Reasons For Refusal Research Articles

P-620. High Risk, Low Compliance: Surprising Post-Pandemic Influenza Vaccine Trends in a Children's Hospital

Abstract Background Post-pandemic, the CDC reports a decline in influenza vaccinations in children 6 months to 17 years by 6.3% from 2019-2020 to 2022-2023. We describe concerning widespread declines in our institution in inpatient influenza vaccinations, outpatient oncology influenza vaccine rates in those receiving active chemotherapy, and employee vaccinations. We present these trends in the context of local influenza epidemiology, influenza admissions, and reasons for refusal. Methods Our institution, a free-standing children’s hospital, collected inpatient influenza vaccinations based on calendar years 2019-2023 and influenza admission rates over winter seasons 2018-2019 to 2022-2023. Additionally, employee vaccination rates, including reasons for refusal, were collected fall/winter 2018-2019 to 2023-2024. Lastly, oncology clinic influenza vaccination rates among the high-risk patients receiving active chemotherapy were collected from Sept-Dec 31 2020-2023. Results Although influenza admissions plummeted from 302 in winter 2019-2020 to 0 in winter 2020-2021, these admissions have since rebounded (Fig. 1). While inpatient influenza immunizations have continued to decline to a low of 0.0029 vaccines/patient day, they are now outpaced by influenza admissions at 0.0037 admissions/patient day (Fig. 2). This trend in decreased vaccines is echoed in oncologic patients on active chemotherapy, with non-medical refusals increasing from 5% in 2020 to 16% in 2023, and in employees, with refusals increasing from 1.9% in 2019 to 5.3% in 2024 (Fig. 3). Although employee rates for medical exemption are consistent, non-medical reasons for refusals have increased 6-fold from 2019 to 2024 (Fig. 4). Conclusion We saw a decline in influenza vaccine rates for hospitalized patients, immunocompromised outpatient oncology patients on active chemotherapy, and employees, despite increased influenza burden in the community post-pandemic. The latter were almost exclusively due to non-medical reasons for refusal. Further study needs to be done to elucidate post-pandemic vaccine trends and identify missed opportunities for immunization, particularly in high-risk patients and their contacts, with emphasis on bolstering influenza vaccine confidence in not only patients, but staff. Disclosures All Authors: No reported disclosures

Lessons Learned in Virtual Launch of an Antenatal Opioid Exposure Study During the COVID-19 Pandemic.

The COVID-19 pandemic prompted researchers to develop new ways to design and launch studies and recruit and retain participants. Pregnant women and infants are considered vulnerable populations in research, and families affected by substance use are particularly difficult to recruit and retain. Recruitment for studies involving medical technologies such as MRI can also be difficult due to misconceptions and fear of the technologies. To describe "lessons learned" during the launch of the Outcomes of Babies with Opioid Exposure (OBOE) study, including successes and challenges when working with high-risk infants and families and the importance of engaging participants through recruitment materials and retention efforts. The OBOE study is a multisite prospective longitudinal cohort study comparing infants with antenatal opioid exposure to unexposed controls from birth to 2 years of age. Chi-square tests were used to examine refusal reasons among caregivers of eligible infants by exposure group and differences in 6-month retention among subgroups based on social determinants of health. Four factors were essential in establishing the Consortium, implementing the study, and retaining participants: (a) creating venues for collaboration, (b) pivoting from in-person to virtual training, (c) anticipating potential enrollment barriers and addressing them directly, and (d) engaging participants through recruitment materials and retention efforts. With these factors in place, only 5% of caregivers of eligible opioid-exposed infants and 8% of control infants declined to participate in the study because of MRIs. Of 310 enrolled infants, 234 infants had attended the 6-month visit. Subgroups of enrolled infants were similar in retention at 6 months. Reporting our successes and challenges in setting up a nationwide consortium during the pandemic may help other consortia that need to be set up virtually. We anticipated that the serial MRIs would be a barrier to participation; however, few indicated they refused to participate because of MRIs, suggesting our efforts to address this potential barrier to enrollment were successful.

Allergen immunotherapy in Italy: How, when, and why-A real-world study conducted through a patient association.

