IntroductionThe aftermath of stroke leaves many consequences including cognitive deficits and falls due to imbalance. Stroke survivors and families struggle to navigate the complex healthcare system with little assistance posthospital discharge, often leading to early hospital readmission and worse stroke outcomes. Telemedicine Guided Education on Secondary Stroke and Fall Prevention Following Inpatient Rehabilitation feasibility study examines whether stroke survivors and their caregivers find value in telerehabilitation (TR) home visits that provide individualised care and education by a multidisciplinary team after discharge from inpatient rehabilitation.Methods and analysisA prospective, single arm, pilot study is designed to evaluate the feasibility of weekly TR home visits initiated postdischarge from inpatient rehabilitation. Newly diagnosed patients with stroke are recruited from a Houston-based comprehensive stroke centre inpatient rehabilitation unit, loaned an iPad with data plan and trained to use information technology security-approved videoconferencing application. After hospital discharge, six weekly TR home visits are led by rotating specialists (pharmacist, physical/occupational therapist, speech therapist, rehabilitation physician, social worker, geriatrician specialised in fracture prevention) followed by satisfaction survey on week 7. Specialists visually assess patients in real time, educate them on secondary stroke and fall prevention and suggest ways to improve function including direct medical interventions when indicated. Primary outcomes are proportion of eligible patients consenting to the study, participation rate in all six TR home visits and satisfaction score. The study started 31 December 2015 with plan to enrol up to 50 patients over 24 months. Feasibility study results will inform us as to whether a randomised controlled trial is warranted to determine efficacy of TR home visit intervention in improving stroke outcomes.Ethics and disseminationEthics approval obtained by the Institutional Review Board (IRB), Committee for the Protection of Human Subjects, IRB number: HSC-MS-14–0994. Study results will be submitted for publication in a peer-reviewed journal.

SESSION TITLE: Imaging SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Pericardial effusion affects as many as 19% of patients with end-stage renal disease (ESRD)1-6 but the pathophysiology is poorly understood. Incidence declines with more efficient dialysis prescription but it’s unclear whether this is due to metabolite correction or optimization of volume status and hemodynamics7,8. Pericardial effusion has been also associated with pulmonary arterial hypertension (PAH)9-10; Mellins et al.11 indicated the elevated right sided pressures may be a necessary condition for the development and maintenance of pericardial effusion. Yoshida and colleagues demonstrated a more profound predisposition for pericardial effusion in patients with central overhydration than with residual metabolic derangements after dialysis, suggesting that volume status and right heart afterload may be the chief contributors to pericardial effusion in dialysis patients12. The influence of pulmonary hypertension in the origin, persistence and severity of pericardial effusion in ESRD patients has not been addressed in the scientific literature. We aim to assess whether elevated pulmonary arterial pressures measured by non-invasive means predicts the presence and persistence of pericardial effusions in our population of ESRD patients. METHODS: Data was retrospectively collected on 129 patients with ESRD on scheduled hemodialysis (SHD) or emergent dialysis (EHD) who had at minimum of two fully descriptive multiple echocardiograms performed in our institution’s county hospital between January 2010 and February 2016. Reported right ventricular systolic pressure (RVSP) and presence and severity of pericardial effusion were noted for the serial echocardiograms and analyses were performed to identify a temporal relationship. We performed our analysis with SPSS 23 software. RESULTS: RVSP > 30 mmHg was poorly associated with presence of pericardial effusion in the same echocardiogram (39.2%, 95% CI 36.6-41.6%). In addition, patients with persistent pericardial effusion were not more likely to have elevated RVSP trends than patients who never developed effusion in our study (95% CI 44% ± 7 vs 55% ± 7, respectively). Conversely, low RVSP trends were not significantly more associated with patients who never developed effusion than patients who had persistent effusion (95% CI 61% ± 11 vs 39% ± 11, respectively). A patient’s first documented pericardial effusion was only accompanied by rise in RVSP 57.7% of the time (95% CI 38.7-76.7%). CONCLUSIONS: A single RVSP measurement poorly predicts coexisting effusion. Persistently low RVSP was a poor predictor of absence of effusion. Persistently high RVSP did not explain incidence or persistence of effusion in our ESRD population, suggesting metabolic phenomena may have a more important role. CLINICAL IMPLICATIONS: Our results do not support that non-invasive RVSP monitoring is a good predictor of incidence and peristence of pericardial effusion. Further investigation of metabolic phenomena in the causation of pericardial effusion is warranted. DISCLOSURE: The following authors have nothing to disclose: Cameron McBride, Ignacio De Cicco, Vincent Gacad, Patrick Yu, Fiorella Llanos Chea, Ruby Benjamin-Garner, Gabriel Aisenberg No Product/Research Disclosure Information

INTRODUCTION Despite the known harmful effects of smoking during pregnancy, the highly addicted find it difficult to quit. Decreased smoking may be regarded as a means of harm reduction. There is limited information on the benefits of smoking reduction short of quitting. This study used salivary cotinine to assess the impact of change in smoking exposure on birth weight in full-term infants. METHODS In a prenatal smoking cessation study, smoking status was validated by saliva cotinine at baseline and end of pregnancy (EOP). Salivary cotinine ≥15 ng/ml defined active smoking. Based on salivary cotinine, women were grouped as nonsmoking/quit, light exposure (<150 ng/ml), and heavy exposure (≥150 ng/ml) at baseline and EOP. EOP and baseline smoking status were stratified to form smoking exposure change groups. Mean birth weight was compared among those who quit, reduced, maintained, and increased. RESULTS Smoking cessation was associated with a 299 g increase in birth weight compared with sustained heavy smoking, p = .021. Reduced exposure from heavy to light was associated with a 199 g increase in birth weight compared with sustained heavy exposure, a 103 g increase compared with increased exposure, and a 63 g increase compared with sustained light exposure. Differences among continuing smokers were not statistically significant. CONCLUSIONS Although not statistically significant, the increase in infant birth weight associated with reduction from heavy to light exposure suggests potential for benefit. The only statistically significant comparison was between quitters and sustained heavy smokers, confirming that smoking cessation should remain the goal for pregnant women.

