Median Number Of Consultations Research Articles

Autologous fat transplantation prior to permanent expander implant breast reconstruction enhances the outcome after two years: a randomized controlled trial.

Radiotherapy is important in breast cancer treatment. A side effect of the treatment is fibrosis that decreases the possibility for a successful breast reconstruction with expanders and with high patient satisfaction with the result. The most common option for mastectomized, irradiated women wishing for a breast reconstruction is autologous tissue transplantation. However, some patients are not suitable for flap surgery. Fifty mastectomized and irradiated women were included in a randomized controlled trial. They underwent breast reconstruction with expanders and were allocated 1:1 to either receive pre-treatment with autologous fat transplantation (AFT) or not. Primary outcomes were frequency of reoperations and complications. Secondary outcomes were number of days in hospital, number of outpatient visits to surgeon or nurse and patient reported outcome as reported with Breast Q. Follow-up time was 2 years. Fifty-two per cent of the intervention group and 68% of the controls underwent reoperations (p = 0.611). Thirty-two per cent of the intervention group and 52% of the controls had complications (p = 0.347). The median number of consultations with the nurse was four in the intervention group and six in the control group (p = 0.002). The AFT patients were significantly more satisfied with their breasts and psychosocial well-being after 2 years. They also had higher increase in satisfaction with breasts, psychosocial well-being, and sexual well-being when comparing baseline with 2 years postoperatively. This randomized controlled trial indicates benefits of AFT prior to breast reconstruction with expanders, especially on patient reported outcome even if the study sample is small.

Abstract 924: Patterns of specialty referral in cancer patients treated with immunotherapy regimens

Abstract Background: Specialty referral rates have been steadily increasing, as much as 94% within a 10-year period (1). Previous studies have shown the benefits of specialty referral in oncology management in specific populations such as lung cancer patients (2). However, there have yet to be larger-scale studies on general trends in specialty referral in oncology. In particular, patients on immune checkpoint inhibitors frequently develop immune-related adverse events (irAEs) affecting a variety of organ systems and may benefit from specialty care (3). Objectives: To evaluate the patterns of specialty referral in patients treated with immune checkpoint inhibitors and identify referral patterns that affect patient outcomes. Methods: This was a retrospective study of all specialty referral for patients on an immunotherapy regimen from 6/1/2022-6/1/2023 at a single-institution cancer center. The specialties consulted included cardiology, dermatology, endocrinology, gastroenterology, infectious disease, neurology, pulmonology, and nephrology. Results: In total, there were 5,602 patients on an immunotherapy regimen, of whom 3,519 patients (62.8%) were referred to a specialist. Of these patients, 2,017 (57.3%) attended a specialist appointment. A majority of the patients were male (n=1038, 51.5%), had a mean age of 64.1 years (SD=13.8) at initial consult, and were White/non-Hispanic (n=1414, 70.1%). The mean and median number of consults per patient were 1.7 (SD=1.3) and 1 (IQR=1), respectively. The maximum number of consultations for a patient was 17. Dermatology was the most commonly consulted service (n=841, 25.9%), followed by neurology (n=781, 24.0%), and endocrinology (n=446, 13.7%). For dermatology, the most common reason for consultation was evaluation of a rash (n=500, 59.5%). Dermatology also had the highest ratio of outpatient to inpatient consultations at 10.4 to 1. The next closest service was endocrinology at 3.0 to 1. The pulmonary service had the shortest time between consult request and patient visit (10 days), followed by dermatology (13 days), and gastroenterology (15 days). Prior to their initial consultation, the vast majority of patients (82.6%) were on a single therapy, and the most common single therapy was pembrolizumab (n=1589, 59.2%). The most common combination therapy was ipilimumab plus nivolumab, accounting for 59.3% of combinations. Fifty percent of patients (n=1008) who saw a specialist were able to continue their immunotherapy regimen. Conclusions: There is a range of specialty and multidisciplinary care that is necessary for the management of patients on immunotherapy regimens. Citation Format: Anna Chen, Stephen Dusza, David Faleck, Neil Shah, Mario E. Lacouture. Patterns of specialty referral in cancer patients treated with immunotherapy regimens [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 924.

