Changes in Prostate Specific Antigen Screening Following the 2018 United States Preventive Services Task Force Guidelines and through the Covid-19 Pandemic

INTRODUCTION AND OBJECTIVE: In 2018, The US Preventive Services Task Force (USPSTF) changed its recommendations for prostate specific antigen (PSA) screening from "non-recommended" to "shared decision-making among men aged 55-69". Thereafter, COVID-19 Pandemic disrupted cancer care with evidence suggesting overall reduced access to and utilization of health care services including preventive screening. We aim to examine the impacts of both events on PSA screening for men aged 55-69. METHOD(S): We analyzed 2013, 2015, 2018, 2019, and 2021 National Health Interview Survey data. Men >54 who reported PSA testing within 12 months preceding survey were considered to have undergone screening. Adjusted difference in differences (DID) analyses were performed to compare changes in screening in men aged 55-69 with reference to men >70 between 2015 and 2019 (pre- and post- 2018 USPSTF recommendation) and between 2019 and 2021 (pre- and post-Pandemic). RESULT(S): A total of 24,308 men were included. PSA screening prevalence was 35.4% (95%CI: 33.7%, 37.1%), 32.1% (95%CI: 30.3%, 33.9%), 33.3% (95%CI: 31.6%, 34.9%), 37.2% (95%CI: 35.7%, 38.8%), and 34.9% (95%CI: 33.3%, 36.5%) respectively for included years. From 2015 to 2019, PSA screening increased 4.6% among men aged 55-69 (95%CI: 1.7, 7.5%) and increased 6.5% among men >70 (95% CI: 2.7, 10.4%). From 2019 to 2021, PSA screening decreased 3.1% among men aged 55-69 (95%CI: 0.58%, 5.8%);PSA screening also decreased 0.8% among older men but did not reach significance (95% CI: -2.6%, 4.2%). DID analysis did not show difference in changes between men aged 55-69 in reference to men >70 from both 2015 to 2019 (DID=-1.9%, 95%CI, -6.7%, 2.9%) and 2019 to 2021 (DID =-2.3%, 95%CI, -6.5%, 1.9%). CONCLUSION(S): We saw an increase in PSA screening after 2018 USPSTF recommendations among its target population e men aged 55-69 and also among older men >70. In contrast, the period from 2019 to 2021 saw a significant decrease in PSA screening in those aged 55-69. The lack of significant DID between groups as well as the downward trend of PSA screening in men >70 together suggest an overall trend of decrease in PSA screening post-Pandemic.

Decreased Utilization of Low-Value Health Care Services during the Covid-19 Pandemic

INTRODUCTION AND OBJECTIVE: Low value health care is defined as care in which the potential to cause harm is greater than benefit. We hypothesize that rationing of health care services during the pandemic decreased the delivery of low value services. METHOD(S): Data was retrieved from the Mass General Brigham Research Patient Data Registry. High value care services were defined by U.S. Preventive Services Task Force guidelines, while low value care services were adapted for claims as described in the literature. Twenty-one services (4 high value and 17 low value) had adequate volume for analysis. Three month periods were considered, consisting of the pandemic period (Q4: 3/2/20 to 6/1/20) and control periods preceding the pandemic (Q1: 12/1/18 to 3/1/19;Q2: 3/2/19 to 6/1/19;and Q3: 12/1/19 to 3/1/20). Ratio measures of services per period were used to account for seasonality and differences in frequency.The 2019 high value (H) care ratio (Y0H = NHQ2/NHQ1) illustrates relative service counts during a typical year and the 2020 ratio (Y1H = NHQ4/NHQ3) represents the change due to the pandemic. Difference in ratios YH=Y1H-Y0H less than zero reflects a reduction in high value services during the pandemic. The same calculation was made for low value (L) procedures;YL=Y1LY0L. The difference between YL and YH is the difference in differences (DID) estimator and illustrates the differential decline in services. YH- YL greater than zero suggests that low value care declined to a greater degree than high value care. Subdivision DID in ratio analyses were performed for cancer and non-cancer care. RESULT(S): Included in this analysis were 3,271,957 patients. Mean age was 51.4 years, 59.1% of patients were female, and 71.7% were non-Hispanic. Of 21 identified services, 18 had a reduction in volume during the pandemic. The YL for PSA testing in men older than 75 was -0.81. The DID in ratios of all care was 0.08 (p<0.01), suggesting a modest decline in low-value care (Figure 1). The reduction was more pronounced for cancer care with a DID in ratios of 3.39 (p<0.01). CONCLUSION(S): We observed a reduction in both low and high value care with a greater reduction in low value services, especially for cancer care. Limitations include use of data from a single health system, limited number of services, and short time periods given the rapid onset of the pandemic.

