Appropriateness Of Use Research Articles

515 Evaluation of growth hormone use in patients with large burns and complex wounds

Abstract Introduction Large burn injuries lead to an extensive and prolonged catabolic state that results in loss of body mass and impaired wound healing. To combat this hypermetabolic response, different strategies have been employed including early excision and grafting, infection control, early nutrition and anabolic therapies such as oxandrolone. Human growth hormone is of interest for burn patients because of its anabolic properties. While its use has been associated with worse outcomes in the critically ill adult with sepsis, it has shown improved outcomes when used in pediatric burn patients. The purpose of this study was to retrospectively evaluate the appropriateness of human growth hormone use, its adverse events and cost in patients with large burns or complex wounds and poor wound healing. Methods This was an IRB approved, retrospective, single center chart review from 2011 to 2019 assessing human growth hormone prescribing patterns in the burn unit. The primary objective was appropriateness of use, defined as documentation of poor wound healing prior to initiation despite adequate nutrition delivery and use of standard anabolic therapies (i.e., oxandrolone). Secondary objectives included perceived benefit, adverse events and median therapy cost per patient of human growth hormone. Results Thirty-eight patients were included in the study, 79% of which were adults, with a median total body surface area involvement of 50% (IQR 40 to 71). Only forty-one per cent of patients receiving human growth hormone met our predefined criteria for appropriateness; this was primarily driven by poor documentation of wound healing. However, 80% of patients were receiving adequate nutrition and oxandrolone, indicating appropriate clinical use. Most adult patients received a dose of 20mg daily, while pediatrics received the weight based 0.2mg/kg daily dose. The median duration of treatment was 24 days (IQR 13–35) and median time from admission to growth hormone initiation was 27 days (IQR 12–34). Overall clinical improvement was noted in 53% of patients, as evident by increased weight, prealbumin and/or documentation of improved wound healing. The most common adverse effect noted was hyperglycemia, followed by new sepsis onset. The median therapy cost per patient was $42,000. Conclusions Human growth hormone may serve as a salvage therapy for large burns with poorly healing wounds. Prior to initiating therapy, nutrition must be optimized and standard, more researched anabolic therapies should be started. While receiving therapy, patients should be monitored for both hyperglycemia and the development of new sepsis.

533 Evaluation of growth hormone use in patients with large burns and complex wounds

Abstract Introduction Large burn injuries lead to an extensive and prolonged catabolic state that results in loss of body mass and impaired wound healing. To combat this hypermetabolic response, different strategies have been employed including early excision and grafting, infection control, early nutrition and anabolic therapies such as oxandrolone. Human growth hormone is of interest for burn patients because of its anabolic properties. While its use has been associated with worse outcomes in the critically ill adult with sepsis, it has shown improved outcomes when used in pediatric burn patients. The purpose of this study was to retrospectively evaluate the appropriateness of human growth hormone use, its adverse events and cost in patients with large burns or complex wounds and poor wound healing. Methods This was an IRB approved, retrospective, single center chart review from 2011 to 2019 assessing human growth hormone prescribing patterns in the burn unit. The primary objective was appropriateness of use, defined as documentation of poor wound healing prior to initiation despite adequate nutrition delivery and use of standard anabolic therapies (i.e. oxandrolone). Secondary objectives included perceived benefit, adverse events and median therapy cost per patient of human growth hormone. Results Thirty-eight patients were included in the study, 79% of which were adults, with a median total body surface area involvement of 50% (IQR 40 to 71). Only forty-one per cent of patients receiving human growth hormone met our predefined criteria for appropriateness; this was primarily driven by poor documentation of wound healing. However, 80% of patients were receiving adequate nutrition and oxandrolone, indicating appropriate clinical use. Most adult patients received a dose of 20mg daily, while pediatrics received the weight based 0.2mg/kg daily dose. The median duration of treatment was 24 days (IQR 13–35) and median time from admission to growth hormone initiation was 27 days (IQR 12–34). Overall clinical improvement was noted in 53% of patients, as evident by increased weight, prealbumin and/or documentation of improved wound healing. The most common adverse effect noted was hyperglycemia, followed by new sepsis onset. The median therapy cost per patient was $42,000. Conclusions Human growth hormone may serve as a salvage therapy for large burns with poorly healing wounds. Prior to initiating therapy, nutrition must be optimized and standard, more researched anabolic therapies should be started. While receiving therapy, patients should be monitored for both hyperglycemia and the development of new sepsis.

