Vulnerable Patient Research Articles

Nutritional Needs of the Infant with Bronchopulmonary Dysplasia.

Growth failure is a common problem in infants with established bronchopulmonary dysplasia (BPD). Suboptimal growth for infants with BPD is associated with unfavorable respiratory and neurodevelopmental outcomes; however, high-quality evidence to support best nutritional practices are limited for this vulnerable patient population. Consequently, there exists a wide variation in the provision of nutritional care and monitoring of growth for infants with BPD. Other neonatal populations at risk for growth failure, such as infants with congenital heart disease, have demonstrated improved growth outcomes with the creation and compliance of clinical protocols to guide nutritional management. Developing clinical protocols to guide nutritional management for infants with BPD may similarly improve long-term outcomes. Given the absence of high-quality trials to guide nutritional practice in infants with BPD, the best available evidence of systematic reviews and clinical recommendations can be applied to optimize growth and decrease variation in the care of these infants.

Analysis of the Outcomes of Tuberculosis Treatment and Factors Associated with Successful Treatment at the Bamenda Regional Hospital: A 10-year Retrospective Study.

Tuberculosis (TB) remains a global public health issue, impacting millions of people worldwide. This study determined the outcomes of TB treatment managed within a 10 year period at the Bamenda Regional Hospital in Cameroon. A retrospective study was carried out among 2428 patients diagnosed and treated for active TB infection from 2013 to 2022, at the Bamenda Regional Hospital. Data collection was done from March to April 2023 using a data extraction form. Bivariate and multivariate logistic regression models were used to identify factors associated with successful TB treatment outcomes. Data was analyzed using SPSS software version 26. Of the 2428 patients with TB, 1380 (56.8%) were cured, 739 (30.4%) completed treatment, treatment failures were recorded in 10 (0.4%) patients, and 200 (8.2%) died during or after receiving treatment. Treatment default was the outcome in 99 (4.1%). Successful treatment outcomes were reported in 2119 (87.3%). Patients within age groups 41-50 (P = 0.010), 51-60 (P = 0.041), and >60 years (P = 0.006), male (P = 0.004), and human immunodeficiency virus-positive patients (P < 0.001) had decreased odds of successful treatment outcomes. The outcomes of treatment within a 10 year period showed that the treatment success was 2.7% below the World Health Organizations target. Prioritizing vulnerable patient groups in TB management and implementing public health interventions such as financial assistance and nutritional support will go a long way in improving treatment outcomes.

Redefine photoprotection: Sun protection beyond sunburn.

Excessive exposure to ultraviolet (UV) light leads to acute and chronic UV damage and is the main risk factor for the development of skin cancer. In most countries with western lifestyle, the topical application of sunscreens on UV-exposed skin areas is by far the most frequently used preventive measure against sunburn. Further than preventing sunburns, increasing numbers of consumers are appreciating sunscreens with a medium- to high-level sun protective factor (SPF) as basis for sustainable-skin ageing or skin cancer prevention programs. However, recent investigations indicate that clinically significant DNA damages as well as a lasting impairment of cutaneous immunosurveillance already occur far below the standard of one minimal erythema dose (MED) sunburn level, which contributes to the current discussion of the clinical value of high-protective SPF values. Exvivo investigations on human skin showed that the application of SPF30 reduces DNA damage for a day long sun exposure (24 MED) drastically by about 53% but is significantly surpassed by SPF100 reducing DNA damage by approx. 73%. Further analysis on different SPF protection levels in UV-exposed cell culture assays focusing on IL-18, cell vitality and cis/trans-urocanic acid support these findings. Whereas SPF30 and SPF50+ sunscreens already offer a solid UVB cover for most indications, our results indicate that SPF100 provides significant additional protection against mutagenic (non-apoptotic-) DNA damage and functional impairment of the cutaneous immunosurveillance and therefore qualifies as an optimized sunscreen for specifically vulnerable patient groups such as immunosuppressed patients, or skin cancer patients.

