Follow-up Phone Research Articles

35 Discriminating bacteremia from contaminants among children with a preliminary positive blood culture in the emergency department

Abstract Background Children with preliminary positive blood cultures in the emergency department (ED) often prompt urgent actions due to the risk of bacteremia. Distinguishing true bacteremia from contaminated cultures is crucial to safely prevent unnecessary, potentially harmful interventions. Objectives This study aimed to assess a peer institution algorithm for discriminating bacteremia from contaminants in discharged ED patients, and to identify variables associated with bacteremia in children with positive blood cultures. Design/Methods This was a retrospective study of all children with positive blood cultures from a tertiary care, paediatric ED between 2018 and 2022. The primary outcome was true bacteremia as defined using a two-step standardized approach based on the bacteria involved and the clinical outcome assessed by two reviewers for each case. The independent variables assessed were demographic data (age and sex), presence of underlying disease, initial blood tests (CBC, CRP), Gram stain, time for positivity (in hours), presence of alternative diagnosis, fever at phone follow-up. The association between independent variables and outcome was measured using logistic regression. It was estimated that a sample of 500 participants would yield at least 200 true bacteremias and allow the evaluation of 20 risk factors. Results 574 participants; 286 (49.8%) with bacteremia and 288 (50.2%) with contaminants were included. Utilizing the algorithm, 364 children (63%) were classified as high risk of true bacteremia, 178 (31%) as medium risk, and 32 (6%) as low risk. Corresponding bacteremia probabilities were 62%, 34%, and 0%, yielding 100% sensitivity (95% CI: 94-100%) and 11% specificity (95% CI:7.7-15%). A sub-analysis restricted to the 165 patients who were initially discharged classified 104 (63.0%) children at high risk, 35 (32.1%) at medium risk and 26 (15.7%) at low risk with proportions of bacteremia of 53.8%, 11.4% and 0 % respectively. The most significant predictors of bacteremia included suspicion of osteoarticular infection (OR: 40.4), presence of internal hardware (OR: 24.6), presence of Gram negative bacteria or Gram positive cocci in chains/pairs (OR: 25.4), and positivity within 19 hours (OR: 3.72). Conclusion While half of the positive blood cultures in our paediatric ED are contaminants, multiple risk factors of true bacteremia were identified. A peer institution algorithm is 100% sensitive to detect discharged patients with bacteremia, it demonstrated low specificity in our population. Multiple improvements opportunities are identified.

Tranexamic acid to prevent bleeding after endoscopic resection of large colorectal polyps: a pilot project

Abstract Background and aims Delayed post-polypectomy bleeding (DPPB) can occur up to a month following the procedure but is typically seen within the first week. Tranexamic acid (TXA) is a member of a class of drugs called antifibrinolytic agents. It reduces fibrinolysis by slowing down the conversion of plasminogen to plasmin, which may prevent bleeding. The goal of this pilot study is to assess the feasibility of using tranexamic acid after endoscopic mucosal resection (EMR) of large (≥2 cm) non-pedunculated colorectal polyps (LNPCPs) to prevent DPPB. Methods This was a single centre feasibility study conducted at the Kingston Health Sciences Centre in 2021. After the polypectomy was completed, IV tranexamic acid was given [1 gram of TXA in 100 mL of normal saline] and infused over a 10-min interval. The participants received tranexamic acid 1 gram PO TID to be taken for 5 days. Results A total of 25 patients were enrolled with a mean polyp size of 3 cm. Intraprocedural bleeding occurred in 7 patients (28%) and all of these were treated with soft coagulation. Two patients had clipping for suspected muscle injury. All 25 patients received IV TXA post-procedure. Sixteen patients (64%) took every dose of the prescribed pills. One patient presented with post-polypectomy bleeding. All patients completed the day 30 follow-up phone call. There were no major adverse events. Conclusions TXA to prevent delayed post-polypectomy bleeding (DPPB) was feasible to use with no major adverse events reported. A randomized controlled study will be needed to see if TXA can significantly reduce DPPB.

