Largest Barrier Research Articles

A scoping review of dental practitioners’ perspectives on perceived barriers and facilitators to preventive oral health care in general dental practice

BackgroundOral health has an important role in the general health and well-being of individuals. Dental teams are ideally placed to support patients in preventing ill-health. Understanding the barriers and facilitators to the adoption, promotion and facilitation of preventive advice and treatment is key to improving oral health services. The Theoretical Domains Framework (TDF) is a useful psychological framework to help identify individual, interpersonal and environmental issues which could be impacting clinicians’ ability to provide preventive advice and care. The aim of this review was to identify the perceived barriers and facilitators to preventive oral health care from the perspectives of the oral healthcare team within the general dental practice.MethodsA search strategy was developed, piloted, and run in: Medline via Ovid, PsycInfo, Web of Science, SCOPUS, EMBASE, Conference Proceedings Citation Index- Science, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews and followed PRISMA guidelines. Identified records were screened independently by two researchers. Data were coded using the Theoretical Domains Framework (TDF) and analysed using narrative data synthesis.Results5610 papers were identified, and 19 included in this review. Thirteen papers focussed on dentists. Of the 106 items mapped onto the TDF, 48 were facilitators. The domains most frequently represented were, environmental context and resources, beliefs about consequences, social professional role and identity, skills, beliefs about capabilities and knowledge. Six studies focussed on dental hygienists. There were 47 items mapped onto the TDF, 18 were facilitators. The domains most frequently represented were environmental context and resources, social influences, beliefs about consequences and knowledge.ConclusionsThe review identified that the delivery of preventive activities did not focus solely on the patient and dental professional interaction as many previous studies have highlighted. The review found that multiple factors influence whether prevention is delivered to patients. The largest barrier and facilitator for the dental professionals identified in this review was the environmental context and resources. Further research is needed to evaluate the effectiveness of interventions that aim to promote preventive oral health care in primary care settings to understand whether they address the barriers identified in this review.

The Implementation of a Doula Grant Program Directed at Families from Economically Vulnerable Backgrounds: A Process Evaluation.

The purpose of this study was to evaluate the process and overall feasibility of a doula grant program for expectant families from economically vulnerable backgrounds. A mixed-methods process evaluation framework was utilized to examine program feasibility and focused on constructs related to fidelity, dose delivered/dose received, reach, program satisfaction, and limited efficacy testing. Evaluation constructs were measured using a program tracking document. Program satisfaction and efficacy were examined through a mixed methodology approach utilizing doula surveys and birthing parent interviews. Related to survey data, analysis focused on presenting descriptive counts and percentages related to the number of doulas that participated and clients served. Continuous variables were calculated as means and standard deviations and categorical data as counts and percentages. Qualitative data analyses were conducted using a structured deductive thematic approach. The grant program was successfully implemented over an 18-month period, and the program had a high rate of fidelity to the grant processes developed by a Midwestern-based nonprofit organization. The program was satisfactory to doulas and parents, and the largest barrier was communication. A high incidence of prenatal anxiety among the birthing parents was reported. Thematic findings from the birthing parent interviews included the following: the grant application process was effective and easy, birth doulas were greatly valued, and a financial burden was lifted. This grant process can be replicated by other organizations seeking to fill a gap between doula services and the economically vulnerable.

Progress in the Development of Stem Cell-Derived Cell-Free Therapies for Skin Aging.