Antibiotic use in first opinion equine practice in the United Kingdom: Serial point prevalence surveys in 17 practices

SummaryBackgroundMonitoring antibiotic use (AMU) is a key component of antimicrobial stewardship. Published data on AMU in first opinion equine practice are limited.ObjectivesTo document AMU in first opinion equine practices.Study designRepeated point prevalence surveys.MethodsAMU was recorded one day every month for 12 consecutive months in 17 equine practices.ResultsTwo hundred and fifty‐two horses were prescribed antibiotics across 2273 consultations (excluding routine appointments) (11.1%; 95% CI 9.8%–12.4%). Median number of consultations per practice was 121 (IQR 112–159; range 27–303). Across 17 practices, the proportion of horses receiving antibiotics varied by practice from 0% to 26.4%. Commonest indications for AMU included cellulitis (66; 26.8%), wounds (46; 18.7%), surgical prophylaxis (36; 14.6%), respiratory infection (27; 11.0%) and skin infection (20; 8.1%). Commonest antibiotics prescribed were potentiated sulphonamides (109; 43.6%), oxytetracycline (58; 23.2%), procaine penicillin (40; 16.0%) and doxycycline (36; 14.4%). 45.0% of oxytetracycline use was for surgical prophylaxis. 44.8% of procaine penicillin use was for cellulitis. 28.6% of ‘other antimicrobial’ use was for pyrexia of unknown origin. Use of antibiotics differed significantly depending on the underlying diagnosis (p < 0.001). Median antibiotic dose rates were: potentiated sulphonamides 30 mg/kg (IQR 27–75; range 10–75; n = 96); procaine penicillin 19 mg/kg (IQR 15–23; range 7–30; n = 35); oxytetracycline 6 mg/kg (IQR 5–6; range 4–30; n = 55); doxycycline 10 mg/kg (IQR 10–20; range 7–30; n = 34).Main limitationsWeight of horses were often estimated. Duration of antibiotic courses was not recorded.ConclusionsAntibiotics were prescribed in 11% of nonroutine consultations. Commonest indication for AMU was cellulitis. Potentiated sulphonamides, oxytetracycline and procaine penicillin were the commonest prescribed drugs. Critically important antibiotic use was infrequent. Dose rates varied, but median values were generally appropriate.

The profile of French osteopaths: A cross-sectional survey

BackgroundOsteopathy is not a health profession in France but it was regulated in 2007. However, the profession is very popular, and the number of osteopaths is the largest in Europe. Since there is limited published data on the profile and characteristics of osteopaths practising in France, this study aimed to survey the current situation of osteopathic practitioners in France. MethodsA voluntary online-based survey was distributed to French osteopaths between March and July 2022. This survey consisted of 52 questions adapted from the original French version of the validated Benelux Osteosurvey. ResultsA total of 1461 osteopaths responded to the study, of which 785 (53.73%) were female. The majority of respondents were aged between 30 and 39 years (50.65%), had full-time training (89.73%), during 5 years (67.15%), were self-employed (99.59%), advertised themselves exclusively as osteopaths (90.35%) and showed a solid professional identity. The median number of consultations per week was 21–25, and nearly one-third of respondents (31.42%) reported having other professional activities outside their clinical practice as an osteopath. Osteopaths in France manage acute and chronic complaints in all body areas but mainly in the spine. ConclusionsThis study provides a first overview of the current profile of osteopathic practitioners in France since 2012. At present, it constitutes a new informative report of their characteristics and provides several perspectives on the profession's development in terms of status and training. Implications for practice●The majority of respondents were aged between 30 and 39 years, had undergone a full-time five-year training, advertised themselves exclusively as osteopaths and manifested a strong osteopathic identity.●Most reported being self-employed, and managing acute and chronic complaints located in all body areas, but mainly the spine.●Respondents expressed a strong desire for a greater integration of osteopathy into the French health system, especially through better collaboration with other healthcare professionals.

