Comparison of blood pressure monitoring from elderly community centres and at home under COVID-19 pandemic

Introduction: Under the COVID-19 pandemic, lockdown measures have been implemented in various countries in response to elevating number of confirmed COVID-19 cases. While there was only limited service from face-to-face community health program on BP management, home BP (HBP) monitoring was promoted. The current study aims to investigate (1) control of BP under the lockdown measures;(2) difference of BP from community health centre and home. Method(s): Participants enrolled in the program since July2020, with automated BP measurement from elderly community centres collected as centre BP. In response to COVID-19 outbreak in November2020 in Hong Kong, service from health program was limited and HBP measurement was promoted since December2020 (pre-section: July-December2020). Service from community health centre was resumed in February2021. One-month runin period was allowed. Subjects were followed up until December2021 (post-section: March-December2021) BP was compared on (1) centre BP between pre- and post-section, and (2) centre BP and HBP during post-section. Result(s): A total of 414 subjects were included in the study, with a mean age of 71.0. Three hundred and eight of them (74.4%) were reported with hypertension diagnosis. Mean centre BP was 135/73 for pre-section and 131/71 for post-section, while mean HBP was 123/70. Centre BP was significantly lower at post-section compared to pre-section, while HBP was significantly lower than centre BP during the post-section. The differences remained consistent regardless of hypertension status. Conclusion(s): There was no worsening of BP management during the COVID-19 outbreak. Despite long term use of automated BP measurement at elderly community centres, white coat effect persisted as demonstrated by difference between centre BP and HBP. HBP shall be preferred for BP management.

Winning Posters from the Canadian Society of Respiratory Therapists 2022 Annual Conference

Canadian Respiratory Therapist COVID-19 vaccination uptake rates and responses were investigated with a look at the reasons behind any delays or non-vaccinations as well as other demographics, attitudes, or factors that may be shown to play a role. An anonymous survey using SurveyMonkey® on vaccination uptake rates, responses, and attitudes was available to Student, Graduate, and Registered Respiratory Therapists in Canada from July to October of 2021. A total of 1066 surveys (8.4% of target population) were started, 983 in English and 83 in French with 1013 completed fully and included in the data analysis. Canadian RT Vaccination uptake rates were compared to those of all Canadian healthcare workers which showed that 90.42% of the surveyed RT population in Canada received their vaccination right away compared to the posted rate at the time of 86.27% for all Canadian Healthcare Workers. Pearson Chi-Square Tests were performed to evaluate association between vaccination status and other categorical parameters evaluated in the survey. There was a significant (P = 0.013) association between early vaccination and age, a significant (P = 0.036) association between vaccination status and participants’ response on whether or not they have a family member or know someone who has had COVID-19, a significant (P < 0.001) association between vaccination status and attitudes towards trusting science to develop safe, effective, new vaccines, and a significant (P < 0.001) association between vaccination status and attitudes towards trusting the Ministry of Health to ensure that vaccines are safe. There was no significant association between vaccination status and gender, province/territory of residency/work, level of education, level of involvement with COVID-19 patients. The results suggest that the RT groups across Canada had higher early vaccination uptake rates than the general Healthcare worker groups and that age, relationship to people with COVID-19 and trust in science played a significant role in their vaccination uptake rates.

iPSC: SELECTION OF O-VE IPSC CLONES FOR HIGH-DENSITY RED BLOOD CELL PRODUCTION IN A SCALABLE PERFUSION BIOREACTOR SYSTEM

Background & Aim: Blood is one of the most vital resources in modern medicine. Blood transfusions have become an essential and often lifesaving procedure for accidents, during surgery, for patients with chronic disorders such as anemia, sickle cell disease, cancer, and myriad other circumstances. However, despite the rapidly growing world population, the availability of healthy blood donors is declining with aging populations. Furthermore, natural and man- made calamities often produce sudden and concentrated shocks in demand, which strains global supply chains. The COVID-19 pandemic has demonstrated this issue on a global scale by reducing the number of blood drives and donations, resulting in 39% of blood centers in the United States being left with only one- to two-day supplies, and a 50% drop of blood units collected in countries such as Zambia. Additionally, storage limitations of 42 days for donor blood limits stock availability during peak demand. Large-scale generation of universal red blood cells (RBCs) from O-ve human induced pluripotent stem cells (hiPSCs) offers the potential to alleviate blood shortages and provide a secure year-round supply. Mature iPSC-derived RBCs and reticulocytes could also find important applications in research in malaria and COVID-19 studies. (Figure Presented) Fig. 1 ( 700). Methods, Results & Conclusion: In this study, we have reprogrammed hiPSC from CD34+ O-ve cells and demonstrated the smallscale generation of high-density cultures of erythroblasts in a stirred perfusion bioreactor system. Twenty O-ve iPSC lines were derived, screened, and characterized for their ability to differentiate towards the erythroid lineage, showing high expression of mesoderm (KDR+, 64.9%), hematopoietic (CD34+/CD45+, 68.4%;CD34+/CD43+, 84.9%), and erythroid markers (CD235a+, 83,5%), and were able to undergo enucleation in vitro. Using the best clones, we were able to achieve erythroblast peak cell density of 34.7 million cells/mL with 92.2% viability in an Applikon perfusion bioreactor using an ultrasound system (Sonosep) to concentrate cells while removing waste media. This resulted in a cumulative-fold expansion of over 1,500 after 29 days of culture. Cells carried O2 effectively as demonstrated by hemoglobin dissociation curves. The perfusion culture platform paves the way for controlled high-density bioreactor culture for the generation of RBCs.

