Training Of Clinical Staff Research Articles

Blinatumomab infusion interruptions in pediatric patients rarely lead to readmission.

Blinatumomab is a bispecific T-cell engager administered as a 28-day continuous infusion. Infusions can be associated with interruptions requiring support from clinical staff, but the frequency of interventions with outpatient blinatumomab has not been characterized. This study is a single-center, retrospective review of patients who received blinatumomab between December 3, 2014 and October 31, 2021 to determine frequency and type of interventions. Forty patients received blinatumomab for 69 cycles. Clinical staff intervention was required in 31 (45%) cycles, only six (8.7%) cycles needed readmission. Management of outpatient blinatumomab infusions requires education and training of clinical staff and caregivers to quickly troubleshoot interruptions.

Abstract B027: Adapting communication resources for clinic staff in a multisite FQHC to improve HPV vaccination encounters with Spanish-speaking parents of adolescents

Abstract Introduction: Adopting evidenced-based strategies (EBS) targeting clinic staff in safety-net settings can improve adolescent HPV vaccination rates. Still, adaptations of EBS are needed to reach racial/ethnic minority patients and families effectively. As part of a larger implementation study on HPV vaccination, we examined and addressed adaptation needs for HPV vaccine communication resources to support clinic staff serving Hispanic adolescent FQHC patients. Methods: In October 2022-January 2023, we partnered with a large multi-site FQHC in Los Angeles, CA to deliver two clinic staff trainings designed to i) improve HPV knowledge and communication strategies; and ii) discuss HPV vaccine workflow. Informed by the Practice Change Model, we completed baseline qualitative interviews with clinic team members (providers, clinic staff, and leadership) and provider and clinic staff surveys to inform the development, implementation, and adaptation of clinic staff training on HPV vaccine knowledge and communication strategies. We then conducted site visits and key-informant interviews with clinic staff immediately post-training. Notes from site visits and key-informant interviews were transcribed to identify potential barriers to adoption and opportunities for adaptation. Results: Baseline data indicated 95% of clinic staff identified as Hispanic and 94% reported speaking a language other than English. Notes from site visits and key-informant interviews with clinic staff indicated clinic staff identified the need for Spanish language messaging to communicate HPV and cancer prevention messages to monolingual Spanish families. As a result, we adapted Spanish-language messages from the 2023 Health Resources and Services Administration toolkit and American Cancer Society to develop a handout with scripts that address top concerns about HPV vaccination with monolingual Spanish-speaking parents of adolescents to that were identified from baseline data collection. Bilingual-bicultural staff then validated messages and confirmed cultural relevance. Developed materials were then presented to clinic leadership to review and suggest further refinement before delivering them to clinic staff. Discussion: Key-informant interviews and post-training site visits played an important role in identifying opportunities to adapt EBS designed to improve HPV vaccination among culturally diverse patients. To better serve diverse communities disproportionately impacted by HPV-associated cancers, clinic staff need resources with HPV vaccine communication messages available in languages that reflect the needs of their patient population. Citation Format: Samantha Garcia, Adrienne Martinez-Hollingsworth, Sheila Salinas Navarro, Sharon Hudson, Zehui He, Emily Dang, Lawrence Palinkas, Lourdes Baezconde-Garbanati, Jennifer Tsui. Adapting communication resources for clinic staff in a multisite FQHC to improve HPV vaccination encounters with Spanish-speaking parents of adolescents [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B027.

Medical training program size and clinical staff productivity and turnover.

