Resource For Health Care Providers Research Articles

Abstract PO1-10-10: Leveraging technology to optimize symptom management and patient empowerment in routine breast cancer care: implementation of a remote patient monitoring (RPM) pathway across 24 hospitals in Europe

Abstract Background: In clinical trials, RPM has been proven to improve the quality of life and toxicity management for patients receiving systemic treatment and is recommended by international guidelines for routine clinical practice (Di Maio et al., Ann Oncol 2022). Resilience is an oncology-specific RPM system (CE marked, class IIa medical device - mobile application [app] or web interface) which prompts patients to complete a weekly survey including core symptoms from NCI’s PRO-CTCAE questionnaire. Severe or worsening symptoms trigger an alert notification sent to the patient’s care team. In addition to the RPM system, the mobile app offers a large pool of breast cancer-specific educational, self-management, and patient empowerment resources that are personalized according to symptoms reported, disease stage, and treatments received. Here we present the implementation of the Resilience RPM pathway in routine breast cancer care across 24 highly diverse cancer centers. Methods: The implementation process followed a phasic process of Exploration, Preparation, Implementation, and Sustainability that involved close collaboration with technology providers, hospital managers, and care teams at participating cancer centers to coordinate, train, provide technical assistance, and respond to site-specific needs. In addition, monthly webinars offered participating centers an opportunity to share best practices and ways to overcome implementation barriers. A dedicated platform with educational RPM resources for healthcare providers was also available. A process evaluation according to the RE-AIM framework was performed assessing the reach, adoption, implementation, and maintenance of the RPM pathway in routine care. The effectiveness of the pathway was assessed as the ability of the care team to timely respond to alerts. Aggregated system level metric of RPM was collected covering patients with breast cancer under active systemic treatment followed by Resilience from 01-11-2021 to 29-06-2023. Usage data of mobile app resources was tracked from 01-01-2023 to 29-06-2023. Qualitative assessments with focus groups complemented this evaluation. Results: 985 patients, 1% male, 99% female, with a median age of 57y (range: 21-95y; P25-75 38.5-64.5y), were registered across 24 cancer centers. In the last 6 months, the predominant RPM interface chosen by patients was the mobile app (64.1 vs 35.9% for the web platform). Adherence to weekly ePRO reporting was 89.4% in the mobile app and 86.6% in the web platform. The median time from prompt receipt to survey completion was 5.6 hours. The median time for the nurse navigator (NN) to process an alert was 3h50min. Most alerts (91%) were handled directly by NN with 9% requiring the support of a physician. The mean number of individual content consumed per patient was 13 (6744 resources/523 pts, 100% of app users accessed resources). Preferred formats of content delivery were written articles (66.5%), followed by videos (23.1%) and podcasts (10.4%). Most assessed contents referred to: symptom management advice (16%), followed by information about breast cancer disease characteristics (12.5%), supportive care strategies (11.5%), self-guided exercises of mindfulness-based stress reduction (9.4%), and breast cancer treatment journey (8.3%). Qualitative assessments of the app interface, educational content, and self-management programs revealed high levels of satisfaction. The RPM pathway is sustained in the 24 cancer centers and implementation is expanding to additional centers. Conclusion: The Resilience RPM pathway was successfully implemented in routine care across a diverse group of cancer centers with elevated levels of patient engagement and responsiveness from NN. In addition, patients accessed evidence-based educational and empowerment resources, adapted to their medical profile according to their preferences and learning style. Citation Format: Maria Alice Franzoi, Arlindo R Ferreira, Juliette Fanton d'Andon, Thomas Grellety, Eliane Ithurbide-Dachary, Laura Polastro, Laurence Caravella, Joseph Rodriguez, Nathanaelle Leprevier, Elsa Blanchard, Stéphane Remy, Belen d' Ythurbide, Romain Rivoirard, Raoudha Boughzala, Joana M Ribeiro, Ines Vaz Luis. Leveraging technology to optimize symptom management and patient empowerment in routine breast cancer care: implementation of a remote patient monitoring (RPM) pathway across 24 hospitals in Europe [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-10-10.

Enhancing Health Care Accessibility and Equity Through a Geoprocessing Toolbox for Spatial Accessibility Analysis: Development and Case Study.

