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Substance use among adolescents continues to present as a public health concern. Screening, Brief Intervention and Referral to Treatment (SBIRT) is an effective process that has been proven to identify, reduce, and prevent at-risk use of substances when appropriately applied. The CRAFFT tool is an evidence-based screen used to identify substance use in adolescents aged 12-21 years of age.The purpose of this project is to assess the rates of substance use in the adolescent population at a behavioral health clinic through the CRAFFT tool while also assessing for provider documentation compliance and overall revenue benefits of SBIRT.A retrospective chart review was used for this practice evaluation. Descriptive statistics were used through assessing frequencies and averages to gain insight not only on the rates of at-risk substance use and documentation compliance, but also on psychiatric diagnoses and medication regimens.Three hundred and forty-one patient encounters were reviewed over a 3-month period. Of these 341 encounters, 63.6% of the visits were in-person and 36.4% were conducted virtually. 72.4% of patient encounters had no documented CRAFFT screen, yet 31% of completed CRAFFT screens were positive for substance use or misuse. For those encounters with no completed CRAFFT screen documented, there was an estimated lost income for potential billings at a rate of $33.41 per encounter for a total of $8252.27.Substance use and misuse in adolescents continues to exist as a public health concern. The CRAFFT tool can be a feasible means of screening for substance use in adolescents when consistently and longitudinally incorporated.

Slow or arrested progress in labor is the most frequent (64%) indication for nonemergent transfer of laboring people from freestanding birth centers to the hospital. After the 2014 publication of the Consensus Statement on Safe Prevention of Primary Cesarean Delivery (Consensus Statement), many freestanding birth centers changed their clinical practice guidelines to allow more time for active labor in the birth center prior to hospital transfer. The result of these changes has not been evaluated in birth centers. Evaluation of adoption of guidelines based on the Consensus Statement in hospitals has shown inconsistent results.Birth centers were contacted to determine whether they changed clinical practice guidelines in response to the Consensus Statement. A before-after analysis compared outcomes for the 2 calendar years before and the 2 calendar years after adoption of new guidelines with a retrospective analysis of deidentified client-level data collected in the American Association of Birth Centers Perinatal Data Registry.A third of responding birth centers (11 of 33) changed their clinical practice guidelines, mostly redefining the onset of active labor as beginning at 6 cm cervical dilatation and allowing 4 hours of arrest of dilatation in active labor before transfer to the hospital. These changes were associated with fewer diagnoses of prolonged first stage of labor (13.8% vs 8.0%, Plt; .01) but not with fewer intrapartum transfers (14.0% vs 14.7%, P = .55) or cesarean births (5.0 vs 4.1%, P = .26.) DISCUSSION: We found no evidence that making these practice changes was associated with better outcomes. Two hours of a lack of documented cervical change in active labor is likely long enough to diagnose arrested progress in labor. Research on proportion of morbidity and mortality associated with prolonged labor could inform practice guidelines for transfers.

Background: Race and socioeconomic factors affect outcomes in breast cancer. We aim to assess the effect of race and neighborhood socioeconomic status (SES) on overall survival and treatment patterns in patients with metastatic breast cancer (MBC) Method: Retrospective cohort study involving patients (N = 1,246) with distant breast cancer metastases diagnosed at UPMC Magee Women’s Breast Cancer Clinic from 2000–2017. Overall survival and treatment patterns were compared between races (African Americans and Caucasians) and SES groups (defined using National Deprivation Index) Results: Low SES, but not tumor characteristics, was associated with African American race (P P = .01) and African American race (Median [IQR] survival 1.8[1.3–2.3] years, vs Caucasians 2.5[2.3–2.7] years P = .008) separately predicted worse overall survival in patients with MBC. In the Cox Proportional Hazard model with SES, race, age, subtype, and number of metastases as covariates, low SES (Hazard ratio 1.19[1.04–1.37], P = .01), but not African American race (Hazard ratio 1.23[0.97–1.56], P = .08), independently predicted overall survival in MBC. Moreover, patients with ER + MBC from low SES neighborhoods were more likely to be treated with tamoxifen than aromatase inhibitors+/-newer agents, and African Americans received fewer lines of chemotherapy than Caucasians. Conclusions: Low neighborhood SES is associated with worse outcomes in patients with MBC. Poor outcomes in African American patients with MBC, at least in part is driven by socioeconomic factors. Future studies should delineate the interplay between neighborhood SES, race, and their effects on tumor biology in MBC.

