TELEMEDICINE FOR POST-COVID-19 MANAGEMENT OF HYPERTENSION

Worldwide, the number of telemedicine visits overall has increased after the onset of COVID19 outbreak. The pandemic has led to changes in regulations and reimbursement rules to generally favor telehealth, as well as increased public awareness and acceptance of virtual visits. In Japan, the adoption of virtual video visits has been slow, largely due to regulations and reimbursement policies. For the whole country, much less than 1% of total outpatient visits has used virtual video visits. Compared to traditional care, hypertension management using online digital solutions has a potential to improve care access and reduce untreated hypertension population. Notably, hypertension is one of the best fit conditions to be managed by virtual care among various acute and chronic illnesses because the primary index of treatment is self-measured home blood pressure and effective medications with minimal side effects are available. However, currently implemented hypertension telemedicine includes different styles of care delivery that needs to be taken into account when discussing remote hypertension management. According to a report, telephone visits and video visits had lower proportion of visits with recorded blood pressure compared to in-person visits (Ye, JMIR Formative Research, 2022). An ideal ICT-assisted management likely involves home blood pressure monitoring, team care with interactive lifestyle modification guidance, and audio-video visits. Post-COVID-19 management of Hypertension can be enriched by combining remote blood pressure monitoring and virtual visits with digital therapeutics and mHealth services promoting lifestyle modifications. The remaining challenge includes cost considerations and disparities that may arise from economic status, internet availability, and digital service familiarity. Especially for a patient population whose primary or sole health condition needing medical attention is hypertension, total care with online visits may have advantage over other forms of care, offering convenience, care effectiveness using accurate BP assessment, and good cost profile. In addition, online hypertension care employing properly-planned data structure can help generate a high-quality real-world dataset which may be used to evaluate the advances in quality of care using technologies.

111. Adaptation and Delivery of a Partially Virtual Curriculum for Pre-Exposure Prophylaxis Peer Mentors in Kenya: Lessons Learned

Purpose: While Pre-Exposure Prophylaxis (PrEP) is highly effective at preventing HIV, uptake is low among adolescents. In low- and middle-income countries (LMIC), peer mentors (PMs) are considered best practice to increase PrEP acceptability and uptake. Globally, COVID19 has shifted much education and training to virtual formats. Most young people in LMIC have cell phones. Our objective is to describe our experiences developing and delivering a mixed virtual/physical curriculum for training PrEP PMs. Methods: IRB and local research ethics committee approval was obtained. A literature search (PubMed, EBSCO, USAID website, and MedEd Portal) yielded one published curriculum for PrEP PMs. This curriculum was combined with locally developed HIV PM education modules to create a new curriculum, with planned virtual and physical sessions. Curriculum materials were reviewed and agreed upon by all authors. All sessions were delivered by authors, with the majority delivered by Americans. The first 4 hours were done virtually via Zoom, covering the basics of HIV, detailed information on PrEP, adolescent development, and confidentiality. The remaining sessions were held in person and covered expectations of PMs, basic family planning, research ethics, action planning, role playing, and a review of virtual topics. Feedback was solicited from the PMs after virtual training. A debriefing session was held with the five facilitators involved in training: 1 research staff and 1 physician investigator from Kenya, 1 research staff and 2 physician investigators from the US - all female. Results: All five PMs (aged 21 – 27) participated. One identified as female, and one as LGBTQ. Feedback was solicited via anonymous survey (n=3) after the virtual sessions and debriefing with Kenyan research staff. Respondents strongly agreed that the virtual training was worth their time. Although PMs felt they were able to learn in the virtual format, facilitators noted more engagement during in-person sessions. Facilitators noted the importance of introductions and challenges of building cohesiveness for virtual sessions, particularly with sensitive content and internet limitations restricting video use (eg. low bandwidth, use of cell phones). Kenyan investigators noted that the Kenyan educational system is hierarchical, with students largely learning passively. They felt that this, combined with the newness of virtual learning and minimal dedicated time for introductions, may have hampered active virtual participation. While no PMs pointed to race or accent as limitations, facilitators noted differences between American and Kenyan English idioms, cadence, speed, and pronunciation that may have caused difficulty. Given Kenya's history of colonialism, all raised concerns that PMs may have been more deferential to light-skinned, foreign facilitators. Facilitators who observed both virtual and in-person sessions felt it was easier to break barriers of colonialism and assess for differences in spoken English in person. Facilitators felt that if virtual training were to be used in the future, it would be beneficial to have physical sessions first to set an interactive, educational tone and allow participants to build rapport. Conclusions: Virtual delivery of PM educator training in a LMIC setting is difficult and requires careful consideration or technological limitations and culture. Sources of Support: Indiana CTSI;Grant Number UL1RR025761-01.

