Documentation Of Counseling Research Articles

Pelaksanaan Layanan Administrasi Kesiswaan di MAN 2 Palembang

This research is titled "Implementation of Student Administrative Services at MAN 2 Palembang." The aim of this study is to analyze how the implementation of student administrative services is carried out at MAN 2 Palembang. This research is a field study, employing a qualitative descriptive approach. Data collection techniques include observation, interviews, and documentation. Data analysis techniques consist of data reduction, data presentation, data verification, and drawing conclusions. The validity of the research data is ensured through source triangulation and technique triangulation. The results of the study indicate that the implementation of student administrative services at MAN 2 Palembang is well underway. The research findings demonstrate that student administrative services at MAN 2 Palembang are effectively executed, encompassing aspects such as effective guidance in the admission of new students, student discipline regulation, guidance and counseling documentation, as well as student learning progress recording. Effective guidance assists students in understanding the process of new student admission clearly, ensuring their comprehension without difficulty, setting clear objectives, and planning strategies to achieve them. Student discipline regulations ensure discipline and responsibility among students, while guidance and counseling documentation provide appropriate guidance and support. Recording student learning progress serves to provide a comprehensive overview of student development and aid them in their educational journey at MAN 2 Palembang.

Contraceptive counselling and uptake of contraception among women with cardiovascular diseases: a systematic review and meta-analysis.

To address the lack of clarity regarding contraceptive counselling and uptake of contraception among women with cardiovascular disease (CVD), this study aimed to conduct a systematic review and meta-analysis on contraceptive counselling and the subsequent uptake of contraception among women with CVD. A search across six databases identified 1228 articles, with 11 studies (2580 participants) included. The pooled prevalence of contraceptive counselling was 63%, varying from 36 to 94% in individual studies. Inconsistent delivery and documentation of counselling were noted, along with a lack of knowledge about pregnancy complications and misconceptions regarding CVD severity. For contraceptive uptake (n = 5), the pooled prevalence was 64% (95% confidence interval, 45 to 82%). Women with CVD were also found to use less effective methods as well as methods not recommended for their condition (e.g., combined hormonal methods among participants with absolute or relative contraindications). Improving contraceptive counselling and choices for women with CVD can not only enhance knowledge and decision-making for women with CVD in line with their reproductive goals and preferences but reduce high-risk unintended pregnancies and adverse pregnancy outcomes.

The impact of updates in headache quality measures on adherence to best practices in a neurology resident clinic: Aquality improvement study.

To apply the 2019 joint American Academy of Neurology (AAN) and American Headache Society (AHS) quality measures for headache management to a cohort of neurology resident physicians and then assess outcomes related to guideline adherence. The optimization of headache management is essential to reduce both the individual and systemic impact of these disorders. In 2014, the AAN developed 10 quality measures for evidence-based management of patients with headache. A workgroup updated and condensed its headache quality measures in 2019, narrowing the set to six measurements, four of which would primarily focus on the management of migraine and two of which would address the management of cluster headache. This quality improvement study was conducted using a pretest-posttest study design. A pre-intervention survey based on retrospective analysis of five clinic notes for adherence to the measures was designed and distributed to all neurology residents (n = 32) at a large, academic tertiary referral center. The intervention included the creation of an electronic medical record template to aid residents in following the measures during clinical encounters, as well as the provision of direct feedback based on pre-intervention results. Finally, a post-intervention survey was distributed for completion based on notes written during the intervention period. Analysis was limited to migraine, given the low percentage of cluster headache seen in clinic. An increase in adherence was seen in three of the four migraine-related quality measures, with the Use of Abortive Medications for Migraine and Documentation of Counseling on Modifiable Lifestyle and Chronification Factors demonstrating statistically significant improvements (75.8% to 88.0% [p = 0.013] and 83.9% to 94.0% [p = 0.029] adherence, respectively). For secondary outcomes, the increase in the utilization of appropriate diagnostic criteria (82.6% to 93.2%, p = 0.018) was significant, and the self-assessed confidence rating for adherence to guidelines was significant (p < 0.001). This study provides evidence that the quality improvement intervention led to increased adherence to the AAN and AHS migraine-related measures. It is anticipated that increased adherence may lead to improved patient outcomes.

