Longer Course Research Articles

Factors Influencing Length of Care in Physical Therapy After Pediatric and Adolescent Concussion.

Social determinants of health including insurance type, income, race, and ethnicity have been shown to influence the utilization of physical therapy and recovery after an orthopedic injury. The influence of social determinants of health on the utilization of physical therapy and recovery from concussion is not well understood. Prospective observational registry study in a specialty concussion program. Patients diagnosed with a concussion using the Postconcussion Symptom Inventory and the visio-vestibular examination (VVE) who were also referred to physical therapy were included. The main outcomes of interest were the number of days from referral to initial physical therapy evaluation and the number of physical therapy visits completed. Information related to patients' age, race, ethnicity, sex, insurance type, and Child Opportunity Index was extracted from the registry. Multivariate and univariate regressions were used to assess the associations of each sociodemographic characteristic with the outcomes. A total of 341 patients diagnosed with concussion between January 2017 and December 2023 met inclusion criteria. The average age was 14.77, and 64% were female. Patients' age, race, ethnicity, insurance type, and Child Opportunity Index were not associated with days to evaluation or length of care in physical therapy. Higher PCSI scores in children under 12years (coefficient: 0.17, 95% CI,0.06-0.29) and female sex (coefficient: 1.2, 95% CI, 0.26-2.1) were associated with a longer course of care in physical therapy. Patients with an abnormal VVE score had on average 2.1 more physical therapy visits than those with a normal VVE score (coefficient: 2.1, 95% CI, 0.73-3.5). Higher PCSI scores in children, female sex, and higher VVE scores in general predicted a longer course of care in physical therapy. Implementation of a clinical care pathway for concussion care using the PCSI and the VVE may be one strategy to help mitigate systemic factors that might otherwise negatively influence access to physical therapy.

Clinical Characteristics and Treatment Outcomes of Pediatric Bacterial Skin and Soft Tissue Infections in Central Vietnam: A Prospective Study.

Objective. This study examined bacterial skin and soft tissue infections (SSTIs) in pediatric patients at a hospital in Vietnam. Methods. An April 2022-June 2023 prospective obsevational study at a Tertiary Paediatric Centre in Vietnam. Results. From We analyzed 87 cases and found that the greatest occurrence rates were reported during the summer season. Common symptoms were fever, edema, and lower leg involvement. Curiously, although blood cultures seldom verified the offender, Staphylococcus aureus was the most common cause. Additionally, the study found that children with infections including pus were administered a more extended course of antibiotics. Approximately one-third of the patients underwent surgical procedures, and most of them were administered intravenous antibiotics. Fortunately, all the youngsters made a full recovery. Conclusions. In summary, the results indicate that children with purulent SSTIs, primarily attributed to Staphylococcus aureus, may need longer courses of antibiotics. Intravenous antibiotic administration emerged as the predominant therapeutic modality.

Analysis of the competition programmes of elite and sub-elite swimmers: The influence of sex, stroke and race distance

The purpose of this study was to analyse contemporary performance data in elite and sub-elite Irish swimmers, to explore the number of days and races required for swimmers to achieve their fastest competitive performances and how this may be influenced by sex, stroke and race distance. The initial dataset consisted of n = 3930 observations on n = 56 swimmers, with n1 = 2709 (68.9%) long course (LC) observations and n2 = 1221 (31.1%) short course (SC) observations. The main findings indicated that, firstly, the swimmers (LC & SC) produced their fastest swim in their first race of the season, approximately 39% of the time. Secondly, there were no significant differences between male and female swimmers regarding the number of days and races required to achieve their fastest performances. The final key finding identified the number of days and races between first and fastest performance was influenced by (a) stroke, for example, LC and SC freestyle and individual medley swimmers required less races and shorter timeframes to fastest swim, with breaststroke requiring the greatest number of mean days in LC and SC formats and (b) race distance, for example, across LC and SC, 400 m swimmers required fewer races (n = 1.83 & 1.64) and shorter time frame (n = 24.83 & 21.26 days) to fastest swim than other distances. These findings are valuable to coaches and practitioners, as (a) they can provide guidelines when designing competition programmes, and (b) support exploration of what a swimmer's competition may look like in terms of volume and duration to support the fastest performance.

