Referral Services Research Articles

Pandemic preparedness of Egyptian community pharmacists and potential facilitators to the successful implementation of a community pharmacy coronavirus disease 2019 referral service: a cross-sectional survey.

The coronavirus disease 2019 (COVID-19) pandemic resulted in an increased need for essential community services including new roles for pharmacists. Globally, community pharmacists are a highly accessible point of contact for referral. To assess the preparedness of and facilitators to community pharmacists referring patients with suspected COVID-19 symptoms for testing. A cross-sectional survey was administered using a structured questionnaire to 1023 pharmacists (one respondent in each pharmacy) in Egypt between 17 and 30 May 2020. Pharmacists who had received pandemic referral training were significantly more familiar with the referral system in comparison to those who had not (n = 180; 17.6% vs. n = 841; 82.4%, P = .014). Case referral was significantly associated with the referrer (n = 161, 15.8%), demographics of region (P = .001), graduation year (P = .035), and gender (P = .015). The vast majority of respondents identified facilitators to referring, namely university-level teaching (n = 984, 96.7%), continuing professional development (n = 958, 94.3%), smartphone app (n = 809, 80.5%) or telephone hotline (n = 933, 91.5%), IT access (n = 861, 84.7%), and managing patients' attitudes through the media in terms of the importance of declaring symptoms to (n = 998, 97.7%) and cooperating with (n = 977, 96.2%) referrers. Pharmacists' lack of preparedness to engage with the referral process and related roles contributing to tracking the national COVID-19 infection rate could be mitigated by the provision of facilitators suggested by respondents. These included improved cooperation from local healthcare authorities, educational interventions, technological solutions, and the use of the media. Demographics associated with pharmacists' attitudes to referral, and hence the reliability and validity of the national infection rate, demand further investigation.

Telehealth Brief Cognitive Behavioral Therapy for Suicide Prevention: A Randomized Clinical Trial.

Suicide rates continue to increase in the US. Evidence-based treatments for suicide risk exist, but their effectiveness when delivered via telehealth remains unknown. To test the efficacy of brief cognitive behavioral therapy (BCBT) for reducing suicide attempts and suicidal ideation among high-risk adults when delivered via telehealth. This 2-group parallel randomized clinical trial comparing BCBT with present-centered therapy (PCT) was conducted from April 2021 to September 2023 with 1-year follow-up at an outpatient psychiatry and behavioral health clinic located in the midwestern US. Participants reporting suicidal ideation during the past week and/or suicidal behavior during the past month were recruited from clinic waiting lists, inpatient service, intermediate care, research match, and direct referrals from clinicians. A total of 768 participants were invited to participate, 112 were assessed for eligibility, and 98 were eligible and randomly assigned to a treatment condition. Data analysis was from April to September 2024. Participants received either BCBT, an evidence-based suicide-focused treatment that teaches emotion regulation and reappraisal skills, or PCT, a goal-oriented treatment that helps participants identify adaptive responses to stressors. Participants were randomized using a computerized stratified randomization algorithm with 2 strata (sex and history of suicide attempts). The primary outcome was suicide attempts as measured by the Self-Injurious Thoughts and Behaviors Interview-Revised. The secondary outcome was severity of suicidal ideation as measured by the Scale for Suicide Ideation. Participants included 96 adults (mean [SD] age, 31.8 [12.6] years; 64 female [66.7%] and 32 male [33.3%]), with 51 receiving BCBT and 45 receiving PCT. Of all participants, 85 (88.5%) completed at least 1 session. From baseline to 12 months, 12 participants receiving PCT (estimated percentage, 35.6%) made 56 suicide attempts and 11 participants receiving BCBT (estimated percentage, 30.0%) made 36 suicide attempts. Participants randomized to BCBT made significantly fewer suicide attempts than participants randomized to PCT (mean [range], 0.70 [0.00-8.00] attempts per participant vs 1.40 [0.00-10.00] per participant) and had a 41% reduced risk for suicide attempts (hazard ratio, 0.59; 95% CI, 0.36-0.96; P = .03). Severity of suicidal ideation significantly decreased in both treatments (F4,330 = 50.1; P < .001) but did not differ between groups (F4,330 = 0.2; P = .91). The findings of this randomized clinical trial suggest that BCBT delivered via video telehealth is effective for reducing suicide attempts among adults with recent suicidal thoughts and/or behaviors. ClinicalTrials.gov Identifier: NCT04844294.

