Differences In Need Research Articles

Factors associated with COVID-19 and its outcome in patients with rheumatoid arthritis.

ObjectiveWe assessed the factors associated with COVID-19, clinical manifestations, and a 30-day-prognosis of COVID-19 in a cohort of rheumatoid arthritis (RA) patients compared with the index population.MethodsIn a cross-sectional study, RA patients were followed in rheumatology clinics of Tabriz University of Medical Sciences, and a group of patients diagnosed with COVID-19 from index population were recruited. Outcomes of COVID-19 were assessed by the hospitalization rate and need to intensive care unit (ICU) and mortality. During a period of 12 weeks, 128 RA patients diagnosed with COVID-19, 760 RA control group, and 92 COVID-19 patients from index population were enrolled.ResultsBeing female, obese, and diabetic, having pulmonary disease and chronic kidney disease (CKD), and treatment with prednisolone > 5 mg/d and TNFα inhibitors (TNFis) were independent predictors of COVID-19 in RA patients. Dyspnea, anosmia, and taste loss were more common in RA patients compared with the index population. Admission in hospital, need to ICU care, and mortality occurred in 38, 11.9, and 8.6 percent of RA patients, respectively. Although hospitalization rate in RA patients was more than the index population, there were no significant differences in need to ICU care and mortality between the two groups.ConclusionsTreatment with prednisolone and TNFis and having comorbidities including obesity, diabetes, pulmonary disease, and CKD increase the risk of COVID-19 in RA patients. Although some differences exist in the clinical manifestations of COVID-19 in RA patients and index population, prognosis of COVID-19 in RA patients is not any worse.Key Points• Being female, obese and diabetic, having pulmonary disease, chronic kidney disease (CKD), treatment with prednisolone > 5 mg/d and TNFα inhibitors (TNFis) were independent predictors of COVID-19 in RA patients.• Dyspnea, anosmia and taste loss were more common in RA patients compared with the index population.• Although COVID-19 related hospitalization was higher in RA patients than in the index population, there was no significant differences in the need to ICU care and mortality between the two groups.

Maternal death related to COVID-19: A systematic review and meta-analysis focused on maternal co-morbidities and clinical characteristics.

BackgroundBesides reducing the quality of obstetric care, the direct impact of COVID‐19 on pregnancy and postpartum is uncertain.ObjectiveTo evaluate the characteristics of pregnant women who died due to COVID‐19.Search strategyCochrane Library, Embase, MEDLINE, Scopus, and Google Scholar were searched from inception to February 2021.Selection criteriaStudies that compared deceased and survived pregnant women with COVID‐19.Data collection and analysisRelevant data were extracted and tabulated. The primary outcome was maternal co‐morbidity.Main resultsThirteen studies with 154 deceased patients were included. Obesity doubled the risk of death (relative risk [RR] 2.48, 95% confidence interval [CI] 1.41–4.36, I 2 = 0%). No differences were found for gestational diabetes (RR 5.71; 95% CI 0.77–42.44, I 2 = 94%) or asthma (RR 2.05, 95% CI 0.81–5.15, I 2 = 0%). Overall, at least one severe co‐morbidity showed a twofold increased risk of death (RR 2.26, 95% CI 1.77–2.89, I 2 = 76%). Admission to intensive care was related to a fivefold increased risk of death (RR 5.09, 95% CI 2.00–12.98, I 2 = 56%), with no difference in need for respiratory support (RR 0.53, 95% CI 0.23–1.48, I 2 = 95%) or mechanical ventilation (RR 4.34, 95% CI 0.96–19.60, I 2 = 58%).ConclusionCOVID‐19 with at least one co‐morbidity increases risk of intensive care and mortality.

The prevalence of mental illness and unmet needs of police custody detainees.

Internationally, there is evidence of high rates of mental disorders amongst police custody detainees but this literature is limited, and there has been little research into the unmet needs of police detainees in the UK, orelsewhere. Such research could support better focussedinterventions for improving health and recidivism outcomes. To examine psychiatric and developmental morbidity amongst police detainees, and ascertain differences in need between morbidity categories. We used a cross-sectional study design and interviewed a 40% sample of people entering police custody in one South London police station over a 2-week period. A series of standardised measures was administered to screen for the presence of mental illness, general health and social care needs. A cohort of 134 people was generated, of whom nearly one-third (39, 29%) had current mental illness (major depression and/or psychosis); more had a lifetime diagnosis (54, 40%). Just under a fifth met the threshold for post-traumatic stress disorder (11, 8%). Clinically relevant alcohol or daily cannabis use affected about one quarter of the sample. Twenty-one percent (or 28) screened positive for personality disorder, 11% (or 15) for attention deficit hyperactivity disorder and 4% (6) for intellectual disability. Nearly one-fifth (24, 18%) were at risk for suicide. Those with psychosis, and those deemed at risk for suicide, had the highest levels of unmet need and, indeed, overall need. The most frequent unmet need was for accommodation. Our findings not only confirm high rates of mental health problems amongst police detainees but also demonstrate their high risk of suicide and high levels of unmet need, especially as regards accommodation. This underscores the need to provide mental health services in police stations, to help identify and resolve these issues at this early stage in the criminal justice system. Extending accommodation capacity to help some arrestees may help to save lives and interrupt cycling through the criminal justice system.

