A collaborative approach to research study recruitment in PLWH during the SARS CoV-2 pandemic

Background: Since COVID there are fewer site investigator meetings for non-CTIMP studies to discuss recruitment barriers. Additionally, literature highlights various research trials that have successfully recruited do not report their strategies, consequently impacting ability to learn from success. The pandemic has had considerable impact on enrolment to clinical research, thus services have needed to revaluate their approach. Following the pandemic, patients report more likely to engage in research if offered remote or combined visits. Method(s): We reviewed recruitment strategies at our clinic for two observational studies with large targets (SCAPE-HIV, Positive Voices). SCAPE-HIV, a prospective study exploring immune responses of PLWH to SARS CoV2 infection and vaccination. Positive Voices, a crosssectional questionnaire study. Minimum recruitment targets, 600 and 262 respectively. SCAPE involves open-offer enrolment, Positive Voices from a defined pre-selected cohort. Initial approaches identified people opportunistically at clinic visits, with research staff offering information. However, reaching our targets through COVID became challenging and a move to virtual appointments condensed our opportunities to approach. To increase recruitment, engagement and training of NHS nursing and clinical staff was undertaken alongside remote patient contact. Result(s): After implementing collaborative methods, Positive Voices recruitment increased to 170 in July/ August 2022 (73 in May/June). SCAPE recruitment also improved. Hybrid nurse practitioners dedicating time to approach people during clinic visits and clinic staff involvement attributed to this rise, representing over half of consents (Table A). The clinic team's substantial knowledge of our cohort, combined with their openness to research, leads to greater understanding of how likely individuals are to accept studies. Conclusion(s): Positive Voices and SCAPE-HIV studies have been successful with recruitment due to a collaborative approach, resulting in our site being the highest current recruiting site involved in Positive Voices. This approach has helped motivate the NHS team to become more involved and has become an exemplar for clinical trial delivery within our Trust. (Table Presented).

Brain fog of post-COVID-19 condition and Chronic Fatigue Syndrome, same medical disorder?

BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is characterized by persistent physical and mental fatigue. The post-COVID-19 condition patients refer physical fatigue and cognitive impairment sequelae. Given the similarity between both conditions, could it be the same pathology with a different precipitating factor? OBJECTIVE: To describe the cognitive impairment, neuropsychiatric symptoms, and general symptomatology in both groups, to find out if it is the same pathology. As well as verify if the affectation of smell is related to cognitive deterioration in patients with post-COVID-19 condition. METHODS: The sample included 42 ME/CFS and 73 post-COVID-19 condition patients. Fatigue, sleep quality, anxiety and depressive symptoms, the frequency and severity of different symptoms, olfactory function and a wide range of cognitive domains were evaluated. RESULTS: Both syndromes are characterized by excessive physical fatigue, sleep problems and myalgia. Sustained attention and processing speed were impaired in 83.3% and 52.4% of ME/CFS patients while in post-COVID-19 condition were impaired in 56.2% and 41.4% of patients, respectively. Statistically significant differences were found in sustained attention and visuospatial ability, being the ME/CFS group who presented the worst performance. Physical problems and mood issues were the main variables correlating with cognitive performance in post-COVID-19 patients, while in ME/CFS it was anxiety symptoms and physical fatigue. CONCLUSIONS: The symptomatology and cognitive patterns were similar in both groups, with greater impairment in ME/CFS. This disease is characterized by greater physical and neuropsychiatric problems compared to post-COVID-19 condition. Likewise, we also propose the relevance of prolonged hyposmia as a possible marker of cognitive deterioration in patients with post-COVID-19.

