Patient Readiness Research Articles

Preparing patients diagnosed with ESKD for climate-driven Atlantic hurricanes

IntroductionPersons diagnosed with end-stage kidney disease (ESKD) who require in-center hemodialysis are among the most vulnerable patients in this era of compounding disasters. Climate change is making Atlantic hurricanes stronger and wetter, with a tendency to stall at the time of landfall, resulting in more powerful and damaging storms that may disrupt dialysis and clinical services for ESKD patients. COVID-19 and airborne disease transmission complicates hurricane evacuation and sheltering. This complex risk landscape requires tailored approaches to disaster preparedness for patients, clinicians, and dialysis providers. MethodsWe interviewed dialysis providers about their 2022 Hurricane Ian experience. We developed a survey that examines ESKD patients’ hurricane threat appraisal, adaptation appraisal, hurricane experience, and disaster preparedness (household preparedness, COVID-19 prevention, ESKD-specific preparedness). ResultsDialysis providers have developed elaborate strategies for warning, preparing, and predialyzing their patients when a hurricane is approaching. They prestage tanker trucks with pure water and with diesel fuel to power the auxiliary generators to provide electricity. Among 232 dialysis centers closed on the day when Hurricane Ian made landfall, 50% were operational 2 days poststorm and 99% were operational 5 days poststorm. Patient preparedness survey results will be presented. DiscussionCompared with other medically vulnerable patient populations, patients with ESKD are disaster-prepared and supported by their network of dialysis providers to maintain or rapidly restart their life-sustaining treatments. ConclusionsMultilayered, climate-driven disaster risks amplify the urgency for developing effective approaches for safeguarding patients with ESKD, their caregivers, their providers, and their care systems.

Perioperative Care Innovations: Optimizing Recovery and Reducing Complications in General Surgery

Significant progress has been made in perioperative care for general surgery with the goal of minimising postoperative complications and improving patient outcomes. This thorough analysis examines developments in the preoperative, intraoperative, and postoperative domains of the perioperative continuum. This article explores the most recent innovations influencing the profession, with a focus on patient-centered tactics, technology improvements, and interdisciplinary approaches.
 Within the context of preoperative optimisation, therapies aimed at correcting dietary deficiencies, individualised exercise programmes, and psychological preparedness are critical to improving surgical patient readiness. Improved surgical methods, such as robotics and minimally invasive surgery, revolutionise surgical accuracy while reducing trauma and facilitating a quicker recovery.
 Innovations in postoperative care, such improved recovery procedures and remote monitoring devices, speed up recovery and lower complications. Pain treatment and infection control advances in pharmacology have a major positive impact on patient comfort and lower morbidity.
 This study emphasises the value of customised treatment plans, collaborative decision-making, and specialised communication while embracing patient-centered methods. It highlights how important it is for patients to be involved in their treatment, how to promote their own autonomy, and how to improve compliance with postoperative instructions.
 This study seeks to highlight the combined influence of these breakthroughs on changing general surgery perioperative care paradigms through an examination of these advances. The perioperative setting is driven by the combination of innovative tactics, cooperation across varied healthcare specialties, and technology breakthroughs with the ultimate goal of optimising recovery and minimising problems.

FTP1.7 Critical decision analysis of pre-hospital major haemorrhage protocol activation