Children With Congenital Heart Disease Undergoing Noncardiac Surgeries in Riyadh, Saudi Arabia

Background Congenital heart disease (CHD) is the most common birth defect. There is an increased number of non-cardiac surgeries in CHD children. This study aimed to describe the characteristics of CHD patients undergoing noncardiac surgeries, the most common type of surgical procedures and the mortality rate. Methods A retrospective cohort study was conducted at King Abdullah Specialist Children Hospital (KASCH) from Jan 2020 to Dec 2021 with total number of 45 cases. Descriptive statistics were used for elaborating patients&amp;apos; demographic characteristics and outcomes. Results A total of 231 patients with congenital heart disease were identified during the study period. Among these, 45 patients with a mean age of 3.97 (SD 3.06) years underwent non-cardiac surgery which represents 19.5%. Most of the patients were Saudis (95.6%). No difference was observed between genders. Most of the patients who underwent gastrointestinal surgeries were intubated for &amp;gt;120 mins. None of children who underwent plastic surgeries were admitted to PICU. Mortality within 20 days after the noncardiac surgeries wase 0. Conclusion 19.5% represents the proportion of 0-14 years old CHD children who underwent noncardiac surgeries in KASCH in period of Jan 2020- Dec 2021. The commonest CHD in our study group was patent ductus arteriosus defect which comprised 8 (17.8%) of the patients. Plastic 14 (26.9%) and gastrointestinal 14 (26.9%) surgeries were the most frequent noncardiac surgeries performed. 20 days mortality is 0. None of children who underwent plastic surgeries were admitted to PICU, intubated for more than 120 minutes, or stayed in the hospital for more than 5 days. Future studies on this topic with a larger population from several health centers are needed to help determine the future of non-cardiac interventions for this vulnerable patient group.

Is resistance to Covid-19 vaccination a “problem”? A critical policy inquiry of vaccine mandates for healthcare workers

&lt;abstract&gt; &lt;p&gt;As the COVID-19 global vaccination campaign was launched in December of 2020, vaccination became mandatory for many healthcare workers (HCWs) worldwide. Large minorities resisted the policy, and the responses of authorities to this resistance led to damaged professional reputations, job losses, and suspension or termination of practice licenses. The joint effect of dismissals, early retirements, career changes, and vaccine injuries disabling some compliant HCWs from adequate performance has exacerbated existing crises within health systems. Nevertheless, leading health authorities have maintained that the benefits of a fully vaccinated healthcare labor force—believed to be protecting health systems, vulnerable patient populations, and even HCWs themselves—achieved through mandates, if necessary, outweigh its potential harms. Informed by critical policy and discourse traditions, we examine the expert literature on vaccine mandates for HCWs. We find that this literature neglects evidence that contradicts official claims about the safety and effectiveness of COVID-19 vaccines, dismisses the science supporting the contextual nature of microbial virulence, miscalculates patient and system-level harms of vaccination policies, and ignores or legitimizes the coercive elements built into their design. We discuss the implications of our findings for the sustainability of health systems, for patient care, and for the well-being of HCWs, and suggest directions for ethical clinical and policy practice.&lt;/p&gt; &lt;/abstract&gt;

Enhancing transmural continuity of care for vulnerable patients with kidney problems. A mixed-methods multi-stakeholder needs-assessment

