Additional Appointments Research Articles

An evaluation of the long-term wear of a distal extension-removable partial denture on abutment teeth that have undergone periodontal therapy

Although the evidence is clear on the long-term effects of removable partial dentures (RPDs) on the periodontal health of abutment and non-abutment teeth, little work has been done on the periodontal outcomes of the remaining teeth previously treated with periodontal therapy. The aim of this study was to evaluate the effect of denture loading on teeth previously exposed to periodontal treatment with additional photo-disinfection. Twelve partially edentulous patients classified as having mandibular Kennedy Class I arches were included. In each quadrant of the mandibular arch, the terminal abutment was diagnosed to have untreated chronic periodontitis. Initially, all the affected abutments received a conservative periodontal treatment in form of scaling and conventional root debridement. Patients were randomly received additional treatment with photodynamic therapy in one of the mandibular quadrants (test group). After the periodontal treatment, a 4-week load-free period was planned. Mandibular distal extension RPDs was fabricated to restore the missing teeth. The clinical periodontal parameters including plaque index (PI), gingival index (GI), gingival recession (GR), probing pocket depth (PD), clinical attachment level (CAL) and tooth mobility (TM) were assessed at baseline, and then for two additional 6-month recall appointments over a period of twelve months after prosthetic treatment. In addition, the mean annual vertical bone loss was also assessed. Except for the PI, GR, and PD, values for the mean GI, CAL, and TM scores at the test group were significantly lower than those in the control group. Better annual vertical bone loss results were observed on the proximal sides of abutments treated with additional photodynamic therapy. The results of this study suggest that RPD abutments affected by chronic periodontitis may perform better as abutments for distal extension RPDs when treated with both conventional root debridement and additional antimicrobial photodynamic therapy.

FUNCTIONAL STATE OF THE LIVER IN PULMONARY TUBERCULOSIS IN THE DYNAMICS OF PATHOGENETIC TREATMENT WITH A COMPLEX OF AMINO ACIDS.

The aim: To investigate the in!uence of prescribing a complex of amino acids in pathogenetic therapy in patients with pulmonary tuberculosis on liver function. Materials and methods: The study included 50 patients with drug susceptible TB and 50 patients with drug-resistant TB (multidrug-resistant and extensively drug-resistant). Results: The study included 50 patients with drug susceptible tuberculosis (TB) and 50 patients with drug-resistant TB. When comparing biochemical pa-rameters characterizing liver function in patients with drug-susceptible TB after 1 month of anti-tuberculosis therapy, it was found that patients receiving additional therapy with a complex of amino acids had a lower level of bilirubin, p <0.05. After 60 doses, patients receiving additional therapy with amino acids had significantly lower bilirubin levels alanine aminotransferase (ALT) and aspartate aminotransferase (AST), p <0.05. When comparing the biochemical parameters characterizing liver function in patients with drug-resistant tuberculosis after a month of anti-tuberculosis therapy, significantly higher protein level was found in the groups of patients receiving additional therapy with amino acids, as well as significantly lower ALT level, AST and creatinine p <0.05. Conclusions: The additional appointment of the complex of amino acids in the pathogenetic therapy of patients with pulmonary tuberculosis makes it possible to reduce the severity of hepatotoxic reactions manifested by the main parameters (AST, ALT, total bilirubin) and to increase the protein-synthetic function of the liver, which allows us to recommend their appointment to improve the tolerance of anti-tuberculosis therapy.

CEO networks and the labor market for directors

Directors at firms with well-connected CEOs are more likely to obtain directorships at firms that are connected to the CEOs. Recommended directors do not become beholden to the CEO. Reciprocity is an important determinant of recommendations because CEOs are more likely to recommend their directors if they received help from their network filling vacant board positions. CEOs also benefit strategically from the additional appointments of their directors. Analyses of appointment announcement returns and director election results show that shareholders are not concerned by such recommendations. The results highlight the importance of CEOs as intermediaries in the director labor market. • CEOs function as intermediaries in the director labor market. • Well-connected CEOs recommend their directors to firms linked to the CEO. • Recommended directors do not become beholden to the CEO. • CEOs recommend their directors for strategic and reciprocity purposes.

