Reducing Secondary Trauma and Promoting Self-Compassion Through a Graduate Medical Education (GME) Wellness Elective (Sch456)

Outcomes: 1. Explore the ways that palliative and mental health providers can collaborate to offer a novel, interdisciplinary wellness curriculum. 2. Evaluate impacts of a wellness course on secondary trauma, self-compassion, and burnout. Background(s): Palliative care and mental health providers possess skill sets that, when combined, can uniquely foster the well-being of colleagues within and beyond our specialties. The need for such peer support has become more urgent during the COVID pandemic. Self-care, compassion satisfaction, and trauma-informed training have been positively associated with an ability to cope with stressors in healthcare. We designed a 2-week GME elective intended to increase self-compassion and connection and reduce secondary trauma and burnout. Description: The course has been offered annually since 2019 to cohorts of 12-15 trainees across 14 specialties. Trainees participated in-person (2019, 2021) and virtually (2020). Coursework includes psychological safety, burnout/suicide prevention, self-compassion, occupational trauma and recovery, expressive art, medical error, cultural humility/upstanding, narrative medicine, conflict resolution, mindfulness, and others. We sought to evaluate the impact of the elective on burnout, self-compassion, and secondary trauma using the Professional Quality of Life (PROQOL) survey in the 2021 cohort. We evaluated trainee satisfaction with the course in all three cohorts (2019-2021). Result(s): 1 month after the elective, trainees reported a reduction in secondary trauma (p<0.0001) and an increase in self-compassion (p<0.005). The effect on burnout was not significant (p=0.57). Over 3 years, 100% of trainees (n=43) strongly agreed that the course was worth their time. Participants reported the course gave them "skills to better tolerate distress about things I cannot change" as well as self-agency through connection: "My peers helped me find new power that I didn't know I had." Conclusion(s): We generated a curriculum that impacted self-compassion and secondary trauma. We did not see an effect on burnout, which could be related to returning to an unchanged stressful environment following the course. Expanding access to this curriculum would afford opportunities to assess impact on a larger scale.Copyright © 2023

Exhaled gases and the potential of cross infection from NIV machines

Background: The indications for Long Term Ventilation (LTV) are expanding. Pneumonia is common in these patients and transmission of bacterial infections, and more recently COVID-19 infection, between users of ventilators is a concern. UK national standards recommend bacterial/viral filters for use with acute Non-Invasive Ventilation (NIV) to protect the ventilator from contamination. However, there are no recommendations made for LTV. UK National guidance also explicitly states that there is no airflow from the patient to the ventilator.1 Aims and objectives: To investigate whether exhaled gas reaches the ventilator outlet. Method(s): We conducted experiments on three ventilators with different circuits during NIV delivered to a member of the study team using standard clinical settings. We used a side-stream end tidal CO2 (EtCO2) analyser attached to the tubing adjacent to the ventilator outlet as shown in the figure. Result(s): Regardless of ventilator and circuit used we demonstrated that exhaled gas reaches the ventilator outlet during NIV. EtCO2 values were 1.6-3.7kPa. Conclusion(s): Exhaled gas reaches the ventilator outlet during NIV. This raises an urgent requirement within the LTV community to test ventilators for bacterial and viral colonisation, consider the use of bacterial/viral filters, and discuss routine decontamination of these devices between individual patient uses. (Figure Presented).

OPTIMA, a prospective randomized trial to validate the clinical utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in high clinical risk early breast cancer