Trends in Definitive Therapy for Prostate Cancer during the Covid-19 Pandemic: A Grade-by-Gradeanalysis

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic placed a significant burden on the US healthcare system. Moreover, many healthcare systems triaged cases based on the severity of disease. Therefore, we assessed the impact of the COVID-19 pandemic on prostate cancer management according to the International Society of Urological Pathology (ISUP) grade groups. METHOD(S): We retrospectively analyzed the National Cancer Database (NCDB) for patients with prostate cancer between 2018- 2020. We divided our cohort into "Pre-Pandemic" (2018/2019) and "Pandemic" (2020) periods. Men were classified according to their ISUP grade group at diagnosis. Hospital characteristics and patient-level clinical and sociodemographic variables were extracted. Our primary outcome was the utilization of definitive treatment (surgery or radiation) versus expectant management (active surveillance, watchful waiting, or no treatment). We performed multivariable logistic regressions to predict the type of management for each ISUP grade group across the two periods adjusting for clinical and socioeconomic covariates. RESULT(S): A total of 398,719 men with a diagnosis of prostate cancer were reported during the "Pre-Pandemic" (70.6%) and "Pandemic" (29.4%) periods. Overall, 24.5% had an ISUP 1, 30.6% an ISUP 2, 18.2% an ISUP 3, 13% ISUP 4, and 13.8% ISUP 5 disease (Table 1). Treatment was less likely during the "Pandemic" compared to the "Pre-Pandemic" period for ISUP grade group 1 (aOR 0.80;95% CI 0.77 - 0.83;p-value <0.001), for ISUP grade group 2 (aOR 0.85;95% CI 0.81 - 0.89;p-value <0.001) and for ISUP grade group 3 (aOR 0.87;95% CI 0.80 - 0.96;p-value <0.003). However, no differences in treatment trends were found for ISUP grade groups 4 and 5 across the two time periods. CONCLUSION(S): During the COVID-19 pandemic, patients with prostate cancers ISUP grade groups 1, 2, and 3 were more likely to receive expectant management than definitive treatment;however, this was not true for patients with more aggressive diseases. This finding suggests a high capacity of facilities to appropriately risk stratify and prioritize higher-risk cases during a public health emergency. A limitation of our study is the inability to assess the treatment trends of men diagnosed in the last 2020 quarter due to the lack of follow-up.

