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Background Fatty acids are important components of diet that may influence the development of CVD. Objective To verify the relationship of dietary fatty acids with cardiometabolic markers in individuals at the cardiometabolic risk. Methods This cross-sectional study involved 282 subjects (116 M/166 F, 42 ± 16 years) attended the Cardiovascular Health Care Program, Universidade Federal de Vicosa (Brazil). Anthropometric and body composition measurements as well as metabolic and inflammatory markers were assessed by standard procedures. Demographic and lifestyle variables [...]

Overshadowed by Sino-pulmonary infections, Cystic Fibrosis (CF) commonly affects gastrointestinal organs because of secretory and motility dysfunction. Infrequently, these changes result in Distal Intestinal Obstruction Syndrome (DIOS), an increasingly diagnosed gastrointestinal entity in adult Cystic Fibrosis patients. We present a case 22-year-old male who presented to our hospital with right lower quadrant abdominal pain with suspicion of acute appendicitis and was subsequently diagnosed as DIOS. Our case highlights the importance of DIOS as one of the differential diagnosis of right lower quadrant abdominal pain in a patient with a CF, especially for physicians working at community hospitals which may not have a Cystic Fibrosis care program available.

Background Telemonitoring enables care providers to remotely support outpatients in self-managing chronic heart failure (CHF), but the objective assessment of patient compliance with self-management recommendations has seldom been studied. Objective This study aimed to evaluate patient compliance with self-management recommendations of an innovative telemonitoring enhanced care program for CHF (ITEC-CHF). Methods We conducted a multicenter randomized controlled trial with a 6-month follow-up. The ITEC-CHF program comprised the provision of Bluetooth-enabled scales linked to a call center and nurse care services to assist participants with weight monitoring compliance. Compliance was defined a priori as weighing at least 4 days per week, analyzed objectively from weight recordings on the scales. The intention-to-treat principle was used to perform the analysis. Results A total of 184 participants (141/184, 76.6% male), with a mean age of 70.1 (SD 12.3) years, were randomized to receive either ITEC-CHF (n=91) or usual care (control; n=93), of which 67 ITEC-CHF and 81 control participants completed the intervention. For the compliance criterion of weighing at least 4 days per week, the proportion of compliant participants in the ITEC-CHF group was not significantly higher than that in the control group (ITEC-CHF: 67/91, 74% vs control: 56/91, 60%; P=.06). However, the proportion of ITEC-CHF participants achieving the stricter compliance standard of at least 6 days a week was significantly higher than that in the control group (ITEC-CHF: 41/91, 45% vs control: 23/93, 25%; P=.005). Conclusions ITEC-CHF improved participant compliance with weight monitoring, although the withdrawal rate was high. Telemonitoring is a promising method for supporting both patients and clinicians in the management of CHF. However, further refinements are required to optimize this model of care. Trial Registration Australian New Zealand Clinical Trial Registry ACTRN12614000916640; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366691

Background and aims Advance care planning (ACP) has the potential to reduce suffering and improve outcomes in serious illness, but its implementation has been limited. A consortium of seven Practice Based Research Networks (PBRNs) in the US and Canada known as Meta-LARC designed a cluster randomized comparative effectiveness trial of two models of ACP in primary care practices. Methods Meta-LARC facilitated identification of primary care concerns and topics through collaboration among researchers, PBRN directors, clinicians and patient/family advisors. Over 2 months, we used the PBRNs to quickly assess interest, develop options, assess feasibility, refine ideas and obtain buy-in. Through this iterative process, we identified an existing ACP program to study (the Serious Illness Care Program by Ariadne Labs) and developed a proposal, research protocol and a stakeholder engagement plan. Results The trial, agreed to by all seven PBRNs, was funded by the Patient Centered Outcomes Research Institute and began in November 2017. This panel will discuss the key decision steps and drivers for the trial design (Part 1) and the accomplishments to date including engaging stakeholders (Part 2), adapting ACP training for teams (Part 3), obtaining ethics approval in two countries (Part 4), supporting ACP implementation in diverse primary care practices (Part 5) and developing patient-reported measures of goal concordant care (Part 6). Conclusion PBRN networks provide an important infrastructure that can facilitate design of a large, complex study of ACP with the potential to influence the spread of ACP in primary care practices in at least two countries.

Background Implementation of ACP is challenging, requiring a multi-pronged approach in primary care. We sought to provide a toolkit that would facilitate practices’ adoption of the Serious Illness Care Program, as a means of improving the quality of care and engaging patients in serious illness care discussions and planning. Methods The joint coordinating center established a working committee to compile implementation resources. We used an iterative approach to identify key issues, materials, and discussion points necessary to engage practices in ACP implementation. We involved stakeholder groups representing patients, clinicians, practice facilitators, researchers, and informaticians. The group identified, adapted, and reached consensus on materials and approaches to facilitating ACP in primary care practices. Results We identified potential implementation barriers, including knowledge, attitudes, workflow, health information technology constraints, and sensitivity of the topic to engaging practices in ACP. We gathered materials to address these barriers including checklists, adaptable templates for dissemination and documentation, and developed a guide to facilitate conversations with practices. The key topics included practice readiness, patient identification, use of prognostic algorithms, workflow enhancement, effective documentation, and sustainability. We are using the TiDier checklist to monitor implementation fidelity to the ACP models in the trial. Conclusion We created a toolkit to support implementation of ACP in primary care practice that can be used by practice facilitators. It covers the major topics identified by stakeholders as essential for ACP implementation. We will evaluate and revise this, making an enhanced implementation guide available to the trial practices as well as to others.

