Incidence and microbiological characteristics of ventilator-associated pneumonia assessed by bronchoalveolar lavage and endotracheal aspirate in COVID-19 patients: COV-AP study

Introduction: Diagnosis of ventilator-associated pneumonia (VAP) in COVID-19 patients remains challenging. Also, the lack of gold standard for microbiological sampling undermines clinical judgement and management. We studied incidences of microbiologically-confirmed VAP comparing endotracheal aspirate (ETA) and bronchoalveolar lavage (BAL) in COVID-19 patients. Etiological agreement between ETA and BAL was then assessed. Method(s): Single-center prospective cohort study (NCT04766983). Patients were enrolled within 48 h from intubation;surveillance ETA ( ETASURV) was performed twice weekly. ETA ( ETACX) and BAL ( BALCX) samples were collected upon VAP suspicion (Johanson's criteria). CDC definitions were used for microbiological confirmation. ETA-BAL agreement (interrater reliability and Cohen's kappa) and clinical/microbiological data were assessed for the first episodes of suspected VAP per patients. Result(s): Ninety intensive care (ICU) patients enrolled from 01/2021 to 05 06/2022, of which 26 females (28.9%);median age was 60 [52-66] years. In-ICU mortality was 30/90 (33.3%), median length of stay in survivors 19 (10-32) days. Fifty-three patients (58.9%) had >= 1 episode of suspected VAP after 6 [5;10] days from ICU admission. ETASURV were available in 52 cases, 2 [1;3] days before VAP suspect, and tested positive in 28 (53.8%). ETACX and BALCX resulted positive in 35 (66.0%) and 29 (54.7%) of episodes. Main microbiological results are displayed in Fig. 1, panel A. Etiological agreement between techniques is shown in Fig. 1, panel B. Incidence rate of VAP suspicions per 1000 ventilator-days was 60.2 (95% CI 43.9-76.4), while incidence rates of microbiologically-confirmed VAP were 27.4 (18.3-36.5) with ETACXand 18.9 (95% CI 12.0-25.8) with BALCX, respectively. Conclusion(s): We observed different incidence of VAP in COVID-19 ICU patients depending on sampling method. Etiological agreement between techniques yielded limited interrater reliability. The potential clinical impact needs further studies.

Cystic fibrosis mental health research priorities: Qualitative content analysis of cystic fibrosis community and provider survey

Background: Mental health is among the top three research priorities of the CF community [1]. In 2020-21, the Cystic Fibrosis Foundation Mental Health Research Prioritization Working Group met to designate areas of focus for CF mental health research [2]. To elicit broad input to inform this work, a mixed-methods study was conducted. In June 2020, a 22-item survey was sent via email and social media to CF health care providers, people with CF, family caregivers, and other CF community members. We aimed to analyze qualitative content to add depth to quantitative findings. Method(s): Three hundred fifty-two providers and 693 community members completed the survey, which included three open-ended questions: Q1) When thinking about research topics specific to mental health, where are the current gaps in knowledge that should be prioritized for future research? Q2) Is there anything else regarding mental health and the needs of the community you would like to share? Q3) Considering the impacts of the COVID-19 pandemic, are there additional mental health topics that are (Figure Presented) Figure 1.: Cystic fibrosis (CF) mental health research priorities of all respondents according to frequency. Overarching top-line categories and general codes for open-ended survey responses of CF health care providers, people with CF, family caregivers, and other CF community members not covered by the survey questions? Reponses containing more than one main idea were subdivided into topic-specific codable items. For Q1 and Q2, a codebook guided hierarchical placement of each item into an overarching top-line category with corresponding general code and, if applicable, one or more specific codes and populations or settings. A simplified process designated only one major theme per item for Q3. Three teams of one CF researcher and two CF community members coded the first 20% of their assigned items by consensus and then worked in pairs to independently double code the remaining 80%. Two-sided t-tests were adjusted with the Bonferroni correction using a significance level of less than 0.1. Result(s): One thousand three hundred ninety-one provider items and 1638 community items were coded for Q1 and Q2, and 565 provider and 323 community items were coded for Q3. Strong inter-rater agreement was obtained across coding dyads (71-90%). For Q1 and Q2, the most common top-line priorities were mental health conditions;living with CF;screening, assessment, and intervention;systems-level barriers and facilitators;and effects of modulators (Figure 1). Strong agreement was found in the ranking of top priorities by community members and providers, although providers were significantly more likely to mention effects of modulators;screening, assessment, and intervention;and substance misuse, and community members were significantly more likely to mention stress and trauma. Respondents also noted concerns captured by a wide range of specific codes (e.g., access to mental health care, role and life changes, family relationships), populations (e.g., children), and settings (e.g., inpatient). For Q3, isolation and anxiety emerged as the top COVID-19 concerns, with isolation more salient forcommunity members and anxiety for providers. Conclusion(s): Qualitative analysis of a large survey of multiple stakeholders provided input on top research priorities for CF mental health. This information facilitated consideration of diverse perspectives to identify gaps and select areas of focus for future researchCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