Abstract Aims Major haemorrhage protocol activation (MHPA) facilitates immediate blood product availability and institutional capacity readiness for bleeding trauma patients. MHPA is a difficult decision pre-hospital, where two thirds of MHPAs occur. We aimed to identify the determinants and influences of the pre-hospital MHPA decision. Methods This prospective qualitative study had Health Research Authority approval (REC 22/PR/0089). Physicians from one helicopter emergency medical service (HEMS) were purposively sampled. Written informed consent was obtained. Cases representing difficult MHPA decisions within the previous six months were included. Semi-structured interviews were conducted via Microsoft Teams, following the critical decision analysis method. Interviews were transcribed and analysed using a 6-step inductive thematic analysis method on NVivo. Results Twelve interviews were conducted with nine participants: median age 37 years (range 34-45), median post-graduate experience 12 years (IQR 10.5-14.8), and median HEMS experience 1 year (IQR 0.5-4.9). Cues for (and against) the MHPA decision included: hard evidence of bleeding (or bleeding judged to be non-severe); initial information fit their mental model of a bleeding patient (or did not); patient deterioration (or response to resuscitation); acknowledgement that injuries and bleeding can be missed (or uncertainty of clinical findings); and alternative diagnoses were considered less likely (or more likely). Other influences of the MHPA decision were heuristics (especially anchoring bias), situational awareness, previous experience, colleagues on-scene, time- and task-pressure, and the desire for diagnostic accuracy and professional reputation. Conclusions Multiple determinants and influences affect the pre-hospital MHPA decision. Acknowledging these cognitive processes will inform efforts to improve decision-making in trauma.

Improving Patient Preparedness for Discharge in an Outpatient Ambulatory Surgery Setting

Improving Patient Preparedness for Discharge in an Outpatient Ambulatory Surgery Setting

Transition readiness of adolescents to adult health care.

Transition in health care is a process wherein adolescents gradually prepare for and shift towards care in the adult system. An initial assessment of the readiness of these adolescents is fundamental in providing appropriate health services for them. This paper aims to determine the readiness of adolescent patients towards transitioning to adult care. This is a prospective cross-sectional study utilizing an interviewer-guided modified Transition Readiness Assessment Questionnaire (TRAQ). Sixty-three adolescents ages 15 to 18 years seen in the Pediatric Outpatient Department (OPD) of a tertiary hospital in Baguio City from July 1 to October 31, 2020 were enrolled. Frequency and percentages were used to describe the demographic data; while mean score and standard deviation determined readiness based on a Likert scale. One-way ANOVA was utilized to determine association between factors and readiness to transition. For all domains of TRAQ, the mean score was 3.64, implying that they are not yet ready to transition. 49.2% belong to General Pediatrics. 44.4% belong to the Igorot ethnic groups. Most are still in High school, and majority of their parents finished High School level. Furthermore, the P-values were more than 0.05 for all variables suggesting no association between readiness to transition and the identified factors in this study. This study showed that adolescents who had both acute and chronic illnesses, were not yet ready to transition. Provision of a platform for assisting the adolescents in their assumption of bigger roles/responsibilities for their own health care is necessary to ensure proper transitioning to adult health care.

“You want them to be partners in therapy, but that's tricky when they’re not there”: A qualitative study exploring caregiver involvement across the continuum of care during the early COVID pandemic

Objective Widespread visitor restrictions were implemented during the COVID-19 pandemic at acute and inpatient rehabilitation hospitals. Family caregivers were physically isolated from their loved ones, which challenged engagement in patient care and readiness for their role. Thus, we aimed to explore the involvement of family caregivers in COVID-19 patients as they journeyed across the care continuum during the early phase of the COVID-19 pandemic. Design We employed a qualitative descriptive approach. Participants We conducted interviews with family caregivers, COVID-19 patients, and healthcare providers between August 2020 and February 2021. Setting Participants were recruited from a single hospital network in Toronto, Ontario, Canada. Interviews were recorded and transcribed. Data were analyzed thematically. Results A total of 27 participants were interviewed—12 healthcare providers, 10 patients, and 5 family caregivers. Four themes were identified: (a) Caregivers were shut out in acute COVID care, (b) Patient discharge from inpatient rehabilitation was turbulent for caregivers, (c) Caregivers were unprepared to support loved ones in the community, and (d) Patient discharge to home was heavily dependent on caregiver availability. Conclusions Visitor restrictions prevent family caregivers from being physically present at patients’ bedside, leading to complex and detrimental impacts such as caregivers feeling that they were not engaged in their loved one's care planning until they were discharged. In turn, discharge to the community was met with several challenges including caregivers feeling underprepared and unsupported to meet their loved one's unique care requirements. This was exacerbated by a lack of community-based resources due to ongoing pandemic restrictions.