Ефективність корекції маси тіла як частини реабілітаційних заходів у хворих на цукровий діабет 2 типу, поєднаний з ожирінням та хронічним панкреатитом

The purpose of the study was to analyze the impact of a physical exercise program and therapeutic massage as a part of rehabilitation program in patients with type 2 diabetes mellitus combined with obesity and chronic pancreatitis on carbohydrate metabolism. Materials and methods. 579 patients with type 2 diabetes mellitus with overweight / obesity and concomitant chronic pancreatitis were included in the study. According to the analysis of the medical case histories, patients took metformin in the minimum dose that ensured the effectiveness and maximum tolerability of the drug, which was 1500-2000 mg/day. Combined therapy, which was taken by some patients, included: metformin and sulfonylurea derivatives in effective therapeutic doses. Against the background of the prescribed therapy, in the post-hospital period, rehabilitation programs were offered, which included a program of physical exercises and therapeutic massage, during 1 month. Results and discussion. It is likely that patients with type 2 diabetes mellitus, regardless of body mass index and the presence of chronic pancreatitis, received combined therapy. At the same time, the largest percentage of patients on combined therapy was recorded with type 2 diabetes mellitus and chronic pancreatitis. Both the use of metformin in the form of monotherapy and the use of combined therapy (metformin and gliclazide) in the condition of patients only with type 2 diabetes mellitus and with a comorbid type 2 diabetes mellitus with chronic pancreatitis and increased body weight / obesity do not allow reaching the target levels of glucose and HbA1c. It was established that the number of patients with type 2 diabetes mellitus without comorbidity who received mono- and combined therapy in combination with a complex of rehabilitation measures reached the target HbA1c indicators. It is also worth noting the increase in the number of insufficiency with type 2 diabetes mellitus combined with overweight / obesity and chronic pancreatitis, indicating the effectiveness of the proposed rehabilitation measures. Conclusion. The additional appointment in the post-hospital period of a complex of rehabilitation program, which includes physical exercises and therapeutic massage, contributed to the achievement of the target level of HbA1c in type 2 diabetes mellitus without comorbidity in 72.73% of patients with monotherapy and in 63.41% with combined therapy and with the associated course of diabetes mellitus, overweight / obesity and pancreatitis, respectively, in 37.62% and 38.28%

Rapid Syphilis Testing

&#x0D; This Horizon Scan summarizes available information regarding rapid point-of-care testing for the detection of Treponema pallidum, the bacteria that causes syphilis.&#x0D; Rapid point-of-care testing to screen people for a possible case of syphilis allows health care providers to screen people where they are, rather than relying on people’s access to traditional health care settings. The rapid provision of test results can also help to guide treatment in the moment, rather than requiring additional appointments that could increase the number of people with active syphilis infections lost to follow-up.&#x0D; There are currently no point-of-care syphilis tests licensed for use by Health Canada; however, at least 1 multiplex syphilis and HIV-1/HIV-2 detection test could be licensed for use in Canada by the end of 2022.&#x0D; Based on the evidence reviewed, rapid tests for the detection of syphilis appear to be adequately sensitive and specific for screening. The use of point-of-care testing, at-home self-testing, at-home sample collection methods, and telemedicine and virtual care options may be interventions to consider as health care systems move forward and work to catch up on the screening backlog and missed tests related to the COVID-19 pandemic, and also find ways to connect with people who have previously been harder to reach.&#x0D;

DYNAMICS OF CLINICAL SYMPTOMS UNDER THE INFLUENCE OF ENDOTYPE-ORIENTED PHARMACOTHERAPY OF CHRONIC RHINOSINUSITIS WITH NASAL POLYPOSIS