Assessing the impact of a leadership development programme on self-reported confidence of Community Pharmacy Neighbourhood Leads in South East London

Abstract Introduction Community Pharmacy (CP) integration is a key NHS England strategy, including for South East London (SEL) Integrated Care Board (ICB). To drive forward this strategy in SEL, the ICB medicines team created and funded community pharmacy neighbourhood lead (CPNL) roles. The CPNLs provide local leadership to strengthen CP-GP relationships and increase uptake of CP services (now badged Pharmacy First). To support implementation, a leadership programme was developed with system partners and delivered by Kaleidoscope,1 building on previous work.2 Core themes were building trust, driving collaboration and embedding innovation. Aim To measure the confidence level of CPNLs in SEL throughout the development programme, and associated outcomes. Methods There were five leadership sessions delivered to invited CPNLs and ICB colleagues between November 2023 and March 2024. The first and last sessions were face-to-face with the others virtual. Sessions covered both theory and implementation. At the end of each session all participants were asked to complete an online Microsoft forms survey compiled by Kaleidoscope, asking about their confidence in the CPNL role (where 1 is not at all confident and 5 is extremely confident), current relationships locally and actions planned and completed to date, using tick box, Likert scale and free text responses. Data was analysed in Microsoft Excel and through content analysis, with analysis completed for all attendees per session and separately for those attending 4 or 5 sessions. This study received ethics approval from Kingston University Ethics Committee (3396). Results A total of 37 individuals attended one or more sessions, with 16 attending 4 or 5 sessions. For all attendees, mean confidence score increased from 3.7 in session one to 4.14 in session five (out of 5) (session two:3.77; session three:4.05; session 4:4.17). Those who attended four or five sessions finished with a mean confidence score of 4.33, starting at 4.00 (session two:3.86; session three:4.19; session four:4.27). Comments showed participants initially reporting that there was room to improve relationships with key stakeholders, such as clinical directors, GPs, ICB and CP colleagues. By session five confidence had increased with comments noting that there was confidence to meet new people, network appropriately, and fulfil the required role. ‘Through the network we have created through this programme, confidence has grown with shared learning and new relationships.’ Comments were also received relating to improved joint working supporting the rollout of community pharmacy initiatives such as the Pharmacy First scheme. ‘Our confidence has grown, and we are arranging training sessions with the clinical directors with the local surgeries for some of the newer services like Pharmacy First.’ Discussion / Conclusion Our programme has increased CPNL confidence and engagement with local stakeholders, with greater confidence seen in those engaging most with the leadership programme. Limitations include not having consistent attendance at sessions. The launch of the national ‘Pharmacy First’ service halfway through the programme had a significant impact on the community pharmacy sector,3 with CPNLs being pivotal in building success in partnership. Further evaluation should assess impact of CPNLs on community pharmacy service provision and referrals by GPs.

Utilization of home-based care and its buffering effects between dementia caregiving intensity and caregiver burden in China.

Home-based care (HBC) services have gained global attention for their potential to reduce caregiver burden among informal caregivers of persons with dementia (PwDs), who experience high caregiving intensity. However, research on HBC and its effects on dementia caregiving in China remains limited. Data were collected from primary caregivers of PwDs in Jiangsu Province, China. Caregiving intensity and HBC utilization were measured using self-developed instruments. Caregiver burden was assessed by The Burden Scale for Family Caregivers-short. Factor analysis was employed to decompose HBC services. Hierarchical multiple regression analysed the moderating effects of HBC on the relationship between caregiving intensity and burden. A community sample of 318 caregiver and PwDs dyads was included. Caregivers averagely aged 62.16 years, with 61% being female, 84% not employed, and 66.2% having low income. PwDs aged 77.45 years averagely, with 52.8% being female and an average behavioural problems score of 42.27. Caregivers averaged 15.19 on response measures. The number and time spent on ADL-based tasks were positively associated with caregiver burden (β = 0.26, p < .001; β = 0.16, p < .01). However, attendance and time of supervision tasks were not significant predictors of burden. HBC services in China comprised four dimensions: Referral service, Household care, Skilled care, and Mental health service. While these did not directly predict caregiver burden, they moderated the associations between ADL-based tasks and caregiver burden (β=-0.25, p < .001; β=-0.24, p < .001; β=-0.23, p < .001; β=-0.20, p < .001), between time of ADL-based tasks and caregiver burden (β=-0.17, p < .001; β=-0.18, p < .001; β=-0.17, p < .001; β=-0.15, p < .01), and between the attendance at supervision tasks and caregiver burden (β=-0.11, p < .05; β=-0.20, p < .001; β=-0.17, p < .001; β=-0.17, p < .001). Only Referral service buffered the relationship between supervision time and caregiver burden (β = -0.13, p < .01). Informal caregivers of PwDs face high caregiving intensity and burden. HBC services may moderate this relationship, with different services playing varying roles. Further research is essential to explore the impact of supervision levels and develop effective strategies to enhance HBC services for dementia caregiving in China.

A review of UK primary care pathways for acute ophthalmic conditions.

