Real-time, leukocyte-related, four times validated, patient data partitioning

Introduction: Indicators that assess relationships among leukocytes may inform more and/or earlier than those measured in isolation. Method(s): Blood leukocyte differential counts collected from 101 Mayo Clinic COVID-19 patients were related to later outcomes following two approaches: (i) as unstructured data (e.g., lymphocyte percentages) and (ii) as data structures that assess intercellular interactions. Analyzing the same primary data, it was asked whether information contents differed among methods and/or when two sets of structured indicators are used. Result(s): While unstructured data did not distinguish survivors from non-survivors (Fig. 1, rectangle A), one data structure (here identified with letters expressed in italics) exhibited one perpendicular inflection that differentiated two patient groups (B). Two survivor-related observations were also distinguished from the remaining data points (B). A second data structure also revealed a single line of observations and a perpendicular data inflection (C), while more (four) patient groups were identified (D). Four validations were conducted: (i) increasing mortality levels among contiguous data subsets (0, 7.1, 16.2, or 44.4%) suggested construct validity (D);(ii) internal validity was indicated because 22 of the 45 survivors detected by the first data structure were also captured by the second one;(iii) the analysis of patients that differed in address, co-morbidities and other aspects supported external validity;and (iv) quasi non-overlapping data intervals predicted statistical validity (E, F). The structured approach also uncovered new and/ or dissimilar information: different leukocyte-related ratios explained the clusters identified in these analyses (E, F). Conclusion(s): Structured data may yield more information than methods that do not assess multicellular interactions. Possible applications include daily, longitudinal, and personalized analysis of hospital data.

Patient-reported respiratory outcome measures in the recovery of adults hospitalised with COVID-19: A systematic review and meta-analysis

Background: The morbidity associated with recovery from COVID-19 is huge with apparent persisting respiratory limitation. Aims and objectives: We investigate the persisting respiratory symptomatic and functional recovery of patients initially hospitalised with COVID-19 in a systematic review and meta-analysis using patient-reported outcome measures (PROMs). Method(s): Comprehensive database searches in accordance with the PRISMA statement were carried out up till 31/05/2021 where data exists for patients >8 weeks after hospital discharge, according to PROSPERO (1). Data were narratively synthesized, and meta-analyses were performed using the random-effects inverse variance method. Result(s): Of 49 studies, across 14 countries with 2-12 months follow up, fatigue was the most commonly reported persisting symptom at 2-4 months (36.6%, 95 % CI 27.6 to 46.6, n=14), and at >4 months (32.5%, 95% CI 22.6 to 44.2, n=15). Modified MRC dyspnoea score >=1 was reported in 48% (95% CI 30 to 37, n=5) at 2-4 months and 32% (95% CI 22 to 43, n=7) at >4 months. Persisting sick leave, change in their scope of work and increased healthcare usage was also reported. Conclusion(s): Persisting respiratory symptoms are experienced by survivors of COVID-19 hospital admission with associated impact on work and healthcare usage.

MENTAL HEALTH MEDICAL EDUCATION LEAD: UNIVERSITY OF QUEENSLAND, BRISBANE - PATIENT SIMULATION AS AN EFFECTIVE 'COVID SAFE' TOOL FOR TEACHING MENTAL HEALTH

Background: The University of Queensland Medical School Mental Health (MH) curriculum had a large online presence prior to 2020, with interactive learning resources and assessments. However, the teaching of clinical skills such as history-taking and mental state examination was typically conducted through small group-based learning and clinical placement. Objectives: To describe The University of Queensland Medical School MH rotation adaptations to teaching clinical skills to account for appropriate social distancing and lockdown learning. Methods: The benefits and challenges associated with physically distanced and online patient simulation for clinical psychiatric skills will be explored. The organisational requirements will also be detailed. Findings: Online patient simulation sessions, facilitated by psychiatrist tutors, allowed appropriate progression of learning and assessment of clinical skills during times when medical students were unable to undertake clinical placement. Feedback provided by students, tutors and patient simulators did not indicate a difference in quality or tolerability. Additional advantages included allowing for increased consistency of teaching across multiple clinical sites and improvement of telehealth interviewing skills. There were significantly increased tutor time requirements, as well as administrative and financial implications. Conclusion: Future development of MH curriculums, including patient simulation, can be enhanced with the MHMELANZ network.

Diabetes and Disasters: Not if, but when, and what we can do

Background: Every country has many people living with diabetes, and disasters of various types will inevitably happen, impacting them and others. During and after any disaster the related challenges to individuals with diabetes increase, amplified by such factors as: loss of shelter, power and communications, reduced access to healthy food, clean water, medications, and to healthcare providers. Injury, infection and unstable diabetes, including increased risk of vascular events may also occur. Morbidity and mortality is increased often for years after the disaster is over. Forward planning can mitigate adverse outcomes and ideally includes multiple stakeholders beyond patients and the healthcare system. Aim: To overview disaster response preparation, including elements related to diabetes care. Method: Available national and international guidelines for disaster responses, in particular those related to diabetes and to the COVID-19 have been reviewed. Results: The ‘’PARR’’ framework: Preparedness, Action, Response and Recovery elements for disaster planning is a useful approach. Multi-level planning, at individual, healthcare professional, the local and national community, and international levels are desirable. Local councils, local and national governments, government, healthcare organisations, the military, communications, power and transport providers, the media, NGOs and international organisations and responders should be considered. Existent and emerging resources, such as from the International Diabetes Federation (IDF), some of the IDF Regions and from various national diabetes associations to assist diabetes care during disasters are or will soon be available. Some existent resources are compiled at ww.ajenkinsdiabetes.org. Checklists, templates, contacts and pre-prepared response kits can be helpful. Some guidance from recent COVID-19 experiences is available. Particularly vulnerable people with diabetes to consider include: those with diabetes complications, such as vision loss, renal failure, amputations, frailty, cognitive impairment, children and youth with diabetes, pregnant women with diabetes and dying people with diabetes. Human Rights-related and Palliative Care aspects of disasters should be considered. Conclusions: Disasters will continue to happen. Careful preparation, particularly with consideration of local circumstances and international resources and contacts can mitigate adverse outcomes for people with diabetes. Discussion: Disasters will continue to happen. Careful preparation, particularly with consideration of local circumstances and international resources and contacts, and collaboration, can mitigate adverse outcomes for people with diabetes.

