Use of a device-based remote management heart failure care pathway is associated with reduced hospitalization and improved patient outcomes: TriageHF Plus real-world evaluation

Background: Heart failure (HF) is a leading cause of hospital admission. However, prompt identification of worsening HF using implantable device data and proactive intervention may reduce hospitalizations. The validated TriageHF algorithm in enabled ICD/CRT devices uses sensor data to risk stratify patients for HF hospitalization in the next 30 days. TriageHF Plus is a novel device-based HF care pathway (DHFP) that uses high risk status as the trigger for remote intervention (see Figure 1 for pathway overview). Outcomes after DHFP implementation in a clinical setting have not been examined. Purpose(s): To evaluate the impact of TriageHF Plus clinical pathway on hospitalisation rates. Method(s): A prospective, multi-center evaluation comparing monthly hospitalization rates for patients enrolled in a DHFP with a concurrent standard of care (SoC) cohort and characterizing staffing resources necessary to implement the DHFP. The DHFP cohort received telephonic assessment and guideline-directed clinical care upon transition to high-risk status. Propensity scores (PS) were applied to DHFP and SoC cohorts to allow unbiased comparison. A negative binomial model was fitted to the monthly number of all-cause hospitalizations with treatment group (DHFP vs. SoC) as a covariate, using PS as weights. Result(s): Between 09/11/2019 and 06/24/2021, 758 patients were included in the study (443 DHFP, 315 SoC). Proportion CRT 76%/ 89% and LVEF <50% 78%/ 66% for DHFP/ SoC, respectively. 196 high risk transmissions prompted telephone assessment, with successful contact in 182;of which, 79 (43%) identified an explanatory acute medical issue. A secondary intervention was undertaken in 44/79 (56%). High risk transmissions took on average 19 minutes per clinical assessment (initial telephone triage and 30 day follow up). The rate of hospitalizations was 58% lower in the DHFP group, compared with SoC, after PS adjustment (IRR 0.42, 95% CI: 0.23, 0.76, p=0.004), see Figure 2. Sensitivity analyses showed Covid-19 had little effect on results. Conclusion(s): This is the first prospective, real-world evaluation of a device-based HF care pathway to report a reduction in hospitalizations and does so with minimal staffing time. Integrated into existing HF services, device-based remote monitoring of HF patients can improve outcomes. (Figure Presented) .

Use of a device-based remote management heart failure care pathway is associated with reduced hospitalization and improved patient outcomes: TriageHF Plus real-world evaluation

Background: Heart failure (HF) is a leading cause of hospital admission. However, prompt identification of worsening HF using implantable device data and proactive intervention may reduce hospitalizations.The validated TriageHF algorithm in enabled ICD/CRT devices uses sensor data to risk stratify patients for HF hospitalization in the next 30 days. TriageHF Plus is a novel device-based HF care pathway (DHFP) that uses "high” risk status as the trigger for remote intervention (see Figure 1 for pathway overview). Outcomes after DHFP implementation in a clinical setting have not been examined. Purpose: To evaluate the impact of TriageHF Plus clinical pathway on hospitalisation rates. Methods: A prospective, multi-center evaluation comparing monthly hospitalization rates for patients enrolled in a DHFP with a concurrent standard of care (SoC) cohort and characterizing staffing resources necessary to implement the DHFP. The DHFP cohort received telephonic assessment and guideline-directed clinical care upon transition to high-risk status. Propensity scores (PS) were applied to DHFP and SoC cohorts to allow unbiased comparison. A negative binomial model was fitted to the monthly number of all-cause hospitalizations with treatment group (DHFP vs. SoC) as a covariate, using PS as weights. Results: Between 09/11/2019 and 06/24/2021, 758 patients were included in the study (443 DHFP, 315 SoC). Proportion CRT 76%/ 89% and LVEF <50% 78%/ 66% for DHFP/ SoC, respectively.196 high risk transmissions prompted telephone assessment, with successful contact in 182;of which, 79 (43%) identified an explanatory acute medical issue. A secondary intervention was undertaken in 44/79 (56%). High risk transmissions took on average 19 minutes per clinical assessment (initial telephone triage and 30 day follow up). The rate of hospitalizations was 58% lower in the DHFP group, compared with SoC, after PS adjustment (IRR 0.42, 95% CI: 0.23, 0.76, p=0.004), see Figure 2. Sensitivity analyses showed Covid-19 had little effect on results. Conclusions: This is the first prospective, real-world evaluation of a device-based HF care pathway to report a reduction in hospitalizations and does so with minimal staffing time. Integrated into existing HF services, device-based remote monitoring of HF patients can improve outcomes. Funding Acknowledgement: Type of funding sources: Private company. Main funding source(s): MedtronicFigure 1. Pathway OverviewFigure 2. Outcomes

