Care Planning Research Articles

Right Information, Right Care, Right Patient, Right Time: Community Preferences to Inform a Self-Management Support Tool for Upper Respiratory Symptoms.

During and after the COVID-19 pandemic, communities must cope with several conditions that cause similar upper-respiratory symptoms but are managed differently. We describe community reactions to a self-management toolkit for patients with upper respiratory symptoms to inform mobile e-health app development. The toolkit is based on the '4R' (Right Information, Right Care, Right Patient, Right Time) care planning and management model. The 4R Cold, Flu and COVID-19 Information Tool (4R-Toolkit) along with a brief evaluation survey were distributed in three ways: through a Bronx NY Allergy/Asthma clinic, through the Bronx Borough President's Office listserv, and through peer recruitment. The survey assessed respondents' perceptions of the 4R-Toolkit's accessibility, preferences for sharing symptoms with clinicians, social media use, and e-health literacy. We obtained a diverse sample of 106 Bronx residents, with 83% reporting personal or a social contact with symptoms suggestive of COVID-19. Respondents varied in the information sources they preferred: computer (39%); smart phone (28%); paper (11%) and no preference (22%). Most (67%) reported that social media had at least some impact on their healthcare decisions. Regardless of media preferences, respondents were positive about the 4R-Toolkit. Out of 106 respondents, 91% believed the 4R-Toolkit would help people self-manage upper respiratory symptoms and 85% found it easy to understand. Respondents strongly endorsed retention of all 4R-Toolkit content domains with 81% indicating that they would be willing to share symptoms with providers using a 4R-Toolkit smartphone app. The 4R-Toolkit can offer patients and community members accurate and up-to-date information on COVID-19, the common cold, and the flu. The user-friendly tool is accessible to diverse individuals, including those with limited e-health literacy. It has potential to support self-management of upper respiratory symptoms and promote patient engagement with providers.

Polycystic ovary syndrome: Fertility, prenatal care, pregnancy, and postpartum care.

Polycystic ovary syndrome (PCOS) is a complex, heterogeneous reproductive endocrinopathy affecting 8% to 13% of women in their reproductive years. PCOS has a vast array of clinical manifestations, including metabolic complications, biochemical and phenotypical hyperandrogenism, menstrual cycle dysfunction, and anovulation resulting in infertility. Understanding the relationship of the disorder's pathophysiologic and clinical manifestations is key to successfully managing patients with PCOS. Patients may have different prenatal, perinatal, and postnatal experiences than those who do not have PCOS, and may require a higher level of care or treatment plan adjustments.

Orofacial features and dental management of a pediatric patient with moyamoya disease-A one year follow up.

Moyamoya disease (MMD) is a chronic cerebrovascular disorder increasing stroke risk. This study presents a four-year-old MMD patient, discussing her multidisciplinary care plan including dental, behavioral, and medical management. It emphasizes the need for awareness among oral physicians and suggests further research due to the rising prevalence of MMD. Moyamoya disease (MMD) is a chronic cerebrovascular disorder that narrows major blood vessels in the brain, reduces blood flow, and increases the risk of stroke. The purposes of this study were to: (1) present the case of a four-year-old patient diagnosed with MMD; (2) discuss important aspects of her multidisciplinary care plan involving dental, behavioral, and medical management; and (3) suggest approaches and recommendations for health care providers. A four-year-old Middle Eastern female diagnosed with MMD, neurogenic bladder, chronic constipation, hyperactivity, and delayed milestones presented to the dental clinic with her parents seeking dental care. The child was referred by a pediatric neurologist for dental care. In the present case, there were no specific oral manifestations. However, oral physicians should be aware of possible behavioral management modalities when providing dental care to pediatric patients, including those diagnosed with MMD.

PERCEPTIONS OF THE APPLICATION OF THE CARE MODEL FOR CHRONIC CONDITIONS IN PARANÁ, BRAZIL

The current healthcare model for users with chronic conditions in the Unified Health System needs to be transformed. In Paraná, there are strategies for continuing education and co-financing of services focused on the Chronic Conditions Care Model. This is a descriptive and exploratory study with a qualitative approach that analyzed the perceptions of Primary Health Care and Specialized Outpatient Care professionals about the implementation of the Chronic Conditions Care Model. Four focus groups were held, with the participation of 37 professionals, and the discussions permeated the work processes from the perspective of thematic analysis. The statements identified elements such as risk stratification of the health condition, organization of care, and team rapprochement. The development of the care plan is incipient due to the lack of understanding of professionals and users about the tool. In health units, access occurs according to the logic of acute care, and care sharing through regulatory centers. Continuing education strategies, structured public policies and specific financing are drivers for the consolidation of the Model.

