OLDER ADULTS' EXPERIENCE OF AND ATTITUDES TOWARDS USING TECHNOLOGY FOR MENTAL HEALTH SERVICES

Older adults (OAs) are particularly vulnerable to negative mental health effects from isolation and loneliness. During the COVID-19 pandemic many older adults are experiencing greater isolation, and many mental health services have moved to remote access. Knowledge and experience of technology are likely barriers for OAs in accessing these supports. Our research aims to understand OAs' experience of, and attitudes towards, using technology;both quantitative and qualitative methods were employed. It was hypothesised that the older cohort (75+) would be less experienced and comfortable with technology and that greater exposure to technology would be associated with greater comfort with its use. Participants (n = 22) were service users (SUs) of an older adult mental health service in Ireland. Results indicated no differences in exposure to technology or comfort with technology based on age. Increased exposure to technology was associated with greater comfort with use, including for engagement with mental health services (MHS). This research has implications for how remote services are offered to and conducted with older people. © 2022, University of Galway. All rights reserved.

The Benefits That a Novel Antimicrobial Provides When Viewed From an Insurance Value Perspective

Objectives: Traditional health economic evaluations of antimicrobials and other therapeutics such as vaccines currently underestimate their value to wider society. It can be supplemented by additional value elements including insurance value, which captures the value of a novel antimicrobial in preventing or mitigating impacts of adverse risk events such as those related to Covid-19 and antimicrobial resistance (AMR). Despite being commonplace in other sectors, constituents of the impacts and approaches for estimating insurance value of therapeutics have not been investigated. Method(s): This study assessed the insurance value of a novel antimicrobial, from the operational healthcare costs and several wider population health and societal perspectives. This was done by: (1) identifying risk events pertaining to 4 relevant scenarios: ward closures, unavoidable shortage of conventional antimicrobials, viral respiratory pandemics and catastrophic AMR, through literature review and multidisciplinary expert workshops, (2) parameterising constituent mitigable costs and frequencies of the risk events, and (3) applying a Monte Carlo simulation model for extreme events, and a dynamic disease transmission model. Modelling was implemented in Excel and R. Result(s): The mean insurance value across all scenarios and perspectives was 718m over a 10-year period, should AMR levels remain unchanged, where only 134m related to operational healthcare costs. The viral respiratory pandemics and catastrophic AMR scenarios contributed most to this value (290m and 297m respectively). This overall value would be 50-70% higher if AMR levels steadily increased or if a more risk-averse view (1-in-10 year downside) of future events is taken. Conclusion(s): The insurance value of a novel antimicrobial can be systematically modelled, and substantially augments their traditional health economic value in normal circumstances. These approaches are generalisable to any health intervention, and form a framework for health systems and governments to recognise broader value in health technology assessments and increase resilience by planning for adverse scenarios. Copyright © 2022

Establishing outpatient ureteric stent changes under local aesthetic in the Northeast region;a safety and feasibility study

Introduction: The COVID19 pandemic has led to unprecedented pressures on theatre waiting lists. The numbers of patients requiring regular ureteric stent changes under general anesthetic (GA) can be significant. We performed a regional study of these patients to assess;i) suitability for procedures under local anaesthetic (LA) and ii) outcomes for those then having LA rather than GA procedures. Patients and Methods: A retrospective cohort study from 3 urology centres was performed. Feasibility criteria for transition to LA stent change was determined on;comorbidities, indication for stent placement and operative factors. 2 centres subsequently initiated regular out-of-theatre LA stent change lists and outcomes were reviewed. Results: 216 cases were included. Median age was 68 and sex ratio 1:1 (M:F). Commonest indications for indwelling stents included benign strictures (37%), non-urological malignancy (24.1%) and urological malignancy (22.2%). 34 patients were suitable for/awaiting definitive procedures. Average number of changes was 2.4/year with 49% of patients being ASA3 or higher. LA stent changes were deemed feasible in 70 patients. 63 procedures were performed under LA with a 98% success rate. Complications (30d) included stent migration (2), haematuria (2) and infection (1). Conclusion: Innovation is required to deal with significant COVID-19 related problems. LA ureteric stent changes are safe and tolerable in appropriately selected patients. Performing these outside of the theatre environment increases capacity on surgical waiting lists. Patient benefits include reduced risks of multiple GA procedures in elderly and co-morbid patients. This data encourages expansion of this initiative.

