Patients March Research Articles

Analysis of Socio-Demographic Factors Influencing Anxiety in Hemodialysis Patients

Background: Advanced chronic kidney disease patients need hemodialysis, the most used method of renal replacement therapy today. The patient will receive hemodialysis therapy for the rest of their life so that it can have a psychological effect like anxiety. Aims: This study aims to examine the socio-demographic variables affecting anxiety in hemodialysis patients. Method: This research used a cross-sectional analytical observational study design. A total sampling technique was used in this research. From 113 outpatient hemodialysis patients in March 2023, 80 samples of patients at Roemani Semarang Hospital met the inclusion and exclusion criteria. Inclusion criteria were patients undergoing hemodialysis at Roemani Semarang Hospital who were willing to participate in the study. Exclusion criteria were incomplete questionnaires, patients with impaired consciousness, patients with communication disorders, and patients using anti-anxiety medication. The information collected was primary information from questionnaires and interviews. The data were tested using the Spearman test with a significance level of p<0.05 for age and family support, and the chi-square test for gender, employment, and educational status. Results: The statistical analysis showed a p-value of 0.704 for age, a p-value of 0.020 for gender, a p-value of 0.558 for employment, a p-value of 0.138 for educational level, and a p-value of 0.000 for family support. Conclusion: The results showed a significant relationship between gender and family support with anxiety levels. The higher the family support, the lower the anxiety level. There is no relationship between age, employment, and education level with the anxiety level of patients undergoing hemodialysis at Roemani Semarang Hospital.

Arthroscopic suture in the management of palmar midcarpal instability.

Patients with midcarpal instability are difficult to manage. It is a rare condition, and few studies have reported the outcomes of surgical treatment. No prospective or retrospective study has reported the results of arthroscopic palmar capsuloligamentous suturing. Our aim was to report the results of a prospective study of arthroscopic suture of this ligament complex in patients with midcarpal instability. This prospective single-centre study was undertaken between March 2012 and May 2022. The primary outcome was to evaluate the functional outcomes of arthroscopic palmar midcarpal suture. The study included 12 patients, eight male and four female, with a mean age of 27.5 years (19 to 42). They were reviewed at three months, six months, and one year postoperatively. There was a significant improvement in flexion, extension, grip strength, abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire score, and pain, in all patients. After telephone contact with all patients in March 2023, at a mean follow-up of 3.85 years (2.2 to 6.25), no patient had a persistent or recurrent clunk. Arthroscopic suture of the midcarpal capsuloligamentous complex represents a minimally invasive, easy, and reproducible technique for the management of patients with midcarpal instbility, with a clear improvement in function outcomes and no complications.

Evaluation of Emergency Department Surge Spaces During the COVID-19 Crisis

Background: In response to the surge of COVID-19 patients in March and April 2020, our emergency department in New York City implemented a novel triage screening process to identify low acuity patients who could be diverted from the emergency department to a surge space. Patients who were (1) ≤ 70 years old; (2) triaged as Emergency Severity Index category 4 or 5, and (3) not requiring use of a stretcher (4) displaying mild COVID-19 symptoms were diverted to one of two surge spaces [West Surge Space (WSS) or Ambulatory Clinic Surge Space (ACSS)], where a complete set of vital signs were taken and an exam by a medical provider was conducted. Methods: From March 12 to April 20, 2020, we analyzed the total volume of patients diverted to the surge space and their discharge disposition (i.e., admitted to hospital, transfer to main emergency department, left against medical advice, discharged from a surge space, or expired). A receiver operator curve (ROC) was calculated to predict discharge disposition based on triage diversion to either surge space. Results: There were 6,241 patients triaged during the study period, in which one-quarter [n = 1,753 (26%)] were diverted to a surge space. The average number of patients per day was 141.8 (standard deviation [SD] 54.5) in the main emergency department and 39.8 (SD 29.9) in the surge spaces. Of the patients triaged and diverted to a surge space, a large proportion were successfully discharged from those areas without entering the main emergency department (84%, n = 866 in WSS and 94%, n = 745 in ACSS). Very few signed out against medical advice (3%, n = 26 in WSS and 2%, n = 12 in ACSS), transferred to the main emergency department (1%, n = 8 in WSS and 0.4%, n = 3 in ACSS), or admitted (13%, n = 130 in WSS and 4%, n = 30 in ACSS]. No patients expired in either surge space. The ROC analysis showed that the model had excellent discrimination power, with an area under the curve of 0.97 for WSS and 0.96 for ACSS. Conclusion: A novel triage screening process successfully diverted 26% of low acuity patients with mild symptoms of COVID-19 to surge spaces. Nearly 92% of these patients were successfully discharged without entering the main emergency department footprint.

