POST-MORTEM MRI to INVESTIGATE PERINATAL LOSS at COUNTIES MANUKAU HEALTH, AUCKLAND, NEW ZEALAND

Background: Magnetic Resonance Imaging (MRI) may be useful as an alternative to perinatal post-mortem autopsy. Our service has high rates of perinatal loss, and low rates of post-mortem autopsy. We have offered post-mortem MRI for the last 5 years, however how MRI is currently being used, have not been reviewed. Aim(s): To describe: (i) the number of perinatal post-mortem MRIs performed, (ii) the reasons for offering MRI, (iii) whether the MRI was contributory to diagnosing cause of perinatal loss or adding extra information. Method(s): Cases were identified crosschecking perinatal loss and radiology data from 2010 to 2021. Anonymised summaries of clinical notes and investigation results of all cases were reviewed by two multidisciplinary groups, each of whom had MRI reports for half of the cases. Congruency of final classification of cause of death was compared and groups reported for each case whether MRI provided new information. Result(s): Between 2018 and 2021 there were 426 perinatal losses, of which 17 were investigated with MRI. In all cases MRI was offered after parents declined autopsy and was performed in addition to other investigations (maternal blood tests, placental karyotype, and histology). MRI changed the final PDC code in 1 case, provided additional findings in 2 cases, confirmed antenatally diagnosed anomalies in 4 cases and was non-contributory to diagnosing cause of death in 11/17 cases. Conclusion(s): In our service, post-mortem MRI has been used infrequently as part of the investigations into perinatal loss. When used, it has been most useful in confirming presence of structural anomalies diagnosed antenatally. Conclusion(s): High COVID-19 community prevalence was associated with increased MROP numbers at our clinical site, but inferences are limited by a lack of standardisation of operative reporting.

Does financial fragility affect consumer well-being? Evidence from COVID-19 and the United States

Financial fragility is of considerable concern for consumer well-being. Besides unleashing a public health crisis, COVID-19 also ignited a financial crisis and thus represents a natural event from the field to study financial well-being. We maintain that well-being is a corollary to one's financial situation. We investigate the linkage between financial fragility and well-being and the moderating role of financial literacy and personality using US data. We find that financial fragility is negatively associated with well-being. This pervasive phenomenon during a financial crisis has harmful consequences. We also find evidence of a differential impact of financial fragility on well-being based on Agreeableness, Conscientiousness, and Neuroticism, supporting our argument that personality has varying degrees of explanatory and predictive power in terms of well-being. Surprisingly, financial literacy does not modify this relationship, possibly due to the well-being affecting an individual's cognition and emotions rather than financial knowledge. Our findings could aid policy makers and financial educators in devising timely strategies to deal with post-crisis complications. © 2023 The Authors. Global Business and Organizational Excellence published by Wiley Periodicals LLC.

IS IT SAFE TO PROVIDE 28 DAY POST-EXPOSURE PROPHYLAXIS (PEP) PACKS IN SEXUAL HEALTH SERVICES, EMERGENCY DEPARTMENTS AND SEXUAL ASSAULT REFERRAL CENTRES?

Introduction Since the beginning of COVID lockdown, we have provided 28 day PEP packs from sexual health clinics, emergency departments and sexual assault referral centres to minimise number of patient contacts. This study is to look at the provision of PEP since the new initiative. Methods Patients who attended our hospital emergency department, sexual assault referral centre, and sexual health clinics between March 2020 and October 2021 were randomly selected. Retrospective patient records were reviewed and the BHIVA 2015 PEP standards were used. Results 434 patients and 468 PEP prescriptions were included. 384 (88%) were male, in whom 337 (87.8%) were MSM. 166 (38.2%) were from our emergency department. 401 (85.7%) were after sexual exposure, 56 (20.0%) were occupational exposure. 413 (88.2%) prescriptions met criteria for initiation, 43 (9.2%) did not and 3 (0.6%) had insufficient information. 448 (95.7%) had baseline blood tests. 28 (6%) did not attend sexual health clinic for follow up. 255 (54.5%) had repeat HIV test after 8-12 weeks of exposure. 213 (45.5%) did not have repeat test. STI screening was performed in 368 (78%) attendances and 106 infections were identified. Discussion The majority of PEP was prescribed appropriately and baseline testing was performed in most cases. Out study demonstrates the safety of 28-day PEP pack being issued in settings other than sexual health clinics. Post-PEP HIV testing remains poor, which is consistent with other national audits. This highlights the need for focussed work to improve followup attendance.