Background: Multi-parameter tumor gene expression assays (MPAs) are used to estimate individual patient risk and guide chemotherapy use in hormone-sensitive, HER2-negative early breast cancer. The TAILORx trial supports MPA use in a node-negative population. Evidence for MPA use in postmenopausal node-positive breast cancer has been provided by the RxPONDER trial interim analysis but this relies on the absence of superiority in an analysis where >50% of events were unrelated to breast cancer. There is much uncertainty about MPA use for premenopausal patients. OPTIMA (Optimal Personalised Treatment of early breast cancer usIng Multi-parameter Analysis) (ISRCTN42400492) is a prospective international randomized controlled trial designed to validate MPAs as predictors of chemotherapy sensitivity in a largely node-positive breast cancer population. Method(s): OPTIMA is a partially blinded study with an adaptive two-stage design. The trial recruits women and men age 40 or older with resected ER-positive, HER2-negative invasive breast cancer and up to 9 involved axillary lymph nodes. Randomization is to standard management (chemotherapy and endocrine therapy) or to MPA-directed treatment using the Prosigna (PAM50) test. Those with a Prosigna tumor Score (ROR-PT) >60 receive standard management whilst those with a low score (<=60) tumor are treated with endocrine therapy alone. Endocrine therapy for premenopausal women includes ovarian suppression for all participants unless they experience a chemotherapy-induced menopause. Adjuvant abemaciclib is permitted. The trial will be analyzed for (1) non-inferiority of recurrence according to randomization and (2) cost-effectiveness. The key secondary outcome is non-inferiority of recurrence for patients with low ROR-PT score tumors. The efficacy analyses will be performed Per Protocol using Invasive Breast Cancer Free Survival (IBCFS) as the primary outcome measure to limit the risk of a false non-inferiority conclusion. Recruitment of 4500 patients over 8 years will permit demonstration of up to 3% non-inferiority of test-directed treatment with at least 83% power, assuming 5-year IBCFS is 87% with standard management. An integrated qualitative recruitment study addresses challenges to consent and recruitment, building on experience from the feasibility study which found that a multidisciplinary approach is important for recruitment success. OPTIMA is strongly supported by a patient group which has helped design all patient documents and which is represented on the TMG. Result(s): The OPTIMA main trial opened in January 2017 and has continued to recruit throughout the COVID-19 pandemic. Overall recruitment as of 1 July 2022 was 2814 (2593 from UK, 221 from Norway). Patient characteristics are well balanced between the trial arms. Currently 95% of randomized participants are eligible for inclusion in the PP analysis. 66% of the MPA-directed arm participants have been allocated to endocrine therapy only. The test failure rate is < 1%. Conclusion(s): OPTIMA will provide robust unbiased evidence on test-directed chemotherapy safety for both postmenopausal and premenopausal women with 1-3 involved nodes as well as for patients with 4-9 involved nodes and for patients treated with abemaciclib.

Surface-Functionalized Metal-Organic Frameworks for Binding Coronavirus Proteins.

Since the outbreak of SARS-CoV-2, a multitude of strategies have been explored for the means of protection and shielding against virus particles: filtration equipment (PPE) has been widely used in daily life. In this work, we explore another approach in the form of deactivating coronavirus particles through selective binding onto the surface of metal-organic frameworks (MOFs) to further the fight against the transmission of respiratory viruses. MOFs are attractive materials in this regard, as their rich pore and surface chemistry can easily be modified on demand. The surfaces of three MOFs, UiO-66(Zr), UiO-66-NH2(Zr), and UiO-66-NO2(Zr), have been functionalized with repurposed antiviral agents, namely, folic acid, nystatin, and tenofovir, to enable specific interactions with the external spike protein of the SARS virus. Protein binding studies revealed that this surface modification significantly improved the binding affinity toward glycosylated and non-glycosylated proteins for all three MOFs. Additionally, the pores for the surface-functionalized MOFs can adsorb water, making them suitable for locally dehydrating microbial aerosols. Our findings highlight the immense potential of MOFs in deactivating respiratory coronaviruses to be better equipped to fight future pandemics.

"Survive and Sustain”: Adaptive and Innovative Library Instruction in the Time of COVID-19

This study surveys members of an Illinois state-wide consortium to chart changes to the instructional practices of academic librarians in response to the conditions brought on by the COVID-19 pandemic. The survey findings and analysis provide insights into changes made to multiple aspects of participants' teaching, such as modality, technology use, instructional design, and adjustments to students' socioemotional needs at a time of rapid change, disruption, and stress. In addition to exploring instructional adaptations of librarians, the study identifies gaps in institutional support that might be addressed at the consortial level. While librarians initially altered their teaching and instructional services in "emergency mode,” their reflections reveal that many changes could be beneficial and long-lasting, given adequate and sustained support. © 2023 The Author(s). Published with license by Taylor & Francis Group, LLC.

Mathematical Model of Analysation of COVID-19 Using Graphs

Mathematical model is an model of an existing behavior of the system using mathematical language. The world health organization has announced that the novel corona virus disease(covid-19) is a major threat for human being. We developed a mathematical model to analyze the threat of covid-19 using graph network and governing the differential equations. © 2022 American Institute of Physics Inc.. All rights reserved.