Seroprevalence of ANTI-SARS-CoV-2 antibodies in patients with inflammatory bowel disease

Patients with inflammatory bowel disease (IBD) treated with biologic and/or immunosuppressant drugs are at increased risk for opportunistic infections. Seroprevalence studies can confirm the diagnosis of SARS-CoV-2 infections as well as the associated risk factors. This is a descriptive study which primary endpoints were to highlight the prevalence of SARS-CoV-2 antibodies in a cohort of IBD patients in March 2021, and to analyze seroconversion in patients with known COVID-19 infection and its relationship with IBD treatments. Patients filled in a questionnaire about symptoms of COVID-19 infection and clinical information about their IBD. All included patients were tested for SARS-CoV-2 antibodies. 392 patients were included. Among patients with clinical infection, 69 patients (17,65%) were IgG-positive, 286 (73,15%) IgG-negative and 36 (9,21%) indeterminate. In relation to seroconversion among patients under biologic treatment, 13 patients of the 23 with a previous positive CRP developed antibodies (56.5%). However, when the influence of immunosuppressive treatment on the probability of developing antibodies was analyzed, no significant differences were seen between those patients with or without treatment (77.8% vs. 77.1%, p = 0.96). In our cohort of IBD patients, after one year of pandemic, there were 18.64% IgG positive patients, a higher prevalence than the general population (15.7%).

Tixagevimab-cilgavimab como tratamiento profiláctico preexposición frente a SARS-CoV-2 en pacientes trasplantados renales

IntroductionIt has been reported that after vaccination with RNAm or viral vectors from SARS-CoV-2 a significant number of solid organ transplant recipients do not develop an effective immune response. In this scenario, the use of tixagevimab-cilgavimab was approved by the European Medicines Agency for COVID-19 prophylaxis in immunocompromised patients in March 2022. We present our experience with a group of kidney transplant recipients who received prophylactic treatment with tixagevimab-cilgavimab. Material and methodsProspective study from a cohort of kidney transplant recipients who had been previously vaccinated with 4 doses and did not achieve a satisfactory immune response to vaccination, presenting antibody titers lower than 260 BAU/mL when measured by ELISA. A total of 55 patients who received a single dose of 150mg of tixagevimab and 150mg of cilgavimab between May and September of 2022 were included in this study. ResultsNo immediate or severe adverse reactions, including worsening of kidney function, were observed after administering the drug or during follow up. All patients who had received the drug 3 months prior presented positive antibody titers (>260 BAU/mL). Seven patients were diagnosed with COVID, and one of those patients had to be admitted to the hospital and died 5 days later from infectious complications and a suspected diagnosis of bacterial coinfection. ConclusionsIn our experience, all kidney transplant recipients reached antibody titers higher than 260 BAU/mL 3 months after receiving prophylactic treatment with tixagevimab-cilgavimab with no severe or irreversible adverse reactions.

Brain CT-Scan Features in Methanol Toxicity and Their Association with Clinical Manifestations and Outcome; a Cross-Sectional Study

Purpose: Early month of the COVID-19 pandemic. The belief of alcoholic beverages as a protective factor against the virus was got viral. We experienced a methanol toxicity outbreak by illegally produced beverages. We had insufficient data about Imaging and clinical finding in Methanol poisoning. We aimed to determine the frequency and importance of each brain finding its clinical manifestation with the prognosis of patients. Methods: in this cross-sectional study, we retrospectively assessed methanol toxicity patients in March and April 2020 at Shiraz Teaching Hospitals. We recorded demographic data, clinical manifestations, vital signs, duration, Lab data, and outcomes. Brain CT scan was reviewed by three clinical radiologists, independently. Brain CT scan results, including hemorrhage, hypodensity, and location of findings, had collected. All data analyzed by chi2 , T-test, and Pearson test was used for assessing correlation. Results: 306 patients had entered. There were 268 (88.88%) male patients. The total mean age of 32.10±9.9 years. 65 (21.8 %) with GCS< 8 were hospitalized mean duration of 2.72±2.46 days. 60(19.9%) patients passed away. about 75.9% (223) blindness, 128 (49.2%) Chronic alcohol users 46(15%) cases with abnormal findings. 30(50%) dead persons had normal imaging. There were 5(1.6 %) ICH Hypo Putamen 34 (11.11%) and diffused cerebral edema 23(7.5%), cerebellum nucleus hypoattenuation, and hemorrhage were the poorest prognosis findings in the CT scan. Conclusion: about 15% of patients had abnormal CT scans, Putamen hypodensity, Cerebellum nucleus hypodensity, and diffused cerebral edema were the most finding. Cerebellum nucleus hypodensity, diffused cerebral edema and ICH are the most faithful brain findings. Blindness, Renal failure, GCS<8, and pH<7.2 were the most faithful findings in the final prognosis.

