Effectiveness Of Specific Interventions Research Articles

A standard set of outcome measures for the comprehensive assessment of osteogenesis imperfecta

BackgroundOsteogenesis Imperfecta (OI) is a genetic disorder also known as ‘brittle bone disease’. The clinical manifestation of OI shows a wide variation. Therefore, care for patients with OI requires an interdisciplinary approach. The effectiveness of particular interventions and treatment protocols of interdisciplinary teams is not clear due to a non-standardized and wide variation of patient outcomes thus making the comparison of outcome measures available in the literature difficult. It is only by agreeing on a common, standard set of outcome measures for the comprehensive appraisal of OI that comparisons across interdisciplinary treatment centers for OI will be possible in the future.MethodsThe Key4OI international interdisciplinary working group of 27 members used a consensus-driven modified Delphi approach to develop a set of global outcome measures for patients with OI. The International Classification of Functioning, Disability and Health (ICF), was used to define domains and organize the outcomes from the literature search. After reviewing the outcomes extracted from the literature, trials and registries, the working group agreed on a final selection of domains and their definition (ICF definition as well as a lay description). These domains were then presented to the focus groups who prioritized the outcome domains by taking into account the items important to the OI community. All content was collected and analyzed and final domains were determined. A consensus of appropriate measuring instruments for each domain was reached with Delphi rounds. The entire approach was in line with the International Consortium for Health Outcomes Measurement ICHOM methodology.ResultsMore than 400 different outcome measures were identified in our literature search. After three Delphi rounds, 24 domains were selected. After the focus group sessions, the number of domains were reduced to 15. A consensus was reached on the measuring instruments to cover these domains for both children and adults.ConclusionThe Key4OI project resulted in standard set of outcome measures focused on the needs and wishes of individuals with OI and their families. This outcome set will enable healthcare teams and systems to compare and to improve their care pathways and quality of care worldwide. Further studies are needed to evaluate the implementation of this standardized outcome set.

Ibuprofen-derived fluorescence inhibitor of COX-2 for breast cancer imaging, prevention and treatment

The integration of precise detection, long-term prevention and effective treatment are beneficial to monitor cancer bioactivity and prevent malignant metastasis for breast cancer patients. Herein, a novel fluorescence probe (IBLN) is designed and synthesized which contains a fluorophore (naphthalimide), a linker and a non-steroidal anti-inflammatory drug (ibuprofen). The specific optical imaging, prevention and treatment effects of breast cancer are relied on the introduction of a powerful cyclooxygenase-2-specific inhibitor, ibuprofen, which makes IBLN possible to successfully differentiate breast cancer cells from normal cells. In addition, fluorescent cellular imaging agent naphthalimide also has anticancer effects via inducing lysosomal membrane permeabilization (LMP). The multi-functional ibuprofen-derived fluorescence inhibitor IBLN realizes the imaging, prevention and treatment for breast cancer, which the selectivity and anticancer effects would be strengthened compared to the single naphthalimide or ibuprofen. Therefore, we envisage that the multi-function strategy in IBLN would be attractive way to explore potential reagent for fluorescence-visible breast cancer therapy in situ.

Determination of Potential Drug Candidate Molecules of the Hypericum perforatum for COVID-19 Treatment.

The novel human coronavirus was firstly emerged in December 2019 in Wuhan, China, and has spread rapidly around the world. There is no known specific effective treatment of COVID-19. The most commonly used agents against this disease both in Turkey and around the world include chloroquine, hydroxychloroquine, lopinavir/ritonavir, favipiravir, and remdesivir. In the study, we investigated the drug potential of molecules that the components of an important medicinal plant Hypericum perforatum by using molecular docking and drug possibility properties of these molecules. The molecular docking results showed that the most stable complex was obtained with COVID-19 main protease and hypericin/isohypericin ligands with − 11 kcal/mol binding energy. Furthermore, ADMET, drug-likeness features of compounds of H. perforatum were investigated using the rules of Lipinski, Veber, and Ghose. According to the results obtained, it has been shown that H. perforatum has the potential to be an effective drug in the COVID-19 pandemic. In the next stage, it is necessary to carry out the clinically necessary reliability studies of these components. It is thought that it can be used for the treatment of COVID-19 if our molecular docking results are found to be in high correlation with clinical studies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40495-021-00254-9.