EFFORTS OF 'S-1 GRAND PRIX', A DELICIOUS LESS SALT RECIPE CONTEST AIMED AT PREVENTING CARDIOVASCULAR DISEASES

Purpose: As the average salt intake of Japanese people is as high as 10 gram per day, it is necessary to reduce the salt intake for the prevention and treatment of cardiovascular diseases. We held a less salt recipe contest to promote delicious less salt recipes among society and examined the potentiality of 'deliciously less salt meals'. Method: National Cerebral and Cardiovascular Center (NCVC) held the 'The 5th S-1 Grand Prix', a contest to develop delicious and less salt bento recipes on a nationwide scale. The contest named after its goal of reducing the salt intake by 1 gram in each meal. Under the theme of a delicious and attractive less salt bento meeting to the nutritional value standards (such as less than 2 gram of salt equivalent per meal), NCVC called for the bento recipe ideas from the 10th of May to 26th of July 2021. All the applied recipes are evaluated and tasted by NCVC contest board members, then the best one was decided for a 'Grand-Prix' award. Contest was held on-line due to the COVID-19, the video presentation made by the applicants were evaluated for the final selection. Result: A total of 67 teams (25 teams in the general category, 15 teams in the student category, 27 teams in the disaster nutrition category) were applied to this contest. We encouraged governments, hospitals, dietitian training schools, and convention-related companies and organizations nationwide to apply the contest. Compared to the 4th tournament, the number of applicants were increased by 16 teams. More than half of the applicants were from 'educational institutions such as universities'. Although the 5th tournament was held online, we were able to hold a recipe contest in a new format, such as using applicants' video presentation for the final selection. Discussion: In the disaster nutrition category, many recipes for the delicious, preserved foods and cooking methods under the disaster were gathered, so that these less salt recipes can be widely adopted in the disaster foods. Through this attempt, we created an opportunity to make a delicious less salt meals, and motivated participants to cook 'deliciously less salt meals'. In the future, more people will participate in this contest in order to get them to participate, we will consider the conditions of the recipe and the recruitment method.

Virtual Healthcare Is Everywhere, But Are Caregivers Satisfied With Virtual Learning And Does It Have A Role Moving Forward?

Rationale: Covid-19 introduced a shift towards telemedicine in paediatric healthcare. In-person education opportunities were therefore reduced. Virtual education opportunities are developing, but do caregivers want these permanently? This study assesses caregivers' experiences following an online anaphylaxis education session. Methods: This project uses data collected as part of the ongoing TEAAM study (Telemedicine as an Educational tool for caregivers regarding Auto-Injectors and Anaphylaxis Management). TEAAM examines the efficacy of online education in improving caregiver anaphylaxis knowledge using a virtual session (with a trainer and video resources), and pre- and post- intervention surveys. The TEAAM population consists of a convenience sample of caregivers of children attending allergy clinic, who have a food allergy and have been prescribed adrenaline. 65 caregivers have completed a post-intervention questionnaire in which we assessed their satisfaction level, perceived benefits, issues and comparison to in-person education. Results: 98.5%(64) of caregivers found participation beneficial (mean satisfaction score 4.7/5). Benefits included time saved (n=55,84.6%), and money saved (n=33,50.8%) due to less travel, having access to education while awaiting appointments (n=54,83.1%), and reduced exposure to infection (n=28,43.1%). During sessions, 78.5%(50) expressed no issues. 3.1%(2) had issues logging in. 9.2%(6) mentioned trainer difficulties in sharing screens. Qualitative comments showed confidence in online education platforms e.g., "I definitely think sessions like this are the way forward”. Only 1 caregiver believed it would be more useful if delivered in-person. Conclusions: Caregivers found online allergy education sessions worthwhile and would like them to continue. Moving forward, we need to build user-friendly, distance-learning resources and ensure staff are adequately trained.

