Care Priorities Research Articles

Global Disparities of Cancer and Its Projected Burden in 2050.

Cancer prevention and care efforts have been challenged by the COVID-19 pandemic and armed conflicts, resulting in a decline in the global Human Development Index (HDI), particularly in low- and middle-income countries. These challenges and subsequent shifts in health care priorities underscore the need to continuously monitor cancer outcome disparities and statistics globally to ensure delivery of equitable and optimal cancer prevention and care in uncertain times. To measure the global burden of 36 cancers in 2022 by sex, age, and geographic location and to project future trends by 2050. This cross-sectional study used population-based data from 2022 in 185 countries and territories were obtained from the Global Cancer Observatory database. Data extraction and analysis were carried out in April 2024. Counts, rates, prevalence, mortality to incidence ratios (MIRs), and demography-based projections were used to characterize current and future cancer burden. This population-based study included 36 cancer types from 185 countries and territories. By 2050, 35.3 million cancer cases worldwide are expected, a 76.6% increase from the 2022 estimate of 20 million. Similarly, 18.5 million cancer deaths are projected by 2050, an 89.7% increase from the 2022 estimate of 9.7 million. Cancer cases and deaths are projected to nearly triple in low-HDI countries by 2050, compared to a moderate increase in very high-HDI countries (142.1% vs 41.7% for cancer cases and 146.1% vs 56.8% for cancer deaths). Males had a higher incidence and greater number of deaths in 2022 than females, with this disparity projected to widen by up to 16.0% in 2050. In 2022, the MIR for all cancers was 46.6%, with higher MIRs observed for pancreatic cancer (89.4%), among males (51.7%), among those aged 75 years or older (64.3%), in low-HDI countries (69.9%), and in the African region (67.2%). In this cross-sectional study based on data from 2022, cancer disparities were evident across HDI, geographic regions, age, and sex, with further widening projected by 2050. These findings suggest that strengthening access to and quality of health care, including universal health insurance coverage, is key to providing evidence-based cancer prevention, diagnostics, and care.

6.G. Scientific session: The importance of using country-specific severity distributions in burden of disease indicators

Abstract One of the most commonly used health gap summary measures in the field of public health is the Disability-adjusted life year (DALY). It has become the key metric for quantifying the burden of disease (BoD) and is used as an information source for setting priorities for health care and health service planning. The DALY metric quantifies gaps between a theoretical population in perfect health and the current health status related to both morbidity and mortality. It is the sum of the number of healthy life years lost due to disability (YLD) and death (YLL). The YLD summarises the loss of healthy life time using the frequency of diseases differentiated by severities or related health states (including sequelae). Depending on each health state, it converts the time spent with diseases into YLD by weighting each year with health limitation with so-called disability weights. This allows the two indicators YLL and YLD to be added to the DALY. Consequently, severity distributions are a means of describing the range of health loss along specific health states, which enables an accurate mapping with disability weights. For most of the diseases, these distributions are usually categorised as mild, moderate, severe, or no health loss (asymptomatic). Conditions with higher severity levels contribute more to the YLD and thus, to the overall disease specific BoD. The severity distributions are highly dependent on utilization at the individual level, but also on available health care services at the society level, which indicates that differences by settings are to be expected. Changes over time in the share of severe cases, for instance, may reflect the effectiveness of health interventions and policies. This underlines the importance of severity distributions, as they also reflect information about the quality of healthcare for those affected. The Global Burden of Disease (GBD) study applies for a significant proportion of their considered diseases uniform severity distributions across countries and broader regions. They acknowledge concerns over applying estimates of severity distributions based on limited data, noting that it is the only available information that they were able to use. As the YLD estimates are often utilized to develop and prioritize health policy interventions, there is a necessity for country-specific estimates that are evidence based and less susceptible to model assumptions. In most cases, the estimation of severity distributions involves complex methodology as data for such assessments are very limited or hardly reliable. In the following workshop, general concepts and country cases from Germany, Scotland, and Belgium will be presented covering a variety of diseases. The examples underline the importance of estimating national and even regional severity distributions when identifying the importance of diseases or comparing the health conditions of populations across time. Key messages • As the Burden of disease indicators are predominantly used to prioritize health interventions and allocate resources, it is crucial to use accurate information in the severity levels of disease. • Severity distributions reflect the health care services and vary across different settings. Utilising country-specific severity distributions when estimating Burden of Disease indicators is essential.