Socioeconomic status and fertility counseling in patients with early onset colorectal cancer.

e15654 Background: The incidence of early onset colorectal cancer (EOCRC) has increased over the past several decades, with a corresponding need to counsel younger patients about options for fertility counseling. The characteristics of patients at risk for going without fertility counseling are unknown. Methods: We conducted a single site retrospective review of all patients diagnosed with colorectal cancer between 2012 and 2019 who were men age 55 or younger or women age 50 or younger. Clinical data and documentation of fertility counseling were extracted from the electronic medical record by explicit chart review. Median household income (MHI) by zip code was gathered from census data and assigned to each patient based on home address. Results: 194 subjects were identified, of whom 69% had colon cancer and 31% had rectal cancer. 61% were male with average age 44 and 39% were female with average age 42. 55% were White, 11% were Black, 14% were Asian, and 10% were Hispanic. 13% had stage II disease, 44% had stage III disease and 40% had stage IV disease. 15.5% had documented fertility counseling, of whom 43% were male and 57% were female. In univariate analysis, age less than 40 years old, female sex, curative intent treatment, and home address in areas of higher MHI were associated with higher rates of fertility counseling. Race, tumor type, stage of disease, and year of diagnosis were not associated with differences in rates of fertility counseling. Conclusions: We found low overall rates of fertility counseling in patients with EOCRC, and consistent with prior analyses, lower counseling of men and those over age 40. We found that patients who live in areas of relative poverty were less likely to receive fertility counseling. Limited fertility counseling and high out-of-pocket costs of fertility preservation may combine to deny vulnerable patients an essential service. Given the increasing diagnosis of EOCRC, efforts are needed to increase the rates of fertility counseling both systemically and equitably. [Table: see text]

Exploring Effect of Patient Counseling on Mode of Delivery After Cesarean Section [ID 2683575

INTRODUCTION: Increasing vaginal birth after cesarean (VBAC) may help lower national cesarean delivery rates in the United States. This study aims to evaluate factors that affect counseling practices and trial of labor after cesarean (TOLAC). METHODS: All term repeat cesarean deliveries (rCDs) and VBACs from September 2018 to February 2020 were reviewed. Antepartum counseling on mode of delivery, demographic, and obstetrical data were collected. Patients who were not TOLAC candidates were excluded. This study was IRB approved. RESULTS: Six hundred thirty-five patients met inclusion criteria. 304 (47.72%) of these patients had rCD, 65 (10.20%) attempted TOLAC with subsequent rCD, and 268 (42.07%) had VBAC. Of the 635 patients, 470 (74.02%) patients had documentation of TOLAC counseling prior to admission for delivery, whereas 165 (25.98%) did not. TOLAC counseling documentation was not associated with age, race, ethnicity, body mass index (BMI), insurance type, or history of vaginal delivery (VD). Prior VBAC increased the odds of documented TOLAC counseling (odds ratio [OR] 2.36; 95% CI, 1.29–4.63). Medicaid insurance (OR 2.18; 95% CI, 1.29–3.73), history of VD (OR 2.28; 95% CI, 1.16–4.68), history of VBAC (OR 269.0; 95% CI, 50.2–5079), and documented TOLAC counseling (OR 21.12; 95% CI, 11.0–45.10) increased the odds of TOLAC. Increasing BMI decreased the odds of TOLAC (OR 0.91; 95% CI, 0.89–0.95). CONCLUSION: Documented TOLAC counseling increased the odds of attempting TOLAC. As only 74.02% of patients had documented counseling prior to admission for delivery, an effort to increase TOLAC counseling and documentation may increase TOLAC and subsequent VBAC rates, decreasing the cesarean delivery rate.

P004 Empowering the reproductive choices of patients with rheumatic disease: using the BSR 2022 pregnancy guidelines audit tool to evaluate pre-conception medication advice

