NIMG-53. 3D BRAIN TUMOR MODELING FACILITATES NEURO-ONCOLOGY CLINIC VISIT AND IMPROVES PATIENT HEALTH LITERACY AND VISIT SATISFACTION

Abstract Explanation of brain tumor imaging (BTI) complexities to patients is a challenge in neuro-oncology. With limited tools, neuro-oncologist attempt to demonstrate tumor volumes and anatomy, estimate surgical risks, and treatment responses. Arming clinicians with alternative BTI might help alleviate the stress of initial patient consults and follow-up surveillance visits. These interactions are critical to the physician-patient relationship, patient compliance, and satisfaction. Currently, 2D-MRI review is standard, often leaving the patient with a less-than-complete understanding of their tumor. Historically, 3D-Brain-Tumor-Modeling (3DBTM) has been used for neurosurgical simulation and planning. Here, we evaluated the use 3DBTM alongside routine MRI impact on patient health literacy and satisfaction. Our institution introduced 3DBTM as a best practice approach. Images were presented as 3D video or tangible 3D color renditions, or 2D MRI. We collected patient pre-visit and post-visit surveys to assess patient’s understanding of tumor features, opportunity to review images, and patient level of satisfaction. Data from 277 pre-visit and 159 post-visit surveys was collected from the Geisinger Neuro-Oncology Clinic over a six-month period. Post-visit survey categories included reviews of: 3DBTM (n=54), 2D-MRI (n=51), and no imaging (n=55). Patients without CNS tumors were excluded (n=101). Pre-visit surveys showed 30% (n=82) of patients had little-to-no prior understanding of their tumor location and size, and 53% (n=147) of patients believed that a 3DBTM would improve their understanding. Post-visit analysis demonstrated that only 21% (n= 29) of patients reported not seeing any imaging during the visit. Nearly 85% (n=46) of patients who had reviewed a 3DBTM noted improved tumor understanding. Of the patients who solely viewed 2D-MRI, 68% (n=35) reported improved understanding of their tumor but would like more advanced imaging teaching. In total, 84% of patients noted overall satisfaction with the clinic visit. These results support the use of 3DBTM in patient education and facilitating clinical interviews.

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Paediatric Brain Tumor Imaging – an Update

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren ◽

10.1055/s-0036-1581717 ◽

2016 ◽

Vol 188 (S 01) ◽

Author(s):

M Warmuth-Metz

Keyword(s):

Brain Tumor ◽

Tumor Imaging

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Evaluation and treatment of children with radiation-induced cerebral vasculopathy

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.7.peds19188 ◽

2019 ◽

Vol 24 (6) ◽

pp. 680-688

Author(s):

David S. Hersh ◽

Kenneth Moore ◽

Vincent Nguyen ◽

Lucas Elijovich ◽

Asim F. Choudhri ◽

...

Keyword(s):

Radiation Therapy ◽

Proton Beam ◽

Tumor Imaging ◽

Clinic Visit ◽

Surgical Patient ◽

Beam Radiation ◽

Proton Beam Radiotherapy ◽

Cranial Radiation ◽

Delayed Complication ◽

Radiation Induced

OBJECTIVEStenoocclusive cerebral vasculopathy is an infrequent delayed complication of ionizing radiation. It has been well described with photon-based radiation therapy but less so following proton-beam radiotherapy. The authors report their recent institutional experience in evaluating and treating children with radiation-induced cerebral vasculopathy.METHODSEligible patients were age 21 years or younger who had a history of cranial radiation and subsequently developed vascular narrowing detected by MR arteriography that was significant enough to warrant cerebral angiography, with or without ischemic symptoms. The study period was January 2011 to March 2019.RESULTSThirty-one patients met the study inclusion criteria. Their median age was 12 years, and 18 (58%) were male. Proton-beam radiation therapy was used in 20 patients (64.5%) and photon-based radiation therapy was used in 11 patients (35.5%). Patients were most commonly referred for workup as a result of incidental findings on surveillance tumor imaging (n = 23; 74.2%). Proton-beam patients had a shorter median time from radiotherapy to catheter angiography (24.1 months [IQR 16.8–35.4 months]) than patients who underwent photon-based radiation therapy (48.2 months [IQR 26.6–61.1 months]; p = 0.04). Eighteen hemispheres were revascularized in 15 patients. One surgical patient suffered a contralateral hemispheric infarct 2 weeks after revascularization; no child treated medically (aspirin) has had a stroke to date. The median follow-up duration was 29.2 months (IQR 21.8–54.0 months) from the date of the first catheter angiogram to last clinic visit.CONCLUSIONSAll children who receive cranial radiation therapy from any source, particularly if the parasellar region was involved and the child was young at the time of treatment, require close surveillance for the development of vasculopathy. A structured and detailed evaluation is necessary to determine optimal treatment.

