Efficacy of levamisole, ivermectin and moxidectin against Capillaria spp. in European hedgehogs (Erinaceus europaeus)

This randomised study aimed to assess and compare the efficacy of treatment protocols containing levamisole, ivermectin, or moxidectin against Capillaria spp. in naturally infected European hedgehogs (Erinaceus europaeus) presented to a British wildlife rehabilitation centre. Faecal analysis, consisting of wet mount and flotation, was performed for 229 hedgehogs weighing ≥200g. Animals testing positive for Capillaria spp. (81%), excluding pregnant females, were randomly allocated a treatment protocol. Initially, hedgehogs (n = 50) received one of six 'pilot' protocols, whereas the remaining animals (n = 97) received one of three 'main' protocols. Faecal analysis was repeated on day 8 and day 12 after treatment initiation. Efficacy of each treatment was assessed based on Capillaria reduction rate (CRR), weight gain, presence of respiratory clinical signs, and outcome. Pilot protocols containing only moxidectin had a significantly lower CRR (≥28.1%) compared to those with levamisole or ivermectin (≥86.6%), whereas the main protocols containing levamisole had a significantly higher CRR (≥93.0%) compared to those containing only ivermectin (≥69.3%). Clinical parameters did not differ significantly between treatments, but animals with respiratory clinical signs at the end of the trial were significantly more likely to have lower CRR and test positive for Crenosoma striatum. C. striatum often appeared refractory to treatment, and managing these infections requires additional anthelmintic therapy. Based on the formulations and dosages trialled, moxidectin is not recommended for treating capillariosis in European hedgehogs, whereas levamisole given orally for two consecutive days at 25-35 mg/kg is suggested as the treatment of choice.

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

INTRODUCTION

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

METHODS

In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.

FINDINGS

Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.

INTERPRETATION

After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Morphometric Characteristics and Genetic Issr Marker Variability in Rhodiola rosea L. (Crassulaceae) in Different Ecological and Geographic Conditions in the Altai Republic

Rhodiola rosea L. is a vulnerable species in the Altai Republic (AR) and Russia in general. For the first time on the territory of AR, studies of the adaptive capabilities of the species and genetic differentiation using ISSR markers were carried out in seven cenopopulations (CP) of R. rosea in 2018 and 2020. The research was founded on the notion of conducting a comparative analysis of the morphogenetic structure of Rhodiola rosea populations in various ecological and geographical conditions of AR. The aim of this work is to evaluate the variability of morphometric traits of sexually mature living female R. rosea plants and to conduct a comparative analysis of genetic variability in cenopopulations (CP) both under undisturbed conditions and under stressful conditions of anthropogenic impact (grazing). Of the 8 primers used, HB12 turned out to be the most informative. The percentage of polymorphic loci in the populations between 0 and 88%. Two populations, located in favorable conditions at relatively low absolute altitudes (2000 m above sea level) (masl) in the undisturbed habitats of the Katun and Altai reserves of AR, were characterized by higher polymorphism. The share of polymorphic loci reached 80%. According to the analysis of statistical data, the highest values of morphometric parameters of the aerial parts of R. rosea plants and the highest potential seed productivity were also recorded in these habitats. Representatives of two high-mountain CPs (2400-2500 masl) in the Sailyugemsky National Park (SNP) were characterized by the lowest genetic polymorphism. Their genetic structure is the most homogeneous, since we have not found polymorphic loci. Due to spatial isolation, these individuals are reliably genetically differentiated. In addition, individuals of one type were subjected to stressful anthropogenic impact (grazing). Therefore, the smallest sizes and lowest potential seed productivity were recorded. Our research shows that alpine populations of R. rosea in AR, under conditions of anthropogenic stress, need protection for their gene pool.

The influence of inter-regional delays in generating large-scale brain networks of phase synchronization

