Follow-up Reminders Research Articles

RF06 | PSAT155 Are We Following the Recommendations to Screen for and Treat the "Silent Killer" in Our Geriatric Population? A Quality Improvement Project

Abstract Introduction Osteoporosis is characterized by weakening of the bone, disruption of its architecture, and loss of skeletal strength, leading to increased risk of fragility fractures. According to the CDC, the prevalence of osteoporosis in 2017-2018 was 5.7% in males and 17.7% in adults aged 65 and older. Approximately 2 million osteoporosis fractures occur annually in the USA. The annual direct cost is estimated to be $25.3 billion by 2025. Implementing effective strategies to help with early diagnosis, treatment, and follow-up is fundamental. Our study aims to identify barriers that render the geriatric population with osteoporosis from receiving optimal medical care. Methods We retrospectively reviewed a sample of 119 patients of a GERIATRIC PACT Veteran administration (VA) clinic between 1/1/2018 and 8/30/2021 to identify patients diagnosed with osteoporosis and monitor the adequacy of education, treatment, and follow-up. Possible treatment barriers and subsequent consequences were noted. Results were presented using descriptive statistics. Results The mean age of the cohort was 83±7 years old, 90% (N=107) of them being males, with a mean BMI and Hb A1c of 27± 6 kg/m2 and 6. 0± 2.1%, respectively. From the total, we obtained a sample of 17.8% (N=15, 12M/3F) patients who had a previous diagnosis of osteoporosis without concurrent medical management. Eight patients (53%) didn't have Osteoporosis management or discussion of the treatment with the clinician at their initial geriatric appointment, and 5 patients didn't discuss osteoporosis in subsequent visits either. Poor mental or physical status, limiting patient follow-up or treatment, was identified in 40%(N=6) of the patients. Adverse reactions were seen in 6.6% (N=1). 20% of the patient were on drug holiday (N=3), and 20% (N=3) refused any osteoporosis treatment. 26.6%(N=4) of the patients had developed fragility fractures. From this subgroup, one patient refused the treatment, and 3 had no osteoporosis treatment discussion at their initial visit. Discussion Our results showed that a significant number of patients with osteoporosis had no screening or evaluation. Osteoporotic fractures were presented within a few months in 20% of them. No identifiable cost barriers or contraindications to osteoporosis treatment were noticed. Multiple factors could have contributed to these events. Lack of universal clinical reminder for osteoporosis screening per national VA guidelines fails to identify men at increased risk for osteoporosis and it does not address the lack of follow-up reminders on this topic. Public misinformation regarding osteoporosis treatment is another barrier that needs to be addressed with education. Plans to identify patients with no concurrent treatment are necessary. Conclusions In geriatric veterans, implementing tools to follow-up on patients with osteoporosis and identifying treatment barriers is an essential step for high-quality, integrated, and comprehensive patient care. Such tools need to be validated with future studies to ensure effectiveness. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:24 p.m. - 1:29 p.m.

The Effect of COVID-19 on United States Pediatric Emergency Departments and Its Impact on Trainees.

The purpose of this study was to quantify the effects of the coronavirus disease 2019 (COVID-19) pandemic on pediatric emergency departments (PED) across the United States (US), specifically its impact on trainee clinical education as well as patient volume, admission rates, and staffing models. We conducted a cross-sectional study of US PEDs, targeting PED clinical leaders via a web-based questionnaire. The survey was sent via three national pediatric emergency medicine distribution lists, with several follow-up reminders. There were 46 questionnaires included, completed by PED directors from 25 states. Forty-two sites provided PED volume and admission data for the early pandemic (March-July 2020) and a pre-pandemic comparison period (March-July 2019). Mean PED volume decreased >32% for each studied month, with a maximum mean reduction of 63.6% (April 2020). Mean percentage of pediatric admissions over baseline also peaked in April 2020 at 38.5% and remained 16.4% above baseline by July 2020. During the study period, 33 (71.1%) sites had decreased clinician staffing at some point. Only three sites (6.7%) reported decreased faculty protected time. All PEDs reported staffing changes, including decreased mid-level use, increased on-call staff, movement of staff between the PED and other units, and added tele-visit shifts. Twenty-six sites (56.5%) raised their patient age cutoff; median was 25 years (interquartile ratio 25-28). Of 44 sites hosting medical trainees, 37 (84.1%) reported a decrease in number of trainees or elimination altogether. Thirty (68.2%) sites had restrictions on patient care provision by trainees: 28 (63.6%) affected medical students, 12 (27.3%) affected residents, and two (4.5%) impacted fellows. Fifteen sites (34.1%) had restrictions on procedures performed by medical students (29.5%), residents (20.5%), or fellows (4.5%). This study highlights the marked impact of the COVID-19 pandemic on US PEDs, noting decreased patient volumes, increased admission rates, and alterations in staffing models. During the early pandemic, educational restrictions for trainees in the PED setting disproportionately affected medical students over residents, with fellows' experience largely preserved. Our findings quantify the magnitude of these impacts on trainee pediatric clinical exposure during this period.