Student Perspective of Team Dynamics before and after a Disaster Response Course

Purpose of Study We need to understand the COVID-19 pandemic impact on healthcare students. Loma Linda University requires an annual Critical Incident Response Course for graduating students about the importance of interprofessional teamwork in a disaster response. We surveyed students about the pandemic impact on their lives. Methods Used This is a mixed methods multidisciplinary cohort study of healthcare students (n=442). The 2020 course consisted of asynchronous content (eight hours) and a synchronous virtual meeting (two hours) focusing on triage, disaster simulation, and interprofessional teamwork. Students completed a pre/post survey on the COVID-19 pandemic response. We report both descriptive statistics and qualitative results from two independent coders. Summary of Results Respondents included Medicine (n=149), Nursing Undergraduate (n=169), Nursing Graduate (n=16), Pharmacy (n=45), Dentistry (n=58), Other (n=5). Inter-rater reliability for coded answers exceeded, k=0.827 (Cohen's kappa analysis). Students reported observing examples of efficient teamwork (77%) compared to 42% reporting inefficiencies. The most common efficiency was Mutual Support/ Collaboration (50%) and the least reported was Team Structure (6%). Most common inefficiency was communication (41%) and the least was adaptability (4%). Students believed their profession will be different after COVID-19 (76%). The most reported anticipated change was Disaster Preparedness/ Infection control (59%). Post-coursework survey showed 55% reported a stronger understanding of their profession's impact on disaster management. Individuals reported changing behavior during the pandemic (84%). The biggest change was in sleep: 15% reported a decrease and 41% reported an increase, followed by connecting with people (21% decrease, 39% increase). The biggest unmet need was Money (27%). The most helpful resources were Friends/Family (89%) and Social Media (43%). 34% volunteered or worked at an essential workplace. Conclusions Healthcare students reported that communication, mutual support, and understanding one's interprofessional contribution are the core of fighting a pandemic. Healthcare students have unique challenges and resource requirements during a pandemic.

Identification of COVID-19 pneumonia changes on CT scan thorax: Comparison between deep learning module and radiologists' findings

Introduction: During the initial pandemic phase, rapid diagnosis of COVID-19 pneumonia is crucial for disease prevention and management. This study aimed to compare the deep learning (DL) module (AXIAL Skymind version 1.0) and radiologists' findings in detecting COVID-19 pneumonia changes in CT-Thorax. Method(s): A cross-sectional study from March to August 2021. 10 case studies HRCT thorax i.e. 9 studies confirmed COVID-19 pneumonia and a normal study. Patient IDs were removed and labelled by research series number. Data collected from their HRCT reports were standardized including their site and type of lesions (ground glass changes, consolidation and crazy-paving patterns) which were commonly found in COVID-19 pneumonia cases. Inter-observer agreement was measured using Fleiss Kappa (95% confidence interval). The radiologist's findings compared with the results generated by the DL module, Axial Skymind version 1.0. Result(s): A total of 330 CT-scan reports by 33 trained radiologists analysed. We used 70% agreement among radiologists as significant findings. However, the DL module managed to detect and report ground glass changes only and could not identify consolidation and crazy-paving patterns. Comparing the radiologists' findings and DL modules on ground glass changes, the average percentage of agreement for the site was 72.5%, ranging from 0-100%. The severity of the ground glass changes was not detected by DL modules. Conclusion(s): There was significant differences between DL modules and radiologists' findings on HRCT Thorax of COVID-19 pneumonia. The DL module needs to be strengthened and improve its accuracy and reliability before the potential use in clinical practice.

Modelling the Long-Term Expected Impact of the Covid-19 Crisis on Commute and Telecommute

The Covid-19 pandemic crisis has forced many people to work from home rather than at their regular workplace. This paper explores the expected long-term changes caused by the pandemic crisis in Israel on work-related travel patterns, that is, the shifts in commuting and telecommuting post- versus pre-pandemic. Methodologically, the analysis is based on two consecutive surveys (of the same respondents) that were distributed during the pandemic (April and June 2020) to evaluate the trends in commuting and telecommuting from pre- to post-pandemic, addressing revealed preferences on work habits before and during the pandemic and stated intentions about work patterns after the pandemic. Four models were estimated based on these data: two multinomial logit models analyzing the trends in commuting and teleworking from before to after the pandemic, and two ordered logit models addressing the frequency of the intended teleworking and commuting trips in the post-pandemic era. The results showed that the Covid-19 crisis is expected to have some long-term implications, specifically, based on our sample, a 5%-6% expected reduction in commuting trips, alongside an expected increase in teleworking. While several socio-demographic, work-related, and personality traits were found to significantly influence commuting/telecommuting trends and frequency, it is interesting to note that working solely from home during the lockdown was found to have a prominent impact on increasing teleworking while decreasing commuting. Quantitative consistency evaluation of behavioral-shift statements across the consecutive surveys revealed moderate consistency, which is very reasonable given the instability associated with the Covid-19 crisis and the inherent changes in human perceptions.

