Daily Screening Research Articles

Delirium in Lower Limb Trauma: The Incidence and Risk Factors in a Prospective Observational Study.

Delirium poses a significant challenge in musculoskeletal trauma patients, particularly the elderly, contributing to elevated morbidity and mortality. Despite unclear pathogenesis, various risk factors have been identified. This prospective observational study, conducted in a tertiary center, aims to estimate delirium incidence and identify associated risk factors in adult patients undergoing lower limb trauma surgeries. Between August 2021 and December 2022, 150 patients with lower limb trauma admitted for surgery were included. Initial assessments recorded Mini-Mental State Examination scores, Injury Severity Scores, and potential risk factors. Confusion Assessment Method scoring done preoperatively (excluding emergencies) and postoperatively on days 2 and 5 or at discharge. Daily delirium screening utilized Nursing 4-Abbreviated Trauma score, with severity assessed using CAM-Severity score. Risk factor analysis categorized patients into Group A (delirium) and Group B (non-delirium), with primary endpoint being delirium occurrence. The study revealed a 10% delirium incidence. Delirium severity ranged from mild to severe. The median age (in years) was 79 vs 46 in delirium and non-delirium group respectively. Delirium patients had longer hospital stay (13 vs 8, p value 0.011). Similarly, factors like female gender, delayed surgery, hyponatremia, hypoproteinaemia, increased injury severity, midazolam use during induction, multiple blood transfusions, and heightened postoperative pain intensity were found significant (p value < 0.05). This study enhances our understanding of delirium in lower limb trauma patients undergoing surgeries. Identified risk factors offer insights for targeted interventions, emphasizing the need for comprehensive preoperative assessments and management strategies to reduce delirium incidence and improve patient outcomes.

2358 Evaluation of a novel screening protocol for respiratory viral infections in long-term care homes

Abstract Introduction Respiratory viral illnesses (RVI) pose a serious threat to LTC residents. Those with frailty often experience non-specific presentations causing delayed diagnosis and treatment of infection. To facilitate early RVI detection, a screening protocol was developed to evaluate changes in cognitive and functional status of LTC residents using the Single Question in Delirium (SQiD) with new Single Question in Functioning (SQiF) and Single Question in Reduced Mobility (SQiRM). This study aims to address: (i) If novel (SQiD/SQiF/SQiRM) screening was superior to public health in detecting COVID-19 in LTC, and; (ii) Did combining the novel and public health screening improve detection of COVID-19. Methods The novel screening protocol was integrated into daily screening for RVI at three LTC homes in Nova Scotia, Canada. Daily assessments were recorded in consenting residents. If any of the novel protocol was positive, the 4As Test (4AT) and Hierarchal Assessment of Balance and Mobility (HABAM) were evaluated and a positive 4AT and/or HABAM triggered an RVI swab for COVID-19. Area under the curve (AUC,) sensitivity and specificity analysis using PCR tests as the reference criterion was utilised. Between October 2021 to February 2024, 378 LTC residents consented to participate, resulting in 142 positive COVID-19 PCR tests. Preliminary results show public health screening had a sensitivity of 68.3%, specificity of 52.1% and AUC of 0.60. Novel protocol exhibited sensitivity of 12.0%, specificity of 85.2% and AUC of 0.49. Combining public health and novel screening yielded a sensitivity of 80.3%, specificity of 32.3% with a AUC of 0.59. Conclusions Preliminary results suggest that incorporating public health and novel protocol screening for daily RVI assessments in LTC is advantageous. Predictive accuracy is slightly less with combined screening, but sensitivity of the combined screening protocols remains high. Other information Ethical approval obtained from Nova Scotia Health Research Ethics Board # 1026558.

Impact of Prolonged Screening and COVID-19 Infection on Acquired Colour Vision Deficiencies Assessed by the Farnsworth–Munsell 100 Hue Test

