Navigation Support Research Articles

Abstract A004: Quitxt mobile text messaging cessation program for primary care and cancer patients development and implementation process

Abstract Background: Physicians have unparalleled access to smokers. It is estimated that over 70% of smokers visit a physician every year, which provides a powerful opportunity to promote tobacco cessation by asking about smoking behaviors and providing cessation advice and counseling to tobacco users at every visit. In general, smokers consider a physician’s advice to quit an important motivator to make a quit attempt. Every patient is screened for tobacco use; if the patient is a tobacco user, healthcare providers (HCPs) advise them to quit, offer nicotine replacement therapy if needed, and recommend enrollment in the Quitxt program to receive daily messages from the program as well as patient navigator support. Purpose: To conduct a system change to facilitate the integration of Quitxt into the healthcare setting of the Primary Care Center (PCC) and the Mays Cancer Center (MCC) at UT Health San Antonio, to increase accessibility and utilization of a bilingual, evidence-based tobacco cessation service among patients. Methods: We adapted our Quitxt program to the patient population attending the PCC and MCC, integrated it into EPIC, and added it to the Best Practice Advisories Banner. All patients are screened for tobacco use, and if a tobacco-using patient is identified, the Best Practice Advisories banner appears on HCPs’ screen, prompting them to counsel patients to quit and encourage them to enroll in Quitxt. Enrollment cards are available in exam rooms and help providers talk about the program and provide information on how to enroll. The EPIC system also places instructions on how to enroll in Quitxt in the patients’ after-visit summary. Selecting referral to Quitxt activates our Patient Navigators (PNs) follow-up. PNs contact patients monthly and provide support, positive reinforcement, and encouragement. They continue with monthly follow-ups throughout the duration of the program (6 months). Results: To date, 194 patients have been referred to the BestPractice basket. PNs made 829 follow-up phone calls. Of those patients, 104 have enrolled in the program. So far, 96% are English speakers, with a mean age of 47 yrs (SD 11.4); 64% female, 38% Hispanic, the mean number of cigarettes smoked per day was 12, and 60% were ready to make a quit attempt the next day. Preliminary results show cessation rates of 22.1% at day 1; 26.2% at 7 days; 20.4% at 1 month; 31.4% at 4 months and 27.6% at 6 months. Conclusion: Integrating Quitxt into the healthcare setting increases the accessibility and utilization of the Quitxt cessation service among primary care and cancer patients. Quitxt can be easily replicated and represents an affordable approach to reach tobacco-using patients, produce a public health impact, and reduce health service costs and tobacco-related diseases and mortality. Citation Format: Patricia Chalela, Vivian Cortez, Sandra G. Sivak, Armida Flores, Edgar Muñoz, Cliff Despres, Ramon Cancino, Mio Kitano, Rahul Mundlamuri, Ganesh R. Gunnam, David Akopian, Amelie G. Ramirez. Quitxt mobile text messaging cessation program for primary care and cancer patients development and implementation process [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A004.

Perspectives on Knowledge Representation in Maritime Education: A Qualitative Exploration of STIP Jakarta Cadets

This research investigates the perspectives of 240 Maritime Institute Jakarta (STIP Jakarta) cadets regarding knowledge representation in navigational decision support systems. Grounded in a qualitative descriptive approach, the study unfolds over three semesters, examining academic self-checked intelligence, professional competences, motivations, and the cadets' viewpoints on the complexities of maritime education. The cadets, enrolled in an international programme, undergo extensive preparation for internships within the global shipping industry, necessitating proficiency in English communication aligned with International Maritime Organization standards. The findings reveal a positive correlation between academic self-checked intelligence and professional competences, underscoring the significance of metacognitive strategies in shaping technical proficiency. Motivations, both intrinsic and extrinsic, emerge as crucial influencers shaping cadets' perspectives on knowledge representation. The study also highlights the evolving confidence of cadets in English maritime literacy, emphasising the necessity of tailored language instruction strategies. Recommendations for enhancing maritime education include promoting metacognitive strategies, integrating real-world applications, tailoring language instruction, providing continuous motivational support, and ensuring regular curriculum reviews. These recommendations offer practical insights for educators and administrators to refine instructional practices and align curricula with industry demands.While acknowledging limitations such as reliance on self-reported data and the focus on a specific cohort, this research contributes to the discourse on maritime education. It serves as a foundation for future studies, urging a diversified methodology and extending the scope to include multiple maritime institutions for a more comprehensive understanding. As STIP Jakarta continues to prepare cadets for global maritime challenges, the insights gleaned from this study are integral for adapting and advancing educational practices.

