ID: 218414 Queen Mary University London Postgraduate Certification in Neuromodulation- Accreditation in Neuromodulation

Introduction: There is a distinct unmet need in structured, curriculum based, unbiased education in neuromodulation. Current teaching is through sporadic industry workshops, cadaver courses and peer proctorship. The COVID pandemic has created a unique opportunity where online platforms have enabled education to be delivered remotely in both synchronous and asynchronously. The William Harvey Research Institute, Queen Mary University, London, UK have initiated University based accreditation- Post Graduate Certificate in neuromodulation (PGCert) that provides candidate a qualification in one academic year through part-time study. Method(s): The program underwent rigorous staged university approval process (figure 1). To ensure market feasibility, two short proof of concept CPD programs "Executive Education in Neuromodulation (EEPIN)" were delivered in 2021. These courses attracted 87 candidates across Australia, Singapore, India, Germany, Poland, Czech Republic, Ireland, and UK. The faculty includes key opinion leaders that will deliver the program ensuring the candidates gain academic background and specialist skills to understand safe practice of neuromodulation. The PGCert advisory board has been established to ensure strict governance in terms of content and unbiased delivery confirming ACCME guidance. In order to obtain PGCert, candidates are required to complete 4 x 15 credit modules (60 credits). The four modules include Anatomy & Neurophysiology;Patient care and Procedurals skills;Devices and available technology;Intrathecal drug delivery for cancer and non-cancer pain. The modular nature of the program is designed to provide cumulative knowledge, from basic science to clinical application in line with the best available evidence. The modules comprise nine lectures, spreading over three consecutive days, followed by a written assignment with 40 direct contact hours in each module. The webpage can be accessed at Results: The anonymous data from EEPIN reported on Likert scale 1-5: Objectives defined 30.6% - 4 and 69.4% -5;Relevance of topics 10.2%- 4 and 89.8% -5;Content of presentations 22.4%- 4 and 77.6% -5;Organization 24.5% -4 and 69.4% -5;Candidate faculty interaction 14.3% -4 and 81.6% -5. 97% of the EEPIN candidates recommended the program to others whilst 81.8% expressed their strong interest to enroll for university-based post graduate qualification if offered. Conclusion(s): This PGcert Neuromodulation is a unique, university accredited program that provides qualification in neuromodulation with access to a flexible online e-learning platform to discuss and exchange ideas, share knowledge in candidate's own time. This will support the ongoing need for formal curriculum-based education in neuromodulation. Disclosure: Kavita Poply, PHD: None, Phillippe Rigoard: None, Jan Kallewaard, MD/PhD: None, FRANK J.P.M. HUYGEN, MD PhD: ABBOTT: Speakers Bureau:, Saluda: Consulting Fee:, Boston Scientific: Consulting Fee:, Grunenthal: Speakers Bureau:, Pfizer: Speakers Bureau:, Ashish Gulve, FRCA, FFPMRCA, FFPMCAI, DPMed, FCARCSI, MD, MBBS: None, Ganesan Baranidharan, FRCA: None, Sam ELDABE, MD, FRCA, FFPMRCA: Medtronic: Consulting Fee:, Medtronic: Contracted Research:, Mainstay Medical: Consulting Fee:, Saluda Medical: Consulting Fee:, Boston Scientific: Contracted Research:, Saluda Medical: Contracted Research:, James Fitzgerald, MA,PhD: St Jude Medical: Consultant: Self, Medtronic: Consulting Fee:, UCB: Contracted Research:, Merck: Contracted Research:, Serge Nikolic, MD: None, Stana Bojanic, BSc MBBS FRCS (SN): Abbott: Contracted Research:, Habib Ellamushi: None, Paresh Doshi, MS MCh: None, Preeti Doshi, MBBS, MD, FRCA: None, Babita Ghai, MBBS, MD, DNB: None, Marc Russo, MD: Presidio Medical: Ownership Interest:, Saluda Medical: Ownership Interest:, Boston Scientific: Contracted Research: Self, Mainstay Medical: Contracted Research: Self, Medtronic: Contracted Research: Self, Nevro: Contracted Research: Self, Saluda Medical: Contracted Research: Self, Presidio Medical: Contracted Research: Self, Freedom Ne ro: Ownership Interest - Own Stocks: Self, Lungpacer: Ownership Interest - Own Stocks: Self, SPR Therapeutics: Ownership Interest - Own Stocks: Self, Lawrence Poree, MD,MPH,PHD: Medtronic: Consulting Fee: Self, Saluda Medical: Contracted Research: Family, Nalu Medical: Contracted Research: Family, Gimer Medical: Consulting Fee: Self, Nalu Medical: Consulting Fee: Self, Saluda Medical: Consulting Fee: Self, Nalu: Ownership Interest:, Saluda Inc: Ownership Interest:, Alia Ahmad: None, Alaa Abd Sayed, MD: Medtronic, Abbott, SPR and StimWave: Consulting Fee:, Salim Hayek, MD,PhD: None, CHRISTOPHER GILLIGAN, MD MBA: Persica: Consulting Fee: Self, Saluda: Consulting Fee: Self, Mainstay Medical: Contracted Research: Self, Sollis Therapeutics: Contracted Research: Self, Iliad Lifesciences, LLC: Owner: individuals with legal ownership in a company:, Vivek Mehta: NoneCopyright © 2023

