Top Reasons Research Articles

The barriers and enablers to completing the RPS core advanced pharmacist credentialing programme via the CPPE/RPS pilot programme

Abstract Introduction The RPS and CPPE launched a pilot programme in March 2023 to support 300 pharmacists to evidence their advanced practice via an e-portfolio aligned to the RPS Core Advanced curriculum1 in a 12-week period. Successful pharmacists are credentialed as Advanced Pharmacists. The pilot involved CPPE education supervisors (ESs) support, an online learning platform and small group learning and support. Aim To ascertain barriers and enablers to completing an advanced e-portfolio and to identify how to improve the on-going programme. Methods The invitation to complete the anonymous survey in May 2024 was administered via www.onlinesurveys.ac.uk and developed linking to key performance indicators around education supervision support, to understand why candidates were deferring cohorts and to ascertain additional support accessed by candidates. Ethical approval was not required as study is service evaluation. Candidates who responded included those who successfully submitted their e-portfolio ‘submitted candidates’ n=10, candidates who are resubmitting their portfolio after not passing ‘resubmission candidates’ n=8, pharmacists currently completing their portfolio ‘current candidates’ n=44 and those who started but left without submitting ‘attrition candidates’ n=13. Results All submitted candidates scored ES support as very good/excellent; 60% agreed strongly they would not have submitted their portfolio without this support. Each cohort had two small-group tutorials where candidates accessed peer support and joined WhatsApp groups. Only 38% of resubmission candidates, compared to 80% of portfolio submitted candidates attended both group tutorials. Resubmission candidates were less likely to access additional peer support (38% for resubmission candidates vs 60% for submitted candidates) or to join the cohort WhatsApp group (75% for resubmission candidates vs 90% for submitted candidates). Resubmission candidates rated the remedial SMART action planning support highly. Submitted candidates would have found it easier to complete their portfolio with more comprehensive (60%) and timely responses (70%) from their collaborators. This compares to 55% and 59% of current candidates recognising the same issues. Submitted candidates wanted more allocated time during working hours to support completion of the portfolio (60% rising to 80% for current candidates). There is a notable increase for current candidates wanting a longer period to complete their portfolio (75% compared to 40% of submitted candidates). Half of submitted candidates (50%) reported spending more than 5 hours (average) each week on their portfolio compared to 18% of current candidates. Top reasons for attrition include too busy with work, family responsibilities, personal health challenges and no support from the workplace. Candidates across all groups suggested programme improvement ideas including more evidence examples, making the RPS platform less difficult to navigate and use, and more education supervisor support. Motivating factors for completion include recognition of advanced level working and preparation for the consultant portfolio. Conclusion Enablers include education supervision, CPPE resources/facilitated support events, peer support, WhatsApp groups, recognition and career progression. Key barriers include needing more time and lack of dedicated time at work to complete e-portfolio, lack of timely and comprehensive support from collaborators and finding the RPS e-portfolio platform difficult to navigate. Limitations – low numbers and response rate. Data collection is on-going. Reference 1. Royal Pharmaceutical Society, Core Advanced Pharmacist Curriculum, 2022 https://www.rpharms.com/Portals/0/Credentialing/RPS%20-%20Core%20Advanced%20curriculumFINAL.pdf?ver=8gc3s2aE9t1nZN37CSU7Lw%3d%3d (Accessed 28 May 2024)

Improving obesity management: Insights from the ACTION Switzerland survey of people with obesity, physicians and dietitians

SummaryACTION Switzerland (NCT05232786) examined obesity‐related perceptions, attitudes, behaviours and potential barriers to treatment among people with obesity (PwO) and healthcare professionals (HCPs). In March/April 2022, adult PwO (body mass index ≥30 kg/m2, per self‐reported height/weight) and physicians/certified dietitians who manage PwO in Switzerland completed online surveys in a cross‐sectional design. Overall, 1002 PwO, 125 physicians and 25 dietitians completed the survey. Most physicians (97%) and dietitians (100%), but only 57% of PwO, recognized obesity as a chronic disease. Only 42% of PwO considered themselves to have obesity/extreme obesity, while 61% who had discussed weight with an HCP reported receiving an obesity diagnosis. Many PwO (76%) believed weight loss was entirely their responsibility; physicians were less likely than dietitians to agree it was completely their patients' responsibility (28% vs. 68%). Physicians and dietitians report primarily initiating conversations about weight when patients have obesity‐related comorbidities (85% and 64%); their top reasons for not discussing obesity were patients' perceived lack of motivation (76% and 60%) or interest (72% and 64%) in losing weight. In conclusion, some PwO are not aware that obesity is a chronic disease and incorrectly assume complete responsibility for weight loss. Improved communication between PwO and HCPs is required.