Rural Veterans' Experiences with Social Risk Factors: Impacts, Challenges, and Care System Recommendations.

Social risk factors, such as food insecurity and financial needs, are associated with increased risk of cardiovascular diseases, health conditions that are highly prevalent in rural populations. A better understanding of rural Veterans' experiences with social risk factors can inform expansion of Veterans Health Administration (VHA) efforts to address social needs. To examine social risk and need from rural Veterans' lived experiences and develop recommendations for VHA to address social needs. We conducted semi-structured interviews with participants purposively sampled for racial diversity. The interview guide was informed by Andersen's Behavioral Model of Health Services Use and the Outcomes from Addressing Social Determinants of Health in Systems framework. Rural Veterans with or at risk of cardiovascular disease who participated in a parent survey and agreed to be recontacted. Interviews were recorded and transcribed. We analyzed transcripts using directed qualitative content analysis to identify themes. Interviews (n = 29) took place from March to June 2022. We identified four themes: (1) Social needs can impact access to healthcare, (2) Structural factors can make it difficult to get help for social needs, (3) Some Veterans are reluctant to seek help, and (4) Veterans recommended enhancing resource dissemination and navigation support. VHA interventions should include active dissemination of information on social needs resources and navigation support to help Veterans access resources. Community-based organizations (e.g., Veteran Service Organizations) could be key partners in the design and implementation of future social need interventions.

A Discrete Choice Experiment of Older Self-Funders’ Preferences When Navigating Community Social Care

Most long-term care systems (social care) for older people rely on some means testing, copayment system, private insurance, or other non-governmental funding to supplement state provision. In England, an estimated quarter of homecare delivery is funded privately. For many older people, the absence of state funding for their care is only part of the problem: they are also expected to search for care in a market characterised by complexity, plurality, and imperfect information. Surprisingly, there are few services available to support private funders to navigate the system. This paper examines willingness to pay for care navigation and seeks to classify heterogeneity of preferences for navigation support. A discrete choice experiment (DCE) survey was completed by 182 participants across England in 2020-21. The results of the random parameter logit model used to analyse preferences showed that people valued information about care options (quality, information, and finances), but they also wanted help to “think things through,” as processing information could be challenging. Generally, participants valued what the navigation service provided, more than how the services were organised and delivered. The study also used latent class analysis to identify four groups with similar preferences, with almost half of participants (48%) expressing high willingness to pay for a comprehensive navigation service. The other three classes represented those with preferences focused on a narrower set of attributes: fast access to information (20%), affordable help to “think things through” (18%), and information provided by their local council (14%). The study demonstrates the potential demand and likely take-up of navigation support if made available to people who pay privately for care. Future research needs to examine the barriers to market development for social care navigation services.

Enhancing the Value of Digital Health Tools for Mental Health Help-Seeking in Canadian Transitional Aged Youth during the Pandemic: Qualitative Study

While the COVID-19 pandemic has greatly exacerbated the mental health challenges of transition-aged youth (TAY) between 17 to 29 years old, it has also led to the rapid adoption of digital tools for mental health help-seeking and treatment. However, to date, there has been limited work focusing on how this shift has impacted perceptions, needs and challenges of this population in using digital tools. The current study aims to understand their perspectives on mental health help-seeking during the pandemic and emerging issues related to digital tools (e.g., digital health equity, inclusivity). A total of 16 TAY were invited from three post-secondary institutions in the Greater Toronto Area. A total of two streams of focus groups were held and participants were invited to share their perceptions, needs and experiences. Five main themes were identified: 1) Helpfulness of a centralized resource encompassing a variety of diverse mental health supports help-seeking; 2) The impact of the shift to online mental health support on the use of informal supports; 3) Digital tool affordability and availability; 4) Importance of inclusivity for digital tools; and 5) Need for additional support for mental health seeking and digital tool navigation. Future work should examine how these needs can be addressed through new and existing digital mental health help-seeking tools for TAY.

