Care Practitioners Research Articles

EPH174 Trends in Postpartum Depression before and during the COVID-19 Pandemic and Correlates of Treatment Choices: A Population-Based Retrospective Cohort Study

COVID-19-related stressors – including social distancing, material hardship, increased intimate partner violence, and loss of childcare, among others – may result in a higher prevalence of depression among postpartum individuals. This study examines trends in postpartum depression in the US from 2018 to 2022, as well as correlates of treatment choices among women with postpartum depression. 1,108,874 women aged 14-64 in the Komodo Healthcare Map with 1+ live birth between April 2018 and December 2021 and had continuous enrollment 2+ years before and 4+ months after the delivery date were included. Prevalence of depression during postpartum (within 3 months after delivery) was calculated before (April 2018–March 2020) and during (April 2020–March 2022) COVID-19. Multinomial logistic regression was used to investigate correlates of treatment choices (no treatment, medication-only, psychotherapy-only, or both). The prevalence of postpartum depression increased from 9.7% pre-pandemic to 12.0% during the pandemic (p < 0.001). Among 119,788 women with postpartum depression in 2018-2022, 47.0% received no treatment, 35.0% received medication-only, 10.0% received psychotherapy-only, and 7.4% received both within one month following their first depression diagnosis. Factors associated with an increase in the odds of receiving medication-psychotherapy treatment (vs. no treatment) included older ages; commercial insurance coverage; lower social vulnerability index; history of anxiety or mood disorder during and before pregnancy; and being diagnosed by a nurse practitioner, physician assistant, or behavioral care practitioner (vs. physician). Similar patterns were observed for medication-only and psychotherapy-only treatments. In this large, nationally representative sample of US insured population, the prevalence of postpartum depression increased significantly by 2.3 percentage-points during the pandemic (or a relative increase of 23.7%). Nonetheless, almost half of women with postpartum depression received no treatment, and only 7.5% received both medication and psychotherapy. The study highlighted potential socioeconomic and provider variation in postpartum depression treatment.

Governing education, governing early childhood education and care practitioners’ profession?

Neo-liberal values affect early childhood education through the production of specific teacher subjectivities. These subjectivities are connected not only to the logic of competition, but also to competing definitions of worth, trust and values, as demonstrated by data. Neo-liberal values of accountability are also intertwined with the traditional discourse of child-centred learning. This study contributes to research concerning early childhood education and care staff’s professionalism by focusing on the effects of the commercialization of early childhood education and care teachers’ understanding of their work. With survey data (161 responses) collected from the five largest municipalities in Finland, the authors examine the reasoning that early childhood education and care staff provide for choosing commercial as well as non-commercial digital applications, licensed programmes and ready-made learning materials. The research is highly topical since the number of innovations targeted at early childhood education and care is increasing. Digitalization opens new ways for the privatization and marketization of education by introducing appealing commercially produced programmes and materials. In this study, the authors show how the advertising of these innovations as providing ‘easy solutions’ to improve either children's learning or early childhood education and care practitioners’ working time has become a discourse through which teachers and other staff members evaluate their work and their professionalism. In addition, the authors suggest that Finnish early childhood education and care practitioners seem to have internalized the pressure to enhance efficiency and accountability in early childhood education and care.

Rural Psychiatrists Know Multidisciplinary Care and Cultural Sensitivity

Rural Psychiatrists Know Multidisciplinary Care and Cultural Sensitivity

Physician Practice Characteristics Influencing Nurse Practitioner and Physician Assistant Care in Nursing Homes: A Scoping Review