Quantitative Analysis of Brain Swelling Resolution With Regard to Cranioplasty After Decompressive Craniectomy

Adequate brain swelling resolution prior to cranioplasty (CP) is an important yet loosely defined issue. Despite efforts to balance timely CP and patient safety, heterogeneous study methodologies have led to conflicting results. This study aims to standardize this issue through quantifying degree of brain swelling resolution using a proposed Visual CP Scale. The proposed Visual CP Scale is validated through a 2-pronged approach. The first prong involves a national survey in Taiwan, where neurosurgeons were surveyed to determine what constitutes a patient's readiness for CP. The second prong involves a large retrospective cohort, where the correlations between timing, degree of brain swelling resolution, and post-CP complication rates, are evaluated. In the national Taiwan CP Survey, 124 out of 772 neurosurgeons (17.2%) completed the survey. Respondents who chose higher grades on the Visual CP Scale preferred later CP timings. In the retrospective data, 378 out of 770 (49.1%) patients had pre-CP brain images, allowing for the utilization of the Visual CP Scale. A Visual CP Scale score of greater than or equal to 4 was associated with fewer complications after CP. The timing of CP should be determined by the degree of brain swelling resolution, not vice versa. The proposed Visual CP Scale offers an objective method for assessing brain swelling resolution, making it an adjuvant tool for clinical decision-making and future research related to CP.

Evaluation of a pharmacist-led interprofessional chronic pain clinic in Canada.

Chronic noncancer pain (CNCP) is a common condition that affects individuals at a biopsychosocial level and can significantly impair function and quality of life. Referral to an interprofessional CNCP program is recommended for most patients; however, these clinics are limited in number and capacity. Expanding access by testing new service delivery models would be of value. The purpose of this study was to measure the impact of a new pharmacist-led, interprofessional model of care developed at the University of Saskatchewan Chronic Pain Clinic. A retrospective chart audit was conducted using data that included adult patients referred for CNCP management between May 2020 and December 2021. Medication use, overall health status (using the Clinical Global Impression of Change-Improvement [CGI-I] scale) and patient readiness to change (using the Transtheoretical Model) were measured 6 months after the initial appointment. The study included 138 patients. Of the 80 patients taking an opioid, 22.5% were switched to buprenorphine/naloxone and the remainder had their mean morphine-equivalent dose reduced by a mean of 41.7 mg/d. Overall patient health status was minimally improved and many patients moved into the Action stage of change. Changes in opioid use demonstrate a clinically important shift toward safer medication regimens that are less likely to lead to toxicity and unintended overdose. CGI-I data suggest that these patients, whose health status is typically very difficult to change, did not deteriorate but slightly improved after attending the clinic. The unique pharmacist-led, interprofessional model of care used by the University of Saskatchewan Chronic Pain Clinic may offer a viable alternative to traditional physician-led models.

Poster 323: Factors Impacting Return to Sport Timing Following ACL Reconstruction