This thesis is concerned with the impact of government guardianship on a group of young Queenslanders, it specifically considered two key questions: 1. Are young Queenslanders adequately prepared to leave care? 2. Are the elements identified as essential for the effective transition from care incorporated within the service experience of young Queenslanders? The study began with data being obtained about the social circumstances of 122 young people who were referred to The Transition From care Program in the first six months of its operation, in 1991. in the following year 65 of these young people were able to be located; 57 agreed to be involved in post-program interviews, information was then collected about the young people’s social circumstances at that time. 51 of this group then agreed to be involved in the second part of the interview, which involved a series of questions to obtain their opinions about their time in care. At referral, the vast majority of young people were clearly unable to cope independently of the Department of Families, Youth and Community Care. At postprogram, while some young people possessed the skills and supports to cope with independence, others continued to lack the capacity to successfully contend with independence. A number of young people were clearly in need of ongoing support and assistance. Of particular concern were the young people who did not have supportive networks. These results were not surprising in the light of findings that many of the elements identified, in literature, as essential for effective transition from care were not incorporated within the service experience of young people.

Introduction To date, gaps exist in our understanding of how child care provider participation in various support programs is associated with the reported implementation of nutrition and physical activity best practices by child care providers. Thus, the purpose of the current study was to compare implementation of nutrition and physical activity best practices among child care providers engaged in the Child and Adult Food Care Program (CACFP), Parent AWARE, and other training opportunities, to implementation among providers who do not participate in each of these opportunities. Methods Cross-sectional analysis of survey data collected from a stratified-random sample of licensed family-home and center-based child care settings (Family-homes n=394; Centers n= 224) in XXX from Month-Month 20XX. Descriptive statistics and multiple regression models were used to characterize differences in adherence to best practices based on program participation (CACFP, Parent AWARE, training) and type of child care setting (center versus family-home). Surveys measured self-reported engagement in nutrition and PA best practices as well as participation in CACFP, Parent Aware, and training opportunities. Results Center-based child care providers participating in CACFP adhered to more nutrition and PA best practices than those not involved in CACFP. Further, with one exception, participating in Parent AWARE and engagement in training were positively associated with adherence to nutrition practices in center and family-home setting, and with adherence to PA practices in family homes. Conclusions Child care providers should be encouraged to participate in available support programs; advocates should work to identify and remove barriers to support program participation.

Children are an active participants in intergenerational care learning opportunities and programs, however, children’s agency within these programs is often not clear. The perspectives and contributions children make in intergenerational programs needs to be considered as part of children’s rights to have a say on matters that affect them. Understanding young children’s experiences in intergenerational care programmes and unpacking the level of choice and impact these programs have on their lives is a critical, yet understudied, area in the intergenerational practice literature. This chapter discusses the use of strategies to explore young children’s voices and experiences of services in which they participate. The example of a case study from a pilot intergenerational care program, which took place in in Brisbane, Australia and gathered the voices and experiences of seven of the 3 to 5 year-old children who participated is discussed. The case study used photo elicitation to seek children’s perspectives about their experiences. The children shared ideas about the physical location of the program as well as the relationships they made with the older adults. The chapter is intended to stimulate further conversations and research about strategies to consult with children who are participating in intergenerational care programs.

The 2014-2016 Ebola epidemic in West Africa influenced how public health officials considered migration and emerging infectious diseases. Responding to the public’s concerns, the US government introduced enhanced entry screening and post-arrival monitoring by public health authorities to reduce the risk of importation and domestic transmission of Ebola while continuing to allow travel from West Africa. This case study describes a new initiative, the Check and Report Ebola (CARE+) program that engaged travelers arriving to the United States from countries with Ebola outbreaks. The Centers for Disease Control and Prevention employed CARE ambassadors, who quickly communicated with incoming travelers and gave them practical resources to boost their participation in monitoring for Ebola. The program aimed to increase travelers’ knowledge of Ebola symptoms and how to seek medical care safely, increase travelers’ awareness of monitoring requirements, reduce barriers to monitoring, and increase trust in the US public health system. This program could be adapted for use in future outbreaks that involve the potential importation of disease and require the education and active engagement of travelers to participate in post-arrival monitoring.

Background Rehabilitation after acute myocardial infarction is a well-proven strategy to improve outcomes and reduce complications rate. Poland recently introduced a novel, fully-reimbursed Coordinated Comprehensive Care (CCC) program after myocardial infarction, a significant portion of which comprises access to free-of-charge cardiac rehabilitation. Purpose The purpose of the study was to analyze all patients qualified for the Coordinated Comprehensive Care Program and evaluate reasons for not completing rehabilitation. We compared two groups of patients - those who completed the rehabilitation and those that did not - in terms of clinical, demographic and laboratory characteristics. Methods All patients (n=169) referred from the cardiology department for the CCC program were included in the study. They were divided into two groups, depending on single, strict criterium of completion or non-completion of the rehabilitation program. Demographic, clinical and laboratory data were collected and analyzed. Results The majority of the patients (n=100, 59.2%) did not undergo cardiac rehabilitation. 61 of them were not qualified for rehabilitation programme by the consortium of doctors: 33 of them due to the need for further invasive treatment, the remainder 28 were disqualified due to severe comorbidities. 32 patients did not commence the program despite referral and encouragement, mostly (n=25) due to personal reasons, 7 patients did not specify reasons for not participating in the rehabilitation. 7 patients were lost to follow-up. Patients who completed rehabilitation (n=69, 40.8%) were younger that those who did not (64.4±9.8 vs. 67.1±9.5 years, respectively; p=0.076), had significantly higher baseline LVEF (49.1±9.4 vs. 44.7±11.9%, p Rehabilitation completed (n=69) Rehabilitation NOT completed (n=100) p Gender – male 40 (35.4%) 73 (64.6%) Conclusion Although fully-reimbursed cardiac rehabilitation is provided for all patients following acute myocardial infarction, there is a significant number of patients who fail to complete the programme. This group comprises more male patients with worse clinical and laboratory test results, especially LVEF and renal function. Efforts should be made to address the problem and modify the programme accordingly.