A Quantitative Study to Examine the Comprehensiveness of Palliative Care Consultations During COVID-19 (Sch406)

Outcomes: 1. Evaluate the comprehensiveness of palliative care consultations in different clinical settings and time periods quantitatively by utilizing national consensus project guidelines. 2. Analyze patient sociodemographic and administrative data and palliative care consultation charts to infer variables that predict the comprehensiveness of consultations. Background(s): COVID-19 has caused unprecedented suffering, strained healthcare systems, and jeopardized the well-being of healthcare providers. Few studies exist to characterize how inpatient specialist palliative care (PC) teams managed an increase in demand for consultations while maintaining the quality of their service. Objective(s): This quantitative study aims to: (1) examine the comprehensiveness of inpatient PC consultations conducted from 2019 through 2022 at a tertiary academic hospital in Toronto, Canada, and (2) assess the predictors of comprehensiveness of PC consultations. Method(s): We are conducting a retrospective cohort study examining a 33% random sample of inpatient palliative care consultation notes (n=600) completed for adult (>18 years old) inpatients at Mount Sinai Hospital between January 1, 2019, and July 1, 2022. Our definition of comprehensiveness is informed by a recent publication addressing necessary clinical domains (eg, performing a spiritual history, code status discussion) in a palliative care assessment. We will code each inpatient palliative care consult note for the completion of individual clinical domains using template analysis. We will dual code a random selection of 10% of the transcripts to evaluate interrater reliability. Informed by Andersen's behavioral model for health services utilization, we will sociodemographic (age, gender, rurality, English language proficiency) and clinical pathophysiological variables (primary diagnosis, referral service, reason for referral, disposition, etc.) from the consult notes and linked administrative data. We will calculate frequencies and distributions of all study variables and use multiple linear regressions to examine predictors of comprehensiveness of PC consultations. Conclusion(s): This study will provide novel data on the clinical work completed by inpatient palliative care clinicians during the COVID-19 pandemic. The data will offer critical insights into how palliative care clinicians prioritize clinical domains during initial assessments of inpatients with varying sociodemographic and clinical backgrounds.Copyright © 2023

Using urgent small bowel ultrasound (SBUS) as a tool for decision-making in patients with inflammatory bowel disease (IBD): Retrospective analysis of United Kingdom (UK) patients' outcome

Background: In the UK, magnetic resonance enterography (MRE) and colonoscopy are the gold standard assessment for mucosal disease activity in IBD. Both techniques require bowel preparation, may be poorly tolerated and are often subject to delay due to capacity issues. In several European centres, ultrasound is used as an alternative tool for disease activity monitoring and clinical decision-making. Recent studies confirm excellent sensitivity, specificity, correlation with MRE / colonoscopy and robust inter-observer agreement. In the UK, a lack of US training in IBD physicians has hindered development of accessible SBUS. In view of issues with MRI capacity during the covid pandemic, a dedicated small bowel ultrasound list with a gastroenterology fellow and a specialist radiology consultant for urgent IBD patients was initiated. Method(s): Records of IBD patients undergoing SBUS between June 2022 and November 2022 were reviewed. SBUS assessed disease activity (vascularity, bowel wall thickness, mesenteric fat and lymphnodes), length of disease, presence of obstruction or fistulating disease. Patients were then retrospectively asked to rate their SBUS experience compared to previous MREs. Result(s): 53 SBUS's (46 (86.7%) CD;2 (3.7%) UC) were performed on a dedicated SBUS list by a gastroenterology fellow and specialist radiology consultant during the study. In 29 patients (54.7%), the area of interest was the terminal ileum. SBUS detected disease complications in 7 (2 (3.7%) patients with obstructive disease, and 5 (9.4%)) patients with penetrating disease. The average waiting time from the point of referral to SBUS was 4.7 weeks, compared to an average waiting time for MRE of 20 weeks. Treatment response was assessed in 18 patients (33.9%). We were able to make treatment decisions with 32 patients (60.3%) based on their SBUS results without further assessment. In 10 patients (18.8%), SBUS was used to confirm a diagnosis in addition to colonoscopy. 18/22 ( 81%) patients reported a preference for SBUS compared to MRE (preference score of 4.5 on scale of 1-5). Conclusion(s): We developed an urgent SBUS service to aid timely clinical decision-making for IBD patients. In our practice, SBUS is an accurate tool to assess disease activity, significantly reduces patients waiting times and is the patient's preferred investigation. There is a clear unmet need to train IBD doctors and radiologists in SBUS.

