ABSTRACT
Background: Physical activity has been shown to have a positive impact on cystic fibrosis (CF) symptoms and slows decline in lung function. Additionally, moderate-intensity activities have been shown to improve sputum expectoration and oxygen saturation in children with CF, improving symptoms [1]. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children with CF. Method(s): This pre-post pilot study included participants aged 6 to 21 who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020 and November 2021. Garmin vivosmart 4 wrist-based activity trackers were issued, and baseline datawere tracked and analyzed for the first 2 study days. Pre-goal number of steps was defined as average number of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participants. Steps after goal settingwere defined as average number of steps taken on study day 3 and beyond while hospitalized, excluding day of discharge. Data collected from the medical record and the activity tracker web-based profile included daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means, and standard deviations. Outpatient data were collected for 3 months to observe adherence to goals after discharge. Result(s): Eight participants aged 6 to 18 completed the study. Hospital length of stay ranged from 4 to 14 days. Participants took an average of 1508 +/- 1078 steps before goal setting, which increased to an average of 3704 +/- 1555 steps after the intervention. Step goals were met 56% of the time, although these data were highly variable. During the first week after hospital discharge, participants took an average of 6303 +/- 1786 steps per day (Figure 1).(Figure Presented) Figure 1. During the intervention, patients met their step goal 56% of the time, although this was highly variable. Two patients met their goal 100% of the time (9- year-old boy, 7-year-old girl), two met it 0% of the time (18-year-old boy, 17-year-old girl), one met it 44% of the time (6-year-old boy), and the remaining three met it 67% of the time (10-year-old girl, 17-year-old girl, 14-year-old boy). Conclusion(s): This intervention shows promise, with daily number of steps doubling from baseline during the intervention period. There was great variability among participants, suggesting that the approach helps some more than others. Enrollment was initially planned for 20 patients, but the SARS-CoV-2 pandemic and changes to CF therapy reduced hospitalizations during the study period. Outpatient data were analyzed for only the first week after discharge because of poor adherence to wearing the device. Although our results showa positive impact, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include determining potential clinical benefit from increased activity during hospitalization and prolonged follow-up to assess long-term benefits of intervention.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
ABSTRACT
Introduction Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current pen-and-paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Methods Patients are approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have preexisting condition i.e dementia, severe aphasia Participants could speak to the digital doctor on the ward or at home via a web-version. Results Recruitment started on 8th December 2020;We have screened 614 people assessed for suspected acute stroke/TIA at Sheffield Teaching Hospitals. Of those we have recruited 71 participants (13 with TIA) Mean NIHSS of 4.5 and mean MoCA of 24.6. We will present initial results of factors affecting participant recruitment. We will also compare the mood and anxiety screening scores used in this study to those collected via the SNAPP database. Discussion Screening was adapted due to Covid pandemic and utilising remote consent and participa- tion allowed the project to continue.
ABSTRACT
Introduction: Over 50% of stroke survivors have cognitive impairment. National guidelines promote early cognitive testing however, current penand- paper based tests are not always appropriate, typically take place in hospital and are time costly for busy clinicians. This project aimed to create an easy-to-use cognitive assessment tool specifically designed for the needs of stroke survivors. We used a computerised doctor utilising automatic speech recognition and machine learning. Method(s): Patients were approached if they pass the eligibility criteria of having recent acute stroke/TIA, and do not have pre-existing medical condition i.e dementia, severe aphasia or too medically unwell to complete the assessment. Participants completed the computerised doctor or "CognoSpeak" on the ward using a tablet or at home via a web-version (on home computer or tablet). The assessment included the GAD and PHQ9. All had standard cognitive assessment done with the Montreal Cognitive Assessment (MOCA). Result(s): Recruitment started on 8th December 2020 and is on-going. 951 people were screened and 104 were recruited. 49 have completed baseline Cognospeak, 8 have withdrawn and 3 have died. The mean NIHSS was 3.8 and mean MoCA of 23.9, 31 were female. Participants had a mean education level of 17 years. Conclusion(s): Preliminary data will be presented highlighting feasibility of an automated cognitive and mood assessment that can be completed at home and on the Hyper-acute Stroke Unit. Screening was adapted due to Covid pandemic and utilising remote consent and participation allowed the project to continue.