Care pathways for the management of acute ophthalmic conditions have developed and transformed significantly over recent years, owing to a combination of legislative changes, policy implementation and the pressing requirement to redistribute increased demand away from traditional secondary care providers through collaboration with primary care. Following UK healthcare devolution in 1999, each nation has developed and implemented their own strategies for managing the growing demands on acute ophthalmology services. Local commissioning across England has seen Enhanced Service Pathways develop to provide acute eye care by primary care optometrists, with provision and access dependent upon locality. Northern Ireland has seen the implementation of a nationwide Primary Eyecare Acute Referral Service, whilst in Scotland and Wales, the respective Governments have redesigned primary care optometry General Ophthalmic Service contracts to incorporate provision of extended investigations and management of acute conditions by optometrists across the nation, recognising the added benefit of optometrists with higher qualifications. This narrative review summarises both peer reviewed and appropriate grey literature articles reporting on acute eye care pathways in primary care. Despite significant progress, particularly during the global COVID-19 pandemic, there is arguably still a great deal of further research and evaluation required relating to pathway innovation, the role of professionals with higher qualifications, including independent prescribing, the role of telemedicine, reassurance around clinical safety, and how digital interconnectivity could potentially add value to collaborative schemes to meet the growing demand on acute eyecare.

Risk factors affecting all-cause mortality in cats hospitalized by a referral soft tissue service.

The objective of this study was to describe the all-cause mortality rate in cats hospitalized by the soft tissue surgery service of an academic referral hospital over a 5-year period and to identify specific risk factors for mortality. The hypotheses were that the all-cause mortality rate during hospitalization would be low, and cats undergoing emergency surgery and those with an American Society of Anesthesiologists (ASA) status of 3 or more would be at increased risk for mortality. The case log of cats hospitalized by the soft tissue surgery service at the University of Georgia was searched retrospectively to identify all cats hospitalized in the years 2015-2020. Data collected about each cat included age, sex and neuter status, weight, body condition score (1-9), pre-existing heart disease, chronic kidney disease, concurrent infection or cancer, emergency status, time of surgery (daytime vs after hours, which was defined as after 4 pm), if the surgery was performed on a weekday or weekend, and general type of surgery. Univariable logistic regressions were implemented to test and estimate odds ratios for the effects of risk factors on in-hospital mortality. A multivariable logistic regression was developed that initially included all risk factors with P <0.05 on univariable analysis. Log-likelihood ratio test P values and profile-likelihood confidence intervals were reported. The all-cause mortality rate was 6.1%. Analysis was limited because of low mortality, but multivariable analysis identified increasing ASA status and emergency surgery as significant risk factors for increased mortality while hospitalized. The findings of this study confirmed that increasing ASA status and emergency procedures are significant risk factors for mortality in cats. Clinicians should be aware of these risk factors and consider how to best monitor and manage these feline patients.

Factors Influencing the Incident of Acute Respiratory Tract Infections in Children Aged 12-59 Months in Wallandimu East Nusa Tenggara

Background: Acute Respiratory Infection Disease is one of the highest causes of morbidity and mortality in children under five in Indonesia, especially in East Nusa Tenggara. The implementation of the ISPA disease control program focuses on finding and treating sufferers as early as possible by involving the active role of cadres, integrated health service support and referrals to related health facilities, however, these control efforts have not shown significant results. Purpose: The aim of this study was to determine the factors that influence the incidence of Acute Respiratory Infection Disease in children aged 12-59 months in the Wallandimu Community Health Center working area. Method: This research uses an analytical research design with a cross sectional approach. The population in this study were toddlers aged 12-59 months in the Wallandimu health center working area and the sample in this study was 30 toddlers. The sampling technique in this research was simple random sampling. The Chi-Square statistical test was used to determine the relationship between variables. Results: The results of the research from 18 respondents showed complete immunization status (76.7%), poor nutritional status (60.0%), and insufficient knowledge (56,7%) regarding the incidence of ISPA in the Wallandimu Health Center working area. The results of bivariate analysis showed no influence between immunization status and the incidence of ISPA (p= 0.896 &gt; 0.05), there was an influence between nutritional status and the incidence of ISPA (p= 0.007 &lt; 0.05), there was an influence between maternal knowledge and the incidence of ISPA (p = 0.010 &lt; 0.05). Conclusion: It is hoped that the Wallandimu Community Health Center will further improve its health programs, especially the Acute Respiratory Infection Disease control program for toddlers and provide education regarding maternal knowledge and the dangers of malnutrition for toddlers, so that the incidence of Acute Respiratory Infection Disease in children aged 12-59 months will decrease.