Summary: Research on supporting the (in)formal caregiver, in enabling autonomy and empowering of persons with a chronic kidney disorder and creating a bridge between primary care and specialized care in hospital settings. &#x0D; Background: Almost half (48%) of hospital readmissions is due to a lack of continuity of care ,e.g. no discharge conversation, poor communication at discharge, lack of patient education and no patient empowerment, a lack of information flow between the hospital setting and primary care, … Especially vulnerable patients with e.g. low health literacy suffer from a not optimally organized transition from the hospital setting to home. More attention is needed for: patient and informal care giver engagement and education, person-centered support, coordination of the transmural care process in order to deliver continuous and responsible care.&#x0D; Target group: Vulnerable patients with kidney problems in the province of Flemish Brabant (Belgium).&#x0D; Involved and engaged stakeholders: Patients, informal care givers, hospital kidney department (doctors, nurses, physiotherapists, social workers, …), primary care professionals (GPs, nurses, physiotherapists, social workers, …).&#x0D; Intervention: A needs-assessment is performed regarding the continuity of care of vulnerable patients with kidney problems. Patients, informal care givers, primary care as well as hospital professionals are surveyed and interviewed.&#x0D; Results: Preliminary results show the need for optimized transmural care from the patient, informal caregiver and professional perspectives. Continuity of care is mainly lacking regarding its informational and therapeutic dimensions. The minimal or even absent information flow (informational continuity) results in therapeutic differences between the services offered by hospital and primary care professionals (therapeutic continuity). Special attention is needed for patient education and empowerment. Relational continuity between the patient and professionals is more fixed, but professionals often do not have fixed partnerships with each other, both within primary care as well as across the primary and hospital care settings.&#x0D; Lessons for international audience: &#x0D; - A multi-perspective needs-assessment uncovers the, sometimes hidden, needs with regard to continuity of care.&#x0D; - Transmural care is often still quite discontinuous, especially from the perspective of the vulnerable patient, informal care giver and primary care professional.&#x0D; - System-wide change is needed in terms of vision, goals, adapting to local health needs, using people as partners, redefining professional responsibilities and (re)training care professionals, and reconfiguring care delivery.&#x0D; Next steps: The information gathered through the needs-assessment is used to co-develop a continuity-enhancing intervention that optimizes the transmural care process with relevant stakeholders (patients and informal care givers or their representatives, primary care professionals, hospital professionals). The intervention is implemented and evaluated through a patient and professionals questionnaire and interviews.

Simulation to improve healthcare pathway and inequities for people with disabilities.

Introduction: The Convention on the Rights of People with Disabilities (1) reported that people with disabilities do not have equitable access to health services. People with intellectual disabilities, especially the ageing, are more susceptible to somatic disease and other lifestyle diseases than the general population (2, 3, 4, 5, 6). &#x0D; General practitioners' (GP) competence in the field of intellectual disability is largely experience-based, not systematic and research-based (7). In municipalities, approximately half of healthcare workers (HCWs) at municipal housing for people with intellectual disabilities are unskilled. These HCWs have experienced not being taken seriously when calling either their patients’ GP or accident and emergency (A&amp;E) department to report that the resident is 'not well', resulting in residents receiving inadequate healthcare. Municipal leaders and educators decided to address the inadequate clinical observation and communication skills among HCWs with a simulation-based training program (SBTP), to improve competence and treatment of residents when escalating levels of care.&#x0D; Methods: Based on national recommendations about ""Early detection of deteriorating condition"" and the urgency of the covid-pandemic, the SBTP was quickly rolled out to all HCW. The SBTP consisted of both theoretical teaching and e-learning in ABCDE, training in the tool NEWS2, as well as the communication technique ISBAR. Baseline NEWS2 scores were established for all residents.&#x0D; Based on positive experience with SBTP in donning and doffing of personal protection equipment (8) in the municipality early in the pandemic, and uncertainty about safer care for sick corona patients in residential homes, leaders requested continued use SMTP to improve observational skills.&#x0D; Results &amp; Discussion: Evidence of improved competency at work and resulting improved escalation of care came fast.&#x0D; One example was of a resident with backpain whose relatives’ recommended painkillers. HCWs performed NEWS2 scoring, discovered pathological changes, contacted A&amp;E, received treatment advice, continually followed up on NEWS2 measurements, secured ambulance help &amp; reaction based on baseline NEWS2, and admission where sepsis was discovered. Similarly, another group of HCWs performed NEWS2 scoring on a patient with presenting manic symptoms, discovered clinical signs of somatic illness, which lead to a completely different medication than expected. These cases were seen as post-SBTP improvements in HCWs behavior, and patient safety.&#x0D; &#x0D; SBTP to improve observational skills in the municipality has led to better differential diagnosis in the early stage, more precise communication with GP and A&amp;E which in turn has led to better healthcare pathways for a vulnerable patient group.&#x0D; Keywords: simulation, observational competence, competence, health rights&#x0D;

The development of a specialist tongue tie assessment clinic for neonates

ObjectivesAnkyloglossia or tongue tie is a condition where the lingual frenulum restricts tongue movement, negatively impacting breastfeeding. An increasing number of infants diagnosed with ankyloglossia may lead to unnecessary procedures. To limit the overtreatment of this problem, we established a specialist clinic to provide the best available evidence-based care to the mother-infant dyad. MethodsWe discuss the development of a specialist tongue tie assessment clinic in our unit. ResultsFrom January to October 2023, there were 162 visits to the clinic by 157 patients. During this time, there were 96 frenotomies performed. ConclusionsThe mother-infant dyad is a vulnerable patient group. Establishing a specialist tongue tie assessment clinic with otolaryngology and lactation expertise provides the best available evidence-based care.

