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and 2015. All adult patients who were discharged home from the ED with a diagnosis of pneumonia were included. Severity of pneumonia was graded based on the CRB-65 score as per the CAP guidelines. Primary outcome was type of antibiotic prescribed by the ED physician. Data was analyzed using simple descriptive statistics. Results: There were a total of 141 patients analyzed during the study period (N = 46 in 2013, N = 59 in 2014, N = 36 in 2015). Demographics and relevant comorbidities were similar across the years: age (2013: median = 53 years, range 20-92 years; 2014: 56, 21-83; 2015: 54, 20-81); preexisting lung disease (30%, 27%, 25% respectively); HIV positive status (9%, 7%, 17%). CRB-65 score was: low risk (0 points) = 70% in 2013, 66% in 2014, 75% in 2015; intermediate risk (1-2 points) = 30%, 34%, 25%; high risk (3-4 points) = 0% in all years. Percentage of patients discharged home with a documented prescription was 83%, 85%, and 94% respectively. In 2013, patients received azithromycin (AZM) (n = 17, 43% of antibiotic prescriptions that year); levofloxacin (LVX) (n = 10, 25%); AMC (n = 5, 13%); clarithromycin (CLR) (n = 5, 13%); trimethoprim-sulfamethoxazole (SXT) (n = 2, 5%); doxycycline (DOX) (n = 1, 3%). In 2014: AMC (n = 26, 51%); AZM (n = 12, 24%); LVX (n = 9, 18%); CLR (n = 2, 4%); DOX (n = 1, 2%); erythromycin (ERY) (n = 1, 2%). In 2015: AMC (n = 17, 47%); AZM (n = 12, 33%); LVX (n = 4, 11%); CLR (n = 1, 3%); SXT (n = 1, 3%); DOX (n = 1, 3%). Number of return ED visits within 2 weeks were: n = 16 (35%); n = 11 (19%); and n = 10 (28%) respectively. Conclusion: The results of this study show that there has been a change in antibiotic prescribing practices in the SMH ED since dissemination of the CAP guidelines, with AMC accounting for nearly half of antibiotic prescriptions. Further antimicrobial stewardship efforts will focus on evaluating factors influencing prescribing practices.

Home based care (HBC) is a key component of care and support for people infected with human immunodeficiency virus (HIV). Understanding the pattern of HBC needs in a population is beneficial in planning and providing optimal HBC services for the people. This retrospective study assessed the pattern of home based care needs and services in patients of the adult antiretroviral therapy (ART) clinic of Jos University Teaching Hospital (JUTH), Jos, Nigeria. All documented home based care visits to patients of the clinic from September 2008 to December 2013 were reviewed. Relevant information was obtained from the patients' clinical and home visit records. Data was analysed using Epi info version 7 statistical software. A total of 152 patients with 542 home visits were reviewed. There were 112 (73.7%) females and 40 (26.3%) males, with a mean age of 34±8.9 years at the time of initial home visits. The three commonest primary reasons for home visits were psychological counselling (22.7%), adherence counselling (15.5%) and ill-health (12.4%), while follow up visits accounted for 32.5% of the home visits. The 3 most frequent services provided during home visits were counselling on clients medication for adherence (77.5%), basic nursing care (61.6%), and psychological counselling (41.5%). By December 2013, out of 152 patients reviewed, 61.8% were alive, 15.1% had died and 23.1% were lost to follow up. The services provided during home visits extended beyond the patients' perceived needs (primary reasons for visit). Home based care brings to light some patient needs that may not be evident or catered for at the facility level of care. This supports the endorsement of home based care as a useful strategy to complement facility care towards achieving an overall patient well-being.

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Introduction: Emergency Department (ED) health care professionals are responsible for providing team-based care to critically ill patients. Given this complex responsibility, simulation training is paramount. In situ simulation (ISS) has many cited benefits as a training strategy that targets on-duty staff and occurs in the actual patient environment. Several evidence-based frameworks identify staff buy-in as essential for successful ISS implementation, however, the attitudes of interdisciplinary front-line ED staff in this regard are unknown. The purpose of this study is to identify contextual trends in interdisciplinary opinions on routine ISS in the ED. Methods: Qualitative and quantitative review, exploring the self-reported attitudes of interdisciplinary ED staff: before, during and after the implementation of a routine ISS pilot program (5 sessions in 5 months) at the Charles V Keating Emergency and Trauma Center in Halifax from Feb-Nov, 2018. Results: 149 surveys were received. Baseline support for ISS was high; 83% of respondents believed that the advantages of ISS outweigh the challenges and 47% favoured simulation in the ED, relative the sim bay (26%) and 28% were indifferent. The attitudes of direct participants in ISS were very positive, with 88% believing that the benefits outweighed the challenges after participation and 91% believing that they personally benefited from participating. A department wide post-ISS pilot survey suggested a slight decrease in support. Support for ISS dropped from 83% to 67%, a statistically insignificant reduction (p = 0.098) but a sizeable change that warrants further investigation. Most notably respondents reported increased support for simulation training in a simulation bay relative to ISS in the ED. Respondents still regarded simulation highly overall. Interestingly, when the results were stratified by position, staff physicians were the least positive. Conclusion: Pre-pilot or baseline opinions of ISS were very positive, and participants all responded positively to the simulations. This study generates valuable insight into the perceptions of interdisciplinary ED staff regarding the implementation and perceived impact of routine ISS. This evidence can be used to inform future programming, though further investigation is warranted into why opinions post-intervention may have changed at the department level.