A descriptive study of older medical cannabis users in medical cannabis clinics

Introduction: There is a dearth of information on older users (65+ years) of medical cannabis, who may face unique challenges due to altered metabolism with aging, concurrent medication use, and risk of adverse effects. This observational study aimed to describe a large cohort of older medical cannabis users in Canada. Method(s): From Oct 2014 to Oct 2020, a commercial medical cannabis provider based in Canada collected anonymized data for research purposes from patient volunteers. Data included demographic, social, and health details (at intake) and cannabis products, self-perceived changes in symptoms and change in medications (at follow-up, variable duration). Cannabis products were categorized as cannabidiol (CBD) only, tetrahydocannabinol (THC) only or mixed CBD/THC. Of the mixed, formulations could be in 1:1 ratios (CBD+/THC+), predominantly CBD (CBD+/THC-) or predominantly THC (CBD-/THC+). Result(s): In total, 9766 subjects in the older cohort (65+ years old) completed the entire questionnaire (mean age (SD) = 73.6 (6.8) y, 60% female). They represented 23.1% of the total dataset (N = 42,267, mean (SD) =51.5 (16.8) y). The proportion of adults in the older cohort tended to increase over time (pre-2018: 17.6%;2018: 26.7%;2019: 31.2%;2020: 22.7%, when the overall intake decreased from 8869 to 5644). Among the older cohort, 15.5% were previous cannabis users and 67.7% were referred for chronic pain (mainly arthritis, chronic pain, lower back pain). Concomitant analgesic use was common (over-the-counter analgesics: 44.5%;opioids: 28.3%;NSAIDs: 24.5%). 7.9% of the sample (compared to 19.9% in the whole sample) were referred for psychiatric disorders, though 21.4% indicated antidepressant use and 12.3% indicated benzodiazepine use. Another 7% were referred for neurological disorders. Follow-up data were captured in visits (11,992) from 4698 older patients, averaging 2.5 visits per patient. The type of medical cannabis used changed over time, with increasing use of cannabis oil compared to herbal cannabis. In 2020, of 2478 visits, 78.9% use was cannabis oil and 6.7% was herbal forms (pre-2018: 57.6% vs 36.2%). The composition of cannabis oil demonstrated a preference for cannabinoid oil (CBD+) over tetrahydrocannabinol (THC+) in 6043 visits: 45.2% were using CBD+ preparations, only 3.2% were using THC+ preparations, and for CBD/THC combinations, CBD predominated (CBD+/THC-: 30.5%;CBD+/THC+: 16.8%;CBD-/THC+: 4.3%). Adverse-effects (7062 visits) included dry mouth (15.8%), drowsiness (8.6%), dizziness (4%) and hallucinations (0.6%). Patients reported improved pain, sleep and mood over time, though 15-20% reported no improvement or worsening. Medication use was mostly unchanged, though 40% of opioid users reported requiring reduced dosages. Conclusion(s): These data were drawn from a large convenience sample. The data suggest an increasing proportion of older users of medical cannabis, though COVID-19 may have affected recent use. Female users comprised a higher proportion, and cannabis oil containing CBD was preferred. Systematic studies of effectiveness and safety in older users of cannabinoids are needed given its increasing use. Funding(s): No funding was received for this work.Copyright © 2021

Big data approach on the impact of COVID-19 lockdown on pediatric neurosurgery

Objective: COVID-19 lockdowns in 2020 limited activities of daily life. Data on the impact on healthcare systems is ambiguous. So far no data has been published for pediatric neurosurgery in Germany. We present the results of a big data approach. Method(s): We obtained anonymous data from the nationwide database of hospital statistics (German Federal Statistical Office, www. desta tis. de) in August 2022. For the age group <18 years in 2016- 2020, the following diagnoses (ICD-10 code) were analysed: Intracranial injury (S06), malignant (C71), benign (D33) and unspecified (D43) neoplasia, abuse (T74), violent attack (Y09) and, for comparison, forearm fracture (S52). The following operations (OPS code) were chosen: Operation of the central nervous system (CNS, 5-01- 05), excision of intracranial lesion (5-015), shunt insertion (5-023), shunt revision (5-024), plastic operations of the spinal cord (5-036) and, for comparison, overall number of operations (OPS-5), spondylodesis (5-836) and functional neurosurgery (5-028) at all ages. Result(s): The number of operations declined from 17.23 million in 2019 to 15.82 million in 2020 (8.2%). CNS operations declined by 5%. Shunt insertion declined by 8.1%, revision by 5.1% and spinal cord operations by 6.6%, whereas excisions of intracranial lesions increased by 1.7%. Spondylodesis and functional operations both decreased by 11.9%. The hospitalisations for intracranial neoplasia declined by 8.8% compared to previous years. The number of inpatients with intracranial injury declined by 16%. Violent attack was also documented less often (-13.2%), but child abuse increased by 3.3%. Forearm fractures declined by 5.6%. Conclusion(s): The COVID-19 lockdown in 2020 lead to reduction of operations. Neuro-oncological operations were not affected. Intracranial injury even declined by 16%, reflecting limited activities and mobility. An increase in documented child abuse by 3.3% compared to the average of previous years was observed. These results help understand the impact of pandemics and political decisions and guide future decision-making.

