Specialty Setting Research Articles

COVID-19 and paediatric health services: A survey of paediatric physicians in Australia and New Zealand.

AimsCOVID‐19 is now a global pandemic. At the time of survey, fewer than 150 children in Australia and New Zealand had documented infection. The aim of this study was to assess attitudes, readiness and confidence in the early stages of the COVID‐19 pandemic through an online survey of paediatric physicians and sub‐specialists across Australia and New Zealand.MethodsMultiple email list groups were used to contact paediatric physicians to undertake an online Likert scale survey between 17 and 24 March. Respondents' specialty, experience and work setting were recorded. Ordinal logistic regression was used to determine respondent factors.ResultsThere were 542 respondents from across Australia and New Zealand: an estimated 11% of the paediatric physician workforce. A minority (36.6%) agreed that their national response had been well coordinated; the majority (92.7%) agreed that senior‐level hospital administrators were taking the situation seriously. Most reported a good understanding of the natural history of COVID‐19 in children, and knowledge of where to find local information. A large proportion of physicians (86.1%) were worried about becoming infected through their work; few (5.8%) reported that they would not come to work to avoid infection. Closure of school and childcares would reduce the ability to continue work at current capacity for 23.6% of respondents.ConclusionDespite limited experience in pandemics, most paediatric physicians felt informed. Concern about exposure at work is common; most were willing to work regardless. The closure of schools and daycares may have an impact on staffing. Coordination and leadership will be critical.

Assessment of Human Trafficking Knowledge Among Staff in a Tertiary Care Academic Medical Center [05G

INTRODUCTION: Millions of men, women, and children are trafficked around the world every year, a number that continues to increase annually. Victims of human trafficking frequently interact with the healthcare system, yet often go unnoticed. Healthcare practitioners hold an important role in recognizing, caring for, and referring victims of trafficking. This study aimed to assess the baseline level of knowledge related to human trafficking amongst staff at a large university hospital. METHODS: A previously validated survey was distributed to all employees at Banner University Medical Center using an online module format. A gift card raffle was utilized as incentive to participate. The study was IRB approved. RESULTS: There were a total of 2,042 survey responses. Respondents were stratified into groups based on role, specialty, and primary practice setting. A total of 81% have never received human trafficking training. Those who indicated prior training demonstrated a higher level of knowledge of human trafficking-related questions, and also felt more confident identifying and treating victims of trafficking. All groups of respondents indicated that the preferred method of additional training be pre-recorded online modules. CONCLUSION: These results support the need for targeted training related to human trafficking. This will allow a thoughtful and targeted approach to education and resource sharing within and among hospital staff. Moreover, the results indicate that additional training allows staff to feel more equipped to identify and intervene when interacting with victims of human trafficking.

Who Is Prescribing Opioids Preoperatively? A Survey of New Patients Presenting to Tertiary Care Adult Reconstruction Clinics.

Preoperative opioid use is detrimental to outcomes after hip and knee arthroplasty. This study aims to identify the prevalence of preoperative opioid prescriptions and the specialty and practice setting of the prescriber, as well as the percentage of patients who do not report their opioid prescriptions and any variables associated with preoperative opioid prescriptions. A total of 461 consecutive new patients evaluated for an arthritic hip or knee were retrospectively studied using institutional data from a tertiary-care, urban center at a university-affiliated private-practice and the state Prescription Monitoring Program to identify opioid prescriptions (including medication, number of pills and dosage, refills, prescriber specialty, and practice setting) within 6 months before their first appointment. Demographic data included age, sex, ethnicity, body mass index, joint, laterality, diagnosis, Charlson Comorbidity Index, duration of symptoms, decision to have surgery, number of days from the first visit to surgery, smoking status, alcohol use, mental health diagnoses, preoperative outcome scores, nonopioid medications, and opioid medications. Patients were separated into opioid and nonopioid cohorts (opioid receivers were further subdivided into those who reported their opioid prescription and those who did not) for statistical analysis to analyze demographic differences using t-tests and Mann-Whitney U tests for continuous variables, the Fisher exact test for categorical variables, and multivariate logistic regression. One hundred five patients (22.8%) received an opioid before the appointment. Fifty-two (11.3%) received schedule II or III opioids, 43 (9.3%) received tramadol, and 10 (2.2%) received both. Primary care physicians were the most common prescriber (59.5%, P < 0.001) followed by pain medicine specialists (11.3%) and orthopaedic surgeons (11.3%). More prescribers practiced in the community than academic setting (63.8% versus 36.2%, P < 0.001). Seventy-eight patients (74.3%) self-reported their opioid prescriptions, with the remaining 27 patients (25.7%; 14 schedule II or III opioids and 13 tramadol) identified only after query of the Prescription Monitoring Program. In regression analysis, higher body mass index, diagnosis other than osteoarthritis, and benzodiazepine use were associated with receiving opioids (P < 0.05), while antidepressant use decreased the likelihood of self-reporting opioid prescriptions (P = 0.044). A striking number of patients are being treated with opioids for hip and knee arthritis. Furthermore, many patients who have received opioids within 6 months do not report their prescriptions. Although primary care physicians prescribed most opioids for nonsurgical treatment of arthritis, a substantial percentage came from orthopaedic surgeons. Further education of physicians and patients on the ill effects of opioids when used for the nonsurgical treatment of hip and knee arthritis is warranted. Level III, retrospective cohort study.