Access to health care services is a critical determinant of population health and well-being. Measuring spatial accessibility to health services is essential for understanding health care distribution and addressing potential inequities. In this study, we developed a geoprocessing toolbox including Python script tools for the ArcGIS Pro environment to measure the spatial accessibility of health services using both classic and enhanced versions of the 2-step floating catchment area method. Each of our tools incorporated both distance buffers and travel time catchments to calculate accessibility scores based on users' choices. Additionally, we developed a separate tool to create travel time catchments that is compatible with both locally available network data sets and ArcGIS Online data sources. We conducted a case study focusing on the accessibility of hemodialysis services in the state of Tennessee using the 4 versions of the accessibility tools. Notably, the calculation of the target population considered age as a significant nonspatial factor influencing hemodialysis service accessibility. Weighted populations were calculated using end-stage renal disease incidence rates in different age groups. The implemented tools are made accessible through ArcGIS Online for free use by the research community. The case study revealed disparities in the accessibility of hemodialysis services, with urban areas demonstrating higher scores compared to rural and suburban regions. These geoprocessing tools can serve as valuable decision-support resources for health care providers, organizations, and policy makers to improve equitable access to health care services. This comprehensive approach to measuring spatial accessibility can empower health care stakeholders to address health care distribution challenges effectively.

Improving communicative access and patient experience in acute stroke care: An implementation journey

IntroductionPatient experience for people with aphasia/families in acute care is frequently reported as negative, with communication barriers contributing to adverse events and significant long-term physical and psychosocial sequelae. Although the effectiveness of providing supported communication training and resources for health care providers in the stroke system is well documented, there is less evidence of implementation strategies for sustainable system change. This paper describes an implementation process targeting two specific areas: 1) improving Stroke Team communication with patients with aphasia, and 2) helping the Stroke Team provide support to families. The project aimed for practical sustainable solutions with potential contribution toward the development of an implementation practice model adaptable for other acute stroke contexts. MethodsThe project was designed to create a communicatively accessible acute care hospital unit for people with aphasia. The process involved a collaboration between a Stroke Team covering two units/wards led by nurse managers (19 participants), and a community-based Aphasia Team with expertise in Supported Conversation for Adults with Aphasia (SCA™) – an evidence-based method to reduce language barriers and increase communicative access for people with aphasia. Development was loosely guided by the integrated knowledge translation (iKT) model, and information regarding the implementation process was gathered in developmental fashion over several years. OutcomesExamples of outcomes related to the two target areas include provision of accessible information about aphasia to patients as well as development of two new products – a short virtual SCA™ eLearning module relevant to acute care, and a pamphlet for families on how to keep conversation alive. Potential strategies for sustaining a focus on aphasia and communicative access emerged as part of the implementation process. ConclusionsThis implementation journey allowed for a deeper understanding of the competing demands of the acute care context and highlighted the need for further work on sustainability of communicative access interventions for stroke patients with aphasia and their families.

Exploring Veteran cultural competency in Canadian health care services

LAY SUMMARY On leaving the military, Canadian Armed Forces Veterans begin receiving health care services in the civilian community. Health care providers may not understand the military culture from which Veterans come and how military service can affect health and well-being. The purpose of this study was to identify what civilian health care providers need to know and do to provide culturally competent care to Canadian Veterans. Veterans and health care providers (family physicians and an occupational therapist) were interviewed, and specific knowledge, skills, and abilities were identified as important when establishing a quality health care relationship. This information can be used to develop resources for health care providers when beginning work with Veterans and their families, as well as for Veterans themselves as they transition to receiving care in civilian systems.

All the King’s Horses and All the King’s Men: Falling Into Moral Injury, During the COVID-19 Pandemic

Health care providers who experienced giving care or abbreviating those services, during the COVID-19 pandemic, risked experiencing a sense of moral injury. Moral injury is a term to describe incidents where a health care provider knows the right thing to do, but constraints make it exceedingly difficult or impossible to execute the right course of action. These incidents likely also were present for sonographers and vascular technologists, and it is vital that these compromises for patients are recognized, and healing strategies offered to those suffering from moral injury. Some suggestions for treatment of moral injury are to recognize these experiences, seek solutions, provide empathy for patients and resources for health care providers. It may also be beneficial to allow employees and employers to forgive the mistakes made during the pandemic and focus on solutions to prevent future incidents of moral injury.

Reducing Violence in Riyadh's Emergency Departments: The Critical Role of Healthcare Providers.

