Zamorahandberg3274

als to address PTSD in people who are vulnerably housed. There is a need to conduct well designed trials that take into account the unique setting of this population and which describe those elements of trauma-informed care that are most important and necessary.

To identify patients at risk of mid-late term revision of hip replacement to inform targeted follow-up.

Analysis of linked national data sets from primary and secondary care (Clinical Practice Research Datalink (CPRD-GOLD); National Joint Registry (NJR); English Hospital Episode Statistics (HES); Patient-Reported Outcome Measures (PROMs)).

Primary elective total hip replacement (THR) aged≥18.

Revision surgery≥5 years (mid-late term) after primary THR.

Cox regression modelling to ascertain risk factors of mid-late term revision. HR and 95% CI assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision.

NJR-HES-PROMs data were available from 2008 to 2011 on 142 275 THR; mean age 70.0 years and 61.9% female. CPRD GOLD-HES data covered 1995-2011 on 17 047 THR; mean age 68.4 years, 61.8% female. Patients had minimum 5 years postprimary surgery to end 2016. In NJR-HES-PROMS data, there were 3582 (2.5%) revisions, median time-to-reneeded to explore the associations with prescription medications observed in our data.

The risk of mid-late term THR is associated with age at primary surgery, 6-month postoperative pain and function and implant factors. Further work is needed to explore the associations with prescription medications observed in our data.

To investigate the efficacy, safety and applicability of internet-based, therapist-led partner-assisted cognitive-behavioural writing therapy (iCBT) for post-traumatic stress disorder (PTSD) symptoms after intensive care for sepsis in patients and their spouses compared with a waitlist (WL) control group.

Randomised-controlled, parallel group, open-label, superiority trial with concealed allocation.

Internet-based intervention in Germany; location-independent via web-portal.

Patients after intensive care for sepsis and their spouses of whom at least one had a presumptive PTSD diagnosis (PTSD-Checklist (PCL-5)≥33). Initially planned sample size 98 dyads.

ICBT group 10 writing assignments over a 5-week period; WL control group 5-week waiting period.

Primary outcome pre-post change in PTSD symptom severity (PCL-5).

remission of PTSD, depression, anxiety and somatisation, relationship satisfaction, health-related quality of life, premature termination of treatment. Outcomes measures were applied pre and post treatment and at 3, 6 and 12 months follow-up.

Twenty-five dyads representing 34 participants with a presumptive PTSD diagnosis were randomised and analysed (ITT principle). There was no evidence for a difference in PCL-5 pre-post change for iCBT compared with WL (mean difference -0.96, 95% CI (-5.88 to 3.97), p=0.703). No adverse events were reported. Participants confirmed the applicability of iCBT.

ICBT was applied to reduce PTSD symptoms after intensive care for sepsis, for the first time addressing both patients and their spouses. It was applicable and safe in the given population. There was no evidence for the efficacy of iCBT on PTSD symptom severity. Due to the small sample size our findings remain preliminary but can guide further research, which is needed to determine if modified approaches to post-intensive care PTSD may be more effective.

DRKS00010676.

DRKS00010676.

To identify patients at risk of mid-late term revision of knee replacement (KR) to inform targeted follow-up.

Analysis of linked national datasets from primary and secondary care (Clinical Practice Research Datalink (CPRD GOLD), National Joint Registry (NJR), English Hospital Episode Statistics (HES) and Patient Reported Outcome Measures (PROMs)).

Primary elective KRs aged ≥18 years.

Revision surgery ≥5 years (mid-late term) postprimary KR.

Cox regression modelling to ascertain risk factors of mid-late term revision. HRs and 95% CIs assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision.

NJR-HES-PROMs data were available from 2008 to 2011 on 188 509 KR. CPRD GOLD-HES data covered 1995-2011 on 17 378 KR. Patients had minimum 5 years postprimary surgery to end 2016. Age and gender distribution were similar across datasets; mean age 70 years, 57% female. In NJR, there were 8607 (4.6%) revisions, median time-to-revision pose is evidence of sociodemographic inequality.

The risk of mid-late term KR revision is very low. Increased risk of revision is associated with patient case-mix factors, and there is evidence of sociodemographic inequality.

Long-term care (LTC) residents frequently experience transitions in the location of more advanced care delivery, including receiving emergency department (ED) care. In this proof-of-concept study, we aimed to determine if we could identify measures in quality of care across transitions from LTC to the ED, via emergency medical services and back, by applying Institute of Medicine (IOM) Quality of Care Domains to an existing dataset.

In the Older Persons' Transitions in Care (OPTIC) study, we collected information on residents' transitions in two Western Canadian cities. We applied the IOM's Quality of Care Domains to the OPTIC data to create binary measures of transition quality. We report the median (MED) per cent and IQR of measures met within each domain of quality.