108 Using the CARG prediction score to influence patient decision to proceed with chemotherapy based on the predicted incidence of toxicity in lung cancer

Introduction: The CARG (Cancer and Aging Research Group) score is a predictive model for patients 65 years and over experiencing grade 3-5 toxicity from chemotherapy. It uses factors such as the number of chemotherapeutic drugs and serological factors such as haemoglobin level. It also incorporates geriatric social factors. Studies have shown mixed results for its usefulness in Oncology practice. Methods: In this study we selected 10 suitable patients from Southend University Hospital who presented to clinic with a new diagnosis of lung cancer. If we offered chemotherapy, we calculated their CARG score and asked them if their predicted percentage of experiencing toxicity affected their decision to proceed with treatment. Results: 10/10 patients did not find the score influenced their decision. Their scores ranged from 32-50%. All patients wanted to proceed with treatment regardless of their CARG score. Participants felt that the score did not provide any additional beneficial information towards their informed decision to proceed with treatment. Conclusions: There are a number of identified flaws with the CARG score. For example, the clinician would be unlikely to offer treatment to a patient who would be at high risk of experiencing severe toxicity based in factors such as performance status. Also, the score did not take account the emergence of combination treatments with immunotherapy, which has a different toxicity profile. The study was done during the COVID-19 pandemic, which understandably has limited the social activity of elderly patients, thereby affecting their score. We conclude that the CARG score may be useful to clinicians but does not appear to influence patient decision. Disclosure: No significant relationships.

Creation of a diversity, equity, and inclusion initiative to address systemic racism

Background: Catalyzed by the horrific death of George Floyd, a Black man, significant concrete efforts to engage workplaces in Diversity, Equity, & Inclusion (DEI) initiatives has gained prominence and administrative backing among workplaces in the United States. A diverse academic geriatrics & palliative medicine department in New York City began meeting weekly in Town Hall sessions to debrief & discuss workplace, local, & national concerns. Discussions focused on COVID19, the Black Lives Matter movement, structural racism, & patient care inequities. These events ignited greater DEI initiatives to meet departmental needs. This report serves to highlight key program components & lessons learned in launching a structured DEI initiative in the academic medicine setting. Methods: First, a new DEI core & department administration met 2-4 times/month to plan & review DEI program activities, vision, & mission. Confidential roundtable discussions about DEI issues & 1:1 interviews were conducted to assess needs. A monthly Humanities, Arts, & Books (HAB) Initiative provided a safe space for discussion & l earning. The HAB platform supported a longitudinal curriculum emphasizing (1) group discussion & self-reflection on DEI topics, (2) knowledge dissemination including a “Learning Pathway” series, & (3) skill-based workshops. With each event, we collected anonymous feedback via survey. Comments were systematically recorded & engagement evaluation was conducted in order to iteratively shape future sessions. Departmental administration was engaged to track DEI-focused measures of recruitment, career advancement, & retention. Finally, we centralized DEI activities on a departmental website, including an anonymous online feedback box. Results: Quantitative & qualitative assessment of DEI initiatives are forthcoming. Metrics include DEI & professional development surveys, departmental demographic & diversity measures, increase in DEI-related projects and grants, & individual participation DEI programs. Conclusions: Creating a strong and sustainable DEI initiative within an academic medical setting requires a passionate and diverse core to centralize efforts, deliberate backing by administration, & thoughtful dissemination of sensitive content in the midst of a highly charged social justice landscape.

