Utilization of Patient-Centered Digital Tools to Improve Adherence Rates for Outpatient Screening Colonoscopies in a Metropolitan Hospital

Introduction: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Screening through stool testing or colonoscopy is the standard of care for all ages 50 to 75 years, but national rates of procedures remain sub-optimal. Digital applications i.e., frequent automated text-based reminders and assess through personal healthcare apps on smartphones, can be effective tools to overcome barriers to screening colonoscopy adherence thus improving the outcomes. Method(s): We performed a retrospective study on a prospectively maintained database on CRC screening adherence rates from July 2019 to March 2022 in outpatient settings of a metropolitan hospital. Only screening colonoscopies (SC) scheduled during the study time period were included. Demographics and health-care resources utilization were reviewed. Primary comparison was between SC performance rates, prior to and after implementation of: a digital navigation program (DNP) developed by a private company that consisted of generating automated messages containing bowel-prep instructions, appointment reminders, driving instructions, short informative procedure videos;and EPIC EMR generated personal health app called MyChart. All participants were offered access to DNP through a digital platform and MyChart app set up on their smartphones. Result(s): Total of 3584 SC were scheduled during the study period. Overall age was 6069.6 years and majority were males at 55%;Hispanics were 49% with Not Hispanics at 24%. Pre-intervention period (n51057), 48% of SC performed and 52% cancelled;and in post-intervention period (n52527), 85% SC performed with 15% cancelled (p< .001) with a percent change of 74% increase in procedures. In postintervention group< DNP enrolled 930 patients of which 87% presented for procedure. Patients who did not present, received additional reminders. Bowel prep between groups showed no significant difference in quality (Table). Conclusion(s): Our study highlights a significant increase in performance rates of scheduled screening colonoscopies with a 74% increase after implementation of a DNP and MyChart app utilization. Usefulness of digital applications in improving screening colonoscopy adherence and reducing no show rates, has been well studied in literature with promising results, but implementation on a larger scale is lacking. Especially after COVID-19 pandemic, use of technology to increase adherence to CRC screening and surveillance seems more warranted.

Family satisfaction with ICU communication during the COVID-19 pandemic: a prospective multi-centre Australian study

Introduction: Virtual communication has become common practice during the COVID-19 pandemic due to visitation restriction. We aimed to evaluate overall family satisfaction in intensive care unit (FS-ICU) with virtual communication strategies during the COVID-19 pandemic period. Method(s): In this prospective multi-centre study involving three metropolitan hospitals in Melbourne, Australia, the next of kin (NOK) of all the eligible ICU patients between 07/01/2022 and 10/31/2020 were required to complete an adopted version of FS-ICU 24-Questionnaire. Group comparisons were analysed for family satisfaction scores: ICU/ care (satisfaction with care), FS-ICU/dm (satisfaction with information/ decision-making) and FS-ICU total (overall satisfaction with the ICU) were calculated. The essential predictors that influence family satisfaction were identified using quantitative and qualitative analyses. Result(s): Seventy-three out of the 227 patients' NOK who initially agreed, completed the FS-ICU questionnaire (response rate 32.2%). The mean (SD) FS-ICU/total was 63.9 (30.8). The mean score for satisfaction with FS-ICU/dm was lower than the FS-ICU/care (62.1 [30.30 vs. 65.4 [31.4];p 0.001) (Fig. 1). There was no difference in mean FS-ICU/ total scores between survivors (n = 65;89%) and non-survivors (n = 8, 11%). Higher patient APACHE-III score, female NOK and the patient dying in ICU were independent predictors for FS-ICU/total score while a telephone call at least once a day by an ICU doctor was related to higher family satisfaction for FS-ICU/dm. Conclusion(s): There was low overall family satisfaction with ICU care and virtual communication strategies adopted during the COVID-19 pandemic. Effort should be targeted for improving factors with virtual communication that cause low family satisfaction during the COVID-19 pandemic.