A diffusion model analysis of belief bias: Different cognitive mechanisms explain how cognitive abilities and thinking styles contribute to conflict resolution in reasoning

Recent results have challenged the widespread assumption of dual process models of belief bias that sound reasoning relies on slow, careful reflection, whereas biased reasoning is based on fast intuition. Instead, parallel process models of reasoning suggest that rule- and belief-based problem features are processed in parallel and that reasoning problems that elicit a conflict between rule- and belief-based problem features may also elicit more than one Type 1 response. This has important implications for individual-differences research on reasoning, because rule-based responses by certain individuals may reflect that these individuals were either more likely to give a rule-based default response or that they successfully inhibited and overrode a belief-based default response. In two studies, we used the diffusion model to describe decision making in a transitive reasoning task. In Study 1, 41 participants were asked to evaluate conclusions based on their validity. In Study 2, 133 participants evaluated conclusions based on their validity or believability. We tested which diffusion model parameters reflected conflict resolution and related those model parameters to individual differences in cognitive abilities and thinking styles. Individual differences in need for cognition predicted successful conflict resolution under logic instruction, which suggests that a disposition to engage in reflective thinking facilitates the inhibition and override of Type 1 responses. Intelligence, however, was negatively related to successful conflict resolution under belief instruction, which suggests that individuals with high cognitive abilities quickly generated a higher-level logical response that interfered with their ability to evaluate lower-level intrinsic problem features. Taken together, this double dissociation indicates that cognitive abilities and thinking styles affect the processing of conflict information through different mechanisms and at different stages: Greater cognitive abilities facilitate the efficient creation of decoupled problem representations, whereas a greater disposition to engage in critical thinking facilitates the detection and override of Type 1 responses.

An Analytic Cognitive Style Negatively Predicts a More Literal but Not a More Symbolic Religiosity Type

ABSTRACT The idea that a more analytic cognitive style is associated with lower religiosity is a theoretical prediction that has been challenged by some empirical findings. We conducted three studies with Argentine participants (N = 719) to clarify this issue. In Study 1, we replicated the negative correlation between analytic cognitive style, measured with the Cognitive Reflection Test, and Belief in Supernatural Agents, Intrinsic, and Intuitive Religiosity. In Studies 2 and 3, participants responded to the Post-Critical Beliefs Scale which measures both the presence of a transcendent dimension in beliefs and the extent to which literal-vs.-symbolic beliefs are endorsed, and we also tested for individual differences in Need for Cognitive Closure. Results showed that a more analytic cognitive style negatively predicted both inclusion of transcendence and a literal interpretation of religious ideas. Moreoever, an analytic cognitive style was negatively associated with a literal but not with a symbolic inclusion of transcendence in beliefs. In turn, higher scores of closed-mindedness were positively associated with a more literal interpretation of religion. We conclude that present data support the hypothesis that religiosity may be negatively associated with an analytic cognitive style, but individuals who experience religion more symbolically do not accommodate to that pattern.

Sex Disparities in the Presentation of Gallbladder Disease.

Although gallbladder disease is more common in women, there is a trend toward more complicated cases in male patients. All cholecystectomies captured by the National Surgical Quality Improvement Program database for the year 2016 were reviewed. This encompassed 38736 records. Records were reviewed for age, sex, procedure performed, operative time, postoperative diagnosis, functional status, American Society of Anesthesiologists (ASA) class, preoperative lab values (total bilirubin, alkaline phosphatase, white blood cell count, and aspartate aminotransferase. Descriptive and inferential statistical analyses were conducted. Male patients are more likely to undergo cholecystectomy for a diagnosis of cholecystitis, gallstone pancreatitis, or cholangitis than women who are more likely to carry a diagnosis of biliary dyskinesia. The average operative time increases for both sexes as the patients become older. The average operative time is higher for men than women in all age groups and the variance becomes greater as the patients become older. Age, sex, postoperative diagnosis, ASA class, and functional status were all independently significant in predicting operative time. There was no difference in need for cholangiogram between the sexes. Female patients were more likely to have their cholecystectomy completed laparoscopically and they were more likely to have their surgery performed as an outpatient. These data show that women were more likely to present with uncomplicated gallbladder disease, while men were more likely to present with complicated gallbladder disease. This suggests that male patients present at a more advanced stage of disease.