The skin is a vital organ as the body's largest barrier, but its function declines with aging. Therefore, research into effective regeneration treatments must continue to advance. Stem cell transplantation, a cell-based therapy, has become a popular skin-aging treatment, although it comes with drawbacks like host immune reactions. Stem cell-derived cell-free therapies have emerged as an alternative, backed by promising preclinical findings. Stem cell secretomes and extracellular vesicles (EVs) are the key components in cell-free therapy from stem cells. However, comprehensive reviews on the mechanisms of such treatments for skin aging are still limited. This review discusses stem cell-derived cell-free therapy's potential mechanisms of action related to skin aging prevention by identifying specific molecular targets suitable for the interventions. A search identified 27 relevant in vitro studies on stem cell-derived cell-free therapy interventions in skin aging model cells without restricting publication years using PubMed, Scopus, and Google Scholar. Stem cell-derived cell-free therapy can prevent skin aging through various mechanisms, such as (1) involvement of multiple regenerative pathways [NFkb, AP-1, MAPK, P-AKT, NRF2, SIRT-1]; (2) oxidative stress regulation [by reducing oxidants (HO-1, NQO1) and enhancing antioxidants (SOD1, CAT, GP, FRAP)]; (3) preventing ECM degradation [by increasing elastin, collagen, HA, TIMP, and reducing MMP]; (4) regulating cell activity [by reducing cell senescence (SA-β-gal), apoptosis, and cell cycle arrest (P53, P12, P16); and enhancing autophagy, cell migration, and cell proliferation (Ki67)] (5) Regulating the inflammatory pathway [by reducing IL-6, IL-1, TNF-⍺, and increasing TGF-β]. Several clinical trials have also revealed improvements in wrinkles, elasticity, hydration, pores, and pigmentation. Stem cell-derived cell-free therapy is a potential novel treatment for skin aging by cell rejuvenation through various molecular mechanisms.

Preferences and Perspectives of Australian General Practitioners' Towards a New "Four-in-One" Risk Assessment Tool for Preventative Health: The LEAD! GP Project.

Dementia risk reduction is a public health priority and general practitioners (GPs) play a pivotal role in preventative healthcare. Therefore, risk assessment tools should be designed with GPs' preferences and perspectives in mind. The LEAD! GP project aimed to investigate Australian GPs' preferences and perspectives relating to design, use and implementation of a new risk assessment tool that simultaneously calculates risk for four outcomes- dementia, diabetes mellitus, myocardial infarct, and stroke. A mixed methods study using semi-structured interviews of a diverse group of 30 Australian GPs was conducted. Interview transcripts were analyzed thematically. Demographics and questions that elicited categorical answers were analyzed descriptively. Overall, GPs felt that preventative healthcare was important with some finding it rewarding, and others finding it difficult. GPs currently use many risk assessment tools. GPs' perception of the usefulness and negatives/barriers of tools related to clinical practice applicability, patient engagement, and practical aspects. The largest barrier was lack of time. GPs responded positively to the concept of a four-in-one tool and preferred it to be relatively short, supported by practice nurses and some patient involvement, linked to education resources, available in different formats, and integrated into practice software. GPs recognize the importance of preventative healthcare and the potential benefit of a new tool that simultaneously predicts risk for those four outcomes. Findings provide important guidance to inform the final development and piloting of this tool with potential to improve efficiency and practical integration of preventative healthcare for dementia risk reduction.

Abstract 3029: Barriers to optimal breast cancer screening modalities for high-risk patients in the primary care setting