Individualized medication card assists the elderly with medication understanding and adherence

Objective: In the outpatient setting, polypharmacy and poor communication among providers has left a gap in drug education involving the elderly population. Linking all of these providers with an accurate medication regimen may be the answer. Nurses can play a pivotal role in drug-related problems in the elderly population. The aim of this study is to use a liaison nurse to help educate the elderly population on the importance of adherence and understanding their medications by using an individualized medication card.Methods: This study used a descriptive study design. A convenience sample (n = 16) of patients, who were sixty-five years of age or older and were taking five prescription medications daily was employed. After collecting patient demographic information, a counseling session was performed with the patient on their medications using an individualized medication card. Data was then collected via two follow-up phone calls at two and four weeks after initial counseling session using a medication questionnaire and a set of five follow-up questions.Results: Sixteen participants received counseling on their medications and an individualized medication card to take home. Only thirteen participants were reached via phone call, two weeks after their initial counseling session. Of these thirteen, two had lost or forgotten their medication card. Eleven reported that the medication card had been helpful in understanding and adhering to their medications. Of the participants who kept their cards, all were satisfied with the counseling materials and methods used.Conclusions: The findings indicate that the elderly population who were taking five or more prescription medications showed benefit from counseling on their medications using an individualized medication card. Such a tool will help nurse practitioners guide elderly patients in medication education and adherence in future practice.

Minimally invasive approach to managing brachiocephalic trunk cannulation complicating central venous catheterization: a case report

BackgroundCentral venous catheterization, crucial for device insertion, monitoring, medication, and fluid resuscitation, commonly uses the subclavian, internal jugular, and femoral veins. Despite its general safety, complications like arterial puncture can be life-threatening, requiring rapid diagnosis and treatment.Case presentationA 74-year-old woman in the recovery phase of cerebral infarction underwent right subclavian vein catheterization. The catheter was mistakenly placed in the brachiocephalic trunk, with its tip in the ascending aorta, as confirmed by computed tomography (CT) and digital subtraction angiography (DSA). With the high surgical risk and the complexity of endovascular treatment, catheter replacement was chosen. One month after the initial placement, the catheter was replaced with a smaller one, and another month later, it was retracted without complications. Follow-up CT and DSA revealed no leakage, with the patient’s vitals remaining stable. A three-month post-discharge phone follow-up confirmed the patient’s continued stability.ConclusionThis case demonstrates the effective use of a catheter replacement technique as a minimally invasive repair method when other options are impractical. Ultrasound guidance is also recommended to improve the procedure’s accuracy and safety.

Providing access to cognitive-behavioral therapy for insomnia in cancer care: Preliminary results of an implementation study.

61 Background: Between 30 to 60% of cancer patients display insomnia symptoms. While cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for cancer-related insomnia, it remains underutilized due to its limited accessibility. To date, we are unaware of any study that has investigated the implementation of CBT-I in routine clinical care. Our prior work showed that a stepped care approach, combining a web-based CBT-I and 1-3 booster therapy sessions, was not significantly inferior in producing sleep improvements than a standard 6-session CBT-I. The main goals of the IMPACT (Insomnia in Patients with Cancer – Personalized Treatment) program are to assess the feasibility and efficacy of implementing this stepped care CBT-I in four cancer centers in Quebec City, Canada. Methods: The ongoing study uses a stepped wedge cluster non-randomized design implementing the stepped care CBT-I at various time intervals across cancer centers. All first-line cancer providers (e.g., nurses, oncologists, radio-oncology technologists, pharmacists) are met every 3-4 months to present/remind them of the rationale of the project and procedures to refer patients to the IMPACT program. Patients having a score ≥ 4 on the sleep item of the Edmonton System Assessment System-Revised (ESAS-R-sleep) receive a leaflet explaining the stepped care CBT-I and how to access the web-based program (first step). Patients with residual insomnia symptoms after completing this first step are offered 1-3 booster sessions with a clinical psychologist (second step). Uptake and retention rates are the main variables. Results: Across cancer centers, 11.9%-50.8% of patients having a score ≥ 4 on the ESAS-R-sleep item were referred to the IMPACT program. The most common reasons for not referring were: 1) the presence of comorbid anxiety or depression symptoms (they were referred instead to the psychosocial oncology team) and; 2) patients declining help. Registration rates were greater when a brief follow-up phone call was conducted to explain the IMPACT program in more detail (vs. giving only the leaflet). Across cancer centers, 10%-54.9% of referred patients registered with the web-based CBT-I, 83.3%-90% of them initiated it and 26%-42.3% completed it. The most common reasons for not completing the web-based CBT-I were: 1) sleep difficulties improved or remitted (36.2%); and 2) the program did not meet patients’ needs (23.4%). Among completers, 29%-56% had residual insomnia and were offered booster sessions. On average, sleep diary data collected during treatment (N=83) indicated a reduction of sleep-onset latency of 20 min and of wake after sleep onset of 45 min. Sleep efficiency increased from 70 to 85%. Conclusions: Although uptake and retention rates could be improved, these preliminary data suggest that stepped care CBT-I can be implemented in routine cancer care and is effective. Clinical trial information: NCT04817163 .

