Complete Screening Research Articles

Less is more: repellent-treated fabric strips as a substitute for full screening of open eave gaps for indoor and outdoor protection from malaria mosquito bites

BackgroundProviding protection from malaria vector bites, both indoors and outdoors, is crucial to curbing malaria parasite transmission. Screening of house entry points, especially with incorporated insecticides, confers significant protection but remains a costly and labour-intensive application. Use of spatial repellents has shown promise in creating areas of protection in peri-domestic areas.MethodsThis study aimed at comparing the protection provided by transfluthrin-treated and untreated complete screens over open eave gaps with incomplete transfluthrin-treated eave strips as a potential replacement for a full screen. Human landing catches were implemented independently inside and outside an experimental hut under controlled semi-field conditions, with insectary-reared Anopheles arabiensis mosquitoes.ResultsThe odds of a female mosquito finding a human volunteer indoors and attempting to bite were similar whether the eaves were completely open or there was an untreated fabric strip fixed around the eaves. However, when the eave gap was completely screened without insecticide, the odds of receiving a bite indoors were reduced by 70% (OR 0.30, 95% CI 0.20–0.47). Adding transfluthrin to the full screen, further increased the protection indoors, with the odds of receiving a bite reduced by 92% (0.08, 95% CI 0.04–0.16) compared to the untreated screen. Importantly, the same protection was conferred when only a narrow transfluthrin-treated fabric strip was loosely fixed around the eave gap (OR 0.07, 95% CI 0.04–0.13). The impact of the transfluthrin treatment on outdoor biting was correlated with evening temperatures during the experiments. At lower evening temperatures, a transfluthrin-treated, complete screen provided moderate and variable protection from bites (OR 0.62, 95% CI 0.37–1.03), whilst at higher evening temperatures the odds of receiving a bite outdoors was over four times lower in the presence of transfluthrin, on either a full screen (OR 0.22 95% 0.12–0.38) or a fabric strip (OR 0.25, 95% 0.15–0.42), than when no treatment was present.ConclusionThe findings suggest that transfluthrin-treated fabric strips can provide a substitute for complete eave screens. They are a simple, easy-to-handle tool for protecting people from malaria mosquito bites indoors and potentially around the house in climatic areas where evening and night-time temperatures are relatively high.

Barriers to mental health services among college students screened in student health: A latent class analysis

Background: Almost a third of college students experience significant mental health concerns, but many do not receive adequate services. This study investigated barriers to mental health services among college students screened in a student health center primary care service. Method: Students (N = 1662) presenting for primary care completed mental health screenings and a barrier measure in the student health center of a university. Latent class analysis created barrier profiles. Results: Three barrier profiles were identified (none, logistical, all barriers). Profiles related to gender (p < .001), with logistical/all barrier profiles more likely amongst female students. No significant difference found by race. Students with higher depression scores were more likely to report logistical barriers than no barriers (p < .001). Conclusion: Programs must address multiple barriers to successfully engage students in treatment. Tailored interventions, including in primary care, should assess and respond to individual barriers, not just common ones.

Identifying Family and Unpaid Caregivers in Electronic Health Records: Descriptive Analysis.