VA’S EXPERIENCE IN BUILDING CAPABILITY TO CONDUCT OUTREACH TO VULNERABLE PATIENTS DURING EMERGENCIES

Abstract The United States (US) has sustained more than 340 weather and climate disasters since 1980. Older adults with complex medical conditions, increasing in numbers, are typically most severely impacted by such events. A growing population of older, medically complex, individuals residing at home, and an increased frequency of severe natural disasters creates a compounded burden on local communities to reduce potential harm to these community-dwelling members during disaster response and recovery. In response, the Veterans Health Administration (VHA) established the Vulnerable Patient Care, Access, and Response in Emergencies (VP CARE) program to provide standardized data tools and guidance to assist VA medical facilities in conducting outreach to and care coordination of medically frail and older Veterans during major emergencies. VP CARE utilizes geographic information system (GIS) tools to allow outreach prioritization based upon geographic proximity to an event and patient clinical needs. In response to Hurricanes Ian and Fiona, the VP CARE team, with the support of the national VEText team, successfully deployed a new 2-way patient texting communication capability. During an emergency, patients receive a text from VEText, are asked whether they require assistance, and the specific help they need. The new VEText capability helped VA staff reduce outreach call volume by 20% and allowed for triage and prioritization of those indicated as needing assistance to the top of the outreach list. This presentation provides an overview of VP CARE approaches and what VHA has learned through its implementation to assist other healthcare systems with establishing similar capabilities.

Acute pancreatitis in childhood - a comparative international study and tale of two cities.

To compare factor(s) contributing to aetiology, management and clinical outcome(s) of paediatric patients acquiring acute pancreatitis (AP) at two major university paediatric surgical centres in Liverpool and Bangkok. All patients (<18 years) with an index diagnosis of AP (ICD 10 coding) during 2006-2016 were studied. 121 patients included n = 79 (65.3%) in Thailand versus n = 42 (34.7%) in the UK centre with no difference(s) in age at diagnosis at 10.4 ± 4.5 and 11.7 ± 6 years. (P = 0.12). Major AP aetiology(s) in Thailand were medications (39.2%) and choledochal cysts (8.9%). In the UK-gallstone disease (21.4%), and medications (16.7%) were leading factors (P < 0.01). Ultrasonography was deployed more frequently in the UK versus Thai centre (74.3% vs. 49.1%; P < 0.01). Pancreatitis was confirmed by imaging in 67.9% (Thai) and 62.9% (UK) patients (P = 0.47). Most patients at both centres had a mild-grade pancreatitis illness (95% Thai vs. 90.5% UK; P = 0.28) while 12.7% of Thai and 19% of UK children developed pancreatitis-related complication (P = 0.37). Overall mortality rate (%) was significantly higher in the Thai versus UK centre (27.8% vs. 9.5%; P = 0.02). Aetiology of acute pancreatitis appears to vary between UK and Thailand children. Timely early diagnosis and healthcare pathways may be driven by local patient-related factor(s). The higher mortality (%) observed in Thailand versus UK in this comparative study was linked to underlying co-existent chronic medical condition(s) in vulnerable patient cohorts.

Endovascular versus Surgical Lower Extremity Revascularization among Patients with Chronic Kidney Disease.

