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Background CDK4/6 inhibitors (CDK4/6i) in combination with endocrine therapy (ET) have a well-established role in the management of hormone receptor-positive (HR+)/HER2- metastatic breast cancer (MBC). The benefit of continuing CDK4/6i beyond progression in combination with a different ET has not been confirmed. Preclinical data suggest synergy between CDK4/6i and PD-L1 inhibition. The PACE trial prospectively evaluates whether continuation of the CKD4/6i palbociclib beyond progression on prior CDK4/6i and aromatase inhibitor (AI), with a change in ET to fulvestrant, improves outcomes beyond change to fulvestrant alone, as well as explores the activity of the palbociclib, fulvestrant, and avelumab triplet. Methods PACE is a multicenter randomized open-label investigator-initiated phase II trial, open at 11 U.S. sites. Eligible patients (pts) had HR+/HER2- evaluable MBC with prior progression on AI and any CDK4/6i after > 6 months (mo) of therapy in the MBC setting, or during/within 12 mo in the adjuvant setting, with no more than 1 prior line of chemotherapy for MBC. Pts were randomized 1:2:1 to fulvestrant alone (F); fulvestrant and palbociclib (F+P); or fulvestrant, palbociclib, avelumab (F+P+A), with tumor assessments every 8 weeks. Blood for circulating tumor DNA (ctDNA) analysis was collected at baseline, at times of tumor assessments, and at progression. The primary objective was to evaluate progression-free survival (PFS) with F+P vs F; secondary objectives included PFS with F+P+A vs F, objective response rate (ORR) in all arms, and safety. A sample size of 220 patients was planned to provide 80% power to detect an improvement in PFS with HR 0.6154 with F+P vs F (6.5 vs 4 mo; α(1)=0.05). Results A total of 220 pts were randomized from 9/2017-2/2022 (F: n=55, F+P: n=111, F+P+A: n=54); median age 57 years (range 25-83), 85% non-Hispanic (7.7% non-Hispanic black), 8.6% Hispanic, 6.4% unknown. 40% had de novo MBC, 60% had visceral disease, and 14% bone-only disease. 16% had 1 prior line of chemotherapy for MBC, 90% had received prior palbociclib, 4.5% ribociclib, 4.1% abemaciclib, 1.4% palbociclib and ribociclib. Pts entered the trial after a median 19 mo of prior CDK4/6i plus AI (interquartile range 12-31 mo). A total of 10 (5%) pts received protocol therapy as first line ET for MBC, 169 (77%) as second line, and 41 (17%) as beyond second line. 88% entered the trial directly after progression on CDK4/6i. After a median follow-up of 24 mo, 18 pts remained on protocol treatment. PFS was not improved with F+P vs F (median 4.6 vs 4.8 mo; HR=1.11, 90% CI 0.79-1.55; 2-sided p=0.62). Median PFS was 8.1 mo with F+P+A (HR=0.75 vs F, 90% CI 0.50-1.12; 2-sided p=0.23). ORR was 7.3% (90%CI 1.5-13.0) with F, 9.0% F+P (4.5-13.5%) and 13.0% F+P+A (5.4-20.5%). No new safety signals have been observed. Analysis of ctDNA panel sequencing encompassing 70 genes from 184 baseline samples, including correlation with known and hypothesized resistance genes, will be presented. Conclusions For ER+/HER2- breast cancer, combining palbociclib with fulvestrant beyond progression on prior CDK4/6i and AI did not significantly improve PFS compared with using fulvestrant alone. The observed longer PFS when a PD-L1 inhibitor was added to fulvestrant plus palbociclib is an intriguing signal in this ER+ population. Translational studies of blood and tumor tissue are ongoing and will be presented. Citation Format: Erica L. Mayer, Yue Ren, Nikhil Wagle, Reshma Mahtani, Cynthia Ma, Angela DeMichele, Massimo Cristofanilli, Jane Meisel, Kathy D. Miller, Trevor Jolly, Elizabeth Riley, Rubina Qamar, Priyanka Sharma, Sonya Reid, Natalie Sinclair, Meredith Faggen, Caroline Block, Naomi Ko, Ann Partridge, Wendy Y. Chen, Michelle K. DeMeo, Victoria Attaya, Amanda Okpoebo, Yuan Liu, Eric Gauthier, Harold Burstein, Meredith Regan, Sara Tolaney. GS3-06 Palbociclib After CDK4/6i and Endocrine Therapy (PACE): A Randomized Phase II Study of Fulvestrant, Palbociclib, and Avelumab for Endocrine Pre-treated ER+/HER2- Metastatic Breast Cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS3-06.