Tocilizumab for Severe and Critical COVID-19 Pneumonia in Queens, NYC.

We retrospectively reviewed charts of patients admitted from March 25 to April 3 with severe or critical COVID-19 pneumonia who received tocilizumab compared with a similar cohort who did not. Analyses were performed to determine differences in outcomes. There was no observed difference in need for mechanical ventilation, length of stay, or mortality rate. In the tocilizumab-treated group, mechanical ventilation rate was 55%, and 49% of patients died. In the control group, 54% required mechanical ventilation and 46% died. Tocilizumab was overall well tolerated, although alanine aminotransferase elevation was more common in the tocilizumab-treated group. Tocilizumab failed to show short-term benefits in clinical outcomes in patients with hypoxic COVID pneumonia at our institution.

Differences in Need for Opioids After Sinonasal Surgery at Day of Surgery and in the Postoperative Period.

In the last years, the use of opioid analgesics has increased, as well as their morbidity and mortality, especially in the United States. Most patients after sinonasal surgery receive opioid analgesics, although up to 90% have leftover opioid pills. Around 70% of these patients keep the opioid analgesics, which could possibly lead to improper use. The objective of the following study was the investigation of the need for, use of, timing and side effects of opioid and non-opioid analgesics after sinonasal surgery. This was a retrospective study of (n = 280) patients who underwent sinonasal surgery in the Otolaryngology Department of the University Erlangen-Nürnberg between January and December 2018. The postoperative pain (3-5 days after surgery) using the numeric rating scale and the postoperative need for on-demand opioids and non-opioid analgesics in relation to demographic and surgical parameters were evaluated. Of total, 59.64% of all patients received opioid analgesics postoperatively on the day of surgery. On the first postoperative day (POD1), the mean pain score yielded the highest values; however, only 0.71% of the patients needed opioid analgesics, and pain was sufficiently controlled with non-opioids or no pain medication at all. There was a significant reduction of the pain score from POD2 to 5 (P = .01; P < .01, respectively). Only 1.8% of the patients needed an opioid analgesic from POD1-5. Of total, 2.1% of the patients presented with a postoperative bleeding complication, and only 1 (0.4%) patient needed endoscopic coagulation. Our results indicate that the majority of patients need opioid analgesics almost exclusively on the day of surgery. There were no major complications in patients taking either opioid or non-opioids. Our results indicate that the postoperative pain regimen from POD1 should initially be started using non-opioid analgesics and be further escalated to opioid analgesics in individual cases.

Characteristics of Hospitalized Children With SARS-CoV-2 in the New York City Metropolitan Area.

To describe the characteristics of hospitalized children with severe acute respiratory syndrome coronavirus 2 in New York City metropolitan area. This was a multicenter, retrospective cohort study at 4 hospitals comprising 82 hospitalized children (0-21 years) who tested positive for severe acute respiratory syndrome coronavirus 2 after symptoms and risk screening between March 1 and May 10, 2020. We subdivided patients on the basis of their admission to acute or critical care units and by age groups. Further subanalyses were performed between patients requiring respiratory support or no respiratory support. Twenty-three (28%) patients required critical care. Twenty-nine (35%) patients requiring respiratory support, with 9% needing mechanical ventilation, and 1 required extracorporeal support. All patients survived to discharge. Children with any comorbidity were more likely to require critical care (70% vs 37%, P = .008), with obesity as the most common risk factor for critical care (63% vs 28%, P = .02). Children with asthma were more likely to receive respiratory support (28% vs 8%, P = .02), with no difference in need for critical care (P = .26). Children admitted to critical care had higher rates of renal dysfunction at presentation (43% vs 10%, P = .002). Children with comorbidities (obesity and asthma in particular) were at increased risk for critical care admission and/or need for respiratory support. Children with renal dysfunction at presentation were more likely to require critical care.