Over the past decade, global screening time has increased, a trend intensified by the COVID-19 pandemic, leading to the integration of screens into daily life. Studies have documented the adverse effects of prolonged screening on ocular health and binocular vision, such as dry eye syndrome, blurry vision, headaches, myopia, and visual fatigue. However, it remains unclear if prolonged screening affects the development of colour vision defects. Objectives: This study aimed to determine the relationship between (a) prolonged screening and acquired colour vision deficiencies and (b) COVID-19 infection and acquired colour vision deficiencies. Methods: A population of 50 individuals with normal trichromatic vision, aged 20 to 30 years, with an average daily screening time of 516.7 min, was evaluated. Participants were initially screened using the Ishihara 32-plate Test to exclude those with congenital colour vision deficiencies. The Farnsworth–Munsell 100 Hue Test (FM100H) and Square Root Total Error Score (√TES) were used to evaluate acquired colour vision deficiencies under standardized conditions. The dataset underwent dual analysis: (1) detailed statistical scrutiny and (2) comparison of √TES values with historical data from 1982, 1991, 2001, and 2002. Results: The global group had a √TES (Mean ± SD) of 5.40 ± 1.58, the COVID-19 subgroup 5.46 ± 1.62, and the non-COVID-19 subgroup 5.32 ± 1.51. No significant differences were found between the √TES values from this population and those reported in previous studies. Statistical analysis showed no significant correlation between gender and COVID-19 infection with √TES values. Conclusions: Neither screening time nor COVID-19 infection appears to significantly impact the occurrence of permanently acquired colour vision deficiencies in individuals aged 20 to 30 years.

Delirium Screening in Critically Ill Children: Secondary Analysis of the Multicenter PICU Up! Pilot Trial Dataset, 2019-2020.

To determine the patient-level factors associated with performing daily delirium screening in PICUs with established delirium screening practices. A secondary analysis of 2019-2020 prospective data from the baseline phase of the PICU Up! pilot stepped-wedge multicenter trial (NCT03860168). Six PICUs in the United States. One thousand sixty-four patients who were admitted to a PICU for 3 or more days. None. Of 1064 patients, 74% (95% CI, 71-76%) underwent delirium screening at least once during their PICU stay. On 57% of the 8965 eligible patient days, screening was conducted. The overall prevalence of delirium was 46% across all screened days, and 64% of screened patients experienced delirium at some point during their PICU stay. Factors associated with greater adjusted odds ratio (aOR) of increased daily delirium screening included PICU stay longer than 15 days compared with 1-3 days (aOR 3.36 [95% CI, 2.62-4.30]), invasive mechanical ventilation as opposed to room air (aOR 1.67 [95% CI, 1.32-2.12]), dexmedetomidine infusions (aOR 1.23 [95% CI, 1.04-1.44]) and propofol infusions (aOR 1.55 [95% CI, 1.08-2.23]). Conversely, decreased aOR of daily delirium screening was associated with female gender (aOR 0.78 [95% CI, 0.63-0.96]), and the administration of continuous infusions of opioids (aOR 0.75 [95% CI, 0.63-0.90]) or ketamine (aOR 0.48 [95% CI, 0.29-0.79]). Neither patient age, the presence of family or physical restraints, or benzodiazepine infusions were associated with daily delirium screening rates. In the 2019-2020 PICU UP! cohort, across six PICUs, delirium screening occurred on only 57% of days, despite the presence of established practices. Female gender, patients in the early stages of their PICU stay, and patients not receiving mechanical ventilation were associated with lower odds of daily delirium screening. Our results highlight the need for structured quality improvement processes to both standardize and increase the frequency of delirium screening.

Synergistic photoinduced charge transfer resonance from porous ZIF-67 decorated violet phosphorus array for SERS immunoassay of SARS-CoV-2 spike protein

As a rapid, highly sensitive, and user-friendly technique, surface-enhanced Raman scattering (SERS) has an extraordinary appeal to home self-test of COVID-19 during the post pandemic era. However, most of the existing SERS substrates have been still criticized in stability, repeatability, and sample enrichment. To address these obstacles, a novel non-metallic SERS substrate with porous surfaces and array geometry was developed by in-situ growing ZIF-67 particles on two-dimensional violet phosphorus (VP) matrix. Chemical enhancement was prominently promoted by the synergistic photoinduced charge transfer resonance in the hybrid band structure of the ZIF-67@VP substrate, facilitating a noble metal-similar enhancement factor of 6.11 × 107. The biocompatible ZIF-67@VP porous array with attractive enhancement capability and high anchoring efficiency was further utilized to monitoring SARS-CoV-2 spike protein in practical saliva samples based on a sandwich immunostructure, achieving a limit of detection of 1.7 ng/mL assisted by black phosphorus nanosheets. This nonmetallic immunoassay strategy with exceptional sensitivity and specificity is predicted to extend the utilization of SERS obstacle in daily infectious disease screening.

