Clinical Schedule Research Articles

Development and validation of a predictive model for adverse left ventricular remodeling in NSTEMI patients after primary percutaneous coronary intervention

IntroductionTo develop and validate clinical evaluators that predict adverse left ventricular remodeling (ALVR) in non-ST-elevation myocardial infarction (NSTEMI) patients after primary percutaneous coronary intervention (PCI).MethodsThe retrospective study analyzed the clinical data of 507 NSTEMI patients who were treated with primary PCI from the Affiliated Hospital of Xuzhou Medical University and the Second Affiliated Hospital of Xuzhou Medical University, between January 1, 2019 and September 31, 2021. The training cohort consisted of patients admitted before June 2020 (n = 287), and the remaining patients (n = 220) were assigned to an external validation cohort. The endpoint event was the occurrence of ALVR, which was described as an increase ≥ 20% in left ventricular end-diastolic volume (LVEDV) at 3–4 months follow-up CMR compared with baseline measurements. The occurrence probability of ALVR stemmed from the final model, which embodied independent predictors recommended by logistic regression analysis. The area under the receiver operating characteristic curve (AUC), Calibration plot, Hosmer–Lemeshow method, and decision curve analysis (DCA) were applied to quantify the performance.ResultsIndependent predictors for ALVR included age (odds ratio (OR): 1.040; 95% confidence interval (CI): 1.009–1.073), the level of neutrophil to lymphocyte ratio (OR: 4.492; 95% CI: 1.906–10.582), the cardiac microvascular obstruction (OR: 3.416; 95% CI: 1.170–9.970), peak global longitudinal strain (OR: 1.131; 95% CI: 1.026–1.246), infarct size (OR: 1.082; 95% CI: 1.042–1.125) and left ventricular ejection fraction (OR: 0.925; 95% CI: 0.872–0.980), which were screened by regression analysis then merged into the nomogram model. Both internal validation (AUC: 0.805) and external validation (AUC: 0.867) revealed that the prediction model was capable of good discrimination. Calibration plot and Hosmer–Lemeshow method showed high consistency between the probabilities predicted by the nomogram (P = 0.514) and the validation set (P = 0.762) and the probabilities of actual occurrence. DCA corroborated the clinical utility of the nomogram.ConclusionsIn this study, the proposed nomogram model enabled individualized prediction of ALVR in NSTEMI patients after reperfusion and conduced to guide clinical therapeutic schedules.

The rationale and guiding principles to design a psychiatry curriculum for primary care doctors of India.

Background Integrating psychiatric care into the general practice of primary care doctors (PCDs) is necessary to overcome the shortage of human resources to cater to the burgeoning public mental health needs of India. The traditional psychiatry curriculum is often top-down and specialist-based that contributes little in terms of skill quotient. We designed an innovative, digitally driven, distance education-based, part-time, modular-based Primary Care Psychiatry Programme (PCPP, skill-based). It is being implemented across many states of India to equip PCDs with skills to provide first-line psychiatry treatment. We discuss the rationale and guiding principles behind designing the curriculum of PCPP. Discussion There are nine guiding principles behind designing and implementing PCPP to provide pragmatic, acceptable, feasible modules of higher translational quotient (TQ) that are essential to upskill PCDs. There is a shift in training the location of PCDs in their live brief general consultations utilizing innovative telemedicine-based 'on-consultation training' (OCT) augmented with collaborative video consultations. A monolithic treatment protocol-driven, trans-diagnostic approach is used to design a concise, all-inone, point-of-care manual containing a culturally sensitive, rapid, validated screener and taxonomy, called 'Clinical Schedules for Primary Care Psychiatry'. This incorporates the PCDs' style of clinical practice that helps in picking up the most commonly prevalent adult psychiatric disorders presenting to primary care. Conclusion This PCPP curriculum contains pragmatic modules with higher TQ. This curriculum is dynamic as the learning is bi-directional. This can be used by policy-makers, innovators and academia for integration with national health programmes such as those for non-communicable diseases and reproductive and child health.

A Case for Academic Teleradiology.

A Case for Academic Teleradiology.

