Implementation Of Interventions Research Articles

Design and rationale of the Botswana Smoking Abstinence Reinforcement Trial: a protocol for a stepped-wedge cluster randomized trial

BackgroundWith expanded and sustained availability of HIV treatment resulting in substantial improvements in life expectancy, the need to address modifiable risk factors associated with leading causes of death among people living with HIV/AIDS (PLWH), such as tobacco smoking, has increased. Tobacco use is highly prevalent among PLWH, especially in southern Africa, where HIV is heavily concentrated, and many people who smoke would like to quit but are unable to do so without assistance. SBIRT (Screening, Brief Intervention and Referral to Treatment) is a well-established evidence-based approach successful at supporting smoking cessation in a variety of settings. Varenicline is efficacious in supporting smoking cessation. We intend to assess the effectiveness of SBIRT and varenicline on smoking cessation among PLWH in Botswana and the effectiveness of our implementation.MethodsBSMART (Botswana Smoking Abstinence Reinforcement Trial) is a stepped-wedge, cluster randomized, hybrid Type 2 effectiveness-implementation study guided by the RE-AIM framework, to evaluate the effectiveness and implementation of an SBIRT intervention consisting of the 5As compared to an enhanced standard of care. SBIRT will be delivered by trained lay health workers (LHWs), followed by referral to treatment with varenicline prescribed and monitored by trained nurse prescribers in a network of outpatient HIV care facilities. Seven hundred and fifty people living with HIV who smoke daily and have been receiving HIV care and treatment at one of 15 health facilities will be recruited if they are up to 18 years of age and willing to provide informed consent to participate in the study.DiscussionBSMART tests a scalable approach to achieve and sustain smoking abstinence implemented in a sustainable way. Integrating an evidence-based approach such as SBIRT, into an HIV care system presents an important opportunity to establish and evaluate a modifiable cancer prevention strategy in a middle-income country (MIC) setting where both LHW and non-physician clinicians are widely used. The findings, including the preliminary cost-effectiveness, will provide evidence to guide the Botswanan government and similar countries as they strive to provide affordable smoking cessation support at scale.Clinical trial registrationNCT05694637 Registered on 7 December 2022 on clinicaltrials.gov, https://clinicaltrials.gov/search?locStr=Botswana&country=Botswana&cond=Smoking%20Cessation&intr=SBIRT

Seeing One Another: The Creation of the Sawubona Healing Circles

In 2020, the Association of Black Psychologists (ABPsi) drew attention to the history of racism in the United States on the creation and exacerbation of extant medical racial inequities to the detriment of Black individuals. Recognizing that solutions based solely in Western frameworks cannot fully address the mental health needs of Black individuals, ABPsi devoted collaborative efforts to develop culturally grounding healing responses for the unique experiences of race-based invisibility and trauma. Additionally, amid the pandemic, individuals of African-descent experienced various mass racial traumas, including a wave of widely publicized police violence. Beginning with COVID-19, these intersecting pandemics of racism elucidated the need for healing, particularly culturally grounding healing. In consultation with the Black Family Summit, ABPsi developed a pilot investigation, the Sawubona Healing Circle (SHC) initiative, which are culturally grounding healing circles to support Black first responders. Using an African-centered worldview, the circles recognize and validate the specific constellation of anti-Black traumas and stressors, equipping them with African-centered healing methods. This paper outlines the theory, development, implementation, and initial evaluation of the SHC intervention.

Adapting and Evaluating a Theory-Driven, Non-Pharmacological Intervention to Self-Manage Pain.