A perspective on the governance of London’s subsurface

The role of the urban subsurface for cities has long been disregarded but is recently getting more attention. To capture it, the city’s geographical and geological setup, its history and the social context it is located within are of particular relevance. As a case study, this paper illustrates the context and governance of London’s subsurface through the lens of a ‘governance arrangement’ looking at these three elements. It is highlighted that feedback loops between the material reality and the societal context – human influences on the subsurface environment – are not sufficiently recognised. The paper demonstrates how the discretionary nature of the UK’s planning system puts local planning authorities on the one hand, and engineers and technical knowledge on the other hand, in central positions to mediate strategic plans and influence specific project applications and decisions. From the empirical analysis presented here, no sense of urgency is assigned to the concept of underground space planning in London at this moment in time. However, the analysis suggests a need for better understanding of the spatial and material effects of specific interventions, as well as of the according policies and strategies. Current discourses around underground data sharing or geothermal energy provision could facilitate the process towards a spatial integration of the various strategies that are in place.

Safety and Efficacy of Sofosbuvir in Hospitalized Adult Patients with SARS-CoV-2: A Preliminary Report

Background: Despite the worldwide spread of the SARS-CoV-2, an effective specific antiviral treatment for COVID-19 is yet to be identified. Here we report the preliminary results of the phase II open-label clinical trial of the safety and efficacy of Sofosbuvir as antiviral therapy among hospitalized adult patients with SARS-CoV-2.Methods: The study was randomized, controlled, open-label phase II clinical trial in hospitalized adult patients with SARS-CoV-2. Patients were randomized into intervention arm receiving Sofosbuvir or comparison arm receiving usual antiviral agents in addition to standard of care. The primary end point of the study was clinical recovery as defined by normal body temperature and normal oxygen saturation, sustained for at least 72 hours within 14 days since the initiation of antiviral therapy. The main secondary outcome was all-cause mortality during the admission in hospital or within 14 days after discharge if applicable. Reports of Severe adverse events were observed in the intervention arm.Findings: From April to Sep 2020, ninety patients were recruited in the study. Thirty-three patients were excluded before enrollment. Fifty-seven patients enrolled into either the clinical trial arm (n = 27) or the comparison arm (n = 30). Primary outcome was achieved by 24 (88.9%) in the intervention arm and 10 (33.3%) in the comparison arm. The intervention arm had a significantly shorter median hospital length of stay [10days (IQR 5-12)] than the comparison group [11.5 days (IQR 8.5-17.75)] (P = 0.016).All-cause mortality was two and thirteen in intervention and comparison groups respectively. No serious adverse events were reported by the patients receiving Sofosbuvir during the study.Interpretation: Among adult patients hospitalized with SARS-CoV-2, those who received Sofosbuvir had more clinical recovery rate and had a shorter hospital length of stay than those who received usual antiviral agents in the study and these differences were statistically significant. Trial Registration: (Iranian Registry of Clinical Trials Number, IRCT20200328046882N1)Funding Statement: Funding by Deputy of Research in Shahid Beheshti University of Medical Sciences.Declaration of Interests: None to declareEthics Approval Statement: The study was approved in the institutional review boards of Shahid Beheshti University of Medical Science (IR.SBMU.REC.1399.001).