Abstract Background: Annual screening breast MRIs are endorsed by current breast cancer screening guidelines as an adjunctive screening modality for high-risk patients (defined by more than 20% lifetime risk) in addition to a screening mammogram. Recent studies showed screening breast MRI remained underutilized despite the current recommendations. On the other hand, validated breast cancer risk models for identifying high-risk patients also remained under-recognized among primary care providers. This study aims to identify the potential barriers for primary care providers (PCPs) to using breast cancer risk models and referring high-risk patients to breast MRI for screening. Methods: An anonymous survey was distributed via email to the PCPs and OB/GYN providers in the network of Mount Auburn Hospital, a community teaching hospital affiliated with Harvard Medical School in Cambridge, Massachusetts. The survey included questions regarding breast cancer screening in average-risk and high-risk patients, providers’ understanding of breast cancer risk models, and current referral status of breast MRIs and high-risk/genetic clinics. Results: The survey was sent to 104 providers, and 43 responses were received. When asked about performing breast cancer risk assessments, 58% reported “Always (91-100%)” and 33% said “Often (71-90%)”. For factors to consider when performing risk assessments, most of the providers considered personal medical history (98%), family history (100%), genetic syndrome history (86%), and previous breast biopsy results (90%). When asked about breast cancer risk models, 58% of the providers had not heard of or used one. 33% of the providers have used the Gail model, and 26% have used the Tyrer-Cuzick model. 51% of the providers correctly identified high-risk as lifetime risk >20%. 56% correctly answered annual mammograms with MRI for breast cancer screening for high-risk patients. The majority of the providers (84%) would prefer to refer patients to the high-risk clinic for risk assessment and screening management. For barriers to referring to MRI, the insurance approval process (49%) was reported to be the largest barrier. 72% of the providers prefer not ordering it and defer to the high-risk/genetic clinic for ordering the test. Conclusions: Our survey has shown different barriers to breast cancer screening in high-risk patients in the primary care setting, including knowledge and logistic barriers. Further education for PCPs is needed for correctly identifying high-risk patients, utilizing risk models, and referring high-risk patients for breast MRI screening. Citation Format: Yu Jen Jan, Prudence B. Lam. Barriers to optimal breast cancer screening modalities for high-risk patients in the primary care setting [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 3029.

Stereochemical inversion of pillar[5]arene. NMR and DFT studies

Pillar[n]arenes, a new class of macrocycles, can be used as drug carriers and as new receptors recognizing biologically important molecules. Investigation of structure and intramolecular mobility of pillar[n]arenes is important for creating pillar[n]arene-based delivery systems with different individual properties. NMR spectroscopy and DFT calculations were used to analyze the conformational dynamics of 4,8,14,18,23,26,28,31,32,35-deca- (carboxymethoxy) - pillar[5]arene and to define the thermodynamic parameters and the reaction paths of stereochemical inversion of pillar[5]arene. The structure and energy of intermediates and transition states were determined in the gas phase and in a water solution. Experimental data show that the energy barrier of stereochemical inversion of pillar[5]arene is about 12 kcal/mol at a temperature of 300 K. DFT calculations overestimate the reaction energetic barrier even with taking into account the solvation effect. The largest barrier is detected for the rotation of the first hydroquinone fragment. Rotating the next fragments requires less energy. Calculations have shown that sequential rotation of neighboring hydroquinone fragments is the most energetically favorable transformation of one enantiomer into another.

Design and Evaluation of an Outdoor Exercise Program for Pediatric Cancer Survivors.

Exercise programs for young people after cancer are not part of regular oncological care. This study describes and evaluates a regional outdoor exercise program and presents data with regard to the promoting and inhibiting factors for participation among pediatric cancer survivors. Exercise options, number of participants, and the cohort were evaluated descriptively for one year. A self-developed questionnaire was used to evaluate satisfaction, mood, motivations, and barriers to exercise. Overall N = 26 survivors (14.6 ± 5.5 years) participated in at least one activity in 2019 including try-out days (N = 10) and active weekend camps (N = 2). No adverse events occurred in 302 physical activity hours. Twenty-one survivors participated in the survey. The largest motivational aspect to participate was “to try out a new sport” (83.9%). Survivors reported “good mood”, and ‘being happy’ after exercising. The largest barrier was concern about ‘not being able to keep up with others’ (38.1%). Around one-third (try-out day) and 50% (active weekend camp) of survivors did not feel confident to continue exercising outside the supervised exercise oncology program. This survey shows high enthusiasm for this exercise program with different outdoor activities and suggests that similar interventions may be accepted by this population.