Allergen immunotherapy (AIT) is the only treatment that modifies the natural course of allergies. However, AIT is only used in some eligible patients, is frequently underused, and only a few studies investigated this aspects. Understanding AIT utilization patterns might disclose information about why it is underused, thus providing valuable insights on how to broaden the positive impact it can have on the population. A questionnaire aiming to assess the trends of the use of AIT in Italy, patient health literacy on AIT, and the impact of respiratory allergies and AIT on patients' lives was submitted to patients affiliated with Respiriamo Insieme APS patient's association during the period between May and October 2023. Nine hundred forty-four patients completed the questionnaire. Most patients reported to be affected by allergic rhinitis (81.1%), allergic asthma (45.4%), and/or allergic conjunctivitis (41.2%), and many of them presenting a combination of these diseases. Only 53.8% knew about AIT's existence, and AIT was proposed to only 33.1% of the 858 patients affected by allergic rhinitis and/or allergic asthma, of which 29.2% decided not to initiate the therapy. Common reasons for AIT refusal were related to indecisiveness (26.5%), costs (22.9%), and skepticism (19.3%). Among the remaining 70.8% who accepted to start AIT, 21.4% discontinued the treatment beforehand, on average 18.26 months from initiation. There was a high heterogeneity in the suggested duration of AIT, with 20.4% of patients receiving indications to continue AIT for less than 3 years. AIT positively impacted patients' lives as most patients who completed AIT found it effective and safe, and experienced a significant reduction in the workdays/schooldays lost due to disease exacerbations. The outcomes of this research pointed out a lot of misinformation surrounding AIT, calling for improvements in awareness and information on its efficacy and safety. Also, we noted a significant reduction in work/school days lost in patients who completed AIT and a good patient-reported safety and efficacy profile. We advocate for better economic accessibility through national-level standardization in treatment refundability. Notably, the collaboration with the patient association was crucial, and it would have been challenging to conduct this research otherwise.

Why women refuse Postpartum IUCD?

ABSTRACT Background: Women are highly motivated and receptive to accepting family planning methods during the antenatal period. Hence, we conducted this study to evaluate the refusal rate and reasons for the refusal of postpartum Intrauterine Contraceptive Devices (PPIUCD). Material and Methods: The present cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, at a tertiary Care Centre, on 400 antenatal women from November 2023 for 2 months. Results: In present study, 331 (82.8%) subjects were knowing condom as contraceptive, followed by 310 (77.5%) subjects knowing about copper T. 282 (70.5%) subjects were knowing tubectomy, 264 (68.5%) were knowing oral contraceptives, 264 (66%) were knowing vasectomy, 205 (51.2%) were knowing natural methods, 179 (44.8%) were knowing injectable contraceptive, 83 (20.8%) were knowing Saheli, and 27 (6.8%) subjects were not knowing any contraceptive method. In total, 185 (46.5%) subjects knew that Copper T could be inserted immediately after delivery followed by 83 (20.9%) who knew that copper T could be inserted after menses. Sixty-nine (17.3%) knew that copper T could be inserted during a cesarean section. A total of 352 (88%) subjects refused postpartum copper T as a method of contraception. Only 48 (12%) subjects were willing to insert postpartum copper T. After counseling, the rate of acceptance of copper T insertion increased from 48 (12%) to 102 (25.5%). Conclusion: Knowledge of PPIUCD in the present study was good, but the refusal rate was high. The commonest reason was fear of side effects.