The Austrian Osteopathic Practitioners Estimates and RAtes (OPERA): A cross-sectional survey.

Since the previous survey of the osteopathic profession in Austria was almost a decade ago, an update was necessary. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as a Europe-based survey, whereby an updated profile of the profession not only provides new data for Austria, but also allows for a clear comparison with other European countries. A voluntary, online-based, closed-ended survey was distributed across Austria in the period between April and August 2020. The original English OPERA-questionnaire, composed of 52 questions in seven sections, was formally translated in German and adapted to the Austrian situation. Recruitment was performed through social-media and an e-based campaign. The survey was completed by 338 individuals, of which 239 (71%) were female, and the median age was 40-49 years. Almost all respondents had preliminary healthcare training, mainly in physiotherapy (72%). The majority of respondents were self-employed (88%) and working as sole practitioners (54%). The median number of consultations per week was 21-25 and the majority of respondents scheduled 46-60 minutes for each consultation (69%). The most commonly used diagnostic techniques were: palpation of position/structure, palpation of tenderness and visual inspection. The most commonly used treatment techniques were cranial, visceral and articulatory/mobilisation techniques. The majority of patients estimated by respondents consulted an osteopath for musculoskeletal complaints mainly localised in the lumbar and cervical region. Although the majority of respondents experience a strong osteopathic identity, only a small proportion (17%) advertise themselves exclusively as osteopaths. This study represents the first published document to determine the characteristics of the osteopathic practitioners in Austria using large, national data. It provides new information on where, how, and by whom osteopathic care is delivered. The information provided may contribute to the evidence used by stakeholders and policy makers for the future regulation of the profession in Austria.

Investigation the contents of employment consultation and support in a cancer center hospital

This study aimed to analyze and categorize the actual situation of employment consultation and support according to consultation times or employment status at the Consultation Support Center of the National Cancer Center Hospital of Japan. We retrospectively analyzed the patient backgrounds, consultation contents, and the number of employment consultation cases conducted at the Consultation Support Center of the National Cancer Center Hospital during a 6-month period from May to December 2018. During the study period, 117 patients (male: female = 46:71) visited the Consultation Support Center. The median age of patients was 48 years old. The most common primary cancer site was the breast in 28 patients followed by the lung in 16 patients, and then gynecologic cancer in 10 patients. The most common cancer treatment was chemotherapy in 53 patients (45.3%), and 12 patients (10.2%) were recurrent patients. Fifty-two patients were in regular employment, 24 were unemployed, 17 were of unknown employment status, 16 were in non-regular employment, and 8 were classified/categorized as other. In terms of working status, 40 were on leave, 35 were working, 15 were seeking work, 8 were unemployed, and 19 were categorized as other. The median number of consultations was 1 (1,11). The content of consultations was the social security system in 44 cases (37.6%) job seeking in 24 cases (20.5%), how to inform the workplace in 14 cases (12%), and workplace environment adjustment in 13 cases (11.1%). We conducted a survey on the actual status of employment consultation in a cancer center hospital. The majority of consultations were completed in one session. In terms of the content of consultations, there was a high need for consultations on the social security system and job seeking. Further study is needed on the characteristics of employment consultations according to employment status and other attributes.

Covid-19 pandemic impacts on follow-up of child growth and development.

ABSTRACTOBJECTIVE To analyze the impact of the covid-19 pandemic on the use of primary health care services to follow-up the child growth and development in Brazil.METHOD A total of 7.9 million consultations of children (0–2 years old) across Brazil between March 2017 and May 2020 were studied. Differences between medians were analyzed using non-parametric tests, the Global Moran Index (IGM) and the Local Indicators of Spatial Association.RESULTS During the initial period of the pandemic, the median number of consultations was significantly lower than the same period in previous years, reducing more than 50%. The drop in 2020, compared to 2019, ranged from 49% to 62.2% across all regions of the country, except the South. The percentage reduction registered in 2019–2020 showed significant spatial autocorrelation (IGM = 0.20; p = 0.04), with the presence of low-low (states with reduction between 29% and 51%) and high-high (states with reduction between 55% and 69%) spatial clusters.CONCLUSION The covid-19 pandemic impacted the follow-up of child growth and development in primary health care services in Brazil, with a geographically uneven reduction.