Physicians, nurse practitioners (NPs), and physician assistants (PAs) are key to the effective delivery of medical care in nursing homes (NHs). Although several studies have reported on the relationship between the care delivered by a given discipline and specific clinical outcomes, the mediating effect of physician practice characteristics is unknown. A scoping review was conducted to determine whether studies examining the impact of NP and PA care in NHs have accounted for both the collaborative relationship between themselves and physicians as well as physician practice size and type. Scoping review. NH and NH residents. Papers eligible for review included peer-reviewed studies written in English and that were quantitative in nature. Inclusion criteria required that more than 1 NH and more than a single NP or PA be included for the analysis. Further, the size of the NH studied must have equaled or exceeded 100 residents and more than 1 clinical outcome reported. Databases searched included Ovid MEDLINE, Cochrane Library, Web of Science; CINAHL, and AgeLine. A total of 1878 studies underwent abstract review of which 1719 were excluded. A full-text review of the remaining articles was completed (n= 157, as 2 articles could not be retrieved), of which 16 met eligibility criteria. The study designs were generally retrospective and quasi-experimental in nature. No randomized controlled studies were identified. Physician practice variables such as number of physicians, total practice case load, case mix, and the nature of the collaborative practice between NP/PA and MD were infrequently specified. In no reports was the type of physician practice characterized and no physician practice variables were adjusted for with regard to outcomes. None of the studies included in the review were found to have incorporated any physician variables into their outcome analyses. Before purporting equivalency between medical provider disciplines in NHs, future studies must, at the very least, consider the mediating effect of physician practice characteristics.

Cost-effectiveness of general practitioner- versus surgeon-led colon cancer survivorship care: an economic evaluation alongside a randomised controlled trial

PurposeThe aim of this study is to assess cost-effectiveness of general practitioner (GP) versus surgeon-led colon cancer survivorship care from a societal perspective.MethodsWe performed an economic evaluation alongside the I CARE study, which included 303 cancer patients (stages I–III) who were randomised to survivorship care by a GP or surgeon. Questionnaires were administered at baseline, 3-, 6-, 12-, 24- and 36-months. Costs included healthcare costs (measured by iMTA MCQ) and lost productivity costs (SF-HLQ). Disease-specific quality of life (QoL) was measured using EORTC QLQ-C30 summary score and general QoL using EQ-5D-3L quality-adjusted life years (QALYs). Missing data were imputed. Incremental cost-effectiveness ratios (ICERs) were calculated to relate costs to effects on QoL. Statistical uncertainty was estimated using bootstrapping.ResultsTotal societal costs of GP-led care were significantly lower compared to surgeon-led care (mean difference of − €3895; 95% CI − €6113; − €1712). Lost productivity was the main contributor to the difference in societal costs (− €3305; 95% CI − €5028; − €1739). The difference in QLQ-C30 summary score over time between groups was 1.33 (95% CI − 0.049; 3.15). The ICER for QLQ-C30 was − 2073, indicating that GP-led care is dominant over surgeon-led care. The difference in QALYs was − 0.021 (95% CI − 0.083; 0.040) resulting in an ICER of 129,164.ConclusionsGP-led care is likely to be cost-effective for disease-specific QoL, but not for general QoL.Implications for cancer survivorsWith a growing number of cancer survivors, GP-led survivorship care could help to alleviate some of the burden on more expensive secondary healthcare services.

Depression and anxiety in people with cognitive impairment and dementia during the COVID-19 pandemic: Analysis of the English Longitudinal Study of Ageing.

