ALZHEIMER'S DISEASE RISK REDUCTION HEALTH COACHING: ALCOHOL EFFECTS

Lifestyle risk reduction at the community-level, is currently considered an effective method to decrease Alzheimer's disease (AD). As part of the Virginia Commonwealth University iCubed Health and Wellness in Aging Core, diverse older adults (60+) in Richmond, VA, with incomes below $12,000/year and managing either diabetes/cardiovascular symptoms, were offered weekly lifestyle telephone-health coaching for 12-weeks, providing education, support, and monitoring for AD lifestyle risk in 2020-21. The study sample (n=40, mean age 68 years (range: 60-77 years) was 88% African American/Black (n=35), 100% Non-Hispanic, 45% males (n=18)), 60% reporting memory problems and 53% reporting any alcohol consumption. Thirty-nine (95%) of subjects successfully participated in coaching sessions;on average 91.9% (11) sessions were completed. Participants provided positive anecdotal feedback and the need for continued coaching during COVID. Average drinks per day decreased across the study period (F=7.44;p=.01) and alcohol risk, defined as more than 1 drink/day, decreased (F=3.46;p=.07). Drinking at baseline was associated with differential change in nicotine dependence (F=14.00 ;p=.02), depression risk (F=3.20;p=.09), light physical activity (F=4.52;p=.05), and cognition (COGTEL) (F=6.35;p=.02). Drinking between-subject effects indicated poorer level differences for smoking risk (F=5.68;p=.02), physical inactivity risk (F=4.66;p=.04), and total health behavior risk (F=14.54;p=.001), but higher cognition-scores (F=3.18;p=.11) for drinkers. In conclusion, there may be a paradoxical health effect for alcohol, with associations for negative health behaviors, but positive cognitive functioning. In conclusion, this preliminary work creates the impetus for future large-scale AD risk reduction investigations to improve the lives of AD-risk, low-income, diverse older adults reporting alcohol consumption.

AGE-FRIENDLY CARE: A FRAMEWORK TO ADDRESS HEALTH DISPARITIES IN NURSING HOMES

Three Geriatrics Workforce Enhancement Programs (Johns Hopkins, Penn State and Virginia Commonwealth) within Health and Human Services Region-3, implemented a project providing tailored educational content designed to meet the regional needs of nursing home staff, residents, and carepartners within the context of the COVID-19 pandemic. Semi-Structured, recorded focus groups were conducted with direct care workers, and family and resident counsels. All groups were interviewed about familiarity and comfort with the 3Ds (Dementia, Delirium, and Depression) as well as what mattered most to them as workers, residents and care partners. The overall goal was to enhance development of the nursing home workforce thus creating a meaningful clinical improvement in care. We aim to go beyond the improvement of routine clinical care and address the long-standing behavioral and mental health disparities observed in this resident population. Policy implications around education, engagement of workforce, resident, and carepartner voices will be discussed.

Micro-eliminating hepatitis C in a network of 47 English Prisons through an industry, prison healthcare and patient organisation partnership

Background and aims: National Health Service England (NHSE) plans to eliminate Hepatitis C (HCV) in England by 2025, five years earlier than World Health Organisation goals. With a reported HCV prevalence of ∼6% in male prisons, and ∼12% in female prisons, secure environments are an essential component of this elimination plan. In 2020, NHSE defined HCV micro-elimination as ³95% of prison residents tested within the previous 12 months, ³90% of RNA positive patients treated or initiated on treatment and presence of a robust system to review ongoing testing and treatment performance to ensure these targets are maintained. Method: To support NHSE in their HCV Elimination Program, a partnership between Gilead Sciences, Practice Plus Group (PPG) and the Hepatitis C Trust (HCT)was formed in 2019. PPG is the provider of healthcare to 47 English prisons with approximately 30, 000 residents. PPG Regional BBV Lead Nurses, and Gilead Medical Scientists worked with prison and HCV stakeholders to optimise test and treat pathways for new prison admissions. Whole prison HCV Intensive Test and Treat events (HITTs) were also run in targeted prisons to ensure testing of residents who were incarcerated before these optimisations were implemented. Results: Following pathway optimisation across the PPG network of 47 prisons, the HCV screening within 7 days of prison entry increased from 41% in May 2019 to 84% in October 2021. This increase was achieved despite there being significant restrictions to reduce the transmission of COVID-19 being in place across all English prisons. HITTs have been performed in 15 PPG prisons to-date. 1, 909 new RNA+ diagnoses were made during this time with 1, 848 patients started on direct-acting antiviral treatments. By November 2021, 16 out of the 47 prisons have been given micro-elimination status by NHSE with 4 more having submitted data demonstrating achievement of this target and awaiting decision. A further 4 more prisons are on track to achieve micro-elimination by April 2022. Conclusion: This partnership has demonstrated that, even during a global pandemic, it is possible to achieve the micro-elimination of HCV in a defined setting. Maintenance of micro-elimination status is essential if we are to achieve the WHO HCV targets, requiring robust pathways that are regularly adapted to the changing environment, and systems for tracking performance, both of which have been put in place by this partnership.