Abstract Background/Aims For ideal pregnancy outcomes, patients with inflammatory rheumatic disease require targeted disease control with pregnancy compatible medications. A proactive approach is required given that people often won’t disclose plans for a pregnancy with healthcare professionals unless directly asked, and 45% of UK pregnancies are unplanned. The BSR 2022 guidelines on prescribing drugs in pregnancy and breastfeeding makes various recommendations on pre-pregnancy counselling for people with rheumatic disease with referral to specialists with relevant expertise as appropriate. Therefore, we used the linked BSR audit tool to evaluate documentation of pre-pregnancy counselling in rheumatology clinics lacking obstetric input at our hospital. Methods Inclusion criteria were all females, aged 15-45 years, attending a doctor-led Rheumatology clinic without obstetric input between 24/4/23 - 30/4/23 at University College London Hospital. Exclusion criteria were infertility and those seen as one-off clinic appointments and not commenced on medications. Clinic notes from all Rheumatology reviews over the preceding one year were assessed using the audit tool in the 2022 BSR pregnancy guidelines. People currently pregnant were audited for the year prior to the date of conception of their pregnancy. Results Among 50 clinics reviewed, 42 female subjects were eligible across 19 clinics, 64% of whom were aged 36-45 years and 36% were aged 21-35 years. Six subjects were pregnant. Diagnoses included: 24% systemic lupus erythematosus; 19.5% rheumatoid arthritis; 17% seronegative axial spondyloarthropathy; and the remaining 39% consisted of fibromyalgia, hypermobility, and other inflammatory arthritidies. 70% of people were screened for antibodies that could adversely impact pregnancy (i.e. anti-Ro or anti-phospholipid). Only 26% of subjects had documentation of being asked if they wished to conceive. In subjects who did not express a wish to conceive, only 21% were asked if they were using contraception. A total of 17% of the 42 subjects were referred to a specialist Obstetric-Rheumatology clinic for pre-pregnancy counselling during the study period. Of 35 subjects taking medications, only 22.8% had documentation of appropriate pre-pregnancy drug counselling within the last year. Of patients without documented pre-pregnancy advice, 46% were taking medications considered unsafe in pregnancy. Furthermore, no patients were signposted to sources of further information on drug therapy and/or rheumatic disease in pregnancy. Conclusion This audit highlights a lack of regular documented discussions around family planning and medication counselling in female subjects of childbearing age attending rheumatology clinics lacking obstetric input. Regular discussions are important for those who do and don’t wish to conceive, to appropriately counsel regarding pre-pregnancy measures or contraception. This audit using the BSR audit tool will be used as the baseline for a quality improvement project to support colleagues in providing regular, accurate reproductive health advice, supported by trusted online resources and referral to a specialist obstetric-rheumatology service as required. Disclosure A. Shirazi: None. B. Goulden: Grants/research support; Undertaking a PhD supported by Versus Arthritis (ref. 22975). I. Giles: Grants/research support; IG has received an unrestricted research grant, travel and speaker fees from UCB Pharma.

Dietary Counseling Documentation Among Patients Recently Hospitalized for Cardiovascular Disease

BackgroundDiet intervention forms the cornerstone for cardiovascular disease (CVD) management. ObjectiveThe objective was to measure the frequency of dietary counseling documentation for patients recently hospitalized with CVD. DesignThis was an observational study. Participants and settingPatients were included from the Michigan Value Collaborative Multipayer Claims Registry from October 2015 to February 2020. Main outcome measureThe study measured the frequency of medical claims that document dietary counseling ≤90 days after hospitalization (ie, an episode of care) for CVD events (coronary artery bypass grafting, acute myocardial infarction, congestive heart failure, and percutaneous coronary intervention). Dietary counseling documentation was defined as having an encounter-level International Classification of Diseases 10th Revision code for dietary counseling or current procedural terminology code for medical nutrition therapy or cardiac rehabilitation. Statistical analyses performedMultivariable logistic regression was used to measure variation in documentation across gender, age, comorbidities, hospital geography, CVD event, and insurer. ResultsThere were 175,631 episodes of care (congesitve heart failure 47.1%, acute myocardial infarction 28.7%, percutaneous coronary intervention 17.0%, and coronary artery bypass grafting 7.3%) among 146,185 individuals. Most episodes occurred among men (55.8%) and those older than age 65 years (71.9%). Dietary counseling was documented for 22.8% of episodes and was more common as cardiac rehabilitation (18.6%) than other encounter types (5.1%). In multivariable analysis, there was lower odds for dietary counseling documentation among those older than age 65 years (odds ratio [OR] 0.77; P < .001), women (OR 0.83; P < .001), with chronic kidney disease (OR 0.74; P < .001), or diabetes (OR 0.95; P < .001), but greater odds for those with obesity (OR 1.28; P < .001) and nonmetropolitan hospitals (OR 1.31; P < .001). Compared with coronary artery bypass grafting, acute myocardial infarction (OR 0.29; P < .001), confestive heart failure (OR 0.12; P < .001), and percutaneous coronary intervention (OR 0.36; P < .001) episodes had lower odds to have dietary counseling coded. Compared with Traditional Medicare, Medicaid and Medicare Advantage health maintenance organization plans had lower odds, whereas Commercial or Medicare Advantage preferred provider organization and Commercial health maintenance organization plans had higher odds to have dietary counseling documented. Results were mostly similar when evaluated by race. ConclusionsDietary counseling was infrequently documented after hospitalization for CVD episodes in medical claims in a Michigan-based multipayer claims database with large variation by reason for hospitalization and patient factors.