Catheter navigation support for mechanical thrombectomy guidance: 3D/2D multimodal catheter-based registration with no contrast dye fluoroscopy.

The fusion of pre-operative imaging and intra-operative fluoroscopy may support physicians during mechanical thrombectomy for catheter navigation from the aortic arch to carotids. Nevertheless, the aortic arch volume is too important for intra-operative contrast dye injection leading to a lack of common anatomical structure of interest that results in a challenging 3D/2D registration. The objective of this work is to propose a registration method between pre-operative 3D image and no contrast dye intra-operative fluoroscopy. The registration method exploits successive 2D fluoroscopic images of the catheter navigating in the aortic arch. The similarity measure is defined as the normalized cross-correlation between a binary combination of catheter images and a pseudo-DRR resulting from the 2D binary projection of the pre-operative 3D image (MRA or CTA). The 3D/2D transformation is decomposed in out-plane and in-plane transformations to reduce computational complexity. The 3D/2D transformation is then obtained by maximizing the similarity measure through multiresolution exhaustive search. We evaluated the registration performance through dice score and mean landmark error. We evaluated the influence of parameters setting, aortic arch type and 2D navigation sequence duration. Results on a physical phantom and data from a patient who underwent a mechanical thrombectomy showed good registration accuracy with a dice score higher than 92% and a mean landmark error lower than the quarter of a carotid diameter (8-10mm). A new registration method compatible with no contrast dye fluoroscopy has been proposed to guide the crossing from aortic arch to a carotid in mechanical thrombectomy. First evaluation showed the feasibility and accuracy of the method as well as its compatibility with clinical routine practice.

Assistive Technologies and Participation of Students with Visual Impairments in Extra Curricular Activities - What Does the Literature Say?

The rapid growth of technological advancement has impacted teaching and learning at all levels of education. Like all other students, visually challenged students need information and communication technologies to bridge the gap from classroom learning to extracurricular activities (indoor and outdoor learning activities). Therefore, this study conducted an empirical literature review on how assistive technology devices enhance participation of students with visual impairments (SVI) in extracurricular activities (ECA). The study utilized peer-reviewed and scholarly articles that provided relevant insights regarding assistive technologies and participation of SVI in ECA. The review found that assistive technologies plays a great role in enhancing participation of SVI in ECA including provision of access to information and materials, navigation and mobility support, communication and social interaction, skill development and educational opportunities. The review also revealed challenges associated with the use of AT in participation of SVI in ECA that included lack of accessibility standards, limited availability and affordability, technological compatibility, and inadequate training and technical support. The review concludes that assistive technologies play a crucial role in enhancing participation of students with VI in ECA and that these students are prepared for better future roles as adults. It also calls for stakeholders to create more inclusive and equitable extracurricular environment through addressing the barriers that hinder SVI to participate in ECA.

VetConnect Cancer Navigator: Enhancing care for veterans with breast and gynecologic cancers.

554 Background: With women becoming the fastest-growing group in the Veteran population, the prevalence of breast and gynecologic cancers among Veterans is a growing concern. Studies have demonstrated higher rates of breast cancer among Veterans compared to nonveterans. As the number of women Veterans continues to rise, an increased incidence of breast and gynecologic cancers is expected. Unfortunately, efficient identification of newly diagnosed cases among Veterans is often lacking, leading to delays in diagnosis and treatment. The Breast/Gynecological System of Excellence (BGSOE) aims to ensure that Veterans with breast and gynecologic cancers receive state-of-the-art, guideline-adherent care, whether within the VA system or at outside institutions. Methods: To address this issue, BGSOE stakeholders collaborated to develop a comprehensive care coordination infrastructure called the VetConnect Cancer Navigator. This tool not only identifies newly diagnosed cases of breast and/or gynecologic cancers, but also provides additional navigation support to Veterans who may be receiving their cancer care within the VA or other healthcare systems. The development process involved designing a user-friendly interface, extracting relevant data, and integrating advanced analytics to optimize user experience. Continuous evaluations, both formal and informal, were conducted to ensure optimal usability and workflow fitness. In January 2023, the VetConnect Cancer Navigator was launched as a pilot program at the Durham VA Medical Center. Results: From January 2021 to June 2023, a total of 5,519 Veterans were identified with newly diagnosed breast and/or gynecologic cancers throughout the entire nationwide VA system. Since the launch of the navigator at the Durham VA Medical Center pilot site, it has successfully identified 37 Veterans with newly diagnosed breast and/or gynecologic cancers. Of these cases, 27 patients have been contacted by the dedicated nurse navigator, 22 have completed an intake form, and 18 have agreed to enroll in the BGSOE navigation program. Conclusions: The VetConnect Cancer Navigator represents a pioneering approach to the design and implementation of health information technology tools. As demonstrated through the pilot site, the navigator facilitates innovative coordination and delivery of healthcare, specifically tailored to the need of the BGSOE program, this tool significantly enhances the quality of care provided to Veterans with breast and/or gynecologic cancers. Through improved care coordination and navigation support, the VetConnect Cancer Navigator plays a crucial role in ensuring Veterans receive optimal, guideline-based care regardless of their treatment location within or outside the VA system.

