Ideal Care Research Articles

The critical role of education in shaping nurses' attitudes and intentions towards neonatal palliative care: A network analysis

BackgroundNeonatal palliative care is an essential component of comprehensive neonatal care; however, its implementation remains challenging worldwide, particularly in low- and middle-income countries due to limited resources, cultural barriers, and lack of training. ObjectivesThe aim of this study was to investigate the structural characteristics of neonatal nurses' attitudes towards neonatal palliative care and their intention to provide such care using network analysis to identify key influencing factors and interrelationships. DesignA multi-center cross-sectional study. SettingThe setting was 92 hospitals across 28 provinces in mainland China. ParticipantsA convenience sampling method was employed to recruit 893 neonatal nurses from October 2023 to February 2024. MethodsThe web-based survey included a sociodemographic questionnaire, the simplified Chinese version of the Neonatal Palliative Care Attitude Scale (NiPCAS), and a single question gauging participants' intention to provide neonatal palliative care. Network analysis techniques were used to examine the structural characteristics of the attitude network. ResultsA total of 767 valid questionnaires were received. The estimated network comprised 26 nodes representing individual NiPCAS items, with 150 non-zero edges out of a possible 325 connections. In-service education experience emerged as the most central and influential node, demonstrating the highest centrality (strength = 2.511; bridge strength = 3.144) and predictability (R2 = 0.475). This was followed by the ideal palliative care environment and staff support for palliative care. On average, 29.3 % of each item's variance could be accounted for by surrounding items. The strongest associations with the intention to provide neonatal palliative care were observed with beliefs about the necessity of palliative care in neonatal nurse education (edge weight = 0.29). ConclusionsThe findings highlight the pivotal role of in-service education experience in shaping nurses' attitudes towards neonatal palliative care, suggesting that educational interventions may significantly influence overall attitudinal structures. The strong associations between the intention to provide neonatal palliative care, and beliefs about the necessity of palliative care in neonatal nurse education, further reinforce the critical role of education in fostering positive attitudes and intentions. The significance of organizational and resource-related factors suggests that efforts to improve neonatal palliative care should focus on enhancing staff support and creating supportive work environments.

Problems and level of satisfaction of patients during their stay in a tertiary care institute in Punjab

Patient satisfaction can be defined as the degree of congruency between a patient’s expectations of ideal care and his /her perception of the real care (s) he receives. It is a multidimensional aspect and represents a vital key marker for the quality of health care delivery.The cross-sectional study was conducted among the IPD patients in the indoor wards of SGRD Hospital which is a tertiary care hospital. A self-structured questionnaire was used to collect data. Questions regarding twelve potential problems were asked which could have been faced by the respondent during their stay in hospital.A total of 226 respondents were interviewed. 52.2% of the respondents were females and remaining (47.8%) were males. Overall satisfaction of the patients from the IPD services provided by the hospital was found to be 87.2%. Major problems faced by the respondent were difficulty in accessing the hospital (46%) and higher overall cost of treatment than expected (45.6%). Most of the respondents were satisfied with quality of food and water available (97.8%) and quality of linen provided by hospital and sanitary conditions of ward (97.3%).The study suggests that majority of In-patients are highly satisfied with the IPD services provided by the hospital which is highly motivating but every attempt must be made to form new policies and reform existing ones to achieve 100% satisfaction of patients. A number of potential barriers have been discovered in this study. Periodic patient satisfaction survey must be institutionalized in order to continuously improve hospital services. Patient counseling and health education cells could be open where patients and their relatives could solve their queries.

Factors associated with delayed admission to the burn unit: A major burn center’s experience

