A519 days; In KPI5 58% of patients received adjuvant chemotherapy within 60 days after surgery; In KPI6 57% of patients performed radiotherapy within 90 days after surgery (who did not receive adjuvant chemotherapy) and 69% within 180 days after surgery (who received adjuvant chemotherapy); In KPI7 74% of the patients with tumor stage I and II performed one diagnostic examinations within 365 months after surgery. ConClusions: This study sustains the replicability of E.Pic.A. in different realities, the use of the KPIs to measure the performance is a way to guarantee a homogenous level of care regardless where the treatment is performed. Potentially, the improvement of these KPIs could lead to cost savings coming from inefficiencies that could be relocated to higher-value interventions for patients. References: 1. Massa et al., The Breast 34 (2017) 103-107. Disease-specific stuDies inDiviDual's HealtH-clinical Outcomes studies piH1 cOmparing tHe effect Of prOgressive relaxatiOn anD perineal strengHtening interval exercises amOng WOmen WitH primaer DysmenOrrHOea tO reDuce menstrual cramps

Objectives: Colorado has the lowest rate of measles vaccination in the entire country, partially due to the ease of obtaining non-medical exemptions. Our primary objective was to determine the magnitude and cost of a measles outbreak in Denver at current vaccination coverage levels. We then simulated the effect of changing the Colorado non-medical exemption complexity to medium or difficult. MethOds: An agent based transmission model simulated the transmission of the measles virus in Denver following the introduction of a measles case. We modeled public health response, including contact tracing and quarantine of cases. Model outputs included the number of secondary cases, hospitalizations and deaths. Four vaccination scenarios were modeled: Colorado vaccination rate, national vaccination rate, Colorado vaccination rate under medium exemption regulations, and Colorado vaccination rate under difficult exemption regulations. Results: At the Colorado vaccination rate, seven secondary cases followed the introduction of an index case, two of which required hospitalization. This outbreak ranged in cost from $111,048-$338,304, which is equivalent to the purchase of 5,580-17,000 measles vaccines. This could increase 2-dose vaccination coverage in Denver by 1.3%. If Colorado increased their difficulty in obtaining non-medical exemptions, the number of secondary cases reduced by 86%, alleviating costs related to public health interventions and the negative consequences of a measles outbreak. At the national vaccination level, no other individuals became infected due to herd immunity. cOnclusiOns: Herd immunity is not established at the Colorado vaccination rate and thus an outbreak is likely following the introduction of an index case. There is an inverse relationship between non-medical exemption complexity and exemption rate. Increasing vaccination coverage by as little as 3.1% (from easy to medium complexity) would reduce the likelihood and magnitude of an outbreak. Adding a required education component or a written statement of objection would be a prudent public health nudge toward measles herd immunity.

Descriptive statistics, ANOVA and student t-test were employed to examine different variables. Results: Community pharmacists were found to have poor knowledge and low level of involvement with an overall mean score of 11.54 and 2.06 respectively. A significant number of community pharmacists never practiced promoting smoking cessation (45.2%), counseling on good foot care techniques (33.7%) and counseling on the potential impact of over the counter and herbal drugs on diabetes management (34%). On the other hand, describing the right time to administer antidiabetic medications (46%) and counseling on suitable administration, handling and storage of insulin (33.7%) were done more frequently. The main reported barriers to the delivery of these services were lack of knowledge or clinical skills, lack of access to additional training programs and lack of personnel or resources. ConClusions: The present study revealed a poor knowledge and low level of involvement in counselling and health education services for patients with diabetes mellitus. Lack of knowledge or clinical skills was the most commonly reported barrier for providing such services. In order to better integrate community pharmacies into future public health programs and optimize the contribution of pharmacists, interventions should focus on overcoming the identified barriers.

Health care reform taking place in the Kazakchstan includes, as an essential element, increasing the efficiency of nursing staff, and improved management of nursing service. Nurse Manager decides on important strategic issues, makes decisions under conditions of extreme instability, constant shortage of all types of resources. An essential criterion of the value of nurses as a Director; becomes its managerial ability, leadership qualities, communication skills, optimism, vision, and willingness to engage in their self-development. MetHoDs of ReseARcH In the research process was applied analytical, mathematical, and statistical methods. tHe Results of tHe stuDy the study involved 10 heads of nursing services, including one chief nurse and nine senior nurses. the majority of heads of nursing services is in the range 40-56 years. Practically all heads of nursing services (90%) have a qualifying category. 40% -the highest category, 40% is the first and 10% in the second and 10% have no qualification category. 70% of managers working in these positions for more than 10 years. In some cases, heads of nursing services indicate a lack of information, regulatory in nature and related to the latest achievements in medicine. In most cases, heads of nursing services possess leadership qualities and have a positive impact on colleagues and on the question: "Are you a leader in the team?" 80% of managers said yes, 20% were undecided. The ConClusions: the above analysis shows that the professional activities of nursing managers contain certain risks affecting the activities of the nursing services. one of the important tasks of management of nursing is "removing" the risks for the effective style of leadership (management) and improving the quality of medical care. PHP234 ComPetenCies of formal Carers regarding BasiC CliniCal and soft skills in tHe Provision of outPatient serviCes and Patients' PersPeCtive: tHe two sides of tHe same Coin

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