Rates of Reproductive Counseling and Contraception Use in Patients with Heart Failure at a Tertiary Care Center

BackgroundIncreasing numbers of women of childbearing age have cardiac disease, including heart failure (HF). In these women, pregnancy can cause significant morbidity and mortality. Contraceptive use and pregnancy counseling in women with HF is an essential part of their medical care. Here, we assess contraceptive use and pregnancy counseling of patients with HF at a single tertiary care center. Methods and ResultsThis was a retrospective, single-center cohort study of female patients with HF with reduced ejection fraction, left ventricular assist devices (LVADs), and heart transplants who were seen in the adult advanced HF outpatient clinics. Patients were identified in the electronic health care record system, and records were reviewed to assess for documentation of contraception and pregnancy counseling. We identified 156 women of childbearing age (aged >18 to <45), seen in the HF clinics between 2018 and 2023. Patients were subdivided by their most recent diagnosis and therapy: HF with reduced ejection fraction (83 [53.2%]), LVAD (18 [11.5%]), and heart transplant (55 [35.3%]). Contraception was documented for 74% of women with HF, 56% of women with LVAD, and 85% of women with heart transplants. Pregnancy counseling was documented for 18.00% of women with HF, 0.06% of women with LVAD, and 29.00% of women with heart transplants. ConclusionsIn our study, many women with HF, LVAD, or transplant have documented contraceptive therapy; however, pregnancy counseling seems to be limited. This vital aspect of medical care should be available for all patients given potential pregnancy-associated risks.

Sugammadex Use Outside of the Postoperative Setting.

Sugammadex rapidly reverses the nondepolarizing neuromuscular blocking agents (NMBAs) rocuronium and vecuronium. The role of sugammadex is not well-defined outside of the postoperative setting. This study aims to describe sugammadex use outside the postoperative setting for the reversal of nondepolarizing NMBAs. This was a single-center, retrospective cohort study conducted in patients who received sugammadex outside of the postoperative setting at an academic medical center between June 2016 and November 2022. The primary outcome was the effect of sugammadex use for rocuronium reversal, defined as any increase in train-of-four (TOF) after sugammadex administration and/or progress note documentation if TOF was unavailable. Secondary outcomes included adverse events and documentation of contraceptive counseling in patients taking hormonal contraceptives with child-bearing ability. A total of 14 383 patients received sugammadex during the study period. Of those patients, 39 (0.3%) were outside of the postoperative setting for the reversal of rocuronium and included in the study. Twenty-nine (74%) patients had an increase in TOF after sugammadex administration and/or progress note documentation if TOF was unavailable. Ten (26%) patients lacked documentation regarding the effect of sugammadex. No adverse reactions were reported. Three (8%) patients included in the study were of child-bearing ability, and 1 of the 3 patients was counseled on using an alternative method of contraception following sugammadex administration. There is a paucity of literature for the use of sugammadex outside of the postoperative setting. This study found that while the use of sugammadex was rare, overall, it was safe and well-tolerated.

Development and utility of a clinical research informatics application for participant recruitment and workflow management for a return of results pilot trial in familial hypercholesterolemia in the Million Veteran Program.

The development of clinical research informatics tools and workflow processes associated with re-engaging biobank participants has become necessary as genomic repositories increasingly consider the return of actionable research results. Here we describe the development and utility of an informatics application for participant recruitment and enrollment management for the Veterans Affairs Million Veteran Program Return Of Actionable Results Study, a randomized controlled pilot trial returning individual genetic results associated with familial hypercholesterolemia. The application is developed in Python-Flask and was placed into production in November 2021. The application includes modules for chart review, medication reconciliation, participant contact and biospecimen logging, survey recording, randomization, and documentation of genetic counseling and result disclosure. Three primary users, a genetic counselor and two research coordinators, and 326 Veteran participants have been integrated into the system as of February 23, 2023. The application has successfully handled 3367 task requests involving greater than 95000 structured data points. Specifically, application users have recorded 326 chart reviews, 867 recruitment telephone calls, 158 telephone-based surveys, and 61 return of results genetic counseling sessions, among other available study tasks. The development of usable, customizable, and secure informatics tools will become increasingly important as large genomic repositories begin to return research results at scale. Our work provides a proof-of-concept for developing and using such tools to aid in managing the return of results process within a national biobank.

Optimasi konseling behavioral melalui teknik self management untuk mengatasi perilaku membolos

This study aims to determine the effect of a behavioral approach with self-management techniques to minimize truancy behavior in class XI students of SMAN 4 Singaraja. The design in this study used "Pre-Experimental Design: One Group Pre Test-Post Test Design", a purposive sampling method involving 10 students and obtained research samples in class XI IPS 1, XI IPS 2, XI IPS 3, XI IPA 1, XI IPA 6, and XI BB 2. The data collection method used was observation and counseling documentation. In data analysis using a list of student attendance. Next, the calculation of the test analysis will be carried out using the Wilcoxon Marked-Level Test calculation. After obtaining the calculated t value, then proceed with consulting the t table value of a significance level of 0.05 of -1.96 or in other words Z0.025 = -1.96. The Z value obtained in the study was 2.26. The Z value in the table with a significance level of 0.05 is -1.96. Or in other words Z0.025 = -1.96. This means Zhit&amp;gt;Za/2, so H0 is rejected, H1 is accepted. So, the application of behavioral counseling using self-management techniques is effective in minimizing truant behavior in class XI students of SMAN 4 Singaraja.