The objective of this analysis was to evaluate the effect of resident program training size on clinician productivity and turnover in the Veterans Health Administration (VHA), the largest education and training platform for medical professionals in the United States. We retrieved administrative data on training programs and training facilities from the VA Office of Academic Affiliations and the VHA Corporate Data Warehouse. Data on primary care physician shortage areas were retrieved from the Health Resources and Services Administration. We used a quasi-experimental instrumental variables 2SLS design and constructed an exogenous predicted training allocation treatment variable as a function of the total national training program allocation. The outcome was clinical staff productivity and turnover. Secondary analyses stratified results using Health Professional Shortage Areas data (HPSA). Data were obtained for a national dataset of 141 VHA medical facilities and 26 specialties that hosted training programs across 11 years from 2011 to 2021 (N = 132,177). Instrumental variables results showed that on average, an increase of one training slot in a specialty leads to a decrease of 0.039 visits per standardized clinic day (p < 0.001) and a 0.02 percentage point increase in turnover (p < 0.001). The direction of this association varied by specialty: while psychiatry and psychology specialties saw a decline in productivity, fields such as primary care and cardiology experienced an increase in productivity. HPSA stratified results indicate that negative effects on productivity and turnover are driven by areas with little to no primary care physician shortage, whereas shortage areas experienced a small increase in productivity and no effect on turnover. This quasi-experimental evaluation indicates that resident training program size is associated with reduced productivity and increased turnover in specialties such as psychiatry and in facilities with high baseline productivity. However, in specialties like primary care and cardiology, as well as areas with shortages of primary care, larger training programs are associated with increased productivity.

Diabetes Self-Management Support Through Diabetes-Related Distress Awareness

Type 2 diabetes mellitus is a prevalent issue in the United States. The Problem Areas in Diabetes (PAID) tool is an evidenced-based tool that helps clinicians screen for diabetes-related distress (DRD) and refer patients challenged with diabetes management. This project focused on training clinical staff in diabetes self-management education support (DSMES) to recognize and address DRD in primary care settings for patients with type 2 diabetes mellitus. This study presents a method for involving all clinicians in screening for DRD, especially in resource-limited primary care clinics.

Validation of a New Ankle Brachial Index Measurement System Using Pulse Wave Velocity.

Peripheral artery disease (PAD) is a common circulatory disorder characterized by the accumulation of fats, cholesterol, and other substances in the arteries that restrict blood flow to the extremities, especially the legs. The ankle brachial index (ABI) is a highly reliable and valid non-invasive test for diagnosing PAD. However, the traditional method has limitations. These include the time required, the need for Doppler equipment, the training of clinical staff, and patient discomfort. PWV refers to the speed at which an arterial pressure wave propagates along the arteries, and this speed is conditioned by arterial elasticity and stiffness. To address these limitations, we have developed a system that uses electrocardiogram (ECG) and photoplethysmography (PPG) signals to calculate pulse wave velocity (PWV). We propose determining the ABI based on this calculation. Validation was performed on 22 diabetic patients, and the results demonstrate the accuracy of the system, maintaining a margin of ±0.1 compared with the traditional method. This confirms the correlation between PWV and ABI and positions this technique as a promising alternative to overcome some of the limitations of the conventional method.

A stepped wedge cluster randomized trial of graphical surveillance of kidney function data to reduce late presentation for kidney replacement therapy

Late presentation for kidney replacement therapy (KRT) is an important cause of avoidable morbidity and mortality. Here, we evaluated the effect of a complex intervention of graphical estimated glomerular filtration rate (eGFR) surveillance across 15% of the United Kingdom population on the rate of late presentation using data routinely collected by the United Kingdom Renal Registry. A stepped wedge cluster randomized trial was established across 19 sites with eGFR graphs generated from all routine blood tests (community and hospital) across the population served by each site. Graphs were reviewed by trained laboratory or clinical staff and high-risk graphs reported to family doctors. Due to delays outside the control of clinicians and researchers few laboratories activated the intervention in their randomly assigned time period, so the trial was converted to a quasi-experimental design. We studied 6,100 kidney failure events at 20 laboratories served by 17 main kidney units. A total of 63,981 graphs were sent out. After adjustment for calendar time there was no significant reduction in the rate of presentation during the intervention period. Therefore, implementation of eGFR graph surveillance did not reduce the rate of late presentation for KRT after adjustment for secular trends. Thus, graphical surveillance is an intervention aimed at reducing late presentation, but more evidence is required before adoption of this strategy can be recommended.