ABSTRACT
As of 8 July 2022, the World Health Organization (WHO) have reported 1010 probable cases of acute hepatitis of unknown aetiology in children worldwide, including approximately 250 cases in the United Kingdom (UK). Clinical presentations have often been severe, with liver transplantation a frequent clinical outcome. Human adenovirus F41 (HAdV-F41) has been detected in most children with acute hepatitis, but its role in the pathogenesis of this infection has yet to be established. Wastewater-based epidemiology (WBE) has become a well-established tool for monitoring the community spread of SARS-CoV-2, as well as other pathogens and chemicals. In this study, we adopted a WBE approach to monitoring levels of HAdV-F40/41 in wastewater before and during an acute hepatitis outbreak in Northern Ireland. We report increasing detection of HAdV-F40/41 in wastewater, concomitant with increasing numbers of clinical cases. Amplicon whole genome sequencing further classified the wastewater-derived HAdV as belonging to the F41 genotype which in turn was homologous to clinically derived sequences. We propose that WBE has the potential to inform community surveillance of HAdV-F41 and can further contribute to the ongoing global discussion supporting HAdV-F41 involvement in acute hepatitis cases. © 2022 The Authors
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A thread common to all disasters is the effect on human health that results when the health care infrastructure and delivery of health services are disrupted. This view has reinforced the importance of an all "all-hazards approach” to preparedness, whereby disaster response planning incorporates principles common to all events and can be adapted to specific contingencies. Preparing for and responding to a disaster in long-term care (LTC) requires a broad view of multiple events that can disrupt daily life and needed services for LTC residents (e.g. hurricanes, pandemics). This symposium will examine the effects of varied emergency events on older adults residing in nursing homes (NHs) and assisted living communities (ALCs) using quantitative and qualitative methodologies. The first presentation will discuss morbidity and mortality of NH residents exposed to Hurricane Harvey (Texas). The second is an investigation of NH direct care staffing during the recent Winter Storm Uri (Texas). The third presentation qualitatively explores the challenges of providing care to residents living with dementia during the COVID-19 pandemic, based on interviews with Florida NH and ALC administrators. The fourth quantitatively and qualitatively explores issues related to resident-to-resident contact restrictions in Florida ALCs. Finally, we will discuss the application of the 4Ms Age Friendly framework (What Matters, Medication, Mentation, and Mobility) to disaster preparedness in LTC. This symposium will provide information that can be used to develop or revise public policies to improve preparedness for and response to a range of emergency events in NHs and ALCs.
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Background COVID-19 changed access to healthcare, including vaccinations, in the United Kingdom (UK). This study explored UK women’s experiences of accessing pertussis vaccination during pregnancy and infant vaccinations during COVID-19. Methods An online cross-sectional survey was completed, between 3rd August-11th October 2020, by 1404 women aged 16+ years who were pregnant at some point after the first UK lockdown from March 23rd 2020. Ten follow-up semi-structured interviews were conducted. Results Most women surveyed were pregnant (65.7%) and a third postnatal (34.3%). Almost all women (95.6%) were aware that pertussis vaccination is recommended in pregnancy. Most pregnant (72.1%) and postnatal women (84.0%) had received pertussis vaccination however, access issues were reported. Over a third (39.6%) of women had a pregnancy vaccination appointment changed. COVID-19 made it physically difficult to access pregnancy vaccinations for one fifth (21.5%) of women and physically difficult to access infant vaccinations for almost half of women (45.8%). Nearly half of women (45.2%) reported feeling less safe attending pregnancy vaccinations and over three quarters (76.3%) less safe attending infant vaccinations due to COVID-19. The majority (94.2%) felt it was important to get their baby vaccinated during COVID-19. Pregnant women from ethnic-minorities and lower-income households were less likely to have been vaccinated. Minority-ethnicity women were more likely to report access problems and feeling less safe attending vaccinations for both themselves and their babies. Qualitative analysis found women experienced difficulties accessing antenatal care and relied on knowledge from previous pregnancies to access vaccine appointments. Conclusions COVID-19 disrupted access to vaccinations in the UK. Vaccine services must ensure equitable access to vaccine appointments during ongoing and future pandemics including tailoring services for lower income and ethnic minority families. Key messages • Pregnancy and infant vaccines was disrupted by COVID-19 with women feeling less safe and having difficulties accessing vaccinations with ethnic minority women more likely to report access issues. • Equitable access to routine pregnancy and infant vaccine appointments must be prioritised during future pandemics, including considering tailoring services for different population groups.