Some studies have identified declines in mental health during the Coronavirus Disease 2019 (COVID-19) pandemic in different age groups, including older people. As anxiety and depression are common neuropsychiatric symptoms among people with cognitive impairment, the mental health experiences of older people during the pandemic should take cognitive function into consideration, along with assessments made prior to the pandemic. This study addresses evidence gaps to test whether changes in depression and anxiety among older people through the COVID-19 pandemic were associated with cognitive impairment. It also investigates whether associations varied according to key sources of sociodemographic inequality. Using data from the English Longitudinal Study of Ageing (ELSA) collected from 2018/2019 to November/December 2020, we estimated changes in depression and anxiety for people aged 50+ in England across 3 cognitive function groups: no impairment, mild cognitive impairment, and dementia. Conditional growth curve models were estimated for continuous measures over 3 time points (N = 5,286), with mixed-effects logistic regression used for binary measures. All models adjusted for demographics (age, gender, ethnicity, and cohabiting partnership), socioeconomics (education, wealth, and employment status), geography (urban/rural and English region), and health (self-rated and the presence of multimorbidity). We found that depression (measured with CES-D score) worsened from 2018/2019 to November/December 2020 for people with mild cognitive impairment (1.39 (95% CI: 1.29 to 1.49) to 2.16 (2.02 to 2.30)) or no impairment (1.17 (95%CI: 1.12 to 1.22) to 2.03 (1.96 to 2.10)). Anxiety, using a single-item rating of 0 to 10 also worsened among those with mild cognitive impairment (2.48 (2.30 to 2.66) to 3.14 (2.95 to 3.33)) or no impairment (2.20 (2.11 to 2.28) to 2.85 (2.77 to 2.95)). No statistically significant increases were found for those with dementia. Using a clinical cutoff for likely depression (CES-D ≥4), we found statistically significant increases in the probability of depression between 2018/2019 and November/December 2020 for those with no impairment (0.110 (0.099 to 0.120) to 0.206 (0.191 to 0.222)) and mild impairment (0.139 (0.120 to 0.159) to 0.234 (0.204 to 0.263)). We also found that differences according to cognitive function that existed before the pandemic were no longer present by June/July 2020, and there were no statistically significant differences in depression or anxiety among cognitive groups in November/December 2020. Wealth and education appeared to be stronger drivers for depression and anxiety, respectively, than cognitive impairment. For example, those with no impairment in the richest two-thirds scored 1.76 (1.69 to 1.82) for depression in June/July, compared to 2.01 (1.91 to 2.12) for those with no impairment in the poorest third and 2.03 (1.87 to 2.19) for those with impairment in the poorest third. Results may be limited by the small number of people with dementia and are generalizable only to people living in the community, not to those in institutional care settings. Our findings suggest a convergence in mental health across cognitive function groups during the pandemic. This suggests mental health services will need to meet an increased demand from older adults, especially those not living with cognitive impairment. Further, with little significant change among those with dementia, their existing need for support will remain; policymakers and care practitioners should ensure this group continues to have equitable access to mental health support.

Why might medical student empathy change throughout medical school? a systematic review and thematic synthesis of qualitative studies

BackgroundSeveral studies suggest that medical student empathy declines throughout medical school. However, no studies have synthesised the evidence regarding why empathy declines.ObjectiveTo conduct a systematic review and thematic synthesis of qualitative studies investigating why student empathy may change throughout medical school.MethodsWe included any qualitative study that investigated why empathy might change during medical school. We searched the Medline, Scopus, CINAHL, ERIC, and APA PsycInfo databases for relevant studies. All databases were searched from their inception to 18 July 2022. We also searched the reference lists of the included studies and contacted experts to identify additional studies. We used the Joanna Briggs Institute tool to evaluate the risk of bias in the included studies. Overall confidence in our results was assessed using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) approach. We used thematic methods to synthesise our findings.ResultsOur searches yielded 2523 records, and 16 studies involving a total of 771 students were eligible for analysis. Most studies (n = 11) were from Europe or North America. The descriptive themes and sub-themes were identified for each study. Increased complexity in patients and their diseases, together with the ‘hidden curriculum’ (including a stressful workload, prioritisation of biomedical knowledge, and (sometimes) poor role models), led to student adaptations, such as cynicism and desensitisation. Students’ prior lives and professional experiences appeared to exacerbate the decline in empathy. However, there were bias concerns for most of the included studies.DiscussionMany of the included studies included were small, and some did not include demographic participant data. Given the likely benefits of providing empathic care for patients and practitioners, medical education interventions should focus on developing an ‘empathic hidden curriculum’ that mitigates the decline in medical student empathy.Trial registrationA protocol for this systematic review was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on 28 July 2022 (registration number CRD42022347856).

Professionalization in early childhood education: how do educators craft their work?

ABSTRACT Job crafting offers an exciting way to understand how people engineer their jobs to create more meaningful work. Work is meaningful if workers perceive their work as significant and serving an important purpose. To examine how four early childhood educators individually and collaboratively craft their work, the study reported here examines data from a case study in a Canadian daycare centre collected over a 16-month period by participating in theory/practice inquiry meetings and individual educator interviews. Educators develop an individual understanding of their job’s requirements, individual beliefs and values but also acquire a shared understanding as they collaboratively craft their work in daily informal discussions. Explicit collaborative job crafting could contribute to professional development and improved job satisfaction for Early Childhood Education and Care practitioners. To develop an explicit collaborative understanding of their profession co-workers and supervisors need enabling working conditions such as opportunities and support for professional knowledge sharing, professional reflection, continuous training, and therefore ongoing professional development.