Emergency department staff are at high risk of experiencing violence and aggression from patients and visitors, which can have negative impacts on healthcare providers in the ED. The aim of this study was to explore the role of healthcare providers in addressing local violence in Riyadh EDs and investigate their preparedness for managing violent incidents. We used a descriptive, correlational design with survey methodology to collect data from a convenience sample of nurses, ED technicians, physicians, and advanced practice providers in Riyadh city's EDs. To examine the associations, we used an analysis of variance (ANOVA) for unadjusted relationships and an analysis of covariance (ANCOVA) for adjusted associations. Measures included a demographic survey, and clinicians responded to an online survey. A total of 206 ED staff participated in the questionnaire, and 59% reported experiencing physical violence during an ED shift, with 61% of incidents being caused by relatives. Additionally, 32% of the participants witnessed workplace violence. Our findings revealed that male healthcare workers, physicians, and those working in the governmental sector were at the highest risk of experiencing violence. We also found a statistically significant association between the rate of patients seen in the ED and the frequency of assault (physical or verbal) in the ED. Our results suggest that the rate of workplace violence in Riyadh EDs is high, and more efforts are needed to protect the health and well-being of healthcare providers. Senior management should take a position against ED domestic violence and reinforce managerial and healthcare provider resources by adopting policies and procedures that protect healthcare workers' safety. This study provides valuable insights into the nature and prevalence of violence in Riyadh EDs and highlights the critical role of healthcare providers in reducing violence in EDs.

Factors associated with HIV testing among youth in Tanzania based on the 2016-2017 Tanzania HIV Impact Survey (THIS).

HIV testing continues to be a challenge among the young population in Tanzania. As of 2017, only 30% of 15-19-year-olds reported getting tested and receiving their results. This study will examine the demographic and socio-behavioral characteristics associated with HIV testing among adolescents and young adults in Tanzania. Interview data from the 2016-2017 Tanzania HIV Impact Survey (THIS) were analyzed on 10,128 adolescents and young adults 15-24 years of age, representing 10.5 million youth in Tanzania. Weighted logistic regression was used to model the relationship of HIV testing with demographic and socio-behavioral characteristics. Half (50%) of respondents reported ever having been tested for HIV. HIV testing was significantly lower among males compared with females (AOR = 0.5;95% confidence interval [CI] = 0.5-0.6; p<0.001), 15-19 year olds compared with 20-24 year olds (AOR = 0.4;95% CI = 0.4-0.5; p<0.001), no education compared with secondary or post-secondary education (AOR = 0.4;95% CI = 0.3-0.6; p<0.001), rural residents compared with urban residents (AOR = 0.7;95% CI = 0.6-0.9; p<0.001) and those who don't use condoms during sexual intercourse compared with those who do (AOR = 0.6;95% CI = 0.5-0.8; p<0.001). Among HIV-infected youth, younger age group, rural residents, education less than primary, single, high income, and sex workers were significantly associated with never testing for HIV. This study highlights the majority of characteristics affecting HIV testing among young people in Tanzania have not changed over the years, thus it is necessary to re-examine the current approaches to HIV testing. The COVID-19 pandemic will add to this challenge as it collides with the ongoing HIV epidemic and competes for needed medical supplies and health care provider resources. In light of this current situation, intensified and targeted HIV testing programs for at risk young populations in Tanzania should be prioritized.

Evaluating the evidence for sacubitril/valsartan across the continuum of heart failure.

Since initial publication of the PARADIGM-HF trial in 2014, sacubitril/valsartan has been investigated in various settings to establish optimal use, further expanding its indications in patients with heart failure (HF). Although numerous studies have been published, until recently these have primarily involved post hoc analyses from the PARADIGM-HF study itself with a consistent focus on use of sacubitril/valsartan in patients with HF with reduced ejection fraction (HFrEF). This has led to a gap in the literature regarding utility of sacubitril/valsartan in other HF subpopulations. The aim of this review is to provide a summary of recent clinical trials further expanding use and guideline recommendations for sacubitril/valsartan. The findings of 15 studies, including clinical trials and post hoc analyses, are summarized and describe the use of sacubitril/valsartan in additional HF subpopulations, such as HFrEF following hospitalization for acute decompensated HF and advanced HF, HF with preserved ejection fraction (HFpEF), and HF postmyocardial infarction. In addition, three studies investigating timing of initiation, dose titration regimens, and cost-effectiveness are examined. Select ongoing trials are also reviewed to demonstrate the continued commitment to further advance care of patients with HF. This comprehensive review serves as a resource for health care providers who pursue optimal utilization of sacubitril/valsartan in their respective clinical practices.