Basal characteristics of the prospective spanish immunotherapy registry of cardiovascular toxicity: SIR-CVT

Background: The immune checkpoint inhibitors (ICI) have improved the prognosis of many cancers in the last years but concerning cardiovascular toxicity (CVtox) have been reported. Nowadays, specific surveillance protocols are lacking, and early diagnosis of toxicity may be challenging. Purpose: To characterize the cardiovascular (CV) effects of immunotherapy and to seek for the mechanisms of CVtox of ICI in a protocolize surveillance program of cardio-oncology. Methods: A multicentre national registry was developed by a research consortium of scientific societies of Cardiology and Oncology (SEC and SEOM) and the cardiovascular research centre (CNIC) in Spain (Figure 1). A total of 18 hospitals participate in recruiting since Q4 2021. A follow-up protocol was stablished with clinical, electrocardiographic (EKG), echocardiography, cardiac magnetic resonance (CMR) and laboratory assessment, including cardiac biomarkers, inflammatory panel and the expression of miR-721, a specific myocarditis biomarker. Toxicity management is performed at each institution following international guidelines. Results: 53 patients were currently included. Median age was 68 [59, 75] years-old, 79% were male. 83% had at least 1 CV-risk factor (75% smoking history, 20% diabetes mellitus, 50% hyperlipemia, 57% hypertension, 19% chronic kidney injury) and up to34% had previous CV disease. 93% had at least one dose of COVID19 vaccine. Dyspnoea was referred by 23% of patients, 28% have abnormal EKG findings and one-third (33%) abnormal cardiac biomarkers (median Troponin I-hs 5.30 [2.60, 11.00];NT-proBNP 199 [68, 736]). Mean LVEF (60% [56.15, 66.78]) and GLS (−18 [−19.75, −16]) were within the normal range but 26% showed LGE at baseline. Cancer characteristics are summarized in Table 1. Conclusion: Real-world SIR-CVT patients show a high CV risk profile and frequent pre-existing CV diseases before ICI treatment. The prospective follow-up of this cohort will help to develop personalized surveillance protocols according to baseline CVtox risk and to define different grades of cardiotoxicity. Funding Acknowledgement: Type of funding sources: None.Figure 1Table 1

Preventive medical examination protocol for health workers exposed to SARS-CoV-2 coronavirus

A preventive medical examination protocol is presented to health workers exposed to SARS-CoV-2 coronavirus based on the best existing scientific evidence. The objective of this article is to identify early impacts on the health of this group of workers, in their workplace, detect diseases unrelated to work or age-related alterations that may make some of them more sensitive to suffering or aggravating certain processes. Documentary analysis is used as an empirical level method. It includes the analysis of information documents in print, digital and internet format to the subject as a basis for collecting evidence. In addition, the practical experience and reasoned intuition of the authors is used. An initial protocol is developed for the implementation of preemployment, periodic and reintegration preventive medical examinations for health workers with exposure to SARS-CoV-2. These include the application criteria, definitions and fundamental concepts to be used;as well as the rules for compliance. The instrument developed is a working tool to contribute to the fight against this pandemic, is justified to the maximum that having an optimal state of health in health workers is a guarantee and strength in triumph over COVID-19.

Knowledge graphs to manage epidemiological information about covid-19

Control of the spread of infectious diseases requires exhaustive epidemiological research, as has been validated by the performance of the Ministry of Public Health during several decades of combat against numerous diseases, such as dengue, cholera and various types of influenza, among others. However, the COVID-19 pandemic is testing the limits of the most rigorous epidemiological protocols in Cuba and worldwide, due to its high transmissibility and fast spread. In this context, the present study had the purpose of using knowledge graphs to support epidemiological research about COVID-19, with greater emphasis on exposure factors and contact tracing. To achieve this end, a study was conducted about the state of the art of knowledge graphs and their use in the health care sector, particularly in the combat against the novel coronavirus SARS-CoV-2. The research applied a methodological approach based on the development and use of knowledge graphs adjusted to the study field. Results are simulated in the context of the outbreak occurring in mid July 2020 in the municipality of Bauta, Artemisa province, using real data obtained from the Internet and combined with other simulated data. © 2021, Centro Nacional de Informacion de Ciencias Medicas. All rights reserved.