BackgroundTimely admission to the burn unit is crucial. Ideal burn care requires prompt interventions such as wound and body temperature management, infection control, and fluid resuscitation to prevent complications like burn progression and infection. In this study, we identify specific factors and outcomes associated with delayed admission to a regional burn center. MethodsPatients admitted to a large urban burn center from January 2015 to December 2023 were retrospectively queried, with subsequent collection of demographic and outcome variables from chart review. Descriptive statistics, Welch’s t-tests of unequal variances, and Chi-square analysis were performed. Multiple logistic regression was performed to explore the association between delayed admission and ICU stay, ventilator requirements, and mortality. ResultsA total of 3137 patients were included in the study. Approximately 63.4 % of patients were admitted within 24 h, while 36.6 % had a significant delay in care of over 24 h after injury. Male patients were likely to experience delayed admission (39.0 vs. 31.8 %, p < 0.001). There was no significant difference in age between the two cohorts (38.6 vs. 39.7 years, p = 0.199). There was no significant difference in time to admission by racial background (p = 0.061). Total body surface area burned (TBSA) varied between the delayed and control cohorts (15.5±18.7 % vs. 8.2±12.9 %, p < 0.001). Patients who were single (p < 0.001) and lived alone (p = 0.011) were more likely to experience a delay in burn unit admission. Homelessness (p < 0.001), substance abuse disorder (p < 0.001), and uninsured status (p < 0.001) were also associated with delayed admission. In regression analysis when controlling for TBSA, delay in care was significantly associated with a greater requirement for ICU stay (p < 0.001) and mechanical ventilation (p = 0.021) but was not associated with increased mortality (p = 0.232). ConclusionSociodemographic variables such as homelessness, lack of social support, and substance abuse are associated with delayed burn unit admission. Knowledge of these factors can inform future interventions to improve outcomes for vulnerable patients, promoting better recovery and long-term outcomes after burn injury.

Revolutionizing cancer survivorship: Using human-centered design to build an innovative model for whole-person healing.

355 Background: The cancer care system has struggled for decades to deliver meaningful post-tx survivorship care, relying on patient uptake of clinical guidelines for surveillance, and SCPs for health promotion and managing late effects. On paper, we know how to support survivors. However, there is a lack of “comprehensive guidance on patient-centered practices that specifically address how cancer patients experience their care or how to personalize survivorship so that it meets patients’ unique needs” (Mead et al, 2020). Tofill this gap, we developed an evidence-based, community-delivered model for whole-person healing throughout acute and extended survivorship. Methods: We co-designed a new care model with 24 survivors, shaped by their lived experience &amp; unmet needs. The pilot comprised: A) 2-day in-person retreat to evaluate healing modalities (incl. yoga, journaling, group discussion, nutrition coaching, songwriting); B) a 3-hour human-centered design workshop defining “thriving,” mapping survivorship challenges/gaps &amp; crafting an ideal care map; C) 8-12 weeks of facilitated organic social engagement with their retreat cohort. We conducted the intervention 3x (6/2003-3/2024) with 7-9 participants aged 29-60. Pre-intervention &amp; 4-month post-intervention surveys measured QOL, symptoms &amp; self-efficacy. Participants also did a qualitative survey post-intervention, sharing preferences &amp; activity impact. Results: The model addresses cancer's proximal/distal psychological, emotional, physical &amp; existential impacts. It builds a connected survivor community &amp; drives long-term behavior change with group accountability. The intervention: A) reduced fears of recurrence &amp; preoccupation with functional concerns &amp; indicated positive changes in self-concept; B) improved social connectedness. 86% agreed/strongly agreed they felt seen &amp; understood; 100% strongly agreed that they can implement 1+ new wellness/healing tool in daily life; 80% increase in confidence keeping emotional distress from interfering with life; 40% reduction in perception of cancer/Tx causing negative changes in self-concept; 60% increase in confidence keeping fatigue from interfering with life. Conclusions: A new model of post-treatment survivorship care is needed that aligns with oncology and primary care delivery, builds on the modern wellness movement, and is able to be sustained in daily life. Survivorship can be delivered in the community leveraging in-person/virtual retreats, workshops, apps and social networks. This intervention shows potential to transform survivorship care delivery &amp; radically improve outcomes.

Hemochromatosis - too much iron

Hemochromatosis is a disorder of genetic origin which affects iron hemostasis, resulting in an increased transferrin saturation, hyperferritinemia and parenchymal iron overload.Recently, a new system for the classification of hemochromatosis has been proposed, wherein patients are separated into 4 groups, based on the disease affected iron regulatory genes. Excess iron and increased transferrin saturation results in the formation of non-transferrin bound iron which leads to tissue damage. Hemochromatosis is a common genetic disease, but screening of the general population is not routinely recommended. In order to provide ideal care for hemochromatosis patients, it is crucial to delineate hemochromatosis from other causes of hyperferritinemia, which is a common finding in patients with metabolic disorders. This article summarizes the diagnostic algorithm for hemochromatosis. Furthermore, recommendations for optimal care - including targets for phlebotomy - are discussed.