Models for predicting the suction of heaving compacted soils using geotechnical properties

Soil suction is the major property that controls the behaviour of unsaturated soils. Suction estimation is challenging both in the lab and the field. Various instruments to measure the suction have been developed with the recent technological advancements. Nonetheless, there are still limitations in regards to the reliability, cost, suction range, accessibility, scope of activity, and appropriateness for use either within the field or lab settings. The filter paper method is probably the simplest procedure to measure the suction for the entire range both in the field and the lab. Nevertheless, the procedure takes time. To alleviate the requirement for conducting this test, it becomes imperative to develop mathematical predictive models for soil suction. In this study, a detailed survey was carried out across the Free State province, South Africa, and sampling points identified. Samples were tested for their geotechnical properties. The influence of the geotechnical properties on soil suction was studied. Multivariate regression analysis was carried out utilizing MINITAB 18 program to develop the mathematical predictive models.

Evaluating the quality and safety of health-related apps and e-tools: Adapting the Mobile App Rating Scale and developing a quality assurance protocol

BackgroundWhilst apps and e-tools have tremendous potential as low-cost, scalable mental health intervention and prevention tools, it is essential that consumers and health professionals have a means by which to evaluate their quality and safety. ObjectiveThis study aimed to: 1) adapt the original Mobile App Rating Scale (MARS) in order to be appropriate for the evaluation of both mobile phone applications as well as e-tools; 2) test the reliability of the revised scale; and 3) develop a quality assurance protocol for identifying and rating new apps and e-tools to determine appropriateness for use in clinical practice. MethodsThe MARS was adapted to include items specific to health-related apps and e-tools, such as the availability of resources, strategies for self-management, and quality information. The 41 apps and e-tools in the standard youth configuration of the InnoWell Platform, a digital tool designed to support or enhance mental health service delivery, were independently rated by two expert raters using the A-MARS. Cronbach's alpha was used to calculate the internal consistency and interclass correlation coefficients were used to calculate interrater reliability. ResultsThe A-MARS was shown to be a reliable scale with acceptable to excellent internal consistency and moderate to excellent interrater reliability across the subscales. Given the ever-increasing number of health information technologies on the market, a protocol to identify and rate new apps and e-tools for potential clinical use is presented. ConclusionsWhilst the A-MARS is a useful tool to guide health professionals as they explore available apps and e-tools for potential clinical use, the training, time, and skill required to use it effectively may be prohibitive. As such, health professionals and services are likely to benefit from including a digital navigator as part of the care team to assist in selecting and rating apps and e-tools, increasing the usability of the data, and technology troubleshooting. When selecting, evaluating and/or recommending apps and e-tools to consumers, it is important to consider: 1) the availability of explicit strategies to set, monitor and review SMART goals; 2) the accessibility of credible, user friendly information and resources from reputable sources; 3) evidence of effectiveness; and 4) interoperability with other health information technologies.

