Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making.

OBJECTIVE: Patient-centered care and shared decision making (SDM) are generally recognized as the gold standard for medical consultations, especially for preference-sensitive decisions. However, little is known about psychological patient characteristics that influence patient-reported preferences. We set out to explore the role of personality and anxiety for a preference-sensitive decision in bladder cancer patients (choice of urinary diversion, UD) and to determine if anxiety predicts patients' participation preferences. METHODS: We recruited a sample of bladder cancer patients (N = 180, primarily male, retired) who awaited a medical consultation on radical cystectomy and their choice of UD. We asked patients to fill in a set of self-report questionnaires before this consultation, including measures of treatment preference, personality (BFI-10), anxiety (STAI), and participation preference (API and API-Uro), as well as sociodemographic characteristics. RESULTS: Most patients (79%) indicated a clear preference for one of the treatment options (44% continent UD, 34% incontinent UD). Patients who reported more conscientiousness were more likely to prefer more complex methods (continent UD). The majority (62%) preferred to delegate decision making to healthcare professionals. A substantial number of patients reported elevated anxiety (32%), and more anxiety was predictive of higher participation preference, specifically for uro-oncological decisions (ß = 0.207, p < 0.01). CONCLUSIONS: Our findings provide insight into the role of psychological patient characteristics for SDM. Aspects of personality such as conscientiousness influence treatment preferences. Anxiety contributes to patients' motivation to be involved in pertinent decisions. Thus, personality and negative affect should be considered to improve SDM.

OUTCOMES OF PATIENTS WITH COVID-19 ON ANTIHYPERTENSIVE MEDICATIONS IN SOUTHERN PENNSYLVANIA

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The controversy surrounding the association of ACE inhibitor (ACEi) use in the COVID-19 pandemic has been well documented. Since then, studies have been published refuting the findings. While there was a recent study in France on hypertensive patients on one of ACEi, angiotensin II receptor blocker (ARB) or calcium channel blocker (CCB), we performed a retrospective study reviewing the outcomes (i.e. admissions, readmission and mortality) associated with COVID-19 patients and their use of anti-hypertensive medications (anti-HTNs), specifically ACEi/ARB, thiazides, beta blocker (BB) and CCB, to look at the outcomes associated with their use, regardless of their roles in anti-hypertensive management. METHODS: We performed a retrospective study on patients with a positive COVID-19 RT-PCR test since January 2019. 606 adult patients were randomly selected. Data on demographics, co-morbidities, admission status, length of stay, types of anti-hypertensives and outcomes were collected and reviewed. RESULTS: Our study demonstrated the use of ACEi (24.1%) and thiazides (17.5%) had a reduced rate of admission when compared to patients on BB (32.3%) or CCB (32.4%). It should be noted thiazides were not as widely used (n = 63) in our population. Thus, it was not possible to comment on whether its use had a role in preventing hospitalization. Among the agents, ACEi is widely used for a multitude of diseases. As a result, it is often a first line agent employed by many, which was consistent with the data (n = 294) collected in this study. Interestingly, when assessing readmission rates, ACEi had the lowest percentage (8.1%;6/74) among the classes (BB 13.3%;8/60, CCB 18.4%;7/38, Thiazide 15.4%;2/13). Its judicious use and lower rates of admission and readmission were perhaps a compliment to the fine work by the physicians involved in their care.For mortality, there was a minimal percentage difference across the classes (ACEi 25.7%, BB 23.3%, CCB 23.7%, thiazides 23.1%). While there was a difference in number of patients across all four medications, the similar mortality suggested the co-morbidities, rather than the medications, may have a stronger influence on the outcomes in these patients. CONCLUSIONS: Our study demonstrated ACEi had a reduced rate of admission and the lowest rate of readmission compared to patients on BB or CCB. There was no difference in mortality across all four anti-hypertensive classes. We believe studies assessing co-morbidities while controlling for anti-hypertensive use could be beneficial in further our understanding in predicting outcomes of COVID-19 patients. CLINICAL IMPLICATIONS: ACEi use did not appear to have higher admission rates than other anti-hypertensives. Its use resulted in the lowest re-admission rates. The use of specific anti-hypertensive class had no bearing on mortality rates of COVID-19 patients. DISCLOSURES: No relevant relationships by Ali AKRAM, source=Web Response No relevant relationships by Vernon Chan, source=Web Response No relevant relationships by Dana Daoud, source=Web Response No relevant relationships by Olufunmilayo Folaranmi, source=Web Response No relevant relationships by Christopher Hemsley, source=Web Response No relevant relationships by Hafiza Wajeeha Javaid, source=Web Response No relevant relationships by Sarah Maurice, source=Web Response No relevant relationships by Junaid mir, source=Web Response No relevant relationships by Aisha Parihar, source=Web Response No relevant relationships by Britney Plotnick, source=Web Response No relevant relationships by Jayaram Thimmapuram, source=Web Response

Generation of a Novel SARS-CoV-2 Sub-genomic RNA Due to the R203K/G204R Variant in Nucleocapsid: Homologous Recombination has Potential to Change SARS-CoV-2 at Both Protein and RNA Level.

BACKGROUND: Genetic variations across the SARS-CoV-2 genome may influence transmissibility of the virus and the host's anti-viral immune response, in turn affecting the frequency of variants over time. In this study, we examined the adjacent amino acid polymorphisms in the nucleocapsid (R203K/G204R) of SARS-CoV-2 that arose on the background of the spike D614G change and describe how strains harboring these changes became dominant circulating strains globally. METHODS: Deep-sequencing data of SARS-CoV-2 from public databases and from clinical samples were analyzed to identify and map genetic variants and sub-genomic RNA transcripts across the genome. Results: Sequence analysis suggests that the 3 adjacent nucleotide changes that result in the K203/R204 variant have arisen by homologous recombination from the core sequence of the leader transcription-regulating sequence (TRS) rather than by stepwise mutation. The resulting sequence changes generate a novel sub-genomic RNA transcript for the C-terminal dimerization domain of nucleocapsid. Deep-sequencing data from 981 clinical samples confirmed the presence of the novel TRS-CS-dimerization domain RNA in individuals with the K203/R204 variant. Quantification of sub-genomic RNA indicates that viruses with the K203/R204 variant may also have increased expression of sub-genomic RNA from other open reading frames. CONCLUSIONS: The finding that homologous recombination from the TRS may have occurred since the introduction of SARS-CoV-2 in humans, resulting in both coding changes and novel sub-genomic RNA transcripts, suggests this as a mechanism for diversification and adaptation within its new host.