Objectives: Forty-one percent of sports injuries are knee injuries. One-fifth of knee injuries involve the anterior cruciate ligament (ACL). The high incidence of ACL injuries results in approximately 129,000 ACL reconstructions in the United States each year. Timing of return to sport (RTS) after ACL reconstruction (ACLR) depends on clearance by the medical team, patients meeting objective RTS criteria, and patient selected timing. A criterion-based approach to RTS commonly includes measurements of quadriceps strength, hop performance, and subjective knee function to guide the decision-making of orthopedic surgeons and physical therapists regarding patient readiness and safety to RTS. Therefore, the purpose of this study was to assess patient-related predictors (age, sex, graft type, psychological readiness, and the duration of physical therapy) of time to pass RTS criteria. We hypothesized that patients with more positive psychological readiness, those who were still completing physical therapy, and male patients would pass RTS testing at earlier time points, while graft type and age would have no effect. Methods: Fifty-four participants between the ages of 10 and 25 years and within 5 to 15 months of ACL reconstruction who were planning to return to at least 50 hours per year of cutting and pivoting activities were included. Patients with a previous history of surgery to either knee or concomitant posterior cruciate ligament reconstruction were excluded from the study. Participants completed clinic testing when RTS was being planned. Testing included unilateral quadriceps strength in each limb (isometric at 90° knee flexion using a crane scale and 1-repetition maximum using a knee extension machine), 4 single-legged hop tests (single, crossover and triple hop for distance; 6-meter timed hop), and self-reported knee function (International Knee Documentation Committee Subjective Knee Form 2000 [IKDC], Global Rating Scale). In order to pass, participants needed scores of at least 90% symmetry for both quadriceps strength measures and all 4 single-legged hop tests as well as 90% on the IKDC and Global Rating Scale. Participants repeated clinic testing until they passed the entire testing battery in a single session. On the day of passing all RTS criteria, psychological readiness was assessed using the ACL Return to Sport after Injury (ACL-RSI) survey. The ACL-RSI is a valid and reliable outcome tool that assesses the participant’s emotional wellbeing, confidence in performance, and risk appraisal. An additional survey question was used to identify if participants were still participating in physical therapy (PT) at the time of passing RTS testing or when they had finished working with a physical therapist. PT was categorized as either a) <6 months of PT, b) 6-8 months of PT, or c) >8 months of PT or still currently in PT. Multivariate linear regression was used to assess the association between age, sex, graft type, ACL-RSI score, and duration of PT on the time to passing RTS testing after ACL reconstruction. An alpha level of p<0.05 was set a priori. Results: The mean age of the participants in this study was 17.3±2.7 years and 50% were female. Graft type and duration of physical therapy data are presented in Table 1. The mean time for passing all components of the RTS test battery was 10.3 ±2.6 months. At the time of passing RTS testing, the mean ACL-RSI score was 86.1±14.2%. Age, sex, graft type, ACL-RSI scores and duration of PT accounted for 44.5% of the variation in the time to pass RTS testing (p<0.001). Sex (β=-0.426; p<0.001), graft type (β=0.340; p=0.008), and age (β=0.194; p=0.111) were the strongest predictors of time to pass RTS testing with younger age correlating with shorter RTS times. Sex (Male: 8.6±3.1 months; Female: 11.1±3.5 months) and graft type (Hamstring: 7.7± 3.9 months; Quadriceps Tendon: 10.8±2.7 months; Patellar Tendon: 11.5±2.6 months; Allografts and IT band: 7.2±1.4 months), were significant predictors of time to pass RTS criteria while PT duration and ACL-RSI were not significant predictors. Conclusions: Female patients and patients with a patellar tendon or quadriceps graft took longer to meet objective RTS criteria after ACL reconstruction. Education with female patients and those with quadriceps and patellar tendon autografts may be required to establish realistic expectations for RTS readiness. While many factors impact graft choice, time to pass RTS criteria is an additional consideration for surgeons and patients. Additionally, previous studies have shown that male patients are more likely to experience graft retear following ACLR than females. This finding could be the result of male patients returning to sport earlier than females, giving the graft less time to heal. [Table: see text]

A qualitative evaluation of the challenges in management for patients with chronic diseases during disasters in Iran.

Iran's health care system faces significant challenges in managing the growing burden of non-communicable diseases, and these are exacerbated during the frequent natural disasters. The current study was designed to understand challenges in providing healthcare services to patients with diabetes and chronic respiratory diseases during such crisis periods. The conventional content analysis was used in this qualitative study. Participants included 46 patients with diabetes and chronic respiratory diseases, and 36 stakeholders with knowledge and experience in disasters. Data collection was carried out employing semi-structured interviews. Data analysis was performed using Graneheim and Lundman method. Four major challenges in providing care to patients with diabetes and chronic respiratory diseases during natural disasters include integrated management, physical, psychosocial health, health literacy and the behavior and barriers to healthcare delivery. Developing countermeasures against medical monitoring system shutdown in order to detect medical needs and problems faced by chronic disease patients including those with diabetes and chronic obstructive pulmonary disease (COPD), is essential in preparedness for future disasters. Developing effective solutions may result in improved preparedness and better planning of diabetic and COPD patients for disasters.