FAMILY AFFLUENCE RELATIONSHIP TO SPORTS SPECIALIZATION IN YOUTH ATHLETES

Background:Specializing in a single sport while excluding others, also known as sports specialization, is increasing in prevalence in the United States. The effect of socioeconomic status (SES) on rates of sports specialization has been previously described in the specialty clinic setting using zip code as a surrogate for SES. Patient-reported family affluence, a validated surrogate for SES, may provide more specific information about how family SES is associated with sport specialization.Purpose/Hypothesis:Our purpose was to examine the association between patient-reported SES and sport specialization level. We hypothesized that athletes who reported higher levels of sports specialization would report greater family affluence.Methods:We conducted a cross-sectional study of youth athletes undergoing a pre-participation evaluation. During the assessment, participants specified their level of sport specialization on a 3-point scale described originally by Jayanthi and colleagues. Participants also completed the Family Affluence Scale, a 6-item scale which is a valid correlate of parental income. We compared family affluence among the sport specialization groups (low/medium/high) using ANOVA with Tukey post-hoc comparisons. We then constructed a multivariable linear regression model to assess the association between family affluence and sport specialization level while controlling for potential confounding variables.Results:A total of 195 youth athletes participated in the study. The majority (52%) reported low levels of sport specialization, 33% reported medium sport specialization, and 15% reported high sport specialization. The sport specialization groups were similar in age, proportion of females, and time spent training in their sport (Table 1). A significantly larger proportion of highly specialized athletes were varsity athletes compared to the low specialization group (Table 1). The high sport specialization group reported significantly greater family affluence than the low sport specialization group (Figure 1). After covariate adjustment, higher levels of sport specialization remained significantly associated with greater reported family affluence (Table 2).Conclusion:In our population of youth athletes, high sports specialization was associated with greater family affluence. Additionally, we found a significantly higher proportion of varsity level athletes in the high sports specialization groups. This study extends previous studies identifying greater sports specialization levels among those with higher SES. By using the Family Affluence Scale and sampling from a large and diverse population during a pre-participation evaluation, our findings reflect accurate patient-level associations. Examining SES and sports specialization affords the sports medicine community an opportunity to better identify and monitor populations who are likely to specialize in a single sport during high school.Table 1.Characteristics of the three sport specialization groups. Continuous variables are presented as means (95% confidence intervals), categorical variables are presented as n (%).VariableLow Sport Specialized(n=101)Medium Sport Specialized(n=64)High Sport Specialized(n=30)P valueAge (years)15.2 (14.8, 15.6)15.3 (15.0, 15.6)15.7 (15.3, 16.1)0.26Female sex49 (49%)29 (45%)17 (57%)0.60Time spent training in sport(hours per week)11.9 (10.8, 13.1)11.6 (10.3, 13.0)12.5 (10.8, 14.1)0.75Varsity athlete28 (28%)26 (41%)15 (50%)0.04** A significantly higher proportion of high sport specialized athletes reported competing at the varsity level compared to low specialized athletes.Figure 1.Family Affluence Ratings between the low, medium, and high sports specialization groups. Data are presented as means (95% confidence intervals). Higher values on the family affluence scale reflect higher socioeconomic status. ANOVA analysis indicated a significant effect between groups (F=5.73; p= 0.0038). Tukey post-hoc comparisons indicated the high sport specialization group had significantly greater family affluence compared to the low sport specialization group (contrast= 1.19; p=0.005; 95% confidence interval for difference= 0.30, 2.08).Table 2.Multivariable regression model results for the association between sport specialization level and family affluence, while controlling for potential confounding variables.Variableβ coefficientStandard error95% confidence intervalP valueSport Specialization Level0.480.190.11, 0.860.012*Varsity athlete0.340.32-0.29, 0.980.29Age-0.040.09-0.21, 0.140.69Sex0.160.29-0.40, 0.730.57Hours per week training in sport-0.020.03-0.08, 0.030.41*After covariate adjustment, higher levels of sport specialization were significantly associated with greater family affluence.