Validating the Arabic Scale of Happiness among College Students

Background: Happiness is well known to have positive consequences not only on one person but also on society as a whole. For this reason, psychologists have become increasingly interested in positive psychology in general and in happiness in particular. This interest has been reflected in studying happiness and measuring it. Thus, questions raised lately about the best methods or producers and tools to accurately measure it. And, because happiness is a culturally influenced construct, the applicability of such tools needs to be verified across cultures. Objectives: The study aimed at assessing the reliability and validity of the Arab Scale of Happiness (ASH). The study was conducted on college students, and the analysis included testing of several statistical analyses such as the correlations between two tools for measuring happiness, namely, the Oxford Happiness Questionnaire (OHQ) and Satisfaction With Life Scale (SWKS), and Beck Depression Inventory (BDI-II). Methods: A total of 731 college students from a public university in UAE were recruited for the tests used in the study. The validation process of the ASH included assessing its factor structure using both exploratory factor analysis and confirmatory factor analysis. Convergent validity, discriminant validity, and internal reliability of the scale were assessed and reported in addition to evaluating gender differences. Results: Results indicated that the ASH is unidimensional, with a dominant factor explained more than 50% of the variance. The internal reliability of the ASH was high (α= .93), and all items performed properly in measuring happiness. The scale has a good convergent validity as it is highly and positively correlated with OHQ and SWLS, and good discriminate validity as its highly and negatively correlated with BDI-II. Conclusion: The ASH is a reliable and valid scale for measuring happiness among youth and college students. It is necessary to establish its appropriateness for use across populations or countries in future studies. Furthermore, the scale can be used in cross-cultural applications to assess happiness among different groups of individuals.

Measuring the Alcohol in Alcohol-Associated Liver Disease: Choices and Challenges for Clinical Research.

Alcohol-related liver disease (ALD) rates are rising dramatically and, with it, the need for more clinical research in ALD. However, while alcohol use is thesingle most important factor in long-term morbidity and mortality, it is often poorly measured in clinical trials which can confound results and may mask the effects of treatments that would otherwise be beneficial. In this concise review, available alcohol use endpoints suggested by the Food and Drug Administration, including total abstinence and percent non-heavy drinking days are reviewed, and their appropriateness for use in clinical trials in ALD is evaluated. Measurement of alcohol use in ALD trials is best accomplished using standardized surveys, such as the Alcohol Use Disorders Identification Test and the Timeline Follow-back, coupled with alcohol biomarkers. Best practices include the use of total abstinence as the primary alcohol use endpoint in ALD trials, extending trials to at least 6 months, using a combination of alcohol surveys and biomarkers to assess for use, stratifying by sex, and consideration of other, non-alcohol-related endpoints.

Appropriateness of Long-Term Acute Care Hospital Transfer: A Multicenter Study of Medicare ACO Beneficiaries

ObjectivesThere is wide variation in long-term acute care hospital (LTACH) use nationwide, the most intensive and expensive post-acute care setting, although appropriateness of use is uncertain. Therefore, we examined the appropriateness and reasons for transfer in a high-use region, and how Medicare criteria for LTACH payment identifies appropriate transfers. DesignMulticenter retrospective observational cohort. Setting and ParticipantsConsecutive hospitalized Medicare beneficiaries transferred to an LTACH from 2017 to 2018 from an accountable care organization in Texas. MethodsThe primary outcome was clinical appropriateness of transfer ascertained by 2 physician reviewers. We abstracted patients’ characteristics and primary reasons for transfer. We examined the positive predictive value (PPV) of meeting Medicare criteria for full LTACH payment [preceding intensive care unit (ICU) stay ≥3 days or prolonged mechanical ventilation] for identifying appropriate transfers, and how this differed if Medicare adopted an 8-day minimum ICU stay criterion recommended by the Medicare Payment Advisory Commission (MedPAC). ResultsOf 105 LTACH transfers, 33 (31.4%) were clinically appropriate. The most common reason among appropriate transfers was respiratory care (58%), but 42% had other indications. Inappropriate transfers most commonly were for wound care (28%), intravenous medication infusions (28%), or patient (17%) and physician preference (26%). The PPV for meeting Medicare LTACH payment criteria was 55%. The PPV improved to 77% if Medicare adopted the 8-day minimum ICU stay criterion, with only a modest absolute increase in appropriate transfers not meeting the more stringent criteria (12% to 17%). Conclusions and ImplicationsTwo-thirds of LTACH transfers in a high-LTACH-use region are clinically inappropriate, and are most commonly transferred for wound care, intravenous infusions, or patient and physician preference. Medicare payment criteria modestly distinguished between appropriate and inappropriate transfers. Adoption of MedPAC's recommended 8-day minimum ICU stay criterion could safely reduce inappropriate transfers, although generalizability to low LTACH-use regions is uncertain.