Evaluating the performance characteristics of five lateral flow assays for the detection of the SARS-CoV-2 nucleocapsid antigen.

In response to the COVID-19 pandemic, lateral flow assays (LFAs) for the detection of SARS-CoV-2 antigen have been proposed as a complementary option to the more costly and time consuming reverse-transcriptase polymerase chain reaction (RT-PCR). We assessed five commercially available SARS-CoV-2 antigen detecting LFAs (ASSUT EUROPE (Rome, Italy), Besthree (Taizhou, China), Encode (Zhuhai, China), Fortress (Antrim UK), and Hughes Medical (Buckinghamshire, UK), using samples collected from hospitalised individuals with COVID-19 and compared these results against established RT-PCR assays with the aim of estimating test performance characteristics. We performed a diagnostic accuracy study of the five LFAs on 110 inpatients with confirmed COVID-19 and 75 COVID-19 negative control participants. Assay evaluation was performed using a modified version of each manufacturer's protocol allowing for parallel testing of a single sample on multiple assays. Additional variables were studied including infection acquisition, oxygenation requirements at time of swabbing, and patient outcomes. The 110 patients were 48% (53) female, with mean age 67 years (range 26-100 years), and 77% (85) cases were community onset SARS-CoV-2. Across the five assays, sensitivity ranged from 64 (95% CI 53-73) to 76% (95% CI 65-85); Fortress performed best with sensitivity of 76% (95% CI 65-85). Specificity was high across all assays with 4/5 LFAs achieving 100%. LFA sensitivity was not dependant on RT-PCR cycle thresholds. SARS-CoV-2 antigen detecting LFAs may complement RT-PCR testing to facilitate early diagnosis and provide community testing strategies for identification of patients with COVID-19, however we find suboptimal test performance characteristics across a range of commercially available manufacturers, below WHO and MHRA pre-set sensitivity performance thresholds. With such variation in sensitivity between LFAs and PCR testing and between assay brands, we advise caution in the deployment of LFAs outside of environments with clinical oversight.

Variability in detection of SARS-CoV-2-specific antibody responses following mild infection: a prospective multicentre cross-sectional study, London, United

Introduction: Immunoassays targeting different SARS-CoV-2-specific antibodies are employed for seroprevalence studies. The degree of variability between immunoassays targeting anti-nucleocapsid (anti-NP;the majority) vs the potentially neutralising anti-spike antibodies (including anti-receptor-binding domain;anti-RBD), particularly in mild or asymptomatic disease, remains unclear. Aims We aimed to explore variability in anti-NP and anti-RBD antibody detectability following mild symptomatic or asymptomatic SARS-CoV-2 infection and analyse antibody response for correlation with symptomatology. Methods A multicentre prospective cross-sectional study was undertaken (April-July 2020). Paired serum samples were tested for anti-NP and anti-RBD IgG antibodies and reactivity expressed as binding ratios (BR). Multivariate linear regression was performed analysing age, sex, time since onset, symptomatology, anti-NP and anti-RBD antibody BR. Results We included 906 adults. Antibody results (793/906;87.5%;95% confidence interval: 85.2-89.6) and BR strongly correlated (p = 0.75). PCR-confirmed cases were more frequently identified by anti-RBD (129/130) than anti-NP (123/130). Anti-RBD testing identified 83 of 325 (25.5%) cases otherwise reported as negative for anti-NP. Anti-NP presence (+1.75/unit increase;p < 0.001), fever ( 38..C;+1.81;p < 0.001) or anosmia (+1.91;p < 0.001) were significantly associated with increased anti-RBD BR. Age (p = 0.85), sex (p = 0.28) and cough (p = 0.35) were not. When time since symptom onset was considered, we did not observe a significant change in anti-RBD BR (p = 0.95) but did note decreasing anti-NP BR (p < 0.001). Conclusion SARS-CoV-2 anti-RBD IgG showed significant correlation with anti-NP IgG for absolute seroconversion and BR. Higher BR were seen in symptomatic individuals, particularly those with fever. Inter-assay variability (12.5%) was evident and raises considerations for optimising seroprevalence testing strategies/studies.