BackgroundMost efforts to identify caregivers for research use passive approaches such as self-nomination. We describe an approach in which electronic health records (EHRs) can help identify, recruit, and increase diverse representations of family and other unpaid caregivers.ObjectiveFew health systems have implemented systematic processes for identifying caregivers. This study aimed to develop and evaluate an EHR-driven process for identifying veterans likely to have unpaid caregivers in a caregiver survey study. We additionally examined whether there were EHR-derived veteran characteristics associated with veterans having unpaid caregivers.MethodsWe selected EHR home- and community-based referrals suggestive of veterans’ need for supportive care from friends or family. We identified veterans with these referrals across the 8 US Department of Veteran Affairs medical centers enrolled in our study. Phone calls to a subset of these veterans confirmed whether they had a caregiver, specifically an unpaid caregiver. We calculated the screening contact rate for unpaid caregivers of veterans using attempted phone screening and for those who completed phone screening. The veteran characteristics from the EHR were compared across referral and screening groups using descriptive statistics, and logistic regression was used to compare the likelihood of having an unpaid caregiver among veterans who completed phone screening.ResultsDuring the study period, our EHR-driven process identified 12,212 veterans with home- and community-based referrals; 2134 (17.47%) veteran households were called for phone screening. Among the 2134 veterans called, 1367 (64.06%) answered the call, and 813 (38.1%) veterans had a caregiver based on self-report of the veteran, their caregiver, or another person in the household. The unpaid caregiver identification rate was 38.1% and 59.5% among those with an attempted phone screening and completed phone screening, respectively. Veterans had increased odds of having an unpaid caregiver if they were married (adjusted odds ratio [OR] 2.69, 95% CI 1.68-4.34), had respite care (adjusted OR 2.17, 95% CI 1.41-3.41), or had adult day health care (adjusted OR 3.69, 95% CI 1.60-10.00). Veterans with a dementia diagnosis (adjusted OR 1.37, 95% CI 1.00-1.89) or veteran-directed care referral (adjusted OR 1.95, 95% CI 0.97-4.20) were also suggestive of an association with having an unpaid caregiver.ConclusionsThe EHR-driven process to identify veterans likely to have unpaid caregivers is systematic and resource intensive. Approximately 60% (813/1367) of veterans who were successfully screened had unpaid caregivers. In the absence of discrete fields in the EHR, our EHR-driven process can be used to identify unpaid caregivers; however, incorporating caregiver identification fields into the EHR would support a more efficient and systematic identification of caregivers.Trial RegistrationClincalTrials.gov NCT03474380; https://clinicaltrials.gov/ct2/show/NCT03474380

The Low Incidence of Viral Hepatitis Reactivation Among Subjects on Immunotherapy Reduces the Impact of Suboptimal Screening Rate

Background and AimsImmunotherapy with immune checkpoint inhibitors (ICIs) is a pillar of many advanced tumors. However, there is scarce data concerning the rate of viral hepatitis screening in this population or the risk of viral reactivation.MethodsRetrospective–prospective study that includes all patients who began ICIs between January/2019 and December/2020 in a University Hospital. Data on viral hepatitis screening prior to the beginning of ICIs were collected. In subjects lacking information, serological tests were requested prospectively. Among HBsAg, anti-HBc, or anti-HCV positive subjects, reactivation was prospectively assessed.ResultsDuring the 2-year period of study, 595 subjects received ICIs (61.2% male, mean age 63 years). The most prevalent cancers found were 35.5% lung cancer, 12.1% melanoma, and 8.2% head and neck; ICIs schemes were mainly anti-PD1 (65.7%), followed by anti-PD-L1 (19.2%), and combined therapy (13.6%). Prior to immunotherapy, anti-HCV screening was performed in 462 (77.6%) subjects, HBsAg in 462 (77.6%), anti-HBc in 335 (56.3%), and the complete screening in 328 (55.1%). The anti-HBc screening was more frequently ordered among patients treated with concomitant systemic therapy (p = 0.003), especially in the case of chemotherapy (p = 0.015), though HCV screening was more commonly performed in concomitant therapies different from chemotherapy (p = 0.001). Serological tests were completed prospectively in those alive, leading to an overall prevalence for anti-HCV of 3.5%, HBsAg at 1.3%, and anti-HBc of 15.2%. HCV-RNA was detected in 2/19 (both patients with hepatocellular carcinoma), HBV-DNA in 4/7 HBsAg positive, and in 1/75 anti-HBc positive subject. Five out of the 7 HBsAg carriers and 1/75 anti-HBc+ subjects (due to concomitant antiretroviral therapy) received antiviral prophylaxis. Neither cases of HBV reactivation nor changes in HCV viral load were observed.DiscussionHBV and HCV screening prior to immunotherapy is suboptimal. Though the rate of viral hepatitis reactivation seems extremely low, efforts should be made to optimize viral hepatitis screening prior to immunotherapy for the selection of candidates for either antiviral prophylaxis or periodical follow-up.