Emergency medicine resident involvement in emergency medical services

Introduction: Emergency medical services (EMS) are a critical component to Emergency Medicine (EM) residency training. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) has established minimum training requirements for EM residency programs. Since the last study exploring resident EMS involvement was performed, there have been over 100 new EM resident programs started. Given the rapid increase in new EM programs, we sought to determine EMS experiences provided to current EM residents. Materials and Methods: A 22-question anonymous online survey was distributed through E-mail to program directors of approved EM residencies in October 2020. A follow-up reminder was sent 3 weeks later. Results: In total, 51 of 257 programs responded (20% response rate). Forty-five percent of EM residents experience between 10 and 25 EMS calls during their residency, 31% experience 26–50, and 20% experience >50 calls. The majority of programs (53%) have a separate EMS rotation where residents function as observers, 24% of residents function as providers, and 25% also have residents respond in a dedicated physician response vehicle. Aeromedical exposure is limited (47% have none and 43% average only 1–9 flights). Two-thirds of programs (67%) have residents provide online medical command during their ED shifts and 61% require residents to provide didactics to EMS clinicians. Despite ACGME requirements, only two-thirds of programs (69%) provide training about disaster/mass casualty incident (MCI) management and 67% have them participate in a disaster/MCI drill. About one-third of programs (31%) have decreased EMS experiences due to limited time in the residency curriculum, and 20% of programs have limited EMS experiences due to the COVID pandemic. Conclusions: The majority of responding EM residency programs meet ACGME EMS-related requirements. There is an opportunity for improvement around disaster education based on these data. Limited time in the curriculum and the COVID pandemic were cited as reasons that programs have limited their EMS experiences. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Medical Knowledge.

S691 Assessment of Occult Blood Testing in Acute Hospital Settings: A Multicenter GI Fellow Driven Study

Introduction: Fecal occult blood testing (FOBT) is an outpatient screening tool for colorectal cancer. It is widely misused in the hospital setting, without accounting for false positives or negatives resulting in unnecessary endoscopic procedures, increased costs and increased length of stay. The aim of our study is to understand the knowledge and current utilization of FOBT among internal medicine residents from multiple programs across the USA. Methods: This is a multicenter survey conducted by a GI fellow in about 25 Internal Medicine Residency programs in Washington-DC, Pennsylvania, New York, New Jersey, Florida, Indiana, Illinois, Georgia, and California. A 15-questionnaire survey on FOBT was emailed on May 18th, 2022, with follow-up reminders until June 3rd, 2022. We considered the end of the academic year as an ideal time to evaluate the understanding and clinical practice of internal medicine trainees. Results: A total of 227 residents responded to our survey {n=96 (42.2%) PGY-I, n=67 (29.5%) PGY-II & n=64 (28.2%) PGY-III}. Overall, 66.7% i.e., 2/3rd of residents sometimes or always ordered FOBT and 67.4% have ordered this test more often in inpatient than in outpatient settings. Approximately 60% of the residents had knowledge of dietary restrictions but only 32% of the residents were questioning the patients before ordering it. The triggers for ordering FOBT were mostly anemia (92.5%) followed by change in stool colour (61%), weight loss (60%) and bleeding per rectum (47.5%). 62% of respondents felt influenced by their supervisors but 57.2% felt that FOBT results will change their management. Overall, as postgraduate year training increased, trainees were less likely to order FOBT for suspected GI bleeding (Table). Conclusion: Our survey results showed that residents were influenced by their supervisors and ordered FOBT largely in the inpatient setting. Although there was noted improvement in understanding of the futility of FOBT in suspected acute GI bleeding, more than half of final year trainees would still order FOBT first. There is a need for better education of internal medicine trainees in the utilization of FOBT. Table 1. - Statistical analysis comparing the level of training with preference to FOBT vs. GI Consult for a suspected GI Bleed For a suspected GI Bleed, which of the following would you consider first Logistic regression analysis, comparing PGY-I with PGY-II & III Postgraduate Year GI Consult FOBT Odds Ratio Confidence Interval P-Value PGY – I 34 (35.4%) 62 (64.6%) Ref Ref Ref PGY – II 28 (41.8%) 39 (58.2%) 0.76 0.40 - 1.44 0.820 PGY – III 37 (43.6%) 27 (56.4%) 0.40 0.21 - 0.77 0.006

