Incorporating Simulation Based Training in the Initial Training of New Graduate Registered Nurses in a Blood and Marrow Transplant (BMT) Unit

Topic significance and study purpose/background/rationale: Nursing schools today have placed greater emphasis on online learning leading to limitations in clinical experience and communication skills. Staff turnover has also led to an increase in novice nurses entering the BMT specialty who are then trained by those with limited experience themselves emphasizing the need to incorporate new teaching methods in our nursing residency programs. Methods, intervention, and analysis: An orientation program was developed incorporating nursing competencies, communication skills, critical thinking, and oncology/BMT knowledge aligned with the hospital's new graduate RN residency program. In addition to formal classroom education covering basic nursing skills, institutional protocols, and foundational oncology/BMT knowledge, simulation scenarios were developed reviewing multiple complications often seen in a BMT unit, including febrile neutropenia, septic shock, and cellular therapy infusion reactions. Debriefing and surveys were conducted evaluating the nurse's level of comfort with the scenarios prior to and after simulation. Findings and interpretation: Each simulation lasted thirty minutes followed by one hour of debriefing, analysis, and evaluation. Individual nursing interventions utilized in the scenario were aligned with appropriate hospital policies and best nursing clinical practices. A survey was conducted rating the level of comfort before and after the simulation. 100% of the nurses reported feeling more comfortable with the situations reviewed after undergoing the simulation. Feedback also included novice nurses' lack of experience with oncologic emergencies during their orientation as preceptors often felt compelled to intervene leaving the resident with less hands-on experience. The novice nurses also felt the simulation provided them with the practical clinical experience that had been limited during the COVID-19 pandemic when more novice nurses were training simultaneously with less numbers of cellular therapy patients. Discussion and implications: Simulation provides a safe and effective way of teaching novice nurses about the cellular therapy specialty and common complications when hands-on experience is limited. By incorporating simulation into training, the nurse residents feel more comfortable practicing independently. Greater confidence, enhanced critical thinking, and improved patient outcomes were advantages noted with this educational method. The benefits and success of these simulations will lead to more scenarios being incorporated into training as the BMT specialty continues to evolve.Copyright © 2023 American Society for Transplantation and Cellular Therapy

Challenges of Singapore's First Acute Geriatric Isolation Facility During the COVID-19 Pandemic

Aim: The COVID-19 pandemic has seen hospitals isolating suspect cases. Geriatric populations are at a risk of severe COVID-19 disease and often present with concomitant geriatric syndromes requiring holistic interdisciplinary care. However, isolation of older people poses challenges to care delivery. This study shares the experience of Singapore's first acute geriatric isolation facility geriatric PARI (Pneumonia-Acute Respiratory Infection) ward and describes the geriatric-related outcomes and pitfalls in care delivery. Method(s): This is a retrospective cross-sectional study performed in 7 negative pressure isolation rooms in an acute care public hospital in Singapore. 100 patients admitted consecutively to the geriatric PARI ward were included. Patient demographics, presenting symptoms and geriatric-related adverse outcomes associated with hospitalisation were collected and analysed. Result(s): Patients' mean age was 86.4 years (standard deviation [SD]: 6.8) with significant comorbidities being hypertension (81%), hyperlipidaemia (74%) and renal disease (70%). 51% of patients had dementia and 24% had behaviour and psychological symptoms of dementia (BPSD). 27% of patients presented atypically with delirium and 15% presented with a fall. Delirium was associated with restraint use (OR: 3.88;p-value 0.01). Falls rate was 1.64 per 1000 occupied bed. 1 patient screened positive for COVID-19. Conclusion(s): The geriatric PARI ward is essential for curbing nosocomial transmission of COVID-19. This is important in the older people with comorbidities who are more likely to develop morbidity and mortality. Our study reveals challenges in delivering person-centred care to the older patients in isolation rooms, especially in the management of delirium and falls prevention. Innovative strategies should be developed to minimise isolation-related adverse outcome.Copyright © The Author(s) 2022.

