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Background: UK restrictions during covid-19 impacted lung cancer care including referrals into secondary care. Aim(s): (1) document pattern of referrals to this semi-rural Trust, (2) evidence any later presentation of disease, and(3) report impact on treatment. Method(s): Data was collected retrospectively and analysed for pre-covid, lockdown/restriction period, and post-relaxation of rules. Non-parametric data were analysed by chi square (X2) analysis for trend. Result(s): Fall in referrals pivoted on the initial UK peak in 2020 with a slow recovery in two week wait referrals post-lockdown (43%, previously 60%). Table 1 shows distribution in disease stage negatively skewed (all >2.46) with themajority at stage 4. Trend showed no statistical difference in stage with X2 (df 6, n=792, = 3.831, p=.6995) andsimilarly when re-analysing earlier stages. Treatment outcome shows non-significant trends to increased palliativecare (28 to 35%) and radiotherapy (10 to 18%), with less chemotherapy (25 to 21%) or surgery (26 to 15%). Conclusion(s): Locally, lung cancer diagnosis numbers have been maintained, with a similar stage at presentation but a change in referral pattern favouring emergency/upgraded presentation may signal reduced access to primary care.
ABSTRACT
TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: INTRODUCTION: Research shows that 90% of blood cultures show no growth and a third of the remainder who test positive are identified as false positives [Garcia RA et al. Am J Infect Control 2015]. Although blood culture contamination rates of <1% are achievable, historical rates at <3% are industry accepted standards[Wayne PA. Clinical and laboratory Standards Institute (CLSI) document M47-A;2007];contaminants from skin flora are the most common, but 20% are from microbes deep in the dermis layer which may be drawn into blood specimens. Evidence for early use of antibiotics managing patients with COVID-19 pneumonitis is lacking but there are anecdotal concerns that more blood cultures than usual have identified organisms usually considered contaminants in sampling. Objectives were to quantify our local findings and relate these to outcome at discharge and during follow up. METHODS: Computer based retrospective review of 228 patients, mean age 71.8 (SD 8.7, range 29-87) years admitted at this hospital between March-May 2020 during the UK COVID-19 (SARS-Cov-2 RNA) peak and surge. Blood cultures reported here correspond to initial presentation with COVID-19 following a sepsis protocol. Comparative analysis by chi square (X2). RESULTS: 137/228 (60%) of patients had blood cultures at admission. 21/137 (15.3%) identified organisms from either one (n=13) or both (n=8) aerobic and anaerobic blood culture bottles. 12/21 (57.1%) (8 died) were identified as coagulase negative staphylococci (CoNS), traditionally considered contaminants at sampling;others included coagulase positive staph aureus (2), Klebsiella (2), E coli (2), and one each for Diptheroids, Proteus Miribalis and Aerococcus Viridans. The remaining 116 reported no growth from initial samples but 3 had positive results later in the admission (2 with CoNS, 1 with E Coli). 7/21 (33.3%) of those with any growth had died during the admission and this was proportionately similar to the 38/116 (32.8%) with no growth on blood cultures [X20.0027, p=.9588, not significant]. At 6 month follow up however, 15/21 (71.4%) of those who had positive findings on original cultures had died compared with 48/116 (41.4%) that had shown no growth [X26.4639, p=.0110, statistically significant]. CONCLUSIONS: Although death rates during admission did not differ, comparing those with and without positive findings on initial blood cultures, a large percentage with positive initial findings then died during follow up. Despite several organisms traditionally considered contaminants, the higher (15.3%) reporting and potential false positive rates requires further study;this should address sampling errors but also revisit bacterial co-infection in COVID-19. CLINICAL IMPLICATIONS: Improving sampling for blood cultures, but research is also needed to make sure this is not a signal for underlying bacterial co-infection. DISCLOSURES: No relevant relationships by Nawaid Ahmad, source=Web Response No relevant relationships by Emma-Jane Crawford, source=Web Response No relevant relationships by Annabel Makan, source=Web Response No relevant relationships by Nikhita Moudgil, source=Web Response No relevant relationships by Harmesh Moudgil, source=Web Response No relevant relationships by Afrah Riaz, source=Web Response No relevant relationships by Koottalai Srinivasan, source=Web Response
ABSTRACT
RATIONALE: Vitamin D supports immunity and inflammation by inhibiting proinflammatory cytokine release from macrophages and up-regulating the expression of anti-microbial peptides exhibiting anti-viral activity. Respiratory epithelial cells also convert inactive 25(OH)D (main circulating vitamin D) to 1,25(OH)2D3 enabling high local concentrations of this biologically active form to increase the expression of vitamin D-regulated genes. Studies continue to investigate the therapeutic effects and establish the optimal serum levels of 25(OH)D required to reduce the impact of respiratory tract infections whilst avoiding toxic hypercalcaemic high-dose 'blind' supplementation. Analysing patients admitted to hospital with COVID-19 (SARS-CoV-2 RNA) during the first phase of the pandemic, objectives and focus on reporting were to (1) document the population where measured vitamin D levels are readily available whilst quantifying those on supplements and (2) compare outcome at discharge depending on most recent available vitamin D status. METHODS: Computer data including clinical outcomes were examined for the 516 patients (55% male) with mean age 67.4 (SD 18.3, range 0 to 100) years admitted from our semi-rural predominantly white European population to our District General Hospitals (Teaching) during the 4 months (March to June 2020) in the first phase of the COVID-19 illness in the UK. Outcomes (death during admission versus discharged alive) were analysed with SPSS comparing those with reduced versus adequate vitamin D levels. RESULTS: Collectively (n=516), vitamin D levels (historical or updated) were available on 163 (31.5%) of patients;17 (3.3%) undertaken during the admission. Data were skewed with median level 47 (interquartile range 24.1 to 66.9) nmol/L. 74 (14.3%) were already on vitamin D supplements and for an additional 10 (1.9%) this was initiated during the admission. Among the 163 patients, 86 (52.7%) had reduced vitamin D levels (deficient or insufficient) and these had worse outcomes with 29/86 (33.7%) having died during the admission compared with 13/74 (17.6%) of those with adequate levels: X2 (df 1, n=163) 6.02, p=.014. Table 1 categorises distribution of values. CONCLUSIONS: Data highlight (1) less than a third of admitted COVID-19 patients have recorded vitamin D levels and of these more than half have reduced levels, (2) 14.3% are already taking vitamin D, (3) very few get tested during the acute admission or get started on supplements, and (4) there is a statistical difference highlighting adverse outcome (death versus discharged alive) for those with reduced vitamin D levels.