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Background Effective communication and respect for women’s autonomy are critical components of person-centered care. Yet, there is limited evidence in low-resource settings on providers’ perceptions of the importance and extent of communication and women’s autonomy during childbirth. Similarly, few studies have assessed the potential barriers to effective communication and maintenance of women’s autonomy during childbirth. We sought to bridge these gaps. Methods Data are from a mixed-methods study in Migori County in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical). Providers were asked structured questions on various aspects of communication and autonomy followed by open ended questions on why certain practices were performed or not. We conducted descriptive analysis of the quantitative data and thematic analysis of the qualitative data. Results Despite acknowledging the importance of various aspects of communication and women’s autonomy, providers reported incidences of poor communication and lack of respect for women’s autonomy: 57% of respondents reported that providers never introduce themselves to women and 38% reported that women are never able to be in the birthing position of their choice. Also, 33% of providers reported that they did not always explain why they are doing exams or procedures and 73% reported that women were not always asked for permission before exams or procedures. The reasons for lack of communication and autonomy fall under three themes with several sub-themes: (1) work environment—perceived lack of time, language barriers, stress and burnout, and facility culture; (2) provider knowledge, intentions, and assumptions—inadequate provider knowledge and skill, forgetfulness and unconscious behaviors, self-protection and comfort, and assumptions about women’s knowledge and expectations; and (3) women’s ability to demand or command effective communication and respect for their autonomy—women’s lack of participation, women’s empowerment and provider bias. Conclusions Most providers recognize the importance of various aspects of communication and women’s autonomy, but they fail to provide it for various reasons. To improve communication and autonomy, we need to address the different factors that negatively affect providers’ interactions with women.

Background: With recent improvements in transducer strength, image resolution, and operator training, ultrasound (US) provides an excellent alternative imaging modality for the diagnosis of rotator cuff tears. Purpose: To evaluate the diagnostic accuracy of US for partial- and full-thickness rotator cuff tears and biceps tendon tears, compare diagnostic values with those of magnetic resonance imaging (MRI) using arthroscopy as the reference standard, assess longitudinal improvements in accuracy, and compare diagnostic values from operators with different training backgrounds. Study Design: Systematic review; Level of evidence, 3. Methods: The PubMed and Cochrane Library databases were systematically searched for full-text journal articles published between January 1, 2010, and April 1, 2020. The inclusion criteria were studies that evaluated the diagnostic accuracy of US for rotator cuff tears or biceps tendon tears utilizing arthroscopy as the reference standard. The exclusion criteria were studies with <10 patients, studies including massive tears without reporting diagnostic data for specific tendons, and studies lacking diagnostic outcome data. Extracted outcomes included diagnostic accuracy, sensitivity, specificity, negative predictive value, and positive predictive value. The mean difference and 95% confidence interval were calculated for both US and MRI diagnostic values, and meta-analysis was conducted using the Mantel-Haenszel random-effects model. Results: In total, 23 eligible studies involving 2054 shoulders were included. US demonstrated a higher median diagnostic accuracy for supraspinatus tendon tears (0.83) and biceps tendon tears (0.93) as compared with subscapularis tendon tears (0.76). US was found to have a higher median accuracy (0.93) for full-thickness supraspinatus tears than partial-thickness tears (0.81). US had superior median sensitivity for partial-thickness supraspinatus tears when performed by radiologists as opposed to surgeons (0.86 vs 0.57). Meta-analysis of the 5 studies comparing US and MRI demonstrated no statistically significant difference in diagnostic sensitivity, specificity, or accuracy for any thickness supraspinatus tears (P = .31-.55), full-thickness tears (P = .63-.97), or partial-thickness tears (P = .13-.81). Conclusion: For experienced operators, US is a highly sensitive and specific diagnostic modality for the diagnosis of supraspinatus tears and demonstrates statistically equivalent capability to MRI in the diagnosis of both full- and partial-thickness rotator cuff tears.