A Virtual Internship Experience

In 2020, the COVID-19 pandemic significantly disrupted life on campuses and around the world. During April 2020, the Student Engineers' Council (SEC) at Texas A&M University recognized that many students in the College of Engineering were notified their summer internships with companies had been cancelled. It was devastating to students who wondered how they were going to replace the professional development experience outside of the classroom. Reacting to this emergency, within three weeks, the President of SEC and Professors of the Practice from the engineering entrepreneurship program developed a summer instruction program which focused on professional skill development through a virtual implementation. All faculty involved had implemented internship programs in their companies and were convinced that a program could be offered, not to completely replace an internship at a company, but to build the professional skills students would need in their jobs. Ultimately, the virtual internship program involved over 350 students, almost 60 mentors, and seven faculty. It was divided into two 6-week phases - 1) professional skill training and 2) teamwork project implementation. Surveys were conducted pre- and post-training to assess the effectiveness of individual skill development and determine what elements of the program should be continued. A final survey was conducted of students and mentors to assess the effectiveness of teamwork development. Participants reported increases in development of individual skill areas over the course of the program. When rating their team performance, participants ratings were between somewhat agree and agree on the majority of the aspects of team performance assessed. Overall, participants had a positive view of their experience in the program. © American Society for Engineering Education, 2021

Nosocomial covid-19 among hospitalized solid organ transplant recipients

Purpose: This study aimed to identify probable cases of nosocomial Coronavirus Disease 2019 (COVID-19) among hospitalized solid organ transplant (SOT) recipients. Methods: All hospitalized SOT recipients diagnosed with COVID-19 by polymerase chain reaction (PCR) from March 11, 2020 to August 24, 2020 were evaluated. Potential nosocomial cases included admissions where the first positive PCR occurred on hospital day 3 or later (intra-admission) or within 14 days of a previous hospital discharge (inter-admission). Two infectious disease specialists independently adjudicated all potential cases into four categories (definitely community-acquired, likely community-acquired, likely hospital-acquired, and definitely hospital-acquired) using systematic chart review of symptom onset, radiographic findings, and community risk factors. Discrepancies were resolved by a third investigator. Results: Of 132 hospitalized SOT recipients diagnosed with COVID-19, nosocomial infections were apparent in 19 (14%;Figure 1). Intra-admission cases (n=11, 4 likely hospital-acquired and 7 definitely hospital-acquired) were diagnosed a median (IQR) of 43 (8 to 53) days after admission. Inter-admission cases (n=8, all likely hospitalacquired) had 5 (3 to 10) days of hospital care in the 14 days preceding diagnosis. The proportion of COVID-19 infections classified as nosocomial varied by time from most recent transplant until diagnosis (P<0.001) and transplant type (P<0.001;Table 1). Probable nosocomial infections peaked in June and gradually declined. Conclusions: Despite infection control measures to sequester SOT recipients and their nurses on dedicated transplant floors and provide patients and healthcare workers with screening, COVID-19 may have been acquired during healthcare interactions in 14% of hospitalized SOT recipients diagnosed with COVID-19. Vaccination against COVID-19 for front-line healthcare workers is important for protection of SOT recipients.