Telemedicine patient satisfaction metrics and methods of recurrence detection for gynecologic cancer patients throughout the initial year of the COVID-19 pandemic (515)

Objectives: To determine the patient satisfaction with telemedicine services throughout the initial year of the COVID-19 pandemic and evaluate detection of recurrence in those patients at a single, academic, tertiary-care medical center.Methods: Our Gynecologic Oncology clinic schedule was queried for all telemedicine encounters during the period of April 27, 2020- March 30, 2021. To assess patient satisfaction with telemedicine encounters, a modified 12-item Telemedicine Satisfaction Survey (TeSS) was administered to patients. Up to three contact attempts by phone were made for each patient. The exclusion criteria included patients requiring interpreter services. To analyze the initial method of diagnosis of recurrent gynecologic cancer during the COVID-19 pandemic, a retrospective chart review was completed on patients reached for survey completion.Results: Three hundred ninety-four patients were contacted. Three hundred sixteen completed the survey, and 78 declined, with a survey response rate of 80.2% (316/394). The mean age at cancer diagnosis was 60.1 years. The mean distance traveled from a patient’s home to the Gynecologic Oncology clinic was 50.4 miles. As detailed in Figure 1, personal comfort using telemedicine was rated as good or excellent by 90.8% of patients (n = 287). Almost 93.7% of patients felt that the explanation of treatment by the telemedicine staff was good or excellent (n=296). The courtesy, respect, sensitivity, and friendliness of staff during the telemedicine encounter was rated as excellent by 80.7% of patients (n=255). Of the 394 patients, 312 had pathologically-proven gynecologic malignancies. Of these patients, 9.3% (29/312) had recurrent gynecologic cancer during the study period. The initial method of recurrence detection included patient-reported symptoms (62.1%, n=18), routine biomarker (24.1%, n=7), and routine imaging (13.8%, n=4). Of the 364 patients, 72.6% used telemedicine for surveillance, 26.1% for postoperative visits, 11.7% for chemotherapy, 3.6% for problem visits, 1.3% for preoperative visits, and 0.5% for initial visits. Ultimately, 92.7% of patients rated their “overall treatment experience at using telehealth” as good or excellent (n=293). Telemedicine was well-received, with 87.0% of patients (n=275) indicating they would use telehealth again and 82.0% of patients (n=259) stating they would recommend telehealth to another gynecology oncology patient.Conclusions: With high patient acceptability, this study provides evidence to support the use of telemedicine as an option for gynecologic cancer surveillance in the post-pandemic period. Guided by patient health factors and preferences, telemedicine may be leveraged to reduce barriers to gynecologic specialty care such as distance traveled to the clinic while at the same time maximizing clinic capacity for patients necessitating in-person examination.

Microbeam Irradiation as a Simultaneously Integrated Boost in a Conventional Whole-Brain Radiotherapy Protocol.

Microbeam radiotherapy (MRT), an experimental high-dose rate concept with spatial fractionation at the micrometre range, has shown a high therapeutic potential as well as good preservation of normal tissue function in pre-clinical studies. We investigated the suitability of MRT as a simultaneously integrated boost (SIB) in conventional whole-brain irradiation (WBRT). A 174 Gy MRT SIB was administered with an array of quasi-parallel, 50 µm wide microbeams spaced at a centre-to-centre distance of 400 µm either on the first or last day of a 5 × 4 Gy radiotherapy schedule in healthy adult C57 BL/6J mice and in F98 glioma cell cultures. The animals were observed for signs of intracranial pressure and focal neurologic signs. Colony counts were conducted in F98 glioma cell cultures. No signs of acute adverse effects were observed in any of the irradiated animals within 3 days after the last irradiation fraction. The tumoricidal effect on F98 cell in vitro was higher when the MRT boost was delivered on the first day of the irradiation course, as opposed to the last day. Therefore, the MRT SIB should be integrated into a clinical radiotherapy schedule as early as possible.