Clinical Profile, Need for Dialysis and Mortality of Community Acquired versus Hospital Acquired Acute Kidney Injury

Introduction: Occurrence of Acute Kidney Injury (AKI) is high in hospitalised and critically ill patients. Most of the cases reported by the developed countries are Hospital Acquired Acute Kidney Injury (HA-AKI). AKI is a major medical complication in the developing world also and is due to predominantly community acquired causes, where the epidemiology differs from that in developed countries. Many studies have reported that Community Acquired Acute Kidney Injury (CA-AKI) and HA-AKI differ in mortality, need for renal replacement and residual renal injury. Aim: To know the difference in need for renal replacement therapy and in-hospital mortality between patients diagnosed with CA-AKI and HA-AKI using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Materials and Methods: A prospective cohort study was conducted from January 2018-December 2018 after obtaining Institutional Ethical Clearance by comparing 50 cases of CA-AKI and 50 cases of HA-AKI admitted by the General Medicine Department as per the inclusion and exclusion criteria. Serum Creatinine (S.Cr) at admission, after 48 hours and at the time of discharge were measured. Serial urine output measurements were done. Need for dialysis was noted in both the groups. Both groups were compared based on need for dialysis, difference in mortality and residual renal injury at the time of discharge. Chi-square and student t-tests were applied respectively and p-value ≤0.05 was considered as significant. Statistical Package for Social Sciences (SPSS) version 17.0 was used for data entry and analysis. Results: the CA-AKI and HA-AKI groups were comparable in age and gender but differed in some co-morbidities. CA-AKI group had underlying hepatobiliary disorders and Non steroidal Anti-Inflammatory Drug (NSAID) abuse more often than HA- AKI group. There was a significant reduction in S.Cr over the duration of hospital stay in CA-AKI (mean S.Cr at admission was 4.85 mg/dL, at 48 hours 2.05 mg/dL and at discharge 1.20 mg/dL). S.Cr increased after 48 hours of admission from baseline and declined later in HA-AKI but did not reach baseline in many patients in comparison to CA-AKI group (mean S.Cr at admission was 1.10 mg/dL, at 48 hours 2.38 mg/dL, at discharge 1.57 mg/dL). The highest stage of AKI was stage 3 in CA-AKI group (22 vs 11 of HA-AKI). HA-AKI group had more number of patients in stage 2 AKI (26 vs 18 of CA-AKI). There was no significant difference in mortality and requirement of haemodialysis between CA-AKI and HA-AKI groups. Conclusion: There was no difference between the two groups in terms of mortality and need for renal replacement therapy but there was significant residual renal injury in HA-AKI group.

Inhaled Nitric Oxide via High-Flow Nasal Cannula in Patients with Acute Respiratory Failure Related to COVID-19.

INTRODUCTIONLimited evidence exists regarding use of inhaled nitric oxide (iNO) in spontaneously breathing patients. We evaluated the effectiveness of continuous iNO via high-flow nasal cannula (HFNC) in COVID-19 respiratory failure.METHODSWe performed a multicenter cohort study of patients with respiratory failure from COVID-19 managed with HFNC. Patients were stratified by administration of iNO via HFNC. Regression analysis was used to compare the need for mechanical ventilation and secondary endpoints including hospital mortality, length of stay, acute kidney injury, need for renal replacement therapy, and need for extracorporeal life support.RESULTSA total of 272 patients were identified and 66 (24.3%) of these patients received iNO via HFNC for a median of 88 h (interquartile range: 44, 135). After 12 h of iNO, supplemental oxygen requirement was unchanged or increased in 52.7% of patients. Twenty-nine (43.9%) patients treated with iNO compared to 79 (38.3%) patients without iNO therapy required endotracheal intubation (P = .47). After multivariable adjustment, there was no difference in need for mechanical ventilation between groups (odds ratio: 1.53; 95% confidence interval [CI]: 0.74-3.17), however, iNO administration was associated with longer hospital length of stay (incidence rate ratio: 1.41; 95% CI: 1.31-1.51). No difference was found for mortality, acute kidney injury, need for renal replacement therapy, or need for extracorporeal life support.CONCLUSIONIn patients with COVID-19 respiratory failure, iNO delivered via HFNC did not reduce oxygen requirements in the majority of patients or improve clinical outcomes. Given the observed association with increased length of stay, judicious selection of those likely to benefit from this therapy is warranted.