Propensity matched analysis of death and non-favorable discharge among hospitalized transplant recipients with covid-19

Purpose: This study compared death and non-favorable discharge following a hospital admission for Coronavirus Disease 2019 (COVID-19) management for patients with a history of solid organ transplant (SOT) vs without (control). Methods: All non-pregnant adults who tested positive with symptomatic or asymptomatic COVID-19 and were admitted at a multihospital health-system from March 17, 2020 through August 24, 2020 were eligible for the study. Patients were excluded if their first positive COVID-19 test occurred >7 days before admission (potentially resolved) or >7 days after admission (potentially nosocomial). Patients not taking immunosuppression immediately prior to COVID-19 diagnosis were excluded from the SOT group. Outcomes included death at 60 days after admission and non-favorable discharge (death or hospice). To adjust for confounding due to differences in baseline demographics, a propensity score was calculated using age, sex, race, body mass index, hypertension, diabetes mellitus, chronic kidney disease, underlying liver disease, month of hospital admission, and area deprivation index (a surrogate for socioeconomic status). The matched cohort was generated using 1:1 nearest neighbor matching without replacement. Outcomes were analyzed using logistic regression that accounted for matching. Results: Among 4,562 included patients (108 SOT recipients and 4,454 controls), 60-day death occurred in 17% SOT vs 10% control (P=0.033) and non-favorable discharge in 18% SOT vs 9% control (P=0.004). Among 214 matched patients (107 SOT recipients, 107 controls), 60-day death occurred in 17% SOT vs 9% control (OR=2.0, 95%CI=0.9 to 4.4, P=0.106) and non-favorable discharge in 18% SOT vs 9% control (OR=2.1, 95%CI=1.0 to 4.6, P=0.063). As expected, propensity matching reduced confounding due to differences in baseline characteristics (Table 1). Transplanted organs included kidney (n=64), liver (n=13), lung (n=12), history of >1 organ (n=13), and heart (n=5). Conclusions: Recipients of SOT had a greater risk of 60-day death and non-favorable discharge among hospitalized patients with COVID-19 using unadjusted analysis. Preliminary data from the propensity matched analysis reported similar magnitudes of association but did not find statistical significance. A larger study may be needed to clarify whether immune-suppressed SOT recipients have greater risk of death or non-favorable discharge from COVID-19. (Table Presented) .

An analysis of objective and subjective sleep and infection symptoms of medical personnel working through the COVID-19 pandemic

Introduction: There is a well-established connection between sleep and the immune system, and in the midst of a global pandemic, it is vital to understand the relationship between COVID-19 symptomatology and sleep. While our communities practice safety protocols, medical personnel working on the COVID-19 response effort are at high risk for exposure and contraction. This creates an urgent need to better understand whether sleep may contribute to COVID-19 symptom onset, severity, and recovery. This study examined the relationship between subjective and objective sleep during infection. Methods: Fifty volunteers (age 35.15±9.97) considered high risk for COVID-19 participated in the study. The sample consisted mostly of medical personnel (93.27%) working through the pandemic. Over six months, participants completed monthly surveys and daily logs via Qualtrics. These surveys included questions about sleep, infection symptoms, COVID-19 tests and diagnoses, and mood. Wrist-worn actigraphy was collected continuously throughout the study. Sleep duration, latency, wake after sleep onset, and efficiency were processed using Philips Actiware 6.0. Actigraphy and survey data were analyzed using SPSS v. 25. Results: Sixty-two percent of participants experienced infection symptoms. Those experiencing symptoms were significantly more likely to report having poorer sleep quality t(255.59)=5.78, p=<.001, poorer mood upon waking t(258.03)=6.53, p=<.001, feeling less alert upon waking t(255.61)=4.56, p=<.001, and spending more time awake at night t(2.66.98)=-7.29, p=<.001. Results showed that compared to those asymptomatic, participants with cough t(2164)=2.07, p=.039, diarrhea t(2161)=2.51, p=.012, and headache t(106.18)=7.05, p=<.001 all had significantly less total sleep time, while those with body aches spent significantly more time awake at night t(2164)=2.10, p=.036. Conclusion: This preliminary examination of the data broadly suggests that medical personnel experiencing infection symptoms may have difficulty obtaining adequate sleep. Further, specific infection symptoms may share a stronger relationship with key sleep parameters than others. These findings support further testing of the bi-direction relationship between infection symptoms and sleep. Results from this research will contribute to enhancing prevention, detection, and treatment guidance related to future domestic and globally-experienced infections.

Point-of-care SARS-CoV-2 serological assays for enhanced case finding in a UK inpatient population.

Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic. Case identification is currently made by real-time polymerase chain reaction (PCR) during the acute phase and largely restricted to healthcare laboratories. Serological assays are emerging but independent validation is urgently required to assess their utility. We evaluated five different point-of-care (POC) SARS-CoV-2 antibody test kits against PCR, finding concordance across the assays (n = 15). We subsequently tested 200 patients using the OrientGene COVID-19 IgG/IgM Rapid Test Cassette and find a sensitivity of 74% in the early infection period (day 5-9 post symptom onset), with 100% sensitivity not seen until day 13, demonstrating inferiority to PCR testing in the infectious period. Negative rate was 96%, but in validating the serological tests uncovered potential false-negatives from PCR testing late-presenting cases. A positive predictive value (PPV) of 37% in the general population precludes any use for general screening. Where a case definition is applied however, the PPV is substantially improved (95.4%), supporting use of serology testing in carefully targeted, high-risk populations. Larger studies in specific patient cohorts, including those with mild infection are urgently required to inform on the applicability of POC serological assays to help control the spread of SARS-CoV-2 and improve case finding of patients that may experience late complications.

A pilot telehealth program for remote home weight and nutrition monitoring for infants with cystic fibrosis

Background: With early diagnosis of cystic fibrosis (CF) by newborn screening, treatment can be initiated in the first weeks of life, preventing severe malnutrition. Even so, many babies are already underweight at diagnosis or have experienced complications such as meconium ileus. Assuring adequate weight gain for CF infants requires close attention by the dietitian (RD) and can also create parental stress and necessitate very frequent clinic visits. Beginning in 2018, we piloted and refined a homebased system to allow us to monitor weights remotely, assessing trends and making adjustments to the regimen even between visits. We postulated this might lead to early correction of suboptimal gains, improved nutrition progress, fewer “bad surprises” in clinic, and potentially fewer needed visits. Methods: We instituted remote nutrition monitoring on 14 CF infants from August 2018 to present. Shortly after joining our clinic, all infants were offered a dedicated iPad and infant scale to borrow. The software platform, developed by Locus Health (Charlottesville, VA), integrated information directly into the patient's electronic medical record. Each family was asked to enter weights < 3 times/week and could also add information on feeds, stool frequency, and enzyme dose. The software program was enabled to calculate average daily weight gain and lipase units/kg/feed, and all information was viewable by our team on a dashboard. Our RD typically communicated with each family weekly. Results: All families accepted the offer of participation in the program. Families entered infant weights an average of 20.4 times per month during the first 3 months of use (Q1), with a gradual decline thereafter: 13.0 in Q2, 6.8 in Q3 and 6.0 times/month in Q4. Our RD recommended changes between in-person visits approximately 2.7 times per month during the first 3 months of use, and less frequently thereafter. These recommendations included change in enzyme dose (53%), feed density (27%), feed volume (10%), acid suppression (5%) and constipation management (5%). After 6 months of monitoring, 6 of 9 infants had attained weight-for-age percentile >25th, and the rest were at the 10-25th percentile. On family surveys, all 10 respondents Agreed or Strongly Agreed that: (1) the program made them feel more comfortable with CF care at home;and (2) the program was user friendly;and (3) the RD communicated and advised them regularly. Nine of 10 agreed it was easy to incorporate into their daily routine. Among directly involved providers, 5 of 5 endorsed the program's utility and its particular benefit in maintaining care during the COVID crisis while clinic visits were less frequent. Conclusions: We developed and implemented a remote nutrition monitoring program specific to CF infants. This facilitated frequent nutrition interventions and potentially accelerated progress, although there was no nonmonitored control population for comparison. Families and providers indicated overwhelmingly positive opinions of the program. An unanticipated benefit came when the COVID-19 pandemic necessitated an abrupt reduction in clinic visits and we remained able to manage our infants' nutrition remotely without interruption. This program represents a successful telehealth innovation for CF care.

Bacterial and fungal coinfection among hospitalized patients with COVID-19: a retrospective cohort study in a UK secondary-care setting.