Large-scale networks of phase synchronization are considered to regulate the communication between brain regions fundamental to cognitive function, but the mapping to their structural substrates, i.e., the structure-function relationship, remains poorly understood. Biophysical Network Models (BNMs) have demonstrated the influences of local oscillatory activity and inter-regional anatomical connections in generating alpha-band (8-12 Hz) networks of phase synchronization observed with Electroencephalography (EEG) and Magnetoencephalography (MEG). Yet, the influence of inter-regional conduction delays remains unknown. In this study, we compared a BNM with standard "distance-dependent delays", which assumes constant conduction velocity, to BNMs with delays specified by two alternative methods accounting for spatially varying conduction velocities, "isochronous delays" and "mixed delays". We followed the Approximate Bayesian Computation (ABC) workflow, i) specifying neurophysiologically informed prior distributions of BNM parameters, ii) verifying the suitability of the prior distributions with Prior Predictive Checks, iii) fitting each of the three BNMs to alpha-band MEG resting-state data (N = 75) with Bayesian optimization for Likelihood-Free Inference (BOLFI), and iv) choosing between the fitted BNMs with ABC model comparison on a separate MEG dataset (N = 30). Prior Predictive Checks revealed the range of dynamics generated by each of the BNMs to encompass those seen in the MEG data, suggesting the suitability of the prior distributions. Fitting the models to MEG data yielded reliable posterior distributions of the parameters of each of the BNMs. Finally, model comparison revealed the BNM with "distance-dependent delays", as the most probable to describe the generation of alpha-band networks of phase synchronization seen in MEG. These findings suggest that distance-dependent delays might contribute to the neocortical architecture of human alpha-band networks of phase synchronization. Hence, our study illuminates the role of inter-regional delays in generating the large-scale networks of phase synchronization that might subserve the communication between regions vital to cognition.

A randomized clinical trial comparing low-fat with precision nutrition-based diets for weight loss: impact on glycemic variability and HbA1c

BACKGROUND

Recent studies have demonstrated considerable interindividual variability in postprandial glucose response (PPGR) to the same foods, suggesting the need for more precise methods for predicting and controlling PPGR. In the Personal Nutrition Project, the investigators tested a precision nutrition algorithm for predicting an individual's PPGR.

OBJECTIVE

This study aimed to compare changes in glycemic variability (GV) and HbA1c in 2 calorie-restricted weight loss diets in adults with prediabetes or moderately controlled type 2 diabetes (T2D), which were tertiary outcomes of the Personal Diet Study.

METHODS

The Personal Diet Study was a randomized clinical trial to compare a 1-size-fits-all low-fat diet (hereafter, standardized) with a personalized diet (hereafter, personalized). Both groups received behavioral weight loss counseling and were instructed to self-monitor diets using a smartphone application. The personalized arm received personalized feedback through the application to reduce their PPGR. Continuous glucose monitoring (CGM) data were collected at baseline, 3 mo and 6 mo. Changes in mean amplitude of glycemic excursions (MAGEs) and HbA1c at 6 mo were assessed. We performed an intention-to-treat analysis using linear mixed regressions.

RESULTS

We included 156 participants [66.5% women, 55.7% White, 24.1% Black, mean age 59.1 y (standard deviation (SD) = 10.7 y)] in these analyses (standardized = 75, personalized = 81). MAGE decreased by 0.83 mg/dL per month for standardized (95% CI: 0.21, 1.46 mg/dL; P = 0.009) and 0.79 mg/dL per month for personalized (95% CI: 0.19, 1.39 mg/dL; P = 0.010) diet, with no between-group differences (P = 0.92). Trends were similar for HbA1c values.

CONCLUSIONS

Personalized diet did not result in an increased reduction in GV or HbA1c in patients with prediabetes and moderately controlled T2D, compared with a standardized diet. Additional subgroup analyses may help to identify patients who are more likely to benefit from this personalized intervention. This trial was registered at clinicaltrials.gov as NCT03336411.

Establishment of a clinical nurse specialist-led, virtual aneurysm surveillance clinic

BACKGROUND

The COVID-19 pandemic has necessitated significant changes to the manner in which healthcare is delivered. Chief among these has been the need to rapidly adopt virtual, or telephone clinics as a means of reducing unnecessary patient exposure to hospitals and clinical care settings. We were greatly aided in our adoption of virtual clinics by our experience in the establishment and maintenance of a Clinical Nurse Specialist-led, virtual clinic for both abdominal aortic (AAA) and extra-aortic aneurysm (EAA) surveillance within our department since 2016. Patients undergoing surveillance for abdominal aortic aneurysm (AAA) require frequent and lifelong clinical review. Previous studies have shown that post-operative surveillance in particular is critical in prolonging survival in AAA patients and in the early detection of late complications particularly following endovascular repair (EVAR). Poor compliance with EVAR surveillance has been shown to result in worse outcomes.

AIM

The aim of this study was to evaluate the success of a nurse-led virtual clinic programme in terms of the safe management of patients undergoing AAA surveillance in a nurse-led virtual clinic.