Public awareness and knowledge about colorectal cancer screening in Saudi Arabia

Background: Colorectal cancer (CRC) is a significant global health concern, ranking second among women and third among men in cancer diagnoses worldwide. In Saudi Arabia, CRC has been the most prevalent cancer in men since 2002. Despite rising incidence rates, public awareness and understanding of CRC screening remain critical for early detection and effective intervention. This study assesses public awareness and knowledge regarding CRC screening in Saudi Arabia. Methods: A cross-sectional, questionnaire-based study was conducted using Google forms to gather data from Saudi Arabia's overall population from 5th December 2023 to 20th December 2023. The online questionnaire included demographic information and assessed participants' knowledge, awareness, and attitudes toward CRC screening. Data analysis was performed using SPSS version 26. Results: Of the 461 participants, 61.4% were female, 38.6% were male, and 53.1% were 50 or older. Only 13.1% of participants aged 50 and above had undergone CRC screening. A significant proportion (55.1%) in other age groups remained undecided about future screening. Lack of awareness (51.9%) was the primary reason for refusal or hesitation. Participants exhibited limited awareness of CRC's global prevalence (50.3%) and the recommended screening age (36.4%). Significant associations were found between awareness levels, gender, education, and age groups. Conclusions: The study highlights a substantial need for more awareness and knowledge about CRC screening in Saudi Arabia, particularly among specific demographic groups. Targeted awareness campaigns are crucial, focusing on increasing knowledge about risk factors, symptoms, and the importance of early screening.

HTA11 Early Access Programs (EAPs) in France: Reasons for Refusal

HTA11 Early Access Programs (EAPs) in France: Reasons for Refusal

Why do healthcare workers refuse tuberculosis preventive treatment (TPT)? a qualitative study from Puducherry, South India

BackgroundThe sustainable development goal (SDG) 3.3.2 prompted India to devise the National Strategic Plan 2017–2025, targeting tuberculosis (TB) eradication by 2030. The prevention pillar of this plan emphasises on Tuberculosis...

Reasons for Declining Participation in Inpatient Research Among Historically Minoritized Racial and Ethnic Communities: A Scoping Review

BackgroundTo promote equitable recruitment for studies conducted in the inpatient hospital setting, we sought to characterize reasons why individuals, both from historically minoritized racial and ethnic groups and the broader patient population, refuse participation in clinical trials within inpatient settings. MethodsAn exhaustive search of the literature was conducted in Cochrane Library, Google Scholar, Embase, MEDLINE, PubMed, Scopus, and Web of Science databases to find relevant articles published from the inception of each database to April 30, 2023. Studies recruiting patients during their inpatient stay and reporting reasons for refusing participation in clinical trials met the inclusion criteria. ResultsThe search resulted in 2264 citations, of which 22 were included. 14 did not report data related to race, while 19 reported no ethnicity data. Reasons for refusal across trials included study burden and inconvenience (n=16), transportation and logistical issues (n=13), lack of interest in research (n=12), and refusal to be randomized (n=10). Prominent concepts included the importance of incorporating social support systems in consenting processes, lack of efforts to include data or recruitment efforts for individuals from minoritized groups, and physician involvement in recruitment. DiscussionTo enhance participation among historically minoritized communities in clinical trials, greater efforts must be made to collect demographic information and document refusal reasons to inform future recruitment methods. Strategies include proactively accounting for culture and language differences in study design and recruitment and intentionally engaging social support networks. Limiting study burden and logistics and optimizing collaborations between clinical and research teams would promote accessibility and foster patient trust.

Establishing a Collaborative Genomic Repository for Adult Burn Survivors: A Burn Model System Feasibility Study.

In this study, we aimed to integrate a genetic repository with an existing longitudinal national burn database. We set out two primary objectives, namely (1) to develop standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing multicenter database; and (2) to demonstrate the feasibility of correlating genetic variation to functional outcomes in a pilot study, using the catechol-O-methyltransferase (COMT) gene. Dubbed the worrier/warrior gene, COMT variants have been associated with varying phenotypes of post-traumatic stress, wellbeing, and resilience. Between August 2018 and July 2020, COMT variants were identified for 111 participants from three sites and correlated with their outcome data. We found no association between COMT variants and functional outcomes, likely due to the inadequate sample size. We also asked all potential participants why they consented to or refused genetic analysis. A thematic analysis of responses revealed altruism and personal interest/enthusiasm in the study as top reasons for consenting. Privacy concerns were the most common reason for refusal. In conclusion, we successfully developed standard operating procedures for genetic sample collection and storage, DNA isolation, and data integration into an existing database, and we demonstrated the feasibility of conducting a multicenter collaborative study using a centralized lab location.

