FLASH in the Clinic Track (Oral Presentations) RAPID CONVALESCENT PLASMA STERILIZATION USING HIGH DOSE RATE ELECTRON RADIATION

Background and Aims: Passive antibody administration through convalescent plasma has shown benefit in treating COVID-19 in the early stages of the disease in patients >65 years old, and in other viral outbreaks. A practical, rapid method to sterilize convalescent plasma while also maintaining antibody function would be valuable for safe treatment in future viral pandemics. Plasma sterilization by irradiation requires kGy of dose to deactivate bacteria and viruses of concern. Conventional lab-based irradiators would require days to reach such doses, while ultra-high dose rate irradiation (FLASH) would require minutes. We present a proof-of-concept on sterilizing plasma with 25 kGy in approximately 3 minutes without damaging the antibodies in the plasma. Methods: A Varian Trilogy LINAC was configured for 16 MeV FLASH electron irradiation. Frozen aliquots of convalescent plasma from patients with COVID-19 were placed in a 3D printed holder submerged in liquid aiming to preserve sample temperature (RT, 4°C or –20°C). The number of pulses was estimated with EBT-XD film. Samples were irradiated with a dose of 25 kGy in ~33,330 pulses over 185 seconds. Antibody binding against the receptor-binding domain (RBD) of the S1 region of SARS-CoV-2 was measured by ELISA pre- and post-irradiation. Results: Frozen plasma aliquots from 10 COVID-19 convalescent plasma donors were irradiated in frozen state to 25 kGy dose. IgG antibody binding against SARS-CoV-2 RBD after irradiation remained at 90.8% of non-irradiated samples (Fig. 1;OD 1.25 vs. 1.36, p<0.0003). (Figure Presented) Fig. 1 ( O034). Plasma aliquots from 10 convalescent plasma samples were irradiated at sterilizing 25-kGy doses. IgG binding to SARS-CoV-2 RBD antigen by ELISA is 90.8% compared to unirradiated. Conclusions: FLASH irradiation allows for rapid sterilization of blood plasma from potential pathogens while largely preserving antibody binding function and specificity.

Trends in osteoporosis care patterns during the COVID-19 pandemic in Alberta, Canada.

PURPOSE/INTRODUCTION: The objective of this study was to describe osteoporosis-related care patterns during the coronavirus disease 2019 (COVID-19) pandemic in Alberta, Canada, relative to the 3-year preceding. METHODS: A repeated cross-sectional study design encompassing 3-month periods of continuous administrative health data between March 15, 2017, and September 14, 2020, described osteoporosis-related healthcare resource utilization (HCRU) and treatment patterns. Outcomes included patients with osteoporosis-related healthcare encounters, physician visits, diagnostic and laboratory test volumes, and treatment initiations and disruptions. The percent change between outcomes was calculated, averaged across the control periods (2017-2019), relative to the COVID-19 periods (2020). RESULTS: Relative to the average control March to June period, all HCRU declined during the corresponding COVID-19 period. There was a reduction of 14% in patients with osteoporosis healthcare encounters, 13% in general practitioner visits, 9% in specialist practitioner visits, 47% in bone mineral density tests, and 13% in vitamin D tests. Treatment initiations declined 43%, 26%, and 35% for oral bisphosphonates, intravenous bisphosphonates, and denosumab, respectively. Slight increases were observed in the proportion of patients with treatment disruptions. In the subsequent June to September period, HCRU either returned to or surpassed pre-pandemic levels, when including telehealth visits accounting for 33-45% of healthcare encounters during the COVID periods. Oral bisphosphonate treatment initiations remained lower than pre-pandemic levels. CONCLUSIONS: This study demonstrates the COVID-19 pandemic and corresponding public health lockdowns further heightened the "crisis" around the known gap in osteoporosis care and altered the provision of care (e.g., use of telehealth and initiation of treatment). Osteoporosis has a known substantial care and management disparity, which has been classified as a crisis. The COVID-19 pandemic created additional burden on osteoporosis patient care with healthcare encounters, physician visits, diagnostic and laboratory tests, and treatment initiations all declining during the initial pandemic period, relative to previous years.