Lessons learned from implementing a digital rehabilitation care planning platform to improve care access for patients with work disability: qualitative process evaluation of the RehaPro-SERVE study

BackgroundInpatient rehabilitation therapies can be applied for in Germany by patients of working age to support their return to work. However, there are some problems that impede an easy and uncomplicated application process. An interdisciplinary case management approach for rehabilitation care planning was developed to facilitate the access to rehabilitation. Case conferences (CCs) were held with relevant stakeholders and took place on a digital communication platform. We conducted a qualitative process evaluation to understand the implementation of the intervention and to identify contextual factors as well as mechanisms for a successful implementation in the context of primary care.MethodsThe process evaluation included interviews with primary care physicians (PCPs), patients and stakeholders involved in the intervention process. Reflexive thematic analysis was used to analyse the data. Emerging themes were structured according to the Donabedian framework of structure, process and outcomes.ResultsA total of 18 interviews were conducted. Important results included the desire for more patient involvement and case management. Patients especially valued the opportunity to receive support from a social worker. Limitations of the platform related to usability and limited opportunities for stakeholder communication. Despite training for PCPs, several problems arose regarding the clarity of the intervention process. Patients were satisfied with their application process and the treatments offered, while PCPs reported an increase in workload.ConclusionsA digitalisation of the application procedure for rehabilitation and further treatment options is acceptable to patients and personal support of a social worker is particularly valued. However, patients should be included in the CC in terms of a shared decision-making process. The digital platform requires sufficient training and adjustments have to be made to enhance usability and to improve the efficiency of the process for PCPs. Overall, the exchange between the various stakeholders in the CC is considered particularly useful in more complex cases.Trial registrationDRKS German Clinical Trials Register, DRKS0 00242 07. Registered on 22 March 2021.

Development of a core predictor set of weaning in critically ill patients: a Delphi-based study protocol.

Prolonged mechanical ventilation in intensive care units (ICUs) leads to increased morbidity, higher mortality rates, and elevated healthcare costs. Predicting successful weaning from mechanical ventilation with accuracy is essential for optimizing resource use and improving patient outcomes. The International Classification of Functioning, Disability and Health (ICF) framework offers a holistic perspective on health conditions and can be adapted to identify key predictors of weaning readiness. This study aims to develop a Delphi-based core predictor set for weaning in critically ill patients, utilizing the ICF model. The core predictor set development comprises three steps: (1) Literature review and expert consultation to gather weaning predictors, (2) Predictor alignment with ICF categories per established rules, and (3) Three-round Delphi survey with a multidisciplinary team. A systematic review across major databases will be conducted to identify predictors related to weaning predictors in critically ill adults from cohort studies, trials, and reviews. Predictors will then be categorized within ICF domains. A multidisciplinary expert panel will evaluate the relevance of each predictor using a 9-point Likert scale to achieve consensus. This study will contribute to the development of a standardized, evidence-based predictor set for weaning readiness in critically ill patients. Using the ICF framework, this study aims to encompass the complex factors that influence weaning, thereby enabling personalized care plans and improving weaning outcomes. The Delphi methodology guarantees a thorough, iterative process for building consensus by integrating diverse clinical perspectives. The proposed Delphi-based study protocol aims to establish a core set of predictors for weaning in the ICU setting, guided by the ICF model. Successful implementation of this predictor set could enhance decision-making around weaning trials, reduce unnecessary ventilation days, and ultimately improve patient outcomes and healthcare efficiency. Future validation and implementation studies will be essential to confirm the utility and generalizability of this predictor set in clinical practice.

Staff shortages in hospitality and tourism industries: how technology influences?

