Team Involvement Research Articles

Missed opportunities to prevent risk of offending in young people with ADHD – a service evaluation from a central London FCAMHS service

ABSTRACT This service evaluation aims to explore the needs of young people (YP) with ADHD engaging in risk behaviours. Demographic, clinical, social, and service involvement data were extracted from records of 443 YP referred to a Forensic Community CAMHS service. A sixth (74, 16.7%) had a diagnosis of ADHD. They had similar CAMHS input (55, 74.3%) compared to those with autism but many more had Youth Offending Team (YOT) involvement (22, 29.7% with ADHD; 5, 6.4% with ASC). A quarter (20, 27.8%) were in mainstream school with a fifth (13, 18.1%) out of education or training (NEET). Half (41, 55.4%) had an Education, Health, and Care Plan (EHCP). The prevalence of ADHD in YP referred and high levels of YOT input suggests missed opportunities to prevent the development of poor outcomes and criminalisation, including those not open to CAMHS and, therefore, unable to access medication, and those out of education without an EHCP.

Patient Preferences and Priorities for the Design of an Acute Kidney Injury Prevention Trial: Findings from a Consensus Workshop.

High-quality clinical trials are needed to establish the efficacy and safety of novel therapies for acute kidney injury (AKI) prevention. In this consensus workshop, we identified patient and caregiver priorities for recruitment, intervention delivery, and outcomes of a clinical trial of cilastatin to prevent nephrotoxic AKI. We included adults with lived experience of AKI, chronic kidney disease, or risk factors for AKI (e.g., critical care hospitalization), and their caregivers. Using a modified nominal group technique approach, we conducted a series of hybrid in-person/virtual discussions covering 3 clinical trial topic areas: (1) consent and recruitment; (2) intervention delivery; and (3) trial outcomes. Participants voted on their top preferences in each topic area, and discussion transcripts were analyzed inductively using conventional content analysis. Thirteen individuals (11 patients, 2 caregivers) participated in the workshop. For consent and recruitment, participants prioritized technology enabled pre-screening and involvement of family members in the consent process. For intervention delivery, participants prioritized measures to facilitate ease of intervention administration and return visits. For trial outcomes, participants identified kidney-related and other clinical outcomes (e.g., AKI, chronic kidney disease, cardiovascular events) as top priorities. Analysis of transcripts provided insight into care team and family involvement in trial-related decisions, implications of allocation to a placebo arm, and impact of participants' experiences of AKI and critical illness. Findings from our workshop will directly inform development of a clinical trial protocol of cilastatin for nephrotoxic AKI prevention and can assist others in patient-centered approaches to AKI trial design.

The Implementation of Bilingual Education in Taiwan: A Case Study of Two Junior High Schools with a Bilingual Curriculum in Taipei City Using the FERTILE Model

The development of bilingual education has rapidly grown in the past few decades, with v and ying implementations reflecting each country’s political, social and cultural contexts. In response, the Taiwanese government launched the Bilingual 2030 policy in Taiwan to improve international competitiveness and communication. Employing the FERTILE model as the theoretical framework, this case study focuses on (1) comprehending the role of the administrative team in implementing bilingual education within schools and (2) exploring the function of bilingual teacher professional learning communities. The results indicate that the involvement of school administrative teams, along with the support from BPLCs, are essential for implementing bilingual education in schools. More importantly, this research highlights the importance of administrative teams in providing a supportive environment. Also, the support from administrative teams is significant for enhancing the function of BPLCs, which play a key role in improving teachers’ instructional strategies. The findings of this study can generate both theoretical and practical contributions to bilingual education in Taiwan. First, the findings provide schools and policy makers in Taiwan with valuable insights for fostering bilingual teacher professional learning communities. Second, the findings from the two case studies, which utilised the FERTILE model to implement bilingual education, can serve as references for its nationwide promotion.