142. The Reach, Implementation, and Effectiveness of Virtual Sex Education for Youth in Foster Care

Purpose: Youth in foster care have high rates of adverse sexual health outcomes and are important targets for evidence-based sex education. With the COVID-19 pandemic, sexual health programming was moved to a virtual format. However, few data existed to guide this transition. While it lowers expenses and can potentially broaden geographic reach, it is unclear if virtual programming meets the needs of youth in foster care or other vulnerable populations. We conducted a mixed-methods analysis comparing the reach, implementation, and effectiveness of virtual vs in-person sex education for youth in foster care before and during the COVID-19 pandemic. Methods: Indiana Proud and Connected Teens (IN-PACT) provides evidenced-based sex education programs to system-involved youth. The data used in this study focused exclusively on foster-care programming and includes attendance records, facilitator session reviews (n=64) from 2020-2021 virtual programs, and youth surveys from 2018-2020 in-person (n=965) and virtual (n=50) programs. Reach was measured using youth baseline survey demographics and sexual behaviors;implementation by free responses from facilitators on challenges and adaptation for virtual teaching;and effectiveness by attendance records and youth behavior intention on follow-up surveys. Results: Reach: Youth demographic diversity was maintained for virtual programming in ethnicity, race, sex, and sexual orientation. However, youth in virtual programs had lower rates of self-reported risk behaviors including lower rates of involvement with juvenile justice (35.0% vs 59.4%, p<0.01) to have ever had sex (44.4% vs 78.8%, p<0.001) or contributed to a pregnancy (4.4% vs 23.4%, p<0.05). And though not statistically significant, virtual youth reported higher rates of condom use (44.4% vs 30.4%, p=0.371) and lower rates of substance use before sex in the past 3 months (15.6% vs 28.5%, p=0.114) as compared to in-person youth. Implementation: Technical challenges included connection difficulties and learning curves to using Zoom. Virtual facilitators incorporated more technology than they did in-person by playing videos on complicated topics such as conception and STIs. In terms of curriculum, hands-on condom demonstrations were changed to facilitator-run experiments such as having youth use socks at home to simulate condoms on their arms. Breakout rooms were utilized to maintain small group work but were cumbersome. Relational challenges included awkward silences, disengagement, and a decrease in group trust due to cameras being turned off during sensitive topics and less connection between youth and facilitators. Effectiveness: Attendance records show that fewer virtual youth completed 100% of programming, as compared to in-person youth (23% vs 54%). More virtual youth answered yes to the question "As a result of this program, will you abstain from sex for the next three months?” as compared to in-person youth (55% vs 45%, p=0.462). However, virtual youth were significantly less likely to have baseline sexual experience. Conclusions: In-person sexual health programming had a wider reach, experienced fewer implementation challenges, and was potentially more effective than virtual programming for youth in foster care. If virtual programming becomes necessary again, sex educators and researchers can use these data to redesign virtual programming that maximizes reach, implementation, and effectiveness. Sources of Support: HHS 90AK0041-02-00 to Health Care Education and Training Inc.

FUNDOSCOPIC EXAMINATION USING A SMARTPHONE CAMERA: A REVIEW OF EFFECTIVENESS AND FEASIBILITY IN DETECTING HYPERTENSIVE RETINOPATHY IN HYPERTENSIVE CRISIS PATIENTS

Introduction: In patients presented with hypertensive crises, a fundoscopic assessment is necessary because once hypertensive retinopathy is discovered, a hypertensive emergency is diagnosed, and intravenous antihypertensive medication is recommended. However, direct ophthalmoscopy is relatively underutilized, especially under the social distance regulation, which may result in delayed diagnosis and treatment. The novel method, namely, smartphone-based fundoscopy offers longer working distance and shorter doctor-patient contact time, however, there is limited data regarding its feasibility and effectiveness. Objective: We aimed to gather scientific evidence on the smartphone-based fundoscopy in terms of its effectiveness, accessibility, and trainability in detecting hypertensive retinopathy among hypertensive crisis patients in emergency room settings. Methods: A literature search was conducted on PubMed, Google Scholar, and the Cochrane Library for papers published from January 2010 to November 2021. Keywords including hypertensive crisis, hypertensive retinopathy, target organ damage, fundoscopic optic examination, direct ophthalmoscope, fundus images, smartphone fundoscopy, digital fundus camera, and COVID-19 were used. Full papers published in English and s of non-English publications were all reviewed. Results: Eight studies out of 34 fulfilled our search criteria. Five observational studies confirmed the effectiveness of smartphone-based fundoscopy in obtaining fundus images adequate for interpretation compared with those from commercially available fundus cameras. Also, smartphone-based fundoscopy offers time-saving properties as it allows fundus examination to be effectively completed within 74 seconds compared to 130 seconds with a traditional direct ophthalmoscope. Two studies investigated the accessibility of smartphonebased fundoscopy and discovered that fundus images can be obtained by using 20 diopter condensing lenses with the video mode of the smartphone camera, which can be easily provided even at a primary level hospital due to their low cost. Another study reviewed the trainability of the smartphone-based fundoscopy in 137 undergraduate medical students which concluded that 75% of these students can identify the optic nerve within 20-25 minutes of face-to-face demonstration. Conclusion: With a greater diagnostic capability, accessibility, and trainability of smartphone-based fundoscopy makes it a potentially game-changing technique for detecting hypertensive retinopathy in hypertensive emergency patients, especially during the current COVID-19 pandemic, in which longer working distance and shorter doctor-patient contact time are both required.