Quality of life and mental health in real-world patients with resected stage III/IV melanoma receiving adjuvant immunotherapy

Introduction Treatment with immune checkpoint inhibitors (ICI) has expanded into the adjuvant setting enhancing the importance of knowledge on the immune-related toxicities and their impact on health-related quality of life (HRQoL). Large phase 3 trials of patients with resected Stage III/IV melanoma found no effect on HRQoL during adjuvant immunotherapy. This study investigates how HRQoL was affected during and after adjuvant immunotherapy in a real-world setting. Methods Patients with resected melanoma treated with adjuvant nivolumab from 2018 to 2021 in Denmark were identified using the Danish Metastatic Melanoma Database (DAMMED). The study was performed as a nationwide cross-sectional analysis as a questionnaire consisting of six different validated questionnaires on HRQoL, cognitive function, fatigue, depression, fear of recurrence, and decision regret was sent to all patients in March 2021. To evaluate HRQoL during and after adjuvant treatment, patients were divided into groups depending on their treatment status when answering the questionnaire; patients in active treatment for 0–6 months, patients in active treatment for >6 months, patients who ended treatment 0–6 months ago, and patients who ended treatment >6 months ago. Results A total of 271/412 (66%) patients completed the questionnaire. Patients who ended therapy 0–6 months ago had the lowest HRQoL and had more fatigue. Patients in active treatment for >6 months had lower HRQoL and more fatigue than patients who started treatment 0–6 months ago. Patients ending therapy >6 months ago had higher HRQoL and less fatigue compared to patients who ended therapy 0–6 months ago. Multivariable analysis showed an association between HRQoL and treatment status, comorbidity, civil status, and employment status. Conclusions Adjuvant nivolumab may affect some aspects of QoL, but the influence seems temporary. Patient characteristics, such as civil status, employment status, and comorbidity were associated with HRQoL.

Development and Application of the First Carbon Ion Therapy System in China

At present, heavy ion is an ideal radiation for cancer treatment, and carbon ion is used in the treatment of many kinds of cancer due to its higher relative biological effect value. In 2019, Wuwei heavy ion center built the first medical heavy ion accelerator-carbon ion radiotherapy system in China, and obtained the registration license from the National Medical Products Administration, and officially received cancer patients in March 2020. This study introduced the development and application of the first carbon ion radiotherapy system in China.

SP11.4 Imaging recommendations during the Covid pandemic for the investigation of right iliac fossa pain: an unachievable and unnecessary burden on radiology services?

AimsInitial Covid-19 surgical guidance, produced without radiological input, recommended that patients with right iliac fossa (RIF) pain should have imaging before intervention. This study quantified the burden on imaging services from these guidelines.MethodsPatients who presented to our surgical unit with RIF pain from March to October 2020 were identified. Clinical parameters, radiology and final diagnosis were recorded. Minimum follow-up was 12 months to identify re-admissions and morbidity.ResultsThere were 417 patients. There was a drop in admissions in the first months of each new wave of Covid (March/April, September/October) compared with intervening months (36% vs. 64%, P=0.036). 266 patients (64%) had a CT scan increasing from 42% of patients in March to 75% in September (P=0.019). The proportion of patients with normal imaging increased correspondingly with over a third (34%) of CT scans being normal. 93 CT scans (35%) showed appendicitis, which was the suspected diagnosis in all but 7 of these patients.Patients with normal imaging had lower white cell counts (Mean 10.1×109 vs. 14.8×109/L, P<0.001) and CRPs (Mean 21 vs. 99, P<0.001). Patients seen first by a consultant were less likely to require imaging.ConclusionsDuring the first year of Covid-19, two-thirds of patients with RIF pain had a CT scan with a third being normal. Most scans showing appendicitis had clinical parameters consistent with this diagnosis. Current guidelines may lead to unsustainable pressures on radiology services; ensuring consultant assessment prior to imaging requests may reduce the burden on these teams.