PEP in the city - A new way of delivering post-exposure prophylaxis from the Emergency Department

Introduction: We present our contingency plan for the management of patients presenting to our Emergency Department (ED) requiring HIV (Human Immunodeficiency Virus) Post-Exposure Prophylaxis (PEP) during the COVID-19 pandemic. Method: The pre-COVID pathway relied on patients who needed PEP being dispensed a 5 day supply of PEP. A generic leaflet was included in each PEP pack. This contained a large amount of medical jargon and no contact details for local services. A handwritten fax referral was sent to Genitourinary Medicine (GUM) who would recall the patient for face to face (F2F) review in order to obtain baseline screening and supply an additional 23 days of medication. F2F follow up testing was arranged at 2 weeks and 8-12 weeks post-PEP. Results: An electronic PEP referral was introduced and the ED Clinical Decision Support Guideline (CDGS) was redesigned. Pharmacy was able to supply 28 days of PEP meaning that if a patient was required to self-isolate, they would have an adequate supply of treatment at home. The patient information leaflet was rewritten using simple terminology and details of local GUM services were included. Baseline bloods were taken within ED removing the need for F2F appointments. Upon receipt of the PEP referral, a Health Advisor would call the patient and arrange for confirmatory home testing kits to be sent at the required window period. Patients attending ED who were non-Manchester residents were eligible for the same service thus reducing unnecessary F2F contact at other clinics. 16 patients were successfully referred from ED to GUM between May/June 2020. Discussion: Our new pathway has helped us to substantially mitigate risk for patients requiring PEP via the ED. Following the success of this collaborative project, we have decided to adopt this pathway permanently as we predict demand for PEP will increase as the UK begins to ease lockdown restrictions.

Measure Twice and Cut Once: How a Budget Cut Impacted Subscription Renewals

Library staff at California State University, Fullerton carried out a project to determine where budget cuts could be made in their electronic journal subscriptions. The team analyzed usage statistics by journal title, determined pricing for each journal, and created a formula to clearly define the cost effectiveness of continuing or deactivating a subscription. In this presentation, Keri Prelitz and Greg Yorba, with contributions from Ilda Cardenas, explain the special considerations, challenges, and outcomes of the project. Using this information, they will repeat the analysis annually, especially in the wake of additional budget cuts due to the current COVID-19 pandemic. © 2021, Published with license by Taylor & Francis. Group, LLC. © 2021 Keri Prelitz, Greg Yorba, Ilda Cardenas and Heather Baker.

Components of a safe cystectomy service during coronavirus disease 2019 in a high-volume centre

Objective: Delivery of a safe cystectomy service is a multidisciplinary exercise. In this article, we detail the measures implemented at our institution to deliver a cystectomy service for bladder cancer patients during coronavirus disease 2019 (COVID-19). Methods: A ‘one-stop’ enhanced recovery clinic had been established at our hospital, consisting of an anaesthetist, an exercise testing service, urinary diversion nurses, clinical nurse specialists and surgeons. During COVID-19, we modified these processes in order to continue to provide urgent cystectomy safely for bladder cancer. We collected patients’ outcomes prospectively measuring demographic characteristics, oncological and perioperative outcomes, the presence of COVID-19 symptoms and confirmed COVID-19 test results. Results: From March to May 2020, 25 patients underwent radical cystectomy for bladder cancer. Twenty-four procedures were performed with robotic assistance and one open as part of a research trial. We instituted modifications at various multidisciplinary steps, including patient selection, preoperative optimisation, enhanced recovery protocols, patient counselling and perioperative protocols. Thirty-day mortality was 0%. The 30-day rate of Clavien ⩾3 complications was 8%. Postoperatively, none of the patients developed COVID-19 based on World Health Organization criteria and testing. Conclusion: We safely delivered a complex cystectomy service during the peak of the COVID-19 pandemic without any COVID-19-related morbidity or mortality. Level of evidence: Level 2b.