Adapting Community Educational Programs During the COVID-19 Pandemic: Comparing the Feasibility and Efficacy of a Lung Cancer Screening Educational Intervention by Mode of Delivery.

Few eligible patients receive lung cancer screening. We developed the Lung AIR (awareness, information, and resources) intervention to increase community education regarding lung cancer screening. The intervention was designed as an in-person group intervention; however, the COVID-19 pandemic necessitated adapting the mode of delivery. In this study we examined intervention feasibility and efficacy overall and by mode of delivery (in-person group vs. one-on-one phone) to understand the impact of adapting community outreach and engagement strategies. Feasibility was examined through participant demographics. Efficacy was measured through pre/post knowledge, attitudes, and beliefs about lung cancer screening, and intention to complete screening. We reached N = 292 participants. Forty percent had a household income below $35,000, 58% had a high school degree or less, 40% were Hispanic, 57% were Black, and 84% reported current or past smoking. One-on-one phone sessions reached participants who were older, had lower incomes, more current smoking, smoked for more years, more cigarettes per day, lower pre-intervention lung cancer screening knowledge, and higher pre-intervention fear and worry. Overall pre/post test scores show significant increases in knowledge, salience, and coherence, and reduced fear and worry. Participants in the one-on-one phone sessions had significantly higher increases in salience and coherence and intention to complete screening compared to participants in the in-person group sessions. The Lung AIR intervention is a feasible and effective community-based educational intervention for lung cancer screening. Findings point to differences in reach and efficacy of the community-based intervention by mode of delivery.

Two-dimensional conductive π-conjugated metal-organic frameworks as promising electrocatalysts for highly efficient hydrogen evolution reaction

Two-dimensional conductive π-conjugated metal-organic frameworks (2D c-MOFs), as a new promising electrocatalytic materials, have spurred great research interests, but the systematic research on the structure-property relationship of c-MOF-based electrocatalysts is scarcely reported. Herein we conduct a first-principles study on the screening of a family of 2D c-MOFs (TM3(HITN)2) as HER electrocatalysts, which are constructed by TM atoms and 2,3,8,9,14,15-hexaiminotrinaphthylene (HITN) functional groups. The data suggests that all these 2D TM3(HITN)2 possess metallic with good conductivity for electrochemical reactions due to their intrinsic π-electron conjugation and sufficient interaction between the TM atoms and the organic linkers. Through the complete computational screening, the Zr3(HITN)2 stands out because of its near-zero ΔG*H value and low activation energy barrier. Moreover, the distinguished HER performance of Zr3(HITN)2 can be attributed to the extremely enhanced electron density derived from the C-2p orbitals near the Fermi level accompanied by the size increase of the tri-dentated aromatic linkers. Hence, this study not only highlights a family of promising 2D c-MOF electrocatalysts toward HER, but also supplies a valuable insight on the design of novel and high-performance c-MOF-based materials for better electrocatalysis.

Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review

ObjectivesTo synthesise evidence on incidence rates and risk factors for myocarditis and pericarditis after use of mRNA vaccination against covid-19, clinical presentation, short term and longer term outcomes of cases,...

A Cross-Sectional Study of Blood Glucose Levels in Neonatal Sepsis and its Outcome in a Tertiary Care Hospital, Davangere