Walking, running, and recreational sports for knee osteoarthritis: An overview of the evidence.

We provided an overview of narrative reviews, systematic reviews, and meta-analyses that summarize primary evidence of how physical activity (PA) relates to structural progression of knee osteoarthritis (OA). This overview can serve as a resource for healthcare providers when recommending PA to patients with, or at risk, for knee OA. We searched the PubMED database for publications on "exercise" [MeSH Terms] and "knee osteoarthritis" [MeSH Terms]. We restricted our search to review articles, originally published in English, from 2005 to 2020. We then added several original studies to provide more detailed support of the findings of the review articles, based on the authors familiarity with the literature. We summarized the findings of 20 reviews and an additional 12 original studies. We found consistent evidence that common forms of PA (walking, running, and certain recreational sports) are not related to structural progression of knee OA, and can be safely recommended to patients with, or at risk, for knee OA. Healthcare providers can refer to this overview of the evidence, as well as current PA guidelines, when recommending PA to their patients with, or at risk for, knee OA. Future studies can support PA guidelines that target preserving the structural integrity of the knees.

Telehealth Expansion During the COVID-19 Pandemic and Beyond.

Information and resources for health care providers.

Implementierung der „Besonders qualifizierten und koordinierten palliativmedizinischen Versorgung“ (BQKPMV) – Erfahrungen und Sichtweisen von SAPV-Teams

IntroductionIn the course of the implementation of the German Hospice and Palliative Care Act of 2015, an agreement was reached to establish an intermediate level of outpatient palliative care (BQKPMV) in Germany. By its degree of specialization, this form of care is located between generalist and specialist outpatient palliative care (AAPV/SAPV). It is still unclear which experiences the SAPV teams have gained with the approach of BQKPMV and how it affects their care routines. MethodsBetween May and August 2021, the project team developed and tested a questionnaire for SAPV teams about their experiences with and views on BQKPMV as a care approach at the interface to SAPV. In September 2021, all 58 teams providing SAPV in Lower Saxony were invited to participate. The information provided by the participants was analyzed using descriptive statistics and frequency analyses. ResultsWith 52 participants (78% female; mean age of 50 years), a participation rate of 89.7 % was achieved. Twenty-eight participants indicated that they were aware of BQKPMV and its content, and 10 had received a request for cooperation under the BQKPMV program. Fifty percent of these 10 requests (n = 5) led to a cooperation agreement.The following questions were answered only by participants who were familiar with the content of BQKPMV (N = 28). For a majority of 15 participants, the BQKPMV has (rather) no part in day-to-day care in SAPV. From the participants’ point of view, BQKPMV largely fails to supplement the existing regulations of SAPV in a meaningful way (n = 14 is not [likely] true), to promote smooth transition between the forms of outpatient palliative care (n = 13 is not [likely] true) and to facilitate communication among the professionals involved (n = 13 is not [likely] true). DiscussionThese results show that the participating SAPV teams know little about BQKPMV and that there has been little cooperation at the interface between SAPV and BQKPMV. In day-to-day care, there is a clear separation between SAPV and BQKPMV provided by general practitioners, which corresponds with the proposition of the legislator by excluding simultaneous provision of both forms of care. The close cooperation between general practitioners and SAPV teams, which is also required under the agreement regarding BQKPMV, leads to challenges in day-to-day care. ConclusionIt remains unclear whether and to what extent the close cooperation envisaged in the framework of BQKPMV can be put into practice at the interface between general practitioners and SAPV teams in their daily routines. Practical recommendations for advancing BQKPMV are needed, which, for example, address the exclusion of the simultaneous provision of both forms of care. Further developments of BQKPMV should aim at establishing a framework in which the tasks and duties of health care provision are distributed and remunerated in accordance with the competencies and resources of health care providers.

Continuing Professional Development in Response to COVID-19: Knowledge Mobilization for Occupational Therapy and Physiotherapy via a Curated Web Site.