BackgroundBetween 2017 and 2022 our caseload almost doubled, however, our in memoriam donations did not significantly increase. This piqued our curiosity: What was the relationship between the care we provided, and the in memoriam donations we received? This project supports the development of our next strategic plan (2024+). There is surging demand for the support of our Dementia Team, and increasingly, patients who are presenting with frailty and other more complex conditions. We sought to understand how the change in the profile of our caseload could impact on our future in memoriam fundraising. AimsTo understand the correlation between the patients who had been remembered with in memoriam donations and their personal circumstances/support from us. To identify if in memoriam fundraising could be at risk. To align care ambitions and fundraising potential in our next strategy. MethodologyDonation information from our fundraising database was exported. It was traced back to patient records by a specialist research colleague. They overlaid the donation information with a set of pre-determined patient criteria including age, illness, team contact, time on caseload and place of death. We also looked at the time-period loved-ones donated for, after their loss. ResultsWe will use this research to:Deepen the relationship between our clinical teams and fundraisers.Inform our future financial planning, aligning it with anticipated care-need trajectories. Invest hospice resources in areas which are likely to support our financial sustainability.ConclusionsMost in memoriam donations are for people who have died from cancer and stayed on our Inpatient Unit. However, the giving behaviour of loved ones who have lost someone to other illnesses is different, they are giving less, for shorter periods. We must incorporate these insights into our future plans.

This report presents the outcome of the joint work of PhD students and senior researchers working with DNA-based biodiversity assessment approaches with the goal to facilitate others the access to definitions and explanations about novel DNA-based methods. The work was performed during a PhD course (SLU PNS0169) at the Swedish University of Agricultural Sciences (SLU) in Uppsala, Sweden. The course was co-organized by the EU COST research network DNAqua-Net and the SLU Research Schools Focus on Soils and Water (FoSW) and Ecology - basics and applications. DNAqua-Net (COST Action CA15219, 2016-2020) is a network connecting researchers, water managers, politicians and other stakeholders with the aim to develop new genetic tools for bioassessment of aquatic ecosystems in Europe and beyond. The PhD course offered a comprehensive overview of the paradigm shift from traditional morphology-based species identification to novel identification approaches based on molecular markers. We covered the use of molecular tools in both basic research and applied use with a focus on aquatic ecosystem assessment, from species collection to the use of diversity in environmental legislation. The focus of the course was on DNA (meta)barcoding and aquatic organisms. The knowledge gained was shared with the general public by creating Wikipedia pages and through this collaborative Open Access publication, co-authored by all course participants.

Abstract Disrespect and abuse during childbirth are violations of women’s human rights and an indicator of poor-quality care. Disrespect and abuse during childbirth are widespread, yet data on providers’ perspectives on the topic are limited. We examined providers’ perspectives on the frequency and drivers of disrespect and abuse during facility-based childbirth in a rural county in Kenya. We used data from a mixed-methods study in a rural county in Western Kenya with 49 maternity providers (32 clinical and 17 non-clinical) in 2016. Providers were asked structured questions on disrespect and abuse, followed by open-ended questions on why certain behaviours were exhibited (or not). Most providers reported that women were often treated with dignity and respect. However, 53% of providers reported ever observing other providers verbally abuse women and 45% reported doing so themselves. Observation of physical abuse was reported by 37% of providers while 35% reported doing so themselves. Drivers of disrespect and abuse included perceptions of women being difficult, stress and burnout, facility culture and lack of accountability, poor facility infrastructure and lack of medicines and supplies, and provider attitudes. Provider bias, training and women’s empowerment influenced how different women were treated. We conclude that disrespect and abuse are driven by difficult situations in a health system coupled with a facilitating sociocultural environment. Providers resorted to disrespect and abuse as a means of gaining compliance when they were stressed and feeling helpless. Interventions to address disrespect and abuse need to tackle the multiplicity of contributing factors. These should include empowering providers to deal with difficult situations, develop positive coping mechanisms for stress and address their biases. We also need to change the culture in facilities and strengthen the health systems to address the system-level stressors.