Sepsis is an important cause of morbidity and mortality among neonates. Neonatal sepsis can alter the glucose level, and both hypoglycaemia and hyperglycaemia may occur. Hence the present study aimed to study the clinical profile of patients with neonatal sepsis and to correlate the blood sugar levels with different outcomes in neonatal sepsis patients. A cross-sectional study was conducted at Bapuji Child Health Institute and Research Institute attached to J.J.M. Medical College, Davangere. A total of 90 neonates under the age of 28 days old admitted to NICU with probable and culture-proven neonatal sepsis were included in the study. Glucose levels, complete blood count, CRP levels, septic screening, lumbar puncture, neurosonogram, urine culture, blood culture and sensitivity were analysed. Results revealed that GRBS scores were &lt; 40 for 24 subjects, 41 to 100 for 39 subjects, 101 to 200 for 22 subjects and &gt; 200 for 5 subjects. There were 57(63.3%) males and 33(36.7%) females in the clinically diagnosed cases of septicemia. Clinical presentation in sepsis showed that 82(91.1%) subjects were not feeding well, 19(21.1%) had convulsions, 51(56.7%) had fast breathing, 39(43.3%) had Severe chest indrawing, 25(27.8%) had a temperature, 43(47.8%) had a fever and 88(97.8%) had Decreased activity of admission. In Conclusion, alteration of glycaemic status occurred in septic newborns, and mortality was higher among septic newborns with altered glycaemic status. Keywords: Neonatal sepsis, GRBS, Hypoglycaemia, Hyperglycaemia, Mortality

Adolescent suicide assessment and management in primary care

BackgroundTo understand how suicide management occurs within the primary care setting in terms of follow-up assessments and referral practices.MethodsAt an initial primary care visit, adolescents (aged 12–20 years old) completed electronic screening. Data were focused on youth who endorsed a suicidal risk item while completing screening at two Midwestern primary care clinics. Data were collected through retrospective chart reviews to analyze actions taken by the primary care physician at the youth’s initial visit and follow-up visit within the next 12 months.ResultsAt initial visits 200 adolescents endorsed a suicidal risk item and 39 (19.5%) were considered to be concerning by their primary care physician. The average age was 14.7 years old (SD ± 2.0). Seventy-two percent (n = 144) were female, and 65% (n = 129) identified as Black. At initial visits, significant differences between suicidal concern groups were found in reporting active suicidal ideation, past suicide attempts, those who were referred to behavioral health counseling, and those who had a diagnosis of depression. Interestingly, only 13% (n = 25) of all patients who endorsed the suicide item were asked whether or not there were weapons in their home and primary care providers asked only 7% (n = 13) of all patients whether they had a safety plan.ConclusionsThere was inconsistent follow-up for adolescents with a history of suicide concerns. At this time, national guidelines do not exist regarding primary care follow-up of youth with suicide concerns. Guidelines are a necessary precursor for practice improvement.Trial RegistrationClinical Trials Registry: NCT02244138. Registration date, September 1, 2014.

Preliminary Findings from a Telephone-Based Cognitive Screening of an Adult HIV Research Cohort during the COVID-19 Pandemic.

ObjectivesFew publications have documented the utility of in-home telephone-based cognitive screeners during COVID-19. This manuscript describes the adaptation of select face-to-face (FTF) neuropsychological tests to telephonic administration in a longitudinal cohort of people with HIV (PWH). Using the cohort’s pre-pandemic neuropsychological data, we explore the utility of telephonic administration in this population.MethodsOf a longitudinal cohort of 170 adult PWH, 59 completed telephonic medical and cognitive screenings with comparable pre-pandemic FTF data. Telephone screeners and FTF evaluations were compared using repeated measures ANCOVAs to examine whether test performance differed between administration types and levels of pre-pandemic cognitive performance. Individuals with pre-pandemic test scores more than a standard deviation below the demographically-corrected mean were categorized as “below average” cognitive performance (n = 23), and the remainder as “average” (n = 36).ResultsOver 90% of participants gave positive feedback about the telephone encounter. The average cognitive performance group scored higher than the below average group on all measures across both administration types. Telephone and FTF test scores did not differ significantly for measures of category fluency, letter fluency, and verbal learning. However, the below average group scored higher on a verbal memory measure administered via telephone compared with FTF.ConclusionsSupport for telephonic adaptation of select FTF measures in longitudinal research is mixed, with verbal fluency tasks showing the strongest equivalency. When employed carefully with a clear understanding of their limitations, telephone adaptations can provide an opportunity to continue study objectives, promote equity, and monitor participant well-being during times of duress.