Hiv Viral Load Suppression and Racial Disparities during the Covid-19 Pandemic in Nyc

Background: Antiretroviral therapy is highly effective in achieving HIV viral load suppression (VLS) but requires sustained engagement in care. The COVID-19 pandemic disrupted medical care, and its impact on engagement in HIV care and VLS remains unclear. Health information exchanges (HIEs) enable examination of patient care across multiple health systems. We sought to leverage HIE data to examine the effect of pandemic-related disruptions in HIV care on VLS and to explore racial/ethnic disparities in VLS. Method(s): We performed a retrospective observational study of people living with HIV (PLWH) using de-identified data from Healthix, an HIE encompassing >20 million patients and 8,000 healthcare facilities in the greater New York City (NYC) region, between 1/1/2018 and 7/14/2022. We identified PLWH based on HIV viral load (VL) tests and HIV diagnosis codes (ICD and SNOMED). We established two cohorts: PLWH engaged in care in 2020 with >=1 VL test in 2019, 2020, and 2021(Group A) and PLWH not engaged in care in 2020 with >=1 VL test in 2019 and 2021 but 0 VL tests in 2020 (Group B). HIV VLS outcomes were categorized as suppressed (< 200 copies/mL) or not suppressed ( >200 copies/mL) using the last VL in 2019, first VL in 2021, and last recorded VL. We compared proportions using X2-tests and fit a group-stratified logistic regression to examine the effect of race/ethnicity on VLS. Result(s): We identified 711,358 VL tests representing 81,122 patients at 249 facilities. Of these patients, 36,199 met our definition of PLWH. Of those, 12,448 met the inclusion criteria for Group A, and 3,377 met the inclusion criteria for Group B. In 2019, Group B had a lower VLS proportion than Group A (85.9% vs 88.1%, X2 = 12.3, p< 0.0001). In 2021, this gap increased;the proportion of VLS was 80.7% in Group B and 88.0% in Group A (X2 = 121.8, p< 0.00001). Most recently, VLS in Group B had increased to 85.6%, but the inter-group gap in VLS had grown from 2.2% to 4.4%. Within both groups, Black and Hispanic patients had lower odds of VLS than white patients. This disparity was greatest in Group B when they reengaged in care in 2021, with 72.0% of Black patients (OR 0.30, 95% CI 0.22-0.42), and 79.1% of Hispanic patients (OR 0.45, 95% CI 0.31-0.63), compared to 89.5% of white patients achieving VLS. Conclusion(s): VLS remained high among PLWH who stayed engaged in care in 2020, dropped among PLWH who disengaged in care, and was lower in minoritized groups even after controlling for engagement in care.

COPD criteria-led discharge impacts on inpatient COPD management

Introduction/Aim: A chronic obstructive pulmonary disease (COPD) criteria-led discharge (CLD) pathway created on evidence-based guidelines was introduced at Canterbury Hospital to reduce unwanted clinical variation detected during a previous Agency for Clinical Innovation (ACI) audit. This audit aims to review whether adherence to COPD evidence-based guidelines improved after the CLD introduction. Method(s): The electronic medical records of patients admitted to Canterbury Hospital between 14/02/2022 and 01/08/2022 with a diagnosis of COPD, defined as DRG codes E65A and E65B, were reviewed. Data including patient demographics, admission dates, vaccination status, smoking status and cessation counselling, oxygen targets, inhalers, antibiotics, steroids and referrals on discharge were recorded in REDCap. Deidentified data was extracted into excel, grouped based on admission date being pre or post the CLD implementation date of 09/05/2022. The chi square test was used to determine significance. Result(s): A total of 66 patients were included for analysis (n = 25 pre-intervention, n = 39 post-intervention). Appropriate steroid discharge plans and inhaler technique reviews improved post CLD implementation. Antibiotic usage was more consistent with community acquired pneumonia guidelines rather than infective exacerbation of COPD for both groups. Vaccination documentation was generally poor aside from for Coronavirus disease (COVID-19), though there was significant improvement in the discussion of influenza vaccine post CLD. Documentation of oxygen targets did not improve. Referrals to outpatient respiratory services were high in both groups. Conclusion(s): Introduction of a COPD CLD improved adherence to some aspects of COPD evidence-based management at Canterbury Hospital. Further initiatives should be considered targeting appropriate antibiotic usage, oxygen targets and discussion of preventative measures such as vaccination.

Hiv Outcomes after Extended 12-Month Scripts for Art during Covid-19 in South Africa

Background: There is an urgent need for more efficient models of differentiated anti-retroviral therapy (ART) delivery, with the World Health Organization and PEPFAR calling for evidence to guide whether 12-monthly ART prescriptions and clinic review (12M scripts) should be recommended in global guidelines. We assessed the association between 12M scripts (allowed temporarily during the COVID-19 pandemic) and clinical outcomes in South Africa. Method(s): We performed a retrospective cohort study using routine, deidentified data from 59 public clinics in KwaZulu-Natal. We included PLHIV aged >18 years with a recent suppressed viral load (VL), and who had been referred from their clinic into a community ART delivery programme with a standard 6-month prescription and clinic review (6M script) or a 12M script. In the community ART programme, PLHIV collected ART every two months at external pick-up points, before returning to the clinic after 6 or 12 months for a new script. We used multivariable modified Poisson regression, accounting for clinic clustering, to compare 12-month retention-in-care (not >90 days late for any visit) and viral suppression (< 50 copies/mL) between 6M and 12M script groups. Result(s): Among 27,148 PLHIV referred for community ART between Jun-Dec 2020, 42.6% received 6M scripts and 57.4% 12M scripts. The median age was 39 years (interquartile range [IQR] 33-46) and 69.4% were women. Age, gender, prior community ART use and time on ART were similar in the two groups (Table). However, a larger proportion of the 12M script group had a dolutegravirbased regimen (60.0% versus 46.3%). The median (IQR) number of clinic visits in the 12 months of follow-up was 1(1-1) in the 12M group and 2(2-3) in the 6M group. Retention at 12 months was 94.6% (95% confidence interval [CI] 94.2%- 94.9%) among those receiving 12M scripts and 91.8% (95% CI 91.3%-92.3%) among those with 6M scripts. 16.8% and 16.7% of clients in the 12M and 6M groups were missing follow-up VL data, respectively. Among those with VLs, 90.4% (95% CI 89.9%-91.0%) in the 12M group and 88.9% (95% CI 88.3%- 89.5%) in the 6M group were suppressed. After adjusting for age, gender, ART regimen, time on ART and prior community ART use, retention (adjusted risk ratio [aRR]: 1.03, 95% CI 1.01-1.04) and suppression (aRR: 1.02(1.01-1.03) were higher with 12M scripts. Conclusion(s): COVID-19 led to temporary introduction of 12M scripts in South Africa. Wider use could reduce clinic visits without negative impacts on shortterm clinical outcomes.