Association between clinical specialty setting and disease management in patients with psoriatic arthritis: results from LOOP, a cross-sectional, multi-country, observational study.

Psoriatic arthritis (PsA) is a chronic and debilitating disease that can be managed by different clinical specialists. The objective of the LOOP study was to evaluate the impact of clinical specialty setting on the time to diagnosis and treatment of patients with PsA. Clinical disease activity and disease burden were also compared between clinical settings. LOOP was a cross-sectional, multicentre, observational study conducted in 17 countries in Western and Eastern Europe, the Middle East, Latin America and Asia. Adult patients (≥18years) with a suspected or established diagnosis of PsA who were routinely visiting a rheumatologist, dermatologist or non-rheumatology/non-dermatology physician were enrolled. All patients were assessed by both a rheumatologist and a dermatologist. Of 1483 enrolled patients, a total of 1273 had a confirmed diagnosis of PsA. There was no significant difference in the median time from onset of inflammatory musculoskeletal symptoms to PsA diagnosis between patients enrolled by rheumatologists and dermatologists (6.0 vs. 3.9months). However, the median time from diagnosis to first treatment with a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) was significantly shorter in the rheumatology setting compared with the dermatology setting (0 vs. 2.0months; P<0.001). In addition, disease activity was significantly higher in the dermatology setting compared with the rheumatology setting. Differences in the management and clinical status of patients with PsA were observed between the rheumatology and dermatology settings. Importantly, median time from diagnosis to first csDMARD was significantly shorter in the rheumatology setting, and patients in the dermatology setting had higher disease activity. These data show the importance of improved collaboration between rheumatologists and dermatologists.

Increasing Volume of Bone Marrow Biopsies by Radiology Providers: Evaluation of Trends by Physician Specialty and Practice Setting.

The aim of this study was to evaluate trends in bone marrow biopsies performed in the United States by physician specialty and practice setting. The CMS Medicare Physician Supplier Procedure Summary database was queried from 2005 to 2016 for bone marrow biopsies and aspirations (BMBs). Data were categorized according to the largest subspecialty groups (medicine, surgery, radiology, pathology, and other) and encounter setting (office, inpatient hospital, and outpatient hospital). Trends in procedure volume by specialty and practice setting were evaluated. Between 2005 and 2016, an annual average of 11,417 BMBs were performed (range, 10,380-14,204), with no significant year-over-year change in volume. Medicine was the largest provider of BMBs by specialty, although their market share over this time period declined from 60.2% to 36.6%. Radiology saw the greatest growth in BMB market share from 4.1% to 16.2%. The compound annual growth rate (CAGR) of BMBs performed by medicine subspecialists demonstrated a decrease in year-over-year procedural volume at-5.16% (P < .001). Both surgery and radiology demonstrated positive trends in the number of BMBs performed, with CAGRs of 6.20% (P < .001) and 12.43% (P < .001), respectively. Independent of physician specialty, there was a decrease in the number of biopsies performed in the office setting, decreasing by a CAGR of-5.59% (P < .001). From 2005 to 2016, medicine has remained the primary provider of BMBs, although their market share has declined. Radiology has experienced the greatest rate of growth in this time period and now represents the third largest individual specialty providing this service.