Post COVID Interstitial Lung Abnormalities-Incidence and Management.

This review aims to summarize the available literature to identify the incidence and risk factors for persistent interstitial lung abnormalities (ILAs) following hospitalization for COVID-19. The current and prospective treatment options are reviewed in an effort to help pulmonary practitioners care for this burgeoning patient population. Statistical modeling suggests that 11.7% of all patients hospitalized with COVID-19 have irreversible fibrotic features on long-term follow-up imaging. The available evidence suggests that up to 30% of patients have ILAs following COVID-19 hospitalization. The radiographic abnormalities improve or resolve in a majority of these patients. However, estimates suggest that up to one-third of these patients have irreversible fibrotic features. Clinical trials of the impact of anti-fibrotic agents are ongoing. As there continue to be thousands of COVID-19 hospitalizations in the USA each week, the management of post-COVID ILAs will become a common problem for the pulmonary practitioner.

The Impact of Nurse Practitioner Care and Accountable Care Organization Assignment on Skilled Nursing Services and Hospital Readmissions.

Accountable care organizations (ACOs) and the employment of nurse practitioners (NP) in place of physicians are strategies that aim to reduce the cost and improve the quality of routine care delivered in skilled nursing facilities (SNF). The recent expansion of ACOs and nurse practitioners into SNF settings in the United States may be associated with improved health outcomes for patients. To determine the relationship between ACO attribution and NP care delivery during SNF visits and the relationship between NP care delivery during SNF visits and unplanned hospital readmissions. We obtained a sample of 527,329 fee-for-service Medicare beneficiaries with 1 or more SNF stays between 2012 and 2017. We used logistic regression to measure the association between patient ACO attribution and evaluation and management care delivered by NPs in addition to the relationship between evaluation and management services delivered by NPs and hospital readmissions. ACO beneficiaries were 1.26% points more likely to receive 1 or more E&M services delivered by an NP during their SNF visits [Marginal Effect (ME): 0.0126; 95% CI: (0.009, 0.0160)]. ACO-attributed beneficiaries receiving most of their E&M services from NPs during their SNF visits were at a lower risk of readmission than ACO-attributed beneficiaries receiving no NP E&M care (5.9% vs. 7.1%; P <0.001). Greater participation by the NPs in care delivery in SNFs was associated with a reduced risk of patient readmission to hospitals. ACOs attributed beneficiaries were more likely to obtain the benefits of greater nurse practitioner involvement in their care.

Goal Contents, State Empathy and Instructional Goals in a Physical Disability Vignette

ABSTRACT Setting and recommending instructional goals represents an important communication process in educational and health domains, which are intersected in many cases. However, little is known about the antecedents of instructional goals. The aim of the present study was to examine how the contents of participants’ personal goals in life (i.e. goal contents) and state empathy during message processing affected the processes of prioritizing instructional goals in the case of an adolescent who presented physical disability and impaired cognitive functioning, as presented in a video vignette. Health and care practitioners who were members of the educational system, in-service teachers and university students of disciplines related to health, rehabilitation or education, participated in a cross-sectional study. The findings showed that the participants proposed instructional goals according to their current goal contents and state empathy. In particular, state empathy demonstrated both main effects and mediations in influencing intrinsic instructional goals. However, state empathy, in fact its associative component, influenced an extrinsic goal domain as well. Interpretations of this phenomenon are presented, and the limitations of some tools are demonstrated. In addition, suggestions are put forward regarding implications and future research for a proximal causation of the instructional goals.