Counseling for opioids prescribed at discharge of hospitalized adolescent trauma patients

BackgroundExpert consensus recommends prescription opioid safety counseling be provided when prescribing an opioid. This may be especially important for youth with preexistent alcohol and other drug (AOD) use who are at higher risk of developing opioid use disorder. This study examined the frequency that adolescent trauma patients prescribed opioids at hospital discharge received counseling and if this differed by adolescents’ AOD use.MethodThis study was embedded within a larger prospective stepped-wedge type III hybrid implementation study of AOD screening across a national cohort of pediatric trauma centers. Data were collected during 2018–2021 from admitted adolescent trauma patients (12–17 yo) at seven centers. Patient data were extracted from the electronic health record (EHR) on any prescribed discharged opioids, documentation of counseling delivered on prescribed opioid, who delivered counseling, and patients’ AOD screening results. Additionally, adolescents received an online survey within 30 days of hospital discharge that included asking about hospital discussions on safe use of prescription pain medication.ResultsOf the 247 adolescent trauma patients enrolled, 158 completed the 30-day survey. AOD screening results were documented in the EHR for 139 patients (88%), with 69 (44.1%) screening AOD-positive. Opioids at discharge were prescribed to 86 (54.4%) adolescent patients, with no significant difference between those screened AOD-positive and AOD-negative (42.4% vs. 46.3%, p = 0.89). Counseling was documented in the EHR for 30 (34.9%) of those prescribed an opioid and was not significantly different by sex, age, race, ethnicity or between adolescent patients with documentation of AOD use (29.3%) versus those who did not (33.3%, p = 0.71). According to the adolescent survey, among those prescribed an opioid, 61.2% reported someone had talked with them about safe use of newly prescribed pain medications with again no difference between AOD-positive and AOD-negative screening results (p = 0.34).ConclusionsAlthough adolescent trauma patients recalled discussions on safe use of prescribed pain medication more often than was documented in the EHR, these discussions were not universal and did not differ if adolescents had screened positive or negative for AOD use as documented in the EHR.Trial Registry: clinicaltrials.gov NCT03297060.

Implementation of substance use screening in rural federally-qualified health center clinics identified high rates of unhealthy alcohol and cannabis use among adult primary care patients

BackgroundScreening for substance use in rural primary care clinics faces unique challenges due to limited resources, high patient volumes, and multiple demands on providers. To explore the potential for electronic health record (EHR)-integrated screening in this context, we conducted an implementation feasibility study with a rural federally-qualified health center (FQHC) in Maine. This was an ancillary study to a NIDA Clinical Trials Network study of screening in urban primary care clinics (CTN-0062).MethodsResearchers worked with stakeholders from three FQHC clinics to define and implement their optimal screening approach. Clinics used the Tobacco, Alcohol, Prescription Medication, and Other Substance (TAPS) Tool, completed on tablet computers in the waiting room, and results were immediately recorded in the EHR. Adult patients presenting for annual preventive care visits, but not those with other visit types, were eligible for screening. Data were analyzed for the first 12 months following implementation at each clinic to assess screening rates and prevalence of reported unhealthy substance use, and documentation of counseling using an EHR-integrated clinical decision support tool, for patients screening positive for moderate-high risk alcohol or drug use.ResultsScreening was completed by 3749 patients, representing 93.4% of those with screening-eligible annual preventive care visits, and 18.5% of adult patients presenting for any type of primary care visit. Screening was self-administered in 92.9% of cases. The prevalence of moderate-high risk substance use detected on screening was 14.6% for tobacco, 30.4% for alcohol, 10.8% for cannabis, 0.3% for illicit drugs, and 0.6% for non-medical use of prescription drugs. Brief substance use counseling was documented for 17.4% of patients with any moderate-high risk alcohol or drug use.ConclusionsSelf-administered EHR-integrated screening was feasible to implement, and detected substantial alcohol, cannabis, and tobacco use in rural FQHC clinics. Counseling was documented for a minority of patients with moderate-high risk use, possibly indicating a need for better support of primary care providers in addressing substance use. There is potential to broaden the reach of screening by offering it at routine medical visits rather than restricting to annual preventive care visits, within these and other rural primary care clinics.

Telephone-Based Intervention to Improve Family Planning Care in Pregnancies of Unknown Location: Retrospective Pre-Post Study.