Characterizing psychosocial services in a pediatric urology practice

Psychosocial needs, which encompass behavioral health and social determinants of health (SDOH), are important mediators of the patient experience and health outcomes. However, many practices have limited experience with systematically assessing the non-billable psychosocial services provided to patients and families. To characterize the non-billable activities of three psychosocial providers in a pediatric urology practice at a freestanding children's hospital. Following Institutional Review Board approval, an adapted version of the Care Coordination Measurement Tool (CCMT) was used to collect data prospectively on non-billable activities performed by a psychologist, social worker (SW), and certified child life specialist (CCLS) in a pediatric urology department. Variables included activity type, time spent per activity, and outcomes affected. Demographic data included age, sex, race, state, zip code, insurance type, and language. From April to October 2022, 3096 activities were performed in support of psychosocial needs over 947 encounters for 527 patients. The median patient age was 9.2 years (IQR 4.8-12.4); 48.4% were male. The psychosocial providers most commonly identified care coordination needs related to delivery of urologic care (73.4%), mental/behavioral/developmental health (29.1%), and referral and appointment management (19.9%). The largest proportion of time was spent on providing direct psychosocial support (45.9%), consisting of psychosocial assessments, education, and other behavioral health interventions. A large proportion of time was also spent on care coordination activities, namely logistics and navigation support (35.9%). Relative time allocation across activities varied by provider type (p<0.001); care coordination constituted 64.2% of non-billable activities for the psychologist, 57.8% for the SW, and 12.3% for the CCLS. Activities were associated with treatment plan modification in 37.7% (n=357), outpatient coordination in 22.5% (n=213), and treatment plan adherence in 19.0% (n=180) of encounters. This study enhances our understanding of psychosocial needs of patients in a pediatric urology practice by assessing non-billable psychosocial services not otherwise captured in the clinical workflow. In addition to direct psychosocial support, care coordination activities constitute a large proportion of such services. These data provide valuable insight into the range of activities necessary for the provision of specialty pediatric medical care. Psychosocial providers in a pediatric urology practice perform many non-billable care coordination and psychosocial support activities. Characterizing these activities is important for beginning to understand patients' psychosocial needs and informing resource deployment.

Implementation of financial toxicity screening and a novel financial navigation program.