Resurgence of blackwater fever among children in sub-Saharan Africa: a scoping review protocol

IntroductionBlackwater fever (BWF), a complication of malaria, has in the past been considered as a rare complication of malaria in children living in high transmission settings. More recently, however, a...

STI prevalence, incidence, and partner notification among women in a periconception HIV prevention program in Uganda.

We provided sexually transmitted infection (STI) screening and facilitated partner notification and treatment among women participating in a periconception HIV prevention program in southwestern Uganda to understand follow-up STI incidence. Women at-risk for HIV exposure while planning for pregnancy completed laboratory screening for chlamydia, gonorrhea, trichomoniasis, and syphilis at enrollment and 6months of follow-up and/or incident pregnancy; facilitated partner notification and treatment were offered for those with positive tests. We performed a logistic regression to determine correlates of follow-up STI. Ninety-four participants completed enrollment STI screening with a median age of 29 (IQR 26-34); 23 (24%) had ≥1 STI. Of the 23 participants with enrollment STI(s), all completed treatment and 19 (83%) returned for follow-up; 18 (78%) reported delivering partner notification cards and discussing STIs with partner(s), and 14 (61%) reported all partners received STI treatment. Of the 81 (86%) who successfully completed follow-up STI screening, 17 (21%) had ≥1 STI. The STI incidence rate was 29.0 per 100 person-years. In univariable regression analysis, enrollment STI, younger age, less education, and alcohol consumption were all significantly associated with follow-up STI. We demonstrated high enrollment and follow-up STI rates and moderate participant-reported partner treatment among women planning for pregnancy in Uganda despite partner notification and treatment. Novel STI partner notification and treatment interventions are needed to decrease the STI burden, especially among women planning for and with pregnancy.

The Impact of Visual Impairment on Completion of Cognitive Screening Assessments: A Post-Hoc Analysis from the IVIS Study.

Aim:The aim of this study was to evaluate completed cognitive screens in stroke survivors with and without visual impairment to explore whether the presence of visual impairment impacts on completion of cognitive screening.Materials and methods:Cognitive screening assessment was undertaken using the Oxford Cognitive Screen (OCS). Data from visual function assessments (inclusive of visual acuity, visual fields, eye movements and visual perception evaluation) were analysed to determine whether presence and/or type of visual impairment impacted on cognitive screening scores achieved. Covariates, including glasses use, gender, age at stroke onset and stroke type, were used to assess confounding impacts on scores attained during cognitive screening.Results:1500 stroke admissions were recruited. One hundred ninety-seven who completed the OCS, were identified from the IVIS study database. Those who reported visual symptoms performed worse statistically on all cognitive tasks except the recall recognition (p = 0.232) and executive tasks (p = 0.967). Visual symptoms did not prevent participants from completing every section of the OCS (p = 0.095). In certain tasks, those not wearing their required glasses performed worse, including the executive function (p = 0.012), broken hearts and sentence reading tasks.Conclusions:Many tasks within cognitive screening assessment are impacted by presence of visual deficits, and adjustments, where possible (e.g. good lighting, large print) should be used to facilitate completion of cognitive screening. It is important to ensure required reading correction is worn during screening.

Real-time coating thickness measurement and defect recognition of film coated tablets with machine vision and deep learning

This paper presents a system, where images acquired with a digital camera are coupled with image analysis and deep learning to identify and categorize film coating defects and to measure the film coating thickness of tablets. There were 5 different classes of defective tablets, and the YOLOv5 algorithm was utilized to recognize defects, the accuracy of the classification was 98.2%. In order to characterize coating thickness, the diameter of the tablets in pixels was measured, which was used to measure the coating thickness of the tablets. The proposed system can be easily scaled up to match the production capability of continuous film coaters. With the developed technique, the complete screening of the produced tablets can be achieved in real-time resulting in the improvement of quality control.