Once the COVID-19 pandemic was declared, clinicians were redeployed to prepare for increased hospitalizations. This disruption necessitated rapid continuing professional development (CPD) resources for health care providers. This mixed-method study explored the experiences of occupational therapists and physiotherapists who accessed a CPD Web site that provided educational resources related to the pandemic to refresh their clinical knowledge and skills. Faculty from the Michener Institute of Education at the University Health Network and University of Toronto along with 60 collaborators created a Web site to support the need for rapid CPD. An occupational therapist and physiotherapist advisory group informed the evolving design of the occupational therapy and physiotherapy content. In the occupational therapy profession 535 users created an account between April and November 2020 (236 practicing, 283 students, and 16 did not specify) and in the physiotherapy profession 829 created an account (532 practicing, 278 students and 19 did not specify). Each user viewed an average of 53 Web pages. Three themes emerged: (1)To prepare for practice changes, clinicians value a single repository of information; (2) Web site features can either facilitate or hinder access to the needed information; and (3) Participants described diverse learning needs. The Web site design features assisted participants in preparing for redeployment and patient care. Features to encourage self-directed learning, such as the grouping of relevant topics and self-check quizzes, can enhance the user experience.

Institutional analysis of intra- and post-operative tracheostomy management for risk reduction.

Determine variability in intra- and post-operative management of tracheostomies (trachs) at our institution as existing literature suggests that trachs are a frequent trigger for airway-related emergencies. Catalyze the development of an institution-wide protocols for trach care. A 39-question online survey was sent to 55 providers who perform open and percutaneous trachs at three of the hospitals within our large, urban, academic medical center. These providers were identified by surveillance of the operating room schedules for 1 year. The survey was completed by 40 of the 53 eligible providers (75.5%). Response rate by question varied. Respondents included members of all departments that perform trachs at our institution (Otorhinolaryngology, Trauma Surgery, Thoracic Surgery, General Surgery, Cardiovascular Surgery and Interventional Pulmonology).While most responses demonstrated uniformity in practice, notable variations included the following: 80% of percutaneous trach providers stated that morbid obesity was not a contraindication to performing a trach outside of the operating room (n = 20) while 58% of open trach providers stated that morbid obesity was a contraindication; only 35% of open trach providers perform a Bjork flap (n = 350). The survey also identified significant variability in practice with regards to timing of trach suture removal. Lack of uniformity was identified in several practices related to intra- and post-operative tracheostomy care. Results did, however, trend toward consensus in many areas. The results are being used to establish a more consistent approach to tracheostomy management across our institution to ensure standardization of practice amidst the rapidly evolving practices of trach placement. With ongoing evolution in the methods of trach placement and its management, the concepts put forth here will be a resource for health care providers at other institutions to consider intra-institutional analysis and establishment of practice standardization.

26452 Impact of COVID-19 on patient willingness to seek in-person dermatologic care

The coronavirus-19 (COVID) pandemic has hindered health care provider operations, and its impact on patient willingness to seek in-person dermatologic care lacks extensive study. Understanding how a pandemic may influence patient motivation to consult a dermatologist may facilitate efficient allocation of health care provider resources both during and after COVID. Participants (n = 416) were recruited through Amazon Mechanical Turk, a web-based survey platform. Subjects were randomized to one of fourteen groups, each entailing a pre-COVID or during-COVID hypothetical scenario of a socially stigmatized skin condition: scalp psoriasis, herpes labialis, acne vulgaris, rosacea, tinea faciei, melanoma, or a benign nevus. Subjects rated their willingness to schedule an in-person dermatology appointment on a 5-point Likert scale (ie, willingness score). Sociodemographic data were collected. Herpes labialis, tinea faciei, and melanoma prompted higher willingness scores during COVID (3.94; 4.03; 3.54) compared with pre-COVID (3.81; 4.0; 3.32); scalp psoriasis, acne vulgaris, rosacea, and benign nevi prompted lower willingness scores during COVID (3.33; 2.88; 3.67; 3.07) compared with pre-COVID (3.93; 3.19; 4.21; 3.7). The benign nevus group displayed the largest decrease in willingness scores from pre-COVID (3.7) to during COVID (3.07). Patients reported higher willingness to seek in-person evaluation for conditions associated with stronger social stigmas, such as scalp psoriasis and herpes labialis, during COVID. We did not control for subject familiarity with each skin condition, and perceived degree of disfigurement was not measured. Patient willingness to seek treatment during COVID may be changing rapidly and, at this time, does not appear to be largely affected by the pandemic.