Decreasing rates of ambulatory and hospitalized exacerbations of COPD during COVID-19 pandemic

Introduction Acute exacerbation of COPD (AECOPD) is a significant event in COPD associated with worse outcome and progressive lung disease. Infectious agents are thought to play an important role in causing AECOPD. Prevention of an exacerbation is an important therapeutic aim in COPD. Methods In order to gain insight into the relationship of ambulatory and hospitalized AECOPD cases we requested anonymized data from the largest local health care insurance including 4.5 Mio insurants of saxony and saxony-anhalt. Between 2016-2021 there were 516.591 ambulatory (466.841) and hospitalized (49.750) patients with an AECOPD (including J44.0 or J44.1;ICD-10). From 2016 to 2019 an average of 81.628 ambulatory and 9.378 hospitalized ECOPD cases per year were documented. Results AECOPD diagnoses in ambulatory care were decreased by 9,7 % (73.702) in 2020 and 18,4 % (66.629) in 2021. AECOPD cases in hospitals were reduced by 27,6 % in 2020 (6.791) and 41,9 % (5.447) in 2021. The percental diagnosis per insurant dropped from a mean of 0,28 % (2016 to 2019) to 0,18 % in 2020 and 0,12 % in 2021. During previous years there was a seasonal peak within the first quarter of the year, more pronounced during the influenza pandemic 2018. In 2021 this seasonal peak was not detectable (*Figure 1). The reduction in hospitalized AECOPD was more significant than that seen in practicing doctor sector. Discussion To our knowledge here we provide the biggest data set regarding information about decline of AECOPD in ambulatory care and hospital. Clearly the observed fall in case numbers of in and out patient AECOPD cases is related to preventive COVID-19 measures such as wearing masks, social isolation, improved hand hygiene, keeping distances, closure of public spaces and restaurants, testing and possibly also due to vaccination strategies. All together, these preventive measures showed effective in eliminating the usual seasonal peak.

Effects of lockdown on physical activity and arrhythmia burden in patients with an implantable cardioverter-defibrillator: The COVID-19 Lockdown ICD-Carelink (CLIC) study

Background: Both COVID-19 and the measures taken to control the pandemic may significantly affect cardiovascular health. The effects of a lockdown on physical activity and its potential consequences for arrhythmia burden remain largely unknown. Purpose(s): In this study, we investigated the effect of the lockdown during the first COVID-19 wave on patients' physical activity and arrhythmia burden. Method(s): All patients with an ICD connected to a Carelink homemonitoring system from two Dutch hospitals were included. Anonymized data on physical activity, heart rate, and occurrence of ventricular tachycardia/ fibrillation (VT/VF), and atrial fibrillation/tachycardia (AF/AT) were obtained and were compared between March-April 2020 (lockdown) and March-April 2019 (reference) within each patient. The study was approved by the local ethics committee. Result(s): The ICDs of 531 patients registered significantly less activity during de lockdown period compared to the reference period (210+/-104 min vs 182+/-103 min, p<0.0001, Figure 1, panels A and B), while weather conditions improved (1A). Daytime and nighttime heart rates were significantly lower during lockdown compared to the reference period (71.3+/-9 bpm vs 72.6+/-9 bpm, p<0.0001 and 63.4+/-9 vs 63.8+/-9, p=0.02, respectively). AF/AT burden increased (Figure 2A) while number of VT/VF episodes decreased (2B). There was no significant difference in number of NSVT episodes. Conclusion(s): During the lockdown in the first COVID-19 wave, the Carelink system revealed significantly less activity, increase in AF/AT burden and decrease in VT/VF episodes. Further investigation is needed to understand the relationship between physical activity and the occurrence of arrhythmias in ICD patients. (Figure Presented).

Acute Coronary Syndrome during the Era of Covid-19: Perspective and Implications Using Google Trends

Background Acute coronary syndrome (ACS) hospital admissions decreased during the start of the COVID-19 outbreak. There is limited information on how Google searches related to patients behavior during this time. Methods We examined de-identified data from 2019 through 2020 regarding monthly: 1) admissions for ACS from the Veterans Affairs Healthcare System;2) out of hospital cardiac arrest (OHCA) from NEMSIS public dataset;and 3) Google searches for "chest pain", "coronavirus", "chest pressure", and "hospital safe" from Google Trends. We analyzed the trends for ACS admissions, OHCA, and Google searches. Results During the early months of the first COVID-19 outbreak: 1)Veterans Affairs data showed a significant reduction in ACS admissions at a national and regional (Florida) level (Figure 1);2) NEMSIS database showed a marked increase in OHCA at a national level;and 3) Google Trends showed a significant increase in the before mentioned Google searches at a national and regional level. Conclusion ACS hospital admissions decreased during the beginning of the pandemic likely due to delayed healthcare utilization secondary to patients fear of acquiring COVID-19 infection. Concordantly, Google searches for hospital safety and ACS symptoms increased along with OHCA events during this time. Our results suggest that Google Trends may be a useful tool to predict patients behavior and increase preparedness for future events, however, statistical strategies to establish association are needed. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

Quality, safety and equity of care outcomes for inflammatory bowel disease patients at four tertiary referral centres in Australia using a cloud based management system Crohn's Colitis Care (CCCare): A real world observational study