Comparison of Respiratory Outcome between Sustained Lung Inflation and Intermittent Positive Ventilation in Preterm Infants Requiring Resuscitation at Birth

Background: Sustained lung inflation (SLI) would permit lung recruitment immediately after birth, improving lung mechanics and reducing the need for intubation and subsequent respiratory support in the neonatal intensive care unit among preterm infants. Aim of the Study: To assess the efficacy of initial sustained lung inflation compared to standard intermittent positive pressure ventilation (IPPV) in preterm infants who need resuscitation in delivery room. Methods: This was prospective randomized observational study that was conducted in the delivery room and NICU of A in shames University hospital from February 2019 to September 2019. The study included 115 preterm infants between 26 - 32 weeks of gestation who needed resuscitation at delivery room. The infants were randomly allocated into 2 groups; SLI group: included the preterm infants who received the SLI at initial inflation pressure of 25 cm H2O for 15 seconds using the Neopuff/T piece. IPPV group: preterm infants who received standard resuscitation; IPPV using the self-inflating bag. The heart rate (HR), oxygen saturation (SpO2), oxygen requirement, and intubation rate as well as need of surfactant in the delivery room were assessed. All cases were evaluated after admission to the NICU for the need of mechanical ventilation in the first 72 hours of life, death in delivery room or NICU and for bronchopulmonary dysplasia or death at 36 weeks post menstrual age (PMA). Results: The percentage of preterm infants who needed resuscitation was 25.5% from the total deliveries during the study period. 56.5% of them received SLI and 43.4% received conventional IPPV. There were no significant differences between the studied groups regarding gestational age, birth weight. Apgar score, heart rate, oxygen saturation was not significantly increased in the SLI group at fifth minutes of age. The percentage of infants who needed further resuscitation was 20% in SLI group and 12% in the IPPV group. There were no significant differences in need for surfactant, CPAP or ventilator among the studied groups. There were no significant differences in relation to complications as BPD, air leak or retinopathy and death between the two groups. Conclusion: This study showed that there was no advantage from use of SLI in delivery room using T-piece upon the conventional IPPV using self-inflating bag.

Individual differences in adolescents’ willingness to invest cognitive effort: Relation to need for cognition, motivation and cognitive capacity

There exist large individual differences in students’ willingness to invest cognitive effort within the academic domain. In a preregistered study, we investigated whether individual differences in adolescents’ willingness to invest cognitive effort, as assessed by an experimental effort discounting task, were related to need for cognition, academic motivation and cognitive capacity. We found that adolescents’ willingness to invest cognitive effort was related to need for cognition and cognitive capacity as indexed by task-performance. Our results demonstrate that individual differences in need for cognition and cognitive capacity contribute to differences in adolescents’ cognitive effort-investment, but academic motivation does not.

Explantation of High Submuscular Reservoirs: Safety and Practical Considerations

BackgroundOver the past decade, high submuscular (HSM) placement of inflatable penile prosthesis (IPP) reservoirs has emerged as a viable alternative to space of Retzius (SOR) placement; however, data comparing the feasibility and complications of HSM vs SOR reservoir removal do not presently exist. AimTo present a comparison of the safety, feasibility, and ease of removal of HSM vs SOR reservoirs in a tertiary care, university-based, high-volume prosthetic urology practice. MethodsData were retrospectively collected on patients who underwent IPP reservoir removal between January 2011 and June 2020. Cases were separated into 2 cohorts based on reservoir location. Statistical analysis was performed using Fisher's exact and Chi-squared tests for categorical variables and Student's t-test for continuous variables. Timing from IPP insertion to explant was compared between the HSM and SOR groups using the Mann-Whitney U test. OutcomesTime from IPP insertion to explant, operative time, intraoperative and postoperative complications, and need for a counter incision were compared between the HSM and SOR groups. ResultsBetween January 2011 and June 2020, 106 (73 HSM, 33 SOR) patients underwent IPP removal or replacement by a single surgeon at our institution. Average time from IPP insertion to removal was 43.6 months (24.2 HSM, 52.7 SOR, P = .07)—reservoir removal occurred at the time of device explant in 70 of 106 (66%) cases. More HSM reservoirs were explanted at the time of IPP removal compared with the SOR cohort (54 of 73, 74% HSM vs 16 of 33, 48.5% SOR, P = .01). Similar rates of complications were noted between the HSM and SOR groups (1.9% vs 6.3%, P = .35). There was no significant difference in need for counter incision between the 2 groups (24 [42%] HSM vs 4 [25%] SOR, P = .16) or in average operative times (76.5 ± 38.3 minutes HSM vs 68.1 ± 34.3 minutes SOR, P = .52). Clinical ImplicationsOur experience with explanting HSM reservoirs supports the safety and ease of their removal. Strengths and LimitationsAlthough the absolute cohort size is relatively low, this study reflects one of the largest single-institution experiences examining penile implant reservoir removal. In addition, reservoir location was not randomized but was instead determined by which patients presented with complications necessitating reservoir removal during the study period. ConclusionsHSM reservoir removal has comparable perioperative complication rates and operative times when compared with SOR reservoir removal.Kavoussi M, Bhanvadia RR, VanDyke ME, et al. Explantation of High Submuscular Reservoirs: Safety and Practical Considerations. J Sex Med 2020;17:2488–2494.