Medical students describe their wellness and how to preserve it

BackgroundDespite widespread efforts to create wellness programming in medical schools, there is a paucity of literature examining students’ perception of wellness and perceptions of these programs. With the inaugural class at the Arizona campus of Mayo Clinic Alix School of Medicine (MCASOM-AZ), an opportunity arose to establish an empirically evaluated wellness curriculum that most inclusively and effectively enables medical students to flourish for years to come. The initial wellness offerings included mental health, academic success, and disability services, curriculum-embedded seminars, wellness committee driven programming, and student-proposed wellness activities. We aimed to improve the relevance and impact of medical school wellness curricula by soliciting in-depth and longitudinal perspectives of medical students themselves. As MCASOM-AZ opened in 2017, the student body at the time of study consisted of first- and second-year medical students.MethodsEmploying a mixed methods analysis of qualitative and longitudinal quantitative data, first- and second-year students at a MCASOM-AZ were invited to respond to an anonymous, online year-long survey (baseline, six months and 12 months) during the 2018–2019 academic year and participate in a structured, in-depth and in-person, peer-to-peer interview about their conceptions of wellness and the MCASOM-AZ wellness curriculum and resources. Qualitative data was coded for themes using thematic analysis strategies by independent raters.ResultsNearly half of eligible students completed the baseline survey,1/3 completed all 3 time-points, and 1/5 participated in an in-depth interview. Participant age, gender, and year of school were representative of the larger student body. Although individual conceptions varied, Wellness was consistently highly valued. Family, Academic Performance, and Friends emerged as most important to well-being across time-points. Academic work arose as the largest barrier to wellness. Analysis of qualitative data revealed five themes. Despite individual differences in approaches to wellness, wellbeing was interrelated to the learning environment; mandatory wellness efforts that didn’t address the medical culture met with skepticism.ConclusionsInterview responses provided understanding and context by which to interpret questionnaire responses. Academics was critical to students’ identity and wellness, while also the largest barrier. Suggested curricular improvements include restructuring academic work, seamlessly integrating wellness within coursework, and offering optional individualized approaches.

MO369: A Systematic Review to Evaluate the Drivers of Non-Adherence to Albuminuria Testing Guidelines and the Clinical and Economic Impact of Not Identifying CKD Over the Course of Progressive Kidney Function Loss

Abstract BACKGROUND AND AIMS The Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend regular estimated glomerular filtration rate (eGFR) and albuminuria testing in patients diagnosed with chronic kidney disease (CKD) and those with specific risk factors such as type 2 diabetes (T2D). In addition, the European Society of Cardiology (ESC) guidelines recommend albuminuria testing for cardiovascular (CV) disease risk assessment in CKD patients. An eGFR test can indicate kidney function decline, whereas albuminuria testing gives an indication of kidney damage. When used in combination, an accurate understanding of CKD risk progression can be obtained. Both KDIGO and ESC guidelines are based on evidence that albuminuria testing is critical to prevent CKD and CV events. Evidence from real-world practice suggests that albuminuria, specifically urine albumin-to-creatine ratio (UACR) testing is suboptimal. For example, UACR testing is not regularly undertaken in clinical practice, with low rates reported in the UK1 (67%), The Netherlands2 (57%) and France3 (29%). A systematic literature review (SLR) was undertaken to explore the barriers to regular albuminuria testing in CKD patients in line with the guidelines, and the clinical and economic impact of not identifying these patients over the course of progressive kidney function loss. Our hypothesis was that in the absence of adequate testing, patients are not identified and are more likely to progress to a worse clinical state with an economic impact on healthcare costs. METHOD This SLR searched MEDALL, Embase, Cochrane CENTRAL, and other databases from the date of inception to August 2021 for studies. Title and abstract screening, followed by full-text screening of included papers was undertaken by two independent reviewers. RESULTS Fourteen studies were included. Only one study explored direct physician barriers to UACR testing, with the biggest perceived barrier being that knowing a test would not significantly impact patient management, potentially due to lack of therapeutic options. Twelve studies reported on the clinical and one reported on the economic impact of not identifying CKD patients with or without T2D upon UACR or eGFR testing. All included studies looked at not identifying the patient population because of late referral. These studies showed that patients who were referred late had increased all-cause mortality, increased CV mortality and lower survival rate versus those patients that were referred on time. No studies looked at patients in the early stages of CKD, those that were referred late based on a UACR and eGFR test result, or those that were diagnosed late due to the lack of reporting of diagnostic test results. CONCLUSION A limited number of studies reporting drivers of non-adherence to albuminuria testing were identified. The largest barrier reported was the perception that testing will not impact patient management. Supporting our original hypothesis, individuals referred late with end-stage kidney disease were shown to experience worse clinical outcomes, including higher rates of mortality, than those referred on time. However, there were limited data on the impact of not identifying or diagnosing patients in the early stages of CKD, and a lack of reporting of the tests used, whether eGFR or UACR, to identify these individuals. Funding: Bayer AG PROSPERO: CRD42021275223