33515 Pilot survey project on procedural skills opportunities in skin of color for dermatology physician assistants

Background: Physician assistants (PAs) are increasingly vital to the dermatology workforce to meet the demands of the U.S. population as it increases in size and diversity. Dermatology physicians undergo training in specialized treatment for skin of color (SoC) patients. This pilot study explored the educational and procedural experiences among dermatology PAs. A survey was used to identify strengths and areas of improvement in SOC procedural skill education. Methods: The link to an IRB-exempt, anonymous 16-item survey was posted to the Society of Dermatology Physician Assistants (SDPA) message forum for 3 weeks, with 1 follow-up reminder. Survey questions assessed the dermatologic education and training for SoC before, during, and after PA education via voluntary self-report. Data on PA procedural experiences, procedural confidence levels, and training satisfaction were collected. Statistical analysis was conducted using R Version 4.0.5. Results: Twenty-five PAs responded, while 19 completed the survey (completion rate: 76%). Forty-four percent (13/19) reported receiving no SoC dermatologic didactic sessions in their PA curriculum. Fifty-two percent (11/19) reported no supervised procedural training specific to SoC. Those who received training reported greater confidence in choosing and performing treatments for SoC patients (P < .05). Conclusion: Our pilot highlighted the need to shorten our questionnaire for ease of completion (acceptability) and develop alternative dissemination options (ie, email) to increase respondent participation (feasibility). Some PAs expressed apprehension about participating, and thus, clarification of study’s goals will be an important factor to improve participation for the next version.

Current and future trends in the teaching of removable partial dentures in dental schools in Malaysia: A cross sectional study

AimsTo investigate, using a validated questionnaire, the teaching of removable partial dentures (RPDs) in dental schools of Malaysia. Materials and methodsA validated questionnaire to investigating trends in the teaching of RPDs in dental schools in Oceania was emailed (in English version form) to Heads of Restorative/Prosthodontics/course coordinators in the 13 dental schools in Malaysia. Follow-up reminders were sent and participants were given six weeks to complete and return the questionnaire. Data was entered into an Excel spreadsheet and results compiled and analyzed. ResultsCompleted questionnaires were received from 13 dental school – a 100% response rate. All schools (n = 13) provided a preclinical technical course in RPD design. In most schools (n = 9, 69.2%), course work was supervised by senior lecturers while rest of the institutions made use of associate professor/professors. There were significant differences (p<0.05) between dental schools in terms of the contact hours dedicated to preclinical teaching. Students received an average of 62 h of instruction. Didactic instruction was the primary focus with practical (78 h) and didactic teaching (32 h). All dental schools (n = 13) provided practical surveyor design teaching (8 h). The staff student ratio for formal lectures (1:61), tutorials (1:29) and lab demonstrations (1:12) were recorded. Majority of the schools (n = 11, 84.6%) employed paired teaching in clinical sessions. All schools (n = 13, 100%) emphasized on increased teaching of RPD design and prescription writing in future clinical RPD courses. ConclusionTeaching of RPDs in Malaysia may be considered sufficient and comparable to the teaching in other parts of the world. Clinical significanceWhilst the teaching of partial dentures at Dental Schools in Malaysia provides the core competencies involved in partial denture design and construction based on sound fundamental, scientific principles they should address the challenges of teaching partial dentures and other areas of dental education including improving working conditions for dental professionals.

503 Social Media as a Platform for Burn Survivor Outreach at a Safety Net Hospital

IntroductionOutpatient follow-up is a critical component of burn recovery. Sociodemographic variables that prevent patients from pursuing follow-up can lead vulnerable groups to have a lower quality of life after burn injury. Social media provides a platform for improvement of patient outreach and support. The purpose of this study is to investigate accessibility and interest in social media interventions among socioeconomically disadvantaged and minority burn patients.MethodsPatients receiving treatment at a burn clinic in a large public hospital were asked to complete a survey about social media usage, difficulty attending follow-up appointments, and interest in engaging with the hospital through social media. Patient demographics and clinical data were obtained via chart review. The relationship between clinical or demographic factors, and interest in social media engagement, was assessed via exact logistic regression.ResultsData were collected from 65 eligible patients. Social media use among participants (76.9%) was similar to the proportion in the U.S. general population (72%). 61.5% of participants used Facebook, 40% used Instagram, and 4.6% used Twitter. 81% of participants had consistent internet access. 58.3% of respondents expected to encounter challenges when planning follow-up appointments. Challenges included difficulty with transportation (26.2%), trouble taking time off work (9.8%), and forgetting to schedule (9.8%). Participants were asked if they were interested in receiving post-discharge education, care team outreach, and follow-up reminders via social media. 36.5% of patients were very or moderately interested, 27% were slightly interested, and 36.5% were unsure or not at all interested.20% of patients both expected follow-up challenges and were moderately or very interested in social media engagement. While controlling for social media use, the odds of having moderate or greater interest in the post-discharge engagement program were estimated to be 2.6 times higher for patients older than 39 (OR 3.64; 95% CI 1.03-14.24; P=.044). There was a pattern of lower interest in social media engagement with higher %TBSA, while controlling for age or social media use, though P values were higher than .05.ConclusionsOver half of the burn patients surveyed expected to face challenges when planning follow-up appointments, a third of whom were moderately or very interested in social media engagement. Social media may be an alternative form of outreach with older patients in particular. Observed overlap between follow-up difficulty and outreach program interest may suggest such a program could ameliorate follow-up challenges.