Reducing hospital acquired pressure injury in a learning health center: Making the case for quality

Introduction: The purpose of this descriptive study is to examine a learning health system (LHS) continuous improvement and learning approach as a case for increased quality, standardized processes, redesigned workflows, and better resource utilization. Hospital acquired pressure injuries (HAPI) commonly occur in the hospitalized patient and are costly and preventable. This study examines the effect of a LHS approach to reducing HAPI within a large academic medical center. Methods: Our learning health center implemented a 6-year series of iterative improvements that included both process and technology changes, with robust data and analytical reforms. In this descriptive, observational study, we retrospectively examined longitudinal data from April 1, 2018 to March 31, 2022, examining the variables of total number of all-stage HAPI counts and average length of stay (ALOS). We also analyzed patient characteristics observed/expected mortality ratios, as well as total patient days, and the case-mix index to determine whether these factors varied over the study period. We used the Agency for Healthcare Research and Quality cost estimates to identify the estimated financial benefit of HAPI reductions on an annualized basis. Results: HAPI per 1000 patient days for FY 20 (October 1-September 30) and FY 21, decreased from 2.30 to 1.30 and annualized event AHRQ cost estimates for HAPI decreased by $4 786 980 from FY 20 to FY 21. A strong, statistically significant, negative and seemingly counterintuitive correlation was found (r = -.524, P = .003) between HAPI and ALOS. Conclusions: The LHS efforts directed toward HAPI reduction led to sustained improvements during the study period. These results demonstrate the benefits of a holistic approach to quality improvement offered by the LHS model. The LHS model goes beyond a problem-based approach to process improvement. Rather than targeting a specific problem to solve, the LHS system creates structures that yield process improvement benefits over a continued time period.

Tolerability of abiraterone (abi) combined with olaparib (ola) in patients (pts) with metastatic castration-resistant prostate cancer (mCRPC): Further results from the phase III PROpel trial

Background: The Phase III PROpel (NCT03732820) trial demonstrated at interim analysis a statistically significant clinical benefit from combining ola + abi in the first-line (1L) mCRPC setting vs placebo (pbo) + abi. Benefit was seen irrespective of a pt's homologous recombination repair mutation (HRRm) status;median radiographic progression-free survival (rPFS) 24.8 for ola + abi vs 16.6 months for pbo + abi (hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.54-0.81;P<0.0001). The safety profile of ola + abi was shown to be consistent with that for the individual drugs. We report additional interim safety analysis from PROpel. Methods: Eligible pts were ≥18 years with mCRPC, had received no prior chemotherapy or next-generation hormonal agent treatment at mCRPC stage, and were unselected by HRRm status. Pts were randomized 1:1 to abi (1000 mg qd) plus prednisone/prednisolone with either ola (300 mg bid) or pbo. Primary endpoint was investigator-assessed rPFS. Safety was assessed in all pts receiving ≥1 dose of study treatment by adverse event (AE) reporting (CTCAE v4.03). Results: 398 pts received ola + abi and 396 pbo + abi (safety analysis set). At data cut-off (July 30, 2021), median total duration of exposure for ola was 17.5 vs 15.7 months for pbo, and for abi 18.2 months in the ola + abi arm and 15.7 in the pbo + abi arm. Anemia (n=183) was the most common AE in the ola + abi arm, and 34% of these 183 events were managed by dose interruption, 23% by dose reduction, and 8% resulted in treatment discontinuation. Anemia and pulmonary embolism (PE) were the only Grade ≥3 AEs in ≥5% of pts (anemia: ola + abi, 15.1% vs pbo + abi, 3.3%;PE: 6.5% vs 1.8%, respectively). Most PEs were detected incidentally on radiographic imaging (69.2% and 71.4% in the ola + abi and pbo + abi arms, respectively) and no pts discontinued. More pts in the ola + abi arm experienced venous thromboembolism (Table). Arterial thromboembolism and cardiac failure AEs were balanced between the treatment arms. No AE of myelodysplastic syndrome/acute myeloid leukemia was reported in either treatment arm. COVID-19 was reported more frequently with ola + abi (8.3% vs 4.5%). Conclusions: PROpel demonstrated a predictable safety profile for ola + abi given in combination to pts with 1L mCRPC unselected by HRRm status. AEs of cardiac failure and arterial thromboembolism were reported at similar frequency in both treatment arms. The majority of PEs were asymptomatic. The safety profile of abiraterone was not adversely impacted by its combination with olaparib.