61 The HEADS-ED under 6: Validation of a mental health and developmental screening and triage tool

Abstract Background The HEADS-ED screening and triage tool was developed for children 6 years to young adults as a communimetric mental health (MH) and addictions screener to help clinicians identify and communicate areas of need and recommended clinical care. Few clinician-administered tools identify both MH and developmental needs in young children under 6. From a review of milestone tools and in consultation with paediatricians, psychiatrists, and family physicians, the HEADS-ED Under 6 is a MH and developmental screening and triage tool that was developed to screen and flag functional impairment and action required in several areas, including: Home &amp; caregivers, Eating &amp; sleeping, Activities &amp; peers, Development /speech/language/motor, Safety, Emotions &amp; behaviours and Discharge &amp; current resources (see http://heads-ed.com for more background and access to both tools available in English and French). Objectives Our objectives were to examine: 1) feasibility of implementing the new HEADS-ED Under 6 screening and triage tool in community and hospital settings, 2) clinical utility of the tool to assist with clinical decision making, and 3) validity of the tool against a comprehensive assessment. Design/Methods We conducted two implementation and validation studies to examine uptake of the tool and how the tool assists in clinical referral decisions to more specialized and intensive services at 2 sites. For our initial validation study, we piloted and validated the tool at a community MH agency in Ontario for children under the age of 6 from November 2019- March 2021 (N=566). For our cross-validation study, we examined how the tool was implemented within a regional coordinated access service housed in a paediatric hospital in Ontario from June 2021- August 2023 (N=589). Results For our initial validation study, the HEADS-ED Under 6 was widely used by intake workers (95%, N = 536/566) to communicate children’s MH and developmental needs (Figure 1) and assisted in recommending services of varying intensity. The tool showed good concordance with the InterRAI Early Years assessment in similar domains requiring no action (61.1% to 81.6%), requiring action but not immediate (49.2% to 88.0%) and requiring immediate action (66.7% to 100%) for children under 4 years old (p's &amp;lt;.001). Three clinical domains (Eating &amp; sleeping, Development/speech/language/motor, and Emotions &amp; behaviours) also independently predicted an urgent care recommendation (p's &amp;lt; .001). For our cross-validation study, the tool was used for all 589 intake appointments, and 96.4% (N = 568/589) had a level of need documented. HEADS-ED Under 6 clinical domains (.24-.38) and total scores (.52) were significantly correlated with level of need (p&amp;lt;.001). Higher HEADS-ED Under 6 total scores helped intake workers decide on more intense services based on level of need (p&amp;lt;.001; Figure 2). ROC analyses (AUC = .807, SE = 68.5% sensitivity, 79.5% specificity) confirmed a total score of 6 or above helped triage to more targeted and intense services. Conclusion The HEADS-ED Under 6 is a brief, straight-forward, and valid screening and triage tool that can be used by intake workers, physicians, and paediatricians to guide their interview in several areas of MH and development, communicate the severity of the child’s MH and developmental needs, and assist with determining level of need for services. When a HEADS-ED Under 6 total score reaches ≥6, clinicians should advocate for more intensive services when making MH service referrals.

Carbon Emission Reduction Associated With Utilisation Of Telehealth In Outpatient Clinics In An Australian Quaternary Health Service

Objective: To assess the impact of implementing telehealth in outpatient clinics on the carbon emissions associated with the delivery of health care. Design &amp; Setting: Retrospective cohort study in large metropolitan quaternary referral health service from January 2021- December 2022. Participants: All patients who attended an outpatient clinic appointment during the study period, either in-person, via telehealth or via telephone. Main outcome measures: The estimation of carbon emissions in tonnes (t) of CO2-equivalent (CO2-e) associated with in-person and telehealth appointments based on emissions associated with travel, telehealth platform usage and N95 mask usage. Results: There were 571,121 outpatient clinic appointments during the study period. Of the appointments, 251,458 (44%) were conducted remotely, resulting in an estimated reduction in 3,629t of CO2-e emissions in the two-year period. Telehealth consultations in this time contributed 4.5t of CO2-equivalent emissions. The total emission usage of telehealth clinic was only 0.12% of emissions generated from face-to-face clinic appointments. Conclusion: Telehealth offers the opportunity of substantial carbon emissions reduction within the healthcare sector, while also providing cost and time-saving benefits for healthcare services and patients. Limitations include generalisation of transportation modes and the retrospective nature of the data collection.