Mobile clinics: Medical service strategy for disaster healthcare response operation

Purpose: Disrupted healthcare facilities due to disasters leave the affected communities without access to sufficient health care. This study proposed the use of mobile health clinics to address the issues faced by medical service providers during disaster response.Design/methodology/approach: A mobile health clinic a mobile facility that performs health care services from a stationary location. The model was developed as a healthcare response strategy, considering demand uncertainties due to the nature of the disaster. Therefore, this study objective is to simultaneously generate the mobile health clinic route and schedule and determine how each mobile health clinic covers patient demands within a pre-specified time horizon. The stochastic model is presented because the disaster's impact varies according to its scale.Findings: An investigation of the medical shelter effect in locations with high number of displaced people and the routing of mobile clinics for several shelter locations with a small number of people show that a hybrid strategy comprising a medical shelter and a mobile health clinic is the best option. Mobile health clinics can serve many locations within an appropriate walking distance. It can also route them to other locations when the time constraint allows. With a high number of people located in a shelter, building a medical shelter provides a better service.Originality/value: This study proposed mobile health clinics as a medical service strategy during disaster response to address the challenges faced by communities during a disaster response. The idea of mobile health clinics (MHC) is to improve communities’ access to healthcare services.

Movement disorders in COVID-19 times: impact on care in movement disorders and Parkinson disease.

The purpose of this review is to outline the impact of the COVID-19 pandemic on movement disorder holistic care, particularly in the care of people with Parkinson disease (PWP). As the pandemic unfolds, a flurry of literature was published regarding the impact of COVID-19 on people with Parkinson disease including the direct impact of infection, availability of ambulatory care, loss of community-based team care, and acceptability of telemedicine. COVID-19 has impacted the care of PWP in numerous ways. Recognizing infection in PWP poses challenges. Specific long-term complications, including emerging reports of long COVID syndrome is a growing concern. Caregivers and PWP have also been impacted by COVID-19 social isolation restrictions, with radical changes to the structure of social networks and support systems globally. In a matter of weeks, the global community saw an incredible uptake in telemedicine, which brought benefits and pitfalls. As PWP adapted to virtual platforms and the changing architecture of care delivery, the pandemic amplified many preexisting inequities amongst populations and countries, exposing a new 'digital divide'.

Increasing North Carolina's Workforce Capacity for Prescribing Buprenorphine Products.

BACKGROUND Inadequate access to opioid use disorder (OUD) treatment is a public health concern. Rates of opioid-related poisoning deaths are increasing in North Carolina and access to OUD treatment is especially sparse in rural areas. DEA-X-waivered providers that can prescribe buprenorphine as a medication for opioid use disorder (MOUD) play an essential role in treating OUD. Increased workforce capacity to treat OUD in an evidence-based, equitable, and patient-centered way is needed. Gaps persist in continuing professional education and academic training.METHODS Description of an interdisciplinary training team effort to engage medical residencies and advanced practice provider (APP) programs across North Carolina in a set of subsidized trainings about substance use disorder treatment and medication-assisted treatment (MAT), with the goal of increasing capacity to administer MOUD, based on each program's needs. Uptake was independently evaluated.RESULTS Engagement exceeded initial goals: 72 unique trainings related to MAT were administered to 1512 providers from 30 residency and 7 APP programs. By the end of the grant period, 902 participants completed a training required to obtain a DEA-X waiver. Evaluation of training uptake identified facilitators and barriers specific to residents and APP trainees.LIMITATIONS Limitations included difficulty coordinating training with existing didactic and clinical schedules during the project time frame and challenges identifying implementation leaders at training sites.CONCLUSION This project highlights a successful and potentially replicable approach to offering structured MAT capacity-building training in combination with technical assistance (TA) within medical education programs.

Residents Are Coming: A Faculty Development Curriculum to Prepare a Community Site For New Learners.