The advent of COVID-19 required educational programs to rapidly transition courses to the remote environment. A postpartum hemorrhage simulation used within a traditional prelicensure bachelor of science in nursing program was rapidly transitioned to the remote virtual format to meet required social distancing guidelines. This quasi-experimental study examined student knowledge before and after participation in a remote virtual simulation (RVS) with a postanalysis of student confidence and satisfaction. RVS can increase student knowledge and provide adequate student satisfaction. However, hands-on learning appears to result in higher student confidence and satisfaction compared to RVS.

Background: Children less than five years of age comprise the largest entry into foster care in the United State at approximately 30% in 2020. Very young children can respond differently to the same adverse life events. Detection of complex interpersonal traumas are core to providing appropriate interventions and prevention of reoccurring negative outcomes in these youth. Methods: Children with complex interpersonal trauma and who did not have traumatic stress symptoms were identified using Child and Adolescent Needs and Strengths data in a large midwestern state from 2010 to 2021. A logistic model was fit to determine effect of cumulative traumatic exposures (e.g. adverse childhood experiences) with increased events resulting in increased likelihood of symptomatic detection. We conducted a latent class analysis to understand the relationship between traumatic experiences, asset-based factors, and the detection of traumatic stress in children aged five years and under who had exposure to traumatic events but did not have detectable traumatic stress symptoms. Results: We detected three classes of youth described as resilient, missed, and unfolding. Very young children do demonstrate asset-based resilience when faced with traumatic experiences. A subset of children with missed diagnoses exhibit behavioral and mental health types similar to those with detected traumatic stress symptoms. Recognition of resilience in very young children is critical for designing systems that customize approaches of trauma-informed care. Conclusions: Detection of traumatic stress may be more difficult in young children. It is important to assess both traumatic stress and strengths to ensure that children who are resilient after exposure to traumatic experiences (i.e., do not demonstrate traumatic stress symptoms) are not referred to unnecessary interventions. Additional educational approaches are needed to help caseworkers identify symptoms of traumatic stress that mirror symptoms of other behavioral and emotional challenges. Precision medicine approaches are required to best match the interventions to specific needs of young children.

The study purpose was to examine the effect of interprofessional naloxone training on students' knowledge, confidence, and interprofessional collaboration competency. The overarching goal was to decrease mortality related to opioid overdoses.A training session for interprofessional students consisted of a lecture presentation, demonstration, and hands-on practice regarding appropriate administration of naloxone for suspected opioid overdose. A questionnaire elicited baseline and change in knowledge, confidence, and interprofessional collaboration competency scores at pretraining and posttraining. In addition, changes in knowledge and confidence were also measured 3 weeks after the training. Thematic analysis explored training components that students perceived as valuable or needing improvement.Participants (N = 100) were nursing (n = 33), physician assistant (n = 37), and pharmacy (n = 30) students. Pretraining and posttraining comparison demonstrated increased knowledge (P.001), confidence (P.001), and collaboration scores (P.001). At 3 weeks, knowledge and confidence remained higher than pretraining (P.001). Knowledge was trending downward compared with posttraining (P = .09). Thematic analysis identified 4 themes: (a) indications for administration of different naloxone types, (b) learning modalities, (c) knowledge application, and (d) improvements.An interprofessional naloxone administration training resulted in increased knowledge, confidence, and interprofessional teamwork. Educators can adapt this training for a variety of future or current healthcare professionals to improve immediate intervention and outcomes in suspected opioid overdoses.

Postpartum hemorrhage (PPH) is a medical emergency that is the primary cause of nearly one-quarter of all maternal deaths worldwide. Prelicensure nursing students are often underprepared to respond to obstetrical emergencies, such as PPH, due to a lack of exposure in the clinical setting. Simulation is used to aid students in developing knowledge, skills, and attitudes in clinical learning and emergency scenarios. The purpose of this pilot study was to evaluate student knowledge before and after participation in a high-fidelity simulation of a patient experiencing PPH. Student confidence and satisfaction after the experience was also assessed. Findings demonstrated that high-fidelity simulation significantly increased student knowledge related to PPH nursing care (p = 0.001). Student perceived confidence and satisfaction were also aggregately rated at 95% after the simulation experience. The PPH scenario utilized is described, and implications of implementing simulation in prelicensure nursing programs are discussed.

