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Objectives To evaluate whether intermittently scanned continuous glucose monitoring (isCGM) with optional alarms (FreeStyle Libre 2) improves glycaemia as measured by HbA1c and sensor-based gluco-metrics, patient reported outcome measures (PROMS) and cost-effectiveness compared with selfmonitoring of blood glucose (SMBG). Design Flash UK is a multicenter, open-label, two arm, parallel, randomised controlled trial delivered in 7 specialist hospital diabetes clinics and 1 primary care centre. Participants 156 people with Type 1 diabetes, age 16 years and over treated with either multiple daily insulin injections or insulin pump therapy with HbA1c 7.5%-11% were randomised. Interventions Participants were randomised (1:1) to the FreeStyle Libre 2 (n = 72) or standard care with SMBG (n = 69). Participants were reviewed at 4, 12 and 24 weeks post-randomisation. Education and treatment optimisation was provided to both groups at randomisation, 4 and 12 weeks. Participants in the SMBG arm wore blinded glucose sensor (Freestyle Libre Pro) during the last 2 weeks of the study;all participants wore a 2-week blinded sensor prior to randomisation. All study visits were conducted either inperson or virtually owing to the COVID-19 pandemic. Main outcome measures The primary outcome was HbA1c at 24 weeks, analysed by intention to treat. Secondary outcomes included glucose time in range (3.9 to 10mmol/l), time below and above range and glucose variability. PROMS included EQ-5DL-5L, Type 1 Diabetes Distress Scale, Diabetes fear of injecting and self-testing, Diabetes Eating Problem Survey, Diabetes Treatment Satisfaction, Patient Health Questionnaire and The Glucose Monitoring Satisfaction Survey. Economic evaluation included healthcare resource use, insulin usage and Freestyle Libre 2 utilisation. Results & Conclusion Results and conclusions will be presented during the 15th International Conference on Advanced Technologies & Treatments for Diabetes, April 27 to 30th Barcelona, Spain and Online.
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INTRODUCTION COVID-19 has placed excess stress on the antenatal health care system and added additional complexity to expecting mothers. This study aimed to study the attitude and precautionary practices of non-infected pregnant women during the COVID-19 pandemic in Nepal. METHODS A cross-sectional study was carried out interviewing all 195 pregnant women attending an antenatal care outpatient department in Nepal, between 15 March and 16 April 2021, using a pretested questionnaire. Precautionary practices were defined as the practice of social distancing, wearing masks, and sanitizing or washing hands, by the mothers during the antenatal period with a 5-point Likert scale for each item Precautionary practices were categorized into good (≥ median score) and poor(< median score). RESULTS The majority of the women who participated in this study were from aged 20–29 years (71.7%), were Brahmin (48.2%) and 84.6% Hindu. Since 46.2% of women assumed the close contact of mother to child as safe practice with specific precautions, only 17.9% were willing to isolate themselves if infected by COVID-19. Overall, 35.9% of the respondents were only willing to breastfeed their newborn, even with specific precaution if infected. Nearly half of the respondents (47.2%) had poor precautionary practice during the COVID-19 pandemic and the level of precautionary practices was found significantly associated with age and occupational status. CONCLUSIONS Most of the respondents were concerned about the threats of mother to child transmission but found to have poor precautionary practices towards COVID-19. Thus, adequate counselling regarding COVID related issues during an antenatal checkup is required to be provided by health workers to break their perceived stigma for better maternal and neonatal outcomes © 2022 Thapa T. et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution NonCommercial 4.0 International License. (http://creativecommons.org/licenses/by-nc/4.0)
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Introduction: The aim of this study was to investigate the developmental pathways of work capacity among higher education employees during the enforced remote work caused by COVID-19, and how physical ergonomics at home, and organizational factors predicts different pathways. Material and methods: A longitudinal web-survey was conducted with four measurement points (April 2020, to February 2021). Employees who responded to all surveys were included (n = 678). Of the respondents 71 % were women, 45 % teachers or research staff, 44% supporting staff and 11 % hired students. Perceived work capacity was measured similarly in all four times. Work stress, musculoskeletal pain, functionality of the home for work, and satisfaction with activities and support of the employer were measured at baseline. Latent class growth curve analysis was used to identify individuals into distinct trajectories. Multinomial logistic regression was used to determine the associations between individual, ergonomic, and organizational factors (predictors) at baseline and profile membership (outcome). Results and discussion: The work capacity for 75% of the employees was stable during remote working, 17 % had a favorable trend (very good-stable or increasing) of the work capacity and 8% had non-favorable (poor-stable or decreasing). Non-favorable work capacity was associated with poor physical workstation at home, dissatisfaction with the support from the organization, high work stress and musculoskeletal pain.