The Impact of ABO Blood Group on Clinical Outcomes and Susceptibility in COVID-19: A Retrospective Population Study of 3305 Patients

Background:Factors determining inherent susceptibility to infection with the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and the risk of severe outcomes in infected individuals remain poorly understood. Landsteiner ABO blood groups have been linked to host susceptibility to various infections through the interaction of the carbohydrate moieties defining ABO antigens with micro-organisms and the immune system. Previous studies of the original SARS coronavirus (SARS-CoV-1) demonstrated a decreased susceptibility to infection in group O individuals (Cheng et al. JAMA 2005; 293:1450-1) and the ability of plasma-derived anti-A antibodies to block the interaction between viral spike protein and human angiotensin-converting enzyme 2 receptor in vitro (Guillon et al. Glycobiology 2008; 18:1085-93). A recent genome-wide association study of patients with respiratory failure complicating coronavirus disease 2019 (COVID-19) suggested a higher risk of severe disease in group A, and a protective effect in group O (Ellinghaus et al. NEJM 2020 DOI:10.1056/NEJMoa2020283). Since the inception of the COVID-19 pandemic, a broad testing strategy was implemented in Kuwait and all individuals testing positive for SARS-CoV-2 were admitted to a single facility, including asymptomatic individuals. Here we examined the clinical outcomes of this cohort with respect to ABO blood group and compared its blood group distribution to that of the general population.Methods:All patients testing positive for SARS-CoV-2 by polymerase chain reaction assay of a nasopharyngeal swab specimen that were admitted to Jaber Hospital between February 24th to May 27th 2020 were included in the study. Relevant demographic and clinical data were extracted from hospital records. An anonymized summary of the distribution of blood types of the entire population of Kuwait was obtained from a national database and used as a control group. Clinical outcomes were in accordance with international consensus definitions. Appropriate statistical tests were used for bivariate analysis. Multivariate logistic regression was performed to determine relationships between variables of interest and outcome.Results:Of 3305 SARS-CoV-2 positive patients 37.1%, 25.5%, 28.9% and 8.5% were group O, A, B and AB respectively. 69.2% were male and 30.8% were female. Median age was 42 years. 48.1% were Kuwaiti citizens and 51.9% were non-Kuwaiti. Commonest comorbidities were hypertension (21.5%) and diabetes (20.1%). 17.4% were obese. 37.2% were asymptomatic on admission. There was no significant difference in baseline characteristics among the blood groups. Univariate analysis of clinical outcomes revealed no significant differences in need for oxygen support, admission to intensive care, intubation or death among the blood groups. However, rates of any adverse event and pneumonia differed significantly (Table 1). Multivariable analysis adjusted for age, sex, obesity and comorbidities showed that group A had higher odds of developing pneumonia compared to the other blood groups combined (adjusted odds ratio 1.32, 95% confidence interval 1.02-1.72, p<0.0363). We found no relationship between pneumonia and other blood groups. Compared to the general population, the COVID-19 cohort had a lower frequency of group O, equivalent frequency of group A and higher frequency of groups B and AB (Table 2). This trend was independent of nationality (Kuwaiti versus non-Kuwaiti). Incorporation of Rh (D) status did not impact the trend observed with ABO blood groups. Finally, no significant difference in Rh (D) status was found between the COVID-19 and general populations (Rh positive 93.4% versus 93.6% respectively, p=0.99)Conclusion:In a large, unselected patient population, no association between blood group and severe clinical outcomes in COVID-19 was found. Consistent with reports in other populations, we found a lower prevalence of blood group O in SARS-CoV-2 positive individuals and higher prevalence of blood group B and AB implicating a potential role of ABO blood group in susceptibility to infection. No association between SARS-CoV-2 infection with blood group A or Rh (D) group was found. Further examination of the mechanistic link between ABO antigens, antibodies and SARS-CoV-2, and its implications on controlling the current pandemic is warranted.DisclosuresNo relevant conflicts of interest to declare.