Chronic rhinosinusitis (CRS) is a clinical syndrome including several clinical phenotypes and endotypes with differences in pathophysiology. Chronic rhinosinusitis with nasal polyposis (NP) is the most severe CRS phenotype associated with treatment resistance and frequent recurrence after surgery. Among patients with CRS with NP, up to 96% have radiological changes that demonstrate damage to the paranasal sinuses and indicate a diffuse lesion. Pharmacotherapy based on endotyping using aminocapronic acid (ACA) competitively inhibits plasminogen and plasmin formation, inhibits C3a and C5a, which can affect the pathophysiological mechanisms of polypus growth, is promising.&#x0D; The aim of the study: to evaluate the clinical effectiveness of the additional appointment of ACA in comparison with patients receiving standard therapy of CRS with NP according to clinical recommendations.&#x0D; Material and methods. The study included 120 outpatients, divided into two groups: the main (n-60) and the control (n-60) ones. The main group (n-60) included 35 (58.3%) men and 25 (41.7%) women, the control group (n-60) included 32 (53.3%) men and 28 (46.7%) of women. The average age of the main group was 45.8 years; the control group was 47.0 years. Patients were prescribed basic treatment, but patients in the main group were additionally prescribed aminocapronic acid (ACA). The evaluation of the treatment effectiveness was based on the analysis of the dynamics of clinical symptoms: rhinorrhea, postnasal drip, nasal congestion, reduced sense of smell according to the SNOT 22 scale (from 0 to 5 points for each symptom) at V2 (5±1), V3 (10±1), V4 (20±1) and V5 (30±1) compared to V0, as well as the presence of indications for surgical treatment were determined at V3.&#x0D; Results. The use of aminocapronic acid in CRS with NP contributes to a reliable reduction in the severity of the main clinical symptoms (rhinorrhea, postnasal drip, nasal congestion, reduced sense of smell) at V2 and V3 in comparison with patients of the control group. This provided a statistically significant difference at 25% in the reduction of operated patients: 56.7% in the main group versus 81.7% in the control group (p&lt;0.05). Conservative treatment was continued for 43.3% of patients in the main group and for 18.3% of patients in the control group (p&lt;0.05). Such a difference in the dynamic of symptoms regression can be explained by the peculiarities of the biological action of ACA, which can influence the pathophysiological features that characterize the endotype of diffuse eosinophilic CRS with NP. After the removal of the operated patients, the groups did not differ significantly differ in the dynamics of the regression of rhinorrhea, postnasal drip, nasal congestion, decreased sense of smell at V4 and V5 (p&gt;0.05). Differences in the results of treatment are attributed to the clinical effects of ACA, since the group characteristics of the patients were commensurable.&#x0D; Conclusions:&#x0D; &#x0D; the use of ACA in addition to the basic therapy in patients suffering from CRS with NP contributes to a significant reduction in the severity of the main clinical symptoms in the first 10 days of treatment compared to patients in the control group;&#x0D; the positive dynamics of clinical symptoms correlates with a reliable, at 25%, reduction in the number of surgical interventions.&#x0D;

DYNAMICS OF GALECTIN-3 LEVELS IN PATIENTS WITH ACUTE CORONARY SYNDROMES AND 2 TYPE DIABETES MELLITUS UNDER THE INFLUENCE OF EMPAGLIFLOZIN AND TRIMETAZIDINE

It is known that cardiovascular diseases (CVD) will continue to occupy a prominent place in the structure of morbidity, mortality and disability of the world population. Patients with diabetes (DM) are several times more likely to develop adverse cardiovascular events. In recent years, markers of inflammation, which are involved in the progression of atherosclerosis, have been studied. One of them is galectin-3, which is involved in cell differentiation, fibrosis and immune inflammation. Data on changes in the activity of galectin-3 concentration in patients with ACS are scarce and contradictory.&#x0D; The purpose is to study the dynamics of galectin-3 content in the blood of patients with acute coronary syndromes (ACS) and concomitant type 2 diabetes in the course of treatment using empagliflozin and trimetazidine.&#x0D; Material and methods. At the first stage, 124 patients with ACS were examined; the control group consisted of 30 practically healthy people. The second stage of the study included 93 patients with ACS and diabetes, who, depending on the treatment strategy, were divided into 3 subgroups: 29 patients who were prescribed therapy in accordance with the guidelines; 30 patients who were additionally prescribed empagliflozin at a dose of 10 mg per day; 34 patients were prescribed a combination of empagliflozin and trimetazidine at a dose of 35 mg twice a day in addition to optimal drug therapy. All patients were examined upon admission before starting the course of treatment. Repeated examinations were carried out on the 28th day and after 3 months. Galectin-3 content was determined by enzyme- linked immunosorbent assay (ELISA). General laboratory tests were carried out, as well as determination of blood levels of brain natriuretic peptide (NT - proBNP), highly sensitive C-reactive protein (hs CRP), glycosylated hemoglobin. The severity of coronary artery damage was calculated according to the Gensini scale. Statistical processing received data were collected using the standard package of the "Statistics 12" program. The data were considered reliable at p &lt;0.05.&#x0D; Research results. The average age of the examined patients was (63.4 ± 5.21) years. The average values of galectin-3 levels in the blood of patients with ACS without type 2 diabetes were: (28.23 ± 3.17) ng /ml, and with concomitant DM – (35.67 ± 2.98) ng /ml (p &lt;0.01), which was 3.18 and 4.01 times higher indicators of control groups : (8.89 ± 3.41) ng /ml, respectively (p &lt;0.001).&#x0D; By the multivariate method regressive linear modeling noted dependence between levels of galectin-3 in patients with ACS with type DM and the number of leukocytes, levels hsCRP, NT- proBNP, creatinine, glucose, glycosylated hemoglobin and severity of coronary artery damage due to the Gensini scale.&#x0D; At the end of study, on the 28th day, a significant decrease in the content of galectin-3 in the blood was observed only in the group of patients who were additionally prescribed a combination of empagliflozin and trimetazidine - by 22.13% of the initial values. At the end of observation (3rd month) in all groups of examined patients, the average values of the specified indicator decreased to the same extent, however, they did not return to normal values.&#x0D; Conclusions:&#x0D; &#x0D; Concomitant type 2 diabetes significantly affects the increase of galectin-3 levels in the blood of patients with acute coronary syndrome.&#x0D; The additional appointment of trimetazidine leads to a faster decrease in the levels of galectin-3 in the blood of patients.&#x0D;