Differentiating Functional Tic-Like Movements from Tourette-Related Tics

Functional tic-like movements or functional tic-like behaviours are functional symptoms that look like tics. There has been a sudden rise in these movements coinciding with the COVID-19 pandemic, prior to which functional tic-like movements were considered very uncommon. As a tertiary specialist Tourette clinic, we have seen our referrals multiply. The referring clinicians often diagnose these young people with Tourette syndrome. We want to describe the differentiating features between Tourette-related (typical) tics and functional tic-like movements based on our experience in London, with the help of data we have collected in a large number of adolescents and through the help of videos (both of typical tics and those of functional tic-like movements). We will also discuss some of the underlying factors that explain the rise of functional tic-like movements in young people. The main differentiating features of functional tics in our clinic (similar to other international specialist tic centres whom we collaborate with) are: (1) The comparatively late age of onset of functional movements (in adolescence) instead of (age 4-7 years) in Tourette-related/typical tics. (2) Change in prevalence by sex (F > M);majority cases are females in our clinic, in contrast the sex ratio in typical tics/Tourette is M > F (4:1). (3) A very abrupt onset over one to a few days in most cases. (4) Presence of complex motor and vocal behaviours, in fact complex tics being more common than typical tics (which is not the case in typical Tics). (5) Prominent involvement of the upper limbs (as opposed to movements starting in the eyes or face or minor sniffing or throat clearing). (6) A significant variability in movements and other symptoms depending upon the environment. We will discuss phenomenology of movements and why it may be better to describe these presentations as functional tic-like movements or behaviours rather than as functional-tics.

Partnering with primary care to implement evidence based interventions (EBI) to address overdue colorectal cancer (CRC) screening in Connecticut (CT)

PURPOSE: Partnering with the largest Federally Qualified Health Center (FQHC) in New Haven, CT, the goal is to implement and test 4 evidence-based interventions (EBI) to increase CRC screening, while evaluating real-world implementation. Here, we report on the six-month (approximate) follow up of a cohort of 3,127 patients overdue for CRC screening who received 1 or more EBIs in October 2021. BACKGROUND: Sociocultural and medical concerns are barriers to colonoscopy uptake contributing to disparities in CRC screening. An additional barrier is system level capacity. COVID-19 associated delays exacerbated the existing backlog of individuals overdue for CRC screening, underscoring the need to expand Fecal Immunochemical Testing (FIT) capacity. This was particularly evident in the safety-net primary care setting that serves lower socio-economic status individuals living in urban New Haven, CT. METHOD(S): We are testing the unique and additive value of multiple evidence-based interventions (EBIs) for increasing CRC screening. The EBIs include the use of medical reminders, addressing the structural barriers (social determinants of health [SDOH]), and providing assistance from community health workers (CHW). We randomized 3,127 patients overdue for CRC screening to one of 4 arms of the study. All individuals received a reminder from their providers that they were due/overdue for CRC screening with instructions to contact the FQHC. Arm 2 also included information on SDOH barriers, Arm 3 included this same information with offer of navigation from CHW/navigator;and Arm 4 included the offer of CHW educational video and support if needed. Six-month (approximate) outcomes include: 1) Engagement with FQHC resulting in ordered test;2) completed test. Results by intervention will be assessed at 12 months. RESULT(S): Of the 3,127 randomized patients, ages 50-75, 77% were Hispanic (33%) or Black (44%). At 6+ months, a preliminary look at EMR data show that a minimum of 1,275 (40.8%) patients "engaged" with providers resulting in an ordered FIT Kit (n= 1174) or COMPLETED screening colonoscopy that was not associated with a positive FIT result (n = 102). 217 (18.5%) individuals completed the FIT testing with 13 requiring confirmatory colonoscopy (31% completed at this time). Thus, a minimum of 319 (10%) of 3,127 individuals in the cohort completed CRC screening at approximately 6 months post intervention. DISCUSSION: Despite investments in community engagement, stakeholder input, and FIT kit capacity building, the pandemic presented unforeseen challenges. Flexibility and steadfast commitment from FQHC providers and staff were critical to successful implementation during multiple waves of COVID-19, resulting in CRC screening ordered for 41% of cohort within 6 months of intervention. SUMMARY: At 6 months follow up of 3,127 individual who were overdue for CRC screening, one or more of 4 EBIs, in addition to system level efforts to address CRC screening, resulted CRC screening tests ordered for 41% of cohort with at least 10% completed screening.