Opioid Consumption Following Breast Reconstruction Decreases With a Brief Educational Intervention: A Randomized, Controlled Trial

PURPOSE: There has been a focus on opioid consumption and overprescribing, but the utility of patient education in reducing opioid consumption has only recently been explored. This randomized trial aimed to evaluate the effectiveness of a brief patient educational intervention in reducing pain and opioid consumption in patients undergoing mastectomy and breast reconstruction. We hypothesized that implementation of an educational intervention on pain control would decrease postoperative opioid consumption. METHODS AND MATERIALS: A parallel, randomized, single-center controlled trial of women undergoing mastectomy and immediate, implant-based breast reconstruction was completed to evaluate the utility of a patient educational instrument. The control group received standard patient counseling, and the treatment group received an additional single-paged handout intervention. Goals of the educational instrument were to normalize the pain experience, set expectations for pain after surgery, and inform patients of alternative (nonopioid) methods of pain control. A questionnaire was administered postoperatively to collect data on pain control and opioid consumption. RESULTS: Over a 12-month time period, 100 patients were randomized. A total of 46 participants from the control group (92%) and 39 participants from the intervention group (78%) completed the postoperative questionnaire. Postoperative questionnaires were completed a median of 13.0 days after surgery in both groups. Review of the electronic medical record showed similar demographics and comorbidities between the control and intervention groups; however, participants in the control group were statistically more likely to be a current tobacco user (P = 0.04). There were no statistical differences in surgical characteristics or postoperative prescriptions between the 2 groups. All outcome analysis was performed according to intended treatment groups. A statistically significant reduction in the number of opioid tablets consumed was seen in the intervention group (control 24.3, SD 21.8; intervention 16.2, SD 16.4; P = 0.05). Although immediate postoperative prescriptions were equivalent between the 2 groups, more participants in the control group required a prescription refill compared to the intervention group (control n = 10, 21%; intervention n = 6, 12%; χ2 = 1.3; P = 0.3). Due to the differences in need for prescription refill, the total average number of opioid tablets prescribed to the control group was statistically higher than the intervention group (control 46.6, SD 21.8; intervention 39.2, SD 11.9; P = 0.04). There was a marginal trend toward lower average postoperative pain scores reported by the intervention group (control 3.6/10, SD 1.6; intervention 3.0/10, SD = 1.8; P = 0.06). CONCLUSIONS: This study was successful in trialing an easily implemented, brief intervention. When tested in a randomized population of breast reconstruction patients, the instrument was found to reduce opioid consumption, while maintaining noninferior pain control and need for opioid refills. The effectiveness of a brief patient education tool on patient opioid consumption has been shown, and implementation of similar protocols in this patient population is recommended.

Health care utilization by women sexual assault survivors after emergency care: Results of a multisite prospective study.

Approximately, 100,000 US women receive emergency care after sexual assault each year, but no large-scale study has examined the incidence of posttraumatic sequelae, receipt of health care, and frequency of assault disclosure to providers. The current study evaluated health outcomes and service utilization among women in the 6 weeks after sexual assault. Women ≥18 years of age presenting for emergency care after sexual assault to twelve sites were approached. Among those willing to be contacted for the study (n = 1080), 706 were enrolled. Health outcomes, health care utilization, and assault disclosure were assessed via 6 week survey. Three quarters (76%) of women had posttraumatic stress, depression, or anxiety, and 65% had pain. Less than two in five reported seeing health care provider; receipt of care was not related to substantive differences in symptoms and was less likely among Hispanic women and women with a high school education or less. Nearly one in four who saw a primary care provider did not disclose their assault, often due to shame, embarrassment, or fear of being judged. Most women receiving emergency care after sexual assault experience substantial posttraumatic sequelae, but health care in the 6 weeks after assault is uncommon, unrelated to substantive differences in need, and limited in socially disadvantaged groups. Lack of disclosure to primary care providers was common among women who did receive care.

What is the Impact of Abnormal Amniotic Fluid Volumes on Perinatal Outcomes in Normal Compared with At-Risk Pregnancies?