The Portuguese Osteopathic Practitioners Estimates and RAtes (OPERA): A cross-sectional survey

ObjectivesOsteopathy is regulated as an independent healthcare profession in Portugal. The Osteopathic Practitioners Estimates and RAtes (OPERA) project was developed as a survey to profile the osteopathic profession. This study aimed to describe the characteristics of Portuguese osteopathic practitioners. MethodsA voluntary online-based survey was distributed across Portugal between February and June 2020. The survey, composed of 52 questions and seven sections, was formally translated from English to Portuguese and adapted from the original version. Two pilot tests evaluated cultural adaptation and reproducibility. Adult, self-defined osteopaths working in Portugal were eligible. Recruitment of participants was performed through social media and an e-based campaign. ResultsA total of 222 osteopaths participated in the study, 143 were male (64%), aging between 30 and 39 years (42%), mainly working in Lisbon (30%). Most respondents had preliminary healthcare training (68%), mainly as massage therapists. The majority of respondents were self-employed (83%), owner of a clinic (55%) and working alone (59%). The median number of consultations per week was 21–25 and respondents scheduled 46–60 min for each consultation. The majority of patients seek care for lumbar (52%), cervical (38%) and upper spine (38%) complaints. Although most respondents experience a strong osteopathic identity, they do not advertise themselves exclusively as osteopaths. ConclusionsThis study represents the first nationwide document to determine osteopaths' characteristics in Portugal. The study results provide a basis for future surveys that will include cohorts with higher levels of education, as well as findings from other European countries.

One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial.

BackgroundChronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management.ObjectiveThe goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway.MethodsPatients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up).ResultsFrom a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19).ConclusionsOne-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice.Trial RegistrationClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177

Ethics Consultation in U.S. Hospitals: A National Follow-Up Study

A 1999–2000 national study of U.S. hospitals raised concerns about ethics consultation (EC) practices and catalyzed improvement efforts. To assess how practices have changed since 2000, we administered a 105-item survey to “best informants” in a stratified random sample of 600 U.S. general hospitals. This primary article details the methods for the entire study, then focuses on the 16 items from the prior study. Compared with 2000, the estimated number of case consultations performed annually rose by 94% to 68,000. The median number of consults per hospital was unchanged at 3, but more than doubled for hospitals with 400+ beds. The level of education of EC practitioners was unchanged, while the percentage of hospitals formally evaluating their ECS decreased from 28.0% to 19.1%. The gap between large, teaching hospitals and small, nonteaching hospitals widened since the prior study. We suggest targeting future improvement efforts to hospitals where needs are not being met by current approaches to EC.

The Impact of Covid-19 on Diabetes Care in Muscat Governorate: A Retrospective Cohort Study in Primary Care.