A Competing Stimuli Intervention Package to Treat Automatically Reinforced Destructive Behavior

Behaviors maintained by automatic reinforcement are often more difficult to treat due to difficulty with identifying the relevant maintaining variable(s). One common intervention to treat automatically maintained behavior includes competing stimuli. Competing stimuli promote item engagement which may replace challenging behavior (i.e., response competition). Competing stimuli have shown to be a widely successful intervention across diverse topographies of challenging behavior;however, few studies have evaluated the use of competing stimuli on destructive behavior. The purpose of the current study was to treat automatically maintained destructive behavior with a competing stimuli intervention package for an adolescent with developmental disabilities. Results showed a decrease in destructive behavior when access to competing stimuli was a component of an intervention package in a clinic setting. Also, preliminary data are provided showing treatment effects when caregivers implemented the intervention. Due to the complexity of the final intervention package, recommendations for clinicians are provided which focus on improving feasibility, practicality, and sustainability of treatment components.Copyright © The Author(s) 2022.

A study of validity and usability evidence for non-technical skills assessment tools in simulated adult resuscitation scenarios.

BACKGROUND: Non-technical skills (NTS) assessment tools are widely used to provide formative and summative assessment for healthcare professionals and there are now many of them. This study has examined three different tools designed for similar settings and gathered evidence to test their validity and usability. METHODS: Three NTS assessment tools designed for use in the UK were used by three experienced faculty to review standardized videos of simulated cardiac arrest scenarios: ANTS (Anesthetists' Non-Technical Skills), Oxford NOTECHS (Oxford NOn-TECHnical Skills) and OSCAR (Observational Skill based Clinical Assessment tool for Resuscitation). Internal consistency, interrater reliability and quantitative and qualitative analysis of usability were analyzed for each tool. RESULTS: Internal consistency and interrater reliability (IRR) varied considerably for the three tools across NTS categories and elements. Intraclass correlation scores of three expert raters ranged from poor (task management in ANTS [0.26] and situation awareness (SA) in Oxford NOTECHS [0.34]) to very good (problem solving in Oxford NOTECHS [0.81] and cooperation [0.84] and SA [0.87] in OSCAR). Furthermore, different statistical tests of IRR produced different results for each tool. Quantitative and qualitative examination of usability also revealed challenges in using each tool. CONCLUSIONS: The lack of standardization of NTS assessment tools and training in their use is unhelpful for healthcare educators and students. Educators require ongoing support in the use of NTS assessment tools for the evaluation of individual healthcare professionals or healthcare teams. Summative or high-stakes examinations using NTS assessment tools should be undertaken with at least two assessors to provide consensus scoring. In light of the renewed focus on simulation as an educational tool to support and enhance training recovery in the aftermath of COVID-19, it is even more important that assessment of these vital skills is standardized, simplified and supported with adequate training.

Novel Methods for Leveraging Large Cohort Studies for Qualitative and Mixed-Methods Research.

Qualitative research methods, while rising in popularity, are still a relatively underutilized tool in public health research. Usually reserved for small samples, qualitative research techniques have the potential to enhance insights gained from large questionnaires and cohort studies, both deepening the interpretation of quantitative data and generating novel hypotheses that might otherwise be missed by standard approaches; this is especially true where exposures and outcomes are new, understudied, or rapidly changing, as in a pandemic. However, methods for the conduct of qualitative research within large samples are underdeveloped. Here, we describe a novel method of applying qualitative research methods to free-text comments collected in a large epidemiologic questionnaire. Specifically, this method includes: 1) a hierarchical system of coding through content analysis; 2) a qualitative data management application; and 3) an adaptation of Cohen's κ and percent agreement statistics for use by a team of coders, applying multiple codes per record from a large codebook. The methods outlined in this paper may help direct future applications of qualitative and mixed methods within large cohort studies.

Software Tools For Systematic Literature Review In Medicine: A Review And Feature Analysis

Introduction. Systematic reviews (SRs) are central to evaluating therapies but have high costs in time and money. Many software tools exist to assist with SRs, but most tools do not support the full process, and transparency and replicability of SR depends on performing and presenting evidence according to established best practices. In order to provide a basis for comparing between software tools that support SR, we performed a feature-by-feature comparison of SR tools. Methods. We searched for SR tools by reviewing any such tool listed the Systematic Review Toolbox, previous reviews of SR tools, and qualitative Google searching. We included all SR tools that were currently functional, and required no coding and excluded reference managers, desktop applications, and statistical software. The list of features to assess was populated by combining all features assessed in four previous reviews of SR tools;we also added five features (manual addition, screening automation, dual extraction, living review, and public outputs) that were independently noted as best practices or enhancements of transparency/replicability. Then, two reviewers assigned binary 'present/absent' assessments to all SR tools with respect to all features, and a third reviewer adjudicated all disagreements. Results. Of 53 SR tools found, 29 were excluded, leaving 24 for assessment. Thirty features were assessed across six classes, and the inter-observer agreement was 86 percent. DistillerSR (Evidence Partners;n = 26/30, 87%), Nested Knowledge (Nested Knowledge;n = 25/30, 83%), and EPPI-Reviewer Web (EPPI-Centre;n = 24/30, 80%) support the most features followed by Giotto Compliance (Giotto Compliance;n = 23/30, 77%), LitStream (ICF;n = 22/30, 73%), and SRDB.PRO (VTS Software;n = 21/30, 70%). Seven tools support fewer than half of all features assessed: RobotAnalyst, SyRF, Data ion Assistant, SWIFT-Review, SR-Accelerator, RobotReviewer, and COVID-NMA. Notably, only 10 tools (42%) support direct search, 7 (29%) offer dual extraction, and 13 (54%) offer living/ updatable reviews. Conclusions. DistillerSR, EPPI-Reviewer Web, and Nested Knowledge each offer a high density of SR-focused web-based tools. By transparent comparison and discussion regarding SR tool functionality, the medical community can choose among existing software offerings and note the areas of growth needed, most notably in the support of living reviews.