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

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

34 Improving language concordant care in the paediatric emergency department

Abstract Background Paediatric patients and families with limited English proficiency (LEP) experience worse health outcomes. Use of professional medical interpreter services (IS) helps ensure that all patients receive high quality care, regardless of their preferred language of communication. Objectives The aim of this quality improvement (QI) study was to improve language concordant care within a paediatric emergency department (ED) in downtown Toronto by increasing the rate of over-the-phone interpreter use by 50% by July 2024 and to understand common reasons for interpreter non-use. Design/Methods Using the model for improvement, we assembled an interdisciplinary team that included physicians, ED registration clerks, triage nurses, and language services staff to understand current workflow and develop targeted interventions aimed at addressing key drivers through multiple plan-do-study-act (PDSA) cycles. Interventions included introduction of a standardized script to capture language preference at ED registration, EMR-integrated preferred language notification and smart text template in provider notes for standardized IS use or non-use documentation, and departmental education. Our primary outcome measure was rate of over-the-phone IS use for all ED visits. Process measures were rate of EMR documentation of patients and caregivers with non-English language preference (NELP) and rate of provider documentation of IS use or non-use. Balancing measures included time to provider initial assessment (PIA) and ED length of stay. Results The baseline period (November 2022-April 2023) revealed an over-the-phone IS rate of 5.2% for all ED visits. The initial results from the first 6 months of the intervention period demonstrated an increase in physician documentation of IS use or non-use in patients with NELP, from 10% to 76%. Additionally, 18.6% of patients or caregivers with NELP had IS use per provider notes. Over the next 9 months of the intervention period, special cause variation is anticipated in the rate of IS use and rate of EMR documentation of NELP. The most common reasons for IS non-use were: ‘deemed unnecessary by provider’, ‘declined by family’ and ‘use of family member/friend as interpreter’. There was no change in PIA or ED length of stay for patients with NELP. Conclusion This QI initiative increased consistent provider documentation of IS use in ED patient records in one of the most linguistically diverse cities in the world. Future efforts will focus on exploring additional ways to capture language preference beyond registration, facilitating IS use in the ED, and addressing top reasons for non-use of IS in patients and caregivers with NELP.

Clinical Validation and Comparison of Bacterial Vaginosis Detection

Abstract Introduction/Objective Bacterial vaginosis (BV) is considered a top reason for women’s gynecological visits, causing symptoms such as vaginal discharge, foul odor, itching, and burning associated with the alteration of the normal vaginal microbiome. It is often presented as a decrease in Lactobacillus spp. and an increase in anaerobic organisms such as Gardnerella vaginalis and Atopobium vaginae. In response to the demand for more automated and less subjective testing, molecular methods have recently been developed to aid in BV testing. The objectives of this study are to validate and compare the molecular Aptima® Bacterial Vaginosis Assay by Hologic® to the established BV Screen via a Gram stained vaginal smear graded through Nugent scoring at RUSH University Medical Center in Chicago, IL and perform a cost analysis between the testing methods. Methods/Case Report Samples of known BV value were tested on the Panther® instrument to validate the Aptima® Bacterial Vaginosis Assay for accuracy and precision. Clinical samples of vaginal swabs were used to make a Gram stained BV screen for Nugent scoring, then afterwards were placed into Hologic Multitest Aptima® probes for molecular testing on the Panther® instrument. Nugent scoring was performed blind by the molecular test. Molecular results of negative, positive, and invalid were then compared to the Nugent scores: scores of 0-3 for negative/normal vaginal flora, 7-10 for positive BV, and 4-6 for intermediate/altered scores were screened for discrepancy. Results (if a Case Study enter NA) The Aptima® BV Assay tested 52 known samples with 97% accuracy and 100% precision. A total of 80 clinical samples of vaginal swabs used for Gram stained BV screens were run on the Aptima® BV Assay; 61 provided conclusive data for comparative analysis. When compared to the original Nugent scores, the positive percent agreement (PPA) was 77.0% and negative percent agreement (NPA) was 92.9%. Conclusion The Aptima® BV Assay proved to be both accurate and precise in its validation testing. Clinically, it was able to screen for BV in vaginal samples with a good percent agreement to Gram stained BV screens. Further testing of additional clinical samples are to be done to continue analysis. Although the supplies needed to perform a Gram stain cost less than molecular testing, the reimbursement payment for molecular testing is much greater and overall reduces employee time costs for performing the test, making it the more cost effective choice for the laboratory.