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OP0257-PARE USING PATIENT HEALTH LITERACY PROFILES TO IDENTIFY SOLUTIONS TO CHALLENGES FACED IN RHEUMATOLOGY CARE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.877 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 162.2-162

Author(s):

M. Bakker ◽

P. Putrik ◽

J. Rademakers ◽

M. Van de Laar ◽

H. Vonkeman ◽

...

Keyword(s):

Health Literacy ◽

The Netherlands ◽

Health System ◽

Demographic Data ◽

Family Doctor ◽

List Type ◽

Research Support ◽

Score Distribution ◽

Patient Health ◽

Literacy Profiles

Background:The prevalence of limited health literacy (i.e. cognitive and social resources of individuals to access, understand and apply health information to promote and maintain good health) in the Netherlands is estimated to be over 36% [1]. Access to and outcomes of rheumatological care may be compromised by limited patient health literacy, yet little is known about how to address this, thus action is required. As influencing individual patients’ health literacy in the rheumatology context is often unrealistic, it is paramount for the health system to be tailored to the health literacy needs of its patients. The OPtimising HEalth LIteracy and Access (Ophelia) process offers a method to inform system change [2].Objectives:Following the Ophelia approach:a. Identify health literacy profiles reflecting strengths and weaknesses of outpatients with RA, SpA and gout.b. Use the health literacy profiles to facilitate discussions on challenges for patients and professionals in rheumatological care and identify possible solutions the health system could offer to address these challenges.Methods:Patients with RA, SpA and gout attending outpatient clinics in three centres in the Netherlands completed the Health Literacy Questionnaire (HLQ) and questions on socio-demographic and health-related characteristics. Hierarchical cluster analysis using Ward’s method identified clusters based on the nine HLQ domains. Three researchers jointly examined 24 cluster solutions for meaningfulness by interpreting HLQ domain scores and patient characteristics. Meaningful clusters were translated into health literacy profiles using HLQ patterns and demographic data. A patient research partner confirmed the identified profiles. Patient vignettes were designed by combining cluster analyses results with qualitative patient interviews. The vignettes were used in two two-hour co-design workshops with rheumatologists and nurses to discuss their perspective on health literacy-related challenges for patients and professionals, and generate ideas on how to address these challenges.Results:In total, 895 patients participated: 49% female, mean age 61 years (±13.0), 25% lived alone, 18% had a migrant background, 6.6% did not speak Dutch at home and 51% had low levels of education. Figure 1 shows a heat map of identified health literacy profiles, displaying the score distribution per profile across nine health literacy domains. Figure 2 shows an excerpt of a patient vignette, describing challenges for a patient with profile number 9. The workshops were attended by 7 and 14 nurses and rheumatologists. Proposed solutions included health literacy communication training for professionals, developing and improving (visual) patient information materials, peer support for patients through patient associations or group consultations, a clear referral system for patients who need additional guidance by a nurse, social worker, lifestyle coach, pharmacist or family doctor, and more time with rheumatology nurses for target populations. Moreover, several system adaptations to the clinic, such as a central desk for all patient appointments, were proposed.Conclusion:This study identified several distinct health literacy profiles of patients with rheumatic conditions. Engaging with health professionals in co-design workshops led to numerous bottom-up ideas to improve care. Next steps include co-design workshops with patients, followed by prioritising and testing proposed interventions.References:[1]Heijmans M. et al. Health Literacy in the Netherlands. Utrecht: Nivel 2018[2]Batterham R. et al. BMC Public Health 2014, 14:694Disclosure of Interests:Mark Bakker: None declared, Polina Putrik: None declared, Jany Rademakers Speakers bureau: In March 2017, Prof. Dr. Rademakers was invited to speak about health literacy at the “Heuvellanddagen” Conference, hosted by Janssen-Cilag., Mart van de Laar Consultant of: Sanofi Genzyme, Speakers bureau: Sanofi Genzyme, Harald Vonkeman: None declared, Marc R Kok Grant/research support from: BMS and Novartis, Consultant of: Novartis and Galapagos, Hanneke Voorneveld: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Richard Osborne Consultant of: Prof. Osborne is a paid consultant for pharma in the field of influenza and related infectious diseases., Roy Batterham: None declared, Rachelle Buchbinder: None declared, Annelies Boonen Grant/research support from: AbbVie, Consultant of: Galapagos, Lilly (all paid to the department)