An ACNAP survey assessing the cardiology multidisciplinary learning needs to support lipid management

Abstract Background/ Introduction: Reducing LDL cholesterol is a high priority in cardiovascular care but requires knowledge and skills to deliver effectively. Nurses and allied professionals (NAPs) can play a major role in supporting lipid optimisation. Most NAPs will work together with patients prescribed lipid lowering therapies, and some may be more closely involved in initiation and monitoring. The Association of Cardiovascular Nursing and Allied Professionals (ACNAP) wanted to gauge the level of understanding, confidence and learning needs of cardiology professionals to better implement European Society of Cardiology (ESC) lipid lowering guidelines. Purpose The aim of the project was to highlight gaps in knowledge to better inform needs for training and educational programmes developed by ACNAP. Methods A 29 question electronic survey was developed by expert consensus, exploring previous experience, clinical knowledge, and perceptions of learning needs. It was launched at the EuroHeartCare conference in June 2023, on social media, and members of the ESC were emailed inviting participation. Results 123 people responded. 29.5% of the respondents were physicians and 70.5% NAPs. Most respondents were involved in lipid optimisation of some description with only 7.0% of respondents having no direct involvement in their patient cohort. A higher percentage of respondents responded "totally agree" when asked it they knew what cholesterol targets to aim for in secondary prevention, compared to primary prevention (61% v 41.5%). 94% of respondents felt comfortable when to initiate statins and and 82% ezetimibe. This reduced to 45% for inclisiran and 40% for bempedoic acid. Similarly, the majority felt comfortable counselling a patient newly initiated on statins or ezetimibe, but significantly fewer the newer lipid lowering therapies. Experience and understanding of familial hypercholesterolaemia (FH) was also explored. Only half the respondents would be comfortable in identifying and diagnosing FH and a further 25% unsure. A large percentage (37%) were unaware of the Simon Broome criteria or the Dutch Lipid Criteria Network (49%). When considering learning needs, 71% of NAP respondents needed extra support to help make lipid lowering decisions. This rises to 84% and 74% when looking at nurses and pharmacists separately, respectively. Nearly 76% would prefer any learning to be delivered online, with interactive online training packages being the most popular method. Conclusions The three main gaps identified by NAPs were: management in primary prevention (initiation and targets), the newer innovative medicines (bempedoic acid, inclisiran and PCSK9 monoclonal antibodies) and FH. Interestingly, these are the same gaps highlighted by physician responders. These findings can help guide ACNAP and ESC in the development of educational programmes with the aim to improve better lipid management overall.

Wasting coexisting with underweight and stunting among children aged 6‒59 months hospitalised in Garissa County Referral Hospital, Kenya.

Management of undernourished children depends only on wasting yet it can coexist with underweight and/or stunting. Among children admitted to hospital with acute illness, we determined the proportion with wasting coexisting with underweight and/or stunting and their risk factors. A retrospective review of hospital records of children 6‒59 months old admitted at Garissa County referral hospital, Kenya, from January 2017 to December 2019 was conducted. Using World Health Organization 2006 growth standards, undernutrition were defined: wasting as Weight-for-height Z-score < -2, stunting Height-for-age Z-score < -2 and underweight Weight-for-age Z-score < -2. We studied wasting coexisting with underweight and/or stunting. Among 624 children recruited, 347 (56%) were males and 511 (82%) <24 months old. Diarrhoea 210 (34%) and pallor/anaemia 310 (50%) were the most frequent admission diagnosis. HIV infection was present among 8 (1.3%) children. Wasting, underweight and stunting were present among 595 (95%), 518 (83%) and 176 (28%) children respectively. 161 (26%), 506 (81%) and 161 (26%) children had wasting coexisting with stunting, underweight and both stunting and underweight respectively. In the multivariable regression, diarrhoea was positively associated with wasting coexisting with stunting (adjusted risk ratio [aRR = 2.96] [95% CI = 2.06‒4.23]) and anaemia with wasting coexisting with underweight (aRR = 1.23) (95% CI = 1.03‒1.47). Overall, 343 (55%) children were discharged alive, 67 (11%) absconded from the wards, 164 (26%) were transferred to another hospital and 50 (8.0%) died before discharge. The risk of inpatient death was 10.3%, 7.9%, 8.4% and 6.8% among children not wasted, wasted only, wasted & underweight, and wasted and underweight and stunted respectively (Chi-square p = 0.60). The study reports an unacceptably high levels of undernourishment, including coexisting forms of undernutrition among hospitalised children. This highlights a public health priority for current nutrition therapeutic care and need of continuity of care among those children discharged alive in the community-based management of acute malnutrition programmes.

Highlights From the 2023 Revision of Pediatric Tactical Emergency Casualty Care Guidelines.