BackgroundCOVID-19 pandemic has led to health service modification and temporary disruption of the routine care provided to patients with diabetes mellitus (DM) in primary care. This was done to minimize outpatient visits, permit physical distancing, and ensure patients’ and healthcare providers safety. There is no evidence that explored or measured the impact of COVID-19 pandemic on diabetes services and patients’ glycemic outcome in Oman.Aim and ObjectivesTo explore the accessibility of DM services in primary care after COVID-19 pandemic announcement, and measure patients’ glycemic outcome.MethodsBefore and after, retrospective cohort study using Al-Shifa healthcare database in primary care. One thousand adult patients with diabetes who attended DM clinic before pandemic announcement in 2019 were randomly selected and followed up until end of 2020. Patients aged ≥18 years and had at least 2 visits in 2019 were included. Access to DM services was identified by number of patients received care, frequency of consultations, mode of consultation, and type of intervention given to patients. Patients’ glycated hemoglobin (HbA1c), and other glycemic parameters after pandemic announcement in 2020 were determined and compared with the same parameters before pandemic in 2019. Association between patients’ HbA1c and mode of consultation was measured using multivariable regression analysis.ResultsA total of 937 patients continued to follow and received DM care after pandemic announcement. Median number of consultations was 2 with interquartile range (IQR): 3-2. 57.4% had face-to-face alone, 32.4% had combined face to face and telephone consultation, and 10% had telephone consultation alone. Mean difference in HbA1c (%) before and after pandemic announcement was 0.2 ± 1.4 (95% CI: 0.1 to 0.3), P = .002. With multivariable linear regression, the mean difference in HbA1c was −0.3 (−2.3 to 1.5), P = .734 for telephone consultation alone, −0.5 (−2.4 to 1.4), P = .613 for face-to-face alone, and −0.5 (−2.4 to 1.3), P = .636 for combined consultations, compared to those who did not receive any formal consultation.ConclusionDespite service modification and disruption of comprehensive care in primary care after COVID-19 pandemic announcement, DM services were accessible as majority of patients maintained follow up. There was an overall increase in mean glycated hemoglobin, however, it was a less than 1 unit increase. After adjusting for multivariable, glycated hemoglobin was reduced among those who received consultation including telephone consultation compared to those who did not, however evidence was unconvincing.

Access to Palliative Care Services and Clinical Outcomes of Patients With Solid Malignancy-Associated Myelophthisis in a Resource-Limited Setting.

Myelophthisis (MPT) has been associated with a dreadful prognosis. Patients' access to palliative care (PC) and factors influencing its clinical outcomes are poorly described. Our aim was to analyze the impact of patient- and disease-specific characteristics on survival of patients with MPT and describe their use of PC in a resource-limited setting. Retrospective study including patients with solid tumor MPT, diagnosed between 1996 and 2018. Seventy patients (median 58 years) were included. 58% were synchronously diagnosed with MPT at time of primary tumor diagnosis. Most common oncologic diagnoses were prostate (25.7%), gastrointestinal (20%), and breast (18.6%) neoplasms. Median overall survival (OS) was 1.9 months. Primaries other than prostate, breast, and lung (HR 1.37, 95% CI 1.15 - 1.8; p = 0.02) and transfusion requirements (HR 2.8, 95% CI 1.01 - 7.9; p = 0.04) were independently associated with decreased OS. Administration of multiple systemic therapeutic interventions (HR 0.15, 95% CI 0.06 - 0.39; p = 0.01) was the sole factor improving OS. Assessment by PC was pursued in 51.4% of patients. The median number of consults per patient was two, with no difference in assessment rate or consult number across different primaries (P = 0.96). Four cases of palliative sedation were reported, all performed by the primary care team. MPT is highly heterogeneous and risk stratification to optimize the use of therapeutic interventions in unison with palliative interventions is needed to maximize efforts toward improving patient quality of life. There is an alarming need of PC services in the multidisciplinary management of patients within developing regions.

How to Identify Common Variable Immunodeficiency Patients Earlier: General Practice Patterns.

Diagnostic delay is a major problem concerning common variable immunodeficiency (CVID). We aimed to determine the pattern of general practitioner (GP) consultations in individuals diagnosed with CVID within 3years before the diagnosis and whether the risk of diagnosis was associated with the frequency of consultations or character of examinations. We conducted a nested case-control study, identifying 132 adult CVID patients and 5940 age- and gender-matched controls from national registers during 1997-2013. We used conditional logistic regression to calculate the odds ratios (OR) and 95% confidence intervals (95%CI). The median number of consultations among individuals with CVID was more than twice that of the controls in all 3years (3rd, 10; 2nd, 11.5; and 1st, 15.4 vs. 4). We found a statistically significant association between the number of consultations and the risk of a subsequent CVID diagnosis, independent of age and gender, but strongest in the individuals < 40years. In the 3rd year before diagnosis, having 9-15 consultations compared with 1-4 was associated with an OR (95%CI) of 5.0 (2.3-10.9), 2.4 (1.1-5.4), and 1.3 (0.3-5.3) for those aged 18-40, 41-60, and > 60, respectively. Several examinations (i.e., blood tests for inflammation/infection and pulmonary function test) were associated with increased odds of a subsequent CVID diagnosis. The risk of a CVID diagnosis was highly related to both the number of consultations and the character of examinations performed by the GP. CVID should be a differential diagnosis among patients with multiple consultations, especially in patients < 40years old.