PURPOSE The purpose of this clinical nurse specialist-led initiative was to reduce catheter-associated urinary tract infection rates to less than 1 infection per 1000 catheter days, to reduce catheter device utilization, and to improve staff adherence to documentation requirements on a traumatic brain injury rehabilitation unit. DESCRIPTION OF THE PROJECT Catheter-associated urinary tract infections are costly hospital-acquired infections increasing length of stay and morbidity for patients. Following an education intervention, a best practice initiative was implemented. Staff performance based on electronic health record documentation, infection rates, and device utilization were compared before and after a bundle of interventions including education, staff competency, simulation, and audits. OUTCOMES Catheter-associated urinary tract infection rates were reduced from 16.67 to 0 per 1000 catheter days and device utilization ratio from 0.122 to 0.056 per patient day. The unit maintained zero infections upon project completion. Following initiative implementation, documentation improved related to urinary catheter necessity, daily care interventions, patient education, and urine output. CONCLUSION This initiative resulted in reductions in device utilization and catheter infection rates, which were maintained following project completion. Adherence to documentation audit criteria also improved.

More nurses without critical care experience are being hired by intensive care units. Eleven newly hired nurses participated in a phased program designed to improve the efficiency of intensive care unit orientation. A pre-post implementation design demonstrated that although there was a 14% reduction in orientation time, there were no statistically significant changes in new hire or preceptor satisfaction nor in first-year registered nurse turnover rates. Expansion of the program is needed to demonstrate its impact.

Background and Objectives Insufficient ethnoracial diversity is a pervasive challenge in Alzheimer’s disease (AD) research. The Recruitment Innovations for Diversity Enhancement (RIDE) is grounded in the premise that culturally informed narratives of research participation can inspire individuals from a given culture-sharing group to consider research enrollment. This study examines factors associated with interest in AD research among Black or African American adults following exposure to RIDE narrative campaign materials. Research Design and Methods A community-based sample of 500 Black or African American adults viewed RIDE narrative materials online and completed a survey of perceptions about research, AD risk, and likelihood of enrolling in AD research. Logistic regression examined predictors and mediators of self-reported likelihood of participating in AD research. Results Most (72%) participants reported interest in being contacted for AD research opportunities. After controlling for key variables, prior experience with clinical research and trust in medical researchers emerged as independent predictors of likelihood of enrolling in AD research. Perceived burden of AD research partially mediated the effects of prior research experience and trust on likelihood of enrollment. Perceived benefits of AD research also played a mediating role, accounting for over one third of the effect of trust on likelihood of enrollment. Discussion and Implications This study advances the field’s understanding of how narrative may function to enhance diversity in AD research. Findings suggest that participant narratives should address experiences regarding the burdens and potential benefits of AD research participation as these factors may influence decisions leading to subsequent research enrollment.

Intensive care unit (ICU) delirium is associated with a proinflammatory state and poor outcomes. An epigenetic mechanism may modify inflammation.To identify inflammatory gene methylation trajectory groups and explore their clinical and demographic variability.Patients were at least 18 years old; received mechanical ventilation for at least 24 hours; had no brain disorder/injury, preexisting dementia, or positive toxicology screen; and were admitted to a medical or surgical/trauma ICU. Delirium was assessed (Confusion Assessment Method for the ICU) and blood samples were collected daily for up to 10 days. Methylation of 3 genes in the inflammatory pathway was quantified. Latent class analysis identified gene methylation trajectories, and variables (including delirium) were compared between trajectory groups.Of 68 patients (53% female, 88% White), 65% developed delirium. Of 3 methylation trajectories for IL6ST, the group with low initial methylation increasing over time included younger male patients who were less likely to have delirium, and the group with high initial methylation decreasing over time included older (P = .01) female (P = .05) patients who more often had delirium (P = .05). IL17C had 2 methylation trajectories without significant differences in delirium, age, or sex. IL13RA1 had 2 methylation trajectories without differences in delirium or age; the group with sustained high methylation had more female patients (P = .003).Temporal variability in inflammatory gene methylation occurs after ICU admission. Delirium, female sex, and older age were more common with higher IL6ST methylation that decreased over time. Larger studies are needed to further elucidate these relationships.

