IMPLEMENTING VIRTUAL CARE PLANNING WITH RESIDENT/FAMILY: A CANADIAN COVID LONG-TERM CARE EXPERIENCE

Background COVID-19 imposed extreme constraints on Canadian long-term care (LTC) homes, leading to intense isolation for residents, restricted family visits, and staff shortages. Consequently, these challenges negatively impacted the mental and physical health of residents, family, and interdisciplinary workforce in LTC homes. Objectives 1. To describe how two LTC homes addressed promising practices - Presence of family, People in the workforce, and Future COVID-19 and non-COVID-19 care with implementation science. 2. To understand the enablers, barriers and outcomes to the implementation of an innovative re-engineered intervention - P.I.E.C.E.S.™ (PIECES), designed to include families virtually for team-based resident care planning, and empower Registered Practical Nurses (RPNs) to build resilience and wellbeing. Methods An interdisciplinary team (residents and family, nurses, and academic researchers), guided by the Consolidated Framework for Implementation Research, employed a mixedmethod design to investigate implementation processes, determinants, and outcomes. Interviews with residents/families and staff focus groups provided insight into enablers and challenges. Pre- and post-intervention results of the Connor Davidson Resilience Scale, Resilience at Work, and Assessment of Interprofessional Team Collaboration Scale informed understandings of personal, professional and organizational resilience outcomes. Results Findings highlighted how implementation of virtual PIECES helped sustain enhanced person-centered care through more comprehensive, collaborative, efficient and effective teams, leading to better outcomes for residents. Moreover, results suggested improved resilience, wellbeing, and communication between LTC home staff and family. New learnings improved preparedness for future outbreaks. Providing a plan for adapting, embedding, and sustaining the intervention based on implementation science will accelerate the spread of highquality actionable research evidence. Conclusions This is the first study to explore implementation processes of a virtually delivered PIECES intervention with meaningful engagement of multiple stakeholders (residents, family, RPNs). Findings provide evidence supporting important healthcare improvements, future spread of virtual interventions, and practice and policy changes for the LTC home sector.

Resilience in mothers during the COVID-19 pandemic.

The coronavirus disease (COVID-19) pandemic has brought immense psychological pressure and disruptions to daily life for all individuals, and particularly children, parents, and families. Despite these difficulties, parents are able to show resilience through adaptive coping and positive parenting behaviors. Although there is robust research on resilience in children, very little research has tested predictors of parental resilience. The present study presents descriptive information about mothers' pandemic-related stressors and positive changes and then tests whether prepandemic maternal well-being and child effortful control predicted mothers' resilient parental outcomes (positive behavior and coping) through the mediators of maternal self-compassion, adherence to family routines, and child coping. The sample comprised 95 mothers (95.38% European American, 3.2% African American, and 1.1% Asian American) with a mean age of 38.21 years (SD = 5.71 years, Range = 25.72-51.60 years) and education ranging from a high school to an advanced degree (M = 16.26 years, SD = 2.28 years, Range = 12-21 years). Results revealed that prepandemic maternal well-being predicted adaptive coping both directly and indirectly through self-compassion. Children's effortful control predicted maternal adaptive coping indirectly through children's own adaptive coping, and predicted mothers' positive parenting behaviors directly. Posthoc models revealed adherence to routines to be a correlate and outcome, rather than predictor, of positive parenting and bidirectional relations between parent and child coping. This study provides evidence for parent, child, and family-level factors related to parental resilience during the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Post-Transplant Cyclophosphamide, Abatacept, and Short Course of Tacrolimus Combination (CAST) Is Safe and Seems Highly Effective in Preventing Graft-Versus-Host Disease Following Haploidentical Peripheral Blood Stem Cell Transplantation