A randomized study of lyric analysis on recognition, taking steps, and commitment to sobriety in adults on a detoxification unit

ABSTRACT Background: Motivation represents a core concept in substance use disorder (SUD) treatment while commitment constitutes a compelling construct lacking empirical investigation. Although music therapy can positively impact motivation in people with SUD, randomized research measuring the effects of specific interventions on commitment is warranted. Purpose: The purpose of this cluster-randomized effectiveness study was to determine the effects of a single lyric analysis (LA) session on recognition, taking steps, and commitment to sobriety in adults with SUD on a detoxification unit. Method: Adults with SUD hospitalized on a detoxification unit (N = 128) were randomly assigned by cluster to one of two single-session conditions: LA or control. Results: Although there was no significant between-group difference in recognition or taking steps, LA participants had slightly higher mean scores on these measures than control participants. There was a significant between-group difference in commitment to sobriety (p = .046), with LA participants having higher commitment to sobriety than control participants. Conclusions: Despite the temporal limitations of single-session therapy typical of detoxification units, LA may represent an engaging and effective intervention to address motivation and commitment in adults with SUD. Implications for clinical practice, limitations, and suggestions for future research are provided.

Telepsychiatry in Low- and Middle-Income Countries During COVID-19: Pandemic, Barriers, and Road Model.

To date, there is lack of specific effective treatment or vaccine for the SARS-CoV-2, and clinical and laboratory research is still ongoing to find successful drugs. Therefore, prevention to be infected through social distancing and isolation is the most effective way. However, all the other physical and mental illnesses continue to exist, if possible even more burdened by the emergency situation and social distancing. The COVID-19 pandemic, especially in many low- and middle-income countries, has caused a deeper gap in seeking psychiatric help. In this scenario, telepsychiatry could play a decisive role in implementing clinical care for frail patients and ensuring continuous mental care. Therefore, we felt the urge to write this article to express our hope that the old health care system at this time of crisis, as we know it, can offer the chance to implement pervasive care technologies that perfectly fit current psychiatric needs.

Pain-related beliefs, cognitive processes, and electroencephalography band power as predictors and mediators of the effects of psychological chronic pain interventions.

The current study used data from a clinical trial to identify variables that are associated with and/or mediate the beneficial effects of 4 psychological chronic pain treatments: one teaching patients self-hypnosis to reduce pain intensity (HYP), one teaching self-hypnosis to change thoughts about pain (hypnotic cognitive therapy [HYP-CT]), one teaching cognitive restructuring skills to change thoughts about pain (cognitive therapy [CT]), and one providing education about pain (ED; included as an active control condition). Of 17 possible mechanism variables examined, and with alpha not corrected for multiple comparisons, significant between-group differences were observed for 3. Two of these (changes in beliefs about control over pain and number of days of skill practice) were supported as mediators of the beneficial effects of HYP, CT, or HYP-CT, relative to ED. Six mechanism variables evidenced significant pretreatment to post-treatment changes in the sample as a whole, without showing significant between-group differences. Pretreatment to post-treatment changes in all 6 were associated with improvements in pain interference, pain intensity, or both. In addition, participant ratings of therapeutic alliance at post-treatment were associated significantly with improvements in both pain intensity and pain interference in the sample as a whole. Thus, of the 17 possible mediators examined, there were relatively few that served as mediators for the beneficial effects of specific treatments; a larger number of variables predicted treatment outcome overall. The extent to which these variables are treatment mediators (ie, are responsible for, rather than merely associated with, treatment-related improvements) will require further research.