Clinical observation and ex vivo studies have established a strong association between inflammation and postoperative atrial fibrillation (POAF). However, it is unclear whether the inflammatory phenotype is causally linked to this event or is an epiphenomenon, and it is not known which inflammatory meditators may increase susceptibility to POAF. The limitations of available animal models of spontaneous POAF (sPOAF) makes it difficult to select an experimental system. Here, we provide experimental and clinical evidence for mechanistic involvement of interleukin-6 (IL-6) in sPOAF. PHASE I: We established a mouse model of cardiac surgery with nonpaced sPOAF. IL-6 knockout mice were protected from sPOAF compared with wild-type mice. PHASE II: At 48 hours after surgery, the heart was separated into 6 regions and cultured. IL-6 was expressed in all regions, with highest abundance in the left atrium (LA). In PHASE III, we demonstrated that IL-6 in the LA elicited early profibrotic properties in atria via the pSTAT3/STAT3 signaling pathway and contributed to sPOAF. PHASE IV: In a translational prospective clinical study, we demonstrated that humans with POAF had a higher IL-6 concentration in pericardial drainage (PD). This study provides preliminary evidence of a causal relationship between IL-6 and POAF in a novel nonpaced sPOAF mouse model. IL-6 is a crucial prerequisite for eliciting profibrotic properties in cardiac myocytes via the pSTAT3 pathway during the early postoperative period, leading to an increased susceptibility to POAF. Measuring IL-6 in PD could be a new noninvasive biomarker for the clinical prediction of POAF.

We examined the association between APOE ɛ2/ɛ4 with incident Alzheimer’s disease (AD) and mild cognitive impairment (MCI) among African Americans using the national dataset from the National Alzheimer’s Coordinating Center (NACC) from 2005 to September 2019. Compared to ɛ3/ɛ3 carriers, ɛ2/ɛ4 carriers exhibited a similar risk of incident AD (adjusted hazard ratio [aHR] = 0.85, 95% CI [0.39, 1.84]) among the AD cohort and similar risk of incident MCI (aHR = 0.88, 95% CI [0.51, 1.50]) among the MCI cohort. Our findings suggest that, unlike the increased risk of AD and MCI in non-Latino whites, APOE ɛ2/ɛ4 genotype is not associated with the incidence of AD and MCI among African Americans.

Background: Although DKA has been traditionally managed in intensive care units (ICU) , some studies suggest that DKA can be safely treated in non-critical care areas. Objective: To compare safety & efficacy of a DKA IV insulin protocol in ICU with stepdown unit (SDU) . Methods: A retrospective chart review of all DKA patients (Age >yrs) admitted to ICU (N=45) & SDU (N=23) from January 20to August 2020. The admission to SDU was based on our hospital protocol (pH>7.2 without organ failure) . We analyzed the compliance to the DKA protocol (Table) and adverse outcomes. Mann-Whitney U & Chi-square/Fishers exact tests were used to compare continuous & categorical variables respectively. Results: ICU & SDU groups were demographically similar: mean age (36.2 ± 15.2 vs. 37.6 ± 18.9 yrs) , sex (F 67% vs. 70%) & BMI (21.2 vs. 21.8 kg/m2) . As expected, ICU group had severe DKA as compared to SDU group with higher mean BG & lower mean serum Bicarb (p0.05) . Conclusions: Our study suggested that a DKA IV insulin can be safely managed in SDU in selected patients, which can help avoid ICU overcrowding. The observed trend toward less strict compliance with the DKA protocol can be overcome with nurse education and optimal nurse to patient ratio. Disclosure T.Ahmad: None. N.Mehrotra: None. W.Ali: None. D.Ren: None. J.Arnold: None. M.T.Korytkowski: None. S.Mon: None.