Background: Inflammatory bowel disease (IBD) is a global problem and Australia has amongst the highest prevalence rates. This study looked to assess the quality, safety and equity of care across four specialised IBD centres in Australia over a 12-month period using the cloud-based IBD clinical management system called Crohn's Colitis Care (CCCare). This study aimed to define existing care at each centre and the range of performance across each centre to propose potential benchmarks for optimal quality IBD care. Method(s): The study was conducted across four tertiary IBD centres in Australia (Centres A, B, and C were public hospitals and D was a private centre). De-identified data within the backend CCCare research registry was audited between 1st of July 2021 to 31st August 2022. People with IBD who had a clinical assessment documented within the platform during this 12-month period were included. We assessed quality of IBD care using disease activity based on patient reported outcome measures (PROMs), biomarkers and endoscopy;surgery rates;health maintenance indicators including vaccination and skin cancer screening rates and;key performance indicators including steroid use, smoking rates and current opioid use. Safety of care was assessed using adverse events from therapy and hospital admission due to therapeutic complications. Equity of care examined education levels and ethnicity. Result(s): A total of 1889 patients were included. 63% had Crohn's disease and 37% had ulcerative colitis. 51% of the cohort was female. The median age was 39 years (IQR 30-53) and the median disease duration was 8.4 years (IQR 3.3-15.7) (Table 1). Current steroid use was between 6% to 15.4%. Faecal calprotectin (FCP) remission rates (250mug/mg) were between 65-84% and patient reported outcome (PRO-2) remission rates were between 76-88% with the highest rates observed at Centre D (Figure 1). 74 patients underwent a surgical procedure. COVID-19 vaccination rates were between 40.1% to 88.8% with the highest rates once again observed at Centre D. 3% of the cohort was documented as currently using opioid medications. 12.2% were recorded as currently smoking at Centre A compared to 2.6% at Centre D. 55 medication related adverse events were recorded and 94 patients had a hospital admission during the study period. Conclusion(s): This study showcases how CCCare can readily provide researchers with granular, real-world data to audit the quality of IBD care at 4 specialised centres in Australia over a 12-month period. While there were some differences (higher vaccination rates, lower smoking and steroid use rates at Centre D), quality and safety of care was still fairly uniform across the various sites and can serve as a standard of care for IBD patients in Australia.

Comorbidities Associated with Increased Risk of Death in Ckd Patients with Covid-19

Introduction: The COVID-19 pandemic has increased the burden on patients living with kidney disease. The higher lethality in this population is associated with an increase in 7 to 18-fold mortality compared to patients with chronic kidney disease who were not infected with the virus. This increased toll on patients with kidney disease urges that further studies be performed to understand the extent of the vulnerability of this population. Method(s): Retrospective cohort study. Patients with previous diagnoses of chronic kidney disease ( CKD) hospitalized with acute respiratory failure with a confirmed COVID-19 diagnosis from January to June 2021 were included. Anonymized data was obtained from the DATASUS public database. Missing data were excluded. Collected data included patients' demographics, clinical characteristics, and outcomes. Patients were stratified on the presence of other comorbidities. P-values < 0.05 were considered significant. Statistical analysis was performed using Microsoft Excel, SPSS IBM e Epi Info 7. Result(s): A total of 18,877 patients were included in the analysis. The majority (59,3 %) were male, and the mean age was 64,5 +/-15,4 years. The most common symptoms or signs in this population were dyspnea (72,5 %) followed by cough (60,9%) and low peripheral O2 saturation(71,0%). Regarding the comorbidities associated with chronic kidney disease, the most prevalent were Cardiovascular disease (55,9%), Diabetes mellitus (42,7%), and Obesity (11%). The presence of each individual comorbidity associated with CKD was noted to increase the risk of death for these patients (Table 1). [Formula presented] 95% C.I.:95 % Confidence Interval Conclusion(s): Cardiovascular disease, diabetes mellitus, and obesity associated with chronic kidney disease significantly increase the risk of poor outcomes in patients hospitalized with acute respiratory failure due to COVID-19. This increased risk should be considered when managing these patients. Furthermore, the interactions between the types of comorbidities must also be worthy of attention due to their risk differences. The simple quantification of the number of comorbidities of each patient or the presence or absence should be replaced and individualized on a patient-by-patient basis. No conflict of interestCopyright © 2023

Hospital admissions in patients with COPD before and during the COVID-19 pandemic

Background: Decreased hospital admissions for acute exacerbations of COPD (AECOPD) have been reported during the COVID-19 pandemic, but not in relation to admissions for pneumonia, influenza and COVID-19 admissions. Aim(s): To study hospital admission rate for AECOPD, pneumonia, influenza and COVID-19, respectively, in COPD patients during the pandemic compared with a prepandemic period. Method(s): Anonymized data on hospital admissions of patients with COPD and a primary diagnosis code for AECOPD, pneumonia, influenza or COVID-19, were obtained from the hospital patient admission register. The pandemic period (February 2020 - May 2021) was compared to a period prior to the pandemic (June 2017 - January 2020). Monthly admission rates were compared using ANCOVA statistics, controlling for admission month. Result(s): Monthly mean admission rates for AECOPD were 51 (95%CI 45-57) vs. 79 (95%CI 74-83;p<0.001), pneumonia 12 (95%CI 9-15) vs. 27 (95%CI 25-29;p<0.001) and influenza 0 (95%CI -2-1) vs. 3 (95%CI 2-4;p<0.001). Reduced AECOPD rates coincided with rising COVID-19 admissions (Figure 1). Total mean admission rates, including COVID-19, remained reduced, 82 (95%CI 75-90) vs. 109 (95%CI 104-114;p<0.001), across the pandemic period. Conclusion(s): The overall burden of hospital admissions among COPD patients for AECOPD, pneumonia, influenza and COVID-19 was significantly reduced during the pandemic, despite the rise in COVID-19 admissions. (Figure Presented).