Effects of ultrasound on the enzymatic degradation of pectin

Ultrasound-assisted enzymatic maceration (UAEM) has gained considerable interest in the fruit juice industry, owing to its potential to increase juice yield and content of polyphenols while simultaneously saving time and energy. In this study, the effects of UAEM (ultrasonic probe, 20 kHz, 21 W*cm−2 and 33 W*cm−2) on pectin degradation in a continuous circulation system were investigated over 60 and 90 min. Main pectinolytic enzymes activities of (polygalacturonase, pectin lyase and pectin methylesterase) of a commercial enzyme preparation were examined for individual synergistic effects with US. Pectin hydrolysis by UAEM differed significantly compared to treatment with ultrasound or enzymes alone regarding the profile of degradation products compared to treatment with ultrasound or enzymes alone. Ultrasound fragmented pectin to less branched oligomers of medium molecular weight (Mp approx. 150 kDa), which were further degraded by pectinolytic activities. The low molecular weight fraction (<30 kDa), which is known to be beneficial for juice-quality by adding nutritional value and stabilizing polyphenols, was enriched in small oligomers of homogalacturonan-derived, rhamnogalacturonan I-derived, and rhamnogalacturonan II-derived residues. Synergistic effects of ultrasound application enhanced the effective activities of polygalacturonase and pectin lyase and even prolonged their performance over 90 min, whereas the effective activity of pectin methylesterase was not affected. Final marker concentrations determined by each enzyme assay revealed a considerable higher total process output after UAEM treatment at reduced temperature (30 °C) comparable to the output after conventional batch maceration at 50 °C. The obtained results demonstrate the high potential of UAEM to produce high-quality juice by controlling pectin degradation while reducing process temperature and equally highlight the matrix and enzyme specific effects of a simultaneous US treatment.

CORONAVIRUS DISEASE-19: A HOLISTIC PERSPECTIVE

Even when the predictions of effective specific antiretroviral treatment improved after 1996, many scientists and health professionals stayed committed to a dominant role of prevention over treatment and care. With the growing need for vaccines and safer drugs, greater attention is now toward the traditional system of medicine. Charak Samhita explains epidemics and its etiological factor in Janapadodhwamsa Adhyay of Vimansthan 3. Ayurveda and Yoga have immersed to have great combat with coronavirus disease (COVID-19) to maintain your overall health. The present study is aimed to get, a holistic approach that suggests a preventive approach and strengthening of Bala and Oja. Ayurveda and Yoga give importance to physical immunity and also psychological immunity as well. By following Rasayan, Sadvritta, Acharasayan, Astanga Yoga and Satvik Karma one manages a proper balance and Tridosha along with physical and mental health. There is a need to explore the holistic care modules stated in different Ayurvedic classical texts and Yoga for COVID-19.

High Serum Creatine Kinase Levels in Infliximab and Vedolizumab-Treated Inflammatory Bowel Disease Patients

Background: TNF inhibitors are relatively safe drugs, but asymptomatic infliximab-induced high serum creatine kinase (CK) levels have been reported in >30% of patients with inflammatory bowel disease (IBD). Whether high serum CK levels are a specific effect of treatment with TNF inhibitors has not been studied in detail. CK levels were therefore compared between infliximab- and vedolizumab-treated IBD patients. Methods: In this retrospective, monocentric study, 131 IBD cases (82 with Crohn’s disease (CD), 49 with ulcerative colitis) of the Basel University Hospital IBD cohort treated either with infliximab or vedolizumab were included. Serum samples for measuring CK, lactate dehydrogenase (LDH), C-reactive protein (CRP), and fecal calprotectin (FCal) levels were collected longitudinally and analyzed using mixed additive models. Results: No significant differences in CK levels between infliximab and vedolizumab-treated patients were observed over time. Infliximab-treated males, however, showed significantly higher CK levels than females and former smokers treated with infliximab showed significantly lower CK levels than nonsmokers. No such differences were observed in vedolizumab-treated patients. LDH and CRP were not significantly different between infliximab- and vedolizumab-treated patients, while adjusted groups showed substantially higher LDH levels with increasing age and significantly lower LDH levels in patients with longer disease duration. Infliximab patients with CD showed significantly lower CRP. However, significantly higher FCal concentrations were noted in infliximab patients independent of diagnosis, gender, disease duration, smoking behavior, and age. Conclusion: In our cohort, high serum CK levels are not an infliximab- or vedolizumab-specific effect.