Background Caring is an essential component of professional nursing practice, which directly affects the quality of patient care. Nurses' caring ability may not meet patients' demands for high-quality care. There are challenges in designing and implementing interventions to improve nurses' caring ability, especially in China. Understanding Chinese nurses' caring ability and related influential factors serves as the basis for effective interventions to improve their ability to care for patients. Aim To describe the caring ability of nurses and its potential predictors in China. Methods From January to February 2018, a cross-sectional survey was conducted among 2304 Registered Nurses working at different levels of hospitals across 29 provinces in China. The structured online survey included socio-demographic information, Caring Ability Inventory, Caring Efficacy Scale and Professional Quality of Life. Descriptive statistics, univariate analyses and multivariate analyses were conducted. Results Overall caring ability and its three dimensions of the participants were all significantly lower than the Nkongho' norm, an international scoring standard of nurse's caring ability. Age, employment type, workplace, caring efficacy, compassion satisfaction, burnout and secondary traumatic stress were predictors of knowing, explaining 41.8% of the variance. Predictors of courage were educational level, bereavement experience, caring efficacy, compassion satisfaction and burnout (31.7% of the variance). Educational level, workplace, exposure to critically ill patients, caring efficacy, compassion satisfaction, burnout and secondary traumatic stress were influencing factors of patience, accounting for 19.5% of the variance. Conclusions Chinese nurses' caring ability, with patience, knowing, and courage in descending order. Particular attention needs to be paid to the courage dimension of the nurses' caring ability. Further, the predictors of overall caring ability and each dimension were diverse. These results indicate that nurse educators and administrators need to identify training priorities and design targeted interventions based on the influencing factors.

Extended work hours and shift work can result in mistimed sleep, excessive sleepiness, and fatigue, which affects concentration and cognition. Impaired concentration and cognition negatively affect employee safety.To examine the evidence of the impact of shift work organization, specifically work hours and scheduling, on nurse injuries including needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and work-related accidents causing a near miss or actual injury to the nurse.A scoping review was conducted using search results from five bibliographic databases.Through database searching, 7788 articles were identified. During the title and abstract screening, 5475 articles were excluded. Full text screening eliminated 1971 articles. During the data extraction phase, 206 articles were excluded leaving 34 articles from 14 countries in the scoping review. The results of the review suggest a strong association in nurses between long work hours and overtime and an increased risk for needlestick and sharps injuries, drowsy driving and motor vehicle crashes, and other work-related accidents. Rotating shifts increase the risk for needlestick and sharps injuries and other work-related accidents while night and rotating shifts increase the risk for drowsy driving and motor vehicle crashes.Proper management of work hours and scheduling is essential to maximize recovery time and reduce or prevent nurse injuries. Nurse leaders, administrators, and managers, have a responsibility to create a culture of safety. This begins with safe scheduling practices, closely monitoring for near miss and actual nurse injuries, and implementing evidence-based practice strategies to reduce these occurrences.

The purpose of this study was to assess the HEARTS (Health, Experience of Abuse, Resilience, Technology use, and Safety) of older adults (OAs). More particularly, we aimed to assess three component...

Present study examines whether perceived stress levels of health controls may be reduced by walking behavior in daily life. The subjects were a part of the Korean National Health and Nutritional Examination Survey (KNHANES), an ongoing nationwide epidemiology study, in 2008 and 2011. We examined the association between walking behavior and perceived stress (PS) of healthy controls based on multi-level modeling. We assumed that walking behavior may have an influence on how people perceive their stress, and observed the significance of the effect with adjustment for other covariates. We found that the odds of ‘high PS’ are about 16% lower for those with walking behavior with adjustment for other covariates. Inj addition, the odds of ‘high PS’ were lower for male subjects than female subjects by about 19%, while current smokers showed 1.2 times higher odds of ‘high PS’. Based on our final model, there was significant interaction effect between age and sleep duration. In particular, sleep duration has a role in reducing the odds of ‘high PS’ by 18% at the reference age of 52.98 years. Walking behavior has the potential to reduce perceived stress in daily life. Also, there are strong associations between smoking, sleep duration, and perceived stress.

The purpose of this clinical nurse specialist-led initiative was to reduce catheter-associated urinary tract infection rates to less than 1 infection per 1000 catheter days, to reduce catheter device utilization, and to improve staff adherence to documentation requirements on a traumatic brain injury rehabilitation unit.Catheter-associated urinary tract infections are costly hospital-acquired infections increasing length of stay and morbidity for patients. Following an education intervention, a best practice initiative was implemented. Staff performance based on electronic health record documentation, infection rates, and device utilization were compared before and after a bundle of interventions including education, staff competency, simulation, and audits.Catheter-associated urinary tract infection rates were reduced from 16.67 to 0 per 1000 catheter days and device utilization ratio from 0.122 to 0.056 per patient day. The unit maintained zero infections upon project completion. Following initiative implementation, documentation improved related to urinary catheter necessity, daily care interventions, patient education, and urine output.This initiative resulted in reductions in device utilization and catheter infection rates, which were maintained following project completion. Adherence to documentation audit criteria also improved.