290 Background: “Financial Toxicity” is the financial burden and stress imposed on a patient due to a disease and its associated treatment. About 50% of patients with gynecologic cancer experience financial toxicity. The aim of the study is to evaluate implementation of financial toxicity screening and a novel financial navigation program for patients with gynecologic oncology. Methods: Patients presenting for initial consultation with a gynecologic oncology provider from July 2022 to January 2023 were included. A new financial navigation program began in July 2022. On October 17, 2022, a financial toxicity screening question was added to new patient intake forms. We quantified patient referrals to the navigator before and after screening implementation, along with needs identified, action taken by the navigator and institutional support services utilized. Results: We included 458 new patients, 49% before and 51% after introduction of screening. The majority were white (61%) and had private insurance (59%) followed by Medicare (31%); median age was 59 (IQR 47-69). Following screening, a higher proportion of patients were referred to the financial navigator (15%) than before screening (4%, p&lt;0.001). Additionally, referrals to other hospital social support services decreased from 9% before screening to 3% after (p&lt;0.001). Uterine and cervical cancers were more prevalent in the 29 patients (12%) who screened positive (31% and 14% respectively) compared to those who screened negative (17% and 1%) or did not respond (24% and 4%). Referrals to the navigator included 59% of those who screened positive, 8% who screened negative and 10% who did not respond. Over six months, 62 patients (new and follow-up) were referred to the navigator. The most common need was transportation (21%) followed by financial assistance (16%) and emotional support (16%). The navigator assisted 11% of patients with transportation and referred 13% to financial counseling/billing and 27% to other resources. Conclusions: Implementing a financial toxicity screening question on intake forms was feasible, and increased identification of patients with financial toxicity and referrals to our financial navigator. Further investigation is needed to understand screening barriers and evaluate the program.

Navigation Support for Students with Intellectual Disability Using Mobile Devices

Since the passing of the Higher Education Opportunity Act in 2008, more students with intellectual disability are being admitted to inclusive postsecondary education programs at U.S. colleges and universities. One of the challenges many students with intellectual disability face when arriving on a college campus is learning to navigate their new surroundings independently. We share how postsecondary education programs can use an assistive technology, Google My Maps, to customize maps to address each student’s unique needs in independently navigating the college campus and the surrounding community. Also discussed are ways to infuse person-centered planning into Google My Maps. Implications for practice and future research directions are discussed.

The stroke transitional care intervention for older adults with stroke and multimorbidity: a multisite pragmatic randomized controlled trial

BackgroundThis study aimed to test, in real-world clinical practice, the effectiveness of a Transitional Care Stroke Intervention (TCSI) compared to usual care on health outcomes, self-management, patient experience, and health and social service use costs in older adults (≥ 55 years) with stroke and multimorbidity (≥ 2 chronic conditions).MethodsThis pragmatic randomized controlled trial (RCT) included older adults discharged from hospital to community with stroke and multimorbidity using outpatient stroke rehabilitation services in two communities in Ontario, Canada. Participants were randomized 1:1 to usual care (control group) or usual care plus the 6-month TCSI (intervention group). The TCSI was delivered virtually by an interprofessional (IP) team, and included care coordination/system navigation support, phone/video visits, monthly IP team conferences, and an online resource to support system navigation. The primary outcome was risk of hospital readmission (all cause) after six-months. Secondary outcomes included physical and mental functioning, stroke self-management, patient experience, and health and social service use costs. The intention-to-treat principle was used to conduct the primary and secondary analyses.ResultsNinety participants were enrolled (44 intervention, 46 control); 11 (12%) participants were lost to follow-up, leaving 79 (39 intervention, 40 control). No significant between-group differences were seen for baseline to six-month risk of hospital readmission. Differences favouring the intervention group were seen in the following secondary outcomes: physical functioning (SF-12 PCS mean difference: 5.10; 95% CI: 1.58–8.62, p = 0.005), stroke self-management (Southampton Stroke Self-Management Questionnaire mean difference: 6.00; 95% CI: 0.51—11.50, p = 0.03), and patient experience (Person-Centred Coordinated Care Experiences Questionnaire mean difference: 2.64, 95% CI: 0.81, 4.47, p = 0.005). No between-group differences were found in total healthcare costs or other secondary outcomes.ConclusionsAlthough participation in the TCSI did not impact hospital readmissions, there were improvements in physical functioning, stroke self-management and patient experience in older adults with stroke and multimorbidity without increasing total healthcare costs. Challenges associated with the COVID-19 pandemic, including the shift from in-person to virtual delivery, and re-deployment of interventionists could have influenced the results. A larger pragmatic RCT is needed to determine intervention effectiveness in diverse geographic settings and ethno-cultural populations and examine intervention scalability.Trial registrationClinicalTrials.gov Identifier: NCT04278794. Registered May 2, 2020.