Percutaneous Coronary Intervention in High-Risk Patients

Ischemic heart disease (IHD) with severe coronary artery disease (SYNTAX score >22 points) in combination with various comorbidities is often a reason for refusal of coronary artery bypass grafting in such patients. Thus, a new term has emerged, "high-risk percutaneous coronary intervention"; however, the criteria, indications and results of these interventions have not yet been sufficiently studied. Therefore, according to current clinical guidelines, the treatment tactics for this patient cohort is determined by the decision of a council, the so-called Heart Team. This analytical review summarizes the criteria for high-risk percutaneous coronary interventions based on the literature, and describes the effect of various comorbidities on the results of direct myocardial revascularization.

The Clinical Frailty Scale to assess patients referred for intensive care therapy.

Decisions to admit patients to intensive care units are often complex, and assessing patients is essential but difficult. In recent years, the Clinical Frailty Scale has been highlighted as a potential assessment tool for triaging patients for admission to the intensive care unit. This study aimed to investigate the clinical differences and Clinical Frailty Scale scores between patients who are refused and those who are admitted to the intensive care unit. All patients assessed for intensive care therapy at a Danish hospital from December 2020 to December 2021 were prospectively registered. The patients' descriptive data, Clinical Frailty Scale scores, three-month mortality rates and reasons for refusal were retrospectively extracted from hospital records. During the study period, 571 patients were admitted to the intensive care unit, whereas 106 were refused admission. Patients who were refused had a significantly higher median age, a higher (poorer) Clinical Frailty Scale score and a significantly higher three-month mortality rate than patients who were admitted to the intensive care unit. The results indicate that the Clinical Frailty Scale may be one of several useful tools when assessing patients for intensive care therapy. However, this assessment is a multifactorial task, and further research needs to be conducted to examine the usefulness of this scale. Lillebaelt Hospital, University Hospital of Southern Denmark and the University of Southern Denmark supported this study. Not relevant.

"They Have to Make an Effort Too": What Decliners Can Teach Us About HIV Cure/Remission-Related Clinical Trials? Results from a French Qualitative Study.

Only one study to date has focused on people living with HIV (PLWH) who refused to participate in a HIV cure/remission-related clinical trial (HCCT)-"decliners" hereafter-that included analytical treatment interruption (ATI). Exploring why these persons refuse may provide valuable information to ensure more ethical recruitment and support in HCCTs within the bigger picture of improving HIV cure research. The qualitative component of the AMEP-EHVA-T02/ANRS-95052 study, called AMEP-Decliners, documented the experiences of French PLWH who refused to participate in EHVA-T02/ANRS-VRI07, a phase II randomized, placebo-controlled HCCT with ATI. AMEP-Decliners comprised semi-structured individual interviews with six decliners in two HIV care sites in France between September 2022 and March 2023. The interviews documented their expectations regarding HCCTs, reasons for refusal, and perceived factors that might have led them to participate. Audio files were transcribed, and an inductive thematic analysis was performed. Surprisingly, the main reason for refusal was not ATI but the trial monitoring. Besides the frequency of appointments, respondents emphasized the incompatibility with their active life. One underlying reason for refusal was that participating would have meant "break[ing] the carefree attitude about the disease," reflecting the substantial psychological burden associated with participation. Finally, respondents perceived that the trial's clinical team did not sufficiently recognize their "normal life" and the level of commitment required to participate, leading them to call for greater involvement by the team: "they have to make an effort too." Results from decliners' discourses highlighted that two levels of commitment to participation must be considered when developing HCCTs: psychological burden and logistical constraints. We suggest allowing home examinations and flexible appointment times, prioritizing face-to-face invitations in order to address the psychological burden associated with HCCT participation, and explaining the reasons for monitoring constraints when they cannot be alleviated. Further studies are necessary to confirm our results.

Respiratory Syncytial Virus (RSV): Independent Community Pharmacy Impact in Promoting Prevention Through Immunization.