This curriculum is designed for emergency medicine attendings in varying years of community practice to prepare them for Emergency Medicine (EM) residents. 15 months. Emergency medicine is a growing field with new residencies approved every year. A strong, competent cadre of clinical educators is essential to the success of any residency, and new programs have the challenge of developing their clinical faculty into outstanding teachers. There is minimal literature guidance for navigating this transition. Our site is a community tertiary care center in the process of applying for an EM residency. We focus on our experience designing a faculty development curriculum to accommodate the needs of a diverse group of physicians in all stages of their careers. We will demonstrate that a curriculum satisfying all stakeholders can easily be implemented in a way that allows for robust participation without excessive additional administrative burden. Our goal is to prepare community-based EM attendings to be outstanding educators to future residents by augmenting their knowledge of current educational practice and adult learning theory, literature review, and biostatistics. The educational strategies used in this curriculum included lectures, guided discussion, small group discussion, and asynchronous learning. This curriculum was implemented in the Geisinger Wyoming Valley Medical center targeted at staff physicians. This educational study was deemed exempt by the institutional review board (IRB). We electronically collected retrospective survey data using a 5-point Likert scale as well as free text responses. The primary measure was agreement with the statement, "Faculty development time makes me feel more prepared to be a clinical educator." We also surveyed whether this was felt to be an appropriate use of time, self-reported growth in key educational and biostatistical domains, and likeliness to change practice based on the material. Responses collected from core faculty after the sessions indicated a uniformly positive review of the series itself with the primary outcome receiving a 4.6 rating on a 5-point Likert scale (strong agreement). Faculty reported that these brief sessions improved the quality of the departmental staff meetings (average rating 4.7/5). Journal club sessions were rated as positive (4.7/5) and attendees self-reported growth in statistical literacy and security in clinical practice. We demonstrated successful implementation of a faculty development curriculum that was favorably assessed by all key stakeholders. Faculty self-reported growth in all educational and clinical domains evaluated. It was successfully implemented without substantially increasing the time burden for physicians with robust clinical and administrative schedules. We feel this is generalizable to other sites seeking to start an EM residency and is useful for sites with existing residencies to efficiently deliver content to junior faculty. Emergency medicine, faculty development, journal club, virtual learning.

Identification of Determinants and Implementation Strategies to Increase PrEP Uptake Among Black Same Gender-Loving Men in Mecklenburg County, North Carolina: The PrEP-MECK Study.

Pre-exposure prophylaxis (PrEP) use is low among Black same gender-loving men (BSGLM) in Mecklenburg County, NC, an Ending the HIV Epidemic priority jurisdiction. We created PrEP-MECK-an investigator partnership among a community-based organization representative, a PrEP provider, and researchers-and conducted iterative preparation research to identify determinants of PrEP uptake and implementation strategies to address them. We first established the PrEP-MECK Coalition of community stakeholders. Next, informed by PrEP-MECK Coalition input and PRECEDE-PROCEED's educational/ecological assessment phase, we conducted focus group discussions with BSGLM not using PrEP and in-depth interviews with BSGLM who were currently or had previously taken PrEP to describe determinants and suggest implementation strategies. Based on interim findings, we partnered with clinics participating in the Mecklenburg County PrEP Initiative, which offers free PrEP services to uninsured individuals. We also conducted Consolidated Framework for Implementation Research-informed organizational assessments with community-based organizations and clinics to assess readiness to pilot the implementation strategies. We conducted 4 focus group discussions, 17 in-depth interviews, and 6 assessments. BSGLM were aware of PrEP yet perceived that costs made it unattainable. Awareness of how to access PrEP and the Mecklenburg County PrEP Initiative was lacking, and clinic scheduling barriers and provider mistrust limited access. We identified client-level implementation strategies, primarily focusing on engaging the consumer, to increase comfort with and awareness of how to access PrEP, and clinic-level implementation strategies focusing on changing clinic infrastructure, to make PrEP access easier. We plan to evaluate implementation of these strategies once fully developed to determine their acceptability and other outcomes in future research.

Comparison of Blood Pressure Readings on a Bare Arm, over a Sleeve Arm and over a Rolled-Up Sleeve Arm in Outpatient Department of Medicine in Dhulikhel Hospital, Kathmandu University Hospital

Background: It is universally recommended that blood pressure should be measured on bare arm for accurate reading. However, this is seldom done in busy clinical schedules. This study aims to see if clothing adjustments should be a concern while measuring blood pressure under suboptimal conditions.
 Materials and Methods: This was a cross sectional study conducted at medicine department of Kathmandu University Hospital, Dhulikhel Hospital among conveniently selected 100 patients. After getting informed consent, consecutive blood pressure measurements were done over rolled-up sleeve arm, sleeve arm and bare arm in seated position. Socio-demographic information were obtained through an interview using a semi-structured questionnaire. Data were entered in Microsoft Excel and analyzed using descriptive and inferential statistics in Statistical Software for Social Sciences version 20.
 Results: The median of differences between sleeved arm and bare arm was 0 for both systolic and diastolic blood pressure and the median value for differences between rolled up arm and bare arm was 2 units for both systolic and diastolic blood pressure. Although the differences looked statistically significant, the size of the differences was not clinically significant.
 Conclusion: Meticulous clothing adjustment has clinically insignificant differences in measurement of blood pressure if patient is wearing thin sleeves. Therefore, in suboptimal conditions, blood pressure can be measured on rolled-up sleeve arm and sleeve arm if patient is wearing thin sleeve clothes.