Patients with chronic kidney disease (CKD) have a high prevalence of peripheral artery disease. How best to manage lower extremity peripheral artery disease remains unclear in this patient population. We therefore sought to compare the outcomes after endovascular versus surgical lower extremity revascularization among patients with CKD. We used data from Optum's de-identifed Clinformatics® Data Mart Database, a nationwide database of commercially insured persons in the United States to study patients with CKD who underwent lower extremity endovascular or surgical revascularization. We used inverse probability of treatment weighting to balance covariates. We employed proportional hazard regression to study the primary outcome of major adverse limb events (MALE), defined as a repeat revascularization or amputation. We also studied each of these events separately and death from any cause. In our cohort, 60,057 patients underwent endovascular revascularization and 9,338 patients underwent surgical revascularization. Endovascular revascularization compared with surgical revascularization was associated with a higher adjusted hazard of MALE (hazard ratio (HR) 1.52; 95% confidence interval (CI) 1.46-1.59). Endovascular revascularization was also associated with a higher adjusted hazard of repeat revascularization (HR 1.65; 95% CI 1.57-1.72) but a lower adjusted risk of amputation (HR 0.71; CI 0.73-0.89). Patients undergoing endovascular revascularization also had a lower adjusted hazard for death from any cause (0.85; CI 0.82-0.88). In this analysis of patients with CKD undergoing lower extremity revascularization, an endovascular approach was associated with a higher rate of repeated revascularization but a lower risk of subsequent amputation and death compared with surgical revascularization. Multiple factors must be considered when counseling patients with CKD, who have a high burden of comorbid conditions. Clinical trials should include more patients with kidney disease, who are often otherwise excluded from participation, to better understand the most effective treatment strategies for this vulnerable patient population.

Overview of the Association Between the Pathophysiology, Types, and Management of Sickle Cell Disease and Stroke.

Sickle cell disease (SCD) is a genetic blood disorder that affects hemoglobin and increases stroke risk, particularly in childhood. This review examines the pathophysiological association between SCD and stroke, the classification of stroke types, risk factors, diagnosis, management, prevention, and prognosis. A comprehensive literature search was conducted via PubMed, Scopus, and Cochrane databases. Relevant studies on SCD and stroke pathophysiology, classification, epidemiology, diagnosis, treatment, and prevention were identified. Sickle cell disease causes red blood cells to become rigid and sickle-shaped, obstructing blood vessels. Recurrent sickling alters cerebral blood flow and damages vessel walls, often leading to ischemic or hemorrhagic strokes (HS). These occur most frequently in childhood, with ischemic strokes (IS) being more common. Key risk factors include a prior transient ischemic attack (TIA), low hemoglobin, and a high leukocyte count. Neuroimaging is essential for diagnosis and determining stroke type. Primary prevention centers on blood transfusions and hydroxyurea for those at high risk. Acute treatment involves promptly restoring blood flow and managing complications. However, significant knowledge gaps remain regarding stroke mechanisms, optimizing screening protocols, and improving long-term outcomes. This review synthesizes current evidence on SCD and stroke to highlight opportunities for further research and standardizing care protocols across institutions. Ultimately, a holistic perspective is critical for mitigating the high risk of debilitating strokes in this vulnerable patient population.

Ongoing challenges of off-label prescribing.

Off-label prescribing refers to prescribing that is not concordant with the indications, doses, routes of administration or patient groups included in the Australian approved product information. Off-label prescribing is common, especially for vulnerable patient groups who tend to be excluded from clinical trials, such as children and pregnant women. There may be increased risk of prescriber liability if the patient experiences an adverse event following off-label prescription, particularly when supporting evidence or guidelines are lacking. There may be additional costs to the patient if the medicine is not subsidised for the off-label indication. Prescribers should ensure patients are aware when a medicine is being prescribed off label, and informed of potential benefits and harms. Alternative pathways for approval of new indications, doses and patient groups may reduce the need for off-label prescribing.

Anti-SARS-CoV-2 Antibody Testing: Role and Indications.