2349 How to provide a cost-effective geriatric peri-operative service within general surgery in line with NELA BPT

Abstract Introduction More than 50% of patients undergoing emergency general surgery are >65 years. The Emergency Laparotomy and Frailty (ELF) study showed strong associations between frailty (CFS ≥ 5) and increased mortality, risks of complications, and length of hospital stay. Methods For nearly 10 years, we have had geriatric liaison input for general surgery and colorectal patients in a tertiary teaching centre. This has transformed into a fully embedded service involving consultant geriatrician, registrars and senior house offices, providing 3-day a week medical input. NELA best practice tariff (BPT) April 2023 emphasises perioperative Geriatric team involvement in frail patients aged 65 and above. The main metrics include CFS, an MDT-based risk assessment, treatment escalation decision making and perioperative geriatrician involvement. Results The service has previously demonstrated significant improvement in patient care and holistic management including reducing the length of stay in hospital (average decrease of 5.5 days). Simple job planning, use of current resources and efficiency can mean Trusts can incorporate geriatricians with essential skills to improve patient management and reach NELA BPT. Conclusion Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Introducing a multidisciplinary geriatric liaison service into the general surgical department can achieve high levels of compliance with national guidelines, resulting in better outcomes for patients as well as financial benefits for Trusts. This is particularly pertinent given the financial constraints on many services across the NHS, this is an opportunity to increase revenue and build a geriatric workforce.

European Society of Clinical Microbiology and Infectious Diseases/European Committee on infection control clinical guidelines on pre-operative decolonization and targeted prophylaxis in patients colonized by multidrug-resistant Gram-positive bacteria before surgery

ScopeThe aim of these guidelines is to provide recommendations for decolonization and perioperative antibiotic prophylaxis (PAP) in multidrug-resistant Gram-positive bacteria (MDR-GPB) adult carriers before inpatient surgery. MethodsThese European Society of Clinical Microbiology and Infectious Diseases/European Committee on Infection Control guidelines were developed following a systematic review of published studies targeting methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, methicillin-resistant coagulase-negative Staphylococci, and pan-drug-resistant-GPB. Critical outcomes were the occurrence of surgical site infections (SSIs) caused by the colonizing MDR-GPB and SSIs-attributable mortality. Important outcomes included the occurrence of SSIs caused by any pathogen, hospital-acquired infections, all-cause mortality, and adverse events associated with the interventions, including resistance development to the agents used and the incidence of Clostridioides difficile infections. The last search of all databases was performed on 1 November 2023. The level of evidence and the strength of each recommendation were defined according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Consensus of a multidisciplinary expert panel was reached for the final list of recommendations. Antimicrobial stewardship considerations were included. RecommendationsThe guideline panel reviewed the impact of decolonization, targeted PAP, and combined interventions (e.g. decolonization and targeted PAP) on the risk of SSIs and other outcomes in MDR-GPB carriers, according to the type of bacteria and type of surgery.We recommend screening for S. aureus before high-risk operations, such as cardiothoracic and orthopaedic surgery. Decolonization with intranasal mupirocin with or without a chlorhexidine bath is recommended in patients colonized with S. aureus before cardiothoracic and orthopaedic surgery and suggested in other surgeries. The addition of vancomycin to standard prophylaxis is suggested for MRSA carriers in cardiothoracic surgery, orthopaedic surgery, and neurosurgery. Combined interventions (e.g. decolonization and targeted prophylaxis) are suggested for MRSA carriers undergoing cardiothoracic and orthopaedic surgery. No recommendation could be made regarding screening, decolonization and targeted prophylaxis for vancomycin-resistant enterococci because of the lack of data. No evidence was retrieved for methicillin-resistant coagulase-negative Staphylococci and pan-drug-resistant-GPB. Careful consideration of the laboratory workload and involvement of antimicrobial stewardship and infection control teams are warranted before implementing screening procedures or performing changes in PAP policy. Future research should focus on novel decolonizing techniques, on the monitoring of resistance to decolonizing agents and PAP regimens, and on standardized combined interventions in high-quality studies.

