Awareness Of Help Research Articles

FRI233 Adrenal Insufficiency Due To An Unusual Culprit

Abstract Disclosure: S. Decamps: None. K.T. Yeung: None. K. McCowen: None. Background: Chronic exogenous use of glucocorticoids is the most common cause of reversible secondary adrenal insufficiency (AI). There is a significant risk of cortisol deficiency if the medication is abruptly discontinued. Chronic glucocorticoid therapy may cause hypothalamic-pituitary-adrenal (HPA) axis suppression, resulting in low ACTH, atrophy of the adrenal zona fasciculata and decreased cortisol production. Immunotherapy rarely causes reversible central AI, usually permanent. We present a case of an immunotherapy-receiving patient who presented with biochemical evidence of adrenal insufficiency after using an oral solution (swish and spit) of dexamethasone as prophylaxis for mucositis. Patient Summary: A 52-year-old woman with stage IIb triple negative breast cancer receiving neoadjuvant Datopotamab, Dertuxtecan and Durvalumab was evaluated for adrenal insufficiency. Prior to starting therapy, serum cortisol level measured 7.9 mcg/dL at 11 AM (normal 6.0-18.4 mcg/dL at 6-10 A.M). She had received a single dose of dexamethasone 10 mg IV with her first cycle, but not thereafter. As part of the immunotherapy protocol, serial cortisol levels were obtained, and 2 weeks after the baseline, noon serum cortisol was 1.0 ug/dL. Patient was asymptomatic. At no point were glucocorticoids replaced, but 1-week later serum cortisol level was 0.6ug/dL at 11:00 AM along with an ACTH of 5 pg/mL. Immunotherapy-induced AI was strongly suspected. Her only glucocorticoid exposure had been a dexamethasone oral mouth rinse (swish 10mL for 1 minute and spit out, four times daily). Cortisol level at 7AM a week later measured 3.5 mcg/dL with ACTH 18.7 pg/mL and a dexamethasone level 108.2 ng/dL (normal < 50 ng/dL for patients not on dexamethasone). Technique of swish and spit was reviewed with the patient, and she was not ingesting the medication. An observational approach was pursued at this time given hemodynamic stability, treatment was continued and several weeks later repeat labs showed cortisol levels of 3.3 (7AM), with a dexamethasone level of 84.3 ng/dL. Her course of therapy has been completed, so she has been off the dexamethasone solution, continues to be asymptomatic and repeat labs now show a 9AM Cortisol level of 9.5 mcg/dL and, given lack of other sources, it is most likely that these low cortisol levels along with elevated dexamethasone levels are related to the use of dexamethasone swish and spit rather than immunotherapy induced permanent HPA axis suppression. Conclusion: There is no literature on dexamethasone swish and spit being absorbed systemically possibly leading to potentially reversible HPA suppression. Our case will raise awareness of help guide clinicians expand their differential when working up these patients. Presentation: Friday, June 16, 2023

Narratives from parents in England and Norway

The framework for assessment in child protection, as well as the context of the welfare state, differs between England and Norway. Assessments in England are structured in terms of a set model (the triangle) and procedures to be followed, whereas in Norway there are few national guidelines and not a set model for assessments. This underpins professional judgement as the most important component in Norway. This is a study of parents` experiences from assessment in these two contexts, and patterns and themes of assessment experiences have been identified in the two countries through a narrative analysis of in-depth interviews with parents. When asked about their opinions of the current assessment framework, parents in both countries talk more about feelings than about framework and procedures, as their experiences of assessment are similar in both countries. First and foremost, they experience strong emotions in a stressful situation, including anxiety, frustration and powerlessness, but also relief. These cross-national emotions might provide information about how assessment is a stressful situation for the parents involved. However, we find some differences in the way social work is acted out according to the national assessment framework and policy context. In England, the framework and procedures seem to provide clarity with regard to process and power within the system. In Norway, the assessment is characterized by a professional judgement accompanied by more resources, which we find enables helpful decisions from a family perspective. However, this heavy reliance on relationships using professional judgement might also be viewed as a source of informal power. These findings are discussed in relation to theories of emotions and the concept of power. Regarding implications for practice, we would recommend a more explicit awareness of help and control in assessment among social workers involved, together with a clear communication on the topic of emotions and power in assessment.

Awareness of Intergroup Help Can Rehumanize the Out-Group

Dehumanizing the enemy is one of the most destructive elements of intergroup conflict. Past research demonstrated that awareness of harm that the in-group imposed on a specific out-group can increase out-group dehumanization as means of justifying the harm. In this research, we examined whether the opposite process would occur when people become aware of help given to an adversary. We reasoned that the need to justify a good deed toward a persistent enemy can result in more human-like out-group attributions. In two experiments, Israeli-Jews read about their group either helping Palestinians or not. In Study 1, awareness of help provided by the in-group to the out-group resulted in greater out-group humanization. In Study 2, we further established that when a third party helped the out-group, the rehumanization effect was not obtained, suggesting that the phenomenon is of specific intergroup nature. Theoretical and applied implications for conflict resolution are discussed.

Caregivers Like Me: Cuidadores Como Yo (SA509-A)

1.Describing how an educational module can increase awareness of end-of-life (EOL) concepts and caretaker fatigue, especially in the Latino population.2.Illustrate the importance of recognition of caregiver stress and need of utilization of outside resources for the EOL Latinos are the fastest growing minority group in the United States. This population has encountered language barriers, financial hardships, higher education disparities, unique family dynamics, and underutilization of community resources such as hospice and nursing homes. These factors have led to a lower end-of-life (EOL) care quality of life. This pilot study focuses on the Latino population proposing an intervention to improve EOL care. 1. Describe how an educational module increases knowledge and awareness on EOL resources in the Latino population. 2. Describe how a video focusing on informal caregivers and patients living at home can change attitudes towards EOL care. 3. Illustrate the importance of recognition of caregiver stress and need of utilization of outside resources for EOL. This is a multicentered, cross-sectional pre-/posttest study design. Three different Latino communities were selected with the assistance of community leaders. An educational module was provided to informal caregivers of terminally ill Latino patients using a 45-minute audiovisual presentation that also addressed EOL caregiver burden topics. Educational intervention was culturally appropriate and bilingual, including a soap opera case-based video. Pre- and posttest questionnaires were administered to participants to evaluate knowledge and attitude changes. One hundred forty-four subjects participated in this study, mostly female (79%), mean age 53 years. Ninety-two percent of participants were satisfied with the study experience and 91% admitted to learning from the video. Caregiver stress alertness increased significantly (t[107]=-3.6, P=.001), whereas their awareness of help needed during caregiving remained the same ( t[108]= -1.2, P=.22). Acceptance of professional help from four of five agencies improved significantly. After the video presentation, 72% of subjects correctly defined EOL concepts discussed in the module. Findings were similar among three sites. By means of a video-based education module, Latino caregivers were able to increase their self-awareness about caregiver stress and the need for looking for and accepting professional assistance while caring for their loved one. Educational modules such as ours can be easily modified and dispersed among other minority populations to prevent caregiver exhaustion and improve quality of life for both patients and caregivers.