We tracked 637 transitions over a 12-month period, with data collected from each setting. We developed 19 safety measures, 20 measures of resident-centred care, 3 measures of timely care and 5 measures of effective care. We were unable to n, health authority, province). Such tracking is necessary to evaluate and improve overall quality of care.Efficient handover of patient care is integral to clinical safety. Barriers in communication can lead to adverse outcomes. The Integrated Liaison Assessment Team (ILAT) has a daily handover meeting which presents several challenges to the multidisciplinary liaison team (MDT including high patient turnover, differing staff shift-work patterns, presence of visitors/students and lack of a unified approach to structured discussion at times. Areas identified for improvement included optimising efficiency, structure and handover documentation. Lack of teaching and learning opportunities were also identified. The primary aim was to reduce handover time to 30 min. The secondary aims were to improve communication by introducing the Situation-Background-Assessment-Recommendation (SBAR) tool, improve team satisfaction and introduce a teaching programme in the time saved. The Model for Improvement methodology was used with MDT focus groups and questionnaires to explore change ideas. This informed our 'Plan, Do, Study, Act' cycles to design a structured handover. Daily measures looked at handover length and individual team member satisfaction. Weekly measures included semiqualitative questionnaires highlighting areas for improvement. Feedback was gathered from emails and MDT discussions. A structured handover format incorporating SBAR, key task allocation and a shift handover lead was introduced. A regular MDT teaching programme was initiated. Over 4 weeks, 'Good' handover ratings increased from 22% to 65%; 'Poor' ratings decreased from 25% to 8%. Mean handover time decreased from 47 min to 31.25 min; a decrease of 33.5%. Overall, the team viewed SBAR positively as an efficiency-promoting tool. Structured handover has promoted staff competencies, team morale and information sharing practices among ILAT. MDT teaching improved team communication and confidence. Sustaining motivation to keep up interventions and documentation of handover were identified as key areas for sustained improvement.

Antibiotic overuse threatens global health, food security and human development through the development of antibiotic resistance. Antibiotic resistance is associated with worse clinical outcomes and increased healthcare costs. Studies suggest urgent cares exceed the national average for inappropriate antibiotic use associated with maintaining patient satisfaction.

Chart audits from an urgent care clinic in the southwest region of the USA revealed that antibiotics were prescribed for upper respiratory infections (URIs) routinely and without patient instruction on methods to reduce their antibiotic use. Further review, exposed that most urgent care sites do not have an Antibiotic Stewardship Plan (ASP) and little-to-no ASP training for medical staff.

A quantitative quality improvement project was implemented to determine the impact of delayed antibiotic prescribing on antibiotic usage rates for adult patients with URI symptoms at an urgent care clinic in central Arizona over 4 weeks.

Implementing the Centers for Disease Control and Prevention's URI adult treatment guidelines for antibiotic use with follow-up phone calls 10 days post-discharge to evaluate the patient's decision-making.

Antibiotic usage rates decreased by 12% in 30 days, N=927, n

598 in the comparative and n

330 in the implementation group. A Mann-Whitney U test demonstrated a statistically and clinically significant reduction in antibiotic usage rates between groups (

=247, p=0.023).

Success in meeting the goal was a result of team and patient engagement strategies that reduced outpatient antibiotic use while maintaining high levels of patient satisfaction.

Success in meeting the goal was a result of team and patient engagement strategies that reduced outpatient antibiotic use while maintaining high levels of patient satisfaction.

Informed decisions on myopia management require an understanding of financial impact. We describe methodology for estimating lifetime myopia costs, with comparison across management options, using exemplars in Australia and China.

We demonstrate a process for modelling lifetime costs of traditional myopia management (TMM=full, single-vision correction) and active myopia management (AMM) options with clinically meaningful treatment efficacy. PR-957 ic50 Evidence-based, location-specific and ethnicity-specific progression data determined the likelihood of all possible refractive outcomes. Myopia care costs were collected from published sources and key informants. Refractive and ocular health decisions were based on standard clinical protocols that responded to the speed of progression, level of myopia, and associated risks of pathology and vision impairment. We used the progressions, costs, protocols and risks to estimate and compare lifetime cost of myopia under each scenario and tested the effect of 0%, 3% and 5% ann to estimate cost in comparable scenarios.

To determine the associations between visual disability and cognitive decline in Chinese middle-aged and older adults.

A total of 6748 subjects were enrolled into this longitudinal, population-based, nationally representative study from two waves of the China Health and Retirement Longitudinal Study. Lagged dependent variable regression was used to model the independent associations between self-reported visual disability and cognitive function including memory and mental status.

The mean age of the 6748 individuals was 56.33 years, and 3350 (49.6%) were women. The prevalence of visual disability was 3.8%, which increased with age (p<0.001). Both memory and mental status score worsened over time (all p<0.001). After controlling for covariates, lagged dependent variable regression models showed that visual disability at baseline was significantly associated with memory decline after 7 years (β=-0.252, p=0.046). After stratifying by age groups, this association was only significant in the 55-64 age group (β=-0.