The existing literature has limited detail on theory-driven interventions, particularly in pain studies. We adapted Bandura's self-efficacy framework toward a theory-driven, non-pharmacological intervention using auricular point acupressure (APA) and evaluated participants' perceptions of this intervention on their pain self-management. APA is a non-invasive modality based on auricular acupuncture principles. We mapped our study intervention components according to Bandura's key sources of self-efficacy (performance accomplishments, vicarious experience, verbal persuasion, and emotional arousal) to facilitate the self-management of pain. Through a qualitative study design, we conducted virtual interviews at one and three months after a 4-week APA intervention among 23 participants using purposive sampling to describe their experiences in managing their pain based on our theory-driven APA intervention. Using thematic analyses, we found four themes: the enhanced self-management of pain, improved pain outcomes, the feasibility of technology, and the sustainability of APA. Describing how interventions are mapped according to the elements of theoretical frameworks can help to guide intervention development, advance science and knowledge development, and promote the implementation of interventions. As such, using Bandura's self-efficacy theory as a foundation for the APA intervention, APA was found to be feasible and sustainable, improving self-management, pain intensity, and pain-related outcomes. Participants provided recommendations for the further improvement of this theory-driven intervention.

Synthesis of Writing Intervention Studies for English Learners With Learning Disabilities

Writing is an essential skill that people use throughout their lifetime. Although previous systematic reviews and meta-analyses had reviewed the effect of writing interventions on students with learning disabilities and English learners, we know little about the effective writing process-types interventions for English learners with or at risk for learning disabilities (ELs with LD). Therefore, this systematic review identified and synthesized seven writing intervention studies that include ELs with LD. We further analyzed participant characteristics, interventionist characteristics, instructional methods, and intervention outcomes across studies. The result showed the scarcity of quantitative intervention studies in the area. Some commonly implemented intervention elements are identified and discussed, as well as implications, limitations, and future directions.

Social Capital and Community Development

Purpose: This study sought to investigate the concept of social capital and its role in promoting community development and resilience, with a focus on practical interventions and policy implications. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to social capital and community development. In this study on social capital and community development, while all authors contribute to the overarching theme, one author stands out for discussing a slightly different topic. Specifically, the author who emphasizes the economic advantages of robust social capital within a community diverges somewhat from the others. While the study as a whole examines various aspects of community development, including economic prosperity, social cohesion, and resilience, this particular author delves deeper into the specific mechanisms through which social capital enhances economic opportunities, such as access to resources, markets, and employment. Therefore, this author's focus on the economic dimension of social capital provides a unique perspective within the broader context of community development discussed by the other authors. Unique Contribution to Theory, Practice and Policy: The Social Capital theory, Community Empowerment theory and Structural Functionalism theory may be used to anchor future studies on the concept of social capital and its role in promoting community development and resilience. The study made several recommendations that contributed to theory, practice, and policy in the field. It suggested further exploration of the mechanisms linking social capital to community development outcomes, integration of social capital considerations into policy frameworks, and implementation of community-based interventions. Additionally, the study emphasized the importance of capacity-building efforts, collaborative partnerships among stakeholders, and robust monitoring and evaluation mechanisms. By investing in these recommendations, stakeholders aimed to foster resilient, inclusive, and thriving communities, leveraging social capital as a catalyst for positive social change.

Primary Immunodeficiency Disorders (PIDs) and its Rheumatologic Manifestations Mohammad Imnul Islam

The hallmark of Primary Immunodeficiency Disorders (PIDs) is increased susceptibility to recurrent infections, which are often poorly responsive to therapy, prolonged and life-threatening. The infections can involve bones and joints. PIDs may also predispose to allergic, autoimmune, autoinflammatory and malignant disorders. Arthritis is the most common rheumatological manifestation of PIDs. Recurrent septic arthritis, arthritis with increased susceptibility to infection, skeletal changes, autoimmune disease or systemic lupus erythematosus with negative antinuclear antibody (ANA) are the essential clinical clues that could be considered rheumatologic manifestations of PIDs. This is considerable concern that early detection of PIDs patients invariably improves the quality of life and life expectancy through the prompt implementation of appropriate medical intervention. BANGLADESH J CHILD HEALTH 2022; VOL 46 (2) : 82-85

Sex differences in health-related quality of life and poverty risk among older people living with HIV in Spain: A cross-sectional study.