Shortened Treatment Regimens for Drug Sensitive TB.

Tuberculosis (TB) has remained a global health challenge despite the availability of effective anti-tubercular drugs and various treatment strategies. Apart from the complications related to TB disease per se, adverse effects of antitubercular therapy (ATT) also contribute to morbidity. In addition to the adverse effects, the long duration of the treatment regimen also reduces the patient's acceptability of ATT. The available "short-course treatment regimens" are still relatively long, thereby adversely affecting treatment compliance. There is a need for effective, safe, short and intensive regimens for TB which can reduce the treatment cost and adverse effects, thereby improving its acceptance. With the emergence of new evidence, the World Health Organization (WHO) has recently endorsed 4 mo short duration ATT regimen for non-severe, drug-sensitive cases of tuberculosis. Even in severe forms of disease like tubercular meningitis (TBM), trials are underway evaluating efficacy and safety of shorter regimens. Inclusion of fluroquinolones and rifapentine help shorten the regimens. These shortened regimens, however, need more close monitoring for adverse effects and may need to be converted to longer course if there is inadequate clinical response. Thus, shorter regimens for pediatric TB are likely to not only decrease the burden on patients and healthcare but also improve compliance and lower the side effects of the drugs due to prolonged exposure. This article reviews the current evidence and the guidelines pertaining to the shortened, intensive regimens for drug-sensitive tuberculosis.

Advancements In Diagnostics, Treatments and Precision Medicines of Lyme Diseases – A Review

The incidence of Lyme disease, which is caused by the bacteria Borrelia burgdorferi and is transmitted by ticks in 77% of cases, has significantly increased. Skin rashes, neurological, dermatological, cardiovascular, and musculoskeletal problems are all brought on by the illness. Ten to twenty percent of individuals with post-treatment Lyme disease syndrome (PTLDS) do not improve after receiving treatment. It is essential to comprehend the traits of Borrelia burgdorferi in order to create Lyme disease diagnostic equipment and treatments. Since North America has the highest prevalence of infected black-legged ticks, the disease is spread by their bite. Preventing health issues requires early detection and treatment. Lyme disease is diagnosed using diagnostic methods such as PCR, qPCR, RT-PCR, NAATs, NGS, and multiplex PCR panels. Lyme arthritis treatment, longer courses of oral antibiotics, intravenous antibiotics, and post-treatment Lyme disease syndrome are among the treatments available. Precision medicine, also known as customized medicine, tries to modify medical judgments and treatments for specific patients in light of their distinctive genetic makeup, way of life, and environment. The future treatment of Lyme disease will comprise better diagnostic equipment, sophisticated imaging methods, precision medicine, individualized vaccination plans, and patient-centered research.

Corticosteroids in sepsis and community-acquired pneumonia.

Sepsis and septic shock, which are often caused by pneumonia, impact millions of people every year. Despite adequate antibiotic therapy, mortality remains high, up to 45% in septic shock, which is characterized by an inappropriate, excessive immune response of the host. Moreover, critical illness-related corticosteroid insufficiency often coexists. Against this background, several trials and meta-analyses evaluated corticosteroid therapy as adjuvant therapy with heterogeneous results. Indeed, before 2000, high-dosage, short courses of corticosteroid treatment resulted in no benefit on mortality and ahigher rate of adverse events. After 2000, thanks to adeeper understanding of the pathophysiology, low-dosage with longer courses of treatment were tested. With this regimen, afaster decrease in inflammation and faster resolution of shock, with alow rate of mild adverse events, was demonstrated although no clear effect on mortality was shown. To date, guidelines on sepsis and septic shock and guidelines on severe community-acquired pneumonia suggest corticosteroid use in selected patients. Furthermore, by utilizing latent class analysis, phenotypes of sepsis patients who benefit the most from corticosteroid treatment were recently identified. Future research should be guided by aprecision medicine approach to identify adequate dosage and duration of corticosteroid treatment for appropriate patients. This article is freely available.