Alzheimer's Disease Prevention Health Coaching.

BACKGROUND: Widespread lifestyle risk reduction at the community level is considered effective in decreasing Alzheimer's disease (AD). To address the limited use of risk deduction in AD, this study aimed to explore the feasibility of community-level implementation. Diverse older adults (60+) living in Richmond, VA, with incomes below $12,000/year and managing diabetic/cardiovascular symptoms were offered weekly lifestyle telephone-health coaching for 12-weeks in 2019-2020 (Phase 1). The health coaching sessions were framed to provide AD lifestyle risk reduction education, goal setting, and support: motivations and self-efficacy. The study sample (n=40, mean age 68 years (range: 60-76 years)) was 90% African American/Black (n=36), 100% Non-Hispanic, and 45% males (n=18). Twenty-five participants (60%) reported experiencing some/often memory problems in the last 12-months. Thirty-nine (95%) of subjects successfully participated in coaching sessions; on average, 11 (91.9%) sessions per subject were completed. Participants provided positive anecdotal feedback and stated the need for continued health coaching. Consequently, n=30 (75%) of the original sample consented to continued health coaching during the 2020-2021 COVID-19 pandemic (Phase 2). All study subjects were examined at baseline (Time 1), 3-month (Time 2), covid-baseline (Time 3), and 3-months postcovid-baseline (Time 4). Repeated Measures ANOVAs were done to examine Time and Time*Memory Status effects. RESULTS: There was a total risk reduction at Phase 1 (F=9.26; p=.004; effect size=.19). At Phase 2, alcohol use decreased (p=.05), quadratic time effects were observed in physical activity (p=.01-.02), and cubic time effects were observed in depression (p=.02). Overall, total risk reduction in Phase 2 was observed at F=5.05; p=.03 effect size=.16. Pre/post-test analyses indicated improvement in Memory Problem Time Interaction (p=.007), AD knowledge (p=.01-.03), and Tired Days (p=.04) across Phase 1. There was also improvement in Social Isolation Time Interaction (p=.03); Tobacco Addiction (p=.001); Poor Mental Health Days (p=.05), and Worried Days Time Interaction (p=.02-.01) across Phase 2. Between subject Memory Status effects, indicating poorer baseline levels for individuals reporting memory problems had greater improvement seen in memory complaints (p=.001), poor mental health days (.02), and tired days (.003-.01). CONCLUSIONS: This preliminary work creates the impetus for future large-scale lifestyle AD risk reduction investigations to mitigate and improve modifiable AD risk among low-income, diverse older adults, including individuals reporting memory problems. Our findings surrounding participant engagement and positive trends in AD risk reduction support the hypothesis that telephone-based health coaching is a practical and feasible AD risk reduction intervention.

Pulmonary embolism in COVID-19: Indicators and outcomes in a district general population

Introduction: Covid-19 (CV19) infection is associated with pulmonary embolism (PE). We sought to detail the presence of PE, clinical, laboratory features, and outcomes of those with PE and CV19 compared to CV19 and no PE. Methods: Retrospective analysis of all computed tomography pulmonary angiogram (CTPA) studies undertaken at our hospital during the peak of the pandemic between 29/2-3/5/2020. We included all inpatients with positive CV19 swab or classical or probable features of CV19 on CTPA. All CTPAs were reviewed by certified radiologists. The patient's electronic health records were reviewed for clinical data. Results: Total 132 (45.9%) of CTPAs met inclusion criteria. Presence of PE was 31 (23.5%), with 13 (41.9%) being central, and 18 (58.1%) peripheral. Men (70.4%, P0.04) and white ethnicity (58.1%, P0.03) were significantly associated with PE. No association was seen between CTPA radiographic severity of CV19 and presence of PE. Thromboprophylaxis was administered to 73.2% of the cohort prior to CTPA, no association (P0.29) between administration and diagnosed PE. No difference in vital observations in the 24hrs prior to CTPA as detected. Median Ddimer and Troponin T were significantly elevated (P<0.01) in those with PE. Median Ddimer was 1050ng/mL (585-2047) in PE compared to 403ng/mL (242-664) in those without. Troponin T level was 3 times higher (25ng/L (11-51) vs 8ng/L (6-18)) in those with PE. No association was detected for other laboratory tests including: white blood cells and differential, ferritin, c-reactive protein, and brain naturetic peptide. Critical illness (composite in-hospital mortality, ITU or respiratory HDU admission, transfer to tertiary centre) occurred in 50.8% of the cohort, there was no difference (P0.9) between groups. No significant difference between in hospital mortality (PE 16.7% vs no PE 13%), ITU admission (PE 38.7% vs no PE 33.7%). Conclusion: Presence of PE is high in those infected with CV19 with males and white ethnicity at risk. Ddimer and Troponin T are useful indicators of PE in those with CV19 and significant elevations in deteriorating patients should prompt evaluation for PE. The significance of PE needs further research considering lack of difference in outcomes within our cohort.