Benefits of a spine team for the surgical management of paediatric scoliosis

BackgroundFor many years, blood-saving techniques and the enhanced recovery after surgery approach have been used to optimise the quality of care and shorten hospital stays. The creation of dedicated spine teams combining surgeons and anaesthesiologists specialised in spine surgery has been proven beneficial in adults. The objective of this study was to determine whether involving a spine team in the management of paediatric patients with scoliosis treated by posterior spinal fusion was associated with shorter hospital stays. HypothesisThe hospital stay would be shorter in patients managed by a spine team. Materials and methodsThis single-centre, non-randomised, comparative study was initiated after approval by the local ethics committee. One group of patients was managed by a spine team composed of an anaesthesiologist and a surgeon with over 10 years of experience and the control group by an anaesthesiologist and a surgeon with less than 5 years of experience. The primary outcome was hospital stay length (median [interquartile range]). ResultsThe study included 157 paediatric patients who underwent spinal fusion in 2021 for adolescent idiopathic scoliosis (AIS, n = 106) or secondary scoliosis (n = 51). The spinal team was involved for 48 (45%) AIS procedures and 38 (74.5%) secondary-scoliosis procedures. Both operative time and anaesthesia time were significantly shorter in the spinal-team group, by 10% and 15% (p < 0.001 for both comparisons), respectively, for SIA and by 20% (p = 0.002) and 25% (p < 0.001), respectively, for secondary scoliosis. The spinal-team group had a shorter median hospital stay, the difference being significant for AIS (in days, 5 [4–7] versus 7.1 [5–10], p = 0.03) and nearly significant for secondary scoliosis (6.9 [5–10] versus 9 [6–23], p = 0.07). Fewer patients required blood transfusion in the spine-team group than in the control group (AIS: 0% versus 8.8%, p = 0.05; and secondary scoliosis, 28% versus 58%, p<0.01). ConclusionInvolvement of a spine team optimises the peri-operative management of patients with AIS, thus shortening the hospital stay. Further work is needed to assess the potential associations of spine team involvement with complication rates. Level of evidenceIII; non-randomised comparative study.

Antecedents of Risk Information Sharing &amp; Processing Mechanism in Supply Chain: A social and technical Perspective

This paper emphasizes Supply Chain Risk Management (SCRM), whose execution can boost an organization's resilience and operating performance. Drawing on quantitative data from 231 supply chain professionals in various industries, the results highlight that subcomponents of SCRM—specifically strategy alignment and technology usage—significantly influence risk information sharing, analysis, and evaluation. Abstract Surprisingly, an SCRM-oriented culture does not significantly affect the exchange of risk information or the amount of risk partnership. At the same time, team support has insignificant effects on risk analysis and assessment. From these insights, it is evident that although having a culture of SCRM in place and some team involvement is beneficial, they could not, altogether, pave the way toward the organizational capability of evaluating and disseminating risk-related information. In its place, the emphasis on aligned SCRM strategy and technological advancement in the supply chain sector becomes a critical factor for risk mitigation. This suggests an absolute imperative for managers: to facilitate a technological-enabled SCRM approach that is collaborative, in line with the strategy, and allows integrated information processing. Fortifying these domains can help minimize weaknesses, increase response, and streamline the supply chain performance; continuous monitoring and improvement of information dissemination processes are essential, as they facilitate better risk management across the supply chain network.

Rehabilitation for Functioning and Quality of Life in Patients with Malignant Pleural Mesothelioma: A Scoping Review.

