Emergency psychiatric care, unplanned hospital admissions, and inpatient health care are the costliest forms of mental health care. According to Statistics Canada (2018), almost 18% (5.3 million) of Canadians reported needing mental health support. However, just above half of this figure (56.2%) have reported their needs were fully met. To further expand capacity and access to mental health care in the province, Nova Scotia Health has launched a novel mental health initiative, the Rapid Access, and Stabilization Program (RASP).

This study evaluates the effectiveness and impact of the RASP on high-cost health services utilization (e.g. ED visits, mobile crisis visits, and inpatient treatments) and related costs. It also assesses healthcare partners’ (e.g. healthcare providers, policymakers, community leaders) perceptions and patient experiences and satisfaction with the program and identifies sociodemographic characteristics, psychological conditions, recovery, well-being, and risk measures in the assisted population.

This is a hypothesis-driven program evaluation study that employs a mixed methods approach. A within-subject comparison will examine health services utilization data from patients attending RASP, one year before and one year after their psychiatry assessment at the program. A controlled between-subject comparison will use historical data from a control population will examine whether possible changes in high-cost health services utilization are associated with the intervention (RASP). The primary analysis involves extracting secondary data from provincial information systems, electronic medical records, and regular self-reported clinical assessments. Additionally, a qualitative sub-study will examine patient experience and satisfaction, and examine health care partners’ impressions.

The results for the primary, secondary, and qualitative outcome measures to be available within 6 months of study completion. We expect that RASP evaluation findings will demonstrate a minimum 10% reduction in high-cost health services utilization and corresponding 10% cost savings, and also a reduction in the wait times for patient consultations with psychiatrists to less than 30 calendar days. In addition, we anticipate that patients, healthcare providers, and healthcare partners would express high levels of satisfaction with the new service.

This study will demonstrate the results of the Mental Health and Addictions Program (MHAP) efforts to provide stepped-care, particularly community-based support, to individuals with mental illnesses. Results will provide new insights into a novel community-based approach to mental health service delivery and contribute to knowledge on how to implement mental health programs across varying contexts.

None Declared

Poor mental health of university students is a growing concern for public health. Indeed, academic settings may exacerbate students’ vulnerability to mental health issues. Nonetheless, university students are often unable to seek mental health support due to barriers, at both individual and organisational level. Digital technologies are proved to be effective in collecting health-related information and in managing psychological distress, representing useful instruments to tackle mental health needs, especially considering their accessibility and cost-effectiveness.

Although digital tools are recognised to be useful for mental health support, university students’ opinions and experiences related to such interventions are still to be explored. In this qualitative research, we aimed to address this gap in the scientific literature.

Data were drawn from “the CAMPUS study”, which longitudinally assesses students’ mental health at the University of Milano-Bicocca (Italy) and the University of Surrey (United Kingdom). We performed detailed interviews and analysed the main themes of the transcripts. We also performed a cross-cultural comparison between Italy and the United Kingdom.

Across 33 interviews, five themes were identified, and an explanatory model was developed. From the students’ perspective, social media, podcasts, and apps could be sources of significant mental health content. On the one hand, students recognised wide availability and anonymity as advantages that make digital technologies suitable for primary to tertiary prevention, to reduce mental health stigma, and as an extension of face-to-face interventions. On the other hand, perceived disadvantages were lower efficacy compared to in-person approaches, lack of personalisation, and difficulties in engagement. Students’ opinions and perspectives could be widely influenced by cultural and individual background.

Digital tools may be an effective option to address mental health needs of university students. Since face-to-face contact remains essential, digital interventions should be integrated with in-person ones, in order to offer a multi-modal approach to mental well-being.

None Declared

Hard-to-treat childhood cancers are those where standard treatment options do not exist and the prognosis is poor. Healthcare professionals (HCPs) are responsible for communicating with families about prognosis and complex experimental treatments. We aimed to identify HCPs’ key challenges and skills required when communicating with families about hard-to-treat cancers and their perceptions of communication-related training.

We interviewed Australian HCPs who had direct responsibilities in managing children/adolescents with hard-to-treat cancer within the past 24 months. Interviews were analyzed using qualitative content analysis.

We interviewed 10 oncologists, 7 nurses, and 3 social workers. HCPs identified several challenges for communication with families including: balancing information provision while maintaining realistic hope; managing their own uncertainty; and nurses and social workers being underutilized during conversations with families, despite widespread preferences for multidisciplinary teamwork. HCPs perceived that making themselves available to families, empowering them to ask questions, and repeating information helped to establish and maintain trusting relationships with families. Half the HCPs reported receiving no formal training for communicating prognosis and treatment options with families of children with hard-to-treat cancers. Nurses, social workers, and less experienced oncologists supported the development of communication training resources, more so than more experienced oncologists.

Resources are needed which support HCPs to communicate with families of children with hard-to-treat cancers. Such resources may be particularly beneficial for junior oncologists and other HCPs during their training, and they should aim to prepare them for common challenges and foster greater multidisciplinary collaboration.

Various water-based heater-cooler devices (HCDs) have been implicated in nontuberculous mycobacteria outbreaks. Ongoing rigorous surveillance for healthcare-associated M. abscessus (HA-Mab) put in place following a prior institutional outbreak of M. abscessus alerted investigators to a cluster of 3 extrapulmonary M. abscessus infections among patients who had undergone cardiothoracic surgery.