Actions of the medicines information centre in the COVID-19 crisis

Background: The pandemic of coronavirus disease 2019 has led to a health crisis situation in which all healthcare sector have set up information mechanisms aimed at their own professionals, as well as the population. Among them, the General Pharmaceutical Council of Spain has carried out different actions to improve knowledge of the pandemic. Purpose(s): Ensuring that the General Council conveys the information to pharmacists, other health professionals and patients. Method(s): The General Council has set up a specific information centre on COVID-19, aimed at centralising the information activities carried out in this area, such as direct resolution of queries from professionals and the general public, publication of technical reports, creation of an information website, issuance of official communications or production of information videos. Result(s): Since the outbreak of the crisis, a total of 198 queries have been received;35% were from Provincial Pharmacists' Chambers, 51% from pharmacists, and 14% from other professionals and citizens. The most consulted topics were about prevention of contagion through hydroalcoholic solutions, use of masks and action procedure in community pharmacy. Conclusion(s): The General Council has positioned itself as an information reference for this health crisis management. The implementation of a landline for telephone queries and real concerns allowed the information issued to be tailored to the demands of health professionals and citizens.

Patient-reported access to telehealth: An important and unmeasured social determinant of health

Background: The recent COVID-19 pandemic expanded opportunities for remote oncology telehealth visits. However, reliable internet connectivity, digital literacy, and patient comfort with virtual medical visits may differ among patients, especially socially disadvantaged groups. The primary aim of this study was to identify patient demographics and social determinants of health (SDOH) which might limit access to remote telehealth services. Method(s): First, a retrospective analysis was performed of composite administrative data of all patient visits to a large regional cancer center over the COVID-19 pandemic (3/2020-4/2022). Second, a prospective, crosssectional study was conducted of patients with known or suspected malignancy presenting to the same center over six-months (11/2021-5/2022). Participants were asked a standard set of survey questions regarding telehealth accessibility during an in-person clinic visit. Demographics and SDOH were ed from the electronic health record (EHR). Result(s): Although Black patients comprised 43% (n=9,021) of all patient visits (n=20,953), the proportion of telehealth visits conducted among Black patients (29%;n=889) was significantly lower compared to White patients (71%, n=2,142, p<0.0001). Within the cross-sectional study cohort (n=149), 51% (n=76) were Black, 39% (n=58) resided in a rural county, and 8.7% (n=13) were uninsured or Medicaid-insured. Black participants were more likely to self-report lack of internet access (73.7% vs. 90.4%, p<0.01) and were less likely to report having access to or actively using a patient portal in the EHR compared to White patients (47.4% and 79.5%, respectively;p<0.001). Rates of self-reported access to videocapable devices (82.9% vs. 90.4%) and confidence in conducting video visits without assistance (59.2% vs. 68.5%) were similar among Black and White patients (p>0.05). The most common selfidentified challenge to telehealth usage among both races was limited digital literacy. Conclusion(s): Black patients disproportionally under-participated in telehealth visits, suggesting underlying structural disparities in access to digital care. A greater proportion of Black participants self-reported lack of internet access and access to a patient portal to the EHR compared to White patients. Ensuring equal internet access and digital literacy will be critical to reduce further disparities in cancer care among racial minorities.