Respiratory syncytial virus (RSV) typically results in mild cold-like symptoms; however, it can lead to severe complications and hospitalization in patients who are 60 years of age and older with long-term health conditions. The aim of this study was to assess patient knowledge about RSV and to provide patients with information about the virus and the vaccination. A multisite cross-sectional pilot study was conducted from September 12, 2023, to March 11, 2024, in the independent community pharmacy setting. Included were all patients aged 60 years and older who consented to filling out the 14-question survey. Excluded were patients who declined to take the survey. Patients completed the survey either on paper or electronically, and the survey included initial consent, demographic information, past medical history, knowledge of RSV, consent to vaccine administration, and reasons for refusal, if applicable. At the end of the survey, patients could consent to vaccine administration onsite and were provided with an educational handout. The primary outcome revealed that 78% of participants had not received any education from their healthcare provider about RSV. Additionally, 70% correctly identified ways RSV might spread, 60% reported knowing how to protect themselves, and 58% correctly indicated that a previous RSV infection does not provide immunity. As for the secondary outcomes, 63% of participants consented to receive the vaccine on the day of the survey. The study underscores the critical role of community pharmacies in healthcare delivery and the need for enhanced educational efforts to support vaccination programs.

Recipient selection for lung transplantation: perspective in decision-making.

To determine the conditions that prevented transplant in patients referred to our center due to end-stage lung disease. Descriptive study. Department of lung transplant clinic, Koşuyolu High Specialization Education and Research Hospital, Istanbul, Turkey, from December 2017 to January 2022. Patients with end-stage lung disease referred to our clinic were retrospectively evaluated with regard to reasons for exclusion, diagnosis, and demographic data. The Karnofsky Performance Status scoring scale was used to measure the functional status of the patients. A total of 311 patients were evaluated during the study period. The mean age was 44.2 (range 4-73) years. There were 207 (66.6%) male patients. The most common indications were idiopathic interstitial pneumonia in 104 (33.4%) patients, chronic obstructive pulmonary disease in 53 (17%) patients, bronchiectasis in 49 (15.7%) patients, and cystic fibrosis in 28 (9%) patients. Of the patients, 106 (34%) were not appropriate candidates for a lung transplant. The most common reasons for refusal were preventable situations such as activity limitation and poor performance in 53 (50%) patients, weight in 49 (46.2%) patients, and smoking in 10 (9.4%) patients. Impaired performance status was the most common cause of lung transplant exclusion. Weight and smoking were preventable causes of exclusion. Implementing pulmonary rehabilitation in very few patients was the most important handicap. It is believed that providing optimal treatment with a multidisciplinary approach and timely referral to transplant centers will significantly reduce the reasons for exclusion. Key message What is already known on this topic? Referring lung transplant candidates to clinics at the earliest stage is essential for assessing their condition and exploring treatment options. What this study adds? Factors like smoking, obesity, and muscle loss can hinder the transplantation process; thus, timely interventions are crucial. The primary reason for excluding candidates from lung transplantation is the decline in performance status. How this study might affect research, practice or policy? Programs focused on smoking cessation, weight management, and muscle strengthening can play a vital role in enhancing patients' health before transplantation. It is imperative to expand and enhance the accessibility of pulmonary rehabilitation programs.

A scoping review of COVID-19 vaccine hesitancy: refusal rate, associated factors, and strategies to reduce.

This study aimed to investigate the evidence regarding vaccine hesitancy including refusal rate, associated factors, and potential strategies to reduce it. This is a scoping review. Three main databases such as PubMed, Scopus, and Web of Science were searched from 1 January 2020 to 1 January 2023. All original studies in the English language that investigated one of our domains (vaccine hesitancy rate, factors associated with vaccine hesitancy, and the ways/interventions to overcome or decrease vaccine hesitancy) among the general population were included in this study. The data were charted using tables and figures. In addition, a content analysis was conducted using the 3C model of vaccine hesitancy (Confidence, Complacency, and Convenience) that was previously introduced by the WHO. Finally, 184 studies were included in this review. Of these, 165, 181, and 124 studies reported the vaccine hesitancy rate, associated factors, and interventions to reduce or overcome vaccine hesitancy, respectively. Factors affecting the hesitancy rate were categorized into 4 themes and 18 sub-themes (contextual factors, confidence barriers, complacency barriers, and convenience barriers). Vaccine hesitancy (VH) rate and the factors affecting it are different according to different populations, contexts, and data collection tools that need to be investigated in specific populations and contexts. The need to conduct studies at the national and international levels regarding the reasons for vaccine refusal, the factors affecting it, and ways to deal with it still remains. Designing a comprehensive tool will facilitate comparisons between different populations and different locations.