Retrospective Analysis of the Impact of Prophylactic Interventions, in Reducing the Rate of Pd Peritonitis Pre and Post Covid Pandemic

Introduction: - Recurrent exit site infection and peritonitis are major causes of PD catheter removal and PD failure - 1/3 lead to hospitalizations - 5-10% lead to mortality - Reported rate in Australia is 0.6 episode/patient-year - Our first hypothesis is that implementing these prophylactic measures should lead to lower rates of PD peritonitis, PD catheter failure and mortality from 2017 onwards - Our second hypothesis is reduction in the impact of these prophylactic interventions during the covid pandemic Methods: - The aim of this study is to assess the impact of prophylactic interventions that were implemented in 2017 at Gosford hospital, particularly looking at the rates of PD peritonitis, PD catheter failure, transition to HD and mortality - The second aim of this project is to assess the effect of covid pandemic on these interventions Inclusion criteria - Adult (ages 18+) - Patients on peritoneal dialysis in the central coast renal unit - Duration from 2013-2022 - Intervention: Prophylactic antibiotic therapy during PD catheter insertion, prophylactic anti-fungal therapy while on antibiotic therapy, nursing, and patient education - Exposure(s) - Prophylactic antibiotic and antifungal therapies, nursing, and patient education - Confounders - Covid pandemic - Primary outcome - Reduction in PD peritonitis - Secondary outcome(s) - PD catheter failure, transition to haemodialysis, mortality Results: - Our data demonstrates reduction in the rate of PD peritonitis and PD catheter failure following the implementation of prophylactic interventions. - There is no significant difference in the rate of PD peritonitis between the pre and post covid pandemic periods, as the prophylactic measures were still being implemented adequately as per hospital policy. Conclusion(s): - Administration of prophylactic antibiotic and antifungal therapies in PD patients is thought to reduce the rate of PD peritonitis, PD catheter failure and mortality based on our current guidelines. - Our research project has been designed to assess the clinical effectiveness of these prophylactic interventions, in addition to the impact of covid pandemic on these outcomes. No conflict of interestCopyright © 2023

POSTAL MEDICINE DELIVERY FOR STAGE-2 HYPERTENSIVE PATIENTS IN COVID-19 SITUATION: TURNING CRISIS TO OPPORTUNITY

Introduction: The COVID-19 pandemic has influenced healthcare systems, particularly in the areas of non-communicable diseases, such as hypertension, where the majority of patients require medication therapy and frequent visits. The postal medicine delivery (PMD) approach was an innovative solution to keep antihypertensive drugs accessible under the social distance regulation. Objective: We aimed to investigate the effectiveness of the PMD in terms of blood pressure (BP) control (< 140/90 mmHg), and target organ damage (TOD) including myocardial infarction, heart failure, acute stroke, and progression of chronic kidney disease) during the use of PMD. Design and method: This was a cross-sectional study in a university hospital, conducted between 11th March to 27th May 2020 when the hospital policy stated that outpatient departments' service would be reduced, and physicians were encouraged to use PMD. Patients without a history of TOD and who had a history of well BP control (< 140/90 mmHg) for the last 2 weeks, were enrolled. All of the patients used smartphones and LINE® applications for contacting the nurse coordinator every 3 months to report their home BP. After 6 months of PMD, patients were assigned to have a follow-up visit at the hospital for office BP measurement and having metabolic panel checked. Results: Thirty-eight patients met the inclusion criteria, and 68% were women. Most of the patients (97.4%) had used home BP monitoring (HPBM). The rate of BP control in goal was 64.2%. There was no TOD during the PMD approach. The medication boxes were sent successfully via postal service within 5-10 days, with no loss or damage recorded. All of the patients reported that they had been taking their antihypertensive medications. More than two-thirds (68.4%) continued to follow a low-sodium diet, while 76.3 percent continued to exercise regularly. Conclusions: In the COVID-19 epidemic, the PMD method could be another effective and safe strategy to enhance medicine access, if suitable enrolment criteria and communication between healthcare practitioners and patients are maintained. (Figure Presented).

The Impact of Parental Presence Restrictions on Canadian Parents in the NICU During COVID-19: A National Survey.

The purpose of this research was to explore parental perspectives on the impact of parent restrictions imposed in response to the COVID-19 pandemic across Canadian Neonatal Intensive Care Units (NICUs). A co-designed online survey was conducted targeting parents (n = 235) of infants admitted to a Canadian NICU from March 1, 2020, until March 5, 2021. Parents completed the survey from 38 Canadian NICUs. Large variation in the severity of policies regarding parental presence was reported. Most respondents (68.9%) were classified as experiencing high restrictions, with one or no support people allowed in the NICU, and felt that policies were less easy to understand, felt less valued and respected, and found it more challenging to access medicine or health care. Parents reported gaps in care related to self-care, accessibility, and mental health outcomes. There is significant variation in parental restrictions implemented across Canadian NICUs. National guidelines are needed to support consistent and equitable care practices.