When restrictions were enforced in March 2020, Heart of Kent Hospice feared the writing was on the wall – we faced very real risk of closure. Although we had grown our reserves, we had three months to find a solution and fill a projected £800,000 gap in funding generated through the closure of shops and cancelled fundraising events. We aimed to:Be transparent about the challenges we were facing with colleagues.Be honest about the scale of the challenge with our supporters.Retain donor relationships and recruit additional support.Look after the emotional wellbeing of our colleagues as they transitioned to home working.Fill the financial gap that had been created to secure the future of the hospice.Clear guidance was provided on the potential scale of the challenge to the fundraising and communications team and we re-forecast organisational expenditure assuming reaching a worst case scenario and meeting the needs of an increasing caseload of patients.The fundraising and communications team were trusted to be creative and:Respond to the eagerness of the local community to want to help us.Try new ideas for income generation – we had nothing to lose!Seek alternative ways to engage with our local community who were experiencing sudden loss; we launched a schools bereavement project and guidance for companies.Look after each other.Our urgent fundraising appeal raised £1.2 million including a grant of £500,000 to support our recovery post pandemic. Our worst and best case fundraising targets were exceeded.As a consequence, we have invested in fundraising resource this year to encourage donors to continue supporting us during the rest of the pandemic and into recovery. Heart of Kent Hospice did not furlough any of the fundraising and communications team; instead, we used agility and creativity to survive and strengthen our potential to recover fundraising.

the use of a structured approach by HF specialist nurse using prompt of an ABCDEF mnemonic to guide management of multimorbidity in HFpEF clinics and compare this with standard care (without prompt by a mnemonic).MethodsThis was a retrospective analysis of a prospective cohort study of 75 patients with recent decompensated HFpEF within 30 days,ResultsThe mean age was comparable between the 2 cohorts. There was also no significant difference in terms of co-morbidities. 30-day all-cause re-admissions showed a trend towards being lower in the mnemonic cohortUse of a structured mnemonic approach to manage multimorbidity appears to be an easy intervention to apply in HFpEF clinics.Conflict of InterestNone