Malignant pleural mesothelioma (MPM) represents a significant clinical challenge due to limited therapeutic options and poor prognosis. Beyond mere survivorship, setting up an effective framework to improve functioning and quality of life is an urgent need in the comprehensive management of MPM patients. Therefore, this study aims to review the current understanding of MPM sequelae and the effectiveness of rehabilitative interventions in the holistic approach to MPM. A narrative review was conducted to summarize MPM sequelae and their impact on functioning, disability, and quality of life, focusing on rehabilitation interventions in MPM management and highlighting gaps in knowledge and areas for further investigation. Our findings showed that MPM patients experience debilitating symptoms, including fatigue, dyspnea, pain, and reduced exercise tolerance, decreasing quality of life. Supportive and rehabilitative interventions, including pulmonary rehabilitation, physical exercise improvement, psychological support, pain management, and nutritional supplementation, seem promising approaches in relieving symptoms and improving quality of life but require further research. These programs emphasize the pivotal synergy among patient-tailored plans, multidisciplinary team involvement, and disease-specific focus. Despite advancements in therapeutic management, MPM remains a challenging disease with limited effective interventions that should be adapted to disease progressions. Rehabilitative strategies are essential to mitigate symptoms and improve the quality of life in MPM patients. Further research is needed to establish evidence-based guidelines for rehabilitative interventions tailored to the unique needs of MPM patients.

Geriatricians' role in the management of aortic stenosis in frail older patients: a decade later.

Increasing evidence supports the implementation of geriatric assessment in the workup of older patients with aortic stenosis (AS). In 2012, an online European survey revealed that geriatricians were rarely involved in the assessment of candidates for transcatheter aortic valve implantation (TAVI). After a "call to action" for early involvement of geriatricians in AS evaluation, the survey was repeated in 2022. Our aim was to investigate whether geriatricians' role changed in the last decade. Online survey conducted between December 16th, 2021, and December 15th, 2022. All members of the European Geriatric Medicine Society were invited to participate. The survey included 26 questions regarding geriatricians' experience with AS and TAVI. Among 193 respondents (79.8% geriatricians), 73 (38%) reported to be involved in AS evaluation at least once a week. During 2 years prior to the survey, 43 (22.3%) had referred > 50% of their patients with severe AS for TAVI. Age influenced TAVI referral in a considerable proportion of respondents (36.8%). TAVI candidates were mainly referred to specialised cardiac centres with multidisciplinary teams (91.8%), including (47.2%) or not including (44.6%) a geriatrician. A total of 38.9% of respondents reported to be part of a multidisciplinary heart team. Geriatricians were less frequently involved (37%) than cardiologists (89.6%) and surgeons (53.4%) in pre-procedural TAVI management. Cardiologists were more frequently involved (85.5%) than geriatricians (33.7%) and surgeons (26.9%) in post-procedural management. Geriatricians' involvement in AS management and multidisciplinary heart teams remains scarce. More efforts should be devoted to implement geriatricians' role in AS decision-making.

A challenging Paediatric Airway Management; Acquired Tracheo-oesophageal Fistula Following Accidental Ingestion of a Metal Bobbin

Acquired trachea-esophageal fistula formation is a rare, life-threatening complication of delayed presentation of foreign body ingestion. Airway management of such a patient is a significant challenge to the anaesthetist due to air leak from the defect leading to difficult oxygenation and ventilation and gastric insufflation. The paediatric age group adds to the difficulty because of small airway caliber and difficult lung isolation.Multidisciplinary team involvement and close communication, prior imaging to identify the anatomy, and planning were vital for successful outcome.

Chronic shoulder pain due to spinal accessory nerve palsies present opportunities for improved care integration.

