the survey 160 services were participating in PRSAS, of which 21 were accredited, 18(86%) returned the service annual survey. Most of the services (77.8% 14/18) reported measurable changes since starting and achieving accreditation, these included improvements to the exercise delivery programme (21.4% 3/14), reduced waiting times (28.6% 4/14) and improved patient outcome measures tools/data collection (42.8% 6/14). Similar numbers (77.8% 14/18) reported positive opportunities post-accreditation, including better clinical links, awareness of PR services within their organisation and/or externally (64.3% 9/14) and increased staffing (retention/recruitment/promotion, 42.8% 6/14). 88.9% (16/18) had implemented recommendations (i.e. embedding operational plans and processes [50.0% 8/16], exercise programme changes [37.5% 6/16]).Feedback from participants highlighted a lack of standardised templates and the need for more information resources to support the process. Variation in assessor requests and as well as additional hurdles with trust requirements for data presentation were also highlighted. Several participants highlighted that the accreditation process can be ’overwhelming’ and ‘tricky’ to coordinate alongside running clinical services. However, after completion of the process many would consider being an accreditation champion (66.7% 12/18), the numbers participating in and completing the process successfully are increasing.ConclusionsThese findings suggest that accreditation provides measurable impact on service Key Performance Indicators and patient outcomes.

BackgroundIn November 2018 the Hull Institute of Learning and Simulation (HILS) became the first centre within the United Kingdom to be awarded the ASPiH Accreditation. Here we share the experience of that journey with intentions of helping others with their applications.Summary of workThe initial stage was ensuring that HILS fulfilled the criteria for the organisation accreditation. The standards framework and guidance from the ASPiH website lists the criteria - four modules;Faculty,Technical Personnel,Activity,ResourcesOnce confident that the requirements could be met, the application form was completed. The application requires the organisation to justify how they meet the criteria for each area, backed up with evidence. Some evidence included with the application is listed below:2 Years of ActivityCourse ProgrammesScenario Design TemplatesSample ScenariosFaculty TrainingStatistical Reports–Footfall, UsageFollowing submission of the application, it was reviewed by ASPiH panel members before arranging an audit of the centre. HILS were tasked with arranging a room for the visit. The panel ask that the centre arranges delegates, faculty and staff members who could be interviewed by the panel, this was challenging as most of the interviewees work clinically but the panel were very flexible in how and when the interviews took place.Following the audit the panel gave the management team some recommendations for HILS to consider. This was very useful for HILS as it provided an external point of view of the service.Summary of resultsA week following the visit; HILS were notified that we had been successful in gaining the centre accreditation having met the required standards for the organisational accreditation.The report stated ‘HILS is a well-run centre with excellent administrative, technical and managerial support’ Areas of commendation are in innovation and new technologies. Areas for development are branding, continued faculty development and clarity over strategy.DiscussionThe process is very much formative. HILS are now working on the recommendations from the report and are accredited for 3 years.ConclusionsThe accreditation, application and audit was a rigorous process but the panel were very supportive and helpful throughout the process.RecommendationsTo ensure a smooth process we would recommend checking off the guidance criteria and start collecting evidence required to support the application as that can be time consuming.ReferencesHILS www.heyhils.co.ukASPIH www.aspih.co.uk