From regulation to practice: Mapping the organisational readiness for registered nurse prescribers in a specialty out-patient clinic setting

From regulation to practice: Mapping the organisational readiness for registered nurse prescribers in a specialty out-patient clinic setting

Identifying and responding to trial implementation challenges during multisite clinical trials

IntroductionThe National Drug Abuse Treatment Clinical Trials Network (CTN) was initiated by the National Institute on Drug Abuse (NIDA) in 2000 with the aim of improving substance use treatment and reducing the time between the discovery of effective treatments and their implementation into clinical practice. While initial trials were conducted almost exclusively in specialty addiction treatment settings, the CTN began evolving strategically in 2010 to conduct research in general medical settings, including healthcare systems, primary care settings, emergency departments, and pharmacies, to broaden impact. The advantages of a research network like the CTN is not only the collective content expertise that investigators contribute to the network, but the collective experience gained by conducting studies in the network and then applying those lessons to future studies. ObjectiveTo summarize trial implementation challenges encountered, and the process by which solutions were identified and implemented, within one of the last early-phase CTN Stage II behavioral intervention studies conducted in a specialty addiction treatment setting. Method and resultsWe describe the implementation of the CTN-0037 STimulant Reduction Intervention using Dosed Exercise (STRIDE) trial. Issues encountered during study implementation are categorized into four major areas, described in terms useful to future study teams: 1) study team infrastructure challenges, 2) participant- and site- level challenges, 3) intervention-related challenges, and 4) longitudinal study design challenges. Potential consequences of identified problems and the solutions developed to manage these problems are discussed within the context of these four areas. We propose how to extend these implementation lessons and apply them in other healthcare settings to expand the CTN. ConclusionsEffective study management allows for flexible, collaborative solutions to expected and unexpected obstacles to study success. Implementation strategies derived from the first 15 to 20 years of CTN studies are a result of working with providers and participants, and the ongoing collaboration among CTN investigators and network staff. Timely identification and response to problems during study implementation are critical to the success of a trial, regardless of its design. We believe a collaborative approach to identifying and responding to study implementation challenges will increase the likelihood of successful adoption of relevant, efficacious interventions. As the CTN continues to expand, the wealth of successful trial implementation strategies developed during the first 20 years of the CTN need to be applied and adapted to studies in broader network settings, and considered in conjunction with more formalized implementation science processes that are currently available.

Analysis on the professional orientation of part-time nursing master degree graduates

Objective To explore the professional orientation of part-time nursing master, in order to provide reference for the cultivation and development of the education of part-time nursing master in China. Methods The information of colleges and universities with admission qualification in 2019 was searched, and the admission requirements and specialty orientation setting of 34 colleges and universities that enrolled part-time nursing master's degree students were investigated. Results The 24 colleges and universities set specific professional directions, mainly focusing on specialized nursing, accounting for 62.50% (15/24) of the total. Clinical work experience is not mandatory in all institutions; In central China and east China, 95.83% (23/24) and 91.67% (22/24) of the colleges and universities admitted students set their major directions respectively. Conclusion China′s part-time nursing postgraduate education is still in its initial stage, and the professional orientation of enrollment is varied but general, so it should be standardized to strengthen the direction of Traditional Chinese Medicine nursing. Educational development is not balanced among different regions, and academic exchanges and cooperation between colleges and universities should be strengthened. Key words: Nursing education; Professional degree postgraduate; Part-time graduate; Professional direction; Specialist care

3:27 PM Abstract No. 45 Evolution in national endovascular management of femoral-popliteal artery disease: an analysis of the 2011 to 2017 Medicare data