Supporting Occupational Participation Among People With Mechanical Circulatory Support & Their Caregivers: Opportunities for OT

Abstract Date Presented 04/21/2023 Supports are needed to address the preparedness and mutuality of patients with mechanical circulatory support and their caregivers. OT interventions can promote daily participation as well as physical and mental health for dyads. Primary Author and Speaker: Ricardo Daniel Ramirez Additional Authors and Speakers: Susan Magasi Contributing Authors: Kathleen L. Grady

Health professionals' views on discontinuation of long-term antidepressants: a systematic review and thematic synthesis.

Long-term antidepressant use, much longer than recommended by guidelines, may cause harmful effects and generate unnecessary costs. To investigate health professionals (HPs) views of long-term antidepressant discontinuation and their barriers and facilitators. Systematic review and meta-synthesis. We included studies that used qualitative data collection and had data on HPs perceptions on (dis)continuing AD use. The review searched nine database sources until May 2022. Study quality was assessed using the CASP checklist and the COREQ criteria. A thematic synthesis was performed. Thirteen studies were included in the review. Nine studies were of GPs' perspectives, one study of psychiatrists', and three of a mix of HPs. Barriers and facilitators to discontinuing long-term AD yielded eight themes, ordered chronologically according to the considerations that HPs make when they review a long-term AD: perception of AD use, fears, HP role and responsibility, HPs attitude towards discontinuation, HPs confidence regarding ability to stop AD, perceived patient readiness to stop, support from relatives and support from other HP. Deprescribing long-term AD is a difficult and complex process for HPs. The review found evidence that the barriers far outweigh the facilitators. More education on the lack of evidence for the long-term effect of AD and the risks of long-term use, guidance on managing long-term use, and support for HPs and patients is needed to increase long-term AD discontinuation. Further research from an HP perspective other than GPs is required and should also explore how HPs can be supported in managing discontinuation ADs.

Patients' Readiness Towards Teledentistry in the Malaysian Urban Population Attending an Undergraduate Teaching University.

Introduction: COVID-19 disease has resulted in suspension of all nonurgent routine dental treatments. In view of COVID-19 situation, social distancing, movement restriction orders, and affected health care systems, there is an urgent need to resume and deliver oral health care remotely. Hence, alternative means of dental care should be available for both patients and dentists. Therefore, this study aims to assess patients' readiness for teledentistry in Malaysian urban population attending an undergraduate teaching university. Methods: A cross-sectional study was conducted among 631 adult patients visiting the Faculty of Dentistry, SEGi University, from January 2020 to May 2021 in Selangor, Malaysia. A validated, self-administered, 5-point Likert scale online questionnaire comprising five domains was administered. (1) Patients' demographics and dental history, (2) patients' access to teledentistry, (3) patients' understanding towards teledentistry, (4) patients' willingness, and (5) barriers in using teledentistry were used to collect the required information. Results: Six hundred and thirty-one (n = 631) participants responded to the questionnaire. Ninety percent of patients were able to connect to Wi-Fi services independently and 77% participants were comfortable using online communication platforms. Seventy-one percent of the participants agreed that video and telephone clinics can reduce chances of infection rather than face-to-face consultation during the pandemic. Fifty-five percent of patients felt that virtual clinics would save time and 60% thought it could reduce travelling costs. Fifty-one percent showed their willingness to use video or telephone clinics when implemented at onsite clinics. Conclusion: Our study shows the readiness of patients to accept teledentistry as an alternative method of oral care if appropriate training and education are provided. The results of this study have prompted an increase in patients' education and shown a need to train clinicians and patients to integrate this technology at SEGi University. This might facilitate unhindered dental consultation and care in all situations.