Background Four recommended self-care behaviors (low salt diet, avoidance of excessive fluid intake, weight control, and flexible diuretic regimen) play an important role in the management of heart failure (HF) patients. However, little is known about the impact of patients' adherence to these self-care behaviors on prognosis and rate of HF re-hospitalizations. The aim of our study was to analyze the impact of HF patients' adherence to maintenance of euvolaemia on all-cause mortality and HF re-hospitalizations. Methods The analysis included data from the international prospective multicenter Optimize Heart Failure Care Program which was collected over 12 months from 628 patients (mean age 62.6±12.3 years, 70% male) hospitalized with decompensated HF, NYHA II-IV (mean 2.7±0.6), mean left ventricular ejection fraction 33.8±9.4%. The underlying etiology of HF was ischemic in 64% of cases. Before discharge from the hospital all HF patients were educated in self-care skills to maintain the euvolaemia. To assess patients' adherence to low salt diet, avoidance of excessive fluid intake, weight control and flexible diuretic regimen, an indirect method (patient-reported compliance, which was measured using a special questionnaire) was used. Three types of adherence were determined: good (patients always maintained euvolaemia), moderate (patients sometimes maintained euvolaemia) and poor adherence (patients did not maintain euvolaemia). Results After discharge from the hospital the overall adherence rates were 66.4% for low sodium diet, 58% for fluid intake, 69.9% for weight control, and 87.2% for the flexible diuretic regimen. However, the adherence to diet and the flexible diuretic regimen significantly decreased (p Conclusion Less than half of HF patients demonstrated good adherence to the guideline-recommended control of euvolaemia. The rates of all-cause mortality and HF re-hospitalizations in the group of good patient's adherence were significantly lower compared with the groups of moderate and poor adherence to maintenance of euvolaemia. Constant efforts to promote the maintenance of euvolaemia in HF patients are needed.

Background: Home care of technology depended children may affect their family’s daily life. Aim: To evaluate the impact on family’s daily life after the implementation of a hospital based home care program for technology depended children. Patients and Methods: Children with chronic respiratory problems who are technology dependent entered prospectively in a hospital based home care program. The program was covered by two nurses and two physiotherapists who visited home on a regular weekly basis and are referred to a tertiary Paediatric Department. The impact on family was evaluated by the measurement of days of hospitalization, hours of sleeping of the parents, family’s days of holidays and quality of life score of the children, one year ago and one year after their entry in the home care program. Total Quality of Life (Qol), assessed with the Disabkids Questionnaire. Results: 40 children with mean age 6, 07 years entered the study. (20/40 with gastrostomy, 18/40 with tracheostomy and 14/40 on mechanical ventilation). Mean days of hospitalization one year ago were 42, 25 and one year after 11, 35 (p Conclusion: The Hospital based Home Care program improved QoL of the technology depended children and specific features of their family’s daily life.

Background: Technology Depended Children (TDC) are frequently admitted to the hospital with significant cost for the Health Care System. Home care programs have been reported to reduce admissions and consequently the health care cost. Aim: The aim of this study was to evaluate the cost of care of TDC who entered a Hospital based Home Care Program. Patients and Methods: Children with chronic respiratory problems who are technology dependent entered prospectively in a hospital based home care program. The program was covered by two nurses and two physiotherapists who visited homes on a regular weekly basis and are referred to a tertiary Paediatric Department. We calculate the cost, the days of planned admissions and planned visits, the days of unplanned admissions in the Paediatric Department and PICU, one year ago and one year after their entry in the program. Results: 40 children entered the study. Mean age was 6, 07 years. (20/40 with gastrostomy, 18/40 with tracheostomy and 14/40 on mechanical ventilation). The mean number of scheduled visits were 2. 67 before and 3.15 after (p= 0,153). Mean number of unplanned admissions were 1. 67 before and 0.97 after (p= 0, 011). Mean days of hospitalization were 42.25 one year before and 11.35 one year after (p Conclusion: Implementation of the Hospital based Home Care program for TDC significantly reduced admissions and almost halved the cost of care for these children.

Resumen Introducción: La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una enfermedad altamente prevalente que se caracteriza principalmente por la disnea, la cual genera un impacto sobre la calidad de vida del individuo. El programa de cuidado respiratorio integral ofrece una intervención esencialmente educativa, individualizada y multidisciplinaria enfocada en las necesidades del paciente y su familia, buscando mejorar la calidad de vida. Objetivo: Describir el efecto de un programa educativo de cuidado integral en la calidad de vida de pacientes con enfermedad pulmonar obstructiva crónica. Materiales y métodos: Se realizó un estudio descriptivo transversal incluyendo pacientes con diagnóstico de EPOC en quienes se aplicó el cuestionario para medición de calidad de vida Saint George al ingreso y a los seis meses de estar vinculado al programa. Se realizaron pruebas estadísticas no paramétricas debido al comportamiento no gaussiano de las variables. Resultados: Se incluyeron un total de 31 pacientes con promedio de edad 82,7 años, 43,3% tenían antecedente de tabaquismo, de las variaciones en la encuesta Saint George se observó un cambio significativo en el dominio de actividad y en el puntaje global de la encuesta al ser aplicada a los seis meses de seguimiento. Conclusiones: La implementación del programa educativo integral parece apoyar la mejoría en la calidad de vida de los participantes con diagnóstico de EPOC. Futuros estudios prospectivos podrán validar esta hipótesis. Abstract Introduction: The Chronic Obstructive Pulmonary Disease (COPD) is a highly prevalent disease, characterized mainly by dyspnea, which has an impact on the quality of life of the person. The program of comprehensive respiratory care offers an essentially educational, individualized and multidisciplinary intervention focused on the needs of the patient and its family, seeking to improve the quality of life and associated morbidities. Objective: To describe the quality of life in a comprehensive care program for patients with chronic obstructive pulmonary disease. Methods: A cross-sectional retrospective descriptive study was carried out, including patients diagnosed with COPD, in whom the Saint George quality of life questionnaire was applied at admission and six months after being linked to the program. Student’s t test was performed for the analysis by normality tests. Results: A total of 31 patients with an average age of 82.7 years were included, 43.3% had a history of smoking, variations in the Saint George survey showed a significant change in the domain of activity and in the overall score when applied to the six-month follow-up. Conclusions: The implementation of the comprehensive educational program seems to support the improvement in the quality of life of participants diagnosed with COPD. Future prospective studies may validate this hypothesis.