Current antiretroviral therapies have increased the life expectancy of people living with HIV (PLHIV). There is, however, limited evidence regarding the health-related quality of life (HRQoL) and living conditions of older people living with HIV (OPLHIV) in Spain. We implemented a self-administered online questionnaire to identify sex differences in HRQoL and poverty risk among Spanish OPLHIV (PLHIV ≥50 years). Participants were contacted through non-governmental organisations. We used the standardised WHOQoL-HIV BREF questionnaire and the Europe 2020 guidelines to estimate HRQoL and poverty risk respectively. The statistical analysis included multivariable generalised linear models with potential confounding variables and robust estimates. The study included 247 OPLHIV (192 men and 55 women). On the WHOQoL-HIV BREF questionnaire, men scored higher on 84% of items and in all six domains. Women had significantly lower HRQoL in five domains: physical health (β: -1.5; 95% CI: -2.5, -0.5; p: 0.002), psychological health (β: -1.0; 95% CI: -1.9, -0.1; p: 0.036), level of independence (β: -1.1; 95% CI: -1.9, -0.2; p: 0.019), environmental health (β: -1.1; 95% CI: -1.8, -0.3; p: 0.008), and spirituality/personal beliefs (β: -1.4; 95% CI: -2.5, -0.3; p: 0.012). No statistical differences were found in the domain of social relations. Poverty risk was considerable for both men (30%) and women (53%), but women were significantly more likely to experience it (OR: 2.9; 95% CI: 1.3, 6.5; p: 0.009). The aging of PLHIV is a public health concern. Our findings indicate that HRQoL and poverty risk among Spanish OPLHIV differ significantly by sex. Spain should, therefore, implement specific policies and interventions to address OPLHIV needs. The strategies must place a high priority on the reduction of sex inequalities in HRQoL and the enhancement of the structural conditions in which OPLHIV live.

Imagining and implementing healthy city interventions: Combined results from parallel concept mapping exercises in Montreal with community members and stakeholders.

Built environment interventions provide structural solutions to complex urban challenges. Though community voices are part of municipal decision-making, planners and public health professionals need tools to better integrate their perspectives for desired changes (what) when implementing built environment interventions (how). We present two simultaneous concept mapping exercises conducted in Montréal, Canada, to facilitate the consideration of these dimensions. Community members were prompted about neighbourhood changes that could improve their quality of life; stakeholders were prompted about factors that contribute to successful implementation of interventions. Through each exercise, items were generated, grouped, and rated on importance and feasibility. Concept maps were produced using multidimensional scaling and hierarchical cluster analysis. The clusters identified by community members and stakeholders were combined into a Community × Stakeholder Matrix, which supported discussions on interventions with the research's Advisory Committee. Thirty-two community members generated 41 responses, which resulted in 6 clusters: (1) strengthen public transportation, (2) reduce space dedicated to cars, (3) foster local social connections, (4) develop quality cycling infrastructure, (5) improve pedestrian accessibility, and (6) green the city. Thirty-seven stakeholders generated 40 items, which resulted in 5 clusters: (1) collaboration with stakeholders and citizens, (2) planning and evaluation, (3) common vision for the future, (4) regulatory framework and funding, and (5) context-informed approach. Capturing the collective vision of our urban environments and the processes underlying change through concept mapping can lead to more successful changes. We propose combining understandings of the what and how into a matrix to support evaluation and strategic planning of interventions and better integrate community voices into operational planning.

The Ergonomic Behaviors Evaluation Tool (EBET) based on social cognitive theory for the assembly line workers: development and psychometric assessment