ASSOCIATION OF INTRAOCULAR PRESSURE CHANGES IN DIFFERENT DEGREES OF MYOPIA

Introduction: Myopia, also known as “short-sightedness” or “near-sightedness,” is an increasingly widespread condition around the world. Myopia is commonly defined as a spherical equivalent (SE) ≤ 0.5 dioptres (D) and develops mainly during childhood and early adulthood when excessive elongation of the eye causes images of distant objects to fall in front of the retina with the eye at rest, resulting in a blurred distance vision. Myopia can be classified according to age of onset, clinical variety, etiology, and degree. According to the degree, myopia can be classified as mild/low myopia (-0.25D to -2.75D);moderate/medium myopia (-3.00D to -6.00D) and high myopia (Above -6.00D).Aim and Objective: To investigate the intraocular pressure changes in the different degrees of myopia. Material and Methods: This study was a clinical study carried out at the department of ophthalmology, rukmani birla hospital,Jaipur. An informed consent was gotten from all the subjects who were part of the study.Clinical tests performed on the subjects include case history, visual acuity, external eye examination, ophthalmoscopy, static retinoscopy and subjective refraction. The subjects with myopia were grouped into three according to the degree of myopia. Their intraocular pressure was measured using the indentation tonometry. Data was collected and uploaded into the Statistical Package for Social Sciences (SPSS) version 21 and the one-way ANOVA was used to test the null hypotheses at 0.05% level of significance and 95% confidence interval. Result: The study included a Sample size of 100 Patients.The table showed that 50 (50.00%) of the subjects had mild myopia;42 (42.00%) had moderate myopia and 8 (8.00%) had high myopia.IOP of 10 - 15 were 20 (20.00%);16 -20,26 (26.00%);21 – 25,4 (4.00%);26 – 30,0 (0.00%).Minimum,maximum and mean IOP values for low myopes were 10.3,30.6 and 17.13 mmHg respectively.For medium myopes,the minimum,maximum and mean IOP values were 11, 22 and 16.63 mmHg respectively. For high myopes, the minimum, maximum and mean IOP values were 18.8, 22 and 20.15 mmHg respectively. SPSS data analysis using the one-way ANOVA at 0.05 level of significance showed that there was a significant difference [P(0.036) &lt; 0.05] in the IOP values between the different degrees of myopia. Conclusion: In conclusion, there was a significant difference in the IOP of different degrees of myopia.Eye care practitioners are advised to closely monitor the IOP of their myopic patients.For young children,as the myopia progresses,the IOP should also be monitored.

Post COVID-19 Pandemic Care for HIV Caregivers

The COVID-19 pandemic that swept the world in 2020 has highlighted the dangers and challenges posed by infectious diseases and encouraged healthcare providers to further re-think the stigma of epidemic and pandemic diseases. HIV infection was reclassified as a chronic disease in Taiwan after highly active antiretroviral therapy was introduced in the country. Because HIV infection is related to behavior, people living with HIV are often affected by a negative social image that is influenced by multiple stereotypes and the general stigma toward AIDS. In Taiwan, this stigma is deeply influenced by Eastern philosophy and Confucian culture, making the context and effect of stigma different from Western countries. The current "U=U" concept of HIV treatment holds that someone under treatment for HIV with an undetectable HIV viral load cannot sexually transmit the virus to others. Therefore, in the post-pandemic era, HIV medical care personnel should apply evidence-based-care thinking. This article describes HIV stigma in the context of Confucianism, U=U as the leading concept of HIV treatment, and the recommended approach to care for HIV healthcare practitioners in the post-COVID-19 era. Reducing HIV stigma will enable Taiwan to achieve the ' Three Zeros' of zero discrimination, zero infection, and zero death advocated by the Joint United Nations Program on HIV/AIDS for ending the AIDS epidemic by 2030.

Nichtinanspruchnahme medizinischer Leistungen in der COVID-19-Pandemie bei Personen mit chronischen Erkrankungen