Stage and Grade Migration of Prostate Cancer during the Covid-19 Pandemic

INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic likely affected the healthcare system's ability to deliver prostate cancer care services. Herein, we sought to evaluate prostate cancer's stage and grade migration resulting from the COVID-19 pandemic. METHOD(S): We retrospectively analyzed the National Cancer Database (NCDB) for men with prostate cancer between 2018-2020. We divided our cohort into the "Pre-Pandemic" (2018/2019) and "Pandemic" (2020) periods. Stage and grade of prostate cancer were stratified according to the severity of disease: PSA value (<=20 vs. >20), clinical T stage (cT1-T2 vs. cT3-T4), clinical M stage (cM0 vs. cM1), International Society of Uropathology (ISUP) grade group (ISUP 1-2-3 vs. ISUP 4-5), and D'Amico risk classification (low risk vs. intermediate & high risk). Pearson's chi-square test was used to assess differences in the distribution of stage and grade across the two periods. We performed multivariable logistic regressions to estimate the effect of the "Pandemic" period on stage and grade distribution adjusting for clinical and socioeconomic covariates. RESULT(S): A total of 398,719 men were diagnosed with prostate cancer during the "Pre-pandemic" (70.6%) and "Pandemic" (29.4%) periods (Table 1). On univariable comparisons, an increase in stage/ grade across the two periods was demonstrated (all p<0.001). After adjusting for covariates, compared to the "Pre-pandemic", the "Pandemic" period was associated with increased odds of PSA >20 levels (aOR 1.06;95% CI 1.03 - 1.08;p-value <0.001), cT3-4 stages (aOR 1.12;95% CI 1.08 - 1.16;p<0.001), cM1 stage (aOR 1.15;95% CI 1.12 - 1.18;p<0.001), ISUP grade group 4 or 5 (aOR 1.03;95% CI 1.01 - 1.05;p=0.003) and D'Amico Intermediate & High risk groups (aOR 1.15;95% CI 1.13 - 1.18;p<0.001). CONCLUSION(S): The COVID-19 pandemic was associated with significant changes in the distribution of both stage and grade of prostate cancer. Possible explanations for this migration include a better selection of patients for prostate biopsy during the pandemic or changes in prostate cancer screening patterns.

The impact of the COVID-19 lockdown on retinopathy of prematurity screening and management in the United States: a multicenter study.

PURPOSE: To study the effect of the pandemic-related lockdown (physical distance measures and movement restrictions) on the characteristics and management of retinopathy of prematurity (ROP). METHODS: In this controlled, multicenter cohort study, the medical records of patients born prematurely and screened for ROP in the neonatal intensive care unit during four time periods were reviewed retrospectively: (1) November 1, 2018, to March 15, 2019; (2) March 16, 2019, to August 2, 2019 (lockdown control period); (3) November 1, 2019, to March 15, 2020; and (4) March 16, 2020-August 2, 2020. RESULTS: A total of 1,645 patients met inclusion criteria. Among the 1,633 patients with complete data, mean gestational age (GA) at birth was 28.2, 28.4, 28.0, and 28.3 weeks across time periods 1 to 4, respectively (P = 0.16). The mean birth weight of all patients was 1079.1 ± 378.60 g, with no significant variation across time periods (P = 0.08). There were fewer patients screened during the lockdown period (n = 411) compared with the period immediately before (n = 491) and the same period in the prior year (n = 533). Significantly more patients were screened using indirect ophthalmoscopy, compared to digital imaging (telemedicine), during the lockdown (P < 0.01). There were 11.7%, 7.7%, 9.0%, and 8.8% of patients requiring treatment in each time period, respectively (P = 0.42), with a median postmenstrual age at initial treatment of 37.2, 36.45, 37.1, and 36.3 weeks, respectively (P = 0.32). CONCLUSIONS: We recorded a decrease in the number of infants meeting criteria for ROP screening during the lockdown. The GA at birth and birth weight did not differ. Significantly more infants were screened with indirect ophthalmoscopy, compared to digital imaging, during the lockdown.

The importance of trust and transparency in managing the COVID-19 pandemic. Evidence from sixteen EU member states

During the COVID-19 pandemic, the European Union's (EU) member states operationalized different methods to control the virus. By April 2022, the EU countries recorded considerably different COVID-19 related deaths. In this study, we investigate whether trust in government and in the medical staff, COVID-19 related transparency, and different mixes of these two, influenced the capacity of sixteen EU countries to manage the pandemic. To substantiate our inquiry, we utilize a modified version of the Trust-Transparency Matrix. Our study suggests that trust and transparency, in the context of the pandemic, operate as contextual variables of effective public management. The value of the trust-transparency framework is to elucidate general governance dynamics and to identify those that are the most pertinent in terms of the response to the pandemic. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

A Decade with DYSS: Lessons Learned and Looking Forward

Each summer over the past decade, the Chemical Engineering Department at the University of Washington has hosted the "Distinguished Young Scholars Seminar" (DYSS) series, bringing outstanding research trainees from top-tier programs around the country for day-long campus visits filled with student discussions, faculty meetings, mock interview questioning, and a research seminar. Here, we discuss the history and evolving structure of DYSS, highlighting prior successes and lessons learned, as well as opportunities for ongoing improvement.