MSR10 An Adaptation of the RAND/UCLA Modified Delphi Panel Method in the Time of COVID-19

MSR10 An Adaptation of the RAND/UCLA Modified Delphi Panel Method in the Time of COVID-19

Flexible and efficient Bayesian pharmacometrics modeling using Stan and Torsten, Part I.

Stan is an open‐source probabilistic programing language, primarily designed to do Bayesian data analysis. Its main inference algorithm is an adaptive Hamiltonian Monte Carlo sampler, supported by state‐of‐the‐art gradient computation. Stan's strengths include efficient computation, an expressive language that offers a great deal of flexibility, and numerous diagnostics that allow modelers to check whether the inference is reliable. Torsten extends Stan with a suite of functions that facilitate the specification of pharmacokinetic and pharmacodynamic models and makes it straightforward to specify a clinical event schedule. Part I of this tutorial demonstrates how to build, fit, and criticize standard pharmacokinetic and pharmacodynamic models using Stan and Torsten.

Design of a Smart Elbow Brace as a Home-Based Rehabilitation Device.

Poststroke and traumatic elbow injuries are the most common cause of elbow stiffness, which results in loss of functional range of motion (ROM). Various studies support early mobilization of the elbow joint after injury or after surgery to reduce risks of elbow stiffness development. After hospitalization, patients are required to follow a long-term rehabilitation program during home recovery. Still, most patients do not adhere to their clinical therapy schedule due to either rehabilitation cost, social obligations, negligence, or lack of inspiration. Moreover, the numbers of therapists and assessment equipment are insufficient. This study introduces a smart elbow brace (SEB) as a home-based rehabilitation device that reduces regular in-patient rehabilitation costs and therapist workload and motivates patients to comply with the rehabilitation program that enhances the achievement of rehabilitation goals. Our device has two active degrees of freedom (2-DoF) that allow extension, flexion, pronation, and supination elbow motions. An extra sliding joint between forearm and wrist is added, which helps dump forces concentration at the elbow joint during extension-flexion movement. Mechanical design requirements, motion-tracking systems, and serious game development are described. The feasibility of a proposed SEB device is tested with five healthy subjects playing developed serious games with the device. The results show that subjects can attain maximum and minimum angles of flexion-extension and pronation-supination motion designed for elbow stiffness rehabilitation. The SEB device will be beneficial and be used at home as a complementary tool to support elbow stiffness rehabilitation during long-term home recovery.

Abstract 5536: Selinexor inhibits lymphoma-leukemia tumor progression directly and through activation of anti-cancer immune response