A computer-aided polyp detection system in screening and surveillance colonoscopy: an international, multicentre, randomised, tandem trial

Studies on the effect of computer-aided detection (CAD) in a daily clinical screening and surveillance colonoscopy population practice are scarce. The aim of this study was to evaluate a novel CAD system in a screening and surveillance colonoscopy population. This multicentre, randomised, controlled trial was done in ten hospitals in Europe, the USA, and Israel by 31 endoscopists. Patients referred for non-immunochemical faecal occult blood test (iFOBT) screening or surveillance colonoscopy were included. Patients were randomomly assigned to CAD-assisted colonoscopy or conventional colonoscopy; a subset was further randomly assigned to undergo tandem colonoscopy: CAD followed by conventional colonoscopy or conventional colonoscopy followed by CAD. Primary objectives included adenoma per colonoscopy (APC) and adenoma per extraction (APE). Secondary objectives included adenoma miss rate (AMR) in the tandem colonoscopies. The study was registered at ClinicalTrials.gov, NCT04640792. A total of 916 patients were included in the modified intention-to-treat analysis: 449 in the CAD group and 467 in the conventional colonoscopy group. APC was higher with CAD compared with conventional colonoscopy (0·70 vs 0·51, p=0·015; 314 adenomas per 449 colonoscopies vs 238 adenomas per 467 colonoscopies; poisson effect ratio 1·372 [95% CI 1·068-1·769]), while showing non-inferiority of APE compared with conventional colonoscopy (0·59 vs 0·66; p<0·001 for non-inferiority; 314 of 536 extractions vs 238 of 360 extractions). AMR in the 127 (61 with CAD first, 66 with conventional colonoscopy first) patients completing tandem colonoscopy was 19% (11 of 59 detected during the second pass) in the CAD first group and 36% (16 of 45 detected during the second pass) in the conventional colonoscopy first group (p=0·024). CAD increased adenoma detection in non-iFOBT screening and surveillance colonoscopies and reduced adenoma miss rates compared with conventional colonoscopy, without an increase in the resection of non-adenomatous lesions. Magentiq Eye.

Deceiving duodenal erosion: fishbone lies beneath.

Incidental identification of foreign body (FB) during daily screening endoscopy is not rare. The patients may have unspecific symptoms and do not report a history of FB ingestion at presentation. Although these FBs mostly pass through the gastrointestinal tract uneventfully, a certain proportion could be impacted and cause complications. Lack of a definite history of FB ingestion could make diagnosis difficult and delay treatment when FB presents with deceiving endoscopic appearances. We report a duodenal FB mimicking erosion found in screening upper endoscopy.

184 Paying attention to the feasibility of daily delirium screening in an acute hospital setting

Abstract Background Delirium is highly prevalent, yet two-thirds of cases remain undetected. Irish national guidance recommends daily delirium screening for all acute hospital in-patients at risk of delirium, including older patients. We conducted a series of stakeholder workshops to identify the screening tool considered most feasible for daily delirium screening by staff nurses in our hospital. Methods We identified four tools validated for daily delirium screening from the Scottish Intercollegiate Guidelines Network guidelines on ‘Risk Reduction and Management of Delirium’. These included the DOS-13 (Delirium Observation Screening Scale); RADAR (Recognising Acute Delirium As part of your Routine); mRASS (modified Richmond Agitation Screening Scale); and SQiD (Single Question in Delirium). Two workshops for local nursing delirium champions were held to discuss the feasibility of each of these instruments. Workshops commenced with teaching on delirium prevention, management and the rationale for daily screening. Factors relating to the time taken to conduct the assessment, training required, suitability for nursing staff use, diagnostic accuracy, and other issues relating to feasibility were explored. Results The RADAR was considered the instrument with the best balance between feasibility of implementation and diagnostic accuracy. The mRASS was preferred as the next best option, however there was concern that this instrument would require significantly more training. The DOS-13 was considered too time-consuming and too detailed, however it was proposed as a useful behavioural charting tool in patients with known delirium. Although the SQiD was considered the quickest test to conduct, it was felt that staff changeover would lead to reduced diagnostic accuracy. Conclusion RADAR was deemed the test of choice for daily delirium assessment in UHW acute wards. A delirium care bundle incorporating the RADAR was hence developed and training of staff has commenced. The next steps will be to evaluate its feasibility and efficacy in the real-world setting.