Design and development of a machine-learning-driven opioid overdose risk prediction tool integrated in electronic health records in primary care settings

BackgroundIntegrating advanced machine-learning (ML) algorithms into clinical practice is challenging and requires interdisciplinary collaboration to develop transparent, interpretable, and ethically sound clinical decision support (CDS) tools. We aimed to design a ML-driven CDS tool to predict opioid overdose risk and gather feedback for its integration into the University of Florida Health (UFHealth) electronic health record (EHR) system.MethodsWe used user-centered design methods to integrate the ML algorithm into the EHR system. The backend and UI design sub-teams collaborated closely, both informed by user feedback sessions. We conducted seven user feedback sessions with five UF Health primary care physicians (PCPs) to explore aspects of CDS tools, including workflow, risk display, and risk mitigation strategies. After customizing the tool based on PCPs’ feedback, we held two rounds of one-on-one usability testing sessions with 8 additional PCPs to gather feedback on prototype alerts. These sessions informed iterative UI design and backend processes, including alert frequency and reappearance circumstances.ResultsThe backend process development identified needs and requirements from our team, information technology, UFHealth, and PCPs. Thirteen PCPs (male = 62%, White = 85%) participated across 7 user feedback sessions and 8 usability testing sessions. During the user feedback sessions, PCPs (n = 5) identified flaws such as the term “high risk” of overdose potentially leading to unintended consequences (e.g., immediate addiction services referrals), offered suggestions, and expressed trust in the tool. In the first usability testing session, PCPs (n = 4) emphasized the need for natural risk presentation (e.g., 1 in 200) and suggested displaying the alert multiple times yearly for at-risk patients. Another 4 PCPs in the second usability testing session valued the UFHealth-specific alert for managing new or unfamiliar patients, expressed concerns about PCPs’ workload when prescribing to high-risk patients, and recommended incorporating the details page into training sessions to enhance usability.ConclusionsThe final backend process for our CDS alert aligns with PCP needs and UFHealth standards. Integrating feedback from PCPs in the early development phase of our ML-driven CDS tool helped identify barriers and facilitators in the CDS integration process. This collaborative approach yielded a refined prototype aimed at minimizing unintended consequences and enhancing usability.

A public health/hospital partnership to improve Emergency Department transitions of care for vulnerable older adults.

Community-dwelling older adults are at high risk for unmet social service needs. We describe a novel partnership embedding county services case managers in the Emergency Department (ED) to connect older adults to community services alongside their medical care. Setting: A medium-sized urban ED with 55,000 patient visits a year. Case managers from the Franklin County, Ohio Office on Aging (OA) were embedded within the ED. The OA team worked with the ED social work team to identify community-dwelling older patients, perform an in-person intake assessment, and initiate needed community services (including home-delivered meals, emergency response systems, house repairs, and transportation). Program logic model and development are reported in detail. From June to December 2023, there were 7284 ED visits for adults ≥60 years old. Referrals to the OA case manager ranged from 1 to 13 per day. The OA case managers performed 252 full intake assessments on unique patients. The population was 51% men. Only 11% (n = 28) were currently connected to OA services, and of those already connected 29% (n = 8) needed increased services. Of the remaining unconnected patients (n = 224), 8% (n = 20) were not county residents and the OA team connected them with other county OAs. Half 53% (n = 120) were accepting of services and had services from the OA or other community health programs initiated during the ED visit. The OA team made three new Adult Protective Services referrals and one referral to the long-term care ombudsman. The program did not increase ED length of stay or hospital admission rates. Embedding county service enrollment within a community ED is a cost neutral intervention that reached a population without previous services. Future plans include expansion of the program and evaluation of the program's ability to detect elder mistreatment and self-neglect.

CIC 2023: Enhancing Referrals to the Supplemental Nutrition Assistance Program (SNAP) through Clinical Integration of a Standards-Based Decision Support System.

The Supplemental Nutrition Assistance Program (SNAP) is one of the most successful national programs to reduce poverty and improve health outcomes, but millions of Americans who qualify still do not have access to SNAP, and limited data is available to determine how referrals to the program can be completed successfully. We aimed to design and develop a standards-based digital care coordination platform to support closed-loop social services referrals between patients and social and health care providers; and demonstrate the feasibility to screen, diagnose, plan, and complete interventions with selected patients in real-settings. We partnered with community members to design the platform through Community Engagement Studios and with a Federally Qualified Health Center, Local Mental Health Authority, and Food Bank to determine the features and workflow requirements of the platform design. We customized currently available systems to use Fast Healthcare Interoperability Resources (FHIR) Application Programming Interfaces (APIs) that could exchange information in real-time across providers and participants. The platform was successfully demonstrated through a pilot where patients were recruited in clinical settings and referred to a Food Bank that provided SNAP application assistance to study participants. We translated the requirements of the platform to national standards and required workflows of providers and patients. Study participants were notified electronically of the specific steps to follow to complete their SNAP applications while receiving support from specialists from the Food Bank. The pilot demonstrated the feasibility of collecting granular social service referral information that can be used to better address gaps in social care. The pilot also highlighted the importance of further coordination on the usage and harmonization of needs assessment nationally and that current digital systems are still not ready to fully utilize national Social Determinants of Health (SDOH) data standards.