Transforming Transitions: Developing Cultural Competence in Supporting Caregivers of Children and Youth Growing up with Autism Spectrum Disorder

BACKGROUND: Transition to adulthood is a stressful time for caregivers of children and youth with Autism Spectrum Disorder (ASD). Anecdotally, we know that cultural perspectives can directly influence decisions made around ASD diagnosis, treatment, and transition to adulthood. However, there is a paucity of research into these cultural perspectives and how they may affect illness trajectories. OBJECTIVE(S): 1.Through open-ended responses, identify cultural values that play a role in decision making around health care and life course planning during transition to adulthood in ASD. 2.Identify criteria for success in adulthood from parents of children and youth with ASD in a culturally diverse population. 3.Identify systemic barriers that prevent families from accessing culturally sensitive care 4.Educate health care workers on any unique cultural perspective that may impact transition planning. DESIGN/METHODS: In-depth interviews (IDIs) were conducted with caregivers (i.e., parents/guardians) of children and youth with autism. Interviews were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders, with inter-rater reliability confirmed by Cohen's kappa coefficient. RESULT(S): A total of 12 IDIs were conducted. The main themes that were discussed included caregivers' understanding of adulthood for their child with ASD, barriers to accessing services, the importance of culture and religion/spirituality to their child's future, recommendations to improve current services and programming and the impact of the COVID-19 pandemic on decision-making. Caregivers expressed their desire for their child to be independent as they transition to adulthood. They also described how cultural or religious/spiritual practices are integrated into their child's life and the importance of maintaining their cultural identity. Caregivers emphasized the lack of culturally tailored resources as their child transitions to adulthood to maintain that sense of community. CONCLUSION(S): Caregivers' cultural perspectives are an integral part of their identity and an important aspect of their environment that should be taken into consideration as children and youth with ASD transition to adulthood.

CT severity score in COVID-19 patients, assessment of performance in triage and outcome prediction: a comparative study of different methods

Background: Lung involvement in COVID-19 can be quantified by chest CT scan with some triage and prognostication value. Optimizing initial triage of patients could help decrease adverse health impacts of the disease through better clinical management. At least 6 CT severity score (CTSS) systems have been proposed. We aimed to evaluate triage and prognostication performance of seven different CTSSs, including one proposed by ourselves, in hospitalized COVID-19 patients diagnosed by positive polymerase chain reaction (PCR). Result(s): After exclusion of 14 heart failure and significant preexisting pulmonary disease patients, 96 COVID-19, PCR-positive patients were included into our retrospective study, admitted from February 20, 2020, to July 22. Their mean age was 63.6 +/- 17.4 years (range 21-88, median 67). Fifty-seven (59.4%) were men, and 39 (40.6%) were women. All CTSSs showed good interrater reliability as calculated intraclass correlation coefficients (ICCs) between two radiologists were 0.764-0.837. Those CTSSs with more numerous segmentations showed the best ICCs. As judged by area under curve (AUC) for each receiver operator characteristic (ROC) curve, only three CTSSs showed acceptable AUCs (AUC = 0.7) for triage of severe/critical patients. All CTSSs showed acceptable AUCs for prognostication (AUCs = 0.76-0.79). Calculated AUCs for different CTSSs were not significantly different for triage and for prediction of severe/critical disease, but some difference was shown for prediction of critical disease. Conclusion(s): Men are probably affected more frequently than women by COVID-19. Quantification of lung disease in COVID-19 is a readily available and easy tool to be used in triage and prognostication, but we do not advocate its use in heart failure or chronic respiratory disease patients. The scoring systems with more numerous segmentations are recommended if any future imaging for comparison is contemplated. CTSS performance in triage was much lower than earlier reports, and only three CTSSs showed acceptable AUCs in this regard. CTSS performed better for prognostic purposes than for triage as all 7 CTSSs showed acceptable AUCs in both types of prognostic ROC curves. There is not much difference among performance of different CTSSs. Copyright © 2022, The Author(s).