OBJECTIVES: To investigate the incidence of bacterial and fungal coinfection of hospitalized patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in this retrospective observational study across two London hospitals during the first UK wave of coronavirus disease 2019 (COVID-19). METHODS: A retrospective case series of hospitalized patients with confirmed SARS-CoV-2 by PCR was analysed across two acute NHS hospitals (20 February-20 April 2020; each isolate reviewed independently in parallel). This was contrasted to a control group of influenza-positive patients admitted during the 2019-2020 flu season. Patient demographics, microbiology and clinical outcomes were analysed. RESULTS: A total of 836 patients with confirmed SARS-CoV-2 were included; 27 (3.2%) of 836 had early confirmed bacterial isolates identified (0-5 days after admission), rising to 51 (6.1%) of 836 throughout admission. Blood cultures, respiratory samples, pneumococcal or Legionella urinary antigens and respiratory viral PCR panels were obtained from 643 (77%), 110 (13%), 249 (30%), 246 (29%) and 250 (30%) COVID-19 patients, respectively. A positive blood culture was identified in 60 patients (7.1%), of which 39 were classified as contaminants. Bacteraemia resulting from respiratory infection was confirmed in two cases (one each community-acquired Klebsiella pneumoniae and ventilator-associated Enterobacter cloacae). Line-related bacteraemia was identified in six patients (three Candida, two Enterococcus spp. and one Pseudomonas aeruginosa). All other community-acquired bacteraemias (n = 16) were attributed to nonrespiratory infection. Zero concomitant pneumococcal, Legionella or influenza infection was detected. A low yield of positive respiratory cultures was identified; Staphylococcus aureus was the most common respiratory pathogen isolated in community-acquired coinfection (4/24; 16.7%), with pseudomonas and yeast identified in late-onset infection. Invasive fungal infections (n = 3) were attributed to line-related infections. Comparable rates of positive coinfection were identified in the control group of confirmed influenza infection; clinically relevant bacteraemias (2/141; 1.4%), respiratory cultures (10/38; 26.3%) and pneumococcal-positive antigens (1/19; 5.3%) were low. CONCLUSIONS: We found a low frequency of bacterial coinfection in early COVID-19 hospital presentation, and no evidence of concomitant fungal infection, at least in the early phase of COVID-19.

New-onset anosmia and ageusia in adult patients diagnosed with SARS-CoV-2 infection.

OBJECTIVES: We investigated the prevalence of anosmia and ageusia in adult patients with a laboratory-confirmed diagnosis of infection with severe acute respiratory distress syndrome coronavirus-2 (SARS-CoV-2). METHODS: This was a retrospective observational analysis of patients infected with SARS-CoV-2 admitted to hospital or managed in the community and their household contacts across a London population during the period March 1st to April 1st, 2020. Symptomatology and duration were extracted from routinely collected clinical data and follow-up telephone consultations. Descriptive statistics were used. RESULTS: Of 386 patients, 141 (92 community patients, 49 discharged inpatients) were included for analysis; 77/141 (55%) reported anosmia and ageusia, nine reported only ageusia and three only anosmia. The median onset of anosmia in relation to onset of SARS-CoV-2 disease (COVID-19) symptoms (as defined by the Public Health England case definition) was 4 days (interquartile range (IQR) 5). Median duration of anosmia was 8 days (IQR 16). Median duration of COVID-19 symptoms in community patients was 10 days (IQR 8) versus 18 days (IQR 13.5) in admitted patients. As of April 1, 45 patients had ongoing COVID-19 symptoms and/or anosmia; 107/141 (76%) patients had household contacts, and of 185 non-tested household contacts 79 (43%) had COVID-19 symptoms with 46/79 (58%) reporting anosmia. Six household contacts had anosmia only. CONCLUSIONS: Over half of the positive patients reported anosmia and ageusia, suggesting that these should be added to the case definition and used to guide self-isolation protocols. This adaptation may be integral to case findings in the absence of population-level testing. Until we have successful population-level vaccination coverage, these steps remain critical in the current and future waves of this pandemic.