Psychometric properties and use of the DEMQOL suite of instruments in research: a systematic review protocol

IntroductionDementia is a public health issue and a major risk factor for poor quality of life among older adults. In the absence of a cure, enhancing health-related quality of life...

ԲԱՌԱՊԱՇԱՐԱՅԻՆ ԻՆՏԵՐՖԵՐԵՆՑԻԱՆ ԵՎ ԴՐԱ ՏԵՍԱԿՆԵՐԸ ԱՆԳԼԵՐԵՆԻ ԴԱՍԱՎԱՆԴՄԱՆ ՄԵԹՈԴԻԿԱՅՈՒՄ / LEXICAL INTERFERENCE AND ITS CLASSIFICATIONS IN ENGLISH TEACHING METHODOLOGY

The purpose of the article is the study of lexical interference and its classifications. The definitions of the term proposed by Armenian, Russian and Western scholars are presented. The author is concordant with the researchers (S. Asatryan, S. Tsenger et al.) who define lexical interference as a negative transfer of the native language in the target language. The types of lexical interference are discussed according to the characteristic features of language units, parts of speech they belong to, as well as the nature and the direction of their origin. Each type is followed by relevant examples. The author presents her own systematized version of classifying lexical interference, emphasizing its advantages and appropriateness of use. It is mentioned that the particular classification contributes to the development of the methods used to correct lexical interference errors made in any language.

247. Validation of the Use of Oral Vancomycin Following Positive Admission Screening Testing for C. difficile

Background Clostridioides difficile can cause a severe infectious colitis and is often associated with significant morbidity and mortality. C. difficile infection (CDI) is defined as the presence of diarrhea plus a positive stool test, whereas C. difficile colonization is defined as a positive stool test in the absence of diarrhea or the presence of diarrhea attributable to causes other than CDI. Widespread use of stool polymerase chain reaction (PCR) testing, especially within the first 3 days of admission, has become common at our institution and has been associated with increased number of positive C. difficile tests results. However, C. difficile colonization rates may be 15% or higher. Oral (PO) vancomycin (vanc) is first line therapy for the treatment of CDI. We sought to evaluate the appropriateness of use of PO vanc in patients who tested positive for C. difficile via stool PCR within 3 days of admission.MethodsWe reviewed the clinical history, presence of diarrhea, risk factors for diarrhea, treatment and use of an infectious disease (ID) consultation for all patients 18 years of age or older found to test positive for C. difficile by PCR on stool assays during the first 3 days of admission from 07/01/18 to 12/31/18.ResultsA total of 228 patients met inclusion criteria. 183 (80%) received PO vanc while 45 (20%) did not. 131 (71.6%) of patients who received PO vanc had diarrhea, 39 (21.3%) did not have diarrhea, 13 (7.1%) the presence of diarrhea was unknown. 41 of 143 (28.7%) of patients without ID consults received PO vanc despite not having diarrhea, while 11 of 40 (27.5%) patients seen by ID received PO vanc despite not having diarrhea (p=0.888).ConclusionMost patients who tested positive for C. difficile received PO vanc had documented diarrhea, meeting the definition of CDI. However, over 1 in 5 (21.3%) of patients who received PO vanc did not have diarrhea and may have been colonized rather than have true CDI. ID consultation did not decrease the number of patients without diarrhea who received PO vanc or prevent treatment of colonized patients. This work reveals there may be an opportunity for improvement regarding management of CDI vs. C. difficile colonization which may enhance antibiotic stewardship and the appropriate use of PO vanc.Disclosures All Authors: No reported disclosures

Carotid Physiology and Neck Restraints in Law Enforcement

This Viewpoint reviews the potential neurologic sequelae of any restriction of blood flow or oxygen to the brain and calls for a radical examination on the safety or appropriateness of use of neck restraints by law enforcement.