Patients followed for a pregnancy of unknown location are generally followed by a team of clinicians through telephone calls, and their contraceptive needs at the time of pregnancy resolution may not be addressed. This study aimed to assess contraceptive counseling and contraceptive uptake before and after a telephone-based intervention. This was a retrospective pre-post study assessing pregnancy intendedness in patients with a pregnancy of unknown location and the proportion of patients who received contraceptive counseling and a contraceptive prescription before and after the initiation of a telephone-based intervention. We reviewed medical records 1 year before and 1 year after implementation of our intervention for demographic characteristics, pregnancy intendedness, pregnancy outcome, contraceptive counseling documentation, receipt of contraception, and repeat pregnancy within 6 months. We assessed the effects of an implementation strategy to address family planning needs once pregnancy was resolved by comparing the proportions of patients who were counseled and received contraception before and after our intervention was implemented. We performed logistic regression to identify associations between covariates and the outcomes of contraceptive counseling documentation and receipt of contraception. Of the 220 patients in the combined cohort, the majority were Black (161/220, 73%) and ultimately had a resolved pregnancy of unknown location (162/220, 74%), and the proportion of pregnancies documented as unintended was 60% (132/220). Before our intervention, 27 of 100 (27%) patients received contraceptive counseling, compared with 94 of 120 (78%) patients after the intervention (odds ratio [OR] 9.77, 95% CI 5.26-18.16). Before the intervention, 17 of 90 (19%) patients who did not desire repeat pregnancy received contraception, compared with 32 of 86 (37%) patients after the intervention (OR 2.54, 95% CI 1.28-5.05). Our postintervention cohort had an increased odds of receiving contraceptive counseling (OR 9.77, 95% CI 5.26-18.16) and of receiving a contraceptive prescription (OR 2.54, 95% CI 1.28-5.05) compared with our preintervention cohort. We found that over half of patients with a pregnancy of unknown location have an unintended pregnancy, and standardization of care through a telephone-based intervention improves contraceptive counseling and prescribing in patients with a resolved pregnancy of unknown location. This intervention could be used at any institution that follows patients with a pregnancy of unknown location remotely to improve care.

A retrospective textual analysis of sexual and reproductive health counseling for adolescent and young adult people with epilepsy of gestational capacity

RationaleThe American Academy of Neurology (AAN) recommends annual sexual and reproductive health (SRH) counseling for all people with epilepsy of gestational capacity (PWEGC). Child neurologists report discussing SRH concerns infrequently with adolescents. Limited research exists regarding documentation of such counseling. MethodsWe retrospectively studied clinical notes using natural language processing to investigate child neurologists’ documentation of SRH counseling for adolescent and young adult PWEGC. We segmented notes into sentences and evaluated for references to menstruation, sexual activity, contraception, folic acid, teratogens, and pregnancy. We developed training sets in a labeling application and used machine learning to identify additional counseling instances. We repeated this iteratively until we identified no new relevant sentences. We validated results using external reviewers; after removing sentences reviewers disagreed on (n = 13/400), we calculated Cohen’s kappa values between the model and reviewers (>0.98 for all categories). We evaluated labeled texts for each patient per calendar year with descriptive statistics and logistic regression, adjusting for race/ethnicity, age, and teratogen use. ResultsData comprised 971 PWEGC age 13–21 years with 2277 patient-years and 3663 outpatient child neurology notes. Nearly half of patient-years lacked SRH counseling documentation (49.1%). Among all patients, 38.0% never had SRH counseling documented. Documentation was present regarding menstruation in 26.7% of patient-years, folic acid in 25.0%, contraception in 21.9%, pregnancy in 3.5%, teratogens in 3.0%, and sexual activity in 1.8%. Documentation regarding menstruation and contraception was associated with prescription of antiseizure medications that have a higher risk of teratogenic effects (OR = 1.27, p = 0.020, 95% CI = [1.04,1.54]; OR = 1.27, p = 0.027, 95% CI = [1.03,1.58]). Documentation regarding contraception, folic acid, and sexual activity was increased among older patients (OR = 1.28, p < 0.001, 95% CI = [1.21,1.35]; OR = 1.26, p < 0.001, 95% CI = [1.19,1.32]; OR = 1.26, p = 0.004, 95% CI = [1.08,1.47]). Documentation regarding sexual activity was decreased among patients identifying as White/Non-Hispanic (OR = 0.39, p = 0.007, 95% CI = [0.20,0.78]). ConclusionChild neurologists counsel PWEGC on SRH less frequently than recommended by the AAN based on documentation.