BackgroundErgonomic behaviors play a crucial role in preventing work-related musculoskeletal disorders (WMSDs). To measure these behaviors, this research aimed to develop and evaluate an ergonomic behaviors tool (EBET) based on the Social Cognitive Theory (SCT) among women workers on assembly lines (WwAL).MethodsThe study was conducted from December 2022 to January 2023 with a focus on the psychometric assessment of EBET. Initially, a literature review and interviews were carried out to identify crucial concepts and primary items. The questionnaire’s validity was evaluated using the Content Validity Ratio (CVR) and the Content Validity Index (CVI). To determine the domains of the tool, construct validity was examined by administering the items to 270 eligible women. The reliability of the tool was assessed using McDonald’s Omega coefficient.ResultsFrom a total of 67 primary items, 50 were confirmed. The study demonstrated good validity with CVR = 0.92 and CVI = 0.97, along with reliable results indicated by McDonald’s Omega coefficient of 0.74. The exploratory factor analysis (EFA) revealed ten distinct dimensions: outcome expectations, outcome expectancies, normative beliefs, perceived barriers, social support, observational learning, reinforcement, behavioral skills, self-efficacy, and intention. Together, these dimensions accounted for 66.25% of the variance in the data. Additionally, the confirmatory factor analysis results supported the presence of these ten constructs and demonstrated a satisfactory fit.ConclusionsEBET is a dependable and valid instrument for evaluating the ergonomic behaviors of workers, utilizing the principles of SCT. Researchers can employ EBET to gather data and implement suitable training interventions to enhance ergonomic behavior among WwAL. However, it is crucial to recognize that EBET may not encompass all facets of ergonomic behaviors. Therefore, it is imperative for future research to prioritize the evaluation of EBET’s suitability among diverse worker populations and to consider additional dimensions of ergonomics to ensure its wider applicability and effectiveness.

Fidelity and acceptability of implementation strategies developed for adherence to a clinical pathway for screening, assessment and management of anxiety and depression in adults with cancer

BackgroundImplementation strategies are crucial to facilitate implementation success. To prepare and support implementation of a clinical pathway for screening, assessment and management of anxiety and depression in cancer patients (the ADAPT CP), six broad categories of implementation strategies; (1) Awareness campaigns, (2) Champions, (3) Education, (4) Academic Detailing and Support, (5) Reporting, (6) Technological Support, were developed. The aim of this paper is to describe the fidelity and acceptability of six categories of implementation strategies and any subsequent changes/adaptations made to those strategies.MethodsThe ADAPT CP was implemented in twelve cancer services in NSW, Australia, as part of a cluster randomised controlled trial of core versus enhanced implementation strategies. Fidelity to and any subsequent changes to the delivery of the planned six categories of implementation strategies were captured using the ADAPT contact log, which recorded the contacts made between the ADAPT research team and services, engagement meetings and monthly meetings. To explore acceptability and awareness/engagement with the implementation strategies, interviews with a purposively selected staff sample across both study arms were held prior to implementation (T0), six months into implementation (T1) and at the end of the 12-month implementation period (T2). Interviews were thematically analysed across the six categories of strategies.ResultsDelivery of all six categories of implementation strategies as planned was moderated by service context and resources and staff engagement. As such, for some implementation strategies, subsequent changes or adaptations to the content, mode of delivery, frequency and duration such as abbreviated training sessions, were made to optimise fidelity to and engagement with the strategies. Most strategies were perceived to be acceptable by service staff. Use of strategies prior to implementation of the ADAPT CP such as the engagement meetings and training sessions, positively impacted on ownership and preparedness to implement the ADAPT CP. Furthermore, ongoing support such as provision of additional training or monthly meetings facilitated increased awareness and engagement with the ADAPT program.ConclusionFlexibility in delivering implementation strategies, and ensuring staff engagement with, and acceptability of those strategies, can support implementation of interventions within healthcare settings.Trial registrationThe ADAPT CRCT was registered prospectively with the ANZCTR on 22/3/2017. Trial ID ACTRN12617000411347. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372486&isReview=true

Promoting a thriving school community: Investigating the effectiveness of positive psychology interventions for improved teacher-student and staff relationships: A critical review

Promoting a thriving school community: Investigating the effectiveness of positive psychology interventions for improved teacher-student and staff relationships: A critical review

Relationship between children's eating behavior (1-6years) and body mass index: a cross-sectional study in French maternal-infant protection centers within the Parisian region.