As the number of elderly citizens in general and the number of persons with dementia in particular rises, the importance of educating geriatric health care professionals increases. Recruitment is, however, impaired by negative stereotypes and insecurity. Previous research has shown that contact with the field of dementia care is important for students' motivation for choosing this career path. This paper presents an extracurricular psychomotor intervention program in which students through eight visits to elderly persons with dementia carry out an intervention involving direct individual contact. Eight psychomotor therapy students participated in follow-up focus group interviews. The purpose was to explore the motivational dynamics that make these experiences meaningful to students. Qualitative analysis of the students' self-assessed outcomes revealed three themes: The relational encounter, Discovering the person, and Making a difference. In combination these themes show important nuances to existing literature on student career dreams by pointing to the benefits of attending to the moment to moment changes in the care situation.

Objetivo: Identificar as condições de saúde e necessidades de cuidados dos idosos assistidos pelo sistema de saúde suplementar. Método: Estudo quantitativo, realizado no domicílio de 92 idosos atendidos pelo programa de atendimento domiciliar de uma instituição de saúde suplementar. Para a coleta de dados utilizou-se instrumento estruturado para caracterizar os idosos e suas necessidades de cuidado, sendo também aplicada a escala de Medida de Independência Funcional e o Mini Exame do Estado Mental. Resultados: A média de idade dos sujeitos foi de 83,2 anos, sendo que 67,5% pertenciam ao grupo dos idosos longevos. Metade da população encontrava-se acamada, sendo corroborado pela avaliação da capacidade funcional na qual 32% dos idosos apresentavam dependência total e avaliação cognitiva onde 54% de idosos estavam com perda de cognição severa. Conclusão: Os programas de assistência domiciliar visam à permanência dos idosos no domicílio, entretanto, as características de saúde encontradas na população exigem uma rede de suporte e apoio fortalecida

Under California's Whole Person Care program, Sacramento is using Medicaid funds to help its homeless population find housing.

Objective: To examine a rural-serving HBPC program's 12-year experience and historical trends to inform future program direction and expansion. Background: There is limited information about longitudinal trends in mature hospital-based palliative care (HBPC) programs serving racially diverse rural populations. Methods: This is a retrospective cross-sectional study of operational and patient-reported outcomes from the University of Alabama at Birmingham (UAB) Center for Palliative and Supportive Care (CPSC) inpatient (n=11,786) and outpatient (n=315) databases from October 2004 to March 2016. Results: Inpatients were a mean age of 63.7 years, male (50.1%), white (62.3%), general medicine referred (19.5%), primarily for goals of care (84.4%); 47.1% had "do not resuscitate/do not intubate" status and 46.9% were transferred to the Palliative Care and Comfort Unit (PCCU) after consultation. Median time from admission to consultation was three days, median PCCU length of stay (LOS) was four days, and median hospital LOS was nine days. Increased emergency department and cardiology referrals were notable in later years. Outpatients' mean age was 53.02 years, 63.5% were female, 76.8% were white, and 75.6% had a cancer diagnosis. Fatigue, pain, and disturbed sleep were the most common symptoms at the time of the visit; 34.6% reported mild-to-moderate depressive symptoms. Of patients reporting pain (64.8%), one-third had 50% or less relief from pain treatment. Discussion: The CPSC, which serves a racially diverse rural population, has demonstrated robust growth. We are poised to scale and spread our lessons learned to underserved communities.

Publisher's version (útgefin grein), Objective: To identify home care clients with substantial functional deficits who had capacity to improve and, thus, for whom recovery goals should be articulated. Design: Retrospective longitudinal analysis of an international home care database. Setting and participants: 523,907 persons receiving home care, having 2 assessments, on average, 8 months apart. Measures: Recovery algorithm variables included counts of dependencies of activities of daily living (ADL) and instrumental ADL (IADL) tasks, hospitalization in the last 30 days, functional decline in the last 90 days, and self-belief in one's capacity to improve. Primary dependent variable was improvement in the IADL-ADL Functional Hierarchy Scale. Results: The Recovery Algorithm has 7 graded levels: the top 3 represent approximately 9% of home care clients, whereas the bottom level (where recovery is least likely to occur) includes 60% of home care clients (many with higher counts of extensive ADL or IADL dependencies). The improvement rates rise from 6.9% to 47.2% across the 7 levels of the algorithm. This relationship between change in IADL-ADL Functional Hierarchy Scale scores and Recovery Algorithm levels remained strong across age categories and cognitive performance levels. Higher rates of improvement occurred for persons who received physical therapy. Conclusions/Implications: The Recovery Algorithm is based on a mix of positive risk indicators and the person's challenged baseline functional status. For persons with higher scores on the algorithm, recovery is expected and should be considered in care plan goals. In addition, use of physical therapy increases the probability of recovery., The authors remain grateful to interRAI.org and specifically the home care clients whose assessments provided the data for this project.

Transition of Care Models can reduce the 30-day hospital readmission rate up to 67% by offering coordination and continuity of care. The purpose of this project was to evaluate a Congregation Transition of Care (CTOC) program in faith-based communities with the use of a faith community nurse and volunteer faith-based registered nurses. Descriptive statistics were used to describe findings, revealing a CTOC program can be effective in reducing 30-day readmissions in the faith community.

Emergency departments are a common access point for survivors of sexual and gender-based violence (SGBV), but very little is known about where survivors live and the neighborhoods they return to. The objectives of this study were to describe the patient population that present for a sexual or partner-based assault and explore the geographic distribution of cases across the Ottawa-Gatineau area. Data for this study were extracted from the Sexual Assault and Partner Abuse Care Program (SAPACP) case registry (January 1 to December 31, 2015) at The Ottawa Hospital. Spatial analyses were conducted using six-digit postal codes converted into Canadian Census Tract units to identify geographic areas with concentrated cases of SGBV. Concentrated areas were defined as Census Tracts with seven or more SGBV cases within a single calendar year. In 2015, there were 406 patients seen at the SAPACP and 348 had valid postal codes and were included in the analyses. More than 90% of patients were female and 152 (43.68%) were below 24 years of age. More than 70% knew their assailant and the most common locations of the assault were at the survivors’ home (31.03%), assailants’ home (27.01%), or outdoors (10.92%). Eight concentrated areas were identified including three in the downtown entertainment district, three lower income areas, one high-income neighborhood, and one suburb more than 20 km from downtown. The findings from this study describe the typical clinical presentation of sexual and domestic assault survivors and also challenge geographic stereotypes of where survivors live and what areas of the city are most affected by SGBV. Using residential information provides a survivor-centric approach that highlights the widespread nature of SGBV and supports the need for population-based approaches to improve care for survivors.