Uptake, Acceptability, and Results of SARS-CoV-2 Antigen Rapid Diagnostic Testing in Community Settings in Cameroon.

Mass gathering event restrictions were part of mitigation measures during the COVID-19 pandemic that were lifted as prevalence decreased and after vaccination rollout. We explored SARS-CoV-2 antigen rapid diagnostic test acceptability and positivity in community settings in Cameroon. In August-October 2022, community workers sensitized and referred individuals for COVID-19 testing to nearby testing points in Douala and Yaoundé. Participants consented to SARS-CoV-2 antigen rapid diagnostic testing, a survey, or both components. We describe the positivity rate, COVID-19-related history, and Likert-scale testing perceptions. Factors associated with testing acceptance were analyzed using logistic regression. Overall, 20.5% (2,449/11,945) of sensitized individuals visited testing points, and 1,864 (76.1%) were enrolled; 50.6% accepted the survey and testing (46.0% accepted survey only). Seven (0.7%) of 1,006 individuals tested positive. Most (71.8%; 1,292/1,800) considered community testing more accessible than hospital-based testing. Individuals accepting versus refusing testing differed in perceived COVID-19 risk (67%, 49%; P <0.001), belief in accurate test results (79%, 47%; P <0.001), and ability to test easily (96%, 55%; P <0.001). Males (adjusted odds ratio [aOR]: 1.26 [1.04-1.53]) and those over 50 years (aOR: 1.9 [1.4-2.7]), with symptoms (aOR: 1.80 [1.30-2.50]), and at least partial vaccination (aOR: 0.76 [0.58-0.99]) were significantly associated with test acceptance. Refusal reasons included lack of perceived need for testing (33.8%) and testing discomfort (26.3%). Although community-based testing was generally perceived as important, actual testing uptake was low. In future pandemics, community testing should be optimized by addressing misinformation, offering alternative testing modalities for greater comfort, creating demand, and tailoring approaches to maximize testing uptake.

State of scientific research problems of judicial proceedings in civil jurisdiction

The article reveals current problems and the state of scientific research on judicial proceedings in civil proceedings. In particular, special attention is paid to the issue of justice. The definitions and content of justice given by both scientists and its normative basis are analyzed. It is established that some scientists define justice as the main function of the court, while others define it as a form of activity of the court itself. The proposed author’s definition of the concept of «justice». Issues of access to justice are highlighted. It is suggested that the issue of access to justice be classified as one of the main principles of the civil process. The availability of justice and access to court is considered in the context of the concept of basic human rights and freedoms. Access to justice is defined as a combination of such interrelated elements as unconditional freedom, state- guaranteed opportunity and equality of a person whose rights have been violated to apply for judicial protection of his rights and legitimate interests to a competent court; the duty of the court to accept the case for its proceedings, without applying formal reasons for refusal. Application of universal and unlimited court jurisdiction; guarantees of competitiveness, proper judicial procedures, which ensure reasonable terms of consideration of the case. Particular attention is paid to the main principles recommended by the Committee of Ministers of the Council of Europe to member states regarding measures that facilitate access to justice. The opinions of scientists revealing the meaning of such principles as simplification of court proceedings, acceleration of proceedings and court costs are established. The work analyzes official statistical data for 2020 - 2023, regarding the number of cases that were considered in the order of simplified legal proceedings in all courts on the territory of Ukraine. It was concluded that, in minor cases, it would be appropriate to develop and implement national standards that would allow individuals to independently fill out understandable standard forms of procedural documents and submit them to the court, without consulting legal experts. It is proposed to use a differentiated approach to determine the size of the court fee depending on the person’s income or depending on the degree of difficulty of the case, taking into account the procedural costs and time for consideration of the case.

Barriers to hospital-at-home acceptance: a systematic review of reasons for patient refusal.