“You rise up and then you start pulling people up with you”: Patient experiences with a peer-delivered behavioral activation intervention to support methadone treatment

BackgroundAlthough medications for opioid use disorder (MOUD) are efficacious treatments for opioid use disorder, retention remains low. Peer recovery specialists (PRSs), individuals with lived substance use and recovery experience, may be particularly well-suited to support patients receiving MOUD. While PRSs are rarely trained in evidence-based behavioral interventions other than motivational interviewing, preliminary evidence suggests that peers can deliver brief behavioral interventions, such as behavioral activation, with efficacy and fidelity. This qualitative study sought to explore patient perspectives on receiving an adapted PRS-delivered behavioral activation intervention (Peer Activate) to support patients receiving methadone treatment. MethodsThe sample (N = 26) included patients recently starting or demonstrating challenges with adherence at a community-based methadone treatment program who received the Peer Activate intervention in a pilot trial. Participants were invited to participate in in-depth, semi-structured interviews at study completion or discontinuation, assessing perceived acceptability and feasibility of Peer Activate, and stigma-related barriers. Interview transcripts were coded using codebook/template thematic analysis. ResultsAnalysis revealed the importance of two areas to promote intervention acceptability: 1) connection with intervention content and skill building, and 2) valued PRS-specific qualities. Intervention flexibility was found to promote feasibility of the intervention in the context of chaotic and challenging life circumstances. Additionally, participants described stigma towards substance use and methadone treatment as potential barriers to engaging in methadone treatment. ConclusionResults support the acceptability and feasibility to patients of this PRS-delivered behavioral activation intervention in the context of outpatient MOUD treatment among a low-income, majority racially minoritized patient population. Future intervention adaptation and implementation should focus on incorporating content related to relationships and interpersonal skills; balancing behavioral intervention content with system navigation support; maintaining flexibility; and further investigation of the impact of individual PRS attributes, including shared lived experiences, on intervention acceptability and shifts in stigma.

Implementing Technologies to Enhance Coordinated Specialty Care Framework: Implementation Outcomes From a Development and Usability Study.

Coordinated specialty care (CSC) has demonstrated efficacy in improving outcomes in individuals at clinical high risk for psychosis and individuals with first-episode psychosis. Given the limitations of scalability and staffing needs, the augmentation of services using digital mental health interventions (DMHIs) may be explored to help support CSC service delivery. In this study, we aimed to understand the methods to implement and support technology in routine CSC and offered insights from a quality improvement study assessing the implementation outcomes of DMHIs in CSC. Patients and clinicians including psychiatrists, therapists, and supported education and employment specialists from a clinical-high-risk-for-psychosis clinic (Center for Early Detection Assessment and Response to Risk [CEDAR]) and a first-episode-psychosis clinic (Advancing Services for Psychosis Integration and Recovery [ASPIRE]) participated in a quality improvement project exploring the feasibility of DMHIs following the Access, Alignment, Connection, Care, and Scalability framework to implement mindLAMP, a flexible and evidenced-based DMHI. Digital navigators were used at each site to assist clinicians and patients in implementing mindLAMP. To explore the differences in implementation outcomes associated with the app format, a menu-style format was delivered at CEDAR, and a modular approach was used at ASPIRE. Qualitative baseline and follow-up data were collected to assess the specific implementation outcomes. In total, 5 patients (ASPIRE: n=3, 60%; CEDAR: n=2, 40%) were included: 3 (60%) White individuals, 2 (40%) male and 2 (40%) female patients, and 1 (20%) transgender man, with a mean age of 19.6 (SD 2.05) years. Implementation outcome data revealed that patients and clinicians demonstrated high accessibility, acceptability, interest, and belief in the sustainability of DMHIs. Clinicians and patients presented a wide range of interest in unique use cases of DMHI in CSC and expressed variable feasibility and appropriateness associated with nuanced barriers and needs. In addition, the results suggest that adoption, penetration, feasibility, and appropriateness outcomes were moderate and might continue to be explored and targeted. Implementation outcomes from this project suggest the need for a patient- and clinician-centered approach that is guided by digital navigators and provides versatility, autonomy, and structure. Leveraging these insights has the potential to build on growing research regarding the need for versatility, autonomy, digital navigator support, and structured applications. We anticipate that by continuing to research and improve implementation barriers impeding the adoption and penetration of DMHIs in CSC, accessibility and uptake of DMHIs will improve, therefore connecting patients to the demonstrated benefits of technology-augmented care.