A novel machine learning-based video classification approach to detect pneumonia in COVID-19 patients using lung ultrasound

Context: Efficiently diagnosing COVID-19-related pneumonia is of high clinical relevance. Point-of-care ultrasound allows detecting lung conditions via patterns of artifacts, such as clustered B-lines. Aims: The aim is to classify lung ultrasound videos into three categories: Normal (containing A-lines), interstitial abnormalities (B-lines), and confluent abnormalities (pleural effusion/consolidations) using a semi-automated approach. Settings and Design: This was a prospective observational study using 1530 videos in 300 patients presenting with clinical suspicion of COVID-19 pneumonia, where the data were collected and labeled by human experts versus machine learning. Subjects and Methods: Experts labeled each of the videos into one of the three categories. The labels were used to train a neural network to automatically perform the same classification. The proposed neural network uses a unique two-stream approach, one based on raw red-green-blue channel (RGB) input and the other consisting of velocity information. In this manner, both spatial and temporal ultrasound features can be captured. Statistical Analysis Used: A 5-fold cross-validation approach was utilized for the evaluation. Cohen's kappa and Gwet's AC1 metrics are calculated to measure the agreement with the human rater for the three categories. Cases are also divided into interstitial abnormalities (B-lines) and other (A-lines and confluent abnormalities) and precision-recall and receiver operating curve curves created. Results: This study demonstrated robustness in determining interstitial abnormalities, with a high F1 score of 0.86. For the human rater agreement for interstitial abnormalities versus the rest, the proposed method obtained a Gwet's AC1 metric of 0.88. Conclusions: The study demonstrates the use of a deep learning approach to classify artifacts contained in lung ultrasound videos in a robust manner.

Inter-Rater Reliability of a Novel Objective Outcome Measure for the Study of Benign Central Airway Stenosis: Segmentation-Based Volume Rendering of Ct Scans

SESSION TITLE: Technological Innovations in Imaging SESSION TYPE: Original Investigations PRESENTED ON: 10/17/22 1:30 PM - 2:30 PM PURPOSE: Central airway stenosis (CAS) is an important cause of pulmonary morbidity and mortality. Current grading and classification systems include subjective qualitative components, with limited data on reproducibility. We propose a novel radiographic segmentation approach to more objectively quantify CAS. Inter-rater reliability of this novel outcome, which is used in an ongoing randomized controlled trial (NCT04996173), has not been previously assessed. METHOD(S): Computed tomography (CT) scans demonstrating tracheal stenoses were identified in the Vanderbilt University Medical Center Benign Tracheal Stenosis registry. CTs were analyzed in OsiriX (Geneva, Switzerland) after upload via a secured cloud transfer service. Four independent readers with variable experience in CT interpretation were chosen (one chest radiologist, one pulmonary fellow, two internal medicine residents). Readers identified the point of nadir airway lumen, measured 1.5 cm above and below that point, then manually segmented visible tracheal lumen area on the soft tissue window of each axial CT slice within that 3 cm length. Missing ROI's were then generated in-between manual segmented areas. The Repulsor function was used to manually adjust the boundaries of the ROI to achieve fit. Intraclass correlation (ICC) was used to calculate the inter-rater reliability of the tracheal lumen volume of between readers. Other data collection variables included the type of CT scan, axial slice interval, the suspected underlying cause of CAS, and average stenotic volume. RESULT(S): Fifty CT scans from 38 individual patients identified in the registry from 2011-2021 were randomly chosen for inclusion. Most (22 of 38, 57.9%) had iatrogenic BCAS (either post-intubation or post-tracheostomy) and 10 (26.3%) had idiopathic subglottic stenosis. Half of the scans (n=25, 50%) were contrasted neck CT and half were non contrasted chest CTs. Scan slice thickness ranged 1 to 5 mm, median 2 mm (1.25-2.875). The median stenotic volume across all readers was 3.375 cm3 (2.52-4.51). The average ICC across all four readers was 0.969 (95% CI 0.944 - 0.982). CONCLUSION(S): Our proposed volume rendering and segmentation approach to BCAS proves to have substantial precision and agreement amongst readers of different skill levels. CLINICAL IMPLICATIONS: A NOVEL METHOD TO ASSESS SEVERITY OF BENIGN CENTRAL AIRWAY STENOSIS DISCLOSURES: No relevant relationships by Leah Brown No relevant relationships by Alexander Gelbard no disclosure on file for Robert Lentz;PI ofan investigator-initiated study relationship with Medtronic Please note: >$100000 by Fabien Maldonado, value=Grant/Research Support PI on investigator-initiated relationship with Erbe Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Consulting relationship with Medtronic Please note: $5001 - $20000 by Fabien Maldonado, value=Honoraria co-I industry-sponsored trial relationship with Lung Therapeutics Please note: $5001 - $20000 by Fabien Maldonado, value=Grant/Research Support Board of director member relationship with AABIP Please note: $1-$1000 by Fabien Maldonado, value=Travel No relevant relationships by Khushbu Patel No relevant relationships by Ankush Ratwani Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee No relevant relationships by Evan Schwartz Copyright © 2022 American College of Chest Physicians