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Background and Aim: Acute-on-chronic liver failure (ACLF) is a global health care challenge, with a 28-day mortality rate of 33.9% and 30-day readmission rate of 37%.1,2 Management of ACLF is often complicated by multiorgan involvement, need for intensive care support, sarcopenia/frailty, and lack of universally accepted diagnostic criteria.3,4 Health care resource utilization is high. Our aims were to assess the safety, efficacy, acceptability, and cost of LivR Well, a new model of intensive, multidisciplinary ambulatory care for patients with ACLF. Method(s): We conducted a prospective, single-arm, mixed-methods study at Monash Health, a large Victorian tertiary network. Adult patients were enrolled from the inpatient ward, emergency department, or outpatient clinic in the first 28 days after a formal diagnosis of ACLF. ACLF was defined using Asian Pacific Association for the Study of the Liver criteria (an acute hepatic insult manifesting as jaundice and coagulopathy, complicated by ascites and/or encephalopathy within 4 weeks).5 Study criteria and the LivR Well intervention are shown in Figure 1. Patients were admitted to hospital in the home and received nursing visits up to 3 times a week and a weekly clinic medical review. Patients accessed physiotherapy, pharmacy, dietetics, social work, addiction medicine, and neuropsychiatry if appropriate. Blood test results were monitored weekly, and patients were followed up for 12 weeks. Health-related quality of life (HRQoL) was measured using EQ-5D and the Chronic Liver Disease Questionnaire (CLDQ) at baseline and Week 6. A qualitative substudy was undertaken to assess acceptability, with interviews performed between Weeks 6 and 12. The primary outcome was safety. Secondary outcomes were readmission, liver disease severity, HRQoL, symptom burden (CLDQ), acceptability, and health care resource utilization. Result(s): Fifty-nine patients (median age, 51 years [IQR, 45-59];66% male) were enrolled between March 2021 and April 2022. Forty-four patients completed the 28-day program, with two deaths (at Days 16 and 27), one drop-out due to COVID-19 requiring isolation, eight patients discharged due to failure to attend, and four patients who remain active in the program. There were no reported adverse events. Alcohol misuse was the most frequent liver disease etiology (73%). There was a significant reduction in median Model for End-Stage Liver Disease-Sodium (MELDNa) score from 16 at baseline (IQR, 12-21) to 15 at Day 28 (IQR, 11-18;P < 0.001). Sarcopenia prevalence decreased from baseline to Day 28 but did not reach statistical significance (27% vs 19%, P = 0.48). HRQoL significantly improved from a median baseline CLDQ score of 4.34 (IQR, 3.37-5.08) to 4.75 (IQR, 3.97-5.81;P = 0.02), with specific improvement in the domains of activity (P = 0.04), fatigue (P = 0.02), and worry (P = 0.001). The qualitative study highlighted universal themes of high acceptability, improved health literacy/insight, and increased autonomy. The median self-reported health perception using a visual analog scale significantly improved from 64% (IQR, 42-77%) to 72% (IQR, 50-80%;P = 0.05). The 28-day mortality rate was 3%, and the 30-day readmission rate was 14%. The median LivRWell program cost was A$4947. The total 6-month median direct health care cost for each LivR Well patient improved from a median of A$30 913 before LivR Well (IQR, $11 201-$61 464) to $784 after LivR Well (IQR, $0-$18 117;P < 0.001). The total direct health care cost for this cohort was reduced by 71%, from $1.16 million before to $335 000 after LivR Well, largely driven by a 40% reduction in 30-day readmission. Conclusion(s): LivR Well is a world-first multidisciplinary ambulatory care program for patients with ACLF. Our feasibility study supported the safety, potential efficacy, and cost-effectiveness of such an intervention, with lower than expected 30-admission, 28-day mortality, and total health care cost for this complex cohort. There was a small, but significant improvement in MELD-Na score, HRQoL, and self-rep rted health perception. We are further evaluating the clinical and economic impact of LivR Well as part of a randomized controlled trial comparing it with standard ambulatory care.