Since the onset of the COVID-19 pandemic in March 2020, over 769 million confirmed COVID-19 cases, including close to 7 million COVID-19-related deaths, have been reported. Although mortality rates have dropped notably compared to the first months of the pandemic, spikes in reported cases and mortality rates continue to be registered. Both recent spikes in case numbers and the continued emergence of new variants suggest that vulnerable patient groups, including older adults, immunocompromised patients, and patients with severe comorbidities, are going to continue to be affected by COVID-19. In order to curb the pandemic, relieve the pressure on primary care facilities, and reduce mortality rates, global vaccination programs have been established by the WHO, with over 13.5 billion vaccine doses having been administered globally. In most immunocompetent individuals, vaccination against COVID-19 results in the production of anti-SARS-CoV-2 spike antibodies. However, certain patient subsets have inadequate or reduced immune responses, and immune responses are known to decrease with age. General recommendations on the timing of booster vaccinations may therefore be insufficient to protect vulnerable patients. This review aims to evaluate the clinical role of anti-SARS-CoV-2 antibodies, focusing on measurement indications, prognostic value, and potential as a correlate of protection to guide future booster vaccination strategies.

Challenges in the Care of Patients with AKI Receiving Outpatient Dialysis: AKINow Recovery Workgroup Report.

Up to one third of survivors of AKI that required dialysis (AKI-D) during hospitalization remain dialysis dependent at hospital discharge. Of these, 20%-60%, depending on the clinical setting, eventually recover enough kidney function to stop dialysis, and the remainder progress to ESKD. To describe the challenges facing those still receiving dialysis on discharge, the AKINow Committee conducted a group discussion comprising 59 participants, including physicians, advanced practitioners, nurses, pharmacists, and patients. The discussion was framed by a patient who described gaps in care delivery at different transition points and miscommunication between care team members and the patient. Group discussions collected patient perspectives of ( 1 ) being often scared and uncertain about what is happening to and around them and ( 2 ) the importance of effective and timely communication, a comfortable physical setting, and attentive and caring health care providers for a quality health care experience. Provider perspectives included ( 1 ) the recognition of the lack of evidence-based practices and quality indicators, the significant variability in current care models, and the uncertain reimbursement incentives focused on kidney recovery and ( 2 ) the urgency to address communication barriers among hospital providers and outpatient facilities. The workgroup identified key areas for future research and policy change to ( 1 ) improve communication among hospital providers, dialysis units, and patients/care partners; ( 2 ) develop tools for risk classification, subphenotyping, and augmented clinical decision support; ( 3 ) improve education to providers, staff, and patients/care partners; ( 4 ) identify best practices to improve relevant outcomes; ( 5 ) validate quality indicators; and ( 6 ) assess the effect of social determinants of health on outcomes. We urge all stakeholders involved in the process of AKI-D care to align goals and work together to fill knowledge gaps and optimize the care to this highly vulnerable patient population.

Building Stakeholder Consensus Regarding Disclosure of Individual Research Results in ADRD Research: A Delphi Study Protocol

AbstractBackgroundInformed decisions to enroll in clinical investigations of Alzheimer’s disease and related dementias (ADRD) require careful consideration of complex risks and uncertain benefits. Decisions regarding scope of research participation and whether to receive information about biomarker status are complicated by lack of scientific consensus regarding biomarkers as surrogate end points for Alzheimer’s disease. This Delphi protocol aims to establish stakeholder consensus regarding the content and features of ethically optimal informed consent support for ADRD research.MethodThis consensus‐building Delphi protocol consists of three rounds of online surveys conducted with three stakeholder groups: Alzheimer’s disease research experts (including ethicists, research oversight specialists, and clinical trialists), Alzheimer’s disease research participants, and study partners of individuals enrolled in ADRD research. Participants will be administered questionnaires developed from a synthesis of researcher‐ and participant‐endorsed decisional needs identified in published literature and a decisional needs assessment conducted with support from an Alzheimer’s Association Research Grant. Participants will also be asked their views on the design, content, and implementation of a decision support tool. ≥70% agreement will be required to achieve consensus. Response rates, level of agreement, medians, interquartile ranges, and group rankings will be analyzed. Following each round of data collection, our research team will undertake qualitative content analysis of open‐ended responses and forum interactions.ResultThis protocol will develop consensus regarding priorities for decision support for ADRD research participants and the key features and content of ethically optimal informed consent support interventions. The Delphi technique is appropriate to develop consensus between diverse stakeholders because of its ability to offer anonymity to other participants and minimize bias.ConclusionFindings will contribute to the development of a digital health research infrastructure that is inclusive of diverse individuals and attentive to the needs of cognitively vulnerable patient populations and their caregivers.