Impact of COVID-19 on Infants Followed After Discharge from the Neonatal Intensive Care Unit via a Telemedicine Model

Background: While the prevalence of SARS-CoV-2 has remained low among newborns, there is increasing evidence that the COVID-19 pandemic impacted healthcare for families with infants in the neonatal intensive care unit (NICU). However, little is known about the impact of COVID-19 on families with infants discharged from the NICU. During the initial pandemic shutdown, our Neonatal Follow-Up Program (NFP) transitioned to a virtual platform and implemented a survey about new/worsened obstacles families might be facing due to the pandemic as standard of care. We aimed to: 1) evaluate for patient-level differences in virtual neonatal follow-up visit rates;and 2) characterize the social impact of the pandemic on families followed via a large, urban NFP. Methods: All infants scheduled for NFP visits during our telemedicine epoch (March 13, 2020- July 31, 2020) were eligible for inclusion. We compared the family demographics and medical history of infants whose televisits occurred to those for whom televisits did not occur as scheduled. Secondly, we conducted a descriptive analysis of caregiver responses to the pandemic-specific challenges survey. Given the known disproportionate impact of SARS-CoV-2 on communities of color, we also assessed for differences in responses by self-identified race. Data was manually extracted by three coders from the electronic medical record who showed high interrater agreement. Results: After excluding visits cancelled by the provider team, we found 499 clinic encounters for 678 scheduled visits during the study period (i.e. a show-rate of 73.6%). When comparing patients who completed their virtual visit to those who did not, we found no differences in infants' sex, birthweight or gestational age at birth, nor in their reliance on medical technology at discharge. (Table 1). There were also no differences by caregiver self-reported race/ethnicity, but infants whose visits did not occur were more often covered by public insurance. (Table 1). In addition, 43.9% of caregivers reported that their employment had changed since the onset of the shutdown and 6.1% reported housing changes. (Table 2). Eight percent of families endorsed having trouble accessing at least one basic infant necessity (i.e. formula, diapers or medical supplies) due to cost issues and 10% of families endorsed having trouble accessing such necessities due to availability. Non-Hispanic Black caregivers reported this challenge and other infant food-related challenges more often than non-Hispanic White caregivers. Conclusion: We found socioeconomic disparities with respect to virtual follow-up visit rates after discharge from the NICU during the initial COVID-19 shutdown. In addition to navigating the discharge of their infant, families also reported pandemic-enhanced stressors related to difficulty accessing basic infant needs as well as employment and housing changes. Our study highlights the importance of proactive strategies to screen for and mitigate the unique economic vulnerabilities of families discharged from the NICU even beyond the pandemic. (Table Presented).

Reliability of remote gait and balance assessment of people with Parkinson's disease

Parkinson's disease is a movement disorder that increases fall risk. Clinicians administer several validated gait and balance tests for people with Parkinson's disease in person. COVID-19 has reduced healthcare access, and this has disproportionately affected older populations. We tested the reliability of remote gait and balance assessments of people with Parkinson's disease using face-to-face as the comparator. Fifteen people with Parkinson's disease (aged 57-82, 11 males) performed 14 tests of gait and balance twice: (i) face-to-face, and (ii) remotely, via videoconference between 7 and 14 days after. A trained physiotherapist rated participant performance. The tests included items from the Berg Balance Scale, Functional Gait Assessment, and the Timed-Up- And-Go. These assessments have been validated face-to-face for people with Parkinson's disease. The videoconference assessment was recorded. We compared face-to-face and live videoconference performance to obtain assessment reliability. The physiotherapist rated the recording at least two weeks after the live videoconference to obtain intrarater reliability. A second rater assessed the recording, and we compared live and recorded telehealth assessments to obtain inter-rater reliability. Reliabil ity was measured using either intraclass correlation (ICC) two-way mixed with absolute agreement (continuous measures) or Fleiss multi-rater Kappa test (ordinal measures). Most tests showed moderate to very good assessment reliability between face-to-face and live telehealth (ICC=0.5-1), between face-to-face and recorded telehealth (ICC=0.5-1) and good to very good inter-rater reliability between the recorded telehealth assessments (ICC=0.63-1). Reliability appeared to be higher in tests involving quantitative, rather than qualitative, measures of performance. A ceiling effect was noted in some tests where all participants completed tests with maximum scores in both face-to-face and remote assessments. This study supports the feasibility of remote assessment in clinical practice for people with Parkinson's disease. Further research with a larger cohort and adjustment of the assessments to avoid ceiling effects is necessary.