Researching children and disasters: What’s different in pandemic times?

The repercussions of the global COVID-19 pandemic are far-reaching and extend to the ways in which scholars conduct disaster research. Research on children and disasters is no exception. Focusing on methodologies, this paper explores the methodological constraints and innovations of studying children during the current crisis, and the implications for post-pandemic research on children and disasters. We begin by reviewing research methodologies to study children and disasters, drawing upon scholarly and grey literature as well as on our own research project on the pandemic experiences of children, adolescents, and older adults. We then discuss how these research approaches, tools, and spaces have changed during the pandemic. Methodological adaptation and innovation are necessary because traditional data collection methods are largely not feasible during the current pandemic;for example, many researchers cannot travel to the disaster site, hold in-person focus groups, interview children and their families face-to-face, or conduct extensive participant observation in places people would usually frequent. We pay particular attention to research ethics issues, including the challenges of navigating the research design process when children are involved. We contend that the massive adoption of online methods during the COVID-19 pandemic is laying the foundation for a seventh wave of research on children and disasters characterized by the integration of in-person and virtual worlds, and of in-person and virtual research methods. Rather than initiating this transition to a hybrid or blended model, the pandemic is accelerating the transition, and compelling more of the research community to engage than might have otherwise. The “bricolage” of methods originating in both in-person and virtual fields, adapted in various ways for both in-person and virtual fields, is better attuned to the spaces where children live their lives, and the ways in which they live their lives. © The Author(s) 2022. (Copyright notice)

B Cells Induce Hypertension, AT1AA, And Complement Activation In Preeclampsia Or In Response To A Prior Covid-19 Infection During Pregnancy

Preeclampsia (PE), new onset hypertension (HTN) during pregnancy, is associated with placental ischemia and chronic inflammation that includes increased CD4+ T cells, B cells secreting agonistic autoantibodies against the angiotensin II type 1 receptor (AT1AA), and activation of the complement system. Previous studies have shown AT1-AA is produced in patients with COVID-19 infection. Interestingly, having had COVID-19 during pregnancy is associated with increased incidence of developing a PE phenotype during pregnancy. We have previously shown an important role for B cell depletion or AT1AA inhibition to attenuate HTN in rat models of PE. Collectively, this data suggests B cells contribute to PE development and that B cells may increase incidence of PE in patients with a history (Hx) of COVID-19 during pregnancy through production of the AT1AA. We hypothesize B cells from PE or CV Hx PE patients produce AT1AA resulting in HTN and complement activation in pregnancy. Placental B cells were isolated from normal pregnant (NP), PE, normotensive (NT) CV Hx, or PE CV Hx patients at delivery. B cells were transferred i.p. into pregnant athymic rats at gestation (GD) 12. On GD18, carotid catheters were inserted. On GD19, blood pressure was measured and tissues collected. PE B cell recipients had increased Mean Arterial Pressure (MAP) (115+/-3 mmHg n=6) compared to NP B cell recipients (97+/-4 mmHg n=6 p<0.05). PE B cell recipients had increased AT1AA (20+/-2 DELTABPM n=4) compared to NP B cell recipients (6+/-1 DELTABPM n=4 p<0.05). PE B cell recipients had increased markers of complement activation such as reduced plasma C4 (1302+/-169 mug/mL n=4) and C3 (516+/-45 mug/mL n=4) compared to recipients of NP B cells (2348+/-338 mug/mL n=4 p<0.05) and (790+/-66 mug/mL n=4 p<0.05) respectively. CV Hx PE B cell recipients had elevated MAP (108+/-3 mmHg n=4) compared to CV Hx NT B cell recipients (101+/-7 mmHg n=4) and increased AT1AA (24+/-3 DELTABPM n=3) compared to CV Hx NT B cell Recipients (4+/-1 DELTABPM n=4 p<0.05). Collectively, this study demonstrates an important role for B cells to cause HTN during pregnancy;and indicates that B cells contribute to a higher incidence of PE in women with a Hx of CV infection during pregnancy possibly by secreting AT1-AA.