Background/IntroductionAcute decompensated heart failure (ADHF) leads to hospitalisations, frequent re-hospitalisations and mortality. The safety and efficacy of telehealth-guided outpatient ADHF management (virtual ward-VW) as an alternative to hospitalisation has not been assessed previously.AimThe aim of this study was to assess the safety and outcomes of our acute heart failure virtual ward (HFVW) pathway (figure 1) when compared to hospitalised ADHF patients.MethodsThis cohort study (May 2022-October 2023) assessed the outcomes of telehealth-guided outpatient ADHF management using bolus intravenous furosemide in a HF-specialist VW. We compared baseline patient characteristics, NTproBNP, ejection fraction, NYHA Class, clinical risk score (Get With the Guidelines-Heart Failure-GWTG-HF), comorbidities (Charlson Co-morbidity Index-CCI), frailty (Rockwood Clinical Frailty Score-CFS), HF therapies and measured clinical outcomes at 1, 3, 6 and 12 months (re-hospitalisations, mortality) in the HFVW cohort versus standard care (ADHF patients managed without telehealth in 2021).Results554 HFVW ADHF patients (age 73.1±10.9 years; 46% female) were compared with 402 ADHF patients (74.2±11.8; p=0.15 and 49% female) in the standard care cohort (SC). Despite similar baseline patient characteristics, GWTG-HF score, CCI and CFS, re-hospitalisations were significantly lower in the HFVW compared to standard care (1 month - 11.6% vs. 21%, p=0.002; 3 months - 20.4% vs. 30%, p=0.001; 6 months -29.3% vs 41%, p=0.02 and 12 months-48% vs. 57%,p=0.03) whereas mortality was lower at 1 month (6% vs. 14%; p<0.001), 3 months (10.5% vs. 15%; p=0.02) and 6 months (15.5% vs. 21%; p=0.04) (figure 2). Multivariate logistic regression analysis showed that an increased daily step count whilst on HFVW independently predicted reduced odds of re-hospitalisations at 1 month (OR 0.85; 95% CI 0.7–0.9; p=0.005), 3 months [OR 0.95 (0.93–0.98); p=0.003] and 1 month mortality [OR 0.85 (0.7–0.95), p=0.01]. Whereas CCI predicted adverse 12-month outcomes [OR 1.2 (1.1–1.4), p=0.03]. Higher GWTG-HF score independently predicted increased odds of re-hospitalisation [1-month OR 1.2 (1.1–1.3), p=0.01; 12-month OR 1.1, 1.05–1.2, p=0.03) as well as mortality [1-month OR 1.2 (1.1–1.4), p=0.01; 12-month OR 1.3 (1.1–1.7), p=0.02]. Similarly higher CFS also independently predicted increased odds of re-hospitalisations [1-month OR 1.5 (1.1–2.2), p=0.03; 12-month OR 1.9 (1.2–3, p=0.01] and mortality [1-month OR 2 (1.1–3.5), p=0.02; 12-month OR 2.6 (1.6–10); p=0.02] throughout the follow-up period.ConclusionsA telehealth-guided specialist HFVW management strategy for ADHF may offer a safe and efficacious alternative to hospitalisation in suitable patients. Daily step count, GWTG, CCI and CFS can play a vital role in assessing suitability for VW and in predicting risk of adverse clinical outcomes.Abstract 139 Figure 1This graph outlines the observed re-hospitalisation rates in the two cohorts (SC - Standard care and HFVW - Heart Failure Virtual Ward) at 1, 3, 6 and 12 months follow up. Significance is shown with p-values and an asterisk (*) where appropriateAbstract 139 Figure 2This graph outlines the observed mortality rates in the two cohorts (SC - Standard care and HFVW - Heart Failure Virtual Ward) at 1, 3, 6 and 12 months follow up. Significance is shown with p-values and an asterisk (*) where appropriateConflict of InterestNone

Advances in arthroscopic methods have provided significant improvements in visualization, characterization, and repair techniques of rotator cuff tears. However, the treatment of massive, retracted tears continues to pre sent a challenge. Although the most common individual tear pattern reportedly is of the crescent-shaped variety, most tears possess at least one mobile limb and require a side-to-side reduction due to the very narrow lateral width of the supraspinatus insertion, shown to be only 1.3 mm. 1 The infraspinatus tendon has been shown to insert anteriorly on the greater tuberosity as it blends with the supraspinatus footprint (Figure 6-1). Thus, tears with an exposed lateral footprint greater than 1.3 mm will usually require some mobilization to allow excursion infraspinatus tissue anteriorly or coracohumeral ligament tissue posteriorly. Crescent tears (Figure 6-2) that are repaired directly laterally with double-row constructs are usually malreduced and will predictably undergo excessive tension at the bone tendon junction (Figure 6-3). Massive cuff tears, which have a reported prevalence of nearly 40%, would be logically expected to pre sent a mobile limb, either anteriorly or posteriorly, in essentially all cases. 1 Tension is the bane of rotator cuff repair, 2 and it is the senior author's contention that in an effort to obtain a double-row construct, the art of tear reduction has been lost.

Rotator cuff tears are debilitating injuries that affect patients' ability to perform activities of daily living in a pain-free environment. Historically, these injuries were repaired with open approaches that resulted in generally satisfactory outcomes; however, with advances in digital optical technology, arthroscopic rotator cuff repair has gained significant popularity and prominence over the traditional methods of open and mini-open cuff repair.