In It for the Long Haul: RE-AIM Evaluation of a Preschool Programme Implementing and Maintaining Adult-Initiated Motor Skill Development and Physical Activity across a Two-Year Period.

Good motor skills (MS) are considered important for children’s social, psychological and physical development and general physical activity (PA) levels. The Motor skill in Preschool study (MiPS) aimed to optimize children’s MS through weekly PA sessions. The aim of this study is to use the RE-AIM framework to report the two-year implementation process of MiPS since the programme’s initiation. Data were collected through a staff questionnaire based on the RE-AIM framework. Data were collected at three months, one year and two years after initiation. Results show that the pedagogical staff believes that the programme promotes MS in children. Implementation measures only showed medium to low fidelity concerning the core element of performing adult-initiated PA sessions with a duration of at least 45 min 4 days a week. The largest barrier was finding the time to plan these PA sessions. Still, the content of the PA sessions achieved high fidelity scores and the programme was deemed suitable for staff’s everyday practice and in alignment with the stated pedagogical goals. The mandatory competence development course was highly valued as strong implementation support. It is notable that there is a large variation in the implementation among the preschools with some struggling more than others.

DNA Enrichment Methods for Microbial Symbionts in Marine Bivalves.

High-throughput sequencing is a powerful tool used for bivalve symbiosis research, but the largest barrier is the contamination of host DNA. In this work, we assessed the host DNA reduction efficiency, microbial community structure, and microbial diversity of four different sample pre-treatment and DNA extraction methods employed in bivalve gill tissue samples. Metagenomic sequencing showed the average proportions of reads belonging to microorganisms retrieved using PowerSoil DNA extraction kit, pre-treatment with differential centrifugation, pre-treatment with filtration, and HostZERO Microbial DNA kit samples were 2.3 ± 0.6%, 2.5 ± 0.2%, 4.7 ± 1.6%, and 42.6 ± 6.8%, respectively. The microbial DNA was effectively enriched with HostZERO Microbial DNA kit. The microbial communities revealed by amplicon sequencing of the 16S rRNA gene showed the taxonomic biases by using four different pre-treatment and DNA extraction methods. The species diversities of DNA samples extracted with the PowerSoil DNA extraction kit were similar, while lower than DNA samples extracted with HostZERO Microbial DNA kit. The results of this study emphasized the bias of these common methods in bivalve symbionts research and will be helpful to choose a fit-for-purpose microbial enrichment strategy in future research on bivalves or other microbe–invertebrate symbioses.

Neonatal nursing led research activity in the UK: a survey of current practice

BackgroundNeonatal nurses are ideally placed in practice to undertake research enhancing the care of families. More information is required, however, around neonatal nursing led research to advance leadership in this area. The aim of this study was to determine neonatal nursing led research activity within the UK.MethodsThe study used a web-based survey design and neonatal nurses were eligible if they were working at or towards Masters or Doctoral level qualification in the UK. The survey was distributed to members of the Neonatal Nurses Association, UK Schools of Nursing and shared on social media pages of authors and professional organisations. Results were analysed using descriptive and frequency statistics and content analysis.ResultsOf the 56 respondents, 14% (n = 8) had a Doctoral level qualification and 43% (n = 24) of participants held a Masters qualification. Lack of time and funding knowledge was the largest barrier to research. Only 30% (n = 3) of participants had a research mentor and only 18% (n = 3) were from a neonatal nursing background.ConclusionsThere are limited numbers of neonatal nurses undertaking or leading nursing research in the UK. Further support is required to enhance clinical academic career trajectories to ensure research is a viable pathway for future generations of neonatal nurses.