ZusammenfassungEinleitungDie COVID-19-Pandemie wirkt sich auch auf die medizinische Versorgung anderer Erkrankungen aus. Differenziert zwischen patient:innen- und anbieter:innenseitigen Gründen wurde untersucht, inwieweit Personen mit chronischen Erkrankungen vom Aussetzen medizinischer Versorgungsleistungen betroffen sind.MethodenEs wurde eine Querschnittstudie auf Datenbasis der Kohortenstudie Hamburg City Health Study (HCHS) durchgeführt. Die Studienpopulation bestand aus allen HCHS-Teilnehmer:innen (Stichprobe der Bevölkerung Hamburgs, 45–74 Jahre) zwischen April 2020 und November 2021. Über das „COVID-19-Modul“ der HCHS wurde die Inanspruchnahme von Versorgungsleistungen erhoben. Als Grunderkrankungen wurden u. a. Herz-Kreislauf‑, Nieren- und Lungenerkrankungen, Krebs und Diabetes mellitus betrachtet. Die Daten wurden deskriptiv und multivariat in logistischen Regressionen ausgewertet.ErgebnisseVon 2047 Teilnehmer:innen hatten 47,9 % mindestens eine Vorerkrankung. 21,4 % der Personen mit Vorerkrankungen hatten mindestens eine Versorgungsleistung ausgesetzt oder eine Terminabsage erhalten. 15,4 % gaben an, von sich aus auf einen Arztbesuch verzichtet zu haben. Fachärztliche Leistungen (Anteil 43,8 %) entfielen häufiger als hausärztliche (16,6 %). Nach Adjustierung für Alter, Geschlecht und Bildung erwiesen sich Lungen- (OR 1,80; p < 0,008) und Krebserkrankungen (OR 2,33; p < 0,001) als unabhängige Risikofaktoren für ärztliche Terminabsagen. 42,2 % der patient:innenseitigen Absagen erfolgten aus Angst vor einer Ansteckung mit SARS-CoV‑2.DiskussionGesundheitspolitik und Medien stehen vor der Herausforderung, mit Ängsten in der Bevölkerung vor einer Infektion so umzugehen, dass notwendige Versorgungsleistungen dadurch nicht vermieden werden.

Impact of a dietitian in general practice: paediatric food allergy.

Food allergy in infants and young children places a significant burden on primary care. This study evaluated a dietetic-led paediatric food allergy service, which attempts to provide more rapid access to the dietitian and reduce the need for general practitioner (GP) and secondary care appointments. Two community dietetic services for children referred with food allergy were compared. The first was dietetic-led care where dietitians train community children's nurses to recognise potential cases of food allergy, undertake basic diagnostic assessment and subsequently refer to the dietitian. The other was a more traditional dietetic community service where patients were referred predominantly by the GP or secondary care. In dietetic-led care 86 patients were seen, compared to 96 in dietetic community care. Dietetic-led care received fewer referrals from the GP, 36% versus 67% (p < 0.001); GP appointments for allergy-related conditions prior to dietetic referral were lower, 3 versus 6 visits (p = 0.001); and input from secondary care was also lower, 8 versus 25 patients (p = 0.002) compared with dietetic community care. Children referred to dietetic-led care were younger, 78% <6 months versus 40% (p < 0.001) in dietetic community care. Dietetic-led care describes a model that has the potential to reduce GP and secondary care appointments, identify patients more quickly and reduce the time to receive dietetic input, thereby resolving symptoms more quickly and reducing prescribed medications. This model demonstrates the importance of integrated care and multidisciplinary working, offering a solution to reducing GP workload while maintaining or improving patient care.

General practitioners practicing anesthesia care in rural Nepal: rewards and challenges

Safe and accessible anesthetic care is critically limited in Asian countries. Perioperative anesthesia related complications are higher in resource limited countries. Neuraxial regional anesthesia is becoming popular and considered as anesthesia of choice in surgeries below umbilicus due to its safety, accessibility, efficacy and low cost. Due to limited numbers of anesthetists and anesthesia assistants, Medical Doctorate in General Practice (MPGP) are widely practicing different types of anesthetic care and performing varieties of surgeries in remote Nepal. Effective coordination, task sharing approach, clinical updates and specific training programs are required to strengthen anesthetic care of general practitioners in rural Nepal.

General practitioner care in nursing homes during the first wave of the COVID-19 pandemic in Germany: a retrospective survey among nursing home managers