The introduction of post-transplant cyclophosphamide (PTCy) has circumvented the need for T-cell depletion following haploidentical stem cell transplantation (SCT). By expanding the donor pool for patients from certain ethnic minorities, this has addressed to some degree an important health care disparity issue in SCT. However, a recent registry study showed increased incidence GvHD and inferior outcomes in patients receiving haploidentical SCT with PTCy, tacrolimus and mycophenolate mofetil for GvHD prevention as opposed to matched unrelated donor SCT with PTCy-based GvHD prevention. Seeking to improve the results of GvHD prevention in the setting of haploidentical SCT, we examined a combination of PTCy, abatacept and a short course of tacrolimus (CAST). Abatacept is a recombinant soluble fusion protein composed of the extracellular domain of cytotoxic T-lymphocyte associated antigen-4 (CTLA-4) fused to the Fc region of IgG1. Abatacept blocks CD28-CD80I86 axis and prevents T-cell co-stimulation. In early studies, abatacept has shown promising results when added to methotrexate and tacrolimus in matched and mismatched donor SCT. We initiated a phase Ib-II clinical trial for patients with hematological malignancies undergoing haploidentical SCT. Patients received G-CSF mobilized peripheral blood grafts from related haploidentical donors. GvHD prevention consisted of PTCy 50mg/kg IV on day +3 and +4 with forced hydration, abatacept 10mg/kg IV on day +5, +14 and +28 and tacrolimus. Tacrolimus was started on day +5 at 0.02mg/kg/day by continuous IV and adjusted thereafter to maintain a trough level of 5-12ng/mL. Tacrolimus taper was planned to begin on day +60 and complete by day +90 in the absence of GvHD. All patients received standard supportive care including levofloxacin until neutrophil engraftment, posaconazole until day +75, acyclovir for 1 year and, if CMV positive by serology, letermovir until day +100. Pneumocystis Jiroveci prophylaxis was started after neutrophil engraftment and continued until 6 months post-transplant. G-CSF was administered routinely until neutrophil engraftment. Since September 2020, 19 patients were enrolled. Three patients are too early in their post-transplant course and were excluded from this analysis. Patients' characteristics are summarized in the table. All but 2 patients received cryopreserved products. Median times to ANC and platelet engraftment were 18.5 days (14-30) and 28.5 (16-61). All 16 patients achieved full whole blood donor chimerism by day +30. There was no secondary graft failure. With a median follow-up was 149.5 days (41-308) with 10 patients having >120 days and 8 >180 days of follow-up, 4 patients developed skin acute GvHD (all grade I). No patient developed grade II-IV acute GvHD. Two patients developed skin chronic GvHD (limited, both moderate). Both cases were diagnosed following COVID-19 vaccination. Fifteen patients completed tacrolimus taper by day +90. Two patients received systemic steroids, one for treatment of cGvHD. The remaining patients required no further immunosuppressive therapy beyond day +90. CMV activation rate was 25%. One patient had EBV reactivation and required preemptive therapy with 2 weekly rituximab doses. There were no cases of adenovirus, HHV-6 virus or BK virus reactivation. Four patients developed renal insufficiency (3 in the setting of acute sepsis and 1 with thrombotic microangiopathy, which resolved after tapering off tacrolimus. One patient with adult T-cell leukemia/lymphoma relapsed and died. All other patients are alive and well. In summary, our preliminary results suggest that CAST with shortened course of tacrolimus is feasible and seems to offer very promising outcomes with low rates of acute GvHD. The study is accruing actively and the results of a larger cohort with longer follow-up will be presented at the meeting. If confirmed, by improving the outcomes of haploidentical SCT, this regimen may further address a health care disparity issue, offering almost every patient in need of allogeneic SCT an alternative donor op ion with equal outcomes. [Formula presented] Disclosures: Al-Homsi: Daichii Sanyko: Consultancy;Celyad: Other: Advisory Board. Abdul-Hay: Abbvie: Consultancy;Servier: Other: Advisory Board, Speakers Bureau;Jazz: Other: Advisory Board, Speakers Bureau;Takeda: Speakers Bureau;Amgen: Membership on an entity's Board of Directors or advisory committees. OffLabel Disclosure: Abatacept - off label use as GvHD prevention Cyclophosphamide - off label use as GvHD prevention

An Academic-Health Department Community Partnership to Expand Disease Investigation and Contact Tracing Capacity and Efficiency During the COVID-19 Pandemic.

Disease investigation and contact tracing are long-standing public health strategies used to control the spread of infectious disease. Throughout the COVID-19 pandemic, health departments across the country have lacked the internal workforce capacity and technology needed to efficiently isolate positive cases and quarantine close contacts to slow the spread of SARS-CoV-2. This article describes an innovative disease investigation and contact tracing program developed through a formalized community partnership between a local county health department and local university. This innovative new program added 108 contact tracers to the county's public health workforce, as well as enabled these contact tracers to work remotely using a call center app and secure cloud-based platform to manage the county's caseload of cases and contacts. An overview of the requirements needed to develop this program (eg, hiring, health data security protocols, data source management), as well as lessons learned is discussed.

Angiotensin (Ang-1-7) and Its Glycopeptide PNA5 Protect Against Overzealous Pulmonary Inflammation to Infectious and Non-Infectious Respiratory Insults

RATIONALE: The peptide hormone angiotensin (Ang-(1-7)) has well-known anti-inflammatory protective effects, inhibiting production and expression of many cytokines and adhesion molecules that are associated with a "cytokine storm." Recent reports suggest that ARDS appears to be a significant predictor of mortality and the COVID-19-induced "cytokine storm" is associated with increased morbidity and mortality. PNA5, a more stable, longer acting, and more brain penetrant glycopeptide analog of Ang-(1-7), has been developed to control inflammation. Our studies were developed to test if Ang-(1-7) and its glycopeptide PNA5 were protective in the lung against overzealous immune responses to infectious and non-infectious respiratory stimuli. METHODS: Wild type mice were treated with infectious or non-infectious agents: Mycoplasma pneumoniae (1x108, intranasal) or LPS (5 mg/kg body weight, oropharyngeal). Within 2 hrs of challenge, a subset of each was given either Ang-(1-7), PNA5, or peptide-free vehicle via different routes of administration: oropharyngeal or subcutaneous. Markers of inflammation in the lung were assessed within 72 hrs for each set of animals. RESULTS: During Mycoplasma infection, one high dose of Ang-(1-7) delivered to the lungs reduced neutrophilia and Muc5AC, as well as TNF-α and keratinocyte chemoattractant (KC). In line with severe COVID-related ARDS, a single dose of the Ang-(1-7) analog, PNA5, delivered subcutaneously to LPS-challenged mice led to significant protection against key features of ARDS: vascular permeability and pulmonary edema, neutrophil influx into the lung and TNF-α production. CONCLUSIONS: Ang1-7 has been shown by others to play a protective role to a variety of stimuli in a myriad of organs. Our new findings demonstrate that Ang1-7 and PNA5 can protect against both live Mp and LPS-induced lung inflammation. Replacement of Ang-(1-7) in ALI/ARDS patients, including severe COVD-19 patients, with an Ang-(1-7) replacement peptide such as PNA5, could be ideal adjunctive therapy to treat ALI/ARDS and support lung health and organ protection.