Group antenatal care (gANC) for Somali-speaking women in Sweden – a process evaluation

BackgroundLanguage supported group antenatal care (gANC) for Somali-born women was implemented in a Swedish public ANC clinic. The women were offered seven 60-min sessions, facilitated by midwives and starting with a presentation of a selected topic, with an additional 15-min individual appointment before or after. The aim of this study was to assess the feasibility for participants and midwives of implementing The Hooyo (“mother” in Somali) gANC intervention, including implementation, mechanisms of impact and contextual factors.MethodsA process evaluation was performed, using The Medical Research Council (MRC) guidelines for evaluating complex interventions as a framework. A range of qualitative and quantitative data sources were used including observations (n = 9), complementary, in-depth and key-informant interviews (women n = 6, midwives n = 4, interpreters and research assistants n = 3) and questionnaire data (women n = 44; midwives n = 8).ResultsLanguage-supported gANC offered more comprehensive ANC that seemed to correspond to existing needs of the participants and could address knowledge gaps related to pregnancy, birth and the Swedish health care system. The majority of women thought listening to other pregnant women was valuable (91%), felt comfortable in the group (98%) and supported by the other women (79%), and they said that gANC suited them (79%). The intervention seemed to enhance knowledge and cultural understanding among midwives, thus contributing to more women-centred care. The intervention was not successful at involving partners in ANC.ConclusionsThe Hooyo gANC intervention was acceptable to the Somali women and to midwives, but did not lead to greater participation by fathers-to-be. The main mechanisms of impact were more comprehensive ANC and enhanced mutual cultural understanding. The position of women was strengthened in the groups, and the way in which the midwives expanded their understanding of the participants and their narratives was promising. To be feasible at a large scale, gANC might require further adaptations and the “othering” of women in risk groups should be avoided.Trial registrationThe study was registered in ClinicalTrials.gov (Identifier: NCT03879200).

Telehealth as an effective method of follow-up for pediatric post tonsillectomy patients

PurposeTo determine if pediatric patients can be safely and effectively managed postoperatively with nurse led telehealth communication. MethodsThis is a retrospective case series conducted at a tertiary academic medical center pediatric otolaryngology practice. Retrospective chart review was conducted on patients <18 years old who underwent tonsillectomy from January 2017 to December 2019. Patients were managed postoperatively with a telehealth communication on postoperative day (POD) 3–5 and again at 4–6 weeks. Patient demographics, satisfaction with follow-up, number of office visits, and postoperative complications were recorded. Results829 tonsillectomy patients were identified. Average patient age was 5.7 years (range 10 months-16 years). Successful contact was made with the patient's caregiver on POD 3–5 for 511 patients. 322 patients successfully completed 4–6 weeks telehealth follow-up. 292 patients (91 %) reported improvement in pre-operative symptoms at 4–6 weeks. Overall, 98 % of patients who completed telehealth follow-up were satisfied with this method and did not desire an additional office appointment. 62 patients (21 %) participated in an office follow-up in 2017, 54 patients in 2018 (19 %), and 36 patients (14 %) in 2019. Only 61 of these visits were routinely scheduled postoperative tonsillectomy office visits. 53 patients (6 %) had a postoperative tonsillectomy bleed and 31 patients (4 %) required return to the operating room for cauterization. ConclusionTelehealth is successful in reducing the number of post-tonsillectomy office visits for pediatric patients without a subsequent increase in complications. Reduction in office visits can lead to cost reduction and increased availability of pediatric otolaryngology appointments.

TH1.1 Self Directed Aftercare is a Safe, Efficient and well tolerated way to follow up Breast Cancer Patients

Abstract Aims Self Directed Aftercare (SDA) was introduced in the Belfast Trust in August 2012. It offered breast cancer patients treated with curative intent an opportunity to self-manage their 5 year follow up, including their annual mammograms. We reviewed the enrolment and outcomes for the first cohort reaching 5 years (diagnosed 2013). Methods The prospective SDA database identified patients on the pathway. Additional outcome data was collated through NIECR. Patient feedback was obtained at several points along the pathway. Results 342 patients underwent surgery for newly diagnosed breast cancer in 2013. 37.7% (129 patients) were enrolled in SDA. Of these, 62.8% (81 patients), remained on the pathway throughout their follow up. 33 patients (25.6%) required no further review, having had yearly mammograms and were discharged after 5 years. The remaining patients received reviews via rapid access or recalled through screening. Feedback was largely positive. Conclusions In its first full year of SDA implementation, the Belfast Trust achieved its target by enrolling 37.7% of patients. 25.6% of patients did not require any additional appointment thereby reducing waiting lists for outpatient surgical review. Of those with a concern, 100% were able to enter back in to the system. 85% of patients entered into SDA attended remote surveillance mammography appropriately. Patients report high levels of satisfaction with the pathway.