In 2023 the Committee for Tactical Emergency Casualty Care (C-TECC) issued updated Pediatric Tactical Emergency Casualty Care (TECC) Guidelines (Guidelines) that focus on the delivery of stabilizing care of children who are the victims of high-threat incidents such as an active shooter event. The Guidelines provide evidence-based and best practice recommendations to those individuals and departments that specifically provide operational medical support to law enforcement agencies caring for children in this uniquely dangerous environment where traditional resources may not be available. This article highlights key takeaway points from the Guidelines, including several updates since the first version was released in 2013.The evidence base for the care of children in this environment is lacking, and medical care delivered in the high-threat environment is inconsistent and often not optimized for the care of infants and children. The Guidelines are supported from the existing literature base where possible, and where it is not, by consensus as to the current best practices as determined by iterative deliberations among the diverse and experienced group of stakeholders who are members of C-TECC. The Guidelines provide patient assessment and management information specific to the care of children in the following 3 dynamic phases of the high-threat environment: Direct Threat, Indirect Threat, and Evacuation. The phases represent a continuum of risk to the patient and the responder ranging from extreme (such as ongoing gunfire) to minimal (during movement toward definitive medical care).The high-threat environment is dynamic and there is competing safety, tactical/operational, and patient care priorities for responders when infants and children are injured. The Guidelines provide recommendations on the type of medical and psychological care that should be considered under each phase of threat and establishes the context for how and why to deliver (or potentially defer) certain interventions under some circumstances in order the maximize the opportunity for a good outcome for an injured pediatric patient. The Guidelines also emphasize the importance of synergizing hospital-based pediatric trauma care with those law enforcement and fire/emergency medical services that may provide field care to children under high-threat circumstances.

Dental outpatient departments and patient safety: Priority for a safe care

Patient safety is an essential aspect of healthcare, including dentistry. Dental Outpatient Departments (OPDs) pose unique challenges, where the risk of infections, procedural errors, and patient discomfort can compromise safety. This review examines patient safety issues in dental OPDs, focusing on common hazards, preventive measures, and evolving strategies to ensure safer care. Infection control, medical emergencies, equipment sterilization, and patient data protection are key concerns. The complex interplay of patient management, dental procedures, and clinician awareness requires robust protocols to mitigate risks. Dental professionals must be vigilant in managing cross-contamination risks, such as through the use of personal protective equipment (PPE) and strict hand hygiene practices. Moreover, regular staff training in handling medical emergencies, such as allergic reactions or fainting, is crucial for effective management.This article also explores the role of technological advancements in enhancing patient safety, such as digital record-keeping, which minimizes documentation errors, and advanced diagnostic tools that reduce invasive procedures. Additionally, patient-centered approaches, including improved communication and informed consent practices, foster trust and reduce misunderstandings. The implementation of evidence-based guidelines and adherence to professional standards further contribute to a culture of safety. By synthesizing current research, this review aims to highlight best practices for improving patient safety in dental OPDs and underscores the importance of continuous monitoring and improvement in these settings. Addressing these safety concerns is critical not only to improve patient outcomes but also to ensure that dental OPDs remain a safe and trusted environment for all.

Healthcare professionals' perceptions on providing support to informal carers within stroke care.

The sudden nature of stroke onset does not provide carers with sufficient time to prepare for the demands associated with caring. Healthcare professionals can have a vital role in providing carers with support and training, which may reduce carer stress and strain, and allow for better health and rehabilitation outcomes for the stroke survivor. The experiences of healthcare professionals on supporting carers in stroke care, however, remain unclear. To understand the experiences and perceptions of healthcare professionals working in stroke care on implementing resources and support to informal stroke carers. Semi-structured interviews were conducted with 11 healthcare professionals (5 occupational therapists, 5 physiotherapists, 1 psychologist) with at least 12 months' experience in working with stroke survivors. Interviews ranged from 25-70 minutes in duration, and were recorded, transcribed, and analysed using thematic analysis. Three overarching categories that were explored were: (1) Experiences of working in stroke care and supporting carers; (2) Recommendations for a program designed for carers; and (3) Future priorities in stroke care. Participants discussed a variety of strategies they utilised to support carers including collaborating with other healthcare professionals and utilising skills and experience. Healthcare professionals highlighted the need for additional resources that are designed specifically for carers and explored key topics including carer stress and fatigue, support services, stroke education, and how to look after oneself. Participants identified priorities for stroke care including additional professional training and resource availability. This study provided a unique insight from the perspectives of healthcare professionals on supporting carers. Participants identified the need for additional training and resources to equip healthcare professionals to better support carers. Future programs designed for carers should be informed by the needs and experiences of both informal carers and healthcare professionals.

Priorities for multimorbidity management and research in cancer: a Delphi study of Australian cancer survivors, clinicians, and researchers.

Multimorbidity is common in people with cancer and associated with increased complexity of care, symptoms, mortality, and costs. This study aimed to identify priorities for care and research for cancer survivors with multimorbidity. A Delphi consensus process was conducted. Elements of care and research were based on Australia's National Strategic Framework for Chronic Conditions, a literature review, and expert input. In Round 1, health professionals, cancer survivors, and researchers rated the importance of 18 principles, 9 enablers, and 4 objectives. In Round 2, new elements were rated and all elements were ranked. In Round 1, all elements reached consensus for care delivery; three principles and one enabler did not reach consensus for research and were eliminated. One principle and two enablers were added, reaching consensus. In the final list, 19 principles, 10 enablers, and 4 objectives were included under care delivery; 14 principles, 9 enablers, and 4 objectives were included under research. For care delivery, principles of 'survivorship' and 'self-management' were ranked highest, and 'peer support' and 'technology' were the most important enablers. For research, 'survivorship' and 'coordinated care' were the highest-ranked principles, with 'peer support' and 'education' the most important enablers. Most elements apply to the general population and cancer survivors; however, additional elements relevant to survivorship need consideration when managing multimorbidity in cancer survivors. Chronic disease frameworks should be more inclusive of issues prioritised by people with, managing, or researching cancer through interdisciplinary approaches including acute and primary care.