Oncology Clinicians' Perspectives of a Remote Patient Monitoring Program: A Multi-Modal Case Study Approach.

Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeast, United States. Explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge. The sample included 30 of 98 clinicians (31% response rate) managing at least five patients in the RPM program and responding to the m-Health Usability between March 2021- October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of five clinicians who responded to the study survey (30% response rate) participated in interview sessions conducted from November 2021 to February 2022, and averaged 60 minutes each. Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians' workload burden. Interview sessions revealed three main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience. Clinicians support the value of RPM for improving symptom management and engaging with providers. Functional changes to enhance the program's utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices.

The impact of multidisciplinary geriatric follow-up on quality of life in older, non-surgical prefrail and frail patients with cancer [sbnd] A randomized controlled trial

IntroductionCancer management in older frail patients can be complex, given the high decline in functional status, comorbidity, and limited life expectancy affecting this group of patients. Therefore, this study aimed to investigate whether oncological treatment combined with comprehensive geriatric assessment (CGA) and tailored follow-up interventions improved or maintained quality of life (QoL) in older prefrail and frail patients with cancer. Materials and MethodsA single-center randomized controlled trial included participants aged 70 or older with head, neck, lung, upper gastrointestinal tract, colon, or rectum cancer referred to non-surgical treatment. All participants underwent CGA conducted by a multidisciplinary geriatric team in an outpatient oncological clinic. The team consisted of a geriatrician and a specialized nurse who provided tailored follow-up visits and phone calls within 90 days after randomization. Exclusion criteria were fit patients, referral for specialized palliative care, or participating in another geriatric research program. In patients with well-functioning cognition, QoL was assessed using the EORTC QLQ-C30 and QlQ-ELD-14 questionnaires before and after the intervention. In patients with cognitive impairment, the Overall QoL-Depression List was used. Changes in QoL were dichotomized into improved/unchanged or worsened and analyzed in a logistic regression model. ResultsIn total, 363 participants were included with a mean age of 76 years (SD 4.6) and 45 % were female. Sixty percent in the intervention group had improved or unchanged QoL compared to 66 % in the control group (odds ratio: 0.75 [95 % confidence interval(CI): 0.45–1.23]). Overall, clinically important changes were found in fatigue and reduced worries about the future. The intervention showed improvements in insomnia symptoms and reported decreased role functioning. Discrepancies were found in the burden of illness without a clinically important difference, where the intervention group experienced an increased burden while the control group had a decreased burden (coefficient: 9.02 [95 % CI, 0.49–17.5]). DiscussionMultidisciplinary geriatric follow-up did not universally improve QoL in older frail patients with cancer. However, positive changes in specific aspects of QoL revealed nuanced impacts, warranting further exploration and larger studies to validate these observations. Tailored interventions targeting fatigue, insomnia, and emotional well-being are crucial for improving QoL in this population. Trial RegistrationRegistered in January 2016 at ClinicalTrials.gov (ID: NCT02837679).