Quantifying caregiver workload during the COVID-19 pandemic using ambient intelligence

Introduction: The COVID-19 pandemic has increased caregiver workload [1]. It is unclear how this workload is distributed across patients with varying presentations. Ambient intelligence (AmI) utilizes neural networks to monitor multiple data points in video feeds, and automatically tracks various aspects of human movement [2]. AmI was used to examine the workload of healthcare staff in relation to temporal and patient characteristics on a COVID ward at a major metropolitan hospital. Method(s): Sensors were deployed in patient rooms on a COVID ward to detect caregiver visits at 5-min intervals. Electronic medical records were used to identify variables hypothesized to contribute to visits. Result(s): 5514 h across 55 patients (mean age 72, range 17-98) were analyzed. The primary reason for admission was medical in 45 cases (81.8%), psychiatric in 8 cases (14.5%) and surgical in 2 cases (3.6%). Medical emergency (MET) calls occurred in 21 (38.2%) cases. As summarized in Fig. 1, visitation was lowest between 0000 and 0400 (27.3 +/- 1.1 min/hour (min/hr)) and highest between 1200 and 1600 (65.5 +/- 1.3 min/hr). The mean +/- SE visitation spent with medical, psychiatric, and surgical patients was 51.7 +/- 0.6, 38.8 +/- 1.3, and 33.7 +/- 3.9 min/hr respectively (p < 0.005). Overall lowest visitation was in surgical patients between 0400 and 0800 (4.5 +/- 4.5 min/hr). Mean +/- SE visitation were 66.7 +/- 4.6 min/hr in the three hours preceding and following MET calls compared to 50.2 +/- 0.5 min/hr in periods without MET calls (p < 0.005). There was no difference in visitation time between patients with respiratory symptoms and those without (50.7 +/- 0.9 vs 48.8 +/- 0.7 min/hr, p = 0.1). Conclusion(s): AmI can help quantify patient workload, potentially improving staff planning. Further studies comparing healthcare attendance between patients on COVID wards and non-COVID wards may provide insight into the impact of unique factors associated with the pandemic.

Non-depolarizing neuromuscular blockade in patients with severe acute respiratory distress syndrome associated with COVID-19: profile of usage and potential deleterious impact on morbidity and mortality

Introduction: Nondepolarizing neuromuscular blockade (NDMB) is a key intervention to avoid ventilation-induced lung injury in acute respiratory distress syndrome (ARDS). In patients with moderatesevere ARDS associated with SARS-CoV-2 infection (CARDS), NDMB were used for prolonged periods of time, with high cumulative doses. We hypothesize that administration of NDMB might contribute to an increased incidence of risk factors later associated with long COVID-19. Method(s): We designed a non-interventional, retrospective study in a large university urban hospital. From January to December 2021, data related to prescription of NDMB, respiratory physiology, mechanical ventilation (IMV) and clinical outcomes were collected from patients' electronic records with a diagnosis of CARDS. Primary outcome was day-90 mortality. Secondary outcomes were ICU length of stay (LOS), ICU-acquired weakness and days of IMV. Mann-Whitney U test was used to compare continuous variables and logistic regression was used to evaluate the association of NDMB use with outcomes, adjusted or not for confounders. Result(s): 116 patients diagnosed with CARDS were included, 87% with severe ARDS and overall mortality was 37.1%. Median age was 57 years (IQ:47-67) and 65.5% were male. P:F ratio at day-1 was 86 (IQ:43). Ventilator-free days (VFDs) at 28 days was 13 (IQ:0-19) in survivors and ICU-LOS was 19 (IQ:10-36). Median time and cumulative dose of NDMB were, respectively, 117 h and 1177.468 mg in patients who survived (n = 70) compared to 197 h and 1898.775 mg in patients who died (n = 41). In addition to days of NDMB exposure (OR 1.05, CI 95% 1.00-1.11), the cumulative dose of cisatracurium, expressed in logs, was correlated with risk of mortality in the ICU, with odds ratio 1.49 (CI 95% 1.08-2.04). Conclusion(s): Patients with severe forms of CARDS received prolonged infusions of NDMB, with high cumulative doses. Both time of exposure and total doses were independently associated with higher risk of mortality.