An audit of NCEPOD quality of care standards for acute pulmonary embolism

Category: Reporting quality Background to the audit: Computed tomography pulmonary angiogram (CTPA) studies are the most common investigation for the diagnosis of suspected pulmonary embolism (PE). The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) enquiry into in 2019 identified areas for improvement in the care of patients with new diagnosis of PE. One principal recommendation is to standardise CTPA reporting with consideration for reporting proforma to include important positives and negatives. Standard: All CTPA reports should comment on the quality/adequacy of study, thrombus burden and the presence/absence of right heart strain. Indicator: As above. Target: Target: 100%. Methodology: Retrospective analysis of CTPA studies from November 2019. Results of first audit round: Total CTPA studies in November 2019: 103 (five were follow-up studies so excluded). CTPA positivity rate 17/98 (17.3%), within accepted standards. Of these 17 studies, seven were outsourced for reporting. Only 9/17 reports commented on the quality of study (53%). All 17/17 reports commented on thrombus burden (100%). 12/17 reports commented on presence/absence of right heart strain (71%);of the five studies that did not comment on the right heart, two demonstrated massive central PEs. No significant difference between onsite radiologist and outsourced reporting. First action plan: CTPA reporting template agreed with the consultant body at the departmental audit/governance meeting. All positive studies to be reported with template now available on Soliton (radiology information system). Results fed back to Outsourcing company. Re-audit at two months. Results of second audit round: Awaited (re-audit delayed by COVID-19). References: 1. National Institute for Health and Care Excellence (NICE Guidelines CG144). Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. London: National Institute for Health and Care Excellence, 2012 (updated in 2015). 2. The Royal College of Radiologists (RCR: 7th Edition iRefer Guidelines CC04). Suspected Pulmonary Embolism (PE) London: The Royal College of Radiologists, 2012. 3. Kingston Hospital (2019). [Blue Book Version 19]. Retrieved from: /media/9739/t-secure-department-folders-governance-department-policies-guidelines-publishing-transfer-to-pcg-pdfs-only-patient-care-experience-blue-book-october-2019-v17.pdf 4. National Confidential Enquiry into Patient Outcome and Death. Know the score: A review of the quality of care provided to patients aged over 16 years with a new diagnosis of pulmonary embolism. London: National Confidential Enquiry into Patient Outcome and Death, 2019. 5. Withey S, Tamimi A, CT pulmonary angiogram reporting for pulmonary embolism: are we informing clinical management? ECR Poster C-0835. ECR 2015. doi:10.1594/ecr2016/C-0835 6. www.rcr.ac.uk/audit/appropriateness-usage-computed-tomographypulmonary-angiography-ctpa-investigation-suspected (last accessed 07/04/2019)

Understanding the dynamics of COVID-19; implications for therapeutic intervention, vaccine development and movement control.

The COVID-19 disease is caused by the SARS-CoV-2 virus, which is highly infective within the human population. The virus is widely disseminated to almost every continent with over twenty-seven million infections and over ninety-thousand reported deaths attributed to COVID-19 disease. SARS-CoV-2 is a single stranded RNA virus, comprising three main viral proteins; membrane, spike and envelope. The clinical features of COVID-19 disease can be classified according to different degrees of severity, with some patients progressing to acute respiratory distress syndrome, which can be fatal. In addition, many infections are asymptomatic or only cause mild symptoms. As there is no specific treatment for COVID-19 there is considerable endeavour to raise a vaccine against SARS-CoV-2, in addition to engineering neutralizing antibody interventions. In the absence of an effective vaccine, movement controls of varying stringencies have been imposed. Whilst enforced lockdown measures have been effective, they may be less effective against the current strain of SARS-CoV-2, the G614 clade. Conversely, other mutations of the virus, such as the Δ382 variant could reduce the clinical relevance of infection. The front runners in the race to develop an effective vaccine focus on the SARS-Co-V-2 Spike protein. However, vaccines that produce a T-cell response to a wider range of SARS-Co-V-2 viral proteins, may be more effective. Population based studies that determine the level of innate immunity to SARS-CoV-2, from prior exposure to the virus or to other coronaviruses, will have important implications for government imposed movement control and the strategic delivery of vaccination programmes.

British Journal of Biomedical Science in 2020. What have we learned?

Each year the British Journal of Biomedical Science publishes a 'What have we learned' editorial designed to introduce readers within the major disciplines of laboratory medicine to developments outside their immediate area. In addition it is designed to inform a wider readership of the advances in the diagnosis and treatment of disease. To this end, in 2020 the journal published 39 articles covering the disciplines within Biomedical Science in the 4 issues comprising volume 77. These included a review of COVID-19 in this issue, 27 original articles, 6 Biomedical Science 'In Brief' and 4 case histories. 27 of the articles involved molecular techniques, with one of these comparing results with a mass spectrometry based method. The preponderance of molecular genetic studies gives us a good idea of the likely future direction of the disciplines.