Early detection of obesity-promoting dietary behavior patterns improves the identification of at-risk families and the implementation of interventions. This is accomplished through the use of the Child Eating Behavior Questionnaire (CEBQ). No study has been conducted using the CEBQ in children followed in Essonne's Maternal-Infant Protection (PMI) centers. We investigated, in a cross-sectional design, the differences in children's eating behavior with PMI follow-up according to their weight status. A questionnaire addressed to parents was collected in PMI centers. Multiple hierarchical regression analysis was used to investigate the predictability of the child's CEBQ on body mass index (BMI). From January to April 2022, 850 children were selected, from which 500 (aged 1-6years) were included, and of whom 10.6% were obese. There was a significant positive association between 'Food Responsiveness', 'Enjoyment of Food' and BMI. In contrast, there was a significant negative association between 'Satiety Responsiveness', 'Slowness in Eating' and BMI. Besides, 'Food approach' and 'food avoidance' behaviors were positively and negatively related to BMI z-scores, respectively. Due to significant differences in children's eating behavior according to their weight, it is needed to raise awareness among parents about their impact on them.

Designing HIV prevention interventions that are acceptable to young adults in sub-Saharan Africa: Insights from a mapping review and inductive thematic analysis

RationaleUnderstanding what young adults and other key stakeholders find acceptable for HIV prevention interventions and reasons explaining acceptability or lack thereof is crucial for intervention developers and implementers in sub-Saharan Africa (SSA). Higher acceptability of health and social interventions can improve intervention uptake and effectiveness. ObjectivesThis paper aims to aggregate and synthesise the evidence on the acceptability of HIV prevention interventions for young adults in SSA, published over the past twelve years. MethodsIn line with PRISMA guidelines, we conducted a systematic mapping review to identify studies assessing the acceptability of HIV prevention interventions with young adults aged 10–24 in SSA, published between 2010 and 2022. We employed descriptive syntheses to aggregate and present study characteristics, methodologies, and findings on overall intervention acceptability. An inductive thematic analysis of quantitative and qualitative findings across studies was then conducted to highlight reasons for the acceptability or unacceptability of interventions among young adults and other stakeholders. ResultsThe review identified 32 studies assessing young adults’ acceptability of HIV prevention interventions. Fourteen studies also explored the acceptability of other stakeholders, such as caregivers, teachers, and healthcare workers. Overall reported acceptability was high. Of the 18 studies that provided a quantitative assessment based on the proportion of participants that found the intervention acceptable, only one study reported acceptability below 50%. The findings of the thematic analysis identified the following seven key factors shaping acceptability: ease of use; intervention understanding; intervention costs; perceived positive effects; perceived negative effects; relevance to young adults’ needs and context; and social factors shaping acceptability. ConclusionThe review highlights the importance of collecting and aggregating information on the acceptability of HIV prevention interventions in Africa to inform future intervention development. It also points to factors developers and implementers of HIV prevention services and programmes should consider. However, our review also exposes gaps in the literature. More research is needed to investigate the acceptability of different stakeholders beyond end-users, the acceptability of integrated interventions, and the development of more robust theoretical frameworks and measurement tools. Understanding what influences the acceptability of interventions among young people and other key individuals will better equip researchers and practitioners to meet their needs and improve opportunities for the transition to adulthood.

Abstract PO1-03-01: Barriers, facilitators, and challenges for the implementation of a hybrid multidisciplinary lifestyle intervention