Background: One of the goals of DM management is to achieve glycemic control to prevent or delay acute and chronic complications. ADA recommends planned visits through team-based approach to improve delivery of DM care. AHN Diabetes Academy (DA) is a 12-week team-based care program for patients w/A1C >9%, T1DM, or worsening complications. Objective: Determine if patients who participated in DA have sustained glucose control at 1 year. Method: Compare A1C at the start, end of DA and at 1-year follow-up. Results: A total of 221 patients were enrolled from 9/26/16 to 10/22/17. Seventy-seven % had T2DM, 21% had T1, 2% had T1.5. Thirty-nine were lost to follow-up or did not have A1C at 1 year, allowing data analysis for 182 patients at 1 year. Mean A1C decreased significantly from 9.4 to 7.7% for all patients from enrollment to discharge; A1C at 1-year follow-up was 7.8%, unchanged from discharge showing sustained glycemic control at 1 year (Figure). When DM subtypes were analyzed, mean A1C decreased significantly for T1 and T2 from enrollment to discharge, no statistical change in T1.5 (likely due to small sample size). No significant change in mean A1C from discharge to 1 year for all subtypes. Conclusion: AHN DA achieved sustained glycemic control at 1 year after completion of 12-week team-based program. Teaching Points: Team based care attains sustained glycemic control at 1 year, is effective for T1 and T2DM, and benefits those at high risk for acute and chronic complications. Disclosure J. Violago: Stock/Shareholder; Spouse/Partner; Abbott, AbbVie Inc., Cardinal Health, Eli Lilly and Company, Johnson & Johnson, Merck & Co., Inc., Pfizer Inc. P. Bononi: Other Relationship; Self; Medtronic.

The University of California, Los Angeles Alzheimer's and Dementia Care (ADC) program enrolls persons living with dementia (PLWD) and their family caregivers as dyads to work with nurse practitioner dementia care specialists to provide coordinated dementia care. At one year, despite disease progression, overall the PLWDs' behavioral and depressive symptoms improved. In addition, at one-year, overall caregiver depression, strain, and distress related to behavioral symptoms also improved. However, not all dyads enrolled in the ADC program showed improvement in these outcomes. We conducted a mixed qualitative-quantitative study to explore why some participants did not benefit and what could be changed in this and other similar dementia management programs to increase the percentage who benefit. Semi-structured interviews (N=12) or surveys (N=41) were completed with 53 caregivers by telephone, mail and online. Seven areas for potential program improvement were identified from the first 12 interviews. These included: recommendations that did not match caregivers' perceived care needs, barriers to accessing care and utilizing resources, differing care needs based on stage of dementia, needing services not offered by the ADC, needing more education or support, behavioral recommendations that the caregiver felt did not work, and poor rapport of the dementia expert with caregivers. Despite having been identified as having had no clinical benefit from participating in the program, most caregivers (85%) reported that the program was very beneficial or extremely beneficial. Respondents identified the close, longitudinal relationship and access to a dementia care expert as particularly beneficial. This dichotomy highlights that perceived benefit for most of the interviewed caregivers was not captured with the formal instruments used by the program.

The case presented here was informed by the systemic model of the Brief Therapy Center (BTC) of the Mental Research Institute (MRI) in Palo Alto, California (Fisch, Weakland & Segal, 1982; Fisch & Schlanger, 1999; Fisch, Ray & Schlanger, 2009; Weakland, Fisch, Watzlawick, & Bodin, 1974). The therapy took place in a community care program at a university clinic in Mexico City. The community that is served comes from the conurbation of the eastern zone of Mexico City – the population is of low economic resources and low socio-cultural level, with conditions of poverty and urban overcrowding.183

OBJECTIVE The aim of this study was to investigate the effectiveness of patients' intensive telephone-based care program (PITC) on depression and its correlation with overall survival in patients with coronary artery disease who have depression. METHODS A total of 224 patients with coronary artery disease who were complicated with depression were allocated randomly to the PITC group and control group in a 1:1 ratio. In the PITC group, PITC and usual care were performed, whereas in the control group, only usual care was given. Depression was assessed using Hospital Anxiety and Depression Scale-Depression (HADS-D) score and Zung Self-Rating Depression Scale (SDS) score. RESULTS No difference in baseline characteristics was found between the PITC and control groups (all P > .05). There were changes the HADS-D score (P = .002) and SDS score (P = .019) from baseline (M0) to month 12 (M12) in the PITC group. Those in the PITC group had a reduced depression rate (assessed by HADS-D score