Creative arts intervention to reduce burnout and decrease psychological distress in healthcare professionals: A qualitative analysis

Creative arts therapy (CAT) can potentially mitigate the unprecedented levels of healthcare professional (HCP) burnout that have been exacerbated by the COVID-19 pandemic. However, empirical evidence about the impact of CAT programs is lacking. We conducted focus groups with HCPs (N = 20) who participated in a 12-week CAT clinical trial to enhance the understanding of the effectiveness of the intervention. For HCPs experiencing burnout and psychological distress, our CAT program supported healing and resiliency through building a sense of community. Participants reported that several programmatic components contributed to this sense of community including: 1) diversity of participants' disciplines, roles, and geographic locations;2) physical separation between the conduct of the CAT program and their primary place of employment;3) facilitator skill;4) collectively contributing to a group project;and 5) being pushed out of their "comfort zone" through the creative activity. Although participants described the particular need for the CAT program in light of additional stressors induced by the COVID-19 pandemic, they believed that this program would have been beneficial pre-pandemic and in the future. To build long-term resiliency, participants suggested that CAT interventions should continue after the 12-week program.Copyright © 2023 Elsevier Ltd

Are allergic diseases a risk factor for more severe COVID-19?

Background: The vast majority of studies indicate that asthma and allergic diseases are not risk factors, neither for COVID-19 susceptibility nor to cause a more severe course of disease. The study aimed to compare medical history, clinical characteristics, and outcome of COVID-19 in patients with allergic comorbidities and in general hospitalized population. Method(s): The study was a single-center retrospective analysis based on data of 632 COVID-19 patients admitted to the City Hospital No 4 (Dnipro) from August to October 2021. The patients' demographics, medical history, particularly the presence of allergic diseases, symptoms and lab tests on admission were collected from medical cards and analyzed. The methods of descriptive and non-parametric statistics were used to process the results. Result(s): Among 632 COVID-19 patients, 27 (4.3%) had the allergic diseases and reactions in medical history (Figure 1). Their median age was 60 (52;69) (p > 0.1), 21 (78%) were women (p = 0.072). The information concerning patients' demographics and clinical characteristics on admission is presented in Table 1. Conclusion(s): The hospitalized patients with COVID-19 and allergic diseases did not differ by from the general population with COVID-19. The Severity Index and lethality weren't higher in patients with allergies. At that time the frequency of saturation < 90% as key indicators of respiratory failure were lower in patients with allergic diseases. While there wasn't difference in need for supplemental oxygen support, interestingly, that there were less patients admitted to ICU in comparison with the general population. Thus, allergic diseases, at least, are not a risk factor for more severe COVID-19.

Using Telehealth through the Mobile Channel to Reduce Health Inequality and Disparity: A Real-World Study Examining Patients with Type 2 Diabetes Mellitus

Background and Aims: COVID-19 led to digital acceleration, raising alarms that minorities (Black/Hispanic) would be left further behind. Did patients with type 2 diabetes (PwT2D) who rely on routine care change their use of health IT resources? Methods: Using longitudinal patient portal usage data of 55,548 PwT2Dfroman urban hospital in the U.S.,we examinedmobile-vsdesktop internet access before-and-after COVID-19. We constructed threemodels using the panel dataset: pooled Ordinary Least Squares (OLS), random effect (RE), and fixed effect (FE). Result(s): The interaction of COVID-PeriodxMinority across the three models (OLS/RE/FE) was significant and showed racial disparity is increasing for desktop use (beta= -0.052/-0.053/-0.054) and decreasing for mobile use (beta = 0.026/0.025/0.025). COVID- 19 has reduced the gap by 34% (0.025/0.073) according to the RE model. Table 1 shows that racial disparity shrinkage is largely driven by the use of mobile communication. Conclusion(s): COVID-19 is a natural experiment providing the opportunity to investigate whether accelerated digitization impacted health inequality and disparity among PwT2D. The effect is mostly driven by mobile device access and cannot be explained by pre-COVID-19 trends. First, COVID-19 has been cited as a ''great magnifier'' of pre-existing racial inequality in health;however, telehealth can become a ''great equalizer'' for reducing inequity. Second, in the U.S., much effort in combating the digital divide has focused on the broadband connectivity gap;the transformative potential of mobile health is overlooked. Third, the lack of access to patient portals has disadvantaged PwT2D minorities;so long as they have access, they can ''catch up.'' NIH Award 5UL1TR001425-03.