Background The global emphasis on medical education quality has established accreditation as a crucial evaluation method. Iran has implemented systematic institutional and program accreditation in medical universities over the past decade. This study analyzes the strengths and implementation challenges of educational accreditation from the perspective of field experts. Methods We conducted a qualitative content analysis study, engaging accreditation experts selected through purposive sampling. Semi-structured interviews were employed to gather expert opinions on the strengths and challenges of implementing educational accreditation in Iran. The resulting data underwent inductive content analysis to distill key themes and insights. Results Analysis of the interviews yielded 140 primary codes, which were organized into two main themes and six categories. The first theme, “the Pillars of the Accreditation System,” encompassed four main categories: accreditation standards, accreditation structure, accreditation evaluators, and accreditation outcomes. The second theme, “Improvement in Conducting Accreditation,” comprised two main categories: improving the structure and improving the implementation process. While accreditation efforts have improved institutional adherence to basic quality standards, challenges such as excessive governmental control and the approval of underperforming institutions raise concerns about the credibility of the process. Conclusion The efforts of the Ministry of Health and Medical Education in implementing accreditation have guided programs and institutions towards achieving minimum quality assurance standards. Structural issues within Iran’s accreditation framework, such as governmental control over the accreditation process and the consideration of multiple factors in accreditation decisions, have led to some concerns. One of these concerns is approving underperforming institutions and programs which has raised some questions about quality and necessity of the accreditation process itself. It is hoped that in the near future, the Ministry of Health and Medical Education will devise and implement strategies to enhance the current system, paving the way for a more robust and effective accreditation process in the future.

Significance & Background: Efforts were concentrated on establishing oncology care in a rural community with limited resources, offering consultations, treatment, and multidisciplinary support. This facility provides a comforting and accessible environment, staffed by skilled oncology professionals from a comprehensive academic cancer center. Experienced oncology certified nurses were hired managing care coordination and infusion services in this state-ofthe-art facility. The physical space and equipment were ready, and staff had been oriented, while leadership faced challenges with unexpected timelines for licensing and accreditation, which hindered the center's full operational capacity. Purpose: Sharing the experience of establishing a network infrastructure- along with the unforeseen challenges and successes- informs the next phase of expansion. Mentorship plays an important role in facilitating organizational progress, helping to minimize obstacles and disseminate the knowledge gained. Interventions: Collaboration with the revenue cycle team included weekly meetings providing updates on timelines. Implementation of shared drives assisted with clear communication and standardization of tasks. Leadership executed strategies keeping staff engaged and productive including cross coverage, precepting and mentoring, focused learning, and community stewardship. Policies and procedures were developed and shared with the newest network site preparing to open, including activation plans, workflows, and essential information about the overall project. Results: Regulatory constraints and licensing delays prevented many patients from accessing the facility for six months, With insurance approvals extending the accreditation process further. This period offered opportunities for professional development, team building, and community outreach. There was zero percent turnover during this time. Quality assurance and improvement initiatives were implemented to enhance clinical outcomes and overall quality of care. Despite a slow start, the volume of new consultations and treatments has since increased significantly month over month. Through patient experience surveys, the team has been able to quantify their success. Sharing lessons learned and successes has been invaluable for transforming new network locations. Discussion: The sustainability and expansion of network infusions are vital for communities in need of accessible care. Key elements for successfully launching an infusion center include regulatory compliance, financial planning, insurance contracts, and a commitment to patient-centered care. Effective communication and strong teamwork are essential for implementation of a community infusion site. Additionally, flexibility and the identification of key metrics are crucial for operationalizing new services, as growth and productivity will ultimately drive the network's success.

Background Accrediting medical specialties programs are expected to influence and standardize training program quality, align curriculum with population needs, and improve learning environments. Despite global agreement on its necessity, methods vary widely. In the Chilean context, a recent new accreditation criteria includes research productivity in relation to educational research on resident programs, so we aimed to define it. What is the profile of publications in educational research produced by Chilean medical specialty residency programs in the last five years? Based on these results, we intend to analyze the potential impact of the new accreditation policy on medical specialty programs in Chile. Methods We performed a preliminary bibliometric search to identify the use of the term “resident” in literature. After that, we conducted a literature search, using a six-step approach to scoping reviews, including the appraisal of the methodological quality of the articles. Results Between 2019 and 2023, an average of 6.2 articles were published yearly (19%). The bibliometric analysis revealed that the dominant thematic area of the journals was clinical, accounting for 78.1%. Most articles focused on residents (84.38%), with only two articles including graduates as participants. One university was responsible for 62.50% of the articles and participated in all multicenter studies (9.38%). Surgical specialties produced 15 research articles focused on procedural training using simulation. Psychiatry was the second most productive specialty, with 5 articles (15.63%) covering standardized patients, well-being, and mental health assessment. The most frequent research focus within residency programs over the five-year period was teaching and learning methodologies, with 19 articles representing almost 60% of the total analyzed. Conclusions Research on medical education in Chile’s postgraduate residency programs is limited, with most studies concentrated in a few universities. The new accreditation criteria emphasize educational research, posing challenges for many institutions to meet higher standards. Understanding unexplored areas in educational research and learning from successful programs can enhance research productivity and align efforts with accreditation expectations. Continuous evaluation and new research on residents’ satisfaction, skills acquisition, and well-being are needed to ensure training quality and accountability.