BACKGROUND: Coordinated specialty care programs are designed to address the needs of youth experiencing first episode psychosis. In the United States, federal funds from SAMHSA were used to support the implementation of programs for first episode psychosis at the state-level. With these funds Washington State developed New Journeys, a network of coordinated specialty care programs for first episode psychosis. We seek to descriptively outline the components of the New Journeys model and the utilization of a Web-based tool to facilitate measurement-based care among community mental health clinics within the New Journeys Network. METHODS: The New Journeys model has been implemented in five community mental health clinics throughout Washington State. Treatment utilizes a shared decision-making framework and is comprised of individualized medication management, individual resiliency therapy, family psychoeducation, supported education and employment, and peer support. Measurement-based care is supported by a Web-based tool (i.e., Evidence-Based Practices (EBP) Toolkit) used to deliver measures that assess anxiety (Generalized Anxiety Disorder-7 item [GAD-7]), depression (Patient Health Questionnaire-9 [PHQ-9]), psychosis (Community Assessment of Psychic Experiences - Positive 15-items Scale [CAPE-P15]; Clinician-Rated Dimensions of Psychosis Symptom Severity [CRDPSS]), quality of life (Health Days Core Module [HDCM]), and substance use (CRAFFT). Clinicians also monitor service utilization, physical health (e.g., blood pressure), and education and employment. RESULTS: Between 2015 and 2018, clinicians have completed 196 screenings using the EBP Toolkit. Of those 89 clients are active, 65 are inactive, 33 were referred to other services, and 9 have completed the New Journeys program. Clinicians have administered 756 PHQ-9, 749 GAD-7, 2,799 CRDPSS, 635 CAPE-P15, 631 Health Days Core Module, and 645 CRAFFT measures during treatment. DISCUSSION: The use of Web-based tools provides an additional method for clinicians to capture client treatment outcomes. This data supports the use of potential validated and short measures that can be utilized within coordinated specialty care programs for first episode psychosis. As the number of specialty care programs increase the harmonization of measurement-based care for first episode psychosis will become increasingly necessary.

Background: Decreased ambient temperature significantly increases office blood pressure, but few studies have evaluated the effect of ambient temperature on home blood pressure. Objective: We aimed to investigate the relationship between short-term ambient temperature exposure and home blood pressure. Methods: We recruited patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital. Blood pressure was measured at home by patients or their caregivers. We obtained hourly meteorological data for Taipei (temperature, relative humidity, and wind speed) for the same time period from the Central Weather Bureau, Taiwan. Results: From 2009 to 2013, we enrolled a total of 253 patients. Mean patient age was 70.28 (SD 13.79) years, and 66.0% (167/253) of patients were male. We collected a total of 110,715 home blood pressure measurements. Ambient temperature had a negative linear effect on all 3 home blood pressure parameters after adjusting for demographic and clinical factors and antihypertensive agents. A 1°C decrease was associated with a 0.5492-mm Hg increase in mean blood pressure, a 0.6841-mm Hg increase in systolic blood pressure, and a 0.2709-mm Hg increase in diastolic blood pressure. This temperature effect on home blood pressure was less prominent in patients with diabetes or hypertension. Antihypertensive agents modified this negative effect of temperature on home blood pressure to some extent, and angiotensin receptor blockers had the most favorable results. Conclusions: Short-term exposure to low ambient temperature significantly increased home blood pressure in patients with chronic cardiovascular diseases. Antihypertensive agents may modify this effect.

To describe the oral health and oral health-related quality of life among social vulnerable adults enrolled in a special oral care program, and to evaluate the effect of oral care on their oral health-related quality of life.Social workers identified social vulnerable persons in social centres and referred them to the program. Dental clinics were arranged including a well-motivated staff to be special responsive to these clients. The participants, (n = 235, mean age 43.5 years) with drug abuse, being homeless, permanently unemployed, or with mental problems were offered low-cost treatment services. Data collection was made by clinical registration and questionnaires. Oral health-related quality of life was measured by means of the Oral Health Impact Profile-14 index (OHIP-14).94% of the participants had actual decayed teeth (mean 9.5). Forty-four per cent had not visited a dentist within 5 years and less than one-third reported tooth brushing twice a day, 17% even less frequent. One hundred and forty-six completed the dental program within the program period. Mean OHIP-14 score was 28.6 at baseline. Among those who fulfilled the program, the OHIP-14 score was reduced to 9.9 (p .001).Oral health among the study population was very poor. However, oral problems in this group can be solved, and their oral health-related quality of life can be increased although it requires special arrangements and special clinical environment.

Background and Objectives Caregiving dyads are fertile contexts for health promotion such as physical activity. However, previous physical activity interventions in caregiving dyads paid limited attention to care recipients’ outcomes and rarely involved paid caregivers. Home care aides (HCAs) provide nonmedical care for older family members or nonfamily clients in publicly funded home care programs in the United States. This study examined whether family and nonfamily HCA–client dyads differed in the outcomes of a 4-month gentle physical activity pilot program led by HCAs in a Medicaid home care program. Design and Methods A single-group prepost design was used to assess changes in clients’ function (self-reported and performance-based) and process outcomes (exercise-related social support provided by HCAs) in 18 family and 32 nonfamily HCA–client dyads. Repeated measures analysis controlled for clients’ demographic and health characteristics. Clients’ and HCAs’ motivation to continue the program beyond the intervention period was examined using quantitative and qualitative data. Results Client outcomes and exercise-related social support provided by HCAs improved, especially in nonfamily dyads. Both family and nonfamily dyads had high levels of motivation to continue the program, supporting the program’s sustainability for both clients and HCAs. Discussion and Implications Empowering HCAs to engage in health promoting activities with their clients is a promising strategy to improve the lives of caregiving dyads.

1. Developing and implementing an intensive interdisciplinary medical home within a large academic medical center was feasible. 2. Deploying a complex care management program that shared staff and resources with an intensive primary care program was not successful. 3. Barriers included traversing legal barriers to text messaging patients, making hospital consults feasible financially, managing challenging patients, team wellness, provider back up, managing homebound patients, and discharging patients. 4. Although expensive, this model may have hidden benefits including improved patient satisfaction, quality of care, and providing a solid care system for a health system's most challenging and vulnerable population.