Effectiveness of the 5As Model-Based Transitional Care Program among Chinese Patients with Type B Aortic Dissection Post-TEVAR: A Randomized Controlled Trial.

Thoracic aortic endovascular repair (TEVAR) is the primary treatment for Stanford type B aortic dissection (type B AD). However, patients often encounter significant difficulties post-TEVAR that endanger their safety when transitioning from hospital- to home-based care. Moreover, information on the ideal transitional care for patients with type B AD post-TEVAR is scarce in China. This single-masked randomized clinical trial aimed to assess the effectiveness of the Assess, Advise, Agree, Assist, and Arrange (5As) model-based transitional care in improving discharge preparation level and transitional care quality post-TEVAR among patients with type B AD in China. This study was conducted at a hospital in China between January 2021 and October 2021. Patients with type B AD were randomly divided into intervention and control groups. Participants in the intervention group received the 5As model-based transitional nursing care. The 5As model is an evidence-based intervention strategy comprising: (1) Assess: assessing the preoperative cardiovascular risk behavior of patients with AD. (2) Advise: making suggestions according to the risk behaviors of the patients. (3) Agree: reaching a consensus on goals and action plans by making decisions with the patients and their families. (4) Assist: assisting patients in solving obstacles to implementing health plans. (5) Arrange: arranging follow-up visits according to the actual situation of the patients and guiding them in adhering to a schedule. The control group received the usual nursing care for the same duration and number of follow-up visits. A trained research nurse collected all the baseline data of the patients on admission, assessed discharge readiness level (using the Readiness for Hospital Discharge Scale) on the day of discharge, and collected transitional quality of care (by the Care Transition Measure-15) data on day 30 after discharge. Overall, 72 patients with type B AD were recruited. Discharge readiness level and transitional care quality in the intervention group were significantly superior to those in the control group. This study showed that the 5As model-based transitional care program can effectively promote discharge readiness and transitional care quality of patients with type B AD post-TEVAR. The Chinese Clinical Trial Registry Center: ChiCTR2200060797 (https://www.chictr.org.cn/showproj.html?proj=167403).

The Evolution of Patient Satisfaction in Postoperative Care: The Impact of Investments and the Algorithm for Assessing Significant Growth over the Last 5 Years.

An analysis of patient satisfaction in the context of healthcare reflects the patient's perception of actual care through the prism of their expectations of ideal care. A study was conducted to investigate patient satisfaction with postoperative care in the context of improvements in hospital medical services (renovations and modernization of operating rooms and wards with beds, endowments in medical equipment for investigation and treatment, new work procedures, and revisions of existing procedures). Statistical analysis was performed based on the questionnaires distributed to patients hospitalized in the surgical wards of the Bihor County Emergency Clinical Hospital, between 2019 and 2023. A total of 4018 questionnaires were collected, and after the elimination of questionnaires with incomplete or incorrect data, 3985 remained in the analysis. Of the total of 2994 people who reported having undergone surgery, a total of 2090 responded to the questions that focused on postoperative care and overall impression of the hospital. No statistically significant differences in patient satisfaction by sociodemographic factors were found. A statistically significant increase in patient satisfaction with postoperative care and overall impression of the hospital was observed over the last 5 years. Correlation testing between postoperative care responses and overall impression, using the Sperman method, shows a directly proportional relationship between the two variables. In the future, it is necessary to extend the patient satisfaction questionnaire to comprehensively analyze the surgical component in order to identify gaps in postoperative care, helping decision makers to improve the medical services provided to patients.

Characteristics of people diagnosed with dementia vs lung cancer and cardiovascular disease at commencement of community palliative care: a population–based study

BackgroundMost people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD).MethodsThis is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients’ functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups—Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively.ResultsOverall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 – 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 – 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 – 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 – 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms.ConclusionCommunity palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia.