333. How the COVID-19 Pandemic Accelerated Development of our Complex Outpatient Oral Antimicrobial Therapy (COpAT) Program

Abstract Background At our university medical center, we have well established programs for outpatient parenteral antimicrobial therapy (OPAT) and inpatient multidisciplinary antimicrobial infusions for patients with substance use disorder. Complex outpatient oral antimicrobial therapy (COpAT) uses oral (PO) in place of intravenous (IV) antimicrobials. Despite evidence supporting early IV to PO antimicrobial transition for serious infections, COpAT Programs are not widely incorporated in clinical practice. COVID-19 pandemic’s impact on inpatient bed scarcity triggered COpAT’s accelerated implementation at our institution. A Nov 2020 CEO email served as the catalyst and by Aug 2022 an Infectious Diseases (ID) Pharmacist was hired. By Oct 2022, an ID Physician at 0.5 FTE was assigned COpAT Medical Director. We hypothesized IV to PO antimicrobial transition increased as our COpAT Program developed. Methods Retrospective cohort study on 380 COpAT patients discharged Jan 2021 to Apr 2023 categorized in 2 groups: Early Discharge: Short course IV antimicrobials < 2 weeks followed by COpAT (n= 115); Traditional: Longer course IV antimicrobials ≥ 2 weeks followed by COpAT (n= 265). Demographic, clinical, and outcomes data were compared. Results Proportion of patients in Early Discharge group increased significantly (19 to 47%, p< 0.001) (Image 1). Traditional group had higher rates of injection drug use and bacteremia. While gram positive organisms predominated in both groups, Traditional group had a higher rate of monomicrobial infection (Image 2). Early Discharge group had a greater proportion of oral antimicrobial days (86 vs. 36%, p< 0.05) and shorter length of stay (8 vs. 24 days, p< 0.05) but higher overall and COpAT-related 30-day readmission rates (15 vs. 6 and 7 vs. 2%, p< 0.05). Both groups avoided inpatient hospital days and had high clinical cure rates (Image 3). COpAT Program ROI was 10.9. Conclusion COVID-19 pandemic accelerated development and maturation of our COpAT Program supported by 0.5 FTE ID Physician and 1.0 FTE ID Pharmacist. While readmission rates in both groups were low, possible association between shorter length of stay and increased readmission rates needs further evaluation. COpAT Program investment pays for itself in less than 2 months, mainly through inpatient days avoided. Disclosures All Authors: No reported disclosures

Insecure Attachment in Schizophrenia A Wider Range of Effect

Attachment serves as an important framework to understand the development, onset and recovery of schizophrenia. Categories of attachment include three organized patterns (secure, dismissing, preoccupied) and one disorganized pattern. Schizophrenia is a disorder typically recognized by delusions and hallucinations, which can significantly impair the patients normal social functioning. This article aims to summarize previous studies of attachment on schizophrenia, and provide new extensions. This paper also discusses the impact of environmental factors on schizophrenia. More importantly, dismissing and disorganized attachment serves as important predictors of positive and negative symptoms, difficult therapeutic relationship and longer course. Dismissing, preoccupied and disorganized attachment orientations also mediate childhood adversity according to previous studies. Based on analysis of cognitive and environmental factors, this article hypothesize that dismissing and preoccupied attachment also mediates schizophrenia and other environmental factors (parental age, migration and low SES). In addition, this article discusses cognitive and neuroscience evidence to prove the connections.

Emulating a Target Trial of Shorter Compared to Longer Course of Antibiotic Therapy for Gram-Negative Bacteremia.