Investigators convened a multidisciplinary team and launched a comprehensive investigation to identify potential sources of M. abscessus in the healthcare setting. Adherence to tap water avoidance protocols during patient care and HCD cleaning, disinfection, and maintenance practices were reviewed. Relevant environmental samples were obtained. Patient and environmental M. abscessus isolates were compared using multilocus-sequence typing and pulsed-field gel electrophoresis. Smoke testing was performed to evaluate the potential for aerosol generation and dispersion during HCD use. The entire HCD fleet was replaced to mitigate continued transmission.

Clinical presentations of case patients and epidemiologic data supported intraoperative acquisition. M. abscessus was isolated from HCDs used on patients and molecular comparison with patient isolates demonstrated clonality. Smoke testing simulated aerosolization of M. abscessus from HCDs during device operation. Because the HCD fleet was replaced, no additional extrapulmonary HA-Mab infections due to the unique clone identified in this cluster have been detected.

Despite adhering to HCD cleaning and disinfection strategies beyond manufacturer instructions for use, HCDs became colonized with and ultimately transmitted M. abscessus to 3 patients. Design modifications to better contain aerosols or filter exhaust during device operation are needed to prevent NTM transmission events from water-based HCDs.

Recent studies have sought to understand the epidemiology and impact of beta-lactam allergy labels on children; however, most of these studies have focused on penicillin allergy labels. Fewer studies assess cephalosporin antibiotic allergy labels in children. The objective of this study was to determine the prevalence, factors associated with, and impact of cephalosporin allergy labels in children cared for in the primary care setting.

Cephalosporin allergy labels were reviewed among children in a dual center, retrospective, birth cohort who were born between 2010 and 2020 and followed in 90 pediatric primary care practices. Antibiotic prescriptions for acute otitis media were compared in children with and without cephalosporin allergies.

334,465 children comprised the birth cohort and 2,877 (0.9%) were labeled as cephalosporin allergic during the study period at a median age of 1.6 years. Third-generation cephalosporins were the most common class of cephalosporin allergy (83.0%). Cephalosporin allergy labels were more common in children with penicillin allergy labels than those without (5.8% vs. 0.6%). Other factors associated with a cephalosporin allergy label included white race, private insurance, presence of a chronic condition, and increased health care utilization. Children with third-generation cephalosporin allergy labels received more amoxicillin/clavulanate (28.8% vs. 10.2%) and macrolides (10.4% vs. 1.9%) and less amoxicillin (55.8% vs. 70.9%) for treatment of acute otitis media than non-allergic peers p < 0.001.

One in 100 children is labeled as cephalosporin allergic, and these children receive different antibiotics for the treatment of acute otitis media compared to non-allergic peers.

The worldwide spread of the COVID-19 pandemic affected all major sectors, including higher education. The measures to contain this deadly disease led to the closure of universities across the globe, introducing several changes in students’ academic and social experience. During the last two years, self-isolation together with the difficulties linked to online teaching and learning, have amplified psychological burden and mental health vulnerability of students.

We aimed to explore in depth students’ feelings and perspectives regarding the impact of the COVID-19 on their mental health and to compare these data among students from Italy and the UK.

Data were resulting from the qualitative arm of “the CAMPUS study”, a large ongoing project to longitudinally assess the mental health of university students enrolled at the University of Milano-Bicocca (Unimib, Italy) and the University of Surrey (UoS, Guildford, UK). We conducted in-depth interviews through the Microsoft Teams online platform between September 2021 and April 2022, and thematically analysed the transcripts.

A total of 33 students (15 for Unimib and 18 for UoS), with a wide range of sociodemographic characteristics, were interviewed. Four themes were identified: i) impact of COVID-19 on students’ mental health; ii) causes of poor mental health; iii) most vulnerable subgroups; vi) coping strategies.

Anxiety symptoms, social anxiety, and stress were frequently reported as negative effects of the pandemic, while the main sources of poor mental health were identified in loneliness, exceeding time online, unhealthy management of space and time, bad organization/communication with university, low motivation and uncertainty about the future. Freshers, international or off-campus students, as well as both extremely extroverted and introverted subjects, represented the most vulnerable populations, because of their extensive exposure to loneliness. Among coping strategies, the opportunity to take time for yourself, family support, and mental health support were common in the sample.

Some differences were found comparing students from Italy and the UK. While at Unimib the impact of COVID-19 on mental health was mainly described in relation to academic worries and the inadequate organization of the university system, UoS students, familiar to the conviviality of campus life, explained these effects as a result of the drastic loss of social connectedness.

The current study highlights the key role of mental health support for university students, mainly during crisis times, and calls for measures to improve communication between students and the educational institution, as well as to encourage social connectedness.

None Declared

To describe the effect of a microbiology comment nudge on antibiotic use for asymptomatic bacteriuria (ASB).

Single-center, before-and-after, quasi-experimental study.

Community-based, public, not-for-profit teaching hospital in the southeastern United States.

Adult inpatients with a positive urine culture and the absence of urinary tract infection signs and symptoms.

Implementation of a microbiology comment nudge on urine cultures.

In total, 204 patients were included in the study. Antibiotics were less likely to be continued beyond 72 hours in the postimplementation group: 57 (55%) of 104 versus 38 (38%) of 100 (P = .016). They were less likely to have antibiotics continued beyond 48 hours: 60 (58%) of 104 versus 43 (43%) of 100 (P = .036). They were also less likely to have antibiotics prescribed at discharge 35 (34%) of 104 versus 20 (20%) of 100 (P = .028). In addition, they had fewer total antibiotic days of therapy: 4 (IQR, 1–6) versus 1 (IQR, 0–6) (P = .022).

Microbiology comment nudging may contribute to less antibiotic utilization in patients with ASB.