IMPACT OF THE COVID-19 PANDEMIC ON FECAL IMMUNOCHEMICAL TESTING, COLONOSCOPY SERVICES, AND COLORECTAL NEOPLASIA DETECTION IN A LARGE UNITED STATES COMMUNITY-BASED POPULATION

Background and Aims: The COVID-19 pandemic profoundly impacted clinical services globally, including colorectal cancer (CRC) testing such as fecal immunochemical test (FIT) screening and colonoscopy. We investigated the impact of the pandemic on FIT and colonoscopy utilization, and colorectal neoplasia detection in a large community-based population in the United States. Methods: We performed a retrospective cohort study of patients ages 18-89 years undergoing FIT screening or colonoscopy in 2019 and 2020 within Kaiser Permanente Northern California (KPNC), a large integrated healthcare organization. We calculated percentage changes in FIT kits mailed, FITs completed, positive FITs, colonoscopies performed overall and by indication, and colorectal neoplasia detection (advanced adenoma and CRC) in 2020 compared to 2019. Results: FIT kit mailings ceased in mid- March through April 2020 but rebounded thereafter leading to an 8.7% increase in total FIT kits mailed in 2020 compared to 2019. However, with the later mailing of FIT kits, there were 9.0% fewer FITs completed and 10.1% fewer positive tests in 2020 compared to 2019. Colonoscopy volumes nadired in April 2020, with a 79.4% reduction compared with April 2019, but recovered to near pre-pandemic monthly volumes in September through December 2020. However, overall, there was a 26.9% decline in colonoscopies performed in 2020 compared to 2019. Declines of 41.5%, 38,3%, 19.9%, and 20.0% were seen for screening, surveillance, diagnostic, and FIT positive colonoscopies, respectively, in 2020 compared to 2019. With the gradual recovery of colonoscopy volumes after the initial pandemic lockdown, by November and December 2020 the numbers of patients with advanced adenomas or CRC detected by colonoscopy were comparable to those same months in 2019. However, the total number of patients with advanced adenomas or CRC detected by colonoscopy declined by 26.9% and 8.7%, respectively, in 2020 compared to 2019. Conclusions: The COVID-19 pandemic led to fewer FIT screenings and colonoscopies performed in 2020 compared with 2019. However, after the lifting of regional lockdowns, FIT screenings exceeded, and colonoscopy volumes nearly reached numbers from those same months in 2019. Overall, the pandemic led to 27% and 9% reductions in advanced adenoma and CRC detection, respectively, in 2020 compared to 2019, validating concerns about the potential for stage progression for cancers that went undetected due to the pandemic. Strategies to identify high-risk patients for expedited colonoscopy procedure scheduling and resolve remaining colonoscopy procedure backlogs are needed to mitigate this risk.(Figure Presented)Figure 1. Number of FIT kits mailed, completed, and positive in 2019 and 2020(Figure Presented)Figure 2. Number of colonoscopies and advanced adenomas and colorectal cancers detected by colonoscopy in 2019 and 2020

Aero-Hydroponic Agriculture IoT System

From the world health organization hunger map, the global hunger population is 821 million in 2020. Moreover, COVID-19 caused the lockdown of the city boundary and the local food supply is not enough for the demand in some small country. Urban farming can help to increase the local food supply. However, it is not cost-effective and not efficient to supply food. Only limited kinds of crops with low efficiency and high cost can be provided. In this research, a newly invented Aero-Hydroponic Agriculture System (AHAS) aims to provide one more source for local food supply by adopting IoT technology to increase productivity. AHAS provides two different layers that allow growing vegetables on the top layer and carbohydrates on the bottom layer. With this IoT system, the temperature, humidity, pH value of nutrient and growth rate of crops can be monitored by the sensors and those environmental parameters can be controlled to offer suitable conditions to grow the crops. As a result, around 75-85% improvement in environment control is achieved by AHAS. With AHAS, more food can be produced in a limited space for the urban farming application. © 2021 IEEE.