ROADMAP TO RESTARTING ELECTIVE SURGERIES POST COVID 19 PANDEMIC - AN ANESTHETISTS PERSPECTIVE

Corona Virus Disease (COVID 19) is a respiratory infection caused by SARS-CoV-2 or COVID 19 virus which struck the world in November 2019 rapidly spreading and attaining the form of a pandemic by March 2020.The disease was officially named as Coronavirus Disease-2019 (COVID-19) by WHO on February 11, 2020.Spread is predominantly through respiratory droplet and close contacts with infected individuals. Airborne transmission is possible during aerosol generating medical procedures as the virus is abundantly present in nasopharyngeal, salivary secretions and body fluids of affected patients. During the pre-peaking, peak and plateau phase of the epidemic, non-emergency surgeries and invasive procedures took a backseat as all resources of healthcare providers were put to combat the disease. As the pandemic fades away the need of adapting the healthcare facilities and restarting elective surgeries has to be addressed. In this article we try to highlight the various challenges faced by the surgeons, anesthetists and healthcare professionals to restart elective surgical work. The strategies to overcome these hurdles are also discussed.

International consensus guidelines for phosphoglucomutase 1 deficiency (PGM1-CDG): Diagnosis, follow-up, and management.

Phosphoglucomutase 1 (PGM1) deficiency is a rare genetic disorder that affects glycogen metabolism, glycolysis, and protein glycosylation. Previously known as GSD XIV, it was recently reclassified as a congenital disorder of glycosylation, PGM1-CDG. PGM1-CDG usually manifests as a multisystem disease. Most patients present as infants with cleft palate, liver function abnormalities and hypoglycemia, but some patients present in adulthood with isolated muscle involvement. Some patients develop life-threatening cardiomyopathy. Unlike most other CDG, PGM1-CDG has an effective treatment option, d-galactose, which has been shown to improve many of the patients' symptoms. Therefore, early diagnosis and initiation of treatment for PGM1-CDG patients are crucial decisions. In this article, our group of international experts suggests diagnostic, follow-up, and management guidelines for PGM1-CDG. These guidelines are based on the best available evidence-based data and experts' opinions aiming to provide a practical resource for health care providers to facilitate successful diagnosis and optimal management of PGM1-CDG patients.

Exclusively Digital Health Interventions Targeting Diet, Physical Activity, and Weight Gain in Pregnant Women: Systematic Review and Meta-Analysis.

BackgroundInterventions to promote a healthy diet, physical activity, and weight management during pregnancy are increasingly embracing digital technologies. Although some interventions have combined digital with interpersonal (face-to-face or telephone) delivery, others have relied exclusively on digital delivery. Exclusively digital interventions have the advantages of greater cost-effectiveness and broader reach and as such can be a valuable resource for health care providers.ObjectiveThis systematic review aims to focus on exclusively digital interventions to determine their effectiveness, identify behavior change techniques (BCTs), and investigate user engagement.MethodsA total of 6 databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], PsycINFO, Cumulated Index to Nursing and Allied Health Literature [CINAHL] Plus, Web of Science, and ProQuest) were searched for randomized controlled trials or pilot control trials of exclusively digital interventions to encourage healthy eating, physical activity, or appropriate weight gain during pregnancy. The outcome measures were gestational weight gain (GWG) and changes in physical activity and dietary behaviors. Study quality was assessed using the Cochrane Risk of Bias tool 2.0. Where possible, pooled effect sizes were calculated using a random effects meta-analysis.ResultsIn total, 11 studies met the inclusion criteria. The risk of bias was mostly high (n=5) or moderate (n=3). Of the 11 studies, 6 reported on GWG as the primary outcome, 4 of which also measured changes in physical activity and dietary behaviors, and 5 studies focused either on dietary behaviors only (n=2) or physical activity only (n=3). The meta-analyses showed no significant benefit of interventions on total GWG for either intention-to-treat data (−0.28 kg; 95% CI −1.43 to 0.87) or per-protocol data (−0.65 kg; 95% CI −1.98 to 0.67). Substantial heterogeneity in outcome measures of change in dietary behaviors and physical activity precluded further meta-analyses. BCT coding identified 7 BCTs that were common to all effective interventions. Effective interventions averaged over twice as many BCTs from the goals and planning, and feedback and monitoring domains as ineffective interventions. Data from the 6 studies reporting on user engagement indicated a positive association between high engagement with key BCTs and greater intervention effectiveness. Interventions using proactive messaging and feedback appeared to have higher levels of engagement.ConclusionsIn contrast to interpersonal interventions, there is little evidence of the effectiveness of exclusively digital interventions to encourage a healthy diet, physical activity, or weight management during pregnancy. In this review, effective interventions used proactive messaging, such as reminders to engage in BCTs, feedback on progress, or tips, suggesting that interactivity may drive engagement and lead to greater effectiveness. Given the benefits of cost and reach of digital interventions, further research is needed to understand how to use advancing technologies to enhance user engagement and improve effectiveness.