P19.04 Psychosocial counseling in neuro-oncology - analysis of topics and needs of brain tumor patients

Objective: In the field of neuro-oncology an increasing focus is being directed towards the psychosocial needs of patients diagnosed with brain tumors. However, it remains challenging to establish psycho-oncological therapies and interventions that meet the specific needs of these patients. Therefore, the aim of this study was to identify major concerns and burdens of brain tumor patients on the basis of our clinical experience. Methods: This retrospective chart analysis included 53 patients attending supportive psycho-oncological counseling at the Department of Neurosurgery, University of Münster between 2010 and 2014. All patients were counseled by the same therapist, a neurosurgeon with specialization in psycho-oncology. Notes were analyzed based on qualitative content analysis. With regard to physical and psychological symptoms, coping strategies and further concerns mentioned by the patients, thematic categories were established. Notes were then assigned to the categories to analyze their frequency distribution and identify the patients’ main concerns. Results: The cohort had a mean age of 48 years. 30 (56.6%) were female. 23 (43.4%) were diagnosed with high grade glioma, 16 (30.2%) with low grade glioma, 10 (8.9%) with a benign brain tumor and 4 (7.5%) had cerebral metastasis. The median number of consultations per patient was 4 (range 1 - 47). During their first consultation, 36 (67.9%) patients listed their physical symptoms and limitations. 40 (75.5%) suffered psychological symptoms, often accompanied by a depressive disorder. The majority of patients expressed issues related to questions concerning meaning of and priorities in life (71.7%), medical topics and questions (62.3%) and death and mortality (56.6%). Furthermore, the following concerns were primarily mentioned: the shock of being diagnosed with a brain tumor, work and occupation, loss of roles and tasks in daily life, family conflicts, reduced mobility, excessive demand and reduced capacity. Concerning coping modes, more patients showed appropriate strategies (including an active attitude toward the disease; 39.6%) than inappropriate strategies, comprising resignation (20.8%) and rumination (18.9%). Concerning psychological symptoms and topics of conversations, there were no significant differences among patients regardless of the dignity of tumor (p= n.s.). Conclusion: These results provide an insight into major concerns and issues that patients diagnosed with a brain tumor are frequently dealing with. Therefore, they can serve as an important basis for the development of psychosocial intervention concepts. No significant differences between the diagnosis groups were found. This suggests that, regardless of prognosis and tumor natural history, the burdens of patients diagnosed with a brain tumor are similar and all patients, despite of their diagnosis, might benefit from psychosocial support.

Palliative Workforce Development and a Regional Training Program.

Our primary aims were to assess growth in the local hospital based workforce, changes in the composition of the workforce and use of an interdisciplinary team, and sources of support for palliative medicine teams in hospitals participating in a regional palliative training program in Chicago. PC program directors and administrators at 16 sites were sent an electronic survey on institutional and PC program characteristics such as: hospital type, number of beds, PC staffing composition, PC programs offered, start-up years, PC service utilization and sources of financial support for fiscal years 2012 and 2014. The median number of consultations reported for existing programs in 2012 was 345 (IQR 109 - 2168) compared with 840 (IQR 320 - 4268) in 2014. At the same time there were small increases in the overall team size from a median of 3.2 full time equivalent positions (FTE) in 2012 to 3.3 FTE in 2013, with a median increase of 0.4 (IQR 0-1.0). Discharge to hospice was more common than deaths in the acute care setting in hospitals with palliative medicine teams that included both social workers and advanced practice nurses ( p < .0001). Given the shortage of palliative medicine specialist providers more emphasis should be placed on training other clinicians to provide primary level palliative care while addressing the need to hire sufficient workforce to care for seriously ill patients.