Time-efficient consultation hours in the department of gynecological endocrinology

Background The aim was to conduct a benchmark pilot study to find the best practice for consultation hours in the field of gynecological endocrinology. Suitable benchmarking participants were found in China, Germany, Greece, and Switzerland. Specifically, the study aimed to find the most time-efficient and beneficial consultation type in gynecological endocrinology focused on menopause and whether a shorter face-to-face consultation correlates with lower patient satisfaction. Methods This was an observational study. To analyze the processes of all benchmarking participants three tools were used: a measurement of time needed for the different consultation types, a questionnaire for patients and one for physicians. The primary endpoint was the time measurement of first consultations. Secondary endpoints were the time measurements of follow-up consultations and phone consultations and patient satisfaction. Results The mean overall duration of a first consultation differed from 20.4 min to 39.7 min (p = 0.003), mainly based on differences of the mean time to acquire the patient history, 5.6 to 21.6 min (p < 0.001). The percentage of patients who felt they had enough time to discuss questions ranged from 70% to 100% (p < 0.001). The percentage of patients who felt fully understood by their physician ranged from 62.5% to 92% (p = 0.006). The duration of a first consultation did not correlate with patients feeling well consulted (r=-0.048, p = 0.557). Conclusions A concise patient history that concentrates on the most relevant points can reduce the total consultation time. Reducing consultation time can be made without compromising how well patients feel consulted.

A pilot randomised controlled trial of a telehealth-delivered brief ‘Sleeping Sound Autism’ intervention for autistic children

BackgroundAccess to behavioural sleep intervention is beneficial for autistic children, yet many families face barriers to access associated with location and time. Preliminary evidence supports telehealth-delivered sleep intervention. However, no studies have evaluated brief telehealth sleep intervention. To address this, we evaluated telehealth delivery of the brief behavioural Sleeping Sound Autism intervention, using a two-armed, parallel-group, non-blinded, pilot randomised controlled trial (RCT) design (trial registration: ANZCTR12620001276943). MethodSixty-one families of autistic children without intellectual disability (5–12 years, 46% female) with caregiver-reported moderate–severe behavioural sleep problems participated Australia-wide, randomised to an intervention (n = 30) or treatment as usual control group (n = 31). Intervention group participants were invited to attend two video-conference telehealth sessions and one follow-up phone call with a trained clinician. Survey data was collected from caregivers at baseline and three- and six-months post-randomisation, to evaluate feasibility, acceptability, and efficacy. Ten intervention group caregivers participated in end-of-study semi-structured interviews to explore their experiences. ResultsForty-nine caregivers completed surveys. At baseline, 87% felt positive and 84% felt confident about participating via telehealth, and 75% believed the program would improve child sleep. At three-months, intervention group caregivers (n = 24) reported the usefulness (100%) of and preference for (71%) telehealth, and 95.8% would recommend this sleep program to other families. A significant group by time difference was observed in child sleep (Children's Sleep Habits Questionnaire) with large effect sizes (d = 0.87–1.05), emotion and behaviour (Developmental Behavior Checklist 2) with moderate effect sizes (d = 0.40–0.57), and caregiver mental health (Kessler 10) with small to moderate effect sizes (d = 0.60–0.28), favouring the intervention group (n = 23). There were no significant group differences in child (Child Health Utility instrument) or caregiver (Assessment of Quality of Life) quality of life. However, there were individual differences in the clinical significance of improved child sleep. Qualitative data showed that whilst telehealth was convenient for caregivers, without attenuating the benefits of most key intervention features, not all children were able to engage effectively with the clinician via telehealth. ConclusionsThis first pilot RCT of a brief telehealth behavioural sleep intervention for primary-school-aged autistic children suggests that telehealth delivery is acceptable, feasible and likely efficacious in improving sleep in the short-term. Providing families with ongoing choice of mode of delivery (telehealth/in-person) and examining the person-environment fit of telehealth for autistic children is important.