The design and impact of culturally-safe community-based physical activity promotion for immigrant women: descriptive review

BackgroundImmigrant women have low rates of physical activity (PA), placing them at risk for chronic diseases. Some research suggests that strategies targeting this group must be culturally-safe and community-based. This study aimed to identify the design (i.e. characteristics) and impact of culturally-safe community-based PA promotion for immigrant women.MethodsWe conducted a descriptive review by searching MEDLINE, EMBASE, SPORTDiscus, CINAHL, SCOPUS, Cochrane Library and Joanna Briggs Institute Database of Systematic Reviews from inception to June 9, 2021 for English language studies that assessed community-based PA promotion strategies targeting adult immigrants and involved at least 50% women. We compiled findings in a preliminary context-mechanisms-outcomes conceptual framework.ResultsWe included 13 studies published from 2004 to 2020. Three included women-only; the remainder included a median of 63% women (range 50 to 98%). Studies included immigrants from Brazil, Dominican, Columbian, Haiti, Mexico, China, Vietnam, Bangladesh, India, Pakistan, Somalia, Sudan and Turkey. All but one study (89%) significantly improved one or more outcomes: PA knowledge, PA participation and anthropometric measures (e.g. weight, BMI, blood pressure). Most (89%) strategies were multi-faceted: in-person group educational sessions reinforced by take-home educational material and/or follow-up reminder phone calls. Single strategies (e.g. mailed educational material, group educational session) also achieved beneficial outcomes. We identified 17 culturally-safe characteristics of PA promotion strategies: language of choice, based in community settings or organizations, led by lay health workers, reflected ethno-cultural linguistic expressions and PA norms, and recognized and offered solutions to barriers of PA. Findings were captured in a preliminary theory of how contextual factors (gender, intersectionality) and mechanism (culturally-safe PA promotion) may influence PA-related outcomes (PA knowledge, self-efficacy and participation; anthropometric measures, quality of life).ConclusionsThis study revealed the characteristics of PA promotion strategies that significantly improved PA-related outcomes among immigrants. Given that few studies focused solely on immigrant women or reported sub-analyses, the conceptual framework generated by this study can be used in future research to more definitively establish the design and impact of culturally-safe, community-based PA promotion for immigrant women.

Enhancing the Quality of Follow-Up Care for Patients With Hepatitis B and C Using an Electronic Reminder System: A 2016-2019 Hospital-Based Study

&lt;p&gt;B、C型肝炎病人需要定期追蹤及檢驗疾病發展狀況，以及早發現肝癌。彰化基督教醫院胃腸肝膽科於2010年開始實行衛生福利部中央健康保險署（下稱健保署）追蹤照護計畫，過程中因病人病識感低，以及門診收案及追蹤流程複雜，截至2016年收案率14.6%、年度完整追蹤率28.8%，皆未達健保署設定的3項品質獎勵監測指標。透過E化之B、C肝照護管理系統，改善並簡化門診收案流程，提升個案管理師收案追蹤效率及提高病人遵從醫囑率，大幅提升了B、C肝病人照護品質。於2017年開始執行E化追蹤管理，2019年收案率提升至58.91%(4542/7710)，年度完整追蹤率達74.45%(3107/4173)。健保署評比2018年度品質獎勵榮獲中區第一名，本院是中區唯一獲得品質獎勵之醫學中心。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Patients with hepatitis B and C require regular follow-up to monitor disease activity and screen for the presence of hepatocellular carcinoma. Since 2010, Changhua Christian Hospital has implemented a hepatitis B and C care plan guided by the National Health Insurance Administration (NHIA), Ministry of Health and Welfare (MOHW). The rates of patient enrollment and follow-up between 2010 and 2016 were unsatisfactory. The annual enrollment and follow-up rates were only 14.6% and 28.8%, respectively, in 2016, falling below the three quality indicator standards established by the NHIA. The absence of insight into patient disease and the complexity of patient enrollment and follow-up procedures were identified as the main problems. Therefore, in 2017, we developed a strategy for improving and simplifying the patient enrollment process, enhancing the efficiency of the case managers involved in patient enrollment and follow-up, and increasing the rate of medical compliance. An electronic follow-up reminder system was implemented to enhance our quality of care among patients with hepatitis B and C. Thus, in 2019, the annual enrollment and follow-up rates had dramatically increased to 58.91% (4542/7710) and 74.45% (3107/4173), respectively. Because of the improved care management system, our hospital was the only medical center in central Taiwan that won an NHI Quality Award in 2018.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Antenatal urinary retention: Risk factors, treatment, and effect on pelvic floor dysfunction