Parcours prédiagnostique des enfants et adolescents atteints de tumeurs solides

to describe medical care pathways between first symptoms and first oncologic consultation in children and adolescents with solid cancers in order to analyze a possible relationship between delayed diagnosis and its potential consequences. Retrospective study on patients aged less than 25years at first consultation in the oncology department of pediatric, adolescent and young adult in Institut Curie during one year. Were collected data on cancer characteristics, components of care pathways, and sociodemographic parents' characteristics. Hundred and six patients were selected, with median age of 6years. Most represented tumor was low-grade cerebral tumor (17.0%). Pain was the most frequent type of disorder observed as first sign (34.3% of patients). First signs were unspecific in only 27.6% of cases. Most patients were first seen by a general practitioner (29.3%). Median total time to diagnosis was one month [ranges: 0-64]. Median number of consultations before referral to oncology expert was 2 [0-7]. Retrospective analysis found a possible delayed diagnosis in 44.3% of patients, with potential vital and functional risks estimated respectively at 14.1 and 20.7% of overall population. Time to diagnosis was shorter if father was of foreign nationality vs. French (34days vs. 72days, P<0.05), and longer if parents were separated (74.5days vs. 42.5days, P<0.03). Overall time to diagnosis is quite fast, even if first signs of pediatric cancers are very polymorphic. Some medical and sociodemographic factors could influence characteristics of care pathways.

Glycemic Control Rate in Patients With Type 1 Diabetes Treated at a Public Tertiary Referral Hospital in Rio de Janeiro, Brazil

Background: The incidence of type 1 diabetes (T1D) has been increasing worldwide, leading to a serious public health problem resulting in reduced life expectancy and increased morbidity. The aim of this study was to determine the glycemic control rate and its demographic and clinical factors, in T1D followed up at a tertiary referral hospital in Brazil. Methods: An observational and retrospective study was conducted between October 2014 and October 2015. Data were obtained from 140 medical records. Results: Satisfactory glycemic control rate was found in 22.14% of patients. There was no difference between the pediatric group and adult group regarding control rate. However, a worse HbA1C level was found in the pediatric group (P = 0.001). The use of long-acting insulin analogue (P = 0.03) was associated with satisfactory glycemic control, and a tendency was observed for both the combination of long-acting and ultra-rapid acting analogues (P = 0.08), and the absence of ketoacidosis during the course of diabetes (P = 0.08). In the group with satisfactory glycemic control, the median number of consultations (1 (1 - 4)) was significantly lower than in the uncontrolled group (2 (1 - 4)) (P = 0.003). Regarding the two major microvascular complications, 23.53% had retinopathy and 12.09% had nephropathy. Conclusions: The majority of patients did not obtain a satisfactory HbA1C level. Good glycemic control factors were directly associated with the use of long-acting insulin analogues, and the combination of long-acting and ultra-rapid analogues as well as the absence of ketoacidosis during T1D’s evolution tended also to be associated with better metabolic control. J Endocrinol Metab. 2016;6(5):135-142 doi: http://dx.doi.org/10.14740/jem369w

Ethics consultation volume at U.S. children's hospitals: A cross-sectional survey

abstractBackground: There is growing interest in credentialing hospital ethicists. Consult volume is being incorporated into credentialing criteria, although few data supporting this approach are available. The objectives of this study were to (1) measure the consult volume at U.S. children's hospitals, (2) identify the factors associated with consult volume, and (3) determine the relevant views of pediatric ethics consultants. Methods: The study population was U.S. children's hospitals with at least 100 beds that have a dedicated pediatric ethics consultation service (n = 56). The study was a cross-sectional, Internet-based survey of the best informants at these hospitals. Results: The response rate was 79% (44/56). The median number of consults conducted per year was 8 (range 1–57). Factors associated with consult volume adjusted for hospital beds were salary support of the consultation service (p = 0.002); the frequency of didactic ethics lectures (p = 0.001); the frequency of ethics consultants informally visiting the hospital wards (p = 0.007), the number of educational services provided (p = 0.003); the frequency of ethics rounds (p = 0.02); and the use of a call schedule (p = 0.003). Seventy-nine percent believed that quality of ethics consultation is related to the number of consults performed, and 68% supported minimum standards for consult volume in a credentialing policy. Overall, 64% expressed support for credentialing of hospital ethicists. Conclusions: Educational and outreach efforts by hospital ethics committees, as well as salary support for hospital ethicists, are associated with increased pediatric ethics consultation volume at U.S. children's hospitals.