Objective: the aim of this study was to provide the evidence base to guide interconversion of the modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) in neurological research. Methods: a retrospective analysis of paired mRS and GOS recordings was conducted using datasets with the following selection criteria: (1) patients had haemorrhagic stroke, (2) simultaneous mRS and GOS measurements were available, and (3) data sharing was possible. The relationship between mRS and GOS was assessed using correlation analysis. The optimum dichotomisation thresholds for agreement between the mRS and GOS were identified using Cohen's kappa coefficient. Two-way conversion tables between mRS and GOS were developed based on the highest agreement between scores. Finally, to identify which direction of conversion (mRS to GOS or vice versa) was better, the Kolmogorov-Smirnov D statistic was calculated. Results: using 3474 paired recordings the mRS and GOS were shown to be highly correlated (ρ = 0.90, p < 0.0001). The greatest agreement between the two scoring systems occurred when mRS=0-2 and GOS=4-5 was used to define good outcome (κ=0.83, 95% confidence interval: 0.81–0.85). Converting from mRS to GOS was better than the reverse direction as evidenced by a lower Kolmogorov-Smirnov statistic (D=0.054 compared to D=0.157). Conclusions: this study demonstrates that the mRS and GOS are highly correlated, establishes the optimum dichotomisation threshold for agreement, provides a method for interconversion and shows that mRS to GOS conversion is superior to the reverse direction if a choice is available.

This quality improvement project created a guide for critical care providers transitioning patients to comfort measures only encouraging communication, collaboration, and shared decision making; ensuring management of patients' end-of-life symptoms and needs; and enhancing provider satisfaction by improving structure and consistency when transitioning patients.Interviews conducted with staff in intensive care units revealed opportunities to improve structure and processes of transitioning patients at the end of life. A subcommittee of experts designed a checklist to facilitate interdisciplinary conversations. Impact on provider satisfaction and symptom management was assessed. Presurveys circulated used a Research Electronic Data Capture tool. A checklist was implemented for 3 months, and then postsurveys were sent. Charts were audited to identify improvement in symptom management and compared with retrospective samples.Clinical improvements were seen in communication (12%), collaboration (25%), shared decision making (22%), and order entry time (17%). In addition, 72% agreed the checklist improved structure and consistency; 69% reported improved communication, collaboration, and shared decision making; 61% felt it improved knowledge/understanding of patient needs; and 69% agreed it improved management of patient symptoms.After checklist implementation, staff felt more involved and more comfortable, and reported more clarity in transitioning patients; no improvement in patient outcomes was realized.

Aneurysmal subarachnoid haemorrhage (aSAH) results in persistent clinical deficits which prevent survivors from returning to normal daily functioning. Only a small fraction of the variation in clinical outcome following aSAH is explained by known clinical, demographic and imaging variables; meaning additional unknown factors must play a key role in clinical outcome. There is a growing body of evidence that genetic variation is important in determining outcome following aSAH. Understanding genetic determinants of outcome will help to improve prognostic modelling, stratify patients in clinical trials and target novel strategies to treat this devastating disease. This protocol details a two-stage genome-wide association study to identify susceptibility loci for clinical outcome after aSAH using individual patient-level data from multiple international cohorts. Clinical outcome will be assessed using the modified Rankin Scale or Glasgow Outcome Scale at 1–24 months. The stage 1 discovery will involve meta-analysis of individual-level genotypes from different cohorts, controlling for key covariates. Based on statistical significance, supplemented by biological relevance, top single nucleotide polymorphisms will be selected for replication at stage 2. The study has national and local ethical approval. The results of this study will be rapidly communicated to clinicians, researchers and patients through open-access publication(s), presentation(s) at international conferences and via our patient and public network.