Mediators of psychosocial well-being for immigrant women living with breast cancer in Canada: a critical ethnography

Abstract Background: Immigrant women living with breast cancer experience a lack of psychosocial and emotional support, which adds to the complexity of navigating and using health care services in Canada. Aim: To explore the mediators of psychosocial well-being for immigrant women living with breast cancer in Canada. Methods: A critical ethnography was used. The study identified 27 immigrants living with breast cancer, who had been born in a foreign country, migrated to Canada within the past 10 years, and lived in rural communities of British Columbia between August 2021 and March 2022. Institutional research ethics board approval and informed consent were obtained. Results: The findings indicated two significant themes: The immigrant women had limited knowledge, information, and communication and experienced physical, psychological, and emotional distress. Conclusion: There is a significant need for culturally responsive care services for immigrant women living with breast cancer in rural communities. Recommendations include the development of psychosocial oncology, such as integrated counseling and therapies, to reduce cancer-related post-traumatic stress and improve their psychosocial and emotional well-being. Interdisciplinary approaches to psychosocial oncology are particularly crucial for immigrants and rural communities, where women need access to cancer navigation and ongoing support for a better health-related quality of life.

Ultrawideband coupled relative positioning algorithm applicable to flight controller for multidrone collaboration

AbstractIn this study, we introduce a loosely coupled relative position estimation method that utilizes a decentralized ultrawideband (UWB), Global Navigation Support System and inertial navigation system for flight controllers (FCs). Key obstacles to multidrone collaboration include relative position errors and the absence of communication devices. To address this, we provide an extended Kalman filter‐based algorithm and module that correct distance errors by fusing UWB data acquired through random communications. Via simulations, we confirm the feasibility of the algorithm and verify its distance error correction performance according to the amount of communications. Real‐world tests confirm the algorithm's effectiveness on FCs and the potential for multidrone collaboration in real environments. This method can be used to correct relative multidrone positions during collaborative transportation and simultaneous localization and mapping applications.

ПРОБЛЕМЫ НАВИГАЦИОННОГО ОБЕСПЕЧЕНИЯ ПОДВИЖНЫХ ОБЪЕКТОВ В ЗОНАХ ЧРЕЗВЫЧАЙНОЙ СИТУАЦИИ

The paper shows the effectiveness of navigation support for grouping mobile objects under conditions of action in a zone with increased danger and destructive effects on the radio navigation field of positioning means. The problems of functioning of the user's navigation equipment are revealed and ways to solve them are proposed. The research results can be applied in the organization of rescue operations using navigation support systems, as well as by manufacturers of navigation equipment for determining the location of mobile objects in difficult operating conditions.

98 Seeing the Unseen– A Retrospective Review of the Demographic Characteristics of a Place-based, Inner-City Social Paediatrics Program

Abstract Background Social paediatrics is a holistic approach to child and youth health that considers the society and environment the child lives in, and aims to address social determinants of health (SDoH) to improve health equity. Place-based social paediatrics clinics minimize health disparities through outreach programs, navigational support, and facilitating access to specialty care services. This model of care was developed in the past few decades as it became widely accepted that SDoH and adverse childhood events have a direct impact on child health. Typical clinic demographics and most prevalent care needs are not well described. Objectives Identify key demographic features and common diagnoses seen by a social paediatrics program’s primary and specialty care services. Design/Methods Ethical approval was obtained from institutional REB. A retrospective chart review of patients accessing the program between Jan 1, 2018 and April 30, 2021, with no additional exclusion criteria, was conducted. Demographic information, factors influencing SDoH, and past medical history were collected. Basic descriptive statistics were used for analysis of the data collected. Results 144 charts have been reviewed to date. The mean age in years at initial assessment was 6.22 (0.07–25.84). The most commonly documented ethnicity was Indigenous (30%), followed by Latinx (8%) and Middle Eastern (8%); 45% of patients were unspecified, as race is not consistently collected in Canadian health records. Poverty was mentioned as an issue in 52 (36%) patients’ charts, ministry involvement noted in 29 (20%), and substance use in 45 (31%) of households. 74 (51%) of charts had evidence of at least one adverse SDoH (e.g. financial and/or housing instability, food insecurity) that could negatively influence health equity. The most frequently documented diagnoses were skin disorders (38%), ADHD (31%), upper respiratory tract infections (29%), learning disability (27%), and speech delay (25%). Developmental disorders were diagnosed in 79 (55%) patients and 45 (31%) had at least one incidence of being seen by a nurse practitioner or general paediatrician for a mental health concern. Conclusion Place-based, equity-oriented social paediatrics clinics see more socially and developmentally complex individuals than traditional paediatric clinics or community health programs. Data analysis of the population seen by our inner-city program found 55% and 31% of patients had developmental and mental concerns, respectively. This suggests that clinicians planning or working in similar programs should be prepared to support neurodevelopmental, mental health, and common medical conditions (e.g. skin disorders and infections).