Design of COVID-19 Smart Door Detection Device for Risk Factor Detection

Early detection of symptoms and appropriate hygiene standards are the basic public health measures to prevent the spread of COVID-19 community. The main purpose of this study is to design a smart door detection device, which can detect the risk factors of COVID-19 virus. First of all, through the early symptom detection instrument, we can get the health status data from the process of people entering the smart door;Then, the risk factors of the COVID-19 virus entering the population were analyzed through the health status data, and the intelligent isolation method was used to realize the post symptom detection and interactive identification between people, so as to evaluate the potential infection vectors and alleviate the possibility of further transmission. The smart door detection device developed in this research is an automatic device that follows the COVID-19 public health protocol. It provides an effective measure to prevent the early symptom recognition of COVID-19 virus spreading in the community. © 2021 IEEE.

Interim Results of a Time and Motion Survey Regarding Subcutaneous Versus Intravenous Administration of Daratumumab in Patients with Relapsed or Refractory Multiple Myeloma

Background: In addition to efficacy and safety, patient and healthcare professional (HCP) experiences are important aspects of treatment selection. Daratumumab (DARA) is a humanized monoclonal antibody targeting CD38 and is approved as monotherapy or in combination with standard of care regimens for the treatment of multiple myeloma (MM). Administration of DARA intravenous (IV) takes approximately 7 hours for the first infusion and 3-4 hours for subsequent infusions. To reduce this burden, DARA subcutaneous (SC;DARA 1800 mg coformulated with recombinant human hyaluronidase PH20 [rHuPH20;2000 U/ml;ENHANZE® drug delivery technology, Halozyme, Inc., San Diego, CA, USA]) was developed. In the phase 3 COLUMBA trial (NCT03277105), at a median follow-up of 7.5 months, overall response and maximum trough concentration with DARA SC were noninferior to DARA IV in patients with relapsed/refractory MM (RRMM). Based on these results, DARA SC was approved by the Food and Drug Administration and European Medicines Agency. Based on an SC injection duration of 5 minutes, administration of DARA SC injections is estimated to take <2 hours (115 minutes) of HCP time during the first year of treatment. A time and motion survey was undertaken to elicit HCPs’ understanding of workflow and time estimates for administration of DARA IV and SC (beyond injection time alone) in patients with RRMM. Data collection was halted due to the COVID-19 pandemic. Here, we report the interim survey results. Methods: A web-based, prospective survey was designed to collect primary data from HCPs at sites that actively enrolled patients in the COLUMBA trial. Data were collected for DARA IV and SC regarding time spent on prespecified drug preparation and drug administration/patient care activities;for each task, the respondent's perception of average time and HCP who performs the task were captured. Patient data, including efficacy and safety information, were not collected. The primary endpoints are mean and median active HCP time for each prespecified activity. Time for each activity was adjusted by its probability of occurring (eg, management of infusion-related reactions). Median results are reported here, as these are considered a better measure of central tendency than the mean. Total median active HCP time was calculated by summing median time for all prespecified activities (drug preparation activities vs activities in the patient care area/infusion suite). A post-hoc analysis estimated patient chair time based on HCP inputs for pre-treatment activities, infusion/injection duration, and post-treatment activities. A sensitivity analysis was conducted comparing a subgroup of respondents with fully validated data with the overall study population. Results: A total of 26 respondents from 8 countries (Brazil, Israel, Japan, Greece, Poland, Sweden, Taiwan, and Ukraine) completed the survey. For DARA IV, the median total active HCP time was 294.2 minutes for the first infusion and 194.9 minutes for subsequent infusions (Figure 1). For DARA SC, the median total active HCP time was 98.7 minutes for the first injection (66.5% reduction in time vs DARA IV) and 82.2 minutes for subsequent injections (57.8% reduction in time vs DARA IV) (Figure 1). For both treatments, the proportions of time spent on drug preparation vs drug administration/patient care were roughly similar for first and subsequent administrations (Table). When extrapolated for year 1 and year 2 (23 administrations in year 1 and 13 in year 2, as per label), estimated active HCP time per patient was 76.4 and 42.2 hours, respectively, for DARA IV and 31.8 and 17.8 hours, respectively, for DARA SC. Estimated chair time for DARA IV was 445.6 minutes for the first infusion and 243.1 minutes for subsequent infusions;for DARA SC, estimated chair time for first and subsequent injections was 8.6 and 6.9 minutes, respectively (Figure 2). Results were confirmed by a sensitivity analysis using fully validated data for 13 of the 26 respondents. Conclusions: Results of this time and motion survey indica e that DARA SC is associated with less active HCP time spent on drug preparation and drug administration/patient care compared with DARA IV. This reduced treatment burden may translate into advantages for patients (less time away from home, family, and/or work) and efficiencies for HCPs and healthcare facilities (ability to treat a greater number of patients). [Formula presented] Disclosures: Slavcev: Janssen: Current Employment. Spinelli: Janssen: Current Employment. Absalon: Syneos Health: Current Employment. Masterson: Janssen: Current Employment. Heuck: Janssen: Current Employment. Lam: Janssen: Current Employment. De Cock: Syneos Health: Current Employment.