Supporting Athlete Wellbeing During A Global Pandemic: The case of COVID-19

In January 2020, the outbreak of the Corona virus across the globe caused the World Health Organization to issue warnings of an international pandemic on a scale never before seen. The world ground to a halt within a matter of weeks. This chapter explores the reactions, feelings and reflections of the first ten weeks of lockdown in England of Josh - a Performance Lifestyle Advisor for the English Institute of Sport - and the elite swimmers he supports. Salient events from the lockdown period - such as the move to land-based training, the delay of the Tokyo 2020 Olympic Games and the rising of social justice movements - are theorised to explore both the practical and existential challenges that arose from home confinement. The chapter concludes with considerations of how the COVID-19 pandemic might serve as a catalyst to reconceptualise staff and athlete mental health and wellbeing in a design that surpasses prioritising performance and, instead, seeks to prioritise the person first and the athlete second. © 2022 selection and editorial matter, Natalie Campbell, Abbe Brady and Alison Tincknell-Smith.

IS REMOTE LEARNING AS EFFECTIVE AS IN-PERSON LEARNING FOR CONTOURING EDUCATION? A COMPARISON OF FACETO-FACE VERSUS ONLINE DELIVERY OF THE ANATOMY AND RADIOLOGY CONTOURING BOOTCAMP

Purpose: The Anatomy and Radiology Contouring (ARC) Bootcamp was a three-day in-person intervention providing integrated radiology, anatomy, and contouring education for radiation oncology (RO) residents and medical physicists. The course consisted of didactic radiology and contouring lectures, small group anatomy sessions using cadaveric prosections, and realtime contouring using commercial software. Acknowledging the importance of increasing access to the Bootcamp, we launched an online version of the ARC Bootcamp in November 2019. We evaluated the online (ONL) course's impact on participants' knowledge acquisition, contouring skills, and self-confidence by comparing it to the face-to-face (F2F) course. Materials and Methods: The F2F Bootcamp was adapted into an ONL version using the Teachable platform (teachable.com). The ONL course was structured in a linear progression of locked modules to offer similar content to the F2F comparator. Participants from the 2019 F2F and the 2019-2020 ONL Bootcamp provided consent for the study and completed pre-and post-intervention evaluations, which assessed anatomy/radiology knowledge, contouring skills, anatomy/radiology knowledge and contouring self-confidence, and course satisfaction. Results: Fifty-seven (F2F: n=30;ONL: n=27) participants completed both evaluations. The ONL course had a substantially wider geographic participation, with participants from 19 countries (versus four countries in the F2F course) completing the preevaluation. F2F had primarily RO resident participation (80%) compared to ONL (41%). In the ONL course, most were from a different field (52%), including medical physics residents or medical students. Compared to baseline self-assessments, both cohorts demonstrated similar self-confidence improvements with their anatomy/radiology knowledge, contouring skills, and in interpreting radiology p<0.001). In the anatomy/radiology knowledge testing, the ONL group showed improvement (mean improvement ± SD: 4.6 ± 6.3 on a 40-point scale;p<0.001) but the F2F group did not (1.6 ± 5.6;p=0.159). The F2F group demonstrated improvement with the contouring assessment (mean ± SD: 0.10 ± 0.17 on a 1-point Dice scale;p=0.004), whereas only a trend was found for the ONL group (0.07 ± 0.16;p=0.076). Both cohorts perceived the course as a positive learning experience (F2F: 4.8 ± 0.4 on a 5-point scale;ONL: 4.5 ± 0.6) and stated it will improve their professional practice (F2F: 4.6 ± 0.5 on a 5-point scale;ONL: 4.2 ± 0.8). Both groups would recommend the course to others (F2F: 4.8 ± 0.4 on a 5-point scale;ONL: 4.4 ± 0.6). Conclusions: The ONL ARC Bootcamp achieved similar results as the F2F version, with improved self-confidence, knowledge scores, and high satisfaction levels among participants. The ONL course is more accessible to diverse geographic regions and disciplines, allows for ongoing education during the COVID-19 pandemic, and can be used as a framework to develop other online educational interventions in radiation oncology.