Facet-dependent catalytic activity of anatase TiO2 for the selective catalytic reduction of NO with NH3: A dispersion-corrected density functional theory study

Recently, the facet-dependent catalytic activity of anatase TiO2 for the selective catalytic reduction of NO with NH3 (NH3-SCR) has been observed experimentally. In this study, the NH3-SCR of NO on the TiO2 (001) and (101) surfaces was systematically investigated using dispersion-corrected density functional theory. We propose that the surface-assisted mechanism is predominant on the (001) surface, which involves the oxygen active sites playing a crucial role in facilitating the reaction. The NH3 dissociation step reveals the largest activation energy barrier (Ea) of 61 kJ/mol on the (001) surface, whereas the NH2NO decomposition step has the largest barrier, Ea ≈ 156 kJ/mol, on the (101) surface. The results obtained by calculation are consistent with the experimental results, which have shown that a TiO2 nanosheet with a dominant (001) facet shows superior catalytic performance in NH3-SCR of NO compared to TiO2 nanoparticles with dominant (101) facet.

Readiness to provide immunization services among community pharmacists in Yogyakarta, Indonesia

Background: Starting from 2019, the government has been aiming to increase the immunization coverage by up to 93%. Community pharmacists are well-positioned to extend access to immunizations by providing immunization services to patients. This objective of this study was to determine community pharmacists' attitudes and knowledge on providing immunizations including perceived barriers to immunizing. Methods: This study was a cross-sectional survey conducted in the community pharmacies in Yogyakarta province, between August to October 2019. A pre-validated questionnaire was used and piloted to a small group of pharmaciets. A convenience sampling was chosen and written informed consent was required. The questionnaire included demographic characteristics of participating pharmacists’, their readiness to provide immunization, and the barriers that may potentially happen when community pharmacists’ implement immunization services. Descriptive statistics were used to present the received data. Result: Among 120 respondents, mostly female (80.83%) and pharmacists degree as education (81.67%). Additionally, to the easiness of accessibility, community pharmacists believed that they will have a powerful role in increasing the rate of immunization and improving the vaccination service. More than half of respondents (54.17%) did not fully have good knowledge of all aspect of vaccine administration. Several barriers have been identified as the factors that can contribute to the immunization services by pharmacists. The largest barrier is the lack of regulation governing immunization by pharmacists (95.83%). Followed by a lack of competency (70.83%), lack of skills training (66.67%), lack of equipment (63.3%), and high workload on conventional services (54.17%). Conclusion: Community pharmacists have a good perception of providing immunization services but the lack of regulation, competency, and skills training becomes a barrier in providing immunization services.

Catalytic Property and Stability of Subnanometer Pt Cluster on Carbon Nanotube in Direct Propane Dehydrogenation

Main observation and conclusionThe stability of nanosized platinum catalyst in direct propane dehydrogenation reaction is one of most critical challenges, which hinders the further improvements of catalytic performance. The cokes from side reaction covering the active site seriously undermine the catalyst stability. In this work, first principles calculations are performed to explore the catalytic properties of supported subnanometer platinum cluster on carbon nanotube support and focus is put on the inhibition of deep dehydrogenation. The reactivities of metal, interface, and tin promoter are investigated at the same footing. The whole reaction pathway from propane adsorption to propene desorption is revealed for different sites. It turns out that the C—H bond activation in propane is not the catalytic step with the largest barrier. Instead, the desorption of propene is more difficult. The comparison between different sites indicates that the interface between metal and support and Sn promoter is helpful to curb the propene deep dehydrogenation. Moreover, a descriptor is proposed to screen the potential effective propane direct dehydrogenation catalyst. The current work provides important insights on the development of new dehydrogenation catalyst.