Impact of Covid-19 Visitation Restrictions on Veterinary Critical Care Staff

Introduction: Historically, visitation of critically ill animals had been common in veterinary ICUs, with visits chaperoned by both veterinarians and the nursing team. Visits may represent a source of comfort and information for owners, but may also be time-consuming to veterinary staff. During the COVID-19 pandemic, almost all specialty/emergency veterinary hospitals pivoted to curb-side service, and typically highly limited client entry into the building for staff safety. Similar restrictions on visitation were instituted in human ICUs, leading to stress among clinicians, nurses, and patient families. The proposed study aimed to assess the visitation policies reported by critical care veterinarians and technicians and the spectrum of effects on veterinary team members. Method(s): An electronic survey was distributed to the emergency and critical care community using email and social media. The study was exempted by the institutional review board. Survey questions included demographics, COVID-19 hospital policies, and questions about the impact of restricting visitation. Descriptive statistics were used. Result(s): There were 326 respondents to the survey, with veterinarians (53%) and veterinary technicians/assistants (40%) being the most common. Visitation restrictions were reported by 286 (88%) participants. Of those, 264 (81%) reported permitting visits only for euthanasia/endof life discussion and/or on a case-by case arrangement and 20 (6%) allowed no visitation at all. By comparison, prior to COVID-19, 309 (95%) respondents reported no visitation restrictions. For the veterinary team, 244 (75%) felt sad if they had to decline a visit, while 211 (65%) reported feeling anxious and/or guilty. Most respondents (218;67%) felt the owners were understanding. Restricting visits was perceived to improve time for patient care for 195 (60%) respondents, decrease overall workload for 192 (59%) respondents, and decrease stress for 137 (42%) respondents. Conclusion(s): Visitation restriction impacts veterinary staff both positively and negatively;careful evaluation of visitation policies is warranted. The impact on owners should also be evaluated.

A qualitative study of the impact of the COVID-19 pandemic on women seeking pelvic organ prolapse surgery in Alberta, Canada.

In addition to altering public infrastructure and social patterning, the COVID-19 pandemic has delayed many pelvic organ prolapse (POP) surgeries. POP-related stigma, symptomology and the experience of waiting for POP surgery can negatively impact women's quality of life and mental health. The experience of preoperative POP patients during the pandemic thus entails a new intersection of gendered, stigmatic and medical realities. Qualitative interviews were conducted with 26 preoperative POP patients as part of a larger qualitative study, 20 of whom spontaneously volunteered information about how the pandemic coloured their experience living with and awaiting surgery for POP. Interviews occurred between January and July 2021, which coincided with the second and third waves of the pandemic in Alberta, Canada, and before full immunisation was available for all Albertans. Pandemic-related interview excerpts were thematically analysed, and four main findings emerged. (1) Though surgical delay meant living with unpleasant symptoms for longer than anticipated, some sought this out in order to protect vulnerable loved ones from possible hospital-acquired infection, (2) shifting and unclear hospital policies and logistics resulted in intense preoperative stress, at times causing women to temporarily cease treatment, (3) decreased access to public restroom infrastructure caused women to reduce their outings and (4) the imperative to minimise social gatherings made it easier for women to engage in POP-related, shame-based self-isolation without the notice of friends and family. As they can influence postoperative outcomes and treatment adherence, trends observed should be of interest to clinicians and policymakers alike.

The Role of Vitamin D3 Levels in Covid-19 Disease Severity: Participant or Non-participant