Evaluation of a virtual pulmonary rehabilitation programme and comparison to traditional face-to-face programmes in COPD

S22 Table 1Number of patients achieving minimal clinically important differences in CRQ and HADS following Virtual Pulmonary Rehabilitation (VPR) or Face-to-Face pulmonary rehabilitation (VPR)Outcomes VPR n (%) F2F n (%) p value (Chi-square test) CRQ-Dyspnoea 32 (54) 30 (55) 0.974 CRQ-Fatigue 30 (50) 34 (62) 0.203 CRQ-Emotion 23 (38) 29 (53) 0.121 CRQ-Mastery 24 (40) 34 (62) 0.019 HADS-Anxiety 17 (33) 24 (44) 0.214 HADS-Depression 12 (23) 27 (50) 0.004 ConclusionsF2F PR provided larger improvements in outcomes and a greater number of COPD patients achieving meaningful improvements in mastery and depression. However, the number of patients achieving clinically meaningful improvements in dyspnoea, fatigue, emotional function and anxiety with VPR demonstrates the success of transitioning to this model during the pandemic and supports the potential use of such alternative delivery models to increase access to PR.

On-demand cold plasma activation of acetyl donors for bacteria and virus decontamination

Antibiotics are commonly used as the first line of defense in the treatment of infectious diseases. However, the rise of antimicrobial resistance (AMR) is rendering many antibiotics less effective. Consequently, effective non-antibiotic antimicrobial strategies are urgently needed to combat AMR. This paper presents a strategy utilizing cold plasma for the "on-demand"activation of acetyl donor molecules. The process generates an aqueous-based antimicrobial formulation comprising a rich mixture of highly oxidizing molecules: peracetic acid, hydrogen peroxide, and other reactive oxygen and nitrogen species. The synergistic potent oxidative action between these molecules is shown to be highly effective at eradicating common wound pathogenic bacteria (Pseudomonas aeruginosa and Staphylococcus aureus) and at inactivating a virus (SARS-CoV-2). © 2021 Author(s).

Respiratory disease, and treatment / thematic poster session impact of the uk lockdown on early copd

INTRODUCTION: Public health measures to reduce the transmission of COVID-19 have required various changes in life-style, including loss or risk to employment and social isolation. We wished to assess how these measured effected 30-45 year old smokers at risk of COPD participating in the BLF Early COPD cohort study METHODS: At enrolment, participants were aged 30-45 years, tobacco smokers with >10 pack-year smoking history, FEV1=>80% predicted and a BMI < 35kg/m2. Participants were seen face-to-face in clinic pre-COVID. During lock-down, they were posted questionnaires and contacted by telephone. The last clinic visit took place on the 12 March 2020, remote visits took place between 16 April and 28 Sep. 260 individuals at six sites (25 Belfast, 38 Birmingham, 25 Edinburgh, 101 London, 27 Manchester and 44 Nottingham) were asked about smoking habits. The MRC chronic bronchitis questionnaire, COPD Assessment test (CAT), Leicester cough questionnaire, Hospital Anxiety and Depression questionnaire were completed in writing by the participant and returned by post or photographed and returned by email. At enrolment, the post-BD FEV1 was 3.81 (SD 0.8) litres, 101% (11) of GLI predicted. Comparisons were made by paired t-tests and chi-squared tests. RESULTS: Level of anxiety increased from 6.74 (SD 4.4) to 7.37 (SD 4.7, n=233;p=0.010) during lock-down;depression scores increased from 4.30 (3.9) to 5.14 (SD 4.1;n=233;p<0.001). Anxiety increased in 78/233 and depression in 89/233 participants by 2 or more units, 2 units is considered the minimally important (MCID) in bronchiectasis, COPD and ILD (Wynne, 2020) Figure 1 shows that during lock-down, the proportion of participants not smoking increased from 31/259 (12.0%) to 62/259 (23.9%;p<0.001). In those who continued to smoke, cigarettes per day (p=0.59) and rolling tobacco consumption (g/week) (p=0.92) were unchanged. Participants reported less chronic bronchitis defined as “do you bring up phlegm like this on most days (or nights) as much as three months each year”, fell from 83/260 (31.9%) participants to 74/259 (28.6%;p<0.001). CAT scores fell from 10.5 (SD 6.4) to 9.6 (SD 6.3;n=233;p=0.007) and total cough score improved from 18.7 (SD 2.7) to 19.1 (2.6;n=204;p=0.007). CONCLUSIONS: Despite increased anxiety and depression, participants quit smoking and those that continued to smoke, did not smoke more. Respiratory symptoms of chronic bronchitis, cough and CAT scores improved. REFERENCES:Wynne SC, et al. Chron Respir Dis. 2020 Jan-Dec;17:1479973120933292. doi: 10.1177/1479973120933292. .