Despite the availability of antimicrobial therapies, gram-negative bacteremia remains a significant cause of morbidity and mortality on a global level. Recent randomized controlled trials support shorter antibiotic treatment duration for individuals with uncomplicated gram-negative bacteremia. The target trial framework using the cloning approach utilizes real-world data but eliminates the issue of immortal time bias seen in observational studies by emulating the analysis of randomized trials with full adherence. A hypothetical target trial allocating individuals with gram-negative bacteremia to either short antibiotic treatment duration (5-7 days) or longer antibiotic treatment duration (8-14 days) was specified and emulated using the cloning, censoring, and weighting approach. The primary outcome was 90-day all-cause mortality. Secondary outcome was a composite endpoint of clinical and microbiological relapse. The emulated trial included individuals from four hospitals in Copenhagen from 2018 through 2021. In sum, 1040 individuals were included. The median age of the cohort was 76 years, the majority were male (54%), had community-acquired gram-negative bacteremia (86%), urinary tract infection as the source of the infection (78%), and Escherichia coli as the pathogen of the infection (73%). The adjusted 90-day risk difference in all-cause mortality was 1.3% (95% confidence interval [CI]: -.7, 3.3), and the risk ratio was 1.12 (95% CI: .89, 1.37). The adjusted 90-day risk difference in relapse was 0.7% (95% CI: -2.3, 3.8), and the risk ratio was 1.07 (95% CI: .71, 1.45). We found comparative outcomes for shorter treatment duration compared to longer treatment duration in patients with gram-negative bacteremia.

Intracardiac thrombi in pediatrics: anticoagulation approach and treatment outcomes

BackgroundIntracardiac thrombi (ICT) are associated with significant morbidity and mortality. Anticoagulation is the first line of treatment and may be complemented by thrombectomy or thrombolysis. However, optimal anticoagulant duration remains ill-defined. High-risk features of ICT that may warrant long-term anticoagulation therapy have not been established. ObjectivesTo describe anticoagulation duration and patterns of ICT resolution. To identify potential risk factors for persistent ICT despite anticoagulation. MethodsA single-institution retrospective chart review identified patients diagnosed with ICT by echocardiogram between January 2014 and March 2022. Descriptive statistics and logistic regression were used. ResultsFifty-one patients with ICT were identified. Median age at diagnosis was 9.2 years (IQR, 0.4-15.2). The most common underlying diagnoses were congenital heart disease (41%), infection (25%), and malignancy (24%). The majority of ICT were in the right atrium (n = 30). The median longest ICT dimension was 1.5 cm (range, 0.4-4.0). The median duration of anticoagulation was 4.3 months (IQR, 2.2-9.1). Among 48 patients who received anticoagulation as first-line treatment, 32 had partial or complete response with 3 to 6 months of anticoagulation, while remaining 16 patients had no response to anticoagulation. Patients with a central venous line had a delayed resolution of ICT [hazards ratio = 0.45 (95% CI, 0.22-0.93)]. ConclusionOur study demonstrates the wide variability in duration of anticoagulation for children with ICT. Majority of the individuals benefit from 3-to-6 month treatment; however, individuals with a central venous line may benefit from a longer course of anticoagulation. Further large-scale studies are recommended to validate our findings.

Clinical and etiological features of peadiatric facial neuropathy and their role in predicting outcomes

The aim: to characterize the clinical and etiological features of facial palsy (FP) in children of different ages at the present stage and their correlation with the outcome and duration of the disease.Materials and methods: the data of 68 children with FP were obtained. The neurological examination with an assessment of the level of facial nerve damage and the severity of FP using the House-Brackmann scale (HB), the concomitant symptoms and the etiological verification of a possible infectious agent were performed to all children. Also, their correlation with the outcomes and duration of the disease were assessed.Results: in the etiological structure infectious FP are more common in children under 12 years of age, with a predominance of herpesviruses and enteroviruses, whereas, more than half of the cases in children over the age of 12 years are idiopathic (Bell’s palsy), less often herpesviruses. A longer course and the probability of an unfavorable are significantly more often observed in the group of children under 12 years of age. There was also a significant correlation between the severity of FP according to HB with the outcomes and duration of the disease.Conclusion: The results confirm the importance and necessity of laboratory confirmation of a possible etiological agent associated with the development of FP. The severity of FP doesn’t depend on the age of the child, but correlates with the outcome and duration of the disease, more less with the synkinesia. A promising direction for further research is to clarify the climatic factors affecting the incidence of FP.