Interim analysis results from a proof-ofconcept study for ASLAN004 in adult moderate to severe atopic dermatitis: A double blind, randomized, placebo-controlled study

Background: ASLAN004 is a fully human monoclonal antibody that binds to IL-13Ra1 with high affinity and inhibits IL-4 and IL-13 signaling via the Type 2 cytokine receptor, an important target in atopic dermatitis (AD). Objective: To evaluate the emerging safety, tolerability, and efficacy of ASLAN004 in a multipleascending dose escalation phase in patients with moderate to severe AD. Methods: Twenty-five adult patients with moderate to severe AD were recruited from the US, Australia and Singapore and randomized 3:1 in three cohorts to receive once weekly 200, 400 or 600mg of subcutaneous ASLAN004 or matching placebo over eight weeks, with a 12-week recovery period. An interim data readout was conducted after Cohorts 1-3 completed eight weeks of treatment to evaluate various clinical endpoints in a limited number of patients before conducting an expansion cohort (Cohort 4, results reported elsewhere). Endpoints in the interim analysis include change from baseline in Eczema Area Severity Index (EASI) score at week 8 and safety assessments including local tolerability and incidence of adverse events (AEs). [NCT04090229] Results: Three of 25 patients randomized into Cohorts 1-3 discontinued due to restrictions imposed in response to the COVID-19 pandemic. 18 of the remaining 22 patients in the planned interim data readout completed at least 29 days of dosing and assessment and were evaluable for efficacy. The mean ± SD (n=18) baseline scores were 32.5±11.8 for EASI and 44% had severe Investigator Global Assessment (IGA) scores. At Week 8, mean reductions in EASI from baseline were 50 percent, 74 percent and 76 percent for the 200mg (n=4), 400 mg (n=6) and 600 mg (n=3) ASLAN004 dose groups respectively, compared with 42 percent (n=5) for placebo. Mean reductions of peak pruritus from baseline to Week 8 were 34 percent, 48 percent and 39 percent for 200mg (n=4), 400mg (n=6) and 600mg (n=2) ASLAN004 dose groups respectively, compared with 16% for placebo (n=5). Other secondary endpoints were also improved for ASLAN004 compared with placebo (EASI-50, EASI- 75, results reported elsewhere). The proportion of patients with AEs and treatment-emergent adverse events (TEAEs) were similar across ASLAN004 treatment and placebo arms. There were no TEAEs leading to discontinuation in the ASLAN004 treatment groups. Conclusion: ASLAN004 was well tolerated, with 400mg and 600mg showing promising eicacy in adults with moderate to severe AD.

Students leading the way: A micro-adaptation of UCLA’s WI+RE model to create information literacy tutorials

The COVID-19 pandemic necessitated that libraries quickly migrate information literacy instruction to an entirely online format. In tra-ditional classroom instruction, librarians have arguably greater flexibility in terms of how we can actively engage students in brainstorming keywords, developing their topics, and construct-ing Boolean searches. All of the sudden, we were all scrambling to put together lesson plans for the online environment, and library tutorials were in great demand. Coincidentally, at the University of Illinois-Chicago (UIC) we had already embarked upon a student-centered tutorial creation project about a month before the pandemic’s onset, which allowed us to bolster our online instructional pres-ence through the generation of student-centered learning objects. © 2021, Association of College and Research Libraries. All rights reserved.

THE INFLUENCE OF VIRTUAL INTERVIEWS ON THE FELLOWSHIP MATCH IN OBSTETRICS AND GYNECOLOGY (OBGYN)

Objective: The purpose of this study was to evaluate how a virtual interview process influences the Obstetrics and Gynecology fellowship match at a single institution. Materials and Methods: During the COVID-19 pandemic, the University of California Los Angeles (UCLA) OBGYN Department conducted all interviews in a virtual setting. Applicants and faculty completed 20 and 13-question surveys, respectively. A 5-point Likert scale was used for survey responses. The fellowship interviewees included those applying to the Reproductive Endocrinology and Infertility, Maternal Fetal Medicine, Gynecologic Oncology, Female Pelvic Medicine and Reconstructive Surgery, and Family Planning programs. Demographic data was collected and descriptive statistics were used to analyze data. Comparative analyses were performed with t-tests. Results: Surveys were distributed to 45 faculty members and 131 applicants with a response rate of 95.6% (n=43) and 46.6% (n=61), respectively. Of respondents, 83.7% (n=36) of faculty and 88.6% (n=54) of applicants agreed or strongly agreed that the video conference interviews (VCI) allowed them to accurately represent themselves (p=0.48). The majority of the applicants (62.3%, n=38) had a good understanding of the program’s culture after VCI. Over 70% (n=78) of applicants and faculty agreed or strongly agreed that they were able to form connections over VCI. Both applicants (67.2%, n=41) and faculty (83.7%, n=36) reported that the VCI helped them decide whether the program or candidate, respectively, was a good fit (p=0.98). Conclusions: Our data demonstrate that the majority of respondents could accurately represent themselves and form connections over VCI. Most importantly, both faculty and interviewees agreed that the VCI process helped to find a good match between applicant and program across all OBGYN fellowship programs. Given that in-person interviews require a significant amount of resources including time, unpredictable residency coverage issues, money, and coordination of travel, VCI is a viable option for fellowship interviews. Future studies should determine a standardized and evidenced-based approach for VCI. Impact Statement: The virtual interview model may be considered a long-term solution for fellowship interviews given the financial costs to the applicants and the time burden of the fellowship interview process for both the applicants and the residency programs. It will be important to optimize the VCI process so that applicants and departments can feel confident that the VCI process mirrors the match results of an in-person interview. Future research should investigate the impact of VCI on other avenues of training including the medical school and residency selection processes.