Textbook outcome in short bowel syndrome

BackgroundTextbook outcome (TO) is a single composite score representing ideal care for a procedure or medical condition. Short bowel syndrome (SBS) patients are at high risk for complications and death. Our aim was to determine the incidence of and predictive factors for a TO in SBS patients. Methods515 adults with SBS were followed for 12 months after initial hospital discharge for SBS. TO was defined based on eight outcome parameters. Demographic data, intestinal anatomy, and nutritional outcome were compared in patients with and without TO. Results78 (15 ​%) patients had a TO. The frequency of the different components of TO were: PN ​< ​1 year (39 ​%), BMI >18.5 ​kg/m2 (89 ​%), no stoma (59 ​%), no surgical intervention (71 ​%), no hospital readmission (56 ​%), no vascular access infection (62 ​%), absence of end stage liver disease (96 ​%), and survival (97 ​%). Intestinal remnant length and anatomy type were predictive of a TO. ConclusionsA TO is achieved in 15 ​% SBS patients using the selected criteria. This is largely attributable to continued need for PN. Intestinal length and anatomy were independent predictors of TO.

Using Twitter (X) to Mobilize Knowledge for First Contact Physiotherapists: Qualitative Study.

Twitter (now X) is a digital social network commonly used by health care professionals. Little is known about whether it helps health care professionals to share, mobilize, and cocreate knowledge or reduce the time between research knowledge being created and used in clinical practice (the evidence-to-practice gap). Musculoskeletal first contact physiotherapists (FCPs) are primary care specialists who diagnose and treat people with musculoskeletal conditions without needing to see their general practitioner (family physician) first. They often work as a sole FCP in practice; hence, they are an ideal health care professional group with whom to explore knowledge mobilization using Twitter. We aimed to explore how Twitter is and can be used to mobilize knowledge, including research findings, to inform FCPs' clinical practice. Semistructured interviews of FCPs with experience of working in English primary care were conducted. FCPs were purposively sampled based on employment arrangements and Twitter use. Recruitment was accomplished via known FCP networks and Twitter, supplemented by snowball sampling. Interviews were conducted digitally and used a topic guide exploring FCP's perceptions and experiences of accessing knowledge, via Twitter, for clinical practice. Data were analyzed thematically and informed by the knowledge mobilization mindlines model. Public contributors were involved throughout. In total, 19 FCPs consented to the interview (Twitter users, n=14 and female, n=9). Three themes were identified: (1) How Twitter meets the needs of FCPs, (2) Twitter and a journey of knowledge to support clinical practice, and (3) factors impeding knowledge sharing on Twitter. FCPs described needs relating to isolated working practices, time demands, and role uncertainty. Twitter provided rapid access to succinct knowledge, the opportunity to network, and peer reassurance regarding clinical cases, evidence, and policy. FCPs took a journey of knowledge exchange on Twitter, including scrolling for knowledge, filtering for credibility and adapting knowledge for in-service training and clinical practice. Participants engaged best with images and infographics. FCPs described misinformation, bias, echo chambers, unprofessionalism, hostility, privacy concerns and blurred personal boundaries as factors impeding knowledge sharing on Twitter. Consequently, many did not feel confident enough to actively participate on Twitter. This study explores how Twitter is and can be used to mobilize knowledge to inform FCP clinical practice. Twitter can meet the knowledge needs of FCPs through rapid access to succinct knowledge, networking opportunities, and professional reassurance. The journey of knowledge exchange from Twitter to clinical practice can be explained by considering the mindlines model, which describes how FCPs exchange knowledge in digital and offline contexts. Findings demonstrate that Twitter can be a useful adjunct to FCP practice, although several factors impede knowledge sharing on the platform. We recommend social media training and enhanced governance guidance from professional bodies to support the use of Twitter for knowledge mobilization.

Dementia Ideal Care: Ecosystem Map of Best Practices and Care Pathways Enhanced by Technology and Community.

Globally, much work has been done by nonprofit, private, and academic groups to develop best practices for the care of people living with dementia (PLWD), including Alzheimer's disease. However, these best practices reside in disparate repositories and tend to focus on one phase of the patient journey or one relevant group. To fill this gap, we developed a Dementia Ideal Care Map that everyone in the dementia ecosystem can use as an actionable tool for awareness, policy development, funding, research, training, service delivery, and technology design. The intended audience includes (and not limited to) policymakers, academia, industry, technology developers, health system leaders, clinicians, social service providers, patient advocates, PLWD, their families, and communities at large. A search was conducted for published dementia care best practices and quality measures, which were then summarized in a visual diagram. The draft diagram was analyzed to identify barriers to ideal care. Then, additional processes, services, technologies, and quality measures to overcome those challenges were brainstormed. Feedback was then obtained from experts. The Dementia Ideal Care Map summarizes the ecosystem of over 200 best practices, nearly 100 technology enablers, other infrastructure, and enhanced care pathways in one comprehensive diagram. It includes psychosocial interventions, care partner support, community-based organizations; awareness, risk reduction; initial detection, diagnosis, ongoing medical care; governments, payers, health systems, businesses, data, research, and training. Dementia Ideal Care Map is a practical tool for planning and coordinating dementia care. This visualized ecosystem approach can be applied to other conditions.