Mental Health Service Referral and Treatment Following Screening and Assessment in Juvenile Detention.

Numerous recommendations have been made to address the high rates of mental health disorders among justice-involved youth. Few data are available on the use, quality, appropriateness, or availability of services to address these needs. This study examined the relationship between trauma-informed mental health screening, other referral pathways for diagnostic evaluation, subsequent DSM-5 diagnoses, and treatments for evaluated youth. Eligible participants were all youth admitted to New York City secure juvenile detention facilities from September 17, 2015 to October 30, 2016 who remained in the facility for at least five days (N = 786). Of those, 581 (73.9%) were voluntarily screened and 309 (53.2%) later received a diagnostic evaluation. Youth who screened positive for depression, posttraumatic stress disorder, and problematic substance use were more likely to be evaluated. Treatment received was related to diagnosis rather than reason for referral. For youth who were referred for behavioral or emotional concerns, 99.1 percent (114 of 115) of those diagnosed with a neurodevelopmental disorder had attention-deficit/hyperactivity disorder (ADHD). These data are among the first to describe DSM-5 diagnoses and treatment among youth detainees. They highlight the prevalence of ADHD in detained youth and argue for the coordination of universal trauma-informed mental health screening and a structured referral system for this population.

12533 A Rare Case of a Growth Hormone Releasing Hormone-Secreting Pulmonary Carcinoid Tumor: Clinical Presentation and Management

Abstract Disclosure: I. Yaseen: None. C. Woods: None. D.B. O'Shea: None. R.K. Crowley: None. D. O'Toole: None. H. Almeamar: None. We present a rare case of an ectopic Growth Hormone Releasing Hormone (GHRH)-secreting pulmonary neoplasm manifesting with acromegaly. A 62-year-old woman presented with Bell’s palsy. An incidental lung mass proved to be a 17.5cm carcinoid tumor, DOTATOC-avid, with bony and liver metastases, Ki67 1% on lung and bone biopsy. After pulmonary service referral to endocrinology, she was noted to have acromegalic features, the most troubling of which was macroglossia associated with mouth ulceration. IGF1 was 549ug/L (57-186), random growth hormone was 225. GHRH in serum was 1937ng/ml (reference &amp;lt; 60). MR Pituitary revealed hyperplasia.The multidisciplinary team discussion was that the lung lesion was unresectable, therefore she was commenced on somatuline autogel 120mg every 28 days and an opinion requested re suitability for Peptide Receptor Radionuclide Therapy. After 6 months of therapy IGF1 normalised to 90ug /L. GHRH reduced to 1056ng/L.Imaging at 8 months showed stability of lung primary and bone / liver metastases, with no benefit likely from PRRT at this time. This case highlights the importance of considering endocrine syndromes in the setting of a lung mass. The prevalence of acromegaly in Ireland is 69 per million people; this is the second Irish case known of GHRH-associated GH excess. Ectopic GH-secreting pulmonary tumors are a rare but important differential in patients presenting with acromegalic features. Complete surgical resection can be curative, underlining the significance of a multidisciplinary approach in management, encompassing endocrinology, thoracic surgery, and pathology. This case of successful medical management adds to the limited literature on such tumors and underscores the potential for non-pituitary neoplasms to cause systemic endocrinopathies. Presentation: 6/1/2024

Psychosocial and mental health concerns among elderly people during COVID-19: Findings from national helpline in India

ABSTRACT Background: WHO reported that the epidemic SARS-CoV-2 spread was a public health emergency of international tension in January 2020 and pandemic in March 2020. In this regard, National Institute of Mental Health and Neuro Sciences (NIMHANS) launched a national helpline with the support of the Ministry of Health and Family Welfare for addressing psychosocial issues and mental health concerns of people during the COVID-19 pandemic. The recorded calls made to the National Psychosocial Support helpline were analysed to elicit the psychosocial issues seen among the elderly during the pandemic. Methods: The data of 70 randomly selected helpline callers were collected by using the sociodemographic data sheet and the semistructured questionnaire. The study employed descriptive research design. Results: In total, 71.1% of callers belonged to the 60-70 years’ age group. 57.1% of callers had approached the helpline by themselves. 38.6% of the callers had reported a preexisting mental illness, of which the majority (33%) reported anxiety and/or sleeplessness. 28.6% of callers complained of comorbid medical issues. Interventions provided to the callers were in the form of supportive psychotherapy (84.28%), the COVID-19-related information (72.85%), referral services (62.9%), lifestyle modifications (41.42%), and behavioural activation (35.71%). Conclusion: Study findings indicate that the older population encountered several mental health issues during COVID-19, and the telephonic interventions were the most feasible, accessible, and helpful method to reach out to them.