Introduction: Cigarette smoking during pregnancy is associated with poor maternal and child health outcomes. Effective interventions to increase smoking cessation rates are needed particularly for pregnant women unable to quit in their first trimester. Real-time ultrasound feedback focused on potential effects of smoking on the fetus may be an effective treatment adjunct, improving smoking outcomes.Methods: A prospective randomized trial was conducted to evaluate the efficacy of a smoking cessation intervention consisting of personalized feedback during ultrasound plus motivational interviewing-based counseling sessions. Pregnant smokers (N - 360) between 16 and 26 weeks of gestation were randomly assigned to one of three groups: Best Practice (BP) only, Best Practice plus ultrasound feedback (BP+US), or Motivational Interviewing-based counseling plus ultrasound feedback (MI+US). Assessments were conducted at baseline and end of pregnancy (EOP).Results: Analyses of cotinine-verified self-reported smoking status at EOP indicated that 10.8% of the BP group was not smoking at EOP; 14.2% in the BP+US condition and 18.3% who received MI+US were abstinent, but differences were not statistically significant. Intervention effects were found conditional upon level of baseline smoking, however. Nearly 34% of light smokers (<= 10 cigarettes/day) in the MI+US condition were abstinent at EOP, followed by 25.8% and 15.6% in the BP+US and BP conditions, respectively. Heavy smokers (>10 cigarettes/day) were notably unaffected by the intervention.Discussion: Future research should confirm benefit of motivational interviewing plus ultrasound feedback for pregnant light smokers and explore mechanisms of action. Innovative interventions for pregnant women smoking at high levels are sorely needed.

OBJECTIVE:Baseline data from the Heart Attack REACT Study provided the opportunity to explore population subgroup differences in exposure to health information in an ethnically diverse sample from 5 regions across the United States.METHODS:During the 4-month baseline period of the REACT study, some 1,200 residents from the 20 study communities were surveyed using random digit dial telephone methods. Respondents were asked to recall health messages seen and/or heard recently, and the sources of these messages. Comparisons were made between sociodemographic subgroups defined by age, sex, race/ethnicity, education, income, work status, and geographic location.RESULTS:Except for education level differences, the amount of exposure to health information did not vary significantly by sociodemographics; however, significant variation among subgroups in the types of messages cited and the sources of these messages was observed. Minority and low-income groups were found to have less exposure to chronic disease prevention information, eg, on nutrition, exercise, and heart disease. Additionally, the sources of health information most popular among sociodemographic subgroups appeared to be a determining factor in the types of messages received.CONCLUSIONS:The results of these analyses support previous findings, adding to the sparse body of information on the best channels for reaching under-served populations.

The potential for reducing cardiovascular disease mortality rates lies both in prevention and treatment. The earlier treatment is administered, the greater the benefit. Thus, duration of time from onset of symptoms of acute myocardial infarction to administration of treatment is important. One major factor contributing to failure to receive efficacious therapy is the delay time from acute myocardial infarction (AMI) symptom onset to hospital arrival. This paper examines the relationship of several factors with regard to intentions to seek care promptly for symptoms of AMI. A random-digit dialed telephone survey (n=1294) was conducted in 20 communities located in 10 states. People who said they would wait until they were very sure that symptoms were a heart attack were older, reported their insurance did not pay for ambulance services, and reported less confidence in knowing signs and symptoms in themselves. When acknowledging symptoms of a heart attack, African-Americans and people with more than a high school education reported intention to act quickly. No measures of personal health history, nor interaction with primary care physicians or cardiologists were significantly related to intention to act fast. The study confirms the importance of attribution and perceived self-confidence in symptom recognition in care seeking. The lack of significant role of health history (i.e. those with chronic conditions or risk factors) and clinician contact highlights missed opportunities for health care providers to educate and encourage patients about their risk and appropriate action.

BACKGROUND Patient delay in seeking health care for heart attack symptoms is a continuuing problem in the United States. METHODS Investigators conducted focus groups (N = 34; 207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative evaluation to develop a multi-center randomized community trial (the REACT Project). Target groups included adults with previous heart attacks, those at higher risk for heart attack, and bystanders to heart attacks. There were also subgroups reflecting gender and ethnicity (African-American, Hispanic-American, White). FINDINGS Patients, bystanders, and those at higher risk expected heart attack symptoms to present as often portrayed in the movies, that is, as sharp, crushing chest pain rather than the more common onset of initially ambiguous but gradually increasing discomfort. Patients and those at higher risk also unrealistically judge their personal risk as low, understand little about the benefits of rapid action, are generally unaware of the benefits of using EMS/9-1-1 over alternative transport, and appear to need the "permission" of health care providers or family to act. Moreover, participants reported rarely discussing heart attack symptoms and appropriate responses in advance with health care providers, spouses, or family members. Women often described heart attack as a "male problem," an important aspect of their underestimation of personal risk. African-American participants were more likely to describe negative feelings about EMS/9-1-1, particularly whether they would be transported to their hospital of choice. CONCLUSIONS Interventions to reduce patient delay need to address expectations about heart attack symptoms, educate about benefits and appropriate actions, and provide legitimacy for taking specific health care-seeking actions. In addition, strategy development must emphasize the role of health care providers in legitimizing the need and importance of taking rapid action in the first place.