Institution-Wide Retreats Foster Organizational Learning and Action at a Comprehensive Cancer Center

Providing safe and informed healthcare for sexual and gender minority (SGM) individuals with cancer is stymied by the lack of sexual orientation and gender identity (SOGI) data reliably available in health records and by insufficient training for staff. Approaches that support institutional learning, especially around sensitive topics, are essential for hospitals seeking to improve practices impacting patient safety and research. We engineered annual institutional retreats to identify and unify stakeholders, promote awareness of gaps and needs, identify initiatives, minimize redundant projects, and coordinate efforts that promote improvements in SGM cancer care, education, and research. The 2022 and 2023 retreats employed a 4-h hybrid format allowing virtual and in-person engagement. Retreat organizers facilitated small-group discussions for brainstorming among participants. We performed descriptive statistics from retreat evaluations. The retreats engaged 104 attendees from distinct departments and roles. Participants expressed robust satisfaction, commending the retreat organization and content quality. Notably, the first retreat yielded leadership endorsement and funding for a Quality Improvement pilot to standardize SOGI data collection and clinical staff training. The second retreat provided a platform for updates on focused efforts across the institution and for receiving direction regarding national best practices for SGM care and research. We report the processes and outcomes of institution-wide retreats, which served as a platform for identifying gaps in organizational healthcare practices and research for SGM individuals with cancer. The strategies described herein may be readily scaled at other cancer hospitals seeking to learn and enact system-wide practice changes that support the needs of SGM patients and families.

Development, implementation, and evaluation of entrustable professional activities (EPAs) for medical radiation technologists in Taiwan: a nationwide experience

BackgroundCompetency-based medical education (CBME) is an outcomes-oriented approach focused on developing competencies that translate into clinical practice. Entrustable professional activities (EPAs) bridge competency assessment and clinical performance by delineating essential day-to-day activities that can be entrusted to trainees. EPAs have been widely adopted internationally, but not yet implemented for medical radiation professionals in Taiwan.Materials and methodsA nationwide consensus process engaged 97 experts in radiation technology education representing diagnostic radiography, radiation therapy, and nuclear medicine. Preliminary EPAs were developed through the focus group discussion and the modified Delphi method. The validity of these EPAs was evaluated using the QUEPA and EQual tools.ResultsThrough iterative consensus building, six core EPAs with 18 component observable practice activities (OPAs) in total were developed, encompassing routines specific to each radiation technology specialty. QUEPA and EQual questionnaire data verified these EPAs were valid, and of high quality for clinical teaching and evaluation.ConclusionThe consensus development of tailored EPAs enables rigorous competency assessment during medical radiation technology education in Taiwan. Further expansion of EPAs and training of clinical staff could potentially enhance care quality by producing competent professionals.

Do people with disabilities experience disparities in cancer care? A systematic review

Background Over 1.3 billion people, or 16% of the world’s population, live with some form of disability. Recent studies have reported that people with disabilities (PwD) might not be receiving state-of-the-art treatment for cancer as their non-disabled peers; our objective was to systematically review this topic. Methods A systematic review was undertaken to compare cancer outcomes and quality of cancer care between adults with and without disabilities (NIHR Prospero register ID number: CRD42022281506). A search of the literature was performed in July 2022 across five databases: EMBASE, Medline, Cochrane Library, Web of Science and CINAHL databases. Peer-reviewed quantitative research articles, published in English from 2000 to 2022, with interventional or observational study designs, comparing cancer outcomes between a sample of adult patients with disabilities and a sample without disabilities were included. Studies focused on cancer screening and not treatment were excluded, as well as editorials, commentaries, opinion papers, reviews, case reports, case series under 10 patients and conference abstracts. Studies were evaluated by one reviewer for risk of bias based on a set of criteria according to the SIGN 50 guidelines. A narrative synthesis was conducted according to the Cochrane SWiM guidelines, with tables summarizing study characteristics and outcomes. This research received no external funding. Results Thirty-one studies were included in the systematic review. Compared to people without disabilities, PwD had worse cancer outcomes, in terms of poorer survival and higher overall and cancer-specific mortality. There was also evidence that PwD received poorer quality cancer care, including lower access to state-of-the-art care or curative-intent therapies, treatment delays, undertreatment or excessively invasive treatment, worse access to in-hospital services, less specialist healthcare utilization, less access to pain medications and inadequate end-of-life quality of care. Discussion Limitations of this work include the exclusion of qualitative research, no assessment of publication bias, selection performed by only one reviewer, results from high-income countries only, no meta-analysis and a high risk of bias in 15% of included studies. In spite of these limitations, our results show that PwD often experience severe disparities in cancer care with less guideline-consistent care and higher mortality than people without disabilities. These findings raise urgent questions about how to ensure equitable care for PwD; in order to prevent avoidable morbidity and mortality, cancer care programs need to be evaluated and urgently improved, with specific training of clinical staff, more disability inclusive research, better communication and shared decision-making with patients and elimination of physical, social and cultural barriers.

TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study.

Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context. We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact. The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training. TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site). TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways.

Perinatal health effects of herbicides exposures in the United States: the Heartland Study, a Midwestern birth cohort study

BackgroundThe objective of the Heartland Study is to address major knowledge gaps concerning the health effects of herbicides on maternal and infant health. To achieve this goal, a two-phased, prospective longitudinal cohort study is being conducted. Phase 1 is designed to evaluate associations between biomarkers of herbicide concentration and pregnancy/childbirth outcomes. Phase 2 is designed to evaluate potential associations between herbicide biomarkers and early childhood neurological development.MethodsPeople (target enrollment of 2,000) who are seeking prenatal care, are ages 18 or older, and are ≤ 20 + 6 weeks gestation will be eligible for recruitment. The Heartland Study will utilize a combination of questionnaire data and biospecimen collections to meet the study objectives. One prenatal urine and buccal sample will be collected per trimester to assess the impact of herbicide concentration levels on pregnancy outcomes. Infant buccal specimens will be collected post-delivery. All questionnaires will be collected by trained study staff and clinic staff will remain blinded to all individual level research data. All data will be stored in a secure REDCap database.Hospitals in the agriculturally intensive states in the Midwestern region will be recruited as study sites. Currently participating clinical sites include Indiana University School of Medicine- affiliated Hospitals in Indianapolis, Indiana; Franciscan Health Center in Indianapolis, Indiana; Gundersen Lutheran Medical Center in La Crosse, Wisconsin, and University of Iowa in Iowa City, Iowa. An anticipated 30% of the total enrollment will be recruited from rural areas to evaluate herbicide concentrations among those pregnant people residing in the rural Midwest.Perinatal outcomes (e.g. birth outcomes, preterm birth, preeclampsia, etc.) will be extracted by trained study teams and analyzed for their relationship to herbicide concentration levels using appropriate multivariable models.DiscussionThough decades of study have shown that environmental chemicals may have important impacts on the health of parents and infants, there is a paucity of prospective longitudinal data on reproductive impacts of herbicides. The recent, rapid increases in herbicide use across agricultural regions of the United States necessitate further research into the human health effects of these chemicals, particularly in pregnant people. The Heartland Study provides an invaluable opportunity to evaluate health impacts of herbicides during pregnancy and beyond.Trial registrationThe study is registered at clinicaltrials.gov, NCT05492708 with initial registration and release 05 August, 2022.

Exploring the Nurses' Perspective on Using Remote Electronic Symptom Monitoring in Clinical Decision-Making Among Patients With Metastatic Lung Cancer

ObjectivesPatient-reported outcome (PRO) measures are commonly used in clinical practice, and an important aspect is how healthcare professionals use these measures to make clinical decisions. This study aimed 1) to understand how remote electronic symptom monitoring using PRO measures can support oncology nurses' clinical decision-making in patients with metastatic lung cancer and 2) to explore factors that potentially can influence how remote symptom monitoring supports clinical decision-making. Data SourcesA qualitative approach using semistructured interviews was conducted with 18 registered nurses working with remote symptom monitoring at oncology departments at eight Danish hospitals. ConclusionNurses reported that remote symptom monitoring supports clinical decision-making because it assisted in identifying relevant problems, monitoring relevant changes over time, and prompting relevant clinical actions. Factors that affected how remote symptom monitoring could support clinical decision-making were access to supplemental information, the trustworthiness of PRO data, nursing competencies and responsibilities, working conditions, and care at a distance. Implication for Nursing PracticeThe use of PRO data in the clinical decision-making process is highly dependent on the nurses' professional competencies, the organizational structure, and the trustworthiness of PRO data. Thus, we recommend considering these factors before implementing PRO data in routine care. For example, train clinical staff in using PRO data in their clinical decision-making, develop guidance for how to use PRO data with other forms of data to make sound clinical actions, and ensure that organizational resources are sufficient.