Trends in osteoporotic fracture and related in-hospital complications during the COVID-19 pandemic in Alberta, Canada.

Fragility fractures (i.e., low-energy fractures) account for most fractures among older Canadians and are associated with significant increases in morbidity and mortality. Study results suggest that low-energy fracture rates (associated with surgical intervention and outcomes) declined slightly, but largely remained stable in the first few months of the COVID-19 pandemic. PURPOSE/INTRODUCTION: This study describes rates of low-energy fractures, time-to-surgery, complications, and deaths post-surgery in patients with fractures during the coronavirus disease (COVID-19) pandemic in Alberta, Canada, compared to the three years prior. METHODS: A repeated cross-sectional study was conducted using provincial-level administrative health data. Outcomes were assessed in 3-month periods in the 3 years preceding the COVID-19 pandemic and in the first two 3-month periods after restrictions were implemented. Patterns of fracture- and hospital-related outcomes over the control years (2017-2019) and COVID-19 restrictions periods (2020) were calculated. RESULTS: Relative to the average from the control periods, there was a slight decrease in the absolute number of low-energy fractures (n = 4733 versus n = 4308) during the first COVID-19 period, followed by a slight rise in the second COVID-19 period (n = 4520 versus n = 4831). While the absolute number of patients with low-energy fractures receiving surgery within the same episode of care decreased slightly during the COVID-19 periods, the proportion receiving surgery and the proportion receiving surgery within 24 h of admission remained stable. Across all periods, hip fractures accounted for the majority of patients with low-energy fractures receiving surgery (range: 58.9-64.2%). Patients with complications following surgery and in-hospital deaths following fracture repair decreased slightly during the COVID-19 periods. CONCLUSIONS: These results suggest that low-energy fracture rates, associated surgeries, and surgical outcomes declined slightly, but largely remained stable in the first few months of the pandemic. Further investigation is warranted to explore patterns during subsequent COVID-19 waves when the healthcare system experienced severe strain.

Should we replace telephone with video consultation to improve patient experience? - The Queen Elizabeth Hospital experience

Content: The COVID-19 pandemic has mandated rapid adoption of a new approach to outpatient appointments for our Haematology patients, the majority of whom are classed as vulnerable and have been required to isolate for prolonged periods following government guidelines. Within a short space of time remote consultation by telephone replaced the traditional face-to-face outpatient consultation for the majority of our patients. There has been appetite in other departments locally and regionally to consider implementation of video consultation as a replacement for telephone consultation and we were asked as a department to consider implementation to enhance patient experience. We were concerned that adoption of video consultation would create barriers for some, and questioned whether our patients would perceive a benefit of video, compared to telephone consultation. We identified and contacted by telephone 36 consecutive patients who had participated in a general haematology telephone consultation during the final two weeks of June 2020. We designed a survey to assess patient satisfaction of the telephone consultation;access to hardware necessary to participate in video consultation;relevant experience of using video calling / conferencing and their preference when offered further remote consultations. Of the 29 patients who consented to be surveyed, 28 were satisfied with the process and quality of their telephone consultation (97%). We found that 6 patients (21%) did not have access to necessary hardware to participate in video consultation and although the rest had the hardware to participate;only 15 patients (52%) had any prior experience of using video calling / conferencing and would feel confident to use similar software. We asked our patients about their level of preference for video consultation in the future. We found that only 5 patients (17%) would prefer to have a video consultation, with the level of preference falling further to only 2 patients (7%) should the software required to participate not be available to install remotely on a home device. Our results show that our patients have a high level of satisfaction using the telephone as a method of remote consultation. We demonstrate a low level of perceived preference for video consultation and highlight both the high level of unfamiliarity using video calling / conferencing software and inability for a significant proportion to access the necessary hardware to participate in video consultation at all. We conclude as a department, that changing to video consultation from telephone consultation as a standard means of remote consultation will not increase patient satisfaction and will focus our attention and resource allocation on other areas of practice to improve our patient's experiences.