Procalcitonin Use in a Large Community Healthcare System

Background: Appropriate testing of blood procalcitonin (PCT) can potentially inform antibiotic de-escalation in patients with severe infections. When used along with observed clinical improvements, PCT testing can support antimicrobial stewardship. However, this testing must be used optimally to ensure that it is actionable, cost-effective, and provides patient benefit. Although this test is widely used, little is known about the appropriateness of this testing in select populations. Methods: In this retrospective review, we evaluated PCT monitoring patterns and appropriateness of use and relationship to antibiotic days of therapy in a system of community hospitals. We evaluated the use of PCT testing in patients with known confounders, namely pregnancy, chronic kidney disease, or neutropenia, which we classified as “inappropriate use” because these conditions can affect the interpretation of PCT results. We also evaluated the relationship between PCT testing and antibiotic days of therapy for patients with sepsis, pneumonia, or lower respiratory tract infections. Results: In a 1-year period, ∼206,302 PCT tests were performed at 146 facilities, an average of ∼1,413 per facility per year. Approximately 27.7% of these tests were given to patients who were pregnant or had a confounding comorbidity such as chronic kidney disease or neutropenia. Of these “inappropriate” tests, >90% were given to patients with chronic kidney disease. Older patients (aged 60–80 years, n = 93,021) were more likely to receive a PCT test while also having a confounding comorbidities; 24% of older patients with a PCT test also had chronic kidney disease. Of all patients with a PCT test and chronic kidney disease, ∼76% were also diagnosed with either sepsis, pneumonia, or lower respiratory tract infections. Conclusions: Confounding conditions can affect PCT levels independently of infection. Additionally, some clinicians use PCT tests as probes for other physiological maladies. This analysis demonstrated that there is opportunity for education about the appropriate use of this test, how to interpret results in the presence of confounding conditions, and how to transform PCT test results into actions that facilitate antimicrobial stewardship and better patient care.Funding: NoneDisclosures: None

Benzodiazepine Use and Deprescribing in Belgian Nursing Homes: Results from the COME-ON Study.

To describe the use and deprescribing of benzodiazepine receptor agonists (BZRAs) among nursing home residents (NHRs), to evaluate appropriateness of use and to identify factors associated with BZRA use and deprescribing. Posthoc analysis of the Collaborative Approach to Optimize Medication Use for Older People in Nursing Homes (COME-ON) study, a cluster controlled trial that evaluated the impact of a complex intervention on potentially inappropriate prescriptions (PIPs) in nursing homes (NHs). A total of 54 NHs in Belgium. A total of 797 NHRs included in the study who had complete medical, clinical, and medication information at baseline and at the end of the study (month 15). Data were recorded by participating healthcare professionals. Reasons why BZRA use was considered as PIPs were assessed using the 2019 American Geriatrics Society Beers Criteria® and the Screening Tool of Older Persons' Prescriptions (STOPP) criteria, version 2. Deprescribing included complete cessation or decreased daily dose. We identified factors at the NHR, prescriber, and NH levels associated with BZRA use and BZRA deprescribing using multivariable binary and multinomial logistic regression, respectively. At baseline, 418 (52.4%) NHRs were taking a BZRA. The use of BZRA for longer than 4 weeks, with two or more other central nervous system active drugs, and in patients with delirium, cognitive impairment, falls, or fractures was found in more than 67% of BZRA users. Eight NHR-related variables and two prescriber-related variables were associated with regular BZRA use. Deprescribing occurred in 28.1% of BZRA users (32.9% in the intervention group and 22.1% in the control group). In addition to four other factors, dementia (odds ratio [OR] = 2.35; 95% confidence interval [CI] = [1.45-3.83]) and intervention group (OR = 1.74; 95% CI = 1.07-2.87) were associated with deprescribing. Use of BZRAs was highly prevalent, and reasons to consider it as PIP were frequent. Deprescribing occurred in one-fourth of NHRs, which is encouraging. Future interventions should focus on specific aspects of PIPs (ie, indication, duration, drug-drug and drug-disease interactions) as well as on nondementia patients.