Quality of life and long-term outcomes after hospitalization for COVID-19: Protocol for a prospective cohort study (Coalition VII).

IntroductionThe long-term effects caused by COVID-19 are unknown. The present study aims to assess factors associated with health-related quality of life and long-term outcomes among survivors of hospitalization for COVID-19 in Brazil.MethodsThis is a multicenter prospective cohort study nested in five randomized clinical trials designed to assess the effects of specific COVID-19 treatments in over 50 centers in Brazil. Adult survivors of hospitalization due to proven or suspected SARS-CoV-2 infection will be followed-up for a period of 1 year by means of structured telephone interviews. The primary outcome is the 1-year utility score of health-related quality of life assessed by the EuroQol-5D3L. Secondary outcomes include all-cause mortality, major cardiovascular events, rehospitalizations, return to work or study, physical functional status assessed by the Lawton-Brody Instrumental Activities of Daily Living, dyspnea assessed by the modified Medical Research Council dyspnea scale, need for long-term ventilatory support, symptoms of anxiety and depression assessed by the Hospital Anxiety and Depression Scale, symptoms of posttraumatic stress disorder assessed by the Impact of Event Scale-Revised, and self-rated health assessed by the EuroQol-5D3L Visual Analog Scale. Generalized estimated equations will be performed to test the association between five sets of variables (1- demographic characteristics, 2- premorbid state of health, 3- characteristics of acute illness, 4- specific COVID-19 treatments received, and 5- time-updated postdischarge variables) and outcomes.Ethics and disseminationThe study protocol was approved by the Research Ethics Committee of all participant institutions. The results will be disseminated through conferences and peer-reviewed journals.

Systematic Review of the Role of BCG in the Treatment of Urothelial Carcinoma of the Prostatic Urethra.

In patients with non-invasive urothelial carcinoma of the prostatic urethra (PUC), treatment with Bacillus Calmette-Guérin (BCG) could be beneficial. To assess the response rates to BCG in the different tumor stages, to describe the clinical impact of transurethral resection of the prostate (TURP) before BCG treatment, and to review the side effects of BCG treatment for PUC. A systematic search was conducted using the PubMed database to identify original studies between 1977 and 2019 reporting on PUC and BCG. Of a total of 865 studies, ten were considered for evidence synthesis. An indication for BCG treatment was found in non-stromal invasive stages (Tis pu, Tis pd) and in stromal infiltrating cases (T1) of primary and secondary PUC when transitional cell carcinoma was the histology of origin. Studies including patients treated with TURP before BCG showed a better local response in the prostatic urethra with a higher disease free survival (DFS) (80-100% vs. 63-89%) and progression free survival (PFS) (90-100% vs. 75-94%) than patients in studies in which no TURP was performed. However, this difference in recurrence and progression in the prostate neither affected the total PFS (57-75% vs. 58-93%), nor the disease specific survival (70-100% vs. 66-100%). The use of resection loop biopsies of the prostatic urethra in appropriate cases during the primary work-up for suspected PUC, as well as the use of the current TNM classification for PUC, need to be improved. BCG therapy for non-stromal invasive stages of PUC show a good local response. Local response is further improved by a TURP before BCG therapy, although the overall prognosis does not seem to be affected. Further evidence for BCG treatment in the rare cases of stromal invasive PUC is needed. Specific side effects of BCG treatment for PUC are not reported.

On the question of a primary and secondary origin of insomnia

Approximately 30% insomnia patients have associated somatic, neurological and psychiatric conditions. Clinician has to define causality of these conditions to determine a treatment plan. Secondary insomnia can result from the symptoms of a primary condition or form an impairment of central nervous system due to neurological disorder. Some associated conditions are characterized by high coincidence with insomnia, similar triggers and crossing genotype, neurophysiological and functional findings. This association with insomnia is observed in anxiety disorders, depression, chronic pain syndromes. The paper presents a concept of comorbid insomnia disorder which proposes the existence of a common neural structure which when affected causes the symptoms of both insomnia and comorbid disorder. Comorbid disorders can also be interconnected due to the overlap of the responsible nerve centers. Positive effect of specific pharmacological, psychotherapeutical and behavioral treatment on both conditions evidences this concept.