PurposeThis paper offers an introduction and sets the stage for the theme issue. It describes the methodology used and highlights the articles that address the strategic question of how hospitality and tourism industries can minimize the effects of labor shortages by embracing advanced technologies.Design/methodology/approachThis special issue explores the potential of automation, artificial intelligence, robotics and advanced data analytics in mitigating staff shortages. Automation streamlines operations, AI enhances customer interactions, robotics reimagines service delivery and data analytics informs strategic decisions. The study addresses a strategic question by combining literature reviews, data analysis, expert insights from practitioners and practical solution recommendations.FindingsThe theme issue presents research that explores how advanced technologies can be effectively utilized to mitigate labor shortages in the hospitality and tourism industries. Automation streamlines operations, AI enhances customer interactions, robotics reimagines service delivery and data analytics informs strategic decisions. However, successful integration of technology requires careful planning, training and ongoing maintenance to ensure a balance between technology and human interaction. By embracing these technologies, businesses can better cope with staffing deficits and position themselves for long-term success in a rapidly evolving environment.Originality/valueThis special issue explores the ways in which advanced technologies, such as automation, AI and robotics, can be leveraged to alleviate the labor shortage crisis faced by the hospitality and tourism industries worldwide. From developed to developing countries, these industries are grappling with severe labor shortages, particularly in terms of skilled workers. The articles presented in this issue offer valuable insights and strategies for addressing this pressing issue.

Palliative care integration into outpatient heart failure management: pilot study

ObjectivesPeople with heart failure have palliative care needs yet services remain underused. The heart failure clinic is a potential setting for initial palliative care delivery though evidence for such services is lacking. We explored the outcomes of an embedded model of palliative medicine within a heart failure clinic.MethodsWe conducted a retrospective cohort study of individuals who received a palliative medicine consultation in a heart failure clinic. Descriptive statistics were used to characterise the cohort and their outcomes, and the McNemar test to compare rates of advance care planning before/after consultation.ResultsMajority of individuals who received a palliative medicine consultation experienced New York Heart Association (NYHA) class II symptoms (65.5%) and had a Palliative Performance Scale score of≥60% (66.8%). While only 17% engaged in advance care planning in the year before consultation, 93% had advance care planning during the first consultation (p<0.001). Care was provided in multiple domains including advance care planning (95%), symptom management (97%) and caregiver support (30%), regardless of the reason for referral.ConclusionsOur embedded model of palliative medicine within the heart failure clinic was associated with increased advance care planning at a time when patients were functional and minimally symptomatic. Further research should substantiate these findings at other sites.

COMPLICATIONS AND RISKS ASSOCIATED WITH PROLONGED PARENTERAL NUTRITION IN PEDIATRIC AND NEONATAL ICU PATIENTS: A SYSTEMATIC REVIEW

Objective: The general objective of this study is to analyze the scientific literature on the complications and risks associated with prolonged parenteral nutrition in pediatric and neonatal patients in intensive care units (ICU), aiming to ensure greater knowledge about this therapeutic practice and its clinical implications. Methodology: The searches were performed through searches in the PubMed Central (PMC) databases. Three descriptors were used in combination with the Boolean term “AND”: Parenteral Nutrition, Neonatal Intensive Care Unit and Risk Factors. A total of 101 articles were found, which were subsequently submitted to the selection criteria. After applying the inclusion and exclusion criteria, 20 studies were selected, of which 10 articles were used for detailed analysis. Results: Parenteral nutrition (PN) is essential in the care of premature newborns and critically ill pediatric patients. However, it is associated with several potential complications, including hepatobiliary, infectious, mechanical and metabolic problems such as hyperglycemia and hypertriglyceridemia. Administration of PN requires careful planning and strict safety policies to minimize risks and maximize clinical benefits. Prolonged PN can lead to serious complications, such as catheter-associated bloodstream infections, cholestasis, and liver dysfunction. Conclusion: Prolonged PN in pediatric and neonatal ICU patients is associated with significant risks that require close surveillance and preventive interventions. Continuous monitoring of glucose, triglyceride levels, and liver function, as well as rigorous infection control practices, are crucial to ensure the safety and efficacy of PN. Further studies are needed to identify management strategies that can reduce these complications and improve clinical outcomes.