Early Detection of Breast Cancer-Related Lymphedema in COVID-19 Pandemic.

Background: This study aimed at presenting a prospective surveillance model of care delivered at home for women qualified for surgery due to breast cancer under the epidemic-related restrictions. Methods and Results: Women (age ≥18 years, diagnosed with breast cancer, no clinical features of upper limbs lymphedema, and a volume difference between the limbs <5%, not using any prophylactic compression products) will be provided with comprehensive education in the field of self-measurements and lymphedema prevention. The outcome measures include limb volume (circumferential measurements with a tape at 4 cm intervals), simplified protocol of three measurement points combined with the symptoms monitoring (according to the physical section of Lymphedema Quality of Life Inventory [LyQLI]). We propose a new calculation method as the RACI (relative arm circumference increase) in accordance with previous research-RAVI (relative arm volume increase) and the new proposal-the RACD (relative arm circumference difference). According to cylinder formula it can be calculated that 5% increase in limb volume results in ∼2% change in RACI. Regular appointments will be planned at 3, 6, 9, and 12 months after the enrollment. Additional urgent appointments will be arranged after the home or phone "red flags" (an increase circumference by ≥2%, positive pitting test, and any new symptoms) detection. We hypothesize that performing only three measurements combined with the typical symptoms monitoring would be accurate for lymphedema diagnosis based on the RAVI of ≥5%. Moreover, RACI/RACD increments combined with positive symptoms would correlate with RAVI. Conclusions: The new proposal of protocol can be the optimal solution in COVID-19 pandemic.

The role of vitamin D for the management ofdepression in patients with autoimmune thyroiditis andhypothyroidism in the West-Ukrainian population

Background. Hashimoto’s thyroiditis is known to be an essential endocrine disease that affects the population and may lead to hypothyroidism. This disease is one of the most commonly spread autoimmune diseases. Hypothyroid patients frequently experience features of depression, which is prevalent among other symptoms in hypothyroidism. Data from recent research has proved that vitamin D deficiency may cause depression manifestations in the population. The purpose of the work is to study the effect of cholecalciferol in patients with autoimmune thyroiditis and hypothyroidism in the West-Ukrainian population on the level of depression in these patients. Materials and methods. The study included the 56 patients with hypothyroidism (H) caused by autoimmune thyroiditis (AIT). We identified the severity of depression levels using the Hamilton Depression Rating Scale (HDRS), which is reliable for depression assessment. Examinations were performed at the beginning and end of the 12-week treatment. Results. In patients of group 1 who received cholecalciferol and L-thyroxine, the level of depression on the Hamilton scale decreased by 40%, while in patients who received only L-thyroxine, the level of depression decreased by 25%. In addition, there was a significant difference between patients in groups 1 and 2 after treatment (p=0.003). That is, treatment with additional cholecalciferol on the background of L-thyroxine was more effective than treatment with L-thyroxine alone. Analyzing the effect of treatment in patients with Group 1 with the additional appointment of cholecalciferol on the background of L-thyroxine in 21.4% of patients disappeared depression. In addition, there was a decrease in depression in other patients in this group. Thus, in the remaining patients the severity of depressive manifestations decreased from moderate severity to mild depressive disorder. At the same time, after treatment only L-thyroxine depressive disorder of moderate severity decreased from 78.6 to 35.7% to mild depressive disorder, but complete disappearance of depression in this group of patients after treatment was not observed. Conclusions. Vitamin D supplementation should be administered in patients suffering from autoimmune thyroiditis and hypothyroidism which may correct depression disorders in these patients.