312 Paying attention to daily delirium screening in an acute hospital setting, an audit of implementation on orthopaedic wards

Abstract Background Delirium is highly prevalent, yet two-thirds of cases remain undetected. Irish national guidance recommends daily delirium screening for all acute hospital in-patients at risk of delirium, including older patients. In this audit, we aimed to assess efficacy of implementation of a Delirium Care Bundle (DCB), incorporating delirium screening, risk factor assessment, and management, on two Orthopaedic wards. Methods Following a detailed feasibility assessment by a multidisciplinary group, the RADAR (Recognising Acute Delirium As part of your Routine) was chosen for daily delirium screening locally. This was incorporated into a DCB and an online training module was developed. Online training of staff was supplemented by in-person training on the wards. Three months post-implementation on two Orthopaedic wards, we audited DCB use. Additionally, we reviewed if patients were screened for delirium on admission (4AT) in the Emergency Department (ED), also recommended in national algorithms. Results Of 57 inpatients on the wards, eight were excluded (seven were too young to meet screening criteria; one was in theatre), leaving 49 patients eligible for audit. Seven (16.6%) patients had been screened in the ED at presentation. Thirty-five patients (71.4%) patient had the DCB commenced. Despite awareness, although the RADAR should be administered twice daily, we estimate that it was completed to 46% of target utilisations. Eleven (22.4%) patients had a positive RADAR at some point, four of whom had a negative 4AT screen in the emergency department. In those with a positive RADAR, documentation of consequent actions and preventative strategies was suboptimal. Conclusion The DCB was commenced appropriately in most patients. This audit identified that the RADAR use can be improved and that action steps following a positive screen were not being taken. Next steps include identifying barriers and facilitators to the use of the DCB and enhancing staff training in its use.

173 The development and early experience of a multidisciplinary acute in-patient frailty team

Abstract Background Frail older adults represent a growing proportion of the acute in-patient population. A point-prevalence audit in our hospital revealed 40% of adult in-patients were frail (median age: 74). Following a patient-mapping exercise and review of service-user requirements, a consensus was reached among stakeholders that a multidisciplinary in-patient frailty team would be the most effective approach to supporting this group. The Rapid Assistance with Frailty Team (RAFT) work closely with Emergency Department (ED) and ward-based colleagues to optimise their care. Methods Newly admitted patients &amp;gt;75 years are screened daily for mild to moderate frailty (Rockwood Clinical Frailty Scale 5–6) and a Comprehensive Geriatric Assessment (CGA) is completed within 72 hours of admission. Hospital-associated complications e.g. deconditioning, delirium, weight loss, constipation, falls, cognitive and functional decline, are addressed through CGA-led recommendations. Physical and functional status are optimised through supplementary ward-based therapy and Geriatric Medicine support, with a view to facilitating earlier discharge. Results 609 CGAs were completed over a one-year period. Patients were primarily identified through daily screening (77.51%). Other referral sources included the ED Therapy Team, Primary Teams, therapies and nurses. In 50% of patients reviewed, new onset of confusion, decline in memory, or delirium was noted, with only half of those having a prior history of cognitive impairment. 80% presented with a decline in general function and approximately 35% were admitted with a fall as their main presentation. Polypharmacy was identified in 80% of this patient population. Conclusion The initial steps in implementing an inpatient frailty service, i.e. developing a system of patient identification, documentation to support CGA, and an integrated approach to working in a busy clinical environment, have been achieved. The focus is now on prospective data collection, continuous monitoring of key performance indicators, and feedback from service-users and staff, to further streamline this approach.

Microbial Contamination, Antimicrobial Activities of &lt;i&gt;Dissotis rotundifolia&lt;/i&gt; Leaf: A Common Ethnomedicine for Ocular Diseases

Backgroud: Direct leaf extracts of Dissotis rotundifolia are commonly used in rural settings including Abakaliki, Ebonyi State, Nigeria as traditional medicine for the treatment of eye injury and related diseases with limited information on the scientific basis of the microbiological quality/safety of the extract.&#x0D; Objective: This study investigated the microbial quality, antimicrobial effects of D. rotundifolia direct leaf extract.&#x0D; Materials and Methods: The extracts were evaluated for microbial contamination and stored for 5 days with daily screening for microbial quality. Antimicrobial test was assessed by agar diffusion at various concentrations against five clinical isolates namely; Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, Citrobacter freundii and Candida species. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were also determined.&#x0D; Results: The findings of the study showed that D. rotundifolia fresh direct extract was not contaminated by any pathogenic bacteria or fungi until after 2 days of storage. The fresh extract was significantly (p &lt; 0.05) more contaminated with Aspergillus flavus (20%) and Aspergillus niger (80%) whereas Aspergillus niger was the only contaminant in the dry extract up to 5 days of storage. The extract significantly (&lt; 0.05) inhibited the growth of all test organisms with zone of inhibition varying between 4mm (S. Pneumoniae) to 15mm (Candida species). MIC for Candida species was observed at 500mg/ml and 200mg/ml for other test organisms while MBC was 500mg/ml for other test organisms.&#x0D; Conclusions: The findings of this study are supportive of the use of D. rotundifolia extract in the treatment of bacterial-related ocular diseases and inflammation.