Validating older adult patient's Medical Treatment Decision Maker's (MTDM). A retrospective observational study with follow-up phone interview transcript

A Medical Treatment Decision Maker (MTDM), also referred to as surrogate decision maker, by law, is to be appointed to make medical treatment decisions on behalf of a person who cannot make such decisions for themselves. In the Emergency Department (ED) and acute healthcare services, the clinicians’ (nurses and doctors) ability to contact MTDMs is essential for patient care, particularly in time-critical situations. Our primary objective was to review the verification process and assess the accuracy of MTDM contact numbers in the Health Information System (HIS) to assess compliance with legislation. We used a quantitative method with retrospective observational study design and follow-up phone interview transcript. One hundred and fifty-nine participants were randomly selected of whom 76 % had MTDM. Patient advancing age had statistically significant association with the number of call attempts made to reach the listed MTDM (P = 0.043; CI, -3.541 to -0.057) and the MTDM's consent to participate (p = 0.023).

Does the Use of Potential Pancreatotoxic Drugs Increase the Risk of Post-Endoscopic Cholangiopancreatography Pancreatitis?

Background and Aim: Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable procedure for pancreatobiliary disorders but carries significant risks, including post-ERCP pancreatitis (PEP). The exact cause of PEP is unclear, but mechanical and thermal injuries during the procedure and patient-related factors have been implicated. This study aims to investigate the possible contribution of potential pancreatotoxic drug (PPD) exposure to PEP risk. Methods: This was a retrospective, single-centre, cohort study conducted at Canberra Hospital, a tertiary university hospital. Consecutive ERCP performed with native papillae within a 4-year period from January 2019 to January 2023 were evaluated. Details of ERCP procedures, patient characteristics, and all medications were contemporaneously collected. All patients had follow-up phone calls or review within 24 h post procedure. The diagnosis of PEP was based on the Cotton consensus definition. Results: A total of 32 out of 444 patients (7.2%) developed PEP. There was no significant difference in the incidence of PEP between patients taking PPD compared to patients who were not (7.1% vs. 7.6%, p = 0.845). Three factors were independently associated with PEP in the multivariate analysis: the presence of a periampullary diverticulum (OR = 5.4, 95% CI 1.7–15.3, p = 0.002), the performance of pre-cut sphincterotomy (OR = 2.8, 95% CI 1.2–6.4, p = 0.017), and pancreatic duct cannulation (OR = 3, CI 1.3–7, p = 0.01). Conclusions: The overall incidence of pancreatitis in our selected group of ERCP patients with native papillae was 7.2%. Our study did not find the use of PPD to be a statistically significant risk factor for PEP.

Non-Invasive Ventilation for Children Affected by Duchenne Muscular Dystrophy in Ukraine

Background: Duchenne Muscular Dystrophy (DMD) poses significant challenges, especially in Low- and Middle-Income Countries (LMIC) with limited access to Non-Invasive Mechanical Ventilation (NIV), which prolongs life expectancy. Two years after Stage 1 of the successfull “1500 years of survival” NIV programme commenced with 8 DMD boys in Ukraine in 2021, this study further explores the Stage 2 of the programme in 2023. Method: DMD patients underwent a 5-day training program at the National Children’s Clinical Hospital “Okhmatdyt” in Kyiv, Ukraine, utilizing donated second-hand bilevel intermittent positive presure ventilators. Indications for NIV included: sleep-related symptoms, high Apnea-Hypopnea Index (AHI&gt;10 events/hour), decreased Forced Vital Capacity (FVC=50%), low minimum saturation during sleep (SpO2&lt;88%), or age above 17 years. Parallel Masterclass on NIV was conducted for Ukrainian healthcare professionals and patients’ parents. Findings: Thirteen DMD inpatients, aged (mean ± standard deviation) 14.8±2.6 years and FVC of 1.8±0.4L (65.5±22.8% predicted value) were enrolled. Criteria for NIV initiation were: age&gt;17 years (n: 4), FVC% =50% (n :6), AHI&gt;10 (n :2) and SpO2&lt;88% (n :5). Follow-up phone calls were conducted to monitor progress. Three months post-hospitalization, all 13 patients consistently adhered to nocturnal ventilator treatment with a mean use of 7.5 hours per night. Conclusions: Despite the lack of equipment and system of reimbursement, the implementation of the comprehensive Stage 2 training programme supplying NIV for DMD patients in an LMIC such as in Ukraine, was a successful experience. The next steps in the home NIV programme will take place in the coming years.