ObjectiveAssessing amniotic fluid volume is an integral part of obstetric practice. Data are sparse on at-risk pregnancy and amniotic fluid volumes. The aim of our study was to determine if there is a difference in perinatal outcomes based on complications of pregnancy and amniotic fluid volumes. We hypothesized that at-risk pregnancies with abnormal amniotic fluid volumes would have worse perinatal outcomes than normal pregnancies with abnormal amniotic fluid volumes.Study DesignThis retrospective cohort study evaluated both normal and at-risk singleton pregnancies with intact membranes on admission for delivery. Amniotic fluid volumes were estimated using both the amniotic fluid index (AFI) and single deepest pocket (SDP) techniques. All sonograms were performed by trained ultrasound technicians or obstetrician/gynecologists. We placed 3365 women into 6 separate groups (at-risk versus normal, then further stratified by oligohydramnios by SDP, normal fluid, or polyhydramnios by AFI).ResultsAt-risk pregnancies with normal fluid and at-risk pregnancies with polyhydramnios have significantly increased risk of neonatal intensive care unit (NICU) admission [OR 2.06 (95% CI 1.63,2.60), OR 2.74 (95% CI 1.54, 4.87)]. Birthweight is significantly higher in at-risk and normal pregnancies with polyhydramnios than those with normal pregnancies and normal fluid (p<0.0001). Birthweight is significantly lower in at-risk pregnancies with oligohydramnios (p<0.0001). There were no significant differences in need for amnioinfusion in labor, variables or lates influencing delivery, meconium staining, or umbilical artery pH <7.1.ConclusionOur study attempted to further define risk of adverse pregnancy outcomes by defining the pregnancy as normal or at-risk and amniotic fluid volumes. Contrary to our hypothesis, we did not find an increased risk of many of the adverse perinatal outcomes we studied amongst at-risk pregnancies with abnormal fluid. There was an increased risk of NICU admission associated with polyhydramnios in normal and at-risk pregnancies.

S0036 Examining Healthcare Utilization Trends for Acute Pancreatitis in a Large Health System

INTRODUCTION: Acute pancreatitis (AP) is the third most common cause of gastrointestinal (GI)-related hospitalizations in the US and the fourth leading GI illness associated with all-cause 30-day readmissions. Readmissions are associated with increased healthcare utilization as well as mortality from AP at one year. To minimize risk for readmissions, guidelines recommend smoking/alcohol cessation counseling and same-admission cholecystectomy for alcoholic and gallstone AP, respectively. We examined healthcare utilization trends for AP using encounters as a proxy within a large health system. METHODS: ICD-10 codes for AP were used to identify patients who presented to emergency departments (ED) within the MedStar Health system between March 2015 and June 2019. 4,043 patient encounters were eligible for retrospective chart review; these included ED visits and inpatient admissions. Manual review yielded 2,542 charts with extractable clinical information, 1,903 of which had AP as defined by Revised Atlanta Classification (RAC). Variables such as demographics, ever-history of AP, and recent AP within the past 30 days requiring an ED visit were collected. Statistical analysis was performed using GraphPad PRISM. RESULTS: Of 1,903 patients who satisfied RAC for AP, 184 (9.67%) had represented within 30 days following discharge from index presentation. Of those who returned, 22.3% had gallstone pancreatitis and 27.7% had alcoholic pancreatitis as their diagnosis on index hospitalization. 39.7% of those with gallstone pancreatitis had a same-admission cholecystectomy. Those with ever-history of AP were more likely to return following discharge (OR 1.51, P = 0.0136); this effect was more pronounced in patients who had presented immediately prior to index encounter (OR 3.62, P < 0.001). Those who had a previous encounter within the past 30 days had a statistically significant longer length of stay. There was no statistically significant difference in need for ICU level of care between those who were admitted within past 30 days and those who were not. CONCLUSION: Patients with prior encounters for AP are at increased risk for returning to an acute care site and thus increased healthcare utilization. These re-encounters tend to be associated with longer length of stays. Following guidelines and identifying subpopulations most at risk for readmissions would allow for targeted interventions to decrease healthcare utilization.

Randomized clinical trial comparing PEG-based synthetic to porcine-derived collagen membrane in the preservation of alveolar bone following tooth extraction in anterior maxilla.

The objective of this randomized controlled trial was to compare alveolar ridge preservation using a bone substitute material and covered with a synthetic or porcine collagen membrane. Thirty-two sockets in the aesthetic maxillary region of 30 patients were randomized into two groups. Randomization was stratified according to bone wall defect. Flapless technique was used, and sockets were grafted with bi-phasic calcium phosphate particulate bone substitute and covered by synthetic polyethylene glycol (PEG; test group) or porcine-derived collagen membrane (CM; control group). No primary closure was attempted. A cone beam computed tomography (CBCT) scan was performed immediately after the surgical procedure and repeated 22weeks later. OnDemand3D was used to superimpose scan images and assess changes. The mean vertical and horizontal percentage bone loss were calculated and implants placed after 6months with or without additional augmentation. There were no baseline differences between groups or dropouts. The mean percentage loss at the labial plate and at the coronal part of the sockets was statistically significantly lower in the test group compared with controls (-2.86% [SD=13.48] versus 7.42% [SD=11.95]; 13.45% [SD=11.97] versus 28.59% [SD=16.97]). Implants were placed after 6months, and there was no difference in need for further augmentation between PEG (n=5) or CM (n=4). Sites treated with PEG membrane showed less percentage loss in horizontal and vertical measurements in this trial.