Disparate access to breast cancer screening and treatment

BackgroundBarriers to breast cancer screening remain despite Medicaid expansion for preventive screening tests and implementation of patient navigation programs under the Affordable Care Act. Women from underserved communities experience disproportionately low rates of screening mammography. This study compares barriers to breast cancer screening among women at an inner-city safety-net center (City) and those at a suburban county medical center (County). Inner city and suburban county medical centers’ initiatives were studied to compare outcomes of breast cancer screening and factors that influence access to care.MethodsWomen 40 years of age or older delinquent in breast cancer screening were offered patient navigation services between October 2014 and September 2019. Four different screening time-to-event intervals were investigated: time from patient navigation acceptance to screening mammography, to diagnostic mammography, to biopsy, and overall screening completion time. Barriers to complete breast cancer screening between the two centers were compared.ResultsWomen from lowest income quartiles took significantly longer to complete breast cancer screening when compared to women from higher income quartiles when a barrier was present, regardless of barrier type and center. Transportation was a major barrier to screening mammography completion, while fear was the major barrier to abnormal screening work up.ConclusionDisparity in breast cancer screening and management persists despite implementation of a patient navigation program. In the presence of a barrier, women from the lowest income quartiles have prolonged breast cancer screening completion time regardless of center or barrier type. Women who experience fear have longest screening time completion. Future directions aim to increase resource allocation to ameliorate wait times in overburdened safety-net hospitals as well as advanced training for patient navigators to alleviate women’s fears.

Abstract 5220: The consequences of 11p15 mosaicism in Beckwith-Wiedemann syndrome/spectrum: Epigenotypes associated with cancer development and necessity for universal tumor screening

Abstract Beckwith-Wiedemann Spectrum (BWSp) is the most common (epi)genetic cancer predisposition disorder. BWSp has a heterogeneous clinical presentation and is caused by epigenetic changes at two regions on chromosome 11p15. These epigenetic changes occur post-zygotically leading to a mosaic distribution among tissues. Clinical molecular testing usually starts with blood; however, we and others have demonstrated that positive molecular testing rates are increased if testing is performed on affected tissues. Clinical and molecular diagnosis is important because patients with BWS are at risk for development of embryonal tumors (Wilms tumor (WT), hepatoblastoma (HB), and neuroendocrine tumors). Formal surveillance guidelines were published in 2017 as part of a United States-based cancer predisposition effort that recommended alpha fetoprotein and complete abdominal ultrasound screening for all patients with BWSp until 4 years of age for HB and renal ultrasound screening until 7 years of age for WT. In contrast, the European-based BWS international consensus group (BWS-ICG) applied stratified cancer screening recommendations based on (epi)genotype. In the present study, we investigated cancer development rates and epigenotype profiles associated with cancer in patients diagnosed with BWSp. We present a series of patients with history of WT, HB, and/or neuroendocrine tumors to highlight that there can be differing BWSp epigenotype profiles in tumor and adjacent normal tissue compared to blood, demonstrating the presence of multiple cell populations with distinct epigenetic changes within patients. These distinct changes show that more than one epigenetic alteration in the chromosome 11p15 region can be present in a single tissue type. These findings suggest that the epigenetic classification in blood alone should not be used to stratify cancer risk in BWSp. Additionally, the mild BWSp clinical phenotype and low BWS-ICG clinical scores for these patients highlight that some patients present with few external features. Therefore, neither blood epigenotype nor external phenotype can help inform an individual’s unique tumor risk. This work further suggests that the BWS-ICG tumor risk stratification system cannot be applied to the full Beckwith-Wiedemann Spectrum due to the emerging epigenetic and phenotypic landscape of patients diagnosed with BWSp. These results support a recommendation of universal tumor screening for all patients diagnosed with even mild BWSp phenotypes and/or a 11p15 epigenetic abnormality. Citation Format: Kelly A. Duffy, Evan R. Hathaway, Mallory E. Byrne, Andrew M. George, Timothy Mcelroy, Suzanne P. MacFarland, Garrett M. Brodeur, Jennifer M. Kalish. The consequences of 11p15 mosaicism in Beckwith-Wiedemann syndrome/spectrum: Epigenotypes associated with cancer development and necessity for universal tumor screening [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 5220.