Virtual/Mobile Overdose Response in Canada: A Social Return on Investment Analysis

The overdose epidemic continues to be one of the leading causes of death in North America and continues to contribute to high healthcare costs. While harm reduction initiatives have significantly reduced the aforementioned costs, there is a dearth of evidence regarding overdose response hotlines and applications. We aim to evaluate the social return on investment (SROI) from a payer perspective of one such overdose response hotline, Canada's National Overdose Response Service, and its implications for service users, service operators, the Canadian healthcare system, and program funders. Outcome variables determined from theory of change models were developed in consultation with the aforementioned vested interest groups. Proxy values were attributed to each variable identified through values present within existing literature and databases. These values were then compared to operational costs accounting for deadweight, attribution, and displacement to determine a final SROI ratio. A discount rate was then applied based on the influence of risk on the outcome achieved. The ratio illustrating the value created for all stakeholders, resulting from the $1,592,00 investment made over two years, is $15.84 per single dollar invested. The value generated stems primarily from overdose prevention, mental health support, staff employment, reductions in emergency service utilization, service referrals, and volunteer well-being, which outweigh costs including operational funding, work-related stressors, compassion fatigue, and false calls. The results of our study demonstrate that the National Overdose Response Service provides a social value that far outweighs the costs attributed to the program's operation.

Defining the Need for Services for Patients at High Risk of Breast Cancer at a Safety-Net Hospital: An Approach to Narrowing the Disparities Gap.

The National Accreditation Program for Breast Cancer (NAPBC) standards were recently revised to promote breast cancer (BC) risk assessment and subsequent referral for high-risk services. This project sought to estimate the proportion of patients at high risk for BC in the authors' safety-net hospital system, gauge patient interest in high-risk services, and define resources for program development. Women presenting for breast imaging during 2 weeks in 2023 were surveyed. Thirty-five patients with a history or diagnosis of BC were excluded. The Tyrer-Cuzick (TC) model version 8 was used to calculate BC risk. High/intermediate risk was defined as a 10-year risk of 5% or more, a lifetime risk of 15% or more, or both. The criteria for genetic counseling and testing referral were based on National Comprehensive Cancer Network guidelines. A total of 257 patients had a TC risk assessment showing 14.8% (n = 38) with a 10-year BC risk of 5% or more (consideration of endocrine therapy), 6.2% (n = 16) with a lifetime BC risk of 20% or more (qualifying for annual screening MRI), and 10.5% (n = 27) with a lifetime BC risk of 15% or more (consideration of high-risk screening). The criteria for genetic counseling/testing were met by 61 (23.7%) of the 257 patients. Overall, 31.5% (n = 81) qualified for high/intermediate-risk screening, risk reduction, and/or genetic assessment/testing, 92.8% of whom were interested in referrals for additional information and care. In the authors' community, almost one third of patients undergoing breast imaging qualify for BC high-risk assessment and services. The majority of the patients expressed interest in pursuing such services. These data will be used in financial planning and resource allocation to develop a high-risk program at the authors' institution in line with NAPBC guidelines. They are hopeful that these efforts will improve oncologic outcomes and survival from BC in their community.

Association between food insecurity, financial toxicity, and healthcare utilization in adolescents and young adults with cancer.

305 Background: Adolescents and young adults with cancer experience high rates of financial toxicity (FT) and unmet health-related social needs (HRSN: food, housing, transportation insecurity). FT and unmet HRSN, specifically FI, are modifiable factors that impact health outcomes; however, the relationship between FI, FT, and healthcare utilization (emergency department (ED) visits or hospitalizations) remains unclear. Leveraging systematic screening for FT and HRSN using the electronic health record (EHR) patient portal among AYAs with cancer, we examined the association between FI, FT, and healthcare utilization measures among AYAs with cancer. Methods: AYAs (ages 15-39) who utilize the EHR patient portal were prompted to complete an 8-item standardized HRSN survey (i.e., food insecurity, housing instability, transportation difficulties) and a 2-item previously established FT survey during e-check in between November 2022 and April 2024. ED visits and hospitalizations were extracted from the EHR directly. Descriptive statistics and associations using chi-square tests were used to describe the patients and examine associations between FI or FT and ED visits or hospitalizations. Results: Of 691 AYAs who completed the HRSN survey, 16% (n=109) screened positive for FI. Among AYAs with FI, 42% (n=46) had at least one ED visit compared with 28% (n=163) among AYAs without FI (p&lt;0.01). Among AYAs with FI, 39% (n=43) were hospitalized at least once compared to 31% (n=179) among AYAs without FI (p=0.07). Of 439 AYAs who responded to the FT survey, 66% (n=290) met criteria for high FT. Within this group, 26% (n=74) had at least one ED visit compared with 17% (n=26) who screened negative (p=0.06). Among AYAs with high FT, 22% (n=65) were hospitalized at least once, compared with 19% (n=28) among those with low or moderate FT (p=0.38). Among 384 AYAs who responded to both the HRSN and FT surveys, 19% (n=74) screened positive for FI, 92% (n=68) of whom also had high financial toxicity. The table describes characteristics of screened AYAs by language and race/ethnicity. Conclusions: FI may be a risk factor for increased ED visits during cancer treatment among AYAs. Systematic screening to identify FI, FT, and other HRSN is important to facilitate referral for resources, support services, or interventions. Sociodemographic characteristics of AYA participants in FI and FT screening. Characteristic +FI -FI +FT -FT N=109 (%) N=582 (5) p-value N=290 (%) N=149 (%) p-value Language &lt;0.01 &lt;0.01 English 82 (75) 496 (85) 241 (83) 134 (90) Spanish 24 (22) 45 (8) 29 (10) 1(1) Other 3 (3) 41 (7) 20 (7) 14 (9) Race/Ethnicity &lt;0.01 &lt;0.01 Hispanic, any race 67 (61) 175 (30) 125 (43) 16 (11) Non-Hispanic Black 12 (11) 62 (11) 30 (10) 10 (7) Non-Hispanic White 16 (15) 219 (38) 78 (27) 84 (56) Other 14 (13) 126 (22) 57 (20) 39 (26)