Tolerability of Metastasis-Directed Stereotactic Body Radiotherapy with Short-Course Triple-Agent Androgen Annihilation Therapy in Recurrent Oligometastatic Prostate Cancer: Secondary Analysis of a Phase II Study.

A majority of patients with oligometastatic prostate cancer experience relapse within 12 months of metastasis-directed therapy. Intense, triple-agent androgen annihilation therapy (AAT) with leuprolide, abiraterone acetate plus prednisone (AAP), and apalutamide may improve efficacy, but long courses of AAT have been shown to be associated with increased rates of grade≥3 toxicity. The purpose of this secondary analysis of this study is to characterize the tolerability of a short, six-month course of AAT added to metastasis-directed therapy. All 28 patients enrolled on this phase II study were included in this analysis. All patients had oligometastatic prostate cancer after initial radical prostatectomy, defined by the presence of 1-5 extrapelvic metastases on prostate-specific membrane antigen (PSMA) PET/CT. Patients were started on six months of AAT. After the first month, patients received stereotactic body radiotherapy (SBRT) in 1, 3, or 5 fractions to metastases with or without radiotherapy to the prostate bed and pelvic lymph nodes. Physician-scored toxicities were graded according to Common Terminology Criteria for Adverse Events (CTCAE), Version 5.0. Median follow-up time was 11.4 months. Twenty patients (71.4%) completed AAT with all three agents. Six patients (21.4%) completed six months of therapy but discontinued at least one agent [4 patients (14.3%) discontinued apalutamide, 1 patient (3.6%) discontinued AAP, and 1 patient (3.6%) discontinued both apalutamide and AAP]. Two patients (7.1%) withdrew from the trial due to adverse events and did not complete therapy. Grade 2 and grade 3 toxicity rates from AAT were each 21.4%. Of the 6 cases of grade 3 toxicity, 3 were skin rashes, 2 were hypertension, and 1 was hepatic toxicity. At the time of SBRT, 1 patient had withdrawn from the study and 1 patient declined radiation therapy. All 26 remaining patients completed SBRT. Grade 2 and grade 3 toxicity rates from SBRT were 7.7% and 0%, respectively. A majority of patients were able to tolerate and complete AAT in combination with metastasis-directed SBRT. Some patients experienced acute grade 3 toxicities, the most common being drug-related skin rashes and hypertension. While efficacy data are needed to evaluate the oncologic benefit, these data suggest a short course of AAT is considerably better tolerated than longer courses of AAT, with grade 3 toxicity rates similar to long courses of single-agent androgen deprivation therapy alone.

Patterns of Care for Patients with Locally Advanced Rectal Cancer Treated with Total Neoadjuvant Therapy between 2016-2020: An NCDB Analysis