A-183 Examination of the Roles and Responsibilities of Clinical Chemists as Determined by an International Peer Response-Based Survey

Abstract Background Doctoral-level clinical chemists (also termed clinical biochemists) have unique, broad roles in laboratory medicine spanning numerous clinical specialties. However, the full scope of responsibilities for a clinical chemist is not well understood, and institutional recognition and support varies. We sought to better understand the roles and responsibilities of practicing clinical chemists through distribution of an online survey designed to examine work-related responsibilities and other key factors related to job satisfaction. Survey results demonstrate the value of clinical chemists and can be used to promote parity within the profession. Methods Survey data was collected for 5 weeks from 10/10/2022-11/14/2022. The survey was targeted towards individuals holding doctoral level degrees (MD, PhD or MD/PhD), and consisted of 41 questions related to demographics, compensation, duties/responsibilities, and institutional support. Data analysis focused on responses from full-time clinical chemists located in the US and Canada (n=223/298 total respondents). Results Survey responses included male (n=109) and female (n=109) clinicians from all career stages (early <10y, n=101; mid 10-20y, n=63; late >20y, n=59). Clinical chemistry was the primary specialty reported (69%), followed by clinical pathology (16%), with 55% of responses reporting more than one specialty of practice, most often toxicology (21%). Multiple institution types (academic, community, reference laboratory, other) and academic career tracks (clinical, education, research, other) were represented; Most respondents were based in an academic hospital laboratory (n=131/223). Self-reported daily working hours varied by gender, years in practice, job duties and institutional setting; Females reported working more hours than males, working hours increased with years in practice, and the academic hospital setting reported the longest working hours, as did those on an ‘Education’ track. Responsibilities were quantified based on time spent per week; Clinical service represented the greatest time spent per week (majority result, 20-40h/week), followed by administrative (1-20h/week), research (<1-10h/week), teaching (<1-10h/week) and CE (<1-10h/week) duties. Support for clinical responsibilities was assessed further; 69% of respondents felt they had adequate time to perform clinical responsibilities, 55% reported access to adequate resources to perform clinical responsibilities and 51% reported feeling ‘Moderately’ or ‘Very’ stressed by clinical workload assignment. Top reasons for feeling overwhelmed included ‘Understaffing or inadequate support staff’ (n=113 responses), ‘Increased volume of work or caseload’ (n=73 responses) and ‘Lack of IT support to make necessary changes/improvements’ (n=70 responses). Resource quality was individually rated; Medical technologists, research technologists/scientists, LIS support and research support received a ‘Less than adequate’ rating by the majority of respondents, while compensation, administrative support and equipment received majority ‘Adequate’ ratings. Conclusions Clinical chemists work in a wide range of healthcare settings with unique career tracks, although the majority of work hours are devoted to provision of clinical service regardless of role definition. Most or all prioritize clinical work due to limited resources, which can limit research time and academic contributions. Clinical responsibilities are tied to feelings of stress and overwhelm in more than half of the survey population and could be reduced with improved quality and/or quantity of staff support.

Telehealth use and acceptability amongst a diverse oncology patient population.