Health Disparities in the Door to Electrocardiogram Time in Patients Presenting with Chest Pain to the Emergency Department: Insight from One of the Largest Public City Hospitals in the United States

Background In recent years, research has demonstrated the disparities in cardiovascular disease diagnosis and outcomes for various populations. We aim to study the demographic and COVID-19-related disparities in the door to electrocardiogram (DtE) time for patients presenting with chest pain in a diverse public city hospital. Methods We conducted a retrospective chart review of patients presenting with chest pain to the emergency department between June 1, 2019 and July 31, 2022. Data regarding age, sex, race, COVID-19 status, and DtE time were collected. Wilcoxon rank sum and Kruskal Wallis tests were used to compare medians. Linear regression was performed to further understand the relationship between age and DtE time. Results Of 10,918 patients, 51% were female (age: 49 +/- 17) and 49% were male (age: 48 +/- 16). A significantly lower median DtE time was noted in males (z=2, p=0.045), patients without COVID-19 (z= -2.84, p=0.004) and in age less than 45 years (z=2.38, p=0.017). In a linear regression adjusting for age, sex, race, and COVID-19 status, advancing age was directly correlated with greater DtE time. For every 10-year increase in age, the DtE time increased by 6.2 minutes (p<0.001). Conclusion DtE time was longer in females and in patients with COVID-19. No race-based disparities were found in this analysis. Paradoxically, younger patients presenting with chest pain had a significantly shorter DtE time, despite a higher prevalence of acute coronary syndrome in older age groups. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

COVID-19 Severity Index (SI): is it a sensitive predictor score for disease outcome in hospitalized patients?

Introduction. The COVID-19 pandemic showed the wide ranging of coronavirus disease prognosing, hence clinical identification of patients who are at risk of poor outcomes is a priority. But there is no proven prognostic scoring system yet. COVID-19 SI was developed as a triage tool, that could be used by healthcare personnel to identify highrisk patients. 1 Aim. To estimate whether COVID-19 SI could predict the disease outcome in hospitalized patients with coronavirus disease already on admission? Methods. The study was a single-center retrospective analysis based on data of 632 COVID-19 patients admitted to the City Hospital No 4 (Dnipro) from August to October 2021. The patients' SI on admission and disease outcome were analyzed and statistically processed. Results. Distribution of survivors and nonsurvivors regarding clinical risk in accordance with SI is presented in Table 1. The sensitivity of SI as prognostic score totaled 37 %;specificity - 52,7 %. Conclusions. The study confirmed COVID-19 SI as a good triage tool on admission, but it has low sensitivity and specificity as prognostic score. (Table Presented).

COVID-19 and comorbidity: possible complications of the complex pharmacotherapy

Introduction: improvement in the prognosis of COVID-19 treatment in patients (pts) with comorbidities is closely related to the safest use of drugs, given their possible interactions when rational polypharmacotherapy is needed. The study aimed to evaluate the safety of complex pharmacotherapy in pts with COVID-19 and comorbidity. Method(s): single-center retrospective analysis of data from 632 prescription sheets of pts in the City Hospital #4 (Dnipro) treated from COVID-19 during the delta burst of the disease (August-October 2021) was performed. Descriptive statistics was used to process the results. Result(s): The analysis showed that pts with COVID-19 who received standard therapy also had 2-3 or more comorbidities. The structure of comorbidity is shown in Table 1. The most common were cardiovascular diseases and diabetes mellitus. Often, pts were prescribed dexamethasone, methylprednisolone, antiviral drugs together with hypoglycemic and antihypertensive drugs, anticoagulants, which required a change in the dosage of drugs due to a possible effect on the prognosis of the therapeutic effect (hyperglycemia, the risk of developing ulcerative lesions, increased activity of heparin, diuretics, etc.). Conclusion(s): in pts with COVID-19 and comorbidity, it is necessary to adjust the doses of drugs and avoid polypharmacy to reduce the risk of side effects from adverse drug interactions.

ANALYSIS OF SPECIALIZED CARE FOR PATIENTS WITH DIABETIC FOOT SYNDROME IN ST. PETERSBURG FOR 2010-2021.

BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus. AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021. MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices <<Diabetic foot>> (DFO) from 2010 to 2021 were analyzed. RESULT(S): The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers - 8,9%, with Charcot's arthropathy - less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality - from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021. CONCLUSION(S): An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality.Copyright © Endocrinology Research Centre, 2022.

Evaluation of COVID-19 Vaccine Refusal in Healthcare Workers

Introduction: Healthcare workers are at the frontline of the COVID-19 pandemic and identified as a priority group for COVID-19 vaccines. We aimed to determine to COVID-19 vaccine acceptance rate and reasons for vaccine refusal in healthcare workers in our hospital. Materials and Methods: A questionnaire consisting of eight questions was applied to healthcare workers working at Ankara City Hospital for 7.5 months after the start of the COVID-19 vaccine in our country, including COVID-19 vaccination, previous years' influenza vaccination, and reasons for vaccine rejection. Results: Six hundred twenty-eight healthcare workers participated in the study. Two hundred fifty-six (40%) of them were doctors. Ninenty-nine of the participants were not vaccinated, the rate of vaccine rejection was 15.7%. The rate of vaccine rejection was the lowest (8.2%) among doctors, and lower among doctors working in the fields of COVID-19 (p= 0.041). While the rates of getting the COVID-19 vaccine were significantly higher in those who had regular or intermittent influenza vaccination every year in the previous years, those who had never had the influenza vaccine did not receive the COVID-19 vaccine either (p= 0.000). The most common reason for vaccine rejection was 'fear of the side effects of the vaccine' (24%), while 'I believe the disease is mild' and 'I want to gain immunity naturally' were other common reasons. Conclusion: Vaccination of healthcare workers has gained even more importance in the COVID-19 pandemic, with both risky and severe working conditions and mortality rates. Determining the reasons for vaccine refusal, finding effective solutions, emphasizing the necessity of vaccination with scientific evidence are important for the control of the pandemic. Vaccination of health workers is a guide in community immunization.

ANALYSIS OF SPECIALIZED CARE FOR PATIENTS WITH DIABETIC FOOT SYNDROME IN ST. PETERSBURG FOR 2010-2021.

BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus. AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021. MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices <<Diabetic foot>> (DFO) from 2010 to 2021 were analyzed. RESULT(S): The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers - 8,9%, with Charcot's arthropathy - less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality - from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021. CONCLUSION(S): An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality. Copyright © Endocrinology Research Centre, 2022.

PP01.22 First Lung Cancer Screening Program in Greece - Initial Experience, Preliminary Data and Pitfalls

Background: Poor prognosis of lung cancer is linked to its late diagnosis, typically in the advanced stage 4 in 50-70% of incidental cases. Lung Cancer Screening Programs provide low-dose lung CT screening to current and former smokers who are at high risk for developing this disease. Greece is an EU country, returning strong from a long period of economic recession, ranked 2nd place in overall age-standardized tobacco smoking prevalence in the EU. In December 2020, at the Metropolitan Hospital of Athens, we started the 1st Screening Program in the country. We present our initial results and pitfalls met. Method(s): A weekly outpatient clinic offers consultation to possible candidates. LDCT (<=3.0mGy), Siemens VIA, Artificial Intelligence multi-computer-aided diagnosis (multi-CAD) system and LungRADS (v.1.1) are used for the validation of any abnormal findings with semi-auto measurement of volume and volume doubling time. Patients get connected when necessary with the smoking cessation and Pulmonology clinic. USPSTF guidelines are used, (plus updated version). Abnormal CT findings are discussed by an MDT board with radiologists, pulmonologists/interventional pulmonologists, oncologists and thoracic surgeons. A collaboration with Fairlife Lung Cancer Care the first non-profit organization in Greece is done, in order to offer the program to population with low income too. An advertisement campaign was organized to inform family doctors and the people about screening programs, together with an anti-tobacco campaign. Result(s): 106 people were screened, 74 males & 32 females (mean age 62yo), 27/106 had an abnormal finding (25%). 2 were diagnosed with a resectable lung cancer tumor (primary adenocarcinoma) of early-stage (1.8%). 2 with extended SCLC (lung lesion & mediastinal adenopathy). 1 with multiple nodules (pancreatic cancer not known until then). 3 patients with mediastinal and hilar lymphadenopathy (2 diagnosed with lymphoma, 1 with sarcoidosis). 19 patients were diagnosed with pulmonary nodules (RADS 2-3, 17%) - CT follow up algorithm. Conclusion(s): We are presenting our initial results, from the first lung cancer screening program in Greece. Greece represents a country many smokers, who also started smoking at a young age, with a both public and private health sector, returning from a long period of economic recession. COVID-19 pandemia has cause practical difficulties along the way. LDCT with AI software, with an MDT board and availability of modern diagnostic and therapeutic alternatives should be considered as essential. A collaboration spirit with other hospitals around the country is being built, in order to share current experience and expertise. Copyright © 2022