Psychometric Testing of a New Instrument for Assessing Cancer Patient Preparedness for the Survivorship Transition.

Background and Purpose: This study aimed to develop and examine the psychometric properties of the "Preparedness for Transition to Survivorship Care Instrument" (PTSCI) for cancer survivors. Methods: A cross-sectional study of cancer survivors in Korea was conducted to test the reliability and validity of the PTSCI. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and concurrent validity tests were conducted. Results: The EFA showed that the 7-factor structure of a 34-item PTSCI accounted for 61.5% of the total observed variance. In CFA, three competing models were created and compared to a 7-factor solution model. A 6-factor 31-item model showed the best fit and was chosen as the final PTSCI model. PTSCI is significantly associated with quality of life, psychological distress, and health promotion. Conclusions: PTSCI can be helpful in preparing for diverse psychosocial and behavioral issues faced by cancer survivors in the survivorship phase.

Benchmarking Patient Engagement Capabilities and Preparedness of Drug Development Sponsors.

Consistent implementation and measurement of patient engagement initiatives across the industry have remained aspirational and elusive despite strong interest in adopting patient-centric approaches. One factor contributing to this inertia stems from a lack of standardized implementation of patient engagement activities, which varies widely from company to company, making it difficult to track and measure. Further, empirical evidence mapping the impact of patient engagement capabilities on clinical research outcomes has remained sparse. To address this gap, the Drug Information Association (DIA) and Tufts Center for the Study of Drug Development (Tufts CSDD) at the Tufts University School of Medicine developed and administered an assessment tool that companies can use to not only evaluate their organization's patient engagement capabilities and implementation preparedness but can also measure the impact of such activities on trial outcomes. Results showed that while most organizations are providing logistical support to increase patient engagement in the form of travel stipends, accommodation, and financial incentives, most are not implementing more involved forms of patient engagement such as gathering patient input through patient input panels or patient steering committees. This paper discusses the process for designing and administering this assessment tool, the results of the assessment, and future implications.

Cancer centers as potential knowledge hubs for emergency preparedness efforts.

e18729 Background: Climate change is altering the frequency and behavior of extreme weather events making it harder for institutions to prepare and respond to increasingly unpredictable circumstances. Emergency preparedness efforts are crucial for meeting the health and safety needs of patients, providers, healthcare facilities, and communities before, during, and after a disaster. National Cancer Institute (NCI)-Designated Cancer Centers are at the forefront of quality cancer care and research, have greater access to resources through accreditation, and are nationally distributed, collectively acquiring a range of emergency preparedness and response experiences on a variety of disasters nationwide. This study evaluated emergency preparedness information provided in NCI-designated Cancer Centers’ websites. Methods: We systematically searched NCI-Designated Cancer Centers’ websites for the presence of information on emergency preparedness and response instructions, resources, and research efforts in September 2022. Results: Out of 71 centers, all (100%) were impacted by a climate-driven disaster between 2016 and 2020, 56 (78.9%) presented some emergency preparedness information, and 36 (50.7%) presented information specific to individuals diagnosed with cancer, all of which included information relevant for the COVID-19 pandemic. In contrast, only 17 (23.9%) of centers’ websites provided emergency preparedness information relevant for climate-driven disasters, and only 7 (9.5%) provided information on emergency preparedness for climate-driven disaster specific for individuals diagnosed with cancer. Just one center (1.4%) mentioned ongoing research on emergency preparedness for cancer patients. None of the centers provided emergency preparedness or response information in a centralized and structured manner. Conclusions: Emergency preparedness research efforts and information sharing on NCI-Designated Cancer Centers’ websites has not kept pace with the challenges posed by climate change. Prioritizing research efforts and structured information sharing of emergency preparedness and response expertise will be crucial to ensure receipt of quality cancer care in the era of compounding disasters.