104 Background: Existing research describes numerous barriers to care for patients with cancer, including time constraints, cost, and additional health conditions. We sought to assess telehealth access and experience amongst a diverse patient population at an academic medical center. Methods: We administered a 60-question, cross-sectional, in-person survey to adult patients with a diagnosis of solid tumor or hematological malignancy on active treatment at Columbia University Irving Medical Center (CUIMC) in New York, NY between January 2023 and February 2024. The survey assessed access to and attitudes, beliefs and experience with telehealth as part of routine care and clinical trials. Demographics including age, gender, race/ethnicity, marital status, income, insurance type and education were self-reported. Results: The survey was administered to 100 patients with cancer (breast cancer, n=25; gastrointestinal cancer, n=25; genitourinary cancer n=25; and hematologic malignancy, n=25); 37% were actively enrolled or previously enrolled on a clinical trial. The mean age was 61 years; 51% were female; 45% non-White, and 23% Hispanic. The majority (63%) reported traveling >30 min to their treatment, with 48% reporting travel costs >$20 per visit. Six percent reported difficulty receiving treatment due to cost, and 23% reported difficulty getting to visits due to other conditions or disabilities. The majority (87%) reported having access to a computer or electronic device; 99% of those had internet access and 81% were comfortable using the internet. Of those who had prior video visits (59%), almost all (97%) reported that video visits addressed their issues/questions well. About a quarter of the patients who had not had a video visit reported that they would prefer to have video visits about a cancer-related issue rather than going into the office. For those who preferred a video visit (n=18), top reasons included elimination of travel, convenience, and not feeling rushed. Top barriers among those who expressed hesitance (n=23) included lack of access to necessary technology, not knowing how to use the technology, concern about getting the same level of care, or preference for in-person communication. Similar to video visits, 52% participants reported that they had a scheduled telephone visit with their oncologist instead of going to the office; 98% reported that their issues were either somewhat or very well addressed. Conclusions: In this cross-sectional study amongst a racially, ethnically and socioeconomically diverse population, we found that most patients with cancer on active treatment had access to telehealth and were satisfied with telehealth visits. Those who had not utilized telehealth were interested given convenience and elimination of travel. We found minimal barriers to telehealth access in this diverse urban population. Telehealth may offer an adjunct to reduce financial and logistic barriers to cancer care.

Palliative care knowledge and access among people with small cell lung cancer and their family caregivers: Preliminary findings.

197 Background: People with small cell lung cancer (SCLC) make up 13-15% of those diagnosed with lung cancer. Although current statistics show the 5-year survival rate of people with lung cancer has improved overall, this is not the case for those diagnosed with SCLC. The disease is rapidly growing and aggressive, making access to palliative care crucial for improving quality of life for both people with SCLC and their family members. We developed a survey to assess palliative care knowledge and access among people with small cell lung cancer and their family caregivers. Methods: An online cross-sectional survey was conducted by the Lung Cancer Registry from GO2 for Lung Cancer (lungcancerregistry.org) from June 2023-present and included questions regarding treatment decision making, palliative care, and access to care. The SCLC survey is promoted to current Lung Cancer Registry participants who indicated a diagnosis of SCLC or were a family caregiver of someone with SCLC. Both people with SCLC and their family caregivers are eligible to participate in the survey. We also recruited people with SCLC through additional targeted online recruitment, direct outreach to community hospitals, and healthcare providers. Descriptive statistics were used to summarize survey findings. Results: As of May 2024, the SCLC survey was completed by 20 participants (mean age, 62 years; White, 85.0%; female, 55.0%; diagnosed with SCLC, 95.0%). Over half of people with SCLC (n = 11, 55.0%) had a family caregiver. While most participants had heard of palliative care (n = 15, 75.0%), less than half (n = 9, 45.0%) were offered or given information about it. Half of participants (n = 10, 50.0%) received or indicated they would like to receive palliative care. When asked what was needed from palliative care amongst these individuals, medication management for pain and physical symptoms was the top response (26.9%). For those who did not receive or would not like to receive palliative care, the top reasons included that it was not offered to them (26.7%) and wanting to learn more about it first to guide their decision-making (20.0%). Lastly, when asked what type of palliative care support was needed, emotional support was the top response (27.3%) followed by information on coping with lung cancer (24.2%). Conclusions: Preliminary findings suggest efforts are needed by care teams to expand access and improve education regarding palliative care among people with SCLC and their family caregivers. The fast-growing, aggressive nature of SCLC makes it especially urgent that care teams reach and meet the needs of this population. Our findings thus far highlight the need for additional research with larger sample sizes to ensure generalizability for the small cell lung cancer community.