Background: Hospitalised COVID-19 patients are known to exhibit varying degrees of immune dysfunction, few modifiable risk factors have been identified to improve this state of which one is the immune modulator effects of vitamin D. Vitamin D is being prescribed as a treatment of COVID-19 in a few guidelines as there is generalised assumption that vitamin D enhances immunity during this illness. So this is an attempt to find out whether a deficiency of vitamin D is associated with the severity of COVID-19. Aim: To study the relationship of serum 25 hydroxy vitamin D [25(OH)D] deficiency with disease severity in hospitalised COVID-19 patients. Materials and methods: The present case-control study compared serum 25(OH)D levels among Mild to moderate and severe COVID- 19 patients. Around 39 diagnosed and Hospitalised Severe COVID- 19 disease are compared with 39 Hospitalised Mild and Moderate COVID-19 disease in Care Hospital, Bhubaneswar, Odisha, India between April 1, 2021, ad August 31, 2021. Patients were divided into 2 groups. The Group 1-Mild to Moderate infection with CT Severity index < 10/25 and Group 2-Severe Infection with HRCT Chest of CTSI >10/25. As per hospital policy, severe infection patients were kept in Critical Care Area and Mild infection patients were kept in Ward/Cabin areas. Any patients becoming sick and being transferred to critical areas are shifted from Group 1 to Group 2 after HRCT chest. Vitamin D levels (25 D Cholecalciferol) are done on the day of admission by chemiluminescence immunoassay test after taking due consent from the patients/attenders. The level of cut-off used in our study is 20 ng/mL. The association was analysed using regression analysis and other statistical methods. Results: The status of 25(OH)D deficiency (present/absent with cut-off being 20 ng/mL) showed no significant difference among cases and control at p < 0.05. Chi-square statistics with Yates correction is 1.8909. The p value is 0.169099. So there were no significant differences in vitamin D3 levels between Mild to moderate and Severe COVID- 19 patients. Conclusion: 25(OH)D levels appear to have no strong association with disease severity amongst hospitalised COVID-19 patients. Hence, its prescription for COVID-19 treatment as well as prevention needs to be reconsidered.

COMMUNICATION CONUNDRUMS OF COVID-19- BARRIERS TO COMMUNICATING WITH DEAF AND HARD OF HEARING PATIENTS DURING A PANDEMIC

CASE: A 53-year-old female with a past medical history of neonatal meningitis complicated by congenital deafness was admitted for evaluation of disorientation. Collateral history provided by family revealed progressive fatigue and labial itching for 1 month. Physical examination revealed excoriated, irregular nodules of the labia with partial obstruction of the vaginal canal. CT of abdomen and pelvis revealed a large mass involving the posterior wall and floor of the bladder with extension to the vagina and vulva, inguinal lymphadenopathy, and multiple liver masses. The admitting team attempted communicating with the patient using a virtual American Sign Language (ASL) interpreter via an iPad and written communication, but both were limited by the patient's vision impairment. The patient was able to lip-read, but this approach was complicated by the need for mask-wearing during the COVID-19 pandemic. The care team was reluctant to remove their masks to avoid putting the patient's health at risk, as her vision impairment would have required them to stand close. The team attempted to arrange for family to assist with communication, but this was limited by hospital policy restricting visitors due to COVID-19. Eventually, an interdisciplinary goals-of-care meeting was held with the patient and her family to discuss diagnosis with the assistance of in-person ASL interpreters. The patient had a better understanding of her diagnosis with in-person interpretation but expressed feeling excluded from her care plan and lack of empathy in communication from her providers. IMPACT/DISCUSSION: This care team was faced with multiple barriers to conveying a life-changing diagnosis and holding a meaningful goals-of-care discussion with the patient. The goal was to convey a diagnosis and create a plan through shared decision-making as promptly and empathetically as would be done for a patient without these barriers to communication. Despite exhausting the available resources for communicating with the deaf population, the ability to communicate at the same standard as patients without their medical condition remained limited. It is important to identify the limitations to communication in this case to improve communication with deaf patients. Unavailability of in-person ASL interpreters during the night, lack of staff education regarding resources available to facilitate communication between providers and patients who are deaf, prevention of communicating emotion with ASL due to mask-wearing, and prevention of family member visitation, who often develop their own effective ways of communicating, due to hospital policy were all barriers to effective communication in this case. CONCLUSION: This case illustrates the challenges imposed by COVID-19 safety precautions on communicating with patients who experience deafness as well as the need for new resources and staff education on current resources available, both inside and outside of their institutions, to assist with communicating with deaf patients.