e13536 Background: The COVID-19 Pandemic represents unprecedented new challenges for healthcare systems, care programs and especially for vulnerable populations like oncologic patients. The J&F Program, developed at the National Cancer Institute (INCan) in Mexico City, provides multidisciplinary care and navigation support for YWBC patients. During the first months of 2020, the whole mexican healthcare system, including the INCan and programs like J&F had to undergo structural adjustments to offer distance care attention (DCA) and face the Pandemic challenges. Methods: From March to September 2020, 196 patients received DCA (phone and video calls, text messages and virtual workshops), which addressed navigation, unmet psychological needs, psychoeducation, oncology and sexual support provided by different healthcare professionals (oncologists, psychologists, sexual specialists). Seventy agreed to participate in this study (intervention group, IG). Forty-three recently diagnosed breast cancer patients could not be contacted by the Program (control group, CG). The patients from the IG completed the emotional distress thermometer and were interviewed about stressors, coping strategies during the Pandemic, and satisfaction with the multidisciplinary support given by the J&F Program. We compared thestandard care given within the institutional facilities and the multidisciplinary support provided virtually by J&F Program for YWBC during the COVID-19 Pandemic regarding their perceived stressors and emotional distress. Results: The CG had more concerns about oncology treatments and their side effects (nausea p = 0.031, fever p = 0.007, anorexia p = 0.006) than the IG. Emotional distress was present in 77% and 86% in the IG and the CG respectively. The IG received significant navigation guidance and multidisciplinary support with the J&F Program’s DCA strategy during the Pandemic than the CG (p < 0.01 and p = 0.019). The J&F Program's psychological care significantly helped YWBC manage their distress (p = 0.001); 70% of the IG patients considered that the support given by the J&F Program dealt with the COVID-19 Pandemic challenges successfully (p < 0.01). Conclusions: DCA by theJ&F Program showed feasibility and benefit in the COVID-19 Pandemic context for YWBC. These findings suggest that multidisciplinary care could be preserved by combining care provision physically and virtually depending on patients' resources or unmet needs.

Objectives 1) to investigate if patients diagnosed with gestational hypertension recover in the 14 days postpartum; 2) to show if women diagnosed with gestational hypertension continue to experience hypertension beyond day 14 post delivery Methods Gestational hypertension data was collected on completion of a 14 days postpartum follow up on 904 patients on the Antenatal Home Care Program (AHCP) to delivery from 2011-2019. Based on blood pressure (BP), the subjects were grouped into 3 pathways. Pathway 1: BP≤140/90, pathway 2: BP 141-91-150/100, pathway 3: BP 151/101-160/110. The three pathways were subdivided into medicated and non-medicated groups. Results On discharge from hospital after delivery, 718 patients (79%, N=904) were in pathway 1, 42.8% were on antihypertensive medication(s). 159 patients, (17.6%, N=904), were in pathway 2, 60% of those were on medication(s). 27 patients, (3%, N=904), were in pathway 3, 81.5% were on medication(s). On discharge from follow up on day 14 postpartum, 686 (75.9%, N=904) were in pathway 1, 51.7% were on medication(s). 191, (21%, N=904); were in pathway 2, 86.4% were on medication(s). 27, (3%, N=904) were pathway 3, 100% were on medication(s). Conclusions AHCP data showed that 698 (77.2%, N=904) of gestational hypertension patients remained hypertensive for 14 days postpartum. Total number of patients on antihypertensive medication(s) increased from 46.9% at start of follow up to 60.9% on day 14 postpartum.

This study aims to produce an Evaluation of Care Program in spraying Disinfectant to Prevent the Spread of Corona Virus by the Regional Leadership Council (DPD) Partai Amanat Nasional (PAN) of the Batu City. The method used in this study is a qualitative research method. Data collection techniques by observation, interview and documentation. The model used is non participatory evaluation research. The results of this study are programs run by the Regional Representative Council (DPD) of the partai Amanat Nasional (PAN) of Batu City in the form of a social care program for spraying disinfectants to prevent the spread of the corona virus through inanimate objects in the Batu City area. because of their initial goal of doing this program for the hurricane and foundations in the Batu City area, when residents heard that spraying was being done by the Regional Representative Council (DPD) of Partai Amanat Nasional (PAN) of Batu City, enthusiastic attitudes of the community immediately arose to ask for spraying in the village they were so Regional Representative Council (DPD) Partai amanat Nasional (PAN) of Batu city experienced constraints in the volunteer workforce.

[Purpose] To present the increase in thoracic kyphosis in a patient suffering from exertional dyspnea, reduced lung capacity, and spinal pains related to straight back syndrome (SBS). [Subject and Methods] A 33-year-old male patient was put on a CBP® corrective care program involving mirror image® traction procedures designed to increase the thoracic kyphosis. [Results] This patient had a 10° improvement in thoracic kyphosis in 16-weeks that was maintained 7-months later. There was a simultaneous reduction of pain, resolved exertional dyspnea, and a greater than 2 liter increase in lung capacity. [Conclusion] This case illustrates that nonsurgical improvement in thoracic kyphosis in a patient with SBS is possible and that this may positively influence lung capacity, health and function.

Introduction Care gaps have been identified in the treatment of osteoporosis after the occurrence of a fragility hip fracture. HiROC (High Risk Osteoporosis Clinic) is a fracture liaison service implemented at our institution. In ProvenCare geriatric hip fracture care program at our institution pre-set orders for the inpatient HiROC consults were prescribed. We hypothesized that there will be a significant increase in the rate of enrollment of patients in the HiROC program after the integration of the pre-set orders. Patients and methods The trauma database at a level-I trauma center was reviewed retrospectively for the charts of patients >50 years of age with fragility intertrochanteric fractures. Patients not treated under the geriatric hip fracture care program and patients treated under the geriatric hip fracture care program were identified and reviewed for the enrollment in HiROC and subsequent follow up. Results Out of 589 patients treated before the implementation of ProvenCare, 443 patients (75%) were enrolled in HiROC at the index consult. In comparison, out of 153 patients treated after the implementation of ProvenCare, 131 patients (85.6%) were enrolled in HiROC at the index consult. The difference between the two groups was statistically significant (p = 0.008). Conclusion Our experience shows that the occurrence of a fragility intertrochanteric fracture can be effectively utilized for the detection and initiation of treatment of osteoporosis. With the implementation of pre-set orders in the geriatric hip fracture care program significantly better enrollment can be achieved.