Abstract 5202: AMG 794, a Claudin 6-targeted half-life extended (HLE) bispecific T cell engager (BITE®) molecule for non-small cell lung cancer and epithelial ovarian cancer

Abstract AMG 794 is a half-life extended BiTE® immune therapy targeting the oncofetal antigen Claudin 6 (CLDN6). AMG 794 redirects T cells to kill CLDN6-expressing tumor cells and is being developed for the treatment of non-small cell lung cancer (NSCLC) and epithelial ovarian cancer (EOC). CLDN6 is a compelling tumor antigen that is expressed during embryonic and fetal development, transcriptionally silenced in adult tissues, and re-expressed on the surface of NSCLC and EOC cells. By immunohistochemistry, CLDN6 staining of the cell membrane was observed in 27% of non-squamous NSCLC (n = 63) and 69% of EOC (n = 92) samples, the majority of which were of the high-grade serous ovarian cancer subtype. Expression of CLDN6 protein was not detected in most normal adult tissues, with rare CLDN6 immunostaining limited to individual cells in the pituitary, pancreas, small intestine, kidney, and female reproductive organs. AMG 794 is a fully human BiTE® molecule that binds both human and cynomolgus monkey CLDN6 and CD3. AMG 794 binds human CLDN6 and CD3 with equilibrium dissociation constant (KD) of 13 nM and 36 nM, respectively. In vitro, AMG 794 redirects human T cells to kill CLDN6-expressing cancer cells with a half-maximal lysis concentration (EC50) of 2.6 ± 1.1 pM to 127.4 ± 53.4 pM. Consistent with the mechanism of action of BiTE® immune therapy, AMG 794 induces T cell activation and transient production of cytokines in co-cultures of T cells and CLDN6-expressing tumor cells. Remarkably, AMG 794 binding and cytotoxic activity is selective for CLDN6 over other claudin family proteins, despite high homology in the extracellular loops with CLDN9. Weekly dosing of AMG 794 significantly inhibited the growth of established lung and ovarian xenograft tumors in immunocompromised mice injected with human T cells. Anti-tumor activity was associated with an increase in tumor-infiltrating T cells. AMG 794 was well tolerated in a one-month repeat-dose toxicology study in cynomolgus monkey, with evidence for target engagement. The potent, selective activity of AMG 794 for CLDN6-expressing NSCLC and EOC cells, together with an acceptable nonclinical safety profile, supported the advancement of AMG 794 into clinical development. A first-in-human study to explore the safety, tolerability, pharmacokinetics, and anti-tumor activity of AMG 794 in patients with CLDN6-positive advanced/metastatic non-squamous NSCLC or EOC will be enrolling patients in March 2022. Citation Format: Elizabeth Pham, Anja Henn, Beate Sable, Joachim Wahl, Kip Conner, Katja Matthes, Shivani Gupta, Rodolfo Yabut, Famke Aeffner, Kristin Lewis Wilson, Jonas Anlahr, Christoph Dahlhoff, Vijay Kale, Matthias Friedrich, Tobias Raum, Peter Kufer, Angela Coxon, Sabine Stienen, Julie M. Bailis. AMG 794, a Claudin 6-targeted half-life extended (HLE) bispecific T cell engager (BITE®) molecule for non-small cell lung cancer and epithelial ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 5202.

Potential Drug–Drug Interactions in Ambulatory Patients with Hypertension: a Retrospective Study