Multiple studies published over the past decade support an endovascular-first approach to management of femoral-popliteal artery disease. Data supporting use of drug-coated balloon angioplasty, atherectomy and stenting have grown in concert. We sought to describe national trends in utilization of each intervention by provider specialty and clinical setting. The Medicare Physician/Supplier Procedure Summary files containing 100% part B claims were interrogated for years 2011-2017. Current procedural terminology (CPT) codes specific for angioplasty-only (PTA), stenting, and atherectomy were used to create summary statistics for utilization by (1) year, (2) clinical setting (hospital inpatient, hospital outpatient, office-based labs), and (3) provider specialty (cardiology, radiology, surgery). All annual frequency data were normalized to 100,000 Medicare fee-for-service person-years. Atherectomy use increased substantially from 34,732/32.8% services in 2011 to 68,633/50.4% services in 2017 and is now the dominant treatment strategy for femoral-popliteal disease. Relative utilization of stenting (36,792/34.7% in 2011 vs. 29,511/21.7% in 2017) and angioplasty-only (34,398/32.5% in 2011 vs. 37,945/27.9% in 2017) decreased concomitantly. Atherectomy use was two-fold higher in the office compared with the outpatient hospital setting (83% OBL vs. 40% outpatient hospital in 2017). Treatment strategy varied by provider specialty in 2011 when cardiologists used atherectomy most frequently (17,925/42.9%), while radiologists used angioplasty-only (5928/45.7%) and surgeons stented (17,648 / 35.9%) most frequently. However, by 2017 all specialties utilized atherectomy most frequently (58.2% for cardiology, 49.7% for radiology, and 44.7% for surgery). National approach to endovascular management of femoral-popliteal artery disease has evolved since 2011, with physicians now favoring an implant-free strategy fueled primarily by a multifold increase in atherectomy use. Discordant rates of atherectomy use between the ambulatory and office setting raise the specter of potential billing abuse.

4:12 PM Abstract No. 363 Trends in advanced practice provider and physician volume and payments for peripherally inserted central catheters among Medicare beneficiaries from 2010 to 2017

To study the utilization of peripherally inserted central catheter (PICC) placement among Medicare beneficiaries and analyze the changing trends in total physician and advanced practice provider (APP) volumes and payments from 2010-2017. Claims from the Medicare Part B Physician/Supplier Procedure Summary Master File (PSPSMF) for the years 2010 to 2017 were extracted using the CPT codes for PICC placement. Total volumes and payment amounts (professional component) by specialty and practice setting were analyzed. Volume for PICC placement by physicians and APPs have steadily declined from 2010-2017 from 243,837 to 149,028 (38.9%). Total payments also decreased from $18,871,291 to $11,079,832 (41.3%). The relative share of placement by interventional radiologist (IRs) declined over that time period (from 77.0%-71.8%) with a corresponding increase in placement volume by APPs (13.6%-18.1%). The average payment (professional component) for IRs and APPs was not significantly changed, $75.18 and $66.02 respectively in 2017. 85% of PICCs were placed for inpatients, and 15% were placed for outpatients. The volume of PICC placement among Medicare beneficiaries has steadily declined since 2010. A sharper decline occurred between 2015 and 2016, correlating with the publication of guidelines, including the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC), recommending more restricted indications for PICCs. APPs have had an increasing role in PICC placement over this time period.

Abstract No. 524 Bone marrow biopsy provider trends in the United States by physician specialty and practice setting

Abstract No. 524 Bone marrow biopsy provider trends in the United States by physician specialty and practice setting

4:12 PM Abstract No. 316 Variations in endovascular management of infrapopliteal arterial disease: national trends from the Medicare procedure database

Growing evidence for the efficacy of endovascular interventions for infrapopliteal atherosclerotic arterial disease has led to increased utilization of these procedures. We aim to characterize developing national trends in use of balloon angioplasty (PTA), stenting, and atherectomy across clinical settings and provider specialties. The Medicare Physician/Supplier Procedure Summary data were used to quantify endovascular interventions performed for infrapopliteal arterial disease between 2011 and 2017 based upon submitted current procedural terminology (CPT) codes. Enrollment-adjusted results were stratified by year and analyzed by provider specialty (cardiology, radiology, and surgery) and clinical setting (office-based lab (OBL), hospital outpatient, and hospital inpatient). Between 2011 and 2017 there was a shift in treatment strategy of infrapopliteal disease, from PTA alone (59.8% to 48.4% of interventions) to substantially increased use of atherectomy (32.4% to 47.8%). Cardiologists were the first to adopt atherectomy as primary therapy (52.8% of interventions). By 2017, radiologists used PTA-only and atherectomy equally (49.3% atherectomy) and surgeons still performed more PTA-only than atherectomy (43.2% atherectomy). Stenting was consistent across specialties, accounting for 8% of cases in 2011 and 4% of cases in 2017. Clinical location impacted the intervention performed, with increasing use of atherectomy in the OBL setting compared to the hospital outpatient setting (58.9% OBL and 31.2% outpatient in 2011, 74.2% OBL and 32.8% outpatient in 2017). Hospital inpatient atherectomy was infrequently used (27.2% in 2011 and 25.3% in 2017). Endovascular treatment of infrapopliteal disease has shifted in recent years to predominant use of atherectomy. Cardiologists were early adopters of atherectomy, followed by radiologists, with surgeons still performing comparatively more PTA-only procedures. Atherectomy is much more prevalent in OBL than the hospital outpatient setting, suggesting possible inappropriate use. Stenting rates remained low and continued to decline, suggesting decreasing bailout for complications of other interventions.