Nicotine is an Immunosuppressant: Implications for Women's Health and Disease

A plethora of evidence supports that nicotine, the primary alkaloid in tobacco products that is generally accepted for maintaining use, is immunoregulatory and may function as an immunosuppressant. Women have unique experiences with use of nicotine-containing products and also undergo significant reproductive transitions throughout their lifespan which may be impacted by nicotine use. Within the extant literature, there is conflicting evidence that nicotine may confer beneficial health effects in specific disease states (e.g., in ulcerative colitis). Use prevalence of nicotine-containing products is exceptionally high in individuals presenting with some comorbid disease states that impact immune system health and can be a risk factor for the development of diseases which disproportionately impact women; however, the mechanisms underlying these relationships are largely unclear. Further, little is known regarding the impacts of nicotine's immunosuppressive effects on women's health during the menopausal transition, which is arguably an inflammatory event characterized by a pro-inflammatory peri-menopause period. Given that post-menopausal women are at a higher risk than men for the development of neurodegenerative diseases such as Alzheimer's disease and are also more vulnerable to negative health effects associated with diseases such as HIV-1 infection, it is important to understand how use of nicotine-containing products may impact the immune milieu in women. In this review, we define instances in which nicotine use confers immunosuppressive, anti-inflammatory, or pro-inflammatory effects in the context of comorbid disease states, and focus on how nicotine impacts neuroimmune signaling to maintain use. We posit that regardless of potential health benefits, nicotine use cessation should be a priority in the clinical care of women. The synthesis of this review demonstrates the importance of systematically defining the relationships between volitional nicotine use, immune system function, and comorbid disease states in women to better understand how nicotine impacts women's health and disease.

Orofacial Pain.

This article explores the multiple etiologies, diagnosis, and management of orofacial pain. Published in 2019, the International Classification of Orofacial Pain has become the internationally accepted classification system for primary and secondary facial pain. New discoveries in temporomandibular disorders have demonstrated that they are far more complex than the traditional dental mechanistic point of view. A 2020 consensus report released by the National Academies of Sciences, Engineering, and Medicine entitled "Temporomandibular Disorders: Priorities for Research and Care" highlighted this paradigm shift and its importance for patient care, education, and research. Orofacial pain comprises many disorders with different etiologies and pathophysiologies. The subjectivity of the pain experience and the interrelated anatomy and physiology of the craniofacial area add to the complexity of diagnosis when the source and etiology of pain are not clear. As orofacial pain straddles the expertise of multiple disciplines, a multidisciplinary approach combining medication, physical therapy, and procedural and psychological strategies is essential in treating patients with orofacial pain.

Strategies for older people living in care homes to prevent urinary tract infection: the StOP UTI realist synthesis.