Dispensing patterns of emergency medicines prescribed by Australian dentists from 1992 to 2018 – a pharmacoepidemiology study

As the population ages, dentists are likely to encounter medical emergencies due to metabolic factors and polypharmacy. To date, there have been no documented studies in Australia that have analysed the prescription rate of Pharmaceutical Benefits Scheme (PBS)-funded emergency medicines for dentists. Therefore, this pharmacoepidemiology study aims to describe the dispensing patterns of emergency medicines as prescribed by dental practitioners, related to medicines covered by the Australian PBS system. Data on dental medications used for emergencies, under the PBS, from 1992 to 2018, were accessed. Cumulative dispensing counts were calculated. Data on medications that were not utilised were also collected in the form of the crude cumulative count. Out of the 56 medications on the dental PBS schedule, eight were utilised for medical emergencies, with a total of 432 prescriptions on a national level, over 27years. The commonly utilised lifesaving medicines of adrenaline, glucagon, as well as glyceryl trinitrate, had a total prescription count of 147, 88 and 27 respectively. Medicines used for opiate overdose; naloxone, had a total prescription count of one. Only one medicine (benztropine injection) for medical emergencies had a prescription count of 0. This study highlights the dispensing patterns of medicines prescribed by dentists for emergency scenarios. Although this study did not assess the appropriateness of use of the emergency medicines, further investigation may be required to ensure the future safety of patients when encountering emergency scenarios.

Antimicrobial stewardship in remote primary healthcare across northern Australia.

BackgroundThe high burden of infectious disease and associated antimicrobial use likely contribute to the emergence of antimicrobial resistance in remote Australian Aboriginal communities. We aimed to develop and apply context-specific tools to audit antimicrobial use in the remote primary healthcare setting.MethodsWe adapted the General Practice version of the National Antimicrobial Prescribing Survey (GP NAPS) tool to audit antimicrobial use over 2–3 weeks in 15 remote primary healthcare clinics across the Kimberley region of Western Australia (03/2018–06/2018), Top End of the Northern Territory (08/2017–09/2017) and far north Queensland (05/2018–06/2018). At each clinic we reviewed consecutive clinic presentations until 30 presentations where antimicrobials had been used were included in the audit. Data recorded included the antimicrobials used, indications and treating health professional. We assessed the appropriateness of antimicrobial use and functionality of the tool.ResultsWe audited the use of 668 antimicrobials. Skin and soft tissue infections were the dominant treatment indications (WA: 35%; NT: 29%; QLD: 40%). Compared with other settings in Australia, narrow spectrum antimicrobials like benzathine benzylpenicillin were commonly given and the appropriateness of use was high (WA: 91%; NT: 82%; QLD: 65%). While the audit was informative, non-integration with practice software made the process manually intensive.ConclusionsPatterns of antimicrobial use in remote primary care are different from other settings in Australia. The adapted GP NAPS tool functioned well in this pilot study and has the potential for integration into clinical care. Regular stewardship audits would be facilitated by improved data extraction systems.

Prescriber responsibility, predictors for initiation, and 20-year trends in use of non-aspirin non-steroidal anti-inflammatory drugs in patients with cardiovascular contraindications: a nationwide cohort study.