Temperature screening and detection of Covid-19 in school-aged children: A retrospective cohort study assessing the efficacy of temperature screening in schools

In July 2020, Corinth School District was the first in Mississippi to return to the classroom setting. Coronavirus disease 2019 (Covid-19) protocols were developed to maintain the safety of students. These included mandatory masking, seating charts, desk spacing, sanitizing protocols, lunch within classrooms, alteration of extracurriculars, cancellation of assemblies, and quarantine policies. Temperature screenings were also performed. Students registering as febrile would undergo Covid-19 testing. To evaluate the efficacy of temperature scanning as a surveillance method for Covid-19 in the school setting, deidentified data was obtained from the Corinth School District. Overall incidence and grade level incidence of Covid-19 were calculated in children attending school from July 27, 2020 to September 25, 2020. Data were examined for a correlation between documented fevers and Covid-19 positivity. Reports provided by the school district were investigated for positive test groupings signifying a school-related outbreak. Of 28 children with fevers at school, zero tested positive for Covid-19. Twenty-six children tested positive for Covid-19;none were febrile at school. The incidence of Covid-19 in our population during the study period was 1.03%. Incidence in elementary students was 0.34%, 0.93% in middle school, and 2.51% in high school students. There were no school outbreaks during the study period. Both relative risk and odds ratio were calculated as equal to zero (0.00). Temperature scanning is not a sensitive screening method for Covid-19 in school children.Copyright © 2023 Policy Studies Organization.

FACTORS AFFECTING DEVELOPMENT OF AKI AMONG COVID-19 HYPERTENSIVE PATIENTS

Objective: To determine risk factors associated with development of AKI with regards to mortality rate among covid-19 patients taking in consideration risk factors such as age, sex and chronic diseases like diabetics considering renal function to outcome. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of patients from two COVID 19 isolation centers. Medical history, demographic data, symptoms, disease complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID 19 hospitalized patients in the period between Feb 2020 and July 2021. Continuous variables were presented as means ± standard deviation (SD) while categorical variables were presented as percent proportions. Logistic regression was used to determine risk factors associated with development of AKI with regards to mortality factors rate among covid 19 hypertensive patients. Result: Out of 406 hospitalized COVID-19 patients, 59.6% had a history of hypertension. Logistic regression was used to analyze risk factors associated with AKI among hypertensive and non hypertensive patients of covid-19. Age factor is highly significant factor for development of AKI for hypertensive (odd ratio [OR]: 4.89, 95% confidence interval [CI]: (1.93-1.36, P = 0.001) and non-hypertensive patients (odd ratio [OR]: 4.73, 95% confidence interval [CI]: (1.58-4.18, P = 0.001). Urea (odd ratio [OR]: 3.06, 95% confidence interval [CI]: (1.63-5.76, P = 0.001), creatinine (odd ratio [OR]: 3.39, 95% confidence interval [CI]: (1.82-6.32, P > 0.001) and potassium[K] (odd ratio [OR]: 2.17, 95% confidence interval [CI]: (2.23-3.83, P = 0.035) are highly significantly increased for hypertensive covid- 19 patients, whereas urea, creatinine and K are not significantly changed for non-hypertensive covid-19 patients Gender and morbidity factor (diabetes mellitus) has no significant effect for AKI development for hypertensive and non-hypertensive covid-19 patients. AKI is considered as a risk factor death among COVID-19 patients (OR:284, CI:1.56-5.15, p = 0.001). Conclusion: The present study indicates that 71% of patients with AKI are hypertensive. The results also highlight the alarming high incidents of hypertension in the studied population. On conclusion hypertension is considered as highly morbidity factor for development of AKI.

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS VERSUS CALCIUM CHANNEL BLOCKERS IN ASSOCIATION WITH MORTALITY RATE IN COVID-19 HYPERTENSIVE PATIENTS: THE EFFECT OF AGE

Objective: To study the association of calcium channel blockers (CCBs), the renin-angiotensin-aldosterone system (RAAS) inhibitors or their combination as antihypertensive medications and the clinical outcome of COVID-19 infection. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of COVID-19 patients in two isolation centers. Medical history, demographic data, symptoms, complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID-19 hospitalized patients between Feb 2020 and July 2021. Hypertension and antihypertensive treatments were confirmed by medical history and clinical records. Continuous variables were presented as means ± standard deviation (SD) while categorical variables were presented as percent proportions. Logistic regression was used to assess the impact of antihypertensive drugs (RAAS inhibitors, CCBs, combination of RAAS inhibitors and CCBs and those not receiving medication) on the prognosis of COVID-19 patients and to explore the risk factors associated with mortality. Result: Out of 406 hospitalized COVID-19 patients, 242 (59.6%) had a history of hypertension. Hypertensive patients under the age of 65 years and receiving RAAS inhibitors or the combination of both RAAS inhibitors and CCBs were at higher risk of mortality than those on CCBs only (odds ratio [OR]: 4.45, 95% confidence interval [CI]: 1.56-12.56, P = 0.005 and OR:3.57, CI: 1.03-12.36, P = 0.045 respectively). Antihypertensive medications did not seem to influence mortality rates among hypertensive patients above 65 years. Routine laboratory investigations were not significantly different between the subgroups receiving different antihypertensive medications regardless of age. Cough was the only symptom associated with mortality among patients under 65 years (OR:2.34, CI:1.24-4.41, P = 0.009). Type II respiratory failure was significantly associated with death among hypertensives under 65 years (OR:5.43, CI:1.08-28.07, P = 0.044) whereas acute kidney injury and septic shocks are the common complications related to death among hypertensives above 65 years (OR:3.59, CI:1.54-8.36, P = 0.003 and OR:7.87, CI: 1.68-36.78, P = 0.009 respectively). Conclusion: Administration of CCBs may improve the outcome of COVID-19 hypertensive patients under 65 years of age. Antihypertensive treatment does not seem to influence the prognosis of COVID-19 patients above 65 years. Such results may affect management strategy of COVID-19 hypertensive patients. Type-II respiratory failure among patients under 65 years of age, acute kidney injury and septic shock among those above 65 years are the most serious complications that can lead to death regardless of blood pressure.