Background: Patients with cardiovascular diseases (CVD) are vulnerable to experiencing drug-drug interactions (DDIs). DDIs are a concern among patients receiving multiple drug regimens but they are also an avoidable cause of adverse drug reactions. The study of potential DDIs (pDDIs) would make it easier for the healthcare provider to deliver better patient care and mitigate pDDIs incidence. Objective: This study aimed to assess the frequency, severity level and risk factors associated with pDDIs among medications used to treat hypertensive ambulatory patients in Universitas Airlangga hospital. Methods: A retrospective observational study was carried out from electronic prescriptions received by hypertensive patients in March 2021. Data collection includes demographic data, the profile of antihypertensive drug use, and pDDIs. pDDIs were identified by severity using Lexicomp Drug Interaction Checker (Application). Univariate logistic regression analysis was used to find associated factors of major pDDIs. A p-value less than 0.05 (≤ 0.05) was considered statistically significant. Results: From 704 patients, 53.98% women and 46.02% men, 89.06% (n = 627) patients had minor to major pDDIs; 1354 pDDIs were identified, 89.4% (n = 1,210) were moderate and 9.8% (n = 133) were major class. Multiple antihypertensive drug regimens had significance associated with the major pDDIs occurrence. Conclusion: We found a high prevalence of pDDIs among hypertensive patients. The majority of pDDIs were of moderate severity. Multiple antihypertensive drug regimens were associated factors in the presence of major pDDIs.

The Presence of Atopic March in Patients Diagnosed with Atopic Dermatitis

Objective: Atopic march is a model that explains the progression of allergic diseases from atopic dermatitis (AD) to allergic asthma and rhinitis. In our study, while evaluating the presence of allergen sensitivity and allergic diseases in patients who were diagnosed with AD and followed up until the age of at least 5 years, we wanted to investigate how much the definition of classical atopic gait responded to expectations. Material and Methods: We retrospectively reviewed the file records of patients diagnosed with atopic dermatitis, whose ages were 2 years and under at the time of application and followed up regularly until at least 5 years of age. We recorded the clinical and laboratory findings. We noted the allergic disease status and allergen sensitivity of the patients when they were 5 years old. Results: Forty-one patients with a diagnosis of AD who met the criteria were identified. During the application, we found food sensitivity in 28 (68.3%) patients. When 41 patients reached the age of 5, 13 (31.7%) were diagnosed with asthma and 12 (29.2%) were diagnosed with allergic rhinitis. Conclusion: We found the frequency of asthma and allergic rhinitis higher in patients with AD than in the normal population. However, we could not show a relationship between food sensitivity and the development of asthma and/or allergic rhinitis. Effective skin care in AD can be protective for developing of allergic diseases. In order for clinicians to understand the heterogeneity of atopic disease models in children and to eliminate this variability, infants with AD should be followed up in later life.

Economic burden of Down syndrome patients and psychological and social discrimination to female caregivers in Changsha, China

To estimate the social and economic burden of Downs syndrome for patients and their families residing in Changsha, China. An 160-item self-administered questionnaire was designed and distributed to the primary caregivers of the patients in March 2020. A total of 81 eligible participants had completed the questionnaire, among which 20 were excluded for incomplete data. A patient perspective was taken to estimate the economic burden of the disease. The social impact of the disease on the patient's family was evaluated through questions adapted from the Stanford Psychological Wellbeing (PWB) Scale. The estimated life-course cost of a Downs syndrome patient in Changsha is 4 985 659 RMB, with the patient and caregiver's loss of income taking the greater proportion. In addition, as the majority of the patients' primary caregivers, female caregivers experienced not only considerable financial hardship caused by the care provision, but also a significant amount of psychological pressure and social discrimination. Increased level of social welfare for the patients and social support for their female caregivers are essential for reducing economic burden and improving their quality of life in the area. In addition, prenatal screening and diagnosis for Downs syndrome are important for reducing both the social and economic burden of the disease by preventing its occurrence.

Large Gathering Attendance is Associated with Increased Odds of Contracting COVID-19: A Survey Based Study.

We used a telephone survey to determine risk factors associated with a positive polymerase chain reaction test of a nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) at a community hospital in Central New Jersey during the early stages of the pandemic. We compared survey responses of 176 patients in March 2020. Respondents were asked about their living situation, work environment, use of public transportation and attendance at one or more large gatherings (more than 10 people) in the 3 weeks prior to undergoing COVID testing. We found that those who attended a large gathering in the 3 weeks prior to their COVID test had a 2.50 odds ratio (95% CI 1.19, 5.22) of testing positive after controlling for age, sex, race/ethnicity, occupation, living situation and recent visit to a nursing home. The total number of gatherings attended or the number of people in attendance was not associated with a positive test. An association was also seen for specific job types such as factory workers, construction workers, and facilities managers. Attendance at a gathering of more than ten people was associated with testing positive for COVID-19.

Incidence of Retinal Artery and Vein Occlusions During the COVID-19 Pandemic.