Treatment for locally advanced rectal cancer (LARC), defined as T3/4 or any T with N+ disease, typically requires multi-modality management consisting of radiation (RT), chemotherapy (CHT), and surgery. Despite emerging evidence that total neoadjuvant therapy (TNT) is the preferred treatment of LARC, it remains unknown what proportion of patients are receiving TNT in the United States. Our objective was to (1) determine the proportion of patients with LARC receiving TNT over time, (2) determine the most common method in which TNT is being delivered, and (3) determine what factors are associated with a lower likelihood of receiving TNT in the United States. Retrospective data was obtained from the National Cancer Database (NCDB) for patients diagnosed with rectal cancer between 2016-2020. Patients were excluded if they had M1 disease, T1-2 N0 disease, incomplete staging information, non-adenocarcinoma histology, received RT to a non-rectum site, or received a non-definitive RT dose. Patients were determined to have received TNT if they (1) received RT and multi-agent (MA)-CHT prior to surgery, (2) had an interval of >180 days from the onset of neoadjuvant therapy to surgery if they received long course (LC)-chemoradiation (CRT) (based on 35 days for LC-CRT + 112 days for 8 cycles of MA-CHT + 30 days to surgery), or (3) had an interval of >150 days from the onset of neoadjuvant therapy to surgery if they received short course (SC)-RT (based on 5 days for SC-RT + 112 days for 8 cycles of MA-CHT + 30 days to surgery). Data were analyzed using linear regression, Chi-square test, and binary logistic regression. Of the 26,375 patients included, the median age was 60 (range 21-90) years, with the majority of patients being <65 years old (65.6%), male (62.1%), and non-Hispanic white (77.0%). A total of 5,003 (19.0%) patients received TNT, and 21,372 (81.0%) patients received classical combined modality therapy (CMT). The proportion of patients receiving TNT increased significantly over time, from 6.1% in 2016, 9.0% in 2017, 15.3% in 2018, 25.8% in 2019, to 34.6% in 2020 (slope = 7.36, 95% CI 4.58-10.15, R2 = 0.96, p = 0.040). The most common TNT regimen was MA-CHT followed by LC-CRT (73.2% of cases from 2016-2020). The proportion of patients receiving SC-RT as part of TNT significantly increased from 2.8% in 2016, 1.7% in 2017, 4.6% in 2018, 7.3% in 2019, to 13.7% in 2020 (slope = 2.74, 95% CI 0.37-5.11, R2 = 0.82, p = 0.035). On multivariate analysis, factors associated with a lower likelihood of TNT use included age >65 (OR 0.66, 95% CI 0.61-0.71, p<0.001), female gender (OR 0.92, 95% CI 0.86-0.98, p = 0.014), Black race (OR 0.87, 95% CI 0.77-0.98, p = 0.024), and T3 N0 disease (OR 0.60, 95% CI 0.52-0.70, p<0.001). TNT utilization rates have significantly increased in recent years, from 6.1% in 2016 to 34.6% in 2020. The observed trend appears to be in line with the recent National Comprehensive Cancer Network (NCCN) guidelines recommending TNT as the preferred approach.

Duration of antifungal treatment in mold infection: when is enough?

Although invasive mold infections (IMI) are a major complication in high-risk populations, treatment duration has not yet been well defined. Guidelines suggest documenting clinical/radiological resolution and immunological recovery before stopping antifungal treatment, after a minimum duration of treatment of 3 months for invasive pulmonary aspergillosis, while longer (up to 6 months) duration is proposed for the treatment of invasive mucormycosis. However, data on and definitions of clinical/radiological resolution and immune recovery remain scarce. Limited real-life data suggest that often much longer courses of treatment are given, generally in the context of continuous immunosuppression, occasionally defined as secondary prophylaxis. However, clearcut definition and distinction of secondary prophylaxis from antifungal treatment remain to be defined. Decisions to stop antifungal treatment are based on poorly defined treatment responses and immune reconstitution and experts' opinions. More evidence is needed to determine the optimal duration of treatment of IMI. Well designed, easy to use, and realistic algorithms to help clinicians decide when to stop antifungal treatment are urgently needed.

A large survey on COVID-19 vaccination in patients with Parkinson’s disease and healthy population

BackgroundA full rollout of COVID-19 vaccination offers the most promising prospect of bringing the pandemic to an end. This study aimed to compare the coverage, safety, and confidence of COVID-19 vaccination between patients with Parkinson’s disease (PD) and healthy individuals so as to give suggestions for future immunization programs. MethodsA web-based, nationwide, multicenter survey was carried out in China from 2021 to 2022. The age and sex-standardized vaccination rate was calculated. Multivariate stepwise logistic regression models were used to estimate the influencing factors of vaccination status. We also investigated vaccination safety, willingness, confidence, and reasons for hesitancy with some ad hoc questions. ResultsA total of 962 PD patients and 1208 healthy individuals participated in this survey with a vaccination rate of 71.1% vs 94.4% respectively. PD patients living in first-tier cities, with comorbidities, experiencing unstable PD with a longer course and levodopa use were less likely to get vaccinated, while healthy individuals living in first-tier cities and feeling physically poor exhibited a lower vaccination rate. For PD patients, concern about the adverse impact on existing illness and disagreement from doctors were the most common reasons for vaccination hesitancy. Whereas, no evidence was present that they experienced any local or systematic adverse events more frequently or seriously than healthy individuals, or their state of PD and comorbidities was seriously exacerbated after vaccination. A prominent transition from a little concerned to unconcerned about the security and efficacy of vaccines was evident among both two populations from pre-vaccination to post-vaccination. ConclusionsThe COVID-19 vaccination rate was remarkably lower in PD patients than healthy individuals in China. The approved vaccines have shown an acceptable safety profile. Our findings would offer a reference to guide future clinical decision-making of COVID-19 vaccination and improve the immunization management of PD patients.