ABSTRACT
As of 8 July 2022, the World Health Organization (WHO) have reported 1010 probable cases of acute hepatitis of unknown aetiology in children worldwide, including approximately 250 cases in the United Kingdom (UK). Clinical presentations have often been severe, with liver transplantation a frequent clinical outcome. Human adenovirus F41 (HAdV-F41) has been detected in most children with acute hepatitis, but its role in the pathogenesis of this infection has yet to be established. Wastewater-based epidemiology (WBE) has become a well-established tool for monitoring the community spread of SARS-CoV-2, as well as other pathogens and chemicals. In this study, we adopted a WBE approach to monitoring levels of HAdV-F40/41 in wastewater before and during an acute hepatitis outbreak in Northern Ireland. We report increasing detection of HAdV-F40/41 in wastewater, concomitant with increasing numbers of clinical cases. Amplicon whole genome sequencing further classified the wastewater-derived HAdV as belonging to the F41 genotype which in turn was homologous to clinically derived sequences. We propose that WBE has the potential to inform community surveillance of HAdV-F41 and can further contribute to the ongoing global discussion supporting HAdV-F41 involvement in acute hepatitis cases.
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Background: Little is known about patients’ interactions with Supported Self-Management (SSM) for early breast cancer (EBC), or confidence in managing their care in this pathway. The PRAGMATIC study allowed us to explore these issues. Methods: Three clinical teams in Surrey and Sussex identified EBC patients due to enter SSM. Patients completed standardised questionnaires (separately reported) +/- semi-structured telephone interviews at baseline, 3, 6, 9 and 12 months. The interviews explored how confident patients felt managing their care, accessing services, managing side effects (SEs), and lifestyle changes. Results: 32/110 patients engaged in interviews;data are available for 30/32 at all timepoints. Participants were representative of the whole group in terms of demographics and treatment received. Patients understood the main reasons for SSM were to: a) assume responsibility for their follow up (18/32;56%) and b) save time and money for them and the hospital (16/32;50%). Most maintained (very/somewhat) confidence over time in managing their care and SEs, but were less confident identifying BC related signs/symptoms especially if screen detected. 19 patients contacted the SSM helpline +/- their GP. 15/19 found the helpline easy to use and 6/19 were seen by a healthcare professional. The main triggers for calling were for advice on signs/symptoms and managing SEs. 5/26 (19%) patients on endocrine therapy (ET) had stopped it completely. Most (29/32) were engaged in exercise before diagnosis, and 8/10 who discontinued during treatment resumed afterwards. The COVID-19 pandemic had a negative impact on exercise and socialising. The interviews’ free text provided a plethora of rich data. Qualitative analysis produced four overarching themes: 1) expectations and experiences, 2) emotional wellbeing, 3) clinical concerns, and 4) effect of COVID-19 pandemic. Conclusions: SSM works for most EBC patients. Clinicians could explain that the helpline is available for psychosocial as well as physical concerns. BC teams may want to review how to help screen detected patients recognise BC related signs/symptoms, how to monitor adherence to ET and offer interventions for treatment related SEs. Clinical trial identification: ISRCTN10777283. Legal entity responsible for the study: University of Sussex. Funding: Surrey & Sussex Cancer Alliance. Disclosure: All authors have declared no conflicts of interest.