ObjectivePhysiological changes to the urinary tract begin early in the first trimester and continue throughout pregnancy. Bladder symptoms vary throughout pregnancy and can remain after the puerperium. Antenatal urinary retention is a severe form of pelvic floor dysfunction and research into this topic is sparse. Little is known about the longer-term effects of antenatal urinary retention on pelvic floor dysfunction. This study aimed to establish the incidence of and risk factors for antenatal urinary retention in our population, and whether this had any impact on pelvic floor dysfunction. Study DesignThis was a cross-sectional study. Women were included if they were currently pregnant when they required catheterisation—either indwelling, intermittent self-catheterisation or both. The Australian Pelvic Floor Questionnaire was posted to all women. No follow-up reminders were sent and any woman who did not return their questionnaire was recorded as a non-responder. ResultsFrom January 2016 to December 2020, 41 women were identified as needing some form of catheterisation for treatment of antenatal urinary retention. During the same period, 44,646 women attended the National Maternity Hospital, giving an incidence of antenatal urinary retention of 0.92/1000 pregnancies. Questionnaire results were available for 25 women. One woman did not respond to one question, giving 99.9% complete data. The median (range) total pelvic floor score was 4.6 (0.2–10.7). Risk factors for antenatal urinary retention were identified in ten women. Most women denied any specific bladder symptoms, including difficulty in voiding and a feeling of incomplete emptying. ConclusionsAntenatal urinary retention is an uncommon form of pelvic floor dysfunction and occurs in 1-in-1000 pregnancies. Most women with antenatal urinary retention can be treated with an indwelling catheter for a short period, with only one in four women requiring intermittent self-catheterisation. Retention typically occurs in the late first and early second trimester, and while some risk factors have been identified, most women appear to have an uncomplicated pregnancy before developing acute urinary retention. Reassuringly, long-term pelvic floor dysfunction is minimal in women who experience antenatal urinary retention.

Effectiveness of three different types of oral health promotion programs among schoolchildren in Sakaka, Saudi Arabia: A cluster randomized controlled trial

Background: Untreated component of dental caries in Saudi Arabia is alarming even though the accessibility of dental services is at free of cost to all Saudi nationals. Aim/Objective: The aim of the present study is to assess the efficiency among three different types of school-based oral health promotion programs in Sakaka children. Materials and Methods: A cluster randomized controlled trail included 765 schoolchildren. Three different models of school-based oral health promotion programs were tested in this study. Outcome measures were evaluated after 12-month follow-up, which include difference in prevalence and mean number of untreated dental caries, annual dental service utilization rates, and difference in mean oral health-promoting behavior between baseline and at the end of the program. Results: Seven hundred and two children were available for outcome measurement. There is reduction in both prevalence and mean number of untreated dental caries in all the three groups but significant reduction observed in Model-3 group of children. Similarly, improvement in dental visit patterns was also observed more in Model-3 group compared with other two groups. Conclusion: Health education including teachers with 6-monthly reinforcement, screening, and referral to specific treatment facility with follow-up reminders was found to be an effective model.

Feasibility and efficacy of text messaging to promote care among trauma patients screened for HIV at an urban emergency department in Tanzania

BackgroundDue to the high prevalence of human immunodeficiency virus (HIV) in Tanzania, provider-initiated HIV testing for patients attending any health care setting is recommended. However, follow-up and linkage to care by those tested remain poor. We determined the feasibility and efficacy of text messaging to promote follow-up among otherwise healthy trauma patients who underwent provider-initiated HIV testing and counseling at an emergency department (ED) in Tanzania.Material and methodsThis randomized controlled trial (RCT) was conducted at Muhimbili National Hospital (MNH) ED between September 2019 and February 2020. Adult trauma patients consenting to HIV testing and follow-up text messaging were randomized to standard care (pre-test and post-test counseling) or standard care plus a series of three short message service (SMS) text message reminders for follow-up in an HIV clinic, if positive, or for retesting, if negative. Investigators blinded to the study assignment called participants 2 months after the ED visit if HIV-positive or 4 months if HIV-negative. We compared the proportion of people in the intervention and control groups completing recommended follow-up. Secondary outcomes were the proportion of patients agreeing to testing, proportion of patients agreeing to receiving text messages, and the proportion of HIV-positive and HIV-negative patients in each study arm who followed up.ResultsOf the 290 patients approached, 255 (87.9%) opted-in for testing and agreed to receive a text message. The median age of the study population was 29 [IQR 24–40] years. There were 127 patients randomized to the intervention group and 128 to the control group. The automated SMS system verified that 381 text messages in total were successfully sent. We traced 242 (94.9%) participants: 124 (51.2%) in the intervention group and 18 (488%) in the control group. A total of 100 (39.2%) subjects reported completing a follow-up visit, of which 77 (60.6%) were from the intervention group and 23 (17.9%) were from the control group (RR = 3.4, 95% CI 2.3–5.0). This resulted in a number needed to treat (NNT) of 2.3. Of the 246 HIV-negative participants, 37% underwent repeat screening: 59% of those in the intervention group and 16% in the control group (RR = 3.7, P = < 0.0001, NNT 2.3). Among the nine positive patients, all five in the intervention group and only three in the controls had follow-up visits.ConclusionAutomated text message is a feasible and effective way to increase follow-up in HIV-tested individuals in a limited income country.