To examine whether new cases of retinal artery occlusion (RAO) or retinal vein occlusion (RVO) increased during the coronavirus 209 (COVID-19) pandemic. This was a retrospective cohort study of patients visiting retina clinics with a new diagnosis in two time periods: between January 1, 2019, and February 29, 2020 (the pre-COVID-19 period), and between March 1, 2020, and December 31, 2020 (the COVID-19 period). The key outcome was the percentage of newly diagnosed central RAO (CRAO), branch RAO (BRAO), central RVO (CRVO), and branch RVO (BRVO) seen in each period. The study population included 285,759 new patients in the pre-COVID-19 period and 156,427 new patients in the COVID-19 period. The overall number of new patients dropped dramatically during the first few months of the COVID-19 pandemic (24%, 66%, and 51% less new patients in March, April, and May 2020 than in the same months in 2019; P < .0001 for all 3 months). However, the decrease in the number of newly diagnosed patients with CRAO, CRVO, and BRAO during these months was less dramatic. As most states reopened in June and the number of patients in retina clinics started to increase, the newly diagnosed patients with these conditions as a percentage of all new diagnoses returned to similar trends as seen in the pre-COVID-19 period. The percentage of new cases of RAO and RVO with respect to all new diagnoses in retina clinics remained stable for the majority of the COVID-19 period. There was an increase in these percentages during the first few months of the COVID-19 pandemic, particularly for CRAO, CRVO, and BRAO, which may have led to the presumption that more patients presented with these conditions during the COVID-19 period evaluated in this study. [Ophthalmic Surg Lasers Imaging Retina. 2022;53:22-30.

Injection of Cryopreserved Amniotic Membrane and Umbilical Cord Particulate for Pressure Injuries: A Retrospective Case Series

PI poses a significant burden to society. Cryopreserved AMUC has potential benefits in managing complex wounds owing to its anti-inflammatory, anti-scarring, and proregenerative properties. AMUC grafts are commonly in sheets, but also come as morselized powders that can be sprinkled or injected. The authors initially used AMUC injection in chronic PIs in March 2017. This is a single-center, retrospective review of patients with nonhealing PIs treated with AMUC particulate between March 2017 and November 2018. Incidence of wound healing (zero wound volume with complete reepithelialization) was measured at 12, 24, 36, and 52 weeks. Review included 26 PIs (21 patients); of which, 85% were stage 4 PIs, per the NPIAP staging system. After AMUC injection, 14 PIs (54%) achieved complete wound closure at a median of 12.4 weeks (range, 5-52 weeks). Complete wound closure was observed in 7 patients (27%) at 12 weeks, 10 patients (38%) at 24 weeks, 13 patients (50%) at 36 weeks, and 14 patients (54%) at 52 weeks. One patient with vascular issues required amputation; however, no treatment-related adverse events or complications were observed. These preliminary results suggest that injection of AMUC particulate may be a safe and promising treatment in promoting wound closure of difficult-to-treat PIs.

Impact of a National Multicentric Strategy to Support Kidney Transplant Patients During the COVID-19 Pandemic in Latin America: FUTAC Team Creation and Activities.

Impact of a National Multicentric Strategy to Support Kidney Transplant Patients During the COVID-19 Pandemic in Latin America: FUTAC Team Creation and Activities.

TRANSCOV, a multidisciplinary project to evaluate long distance COVID patients transfers

BackgroundFaced with an abrupt surge of severe COVID patients in March and April 2020, intensive care units (ICU) from four French regions transferred around 660 patients towards six other regions and four neighbouring countries. The intensity and the diversity of the vectors used (plane, helicopter, train, ambulance), during this wave of medical evacuations make it an unprecedented event. The aim of TRANSCOV is to examine the impact of long distance transfers on patient's health and to understand how actors collaborated to overcome clinical and logistical challenges.MethodsTRANSCOV is made of three disciplinary components: 1) interviews with clinicians and health authorities staff involved in the organisation and realisation of the transfers as part of the qualitative component; 2) a retrospective cohort collecting clinical parameters and pathway details before during and after transfer; 3) a collection of data regarding human and logistical resources mobilised during transfers as part of an economical evaluation.ResultsPreliminary results indicate that prior experience in medical evacuations proved useful to collaborate effectively in the exceptional circumstances prevailing in spring 2020. Clinicians had to establish quickly eligibility criteria for transfer. Actors' opinions may vary on the appropriateness of vectors to transfer isolated (e.g. via helicopter) or grouped (train) patients. Early epidemiological data suggest that transferred patients were younger and experienced comparable, if not lower, in-hospital mortality compared to other patients. The economic evaluation is in progress.ConclusionsInitial results indicate that effective collaborations led to the selection of clinically eligible patients and the realisation of safe distant transfers.Key messages Healthcare organisations have been able to adapt and create organizational innovations to respond to COVID-19.Multidisciplinary approaches are appropriate to evaluate such complex innovations.