143-LB: Preconception Counseling and Reproductive Education Program for Persons with Diabetes (PREPPD)

Objective: Pregnancy without preparation in people with diabetes (PWD) can lead to adverse maternal and fetal outcomes. Improved patient knowledge through effective preconception counseling can help reduce the rate of complications. We developed a quality improvement initiative to improve both patient and provider knowledge. Methods: Interventions were implemented for PWD and providers (HCPs) at 2 underserved clinics. HCPs completed pre-intervention questionnaires (highest score of 10) about management of diabetes in pregnancy and preconception goals followed by a training lecture. PWD aged 18-50 with reproductive potential were identified to receive a survey (highest score of 6) about preconception preparation, contraceptive use, glycemic targets, and safer medications in pregnancy. HCPs used a standardized template to guide counseling during visit. PWD and HCPs completed a follow up survey 3- 6 months later. Results: Pre-intervention surveys were completed by 75 PWD and 16 HCPs. Documentation of preconception counseling by HCPs increased from 38% to 83% post intervention. Counseling was perceived as satisfactory by 83% of PWD. Conclusion: Process measures have improved with our pregnancy focused QI initiative. Continued enrollment and post-intervention assessment as well as expansion to include adolescent PWD will enable us to further evaluate outcome measures. Disclosure R. Fallurin: None. C. J. Levy: Advisory Panel; Dexcom, Inc., Research Support; Abbott Diabetes, Dexcom, Inc., Insulet Corporation, Tandem Diabetes Care, Inc., T1D Exchange. M. Rouviere: None. G. O'malley: Research Support; Dexcom, Inc., Abbott Diabetes, Tandem Diabetes Care, Inc., Omnipod, Eli Lilly and Company. S. Rodriguez ortega: None. A. W. Wang: None. S. J. Ogyaadu: None. C. Levister: Research Support; Dexcom, Inc., Tandem Diabetes Care, Inc., Abbott Diabetes. D. W. Lam: None. N. Shah: Research Support; Dexcom, Inc.

Vaccines and use of immunosuppressive and immunomodulatory therapy in a pediatric dermatology clinic-A single institution experience.

Vaccine type and timing are critical issues to prevent unintended infections in those on immunosuppressive therapies. We retrospectively chart reviewed patients at Children's Wisconsin Pediatric Dermatology Clinic on immunosuppressives and immunomodulators between 11/1/2012 and 6/1/2020 and found that approximately 76% of patient encounters do not have documented vaccine counseling in the medical chart before initiation of immunosuppressives and immunomodulators. As age increased, vaccine counseling was less likely to be documented (odds ratio: 0.89; 95% confidence interval: 0.84-0.95, p = .001). In addition, 13 patient encounters (4%) were not up to date with live vaccines before immunosuppressive or immunomodulating therapy. There is an opportunity to improve clinical processes to ensure documentation of vaccination status and vaccine counseling before starting immunosuppressive and immunomodulator medications in a pediatric dermatology clinic.

A Retrospective Textual Analysis of Sexual and Reproductive Health Counseling for Adolescent and Young Adult Women with Epilepsy (P3-9.011)

<h3>Objective:</h3> To analyze documentation of pediatric neurologists’ counseling regarding sexual and reproductive healthcare (SRH) for adolescent women with epilepsy (WWE) <h3>Background:</h3> The American Academy of Neurology (AAN) recommends annual SRH counseling for WWE beginning at menarche. Pediatric neurologists self-report discussing SRH concerns infrequently with adolescent WWE. Documentation of such counseling has not been defined. <h3>Design/Methods:</h3> We retrospectively studied outpatient pediatric neurology notes (n=3663) for WWE age 13–21 using natural language processing to investigate documentation of SRH counseling. Notes were segmented into 388,019 sentences and evaluated for references to SRH counseling regarding: menstruation, sexual activity, contraception, folic acid, teratogens, and pregnancy. We developed training sets in Watchful and utilized spaCy machine learning to identify additional counseling instances. We repeated this process iteratively until no new relevant sentences were identified. Two external reviewers assessed for validity (n=400 sentences, Cohen’s kappa for all categories &gt;0.88); we then removed sentences reviewers disagreed on (n=13) and calculated kappa values between the model and reviewers (&gt;0.98). We evaluated aggregated labeled texts for each patient per calendar year (n=2277 patient-years) with descriptive statistics and logistic regression (adjusting for race, age, and teratogen use). <h3>Results:</h3> Nearly half of patient-years had no mention of SRH counseling (49.1%). Among 971 WWE, 38.0% never had SRH counseling documented. Documentation was present regarding menstruation in 26.7% of patient-years, folic acid in 25.0%, contraception in 21.9%, pregnancy in 3.5%, teratogens in 3.0%, and sexual activity in 1.8%. Documentation regarding menstruation and contraception was associated with prescription of teratogens (OR=1.26, p=0.020; OR=1.27, p=0.028). Documentation regarding contraception, folic acid, and sexual activity was associated with older patients (OR=1.28, p=0.000; OR=1.26, p=0.000; OR=1.26, p=0.004). Documentation of sexual activity was decreased among patients identifying as White (OR=0.40, p=0.012). <h3>Conclusions:</h3> Pediatric neurologists counsel WWE on SRH less frequently than recommended by the AAN based on chart documentation. <b>Disclosure:</b> Dr. Harrison has nothing to disclose. The institution of Dr. Kirkpatrick has received research support from American Academy of Neurology. The institution of Dr. Kirkpatrick has received research support from Academic Pediatric Association. The institution of Dr. Kirkpatrick has received research support from American Academy of Pediatrics. The institution of Dr. Kirkpatrick has received research support from Society of Family Planning. The institution of Dr. Kirkpatrick has received research support from North American Society for Pediatric and Adolescent Gynecology. Dr. Hochheiser has a non-compensated relationship as a Researcher with Veteran’s Administration that is relevant to AAN interests or activities. Dr. Sogawa has nothing to disclose. The institution of Traci Kazmerski has received research support from Cystic Fibrosis Foundation. Traci Kazmerski has received personal compensation in the range of $5,000-$9,999 for serving as a PEP Trainer with Cystic Fibrosis Foundation.