Improving colorectal cancer screening in rural primary care: Preliminary effectiveness and implementation of a collaborative mailed fecal immunochemical test pilot.

Mailed fecal immunochemical test (FIT) outreach can improve colorectal cancer (CRC) screening rates. We piloted a collaborative mailed FIT program with health plans and rural clinics to evaluate preliminary effectiveness and refine implementation strategies. We conducted a single-arm study using a convergent, parallel mixed-methods design to evaluate the implementation of a collaborative mailed FIT program. Enrollees were identified using health plan claims and confirmed via clinic scrub. The intervention included a vendor-delivered automated phone call (auto-call) prompt, FIT mailing, and reminder auto-call; clinics were encouraged to make live reminder calls. Practice facilitation was the primary implementation strategy. At 12 months post mailing, we assessed the rates of: (1) mailed FIT return and (2) completion of any CRC screening. We took fieldnotes and conducted postintervention key informant interviews to assess implementation outcomes (eg, feasibility, acceptability, and adaptations). One hundred and sixty-nine Medicaid or Medicare enrollees were mailed a FIT. Over the 12-month intervention, 62 participants (37%) completed screening of which 21% completed the mailed FIT (most were returned within 3 months), and 15% screened by other methods (FITs distributed in-clinic, colonoscopy). Enrollee demographics and the reminder call may encourage mailed FIT completion. Program feasibility and acceptability was high and supported by perceived positive benefit, alignment with existing workflows, adequate staffing, and practice facilitation. Collaborative health plan-clinic mailed FIT programs are feasible and acceptable for implementation in rural clinics and support CRC screening completion. Studies that pragmatically test collaborative approaches to mailed FIT and patient navigation follow-up after abnormal FIT and support broad scale-up in rural settings are needed.

Screening tools to identify patients with unmet palliative care needs in the emergency department: A systematic review.

This systematic review identified and assessed psychometric properties of the available screening tools to identify patients with unmet palliative care (PC) needs in the emergency department (ED). A comprehensive search of electronic databases and the gray literature was conducted. Two independent reviewers completed study screening and inclusion, data extraction, and quality assessment. A descriptive summary of the results was reported using median of medians and interquartile ranges (IQRs). A total of 35 studies were included, involving the assessment of 14 unique screening tools. The most commonly used screening tool was the surprise question (SQ; n=12 studies), followed by the Palliative Care and Rapid Emergency Screening (P-CaRES) tool (n=8), and the screening for palliative and end-of-life care needs in the emergency department (SPEED) instrument (n=4). Twelve of the included studies reported on the psychometric properties of the screening tools, of which eight of these studies assessed the performance of the SQ to predict patient mortality. Overall, the median sensitivity (63%, IQR 38%-78%) and specificity (75%, IQR 57%-84%) of the SQ to predict mortality at 1 or 12 months was moderate. While the median positive predictive value of the SQ was low (32%, IQR 16%-40%), the median negative predictive value was high (91%, IQR 88%-95%). Across the studies, the proportion of patients identified as having unmet PC based on the criteria of the screening tools ranged from 5% to 83%. This review identified 14 unique screening tools used to identify adult patients with unmet PC needs in the ED. One screening tool, the SQ, was found to have moderate sensitivity and specificity to accurately predict future patient mortality. Additional research is needed to better understand the clinical value of this and the other available tools prior to their widespread implementation.

Increasing colorectal screenings with navigation at federally qualified health centers.