ART AND EMOTIONAL WELL-BEING IN TIMES OF MANDATORY CONFINEMENT: EVIDENCE TO STRENGTHEN THE RELATIONSHIP BETWEEN CULTURAL AND MENTAL HEALTH POLICIES

The coronavirus pandemic has forced governments around the world to enact hitherto unknown measures to curb its worst economic and social consequences. In Spain, Royal Decree 463/2020 of March 14, 2020 declares the state of alarm for the management of the health crisis situation caused by COVID-19. From that moment, the population was confined to their homes in a general way, with minors being locked up between March 14 and April 26, 2020. In this study we identify the behaviors, emotions and physical symptoms that they may have suffered minors derived from confinement. We also analyze whether the development of creative activities during confinement has motivated emotional and behavioral changes in them. The results confirm that the performance of these activities has positive effects, contributing to significantly mitigate some symptoms such as nervousness or excessive attachment to adults, also significantly improving their behavior and attitude in this extraordinary situation. The investigation is completed comparing the effects of confinement with pediatric hospitalization, influencing the attitudinal and sociability changes of minors. Faced with the current trend towards the displacement of artistic education from the curricula, the evidence found reinforces the demands that art occupy a central place in society;a role that goes beyond the narrow space traditionally limited to the Economy of Culture and directed by the market. In conclusion, we reflect on the direction that economic policies should have to relate cultural policy and mental health policies from the early stages.

Intervention by the Clinical Psychology team from the Liaison Unit of the IPS Gregorio Maranon during the COVID-19 crisis

The Covid-19 pandemic is generating an array of psychological difficulties in survivors, families and first-line health professionals. The need for psychological interventions within the hospital has led to the increase in the capacity of the Clinical Psychology Liaison Service in the Gregorio Maraiion General University Hospital. The crisis intervention model has underpinned the organization of the care, with a focus on preventing complicated grief and post-traumatic stress disorder. In this paper, the most frequently reported psychological difficulties are outlined and the interventions carried out in the service are described (reduced groups for professionals, face-to-face and telephone-based interventions with patients, families and professionals, crisis intervention, consulting role of the physicians and nurses, etc.).

Standard operating procedure of image-guided intervention during the COVID-19 pandemic: a combined tertiary musculoskeletal oncology centre experience.

AIM: To evaluate the response measures in continuing an image-guided intervention service in two tertiary-level musculoskeletal oncology centres during the COVID-19 pandemic. MATERIALS AND METHODS: This study was a retrospective review of all patients undergoing image-guided intervention in the computed tomography (CT) and normal ultrasound (US) rooms from 24 March 2020 to 24 May 2020 (during the COVID-19 pandemic peak) at Royal National Orthopaedic Hospital, London, and Royal Orthopaedic Hospital, Birmingham, UK. Measures were put in place to address air pressures, airflow direction, aerosol generation, and the safe utilisation of existing scanning rooms and work lists for interventional procedures. RESULTS: Three hundred and thirty-one patients (164 at Royal National Orthopaedic Hospital and 167 at Royal Orthopaedic Hospital) underwent image-guided procedures at both sites in the CT and US rooms. At the Royal National Orthopaedic Hospital, 40% of all procedures were performed under general anaesthesia. These consisted of 47 CT biopsies, 7 CT radiofrequency ablations (RFAs), and 12 US biopsies. At the Royal Orthopaedic Hospital, 86% of all procedures were performed under local anaesthetic, with no general anaesthetic procedures. These consisted of 61 CT biopsies and 83 US biopsies. All 256 patients having procedures in the CT room had no post-procedural complications or COVID-19-related symptoms and morbidity on follow-up. CONCLUSION: By adopting a pragmatic approach with meticulous planning, a limited, but fully functional image-guided interventional list can be run without any adverse patient outcomes.