Advances in medical device technology have led to greater connectivity with other devices, networks, and systems, raising concerns about associated security risks. Many clinicians, as well as the patients who rely on these lifesaving devices, are unaware of these risks and how they can be mitigated. This article describes several types of cyberattacks, including medjacking, hacking, and ransomware, and what nurses can do to guard against security threats and educate patients.

Objectives: Previous research on COVID-19 vaccination hesitancy has found that sociodemographic factors including sex, age, education and occupation were associated with vaccination acceptance, along with other variables like trust in authorities, risk perception of COVID-19 and perception of vaccine efficacy and safety. However, this research has been limited by the use of non-validated measures for vaccination hesitancy and utilizing general samples that did not focus on minoritized groups. The purpose of the current study was to determine factors associated with vaccination uptake in a community sample of predominantly Black and Latinx adults. Methods: One-hundred and nine participants (70% female, 40% Black, 40% Latinx) completed a survey assessing sociodemographic variables, vaccination uptake, medical mistrust and vaccination attitudes. Results: Multivariate logistic regression revealed that higher scores on the mistrust of the vaccine benefit subscale were associated with lower vaccination uptake (OR = 0.45, p < 0.001) and higher levels of education was associated with higher levels of vaccine uptake (OR = 1.56; p = 0.048). No other demographic variables, nor other aspects of vaccination hesitancy, were associated with vaccine uptake. Conclusions: Taken together, our findings speak to the importance of dispelling misinformation and building community trust in public health efforts. Specifically, vaccine mistrust may be an especially important focus of community-based education efforts.

Objective: Few studies of prescription stimulant non-oral, non-medical use (NMU) (defined by use not as prescribed) have been conducted in adults beyond the college population. The purpose of this study was to characterize prescription stimulant non-oral use, specifically intranasal (IN) use (snorting) in young adults. Method: Amazon’s MTurk platform was used to recruit participants for an online survey. Data were collected from March to April 2020. Results: Thirty-two percent ( n = 157) of survey respondents ( N = 975), aged 18 to 30, reported IN prescription stimulant use (average of 32.1 episodes of lifetime IN use). Adderall was the most-reported prescription stimulant used intranasally (89.2%). Most IN users (82%; n = 68) reported spending no more than 5 minutes tampering with prescription stimulants. Intranasal users said they would take the medication orally if unable to tamper or manipulate medication for IN use. Conclusion: These data help quantify a complex public health issue of ongoing IN use of prescription stimulants and suggest a potential role for manipulation-deterrent medications.

Background The results remain mixed regarding improved student academic performance and satisfaction when 2-stage collaborative testing (CT) is used in nursing education. Purpose The purpose of this study was to evaluate student academic performance and perceived satisfaction after a CT experience and to compare academic performance between a CT and non-CT cohort. Methods A quantitative design was used to evaluate the effect of CT on academic performance by comparing examination scores and item difficulty values (IDVs) within a CT cohort (n = 111) and between the CT cohort and non-CT retrospective cohort (n = 105). A faculty-created survey was used to measure student-perceived satisfaction in the CT cohort. Results Student examination scores increased after the CT experience on a duplicate unit examination. The IDVs on 8 content-specific duplicate final examination items 1 month after the CT experience were significantly increased. There were no significant differences in the IDVs on the 8 content-specific items between a CT and non-CT retrospective cohort. Conclusions Collaborative testing is an active learning modality that can be used in nursing programs to aid students in their learning of specific nursing concepts.

Highlights • Food insecurity impacts 821 million people worldwide with projected increases due to the COVID-19 pandemic. • Healthcare curricula are deficient in providing appropriate healthcare provider education about food insecurity assessment and care. • Utilizing the competency-based medical education framework, the SEARCH mnemonic, and continuous improvement process can aid educators with curricular implementation of appropriate food insecurity training., Currently, food insecurity is a lack of access to enough food for a healthy life that impacts approximately 40 million Americans and 821 million people worldwide. These statistics are expected to rise as a result of the COVID-19 pandemic drastically. Studies show that healthcare and nursing curricula are currently deficient in providing education to help healthcare providers combat food security and provide patient education. The purpose of this article is to discuss a curricular framework that can be implemented in both nursing and healthcare curricula to offer appropriate training for food insecurity assessment, care, and patient education.