Guidelines for teleconsultations

Introduction: The COVID-19 pandemic forced oncology nurses to deliver more consultations by telephone (teleconsultations). Nurses in Switzerland are in general not trained to provide teleconsultations, making this change of practice a considerable challenge. The Academic Society Oncology Nursing invited health care professionals to webinars in French and German to discuss their experiences related to COVID-19 policies. Method(s): Members of the Academic Society searched for international guidelines and already implemented digital tools to facilitate teleconsulta-tions in oncological settings. Overall, ten national and international health care experts including nurses, an oncologist, and an expert for telephone consultations participated at two webinars. The same outline was used in French and German and both webinars were video recorded. Result(s): COVID-19 pandemic policies drove an increase in teleconsulta-tions. Guidelines for telephone triage from the Oncology Nursing Society (ONS) in the USA and in the UK (UKONS) incorporated procedures to assess COVID-19 symptoms and to defne patient referrals based on local health system capacities. In France, the Gustave Roussy Institute created the CAPRI-COVID program to facilitate the remote monitoring of cancer patients during the COVID-19 pandemic. In Switzerland, nurses used local guidelines implemented for follow-up consultations by telephone to support cancer patient adherence to treatment and to assess symptom trajectories, to structure their teleconsultations. The assessment of COVID-19 symptoms was not always included. The sudden change to support patients remotely was challenging when no guidelines or standards for this kind of support were already in place. Documenting tele-consultations was difcult when no electronic documentation system was implemented. The reimbursement of nursing teleconsultations was a major, important barrier nurses faced, leading to unpaid provided services. Conclusion(s): The federal health system in Switzerland has provided no national recommendations for nursing teleconsultations. However, ONS and UKONS guidelines could inform the development of evidence based recommendations for oncology nursing teleconsultations in Switzerland. The Academic Society Oncology Nursing will take an initiative to discuss reimbursement of nursing teleconsultations with Swiss stakeholders including health care professionals and policy makers.

Comparison of disease activity outcome virtually (tele-rheumatology) and face-to- face disease activity scores for patients with rheumatoid arthritis: A prospective study

Background and Aim: Since the emergence of COVID-19, tele-rheumatology care has presented as an appealing alternative way for accessing health care. The efficacy of tele-care needs to be evaluated in our setting. This study aimed at assessing the agreement between the tele-visit and the face-to- face clinic-based visit. Methodology: We prospectively recruited patients with rheumatoid arthritis;who were following up in the out-patient department clinics between December 2021 and May 2022. Each patient underwent disease activity assessment by means of disease activity score 28-c- reactive protein (DAS28-CRP) and disease activity score28-erythrocyte sedimentation rate (DAS28-ESR). Within two weeks from the face-to- face visit, we virtually assessed their disease activity, through a telephone-based interview, by applying Routine Assessment of Patient Index Data 3 (RAPID3) score, collecting data on demographics and inquiring about satisfaction with the tele-visit. Disease activity scores were categorized into remission or low disease activity, and moderate to high disease activity. Result(s): In our study, 78 patients were recruited and completed the two-points interview. A total of 62(79.49%) of the participants were female;mean age of 54.73 +/- 13.71 years. Seropositivity for rheumatoid factor and/or anti-citrullinated peptide was found in 51(83.61%) participants. 27% of patients with RAPID3 had remission or low disease activity. While this was 71% and 33% for DAS28-CRP and DAS28-ESR, respectively. Moderate to high disease activity percentage of 73%, 29% and 67% were found in RAPID3, DAS28-CRP and DAS28-ESR, respectively. Furthermore, the correlations of RAPID 3 were relatively moderate but significant with DAS28-CRP (r = 0.6, P-value < 0.001) and DAS28-ESR (r = 0.4, P-value = 0.001), respectively. Satisfaction rates with the tele-visit were at odds with other reported publications. Conclusion(s): Tele-rheumatology assessment of disease activity for patients with rheumatoid arthritis appears to be feasible in our setting. Further studies should aim at assessing patients' satisfaction and the recently implemented video-based tele-clinics.