BARRIERS IN THE MANAGEMENT OF PEDIATRIC HIGHGRADE GLIOMAS IN A LOW-RESOURCE SETTING DURING THE COVID ERA

INTRODUCTION: High-grade gliomas account for <5% of all pediatric brain tumors with a 20% 5-year overall survival even with maximal safe resection followed by concurrent radiotherapy and chemotherapy. Patients in low-and middle-income countries already face delays and barriers to the treatment they require. The current COVID pandemic has added unique challenges to the delivery of complex, multidisciplinary health services to these patients. METHODOLOGY AND RESULTS: We retrospectively reviewed the records of four patients, ages 2-18 years old, with histologically confirmed high-grade glioma managed in a tertiary government institution from 2020-2021. Three of the patients had a supratentorial tumor and one patient had multiple tumors located in both supra-and infratentorial compartments. Neurosurgical procedures performed were: gross total excision (1), subtotal excision (2), and biopsy (1). The tissue diagnoses obtained were glioblastoma (3) and high-grade astrocytoma (1). Two patients survived and are currently undergoing adjuvant radiotherapy and chemotherapy. The remaining two patients expired: one from hospital-acquired pneumonia and the other from COVID-19 infection. DISCUSSION: Decreased mobility due to lockdowns, the burden of requiring negative COVID-19 results before admission for surgery, reduced hospital capacity to comply with physical distancing measures, the postponement of elective surgery to minimize COVID-19 transmission, physician and nursing shortages due to infection or mandatory isolation of staff, cancellation of face-to-face outpatient clinics, and hesitation among patients and their families to go to the hospital for fear of exposure were found to be common causes of delays in treatment. Also, the redirection of health resources and other government and hospital policies to handle the COVID-19 pandemic resulted in an overall delay in the delivery of health services. In particular, the management of pediatric patients with cancers, especially high-grade gliomas, was significantly disrupted.

The Impact of the COVID-19 Pandemic on Postpartum LARC: A Retrospective Cohort Study

INTRODUCTION: At the onset of the COVID-19 pandemic, providers were encouraged to counsel patients interested in longacting reversible contraception (LARC) about immediate postpartum placement to decrease in-person postpartum visits. We assessed the impact of this COVID-related hospital policy on postpartum LARC uptake. METHODS: In this retrospective cohort study, we compared patients who delivered a live born infant(s) during two periods, one immediately prior to the COVID pandemic (“pre-COVID cohort” (December 16, 2019 to March 1, 2020)), and one at the onset of the pandemic (“COVID cohort” (March 16-May 31, 2020)). We collected electronic medical record data, including sociodemographic characteristics and contraception choices, in the antenatal and postpartum periods for 649 patients. Odds ratios were adjusted for age and race. RESULTS: We found an increase in immediate postpartum LARC use during COVID (13% vs. 9%, P=.12, aOR 1.44, CI 0.87-2.39). The etonogestrel implant was the most placed form of immediate postpartum LARC in both cohorts (67% and 71% in pre- and during COVID cohorts, respectively). In general, contraceptive choices at discharge differed between the cohorts (P=.01), with fewer patients desiring LARC placement at the postpartum visit during COVID (13% vs. 6% in pre- and during COVID cohorts). There was no difference between the average number of postpartum visits attended in each cohort (OR 0.93, CI 0.68-1.28). CONCLUSION: Changes in contraceptive counseling during COVID were accompanied by differences in postpartum contraceptive choices at discharge. Targeted contraceptive counseling can influence patient choices in the setting of expected barriers to routine postpartum care.

IMPACT OF BREAKTHROUGH COVID-19 ON VACCINATED ELECTIVE AND AMBULATORY COLORECTAL SURGERY PATIENTS

Purpose/Background: Hospitals and ambulatory surgery care centers had to adapt as the COVID-19 pandemic progressed. Elective surgeries were initially restricted. Protocols to test for COVID-19 fluctuated as elective surgeries resumed, patients were vaccinated, and variants increased infection rates. Hypothesis/Aim: Our study aims to look at the number of breakthrough cases of COVID-19 on vaccinated ambulatory patients and the impact this had on a single colorectal division at a large urban academic institution. Methods/Interventions: This is a retrospective comparative cohort study that studied 123 surgeries from July 2021-October 2021. Prior to August 16, 2021, elective and ambulatory surgeries at our institution did not require a negative COVID test for vaccinated patients. After that date, vaccinated patients still had to get tested 3-5 days before surgery in order to proceed. Our study evaluates a cohort of patients prior to that date and compares it to patients after that date to see if there were breakthrough infections in vaccinated patients, but also to see if this significantly affected the number of cancellations in our surgical division. Analysis was performed in Microsoft Excel and R. Results/Outcome(s): Amongst the two groups, there were equal distributions amongst sex, age, and type of operation scheduled. The majority were ambulatory anorectal cases. Of 123 surgeries, 89 (72%) were completed. The rest were canceled (16%), rescheduled (11%), or no-show (1%). Of the rescheduled surgeries, two were repeat patients, and one was a close contact of a COVID+ person. In the period before the August 16th cutoff, all of the patients canceled for reasons other than COVID-19, and four of them had negative COVID tests recorded. All of the patients (n=2, 6%) who tested positive with breakthrough infections after COVID vaccination occurred after the August 16th cutoff. They both had recorded vaccinations 3-6 months prior. Limitations: This is a small study based on a single division at an academic institution during a limited time period. Conclusions/Discussion: New York City's positive COVID test rate reached a nadir on July 14, 2021, at 1.51%. As people were vaccinated and establishments re-opened, the positivity rate increased, reaching a peak of 4.02% on August 14, 2021. In response to this, our institution required COVID testing to assess for breakthrough cases in vaccinated patients. Two of our vaccinated patients tested positive and had their elective surgeries canceled, a rate of 6%, double the average positivity rate in New York City during the same time period. While the impact of two cancellations may seem small, this study addresses the fact that the new testing policies did catch significant breakthrough infections. Furthermore, this study supports hospital policies that may seem damaging to the hospital's revenue in favor of public safety. Future studies will examine the patient factors related to breakthrough infections in a vaccinated surgery population.