Background: Over half of HR+ BC recurrences occur >5 years (y) from diagnosis (dx). While the risk of late recurrence is constant and extends for at least 20y, little is known about concerns, perceptions, knowledge, and interest in risk reduction in longer-term HR+ BC survivors. Methods: From 1/2021-1/2022, we prospectively identified patients (pts) at Dana-Farber Cancer Institute with a history of stage II/III, HR+/HER2- BC, ≥5y from dx, without recurrence. Pts were invited to participate in a study investigating circulating tumor DNA and risk of recurrence as well as a separate, 1-time survey that assessed physical/mental health (PROMIS), dx/treatment concerns (Brief Illness Perception Questionnaire), risk perceptions, knowledge, and interest in risk reduction. “Overestimation” was defined as estimating ≥20% risk based on the response to the question: “If 100 women with HR+ BC are treated according to recommended guidelines, about how many will have BC come back in the 5-10y following completion of active treatment.” Descriptive statistics included medians and proportions. Logistic regression identified factors associated with overestimation of 5-10y metastatic recurrence risk. Results: Among 166 women (of 209 sent surveys, 79%), median age at dx was 51 (range 21-76), 4% were Hispanic and/or Black; 19% did not have a college degree. Approximately 30% had stage III disease, most received chemotherapy (72%) and radiation (81%) and over half (57%) a mastectomy. Median time from dx was 10 y (range: 5-23). Almost all (97%) reported prior (44%) or current hormonal therapy (14% tamoxifen, 39% AI). Median PROMIS anxiety (53; range: 37-73), physical (51, range: 32-68), and mental (51, range: 25-68) scores were similar to population norms (score of 50). On a 0 (not at all)-10 (extremely) scale, the median rating for concern about dx/treatment was 5; for emotional impact of dx/treatment, the median rating was 9. Regarding risk perceptions, participants estimated that on average, a median of 15 and 10 women (of 100 women) would develop a loco-regional or distant recurrence, respectively, in the 5-10y interval; 43% and 40% estimated the risk of loco-regional and distant recurrence as ≥20%, respectively, for this interval. Pts without a college degree were more likely to overestimate 5-10y distant recurrence risk (multivariable OR: 3.66, 95% CI: 1.56, 8.59); age, chemotherapy receipt, surgery type, stage, and grade were not associated with overestimation. When asked, on average, which women have a higher chance of BC returning after 5y, 17% correctly responded HR+; 42% responded triple negative and 41% responded the risk was the same for both. While >1/3 responded they believed alcohol in moderation may decrease the risk of BC coming back, most also responded that having a healthy weight, eating ≥5 fruits/vegetables a day, and exercise may decrease this risk, with over half reporting engagement in these behaviors (Table). Conclusion: While most longer-term stage II/III HR+ BC survivors report mental and physical health commensurate to population norms, inaccurate knowledge and perceptions about recurrence are common. Strategies to effectively communicate risk (e.g., pictograms, decision/conversation aids) and risk reduction information can promote an accurate understanding of risk in the setting of longer-term HR+ BC survivorship, potentially mitigating emotional concerns which are prevalent ≥5y post-dx. The association between lower educational attainment underscores the importance of attention to literacy and numeracy when developing interventions to improve risk communication. Table. Perceived impact of health behaviors on recurrence risk. Citation Format: Shoshana Rosenberg, Yue Zheng, Katheryn Santos, Elizabeth Riley, Hugh Meadows, Craig Snow, Melissa E. Hughes, Elizabeth Frank, Nancy U. Lin, Ann Partridge, Eric Winer, Heather A. Parsons. Patient-reported outcomes, perceptions, and knowledge about recurrence in women with high-risk hormone receptor-positive (HR+) breast cancer (BC) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-05.