Digital rehabilitation care planning for people with chronic diseases (RehaPro-SERVE): study protocol for a German multicentre randomised controlled trial

BackgroundChronic diseases are a significant and growing problem of our time. They impair the ability to work and increase the risk of early retirement. To support the return to work, rehabilitation services can be applied for in Germany. Currently, the application system for rehabilitation allows only a limited degree of individualisation of the treatment and is associated with a lack of multidisciplinary communication. To facilitate rehabilitation care planning, we developed a complex intervention. A digital, platform-based case management approach (intervention) will ensure multidisciplinary communication and the tailored selection of medical treatments and/or non-medical support measures. The overall objective is to assess the effectiveness of the intervention compared to treatment as usual (control condition). The German Federal Ministry of Labour and Social Affairs (BMAS) funds the RehaPro-SERVE study (grant number: 661R0053K1).MethodsThis is the protocol for an investigator-initiated, pragmatic, multicentre, randomised and controlled two-arm parallel-group superiority trial with embedded qualitative process evaluation. The study will be conducted in Hesse state, Germany. N = 59 primary care physicians will be recruited and tasked with the recruitment of six eligible patients each. Eligibility criteria: age 40–60; minimum of 4-week work disability due to musculoskeletal, oncologic or psychological conditions or the post-COVID-19 syndrome within the last 6 months; at high risk for early retirement. In total, n = 352 patients will be randomised with a 1:1 allocation to intervention or control group and stratified by primary care practice using permuted blocks. The primary outcome is the number of days of sick leave during a 12-month period after the assumed completion of treatments (t1 to t2). Secondary outcomes include the number of days of sick leave (self-report), work ability, and health-related quality of life, as well as data from the qualitative process evaluation.DiscussionThe results of the study will inform the design of future care services and provide valuable information on multidisciplinary case management in the context of rehabilitation care planning. The results of the qualitative process evaluation will further contribute to the understanding of facilitating and hindering factors.Trial registrationDRKS-German Clinical Trials Register, DRKS0 00242 07. Registered on 22 March 2021.

Personalised care for hyperlipidaemia by tailoring shared decision-making toward patient priorities & needs: results from a patient-led study

Abstract Background The European cardiovascular disease community is actively promoting a shift towards delivering more personalized cardiovascular care. This shift requires a reassessment of current clinical approaches, including approaches to shared decision-making. To be effective, shared decision-making should be grounded in factors impacting treatment adherence and oriented toward patient-relevant outcomes. (1)(2) Purpose To learn from people with hyperlipidemia about their experiences, priorities and needs inside and outside the health system, including pathways and barriers to diagnosis, treatment and adherence. These insights can guide healthcare providers (HCPs) in delivering personalised, patient-centred care. Methods A global Steering Committee of patient advocates, cardiology researchers and HCPs guided study design and interpretation. Forty-six individuals with confirmed high cholesterol (51% female) in Brazil, Australia and the US participated in 60-minute interviews. Half of participants were required to have a prior hospitalization for an ASCVD event. Transcripts were analyzed using a team-based approach. Results Participants are described in Picture 1. Across countries, participants described how HCPs can work with patients to personalize care through realistic, individualized care plans. First, HCPs can make patients more comfortable by using plain language (e.g., heart problems not cardiovascular events) and clearly explain the life-threatening dangers of unmanaged LDL-C, a prerequisite for patients to take high cholesterol management seriously. Once the risks are clear, HCPs and patients can co-develop care plans based on attainable, measurable goals. Topics that should be discussed include individual circumstances that may impact care plan adherence, such as competing priorities (e.g., work travel or family obligations), support system, and finances. Other topics include the range of treatments and lifestyle changes, including how these work in tandem. When discussing treatment options, HCPs can address treatment attributes desirable to patients, including convenience, treatment benefits, safety profiles and costs. Convenience attributes reflect participant desires for therapies that come in a form they are comfortable administering (e.g., tablet, injection) combined with a desire to minimize administration frequency. Meaningful treatment benefits include improving laboratory values, avoiding heart-related events and living longer to spend more time with family. Conclusions: This study identified topics patients would like their HCP to include in shared decision-making. It can inform HCP efforts to deliver personalised cardiovascular care. Structural barriers to effective shared decision-making exist in many health systems, including the time HCPs have allotted to appointments, administrative burden and access. Patient advocacy organisations and HCP organisations can partner to drive policy changes to overcome these barriers.Study ParticipantsIllustrative Quotes

Patients on the ledge; ablation of incessant tachycardia. A single centre registry