Open Mental Health: A Mental Health Eco System Developed in Collaboration With Communities

AimsSomerset drew upon the Community Mental Health (MH) Service Framework, and local experience and recognised that too often service user experience of mental health was beset with artificial barriers, gateways and eligibility with people sometimes needing to deteriorate before they got the vital support they needed. In addition, we recognised that the gap between secondary care and primary care was experienced by service users as a “cliff edge”. The radical redesign of mental offers in Somerset aimed to deliver an experience of “no wrong door” and where, via a partnership between health, social care and Voluntary, Community and Social Enterprise (VCSE), people's needs could be met; both in terms of specific mental health offers as well as tackling the wider determinants of mental ill health.MethodsOMH was launched early 2019, just before the pandemic, and so traditional project methodology did not always apply. Instead all partners focused on standing up the offer at pace in order to support the population within Somerset with the emotional and psychological consequences of the pandemic, and any pre existing challenges. The model was co-produced with Experts by Experience significantly contributing to the shape of the offers.The model developed comprised of two key facets: •A mental health offer, where the needs of individuals, families and carers are met by a range of health, social care and VCSE partners (including the wider determinants of mental well being such as finance / housing)•A mental health eco system developed in collaboration with communities (including underserved communities), where support is available throughout geographical communities and communities of identity.ResultsThe project has delivered both quantitively and qualitatively. Over 4100 additional appointments are offered to people in Somerset per month and reported outcomes and evaluation has been very positive. Work is underway to collate further Patient Related Outcome Measures. Following a Realist Evaluation methodology, the researcher in residence has highlighted the culture changes that are key to delivering the aspirations of the Community MH Service framework. These include; the narrative of “no wrong door”, an increased and open range of offers and interventions, blended staffing models across traditional organisational boundaries, partnership working, the role of lived experience and the ambition of addressing inequalities.ConclusionOMH, the product of Community MH Transformation in Somerset, is a radical and co produced redesign of MH services in partnership with the VCSE and Local Authority that has improved access and support to all people in Somerset.

Clinical experience with tocilizumab in the treatment of pregnant woman with severe COVID-19

The aim of the work – to present a case of positive use of tocilizumab in the treatment of pregnant woman with severe COVID-19. Materials and methods. A self-observation clinical case of severe coronavirus disease (COVID-19) in pregnant K., 40 years old, who was treated at Municipal Non-Profit Enterprise “Regional Infectious Diseases Clinical Hospital” of Zaporizhzhia Regional Council. The patient was treated in accordance with the “Protocol for the provision of medical care for the treatment of coronavirus disease (COVID-19)”. Results. Our own clinical observation demonstrates the formation of severe COVID-19 in a 40-year-old pregnant woman in the second trimester of pregnancy. Combination treatment with glucocorticoids in the presence of oxygen dependence on the 11th day of the disease was ineffective for two days of clinical and laboratory parameters monitoring, which required a decision on the additional appointment of tocilizumab. The development of “cytokine storm” clinical and laboratory signs on the 12th day of the disease was evidenced by the preservation of fever in the range of 37.5–37.8 °C, no regression of oxygen dependence. According to laboratory data, an increase in the severity of lymphopenia as a relative quantity – up to 5 % and absolute quantity – up to 0.5 × 109/l, an increase in fibrinogen – up to 5.8 g/l and D-dimer – up to 1.9 ng/ml, high level of C-reactive protein – up to 190 mg/l. These data justify the additional use of tocilizumab, which was administered at a dose of 8 mg/kg in the absence of contraindications. Tocilizumab administration was effective, contributing to oxygen dependence regression and recovery of laboratory parameters within a week. Conclusions. Our own clinical observation demonstrates the formation of severe COVID-19 in pregnant woman in the second trimester of pregnancy. Due to the ineffectiveness of glucocorticosteroid therapy and the presence of clear clinical and laboratory signs of “cytokine storm” on the 12th day of the disease, the use of tocilizumab was effective, which contributed to the oxygen dependence regression and recovery of laboratory parameters within a week. Treatment of pregnant woman with severe COVID-19 requires adherence to existing protocols.

Cancer Prevention in a Postpandemic World: A One-Stop-Shop Approach

Cancer Prevention in a Postpandemic World: A One-Stop-Shop Approach

A Community Prenatal Intervention in Social Nutrition: Evaluating the Impact on Pregnancy and Birthweight Outcomes.

This study aims to assess the associations between structural features of the Montreal Diet Dispensary’s social nutrition intervention and pregnancy (i.e., anemia, gestational diabetes mellitus (GDM), gestational weight gain (GWG), hypertension) and birthweight outcomes (i.e., small- or large-for-gestational-age) among pregnant women, most of them recent immigrants. The study consists of a secondary analysis of the digital client database of the Montreal Diet Dispensary (n = 2925). Logistic regressions were used to estimate the odds of pregnancy and birthweight outcomes, depending on structural features of the intervention. Pregnant women who attended a welcoming group session presented lower odds of GDM and anemia compared to those who did not attend. A longer duration of intervention was also associated with lower odds of GDM and anemia. Each additional appointment with a dietitian was associated with higher odds of excessive GWG and lower odds of insufficient GWG only among women with a pre-pregnancy BMI lower than 25 kg/m2. This study emphasizes the importance of providing nutritional services early in pregnancy to reduce the risk of GDM and anemia. It also stresses the importance of using appropriate nutritional guidelines to avoid increasing the risk of excessive GWG.