Introduction: The unpredictable nature of the COVID-19 pandemic portends further uncertainty in patient decisionmaking. This study explores decisional conflict and patientspecific concerns for people undergoing otolaryngologic surgery during the pandemic. Method: This was a prospective, single-institution, crosssectional study of English-speaking adults undergoing otolaryngologic surgery, conducted from April 22 to August 31, 2020. Individuals who were non-English speaking, lacked autonomous medical decision-making capacity, underwent emergent surgery, or had a communitive disability were excluded. The primary outcome of decisional conflict was measured using the validated “SURE” screening questionnaire. Relationships between decisional conflict and patient demographics were assessed via bivariate analyses, multivariable logistic regression, and conjunctive consolidation. The secondary outcome of patient-specific concerns was obtained through open-ended interview and qualitatively assessed using thematic analysis with open coding. Results: There was a 41% response rate (182 of 444 patients). The median age was 60.5 years (range 18-88);92 patients (51%) were women. Decisional conflict was more prevalent in non-White compared with White participants (difference 18%;95% CI, 0.6%-37.0% and adjusted odds ratio 3.0;95% CI, 1.2-7.4). Combining information from multiple variables through conjunctive consolidation, the group with the highest rate of decisional conflict was non- White patients with no college education, receiving urgent surgery. “Intraoperative” and “postoperative concerns” were the most common patient-specific concerns. Among those patients reporting concerns about COVID-19, the majority had decisional conflict. Conclusion: This study highlighted factors associated with decisional conflict and emphasized the need for physicians to engage in shared-decision making with patients. The COVID- 19 pandemic contributed to decisional conflict. Consistent discussion of risks and benefits is essential. The role of race and decisional conflict needs further study.

Background Open educational resources (OERs) provide many benefits in nursing education, such as continuously updated course content and textbook cost savings. Purpose The purpose of this study was to determine the effectiveness of OER adoption by analyzing final course grades (to measure student performance) and course evaluations (to measure student satisfaction) in an online nursing informatics course in an RN-BSN completion program. Methods This study used a quantitative, retrospective design to compare course grades and student course satisfaction between an OER-based (n = 70) and textbook-only (n = 73) nursing informatics course. Results A Mann-Whitney U test revealed a statistically significant difference in mean course grades (P = .03, r = 0.18) for the OER group. There were no differences in course satisfaction between the textbook and OER groups (P = .41, r = 0.18). Conclusion The results showed that courses designed with OER content can improve student performance in nursing informatics while maintaining course satisfaction.

The number of referrals for children and young people seeking to affirm their gender has risen exponentially in Australia and elsewhere. Whilst the individual mental health needs and treatment outcomes for this group have been the subject of recent research, considerably less emphasis has been placed on exploring and amalgamating individual family member experiences, particularly siblings, using circular questioning. Yet, gender diversity is known to affect everyone in the family, and research clearly demonstrates that youth who feel validated and supported by individual family members in their gender identities benefit from improved mental health and global outcomes. This study aims to explore current clinical practices, professional viewpoints, use of circular questioning, and whole‐of‐family involvement in specialist youth gender diversity services in Australia. Clinical leads and coordinators of publicly funded youth gender diversity services and individual specialists across Australia were invited to complete an online survey, exploring individual protocols and practices in relation to involving the family, and the rationale underpinning this. All six respondents agreed that adopting a systemic understanding, considering general family functioning, and seeking individual family member opinions, was critical. Nevertheless, all family members were infrequently seen, with resourcing issues and time constraints being cited as the main reasons. The value of adopting a systemic and whole‐of‐family line of enquiry was supported by all respondents. Whilst sibling viewpoints were considered valuable by most professionals, siblings were infrequently seen for a variety of reasons. Further attention could therefore be given to involving siblings during specialist assessments. The findings consistently highlighted the value of a systemic line of enquiry and whole‐of‐family approach for gender diversity services and specialists. However, no current assessment guidelines incorporate this as a recommendation. Therefore, future Australian guidelines could formalise a systemic approach.

Background: Previous research has suggested that gender diversity affects everyone in the family, with positive mental health and global outcomes for gender diverse youth reliant on receiving adequate family support and validation. Although the individual mental health, treatment and outcomes for gender diverse youth have received recent research attention, much less is known about a family perspective. Hence, a review of the literature exploring youth gender diversity from a family perspective is warranted. Aims: To systematically identify, appraise and summarize all published literature primarily exploring gender diversity in young people under the age of 18 years, as well as selected literature pertaining to a family understanding. Methods: Six electronic databases (CINAHL, MEDLINE, EMBASE, PsycINFO, SCOPUS, Web of Science) were searched for relevant literature pertaining to youth under the age of 18 years. Results: Research evidence was consistently found to support the beneficial effects of a supportive family system for youth experiencing gender diversity, and a systemic understanding and approach for professionals. Conversely, lack of family support was found to lead to poorer mental health and adverse life outcomes. Few articles explored the experience of siblings under the age of 18 years. Discussion: This literature review is the first to critically evaluate and summarize all published studies which adopted a family understanding of youth gender diversity. The review highlighted a lack of current research and the need for further targeted research, which utilizes a systemic clinical approach to guide support for gender diverse youth and family members.