Urinary tract infection is the most diagnosed infection in older people. It accounts for more than 50% of antibiotic prescriptions in care homes and is a frequent reason for care home residents being hospitalised. This realist review developed and refined programme theories for preventing and recognising urinary tract infection, exploring what works, for whom and in what circumstances. The review used realist synthesis to explore existing literature on the detection and prevention of urinary tract infection, complemented by stakeholder consultation. It applies to the UK context, although other healthcare systems may identify synergies in our findings. Bibliographic databases searched included MEDLINE, CINAHL, EMBASE, Cochrane Library, Web of Science Core Collection (including the Social Sciences Citation Index), Sociological Abstracts, Bibliomap and National Institute for Health and Care Research Journals Library. Title and abstract screening were undertaken by two researchers independently of each other. Selection and assessment were based on relevance and rigour and cross-checked by a second researcher. Data extracted from the included studies were explored for explanations about how the interventions were considered to work (or not). Evidence tables were constructed to enable identification of patterns across studies that offered insight about the features of successful interventions. Programme theories were constructed through a four-stage process involving scoping workshops, examination of relevant extant theory, analysis and synthesis of primary research, teacher-learner interviews and a cross-system stakeholder event. A process of abductive and retroductive reasoning was used to construct context-mechanism-outcome configurations to inform programme theory. The scoping review and stakeholder engagement identified three theory areas that address the prevention and recognition of urinary tract infection and show what is needed to implement best practice. Nine context-mechanism-outcome configurations provided an explanation of how interventions to prevent and recognise urinary tract infection might work in care homes. These were (1) recognition of urinary tract infection is informed by skills in clinical reasoning, (2) decision-support tools enable a whole care team approach to communication, (3) active monitoring is recognised as a legitimate care routine, (4) hydration is recognised as a care priority for all residents, (5) systems are in place to drive action that helps residents to drink more, (6) good infection prevention practice is applied to indwelling urinary catheters, (7) proactive strategies are in place to prevent recurrent urinary tract infection, (8) care home leadership and culture fosters safe fundamental care and (9) developing knowledgeable care teams. We adapted our approach and work to online interactions with stakeholders and as a research team because of COVID-19. This also had an impact on bringing stakeholders together at a face-to-face event at the end of the project. Studies focusing on the prevention of urinary tract infection in care home settings were predominantly from the USA and Europe where the regulatory and funding systems for the long-term care of the elderly have some differences, particularly in the USA where national reporting plays a significant role in driving improvements in care. Care home staff have a vital role in the prevention and recognition of urinary tract infection, which can be enabled through integration and prioritisation within the systems and routines of care homes and delivery of person-centred care. Promoting fundamental care as a means of facilitating a holistic approach to prevention and recognition of urinary tract infection helps staff to recognise how they can contribute to antimicrobial stewardship and recognition of sepsis. Challenging assumptions made by staff about the presentation of urinary tract infection is complex and requires education that facilitates 'unlearning' and questioning of low-value practices. Programmes to prevent urinary tract infection need to be co-designed and supported through active and visible leadership by care home managers with support from specialist practitioners. We will focus on co-designing tools that facilitate implementation of our findings to ensure they fit with the care home context and address some of the challenges faced by care home leaders. This will underpin action at care home and system levels. Further research is needed to better understand the perspectives of residents and family carers, the effectiveness of non-pharmacological, pharmacological and specialist practitioner interventions and non-traditional approaches to training and educating the workforce in care home settings. This study is registered as PROSPERO CRD42020201782. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR130396) and is published in full in Health Technology Assessment; Vol. 28, No. 68. See the NIHR Funding and Awards website for further award information.

A STUDY ON THE DIFFERENT CLINICAL PRESENTATION PATTERNS OF BLUNT THORACIC TRAUMA AND ASSOCIATED MORBIDITY FOLLOWING ROAD TRAFFIC ACCIDENT IN A TERTIARY CARE CENTRE

Introduction:Chest trauma is a significant cause of morbidity and mortality following road traffic accidents (RTA). Given the significant potential for complications including respiratory failure and shock, blunt chest trauma following RTA remains a priority in trauma care and so this study aims to look into the clinical pattern of presentation of patients following chest trauma with/without associated injuries to other parts of body i.e. head/abdomen/extremities along with morbidity and mortality associated with it. Aims and objectives of the study : 1. To study the various clinical patterns of presentation of RTA patients with blunt chest trauma. 2. To study the disease burden and death rate of individuals with blunt chest trauma. Methodology: The study has been conducted in the Department of General Surgery, Silchar Medical College and Hospital from March 2024 to August 2024 after taking appropriate consent from 53 patients diagnosed with chest trauma following RTA with/without associated extra- thoracic injuries. Their data was analyzed and results published. Result and Analysis: Mean age in my study was 38.90 ± 6.57 years with male preponderance. Most patients had 3 rib fractures with pulmonary contusion being most common complication. Most common associated extra-thoracic trauma is abdominal injuries (24.5%) with mean ISS of 13.25 ± 7.73. most patients were managed conservatively with adequate pain control. Surgical intervention carried out were either tube thoracostomy (92.3%) or needle thoracostomy (7.2%). Most common secondary complication following blunt chest trauma is pneumonia (18.84%) while ARDS complication arose in 9.43% of the patients. Mortality rate was 5.6% and the most common cause that let to the demise was ARDS. Conclusion: To conclude, blunt thoracic injury is a major health problem as it carries significant mortality and morbidity more so, in case of RTA and association of other extra-thoracic injuries also play a pivotal role in the process of recovery of the patient. Presence of lung contusion, pneumothorax, hemothorax are to be dealt adequately with proper analgesia. Even though most cases of chest trauma can be dealt conservatively need for emergency surgical intervention needs to be assessed promptly. One must look for number of rib fractures as they may reflect the disease burden of the patient. Pneumonia and ARDS are a major mortality factor following chest trauma and its complications.

FERTILITY CARE IN LOW AND MIDDLE INCOME COUNTRIES: Implementing fertility care: insights from a participatory workshop in The Gambia.