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Introduction: Following a change in national diabetic guidance [1,2], local audit performed in 2019 identified areas of improvement which were incorporated into a revised care pathway for elective caesarean section (ELCS) in 2020. Shortly after introduction, the COVID-19 pandemic led to telephone (rather than face-to-face) pre-assessment. We performed a re-audit in 2021 to assess the impact of the new pathway and pre-assessment changes. Methods: Following local audit registration, retrospective notes review of all diabetic mothers having ELCS (22/11/21–24/12/21) was performed and results compared to the previous audit (2019) and national recommendations [1,2]. Results: Notes were available for all 10 women having ELCS in 2021 and compared to 10 women in 2019. In 2021 all women had gestational diabetes (GDM) and treatment included diet control (3), metformin alone (5), or insulin and metformin (2). In 2019, eight women had GDM and two were type-1 diabetics, with treatment including diet control (3), metformin alone (2), insulin alone (1) and dual insulin and metformin (4). The revised care pathway advised variable rate insulin infusion for all diabetics with blood glucose >7 mmol/L. In 2021, no women required a VRII, compared to two in 2019 due to type one diabetes and blood glucose over 9 mmol/L. In both audits, all women were admitted on the day of surgery and had ELCS under spinal anaesthesia. A comparison of the audit results in 2019 and 2021 is shown (Table). (Table Presented) Discussion: Despite a revised care pathway, guideline compliance for perioperative management of diabetic women having ELCS did not improve, although no woman had a documented blood glucose >7 mmol/L. Compliance was poor in all areas of perioperative management. We now plan to relaunch the pathway in all perioperative clinical areas to improve awareness. This re-audit highlights the importance of reviewing clinical practice to assess the impact of the pandemic on service improvements in perioperative obstetric care.
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INTRODUCTION: Emergencies during gynecologic office procedures are uncommon. However, knowledge in management of these complications is essential as more gynecologic procedures move from the operating room to the office. Our goal was to develop an interactive curriculum to address a gap in residency training in the management of office-based procedural emergencies. METHODS: A curriculum including management of unanticipated bleeding, anaphylaxis, vasovagal response, and local anesthetic systemic toxicity (LAST) was developed and implemented using a combination of simulated patient sessions, a “choose-your-own-adventure” PowerPoint, and a mock oral board session. Pre and post intervention surveys queried participants' confidence in recognition and management. The curriculum was delivered as in-person simulation sessions or virtual sessions due to COVID restrictions. Institutional review board (IRB) approval was obtained. Mean pre and post intervention scores were compared using paired t-test. RESULTS: Four accredited obstetrics and gynecology residency programs participated. Twenty-nine trainees completed the curriculum, and 24 submitted pre and post surveys (82.8% response rate). There was significant improvement in confidence scores for management of unanticipated bleeding (mean difference 0.96, P<.001), anaphylaxis (mean difference 1.7, P<.001), vasovagal response (mean difference 1.0, P<.001), and LAST (mean difference 2.5, P<.001). Additionally, significant improvement in confidence scores for identification of risk factors and signs/symptoms of vasovagal response (mean difference 0.96, P<.001, and 0.46, P=.005) and LAST (mean difference 2.3, P<.001, and 2.2, P<.001) was noted. CONCLUSION: Implementation of an office emergencies curriculum significantly increased confidence in identification and management of unanticipated bleeding, anaphylaxis, vasovagal response, and LAST. Future studies evaluating knowledge-based assessments of learners are needed.