Objective Cognitive performance in trauma-exposed populations, such as combat Veterans, has been shown to be worse than in nonexposed peers. However, cognitive performance has typically been within the normal range (within 1 SD of normative mean), and the prevalence of clinically significant cognitive dysfunction (i.e., performance more than 1 SD below the mean on multiple measures in a domain) in younger adults with trauma exposure remains unknown. The objective of our study was to measure this. Method We applied Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) cutoffs for clinically significant cognitive dysfunction (>1 SD below the mean in multiple measures within a domain) in the domains of memory, executive function, and attention to a sample of combat-exposed Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND; N = 368, mean age = 31.7 years, 90% men) Veterans. We then compared psychiatric, physiological, and neural measures, as well as functional outcomes, between those with and without cognitive dysfunction. Results Veterans with cognitive dysfunction (n = 129, 35.1%) had lower premorbid reading ability and more severe psychological distress, including increased anxiety, depression, posttraumatic stress disorder (PTSD), sleep difficulties, pain, and alcohol consumption. Those with cognitive dysfunction also had worse functional outcomes, with mild but significant disability. In contrast, we found associations between outcome and age, traumatic brain injury, physiological and neural measures to be weak or not significant. Conclusions Together, this suggests that premorbid abilities and trauma-related psychological symptoms contribute significantly to cognitive dysfunction in OEF/OIF/OND Veterans, and that neurological insult and aging may play less of a role. Cognitive dysfunction may be at least partially ameliorated by treating trauma-related symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Scholarly writing has been documented in the rearch as crucial to nursing education and professional development. However, there remains a lack of clarity on the best standardized guidelines regarding tutorials and resources in nursing education. The purpose of this quantitative, non-experimental study was to further explore the impact of a scholarly writing tutorial on writing assignment rubric scores in an online, RN-BSN completion program. Statistical significance was found between a pre and post-intervention group when comparing the difference in median rubric scores of RN-BSN nursing students which supports the use of an interactive, online scholarly writing tutorial.

Attending to targets in a detection task can facilitate memory for concurrently presented information, a phenomenon known as the attentional boost effect. One account of the attentional boost suggests that it reflects the temporal selection of behaviorally relevant moments, broadly facilitating the processing of information encountered at these times. Because pupil diameter increases when orienting to behaviorally relevant events and is positively correlated with increases in gain and activity in the locus coeruleus (a purported neurophysiological mechanism for temporal selection), we tested whether the attentional boost effect is accompanied by an increase in pupil diameter. Participants memorized a series of individually presented scenes. Whenever a scene appeared, a high or low pitched tone was played, and participants counted (and later reported) the number of tones in the pre-specified, target pitch. Target detection enhanced later memory for concurrently presented scenes. It was accompanied by a larger pupil response than was distractor rejection, and this effect was more pronounced for subsequently remembered rather than forgotten scenes. Thus, conditions that produce the attentional boost effect may also elicit phasic changes in neural gain and locus coeruleus activity.

This study explores the effect of rapidly transitioning an in-person pre-licensure nursing specialty course to remote instruction during the COVID-19 pandemic. The redesign included the following learning technologies: live and recorded whiteboard lectures with Socratic-style questioning, electronic audience response systems, remote simulations, and virtual unfolding case studies to replace didactic and clinical learning experiences. Quantitative results indicate that learning quality was sustained, with no significant difference in students’ course performance or satisfaction. These specific technologies can be utilized in any discipline-specific course during emergency remote instruction to promote essential student-to-student and faculty-to-student interactivity.