Knowledge and awareness of COVID-19 among Indonesian migrant workers in the Greater China Region.

OBJECTIVES: Migrant workers are one of the most vulnerable population groups during the coronavirus disease 2019 (COVID-19) pandemic. This study investigated knowledge and awareness of COVID-19 among Indonesian migrant workers (IMWs) in Macao (SAR), Hong Kong (SAR), and Taiwan. STUDY DESIGN: This was a cross-sectional study. METHODS: Data were collected through an online survey in February and March 2020 to gain information on (1) participants' sociodemographic characteristics, (2) experience and awareness regarding COVID-19 information, and (3) knowledge and understanding of COVID-19. A series of Chi-squared, t-test, and logistic regression analyses were conducted. RESULTS: The survey was completed by 491 participants (92.1% female). Knowledge of COVID-19 was obtained from multiple sources, including a large proportion from online social media. However, participants who obtained information from their employer, local social networks, and migrant organisations answered a greater number of questions correctly. One-third of participants reported receiving hoax, fake news, and incorrect information and obtained information from unverified sources. Participants were most interested in information about how to cure COVID-19, and 57.8% knew that no specific drug or vaccine was currently available. Almost all participants correctly identified fever and wearing a facemask as the main COVID-19 symptom and prevention strategy, respectively. Participants with senior high school or higher education and who worked as domestic or care workers had a greater knowledge of COVID-19 than their counterparts. CONCLUSIONS: Public health communication strategies using multiple channels, including employers and community organisations, would help to minimise COVID-19 knowledge gaps. In addition, it is recommended that digital literacy content is added to public health campaigns.

Editorial: Diagnostic Testing for SARS-Coronavirus-2 in the Nursing Facility: Recommendations of a Delphi Panel of Long-Term Care Clinicians.

With the COVID-19 pandemic progressing, guidance on strategies to mitigate its devastating effects in nursing facilities (NFs) is critical to preventing additional tragic outcomes. Asymptomatic spread of COVID-19 from nursing facility staff and residents is a major accelerator of infection. Facility-wide point-prevalence testing is an emerging strategy in disease mitigation. Because time is not available to await the results of randomized controlled trials before implementing strategies in this high-risk setting, an expert Delphi panel composed of experienced long-term care medicine professionals has now met to provide testing guidance for SARS-Coronavirus-2 to NFs. After many email and telephone discussions, the panel responded to a questionnaire that included six different scenarios, based on varying availability of Polymerase Chain Reaction (RT-PCR) testing and personal protective equipment (PPE). The panel endorsed facility-wide testing of staff and residents without dissent when diagnostic RT-PCR was available. While the panel recognized the limitations of RT-PCR testing, it strongly recommended this testing for both staff and residents in NFs that were either COVID-19 naive or had limited outbreaks. There was also consensus on testing residents with atypical symptoms in a scenario of limited testing capability. The panel favored testing every 1 to 2 weeks if testing was readily available, reducing the frequency to every month as community prevalence declined or as the collection of additional data further informed clinical critical thinking and decision-making. The panel recognized that frequent testing would have consequences in terms of potential staff shortages due to quarantine after positive tests and increased PPE use. However, the panel felt that not testing would allow new clusters of infection to form. The resulting high mortality rate would outweigh the potential negative consequences of testing. The panel also recognized the pandemic as a rapidly evolving crisis, and that new science and increasing experience might require an updating of its recommendations. The panel hopes that its recommendations will be of value to the long-term care industry and to policy makers as we work together to manage through this challenging and stressful time.

Virtual hackathon to tackle COVID-19 unmet needs

What are the new findings? ►► The COVID-19 pandemic prevented physical innovation formats and virtual innovation strategies such as the virtual hackathon proposed in this article may address this challenge. ►► Virtual interdisciplinary collaboration between students and early career professionals can ead to rapid innovations to address urgent unmet clinical needs in times of global emergencies. How might it impact on healthcare in the future? ►► Innovation pathways should be augmented with virtual innovation strategies to break down barriers to engagement in healthcare innovation, improve global interdisciplinary collaboration and enhance rapid innovation adoption moving into the future. ►► Particular healthcare technologies likely to be positively impacted by this include those in digital health, global health and medical device sectors. © 2021 Georg Thieme Verlag. All rights reserved.