The Gambia, West Africa, has made recent progress on infertility, a component of sexual and reproductive health that is lagging behind others. Since 2016, there is favourable policy environment stemming from infertility research and partnership building with national stakeholders and local civil society organisations focussing on infertility. Here, we report outcomes from a participatory workshop on infertility policy implementation in The Gambia and provide insights on setting national priorities for fertility care in resource-limited settings. We conducted a participatory workshop involving 29 participants from Gambia's public and private health sectors. Using selected participatory group work tools, stakeholders identified and prioritised key activities within the framework of five pre-defined areas of action, including (i) creating guidelines/regulations; (ii) recording/reporting data; (iii) building public-private partnerships; (iv) training health providers; and (v) raising awareness and health-seeking. A total of 17 prioritised activities were proposed across the five action areas, according to short-, medium-, and long-term timeframes. Three were further prioritised from the overall pool, through group consensus. A group model building activity helped to envision the complexity by elucidating links, loops, and connections between each activity and their expected outcomes. The participatory workshop identified actionable interventions for fertility care in The Gambia, with stakeholders setting a clear path ahead. Despite challenges, the continued engagement of Gambian policymakers, practitioners, researchers, and activists in efforts to move beyond policy creation to its implementation is essential. Improving fertility care in The Gambia and other low- and middle-income countries is feasible with effective collaboration and financial support. In The Gambia, a partnership of stakeholders from various domains, including research, grassroots activism, clinicians, and policymakers, contributed to an increased awareness of infertility. This, in turn, led to the inclusion of infertility in the national reproductive health strategic plan. An in-country participatory workshop involving participants from both public and private health sectors was held in October 2023 with the objective of identifying priorities for moving beyond planning to implementation, within the context of resource constraints. The top three identified priorities were: (i) training about infertility for health providers; (ii) harmonisation of data collection; and (iii) the development of clinical guidelines for infertility management. It is important for the Gambian Ministry of Health to implement these proposed locally relevant fertility care activities. Despite current and future challenges, having a clear vision and pathway will help establish fertility care in the country, with Gambia potentially leading the way among many other countries.

The effectiveness of a knowledge translation intervention on the implementation of NEWS2 in nursing homes, a pragmatic cluster RCT

BackgroundImproving the uptake of relevant and reliable research is an important priority in long-term care to achieve sustainable and high-quality services for the increasingly older population.AimThe purpose was to assess the effectiveness of a tailored, adaptive and a multifaceted KT capacity program, relative to usual practice, on the implementation of National Early Warning Score 2 (NEWS2).MethodsThis study was carried out as a pragmatic cluster-randomized controlled trial. The capacity program consisted of an educational part to address implementation capacity gaps and a facilitation-upon-implementation part to address a relevant knowledge gap in nursing homes. A collective decision was made to address the challenge of early detection of clinical deterioration among nursing home residents, by implementing the (NEWS2) as clinical innovation.Public nursing homes in a Norwegian municipality (n = 21) with a total of 1 466 beds were eligible for inclusion. The study-period spanned over a 22-month period, including a 12-month follow-up.Data was extracted from the Electronic Patient Journal system and analyzed using multilevel growth model analysis.ResultsThe intervention had a large effect on the use of NEWS2 among care staff in intervention nursing homes, compared to the control group (standardized mean difference, d = 2.42). During the final month of the implementation period, residents in the intervention group was assessed with NEWS2 1.44 times (95% CI: 1.23, 1.64) per month, which is almost four times more often than in the control group (mean = 0.38, 95% CI: 0.19, 0.57). During the follow-up period, the effect of the intervention was not only sustained in the intervention group but there was a substantial increase in the use of NEWS2 in both the intervention (mean = 1.75, 95% CI: 1.55, 1.96) and control groups (mean = 1.45, 95% CI: 1.27, 1.65).ConclusionsThis tailored implementation strategy had a large effect on the use of NEWS2 among care staff, demonstrating that integrated knowledge translation strategies can be a promising strategy to achieve evidence-based care in the nursing home sector.Trial registrationISRCTN12437773. Registered 19/3 2020, retrospectively.

Equity considerations for the implementation of health insurance benefit package in Ethiopia: result of expert Delphi exercise

BackgroundEfficiency, equity and financial risk protection are key health systems objectives. Equitable distribution of health care is among the priority strategic initiative of the government of Ethiopia. However, data on the distribution of interventions benefits or on disease burden disaggregated by subpopulations to guide health care priority setting is not available in Ethiopia.MethodsAligned with policy documents, we identified the following groups to be the worse off in the Ethiopian context: under-five children, women of reproductive age, the poor, and rural residents. We used the Delphi technique by a panel of 28 experts to assign a score for 253 diseases/conditions over a period of two days, in phases. The expert panel represented different institutes and professional mix. Experts assigned a score 1 to 4; where 4 indicates disease/condition predominantly affecting the poor and rural residents and 1 indicates a condition more prevalent among the wealthy and urban residents. Subsequently, the average equity score was computed for each disease/condition.ResultsThe average scores ranged from 1.11 (for vitiligo) to 3.79 (for obstetric fistula). We standardized the scores to be bounded between 1 and 2; 1 the lowest equity score and 2 the highest equity score. The scores for each disease/condition were then assigned to their corresponding interventions. We used these equity scores to adjust the CEA values for each of the interventions. To adjust the CEA values for equity, we multiplied the health benefits (the denominator of the cost-effectiveness value) of each intervention by the corresponding equity scores, resulting in equity adjusted CEA values. The equity adjusted CEA was then used to rank the interventions using a league table.ConclusionsThe Delphi method can be useful in generating equity scores for prioritizing health interventions where disaggregated data on the distribution of diseases or access to interventions by subpopulation groups are not available.