Healthcare Personnel Perceived Benefit of Infection Prevention Strategies during COVID

Background. During the COVID-19 pandemic, many infection prevention policy and practice changes were introduced to mitigate hospital transmission. Although each change had evidence-based infection prevention rationale, healthcare personnel (HCP) may have variable perceptions of their relative values. Methods. Between October-December 2020, we conducted a voluntary, anonymous, IRB-approved survey of UNC Medical Center HCP regarding their views on personal protective equipment (PPE) and hospital policies designed to prevent COVID acquisition. The survey collected occupational and primary work location data (COVID unit or not) as well as their views on specific infection prevention practices during COVID. Chi squared tests (two tailed) were used to compare differences in the proportions. Results. The overall results are displayed (Figure). Among the 694 HCP who responded to the survey, we found HCP were largely (68%) satisfied that the organization was taking all the necessary measures to protect them from COVID-19. A significantly greater proportion (14% more) of HCP (81.7% compared to 67.6%;95% CI of difference 9.4-18.5%, P< 0.0001) agreed that all PPE was available to them compared to those who were confident that the organization was taking necessary steps for protection, highlighting that safety is more than simply availability of supplies. More than 90% felt that daily screening of patients/visitors and patient/visitor mask requirements were important for protecting them from acquiring COVID in the workplace and that wearing a mask themselves was a key intervention for protecting others. Fewer HCP (72-80%), although still a majority, perceived that eye protection and daily symptom screening for HCP were beneficial. Symptom screening for patients/visitors was perceived by 19% more HCP (90.9% compared to 72.2%;95% CI of difference 15-23%) to be beneficial than symptom screening of HCP (P< 0.0001). Conclusion. Although infection prevention strategies were implemented based on evidence and in alignment with CDC recommendations, it is important to acknowledge that the perception and acceptance of these recommendations varied among our HCP. Compliance can only be optimized with key interventions when we seek to understand the perceptions of our staff.

Assessment of infant sleep habits while hospitalized in a non-birthing children's hospital

Purpose of Study Sleep-related deaths account for 18.2% of all infant mortalities in Tennessee. In 2019, Shelby County had the highest number of infant sleep-related deaths in the state of Tennessee with 23 cases (22% of all infant deaths in the county). Most occur while in an unsafe sleep environment, including co-sleeping or from suffocation items in the crib. A committee was formed at our tertiary care children's hospital to implement and model safe sleep practices. The purpose of this study is to evaluate the effectiveness of our safe sleep interventions by comparing type and proportion of unsafe sleep practices before and after implementation of a safe sleep policy and staff education. Methods Used Residents and medical students assessed infant (less than 6 months old) sleep practices with a 6-question survey evaluating sleep location, position, and presence of suffocation items. ICU and NICU patients were excluded. Baseline data was collected from May 2019 to January 2020, with the following interventions implemented thereafter: crib cards explaining safe sleep, [ASLR1] recommendations for removal of extra blankets and other items from the crib, an updated hospital policy based on American Academy of Pediatrics guidelines, and online training for staff. Follow up data was collected from May 2020 to October 2020. Further data collection was limited due to the COVID-19 pandemic until February 2021. Summary of Results Data was collected for 105 infants in the baseline group and only 29.5% were sleeping safely: 87.6% were in a safe position, 90.5% were in a safe location, but only 30.5% had no suffocation items in the crib. After safe sleep interventions were implemented, data from May to October 2020 in 46 infants showed a slight decline in safe sleep to 23.9%: 84.8% in a safe position, 89.1% in a safe location, and 26.1% with no suffocation items in the crib. Among 116 infants evaluated from February to August 2021, only 13% were sleeping safely: 83% in a safe position, 77% in a safe location, and 30% with no suffocation items in the crib. Conclusions Overall, infants tend to sleep in safe positions and locations in our hospital, but many continue to have suffocation items in the cribs. Differences in results of the two periods of follow up data could be related to a stricter definition of 'overall safe sleep' for survey responses. Due to lack of improvement after initial safe sleep policy implementation, new interventions, including requirement for a physician order for head of bed elevation, involvement of nursing staff as 'Safe Sleep Champions', and additional education on suffocation items are planned in order to improve safe sleep in our hospital.