The cost of virtual interviews; more than just the money

PurposeThe COVID-19 pandemic resulted in travel restrictions to limit virus transmission, altering the residency interview process across the country. While the transition to virtual interviews has the potential benefit of convenience and cost savings, concerns remain about the impact on applicants’ ability to distinguish programs. We sought to understand individual applicant motivations when presented with the opportunity to interview in-person or virtually and the associated costs.MethodsAn anonymous, voluntary, mixed-methods survey was distributed to all US allopathic medical school general surgery applicants who applied to our program in the 2023 cycle. The primary outcome was identifying factors that impacted the decision to interview either in-person or virtually. Secondary outcomes included costs associated with the entire interview process, including travel for away rotations, in-person interviews, and program second looks.Results155 (21.3%) applicants completed the survey. The average number of interviews completed was 14.2 ± 6.25. Females completed more interviews than males (14.9, 12.6, p = 0.047). Respondents accepted a mean of 89% of virtual interviews offered. 73% of applicants selected to complete at least one interview in-person. Top reasons for electing in-person interviews were to gain a stronger impression of the program (64%), make a greater impression of the program (50%), and strength of interest in the program (64%). Top factors for choosing virtual interviews were decreased costs (64%), less travel time (53%), and the ability to complete more interviews (53%). 58% of applicants planned to visit at least one program in-person post-interview. The mean total cost of interviews was $122 for virtual and $358 for in-person. Travel for a “second look” visit cost $279. 53% of respondents completed an away rotation, spending an average of $1688 per away rotation.ConclusionWhen presented with the option, applicants chose to interview in-person because of a mutual feeling of portraying and receiving a stronger impression. Candidates chose virtual due to cost reduction and the ability to complete more interviews. The financial savings of virtual interviews should be examined in the context of increased applications, increased interviews, post-interview travel or "second look" experiences, and costs associated with away rotations. Future work is needed to elucidate the role of in-person contact or away rotations on the likelihood of an applicant to interview and match in a largely virtual interview era.

Management of Acute Hand Burns: A Survey of American Burn Association-Verified Burn Centers.

Hand burns have a significant impact on the long-term function of burn patients. Recently, new protocols and technologies, such as dermal substitutes, have been introduced for the treatment of hand burns. This cross-sectional study investigates the preferred current management of acute hand burns and the role of dermal substitutes in treatment. A 10-question survey related to acute hand burns management was sent to 64 directors of American Burn Association (ABA)-verified burn centers. A total of 51.6% (n=33) directors of ABA-verified burn centers responded to the survey. For the treatment of superficial partial-thickness hand burns, 90.9% preferred a non-operative approach. Conversely, most respondents chose a single-stage excision and skin graft for deep partial-thickness hand burns (75.8%) and full-thickness hand burns (51.5%). However, for full-thickness hand burns, some surgeons prefer a two-stage reconstruction involving excision and placement of a skin substitute (27.3%) or allograft (9.1%), followed by a skin graft. Only 6.1% would utilize a three-stage reconstruction involving excision and allograft, excision and skin substitute, followed by skin grafting. Among surgeons who used skin substitutes (n=26), Integra (42.3%) and Novosorb Biodegradable Temporising Matrix (BTM) (23.1%) were preferred. The top reasons for choosing one specific dermal substitute were surgeon's preference (n=20; 76.9%) and cost (n=9; 34.6%). While a conservative non-operative approach is preferred for superficial partial-thickness hand burns, excision and skin grafting as a one-stage procedure remains the most common strategy for deep partial-thickness and full-thickness hand burns.

Knowledge and Attitudes About HIV Pre-Exposure Prophylaxis Among Sexually Active Black and Latina Cisgender Women: Findings from the 2017 and 2018 New York City Sexual Health Survey.

Pre-exposure prophylaxis (PrEP) is a highly effective tool to prevent HIV, yet it is underutilized among women. The current study aims to evaluate the awareness, attitudes, and perceptions of PrEP among a large survey sample of Black and Latina women in New York City (NYC). Interviewer-administered surveys were conducted in high HIV incidence neighborhoods in NYC among Black, Latina, and Afro-Latina women who reported recent sex with a man in 2017 (n = 398) and 2018 (n = 405). About 40% of participants were aware of PrEP, whereas 30.4% indicated interest in using it. The top reason for not utilizing it was low HIV risk perception. However, most participants supported the idea that using PrEP meant asserting control over their health (94.1%). Primary care providers and obstetricians/gynecologists were participants' preferred sources for PrEP (91.6%). Across survey cycles, compared to non-Black Latina participants, Black participants had significantly higher PrEP awareness (44.4% vs. 29.1%). PrEP awareness was also significantly higher among survey participants in 2018 (45.2%) than in 2017 (34.3%). Less than half of the participants were aware of PrEP, but those who were aware expressed largely positive attitudes toward the medication. Our findings may inform future PrEP implementation strategies to optimize awareness and access to PrEP among women disproportionately affected by HIV, like focusing on personal empowerment instead of risk-based messaging and training women's sexual health care providers in PrEP provision.