Abstract A062: Intersectionality in cancer health disparities: Rurality, socioeconomic factors, and health resources

Abstract Purpose: Cancer health disparities are results of complex, intersectional effects of many factors that shape people’s exposure and response to disease risks and patterns of health service utilization. We examined the cancer incidence and mortality rates in different types of rural places that were classified based on relevant population and health-resource characteristics. Methods: We developed a taxonomy of rural places using the most recent census, American Hospital Association Survey, Nursing Home Compare, and National Provider Identifier data. Cluster analysis was used to empirically classify US nonmetropolitan counties into distinct types of places based on both population characteristics (race/ethnicity, poverty, unemployment rate, health insurance status, and age distribution) and health resources (numbers of primary care physicians, specialists, other providers, staffed hospital beds, skilled nursing facility beds, and average daily census per capita). Surveillance, Epidemiology, and End Results data from 18 cancer registries were used to analyze the differences in 2000-2016 age-adjusted incidence rate (AAIR), late-stage incidence rate, and mortality rate (AAMR) for all cancers and behavior-related cancers (e.g., cancers associated with alcohol use, tobacco use, HPV, physical activity) between urban and different types of rural counties. Principal Findings: Four distinct types of rural places were identified based on four intersecting factors: economic and racial factor, age distribution, healthcare provider resources, and healthcare facility resources. The four types of rural counties included: Type 1 with lower economic resources and more racial/ethnic minority; Type 2 with younger population, higher economic resources, and fewer racial/ethnic minority; Type 3 with older population; and Type 4 with higher healthcare provider and facility resources. Type 1 rural counties had a lower all cancer AAIR (448.7 per 100,000) than urban and other types of rural counties. Urban and Type 4 rural counties had slightly higher AAIR for cancers associated with alcohol use (137.4 and 137.3) and low physical activity (97.4 and 97.0). Type 1 rural counties had higher AAIR for cancers associated with tobacco use (214.1) and HPV (13.2). For late-stage AAIR, Type 1 rural counties had significantly higher rates for all cancers combined (123.7) and for every type of behavior-related cancers. Type 1 rural counties also had a significantly higher AAMR (197.1) than all other types of counties (AAMR ranges between 168.5 and 177.6). Conclusions: Based on relevant population and health-resource characteristics, there appear to be four distinct types of rural places. Rural places that have lower economic resources and more racial/ethnic minority experience higher cancer health disparities reflected in higher incidence rates for certain behavior-related cancers, higher late-stage incidence rates, and higher mortality rate. Citation Format: Xi Zhu, Amanda R Kahl, Mary E Charlton. Intersectionality in cancer health disparities: Rurality, socioeconomic factors, and health resources [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A062.

Improving LGBTQ Health and Well-Being.

Free, evidence-based resources for health care providers, individuals, and families.

Review of Emerging Pharmacotherapy for the Treatment of Coronavirus Disease 2019.

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has evolved into an emergent global pandemic. Coronavirus disease 2019 (COVID‐19) can manifest on a spectrum of illness from mild disease to severe respiratory failure requiring intensive care unit admission. As the incidence continues to rise at a rapid pace, critical care teams are faced with challenging treatment decisions. There is currently no widely accepted standard of care in the pharmacologic management of patients with COVID‐19. Urgent identification of potential treatment strategies is a priority. Therapies include novel agents available in clinical trials or through compassionate use, and other drugs, repurposed antiviral and immunomodulating therapies. Many have demonstrated in vitro or in vivo potential against other viruses that are similar to SARS‐CoV‐2. Critically ill patients with COVID‐19 have additional considerations related to adjustments for organ impairment and renal replacement therapies, complex lists of concurrent medications, limitations with drug administration and compatibility, and unique toxicities that should be evaluated when utilizing these therapies. The purpose of this review is to summarize practical considerations for pharmacotherapy in patients with COVID‐19, with the intent of serving as a resource for health care providers at the forefront of clinical care during this pandemic.