e18566 Background: From 2017 to 2019 there were a total of 423 federally qualified health center colonoscopy referrals (FQHC's) and only 81 (19%) patients followed through and had colonoscopies completed, identifying a significant gap in cancer care within an at risk populations. Methods: The Community Outreach team used a team based problem solving tools and data analytics to increase the number of patients who received colon screenings from FQHC’s. The team held brief, weekly huddles using a variety of continuous improvement tools to identify possible causes of the problem. The team identified 14 potential causes of the 19% gap in FQHC referrals to colonoscopy screenings. The potential causes were analyzed and 4 were identified as the root cause and grouped by common themes into the following opportunities for improvement: Poor engagement with FQHC's. Lack of knowledge on FQHC healthcare effectiveness data and information sets. No standardized workflow for FQHC referrals within the navigation process. Inefficient process for filling the number of screening appointment slots. After identifying the key potential causes, the team developed a task list with countermeasures for improvement and met weekly until the tasks were completed. Through root cause analysis the following key countermeasures were identified: Countermeasure 1: Increased engagement through weekly calls and monthly in person meetings at FQHC's. Countermeasure 2: Developed a quarterly newsletter for FQHC's to review colonoscopy referrals and completed screenings. Countermeasure 3: Developed and implemented a standardized process flow for receiving referrals from FQHC's. Countermeasure 4: Worked with the analytics team to create a dashboard to analyze the real time referrals and completed screenings along with sending e-mail notifications to the navigation program manager providing daily visual management of the number of new patient referrals from FQHC's. Results: After implementing the countermeasures, the community outreach team improved the number of FQHC referrals, from 423 in January of 2017 thru January 2019 to 1399 from January 2020 of December 2021.This was a 160% improvement. They also increased the number of completed colonoscopies from FQHC's from 81 in January of 2017 thru January of 2019 to 328 in January of 2020 thru December of 2021. This was a 200% improvement. The completed screening rate is 23% up from 18%. Conclusions: This project demonstrates the value of utilizing problem solving, visual management and data analytics for continuous quality improvement projects related to patient care. Cross-disciplinary collaboration should be explored with the use of visual tools and other resources to facilitate communication that is understood by all disciplines. The use of patient navigation to schedule patient screening appointments, reminders calls and resolved barriers improved no show rates.

Efficacy of camrelizumab and apatinib combination therapy versus apatinib only in treatment of advanced hepatocellular carcinoma: A meta-analysis.

e16147 Background: Recent studies have assessed the efficacy of some therapeutics in advanced hepatocellular carcinoma. Our aim is to perform a meta-analysis to compare the efficacy of Camrelizumab and Apatinib combination therapy versus Apatinib only in treatment of advanced hepatocellular carcinoma. Methods: We searched PubMed, WOS, Embase and Scopus databases. Inclusion criteria were clinical trials and cohort studies that evaluated the efficacy of Camrelizumab and Apatinib combination therapy or Apatinib only in treatment of advanced hepatocellular carcinoma. We excluded case reports, conference abstracts, editorials and animal studies. CMA software (version 3) was used to perform the meta-analysis. Continuous outcomes were presented as (mean and SD) and dichotomous outcomes as event ratio(ER), with 95% confidence interval (CI). Results: After complete screening, 12 studies were finally included in our study. 4 studies for combination of Camerlizumab and Apatinib while 8 studies investigated the role of Apatinib in patients with advanced hepatocellular carcinoma. The total number of patients included in the study is 844; 172 in combination group and 672 in Apatinib group. By indirect comparison, combination therapy is associated with a relatively better pooled survival rate (ER = 0.532, 95% CI [0.446, 0.615]) compared to Apatinib only therapy (ER = 0.262, 95% CI [0.218, 0.313]). Combination therapy was also associated with higher pooled rates of disease control (ER = 0.755, 95% CI [0.683, 0.815]) compared with Apatinib only (ER = 0.683, 95% CI [0.644, 0.720]). While the Combination therapy was associated with lower pooled rate of stable disease (ER = 0.13, 95% CI [0.339, 0.491]) than Apatinib (ER = 0.531, 95% CI [0.492, 0.570]). The overall survival time was significantly higher in combination therapy (Mean = 14.375, 95% CI [14.101, 14.649]) compared to the pooled mean survival time from Apatinib only therapy (Mean = 10.390, 95% CI [9.925, 10.855]). Conclusions: This study showed that Camrelizumab and Apatinib combination therapy is associated with increased survival rate, disease control and overall survival time in advanced hepatocellular carcinoma patients compared with Apatinib only. It revealed also that combination therapy is associated with lower stable disease than Apatinib only. Further multicenter clinical trials are needed to support our results.