Objectives Highlight the identified palliative care needs of the elderly. Explore the current use of the hospital palliative care team in the care of geriatric patient.

Background: There is little information about providing pediatric palliative care (PPC) in non-metropolitan areas. Objective: Describe the strengths of and challenges to delivering PPC in non-metropolitan communities and identify opportunities to improve care delivery. Design: A qualitative study involving focus groups (FGs) with PPC stakeholders. Setting/Participants: From 4 non-metropolitan areas in Illinois, we recruited 3 stakeholder groups: healthcare providers (HPs); bereaved parents; and parents caring for a seriously ill child (SIC). Measurements: At each site, we held an FG with people of the same stakeholder group and then an FG involving all stakeholders. Discussion topics included: availability and strengths of local PPC services, barriers to local PPC, opportunities for improving local PPC access and quality, and clinician educational needs. We analyzed data using phenomenology and directed content analysis. Results: Thirty people, 12 parents and 18 HPs, participated in FGs. Identified themes related to: PPC perceptions; availability and use of local resources; and challenges associated with travel, care coordination, and finances. Participants described benefits of and limits to local PPC including pediatric-specific issues such as attending to siblings, creating child peer-support activities, providing school guidance, and financing for PPC. Recommendations included suggestions to enhance care coordination, use existing resources, improve community and provider education, develop community networks, and minimize financial challenges. Conclusion: Unique PPC challenges exist in non-metropolitan areas. PPC in non-metropolitan areas would benefit from enhancing local resource utilization and quality. Future work should address the challenges to providing PPC in non-metropolitan areas with a focus on pediatric-specific issues.

BACKGROUND Glioblastoma (GBM) is the most common primary malignant brain tumor and carries a very poor prognosis. Recent data report a negative association between the incidence of GBM and atopic disease. The underlying immunologic mechanisms of protection and the associated potential biomarkers are unclear. The aim of this retrospective study is to assess the relationship of eosinophil count to GBM risk by collecting eosinophil count in GBM patients with and without existing atopic disease. METHODS This is a retrospective study of 790 patients diagnosed with GBM from 2009–2019. Of those patients, 140 had laboratory values at least one year prior to diagnosis. Chart review was used to exclude patients with lymphoma, leukemia, other cancers, myelodysplastic syndromes, and unconfirmed drug, food, and adhesive reactions. 14 patients with chart-confirmed allergic rhinitis, asthma, or eczema and 47 controls were found. Wilcoxon rank sum test was used to compare the two groups. RESULTS The two groups did not differ in pre-diagnostic eosinophil counts (p=0.426). The two groups also did not differ in pre-diagnostic basophil, lymphocyte, neutrophil, or monocyte counts. Pre-diagnostic eosinophil to lymphocyte, monocyte to lymphocyte, and neutrophil to lymphocyte ratios also did not differ between the two groups. There were no other quantitative differences that would suggest a difference in immune cell profile. CONCLUSIONS In our study, the subset of GBM patients with atopic disease did not significantly differ in eosinophil count or other white blood cell subtypes when compared to GBM patients without atopic disease. Given that atopic disease is a known protective factor, and our atopic patients with GBM had normal eosinophil counts, we conclude that underlying immunologic factors such as eosinophilia may be protective from GBM as opposed to simply the presence of atopic disease. Prospective analysis to best understand eosinophil count as a surrogate for GBM risk is warranted.

ObjectivesDescribe how domains of palliative care can be integrated into the care of high-risk infants in the Neonatal Intensive Care Unit (NICU). Delineate the effects of an integrated palliative and neonatal interdisciplinary conference on staff moral distress and neonatal providers' perceptions towards palliative care. Original Research Background. Despite national recommendations to incorporate palliative care (PC) into the Neonatal Intensive Care Unit (NICU), providers' (MD and APN) perceptions may prevent optimal PC delivery in this setting, leading to moral distress in staff.Research Objectives. Objectives were to investigate the efficacy of a weekly case-conference to improve moral distress and perceptions of PC in the NICU and to increase consultation rate to specialty PC for newborns at high risk for mortality and/or morbidity.Methods. An interdisciplinary PC/NICU case-conference served as a platform for educating providers on incorporating palliative care domains into the care of high-risk NICU infants. NICU providers' PC perceptions were measured at baseline and after 12 months of implementation (follow-up) using a published survey. Providers and multidisciplinary NICU staff completed the Moral Distress Scale-Revised at baseline and follow-up. NICU consultation rate to PC at follow-up was compared to baseline. Results. Surveys were completed by 57 MDs/APNs and 176 NICU staff, mostly RNs. Compared to baseline, providers were significantly more likely to endorse that they provide families with PC options (84% v. 95%; p<.03); are comfortable with PC (84% v. 97%; p¼.03); are satisfied with EOL care (65% v 79%; p<.02); have time to provide PC (42% v 72%; p<.02); and perceive parents are involved in PC decisions (81% v. 95%; p<.01). Additionally, moral distress among NICU staff was significantly reduced (p¼.005) and the number of PC consultations increased by 56%. Conclusion. Moral distress, provider perceptions of PC, and PC consultation rate can be improved by a weekly case-based interdisciplinary conference that includes PC and NICU stakeholders.