The Impact of COVID-19 on Acute Myeloid Leukemia (AML) Treatment Patterns in the United States: Retrospective Analysis of an Electronic Medical Records (EMR) Database

INTRODUCTION: COVID-19 has disrupted healthcare access for patients (pts) with cancer, which may pose an especially high risk for pts with hematologic malignancies (NCI, 2021). The standard of care for newly diagnosed (ND) AML is induction with intensive chemotherapy (IC;“7+3”) ± consolidation for eligible pts;while during the COVID era, lower-intensity regimens, such as a hypomethylating agent (HMA) plus venetoclax (VEN), may be recommended over 7+3 to eligible pts to minimize transfusions and inpatient hospitalizations. For pts who achieved remission from induction, COVID-19 may have led some practitioners to reduce the number of consolidation cycles and/or lower the cytarabine dose used for consolidation. Transplantation, including hematopoietic stem cell transplantation (HSCT), has been severely impacted (even halted in some areas) during COVID-19 (NasrAllah, 2021). The influence of COVID-19 on AML treatment (Tx) and outcomes has yet to be adequately studied. OBJECTIVE: To assess the impact of COVID-19 on AML Tx patterns and survival in the real-world practice setting. METHODS: The Flatiron™ EMR database was used in this retrospective analysis of US pts aged ≥ 18 years with an AML diagnosis between 1 Jan 2018 and 31 Jan 2021 and who had ≥ 2 months of follow-up. Tx patterns and survival outcomes were compared between a Pre-COVID cohort, defined as pts diagnosed with AML between 1 Jan 2018 and 31 Dec 2019, and a Post-COVID cohort of pts diagnosed between 1 Mar 2020 and 31 Jan 2021. Pt characteristics and Tx patterns were assessed for all pts and in the Pre- and Post-COVID cohorts using summary statistics. Time to event analyses used Kaplan-Meier methods for survival curves and were compared by log-rank tests. RESULTS: In all, 2,133 pts met the selection criteria (mean age was 66.0 years, 57.5% were male, and 75.7% were treated in community practices);1,582 (74.2%) pts were in the Pre-COVID cohort and 551 (25.8%) were in the Post-COVID cohort. Pt characteristics were generally similar between cohorts. In the Post-COVID cohort, use of IC and HMA-only induction decreased significantly, while induction with VEN + an HMA increased (Fig. A): 29.4% of pts (n=132) in the Post-COVID cohort received VEN + azacitidine and 19.8% (n=89) received VEN + decitabine, compared with 16.0% (n=190) and 9.0% (n=107), respectively, in the Pre-Covid cohort (P < 0.001, both comparisons). Time to induction was shorter in the Post-COVID cohort vs the Pre-COVID cohort (median 14 vs 18 days;P < 0.001). In all, 1,056 pts attained remission within 180 days of induction, including 774 Pre-COVID and 282 Post-COVID pts. Among them, 621 pts had a follow-up period of ≥ 180 days (394 pts Pre-COVID, 227 pts Post-COVID) and 41.1% (n=162) vs. 14.1% (n=32) of pts in the Pre- and Post-COVID cohorts, respectively, received consolidation (P < 0.001). Proportions of pts receiving maintenance therapy (MT) were 23.9% (n=94) and 17.6% (n=40) in the Pre- and Post-COVID cohorts, respectively (P = 0.069). Time to HSCT was significantly increased for pts in the Post-COVID cohort (P = 0.035;Fig. B), and rate of HSCT was reduced for Post-COVID pts vs Pre-COVID pts (19.0% vs 13.3%, respectively, at 180 days, and 31.3% vs 22.7% at 360 days). Estimated overall survival (OS) was significantly longer in the Pre-COVID cohort (P = 0.006 vs. Post-COVID);at 360 days of follow-up, estimated survival rates in the Pre- and Post-COVID cohorts were 68.3% vs. 51.3%, respectively. CONCLUSIONS: Induction with IC and HMAs was less frequent for pts diagnosed with AML during COVID-19, while induction with VEN + an HMA increased in these pts. Use of consolidation significantly decreased during COVID-19, and use of MT also decreased. These changes may have been influenced by inpatient resource constraints. Compared with the Pre-COVID cohort, Post-COVID pts were significantly less likely to receive HSCT, and longer HSCT waiting times suggest the pandemic affected access to timely transplantation, potentially due to hospital policies limiting surgeries, lack of available inpatient beds, or donor reluctance to visit a hospital during the pandemic. OS and 1-year survival were compromised in the Post-COVID cohort vs Pre-COVID pts, likely due to COVID-19 infection, but perhaps in part due to constraints on access to healthcare resources. These data suggest a need for oral Tx that can prolong remission while reducing clinic and inpatient visits, and that can bridge the gap until HSCT. [Formula presented] Disclosures: Chen: Bristol Myers Squibb: Current Employment, Current equity holder in publicly-traded company. Rotter: SmartAnalyst Inc.: Current Employment. Potluri: Bristol Myers Squibb: Consultancy.

Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review.

BACKGROUND: Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals. METHODS: We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. RESULTS: Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). CONCLUSIONS: Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. TRIAL REGISTRATION: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction.

Content and Communication of Inpatient Family Visitation Policies During the COVID-19 Pandemic: Sequential Mixed Methods Study.

BACKGROUND: Inpatient health care facilities restricted inpatient visitation due to the COVID-19 pandemic. There is no existing evidence of how they communicated these policies to the public nor the impact of their communication choices on public perception. OBJECTIVE: This study aims to describe patterns of inpatient visitation policies during the initial peak of the COVID-19 pandemic in the United States and the communication of these policies to the general public, as well as to identify communication strategies that maximize positive impressions of the facility despite visitation restrictions. METHODS: We conducted a sequential, exploratory, mixed methods study including a qualitative analysis of COVID-19 era visitation policies published on Pennsylvania-based facility websites, as captured between April 30 and May 20, 2020 (ie, during the first peak of the COVID-19 pandemic in the United States). We also conducted a factorial survey-based experiment to test how key elements of hospitals' visitation policy communication are associated with individuals' willingness to seek care in October 2020. For analysis of the policies, we included all inpatient facilities in Pennsylvania. For the factorial experiment, US adults were drawn from internet research panels. The factorial survey-based experiment presented composite policies that varied in their justification for restricted visitation, the degree to which the facility expressed ownership of the policy, and the inclusion of family-centered care support plans. Our primary outcome was participants' willingness to recommend the hypothetical facility using a 5-point Likert scale. RESULTS: We identified 104 unique policies on inpatient visitation from 363 facilities' websites. The mean Flesch-Kincaid Grade Level for the policies was 14.2. Most policies prohibited family presence (99/104, 95.2%). Facilities justified the restricted visitation policies on the basis of community protection (59/104, 56.7%), authorities' guidance or regulations (34/104, 32.7%), or scientific rationale (23/104, 22.1%). A minority (38/104, 36.5%) addressed how restrictive visitation may impair family-centered care. Most of the policies analyzed used passive voice to communicate restrictions. A total of 1321 participants completed the web-based survey. Visitation policy elements significantly associated with willingness to recommend the facility included justifications based on community protection (OR 1.44, 95% CI 1.24-1.68) or scientific rationale (OR 1.30, 95% CI 1.12-1.51), rather than those based on a governing authority. The facility expressed a high degree of ownership over the decision (OR 1.16, 95% CI 1.04-1.29), rather than a low degree of ownership; and inclusion of family-centered care support plans (OR 2.80, 95% CI 2.51-3.12), rather than no such support. CONCLUSIONS: Health systems can immediately improve public receptiveness of restrictive visitation policies by emphasizing community protection, ownership over the facility's policy, and promoting family-centered care.

Hospital Visitation Policies During the SARS-CoV-2 Pandemic.

A significant change for patients and families during SARs-CoV-2 has been the restriction of visitors for hospitalized patients. We analyzed SARs-CoV-2 hospital visitation policies and found widespread variation in both development and content. This variation has the potential to engender inequity in access. We propose guidance for hospital visitation policies for this pandemic to protect, respect, and support patients, visitors, clinicians, and communities.