Abstract Background. Breast cancer is the leading cause of cancer-related death and disability among young women in Mexico. The physical and psychological symptoms they experience affect their quality of life, physical functioning, and psychological well-being. To address this, the National Cancer Institute in Mexico City developed a program called "Joven & Fuerte" that provides services for young women with breast cancer. Due to the COVID-19 pandemic, the program has migrated to virtual attention and now offers hybrid attention to meet the needs of these patients. The research group developed the "Joven, Fuerte & Saludable" intervention, which is a hybrid (face-to-face and virtual) multidisciplinary lifestyle intervention that includes nutrition, rehabilitation, psychological support, mindfulness intervention, and lifestyle education for early disease young women undergoing oncology treatments. This study aims to evaluate the barriers and facilitators for implementing this lifestyle intervention. Methodology. The study involved young women with early breast cancer enrolled in the "Joven & Fuerte" program in 2022. They were invited to participate in a study to evaluate the barriers, facilitators, and challenges of a hybrid multidisciplinary lifestyle intervention during the first months since the diagnosis (3 months). The intervention included face-to-face consultations for anthropometric and biochemical assessments, interdisciplinary team evaluations, and virtual support through WhatsApp and Zoom. Educational materials such as printed or digital healthy lifestyle guides and educational videos were available on a private Facebook and YouTube group. Follow-up sessions were conducted via phone, video, or on-site visits. To evaluate lifestyle habits and quality of life status, distress, anxiety, and depression validated questionnaires were used. The CFIR and RE-AIM questionnaires were used to identify the barriers and facilitators among the program staff and patients while adopting the intervention. Results. The study found that patients were satisfied with the intervention and educational materials, but there were some barriers for implementation. One of the main barriers was the patients' geographical location, as 62.5% of patients were foreign and lived far from the hospital. Additionally, patients only sometimes used the educational materials due to forgetfulness, lack of time, not having internet access, or low digital literacy. Patients also had difficulty recognizing the impact of a "healthy lifestyle" and prioritized other consultations before the program schedule. Institutional barriers included a lack of human resources, which led to a loss in follow-up and patient motivation due to waiting-list periods. Undergraduate and postgraduate training students were introduced to support the multidisciplinary team in overcoming this challenge. Despite these obstacles, patients reported feeling supported by the multidisciplinary team and experienced benefits such as reduced stress and anxiety and better management of treatment side effects upon completing program activities. An important institutional success was achieved by reducing service waiting times from three months to just 1-2 weeks for all services. Conclusions. Cultural behavior and emotional distress at diagnosis and during the first 3 months of intervention are the major challenges for patients. A hybrid educational intervention seems convenient to make follow-up more practical and accessible. Patients feel motivated because they are in touch with their clinicians and receive fast resolutions to their concerns. Many talented and enthusiastic human resources are needed to implement these interventions, but it is possible for a Latin American public hospital, considering the essential benefits for the patients. Citation Format: Daniela Martinez-Palacios, Marlid Cruz-Ramos, Fernanda Sarahi Fajardo-Espinoza, Yanira Elvira Rodriguez-Fonseca, Alicia Gonzalez-Perez, Aline Barranco-Cortés, Dana Aline Pérez-Camargo, Alejandro Mohar, Cynthia Mayté Villarreal Garza. Barriers, facilitators, and challenges for the implementation of a hybrid multidisciplinary lifestyle intervention [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-03-01.

Determinants of the optimal selection of vascular access devices: A systematic review underpinned by the COM-B behavioural model.