Mental Health Evacuation Rate in USCENTCOM.

Mental health diagnosis requiring further treatment is one of the top reasons for medical evacuation in the U.S. Central Command (USCENTCOM) area of responsibility (AOR) as of 2022. This study establishes a baseline in which the effectiveness of medical interventions can be measured to determine if they have an impact on the rate of evacuation out of USCENTCOM. The study period was January 1, 2017 to December 31, 2021. Individual evacuation data including date of initial movement and necessary specialty care requirements originating from the USCENTCOM AOR were acquired via U.S. Transportation Command's Regulating and Command & Control Evacuation System. The base evacuation rate was calculated for each month, and evacuation rates were analyzed for variations. For the entire study period, the mean monthly evacuation rate was 0.44 evacuations per 1,000 people in the AOR (95% CI, 0.41-0.47). There was no statistically significant difference between any monthly evacuation rate (P = .505). There is a statistically significant difference in the mean evacuation rates for calendar years (P = .003). The highest evacuation rate occurred in 2021. The study establishes a benchmark mental health evacuation rate. This rate will be useful for assessing mental health evacuation reduction initiatives in the USCENTCOM AOR.

Awareness of skin cancer screening coverage in U.S. healthcare plans: Is there a need to better educate the public?

ObjectivesTo understand whether financial barriers or the lack of accessibility to dermatology services was a significant motivation for the public to seek free skin cancer screening. MethodsAn anonymous and voluntary survey was administered to participants of The Sun Bus free skin cancer screening program in 2023 at U.S. outdoor events in Colorado, Texas, Arizona, New Mexico, Iowa, Wyoming, Missouri, and Montana. 491 respondents answered questions on motivation, healthcare coverage, and demographics. Survey data was analyzed using Qualtrics’ crosstab IQ and statistical tests software. ResultsSkin screening found suspicious lesions in 45 % of 1300 participants with 18 % of respondents sharing a previous history of skin cancer. Concern for a lesion or Curiosity were the two top reasons for 60 % of respondents to seek free skin screening and remained the top reasons after data was stratified by gender, age, or income. Only 15 % of respondent were motivated by the cost of dermatology services or a long wait to see a dermatologist. A total of 38 % of people surveyed reported comprehensive plans covering skin screening while 46 % were unaware of the inclusion of screening in their healthcare plan. Notably, this unawareness increased up to 52 % among younger and less affluent respondents. Additionally, females were less likely than males to be aware of skin screening options in their healthcare plans. ConclusionsThis work highlights the significance of promoting public awareness of dermatology services covered by health insurance and the need for continued efforts in skin cancer education and screening programs.

Undergraduates’ experiences with library portal services: perceptions of usefulness and satisfaction

PurposeThe purpose of this study is to evaluate the perceived usefulness and satisfaction levels of undergraduate students with respect to university library portal services, specifically within selected universities in South-West Nigeria.Design/methodology/approachA descriptive survey research design was used to investigate the perceived usefulness and satisfaction levels among undergraduate students regarding university library portal services. Data were collected through surveys administered to 658 undergraduate respondents across multiple universities in South-West Nigeria.FindingsThe findings indicate that undergraduate students’ top reasons for using the portal were for tasks such as locating research materials, accessing databases, requesting bibliographies and checking the library catalog. Library computers and school information and communication technology center computers were identified as the most preferred access point, followed by computer labs and campus Wi-Fi networks. Undergraduates rated the portals as highly useful, particularly for saving time locating resources, checking material status and patronizing the library. High satisfaction was reported for services such as attending workshops, events and receiving research support through the portals workshops. Moderate satisfaction levels existed for accessing policies/hours, the institutional repository and renewals of books online. A strong positive correlation (r = 0.785, p < 0.05) was found between perceived usefulness and satisfaction.Originality/valueThis study contributes to the understanding of undergraduate students’ perceptions regarding the utility and satisfaction of university library portal services in the context of South-West Nigeria. It underscores the importance of aligning portal services with students’ academic and research needs to enhance overall satisfaction levels. In addition, it provides insights into areas where improvements can be made to further enhance the effectiveness and satisfaction derived from these services.