HYPERTENSION AND RISK FACTORS ASSOCIATED WITH IN-HOSPITAL DEATH IN PATIENTS WITH COVID-19

Objective: To explore the prevalence of hypertension and the common risk factors associated with increased death rate among (Covid-19) patients. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of patients from two COVID 19 isolation centers. Medical history, demographic data, self-reported comorbidities, symptoms, disease complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID 19 hospitalized patients between Feb 2020 and July 2021. The outcomes of interest were death or discharge from the hospital. Logistic regression analysis was used to assess the impact of age, gender, associated comorbidities and some laboratory abnormalities on increased death rate among in-hospital (Covid-19) patients. Results: The prevalence of hypertension, was 59.6%, followed by diabetes (47.3%). COVID-19 patients with hypertension were older (67.0 ± 10.7vs 65.0 ± 13.0 P = 0.001). 70.4% were males. Undiagnosed high blood pressure was detected among 14.5%. Overall mortality was 46.2%, while mortality among normotensives, known hypertensives and undiagnosed hypertension was 47.7%, 54.7% and 37.6%, respectively (p < 0.005). Death was significantly higher among the age group > 65 years compared to ≦ 65 years old (53.6% % vs 39.0% (P = 0.005) irrespective of their blood pressure. Severe respiratory and gastrointestinal symptoms were significantly higher among hypertensives. Type I Respiratory failure 22.1%, and acute kidney injury 11.8% were the most typical complications among hypertensives. Leucocytosis (24.2%), Lymphopenia (56.8%) and higher levels of D-Dimer (47.7%) and C-reactive protein (49.7%) were mainly observed among hypertensive patients. Logistic Regression analysis after adjusting for age significantly showed age OR: 1.81, 95% CI: (1.12: 2.73, p = 0.01), undiagnosed HTN OR: 5.65, 95% CI: (2.04:15.67, p = 0.00), low platelets count OR: 6.53, 95% CI, (1.23:35.23, p = 0.02), higher levels of urea OR:1.67, 95% CI, (1.04:2.63, p = 0.03) and creatinine OR:1.71, 95% CI, (1.063:2.70, p = 0.02), were associated with worse prognosis and in-hospital death among Covid- 19 patients. Conclusion: The age group, more than 65 years with undiagnosed BP of more than 140/90, is significantly associated with higher in-hospital death. Thrombocytopenia and elevated urea and creatinine levels were the most prominent laboratory markers and may be used as a potential indicator for prognosis and outcome among Covid 19 hypertensives. (Table Presented).

Icu Admission Trends of Low-Risk Monitor Patients during Covid Surges

INTRODUCTION: Patients are admitted to intensive care units (ICU) either for ICU-level treatments (mechanical ventilation, vasopressors, et cetera) or ICU-level monitoring (often institution dependent, such every hour neuro checks, or diabetic ketoacidosis with serum pH < 7.10, et cetera). Determining which LRM patients should be admitted to ICUs and which can be monitored on wards or intermediate care units and if bringing more LRM patients to the ICUs actually improves/worsens outcomes has always be a subject of much debate between ICU and floor providers, however data in said outcomes has always been sparse. We hypothesized that during various COVID-19 surges where ICUs were under particularly high strain, ICU triaging providers would (out of simple staffing / bed necessity) admit less LRM patients who would ordinarily meet ICU-admission criteria. METHOD(S): Anonymized data captured in the hospital's APACHE database from 3/1/2020 - 3/31/2022 was used to assess the monthly relationship between percentage of COVID ICU admissions and LRM ICU admission. 1/1/2018 - 2/28/20 data was used for baseline rates. RESULT(S): Baseline LRM as a percentage of total ICU admissions was 18.4% in 2018-19 and 20.2% in Jan/Feb 2020. A total of 6196 patients were admitted to the ICU 3/1/20-3/31/22. LRM fell to 13.6% as COVID hit 25% in 3/20, with inverse correlation (Pearson's r=-63.2). Peak COVID at 56.8% in 12/20 resulted in LRM of 14%. ICU SMR, vent days and LOS ratio all increased from baseline during each surge, and approached but did not return to baseline in between waves. CONCLUSION(S): LRM admissions decreased dramatically during each COVID-19 surge, suggesting elasticity in ICU triage criteria. Mortality, LOS and ventilator day ratios increased from baseline possibly indicating capacity strain, most notably 5/2020-7/2020, 1/2021 and 12/2021-1/2022 reflecting the original, alpha and omicron surges. We will use this data to study the hospital course and outcomes in those LRM patients who were not admitted to the ICU and if there are any statistically and clinically significant changes that could potentially be made to our ICU admission criteria in the future.