Impact of respiratory syncytial virus in an open bay neonatal intensive care unit

Background: Respiratory syncytial virus, RSV, is a respiratory virus that causes cold-like symptoms in adults. In infants and young children, RSV can cause severe illnesses such as bronchiolitis or pneumonia. We describe a successful response to a laboratory-confirmed RSV outbreak in a 21-bed open-pod neonatal intensive care unit (NICU) at a level 2 trauma hospital. Methods: After 2 of the 3 initial neonates were diagnosed with hospital-onset RSV, an outbreak investigation began on November 16, 2022. Following the results, testing was expanded to all neonates in the NICU. The clinical case was defined as a hospitalized neonate with laboratory confirmation of RSV by RSV antigen screen or polymerase chain reaction (PCR) detection on the Biofire respiratory panel. Outbreak resolution was determined by utilizing a viral test for the remaining positive neonates after the 2-week incubation period from the last identified positive neonate. Results: On day 1 of the investigation, 6 of 18 neonates were identified as positive for RSV. The initial 12 negative neonates received a prophylactic dose of palivizumab. Due to the increase in positive neonates, enhanced infection prevention and control measures were immediately implemented. These measures included the immediate closure of the NICU for new transfers, placing all positive neonates in a single-bay cohort in the NICU, implementing contact and droplet precautions, minimizing shared staff, increasing environmental cleaning, and using dedicated equipment. With awareness of the increased community occurrence of RSV, additional measures were taken to monitor adherence to infection prevention and control measures by staff and visitors entering the NICU, including daily symptom screening. Visitation was restricted to block scheduling to monitor the number of individuals in the NICU. Once we obtained the complete conversion of the initial neonate cohort, the additional focus shifted to maintaining the enhanced precautions until all neonate laboratory tests were negative. The NICU was successfully reopened once the remaining 3 positive neonates received no growth on their viral culture. Conclusions: The quick and effective response from a multidisciplinary team allowed a successful intervention to mitigate the identified outbreak. This investigation highlights the importance of enhanced infection prevention and control practices during increased community spread. Future efforts focus on educating staff and visitors on appropriate measures to decrease transmission risks.Disclosures: None

Android-Based Mobile Application for the Control of Anemia in Children Aged 6 to 23 Months Old in the District of Comas – Lima

One of the main health problems facing the country is iron deficiency anemia. This condition reduces the level of hemoglobin present in the blood, which produces symptoms that affect the sufferer's daily activities. According to the INEI (National Institute of Statistics and Informatics), the urban area has 36.7% of anemia, and Comas is the second district of the capital (Lima) with the second highest rate of anemia with 43.4%. This article proposes a technological solution that allows the control and prevention of iron deficiency anemia in children from 6 to 23 months old in Comas through the follow-up of the screenings performed and by improving eating habits. The result obtained was an Android-based mobile application with three navigation options. The Children option allows the registration of each screening performed and notifies the level of anemia present in the child, the Home option displays information about this condition, and the Kitchen Recipes option is responsible for enriching the child's diet by presenting a highly nutritious recipe book, categorized according to age range. It also obtained a 90% positive acceptance rate from the sample population identified as users and patients, and a daily screening was recorded. This result can be applied to any coastal area of the country and, therefore, contributes to improving the quality of life of children by reducing anemia rates.

Risk factors for SARS-CoV-2 seropositivity in a health care worker population during the early pandemic