ThP7.5 - District General Hospital Management of Chest Trauma in Frail Adults: A Need for National Guidelines for Frailty in General Surgery

Abstract Annually, 16,000 adults face chest trauma, with blunt injuries in the elderly leading to high mortality rates. In TARN Chest trauma ranks as the second deadliest trauma in older adults, following head injuries. There's significant inconsistency, nationally, in the General Surgical management of these patients. Aims This study evaluates outcomes at a DGH to establish a basis for national guidelines Methods Single centre retrospective review of patients over the age of 65 presenting with chest trauma from Jan 2022 to Jan 2023. Results 114 Patients were included. Median age was 81 with a male predominance of 57.9%. Mortality was 17/109 (15.6%). Mechanisms of injury were fall from standing height (71.9%), fall from height &amp;gt;2m (18.8%) and RTA 9.3%. Median Rib fractures sustained were 4 (range 0 - &amp;gt;10). 51.8% of the patients had an associated pleural injury, 14 patients required a drain. 70 (61.4%) had isolated chest injuries, 29 (25.4%) had one other injured body region and 15 (13.2%) had three or more injured body regions. Median STUMBL score was 25 (9 – 52), 42.6% had a score of ≥ 27. 16.4% of patients were vulnerable and 51% were frail. Median Charlson co-morbidity index was 5 (range 2-11). 39% of patients had timely Geriatric review during admission and 14% were not referred. Conclusion DGH General Surgery teams admit high volumes of frail patients with chest trauma. Nationally there is an absence of general surgery chest trauma guidance (BOASTs now archived). These patients are complex requiring early support from Geriatricians to guide the goals of care. Careful consideration should be given to referral pathways, MDT and priorities of care.

Anxiety and Depression in Youth With Chronic Pain

For youth with chronic pain, anxiety and depression are reported as consequences of experiencing pain and maintaining factors of ongoing pain and disability. However, prevalence estimates of anxiety and depression remain unclear. To report the prevalence of clinical anxiety and depression for youth with chronic pain and compare symptoms of anxiety and depression between youth with and without chronic pain. MEDLINE, PsycINFO, CENTRAL, and Embase from inception to April 30, 2023. Included studies that reported prevalence data or symptom scores for anxiety and/or depression in individuals younger than 25 years (mean, ≤18 years) with chronic pain and were published in English. From 9648 nonduplicate records, 801 full-text articles were screened. Screening and data extraction occurred in duplicate. Prevalence was determined using event rate calculations. Between-group symptom differences were calculated using Hedges g. Analyses were conducted using the random-effects model. Reporting bias and Grading of Recommendation, Assessment, Development, and Evaluation assessments were conducted. Prevalence of anxiety and depression (based on diagnosis and clinical cutoff scores) and differences in anxiety and depression symptoms. Moderators of prevalence and symptom differences were analyzed when data allowed. A total of 79 studies were included with a total sample of 22 956 youth (n = 12 614 with chronic pain). Most youth were female (mean, 74%), with an age range of 4 to 24 (mean [SD], 13.7 [2.10]) years. The prevalence estimate of anxiety diagnoses was 34.6% (95% CI, 24.0%-47.0%) and the portion that exceeded clinical cutoff scores was 23.9% (95% CI, 18.3%-30.6%). The prevalence of depression diagnoses was 12.2% (95% CI, 7.8%-18.7%) and the portion that exceeded clinical cutoff scores was 23.5% (95% CI, 18.7%-29.2%). Youth with chronic pain had greater symptoms of anxiety (g = 0.61; 95% CI, 0.46-0.77) and depression (g = 0.74; 95% CI, 0.63-0.85) compared with controls. Sex, age, pain location, and recruitment sample may moderate anxiety and depression. Considerable heterogeneity was reported for all outcomes. Studies had a low reporting bias, and outcomes were moderate to high quality. The findings of this meta-analysis suggest that 1 in 3 youth with chronic pain meet criteria for anxiety disorder, and 1 in 8 meet criteria for a depressive disorder. This represents a major clinical comorbidity. Moving forward, screening, prevention, and treatment of mental health should be important health care priorities for youth with chronic pain.

Administration of Nitrous Oxide by Medical Assistants for Painful Procedures in Outpatient Pediatric Settings.