Abstract Background Incessant tachycardia was first described by Cassidy (1). in 1924, it is strongly associated with tachycardia induced cardiomyopathy. There is no data about its true incidence however, it seems to be more common during infancy and childhood. Objectives To present 5-year single centre experience in ablating incessant tachycardia in a cohort of pediatric and adult patients. Methods From 2018 to 2023, We reviewed patients presented to our centre with incessant tachycardia, their clinical data, ECGs, imaging modalities, procedures details & outcomes were examined thoroughly. Results Over 5 years, 900 patients were referred to our centre for ablation, among them 25 patients (2.7%) presented with incessant tachycardia. Of them: 10 patients were pediatrics (40%), the youngest was 40 days old, 3.4 Kg, 6 patients were haemdynamically unstable necessitating ventilation& IV supports, 14 patients had impaired EF, with the lowest EF of 20%.(A) Regarding the diagnosis, 14 patients had AT (4 CS ostium, 3 LAA, 2 parahisian, 2 Crista, 1 LSPV, 1 TA, 1RAA), 4 AVRT (2 concealed parahisian accessory pathways & 2 PJRT), 3 VT (2 scar related VT, 1 anterior papillary muscle), 4 AFL (3 CTI flutter & 1 mitral isthmus flutter). All patients were ablated using 3D mapping system except 4 pediatric patients (2 AT from CS, 2 concealed parahisian accessory pathways) due to accesses limitations or unavailability of 3D mapping, single catheter technique was used in one patient weighing 3.4kg with AT from CS (only one venous access accommodating 5F catheter could be obtained)(B), Rt & Lt jugular accesses were used for ablation of RAA AT in a pediatric patient with bilaterally occluded femoral veins.(C) NCC was used as a safe access for ablating parahsisan AT & accessory pathways in our cohort.(D) All patients had successful ablation with full recovery for those with impaired function except 2 patients of scar related VT as their EF was impaired previously. Regarding the complications, one patient had DVT and another patient had retroperitoneal hematoma, both were managed conservatively. Conclusion Incessant tachycardia ablation is quite challenging but carries good results. Careful planning, experienced team & selection of the appropriate approach are the keys for successful safe procedures.

Advancing Dementia Care in Austria: developing a Dementia Registry using a multimethod approach

Abstract Background Austria faces an increasing demand for dementia care in an ageing population. However, a lack of representative data hampers evidence-based policy development and evaluation of care. To address this gap, the Austrian National Institute of Public Health is undertaking the task of developing the Austrian Dementia Quality Registry (ÖDQR). Methods Based on the AIHTA Good Practice Framework for Dementia Registries, the development and testing of the ÖDQR has unfolded in 4 distinct phases: 1) planning; 2) registry design (including definition of quality indicators and minimum data set, recruitment, and governance); 3) definition of data collection, sources, and management; 4) pilot testing. A steering committee of government representatives and dementia care experts was convened to oversee the project. A scientific committee provided oversight and ensured methodological rigor. Working groups of national and international dementia care experts focused on standards for diagnosis and therapy, activities of daily living and quality of life, legal aspects, and technical implementation, thus contributing to the content development of the ÖDQR. Results An initial systematic literature review informed the selection of quality indicators in the working groups. A conceptual framework of 15 descriptive and 30 quality indicators was developed. Preliminary results of pilot testing indicate feasibility and content validity. As a result, the ÖDQR will be established as a longitudinal survey-based registry, based on an instrument comprising 163 variables and emphasizing data collection across care settings. Legal and technical frameworks are being developed. Conclusions The öDQR holds the promise of informing evidence-based policy and improving the quality of dementia care in Austria. Careful planning and collaboration have laid the foundation for a data repository that will inform policy and improve care for people with dementia and their caregivers. Key messages • Dementia registries require a complex development to assure validity and adherence. • The Austrian Dementia Registry aims to establish best practice by focusing on the life situation of those affected by this condition.

Evidencing the challenges of care delivery for people with intellectual disability and epilepsy in England by using the Step Together toolkit.

People with intellectual disability (PwID) and epilepsy have increased premature and potentially preventable mortality. This is related to a lack of equitable access to appropriate care. The Step Together guidance and toolkit, developed with patient, clinical, charity and commissioning stakeholders, allows evaluation and benchmarking of essential epilepsy service provision for PwID in eight key domains, at a care system level. To evaluate care provisions for adult PwID and epilepsy at a system level in the 11 integrated care systems (ICSs) of the Midlands, the largest NHS England region (population: approximately 11 million), using the Step Together toolkit. Post training, each ICS undertook its benchmarking with the toolkit and submitted their scores to Epilepsy Action, a national UK epilepsy charity, who oversaw the process. The outcomes were analysed descriptively to provide results, individual and cumulative, at care domain and system levels. The toolkit was completed fully by nine of the 11 ICSs. Across all eight domains, overall score was 44.2% (mean 44.2%, median 43.3%, range 52.4%, interquartile range 23.8-76.2%). The domains of local planning (mean 31.1%, median 27.5%) and care planning (mean 31.4%, median 35.4%) scored the lowest, and sharing information scored the highest (mean 55.2%, median 62.5%). There was significant variability across each domain between the nine ICS. The user/carer participation domain had the widest variation across ICSs (0-100%). The results demonstrate a significant variance in service provision for PwID and epilepsy across the nine ICSs. The toolkit identifies specific areas for improvement within each ICS and region.