BackgroundThough evidence on the detrimental impact of the COVID-19 pandemic in nursing homes is vast, research focusing on general practitioners’ (GP) care during the pandemic in nursing homes is still scarce.MethodsA retrospective online survey among 1,010 nursing home managers in Germany was conducted during the first wave of the COVID-19 pandemic between November 2020 and February 2021. Associations between perceived deficits in GP care (routine and acute visits) and both general and COVID-19-related characteristics of nursing homes were analysed using multiple logistic regression analyses.ResultsThe majority of nursing home managers reported no deficits in GP care (routine visits, 84.3%; acute visits, 92.9%). Logistic regression analyses revealed that deficits in GP care (routine visits) were significantly associated with visiting restrictions for GPs and nursing home size. Small nursing homes (1–50 residents) were significantly more likely to report deficits in GP care (routine visits) compared to medium (51–100 residents) and large nursing homes (> 100 residents). Further, deficits in GP care (acute visits) were significantly associated with dementia as a focus of care and the burden of insufficient testing for SARS-CoV-2 among residents. Moreover, visiting restrictions for GPs were significantly associated with dementia as the focus of care and the COVID-19 incidence at the federal state level. Finally, COVID-19 cases in nursing homes were significantly associated with size of nursing homes, COVID-19-incidence on the federal state level and the burden of insufficient testing capacities for SARS-CoV-2 among residents.ConclusionWe found structural factors associated with GP care deficits during the pandemic. New concepts for GP care should be implemented in pandemic preparedness plans to ensure high quality, consistent, and reliable GP care as well as effective infection prevention measures in nursing homes.

System-Level Changes to Better Support Women Survivors of Intimate Partner Violence and Traumatic Brain Injury

<h3>Research Objectives</h3> Traumatic brain injury (TBI) occurring during intimate partner violence (IPV) is a largely unrecognized but significant public health crisis. One in 3 women will experience IPV in their lifetime, up to 75% of whom will sustain a TBI as a result. Our main objectives were to: (1) Identify key needs, facilitators, and barriers to care for women survivors of IPV presenting with TBI (2) Cocreate ideas for resources and principles for identification, clinical care, and support for healthcare practitioners who treat women exposed to IPV and TBI. <h3>Design</h3> Data were gathered through small group breakout sessions using semi-structured discussion guides. Sessions were recorded, transcribed verbatim, and analyzed using thematic analysis techniques. Stakeholders contributed to the analysis and knowledge translation through member-checking activities. <h3>Setting</h3> The study took place in the community using a community-based participatory research approach, and was conducted through 2 half-day virtual meetings. <h3>Participants</h3> We engaged 30 stakeholders drawn from a national IPV-TBI Knowledge-to-Practice (K2P) Network including diverse women survivors, service providers, researchers, and decision makers. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> Three main systems-level themes arose during these discussions: (1) the need for trauma-informed, anti-racist, and equitable health and social care systems; (2) the need for cross-pollination of knowledge between disciplines; and (3) the need for systems-level support for integrated and coordinated care. This presentation will explore these needs and will provide recommendations and suggestions for paths forward. <h3>Conclusions</h3> The findings of this project enhance understanding of system-level needs among women survivors and provide a template for a national agenda for IPV-TBI research and practice. <h3>Author(s) Disclosures</h3> The authors declare no conflicts of interest.

"My Person" or "A Person": CarePartner and Practitioner Perceptions Caring for Persons in Disordered Consciousness

<h3>Research Objectives</h3> Compare perceptions of carepartners (CP) and rehabilitation practitioners (RP) caring for a person in disordered consciousness (DoC) following brain injury. <h3>Design</h3> Qualitative, exploratory design. <h3>Setting</h3> Post-acute care (PAC) and community. <h3>Participants</h3> 16 CPs for persons in DoC. 21 RPs working in PAC. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> N/A. <h3>Results</h3> CP and RP perceptions of personhood in persons in DoC are compared. The CP searching for "my person" through the recovery process and the RP searching for "a person". CPs described this through subthemes of looking for their old person ("Just like the old Katie",), searching for evidence their person is "in there" ("I am in here why can't I get to you") and the emergence of a "new person" ("he does the loudest laugh, I guess this is the new person"). In contrast RPs described their search for "a person". RPs search for scientific proof of "a person". They described this through subthemes of searching for consistent and purposeful behavior ("Is she truly consistent? Like 100%?"), cognitive dissonance associated with interpretation of observed behaviors ("Did I just see that?"), and the search for signs of consciousness ("it's not a black and white thing"). <h3>Conclusions</h3> CPs and RPs for persons in DoC have different world views through which they see the person. These worldviews can lead to challenges with perceptions of recovery. A shared understanding of "my person" and "a person" is essential to ensure CPs and RPs exchange information supportive to everyone's needs. <h3>Author(s) Disclosures</h3> There are no disclosures for any of the authors on this poster.

Precision medicine in Australia: now is the time to get it right.

Precision medicine in Australia: now is the time to get it right.