Optimal selection of vascular access devices is based on multiple factors and is the first strategy to reduce vascular access device-related complications. This process is dependent on behavioural and human factors. The COM-B (Capability, Opportunity, Motivation, Behaviour) model was used as a theoretical framework to organize the findings of this systematic review. To synthesize the evidence on determinants shaping the optimal selection of vascular access devices, using the COM-B behavioural model as the theoretical framework. Systematic review of studies which explore decision-making at the time of selecting vascular access devices. The Medline, Web of Science, Scopus and EbscoHost databases were interrogated to extract manuscripts published up to 31 December 2021, in English or Spanish. Among 16 studies included in the review, 8/16 (50%) focused on physical capability, 8/16 (50%) psychological capability, 15/16 (94%) physical opportunity, 12/16 (75%) social opportunity, 1/16 (6%) reflective motivation and 0/16 (0%) automatic motivation. This distribution represents a large gap in terms of interpersonal and motivational influences and cultural and social environments. Specialist teams (teams created for the insertion or maintenance of vascular access devices) are core for the optimal selection of vascular access devices (75% physical capability, 62% psychological capability, 80% physical opportunity and 100% social opportunity). Specialist teams predominantly lead all actions undertaken towards the optimal selection of vascular access devices. These actions primarily centre on assessing opportunity and capability, often overlooking motivational influences and social environments. A more implementation-focused professional approach could decrease inequity among patients and complications associated with vascular access devices. Optimal selection of vascular access devices is the primary strategy in mitigating complications associated with these devices. There is a significant disparity between interpersonal and motivational influences and the cultural and social environments. Furthermore, specialized teams play a pivotal role in facilitating the optimal selection of vascular access devices. The study can benefit institutions concerned about vascular access devices and their complications. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No Patient or Public Contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Optimal selection of vascular devices remains a growing yet unresolved issue with costly clinical and patient experience impact. Interventions to improve the optimal selection of vascular devices have focused on training, education, algorithms and implementation of specialist vascular teams; alas, these approaches do not seem to have substantially addressed the problem. Specialist vascular teams should evolve and pivot towards leading the implementation of quality improvement interventions, optimizing resource use and enhancing their role.

Chemotherapy safe handling practices in Ethiopia: A comprehensive multi-center evaluation.

The increasing incidence of cancer and capacity for cancer care in Ethiopia has led to an upsurge in chemotherapy use in the country; however, studies indicate that there is a gap in the safe handling of chemotherapy by healthcare workers. There exists a need to understand if such unsafe practices occur in Ethiopia and, if so, which areas along the chemotherapy life cycle need the most improvement. This study utilized a multi-method design through an online survey administered to health care professionals and evaluative site visits of eight cancer units in Addis Ababa, Ethiopia to understand the current conditions of chemotherapy handling. In addition, a survey was conducted among Ethiopian health care professionals from across the country. Fifty-five percent of survey participants disagreed or strongly disagreed that there are systems in place to identify, prevent, and address chemotherapy hazards in their workplace, and 71% of respondents denied having an active and effective health and safety committee and/or worker health and safety representative where they work. At evaluative site visits, only 30% of health care workers met the minimum guidelines for proper hand hygiene, and 20% of health care workers used adequate Personal Protective Equipment according to guidelines across the chemotherapy lifecycle. Results of this study indicate an urgent need for implementation of evidence-based interventions to improve chemotherapy handling in Ethiopia so that all patients and health care workers are protected from the hazardous toxicities of these drugs.

Abstract Db1-01: Anthracyclines …to give or not to give? “For” argument

Abstract Anthracyclines have been one of the mainstays of early breast cancer treatment for decades. In a recent patient-level meta-analysis including data from over 18,000 patients, anthracycline-containing regimens were associated with improvements in disease-free survival and overall survival, regardless of estrogen receptor or nodal status. Importantly, trials specifically designed and powered to assess the safety of anthracyclines omission failed to demonstrate the non-inferiority of taxane-based anthracycline-free regimens and confirmed the benefit of these agents, particularly in patients with node-positive and hormone receptor-negative breast cancer. Several therapies incorporated into the management of early breast cancer were studied in populations largely treated with anthracycline-based chemotherapy backbones in both HER2-negative (i.e., perioperative pembrolizumab, post neoadjuvant olaparib and capecitabine) and HER2-positive disease (i.e., dual HER2 blockade, adjuvant T-DM1). It is uncertain whether the benefits demonstrated by these strategies would be maintained if anthracyclines were omitted. While anthracyclines are associated with some long-term toxicities, particularly with an increased risk of lymphoproliferative malignancies and dose-dependent cardiotoxicity, these adverse events are not associated with an increased risk of death (including deaths from cardiovascular causes) when compared to anthracycline-free regimens. The identification of risk factors for cardiotoxicity, combined with improvements in monitoring strategies, allows improvements in patient selection, early detection of myocardial damage and, possibly, implementation of cardioprotective interventions, leading to improved cardiovascular outcomes. Until high-quality evidence demonstrates the safety of omitting anthracyclines in high-risk populations, these agents should continue to be used in carefully selected patients after individual risk versus benefit assessment to be shared with the patient. Citation Format: Martine Piccart, Guilherme Nader-Marta. Anthracyclines …to give or not to give? “For” argument [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr Db1-01.