The impact of COVID-19 in chronic kidney disease stage 5 patients on haemodialysis in Romania

BackgroundCKD 5 is a life threatening condition irrespective of cause. Most patients reach RRT. Predominant therapy is HD. Pandemic preparedness is an important pro-active public health function.Objectives1) to describe the incidence of COVID19 and IFR among CKD HD patients; 2) to evaluate the vaccination coverage among HD patients (Jan-Mar 2021); 3) to update a spreadsheet CKD5 HD 12-scenario treatment model by considering two new scenarios based on IFR: before and after vaccination.MethodsFirst two objectives use secondary data: JHSU and ECDC (secondary sources of COVID19 data) for Apr 2020-Mar 2021. The 3 NPM periods are: Apr-May 2020 (state of emergency), Jun-Dec 2020 (state of alert; vaccination -), Jan-Mar 2021 (state of alert; vaccination +). Data are taken from the Romanian Renal Registry and population data from Eurostat (available July 2021). IFR was estimated with a modified Kaplan-Meier method (Ghani,2005). A calibrated and validated CKD5 treatment model has previously been defined (10.1093/eurpub/cku161.026). Scenarios are re-run with one parameter adjusted by IFR levels. Analyses used Excel, SPSS.Resultsn = 14300 adult HD patients in March 2020; highest incidence (risk) was recorded in Apr-May 2020: 4.5% (CI95% from 4.1 to 4.8) and 2.5% (CI95% from 2.2 to 2.7). Cumulative incidence was 6.9% vs 18.5 pmp in the general population (period 1). In the general pop COVID19 incidence was highest at 443 pmp in Nov 2020 (period 2). The IFR requires full data validation; CFR was 7.7% (CI95% from 5.97 to 9.46; period 1). It is estimated that by Mar 2021 the IFR has decreased by 50%. Vaccination coverage in HD patients reached 94% (Apr 2021). Preliminary results from the updated model are presented. The model upholds its validity as the IFR allows for a better fine tuning of one parameter (mortality).Conclusionstreatment need and inequality in service provision can be addressed with a spreadsheet model by including pandemic preparedness measures.Key messages Haemodialysis patients had a very high COVID-19 incidence and CFR during the first two months of the COVID-19 pandemic when compared with the incidence in the general population.Pandemic preparedness must include protection measures for patients with chronic diseases. Renal patients are particularly vulnerable given their co-morbidity.

Deployed: One Pediatric Department's Experience of Adult Care During COVID-19.

The number of hospitalized coronavirus disease 2019 patients in March 2020 to April 2020 in our New York City hospital required increased physician staffing, including deployment of pediatricians to adult care. To improve the deployment process, we sought to understand the mindset, preparations for, and experience during deployment of pediatric faculty in our institution. Faculty members of the Department of Pediatrics completed pre- and postsurveys evaluating perspectives, fears, and preparations relevant to deployment. Demographic characteristics of the faculty members were collected. Survey questions included Likert scale, multiple choice, and free-text responses. Descriptive statistics, Fisher's exact test, and χ2 test were used to compare groups. Free-text responses were categorized by topic. Survey responses were shared with leadership in real time and adjustments to the deployment process made. The predeployment survey was sent to 202 pediatric faculty members, with a 29% (n = 59) completion rate. Of the 36 deployed faculty, 29 (81%) completed all items of the postsurvey. The majority (74%, n = 42) expressed discomfort with care of adults and fear and/or nervousness about deployment (61%, n = 35). Most faculty (88%, n = 52) prepared for deployment and cited local guidelines and published literature as helpful preparation materials (55%, n = 16). Dissemination of details about schedules and role clarification before deployment were areas for improvement. Pediatric faculty facing deployment to adult care have concerns about the process of deployment as well as the work itself. Specific information distributed in advance, along with consistent and frequent communication, may help mitigate these fears.