Exploring Perspectives on Stroke Standard Set Data Collection: A Qualitative Descriptive Study.

BACKGROUND: The International Consortium on Health Outcome Measurement developed a standard set for stroke (SSS) that includes patient-reported outcome measures to help capture patients' perspectives on their poststroke recovery. The objective of this study was to explore the experiences and perspectives of individuals who collected SSS data from patients who were admitted to hospital for a stroke. METHODS: A qualitative descriptive approach was taken. Semistructured, audio-recorded interviews were conducted with individuals employed at 2 acute neurological inpatient units in Southwestern Ontario, Canada. Interviews were transcribed verbatim and written text responses were analyzed directly. Transcripts were coded line by line and then organized into 5 overarching themes: adoption, acceptance, appropriateness, feasibility, and sustainability. RESULTS: Six interviews were conducted with participants from varying roles (eg, nurses, manager, web developer, social worker, medical clerk). Participants reported that patients were receptive to completing the SSS. Follow-up phone calls provided a significant opportunity to monitor patients' recovery postdischarge. Many patients requested medical guidance and help navigating health and social resources for unmet stroke-related needs. Barriers to consistent SSS assessment included high employee turnover and lack of time, space, or capacity for follow-up. To sustain data collection, a dedicated, financially supported neurological nursing role was suggested. CONCLUSION: Participants were supportive of SSS data collection that could provide monitoring, oversight, and follow-up of stroke patients after discharge from acute care. However, the utility of the dataset is heavily dependent on having the data collection process properly resourced.

Design of the SPIROMICS Study of Early COPD Progression: SOURCE Study.

The biological mechanisms leading some tobacco-exposed individuals to develop early-stage chronic obstructive pulmonary disease (COPD) are poorly understood. This knowledge gap hampers development of disease-modifying agents for this prevalent condition. Accord-ingly, with National Heart, Lung and Blood Institute support, we initiated the SPIROMICS Study of Early COPD Progression (SOURCE), a multicenter observational cohort study of younger individuals with a history of cigarette smoking and thus at-risk for, or with, early-stage COPD. Our overall objectives are to identify those who will develop COPD earlier in life, characterize them thoroughly, and by contrasting them to those not developing COPD, define mechanisms of disease progression. SOURCE utilizes the established SPIROMICS clinical network. Its goal is to enroll n=649 participants, ages 30-55 years, all races/ethnicities, with ≥10 pack-years cigarette smoking, in either Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups 0-2 or with Preserved Ratio Impaired Spirometry (PRISm); and an additional n=40 never-smoker controls. Participants undergo baseline and three-year follow-up visits, each including high-resolution computed tomography; respiratory oscillometry and spirometry (pre- and post-bronchodilator administration), exhaled breath condensate (baseline only); and extensive biospecimen collection, including sputum induction. Symptoms, interim healthcare utilization, and exacerbations are captured every six months via follow-up phone calls. An embedded bronchoscopy sub-study involving n=100 participants (including all never-smokers) will allow collection of lower airway samples for genetic, epigenetic, genomic, immunological, microbiome, mucin analyses, and basal cell culture. SOURCE should provide novel insights into the natural history of lung disease in younger individuals with a smoking history, and its biological basis.

Examining the Nexus Between Customer Engagement and Satisfaction: Evidence from A Selected Retail Bank in South Africa