Training Clinical Staff in Genuine CBT: One Large Agency’s Preliminary Story

While the science documenting CBT’s efficacy and effectiveness is strong, workplace applications of the treatment model are often implemented improperly. Therefore, training clinicians in the correct delivery of CBT is essential. This article describes one large agency’s initial effort to develop and evaluate a system-wide initiative to supervise clinicians in CBT. Thirty-five clinicians received supervision over 10 sessions and were evaluated on the Cognitive Therapy Rating Scale for Children and Adolescents (CTRS-CA). Client progress was concurrently monitored by the Pediatric Symptom Checklist-17 (PSC-17). The results showed that the initiative was feasible and acceptable. There was an improvement in competency scores (t = 4.71, p < 0.001, d = 8.98). Sixty-nine percent of clinicians reached the competency threshold by the end of the training period. Clients also demonstrated significant improvement on the PSC-17 (t = 4.31, p < 0.001, d = 4.67). Consequently, this project illustrated the importance of a structured system-wide approach to supervision and training staff to competently deliver CBT.

Preventing Risks of Infections and Medication Errors in IV therapy (PRIME): a patient safety initiative.

Two major avoidable reasons for adverse events in hospital are medication errors and intravenous therapy-induced infections or complications. Training for clinical staff and compliance to patient safety principles could address these. Joint Commission International (JCI) consultants created a standardised, 6-month training programme for clinical staff in hospitals. Twenty-one tertiary care hospitals from across south-east Asia took part. JCI trained the clinical consultants, who trained hospital safety champions, who trained nursing staff. Compliance and knowledge were assessed, and monthly audits were conducted. There was an overall increase of 29% in compliance with parameters around medication preparation and vascular access device management. The programme improved safe practice around preparing medications management and managing vascular access devices. The approach could be employed as a continuous quality improvement initiative for the prevention of medication errors and infusion-associated complications.

Group Decision Making in Competency-Based Medical Education - Clinical Competency Committee

&lt;p&gt;臨床能力委員會(Clinical Competency Committee, CCC)在勝任能力導向醫學教育的總結性評量中扮演重要的角色。委員會根據以評量藍圖執行的職場觀察評量結果，進行系統性的討論，對學員的能力進展做出公正可靠的判斷，回饋給相關利害關係人，並協助學員擬定個人化之補強訓練計畫。進行會議前應有共識會議、師資培育課程、及學員能力進展資料閱讀，事前的學員自我評量能夠促進學員與教師對學員能力進展的認知，並促進學員對於教師回饋的接納理解程度；會議中須建立結構化的決策過程，最終獲得客觀且可信的決策成果；會議後應向學員提供回饋，並協助制訂補強學習計畫或提供訓練協助規劃。藉由完善的CCC程序，可提升臨床醫事人員的訓練品質、教師教學水準、醫療服務品質及專業認同。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Clinical Competency Committee (CCC) plays a key role in the summative assessment of competency-based medical education (CBME). Specifically, CCC conducts systematic discussions according to the results of workplace observation and assessment derived from assessment blueprints to provide an accountable and reliable judgment on the progression of trainees&amp;rsquo; competencies. CCC then informs assessment results to stakeholders and assists trainees in developing personalized remedial learning plans. CCC members should conduct a consensus meeting, complete faculty training courses, and review trainees&amp;rsquo; competency development data before calling a CCC meeting . Student self-assessment should also be completed before the CCC meeting to improve trainees&amp;rsquo; and CCC members&amp;rsquo; understanding of the progress of their competency development and to ensure that trainees agree with and accept teachers&amp;rsquo; feedback. During the CCC meeting, a structured decision-making procedure must be constructed for objective and credible decision-making. After the meeting, feedback should be provided to students to assist them in developing remedial learning plans or training assistance plans. A comprehensive group decision-making procedure should be carried out in CCC to improve the quality of clinical staff training, teaching, and medical services as well as the professional identity of clinical staff.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Localizing Delirium through Automated Lesion Segmentation and Neural Network Mapping (N1.001)