Addressing disaster vulnerability among homeless populations during COVID-19

During the COVID-19 pandemic, disruptions to key services for populations experiencing homelessness may lead to secondary effects in the context of a disaster, including effects on health and safety, which require additional population-specific support. Reducing disaster vulnerability for people experiencing homelessness during the COVID-19 pandemic requires adapting existing preparedness guidance to an evolving situation. Addressing Disaster Vulnerability among Homeless Populations during COVID-19 reviews research on disaster vulnerability, homelessness, the pandemic, and intersecting hazards and disasters. This rapid expert consultation includes considerations for alternative shelter facilities for homeless populations during a disaster;suggestions on how to navigate service reductions and support population-specific needs;and guidance for supporting populations experiencing homelessness in the aftermath of disasters. © National Academy of Sciences. All rights reserved.

VIRTUAL FRACTURE CLINIC: A PANDEMIC-READY TOOL for IMPROVING the EFFICIENCY of FRACTURE CLINIC

BACKGROUND: The traditional model of care of the Orthopaedic Fracture Clinic (OFC) is labour intensive, expensive, has poor satisfaction rates, and often has minimal impact on management and outcomes of patients with minor injuries. Our aim was to implement a Virtual Fracture Clinic (VFC) for the management of minor injuries that is safe, reduces OFC clinic workload and reduces the OFC failure to attend (FTA) rate. METHODS: This study was a retrospective longitudinal audit of OFC workload before (January 2012 -February 2017) and after (March 2017 - December 2019) implementation of the VFC. It was performed in an urban district general hospital in South East Queensland, Australia. The primary outcome measures included attendances per timepoint (month). RESULTS: Overall, we observed a significant reduction in total number of patients from 1, 055 (IQR 104.5) to 831 (IQR: 103) per month coming through the OFC following the introduction of the VFC (F = 21.9;df=1;p <0.0001). The failure to attend rate was reduced by 44% from 271 (IQR: 127.3) to 151 (IQR: 72.8) (F=4.0;df=1;p = 0.047). CONCLUSION: The VFC implementation was successful in improving efficiency and reducing the current OFC workload, as well as reducing FTA rate. Reduction in clinic workload allows more time to be spent with complex patients, prevents clinic backlogs and overbooking, and crowding of waiting rooms. In the midst of a global pandemic that is spread by close contact, virtual clinics seem the way of the future to treat patients whilst minimising risk of COVID-19 spread. © 2021 Australasian College of Health Service Management. All Rights Reserved.

Is Remote Learning as Effective as In-Person Learning for Contouring Education? A Comparison of Face-to-Face vs. Online Delivery of the Anatomy and Radiology Contouring Bootcamp