We developed a high efficiency endocrine operative protocol based on a mathematical programming approach, process reengineering, and value-stream mapping to increase the number of operations completed per day without increasing operating room time at a tertiary-care, academic center.Using this protocol, a case-control study of 72 patients undergoing endocrine operation during high efficiency days were age, sex, and procedure-matched to 72 patients undergoing operation during standard days. The demographic profile, operative times, and perioperative complications were noted.The average number of cases per 8-hour workday in the high efficiency and standard operating rooms were 7 and 5, respectively. Mean procedure times in both groups were similar. The turnaround time (mean ± standard deviation) in the high efficiency group was 8.5 (±2.7) minutes as compared with 15.4 (±4.9) minutes in the standard group (P .001). Transient postoperative hypocalcemia was 6.9% (5/72) and 8.3% (6/72) for the high efficiency and standard groups, respectively (P = .99).In this study, patients undergoing high efficiency endocrine operation had similar procedure times and perioperative complications compared with the standard group. The proposed high efficiency protocol seems to better utilize operative time and decrease the backlog of patients waiting for endocrine operation in a country with a universal national health care program.

The unmet need for cleft lip and/or palate (CL/P) care in India is significant. However, estimates required for CL/P care program planning are lacking.To estimate the unmet need for CL/P surgery in India at the state level.To determine the proportion of individuals with CL/P who presented for care in India, data were used from patients who received care at Operation Smile programs in 12 low- and middle-income countries from June 1, 2013, to May 31, 2014. The resulting model describes the prevalent unmet need for cleft surgery in India by state and includes patients older than the surgery target ages of 1 and 2 years for cleft lip and cleft palate repair, respectively. Next, the total number of unrepaired CL/P cases in each state was estimated using state-level economic and health system indicators.Prevalent unmet need for CL/P repair.In the 28 states with available data, an estimated 72 637 cases of unrepaired CL/P (uncertainty interval, 58 644-97 870 cases) were detected. The percentage of individuals with unrepaired CL/P who were older than the respective target ages ranged from 37.0% (95% CI, 30.6%-43.8%) in Goa to 65.8% (95% CI, 60.3%-70.9%) in Bihar (median, 57.9%; interquartile range, 52.6%-63.4%). The rate of unrepaired CL/Ps ranged from less than 3.5 per 100 000 population in Kerala and Goa to 10.9 per 100 000 population in Bihar (median rate, 5.9 [interquartile range, 4.6-7.3] per 100 000 population).An estimated 72 000 cases of unrepaired CL/P are found in India. Poor states with less health care infrastructure have exceptionally high rates (eg, Bihar). These estimates are useful for informing international and national CL/P care strategies, allocating resources, and advocating for individuals and families affected by CL/P more broadly.NA.

The Community Aging in Place, Advancing Better Living for Elders (CAPABLE) program, funded by the Center for Medicare and Medicaid Innovation, aims to reduce the impact of disability among low-income older adults by addressing individual capacities and the home environment. The program, described in this innovation profile, uses an interprofessional team (an occupational therapist, a registered nurse, and a handyman) to help participants achieve goals they set. For example, it provides assistive devices and makes home repairs and modifications that enable participants to navigate their homes more easily and safely. In the period 2012-15, a demonstration project enrolled 281 adults ages sixty-five and older who were dually eligible for Medicare and Medicaid and who had difficulty performing activities of daily living (ADLs). After completing the five-month program, 75 percent of participants had improved their performance of ADLs. Participants had difficulty with an average of 3.9 out of 8.0 ADLs at baseline, compared to 2.0 after five months. Symptoms of depression and the ability to perform instrumental ADLs such as shopping and managing medications also improved. Health systems are testing CAPABLE on a larger scale. The program has the potential to improve older adults' ability to age in place.

Objective: The aim of this study is to evaluate mortality and survival rates of patients aged 65 years or older who sustained a hip fracture and were treated at a hospital in Bogotá, Colombia, after the establishment of an Orthogeriatric Program. Method: In total, 298 patients were treated according to the program’s protocol. The primary outcome was 1-year mortality. Mortality predictors were estimated using Cox proportional hazards model, and survival was measured with Kaplan–Meier analysis. Results: The annual survival rate increased from 80% to 89% ( p = .039) 4 years after its implementation. There was a significant decrease in mortality risk (Hazard Ratio = 0.54, p = .049). Arrhythmia, valvular heart disease, history of myocardial infarction, and age greater than 85 years were predictors of mortality. Discussion: This is the first study in Latin America to show decreased mortality rates 1 year after the implementation of an Orthogeriatric Program. Our rates were lower than developed countries, suggesting the existence of additional factors that influence long-term outcomes.

Up to 25% of patients hospitalized with heart failure (HF) are re-admitted within 30 days. The highest risk of re-admission is within the first days after discharge. Transitional care programs usually only involve nurses and physicians. The purpose of this study was to describe a post–acute care program including physical therapists and to evaluate re-admission rates following program implementation. The program provided HF-specific training encouraging nurses and physical therapists to assess HF status and instruct on self-monitoring. Thresholds for communication with medical providers were established. Patient groups before ( n = 162) and after implementation ( n = 300) were similar. Following implementation, there was a 16% decrease in re-hospitalization with little change in the number of visits. Similar multidisciplinary programs may impact re-hospitalization rates and health care costs for HF.

Renal supportive care (RSC) denotes a care program dedicated for patients with acute, chronic renal failure, and end-stage renal disease (ESRD), aiming to offer maximal symptom relief and optimize patients' quality of life. The uncertainty of prognosis for patients with chronic kidney disease and ESRD, the sociocultural issues inherent to the Taiwanese society, and the void of structured and practical RSC pathway, contributes to the underrecognition and poor utilization of RSC. Taiwanese patients rarely receive information regarding RSC as part of a standardized care and are not commonly offered this option. In National Taiwan University Hospital Jinshan branch, we started a RSC subprogram, supported by the community-based palliative/hospice care main program. We focused on understanding the need and providing the choice of RSC to suitable candidates. A three-step and four-phase protocol was designed and implemented to identify appropriate patients and to enhance the applicability of the RSC. We harnessed family visit and home-based family meeting as a vehicle to understand the patients' preferences, to discover what ESRD patients and their family value most, and to introduce the option of RSC. In the current review, we described our pilot experience of establishing a RSC program in Taiwan, and discuss its potential advantage.