In the current retail banking environment, effective customer engagement is crucial for the success of organizations, impacting customer satisfaction, loyalty, and overall business performance. Given the competitive landscape and evolving customer expectations, it is essential for banks, especially Absa bank in South Africa, to understand the dynamics of customer engagement. This study aims to investigate how customer engagement initiatives influence customer satisfaction at Absa bank in the Durban area to provide strategic insights for enhancing competitiveness. Using theoretical frameworks such as Sashi's customer engagement cycle and Gronroos' model of service quality, this research explores the relationship between communication strategies related to organizational change and customer satisfaction levels at Absa bank in Durban. A quantitative research approach was employed, utilizing a structured questionnaire survey and convenience sampling to gather data from walk-in clients at various Absa bank branches. Statistical analyses, including descriptive and inferential methods, were used to analyze the data and test hypotheses. The results of the study offer valuable insights into customer preferences and expectations in the retail banking sector. Customers appreciate consistent messaging across different engagement channels and value personalized communication from the bank. Personalized calls, follow-up phone calls, and nonverbal cues such as a firm handshake were found to significantly impact customer perceptions and satisfaction with Absa bank's services. Customers display a high level of trust, satisfaction, and engagement with Absa bank, indicating the success of its customer engagement initiatives. The study also emphasizes the importance of social media in enhancing positive word-of-mouth and shaping consumer perceptions. Based on these findings, it is recommended that Absa bank implements a proactive customer engagement strategy focused on providing positive and personalized experiences to its existing customers. Key strategies include tailoring customer interactions, soliciting feedback, introducing loyalty programs, and utilizing various engagement platforms.

2250 A mixed-method feasibility study of an intervention to reduce sedentary behaviour in community-dwelling older adults aged ≥ 75 years

Abstract Introduction Older adults are the fastest growing and most sedentary group in society. With sedentary behaviour associated with negative health outcomes, reducing sedentary time may improve overall wellbeing. This single-arm mixed-method feasibility study explored the acceptability of an intervention to reduce sedentary behaviour in community-dwelling older adults aged ≥75 years. Methods Participants were recruited from the Community Ageing Research 75+ Study (CARE75+) cohort, with factors such as age, frailty status, living arrangements and levels of sedentariness being considered. The intervention consisted of an educational booklet including advice on how to reduce sedentary behaviour, a smartwatch with a sedentary reminder function, educational group sessions and follow up phone calls. The 9-week intervention was conducted from June–August 2023. Reach, uptake, adherence, and adverse events were recorded, and the acceptability of the intervention was explored through semi-structured exit interviews. Results Of the 39 eligible participants, 10 consented (5 M:5F) and had a mean age 84.3 years. The intervention had an uptake and reach of 25.6%, and retention of 100%. No falls, hospitalisations or deaths occurred, and three cases of mild irritation were reported which resolved during the study. 100% adherence was observed for the group sessions and follow-up phone calls, and 65% for self-monitoring. Qualitative data suggests that participants were receptive of the intervention according to the domains of the Theoretical Framework of Acceptability, and suggestions were provided on refining the intervention components. Conclusion Strategies to reduce sedentary behaviour were tested on a diverse sample of community-dwelling older adults in the oldest old age group, with varying levels of sedentary behaviour and frailty status. The presented strategies appear to be acceptable, appropriate, safe, and high levels of adherence were observed. Participant feedback will be used to refine the intervention.

Dynamic Control of Service Systems with Returns: Application to Design of Postdischarge Hospital Readmission Prevention Programs

Dynamic Control of Service Systems with Returns Postdischarge interventions (e.g., follow-up phone calls, outpatient appointments) are commonly used to reduce unplanned hospital readmissions. Such interventions have been shown to be effective (to varying degrees) in reducing the probability of readmission (or return). The interventions are, however, costly, and hence, their benefits need to be carefully balanced with the costs. In “Dynamic Control of Service Systems with Returns: Application to Design of Postdischarge Hospital Readmission Prevention Programs,” Chan, Huang, and Sarhangian investigate how postservice interventions should be dynamically allocated, accounting for their costs as well as their benefits in terms of reducing returns and congestion costs. To this end, they study a transient queueing control problem and examine the structure of the optimal policy by analyzing associated fluid-control problems. The structural results motivate the design of intuitive surge protocols whereby different intensities of interventions are provided based on the congestion level of the system.