Training of nonophthalmologists in diabetic retinopathy screening.

The burden of diabetes mellitus (DM) and diabetic retinopathy (DR) is at alarming proportions in India and around the globe. The number of people with DM in India is estimated to increase to over 134 million by 2045. Screening and early identification of sight-threatening DR are proven ways of reducing DR-related blindness. An ideal DR screening model should include personalized awareness, targeted screening, integrated follow-up reminders, and capacity building. The DR screening technology is slowly shifting from direct examination by an ophthalmologist to remote screening using retinal photographs, including telescreening and automated grading of retinal images using artificial intelligence. The ophthalmologist-to-patient ratio is poor in India, and there is an urban–rural divide. The possibility of screening all people with diabetes by ophthalmologists alone is a remote possibility. It is prudent to use the available nonophthalmologist workforce for DR screening in tandem with the technological advances. Capacity-building efforts are based on the principle of task sharing, which allows for the training of a variety of nonophthalmologists in DR screening techniques and technology. The nonophthalmologist human resources for health include physicians, optometrists, allied ophthalmic personnel, nurses, and pharmacists, among others. A concurrent augmentation of health infrastructure, conducive health policy, improved advocacy, and increased people's participation are necessary requirements for successful DR screening. This perspective looks at the characteristics of various nonophthalmologist DR screening models and their applicability in addressing DR-related blindness in India.

Implementation of “Epic Healthy Planet” registry for survivorship care coordination.

337 Background: The evolving Commission on Cancer (CoC) reporting mandate and institution’s growing survivorship program led to identifying the need for systematic tracking of survivorship patients, surveillance tests, return appointments and referrals placed. Our aim was to develop an electronic medical record (EMR) integrated registry utilizing discrete data fields to assist our team in tracking key elements of high-quality survivorship care. Methods: Stakeholders from our survivorship team (APP/RN), medical oncology, psychology, research, operations and IT analytics reached consensus on essential discrete EMR fields to be included in the registry. For implementation we utilized the EPIC module, “Healthy Planet”, where patients enter the registry by initiating an “Episode of Care” at their initial survivorship visit. SmartForm fields create unique discrete patient data points identified by the stakeholders. Results: The following domains were identified as important elements of care that require tracking in a dedicated survivorship program. The registry domains populate from two sources: 1) currently existing EMR data fields, 2) domains with no currently discrete data (e.g. lymphedema, peripheral neuropathy) were captured in the developed SmartForm (see Table). From January 1, 2019 to June 1, 2021, 778 patients were entered into the registry. Since September 4, 2020, 112 patient follow-up appointment reminders were sent via EMR which has led to a noticeable increase in return appointments. SmartForm data fields are being amended as additional malignancy types are added to our survivorship program. Conclusions: The utilization of Healthy Planet is an effective and user-friendly way to track survivorship return appointments, remind providers of diagnostic tests that are due, and track referrals for CoC reporting. As the numbers of cancer survivors continues to increase, systematic population management tools are essential to ensure adherence to survivorship guideline recommendations, follow-up care and mandatory reporting.[Table: see text]

Lifestyle and Career Satisfaction among U.S-based Oral and Maxillofacial Surgeons: Results of a Nationwide Survey