To examine whether prescription patterns complied with recommendations not to use non-steroidal anti-inflammatory drugs (NSAIDs) in patients with cardiovascular contraindications. Moreover, we examined predictors for initiation and prescriber responsibility. We used Danish medical databases to identify all patients with first-time cardiovascular disease during 1996-2017 (n = 628 834). We assessed standardized prevalence proportions, predictors from logistic regression, and prescriber identifiers. One-year prevalence of NSAID initiation increased 3.4% from 1996 (19.4%) to 2001 (22.7%) and declined by 2.7% thereafter until 2017 (13.5%). Trends were independent of age, sex, and disease subtype, although larger annual declines occurred for heart failure (3.9%) and ischaemic heart disease (3.5%) since 2002. One-year prevalence remained highest among patients with venous thromboembolism (16.6%) and angina (13.8%), and lowest for ST-segment elevation myocardial infarction (7.0%) and heart failure (8.8%). Initiators were predominantly prescribed ibuprofen (59%), diclofenac (23%), and etodolac (6%). Diclofenac and coxib use declined, while ibuprofen and naproxen use increased. Median prescribed pill dose of ibuprofen declined after 2008 from moderate/high (600 mg) to low (400 mg). Treatment duration declined for all NSAIDs, except celecoxib. Rheumatic, obesity, and pain-related conditions predicted NSAID initiation. General practitioners issued 86-91% of all NSAID prescriptions, followed by hospital prescribers (7.3-12%). Initiation of NSAIDs in patients with cardiovascular disease declined since 2002. Shorter treatment duration, declining COX-2 inhibition, and increasing use of naproxen and low-dose ibuprofen suggest adherence to guidelines when NSAIDs cannot be avoided. Still, NSAID use remained prevalent despite cardiovascular contraindications, warranting awareness of appropriateness of use among general practitioners in particular.

Abstract D015: A Hispanic community’s evaluation of the culturally adapted Conexiones program: An inductive analysis of focus groups

Abstract Purpose: This study examined the priority population’s evaluation of the Conexiones program’s cognitive and cultural appropriateness for use with Hispanic mothers. Introduction: When programs lack cultural relevance, there is a lost opportunity to engage ethnic minorities in services that can help combat health disparities. Priority populations should be included in cultural adaptation processes to address cultural mismatches between program validation groups (e.g. Non-Hispanic White) and new consumer groups (e.g. Hispanics). No education programs are designed to help Hispanic mothers diagnosed with cancer manage the impact of their diagnosis on their school-aged children. An evidence-based cancer-parenting program was culturally-adapted to create the Conexiones program for cancer-diagnosed Hispanic mothers. In this study, Hispanic mothers evaluated the adapted Conexiones program for cognitive and cultural appropriateness. Methods: A series of questions guided focus groups of Hispanic mothers in assessing cognitive (e.g., wording, sequencing) and cultural components of the Conexiones materials. Focus groups were audiorecorded and transcribed. Transcriptions were analyzed using inductive content analysis. Trustworthiness was protected by coding to consensus, systematic peer debriefing, and maintenance of an audit trail. Results: Participants described four domains for improving the Conexiones educational materials: Softening the Language, Incorrect Translation, Finding the Right Words, and Not Making Assumptions. Softening the Language captured the participant’s desire for greater empathy and a warmer and more conversational tone in the patient educator script. Incorrect Translation identified literal translation from English to Spanish that failed to capture the intended meaning of the program text. Poor grammar, lack of context, and misinterpretation also resulted in comprehension problems. Finding the Right Words consisted of suggestions participants made to replace words or reorder phrases to make the text consistent, less repetitive, and reflect language used in the border region. Not Making Assumptions included participants’ warning against making presumptions about the priority population (e.g. that patients will have social support from other adults). In addition to these recommendations, participants highlighted cultural and regional considerations for the program and shared positive feedback on the program content. Conclusion: The priority population’s evaluation of Conexiones after its initial adaptation helped to further refine the program and ensure it fit the needs and beliefs of the new consumer group, Hispanics. Such efforts are important to making evidence-based programs culturally acceptable and appealing to Hispanics. Inclusion of priority populations in the adaptation process ultimately helps develop an optimal program that can be more engaging and beneficial. Citation Format: Isela Garcia, Clara Reyes, Rebecca Palacios. A Hispanic community’s evaluation of the culturally adapted Conexiones program: An inductive analysis of focus groups [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D015.

