Background
Advance care planning (ACP) is low among Latinx older adults. We used community‐based participatory research (CBPR) to identify ACP barriers/facilitators and design community‐based ACP events.
Methods
In partnership with community‐based organizations, clinicians, and local government, we formed a Latinx Community Committee (n = 13 community members). We then conducted 6 focus groups with Latinx‐identifying, English or Spanish‐speaking older adults (age ≥ 55), caregivers, and community leaders to assess ACP barriers/facilitators. We analyzed transcripts using thematic analysis and, based on these learnings, designed and implemented community‐based ACP events. Using a validated survey, we assessed acceptability and pre‐to‐post‐event ACP readiness (4‐point scale; 4 = most ready; 0.2 change considered meaningful) with Wilcoxon signed‐rank tests.
Results
Focus groups included 10 Spanish‐speaking older adults, 8 caregivers, and 10 community leaders. Themes highlighted the importance of ACP (e.g., means of advocacy), barriers (e.g., how to start conversations), and facilitators (e.g., trusted community spaces) in the Latinx community. Ninety‐seven people attended 5 events targeting 3 Latinx populations (LGBTQI+, intergenerational, and older adults broadly). Overall pre‐to‐post‐event ACP readiness increased (2.62 (SD 0.97) to 2.95 (SD 0.93); p = 0.05). Readiness to document wishes increased significantly (2.44 (SD 1.0) to 2.98 (SD 0.95); p = 0.003). Most reported being comfortable attending events (85%) and would recommend them to others (90%).
Conclusions
This study describes a feasible, acceptable, and effective CBPR ACP intervention. Co‐developed community events represent a promising approach to reducing disparities in ACP among the Latinx population.
Epstein-Barr virus is a known cause of dacryoadenitis that is typically sensitive to corticosteroid treatment. When affecting the orbit, particularly the lacrimal gland, Epstein-Barr virus may cause chronic proptosis and a bilateral lacrimal mass effect. We provide a case of bilateral Epstein-Barr virus associated dacryoadenitis initially resistant to corticosteroid treatment requiring biopsy and confirmation by polymerase chain reaction of lacrimal tissue. Herein, we discuss the presentation with associated magnetic resonance imaging and histopathologic images, diagnostic dilemma, and treatment of an atypical case.
IMPORTANCEMany patients seen for eye-related issues in the emergency department do not receive recommended follow-up care. Prior evidence supports that scheduling appointments is a barrier to accomplishing the transition to outpatient ophthalmology care.OBJECTIVE To evaluate time until appointment scheduling following emergency department discharge with urgent outpatient ophthalmology referral.
DESIGN, SETTING, AND PARTICIPANTSThe A3 problem solving process was implemented by a multidisciplinary team as part of a structured quality improvement program with the goal of reducing the mean time between urgent referral placement in the emergency department and outpatient ophthalmology appointment scheduling. The study was conducted at Stanford Health Care, an academic medical center in Palo Alto, California, affiliated with
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