Research illustrates a clear gap between academic and practice facilities concerning new graduate nurses. Nursing programs are charged with training nursing graduates who can provide safe, quality patient care. One way to enhance the quality of patient care and aid with retention of new graduate nurses in health care facilities is through academic-practice partnerships. This article describes the planning, implementation, and evaluation of a partnership between a health care facility and an associate of applied science nursing degree program to aid with registered nurse retention and quality patient care.

e18706 Background: PrOFILE is a dynamic 360o evaluation of health service delivery that helps care teams and institutions committed to increasing childhood cancer survival define an improvement strategy. PrOFILE stands for Pediatric Oncology Facility Integrated Local Evaluation. As of December 2021, PrOFILE has been utilized in over 130 facilities from over 25 countries around the globe. The standard outputs are presented by module, which reflect the patient-care continuum. The Institute of Medicine (IOM) has proposed six aims for improvement to drive fundamental change in health care delivery. The IOM Committee recommends periodically evaluating progress and developing strategies for overcoming barriers.However, a tool to assist facilities to set a baseline and periodically assess progress does not exist. We evaluated the feasibility of leveraging PrOFILE data to identify (1) the status of each quality aim as defined by IOM and (2) the status compared to facilities in the same country or region. Methods: This study employed a multi-step mapping approach. We first mapped the 1,279 PrOFILE variables to the six IOM quality aims. Mapping was first performed independently by two authors, then reviewed by PrOFILE experts to achieve consensus. Each variable could only contribute to one aim. We then validated the mapping by running the previously collected data available from two cohorts (one with 13 and one with 17 facilities) and benchmarking institutional data to cohort data. Quality improvement experts and local stakeholders provided feedback on further use of the illustrations and benchmarks. Results: We identified 305 PrOFILE variables that reflect the IOM quality aims (Table). More PrOFILE questions could be used as proxy for safety, effectiveness, and timeliness aims, than patient-centeredness, efficiency, and equity (Table), however, all domains could be represented. Benchmarking the institution results to the regional or country cohort results allowed for context-relevant insightful benchmarking. Framing PrOFILE results utilizing the IOM six aims allowed local healthcare teams and relevant stakeholders to evaluate their baseline and set targets for improvement. Conclusions: This exercise demonstrates the feasibility of leveraging PrOFILE data to assess institutional alignment with the IOM quality aims. The results allow illustrating, benchmarking, and engaging with stakeholders in conversations aimed at improving delivery of pediatric oncology care in global real-world settings utilizing this perspective. Future PrOFILE reports will incorporate this feature, supporting establishing a baseline and tracking of progress over time.[Table: see text]

Objective The objective of this study is to evaluate patient and provider satisfaction with telemedicine encounters across 3 otolaryngology practices. Study Design Cross-sectional survey. Setting A military community hospital, an academic military hospital, and a nonmilitary academic center. Methods A telephone-based survey of patients undergoing telemedicine encounters for routine otolaryngology appointments was performed between April and July 2020. Patients were asked about their satisfaction, the factors affecting care, and demographic information. A provider survey was emailed to staff otolaryngologists. The survey asked about satisfaction, concerns for reimbursement or liability, encounters best suited for telemedicine, and demographic information. The results were analyzed with descriptive statistics and a multivariable logistic linear regression model to determine odds ratios. Results A total of 325 patients were surveyed, demonstrating high satisfaction with telemedicine (average score, 4.49 of 5 [best possible answer]). Patients perceived “no negative impact” or “minor negative impact” on the encounter due to the lack of a physical examination or face-to-face interaction (1.86 and 1.95 of 5, respectively). High satisfaction was consistent across groups for distance to travel, age, and reason for referral. A total of 25 providers were surveyed, with an average satisfaction score of 3.44 of 5. Providers reported “slight” to “somewhat” concern about reimbursement (40%) and liability (32%). Conclusion Given patients’ and providers’ levels of satisfaction, there is likely a role for telemedicine in otolaryngology practice that may benefit patient care independent of the COVID-19 pandemic.

Housing insecurity has been shown to have an impact on the health care system due to negative maternal and neonatal outcomes. Housing insecurity is associated with the social determinants of health under the umbrella of economic stability and neighborhood/physical environments. Research shows that educational programs and support resources can help alleviate this strain for women who are pregnant. This article discusses the development and implementation of an advanced practice registered nurse (APRN)-led, prenatal education group for women facing housing insecurity who are pregnant and high risk. The curriculum was revised and based on a March of Dimes Becoming a Mom with alignment to Maslow's Hierarchy of Needs. The 10-week prenatal education program was created and implemented by a group of APRNs and registered nurses to aid pregnant women facing housing insecurity with coping strategies and education regarding their pregnancy.