Health Policy Analysis of Written Question Motions Submitted to the Presidency and Ministries by the Deputies Between 2018-2022 in Turkiye

Objectives: The aim of this study is to analyze written question motions submitted by parliamentarians to the ministers and the vice president of Turkiye. Method(s): Keywords in the field of health were determined in order to examine written question motions published on the official website of the Turkish Grand National Assembly. The keywords that have been determined are pharmacy, hospital, medicine, health, medical device, and medical equipment. Motions published between 01.01.2018 and 31.01.2022 were included in the research. Written question motions containing the determined keywords were documented through the Microsoft Office Excel program and analyzed. Result(s): There were 3,727 motions containing the determined keywords, of which 50% were in the field of health, 37% in hospitals, 10% in pharmaceuticals, 2% in medical devices & medical supplies and 1% in the field of pharmacy. It was found that 29% of the motions presented in the field of health were related to the health status of the convicts and 14% were related to COVID-19. It was also found that 16% of the motions presented on the subject of hospitals were related to city hospitals and 22% were related to regarding the need, resignation and retirement of employment and problems of health personnel in hospitals. Furthermore, 13% of the motions presented in the field of medicine are related to the problems experienced in accessing and supplying medicines for rare diseases. In addition, motion topics related to COVID-19 are presented in every field. Conclusion(s): Considering that convicts face many problems while accessing health services and medicines and supplying medicines in the written question motions submitted in Turkiye, it can be said that policy arrangements are needed in this area. Copyright © 2022

SPONTANEOUS THORACIC FREE AIR IN COVID-19 PNEUMONIA AND CORRELATION WITH PATIENT OUTCOMES: A MULTICENTER RETROSPECTIVE ANALYSIS AND LITERATURE REVIEW

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema are reported as rare complications of COVID-19 pneumonia in various observational studies. The purpose of this study is to investigate the incidence of these complications and their outcome in hospitalized patients with COVID-19 pneumonia, at our inner-city hospital system in Central Pennsylvania. METHODS: We performed a retrospective chart review of the patients admitted with COVID-19 pneumonia from March 2020 to March 2021 in 3 different hospitals located in central Pennsylvania. Data on their demographics, pre-existing comorbidities, inpatient location, radiologic findings, timeline of events, mode of oxygenation and ventilation, hematology, chemistry profile and inflammatory markers were obtained. Patients with known inciting events for barotrauma, other than COVID-19 pneumonia were excluded from our analysis. RESULTS: The mean age of patient cohort was 66 years (SD 14.07). Almost fifty two percent were obese with BMI more than 30 kg/m2 and 69.5% were male. Only 11.4% of the study population had history of COPD and majority (63.6%) did not have history of smoking. Out of 31,260 inpatients, only 44 (0.0014 %) patients spontaneously developed thoracic free air. Among them, 33 (75%) had pneumothorax, and 22 (50%) needed chest tube for the management. 18 (40.9%) had pneumomediastinum, and 20 (45.5%) had subcutaneous emphysema. These are not exclusive findings and some patients had free air in more than one location. Thirty (68.2%) patients were admitted to ICU (Intensive Care Unit), 20 (45.5%) patients needed invasive ventilation and 26 (61.4%) had in-hospital mortality. Mortality in ICU was significantly high (86.67%) compared to non-ICU patients (7.14%). The average duration of hospitalization was 28.18 days (SD 25.46). CONCLUSIONS: Incidence of spontaneous thoracic free air complication in COVID –19 pneumonia is a rare phenomenon. In our patient cohort, occurrence of these events was seen irrespective of type of oxygen delivery and ventilation. However, patients having these complications had a high rate of ICU admission. Mortality is significantly high especially in patients admitted to ICU. CLINICAL IMPLICATIONS: Spontaneous thoracic free air complication in COVID-19 pneumonia is rare but can be a marker of poor prognosis. Vaccination status of study population was unknown, therefore the role of vaccination to prevent these complications and their outcome needs to be explored. DISCLOSURES: No relevant relationships by Yi-Ju Chen No relevant relationships by Anatoliy Korzhuk No relevant relationships by Rajan Pathak No relevant relationships by Navitha Ramesh No relevant relationships by Michaela Sangillo