158 Telemedicine and Cleft Care in the UK: Adequacy and Appropriateness

Abstract Aim The efficacy of teleconsultations for cleft lip/palate (CLP) patients is not established. Accurate speech assessment and intraoral examinations pose unique challenges. This study evaluates the adequacy, benefits, and limitations of video-consultation for CLP patients. Method Retrospective analysis of all cleft multidisciplinary team (MDT) clinics on the electronic hospital system, Epic, from 05/2020–03/2021 covering East Anglia, UK. Adequacy of video consultations was based on: difficulties faced during the consultation, conversion to telephone, and whether additional face-to-face appointments were generated. MDT members were surveyed to identify benefits of teleconsultation, and types of appointments deemed most suitable for teleconsultation. Results Of 353 cleft MDT clinic appointments, 90% were by video and 10% by telephone; 75% of video consultations were rated as ‘adequate’. 72 additional face-to-face appointments were generated, 38 (53%) of which were due to technical factors such as connectivity. Child (e.g., shyness) and carer (e.g., digital literacy) factors accounted for 8 and 4 cases respectively. Three- and five-year reviews, and those requiring formal speech assessment, generated most additional appointments, followed by surgical reviews requiring intraoral examination. Staff survey revealed reduced travel, flexibility, and regular contact as most frequently reported benefits, concerns were raised over the loss of the ‘human touch’. Overall, respondents agreed that teleconsultation is suitable for select patients, and as a screening tool. Conclusions Selective use of teleconsultations that considers patient preference, age, and clinical factors is necessary. Anticipated surgical examination, speech assessment, and younger patients should be scheduled for face-to-face appointments. Technical issues must be addressed as a priority.

Abstract P3-01-16: Screening for genetic risk at the time of mammography

Abstract Introduction: Approximately, 10-15% of breast cancers may be hereditary. Early identification of elevated genetic risk may decrease morbidly and mortality associated with breast cancer for this population by enabling timely implantation of optimized screening techniques. Reaching out to women with breast cancer risk assessment at the time of mammography may provide an opportunity to connect risk perception with risk reduction action. We hypothesized that women receiving a high-risk assessment at the time of mammography would facilitate entry to genetic counseling. Methods: In September 2019, Jefferson Health New Jersey (JHNJ) started utilizing a tool to screen individuals for an increased risk for hereditary breast cancer syndromes (family history screening 7; FHS-7) to all women presenting for mammography at its three breast imaging centers. The FHS-7 tool was embedded into the electronic medical record system and would generate a score based on 7 questions related to a patient’s family history of breast, ovarian and bowel cancer. Women who were identified at elevated risk (FHS-7 scores ≥1) were asked by the mammography technician prior to performing the screening mammogram for their permission to be contacted by a high-risk counselor for a formal high-risk assessment and potential genetic counseling/testing. In March 2020, nearly all cancer screening services shut down with the COVID-19 pandemic. Services re-opened in June 2020. We report on our experience in three-time frames: September 2019-February 2020; March 2020-May 2020, and June 2020-present. Results: From September 2019-February 2020: 3,169 mammograms and FHS-7 screenings were performed. 44 had scores ≥1 (1.4%). 4 (9%) agreed to be contacted for an appointment with a high-risk counselor. Of these, 2 had previously met with genetics. No additional appointments were scheduled. From March 2020-May 2020, 576 mammograms and FHS-7 screenings were performed. 9 had scores ≥1 (1.6%). None agreed to be contacted for an appointment with a high-risk counselor. Two appointments had previously been completed. From June 2020-June 2021, 9,131 mammograms and FHS-7 screenings were performed. 240 had scores ≥1 (2.6%). 22 (9%) agreed to be contacted for an appointment with genetics. 11 appointments had previously been completed. 8 (73%) were completed as a consequence of this direct outreach. Conclusion: Although our work was interrupted by the COVID-19 pandemic, screening for hereditary risk at the time of mammography may be an effective way of facilitating referrals for genetic counseling/testing for high-risk patients. Consent to be contacted for a formal high-risk assessment was consistent at 9% pre-mammography closure and post-mammography re-opening. Consent to be contacted for genetics is likely to be associated with breast cancer risk perception. Future Directions: We are planning an educational intervention regarding the FSH-7 risk assessment tool and a positive score’s association with the risk of hereditary breast cancer syndromes, as well as the benefits of optimized screening techniques depending on a patient’s life-time risk of developing breast cancer. We anticipate that this will likely result in greater acceptance of a formal high-risk assessment for this at-risk population. Citation Format: Jason Shames, Dina Alnabulsi, Olivia Trachtenberg, AnaMaria Lopez. Screening for genetic risk at the time of mammography [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-01-16.