Engaging Men of Diverse Racial and Ethnic Groups With Advanced Prostate Cancer in the Design of an mHealth Diet and Exercise Intervention: Focus Group Study.

Healthy diet and exercise can improve quality of life and prognosis among men with prostate cancer. Understanding the perceived barriers to lifestyle change and patient preferences in a diverse cohort of men with prostate cancer is necessary to inform mobile health (mHealth) lifestyle interventions and increase health equity. We conducted a multisite study to understand the preferences, attitudes, and health behaviors related to diet and lifestyle in this patient population. This report focuses on the qualitative findings from 4 web-based focus groups comprising a racially and ethnically diverse group of patients with advanced prostate cancer who are on androgen deprivation therapy. We used grounded theory analyses including open, axial, and selective coding to generate codes. Qualitative data were analyzed as a whole rather than by focus group to optimize data saturation and the transferability of results. We present codes and themes that emerged for lifestyle intervention design and provide recommendations and considerations for future mHealth intervention studies. Overall, 14 men participated in 4 racially and ethnically concordant focus groups (African American or Black: 3/14, 21%; Asian American: 3/14, 21%; Hispanic or Latino: 3/14, 21%; and White: 5/14, 36%). Analyses converged on 7 interwoven categories: context (home environment, access, competing priorities, and lifestyle programs), motivation (accountability, discordance, feeling supported, fear, and temptation), preparedness (health literacy, technological literacy, technological preferences, trust, readiness to change, identity, adaptability, and clinical characteristics), data-driven design (education, psychosocial factors, and quality of life), program mechanics (communication, materials, customization, and being holistic), habits (eg, dietary habits), and intervention impressions. These results suggest actionable pathways to increase program intuitiveness. Recommendations for future mHealth intervention design and implementation include but are not limited to assessment at the individual, household, and neighborhood levels to support a tailored intervention; prioritization of information to disseminate based on individuals' major concerns and the delivery of information based on health and technological literacy and communication preferences; prescribing a personalized intervention based on individuals' baseline responses, home and neighborhood environment, and support network; and incorporating strategies to foster engagement (eg, responsive and relevant feedback systems) to aid participant decision-making and behavior change. Assessing a patient's social context, motivation, and preparedness is necessary when tailoring a program to each patient's needs in all racial and ethnic groups. Addressing the patients' contexts and motivation and preparedness related to diet and exercise including the household, access (to food and exercise), competing priorities, health and technological literacy, readiness to change, and clinical characteristics will help to customize the intervention to the participant. These data support a tailored approach leveraging the identified components and their interrelationships to ensure that mHealth lifestyle interventions will engage and be effective in racially and ethnically diverse patients with cancer. ClinicalTrials.gov NCT05324098; https://clinicaltrials.gov/ct2/show/NCT05324098.

Factors influencing readiness of patients for the use of exogenous insulin for the management of type 2 diabetes mellitus.

Objective: This study aimed to explore the T2DM patients’ reasons for refusing insulin therapy and their initial barriers to use insulin. Study Design: Cross-sectional Observational study. Setting: Primary Outpatient Health Care Center Karachi. Period: 15th October 2022 to 15th January 2023. Material & Methods: Total 800 diagnosed patients of type-II diabetes mellitus having HbA1c level about 7.0% were included in study, participants were interviewed and necessary data and their response against insulin was recorded on designed questionnaire. Results: Total 800 number of patients were enrolled in study, 434 were female (54.25%) while 366 were male (45.75%) participants. The average age of total patients was 45.6±10.5. Study reported that 28.5% patients mentioned that its painful procedure. 25% patients were unaware about insulin, 15% mentioned that it is difficult to self-inject, 10.5% lack of technical person or medical staff that can inject over there, 7.5% patients believe that insulin is last resort of treatment, 5% needle phobia, 4.5% reluctant due to un affordability of insulin, 3% insulin would be addictive, and 1% patients with religious restriction was reported. Conclusion: Study explore many reason that are mainly influencing use of exogenous insulin for the treatment of diabetes mellitus. Insulin therapy is painful procedure consideration have been recorded more common while other factors unawareness about insulin, needle phobia, lack of technical people in home specially in backward areas and insulin is last resort of treatment beliefs are also major important factors reported during study.