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Background: Many studies have reported a poor prognosis from COVID-19 infection among patients with reduced eGFR. These findings may be partly explained by the high burden of comorbidities affecting patients with CKD but the impact of CKD itself is unclear. The aim of this study was to evaluate and quantify the effect of CKD on COVID-19-related deaths, hospitalisations and cardiovascular (CV) events in a Scottish population, using a propensity-score-based method to eliminate confounding factors. Methods: All adult patients in Tayside and Fife, Scotland, UK with a COVID-19 positive PCR test between 03/ 2020 and 02/2021 were included in the cohort and further divided into two groups (CKD and non-CKD). Patients were included in the CKD group if their most proximal eGFR was <60 mL/min/1.73 m2 and they had another eGFR measurement<60 at least 90 days before. A Covariate Balancing Propensity Score (CBPS) algorithm was implemented to account for systematic differences in their baseline characteristics. Doubly robust Cox and logistic regression enabled to estimate the effect of CKD on COVID-19 outcomes. Results: The cohort included 4556 patients (858 with CKD and 3698 without CKD). Patients with CKD were older (84 versus 59 years old, p < 0.001) and had a higher burden of comorbidities. After implementation of the CBPS algorithm, the characteristics of the two groups were similar. Patients with CKD experienced worse outcomes than those without CKD (mortality: 37% versus 12%, hospitalisation: 38% versus 23%, CV events: 12% versus 3%, p < 0.001). Although reduced after CBPS adjustment, those differences remained significant for COVID-19-related deaths and CV events but not for the risk of hospitalisation or the length of stay. The cause specific hazard ratio for COVID-19-related deaths was 3.67 (95% CI 3.17 to 4.24 - logrank test p < 0.001) before CBPS and 1.28 (95% CI 1.07 to 1.52 - p < 0.001) after CBPS adjustment (Figure 1). For all outcomes, the risk magnitude progressively increased as lower eGFR values were reached. Indeed, after CBPS adjustment, having CKD G3A was not associated with a higher risk of COVID-19-related outcomes. However, CKD G4/5 or being on dialysis was associated with an approximately twice higher risk of death and CV event, compared with having a normal renal function (Figure 2 for risk of death). Conclusion: Patients with CKD experience worse outcomes following a COVID-19 infection, compared to those with a preserved renal function. A large part of this increase in risk for poor outcomes is related to the greater burden of comorbidities affecting patients withCKD, but our analyses suggest thatCKDis also an independent risk factor. The effect of CKD on COVID-19 severity was particularly marked in more advanced CKD stages. Patients with CKD are at increased vulnerability to COVID-19 and should be prioritised for preventive measures such as vaccination. (Table Presented).
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Introduction/Aim: We are seeing the rapid emergence of a significant new threat to CF survival;chronic nontuberculous mycobacterial (NTM) infection. This study aims to understand the aetiology and epidemiology of NTM in Australians with CF. Methods: Nationally, nine adult and nine paediatric CF services prospectively collected respiratory samples from people with CF (pwCF) for acid fast bacilli (AFB) culture at regular clinic appointments (Baseline, 6 months, 1 year, then annual to 4 years);associated clinical data, geographic and social data was also collected. Sites commenced recruitment between December 2016 and August 2018. Retrospective clinical and culture data were also collected to offset the shift to a telehealth model of care during the global coronavirus pandemic. Results: 15.1% of 1322 study participants cultured NTM (NTM+) from at least one AFB culture during the study, 5.1% of study participants were M. abscessus (MABS) positive. Adolescents and young adults (11-25 years) had the highest rates of NTM infection (19%, p = 0.0004). MABS was more commonly isolated in participants <25 years (6.7%) compared to participants 25 years and older (2.5%, p < 0.001). Of NTM+ study participants, 49% were incident cases. The species of NTM recovered from participants varied depending on the Australian state of residence, with South Australia, Western Australia and Tasmania having greater diversity of isolated species. Conclusion: In Australia, during this sampling period pwCF <25 years of age were more likely to be infected with MABS than older pwCF. We hypothesize that this may be due to increasing attempts at eradication of Pa in early life and/or increased exposure from environmental sources at a vulnerable age.