Improving Care Beyond Birth: A Qualitative Study of Postpartum Care After High-Risk Pregnancy.

Background: The postpartum period is a window to engage birthing people in their long-term health and facilitate connections to comprehensive care. However, postpartum systems often fail to transition high-risk patients from obstetric to primary care. Exploring patient experiences can be helpful for optimizing systems of postpartum care. Methods: This is a qualitative study of high-risk pregnant and postpartum individuals. We conducted in-depth interviews with 20 high-risk pregnant or postpartum people. Interviews explored personal experiences of postpartum care planning, coordination of care between providers, and patients' perception of ideal care transitions. We performed thematic analysis using the Capability, Opportunity, Motivation, Behavior (COM-B) model of behavior change as a framework. COM-B allowed for a formal structure to assess participants' ability to access postpartum care and primary care reengagement after delivery. Results: Participants universally identified difficulty accessing primary care in the postpartum period, with the most frequently reported barriers being lack of knowledge and supportive environments. Insufficient preparation, inadequate prenatal counseling, and lack of standardized care transitions were the most significant barriers to primary care reengagement. Participants who most successfully engaged in primary care had postpartum care plans, coordination between obstetric and primary care, and access to material resources. Conclusions: High-risk postpartum individuals do not receive effective counseling on the importance of primary care engagement after delivery. System-level challenges and lack of care coordination also hinder access to primary care. Future interventions should include prenatal education on the benefits of primary care follow-up, structured postpartum planning, and system-level improvements in obstetric and primary care provider communication.

Evaluating Quality of Care for Patients with Asthma in the Readmission Penalty Era.

Rationale: Asthma poses a significant burden for U.S. patients and health systems, yet inpatient care quality is understudied. National chronic obstructive lung disease (COPD) readmission policies may affect inpatient asthma care through hospital responses to these policies because of imprecise diagnosis and identification of patients with COPD and asthma. Objectives: Evaluate inpatient care quality for patients hospitalized with asthma and potential collateral effects of the Medicare COPD Hospital Readmissions Reduction Program (HRRP). Methods: This was a retrospective cohort study of patients aged 18-54 years hospitalized for asthma across 924 U.S. hospitals (Premier Healthcare Database). Results: Care quality for patients with asthma was evaluated before HRRP implementation (n = 20,820; January 2010-September 2014) and after HRRP implementation (n = 26,885; October 2014-December 2018) using adherence to inpatient care guidelines (recommended, nonrecommended, and "ideal care" [all recommended with no nonrecommended care]). Between 2010 and 2018, at least 80% of patients received recommended care annually. Recommended care decreased similarly (rate of 0.02%/mo) after versus before HRRP (P = 0.8). Nonrecommended care decreased more rapidly after HRRP (rate of 0.29%/mo) versus before HRRP (rate of 0.17%/mo; P < 0.001), with changes driven largely by decreased antibiotic prescribing. Ideal care increased more rapidly after HRRP (rate of 0.25%/mo) versus before HRRP (rate of 0.17%/mo; P = 0.02), with changes driven largely by nonrecommended care improvements. Conclusions: Post-HRRP trends suggest asthma care improved with increased rates of guideline concordance in nonrecommended and ideal care. Although federal policies (e.g., HRRP) may have had positive collateral effects, such as with asthma care, parallel care efforts, including antibiotic stewardship, likely contributed to these improvements.

It's Current: NAEC Provides Us With the Recipe to Build a Better Epilepsy Center.