Hospital-at-home (H@H) models have gained recognition as a safe and potentially cost-effective solution for the current rising global healthcare needs. However, despite these models' potential, their adoption has been limited partly due to patients refusing care at home. This systematic review analyses the reasons behind their refusal. We searched five databases: Embase, Google Scholar, PubMed, Scopus, and Web of Science, limiting our search to papers from 2005 to 2024. Our search focused on papers reporting patient-provided reasons for declining treatment in a H@H setting without language or country restrictions. In addition to reasons for refusal, we extracted patient demographics and predictors for refusal to ensure a broad understanding of the factors influencing patient decisions. The quality of the studies included was evaluated using the Mixed Methods Appraisal Tool (MMAT) version 2018. From the 1,067 articles identified, seven met our inclusion criteria. The papers reported reasons from 418 patients participating in diverse H@H models from the United States, United Kingdom, Spain, and Singapore, primarily focusing on acute home-based care. The most common reasons for declination included concerns about model effectiveness, safety at home, preference for in-hospital care, physician advice, family burden, and visitor concerns. Additionally, common significant demographic factors associated with decliners were the enrollment site, partnership or marital status, risk of adverse outcomes, and previous healthcare utilization. Understanding patients' motivations for declining H@H is crucial for its successful implementation. Targeted communication strategies and collaboration between healthcare providers are paramount to ensure that patients understand the benefits and safety of H@H models. Future research should explore effective communication and engagement techniques to address patient apprehensions and broaden H@H adoption.

Optimization of surgical evaluation algorithms for living donor liver transplantation

BackgroundLiving donor liver transplantation (LDLT) is an established and endorsed alternative for deceased donor liver transplantation with better recipient outcomes. Nevertheless, while extensive evaluation of potential donors is crucial, evaluation algorithms differ between transplant centres and guidelines. MethodsWe included 317 individuals evaluated for LDLT between 07/2007–07/2022 in a retrospective analysis. The evaluation process was analysed to identify the key reasons for declining 77 potential donors. Additionally, 146 donors that underwent LDLT were analysed regarding risk factors for complications. ResultsThe main reasons for donor refusal were liver volumetry (40.3 %) and metabolic factors including obesity or steatotic liver disease (20.8 %). Contrast-enhanced computed tomography (CECT) identified 63.6 % of all declined donors; CECT combined with assessment of medical history, physical examination, blood testing and ultrasonography, identified 87.0 % of declined potential donors. Associated with this selection, complication rates in donors were low (≥II in 17.1 %; none with ≥IVb). Notably, higher age was a risk factor for developing a complication ≥II after hemi-hepatectomy (p = 0.0373). ConclusionsWe propose a progressive 4-step evaluation algorithm that begins with a very basic assessment combined with up-front CECT. This early phase of testing is expected to identify nearly 90 % of ineligible donors, thereby conserving critical resources, time and money, as well as minimising burden for potential donors. FundingJ.M.W. received funding by grant We-4675/6–1 from the Deutsche Forschungsgemeinschaft (DFG) in Bonn, Germany.

Parents' Willingness to Vaccinate Their Children Aged From 6 Months to Under 5 Years With COVID-19 Vaccines.

Despite strides in vaccinating priority groups against COVID-19, children under 5 years in Vietnam are still under-immunized, emphasizing a significant gap in prioritization. This study aimed to assess parental willingness to vaccinate children aged 6 months to under 5 years against COVID-19 in Vietnam and identify influential factors affecting this willingness. Data were collected via a survey of 5960 parents/guardians between May and June 2022. Multinomial logistic regression was employed to analyze the impact of various factors on parents' willingness to vaccinate their children, alongside investigating reasons for reluctance or refusal and preferences for vaccine origins. Approximately 50.5%, 30.2%, and 19.3% of parents were willing, hesitant, and unwilling to vaccinate their children, respectively. Primary reasons for reluctance included concerns about vaccine safety, efficacy, and the severity of the pandemic. The most preferred vaccines originated in the United States. Factors significantly influencing willingness included parents' age, knowledge of COVID-19 and vaccines, residency, education, perception of information sufficiency, children's comorbidities, and family members' vaccination status. Promoting child vaccination habits can boost COVID-19 immunization rates. Targeting hesitancy among parents of children with comorbidities is crucial. Enhancing parental knowledge and leveraging fully vaccinated family members are effective strategies.