BackgroundWhile others have reported severe acute respiratory syndrome-related coronavirus 2(SARS-CoV-2) seroprevalence studies in health care workers (HCWs), we leverage the use of a highly sensitive coronavirus antigen microarray to identify a group of seropositive health care workers who were missed by daily symptom screening that was instituted prior to any epidemiologically significant local outbreak. Given that most health care facilities rely on daily symptom screening as the primary method to identify SARS-CoV-2 among health care workers, here, we aim to determine how demographic, occupational, and clinical variables influence SARS-CoV-2 seropositivity among health care workers.MethodsWe designed a cross-sectional survey of HCWs for SARS-CoV-2 seropositivity conducted from May 15th to June 30th 2020 at a 418-bed academic hospital in Orange County, California. From an eligible population of 5,349 HCWs, study participants were recruited in two ways: an open cohort, and a targeted cohort. The open cohort was open to anyone, whereas the targeted cohort that recruited HCWs previously screened for COVID-19 or work in high-risk units. A total of 1,557 HCWs completed the survey and provided specimens, including 1,044 in the open cohort and 513 in the targeted cohort. Demographic, occupational, and clinical variables were surveyed electronically. SARS-CoV-2 seropositivity was assessed using a coronavirus antigen microarray (CoVAM), which measures antibodies against eleven viral antigens to identify prior infection with 98% specificity and 93% sensitivity.ResultsAmong tested HCWs (n = 1,557), SARS-CoV-2 seropositivity was 10.8%, and risk factors included male gender (OR 1.48, 95% CI 1.05–2.06), exposure to COVID-19 outside of work (2.29, 1.14–4.29), working in food or environmental services (4.85, 1.51–14.85), and working in COVID-19 units (ICU: 2.28, 1.29–3.96; ward: 1.59, 1.01–2.48). Amongst 1,103 HCWs not previously screened, seropositivity was 8.0%, and additional risk factors included younger age (1.57, 1.00-2.45) and working in administration (2.69, 1.10–7.10).ConclusionSARS-CoV-2 seropositivity is significantly higher than reported case counts even among HCWs who are meticulously screened. Seropositive HCWs missed by screening were more likely to be younger, work outside direct patient care, or have exposure outside of work.

A Quality Improvement Initiative to Reduce Unnecessary Screening Chest Radiographs in a Pediatric ICU.

The Critical Care Societies Collaborative included not ordering diagnostic tests at regular intervals as one of their Choosing Wisely initiatives. A reduction in unnecessary chest radiographs (CXRs) can help reduce exposure to radiation and eliminate health care waste. We aimed to reduce daily screening CXRs in a pediatric ICU (PICU) by 20% from baseline within 4 months of implementation of CXR criteria. All intubated patients in the PICU were included in this quality improvement project. Patients with tracheostomies were excluded. We developed criteria delineating which patients were most likely to benefit from a daily screening CXR, and these criteria were discussed for each patient on rounds. Patients on extracorporeal membrane oxygenation, on high-frequency oscillatory ventilation, or on high support on conventional mechanical ventilation were included as needing a daily screening CXR. We tracked the percentage of intubated subjects receiving a screening CXR as an outcome measure. Unplanned extubations and the number of non-screening CXRs per intubated subject were followed as balancing measures. The percentage of intubated subjects receiving a daily screening CXR was reduced from 79% to 31%. There was no increase in frequency of unplanned extubations or number of non-screening CXRs. With an estimated subject charge of roughly $270 and hospital cost of $54 per CXR, this project led to an estimated $300,000 in patient charge savings and $60,000 in hospital cost savings. Adopting criteria to delineate which patients are most likely to benefit from screening CXRs can lead to a reduction in the percentage of intubated patients receiving screening CXRs without appearing to increase harm.

Utility of Opportunistic Infections, Joints’ Involvement and Accuracy of Various Screening Tests to Diagnose Rheumatoid Arthritis Patients

Background and Objectives: Rheumatoid Arthritis (RA) is an auto-immune disease in which the body mistakenly considers some parts of its own system as pathogens and attacks them. Prevalence is approximately 0.75% in India. About 40% of the diseased become work disabled within 5 years from the onset of symptoms. The objective of this paper is to assess the sign/symptoms, joints' involvement, difficulties in daily activities and screening accuracy of serology tests of clinically suspected RA patients. Material and Methods: A cross-sectional cohort study design was conducted on two hundred ninety clinically suspected subjects who were referred by different OPDs of hospitals for screening. The profiles of study subjects were carried through a semi-structured, pre-tested schedule method. About 2 mL of blood samples were collected in a plain vial from each patient and tested for diagnostic tests RF, CRP and AntiCCP by using RF-Latex, CRP Latex and ELISA method, respectively, by the laboratory persons. Results: Joint pain shows to be a leading problem in RA as compared to other signs and symptoms. The majority of the study subjects suffer from knee problems (62%). Approximately equal numbers of RA-positive cases were screened by RF and AntiCCP tests. The CRP test screened about one-third of cases. CRP+ AntiCCP, RF+ AntiCCP and RF + CRP all have good sensitivity, and RF+ AntiCCP + CRP has a very high sensitivity for diagnosing RA. Conclusions: This study found that a substantiation of a major proportion of clinically suspected RA patients were suffering from knee pain. Predication of AntiCCP increased the possibility for the diagnosis of RA. However, RF was also moderately related to the diagnosis of RA, and the combination of both tests was more valuable.