Aim: Chronic shoulder pain due to iatrogenic spinal accessory nerve (SAN) injury continues to be under-recognized, resulting in delayed time-to-diagnosis and poorer outcomes. Solutions are needed to improve the management of this condition, which can be challenging as care needs to be coordinated across pain management, neurophysiology, rehabilitationand reconstructive surgery.Cases: We present a series of sixpatients with shoulder pain refractory to conservative pain treatments to highlight how SAN injuries continued to be missed and treatment delayed, even at advanced care centers. The time to diagnosis of SAN palsy took an average of 21months and treatment was inconsistent for all patients.Discussion: None of the sixcases had initial suspicion of SAN palsy and only onepatient received targeted SAN injury care. SAN treatment should be started as early as possible so that patients can be referred for prompt surgical evaluation if they fail conservative management. Integrated care pathways may be a solution for formalizing multidisciplinary team involvement and improving SAN injury outcomes.Conclusion: Systemic processes, such as integrated care pathways, are needed to optimize early recognition and targeted treatment of SAN injury and may be beneficial for other underdiagnosed and undertreated neuropathic pain conditions.

Unraveling the Enigma of Gossypiboma: A Series of 14 Cases Highlighting the Prevalence, Root Causes, and Outcomes in Resource-Limited Settings.

Gossypiboma or textiloma is the unintentional retention of textile material in a patient's body, often occurring during abdominal surgery and involving surgical sponges. The body may respond to this foreign body with an exudative inflammatory reaction or an aseptic fibrotic reaction, encapsulating the cotton material and forming a mass. This rare but dramatic event can lead to life-threatening complications, and due to legal and ethical concerns, few publications exist. There were no published papers regarding this issue in our nation (Yemen). This study aims to report the retained surgical sponges' cases and their associated factors in a resource-limited setting to improve prevention. A retrospective case series study was conducted at hospitals affiliated with Ibb University, Ibb, Yemen, between March 22, 2018, and May 12, 2024. The study included 14 cases of diagnosed and surgically confirmed retained surgical sponges. Data on demographic characteristics, type of operation, and risk factors were gathered and analyzed. Among 15,120 surgical procedures, there were 14 cases of retained surgical sponges with a prevalence rate of 0.09%. The mean age was 32.5±17.0 years, with 10 (71.4%) females and 4 (28.6%) males. Gynecological surgery was the most common causal procedure (n=7, 50.0%). The most common clinical presenting features were abdominal pain in 12 (85.7%), followed by infections and a systemic reaction in 9 (64.3%). The median symptom incubation time was 37 days. 11 (78.5%) patients underwent abdominal X-rays, and 13 (92.8%) had abdominal ultrasounds, with 4 (28.6%) X-rays and 5 (35.7%) abdominal ultrasounds being deemed non-diagnostic. An abdominal-pelvic CT scan was done on 11 (78.5%) individuals, with the results being diagnostic in 10 (71.4%) and non-diagnostic in one (7.1%). The leading causes for gossypiboma occurrence were prolonged surgical procedures > one hour and emergency in 7 (50.0%) cases, followed by multiple surgical team involvement and change in nursing staff during procedures in 5 (35.7%) cases. A gossypiboma or retained foreign body diagnosis can be achieved through comprehensive patient history, radiologist-surgeon interaction, understanding of risk factors, and familiarity with imaging patterns. Safety procedures should be robust and straightforward, and effective communication among surgical professionals can help minimize medical negligence and protect patients in chaotic situations.Furthermore, the surgeon should adhere to the standard prescribed method and report cases of retained surgical sponges.

Health behavior change: The challenging turning point of lifestyle medicine interventions

The most common lifestyle-related diseases such as cardiovascular disease, type 2 diabetes, cancer, stroke, chronic obstructive pulmonary disease, depression, or autoimmune disease burden medical systems all over the world and decrease the patient’s quality of life. Limited behavior change knowledge and insufficient understanding of the importance of health behaviors for an individual’s well-being among clinical practitioners are important underlying factors that impair the effective prevention and treatment of the disease cause, focusing on alleviating symptoms instead. The fundamentals of behavior change serve as core competencies in lifestyle medicine, and developing patient-centered therapies is essential. From setting SMART goals to exploring and making use of psychological and behavioral theories such as the health belief model (HBM), the social learning theory (SLT), or the transtheoretical model (TTM), healthcare professionals of all specialties should consider using behavior change techniques in clinical practice for guiding patients adopting and maintaining healthy lifestyles. Furthermore, the clinician-patient collaboration, the involvement of multidisciplinary teams, and positive psychology increase the chances of success in supporting the patient to change unhealthy habits. Identifying patient resources and aptitudes for performing a behavior along with the follow-up process and relapse prevention represent the main challenges in this innovative approach. However, evidence-based knowledge and useful resources are available for educating individuals based on behavior change theories as well as, supporting their health-related endeavors.