Using diverse community feedback to inform inclusive community action: Insights from the Louisiana Community Engagement Alliance

Purpose of Study: Clinical trial participation remains low among US minority groups, who account for <1/10 of trial participants.1,2 Diverse, equitable and inclusive participation is needed to lessen disparities in health status and clinical outcomes.3 Community-based participatory research (CBPR) strategies identify salient community issues, and may be useful for understanding and addressing participation barriers among minority groups.4,5 The Louisiana Community Engagement Alliance Against COVID-19 Disparities (LA-CEAL) - a partnership of universities, community pharmacies, faith-based organizations (FBOs), and federally qualified health centers (FQHCs) - aims to strengthen and leverage community relationships to address barriers to uptake of preventive/therapeutic strategies in underserved populations. This study examines the utility of LA-CEAL's CBPR approach in facilitating inclusive participation in clinical trials. Methods Used: Listening forums were held with a diverse group of LA community stakeholders, including healthcare providers, community pharmacists, FBO leaders and other trusted community members, to gather views on the need for and challenges to inclusive trial participation. Ongoing discussions between community representatives and leaders, academics and program staff facilitated outreach and guided development of informational strategies targeting minority groups. Summary of Results: Listening forums (N = 4;20 participants) revealed limited awareness, mistrust and fear stemming from historical and present injustices, and difficulty accessing opportunities as key themes underlying barriers to participation. To address identified barriers, 8 video testimonials featuring participants, investigators, and health advocates (62.5% Black;12.5% Hispanic;50% female) were developed to educate on expectations and experiences, motivations to participate, human subject protections, and the importance of diversity. Two animated videos featuring trusted community leaders and cultural ambassadors (e. g., New Orleans cultural icon, Irma Thomas) were created to explain trial processes, discuss participation benefits, and address the history of racism in medicine. Finally, connections between the Tulane Clinical Translational Unit and rural FQHCs enabled clinical trial study buses to visit and recruit in diverse LA communities. Conclusion(s): Via LA community stakeholder discussions, targeted strategies to address barriers to minority participation in clinical trials were developed and applied. Use of CBPR strategies was critical to developing intentional action reflective of LA community needs. Copyright © 2023 Southern Society for Clinical Investigation.

Management of Extremely Complex Constipation Patients in a Nurse-Led Clinic with Health Play Specialist Involvement

Introduction Children with idiopathic chronic constipation are extremely challenging to manage. Before review by tertiary specialist teams, Children have suffered for years with constipation, which leads to significant behaviour related issues around toileting, despite adequate medical treatment. The involvement of the health play specialist (HPS) in the nurseled constipation clinic is to address behaviours around toileting. Aims To demonstrate involvement of HPS in the clinic led to improved outcomes for children and families. This will be identified through the use of parental satisfaction questionnaires and four case studies. Case Studies We demonstrate four extremely complex constipation cases referred to clinic and successfully managed by HPS with unique individualised approach with support and plans for parents and school. 9-year-old boy with history of sexual abuse, with soiling and wetting accidents. 5 sessions with the HPS, focusing on toileting behaviours. Sessions involved desensitizing play around the body, use of toilet related games/activities, videos and mobile apps. All issues resolved. 5-year-old boy: Stool with-holding, will only pass stools in a nappy and soiling. 8 sessions with HPS - Intense toilet training for 2-4 days with hourly sits. Reward charts to compliment interests, targets adjusted when goal reached, prizes given. Desensitization play around toileting behaviours. Using analogies to improve behaviour, he loved dustbin lorries - body empties the waste (poo) just like the bin men collecting the rubbish to get rid of it from home. No more accidents, independent toileting achieved 5-year-old girl Issues with constipation, soiling and toilet refusal. All bowel movements in knickers. Complete HPS treatment virtually, secondary to COVID restrictions. 6 Video call sessions- individualised plan of regular sits to relax, with no pressure to perform. To do an activity whilst on the toilet. Visual pictures/videos explaining how the body works and the plan was adjusted on the video. Rewards when child reached the target, and prize sent in post. Outcome -no fear of the toilet, bowels open on the toilet, no accidents. 8 year old boy premature 33 + 5 weeks. Constipation with overflow since birth. Referred to surgeons for rectal biopsies and botox injections at the age of 3 but no improvement. Age 4 admitted to the ward for 1 week for observation, transit marker study and toilet training was unsuccessful. Referred to another unit for second opinion at parental request. Started to refuse medications. ACE surgery discussed. Diagnosed with Autism at 7 years. Invited for a week of intense toileting with HPS, hourly sits and desensitization activities on medication taking, toileting, with-holding, signs and signals of body. Reward system in place, when reached expectations, reward given by hospital. Outcome bowels open daily in the toilet, wears pants all the time. Satisfaction questionnaires were given to parents and feedback was extremely positive. Conclusion The health play specialist involvement in the nurse led constipation clinic allows for individualised intervention guided by the child's needs. Pharmacological interventions alone may be unsuccessful without addressing behavioural needs.