PurposeThe purpose of the study is to identify predictors of lifestyle and career satisfaction among U.S-based oral and maxillofacial surgeons (OMSs). MethodsAll active members of the American Association of Oral and Maxillofacial Surgeons (AAOMS) with a non-generic email were invited to participate in a survey-based assessment. The survey was constructed using the online platform Qualtrics (Provo, UT). A total of 12 close-ended questions were designed and distributed. Two follow-up reminder emails were sent, each after a two-week period. Descriptive statistics were computed. Responses were evaluated through univariate analysis. ResultsIn total, 280 of the 820 invitees completed the survey for an overall response rate of 34%. Majority of respondents were male (89%), more than 45 years old (71%), working in a private-practice setting (55%), and had been in practice for more than 15 years (66%); 61% of the respondents reported taking call more than 3 days a week, with 88% of them stating a negative impact on their practice due to their call schedule. An overwhelming majority of 84.2% OMSs reported being satisfied with their career and 77.5% of respondents were willing to choose a career in oral and maxillofacial surgery again as a fourth-year dental student. On univariate analysis, factors associated with overall career satisfaction included: age, practice location, salary, and personal life balance (P < .01). ConclusionDespite length of training and professional burnout, there is a significant degree of career satisfaction among OMSs practicing in the United States. The majority of queried surgeons would choose the specialty as a profession if given the choice again. Factors associated with negative impact on professional practice need to be further studied at local, regional, and national levels.

Understanding the Effect of a Healthcare Provider-Led Family Planning Support Intervention on Contraception use and Pregnancy Desires among Postpartum Women Living with HIV in Southwestern Uganda.

Modern contraceptive prevalence among women living with HIV (WLWH) in Uganda is still low at 45%, and up to a third of women are likely to discontinue the method within the first year of initiation. This increases risks of unplanned pregnancies, perinatal HIV transmission and pregnancy complications. We aim to explore and explain the mechanism of effect of a family planning support intervention investigated in a randomized controlled trial conducted between October 2016 and June 2018 among 320 postpartum WLWH at a referral hospital in Southwestern Uganda that led to improved uptake, decreased contraception discontinuation and lowered pregnancy rates. Thirty WLWH and 10 of their primary sexual partners who participated in this trial were purposively selected and interviewed in the local language; interviews were digitally recorded. Translated transcripts were generated and coded. Coded data were iteratively reviewed and sorted to derive descriptive categories using an inductive content analytic approach. Up to 83% of women wanted to avoid pregnancy within the first year postpartum. Qualitative data showed that contraception uptake and use were influenced by: 1) Participant awareness and understanding of different methods available; 2) Participant perception of offered health services; 3) Healthcare provider (HCP) socio-cultural sensitivity to individual experiences and (mis)conceptions surrounding contraception; 4) Having tactile engagement, follow-up reminders and a reference to prompt action or discussions with partners. Supportive and culturally sensitive HCPs and systems facilitated information sharing leading to increased patient awareness and understanding of the contraceptive methods, and improved health user experience, care engagement, confidence and willingness to take up and continue using modern contraceptive methods.

Abstract 97: Designing a Counseling App to Reduce the Psycho-Social Impact of HPV-Testing: A User-Centered Design Approach

Abstract Purpose: HPV-testing detects sexually transmitted infection with oncogenic types of HPV. For many HPV+ women, this result has negative connotations, it produces anxiety, fear of cancer or death, and disease denial. While face-to-face counseling could present many difficulties in its implementation, a counseling mobile-app may help HPV+ women reduce the psychosocial impact of the result, improve their knowledge about HPV and CC and increase adherence to follow-up. Methods: We conducted formative research based on a user-centered design approach. We carried out 29 individual online interviews with HPV+ women aged 30 and over, and four focus groups (FG) with a total of 19 participants through a virtual platform. We used a focus group guide to produce data for the information architecture (i.e., how to organize contents into features). We carried out thematic analysis using constructs from the Health Belief Model and Integrative Behavioral Model to identify content preferences and turn them into app features. We used the RQDA package of R software for data processing. Results: Preliminary results showed that participants needed more information regarding the procedures they had received; about what HPV+ means; what are the causes of HPV; if the HPV is present only in females; and if HPV has consequences on their sexuality. Also, we found that women's fear of the disease and death could increase after medical consultations. They had complaints when they had left the consultation with unanswered questions and misconceptions, such as believing that HPV+ is a synonym for cancer. Women accepted the App as a tool to get information and they agreed it can be useful to reduce fears related to HPV-positive results. They would use a mobile-app if the doctor or a health authority recommends it. They believe the app should provide information through videos, illustrations, or infographics, but not by pictures or only text. The app has to offer information on the next steps in the follow-up and medical appointment reminders. Conclusion: Providing information that meets women's needs and counseling could be a way of reducing fears. A mobile-app seems to be an acceptable and suitable tool to provide support to HPV+ women. Funding: This work was supported by a Conquer Cancer International Innovation Grant. Any opinions, findings, and conclusions expressed in this material are those of the author(s) and do not necessarily reflect those of the American Society of Clinical Oncology® or Conquer Cancer®. Citation Format: Victoria Sanchez Antelo, Lucila Szwarc, Paula Frejdkes, Melisa Paolino, Diana Saimovici, Silvia Massaccesi, Silvina Arrossi. Designing a Counseling App to Reduce the Psycho-Social Impact of HPV-Testing: A User-Centered Design Approach [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 97.