Background: Pressure Injuries (PIs) are largely preventable. Accurate documentation of PI stage or progression is a key quality measure. Local Problem: Nurses frequently fail to accurately assess and document their findings in the electronic medical record. This project sought to increase nurses’ knowledge and accuracy of staging and documentation of PIs. Method: Educational interventions; direct observation of PI status; review of nurse documentation; feedback,;and referrals to wound, ostomy, and continence nurses (WOCNs). Interventions: Nurses completed a pre- and post-test and online training modules, and participated in training sessions. Clinical experts completed direct skin observations and provided feedback about PI staging. Results: There was a statistically significant improvement in nurses’ knowledge about PIs (p = 0.004). Skin assessments were conducted on 108 patients (13 PIs identified). The bedside nurse accurately assessed a PI stage in only 31% of these observations. Referrals to WOCNs increased by 18% compared to the baseline period. Conclusions: Educational interventions enhanced nurses’ knowledge; however, appropriate PI staging may require skills development and validation to build competency. Keywords: pressure injury, pressureulcer,wound care, prevention, evidence-based practice, prevalence, assessment, documentation, education

Background Black women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared with White women. Adding further risk, older patients with breast cancer are most at risk for treatment modifications; however, it is unclear if this remains true for Black patients. Furthermore, the clinical implications of treatment modifications and delays on survival is uncertain, particularly in Black patients. Patients and Methods The purpose was to investigate whether age was a moderator for the association between treatment modifications (dose held, dose delayed, and early cessation) and overall survival and disease-free survival (DFS) in Black women with breast cancer using a retrospective cohort study of patients with early stage breast cancer treated with adjuvant chemotherapy. Results Across the entire sample (n = 115), 37.4% (n = 43) of patients experienced a treatment modification. There was a significant interaction between age group and held dose for DFS (P = .026). Specifically, those diagnosed at 55 years of age and older, who had doses of chemotherapy held, experienced worse DFS compared with those who did not (hazard ratio, 4.185; 95% confidence interval, 1.187-14.75). In contrast, there was no difference in DFS between those who did and did not have doses held in patients diagnosed below 55 years of age (hazard ratio, 0.626; 95% confidence interval, 0.177-2.218). Conclusion In this study, Black women receiving adjuvant chemotherapy for treatment of early stage breast cancer had roughly equal treatment modifications across age groups. However, held doses of chemotherapy in older Black patients were associated with worse DFS. Age may impact clinical outcomes seen with adjuvant chemotherapy treatment modifications.

BACKGROUND/OBJECTIVE: Preclinical evidence suggests iron homeostasis is an important biological mechanism following aneurysmal subarachnoid hemorrhage (aSAH), however, this concept is underexplored in humans. This study examined the relationship between patient outcomes following aSAH and genetic variants and DNA methylation in the hepcidin gene (HAMP), a key regulator of iron homeostasis. METHODS: In this exploratory, longitudinal observational study, participants with verified aSAH were monitored for acute outcomes including cerebral vasospasm (CV) and delayed cerebral ischemia (DCI) and evaluated post-discharge at 3 and 12 months for long-term outcomes of death and functional status using the Modified Rankin Scale (mRS; poor = 3-6) and Glasgow Outcome Scale (GOS; poor = 1-3). Participants were genotyped for two genetic variants and DNA methylation data was collected from serial cerebrospinal fluid over 14 days post-aSAH at 8 methylation sites within HAMP. Participants were grouped based on their site-specific DNA methylation trajectory, with and without correcting for cell type heterogeneity (CTH), and the associations between genetic variants and inferred DNA methylation trajectory groups and patient outcomes were tested. To correct for multiple testing, an empirical significance threshold was computed using permutation testing. RESULTS: Genotype data for rs10421768 and rs7251432 were available for 241 and 371 participants respectively and serial DNA methylation data were available for 260 participants. Acute outcome prevalence included CV in 45% and DCI in 37.1% of the overall sample. Long-term outcome prevalence at 3 and 12 months included poor GOS in 23% and 21%, poor mRS in 31.6% and 27.3%, and mortality in 15.1% and 18.2%, respectively in the overall sample. Being homozygous for the rs7251432 variant allele was significantly associated with death at 3 months (p=0.003) and was the only association identified that passed adjustments for multiple testing mentioned above. Suggestive associations (defined as trending toward significance, p-value

The greatest increase in childhood obesity prevalence occurs from preschool to school-age (SA). Evidence supports a family-centered approach to promote healthy lifestyle behaviors and weight management among SA children. The purpose of this study was to establish a healthy weight management support group in a pediatric patient-centered medical home.Overweight or obese SA children and their parent participated in four biweekly support meetings consisting of an educational presentation, group exercise, and a healthy snack. Sessions included education about nutrition, exercise, emotions, and health. Anthropometrics, the Healthy Habits screening tool, and Daily Logs, including step counts, were utilized to track outcomes.There was a significant improvement in fruit and vegetable intake and dining out (p =.05), and a clinical improvement in physical activity and sugar sweetened beverage intake.Setting Kids Up For Success provides a framework for patient-centered medical home's to provide a healthy lifestyle support group for SA children and their families.