The benefits of belonging: Students' perceptions of their online learning experiences

Learning environments that support a sense of belonging have been shown to help students fully and meaningfully participate in their learning. Less is known, however, about the social organization of online learning environments that support a sense of belonging, particularly in postsecondary contexts. With an explicit attention to issues of equity, this mixed-methods study examined what makes undergraduate students in the United States of America (N = 4,544) feel included in online learning environments during a global pandemic. Survey responses collected in the fall of 2020 were analyzed through a sociocultural learning theory framework. Rating scale and open-ended responses revealed that students' sense of belonging and inclusion varied by student race and gender and by instructional modality (synchronous vs. asynchronous). Opportunities for discussion, interaction with peers, and feeling that one's racial or ethnic group was represented in the curriculum were among the environmental affordances that supported a sense of belonging.

Trust and the Smart City

Hong Kong, consistently ranked as one of the world’s leading smart cities, is undergoing a period of disruptive change.1 While still shaped fundamentally by the “one country, two systems” arrangement, Hong Kong is increasingly integrated into the political (Liaison Office) and economic (Greater Bay Area, GBA) logics of mainland China (Ho and Tran 2019). The “dynamic zero-Covid approach” has also significantly impeded Hong Kong’s place branding as “Asia’s World City,” with the relocation of corporations to cities that have adopted a back-tonormal outlook, and the exodus of tens of thousands of residents. These counter-winds were captured by a territory-wide survey and a purposive sample of interviewees, selected at a specific point in the recent history of the Hong Kong Special Administrative Region (HKSAR), namely that of the transformation of the hybrid “one country, two systems” arrangement and the emergency politics of the post-National Security Law era. © 2022,China Perspectives. All Rights Reserved.

Impact of Inpatient Tele-Nephrology Treatment Outcomes in Rural Alabama

Background: Access to nephrology care including dialysis in rural Alabama (AL) hospitals is lacking. The University of Alabama at Birmingham (UAB) with Sanderling Inc. started inpatient tele-nephrology (TN) services in 2019 and currently serves 3 rural AL hospitals. Since the COVID-19 pandemic, transfer to TN-equipped hospitals in AL played a pivotal role for patients needing nephrology services when primary referral centers were at capacity. Method(s): TN services were 100% virtual and video-based. Consults were completed by UAB nephrology faculty. Home hemodialysis machine (HHD) was used to provide kidney replacement therapy (KRT) in the hospital, with aid of inpatient dialysis technicians supervised remotely by TN dialysis nurses. TN consults were evaluated from Jun 2019 to Dec 2021. Retrospective chart review for pre-defined outcomes was performed and analyzed. Result(s): There were 694 inpatient TN encounters. Mean age was 64 (18-96) yr. 74% of consultations involved black patients. Mean stay was 6 d. 44% were ICU patients;18% were COVID-19 positive. AKI and known ESKD patients contributed to 48% and 44% consults, respectively. 11% had AKI necessitating KRT. 20% and 13% of consults involved hyperkalemia and dysnatremias, respectively. 792 dialysis treatments were performed with 11% complicated by intradialytic hypotension (IDH). Patients were discharged 64% and transferred to higher level of care 18% of the time. 90 patients expired. 66% of deaths were attributable to COVID-19. Preliminary economics analysis at the hospital with the most consults showed increase in case-mix index and higher census since implementation of TN services. Conclusion(s): Inpatient TN in community hospitals in rural AL provided essential nephrology care to underserved populations amidst a pandemic limiting transfer to nephrology-staffed medical centers at capacity. Most patient encounters resulted in discharge without need for transfer to bigger centers thus saving vital time and resources. Dialysis safety was favorable with low IDH prevalence likely given HHD use. TN services can be beneficial for nephrology care in remote community hospitals with further studies warranted.