Psychological Support for the Foreign Language Training of the Students at International Relations Faculties

The article studies the innovative elements of psychological support for the professional foreign language training of students at international relations faculties, offers and experimentally verifies the effectiveness of techniques and exercises for the intensification of the foreign language training, based on professional communicative situations in high-risk foreign language environment. Such elements include the use of stress-management techniques and exercises based on real-life professional situations, along with practicing foreign language skills. The appropriateness of use of the elements of psychological support for the professional foreign language training of would-be professionals in international relations was proved to be effective through the experiment. It was conducted with students of international relations faculties through the comparison of levels of performance of two groups of students: those whose professional foreign language training include elements of psychological support and those with traditional training. In order to assess the difference between two groups of students at the summative stage of the experiment, the Mann –Whitney U test was used. The use of psychological support for the professional foreign language training is significant in terms of improvement of would-be specialists' in international relations professional competence.

Long-term impact of an intervention on rapid antigen detection tests in acute pharyngitis

ObjectiveThis study was aimed at evaluating the appropriateness of use and interpretation of rapid antigen detection testing (RADT) and antibiotic prescribing for acute pharyngitis six years after a multifaceted intervention. DesignBefore-and-after audit-based study. LocationPrimary care centres in eight autonomous Communities. ParticipantsGeneral practitioners (GP) who had participated in the HAPPY AUDIT intervention study in 2008 and 2009 were invited to participate in a third audit-based study six years later (2015). MethodRADTs were provided to the participating practices and the GPs were requested to consecutively register all adults with acute pharyngitis. A registration form specifically designed for this study was used. ResultsA total of 121 GPs out of the 210 who participated in the first two audits agreed to participate in the third audit (57.6%). They registered 3394 episodes of pharyngitis in the three registrations. RADTs were used in 51.7% of all the cases immediately after the intervention, and in 49.4% six years later. Antibiotics were prescribed in 21.3% and 36.1%, respectively (P<.001), mainly when tonsillar exudates were present, and in 5.3% and 19.2% of those with negative RADT results (P<.001). On adjustment for covariables, compared to the antibiotic prescription observed just after the intervention, significantly more antibiotics were prescribed six years later (odds ratio: 2.24, 95% confidence interval: 1.73–2.89). ConclusionsThis study shows that that the long-term impact of a multifaceted intervention, focusing on the use and interpretation of RADT in patients with acute pharyngitis, is reducing.

A Pragmatic Approach to Resolving Technological Unfairness: the Case of Nike\u2019s Vaporfly and Alphafly Running Footwear

BackgroundTechnology is often introduced into sport to facilitate it or to improve human performance within it. On occasion, some forms of novel technology require regulation or prevention entirely to ensure that a sport remains fair and accessible. Recently, the Nike Vaporfly and Alphafly shoes have received some concerns over their appropriateness for use in competitive distance running.MethodsThis paper evaluates the use of these shoes against an existing framework for sports technology discourse and adopts a pragmatic approach to attempt to resolve them.ResultsIt is proposed that the three concerns regarding cost, access and coercion cannot be ruled out but likely remain short-term issues. As a result, it is proposed that these running shoes are acceptable forms of technology but that ongoing vigilance will be required as such technologies develop further in the future.ConclusionsThe Nike Vaporfly/Alphafly shoes do push the perceived acceptability of running shoes to the limits of the current sports regulations. However, the alleged gains have not manifested themselves to a level that could be considered excessive when reviewing historical performances or when evaluated against a set of well-cited criteria. The sport will need to adopt a stance of ongoing vigilance as such technologies continue to develop or be optimised in the future.