Mental health concerns in patients with symptomatic peripheral artery disease: Insights from the PORTRAIT registry

ObjectivesTo document the prevalence and patient profiles of mental health concerns in patients with peripheral artery disease (PAD) seen in the vascular specialty setting. MethodsIn a cohort of 1275 patients presenting to 16 specialty clinics with new or worsening claudication, symptoms of depression, anxiety, and stress were quantified in 957 patients. The Patient Health Questionnaire-8 (PHQ-8), Generalized Anxiety Disorder scale-2 (GAD-2), and Perceived Stress Scale-4 (PSS-4) were assessed for mental health concerns at the initial PAD work-up and repeated 12 months later. PHQ-8 ≥ 10, GAD-2 ≥ 3 and PSS-4 ≥ 6 were considered significant for depression, anxiety and stress respectively. Patient characteristics were compared in groups divided by presence of 0, 1, 2 or all 3 mental health concerns. ResultsOn the initial office visit, 336/957 (35%) of patients had high levels of at least one of the three mental health concerns. At both baseline and 12 months, high levels of perceived stress were most often reported (28.7% and 17.5% respectively), followed by symptoms of depression (14.1% and 8.9%) and then anxiety (8.3% and 5.7%). Patients with mental health concerns were more often female, younger, had more financial strain, less social support, and worse perceived health status. ConclusionsMental health concerns, particularly stress, are highly prevalent in patients with PAD, especially upon first presenting with new or worsening symptoms. The role of stress and how it may impede successful PAD management and impact subsequent outcomes warrants further investigation.

On the establishment of social work major in Higher Vocational Colleges

Higher vocational colleges; Specialty setting; Social work

Physician Distribution by Specialty and Practice Setting: Findings in Japan in 2000, 2010 and 2016.

As the medical demand is projected to increase along with the population aging in Japan, the geographical distribution of physicians is a significant concern for society and policymakers. To implement effective measures on geographical physician distribution, this study aimed to describe and compare the distribution of physicians by specialty in 2000, 2010 and 2016 in Japan, and examine whether practice setting was associated with distribution. To quantify the geographical physician distribution by specialty, we calculated the Gini coefficients of physicians working at clinics or hospitals in 2000, 2010, and 2016. We used the basic geographic unit for medical care planning in Japan, a secondary medical area, as the study unit. To show the association between the geographical distribution of physicians in each specialty and their practice setting, we categorized specialties into two groups by the proportion of physicians in that specialty working in hospitals, and showed aggregated Lorenz curves for each category. The overall geographical distribution of physicians appeared to improve during the study period, but varied by specialty. Those in specialties, where at least 90% of physicians work in hospitals such as anesthesiologists and radiologists, were more clustered, as shown by the Lorenz curves and the Gini coefficients. Similar distributional differences were also found even when we excluded physicians working in clinics, meaning that the distributional variation could be explained by other factors than the distribution of hospitals. These results suggest that the nature of practice in each specialty strongly affects the geographical distribution of specialists.

Parental Preference for Parental Separation and Their Satisfaction Regarding Their Children Dental Treatment in Pediatric Dental Clinics in Saudi Arabia.