The National Association of Epilepsy Centers (NAEC) recently published their updated guidelines for specialized epilepsy centers. The first NAEC guidelines provided basic expectations for in-patient care, with the goal of makingan accurate diagnosis and choose the best intervention- medical or surgical. With the 2001 report, the emphasis was for epilepsy centers to be able to provide comprehensive diagnostic and treatment services. The NAEC 2010 guidelines further delineated the essential elements of level 3 and 4 specialized epilepsy centers.The goal of the 2023 guidelines is not only to provide optimal standards of care, but also to "elevate evidence-based science into standard practice."4 Therefore, these are the first NAEC guidelines that are solely funded by NAEC and also the first founded on an evidence-informed, consensus-based process. The 2023 guidelines now include 52 recommendations across the following domains: Inpatient Services/EMU, Surgery, Diagnostic Evaluation, and Outpatient Services. The guidelines provide us with the recommendations when creating new centers or ways to improve our current centers. Well- documented guidelines such as these provide us with support when seeking additional financial and personnel resources. Put simply, these guidelines have provided us with the recipe for ideal comprehensive epilepsy care for PWE.

Projected Life Expectancy for Adolescents With HIV in the US

Life expectancy is a key measure of overall population health. Life expectancy estimates for youth with HIV in the US are needed in the current HIV care and treatment context to guide health policies and resource allocation. To compare life expectancy between 18-year-old youth with perinatally acquired HIV (PHIV), youth with nonperinatally acquired HIV (NPHIV), and youth without HIV. Using a US-focused adolescent-specific Monte Carlo state-transition HIV model, we simulated individuals from age 18 years until death. We estimated probabilities of HIV treatment and care engagement, HIV progression, clinical events, and mortality from observational cohorts and clinical trials for model input parameters. The simulated individuals were 18-year-old race and ethnicity-matched youth with PHIV, youth with NPHIV, and youth without HIV; 47%, 85%, and 50% were assigned male sex at birth, respectively. Individuals were categorized by US Centers for Disease Control and Prevention-defined HIV acquisition risk: men who have sex with men, people who ever injected drugs, heterosexually active individuals at increased risk for HIV infection, or average risk for HIV infection. Distributions were 3%, 2%, 12%, and 83% for youth with PHIV and youth without HIV, and 80%, 6%, 14%, and 0% for youth with NPHIV, respectively. Among the simulated youth in this analysis, individuals were 61% Black, 24% Hispanic, and 15% White, respectively. HIV status by timing of acquisition. Life expectancy loss for youth with PHIV and youth with NPHIV: difference between mean projected life expectancy under current and ideal HIV care scenarios compared with youth without HIV. Uncertainty intervals reflect varying adolescent HIV-related mortality inputs (95% CIs). Compared with youth without HIV (life expectancy: male, 76.3 years; female, 81.7 years), male youth with PHIV and youth with NPHIV had projected life expectancy losses of 10.4 years (95% CI, 5.5-18.1) and 15.0 years (95% CI, 9.3-26.8); female youth with PHIV and youth with NPHIV had projected life expectancy losses of 11.8 years (95% CI, 6.4-20.2) and 19.5 years (95% CI, 13.8-31.6), respectively. When receiving ideal HIV care, life expectancy losses were projected to improve for youth with PHIV (male: 0.5 years [95% CI, 0.3-1.8]: female: 0.6 years [95% CI, 0.4-2.1]) but were projected to persist for youth with NPHIV (male: 6.0 years [95% CI, 5.0-9.1]; female: 10.4 years [95% CI, 9.4-13.6]). This adolescent-focused microsimulation modeling analysis projected that youth with HIV would have shorter life expectancy than youth without HIV. Projected differences were larger for youth with NPHIV compared with youth with PHIV. Differences in mortality by sex at birth, sexual behavior, and injection drug use contributed to lower projected life expectancy among youth with NPHIV. Interventions focused on HIV care and social factors are needed to improve life expectancy for youth with HIV in the US.

Shortcomings of Current PCOS Care: Provider Bias and Provider–Patient Goal Misalignment [ID 2683466