Abstract Background: Selinexor is a Selective Inhibitor of Nuclear Export (SINE) compound that binds covalently to Exportin 1 (XPO1) and inhibits its nuclear export function, resulting in nuclear accumulation of tumor suppressor proteins (TSPs) including p53, pRB, and IκB-α. Selinexor was evaluated for improved survival in tumor-bearing mice with hematological malignancies using EL-4 (T cell lymphoma/leukemia) and C1498 (Acute myeloid leukemia) models. We hypothesized that selinexor increases survival by directly inducing tumor cell apoptosis and blocks immunosuppressive effects of myeloid derived suppressor cells (MDSCs). Methods: Mice were injected with 2×106 EL-4 or 1×106 C1498 cells intravenously followed by oral treatment with saline, vehicle, or different selinexor dosing schedules (5 mg/kg weekly (5), twice weekly on Wed and Fri (5 d1/3) or Mon and Fri (5 d1/5) or 10 mg/kg weekly (10). Selinexor was given by gavage. To examine the effect of selinexor on immune cells during tumor growth, Tumor bearing mice treated with vehicle or selinexor were euthanized at day 14 after tumor injection. Spleens were removed, single cell suspensions were isolated and the percentage of immune cells including MDSCs, regulatory T cells (Tregs) and the production of interferon gamma (IFN-γ) were analyzed by flow cytometry. Tumor bearing mice were monitored for survival in separate experiments. Results: Selinexor at the weekly 5 d1/3 and the 10 dosing significantly increased survival in mice injected with either tumor line. Whereas weekly 5 or 5 d1/5 dosing did not significant affect survival. Selinexor at weekly 10 dosing significantly reduced the population of polymorphonuclear MDSCs (PMN-MDSCs). Selinexor at 10, 5 d1/3 and 5/1/5 weekly dosing significantly increased IFN-γ production by CD8+ and CD4+ T cells when compared to vehicle. There were no differences in Tregs populations. Conclusions: These data demonstrate that different selinexor dosing and schedules have differential efficacy on survival in murine models of leukemia/lymphoma. Selinexor effects are dose and schedule dependent. We found that in contrast to the split dosing, the single weekly high dose of selinexor reduced splenic PMN-MDSC accumulation. While both dosing schedules increased the percentage of IFN-γ positive T cells in tumor bearing mice suggesting that selinexor’s anti-cancer activity is not limited only to direct cytotoxic or cytostatic tumor cells. These data support the concept that once weekly selinexor, at a higher dose (10 mg/kg (approximately 30 mg/m2) which is comparable to the clinical dose schedule (50-60 mg weekly) can modulate the immune system to target cancer cells and could be used alone or in combination with other immunotherapies to enhance the immune system. Citation Format: Hemn Mohammadpour, Yosef Landesman, Philip McCarthy. Selinexor inhibits lymphoma-leukemia tumor progression directly and through activation of anti-cancer immune response [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5536.

Learning From Experience- Confronting Challenges and Adapting to Change in a Large Academic Abdominal Radiology Practice: Insights From a Faculty Retreat

RationaleSubstantial organizational changes, increasing clinical volumes, and the COVID-19 pandemic presented compound stressors to faculty radiologists in our large academic abdominal radiology division and necessitated multiple changes in our practice. MethodsTo address the challenges and establish group consensus, we conducted a virtual divisional faculty retreat centered on themes of team building, clinical work, trainee education, and faculty mentorship. A pre-retreat survey evaluated satisfaction with aspects of professional life and clinical work practices and invited personal reflections. Survey data were presented in the retreat segments focused on each theme, and subsequent discussion was facilitated in small group breakouts. ResultsResponses to the team-building survey revealed common values and sources of gratitude, including health, family and meaningful work and relationships. Faculty reported a strong sense of personal accomplishment, but with varied emotional exhaustion scores. Faculty were satisfied with remote work assignments but identified opportunities to improve the clinical work schedule including reversion of some remote assignments to in-person and increased interventional radiology shift staggering. Compared to pre-COVID practice, faculty respondents perceived giving lower quality and less frequent feedback to trainees; evolving educational resource needs were identified. A more formal approach to faculty mentoring was sought. A post-retreat survey revealed high participant satisfaction. OutcomesIn the future, we plan to continue divisional retreat activities to respond to evolving challenges and further improve team building, clinical workflow, trainee education, and faculty mentorship.

Using a clinical trial schedule of assessments (SOA) as a quality improvement tool.