Lung Transplantation for COVID-19-Associated Lung Injury (CALI): An International Registry

Background. SARS-CoV-2 can result in a range of infections from asymptomatic disease to progressive COVID-19 and death. In some pts with CALI, lung transplantation (LTx) may be lifesaving. Up to 10% of LTx in the US is currently for pts with CALI. Understanding the characteristics and outcomes of these pts is critical. Methods. A open-access electronic registry was established to collect deidentified data from pts who have undergone LTx for CALI from centers globally. The study was IRB approved at Northwestern with a wavier for consent (no PHI is collected sites could submit data about pre-Tx, peri-Tx and post-Tx course). Follow-up for 1-yr post-LTx was collected. Results. To date, 89 pts with complete day 30 post-LTx data have been entered into the registry. Pt demographics and pre-Tx status are shown in Table 1. 3 pts required oxygen prior to COVID-19. Most sites required neg PCR tests prior to listing (11 (12.4%) required no - PCRs, 11 (12.4%) required 1 and 61 (68.5%) required 2). LTx occurred 137 days post-infection and none developed COVID-19 in the first 30 d;4 were given monoclonal antibodies post-tx. Post-tx ICU LOS averaged 24.5 d with total post-tx hospitalization of 37.6 d (See Table 2). Most experienced infectious and noninfectious morbidity. Most (47.8%) required an additional 30 days of rehab. 2 pts died within 30 days due to sepsis and anoxia. 5 died between day 30 and 90 and an additional 12 died between day 90 and 365. Conclusion. The contribution of cases to this international registry is ongoing. While outcomes of LTx for CALI are generally good, patients experience prolonged post-transplant hospitalization, rehabilitation and significant morbidity and infections are common. (Table Presented).

Impact of the COVID-19 pandemic on supportive care outcomes of breast cancer survivorship patients in Gippsland, Victoria

Background: The psychological impact of breast cancer diagnosis and management are well known, and the COVID-19 pandemic may have exacerbated this distressing experience for these patients. Objective(s): We aimed to assess the supportive care outcomes and level of psychological distress experienced by breast cancer patients in our regional survivorship clinic during the COVID pandemic, in comparison to a pre-pandemic population. We also sought to determine whether using telehealth during the pandemic was preferred by oncology patients. Method(s): All 49 patients who attended the breast cancer survivorship clinic in 2019, and 50 patients who attended in 2021, were included in this study. Deidentified data was collected from the end of treatment care plan.We also collected self-reported scores on The National Comprehensive CancerNetwork Distress Thermometer (DT). Patients with a self-reported DT score >4 were asked to complete the Kessler Psychological Distress Scale questionnaire as a secondary assessment of depression and anxiety. Result(s): Breast cancer patients in the 2021 pandemic cohort recorded higher levels of distress (4.2/10) on the Distress Thermometer compared to the 2019 pre-pandemic cohort (2.4/10) (p = 0.0007). In the pandemic cohort, 38% of breast cancer patients reported a K10 score >16 indicating a moderate-to-high or threefold population risk of having a current anxiety or depressive disorder, compared with 12% of the patients in the pre-pandemic cohort. Patients in the prepandemic group most commonly identified physical concerns including fatigue (61%), poor sleep (43%), pain (33%) and neuropathy (31%). The key concerns of patients in the 2021 group were fatigue, anxiety, depression and fear of recurrence. This study demonstrated the use of supportive care tools to identify breast cancer patients who are vulnerable to increased psychological distress during the COVID pandemic. It also highlights the need to address the limited access to psychological support services for cancer patients in Gippsland.

Splanchnic vein thrombosis and Budd-Chiari syndrome after SARS-CoV- 2 vaccination-Incidence of VITT

Background: Several studies have been published on a rare side effect of severe venous thrombosis at unusual sites and thrombocytopenia after vaccination against SARS-CoV- 2, referred to as vaccine-induced immune thrombocytopenia and thrombosis (VITT). Aim(s): To identify new cases of acute splanchnic vein thrombosis (SVT) or Budd-Chiari Syndrome (BCS) who presented following SARS-CoV- 2 vaccination in the Vascular Liver Disease Group (VALDIG) network, and to evaluate the incidence of VITT. Method(s): We conducted a prospective international cohort study between May 1st, 2021 and January 10th, 2022, on consecutive patients with acute SVT or BCS who presented within 6 weeks following any type or dose of SARS-CoV- 2 vaccination. Anonymous data were collected including baseline characteristics, risk factors, treatment and survival. Cases were identified as definite VITT, probable VITT or possible VITT or unlikely VITT as defined by Pavord et al (NEJM 2021). Result(s): 25 patients with acute (N = 24) or recurrent (N = 1) SVT or BCS were collected from 14 centers in 4 countries (after ChAdOx1 nCoV-19 N = 11, BNT162b2 N = 9, Ad26.COV2.S N = 1, mRNA-1273 N = 1). Median time after vaccination to symptoms was 10 days (2-40). Median age was 52.5 years (21-66), 52% were female. Three patients (12%) fulfilled criteria for definite VITT, 6 (24%) for probable VITT, 2 (8%) for possible VITT, 14 (56%) for unlikely VITT. Thrombosis was located in the portal vein (N = 20), hepatic vein(s) (N = 9), mesenteric vein (N = 18) or splenic vein (N = 9). Concomitant extra-abdominal thrombosis was seen in 5 patients (20%). Patients were treated with LMWH (60%), DOACs (24%) or VKA (40%). Six (2/3 with definite VITT) received IVIG. Thrombophilia was found in 5 patients and 3 had a myeloproliferative neoplasm. Conclusion(s): 25 cases of acute SVT or BCS following SARS-CoV- 2 vaccination were identified. Although definite VITT was rare (12%), no underlying disorder was identified in the majority of patients, contrary to 'typical' cases of SVT and BCS.