Differing needs for Advance Care Planning in the Veterans Health Administration: use of latent class analysis to identify subgroups to enhance Advance Care Planning via Group Visits for veterans

BackgroundAdvance Care Planning via Group Visits (ACP-GV) is a patient-centered intervention facilitated by a clinician using a group modality to promote healthcare decision-making among veterans. Participants in the group document a “Next Step” to use in planning for their future care needs. The next step may include documentation of preferences in an advance directive, discussing plans with family, or anything else to fulfill their ACP needs. This evaluation seeks to determine whether there are identifiable subgroups of group participants with differing needs prior to delivery of the ACP-GV program and, if so, to use information about the subgroups to enhance the program offered to veterans in United States Department of Veterans Affairs (VA) healthcare settings.MethodsWe conducted a secondary analysis of national data from a quality improvement evaluation. Patient- and provider-level data from administrative healthcare records for VA users in all 50 states, territories, and the District of Columbia provides data on veterans attending ACP-GV during federal fiscal years 2018–2022 (N = 26,857). Latent class analysis seeks to identify the various subgroups of veterans based on their level of ACP self-efficacy before attending ACP-GV and any demographic differences across the resulting subgroups of veterans attending ACP-GV. ACP self-efficacy is derived from seven items obtained from a participant worksheet used during the group.ResultsAnalysis revealed two distinct groups of veterans, distinguishable by their pre-ACP-GV levels of one aspect of ACP self-efficacy: prior knowledge of ACP. Veterans with higher prior knowledge of ACP are associated with an identified next step focused on checking their current AD status and updating it, and veterans with lower ACP prior knowledge are associated with identifying a next step to discuss ACP more fully with family. Differences in age, sex, race, ethnicity, and marital status exist across subgroups of veterans.ConclusionGreater attention must be paid to ACP and veterans’ prior knowledge of ACP to consistently encourage annual review and status updates.

6.G. Scientific session: The importance of using country-specific severity distributions in burden of disease indicators

Abstract One of the most commonly used health gap summary measures in the field of public health is the Disability-adjusted life year (DALY). It has become the key metric for quantifying the burden of disease (BoD) and is used as an information source for setting priorities for health care and health service planning. The DALY metric quantifies gaps between a theoretical population in perfect health and the current health status related to both morbidity and mortality. It is the sum of the number of healthy life years lost due to disability (YLD) and death (YLL). The YLD summarises the loss of healthy life time using the frequency of diseases differentiated by severities or related health states (including sequelae). Depending on each health state, it converts the time spent with diseases into YLD by weighting each year with health limitation with so-called disability weights. This allows the two indicators YLL and YLD to be added to the DALY. Consequently, severity distributions are a means of describing the range of health loss along specific health states, which enables an accurate mapping with disability weights. For most of the diseases, these distributions are usually categorised as mild, moderate, severe, or no health loss (asymptomatic). Conditions with higher severity levels contribute more to the YLD and thus, to the overall disease specific BoD. The severity distributions are highly dependent on utilization at the individual level, but also on available health care services at the society level, which indicates that differences by settings are to be expected. Changes over time in the share of severe cases, for instance, may reflect the effectiveness of health interventions and policies. This underlines the importance of severity distributions, as they also reflect information about the quality of healthcare for those affected. The Global Burden of Disease (GBD) study applies for a significant proportion of their considered diseases uniform severity distributions across countries and broader regions. They acknowledge concerns over applying estimates of severity distributions based on limited data, noting that it is the only available information that they were able to use. As the YLD estimates are often utilized to develop and prioritize health policy interventions, there is a necessity for country-specific estimates that are evidence based and less susceptible to model assumptions. In most cases, the estimation of severity distributions involves complex methodology as data for such assessments are very limited or hardly reliable. In the following workshop, general concepts and country cases from Germany, Scotland, and Belgium will be presented covering a variety of diseases. The examples underline the importance of estimating national and even regional severity distributions when identifying the importance of diseases or comparing the health conditions of populations across time. Key messages • As the Burden of disease indicators are predominantly used to prioritize health interventions and allocate resources, it is crucial to use accurate information in the severity levels of disease. • Severity distributions reflect the health care services and vary across different settings. Utilising country-specific severity distributions when estimating Burden of Disease indicators is essential.