Cloud Computing based Influenza Virus Prevention and Control for Bio-Medical Applications

Aims: To improve the flexibility and efficiency of measurement of influenza virus prevention and control, and realize the combination of modern Internet technology and medical technology, in this article, the cases of influenza virus outbreaks in the past five years will be retrieved from various websites. Background: A total of 5087 articles including clinical case analysis literature, individual infection case reports, review literature, Chinese and English literature, outbreak cases, and duplicate literature of non-human infection cases should be excluded Method: Natural Development of Influenza Virus Infection in Individuals Result: The results show that in the influenza virus epidemic database, the longest course of influenza virus infection is 10 days, the shortest is 2 days, the average course is 5.6 (5.6 ± 1.7) days, and the proportion of cases with the course of 5 days is the largest, and the proportion of cases with the course of 8 days is the smallest. Conclusion: In the international common mathematical modelling research, it is found that the latency of influenza viruses is 1-7 days, most of them are 2-4 days, the average latency is 1.9 days, and the course of the disease is 3-6 days. In this study, through the medical information sensor system based on cloud computing, the SEIAR model of the influenza virus outbreak database is built, and the average latency of all outbreaks is calculated. The average latency of the influenza virus is 2.0 days, which is very close to the international research data, and the difference between the two is only 0.1 days. Compared with non-interventional outbreaks, influenza virus control measures push the peak period from 145 days (no intervention) to 169 days (i.e. 24 days later). The infection rate of the influenza virus decreases from 74.75% untreated to 26.41%, that is to say, 48.34

Special Educator Course Format Preferences

Online special education courses and programs are widely available and provide pathways for both initial certification and in-service professional learning. Despite the wider availability of online special educator courses and programs due to the COVID pandemic, very limited research about special education candidates and educator preferences for online courses is available. This study included 965 special education teachers and paraprofessionals who completed an online survey of their preferences about various special education course formats and lengths. Results indicated that special educator course format and length preferences varied and that fully online courses are not uniformly the top choice. Findings also suggested that shorter online courses (e.g., 7-weeks) are best suited to knowledge-based topics, while skills-based courses benefit from longer course duration (e.g., 15-weeks). Implications for special education program delivery are discussed.

E10 Temporo-mandibular joint involvement risk factors in juvenile idiopathic arthritis

Abstract Introduction Recent recommendations suppose temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) is a risk factor of poor outcomes and severe disease course. Objectives To compare the clinical characteristics of patients with juvenile idiopathic arthritis with and without TMJ involvement. Methods We analyzed the data of 753 patients with juvenile idiopathic arthritis aged 2–17 years, depending on TMJ arthritis (n = 43; 5.7%) or no TMJ arthritis (n = 710; 94.3%). Clinical, laboratory characteristics and treatment regimens were compared. Odds ratio (OR) analysis of sensitivity (Se) and specificity (Sp) was performed to obtained the predictors of TMJ involvement. Results Despite the similar age of onset, TMJ arthritis was associated with longer course of the disease, polyarticular JIA category, use of systemic corticosteroids and longer achievement of remission with similar rate of biologic administration. TMJ arthritis was associated with involvement of cervical spine, hip and shoulder arthritis. The main risk factors, associated with TMJ involvement in JIA were active joints &amp;gt; 8 (OR = 14.9 (5.8; 38.3), P = 0.0000001), delayed remission &amp;gt; 7 years (OR = 3.1 (1.6; 5.8), P = 0.0004), delayed hip involvement (OR = 4.6 (0.9; 22.6), P = 0.041), hip osteoarthritis (OR = 4.0 (1.2; 13.0), P = 0.014), and avascular necrosis of the hip. Cervical spine arthritis (OR = 10.3 (5.4; 19.8), P = 0.000001), and corticosteroid treatment (OR = 2.3 (1.2; 4.4), P = 0.0007) were associated with TMJ arthritis. Patients with TMJ arthritis required more biologics (OR-3.2 (1.6; 6.2), P = 0.0006). Oligoarticular JIA category and uveitis were protective against TMJ involvement. Data are in the table. Conclusion TMJ involvement is marker of poor disease prognosis. Early initiation of biologics and avoidance of corticosteroids might improve the risk of TMJ involvement. Ethics Written consent was obtained according to the declaration of Helsinki. This retrospective study's protocol was approved by the local Ethical Committee of Saint Petersburg State Pediatric Medical University (protocol number 11/10 from 23.11.2020).