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Background: Acute peritoneal dialysis (AKI-PD) used to manage about 20% of our COVID-19 AKI patients requiring renal replacement therapy (RRT) of whom 45% had renal recovery. Methods: Retrospective chart review of 11 consecutive patients undegoing bedside PD catheter placement from 4/1/2020 to 4/30/2020 Results: Median time from admission to the development of AKI was 1 day (IQR 0-3) (Table 1). In 73% of the patients, CRRT or intermittent HD was used as the initial RRT modality;CRRT circuit clotting was the primary reason for switching to PD in 2 patients. Median time from diagnosis of AKI to PD catheter insertion was 5 days (IQR 2-14). At one week, 10 catheters (91%) were functional with no leaks or bleeding detected. Only one patient was switched to CRRT due to primary PD catheter non-function;thispatient had BMI greater than 35 kg/m2 and a history of appendectomy. Median duration of follow up from time of PD catheter placement was 37 days (IQR 32-37.5), death-censored median follow up was 35 days (IQR 30-37.5). The median time from AKI to death was 17 days (IQR 14-22). Median time from AKI to renal recovery was 34 days (IQR 21- 40). Conclusions: In our AKI-PD cohort, the mortality rate was noted to be 36% and 45% had renal recovery during the follow up period. We hypothesize that preservation of residual renal function utilizing PD may have contributed to the high rate of renal recovery observed. Two of our patients converted from CRRT to PD due to repeated filter clotting. We did not observe any bleeding complications in our cohort. We hypothesize that hypercoagulable COVID-19 patients may be excellent candidates for PD potentially due to lower risk of bleeding complications.
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Background: Procalcitonin is a widely used test to distinguish bacterial infections from viral infections, but its level is influenced by kidney function. The normal range of procalcitonin levels in end-stage renal disease (ESRD) patients on hemodialysis (HD) is not well established. In this study, we evaluated the relationship between Procalcitonin and inflammatory markers and outcomes in ESRD outpatients on HD. Methods: We recruited 71 ESRD outpatients on HD from October 1st 2019 to December 15th 2019 and measured their procalcitonin levels prior to dialysis. We evaluated whether procalcitonin levels were associated with clinical characteristics, laboratory parameters, and future hospitalizations and infections. Results: In this cohort, the median procalcitonin level was 0.38 ng/mL with an interquartile range of 0.23 ng/mL and 0.54 ng/mL. The distribution of procalcitonin values are found in Fig. 1A. African Americans had a significantly higher procalcitonin level than non-African Americans (P=0.02, Wilcoxon rank sum test). ESRD outpatients who had hypertension, diabetes mellitus, or HIV did not have significantly higher procalcitonin levels than those who did not (P> 0.05). Procalcitonin levels were positively correlated with CRP (r=0.57, P<0.001) (Fig. 1B) and negatively correlated with albumin (r=-0.28, P=0.02) (Fig. 1C). Procalcitonin levels were not correlated with Kt/V, white blood cell count, and ferritin levels (P>0.05). ESRD outpatients who developed infections or who were hospitalized did not have significantly higher initial procalcitonin levels than those who did not (P>0.05). Conclusions: Procalcitonin levels are correlated with inflammatory markers such as CRP and albumin, suggesting its potential use to identify ESRD on HD at high risk for complications, especially in the era of COVID-19. (Figure Presented).