Aims and Objectives:Behavior management of child dental patients is essential for the provision of high-quality dental care and is influenced by parental preference. Therefore, this cross-sectional study aimed to assess parental satisfaction regarding dental treatment and different behavior management methods used with their children in a pediatric dental specialty setting at King Abdulaziz University Dental Hospital (KAUDH) in Jeddah, Saudi Arabia. In addition, it aimed to assess parental preference for parental separation and factors related to their preference.Materials and Methods:All parents of children attending the pediatric dental clinic at KAUDH in Jeddah, Saudi Arabia from September 2017 to June 2018 were included in this study. They were interviewed over the phone and were asked to complete a questionnaire on their acceptance of the behavior management techniques used with their children and their satisfaction with the treatment provided.Results:Of 549 parents, 283 agreed to participate (51.5% response rate). In 254 (89.7%) cases communication and communicative guidance were used, whereas 38 (13.4%) cases involved the use of N2O. Parental separation was preferred by 68 (24%) parents, and not preferred by 215 (76%). No significant relation was anticipated between the covariance and the dependent factor of parental preference (P > 0.05). The main reason for parents not preferring parental separation was “safety and protection,” as reported by 106 parents. On the contrary, the main reason for parental preference for separation was to “improve child’s behavior.”Conclusion:Parental satisfaction with the treatment outcome and behavior management methods was found to be acceptable. Most parents did not prefer parental separation, primarily because of concerns regarding safety and protection.

Implementation of intimate partner violence education for adolescents with spina bifida.

Intimate partner violence (IPV) prevention among adolescent patients with disability is needed, yet rarely discussed in the clinical setting. This study evaluated the feasibility of implementing a brief educational training based on an evidence-based IPV intervention in a pediatric spina bifida clinic. Frequency of IPV discussion was assessed through evaluation of patient feedback and provider surveys. Adolescent patients with spina bifida aged 12-21 completed after visit surveys before (N= 13) and after the provider training (N= 21). Primary outcomes included frequency of provider discussion about IPV and receipt of patient safety cards. Chi-square tests compared patient feedback prior to and two months following the education session. Provider knowledge and attitude changes were assessed with pre-post surveys. More patients discussed IPV with providers following the education session compared to baseline (p= 0.03). Provider feedback, both immediately and at two months after the education session showed increased awareness of IPV, comfort with assessment, disclosure, and referral to resources. The educational intervention increased provider comfort with addressing IPV within a specialty clinical setting. The frequency of IPV communication significantly increased as compared to baseline, patients reported the discussions were beneficial, and providers reported greater comfort discussing IPV and referring patients to resources.

Multidisciplinary Teams Knock Down Barriers to Medication Treatment for OUD

Multidisciplinary Teams Knock Down Barriers to Medication Treatment for OUD

Serious illness communication practices in glioblastoma care at an academic medical center.

28 Background: Glioblastoma (GBM) is an aggressive primary brain tumor with a disease course marked by both cognitive and physical decline. Early conversations about end-of-life (EOL) preferences are important given the average life expectancy of 14 months. Little is known about patterns of communication in GBM. Objective: To describe current practices surrounding EOL conversations in GBM patients at an academic medical center. Methods: We reviewed the medical records of 240 patients treated for GBM at the University of Pennsylvania who died between 2017 and 2019. We systematically identified and characterized EOL conversations, as defined by documented discussions of prognosis, goals of care, EOL planning and/or code status. Results: Patients in this study were predominantly male, white, privately insured and had relatively high performance status (median KPS 80 at initiation of therapy). Median survival was 487 days and 96% of patients received both chemotherapy and radiation. Nearly all patients (96%) had at least one EOL conversation documented. The median number of documented conversations per patient was 4. The first EOL conversation occurred at a median of 24 days after diagnosis (range 0 to 3,883) and 362 days before death (0 to 2,401). The last EOL conversation occurred at a median of 32 days before death (0 to 1,514). EOL conversations took place earlier among older patients, with each additional year of age at diagnosis associated with a first conversation 8 days earlier (95% CI: -12 to -4 days; p&lt;0.01). At least one EOL conversation occurred at an outpatient visit for 89% of patients; 33% had conversations during hospital admissions; and 38% had EOL conversations via telephone. Medical oncology was the most common specialty to document EOL conversations (89% of patients), followed by palliative care (19%), radiation oncology (13%) and neurosurgery (10%). Conclusions: EOL conversations appear to have occurred relatively early and often, but further work is needed to evaluate the quality of documented discussions and to determine whether this pattern is unique to this single center or widespread. The variety in provider specialty and conversation setting reflects the complexity of the care environment in GBM.