Youth mental health outreach interventions: lessons from an experience capitalisation process

Abstract Issue Young people face socioeconomic, geographical and cultural barriers to access care and support in mental health. Practitioners implement outreach initiatives to improve mental health and address health inequalities, mostly developed in a ‘no-request for care’ context. Methods To better understand the implementation mechanisms of these initiatives, Fondation de France commissioned the French Society for Public Health to carry out an experience capitalisation to inspire other professionals. Experience capitalisation method was used, based on in depth interviews with project stakeholders. Covered themes were: the description of history, strategies and activities; identification of key moment and key levers; skills and knowledge used. Results Nine mental health outreach projects implemented across regions of France were selected with the help of a multidisciplinary steering committee. Each project was synthetised in a capitalisation document and a cross-sectional analysis was undertaken. Lessons • A variety of outreach approaches were carried on: meeting adolescents in the street or at coffee shops; home-based interventions; consultations in converted van etc. • Outreach is not just a matter of physically moving outside health structures but requires non-judging and flexible stance to adjust to the youth’s pace and will. To extend their approach to mobility, professionals deepen their team’s multidisciplinarity, broaden cross-sector partnerships and mobilise new skills and creativity. • Adolescents’ participation to care or support plans was one of projects strengths, whether they suffer from anxiety or mental disorders. However, their participation in governance and decisions regarding global projects remained limited. Key messages • To reduce mental health inequalities and enhance youth participation in outreach interventions, empowerment and wellbeing of interventions practitioners should also be supported. • Capitalisation of experience in health promotion is a promising method contributing to professional acknowledgment and development of shared knowledge on interventions implementation.

Integrating psychiatry and family medicine in the management of somatic symptom disorders: Diagnosis, collaboration, and communication strategies

AbstractSomatic symptom disorders (SSDs) present a complex interplay of physical and psychological factors, necessitating an integrative approach to diagnosis and management. This article explores the collaborative efforts between family medicine and psychiatry in addressing SSDs, emphasizing the importance of a multidisciplinary strategy for comprehensive patient care. Effective diagnosis involves recognizing the significance of both somatic symptoms and the patient's psychological response, with tools like structured clinical interviews and self‐report questionnaires playing crucial roles. Management strategies include psychotherapeutic interventions such as cognitive behavioral therapy (CBT), pharmacological treatments, and lifestyle modifications, all tailored to the patient's needs. Communication strategies are vital in validating patients' experiences while addressing underlying psychiatric issues. Techniques such as active listening, biopsychosocial framing, and the teach‐back method foster trust and improve treatment adherence. Cultural considerations and the use of interpreters enhance communication with diverse patient populations. Training programs for healthcare providers further improve competency in managing SSDs. This integrative approach aims to enhance patient outcomes by addressing the multifaceted nature of SSDs through collaborative care, effective communication, and comprehensive treatment planning.

Long-term outcome of diabetic patients after unprotected left main percutaneous coronary interventions