INTRODUCTION: Polycystic ovary syndrome (PCOS) affects 5–7 million people. Diagnosis is often only achieved after long delays and multiple opinions. We conducted focus groups to elucidate patient experience with diagnosis and treatment in PCOS. METHODS: We conducted semistructured virtual focus groups of individuals with diagnosed or suspected PCOS recruited from a university hospital obstetrics and gynecology clinic. Questions focused on experiences of bias in PCOS care and opportunities to improve care approaches. Rapid qualitative analysis of focus group transcripts was performed. RESULTS: Participants' (n=24) median age was 29 years. Three were non-White, eight Hispanic or Latino ethnicity, and one other than female gender. Provider bias influenced PCOS diagnosis: PCOS testing was delayed in those with smaller bodies, while symptoms of participants with larger bodies were attributed to body weight rather than to medical conditions. Provider recommendations were frequently misaligned with patients' needs and goals: Providers focused on weight loss when other approaches were requested, and fertility was centered, even for patients not desiring childbearing. Providers assumed and mistrusted patient reports of health behaviors: Larger body size was assumed to imply poor dietary habits and sedentary lifestyle. Participants frequently self-advocated to access testing, alternate treatments, and specialists. Conceptualizations of ideal PCOS care included centering patients' goals, access to specialists, and care coordination. Participants desired PCOS education, resources, and support for themselves and their communities. CONCLUSION: Provider bias and misalignment with patients' goals are common experiences in PCOS care. Centering patients’ goals, addressing weight bias, and creating additional PCOS educational and support resources are earnestly needed.

Integration of the geriatric palliative care in oncological care of elderly patient with cancer.

The objective of this article is to describe the profile of the population attended to by the palliative geriatrics clinic and to evaluate the symptomatic control derived from the care provided. During 2017 a model based on a holistic approach was implemented, in this model the team geriatric palliative care plays a fundamental role by being part of the palliative care team and functioning as a liaison with the oncology team and other required services. We outlined the profile of 100 patients aged 70 and older seen between 2017 and 2019 at our geriatric palliative care clinic. Descriptive statistics were used. In addition, the symptoms and the care clinic model effect on the symptomatic control were analyzed, as well as the complexity of patients in palliative care with IDC-Pal. The patients median age was 83.5 years. Patients were classified by type of management: 47% within the supportive care group and 53% with palliative care only; 58% had metastatic disease and 84% presented at least 1 comorbidity. Frailty was observed in 78% and a Karnofsky scale of 60 or less was observed in 59% of the overall population. Elderly cancer patients have a complex profile and may have multiple needs. Integrating geriatric palliative care can help to provide better and personalized care along with symptomatic control. Further studies are required to establish the ideal care model for these patients. Importantly, a personalized treatment with a geriatric palliative care specialist is a key element.

A92 THE CURRENT STATE OF PEDIATRIC TO ADULT TRANSITION OF CARE: A ROUND TABLE DISCUSSION WITH KEY STAKEHOLDER GROUPS

Abstract Background There is a severe paucity in available resources to facilitate a safe and effective pediatric to adult health care transition for patients with chronic disease. Aims This study aims to better understand the experiences of key stakeholder groups involved in pediatric to adult transition of care across various chronic disease specialties within a tertiary care urban environment. Methods A focus group was conducted on July 12th, 2018 at Women’s College Hospital with key stakeholder groups. Questions focused on the top issues related to pediatric to adult transition of care and an ideal transition model for their respective patient populations. The second part of this study included individual interviews with patients and carepartners. Focus group meetings and individual interviews were both audio-recorded and transcribed for qualitative thematic analysis. Results Seventeen pediatric and adult care physicians representing ten chronic disease specialties were represented. Seven patients and care partners were interviewed. Major focus group themes included: disproportionate access to resources between and within specialties (n=10), lack of mental health support in the adult setting (n=8), fragmentation of care due to multiple providers as a result of patients leaving for employment or education (n=6), patients feeling alienated due to decrease in allied health support or due to shorter appointment times (n=8), and difficulty retaining consistent care due to missed appointments as a result of inconsistent communications or change in location for education or employment (n=7). Ideal care models were suggested to include: centralized intake procedure to identify patients who may require extra support (n=9), education for scheduling administrators about second chances after a no-show (n=5), implementation of joint clinics with pediatric and adult care teams or back-and-forth clinic sessions to ensure bidirectional provider comfort before discharge to adult care system (n=4), and implementation of a dedicated transitions navigator or point of contact for patients (n=10). The individual patient and carepartner interviews emphasized the need for: centralized and comprehensive online resource (n=7), simple and clear educational content introducing the adult healthcare system (n=7), opportunities to meet and share information with other individuals in a similar position (n=3), and availability of a transitions navigator (n=4). Conclusions Current pediatric to adult transition of care resources are fragmented, allocated inefficiently, difficult to ascertain and often constrained to a specific condition or location. Future efforts should focus on improving the care transition process for high-risk patient populations by taking a comprehensive approach utilizing innovative, and multidisciplinary solutions. Funding Agencies None

Hypochlorous acid-the future of wound care?