Evaluation of factors affecting visit adherence in patients receiving intravitreal injections for neovascular age-related macular degeneration during the COVID-19 Pandemic

Purpose : The COVID-19 Pandemic has disrupted the care of patients receiving intravitreal injections for neovascular age-related macular degeneration (nAMD). This study looks at the factors that affected visit adherence for this population of patients during the height of the first pandemic surge. Methods : In this retrospective, observational, case-control study, we included nAMD patients receiving anti-VEGF injections with an appointment scheduled during the target periods of March 11, 2020-May 26, 2020 at either an urban hospital-based or suburban eye clinic. Patients who did not present for their appointment (cases) were compared to patients who did present to their appointment (controls). Medical records were reviewed to collect age, sex, race, presence of appointment attendance, language, marital status, distance from clinic, and area of deprivation index (ADI), which is a measure of socioeconomic health. Multivariate regression models were created with Stata (College Station, Texas) to determine the differences of these factors between no-show and show groups. Results : 115 no-show patients (21% male, mean age 81 years) and 129 controls (26 % male, mean age 80.9 years) were enrolled. The odds of no-show were higher in non-White patients compared to White [(odds ratio (OR) = 2.7, 95% Confidence Interval (CI) = 1.22- 6.17, P = 0.01)], the urban site compared to suburban site (OR = 3.1, 95% CI = 1.70-5.76, P = 0.0001) and single patients compared to married (OR = 2.3, 95% CI = 1.09-4.89, P = 0.02) in univariate analysis. The associations remained significant in multivariate analysis for non-White patients (OR = 3.1, 95% CI = 1.30-6.88, P = 0.01) and urban site (OR = 4.3, 95% CI = 1.78-10.3, P = 0.001) after adjusting for age, gender, language, distance from clinic and ADI. Age, distance from clinic, gender, ADI, and language were not statistically different between the two groups. Conclusions : Visit adherence was lower for non-White patients during the first surge of the COVID-19 pandemic underlying the disparities which can be seen during the pandemic. Patients treated at an urban hospital were less likely to present for their anti-VEGF treatments than those receiving care in a suburban clinic. Further research is needed to determine whether differences in visit adherence effected long-term vision outcomes.

Knowledge, Attitude and Anxiety Levels about COVID-19 among Healthcare Workers at Ankara City Hospital, Türkiye

Introduction: We aimed to assess the present knowledge, attitude and anxiety levels of coronavirus disease 2019 (COVID-19) among healthcare workers at Ankara City Hospital. Materials and Methods: The study was implemented in the form of an online survey, based on voluntary participation and conducted on healthcare workers at the Ministry of Health Ankara City Hospital by using convenience sampling and snowball method between 30 May-2 July 2020. There were 28 questions on knowledge and 8 questions on attitude. The Beck Anxiety Inventory (BAI) was used to measure the anxiety level of the participants. The results were analyzed using the SPSS program. Results: Of the participants, 75% were females, 61.25% were nurses/midwives, and mean age was 34.5 ± 10.1 years. A significant portion of the participants (84.50%) had a moderate or adequate level of knowledge. The highest knowledge score in terms of their professions are doctors, followed by nurses/midwives. The most used resource (71.25%) by our participants was the Ministry of Health’s web page, posters and brochures. The knowledge adequacy of those who have a case algorithm is 1.8 times. Of the participants, 61.0 % demonstrated a positive attitude. 25.25% were gauged to have severe and moderate anxiety. Of the participants, 42.39% stated that anxiety causing reason was the future of their family in case of death in our study. The anxiety score of the female participants was higher than that of the men, young people were higher than the other age groups. There was no significant correlation between the level of knowledge and attitude;whereas a negative, weak correlation was identified between the level of knowledge and anxiety, and between attitude and anxiety. Conclusion: Although the knowledge level of the participants was found to be adequate, in-service training on infection control measures, especially on the use of personal protective equipment should be continued using official information, such as algorithms are designed and other sources by the Ministry of Health. Health workers, especially women and young people, should be monitored psychologically, treated and social support for them should be increased during the pandemic. Increasing knowledge and positive attitudes may be contribute to decrease anxiety scores.