e18638 Background: The SOA is a key part of any clinical trial as it highlights activities to be performed during trial execution. Such a schedule provides a roadmap and calendar of tests, measurements, and evaluations. Normally, such a schedule is created after a protocol has been mostly created. Our aim is to demonstrate that the SOA can have a broader usage: that of a quality improvement (QI) tool used during protocol creation, thus helping to ensure a high-quality protocol at the design. When creating a protocol conflicting uses of the Protocol contribute to operational tension. For example, Trial Operations, which wishes to minimize the complexity of the trial, may debate with Clinical Science, who wish to collect the greatest amount of scientific tests and data. The more complex a set of requirements in the protocol, there is a corresponding drop in available sites able to meet those needs. Additionally potential sites may comment about being burdened with tests that are unnecessary to the core protocol aims, thus creating unnecessary delays in the trial. All these issues may be addressed by using the SOA as a QI tool. Methods: This research was completed at a major, international pharmaceutical organization for a Phase III oncology clinical trial. A team was created composed of: Clinical Scientist Lead , Stats/Data Lead, Trial Operations Led, Medical Monitor, Medical Leader, and Lean Expert. Methodologically, this was led by the Lean Expert and each team member was sent an electronic version of a draft SOA for review. They inserted questions and comments that were visible to the entire team. After this, an SOA issues log was created in an SOA tracking system. This system categorized and ranked issues for discussion by the entire team during the creation process of both the SOA and the protocol. The process used a “House of Quality” framework, allowing for the aggregation of protocol requirements so that they could be addressed in total, rather than individually. Results: The process was successful in 3 critical dimensions. From a time metric, the SOA was produced 3 to 6 months faster, enabling numerous efficiencies such as providing the development team with information both faster and at the time the team was creating the final protocol. Second, from an economic standpoint, the labor efficiency of the trial was improved as it required 33% less individuals to produce the SOA and protocol resulting in a protocol at record speed. Finally, protocol quality was increased as in this method the team worked jointly together, nearly simultaneously, to complete both the SOA and the protocol. This reduced the number of Protocol Amendments by 50%. Conclusions: Using this method, there was an increase in quality, a reduction in cost, and a faster time to the sites. This reduced the commercialization timeline by 3-6 months which is a significant cost savings. But most importantly, this allows for better treatment faster to be in the hands of oncologists to treat patients.

Nonprofit Board Membership: A Novel Mechanism for Authentic Community Engagement and Leadership Development for Resident Physicians.

Many residency programs have increased curriculum emphasis on the social determinants of health in recent years, and genuine longitudinal experiences for community engagement can be rare and challenging to design. The pediatric residency program at the University of Pittsburgh Medical Center Children's Hospital of Pittsburgh has its separate Pediatric Advocacy-Leadership-Service (PALS) program track with 6 total residents across all trainee levels in a given academic year. Since 2011, the PALS program's mission is to train residents to be outstanding primary care pediatricians with the knowledge and skills to provide effective health care, leadership, and advocacy on behalf of children and families in medically underserved communities. This specific training is accomplished through multiple elements in the spirit of the acronym. Authentic leadership training, beyond personality profiles and suggested readings, is exceptionally difficult to provide. The PALS program provides the following unique training opportunity to meet this need.Enabling authentic community engagement while simultaneously offering robust leadership development, the PALS program facilitates each resident to be a member on the board of directors of a local nonprofit organization during residency training. This pairing is done with individual attention to each resident's interests and the community organization's vision and values. First-year PALS residents are asked to critically reflect on personal strengths, goals, and areas of growth. Local community pediatrician and public health leader, Dr Amy Nevin, has years of experience with grassroots community health networks to coordinate “the match” between each nonprofit organization and resident. To enable junior residents to contribute meaningfully as board members, she and the PALS third-year residents provide specific mentorship and are in communication with various local nonprofits gauging specific organization needs. First, an interview is completed, and the nonprofit leadership decides whether the resident physician is their desired board member candidate. If all parties are interested in proceeding, clear expectations are outlined upfront. For example, residents are never expected to make large personal financial donations to the organization. Residents are transparent regarding their rigorous clinical schedules. Nonprofit organizations provide board meeting times to the residents and share reasonable attendance expectations. Residents then provide board meeting times in advance to residency program leadership for accommodations when possible. The timeline varies per each pairing but is finalized by the end of intern year at the latest to provide at least 2 full years of active nonprofit board membership.The resident nonprofit board membership experience has been an empowering community opportunity with mutual benefits for both local nonprofits and residents. Several residents have cited their nonprofit board role as one of their most rewarding experiences of residency. Many residents invited their community partners to visit the hospital for guest lectures during teaching conferences. Community nonprofits have utilized resident perspectives, often the only medical voice on many boards, on numerous occasions including navigating the COVID-19 pandemic. The list of participating nonprofit organizations (Table) has grown even as some partners actively seek a new resident board member as graduating ones complete their residency programs. Most residents had never previously held board responsibilities, and this leadership opportunity intends to serve all graduates as future community health leaders in their careers. Further investigation is needed longitudinally to survey graduates and community partners of this experience to understand its long-term career impact.