Advancing ocular oncology care through teleophthalmology: a patient-centric perspective

ObjectiveAssessing patient satisfaction is an important component of understanding a program's efficacy and quality. The purpose of this study is to evaluate patient satisfaction with a teleophthalmology program tailored for ocular oncology that provides screening, remote assessment, care planning, and follow-up. Study designRetrospective survey. MethodsAn adapted version of the Telehealth Satisfaction Scale, consisting of the 8 questions plus 5 additional questions specific to the teleophthalmology program, was used to survey patients. The teleophthalmology program involves diagnostic imaging, remote physician assessments, and follow-up phone calls from health care team members to deliver results to patients. For reporting, the Consensus-Based Checklist for Reporting of Survey Studies was used. T-tests explored satisfaction differences across demographics and teleophthalmology visits. ResultsAmong the 95 patients contacted, 91 agreed to participate in the survey (96% response rate). Participants exhibited high overall satisfaction with the teleophthalmology program, reflected in a mean Telehealth Satisfaction Scale score of 28.88 (SD = 3.35 of 32). The median number of teleophthalmology visits completed was 4.0 (range of 1–8 appointments). No significant differences in satisfaction were found on the basis of age (P = 0.56), urban or rural residence (P = 0.17), or the number of telemedicine appointments (P = 0.51). ConclusionsThis analysis displays high satisfaction levels among patients within an ocular oncology clinic participating in the current telemedicine program, irrespective of age, geography, or number of teleophthalmology visits. Participants reported having their health care needs met with minimal clinical encounters due to remote consultations and telephone communications.

Return to Driving Following Moderate-to-Severe Traumatic Brain Injury: A TBI Model System Longitudinal Investigation.

To examine longitudinal patterns of return to driving (RTD), driving habits, and crash rates associated with moderate-to-severe traumatic brain injury (TBI). Eight TBI Model System sites. Adults (N =334) with TBI that required inpatient acute rehabilitation with follow-up of 197 and 218 at 1 and 2years post-injury, respectively. Data collection at 2 years occurred almost exclusively during the pandemic, which may have affected results. Longitudinal and observational. Driving survey completed during rehabilitation and at phone follow-up 1 and 2years after injury. The rate of RTD was 65% at 1-year follow-up and 70% at 2-year follow-up. RTD at both follow-up time points was positively associated with family income. The frequency of driving and distance driven were diminished compared to before injury. Limitation of challenging driving situations (heavy traffic, bad weather, and at night) was reported at higher rates post-injury than before injury. Crash rates were 14.9% in the year prior to injury (excluding crashes that resulted in TBI), 9.9% in the first year post-injury, and 6% during the second year. RTD is common after TBI, although driving may be limited in terms of frequency, distance driven, and avoiding challenging situations compared to before injury. Incidence of crashes is higher than population-based statistics; however, those who sustain TBI may be at higher risk even prior to injury. Future work is needed to better identify characteristics that influence the likelihood of crashes post-TBI.

Association of maternal infection of SARS-CoV-2 and neonatal susceptibility: A retrospective cohort study

ObjectiveThis study aims to assess the risk of neonatal susceptibility to COVID-19 among pregnant women. MethodsWe conducted a retrospective cohort study involving 1089 pregnant women ≥28 weeks of gestational age, who were categorized into infected and uninfected groups. Data for all participants were collected through a comprehensive review of electronic medical records and follow-up phone calls. The primary outcome was neonatal infection with SARS-CoV-2, while secondary outcomes included delivery patterns and gestational age at delivery. ResultsMaternal vaccination (OR 95%CI:0.63[0.46, 0.85]) and maternal infection with SARS-CoV-2 (OR 95%CI: 0.45[0.34, 0.60]) were found to be associated with a decreased risk of neonatal infection. The infected group exhibited a lower neonatal SARS-CoV-2 infection rate (25.93%) compared to the uninfected group (45.15%). Logistic regression analysis identified several risk factors associated with an increased risk of neonatal infection, including pregnancy BMI (OR 95%CI: 1.04[1.01, 1.08]), age at first pregnancy (OR 95%CI: 1.05[1.01, 1.10]), age at menarche (OR 95%CI: 1.13[1.02, 1.26]), and parturition (Yes vs. No) (OR 95%CI:1.4 [1.04,1.88]). ConclusionMaternal vaccination and perinatal infection with SARS-CoV-2 play a protective role in preventing neonatal SARS-CoV-2 infection.