Interventions on informal healthcare providers to improve the delivery of healthcare services in low-and middle-income countries: a systematic review.

Informal healthcare providers (IHCPs) play a big role in health systems in low-and middle-income countries (LMICs) and are often the first point of contact for healthcare in rural and underserved areas where formal healthcare infrastructure is insufficient or absent. This study was performed to systematically review the literature on interventions targeting IHCPs in improving the delivery of healthcare services in LMICs. PubMed, Embase, and Cochrane CENTRAL databases were searched for studies that assessed any type of intervention among IHCPs to improve the delivery of healthcare services in any LMIC. Outcomes included changes in knowledge, attitude, and reported practice of appropriate case diagnosis and management; improved referral services; effective contraceptive use; and medication appropriateness (PROSPERO ID: CRD42024521739). A total of 7,255 studies were screened and 38 were included. Most of the studies were conducted in Africa and Asia. The IHCPs who were trained included medicine sellers, community health workers/traditional healers, and traditional birth attendants. The main intervention used was educational programs in the form of training. The other interventions were health services, policy and guidelines, and community-based interventions. Most of the interventions were multi-faceted. The disease/service areas targeted were mainly maternal and child health, sexually transmitted diseases, common infectious diseases, medicine use/dispensing practices, and contraception. The outcomes that showed improvements were knowledge, attitude, and reported practice; diagnosis and case management; improved referral services; contraceptive uses; and medication appropriateness. Around one-fourth of the studies reported negative results. The certainty of evidence generated (GRADE criteria) was very low. Some multifaceted interventions coupled with training showed improvements in the delivery of healthcare services by IHCPs. However, the improvements were inconsistent. Hence, it is unclear to identify any context-specific optimum intervention to improve the delivery of healthcare services by IHCPs.

Prevalence of sleep disorders and association with various occupations among Indian population aged ≥ 45 years: Insight from Longitudinal Ageing Study in India (LASI)

ABSTRACT Introduction: By scrutinizing the impact of job schedules, workplace culture and stress levels, our study aims to determine the prevalence of sleep disorders among various occupations and its associated factors. The findings promise to enhance the overall well-being, sleep quality and productivity in various occupational settings. Methods: This is an analytical cross-sectional study involving secondary data from the nationally representative Longitudinal Ageing Study in India (LASI Wave I 2017-18) of 35 Indian states and union territories with exception of Sikkim. The study included 59441 Indian volunteers who older than 45 years. Multivariable logistic regression analysis was conducted to study the association of sleep disorders among various occupations while accounting for other associated factors. Results: Prevalence of sleep disorders was higher among the females (12.66%), unemployed (13.34%), ≥ 60-yr age group (13.45%), those who lived in rural areas (12.35%), those who were illiterate (12.80%) and reported themselves to be widowed, separated or divorced (14.54%), people with no health insurance (11.74%), smokers (12.11%), without physical activity (12.67%) and also rated themselves as poor in the self-rated health status (26.77%). Alcohol consumption was not statistically significant factor for sleep disorders. Conclusions: There is an emerging need for targeted screening, prompt detection and early management of insomnia and other sleep disorders among the high-risk groups. Provision of accessible and affordable screening tools, training skills for early diagnosis at primary care level and/or proper referral services to higher centres form the cornerstone for adequate management of sleep disorders.