Background: During chemotherapy for breast cancer, African American women receive less relative dose intensity with more dose reductions and early chemotherapy cessation compared to Caucasian women. Other research has found that older breast cancer patients are most at risk for treatment modifications; however, it is unclear if this remains true for African American patients. Furthermore, the clinical implications of treatment modifications and delays on survival is uncertain, particularly in African American patients. Purpose: The purpose of this study was to investigate whether age (diagnosis Methods: A retrospective cohort study of early stage African American breast cancer patients treated with adjuvant chemotherapy was employed. Dose held, dose delayed and early cessation were examined as dichotomous variables: any adjustment to the initially prescribed treatment plan was considered a modification. Medical record data extraction was utilized to gather this information. The sample was divided into two groups: those diagnosed Results: In the study of 115 participants, 58 (50.4%) were diagnosed before the age of 55, and 57 (49.6%) were diagnosed age 55 or older. Across the entire sample, 43 (37.4%) patients experienced a treatment modification. There were no significant differences in the proportions of treatment modifications between the two age groups. We found no interaction between age group and treatment modifications for OS. However, there was a significant interaction between age group and held dose for DFS (p=0.045). Specifically, those diagnosed at 55 years of age and older, who had doses of chemotherapy held, experienced worse DFS compared to those who did not (hazard ratio (HR)=3.390, 95% CI (1.013,11.34)). In contrast, there was no difference in DFS between those who did and did not have doses held in patients diagnosed below 55 years of age (HR=0.563, 95%CI (0.159, 1.986)). Conclusions: African American women receiving adjuvant chemotherapy for treatment of early stage breast cancer have high levels of treatment modifications across all age groups. However, held doses of chemotherapy in older African American patients were associated with worse DFS. Further research is needed to elucidate the clinical implications of adjuvant chemotherapy treatment modifications, particularly in African American patients, and the subgroups of patients who are at greatest risk. Citation Format: Nugent BD, Ren D, Bender C, Rosenzweig M. The impact of age and adjuvant chemotherapy modifications on disease-free and overall survival among African American women with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-17-10.

Purpose The purpose of this project was to evaluate a long-acting injectable (LAI) antipsychotics program regarding the quality of care and outcomes of individuals with schizophrenia. Design and methods Observational design with retrospective chart review and survey was utilized in an outpatient clinic. Findings Individuals on LAIs receive the quality of care by exhibiting favorable knowledge about LAIs, positive attitude toward medications, and satisfaction with care. They take higher dosages of medications than those who take oral antipsychotics and report decreases in hospitalizations/emergency room visits after LAIs. Practice implications Reducing reservations about LAIs may provide awareness of the positive effects of treatment leading to viable management options and patient satisfaction.

BACKGROUND: Obstructive sleep apnea (OSA) is a highly prevalent and consequential sleep disorder in older adults. Untreated moderate to severe OSA substantially increases the risk for hypertension and cardiovascular disease (CVD), which can be attributed to the accelerated progression of atherosclerosis and endothelial dysfunction. OBJECTIVE: The aim of this study was to identify factors that can function as correlates of endothelial function in older adults with untreated, moderate to severe OSA and CVD or CVD risk factors. METHODS: A subsample (N = 126) of adults aged 65 years and older from the HeartBEAT study were included in the analyses. Univariate analyses and multiple linear regression models were conducted to establish which demographic and CVD risk factors were the best correlates of endothelial function. RESULTS: In the univariate analyses, sex, employment status, body mass index, waist circumference, hip-to-waist ratio, neck circumference, diastolic blood pressure, total cholesterol, high-density lipoprotein cholesterol, total cholesterol to high-density lipoprotein cholesterol ratio, plasminogen activator inhibitor-1, calcium channel blocker use, and beta-blocker use were associated with endothelial function at a level of P < .10. In the most parsimonious model, male sex (b = −0.305, P < .001), calcium channel blocker use (b = −0.148, P < .019), and body mass index (b = −.014, P < .037) were negatively associated with endothelial function after adjusting for the other covariates. CONCLUSIONS: The authors identified the correlates of endothelial function in older adults with untreated OSA and CVD or CVD risk factors, which are different than the correlates in middle-aged adults with the same conditions.