Abstract A083: Initiation and persistence of hormone therapy in endocrine positive breast cancer at an urban safety-net hospital

Abstract Background: Evidence demonstrates inequities in receipt and persistence of hormone therapy among breast cancer patient populations based on race, ethnicity, insurance, and language. Institutions where patients seek cancer care may have an impact on receipt of treatment. It is unknown whether safety net hospitals, servicing a vulnerable patient population, exhibit inequities in receipt of hormone therapy for breast cancer. Study Design: We performed a retrospective study of patients diagnosed with all stages of hormone positive (ER+ and/or PR +) breast cancer treated at a safety net institution over the five year period from January 1, 2009 to December 31, 2013. The initiation of and persistence of hormone therapy were assessed by race, ethnicity, insurance status, and primary language. Persistence of therapy was defined as defined as at least 3 prescriptions (90 day supply) or more than 1 visit after start of treatment documenting taking treatment. Results: A total of 599 women were identified. The median age was 59 years, 58% were non-White, 32% were non-English-speaking, and 35% had Medicaid or no insurance. A total of 506 (84%) were started on hormone therapy. In multivariate regression analysis, the rate of endocrine therapy initiation was associated with higher stage at diagnosis, post-menopausal status, and HER2 negative status. Non-white race, Hispanic/Latino ethnicity, non-English-language, and Medicaid/no insurance were not significantly associated with or without initiation of hormone therapy. 93% of patients started on hormone therapy had evidence of continued treatment, 91% had evidence of continued treatment at 1 year, 75% finished their recommended course of hormone therapy. Conclusion: At an urban safety-net hospital, we do not observe inequities in the initiation of endocrine therapy for breast cancer by race, ethnicity, insurance, or language. Persistence of therapy was similar to nationally reported data. Additional research by hospital type, and granular reasons for non-adherence are warranted. Citation Format: Quinn S. Solfisburg, Brendin R. Beaulieu-Jones, Michael R. Cassidy, Naomi Y. Ko. Initiation and persistence of hormone therapy in endocrine positive breast cancer at an urban safety-net hospital [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A083.

OP33 Child And Adolescent Mental Health Care Models: A Scoping Review

IntroductionMental illnesses are among the most common health problems in children and adolescents worldwide, and their prevalence has recently increased. At the same time, many countries face gaps in care and a shortage of services. To address these challenges, countries are developing child and adolescent mental health (CAMH) strategies and adopting their models of care. This paper aimed to give an international overview of these strategies and care models to support decision makers and stimulate mutual learning and improved CAMH care.MethodsWe identified core topics within published CAMH strategies and care model documents from seven selected countries within the Global North, which represented different healthcare systems, geographical regions, and public health traditions to maximize variety. We systematically extracted data on the identified topics and summarized them narratively by applying qualitative content analyses.ResultsThe documents addressed the following core topics: awareness raising activities; prevention and promotion; detection; treatment; telemedicine; care pathways; transitional psychiatry; vulnerable patient groups; user participation; infrastructure; workforce development; implementation; digital tools for case management; and data acquisition and research. A stand-alone CAMH strategy exists in most countries.Recommendations on CAMH care often followed a public mental health approach and placed a high priority on mental health promotion and cross-sectional organization and funding of CAMH care services. Key principles of future CAMH care included: increased flexibility of care settings; early intervention; an open and non-judgmental attitude among staff; and strengths orientation instead of focusing on deficits and diagnoses.ConclusionsReducing the prevalence of mental illness and current shortcomings in care requires action at the policy level (e.g., developing a CAMH strategy with a focus on mental health promotion and installing cross-sectoral governance), organizational level (e.g., reorganizing treatment settings and pathways of care), and individual level (e.g., strengthening user involvement and workforce development). Applying the recommended approaches in other countries will likely require redesign, ideally with a participatory approach and evaluation alongside piloting.