Effect of Specific Manipulative Therapy Treatment in Cervico-Brachial Pain Syndrome

Effect of Specific Manipulative Therapy Treatment in Cervico-Brachial Pain Syndrome

Threat of hiv infection for public health: 40 years of confrontation

Introduction. HIV infection is a very dangerous disease and due to the lack of specific prevention methods and effective treatment methods leads to early disability or death. Now this problem is actual for every state, especially for ours, because Ukraine has the highest rate of the epidemic in Europe, therefore, humanity is alarmed by what is happening to the country, which is located in the center of Europe. If this disease is not stopped, the threat of a demographic, economic and social crisis will also increase for other states. Aim – the study of epidemiological features and reasons for the further spread of HIV infection in Ukraine according to open sources of medical statistics in Ukraine and other countries of the world. Results. The article provides data on the study of the problem of the global spread of HIV infection, which has not lost its relevance over the past 40 years. Detailed official statistical information on the social significance of the prevalence of HIV infection in our country and in the world has been provided. The main measures for the prevention of this disease, which is the most dangerous for adolescents, are given. A characteristic feature of the current stage of the spread of infection is that transmission and infection are associated with populations including children of HIV-infected people, members of their families and victims of violations of safety standards in certain medical institutions. Numerous "secondary risk groups" are formed, the emergence of which has a completely social nature. Conclusions. Nowadays, it is understood that diseases that are dangerous to society, such as HIV infection, are phenomena in the fight against which exclusively medical measures are ineffective. Solution to the problem of HIV infection should be a priority of state policy; it should be aimed, first of all, at preventive and elucidating work with young people, who are, without exaggeration, the main risk group. The authors substantiated the need to strengthen control by state institutions and to develop and implement a system of special measures to protect the rights and legitimate interests of citizens and society to preserve the national security of Ukraine.

BayesCTDesign: An R Package for Bayesian Trial Design Using Historical Control Data.

This article introduces the R (R Core Team 2019) package BayesCTDesign for two-arm randomized Bayesian trial design using historical control data when available, and simple two-arm randomized Bayesian trial design when historical control data is not available. The package BayesCTDesign, which is available on CRAN, has two simulation functions, historic_sim() and simple_sim() for studying trial characteristics under user defined scenarios, and two methods print() and plot() for displaying summaries of the simulated trial characteristics. The package BayesCTDesign works with two-arm trials with equal sample sizes per arm. The package BayesCTDesign allows a user to study Gaussian, Poisson, Bernoulli, Weibull, Lognormal, and Piecewise Exponential (pwe) outcomes. Power for two-sided hypothesis tests at a user defined alpha is estimated via simulation using a test within each simulation replication that involves comparing a 95% credible interval for the outcome specific treatment effect measure to the null case value. If the 95% credible interval excludes the null case value, then the null hypothesis is rejected, else the null hypothesis is accepted. In the article, the idea of including historical control data in a Bayesian analysis is reviewed, the estimation process of BayesCTDesign is explained, and the user interface is described. Finally, the BayesCTDesign is illustrated via several examples.

COVID-19 Treatment: Drug Safety Prior to Conception and During Pregnancy and Breastfeeding.