Premature ovarian insufficiency

Key content: Premature ovarian insufficiency (POI) is a clinical syndrome involving ovarian follicle depletion and defined by loss of ovarian function before 40 years of age. The diagnostic workup in women with suspected POI is in two steps: confirming the diagnosis and establishing its cause; it is important to understand the rationale for performing each diagnostic test, how to interpret results and appropriate multidisciplinary team involvement. Treatment options include various regimens and preparations of hormone replacement therapy (HRT), monitoring and surveillance, induction of puberty in those with very early POI, complimentary treatment and fertility treatment. Management of POI requires a comprehensive and personalised strategy that addresses not only the physical symptoms and disease risks, but also the psychosocial and reproductive health aspects, and it is important that women receive adequate counselling. Learning objectives: To raise awareness of early diagnosis of POI. To be able to discuss the implications of POI for the health of women affected and their families, as well as for different hormonal and non‐hormonal treatment options. To understand various fertility treatment options for POI. Ethical issues: It is important to consider the reproductive and diagnostic implications for women with chromosomal or genetic problems (e.g. Turner syndrome, Fragile X mutation carriers) and for their family members. A diagnosis of POI may have differing implications based on social and cultural factors, and healthcare providers should consider a patient's values, beliefs, cultural background and preferences.

Chatting: Family Carers' Perspectives on Receiving Support from Dementia Crisis Teams.

Family caregivers are vital to enabling people with dementia to live longer in their own homes. For these caregivers, chatting with clinicians-being listened to empathetically and receiving reassurance-can be seen as not incidental but important to supporting them. This paper considers and identifies the significance of this relational work for family carers by re-examining data originally collected to document caregivers' perspectives on quality in crisis response teams. This reveals that chatting, for family caregivers, comprises three related features: (i) that family caregivers by responding to a person's changing and sometimes challenging needs and behaviors inhabit a precarious equilibrium; (ii) that caregivers greatly appreciate 'chatting' with visiting clinicians; and (iii) that while caregivers appreciate these chats, they can be highly critical of the institutionalized character of a crisis response team's involvement with them.

Examining the influence of talent management on organizational performance: A comprehensive overview

In the current environment, organizations are highly motivated to possess the most effective talent administration solutions. While it is crucial for the growth of an organization, attracting and keeping exceptional talent has proven to be one of the common problems facing businesses. Employee engagement is a crucial element that improves the correlation between talent management (TM) and organizational achievement. The goal of this study is to provide a comprehensive review of the TM techniques that have been presented and used in the relevant literature. Systematic literature review (SLR) is the study approach that was employed to gather and summarize the most significant information about the last four years (2020–2024) of enhancing organizational performance with methods for people management. The SLR procedure used 30 published studies and adhered to PRISMA requirements. By analyzing both internal and external factors that affect TM's application, the research's findings were aimed to provide significant perspectives for the discussion on the validity of TM to public organizations. Talent management improves organizational performance by encouraging team development, involvement, and loyalty, assuring sustained profitability and edge over the competition.