Real-world anti-seizure treatment and adverse events among individuals living with drug-resistant focal epilepsy in the United States.

This study aimed to understand how people living with drug-resistant focal epilepsy (DRE) navigate through lines of antiseizure medications (ASM) and experience adverse events (AEs) in the real-world setting in the United States. A retrospective study was conducted with medical chart data from clinical practices in the United States. Eligible adults had a confirmed diagnosis of DRE and initiated a third-line ASM therapy between January 2013 and January 2020 (i.e., the index date). Subjects must have medical history data available for ≥1 year prior to (the baseline) and ≥2 years after the index date (the follow-up). Treatment patterns were captured from first to fourth lines. After the emergence of drug resistance, time to ASM discontinuation, reasons for discontinuation, AE experience and AE management were reported separately during third and fourth lines of treatment and beyond. The study included a total of 345 individuals, with an average (standard deviation) age of 23.9 (11.9) years at first diagnosis. All individuals had at least three lines of ASMs with first and second lines during baseline, and third line during follow-up. The first line for most individuals was monotherapy. As individuals progressed through additional lines of ASM therapy, they were more likely to receive polytherapy. The regimens were more individualized after meeting drug resistance criteria. The top reasons for discontinuing were uncontrolled seizure and/or intolerance/AEs for both third and subsequent lines. More than a third of individuals experienced at least one AE. Among those with at least one AE, many individuals had to manage these AEs with dose adjustment (39.4%), discontinuation of offending ASM (37.9%), de novo pharmacotherapy (25.8%), emergency room visit (13.6%), and hospitalization (12.1%). This study demonstrated that individuals living with DRE experience significant AEs, and many of these AEs lead to treatment disruption and significant healthcare resource utilization. This study examined how individuals with focal epilepsy are treated across various clinics in United States and reported the adverse events these individuals experienced during treatment, along with the consequence associated with these adverse events. We found that as individuals progressed through additional treatments, they were more and more likely to receive more than one antiseizure medication, and a significant portion of individuals experienced at least one adverse event, often manifested as headache, somnolence, dizziness, and fatigue.

Home-based advanced care is a solution to quality health care in rural Taiwan: Lessons learned during the COVID-19 pandemic

Background/purposeThe integrated home-based medical care (iHBMC) program has been implemented by the Taiwanese government since 2016. The pandemic of coronavirus disease 2019 (COVID-19) accelerated the shift from hospital-based to community-based healthcare, with a special focus on advanced home care for frail older adults. This study focuses on home-based advanced care, such as hospital at home (HaH), aiming to explore the feasibility and resilience of HaH within a home-based medical care model in a rural community in Taiwan. MethodsWe conducted a retrospective review of medical records from February 2020 to August 2022. Two clinical professionals reviewed and abstracted data from the electronic medical records of 189 patients receiving home healthcare during the COVID-19 pandemic. The HaH event was calculated if patients had any acute infection and received treatment at home. ResultsA total of 62 HaH events occurred during 2020–2022 and the average HaH events per person was 1.4. In these events, the top reason for patients receiving HaH was pneumonia, followed by urinary tract infection, soft tissue infection, and sepsis. 77.4% of patients completed the HaH treatment and did not experience any recurrent acute infections in the 30-day follow-up. ConclusionDifferent forms of home healthcare enhance the resilience of medical care provision in rural areas. As Taiwan approaches a hyper-aged society by 2025, it is crucial that National Health Insurance policies support various home-based care models that address transportation issues and maintain high care standards in underserved rural areas.

Sleepy University Students: Anxiety &amp; Its Relationship to Sleep Quality &amp; Quantity

Abstract Date Presented 03/21/24 University students’ inability to get the recommended quality and quantity of sleep is associated with higher anxiety scores (p = .027), with worry as a top reason for disrupted sleep. Addressing sleep is critical in anxiety prevention and treatment. Primary Author and Speaker: Valerie Buzzelli Additional Authors and Speakers: Olivia Gonzales, Emerson Cole, Alexis Juergens Contributing Authors: Barbra Katerberg

Helping athletes to select botanical supplements for the right reasons: A comparison of self-reported reasons for use versus evidence-based supplement claims.