980. Drexel Medicine Resident Knowledge, Practices and Attitudes Regarding Pre-exposure prophylaxis (PrEP)

BackgroundPre-exposure prophylaxis (PrEP) is a highly effective daily oral antiretroviral medication that was approved by the FDA in 2012 and has been shown to reduce the risk of HIV by 95% in real-world studies. Despite this, many healthcare providers are not offering PrEP to their patients who are at risk for HIV.MethodsWe performed a cross-sectional study among Drexel Internal Medicine, Family Medicine, and Obstetrics and Gynecology residents. The survey included questions about experience, knowledge, attitudes toward and barriers to using PrEP. The survey was adapted from previous studies regarding medical providers’ attitudes and knowledge about PrEP (Petroll, 2016; Seifman, 2016; Blumenthal, 2105). A Likert 5-point scale was used for attitude and barriers questions.ResultsAmong 143 participants, 80% specialized in Internal Medicine. 43% of participants were in their first year of training and the mean age (+ SD) was 28.8 + 2. 76% reported never initiating a conversation about PrEP with a patient and only 18% reported ever prescribing PrEP to their patients. 92% reported being very or extremely willing to prescribe PrEP to a male with a current male partner known to be HIV positive. Only 43% of residents reported being moderately likely to prescribe PrEP to a patient coming in for a STI exposure. 68% of residents reported their knowledge about PrEP was a major barrier to prescribing PrEP.ConclusionWe found that most residents have minimal experience with prescribing PrEP, and knowledge was identified as the largest barrier. Additional education and a better understanding of PrEP indications is necessary to ensure eligible PrEP patients have access to this highly effective HIV prevention method.Disclosures All Authors: No reported disclosures

Pediatric Healthcare Needs and Barriers Self-Reported by a Rural Hispanic Community.

PurposeHispanic immigrants in rural communities can be a hard-to-reach population with many unmet medical needs that have yet to be properly identified. This is particularly true for rural immigrant children. This study focused on documenting self-reported healthcare barriers among this isolated population to identify methods for reducing health disparities among this vulnerable population.MethodsParticipants at recurrent mobile health fairs were anonymously surveyed from June 2016 to January 2018. Differences between the US and foreign-born Hispanic participants were investigated in bivariate analyses.FindingsWe received 35 completed surveys. The majority (79.3%) of participants reported household incomes below the federal poverty line for a family of four. Only 4.5% of foreign-born children were insured, compared with 77% of US-born children (p<0.001). Greater than 85% of foreign-born and 100% of US-born children were fully vaccinated, but half of the participants were seeking preventative care. Most patients identified insurance and cost as the most significant barriers to healthcare.ConclusionsAccess to insurance was the largest barrier identified by this population, with a significant difference between foreign and US-born children. This gap is further compounded by many responders living below the federal poverty line, limiting their ability to pay for the growing costs of uninsured treatment. This study also indicates this Hispanic community's prioritized desire for access to preventative healthcare and high uptake of childhood immunizations.

Abstract 16785: Student Abstractors Reduce the Cost of Registry Use Without Compromising Quality

Introduction: Accurate data abstraction is the cornerstone of successful implementation of Get With The Guidelines-Heart Failure, but abstraction costs are the single largest barrier to participation. Objective: The Heart Failure Abstraction Internship was established to test the efficacy of part-time, graduate students as GWTG-HF abstractors in comparison to a registered nurse using an acceptable Data Element Agreement Rate (DEAR). Methods: The selection criteria for the pilot hospital, Ben Taub Hospital, Houston Texas was: not a GWTG-HF participant; serving diverse populations; administrative and physician support and available supervision for interns. Intern abstractors were recruited and paid as American Heart Association (AHA) employees. For the pilot term, the interns were onboarded as volunteers for the pilot hospital. They met the onboarding requirements of AHA and the pilot institution’s requirements for hospital volunteers. The interns; worked on-site at the pilot institution; were given computer access to EPIC electronic medical records and GWTG-HF; were trained by AHA Quality staff and the pilot hospital Cardiology Program Manager; and abstracted all patients with a primary diagnosis of heart failure from October 2017 to December 2018. An AHA nurse auditor virtually re-abstracted 5 records with the pilot, Cardiology Program Manager. The audit was conducted using the July 2018 Clinical Registry Form (CRF) that was also used during the pilot. Results: The intern abstractors matched the re-abstractor at a DEAR of 86.4% with 340 total elements and 46 mismatches. Conclusions: The hypothesis was proven with a DEAR of 86.4%, suggesting hospitals can be successful participants in GWTG utilizing student abstractors for data collection needs. The median payrate for a nurse abstractor is $24.50 per hour, not including benefits*. The rate for part time employment for the abstraction interns was $10.00 per hour. In addition to financial savings for the pilot organization, the interns worked efficiently as they focused on one task allowing the clinical team to focus on process improvement based on the data collected. This PI focus led to other outcome improvements including reduced readmission and increased compliance with GDMT. *Payscale.com