The effect of a training webinar on decreasing inter-observer variability in making a radiologic diagnosis of bronchiectasis.

Non-cystic fibrosis bronchiectasis is a clinically important disease with an estimated 340,000-522,000 persons living with the disease and 70,000 being diagnosed annually. The radiographic diagnosis remains a pivotal part of recognizing the disease due to its protean clinical manifestations. As physicians are sensitized to this disease, a greater proportion of patients are being diagnosed with mild to moderate bronchiectasis. Despite the established use of CT chest as the main tool for making a radiologic diagnosis of bronchiectasis, the literature supporting the process of making that diagnosis is somewhat sparse. Concurrently, there has been an increased trend to have Web-based radiologic tutorials due to its convenience, the ability of the learner to set the pace of learning and the reduced cost compared to in-person learning. The COVID-19 pandemic has accelerated this trend. We wanted to look carefully at the effect of a Web-based training session on interrater reliability. Agreement was calculated as percentages and kappa and prevalence adjusted kappa calculated. We found that a single Web-based training session had little effect on the variability and accuracy of diagnosis of bronchiectasis. Larger studies are needed in this area with multiple training sessions.

A retrospective observational study of the effects of Kaftrio® on the current cohort of patients at Nottingham University Hospitals NUH trust

Background: Due to disease progression, people with cystic fibrosis (PwCF) were expected to lose 1–2% of the FEV1% predicted per year along with decreased exercise tolerance, malabsorption and weight loss. Research into the development of CFTR modulators has dominated PwCF research, and in 2020, NHSE agreed to a deal which made approximately 80% of PwCF eligible for Triple Modulator Therapy (Kaftrio®). The combination of the elexacaftor/tezacaftor/ivacaftor has shown improvements in the structure and function of the NaCl channels. PwCF reported improvements in: energy, strength, breathing, sputum production, diabetes control, BMI and lung function (Edgeworth 2017).Wewere therefore interested to observe the effects of Kaftrio® on our patient group at Nottingham University Hospitals Trust (NUH) Objectives: To observe the physiological effects of Kaftrio® in regard to weight, FEV1, grip strength and 6MWT in adult PwCF at NUH Methods: A retrospective observation of 99 eligible patients who attended the NUH (Sept 20-March 21) was undertaken on initiation of on-license Kaftrio®. Patients were seen on initiation and after 3 months. Data was collected as part of their routine MDTAnnual Assessment process (Weight, FEV1, grip strength and 6MWT). Results: Of the 99 patients (aged 18–50) we observed, weight +4.14% (n = 55), FEV1 +22.5% (n = 42), grip strength − 0.48% (n = 41) and 6MWT +1.14% (n = 36). Limitations: Patient dissent to assessments, interrater reliability, variability in spirometry device, COVID-19 pandemic restrictions and side effects resulting in termination of Kaftrio®. Conclusions: Overall improvement occurred in all areas except for grip strength. It is encouraging to see a general improvement within our cohort of patients which reflects changes aligned with international research. However, the reduction in chest symptom burden does pose the question of the nature of thephysiotherapy involvement in cystic fibrosis for thefuture.

Inter-Rater Reliability and Agreement of Fetal Echocardiography Measurements Among Investigators From Multiple Sites

Background: Single institutions specialising in fetal cardiology often have too few cases to develop robust prognostic indicators for specific conditions. The Australia and New Zealand (ANZ) Fetal Cardiology Working Group instigated a multicentre study to examine fetal risk factors for early postnatal intervention in Tetralogy of Fallot (ToF). Centralised data analysis was not possible due to COVID-19 travel restrictions and ethical constraints related to sharing of retrospectively acquired images. A study of inter-observer agreement of standardised in utero cardiac measurements was undertaken to assess the feasibility of combining data from multiple centres. Methods: Ten fetuses with ToF were randomly identified. Deidentified images were distributed securely to ten ANZ fetal cardiologists. The pulmonary valve (PV) annulus, main pulmonary artery (MPA), branch pulmonary arteries (BPA), aortic valve (AV) annulus, ascending aorta (AA), and ductus arteriosus (DA) were measured in triplicate following a defined protocol. Inter-rater reliability was assessed using a two-way random effects model to calculate the intra-class coefficient (ICC). Results: Measurements were available for seven ANZ fetal cardiologists. There was moderate inter-observer agreement for PV (ICC 0.74, 95% CI 0.49–0.91) and AV (0.71, 95% CI 0.48–0.90), and good agreement for MPA (0.81, 95% CI 0.62–0.94) and AA (0.91, 95% CI 0.80–0.97). Inadequate data were available for BPA and DA analysis. Multi-variate analysis found no patient or investigator factors that influenced measurement variability. Conclusion: Fetal cardiac structures can be measured using a defined measurement protocol by multiple investigators with at least moderate agreement. Analysis of large datasets by multiple investigators is a reasonable alternative to centralised data analysis.