RESULTS

Over the course of the 4-year period from 2016 to 2019, 1352 patients were enrolled in the virtual aneurysm surveillance clinic. The majority of patients each year were male, ranging from 78.2% in 2016 to 85.2% in 2017. The majority of patients encountered the service owing to pre-operative surveillance of an AAA, with this group comprising at least 65% of the total cohort of patients each year.Over the course of the 4-year period of the virtual clinic there were 1466 patient encounters. Each ambulatory day care centre (ADCC) attendance normally costs the hospital €149. Therefore, a total saving of €218,434 resulted from this initiative alone. No patient presented as an emergency with a ruptured aneurysm during the time period studied.

CONCLUSION

Patients with AAA can be safely kept under surveillance in a nurse-led virtual clinic. Our experience with this model of care proved to be particularly advantageous during the period of the early COVID-19 pandemic.

Themes in Health Sciences Librarianship Literature, 2016-2020: A Keyword and Subject Analysis

Previous investigations into trends in Library and Information Science literature have revealed changes in the topics librarians publish on over time, with older studies highlighting classification and indexing, and information retrieval and more recent studies highlighting keywords such as Internet, information technology, digital libraries, and again, information retrieval. No similar investigation has been conducted on current publication trends by health sciences librarians. This study analyzes the top themes on which health sciences librarians published from 2016 to 2020 by examining the frequency of keywords. Keywords and subject headings were analyzed from The Journal of the Medical Library Association, Medical References Services Quarterly, The Journal of Hospital Librarianship, and The Journal of Electronic Resources in Medical Libraries. A total of 8,806 keywords were downloaded for analysis and organized into 292 categories during taxonomy creation. The ten most frequent themes were: libraries, information, education, humans, demography, librarian, geographical locations, research, electronic resources, and technology. The study also found that data, psychiatry and psychology, informatics, and publishing were other key themes, indicating that health sciences librarians are publishing on a wide range of topics. Some keywords that appeared only once, such as telecommuting and flexible staffing, suggest emerging areas of research for librarians.

Modules in connectomes of phase-synchronization comprise anatomically contiguous, functionally related regions

Modules in brain functional connectomes are essential to balancing segregation and integration of neuronal activity. Connectomes are the complete set of pairwise connections between brain regions. Non-invasive Electroencephalography (EEG) and Magnetoencephalography (MEG) have been used to identify modules in connectomes of phase-synchronization. However, their resolution is suboptimal because of spurious phase-synchronization due to EEG volume conduction or MEG field spread. Here, we used invasive, intracerebral recordings from stereo-electroencephalography (SEEG, N = 67), to identify modules in connectomes of phase-synchronization. To generate SEEG-based group-level connectomes affected only minimally by volume conduction, we used submillimeter accurate localization of SEEG contacts and referenced electrode contacts in cortical gray matter to their closest contacts in white matter. Combining community detection methods with consensus clustering, we found that the connectomes of phase-synchronization were characterized by distinct and stable modules at multiple spatial scales, across frequencies from 3 to 320 Hz. These modules were highly similar within canonical frequency bands. Unlike the distributed brain systems identified with functional Magnetic Resonance Imaging (fMRI), modules up to the high-gamma frequency band comprised only anatomically contiguous regions. Notably, the identified modules comprised cortical regions involved in shared repertoires of sensorimotor and cognitive functions including memory, language and attention. These results suggest that the identified modules represent functionally specialised brain systems, which only partially overlap with the brain systems reported with fMRI. Hence, these modules might regulate the balance between functional segregation and functional integration through phase-synchronization.

Chemotherapy induced phlebitis experienced by women with breast cancer following administration of epirubicin using a volumetric infusion pump; an observational study

OBJECTIVE

To establish the incidence and severity of chemotherapy-induced phlebitis (CIP) following administration of epirubicin chemotherapy using a volumetric infusion pump (Hospira Plum 360), compared to a previous study of manual injection of epirubicin. Also the study aimed to gain insight into staff perceptions of ease of use and safety of infusion pump administration.

METHODS

An observational study of women with breast cancer (n = 47) receiving epirubicin via volumetric infusion pump. Phlebitis was reported through a participant self-assessment questionnaire and graded by clinical assessment three weeks after each chemotherapy cycle. Staff perceptions were explored using questionnaires.

RESULTS

Infusion pump administration delivered a significantly higher concentration of epirubicin (p < 0.001), a significantly higher rate of grade 3 and 4 participant reported CIP between cycles (p = 0.003) but demonstrated no significant difference in grade 3 and 4 CIP when assessed clinically three weeks after treatment (p = 0.157).