O02 Nitrofurantoin: what is the evidence for current guidance?

Abstract In this abstract, we review current approaches to the management of uncomplicated urinary tract infection (UTI) and begin to explore alternative approaches to antibiotic prescribing. We review clinical guidelines on the use of nitrofurantoin internationally to capture the level of variation in evidence-based guidance. We find that the evidence base has been interpreted in very different ways. UK guidelines from NICE and the Scottish Intercollegiate Guidelines Network (SIGN) are unusual in promoting short (3 day) courses of nitrofurantoin. We find little direct evidence to support this, and that this guidance has been extrapolated from studies based on other agents. ‘Short’ courses of antibiotics aim to provide optimum balance between providing effective treatment whilst reducing selective pressure driving resistance amongst colonizing microbial flora. Three days of nitrofurantoin may indeed be a useful intervention in a large group of patients. Longer courses of nitrofurantoin still demonstrate considerable rates of treatment failure. The concept of a course length in itself is limited. The variation between recommendations internationally reflects both the uncertain foundations upon which evidence-based guidelines are written, and the limits of what can be safely concluded from evidence. We join others in pointing out there may be ways of customizing duration of therapy to the patient’s response in primary care settings. There is a need for a more patient-focused approach to uncomplicated UTI, including better safety-netting and (currently lacking) guidance on best practice in the common clinical scenario of treatment failure.

Experience with intraoperative radiation therapy in an urban cancer center

Background/objectiveIntra-operative radiation therapy (IORT) is a newer partial breast irradiation technique that has been well studied in 2 large randomized trials, the TARGIT-A and ELIOT trials. We initiated our IORT program in 2018 in the context of a registry trial, and aim to report our early results thus far.MethodsWe instituted an IORT practice using Intrabeam® low energy 50kVp x-rays for selected breast cancer cases in 2018. Patients were enrolled on our institutional registry protocol which allowed for IORT in ER + patients with grade 1–2 DCIS ≤ 2.5 cm or invasive disease ≤ 3.5 cm in patients of at least 45 years of age.ResultsBetween January 2018 and December 2021, 181 patients with clinical stage 0-IIA ER + breast cancer were evaluated. One hundred sixty-seven patients ultimately received IORT to 172 sites. The majority of patients received IORT at the time of initial diagnosis and surgery (160/167; 95.8%). Re-excision post IORT occurred in 16/167 patients (9.6%) due to positive margins. Adjuvant RT to the whole breast +/- LN was ultimately given to 23/167 (13.8%) patients mainly due to positive sentinel LN found on final pathology (12/23; 52%); other reasons were close margins for DCIS (3/23; 13%), tumor size (3/23; 4.3%), and multifactorial (5/23; 17.4%). Five patients (3%) had post-operative complications of wound dehiscence. There were 3 local recurrences (1.6%) at a median follow-up of 27.9 months (range: 0.7– 54.8 months).ConclusionsIORT has been proven to be a safe and patient-centered form of local adjuvant RT for our population, in whom compliance with a longer course of external beam radiation can be an issue. Long term efficacy remains to be evaluated through continued follow up. In the era of COVID-19 and beyond, IORT has been an increasingly attractive option, as it greatly minimizes toxicities and patient visits to the clinic.Trial registrationAll patients were prospectively enrolled on an institutional review board-approved registry trial (IRB number: 2018–9409).