Population effect of a large‐scale stream restoration effort on Chinook salmon in the Pahsimeroi River, Idaho

AbstractStream habitat restoration is an important tool for fisheries management in impaired lotic systems. Although small‐scale benefits of stream habitat restoration are commonly investigated, it is difficult to demonstrate population effects. The Pahsimeroi River Chinook salmon Oncorhynchus tshawytscha population was previously restricted to the lower portion of the river by multiple irrigation structures. To address fish passage issues, a combination of restoration projects was initiated including barrier removals, instream flow enhancements and installation of fish screens on diversions. The largest barrier was removed in 2009, more than doubling the amount of accessible linear habitat. We hypothesized restoration efforts would expand the distribution of spawning salmon in the Pahsimeroi River watershed, leading to a broader distribution of juveniles. We also hypothesized a broader juvenile distribution would have population effects by reducing the prevalence of density‐dependent growth and survival. Redds were documented in newly accessible habitat immediately following barrier removal and accounted for a median of 42% of all redds in the Pahsimeroi River watershed during 2009–2015. Snorkel surveys also documented juvenile rearing in newly accessible habitat. Juvenile productivity increased from a median of 64 smolts/female spawner for brood years 2002–2008 to 99 smolts/female spawner for brood years 2009–2014. Overall, results suggested increased habitat accessibility in the Pahsimeroi River broadened the distribution of spawning adult and rearing juvenile salmon and reduced the effects of density‐dependent survival. Large‐scale stream restoration efforts can have a population effect. Despite the large‐scale effort and response, habitat restoration alone is likely not sufficient to restore this population.

An End-of-Life Care Educational Series to Improve Staff Knowledge and Comfort Levels.

Nursing staff play a key role in enhancing a patient's quality of life during end of life; however, they perceive lack of knowledge to be the largest barrier in providing quality end-of-life (EOL) care. Literature suggests that implementation of palliative and EOL care education can improve nursing EOL care practices. In order to address the gap in nursing knowledge and comfort, a quasi-experimental study was conducted; this study included the implementation of a multimodal EOL care educational series on an inpatient pediatric hematology oncology floor over 6 months. Prior to implementation, nursing staff completed a survey to measure perceived knowledge and comfort level regarding EOL care. The series included didactic sessions, in-services, case studies, practice exercises, and interactive discussions led by an interprofessional team of nurses, child-life specialists, and social workers. Educational topics included EOL symptom management, child-life services, supportive care resources, COMFORT communication, and an End-of-Life Nursing Education Consortium course. Following the educational series, the survey was repeated. Results of the survey demonstrated an increase in nursing knowledge and comfort levels. Significant improvements were observed across several items including medication management of dyspnea (χ1,83 =5.1, P = .023), comfort with implementing interventions (χ1,93 = 3.9, P = .049), and knowledge of hospital resources (χ1,93 = 6.1, P = .014). These results suggest that while EOL education strategies can vary, a combination of learner engagement tactics can increase knowledge and comfort regarding EOL concepts and potentially positively impact nursing practice.