How Were Modified the Human Anatomy Study Habits During and After Confinement By the COVID-19 Pandemic?

During 2020 and 2021 the anatomy subject was developed by online classes. In 2022, face-to-face teaching activities were resumed. The objective was to compare the autonomous study habits of two student generations that coursed the Human Anatomy subject in online and face-to-face mode. Two groups of students were asked to fill-out an online questionnaire. Online Generation (OL) (n=185) and Face-to-face Generation (FF) (n=154). The difference between both groups was the learning activities. OL received only online classes, and FF received theoretical classes and laboratory activities in face-to-face sessions. The most of OL subjects had greater clarity about the contents (71.9 %) and the depth (50.8 %) that they should study them, in contrast with FF (58.4 %, p = 0.0124 and 24.7 %, p < 0.0001 respectively). In OL, 47 % spent more than 4 hours weekly studying human anatomy, whereas in FF 68.2 % (p<0.0001). In both groups, the most important resource was the Video Recorded Classes (90.8 % in OL, and 83.1 % in FF). For OL, the three priority resources were exclusively electronic: 1) Video Recorded Classes, 2) Apps on smartphone or tablets, and 3) Apps on laptop or computer. FF generation prioritized: 1) Video Recorded Classes, 2) Anatomy Atlas, and 3) Class Slides. During the COVID-19 pandemic, the students that received only online classes were able to plain their study time in a better way than whose were in face-to-face classes. However, they spent less time to study the topics. In addition, it was possible to determine that students prefer digital resources (video classes recorded and apps in smartphone or computer) over traditional resources such as textbook and anatomy atlas. It proposes to consider these results in the Human Anatomy subjects design, in virtual or face-to-face mode. Copyright © 2022, Universidad de la Frontera. All rights reserved.

Insight into cervical cancer prevention awareness, experiences, and attitudes among Southern Vietnamese women

Background At least 80% of new cervical cancer cases and deaths occur in low- and middleincome countries. Vietnam is a middle-income country where cervical cancer is the second most common and the deadliest gynecologic cancer. Cervical cancer incidence in Southern Vietnam has been shown to be 1.5-4 times higher than that in Northern Vietnam. However, less than 10% of Southern Vietnamese women have received the Human papillomavirus (HPV) vaccine and only 50% have ever been screened for cervical cancer. No study has examined the perceptions toward cervical cancer prevention and screening in Southern Vietnamese women. Hence, this study aimed to explore cervical cancer awareness, barriers to screening, and acceptability of HPV self-sampling for cervical cancer screening among rural and urban women in Southern Vietnam. Methods In October-November 2021, three focus groups were conducted in the rural district of Can Gio (n=21 participants) and three were conducted in the urban District Four (n=23 participants) in Ho Chi Minh City, Southern Vietnam. All participants were cervical cancer-free women aged 30-65 years. Awareness of, attitudes toward, and experience with cervical cancer prevention and screening were explored using audio-recorded, semi-structured discussions in Vietnamese. During the focus groups, participants also watched four short videos with Vietnamese subtitles and voiceover about cervical cancer screening methods and discussed their views on each. The recordings were transcribed, translated into English, and coded and analyzed using Dedoose 9.0.46. Results Four main themes emerged. First, women showed low awareness, but high acceptance of cervical cancer screening and HPV vaccination. Second, screening barriers were related to logistics (e.g., cost, time, travel distance), psychology (e.g., fear of pain, embarrassment, fear of the test revealing they had cancer), and healthcare providers (e.g., doctors' impolite manners, male doctors). Third, women were concerned about self-sampling incorrectly and pain, but believed HPV self-sampling to be a feasible screening tool in some circumstances (e.g., during the COVID-19 pandemic, those living in remote areas). Fourth, women related cervical cancer prevention to COVID-19 prevention;they believed strategies that have been successful for COVID-19 control in Vietnam could be applied to cervical cancer. No differences in themes emerged by rural/urban areas. Conclusions Southern Vietnamese women showed low awareness but high acceptance of cervical cancer screening despite barriers. Strategies for successful COVID-19 control in Vietnam, including campaigns to increase public awareness, advocacy from the government and doctors, and efforts to increase access to screening and vaccination, should be applied to cervical cancer control. Health education programs to address HPV self-sampling concerns and promote it as a cervical cancer screening tool are warranted given its potential to improve screening uptake in this low-resource setting.