Abstract OT2-10-01: The VIOLA study: Validating individualized breast cancer screening by offering a new link in access

Abstract The VIOLA Study is a Clinical Utility Study designed to investigate the useability of Melody®, a tear-based screening assay for breast cancer developed and validated by Namida Lab, Inc., a high complexity CLIA certified lab. It is well established that disparities exist in breast health, preventative care, and screening mammography. Namida Lab believes in the potential of Melody® to be a tool that bridges the gap between underserved populations and positive health outcomes. As such, Namida Lab, Inc. is partnering with federally qualified health centers and large employers to evaluate the clinical utility of Melody®. Melody® consists of two parts: tear sample collection and clinical lab assay. Participants will have a tear sample collected at a study site. The clinical lab assay, Melody®, will be performed at Namida Lab, Inc. The results of the Melody® assay will be returned to the site clinician to be discussed with the participant. The administration of Melody® does not require additional appointments or trips and can be done by any member of a medical team. A minimum participation of 205 women who are 40 to 74 years of age, at average risk for developing breast cancer, asymptomatic, and have no concerns or breast abnormalities. To date 28 participants have been enrolled in the study. Study enrollment and eConsent will be conducted through our mobile application. Each participant will be required to take an enrollment survey that collects information on race, ethnicity, and socio-economic status. Participant's addresses will be obtained as part of the requisition process for the CLIA lab, from which information on geographic location can be obtained. In addition to the factors listed above, the enrollment survey also collects information on status and type of health insurance, reproductive health, breast health knowledge, prior screening history, and family and personal history of cancer The exit survey has been designed to collect information on the participant experience with Melody® and comprehension of the Melody® results relayed through their site clinician. In addition, information is collected on participant''s intention to schedule/participate in future screening mammograms and/or change in intention to participate in a previously scheduled screening mammogram. Primary endpoint: The VIOLA Study is designed to assess how incorporating Melody® into a primary care provider setting affects participation and confidence in the current breast health continuum of care. Secondary endpoint: Quantifying the relationship between Melody® and increased participation in breast health care offers the clinical utility evidence required for adoption into the Standard of Care. Citation Format: Anna Daily. The VIOLA study: Validating individualized breast cancer screening by offering a new link in access [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-10-01.

Multicenter RCT on intensive caries prevention for children undergoing dental general anaesthesia: Intensive caries prevention for children undergoing dental general anesthesia

ObjectivesEarly childhood caries is a persistent problem often leading to dental treatment under general anesthesia (GA). Thus, this study investigated the effect of two additional individual caries prevention appointments before and after GA. Materials and MethodsIn this multi-center, 2-arm randomized, controlled clinical trial, 408 children (age 2–5 years, mean 4.2 ± 1.04) intended for GA were recruited and randomly assigned to the intervention and control groups with or without two additional intensive oral hygiene appointments before and after the GA. At baseline and at 6-/12-months follow-ups, approximal plaque index (API), gingival sulcus bleeding index (SBI), caries experience (dmft/s) and initial caries were recorded. ResultsParticipants in test group and control group (ITT; n = 161 vs. n = 147) as well as drop-outs in test and control groups (n = 40 vs. n = 58) showed no statistical significant difference in baseline characteristics. Test and control groups showed equivalent baseline oral health parameters (API: 78 and 77%, SBI: 22.6 and 23.5%, dmft: 8.5 and 8.2, respectively), which continuously improved during the study. The test group exhibited statistically significant greater improvement (API: 42%, SBI: 7%) than the control (API: 54%, OR: 0.48; P = 0.003; SBI: 12%, OR=0.44; P = 0.005). Due to the robust rehabilitation with predominantly stainless steel crowns and extractions, caries incidence was minimal and, therefore, without statistical significance (mean increase dt, test: 0.5, control: 0.6; P = 0.68), which was also true for new initial carious lesions (mean increase test: 0.8 vs. control: 0.9; P = 0.55). ConclusionsAdditional preventive sessions for children undergoing treatment under GA improved their oral hygiene parameters signifiqantly. Clinical significanceIntensive caries prevention appointments for children receiving dental treatment under GA improved their oral hygiene and might reduce their caries risk.