In December 2019, a new viral respiratory infection known as coronavirus disease 2019 (COVID-19) was first diagnosed in the city of Wuhan, China. COVID-19 quickly spread across the world, leading the World Health Organization to declare it a pandemic on March 11, 2020. The disease is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a similar virus to those involved in other epidemics such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV). Epidemiological studies have shown that COVID-19 frequently affects young adults of reproductive age and that the elderly and patients with chronic disease have high mortality rates. Little is known about the impact of COVID-19 on pregnancy and breastfeeding. Most COVID-19 cases present with mild flu-like symptoms and only require treatment with symptomatic relief medications, whereas other cases with COVID-19 require treatment in an intensive care unit. There is currently no specific effective treatment for COVID-19. A large number of drugs are being used to fight infection by SARS-CoV-2. Experience with this therapeutic arsenal has been gained over the years in the treatment of other viral, autoimmune, parasitic, and bacterial diseases. Importantly, the search for an effective treatment for COVID-19 cannot expose pregnant women infected with SARS-CoV-2 to the potential teratogenic risks of these drugs. Therefore, it is necessary to determine and understand the safety of anti-COVID-19 therapies prior to conception and during pregnancy and breastfeeding.

COVID-19 Threat to the World: Current and Possible Diagnostic/Treatment Strategies.

The outbreak of coronavirus disease 2019 (COVID-19) has resulted in a world-wide crisis. To contain the virus, it is important to find infected individuals and isolate them to stop transmission. Various diagnostic techniques are used to check for infection. With the havoc that severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has created, it is imperative to work on alternative diagnostic techniques that can be used at both point of care with little or no expertise and at mass testing (i.e., when screening). Despite extensive research, to this date no specific effective treatment or cure is available to neutralize this viral infection. Globally, researchers are working to develop effective treatments, and several vaccines have been approved for public use. We found the studies that we explored for this review using appropriate key words for indexing in PubMed and Google Scholar from 2019 to 2020. We compile various techniques that have been used worldwide to diagnose and treat SARS-CoV-2 and discuss novel methods that may be modified for use in diagnosis and treatment. It is crucial to develop a more specific serological test for diagnosis that can rule out the possibility of COVID-19 and be used for mass testing. An affordable, safe, targeted, effective treatment must be developed to cure this disease, which has created a public health emergency of international concern.

56. Could Maturation Effect Contribute to In-hospital Mortality Improvement During COVID-19 Pandemic?

BackgroundThe surge of COVID-19 cases overwhelms hospital systems necessitating rapid learning of the disease process and management. During the course of a novel pandemic, multiple interventions are rapidly implemented to improve patient outcomes. When evaluating efficacy of individual interventions, one should account for the simultaneous improvements in knowledge and experience of healthcare providers (HCP), known as the maturation effect. We hypothesized that multiple processes rapidly implemented, along with the maturation effect would result in improved survival of COVID-19 patients hospitalized over the course of the pandemic.MethodsThis retrospective study was done at Henry Ford Hospital (HFH), a 900-bed tertiary care facility in Detroit, Michigan. The first COVID-19 patient was hospitalized on March 10, 2020 followed by a rapid surge of cases. We evaluated the trends of in-hospital case fatality rate of COVID-19 PCR positive patients through April 28, 2020. Time-points of sequential implementation of key measures for the management of COVID-19 patients were recorded.ResultsA total of 1023 COVID-19 patients were hospitalized during the study period with 165 deaths (16 %). Case fatality rate during week one was 42% and down trended over time (Figure 1). Key measures were sequentially implemented over the course of the study period as shown in Figure 1. These included development and implementation of in-house PCR testing, dedicated infectious diseases COVID-19 rounding teams, treatment guidelines and algorithms, and early steroid use in hypoxic patients. Figure 2 demonstrates that despite the surge of COVID-19 admissions, mortality continued to improve over time.Figure 1. Trend line of all-cause in-house morality over time Figure 2. Mortality by admission date over time ConclusionMaturation effect takes into consideration that regardless of individual interventions, HCP improve their knowledge of the disease process and treatment over time leading to better outcomes. Our study shows the possibility of the maturation effect leading to improved survival in hospitalized COVID-19 patients. The maturation effect should be accounted for when evaluating the effect of specific interventions for COVID-19.DisclosuresMarcus Zervos, MD, Melinta Therapeutics (Grant/Research Support)