Am2P: A New Accredited Academic Training Program in Pharmacovigilance and Pharmacoepidemiology Designed for US, Canadian and Caribbean Healthcare Professionals: An International Journal of Medical Toxicology and Drug Experience

Introduction: Pharmacovigilance (PV) is the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other medicine/vaccine related problem. Objective: In November 2021, the North American Society of Pharmacovigilance (NASoP), a Chapter of the International Society of Pharmacovigilance (ISoP), launched PV courses for the education of North American stakeholders, in collaboration with Eu2P academic institutions. Methods: The Am2P program (Am2P) follows WHO-ISoP Core Elements of a Comprehensive Modular Curriculum and subscribes to the Innovative Medicines Initiative (IMI) Education and Training quality standards, jointly developed by Eu2P and other IMI Education and Training projects to foster quality in lifelong learning and continuing professional development. Convenient online education in PV supports the mission of ISoP to foster PV scientifically and educationally and enhance the safe and proper use of medicines worldwide. Am2P was designed by experienced PV experts from multiple institutions within NASoP, in partnership with Eu2P instructors, to comprise North America-focused online courses that benefit from existing Eu2P material, education technology, and academic accreditation. Results: Am2P offers two academic options: the Certificate degree and the Short Course certificate of achievement in PV. Four modular course programs are available on the Am2P website (https://www. am2p-courses.com) providing education on core and specialized PV topics with a focus on North America: Basic Pharmacovigilance (PV) & PV regulations;PV for Biologics;External databases/Real World Data/Real World Evidence;Benefit-Risk assessment. Program approval is ensured by the Eu2P Executive Board including academic representatives of the 6 Eu2P degree-awarding universities. Am2P and Eu2P Certificate Courses hold the same academic value. A regular Certificate course involves 75h student workload over three months, recognized as 3 ECTS (European-Credit Transfer and Accumulation System) credits, equivalent to 1.5 American credits. Am2P Short Courses are bite-sized courses to provide or reinforce solid, current knowledge in PV focused on North America. Conclusion: Am2P is a partnership between NASoP and Eu2P to build a set of North America-focused online courses offered in PV. Am2P offers accredited PV training of the highest standard, focused on North America, as an extension of the Eu2P program. Online PV training addresses needs of new entrants to PV, and seasoned personnel.

A study evaluating outcomes of a virtual specialist liver cirrhosis clinic

Background and aims: Managing patients in a specialist cirrhosis clinic improves survival. The COVID-19 pandemic necessitated the transition to virtual clinics (VC). We aimed to evaluate the clinical impact of VC on survival, admission and decompensation rates in cirrhotic patients managed in a specialist service. Method: We retrospectively analysed cirrhotic patients who had a specialised VC from March to June 2020. Clinical parameters were collected at baseline and 6 months and compared with a cohort of patients reviewed face to face (F2F) in the same specialist cirrhosis clinics from March to June 2019. Patients with COVID-19 were excluded. Results: 143 patients attended for VC, 129 for F2F review. Groups were matched for age, sex, aetiology, and Child Pugh grade (CP). There was no difference at 6 months in survival, change in MELD/UKELD, decompensation or need for ambulatory reviewin all cirrhosis grades combined or CP BandC subgroup alone (p > 0.05) (Table 1). Fewer patients were admitted in the VC vs the F2F group (p = 0.01) but this was not validated in CP BandC subgroup (p = 0.28). Fewer blood tests were ordered for the VC group (p = 0.0001). The VC group had longer delays for ultrasound HCC surveillance (<0.0001) without an increase in new HCC cases.Table: Baseline Patient Demographics and 6 months’ outcome (*p < 0.05, **p < 0.01)(Table Presented)Conclusion: VC have not resulted in poorer clinical outcomes, even in patients with decompensated cirrhosis. Access to ambulatory care was still required. Fewer blood tests ordered and completed in the VC group did not result in adverse outcomes and this raises the possibility of cost-saving. urther studies need to confirm the longterm clinical impact and cost-effectiveness of specialist VC in management of cirrhotic patients.