210-POS

Objectives To describe sociodemographic, obstetric and clinical characteristics of women with acute kidney injury (AKI) secondary to preeclampsia/eclampsia. Methods A retrospective cross-sectional descriptive study was conducted. Women admitted to IMIP’s Obstetric ICU, Northeast of Brazil, during pregnancy and childbirth with AKI and preeclampsia/eclampsia, from September 2012 to September 2013 were recruited. Women with acute kidney injury secondary to other conditions were excluded. The study was approved by the Research Ethics Committee of the Institution. Results During the study period 872 women with preeclampsia/eclampsia were admitted at the ICU and were 91 diagnosed with AKI (10.4%). Average age of participants was 25.5 years (SD = 8.2) and median parity was 1. Dark skin color predominated (71.6%), only 23.3% had no partner and 42.2% had up to 4 years of study. Two women did not receive any prenatal care and median number of consultations was 5. Eighty four women (92.3%) were admitted postpartum, and 63 of these (75%) had cesarean sections. Six women were diagnosed with eclampsia (6.6%) and 74 (81.3%) of pre-eclampsia, and 11 (12%) of these had chronic hypertension superimposed or not by preeclampsia. HELLP syndrome was present in 30 women (32.9%), placental abruption in six patients (6.7%) and postpartum hemorrhage in nine (9.8%). Urine output less than 25 mL/h was present in 79% of the sample, urea above 40 mg/dL was present in 51.1% and creatinine greater 0.8 mg/dL in 58.8% of cases. Hyperkalemia occurred in 5.5% of patients and acute pulmonary edema in one (1.1%). Dialysis was required in 12 women (13.2%), with a median of 5 days of dialysis; nine were discharged yet on dialysis. There were 3 deaths (3.3%). Conclusions Acute kidney injury is a significant morbidity associated with hypertensive disorders of pregnancy, contributing to increased costs and mortality associated with this disease. Disclosures L. Katz: None. I. Souza: None. I. Coutinho: None. M.M. Amorim: None.

Geriatric Fracture Center

Since April 1, 2008, patients aged ≥65 years presenting with a hip fracture at Ziekenhuisgroep Twente, Almelo (ZGT-A), The Netherlands, have been admitted to the geriatric fracture center (GFC) and treated according to the multidisciplinary treatment approach. The objective of this study was to evaluate how implementation of the treatment approach has influenced the quality of care given to older patients with hip fracture. Prospective cohort study with historical control group. Two groups of patients with hip fracture were compared, 1 group was treated according to the new multidisciplinary treatment approach in 2009-2010, and the other group received the usual treatment in 2007-2008. The number of readmissions within 30 days after discharge was compared, and an analysis was carried out regarding the number of complications, the number of consultations with various specialists and with the geriatrician, and the duration of hospital stay. In all, 140 patients from 2009 to 2010 group and 90 patients from 2007 to 2008 group were included. In 2009-2010 group, the number of readmissions within 30 days dropped by 11 percentage points (P = .001). The incidence of the number of complications decreased with a median of 1 compared with 2007-2008 (P = .017) group. Delirium was diagnosed to be 6 percentage points more frequent. The median number of consultations with various specialists per patient decreased by 1 percentage point as a result of geriatrician cotreatment (P = .002). The median duration of hospital stay was 1 day shorter than that in 2007-2008 group. The use of the multidisciplinary treatment approach led to a significant reduction in the number of readmissions within 30 days after discharge. It appears to be associated with improved short-term treatment outcomes for older patients with a hip fracture.