Managing pain and distress in children experiencing procedural pain is a priority in pediatric care. Nitrous oxide (pre-mixed formulation of 50% nitrous oxide to 50% oxygen) is widely used to alleviate anxiety or pain during care procedures in various medical domains. This pharmacological intervention is safe to administer to children. Administration by non-anesthesiologist personnel is widespread throughout the world, though it is almost exclusively performed by doctors and nurses. The purpose of this study is to describe the experience of nitrous oxide (N2O) use by medical assistants and safe handling during the performance of painful procedures. A retrospective study was conducted in a pediatric outpatient unit of a regional hospital, including medical and surgical consultations. Nitrous oxide was administered by medical assistants to 324 children aged 3 to 19 years. No respiratory and/or cardiovascular problems were noted. Most patients were calm and relaxed. The use of N2O for minor procedures in children in a pediatric outpatient unit improved pain management through administration by medical assistants with a high level of satisfaction from patients, parents and health professionals. This study suggests that the use of nitrous oxide by trained medical assistants can be safe, feasible and effective within the specific context of this study.

Understanding health-related quality of life after hypospadias repair: A qualitative study with pre-adolescent males and parents

Hypospadias is a common disease that affects approximately 1 in every 200 live male births in the United States, and long-term studies of individuals who have undergone repair demonstrate complication rates of 15%-70%. The Hypospadias-Specific Health-related Quality of Life (HRQOL) Conceptual Framework for youth and adults suggests that additional morbidity may be incurred from poor psychological, social, and sexual health. The current study sought to clarify hypospadias-specific HRQOL and care priorities in a pre-pubertal population. This IRB-approved, semi-structured interview study used rigorous qualitative research methods. Eligible patients were English-speaking 8-12-year-old males with hypospadias and their parents. Families completed a demographic questionnaire and separate youth and parent 30-min telephone interviews. We used hybrid thematic analysis to develop an operational codebook, analyze participant responses, and generate conceptual themes. Mixed methods analysis was used to explore patterns of experiences across groups defined by socioeconomic level. We interviewed 10 parents and 8 children (Median age 9 years, Range 8-11). We generated three overarching themes: Penile Factors, Psychosocial Concerns, and Expectations of Surgery and the Healthcare Team. These highest-order themes were generated for youth, parent-proxy, and parent self-reported experiences, and there were different sub-themes for each participant type (Figure). Youth were focused on avoidance of disclosure and the psychological impact of self-comparisons and embarrassment, while the parental perspective centered on worries about future fertility, complications, psychological health, and normality. Some youth and parents from disadvantaged neighborhoods or those with public insurance indicated a need for more education on normal penile functions and provision of strategies for long-term self-monitoring and facilitation of long-term follow-up on mixed methods analysis. These findings add insight into the multifaceted experiences of pre-pubertal youth and families dealing with hypospadias, and underscore the consistent, wide-ranging interplay between medical, psychological, and social concerns. Patterns in themes across socioeconomic status and insurance coverage suggest that access to information and quality care may vary significantly and could contribute to health disparities. Urologists should employ an individualized approach to counseling and care delivery. Future studies will seek to characterize care priorities in pubertal and post-pubertal age groups to design developmentally adjusted support tools for youth and adults with hypospadias and their families.

Cancer-related cognitive impairment: updates to treatment, the need for more evidence, and impact on quality of life-a narrative review.

Due to advances in early detection and treatment options, non-central nervous system (non-CNS) cancer survivors are living longer, even those with metastatic disease. Many of these survivors will experience enduring symptoms of breast cancer, such as cancer-related cognitive impairment (CRCI). Although CRCI is bothersome and, in some cases, potentially debilitating, little research has been done to address this symptom. Thus, the overarching goal of this narrative review is to provide both an overview of the problem of CRCI and its impact and focus on the latest research aimed at addressing CRCI in non-CNS cancer survivors. A MEDLINE database (PubMed) search was conducted for terms related to non-CNS cancer, cognition, impacts of CRCI, and interventions. The English-language articles published until April 8th, 2024, were included in the search. CRCI includes self-reported cognitive complaints and/or impaired performance in multiple cognitive domains, including memory, processing speed, attention, and executive function. CRCI, in turn, can have a significant impact on everyday functioning, work ability, work engagement and productivity, and overall quality of life (QoL) of cancer survivors. While some researchers have examined pharmacological approaches, the vast majority of the interventional studies to date to address CRCI has focused on non-pharmacological approaches. Three of the most common non-pharmacological approaches are physical activity or exercise, mind-body approaches [e.g., mindfulness-based stress reduction (MBSR)], and cognitive rehabilitative approaches [e.g., cognitive training (CT) and cognitive behavioral therapy (CBT)]. Addressing the cognitive health of cancer survivors is imperative but has only recently been the focus of interventional research. More research in larger and more diverse samples of non-CNS cancer survivors is needed to identify effective ways to manage CRCI for all cancer survivors. Overall, maintaining cognitive health, especially in cancer survivors who are at increased risk for deficits, is a national health care priority that should not be ignored.