Use of food supplements (FS) by athletes is well characterised but there is little information on 'herbal' or 'botanical' FS beyond 'natural'. This study determined, by questionnaire, whether athletes' main self-reported reason for using FS was reflective of what was written on product labels or, when these claims were unavailable, was in accordance with the scientific literature. In 217 elite (n = 55) and amateur (n = 162) athletes living on the island of Ireland, 71% (n = 153) consumed any kind of FS, with 16% (n = 34) of the entire cohort deemed botanical consumers. 'Protein' (21%, n = 46), 'vitamin D' (17%, n = 37) and 'vitamin C' (15% n = 32) were most consumed with the top reasons for use being 'to support health', 'to prevent illness/for immunity purposes' and 'recovery'. There was generally good agreement between approved nutrition and health claims for such products and athletes' main reported reasons for use. Only the amateur athletes in our pool described using botanical supplements, with reasons for use stated as 'sleep improvement' (21%), 'recovery' (14%), 'supporting health' (12%) and 'energy' (12%), resulting in poor agreement with either approved claims or scientific evidence. Only half of amateur athletes knew if their botanical FS were third-party tested. Athletes and practitioners require guidance to avoid consuming supplements for which there is little scientific evidence, and which may risk being contaminated/fraudulent.

Psychological Distress and Associated Factors among Technical Intern Trainees in Japan: A Cross-Sectional Study.

Japan is experiencing significant demographic shifts due to an aging and declining population. In 1993, the Japanese Government introduced the Technical Intern Training Program (TITP) to accept foreign national workers. While the number of technical intern trainees under this program has constantly increased, many of them face challenges in their daily lives, such as stress, health insecurities and limited access to healthcare. Therefore, we conducted a cross-sectional study to assess the mental well-being of technical intern trainees, focusing on psychological distress and its related factors. This study included 304 technical intern trainees from 12 prefectures in Japan, and was conducted from August 2021 to October 2021. We used self-administered questionnaires in the participants' native languages to assess their sociodemographic conditions, health-related conditions such as health insecurities and healthcare-seeking behaviors, and psychological distress. The K6 Kessler Psychological Distress Scale was applied to evaluate the levels of psychological distress. Among the participants, 26.3% had moderate psychological distress and 2.3% had severe psychological distress. In addition, about 15% of the participants reported health insecurities and did not see a doctor despite wanting to. The multivariate model of logistic regression revealed significant associations between psychological distress and female gender (AOR 2.62, 95% CI 1.12-6.12), nationality other than Vietnamese (AOR 4.85, 95% CI 2.60-9.07), tough financial conditions (AOR 2.23, 95% CI 1.18-4.19), experiencing health insecurity (AOR 2.21, 95% CI 1.04-4.66) and the health behavior of refraining from seeking medical care (AOR 3.06, 95% CI 1.49-6.30). The top reasons for refraining from seeking medical care were the participants' limited knowledge about the healthcare system in Japan and their worries about medical bills. These findings highlight the necessity to extend mental health support services, including counseling services, and share information about Japan's healthcare system to supply medical services to the targeted technical intern trainee population.

Evaluation of the implementation, frequency of use, type, and impact of veterinary emergency service pause systems.

To determine the prevalence of veterinary emergency service pause systems (VESPSs) and describe aspects of implementation and perceived impact. Electronic questionnaire SETTING: Membership of the Veterinary Emergency and Critical Care Society (VECCS). None. None. A questionnaire was distributed to 6176 VECCS members with 1168 responses. Seventy-six percent of the respondents were veterinarians. Ninety-one percent of respondents practice in the United States, with 74% of them working at 24/7 multispecialty practices. Eighty-seven percent of respondents indicated patient volume had increased, and 75% reported that a VESPS had been implemented between September 2020 and December 2021. Sixty-two percent reported that their emergency service had been paused or closed once per week or more. The top reasons for implementing a VESPS included excessive caseload and staffing shortages. A variety of methods were utilized to implement a pause. Sixty-nine percent reported their VESPS was less than ideal for effectiveness. Pause systems were reported to be highly supported by medical staff. Seventy-seven percent reported increased client frustration and complaints, and 57% reported staff were stressed from denying care. Of those who do not currently have a VESPS in place, 74% would prefer to have one. VESPSs were in widespread use at the time of this survey, and most have been implemented between September 2020 and December 2021. The majority of VESPSs were employed to mitigate increased caseload and staffing shortages. Although VESPSs are largely supported by medical staff, drawbacks may include staff stress and client frustrations, and improvements are warranted.