CORONET;COVID-19 in Oncology evaluatiON Tool: Use of machine learning to inform management of COVID-19 in patients with cancer

Background: Patients (pts) with cancer are at increased risk of severe COVID-19 infection and death. Due to COVID-19 outcome heterogeneity, accurate assessment of pts is crucial. Early identification of pts who are likely to deteriorate allows timely discussions regarding escalation of care. Likewise, safe home management will reduce risk of nosocomial infection. To aid clinical decisionmaking, we developed a model to help determine which pts should be admitted vs. managed as an outpatient and which pts are likely to have severe COVID-19. Methods: Pts with active solid or haematological cancer presenting with symptoms/asymptomatic and testing positive for SARS-CoV-2 in Europe and USA were identified following institutional board approval. Clinical and laboratory data were extracted from pt records. Clinical outcome measures were discharge within 24 hours, requirement for oxygen at any stage during admission and death. Random Forest (RF) algorithm was used for model derivation as it compared favourably vs. lasso regression. Relevant clinical features were identified using recursive feature elimination based on SHAP. Internal validation (bootstrapping) with multiple imputations for missing data (maximum ≤2) were used for performance evaluation. Cost function determined cut-offs were defined for admission/death. The final CORONET model was trained on the entire cohort. Results: Model derivation set comprised 672 pts (393 male, 279 female, median age 71). 83% had solid cancers, 17% haematological. Predictive features were selected based on clinical relevance and data availability, supported by recursive feature elimination based on SHAP. RF model using haematological cancer, solid cancer stage, no of comorbidities, National Early Warning Score 2 (NEWS2), neutrophil:lymphocyte ratio, platelets, CRP and albumin achieved AUROC for admission 0.79 (+/-0.03) and death 0.75 (+/-0.02). RF explanation using SHAP revealed NEWS2 and C-reactive protein as the most important features predicting COVID-19 severity. In the entire cohort, CORONET recommended admission of 96% of patients requiring oxygen and 99% of patients who died. We then built a decision support tool using the model, which aids clinical decisions by presenting model predictions and explaining key contributing features. Conclusions: We have developed a model and tool available athttps://coronet.manchester.ac.uk/ to predict which pts with cancer and COVID-19 require hospital admission and are likely to have a severe disease course. CORONET is being continuously refined and validated over time.

Telephone consultation - The patient perspective

Background: Our regional assisted ventilation service has a cohort of almost 1000 patients receiving Long Term Ventilation (LTV) in the community. The clinical review of these patients has historically been delivered in the outpatient setting, either at the base hospital or at outreach clinics elsewhere in the region. During the early part of the COVID-19 pandemic, it was recognised that face-to-face contact with this shielded group of patients was impractical, therefore the routine outpatient review was replaced with a telephone consultation. Patients who required urgent assessment or review were prioritised, and were seen face-to-face either in the outpatient department or in the community, observing strict infection prevention and control measures in either setting. Objective To gain an understanding of the perspective of LTV patients about their clinical review being provided by telephone. Method: We sent a survey to 930 patients asking: • Whether they had received a telephone consultation during the last few months • If so, to score how helpful the telephone consultation was • Whether they would consider changing some of their future consultations to telephone/video • To score what their preferred method of consultation would be in the future Results: We received feedback from 355 respondents who had participated in a telephone consultation. Most patients (98%) rated their telephone consultation as helpful. 66% would consider changing their future consultation to telephone review. When asked about future management, one third would prefer face-to-face consultation, one third would prefer telephone review and one third would prefer a mixture of both. Discussion Throughout the COVID-19 pandemic, due to reduced face-to-face clinical contact, LTV patients have demonstrated a significant level of independence in self-managing their health care. This is an opportunity to embrace the flexibility in the way health care delivery has evolved during this time. Conclusion: The patient perspective on how their health care is delivered is critically important. LTV services will continue to need to apply clinical judgement when organising their patient review process, but this feedback demonstrates that most patients would be happy for telephone consultations to replace some, if not all, of the face-to-face review they have previously had.