Learning from the Active Hospital-Based Cancer Registry in India: An Ethnography Study

PurposeThe increasing incidence of cancer in low- and middle-income countries highlights the need for better cancer data management. Hospital-based cancer registries (HBCRs) enhance patient outcomes by managing cancer data, reviewing clinical performance and allocating resources. However, sustainability remains a challenge despite government initiatives. Therefore, this study documented the functionalities, core processes, and team involvement of active HBCRs in India, aiming to identify factors that facilitate their sustainability.MethodsAn ethnographic study was conducted in two Indian hospitals, one specializing in cancer care and the other offering multispecialty services, focusing on their HBCRs. The study involved process observations, interviews, and record reviews, with thematic analysis guided by ethnographic investigations. The staff managing the HBCRs were key participants.ResultsThe findings are categorized into three themes: (1) existing management strategies and infrastructure, (2) the implementation process, and (3) the sustainability and scalability of the registry model. This study highlights the key factors necessary for a sustainable HBCR, including human resources, training, and a well-structured management system. The involvement of oncologists and physicians, funding, qualified staff, adequate space, and digitalization are crucial for success. Data management errors can be minimized through training, while interdepartmental coordination and data quality play essential roles.ConclusionThis study offers critical insights into enhancing cancer surveillance systems, thereby improving cancer care and public health interventions in India and similar contexts worldwide. Policymakers and healthcare practitioners can leverage these findings to strengthen existing systems and address the growing burden of cancer effectively.

De-escalating treatments and transitioning care in a cardiac intensive care units network

Abstract Funding Acknowledgements None. Background Recent data (1) have shown that end-of-life (EOL) management of patients with acute decompensated heart failure (ADHF) in Cardiac Intensive Care Units (CICU) is aggressive, with late or no involvement of palliative care (PC) teams. Purpose To evaluate current PC and EOL practices in a contemporary multicenter registry of patients with ADHF who deteriorated to cardiogenic shock (CS). Methods A survey-based approach was used to collect data on PC and EOL management practices. We enrolled CS patients from 12 participating centers. A subset of 153 patients with ADHF-CS, enrolled between March 2020 and March 2023, was analyzed. We asked participating centers to report their practice regarding de-escalating treatments and transitioning care in the context of EOL, focusing on 1) discussion of implantable cardioverter defibrillator (ICD) deactivation with patients, 2) documentation of do-not-resuscitate (DNR) orders in the patient's medical record, and 3) documentation of advance directives in the patient's medical record. We also examined early PC team involvement and ICD deactivation as indicators of de-escalating treatments and transitional care in ADHF-CS. Results are presented as numbers and percentages (%) for categorical variables and medians (interquartile range, IQR) for continuous variables. Results Baseline characteristics of the population are shown in Table 1. Figure 1 describes the practices of the participating centers. DNR was routinely documented in the medical records in only 5 of 12 centers (41.7%). PC teams were involved in 21 of 153 enrolled ADHF-CS patients (13.7%). Of the 51 patients with an ICD, 17 died: 13 patients (76%) died in the hospital and 4 (24%) died within 6 months of discharge. ICD deactivation occurred in 6 of 17 deceased patients (35.3%). One patient had ICD deactivation supported by home PC services. Conclusions This study shows that the practice of de-escalating therapy, including ICD deactivation, is not routine in the participating centers. Our findings highlight the importance of integrating PC as a concurrent process with intensive care to effectively address the unmet needs of these patients and their families.

Lived experiences of end-of-life care at home in the UK: a scoping review of qualitative research