Dear Editor, Wounds, especially chronic wounds and associated infections, impose a substantial burden on individuals and healthcare systems, leading to escalated morbidity rates and a significant ris in healthcare costs. Chronic wounds create ideal conditions for infection and the formation of biofilms, making it essential to implement comprehensive wound care techniques to promote wound healing1. Antiseptics are substances that impede or eradicate pathogens found within wounds or on the skin. Iodine-based agents such as povidone-iodine (PVP-I) have been used to treat wounds for decades. PVP-I is widely used and accepted due to its broad activity spectrum against gram-positive and negative bacteria, no development of cross-resistance upon use and its ability to penetrate biofilms. While being widely utilized worldwide, certain concerns have been raised regarding hypersensitivity, inadequate penetration, and potential cytotoxicity on host cells associated with its use. Reports have emerged documenting instances of both immediate and delayed allergic reactions to PVP-I. There have also been reports of iodine toxicity in patients when PVP-I was used as a constant wound irrigant2. Hypochlorous acid (HOCl) is a potent antimicrobial compound naturally synthesized by the immune system. It exhibits remarkable efficacy against a wide range of bacterial, viral, and fungal pathogens, effectively neutralizing their presence. A study conducted by Sakarya et al. concluded that stabilized HOCl solution is minimally allergenic as it’s produced naturally in the body and is also an ideal wound care solution3. A few comparative studies have been conducted between HOCl and PVP-I. In very recent research, it was concluded that in neonatal circumcision, the group of patients that used PVP-I had a greater occurrence of edema and delayed wound healing as compared to patients that used HOCl4. Moreover, PVP-I has been demonstrated to be cytotoxic to cellular components of wound healing while HOCl controls bacterial spread without disrupting the wound healing process as it is non-cytotoxic to cells at concentrations that achieve antimicrobial action. The amount of exudate also decreases when Hypochlorous acid is used instead of Povidone iodine5. To sum it up, Physicians and nurses face a formidable hurdle in identifying a topical antiseptic agent that is both safe and efficacious. PVP-I is being widely used as an antiseptic agent for wound healing but patients do experience some side effects. Research suggests that hypochlorous acid is also an effective option to treat lesions with less adverse effects, although more research should be conducted to reach absolute conclusive results.

Study on Long-Term Care Service Awareness, Needs, and Usage Intention of Older Adult Male Homosexuals in Taiwan and Their Ideal Long-Term Care Service Model.

As the significance of long-term care services for older adults becomes more pronounced in Taiwan, especially considering the intensifying trend of an aging population, there remains a lack of comprehensive attention to the long-term care needs and experiences of older adult individuals within the LGBTQ+ community. The present study examines the long-term care service awareness, needs, and usage intention of older adult male homosexuals in Taiwan and assesses their ideal long-term care service model. This study of five older adult male homosexual subjects aged 66 to 73 years is intended as a preliminary exploration. Interviews were used to collect data. The study determined that the five subjects displayed high awareness of long-term care services, as they possessed actual experience of these services or had even participated in care service staff training to obtain certificates. Some even had experience in applying for home care services and reported problems during use. The subjects perceived that they were very likely to require long-term care services in the future and tended to opt for home care services if they required long-term support. Due to their personal experiences, the subjects displayed negative awareness of long-term care services and expressed worry that long-term care service staff harbored poor attitudes toward homosexuals. The subjects considered the most important aspects of long-term care to be basic medical care and lifestyle care. However, they worried that long-term care staff would delay or refuse to provide such services due to the subjects' sexual orientation or stereotypes related to it, and they were concerned above all about the "friendly attitude" of long-term care staff. They hoped that long-term care staff were friendly toward homosexuals and did not discriminate against them, feeling that it would be more appropriate for homosexual long-term care staff to provide assistance. In terms of vision, while preferring organizations with homosexual employees, the subjects worried that they would be stigmatized and discriminated against. Regarding ideal long-term care services, while considering institutions with homosexual staff to be ideal, the subjects also worried that these would be labeled as institutions that were dedicated to homosexuals, potentially resulting in discrimination. Therefore, they hoped that the sexuality sensitivity of long-term care staff could be improved and that they would undergo professional continuing education to learn about homosexuals, their situations, and care needs.