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Contraception for young people

InnovAiT Education and inspiration for general practice ◽

10.1177/1755738020977555 ◽

2021 ◽

Vol 14 (3) ◽

pp. 159-167

Author(s):

Rajesh Varma

Keyword(s):

Young People ◽

Health Care Professionals ◽

Best Practice ◽

Unplanned Pregnancy ◽

Treatment Plan ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Competency Testing ◽

Practice Approach ◽

Age Appropriate

Significant progress has been made in improving the awareness of young people of available contraception services and their access to these services. Nonetheless, many young people are reluctant to engage with health care professionals, and thus, can experience adverse consequences, such as unplanned pregnancy and sexually transmitted infection. This article presents a best practice approach to the management of young people requesting contraception in primary care. A systematic approach is advocated, employing an age-appropriate consultation style, confidentiality, competency testing, risk assessment and an individualised contraceptive treatment plan.

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International survey for assessing COVID-19’s impact on fear and health: study protocol

BMJ Open ◽

10.1136/bmjopen-2021-048720 ◽

2021 ◽

Vol 11 (5) ◽

pp. e048720

Author(s):

Kris Yuet-Wan Lok ◽

Daniel Yee Tak Fong ◽

Janet Y.H. Wong ◽

Mandy Ho ◽

Edmond PH Choi ◽

...

Keyword(s):

Health Literacy ◽

International Study ◽

Ethics Committees ◽

Well Being ◽

International Perspective ◽

Community Dwelling ◽

Health Study ◽

The World ◽

Patient Health ◽

Health Related

IntroductionCOVID-19, caused by the SARS-CoV-2, has been one of the most highly contagious and rapidly spreading virus outbreak. The pandemic not only has catastrophic impacts on physical health and economy around the world, but also the psychological well-being of individuals, communities and society. The psychological and social impacts of the COVID-19 pandemic internationally have not been well described. There is a lack of international study assessing health-related impacts of the COVID-19 pandemic, especially on the degree to which individuals are fearful of the pandemic. Therefore, this study aims to (1) assess the health-related impact of the COVID-19 pandemic in community-dwelling individuals around the world; (2) determine the extent various communities are fearful of COVID-19 and (3) identify perceived needs of the population to prepare for potential future pandemics.Methods and analysisThis global study involves 30 countries. For each country, we target at least 500 subjects aged 18 years or above. The questionnaires will be available online and in local languages. The questionnaires include assessment of the health impacts of COVID-19, perceived importance of future preparation for the pandemic, fear, lifestyles, sociodemographics, COVID-19-related knowledge, e-health literacy, out-of-control scale and the Patient Health Questionnaire-4. Descriptive statistics will be used to describe participants’ characteristics, perceptions on the health-related impacts of COVID-19, fear, anxiety and depression, lifestyles, COVID-19 knowledge, e-health literacy and other measures. Univariable and multivariable regression models will be used to assess the associations of covariates on the outcomes.Ethics and disseminationThe study has been reviewed and approved by the local ethics committees in participating countries, where local ethics approval is needed. The results will be actively disseminated. This study aims to map an international perspective and comparison for future preparation in a pandemic.

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Integrating social class and privilege in the community medicine curriculum

The International Journal of Psychiatry in Medicine ◽

10.1177/0091217417730286 ◽

2017 ◽

Vol 52 (3) ◽

pp. 228-235

Author(s):

Christopher Haymaker ◽

Amber Cadick ◽

Allison Seavey

Keyword(s):

Social Class ◽

Hidden Variables ◽

Therapeutic Approaches ◽

Physician Patient Relationship ◽

Health Curriculum ◽

Group Format ◽

Resident Physicians ◽

Patient Health ◽

Patient Relationships ◽

Physician Patient

Social class and privilege are hidden variables that impact the physician–patient relationship and health outcomes. This article presents a sample of activities from three programs utilized in the community health curriculum to teach resident physicians about patients within context, including how social class and privilege impact physician–patient relationships and patient health. These activities address resident physicians’ resistance to discussion of privilege, social class, and race by emphasizing direct experience and active learning rather than traditional didactic sessions. The group format of these activities fosters flexible discussion and personal engagement that provide opportunities for reflection. Each activity affords opportunities to develop a vocabulary for discussing social class and privilege with compassion and to adopt therapeutic approaches that are more likely to meet patients where they are.

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