Implementation of a “genetic testing station” in a safety net hospital to optimize access and increase equity.

e18565 Background: Diagnosis of hereditary cancers by genetic testing (GT) has significant implications for treatment decisions for individuals and risk reduction among family members. Recent guidelines have expanded the eligibility criteria for GT. However, significant disparities in GT completion persist based on race, ethnicity, insurance status, and English proficiency. Thus, novel interventions are needed to provide diverse populations equitable access to GT. Methods: From March to October 2021, we conducted a single arm study of a genetic testing station (GTS) intervention in a safety net hospital. The GTS intervention included (1) screening of clinic schedules for eligible patients; (2) video-based GT education in English, Spanish, and Cantonese; (3) consent for GT and collection of a blood or saliva sample by a genetic counseling assistant; (4) telehealth-based post-test counseling with a genetic counselor (GC). Bilingual, culturally concordant staff developed the educational videos and study materials. Patients who met the NCCN criteria for GT were eligible. We compared this group to a historical cohort who initiated GT in the preceding nine months. The historical cohort underwent GT in a traditional model: (1) oncologist-initiated referral, (2) pretest counseling with a GC, (3) GT if appropriate, and (4) post-test counseling to review and discuss results. Our primary outcomes were accessibility and feasibility assessed by tracking the implementation process. Secondary outcomes included completion rates of GT and post-test GC visit, and time from enrollment to GT result disclosure. We evaluated all associations with Chi-square tests for categorical variables and Pearson’s Chi-square test of medians for time to post-test visit. Results: We approached 92 patients for GTS; 3 declined, 89 patients underwent the GTS intervention. Of 155 patients (GTS: n = 89, historical cohort: n = 66), 15% were Black, 28% Asian, 17% White, 31% Hispanic/Latinx, 2% Native Hawaiian/Pacific Islander, and 7% multiethnic/other; 51% spoke English, 27% Spanish, 17% Cantonese, and 5% other. In the GTS cohort, 85 (96%) of participants completed GT and 80 (90%) completed the post-test GC visit, compared to 46 (70%, p < 0.001) and 42 (64%, p < 0.001) respectively in the historical cohort. The median time to result disclosure was 30.5 days (IQR 23.8 - 38.8) for the GTS cohort and 80.5 days (IQR 37.5 - 137.5, p = 0.001) for the historical cohort. Conclusions: Implementation of GTS was feasible and acceptable in a safety net setting. GTS resulted in more patients completing GT and post-test counseling and significantly reduced the time to result disclosure, which has the potential to impact treatment decisions and outcomes. As GT eligibility criteria broaden, innovative interventions, workflows, and tailored educational resources for diverse populations are needed to ensure equitable access to GT.

SPT and SPTA tandem learning in a pro bono environment: a model for intraprofessional learning

Objective: Clinical education and collaboration are critical components of developing student physical therapists (SPTs) into safe and competent clinicians. While students may find themselves in various settings upon entering the workforce, working alongside a physical therapist assistant (PTA) is highly likely. With the rise in demand for therapy services, realistic and comprehensive training in SPT-SPTA (student PTA) collaboration is needed to support quality health care. Model: A student-run pro bono clinic hosted within a Midwestern DPT Program uses a peer-to-peer model that provides the space for collaborative learning between SPTs and SPTAs. Serving as a clinical rotation site for 4 weeks, the pro bono clinic schedules an SPTA alongside a pair of SPTs. Discussion: SPTs gain early experience in decision-making related to delegating tasks to SPTAs with various skill levels, engaging in intraprofessional communication and reporting improvements in confidence levels. Qualitative reporting from the SPTAs and their host institution’s faculty indicate that the team approach to learning has become a preference among their students. Furthermore, students feel more comfortable learning and working with fellow young professionals, showing more significant interactions with clients and more opportunities for clinical growth. Clinical relevance: This model combines two previously described beneficial approaches to learning: a program attached pro bono clinic and a PT/PTA team learning environment. Integrating these concepts may catalyze intraprofessional education of SPTs and SPTAs.