<h3>Objective:</h3> To determine whether delirium in acute ischemic stroke is localizable to specific neural networks. <h3>Background:</h3> Delirium is estimated to occur in one-fourth of patients with acute stroke. Despite its associated morbidity and mortality, prediction and pathophysiological understanding of delirium remains challenging. A recent meta-analysis of patients with delirium and stroke found increased risks of delirium in supratentorial, cortical, and anterior circulation strokes, raising the possibility of an underlying neural network for delirium. <h3>Design/Methods:</h3> We performed a retrospective cohort study of patients admitted to a comprehensive stroke center with acute ischemic stroke from January 2016 to April 2019. Patients were assessed for delirium by trained clinical nursing staff using the Confusion Assessment Method (CAM) framework. Acute stroke lesions from MRI diffusion weighted images (DWI) lesions were automatically segmented using a machine learning algorithm. Lesions were registered to a 2mm Montreal Neurological Institute template (MNI-152). We then used lesion network mapping to identify potential unifying brain networks for delirium in patients with acute stroke. <h3>Results:</h3> 907 scans from unique patients were analyzed. 274 patients had delirium (30.2%), 47.5% were women (431), and the mean age was 69.6 years old. In comparison to a general stroke cohort, patients with delirium had lesions connected to the right and left inferior frontal gyri and left middle temporal gyrus and left temporo-parietal junction (one-sample t-test, family-wise error p&lt;0.05). Sensitivity analysis showed that delirium was not associated with parietal, occipital, brainstem, and cerebellar lesions. <h3>Conclusions:</h3> Delirium in stroke localizes to a network connected to frontotemporal regions. These results have implications for prediction of delirium in patients with acute stroke, with the potential for targeting multimodal prevention. Future work will refine their specificity, however, the results suggest that frontotemporal networks may be particularly important for cardinal symptoms of delirium, a disorder of impaired attention and awareness <b>Disclosure:</b> Dr. Rhee has stock in NTAP. Dr. Rhee has stock in TSLA. Dr. Rhee has stock in BABA. Dr. Rhee has stock in ZM. Dr. Rhee has stock in GM. Dr. Rhee has stock in PFF. Dr. Rhee has stock in AMZN. Dr. Rhee has stock in META. Dr. Rhee has stock in GE. Dr. Rhee has received publishing royalties from a publication relating to health care. Dr. Rhee has received personal compensation in the range of $0-$499 for serving as a Director of the Hippocratic Forum with Abigail Adams Institute. Dr. Ferguson has nothing to disclose. Dr. Bonkhoff has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NeuroImage Clinical (Elsevier). Mr. Patel has nothing to disclose. Dr. Bretzner has nothing to disclose. Dr. Hong has nothing to disclose. Dr. Ryan has nothing to disclose. Dr. Westover has stock in Beacon Biosignals. The institution of Dr. Westover has received research support from NIH. Dr. Westover has received publishing royalties from a publication relating to health care. Dr. Westover has a non-compensated relationship as a cofounder with Beacon Biosignals that is relevant to AAN interests or activities. Dr. Fox has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wiley. Dr. Rost has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care. The institution of Dr. Kimchi has received research support from NIH. The institution of an immediate family member of Dr. Kimchi has received research support from NIH.

Psychosocial Care of Early Bereaved Parents - A Quantitative Cross-Sectional Study at German Maternity Wards

The death of an infant shortly after birth places a massive psychological burden on the parents involved. The availability of compassionate obstetric care is an important contributor to the prevention of sequelae. The aim of this study is to survey the current practice of psychosocial care for parents in perinatal infant death in German hospitals and to investigate the association between hospital size and number of information services for parents and between support services for hospital staff and number of information services for bereaved parents. In a quantitative cross-sectional study in the form of a full survey, professionals in 206 German hospitals with maternity wards were interviewed using questionnaires. The data were analyzed using a regression analysis. 206 hospitals participated in the survey. The analyses confirm: Hospital size has a highly significant positive influence on the number of services for bereaved parents. The number of services provided to hospital staff has a highly significant positive influence on the number of informational services provided to bereaved parents. Recommendations for action from this study are: Special training of clinic staff on the topic of perinatal infant death, strengthening of the doctor-patient relationship through Balint or supervision groups, and promotion of internal and external interdisciplinary collaboration.