Abstract Background Diabetes mellitus (DM) represents an elevated risk in terms of percutaneous coronary intervention (PCI), especially in patients with significant left main (LM) disease. Purpose Our aims were to investigate the 60-month mortality and event-free survival of consecutive patients with DM undergoing unprotected LM PCI at our centre and sought to determine the independent predictors of event-free survival. Methods We included all patients undergoing unprotected LM PCI at our tertiary care centre between 1 January 2007 and 31 December 2014. The primary endpoint was the composite of all-cause mortality, myocardial infarction, and target lesion revascularization at 60 months. Survival curves were constructed using the Kaplan-Meier non-parametric estimator. ROC analysis was used to investigate the predictive power of conventional risk scores (SYNTAX, SYNTAX II, EuroSCORE II, additive and logistic EuroSCORE, ACEF, GRACE 2). Independent predictors were determined by univariate and multivariate analysis. Results A total of 513 patients (mean age 68 ± 12 years, 64% male) underwent unprotected LM PCI during this period, among these 310 (60%) were non-diabetic (non-DM) and 203 (40%) were diabetic (DM). In terms of indication, 157 (31%) elective and 356 (69%) acute LM PCI were performed. There was no significant difference between the non-DM and DM groups in terms of acute indication (218 (70%) vs. 138 (68%), p=0.574). Within the DM group, 135 (67%) were treated with oral antidiabetics (OAD) and 68 (33%) were treated with insulin (IDM). The mean survival (34.6 vs. 39.7 vs. 43.1 months, p=0.003) and event-free survival (29.3 vs. 34.7 vs. 39.3 months, p=0.001) were significantly lower in the IDM and OAD groups compared to non-DM, respectively. Of the risk scores, the SYNTAX score was the most predictive in diabetic patients (AUC=0.767). Based on the SYNTAX score, diabetic patients with a low SYNTAX score (<23) had less events (59% vs. 66%, p=0.043) than those having a moderate/high SYNTAX score (≥23). LVEF (HR 0.976; 95% CI, 0.965-0.987, p<0.001), right coronary artery occlusion (HR 2.031; 95% CI, 1.346-3.064, p=0.001), acute coronary syndrome (HR 1.861; 95% CI, 1.252-2.767, p=0.002), use of FFR (HR 0.481; 95% CI, 0.265-0.871, p=0.016), true bifurcation lesion (HR 1.559; 95% CI, 1.068-2.277, p=0.021) and newer DES generation (HR 0.706; 95% CI, 0.568-0.877, p=0.002) were predictors of event-free survival in diabetics by univariate analysis. Glomerular filtration rate (HR 0.982; 95% CI, 0.973-0.991, p<0.001) emerged as an independent predictor according to multivariate analysis. Conclusion Consecutive diabetic patients with significant unprotected LM stenosis have poor long-term outcome after LM PCI. Anatomical complexity of the lesions is a significant predictor of event-free survival. Careful intervention planning and the use of appropriate tools can improve the outcome in this high-risk population.

Clinical validated risk prediction model for development of heart failure after contemporary breast cancer treatment

Abstract Background Patients receiving breast cancer (BC) treatment are at risk for heart failure and cardiomyopathy (HF/CM). European Society of Cardiology (ESC) cardio-oncology guidelines recommend baseline cardiovascular (CV) assessment, however, there is limited data about cardiotoxicity risk specific to patients with BC. Our aim was to develop and validate model for prediction of HF/CM in women receiving contemporary treatment for invasive early-stage BC. Methods We assembled a cohort women diagnosed with Stage I-III BC from 2008-2020 and followed through 2021 in a large health care plan. Women age >80, with history of HF/CM, and women who received both anthracyclines and trastuzumab were excluded, leaving N=26,044 for analysis. Study cohort was randomly split into derivation (60%) and validation (40%) datasets. Elastic-net penalized Cox proportional hazard model was created using the derivation dataset to select risk factors and to calculate the panelized coefficient which defined the HF/CM risk score. Risk score system was assessed by Hosmer-Lemeshow goodness-of-fit test and area under the ROC curve (AUC). Event rates of <5% constituted low risk; 5-14% moderate; and >15% high risk category. Incident HF/CM events were examined using Kaplan-Meier approach in derivation and validation datasets. Results HF/CM risk score had high discrimination ability and sufficiently good model of fit regarding HF/CM events (P value=0.163 and 0.667 from Hosmer–Lemeshow test;AUC 0.751 and 0.764, in derivation and validation sets, respectively). There were 10% of women in the high risk; 30% in moderate; and 60% in low-risk group. Variables associated with the higher HF/CM risk score included age, receipt of anthracycline-based chemotherapy or anti-HER2 therapy, presence of hypertension, diabetes, or history of other CV conditions at baseline. The score pattern showed major effect of age, with anthracycline and anti-HER2 therapy increasing the risk across all age groups (Figure 1). Kaplan-Meier analysis of incident HF/CM over 14 years after BC diagnosis showed significantly lower number of HF/CM events in low risk compared to moderate and high-risk score groups (p<0.0001, Figure 2). Conclusion Our robust risk prediction model for HF/CM among women with early-stage BC provides a new tool to identify women at higher CV risk and inform cardiac function monitoring during and after BC treatment. Our findings may guide further validation studies and build evidence for the cardiotoxicity risk stratification in patients with BC.Risk Score for HF/CM by Age/ChemoTxK-M curves of freedom from HF/CM