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Purpose/Background: The COVID-19 pandemic has resulted in global disruptions to the delivery of healthcare.(1) The national responses of Australia and New Zealand has resulted in unprecedented changes to the care of colorectal cancer patients, amongst others. This paper aims to determine the impact of COVID-19 on colorectal cancer diagnosis and management in Australia and New Zealand. Methods/Interventions: This is a multicentre retrospective cohort study using the prospectively maintained Binational Colorectal Cancer Audit (BCCA) registry. Data is contributed by over 200 surgeons in Australia and New Zealand. Patients receiving colorectal cancer surgery during the pandemic were compared to averages from the same period over the preceding three years. Results/Outcomes: There were fewer operations in 2020 than the historical average. During April to June patients were younger, more likely to have operations in public hospitals and more likely to have urgent or emergency operations. By October to December proportionally less patients had stage I disease, proportionally more had stage II or III disease and there was no difference in stage IV disease. Patients were less likely to have rectal cancer, were increasingly likely to have urgent or emergency surgery and more likely to have a stoma created. Conclusion/Discussion: This study shows that the response to COVID-19 has had measurably negative effects on the diagnosis and management of colorectal cancer in two countries that have had significantly fewer COVID-19 cases than many other countries. The long-term effects on survival and recurrence are yet to be known, but could be significant. Findings will be updated with 2021 data at the completion of the year. (Figure Presented).
ABSTRACT
Purpose of Study Cystic Fibrosis (CF) is a progressive, genetic disease that affects over 30,000 individuals across the nation and results in decreased functionality of the lungs. Physical activity has a positive impact on the symptoms of CF and works to slow the decline in lung function. Additionally, activities with moderate intensity have been shown to improve sputum expectoration and oxygen saturation in children with CF. This study assessed whether using fitness trackers and providing a daily step goal would increase physical activity in hospitalized children and young adults with CF. Methods Used This prospective study included participants 6- 21 years of age who were admitted to the hospital for a pulmonary exacerbation of CF between October 2020-May 2021. Study enrollment occurred no more than 48 hours after hospital admission. Garmin vivosmart® 4 wrist-based activity trackers were issued and baseline data were tracked and analyzed for the first 2 study days. Pre-goal steps were defined as the average of steps taken on those 2 days. On study day 3, a step goal and menu of activities designed to increase physical activity were shared with the participant. Steps after goal setting were defined as the average of steps taken on study day 3 and beyond, excluding day of discharge. Data were collected from the electronic medical record and the activity tracker web-based profile and included the following: daily oxygen requirement, daily step count, sleep duration, overnight pulse oximetry levels, resting heart rate, calories expended, and intensity minutes. The primary outcome of change in daily steps and attainment of step goals was analyzed using descriptive statistical testing, means and standard deviations. Summary of Results Six patients, aged 6-18 years, completed the study. Mean baseline FEV1for study participants was 66% predicted (range 38 to 92%). Hospital length of stay ranged from 4-14 days. Participants took an average of 1772 ± 1011 steps before goal setting. This increased to an average of 3741 ± 1780 steps after goal setting. Overall, step goals were met 52% (Range 0-100%) of the time. Conclusions This intervention shows promise, as daily steps doubled from baseline during the intervention period. There was great variability among the participants, suggesting the device may help some people much more than others. Enrollment was initially planned for 20 patients;however, the SARS-CoV-2 pandemic and consequent changes to CF therapy drastically reduced hospitalizations during the study period. Though our results show a positive impact of increased physical activity following goal implementation, further research is needed to determine the effect such an intervention would have on a larger scale. Future directions of research include having a larger sample size, conducting a multi-center study to increase population diversity, and implementing a longer follow- up period to better assess long term benefits of intervention.