Can german discharge management by law support people with cognitive impairments across sectors

AbstractAround 1.8 million people in Germany live with dementia. Ascending trend. Discharging people with cognitive impairment from the hospital and transitioning them to outpatient care brings special challenges and presents the health care system with a new and increasingly important task. In Germany there are legal efforts (§39 paragraph 1a, SGB V) to close gaps, wich are supposed to develop the discharge and transfer process. A relevant Cochrane review provided further impressions of the effectiveness of individualized discharge planning.The analysis is part of the intersec‐CM study; a multi‐centered, randomized controlled study to analyze the effectiveness of an intersectoral intervention and care management system. Discharge documents of all documents available at the time of discharge could be recorded by n = 382 subjects. This corresponds to a sample size of 95.02% of the total study population.Aim of the presentation is to provide an overview of the documentation process for discharge and transfer management in everyday clinical practice after the discharge management law came into force in accordance with §39 paragraph 1a, SGB V. It answers the research question „What form does documentation take within the framework of statutory discharge management for people with cognitive impairments?“ It highlights further characteristics of the discharge documents for vulnerable patient groups and shows which contents in the discharge documentation play a role in order to be able to provide cross‐sectoral support for people with cognitive impairment.There can be shown three findings; formal, content‐related and translational results. Even formal results show, that there is no standardization for discharge documents. Further content‐related results confirm, that the documentation process according to §39 paragraph 1a, SGB V has large documentation gaps. The documentation appears to be heterogeneous and communication for follow‐up treatment needs improvement. The greatest learning objective is to create awareness for standardization in the discharge documentation for people with cognitive impairment.

The Association Between Non-Clinically Apparent Liver Fibrosis and Pulmonary Arterial Hypertension in Hispanic Patients.

Pulmonary arterial hypertension (PAH) is a deadly cardiopulmonary disease with multi-organ involvement including impaired liver function. Liver dysfunction in PAH is poorly understood but significantly associated with morbidity and mortality. Hispanics have a significantly higher prevalence of non-alcoholic fatty liver disease (NAFLD) and evidence of more advanced disease in comparison to other ethnic groups. The clinical impact of NAFLD in Hispanic PAH patients is unknown. We aimed to investigate the impact of a validated scoring system, non-alcoholic fatty liver disease fibrosis score (NFS), to predict the degree of liver fibrosis in a Hispanic PAH population and its relationship to hemodynamics, functional class, and outcomes. A retrospective review of all treatment-naive Hispanic patients with group I World Health Organization (WHO) pulmonary hypertension (PH) at a single academic center between February 2016 and March 2021 was performed. Patients with history of substance or alcohol abuse, non-group I WHO PH, pre-existent liver disease, chronic kidney disease, atrial fibrillation, thyroid disease, and warfarin use were excluded from the study. The diagnosis of group I WHO PH was determined by cardiac catheterization after the exclusion of other etiologies. NFS was calculated for each patient and correlated with functional capacity, hemodynamics, N-terminal-pro-B-type natriuretic peptide (NT-proBNP), and survival. A total of 96 Hispanic patients were included in our study. The median age of patients in our cohort was 49 years (interquartile range: 15) and 69% of our cohort were females. Higher NFSs indicating advanced hepatic fibrosis (F3-F4) were found to correlate with elevated right-sided cardiac filling pressures (r = 0.27, P = 0.03), elevated levels of NT-proBNP (r = 0.32, P = 0.01), lower 6-minute walk distance (6MWD) (r = -0.49, P = 0.001), lower functional capacity (World Health Organization functional class, WHO-FC, r = -0.35, P = 0.051), a higher prevalence of diabetes (21.1% versus 51.9%, P = 0.001), a higher prevalence of risk factors for metabolic syndrome (81.5% versus 65.0%, P = 0.035), and worse 5-year survival rates. In Hispanic patients with PAH, NFSs correlate with the degree of right-sided pressure overload. In addition, advanced NFSs were independently associated with lower 5-year survival rates and added prognostic information to other established risk parameters in PAH. This study suggests that screening for liver disease in this vulnerable patient population can aid in earlier detection leading to discussion of lifestyle modifications and possible escalation of PAH-targeted therapies, thus leading to potential improvement in survival rates.