Introducción: la tipificación HLA de alta resolución es requisito para los donantes intrafamiliares HLA haploidénticos, y para la selección de donantes no relacionados de registros internacionales y de bancos de unidad de cordón umbilical. Hasta la fecha, toda tipificación confirmatoria se llevaba a cabo fuera del país, ya que no existía ningún laboratorio acreditado internacionalmente para llevar a cabo estos estudios. Desde el 2017, nuestra institución inició la tipificación HLA de alta resolución por secuencia NGS con la plataforma TruSight HLA de Illumina y, posteriormente, con la plataforma AlloSeqTx de CareDx obteniendo acreditación para la tipificación NGS en el año 2020. Desde el año 2021 iniciamos análisis con la plataforma Miafora (Immucor Corp). Este año hemos recibido acreditación internacional por la European Federation of Inmunogenetics (EFI) para el análisis HLA de alta resolución por secuencia para donantes intrafamiliar relacionado y para donantes no relacionados, tanto de unidades de cordón umbilical como de registros internacionales de donantes. Métodos: se llevó a cabo validación y acreditación de la plataforma Miafora HLA 11 Loci por NGS en un equipo MySeq utilizando 10 muestras (retrospectivas) de pruebas de intercomparación internacional del programa de la American Society for Histocompatibility and Inmunogenetics (ASHI) y 20 muestras prospectivas del mismo programa. Se evaluó la concordancia de los resultados obtenidos a partir de las muestras procesadas con los reportes de intercomparación emitidos por ASHI. Resultados: de un total de 30 muestras analizadas (660 loci) se obtuvo concordancia en la tipificación en todas ellas. Sin embargo, se observó discrepancia en el formato de reporte en 2 loci (3,3%) debido a que no se tuvieron en cuenta posibles ambigüedades en los GGroups o en los PGroups (https://hla.alleles.org/alleles/g_groups.html) en la nomenclatura utilizada. Se llevaron a cabo las acciones correctivas para resolver los puntos relacionados con nomenclatura. Se obtuvo acreditación internacional para Ttipificación HLA de Alta Resolución por Secuencia NGS.

Introduction International accreditation of universities is a comprehensive evaluation process conducted by reputable external bodies to ensure adherence to quality and effectiveness standards in higher education institutions. This study aimed to identify the challenges and strategic solutions related to the international accreditation of Iranian universities of medical sciences (IUMS). Methods This qualitative study was conducted in 2023 across IUMS. Data were collected through purposive semistructured interviews with 36 individuals, including administrators, faculty members, and experts from various university departments under the supervision of the Ministry of Health and Medical Education (MOHME). The interviews continued until data saturation was achieved. The data were analyzed using the conventional content analysis approach proposed by Graneheim and Lundman. Results A total of 52 challenges were identified, the most critical of which were cultural barriers, weak implementation processes, and inappropriate organizational structures. In parallel, 57 solutions were classified into seven categories, including training and education, infrastructure development, communication enhancement, policymaking and planning, self-assessment, improvement of standards and indicators, and process optimization. Conclusions This study identified major barriers to international accreditation in IUMS and proposed practical solutions. Progress requires joint action: universities should strengthen training, infrastructure, documentation, and internal quality assurance, while accrediting bodies and national authorities must provide supportive regulations, adequate resources, and context-sensitive standards aligned with global frameworks. Coordinated efforts at both levels are essential for enhancing accreditation readiness, improving quality, and increasing global competitiveness.