Polypharmacy Prevalence and Perceptions of Deprescribing in Elderly Patients Among Community Primary Care Providers in Mid-Michigan Practices.

Polypharmacy is common among the elderly and can predispose them to increased morbidity and higher healthcare expenditures. Deprescribing is an important aspect of preventative medicine to minimize polypharmacy-related adverse effects. Mid-Michigan has historically been considered a medically underserved area. We sought to describe polypharmacy prevalence and primary care provider (PCP) perceptions of deprescribing in the elderly at community practices in the region. Medicare Part D claims data from 2018 to 2020 were queried to calculate the prevalence of polypharmacy, which is defined as Medicare beneficiaries who were concurrently prescribed at least five medications. PCPs from four community practices in adjacent counties in mid-Michigan, including two high- and two low-prescribing practices, were surveyed to assess their perceptions of deprescribing. The prevalence of polypharmacy in two adjacent mid-Michigan counties was 44.0% and 42.5%, which was similar to Michigan's overall prevalence of 40.7% (p = 0.720 and 0.844, respectively). Additionally, 27 survey responses were received from mid-Michigan PCPs (response rate, 30.7%). Most respondents expressed confidence in deprescribing in the elderly from a clinical standpoint (66.7%). Barriers to deprescribing included patient/family concerns (70.4%) and lack of time during office visits (37.0%). Facilitators to deprescribing included patient readiness (18.5%), collaboration with case managers/pharmacists (18.5%), and up-to-date medication lists (18.5%). An exploratory comparison of perceptions at high- and low-prescribing practices showed no significant differences. These findings demonstrate a high prevalence of polypharmacy in mid-Michigan and suggest that PCPs in the region are generally supportive of deprescribing. Potential targets to improve deprescribing in patients with polypharmacy include addressing visit length, patient/family concerns, increasing interdisciplinary collaboration, and medication reconciliation support.

Trauma-Informed Approaches in Primary Healthcare and Community Mental Healthcare: A Mixed Methods Systematic Review of Organisational Change Interventions

A trauma-informed approach is a framework for organisational (synonym system) change interventions that address the universal prevalence and impact of trauma. This mixed methods systematic review assessed the effects of trauma-informed approaches on psychological, behavioural, and health outcomes in health-care providers and adult patients in primary care and community mental healthcare. We searched five databases and grey literature and consulted experts for reports published in January 1990 to June 2021. The quantitative descriptive and qualitative framework syntheses were integrated through a line of argument and mapped onto a logic model. We included six nonrandomised studies that evaluated eight interventions with varied theoretical developments, components, and outcomes. The most common components were budget allocation, workforce development, identification/response to violence and trauma, and evaluation. Evidence for intervention effects was limited and conflicting. Four studies reported improvement in provider readiness and sense of community, while three reported conflicting effects on provider behaviour regarding delivery of trauma-informed care. Four studies reported some improvement in patient readiness for disease management and access to services; however, the evidence for patient satisfaction was conflicting. Two studies found that patients and providers felt safe. While one study reported improvement in patient quality of life and chronic pain, another found no effect on substance use, and three studies reported conflicting effects on mental health. Intervention mechanisms included a package of varied components, tailoring to the organisational needs, capacities and preferences, staff education and self-care, creating safe environments, and shared decision-making. Intervention effects were moderated by contextual (health system values, policies, governance, business models, trauma-informed movement, organisational culture, and social determinants of health) and intervention factors (buy-in from all staff, collective learning through conversations, equal attention to staff and patient well-being, and sustainable funding). No studies measured adverse events/harm, cost effectiveness, or providers’ health. We need more methodologically robust evaluations of trauma-informed organisational change interventions.