Medical Student Social Calls to Isolated Older Adults: A Pilot Study

Introduction The COVID-19 pandemic has amplified social isolation and loneliness among older adults, a quarter of whom were considered socially isolated prior to the pandemic (Wu 2020). Inspired by a Columbia University student initiative (Nathanson et al. 2021), students at Hackensack Meridian School of Medicine [HMSOM] formed a new medical school volunteer club, the "Phone Pal Program.” The program matches medical student volunteers [MSV] with isolated seniors in the community to engage in social phone calls. Similar programs have been reported to have beneficial effects on both the participating older adults and volunteering students (Office et al. 2020). Ageism is a growing concern in our society, leading to poorer outcomes in older adults and highlighting gaps in medical school curricula (Mikton et. al, 2021). The MSVs and older adults engaged in phone calls for three months, and we collected data, including: (1) independent post-surveys of the participating MSVs and the older adults to assess their perception of the program, (2) pre and post ageism questionnaire replies completed by the MSVs, and (3) ageism questionnaire replies provided by a group of non-participating control students at the beginning and end of the project period. Methods Setup of the MSV club took over six months, with advising from faculty, student affairs leadership, and legal review. Once the program received formal approval, older adults reporting isolation or loneliness to their geriatric psychiatrist at participating outpatient clinics were invited to join the Phone Pal Program. HMSOM students were recruited as volunteers, and after undergoing a training course, were each matched with a consenting older adult. The MSVs and older adults engaged in bi-weekly social calls over three months. Volunteers submitted digital logs of their phone calls and were provided with feedback from faculty and student club leadership throughout the program period. The Phone Pal Program team was supported by a team including psychiatrists, social workers, and residents. A digital survey incorporating qualitative and quantitative elements, including questions about background experiences with older adults (e.g., home life, work experience), characterization of older adults, and the Ambivalent Ageism Scale [AAS] (Cary et. al, 2017), was administered before and after the three-month period to the MSVs and the non-participating control student group. Baseline data was compared using t-tests and Fisher's exact tests as appropriate and responses to the mixed and stratified ordinal regression analyses. Results After the formation of the Phone Pal Program as a MSV club, 30 students responded to the initial call for volunteers. 14 students joined the virtual interest meeting, and 13 committed to attending a training session. Four training sessions with faculty supervisors were held in February 2022, and all 13 volunteers completed the training program. Ultimately 12 volunteers established and maintained contact with their older adult, conducting a median of 3 calls per pair over the project period and averaging approximately 28 minutes per call. Both the MSV and non-participating control student groups were largely similar regarding age (P=0.48), sex (P=0.25), previous coursework in geriatrics (P=0.09), work with older adults (P = 0.08), volunteering with older adults (P=0.72), having lived with older adults (P=0.73), planning to live with older adults (P=1.0), and desire to work with older adults (P=0.30). The MSV group more frequently gave higher responses to AAS items 4 (P=0.04), 10 (P=0.02), and 11 (P=0.03) at baseline than the controls. After the intervention, however, no statistically significant differences were detected except for AAS item 1 (P<0.001), which was significantly lower for the intervention group. All MSVs completed a satisfaction survey at the end of the project period. About two thirds of the older adults agreed to complete a satisfaction survey. The survey results suggested that the majority of the MSVs found the program beneficial in fostering connection and appreciated the flexibility of the program. The majority of older adults endorsed feeling connected with their MSVs. Conclusions The creation of the Phone Pal Program as a MSV club required a large time commitment from HMSOM student leaders, faculty mentors, and administrators. MSV retention and satisfaction was high, and the data collected suggests the majority of MSVs and older adults found the program beneficial. Although this was a small pilot study, we were still able to demonstrate a clear reduction on at least one item of the AAS. Further refinements to the training program may be helpful to further reduce ageism among our student and patient population. A larger scale study involving more participants is warranted, as a larger sample may reveal more beneficial effects that were missed in this pilot project. We hope that as the program grows, we can draw clearer conclusions regarding their experiences. This research was funded by None.

Efficacy and safety of CD24Fc in hospitalised patients with COVID-19: a randomised, double-blind, placebo-controlled, phase 3 study.