1013 Background: Socioeconomic status (SES) and race are major determinants of health outcomes in the United States. We aim to assess the effect of SES as measured by the Neighborhood Deprivation Index (NDI) and race on outcomes in metastatic breast cancer patients at our center. Methods: The NDI scores for patients with metastatic breast cancer who were treated at our center between 2000 and 2017 were obtained from the Neighborhood Atlas using their Zip-Code (N = 1246). The SES groups were defined as low deprivation with an NDI score in the bottom tertile and high deprivation with NDI in the top or middle tertiles. Baseline characteristics were compared between the SES groups with Bonferroni correction. Univariate and multivariate survival analysis were performed using the R packages “survival” and “survminer”. Results: Race was the only baseline characteristic that was significantly different between the SES groups, the high deprivation group had a higher proportion of African Americans (10.5%) than the low deprivation group (3.7%, P = 9.3e-05). In univariate Kaplan-Meier survival analysis, both SES and race had significant effect on overall survival such that the high deprivation group had worse survival than low deprivation (Log Rank P = 0.01) and African Americans had worse survival than Caucasians (P = 0.008). In multivariate Cox proportional hazard model, SES, but not race, had a significant effect on overall survival (hazard ratio for high deprivation was 1.19 [95% Confidence interval 1.04 - 1.37], P = 0.01; Table). Progression-free survival on first-line chemotherapy was not different between the SES groups or racial groups in both univariate and multivariate analysis. Conclusions: The current study shows that patients from the high deprivation group (i.e., low SES), have worse survival in metastatic breast cancer. Race was no longer a significant predictor of survival when SES was accounted for in the analysis. This possibly suggests that poor outcomes in the African American population is explained by the association between low SES and African American race. Based on these results, there is an urgent need for healthcare investments in the low SES neighborhoods. [Table: see text]

Purpose This paper describes a project to assess the feasibility of a brief healthy lifestyle health education group (HE) program and its effects on patient outcomes. Design and methods Forty adult inpatients were enrolled in the HE program, which featured a one-group, pretest or posttest design deployed in an adult psychiatric unit. Outcomes comprised (1) feasibility and acceptability of the program and (2) changes in patient knowledge and weight. Findings The HE program demonstrates not only feasibility, but also improvement in patient outcomes related to maintaining a healthy lifestyle. Practice implications Requisite changes in practice are necessary for the success of the HE program deployed in a typical, inpatient psychiatric unit.

Purpose The purpose of the study is to describe the characteristics and selected health outcomes of a sample of Chinese patients with type 2 diabetes (T2DM) and to examine gender differences based on social cognitive theory. There is limited study in theory-driven research conducted in China and a lack of evidence in collectively examining the associated factors among Chinese patients with T2DM based on a theory, especially among those living in a suburban area. Methods Following a cross-sectional design, data were collected from 207 patients (50.2% women; mean age, 56.1 years) with T2DM from an outpatient clinic in a suburban area of Beijing, China. Participants completed a survey, and clinical values were retrieved from the patients’ medical records. Results Of the participants, more than half had suboptimal glycemic control; only a small proportion had recommended levels in performing self-management behaviors. A large proportion had metabolic syndrome and were overweight or obese. Compared with men, women demonstrated poorer health literacy and problem solving, received less social support, and presented with more depressive symptoms. Conclusion Glycemic control and self-management were suboptimal in this sample, and a large proportion of the sample was at risk of developing cardiovascular disease. Gender differences exist regarding health literacy, depressive symptoms, problem solving, and social support. Social cognitive theory may provide a lens for addressing factors that are important in improving health outcomes among Chinese patients with T2DM. This evidence will help health care providers to identify pertinent factors through a multifactorial approach, therefore providing tailored care for Chinese patients with T2DM.

Currently, the aging adult population is rising fast and presenting multiple challenges for the US healthcare system. Older adults present unique challenges in their care of medical and psychiatric conditions. This study retrospectively examined characteristics that are associated with length of stay on an inpatient geriatric psychiatric unit in an urban located psychiatric hospital. A sample of 74 individuals was examined. Factors that influenced length of stay included commitment status and discharge to a different level of care. Reducing the length of stay for geriatric patients can help reduce costs and improve health outcomes.