Abstract PO2-11-07: Early Integration of Exercise into Breast Cancer Care: The MSK Healthy Living Program

Abstract Background: In patients with early-stage breast cancer, quality of life (QoL) worsens within 3-6 months following diagnosis. Physical activity (PA) can mitigate the adverse effects of treatment and improve QoL, and low PA level is associated with cancer recurrence and mortality. However, PA interventions are not included in standard cancer care. Early intervention to increase PA levels may improve QoL during active cancer therapy. The Healthy Living Program (HLP) at Memorial Sloan Kettering Cancer Center (MSK) is a lifestyle and survivorship program that engages early-stage breast cancer patients at the time of diagnosis using lifestyle risk stratification and matched referrals. We investigated whether early exercise intervention through the MSK HLP impacts QoL within the first months after cancer diagnosis. Methods: At the time of diagnosis, patients complete a lifestyle questionnaire (LQ), which is a composite of validated instruments, including the Godin Leisure Time Exercise Questionnaire (GLTEQ). Patients not meeting PA guidelines per the GLTEQ are offered a referral to an exercise physiologist (EP). The EP creates an individualized, home-based exercise program using the FITT Principle (Frequency, Intensity, Time, and Type). Patients meet with the EP every 4 weeks for 16 weeks; if exercise recommendations continue to be unmet, the program is extended. The Functional Assessment of Cancer Therapy-Breast (FACT-B) and 36-Item Short Form Survey Instrument (SF-36) were completed at baseline and the 16-week follow-up. Results: 252 patients enrolled between April 2020 – February 2023, of whom 92 volunteered to complete the QoL assessments. Median age was 53 years [range 23-84]; 12/252 (13.0%) of patients had ductal carcinoma in situ, 60/252 (65.2%) had Stage 1 disease, 17/252 (18.5%) had Stage 2 disease, and 3/252 (3.1%) had Stage 3 disease. 29/252 (31.5%) received chemotherapy, 62/252 (67.4%) received radiation, and 79/252 (85.9%) received hormone therapy. The mean baseline FACT scores were FACT-B: 116, FACT-G: 87, and FACT-B Trial Outcome Index (TOI): 73. At the 16-week follow-up, all QOL scores remained stable from baseline (means FACT-B: 118, FACT-G: 89, and TOI: 75). Improvements were observed among the subscales of the SF-36 from baseline to follow-up. The largest improvements were observed in physical and emotional role function scores, with 22% and 13% improvements from baseline to follow-up, respectively. Conclusions: A clinically implemented exercise intervention embedded in standard of care prevented decreases in QoL and improved physical and emotional functioning during the initial course of adjuvant breast cancer therapy. These findings support early implementation of lifestyle modification after a breast cancer diagnosis. Citation Format: Kylie Rowed, Sherry Shen, Andrea Smith, Bridget Kelly, Rocco Magnoli, Stacie Corcoran, Melissa Emerzian, Cynthia Cruz, Erica Salehi, Cara Anselmo, Mark Robson, Neil Iyengar. Early Integration of Exercise into Breast Cancer Care: The MSK Healthy Living Program [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-11-07.

Relationship among Falls, Fear of Falling, and Physical Activity Level in Patients on Hemodialysis.

Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis. A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I. A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed. FOF was associated with the incidence of falls in patients on hemodialysis. The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls.

Factors affecting implementation of interventions for oral health, substance use, smoking and diet for people with severe and multiple disadvantage: a community-based qualitative study in England

BackgroundPopulations facing severe and multiple disadvantage (SMD), co-occurring homelessness, substance use and repeat offending have high levels of physical and mental ill-health. Poor oral health is one of the most...