Neurological Impairment in Critically Ill Patients on Dialysis: Research Letter for the INCOGNITO-AKI Feasibility Study.

Acute kidney injury (AKI) resulting in kidney replacement therapy is rising among critically ill adults. Long-term kidney replacement therapy and critical illness are independently linked to acute and prolonged cognitive impairment, and structural brain pathology. Poor regional cerebral oxygenation (rSO2) may be a contributing factor. To assess the feasibility of testing the association between intradialytic rSO2 and acute and long-term neurological outcomes. Longitudinal observational study. We enrolled patients initiating continuous kidney replacement therapy or intermittent hemodialysis in the Kingston Health Sciences Centre (KHSC) Intensive Care Unit (ICU). rSO2 was monitored during the first 72 hours of continuous kidney replacement therapy or throughout each intermittent hemodialysis session. We measured acute neurological impairment by daily delirium screening and long-term neurocognitive outcomes using the Kinarm robot, Repeatable Battery for the Assessment of Neuropsychological Status, and brain magnetic resonance imaging. Of 484 ICU patients, 26 met the screening criteria. Two declined, and 13 met at least one exclusion criteria. Eleven patients were enrolled. Eight died in ICU, one died 2 months after discharge, and one declined follow-up. Data capture rates were high: rSO2/vitals (91.3%), and delirium screening and demographics (100%). Longitudinal testing was completed in 50% (1 of 2) of survivors. Enrollment was low due to a variety of factors, limiting our ability to evaluate long-term outcomes. rSO2 and delirium data collection is feasible in critically ill patients undergoing kidney replacement therapy; high mortality limits follow-up.

Cross-lagged regression study on daily stress, mental health, and psychological burden among young adults during the COVID-19 pandemic

During the coronavirus disease 2019 (COVID-19) pandemic, young adults have experienced many maladaptive symptoms that have consequently affected their mental health. Most studies have examined the risk factors of mental health while ignoring the protective factors. This longitudinal study aims to investigate whether daily stress, depression, anxiety and stress, and positive mental health have a predictive effect on the psychological burden of COVID-19. We conducted three follow-up surveys in 2014 (T1), 2015 (T2), and 2020 (T3) to understand the predictive effect of daily stress and mental health on the psychological burden of COVID-19 on young adults. Data were assessed in 2014 (T1) and 2015 (T2) using the depression, anxiety, and stress scale (DASS-21), positive mental health scale (PMH), and brief daily stressor screening scale (BDSS), and in 2020 (T3), where we incorporated the psychological burden of COVID-19 to evaluate its psychological burden status on young adults. A total of 556 young adults participated in three surveys. Cross-lagged analysis indicated that (1) daily stress at T1 significantly predicted DASS and PMH at T2, DASS at T2 significantly predicted the psychological burden of COVID-19 at T3, but PMH at T2 could not predict the psychological burden of COVID-19 at T3; (2) PMH at T1 significantly predicted daily stress and DASS at T2, which significantly predicted the psychological burden of COVID-19 at T3. Individuals with low daily stress and depression, anxiety, and stress symptoms can still maintain a low psychological burden during the pandemic.