BACKGROUND: Non-antiviral therapeutic options are required for the treatment of hospitalised patients with COVID-19. CD24Fc is an immunomodulator with potential to reduce the exaggerated inflammatory response to tissue injuries. We aimed to evaluate the safety and efficacy of CD24Fc in hospitalised adults with COVID-19 receiving oxygen support. METHODS: We conducted a randomised, double-blind, placebo-controlled, phase 3 study at nine medical centres in the USA. Hospitalised patients (age ≥18 years) with confirmed SARS-CoV-2 infection who were receiving oxygen support and standard of care were randomly assigned (1:1) by site-stratified block randomisation to receive a single intravenous infusion of CD24Fc 480 mg or placebo. The study funder, investigators, and patients were masked to treatment group assignment. The primary endpoint was time to clinical improvement over 28 days, defined as time that elapsed between a baseline National Institute of Allergy and Infectious Diseases ordinal scale score of 2-4 and reaching a score of 5 or higher or hospital discharge. The prespecified primary interim analysis was done when 146 participants reached the time to clinical improvement endpoint. Efficacy was assessed in the intention-to-treat population. Safety was assessed in the as-treated population. This study is registered with ClinicalTrials.gov, NCT04317040. FINDINGS: Between April 24 and Sept 22, 2020, 243 hospitalised patients were assessed for eligibility and 234 were enrolled and randomly assigned to receive CD24Fc (n=116) or placebo (n=118). The prespecified interim analysis was done when 146 participants reached the time to clinical improvement endpoint among 197 randomised participants. In the interim analysis, the 28-day clinical improvement rate was 82% (81 of 99) for CD24Fc versus 66% (65 of 98) for placebo; median time to clinical improvement was 6·0 days (95% CI 5·0-8·0) in the CD24Fc group versus 10·0 days (7·0-15·0) in the placebo group (hazard ratio [HR] 1·61, 95% CI 1·16-2·23; log-rank p=0·0028, which crossed the prespecified efficacy boundary [α=0·0147]). 37 participants were randomly assigned after the interim analysis data cutoff date; among the 234 randomised participants, median time to clinical improvement was 6·0 days (95% CI 5·0-9·0) in the CD24Fc group versus 10·5 days (7·0-15·0) in the placebo group (HR 1·40, 95% CI 1·02-1·92; log-rank p=0·037). The proportion of participants with disease progression within 28 days was 19% (22 of 116) in the CD24Fc group versus 31% (36 of 118) in the placebo group (HR 0·56, 95% CI 0·33-0·95; unadjusted p=0·031). The incidences of adverse events and serious adverse events were similar in both groups. No treatment-related adverse events were observed. INTERPRETATION: CD24Fc is generally well tolerated and accelerates clinical improvement of hospitalised patients with COVID-19 who are receiving oxygen support. These data suggest that targeting inflammation in response to tissue injuries might provide a therapeutic option for patients hospitalised with COVID-19. FUNDING: Merck & Co, National Cancer Institute, OncoImmune.

Impact of the COVID-19 Pandemic on the Loading and Quality of an Emergency Department in Taiwan: Enlightenment from a Low-Risk Country in a Public Health Crisis.

The impact of the coronavirus disease 2019 (COVID-19) pandemic on health-care quality in the emergency department (ED) in countries with a low risk is unclear. This study aimed to explore the effects of the COVID-19 pandemic on ED loading, quality of care, and patient prognosis. Data were retrospectively collected from 1 January 2018 to 30 September 2020 at the ED of Tri-service general hospital. Analyses included day-based ED loading, quality of care, and patient prognosis. Data on triage assessment, physiological states, disease history, and results of laboratory tests were collected and analyzed. The number of daily visits significantly decreased after the pandemic, leading to a reduction in the time to examination. Admitted patients benefitted from the pandemic with a reduction of 0.80 h in the length of stay in the ED, faster discharge without death, and reduced re-admission. However, non-admitted visits with chest pain increased the risk of mortality after the pandemic. In conclusion, the COVID-19 pandemic led to a significant reduction in low-acuity ED visits and improved prognoses for hospitalized patients. However, clinicians should be alert about patients with chest pain due to their increased risk of mortality in subsequent admission.