A Review on the Impact of Covid-19 on Mental Health and Wellbeing of Health Care Workers

The front-line health care workers faced many challenges and risks during this COVID-19 pandemic. The HCWs has a direct effect and carried a major burden and consequences in the control of this virus. Apart from physical stress the HCW suffering from psychological complications. This systemic review highlights the adverse mental health outcomes and other identifiable risk factors that affect their psychological behaviour during this COVID-19 pandemic. In this review, three databases were reviewed in different time points and literature have done according to WHO guidelines and PRISMA guidelines. In this review, we included various observational, experimental, and published articles that reported the mental health or psychological affects of the COVID-19 pandemic on HCWs. This study indicates that the COVID 19 pandemic has a potential effect on front-line HCWs in their psychological well-being. The data obtained from 24 studies in this review mainly from HCWs working at urban hospitals in China. Till now there is no evidence comparison with primary care workers. Whereas nurses are at high risk of adverse mental health outcomes compared to other health care workers. Other factors like gender, socioeconomic factors, underlying illness, lack of systemic support were the risk factors of adverse mental health outcomes. Furthermore, it is evident that PPE, exposure, workplace setting, testing have an impact on HCWs with COVID 19 infection and affect their mental health outcomes. It was observed that the maximum number of HCWs reported this COVID 19 infection during the first six months of the pandemic. The prevalence of hospitalization is 15% and with psychological problems of 1.5%. Still, extensive data is needed to observe the mental health problems among HCWs.

EVALUATION after COVID-19 VACCINATION in PATIENTS with ANTIPHOSPHOLIPID SYNDROME: A RETROSPECTIVE COHORT STUDY

Background: Anti-phospholipid syndrome (APS) is an autoimmune disorder characterized by presence of anti-phospholipid antibodies (aPL) comprising lupus anticoagulant, anti-β2-glycoprotein I and/or anti-cardiolipin antibodies together with recurrent thrombosis and/or obstetric morbidity. In the course of COVID-19, thromboembolism may ocur due to endothelial dysfunction directly related to the viral factor and systemic infammatory response. Concerns about COVID-19 vaccines began to arise after unexpected thromboembolic events were launched with the launch of vaccine campaigns around the world to prevent the disease. Objectives: The purpose of the study is to contribute to the literature on this subject by evaluating the development of any side effects or activation of the disease after the COVID-19 vaccine in our APS patients. Methods: This study was designed as a cross-sectional, retrospective cohort study. The patients who meet the Sapporo Criteria for APS which are followed up in Ankara City Hospital Rheumatology Clinic, 18 years and over and vaccinated with any of the COVID-19 vaccines, were included into the study. The files of the patients were examined in order to evaluate the side effects and APS disease activation (thrombosis, embolism or pregnancy complications) in the 3-month period after the last dose of the COVID-19 vaccines (CoronaVac and BNT162b2). Also, information of the patients was collected via telephone or reviewed at regular follow-up visits. Results: A total of 35 patients were included into the study (Table 1). In our patients, we did not observe any new thrombotic events or pregnancy complications during the 3-months observation period after COVID-19 vaccinations. The most common side effects after vaccinations were as follows;myalgia (30%), weakness (16.7%) and fever (10%) (Table 2). No patient became pregnant or gave birth during the follow-up. Conclusion: According to our results, no thrombotic events or pregnancy complications were observed after CoronaVac and BNT162b2 vaccines in APS patients. Apart from this, minor side effects related to COVID-19 vaccines were clinically acceptable level.