1196. Environmental Contamination of Rooms of Patients Harboring Multidrug-Resistant Organisms

Abstract Background Healthcare environmental contamination by patients harboring multidrug-resistant organism (MDROs) is an important source of hospital MDRO transmission. We aimed to determine the MDRO contamination and bioburden of surfaces within hospital rooms of patients with positive MDRO clinical cultures. Methods Patients with positive clinical cultures of MDROs (carbapenem resistant Acinetobacter baumannii [CRAB], carbapenem resistant Pseudomonas aeruginosa [CRPA], extended spectrum cephalosporin and carbapenem resistant Enterobacterales [ESCRE, CRE] and vancomycin resistant Enterococcus [VRE]) were identified through daily screening of clinical microbiology results. Patient peri-rectal, inguinal, and wound sampling was performed. E-swab and environmental sampling of room surface composites was performed using environmental sponge wipes. Composite 1 included the TV remote, telephone, call button and bed rails. Composite 2 included the room door handle, IV pole and overbed table. Composite 3 included toileting surfaces. Each composite surface area was no more than 350mm3 each. Sponge wipes were expressed in phosphate-buffered saline containing 0.1% Tween 20 using a stomacher. The eluate was concentrated removed leaving ∼ 5mL, and remaining resuspended by vortex. Undiluted suspension was plated on selective MDRO medias and broth. Microbial burden was calculated by summing composites bioburdens. Samples that were only broth positive were given a value of 1 CFU. Table 1.Demographic and Clinical Characteristics of Multidrug-resistant Organisms Positive Patients (n=5)Abbreviation: CRAB: carbapenem-resistant Acinetobacter baumanii, CRPA: carbapenem-resistant Pseudomonas aeruginosa, ESCRE: extended spectrum cephalosporin-resistant Enterobacterales, ESLD: end-stage liver disease, IBD: inflammatory bowel diseases, HTN: hypertension, MDRO: multidrug resistant organism, TBI: traumatic brain injury, VRE: vancomycin resistant enterococcus1- Immunosuppressed defined as solid organ transplant, bone marrow transplant within 12 months, chemotherapy within 6 months, HIV and CD4 &amp;lt;200, any immunomodulatory agent within the past 30 days, at least 10 mg of corticosteroid for &amp;gt;14 daysTable 2.Multidrug-resistant Organism Environmental Contamination and Bioburden of Patients and Environmental CompositesAbbreviation: CRAB: carbapenem-resistant Acinetobacter baumannii, CRPA: carbapenem-resistant Pseudomonas aeruginosa, ESCRE: extended spectrum cephalosporin-resistant Enterobacterales, VRE: vancomycin resistant Enterococcus, ND: not done, NG: no growth, N/A; not applicable1Patient Swab P1: peri-rectal, P2: wound or tracheostomy, P3: inguinal2Environmental Swab C1: TV remote, telephone, call button and bed rails; Composite 2 room door handle, IV pole and overbed table; Composite 3: toileting surfaces Results Five patients were included with target MDROs (1 CRAB, 1 CRPA, 2 ESCRE, 1 VRE). Demographic, clinical, and microbiological characteristics are summarized in Table 1. The same MDRO was detected in the environment of 60% (3/5) patients. Additional MDROs other than the clinical culture were cultured from patient and composite sites swabs (Table 2). Antibiotic susceptibility data confirmed similarity between patient and environmental isolates and identified additional MDROs present (Table 3,4). Additional patient enrollment and WGS isolates from clinical culture, patient and environmental isolates is ongoing. Table 3.Antimicrobial Susceptibility Profile of Isolates from Patients with Concordant Clinical and Environmental MDROsAbbreviation: CRAB: carbapenem-resistant Acinetobacter baumannii, ESCRE: extended spectrum cephalosporin-resistant Enterobacterales, MIC: minimum inhibitory concentration, N/A; not applicableTable 4.Antimicrobial Susceptibility Profile of Concordant Clinical and Environmental MDROsAbbreviation: CRAB: carbapenem-resistant Acinetobacter baumannii, MIC: minimum inhibitory concentration, N/A; not applicable, VRE: vancomycin resistant enterococcus Conclusion Concordance of clinical isolates with environmental isolates suggest that decolonization interventions could reduce environmental bioburden Disclosures All Authors: No reported disclosures.

Cognitive complaints in older adults: relationships between self and informant report, objective test performance, and symptoms of depression

ABSTRACT This study explored the relationships between objective measures of cognitive functioning, self and informant reports of cognitive problems in daily life, and depression screening in older adults who had been referred because of reported or suspected cognitive changes. We used archival data from 100, predominantly White (97%), typically educated (M = 13.25 years), older adults (M = 70.38 years) who received an outpatient neuropsychological evaluation. We characterized the cognitive performance using the CVLT–II Total score. We characterized patient and collateral reports using the BRIEF–A MI index, a normed scale of cognitive problems in daily life. We also incorporated a depression screener (PHQ–9) into our analyses. Multiple linear regression analysis revealed that only the informant reported problems in daily life, using the BRIEF–A MI index, was a significant predictor of objective cognitive deficits, as defined by CVLT–II Total scores. Self BRIEF–A MI index scores were not significant predictors of CVLT–II Total performance after we accounted for depression using the patient’s PHQ–9 score. Additionally, elevated depression widened the discrepancy between raters, with elevated depression associated with worsening sself-report scores compared to informant-reported scores. As informant-reported problems were the strongest predictor of cognitive deficits, we recommend routine collection of collateral informant reports in the neuropsychological evaluation of older adults referred for cognitive concerns. We also recommend incorporating self-ratings of daily life functioning and screening for depression to contextualize patient complaints and address their concerns, even in the absence of objective cognitive dysfunction.