Purpose/Objective(s): The Anatomy and Radiology Contouring (ARC) Bootcamp was a three-day in-person course providing integrated radiology, anatomy, and contouring education for radiation oncology (RO) residents and medical physicists. The course consisted of didactic radiology and contouring lectures, small group anatomy sessions using cadaveric prosections, and real-time contouring using commercial software. Acknowledging the importance of increasing access to the Bootcamp, we launched an online (ONL) version of the ARC Bootcamp in November 2019. We evaluated the ONL course's impact on participants' knowledge acquisition, contouring skills, and self-confidence by comparing it to the face-to-face (F2F) course. Materials/Methods: The F2F Bootcamp was adapted into an ONL version using the Teachable platform (teachable.com). The ONL course was structured in a linear progression of locked modules to offer similar content to the F2F comparator. Participants from the 2019 F2F and the 2019–2020 ONL Bootcamp provided consent for the study and completed pre-and post-intervention evaluations, which assessed anatomy/radiology knowledge, contouring skills, anatomy/radiology knowledge and contouring self-confidence, and course satisfaction. Results: Fifty-seven (F2F: n = 30;ONL: n = 27) participants completed both evaluations. The ONL course had a substantially wider geographic participation, with participants from 19 countries (vs. 4 countries in the F2F course) completing the pre-evaluation. F2F had primarily RO resident participation (80%) compared to ONL (41%). In the ONL course, most were from a different field (52%), including medical physics residents or medical students. Compared to baseline self-assessments, both cohorts demonstrated similar self-confidence improvements with their anatomy knowledge, contouring skills, and in interpreting radiology images (all P < 0.001). In the anatomy/radiology knowledge testing, the ONL group showed improvement (mean improvement ± SD: 4.6 ± 6.3 on a 40-point scale;P < 0.001) but the F2F group did not (1.6 ± 5.6;P = 0.159). The F2F group demonstrated improvement with the contouring assessment (mean ± SD: 0.10 ± 0.17 on a 1-point Dice scale;P = 0.004), whereas only a trend was found for the ONL group (0.07 ± 0.16;P = 0.076). Both cohorts perceived the course as a positive learning experience (F2F: 4.8 ± 0.4 on a 5-point scale;ONL: 4.5 ± 0.6) and stated it will improve their professional practice (F2F: 4.6 ± 0.5 on a 5-point scale;ONL: 4.2 ± 0.8). Both groups would recommend the course to others (F2F: 4.8 ± 0.4 on a 5-point scale;ONL: 4.4 ± 0.6). Conclusion: The ONL ARC Bootcamp achieved similar results as the F2F version, with improved self-confidence, knowledge scores, and high satisfaction levels among participants. The ONL course is more accessible to diverse geographic regions and disciplines, allows for ongoing education during the COVID-19 pandemic, and can be used as a framework to develop other online educational interventions in radiation oncology.

Characteristics and epidemiology of a native american community with a high prevalence of COVID-19

Background: COVID research and reporting has focused on large urban populations. However, limited data suggests that rural Native American (NA) populations are disparately impacted. We serve a well-defined NA population of ≈18,000 that is relatively geographically isolated in the White Mountains of eastern Arizona. Our first case SARS-CoV-2 was confirmed April 1st. We have since confirmed an attack rate significantly higher than most of the United States. We provide testing and case trends in addition to characteristics of the first 800 cases. Methods: We sequentially reviewed the charts of all laboratory-confirmed COVID-19 patients from April 1 to June 3, 2020. In addition to calculating prevalence and rates, we provided summary statistics that were used to describe testing breakdown, demographics, symptoms, and co-morbidities. Results: From April 1 to June 3, we tested 2,662 persons, of which 884 (33.2%) were positive. The estimated prevalence of the time of writing is 4.9% and the rate of 4,911 per 100,000 persons. Data compiled from the first 800 laboratory-confirmed patients is summarized in table 1. Median age for confirmed cases was 40.6 (IQR 28-54). 555 cases (72.1%) were symptomatic. The most common symptoms were cough (67.7%), subjective fever (39.5%), and muscle aches (36.8%). 30.6% of confirmed cases were asymptomatic at the time of testing. The majority of cases were among persons aged 30-39 years (22.9%). Some of the most common comorbidities in confirmed cases included cardiovascular disease (30.4%), substance abuse (30.1%), and diabetes (25.0%). There were 18 (2.04%) deaths. Clinical findings among symptomatic patients Conclusion: We observed a significantly higher prevalence (10-times) and attack rate of (17-times) COVID-19 in a well-defined NA population, when compared to the general Arizona population. We provide characteristics of these cases and report that nearly a third were asymptomatic at the time of testing. More research is needed to understand the rapid spread of COVID-19 in vulnerable rural communities.