Adapting Safety Check as a Universal Suicide Prevention Strategy in Pediatric Primary Care

The presence of unlocked firearms in the home is associated with increased risk of suicide and unintentional injury in youth. We adapted an evidence-based program for promoting safe firearm storage, Safety Check, to enhance its acceptability as a universal suicide prevention strategy in pediatric primary care. We applied ADAPT-ITT, an established adaptation framework, to guide iterative program adaptation with ongoing input from key stakeholders. The present study describes 2 phases of ADAPT-ITT: the Production phase (generating adaptations) and the Topical Experts phase (gathering stakeholder feedback on adaptations). After generating proposed program adaptations based on 3 inputs (stakeholder feedback collected in a prior study, the behavioral science literature, and best practices in pediatric medicine), we elicited feedback from stakeholders with firearm expertise. The adaptations included changes such as clarifying firearm ownership will not be documented in the medical record and offering follow-up reminders. We also crowdsourced feedback from 337 parents to select a new name and program logo. Saturation was reached with 9 stakeholders. Feedback confirmed the value of adaptations that: 1) considered context (eg, reason for ownership), 2) promoted parent autonomy in decision-making, and 3) ensured privacy. The most preferred program name was Suicide and Accident prevention through Family Education (SAFE) Firearm. Guided by an established adaptation framework that prioritized multistage stakeholder feedback, adaptations to the original Safety Check were deemed acceptable. We plan to test the SAFE Firearm program as a universal suicide prevention strategy in pediatric primary care via a hybrid effectiveness-implementation trial.

Current practice patterns of society of urologic oncology members in performing inguinal lymph node staging/therapy for penile cancer: A survey study

ObjectivesInguinal lymph node (ILN) staging and therapeutic procedures are important for the diagnosis and management of suspected Inguinal lymph node metastasis in the setting of penile cancer. Morbidity associated with inguinal lymph node dissection (ILND) and the lack of standardization in its perioperative management are both significant. In this study, we aimed to define current management approaches and potential opportunities for improving outcomes. Methods and materialsA questionnaire was developed with 16 questions regarding pre, peri, and postoperative management of patients undergoing ILND. The questionnaire was approved by the Society of Urologic Oncology (SUO) Questionnaire Committee, which facilitated its dissemination through an initial email and a follow-up reminder to 1,003 members. The study was conducted from July to August, 2020. ResultsOf the 1,003 SUO members invited to participate, 93 responded (9.3% response rate); 49% performed 1 to 2 ILNDs annually, and 60% chose open ILND for high-risk primary cancer cN0. For suspicious lymph nodes > 2 cm, 69% preferred ILND, 86% preoperative systemic neoadjuvant chemotherapy, followed by surgery for bulky inguinal metastasis, and 84% used perioperative antibiotics (ABX), 53% of whom discontinued ABX 24 hours after surgery. Prophylactic anticoagulation was used by 78% of respondents, and 60% stopped it after ambulation. Specific ligation of lymphatics (versus none) was used by 82% of respondents, 55% obtained frozen sections, and 94% used inguinal drains. A saphenous sparing technique was used by 75% of respondents. An incisional wound vacuum device was used by 17% of respondents. Compression stockings and/or referral to a lymphedema specialist were used to manage postoperative lymphedema by 61% of respondents. ConclusionsResponses to a penile lymphadenectomy survey were relatively low and were primarily from the academic surgeon subset of the SUO. Significant consensus ( ≥ 70%) was noted for neoadjuvant chemotherapy for bulky nodal metastasis prior to surgery, perioperative antibiotic use, ligation of lymphatics, drain placement, and saphenous sparing dissection techniques. Other evidenced-based strategies that could decrease morbidity were rarely used, including dynamic sentinel node biopsy, incisional wound vacuums, and lymphedema prevention. Prospective trials are needed to validate and resolve existing treatment paradigms and to optimize perioperative pathways to reduce complications in penile cancer management.

Cervical cancer screening invitations in low and middle income countries: Evidence from Armenia.

Roughly 90 percent of cervical cancer deaths occur in low- and middle-income countries (LMICs), where the lack of adequate infrastructures hampers screening, while informational, cultural, and socio-economic barriers limit participation in the few programs that do exist. We conducted a field experiment with the Armenian cervical cancer screening program to determine whether, despite these barriers, the simple, economical invitation strategies adopted in high-income countries could enhance screening take-up in LMICs. We find that letters of invitation increase screening take-up, especially when there are follow-up reminders. Different ways of framing messages appear to have no impact. Finally, women in rural areas are more likely to respond to invitation by letter, helping to narrow the urban-rural screening gap.