22 Families’ Experiences with Autism Service Navigation and Mobile Application-based Support

Abstract Background Navigating services following an autism spectrum disorder (ASD) diagnosis is a challenging and lengthy process. Families of children with ASD increasingly experience difficulty locating and accessing services, leading to the inaccessibility of care. These difficulties were further exacerbated by COVID-19 and little is known about families' experience navigating services during the pandemic. Given the complexities of accessing publicly funded developmental services and the lack of a comprehensive platform to navigate available services, prior to the pandemic our research team developed a mobile application, My Autism Passport (MAP), to assist families in identifying publicly available ASD services. Our goal was to determine whether a mobile application would provide families with greater self-efficacy during these challenging times. Objectives The primary objective of our study was to determine the impact of MAP on caregiver self-efficacy. Design/Methods A randomized controlled trial of 34 caregivers of children under 6 years of age who were given a new diagnosis of ASD in the last year were recruited into the study. 17 were randomized to receive MAP. Access to ASD services and parent self-efficacy scores were collected via questionnaires at baseline and then at 6 months from recruitment in both groups. Self-efficacy was measured using the Parent Empowerment and Self-Efficacy Measurement (PEEM). Results Our study consisted of an ethnically diverse group of participants with varying socioeconomic levels. At baseline, participants indicated an overall mean PEEM score of 131.8 (±28.2) in the control arm, and 138.5 (±23.3) in the App arm at the time of diagnosis (p-value 0.6149). At 6 months following ASD diagnosis, the overall score was 123.2 (±35.7) in the control arm, and 137.3 (±33.3) in the App arm (p-value 0.4413). There was a trend towards decreasing feelings of self-efficacy in the control group compared to those with the App who had a stable self-efficacy score. Conclusion Our study indicates that the use of a mobile app to assist service navigation may be helpful for families in self-navigation for autism services. Data collection and analysis are ongoing for one-year post-diagnosis.

Персонализированная навигационная панретинальная лазеркоагуляция: миф или реальность в клинической практике?

Purpose.To present the results of personalized navigated panretinal laser coagulation in the treatment of proliferative diabetic retinopathy based on angioimaging data. Methods. Personalized navigated panretinal laser coagulation of the retina using Navilas 577s navigated laser system (OD-OS, Germany) was performed in 15 patients with proliferative diabetic retinopathy. Angioimages obtained by optical coherence tomography or data from wide-field fluorescein angiography (off-label) were superimposed on photographs of the retina obtained on the navigated laser system. Based on the image obtained in this way, boundaries of nonperfusion, areas of neovascularization were determined, after which individual planning of navigated panretinal laser coagulation was performed. Results. The results of navigated panretinal laser coagulation were evaluated before each subsequent session of laser treatment, the final control examination was carried out 1 month after the last session. Average total duration of laser treatment was 4.25±0.93 months. According to wide-field SOCT angiography, ischemic zones were blocked and did not extend beyond the laser exposure. At the same time, perfused areas of the retina were intact. Conclusion.Angiovisualization in modern diagnostic devices makes it possible to determine the individual boundaries of nonperfusion zones, develop a personalized plan for panretinal laser coagulation and presence of navigation support for the procedure makes it possible to implement the planned treatment accurately in patients with proliferative diabetic retinopathy. Key words: proliferative diabetic retinopathy; navigated panretinal laser coagulation; angioimaging.