Feasibility study to evaluate capabilities for conducting psychiatric clinical research within the Rwandan mental healthcare system

ObjectiveTo evaluate the feasibility of conducting a large clinical trial within the Rwandan mental healthcare system that would establish the safety, efficacy and benefit of paliperidone palmitate once-monthly (PP1M) and...

Abstract P609: Polyphenol Metabolite Production Displays Individual Variability and Associations With Usual Diet: A Dietary Challenge Study

Background: Fruits and vegetables, rich in polyphenolic compounds, contribute to cardiovascular disease (CVD) prevention. Polyphenolic metabolism is complex and relies on the gut microbiota, which in turn is shaped by usual diet. Individual variability in metabolite production has implications for precision nutrition approaches to CVD prevention. Methods: Forty healthy adults were recruited from the Kannapolis, NC, area for a 3-day dietary challenge study [2019; ages: mean (SD)=39.1 (12.3); sex (n=23 female, 17 male); race/ethnicity (n=28 non-Hispanic White, 1 Hispanic White, 5 Black, 4 Asian, 2 mixed race); BMI: mean (SD)=25.4 (3.1)]. On Day 1, participants were provided 2 days of meals, designed to be low in precursors of target metabolites and prepared in a metabolic kitchen; completed the Diet History Questionnaire II (DHQ-II); and had clinical measures taken by trained clinic staff. On Day 2, participants received a combination dietary challenge, including cocoa capsules (750 mg cocoa flavanols) and pomegranate juice (500 mL). Participants collected their urine (not pooled) for 24 hours, from challenge to the morning of Day 3. Targeted LC-MS analysis was conducted on samples within the collection period. Multivariable-adjusted linear regression was used to test associations between urine metabolite concentration and past-year consumption of foods, with multiple comparisons adjusted by the false discovery rate. Results (Table): Valerolactones displayed large variability in post-challenge production. Metabolite production was significantly associated with usual intake of several food groups. Conclusion: Our findings document appreciable variability in the production of valerolactones, after ingesting constant amounts of precursor-containing products, potentially contributing to differential dietary effects on CVD. Metabolite production was significantly associated with usual intake of several major food groups.

1881. Detection of SARS-CoV-2 Transmission on a College Campus using a Combined Contact Tracing and Molecular Strategy

Abstract Background SARS-CoV-2 has caused unprecedented global disruption following its introduction into the human population. Beginning in August 2021, a residential college initiated an asymptomatic testing protocol using PCR-based detection of human saliva samples (Thermofisher, TaqPath SARS-CoV-2 Assay; QuantStudio v1.3). In January 2021 all students were invited to campus and were required to test once or twice weekly in an effort to isolate those positive (cases) as early as possible and minimize transmission. Methods Cases were contacted within 12 hours by trained clinical staff and interviewed with a standardized questionnaire to determine contacts and exposures. Positive samples were submitted for RNA-Seq analysis (ARTIC amplicon sequencing protocol, Illumina MiSeq) and analyzed using Nextclade and USHER (comparison data from GISAID). Using this sequence data, we monitored the evolution, transmission, and emergence of variants over time in the campus community. Results In March 2022 a one-week break and the activities preceding it were followed by an outbreak of COVID among campus members. All cases were attributed to the Omicron variant. Based on traditional contact tracing 10 presumed clusters of transmission were identified (34 students). Sequence data from these 34 samples were assembled to identify phylogenetic and molecular patterns of similarity. Several molecular signatures were identified. In a group of 5 cases, all were Omicron BA.2.9; these individuals comprised a clinical cluster of students who had travelled together. Other lineages were BA.2 (N=26), BA.1(N=2), BA.2.12. (N=3), BA.2.3 (N=1) and an Omicron Clade 21M variant that appeared to be a BA.1/BA.2 recombinant (N=2). The BA.2.12 samples were contributed over 2 days; they were found in two different clusters (a social club and an artistic group), demonstrating likely transmission between members. The BA.2 samples were distributed across a wide number of student groups, and while not identical with one another, did not fall into the clusters identified by contact tracing, suggesting endemic transmission across our campus. Conclusion This analysis demonstrates that molecular analysis of SARS-CoV-2 transmission can supplement and inform the data provided by clinical/epidemiological analysis of cases. Disclosures All Authors: No reported disclosures.