&lt;b&gt;Background&lt;/b&gt; Home is the preferred place of care and death for most people with advanced illness. &lt;b&gt;Aim&lt;/b&gt; To examine and describe the published qualitative literature on the lived experiences of dying at home, to characterise the participants and their contexts and to identify key gaps, with a view to informing future research. &lt;b&gt;Design and Setting&lt;/b&gt; A scoping literature review in accordance with the PRISMA-ScR guideline. &lt;b&gt;Method&lt;/b&gt; The online databases CINAHL and MEDLINE were searched with relevant MeSH terms and keywords to identify primary qualitative research published between 2010 and 2022, exploring the lived experience of patients, families and/or unpaid carers in the United Kingdom. &lt;b&gt;Results&lt;/b&gt; In total, 462 papers were screened, 58 underwent full text review and 13 studies were retained in the final set. All studies explored the experience of bereaved family and/or unpaid carers and only one study interviewed a dying person. Where specified, the majority of experiences related to deaths from cancer, many with specialist palliative care team involvement. Included papers yielded a breadth of diverse findings, with the most common subject themes relating to the availability and quality of care and support for families and carers. &lt;b&gt;Conclusion&lt;/b&gt; There is limited published evidence exploring lived experiences of end-of-life care at home and this constrains the extent to which community services can be evidence-informed in their design and delivery. More research is needed to examine the first-hand experiences of people who are dying at home, particularly for those with non-cancer conditions and where specialist services are not involved.

E031 Retinal vasculitis with Libman-Sacks endocarditis as presenting features of a systemic lupus erythematosus with antiphospholipid antibody syndrome patient

Abstract Background/Aims Ocular manifestations of systemic lupus erythematosus (SLE) are rarely reported at the time of disease onset. Retinal vasculitis is usually associated with the active generalised disease. We report a case of a 22-year-old lady who was diagnosed with SLE with antiphospholipid antibody syndrome (APS) as the initial presentation of retinal vasculitis and Libman-Sacs endocarditis. Methods A 22-year-old lady with a background history of benign hypermobility spectrum disorder, presented to the eye casualty with a 4-week history of right-sided visual disturbances and was diagnosed with retinal vasculitis associated with uveitis, central retinal vein occlusion with multiple emboli in the retinal artery of the right eye and a single embolus in the left eye. In terms of family history, both father and brother were diagnosed with spondyloarthropathy, and the maternal uncle had Sjogren’s syndrome. She was then referred to the medical team for proper evaluation. On query, she mentioned photosensitive rash on her face getting worse in sunlight, a history of Raynaud’s phenomenon, significant hair loss, and one miscarriage before the 10 weeks of gestation. On examination, mild alopecia and a faint butterfly rash on the face were noted. Cardiac auscultation revealed pansystolic murmur. The rest of the systemic examinations were unremarkable. Results The blood test showed thrombocytopenia (130 u/L), positive antinuclear antibody (1:80, speckled pattern) with anti-double stranded DNA (26 IU/L), low complement (C3-0.74, C4- 0.12), markedly raised anticardiolipin antibody IgG (2016 u/ml), anti beta 2 glycoprotein 1 IgG ( &amp;gt;6100 u/ml) including presence of lupus anticoagulant. Her urinary protein creatinine ratio was 66mg/mmol. 3 sets of blood cultures came back negative. Transthoracic echo showed vegetation on the posterior mitral valve leaflet (0.95x 1.2cm) with moderate mitral regurgitation while transesophageal echo additionally found the possibility of perforation at the junction of leaflets of the mitral valve which was later confirmed by cardiac magnetic resonance imaging (MRI). The head MRI scan did not show any central nervous system abnormality. She was initially treated with 500mg intravenous methylprednisolone for 3 days followed by 20mg oral prednisolone daily with gradual tapering. Hydroxychloroquine and mycophenolate mofetil were added. Her case was discussed in the cardiology multidisciplinary team meeting and an opinion from the cardiothoracic surgery was taken to consider valve replacement in the future. Due to aspirin allergy, only warfarin was considered for APS. She had 2 sessions of pan-retinal photocoagulation as well. In subsequent follow-up, it was noted significant improvements in terms of her symptoms. Conclusion Vaso-occlusive retinopathy is a rare, potentially vision-threatening initial manifestation of SLE, which can be an indicator of active disease. Early identification of patients is necessary for timely intervention and multidisciplinary team involvement is required for comprehensive treatment plans. Disclosure M. Islam: None. S. Quddus: None. M. Hughes: None. R. Kumar: None.