Revitalization of Community Pharmacists: a Review of Regulation and Implementation

Community pharmacists have implemented standard pharmaceutical practices particularly in procurement and clinical pharmacy. The purposes of this review were describing the role of community pharmacists in safety use of medicine and responses to COVID-19 outbreak urgency. Review of published literature. Practice of Community Pharmacist in Indonesia based on Ministry of Health Regulation. In medicine use, Indonesia has National Medicine Policy since 2006. National Medicine policy will ensure the availability, equality and affordability of medicine including the essential. It guarantees that available medicine will meet standard of safety, efficacy and has good quality. Also, goal of this policy is to enhance rational use of medicine and preventing misuse/ abuse. Indicator of good pharmaceutical services is patient received good quality of medicine, proper information, and prevention of adverse drug reactions (ADRs). Hospital and community pharmacists have implemented Standard of Pharmaceutical Services. Documentation of medicine information and counselling has been reported to Ministry of Health regularly. Many programmes, activities have been conducted to ensure quality of care, including prevention of adverse drug reactions.

Assessing the clinical utility of toxicology testing in the peripartum period

Toxicology testing is frequently used as a means of gathering objective data about substance use in pregnancy, but little is known about the clinical utility of testing in the peripartum setting. This study aimed to characterize the utility of obtaining maternal-neonatal dyad toxicology testing at the time of delivery. We performed a retrospective chart review of all deliveries in a single healthcare system in Massachusetts between 2016 and 2020, and identified deliveries with either maternal or neonatal toxicology testing at delivery. An unexpected result was defined as a positive test for a nonprescribed substance that was not known on the basis of clinical history, self-report, or previous toxicology testing within a week of delivery, excluding results for cannabis. We evaluated the characteristics of maternal-infant dyads with unexpected positive results, unexpected positive results by rationale for testing, changes in clinical management after an unexpected positive test, and maternal outcomes in the year after delivery using descriptive statistics. Of the 2036 maternal-infant dyads with toxicology tests performed during the study period, there were 80 (3.9%) with an unexpected positive result. Diagnosis of substance use disorder with active use in the last 2 years was the clinical rationale for testing that yielded the greatest number of unexpected positive results (10.7% of total tests ordered for this rationale). Inadequate prenatal care (5.8%), maternal use of medication for opioid use disorder (3.8%), maternal medical indications such as hypertension or placental abruption (2.3%), history of substance use disorder in remission (1.7%), or maternal cannabis use (1.6%) yielded lower rates of unexpected results compared with a recent substance use disorder (within the last 2 years). Solely on the basis of findings from unexpected test results, 42% of dyads were referred to child protective services, 30% of dyads had no documentation of maternal counseling during delivery hospitalization, and 31% did not receive breastfeeding counseling after an unexpected test; 22.8% had monitoring for neonatal opioid withdrawal syndrome. Postpartum, 26 (32.5%) were referred to substance use disorder treatment, 31 (38.8%) attended a postpartum mental health visit, and only 26 (32.5%) attended a postpartum visit. Fifteen individuals (18.8%) were readmitted in the year after delivery, all for substance-related medical complications. Unexpected positive toxicology results at delivery were uncommon, particularly when tests were sent for frequently used clinical rationales for testing, suggesting a need to revisit guidelines surrounding appropriateness of indications for toxicology testing. The poor maternal outcomes in this cohort highlight a missed opportunity for maternal connection to counseling and treatment in the peripartum period.