CONCLUSION

Peripheral epirubicin administration will result in severe CIP being experienced by a proportion of patients irrespective of whether infusion pump or manual injection method is used. Those at high risk of severe CIP should be informed of the risk and offered a central line. For those with a lower risk of severe phlebitis use of the infusion pump appears to be a safe option.

Factors Associated With Long COVID Symptoms in an Online Cohort Study

Background

Few prospective studies of Long COVID risk factors have been conducted. The purpose of this study was to determine whether sociodemographic factors, lifestyle, or medical history preceding COVID-19 or characteristics of acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are associated with Long COVID.

Methods

In March 26, 2020, the COVID-19 Citizen Science study, an online cohort study, began enrolling participants with longitudinal assessment of symptoms before, during, and after SARS-CoV-2 infection. Adult participants who reported a positive SARS-CoV-2 test result before April 4, 2022 were surveyed for Long COVID symptoms. The primary outcome was at least 1 prevalent Long COVID symptom greater than 1 month after acute infection. Exposures of interest included age, sex, race/ethnicity, education, employment, socioeconomic status/financial insecurity, self-reported medical history, vaccination status, variant wave, number of acute symptoms, pre-COVID depression, anxiety, alcohol and drug use, sleep, and exercise.

Results

Of 13 305 participants who reported a SARS-CoV-2 positive test, 1480 (11.1%) responded. Respondents' mean age was 53 and 1017 (69%) were female. Four hundred seventy-six (32.2%) participants reported Long COVID symptoms at a median 360 days after infection. In multivariable models, number of acute symptoms (odds ratio [OR], 1.30 per symptom; 95% confidence interval [CI], 1.20-1.40), lower socioeconomic status/financial insecurity (OR, 1.62; 95% CI, 1.02-2.63), preinfection depression (OR, 1.08; 95% CI, 1.01-1.16), and earlier variants (OR = 0.37 for Omicron compared with ancestral strain; 95% CI, 0.15-0.90) were associated with Long COVID symptoms.

Conclusions

Variant wave, severity of acute infection, lower socioeconomic status, and pre-existing depression are associated with Long COVID symptoms.

The Perceived Health Implications of Policies and Rhetoric Targeting Transgender and Gender Diverse Youth: A Community-Based Qualitative Study

Purpose

In early 2021, >50 bills targeting transgender and gender diverse (TGD) youth in the United States were proposed; these policies and the rhetoric surrounding them is associated with TGD health disparities.

Methods

A community-based qualitative study utilized focus groups with a TGD youth research advisory board to explore their knowledge and perceived impacts of the current policy climate and rhetoric in one Midwestern state.

Results

Themes revealed (1) mental health, (2) structural impacts, and (3) messages to policymakers.

Conclusions

Discriminatory policies and rhetoric harm TGD youth; health professionals should denounce the harmful disinformation perpetuated by these policies.

Attitudes, perceptions, and preferences towards SARS CoV-2 testing and vaccination among African American and Hispanic public housing residents, New York City: 2020-2021

BACKGROUND

African American and Hispanic populations have been affected disproportionately by COVID-19. Reasons are multifactorial and include social and structural determinants of health. During the onset and height of the pandemic, evidence suggested decreased access to SARS CoV-2 testing. In 2020, the National Institutes of Health launched the Rapid Acceleration of Diagnostics (RADx)- Underserved Populations initiative to improve SARS CoV-2 testing in underserved communities. In this study, we explored attitudes, experiences, and barriers to SARS CoV-2 testing and vaccination among New York City public housing residents.

METHODS

Between December 2020 and March 2021, we conducted 9 virtual focus groups among 36 low-income minority residents living in New York City public housing.

RESULTS

Among residents reporting a prior SARS CoV-2 test, main reasons for testing were to prepare for a medical procedure or because of a high-risk exposure. Barriers to testing included fear of discomfort from the nasal swab, fear of exposure to COVID-19 while traveling to get tested, concerns about the consequences of testing positive and the belief that testing was not necessary. Residents reported a mistrust of information sources and the health care system in general; they depended more on "word of mouth" for information. The major barrier to vaccination was lack of trust in vaccine safety. Residents endorsed more convenient testing, onsite testing at residential buildings, and home self-test kits. Residents also emphasized the need for language-concordant information sharing and for information to come from "people who look like [them] and come from the same background as [them]".

CONCLUSIONS

Barriers to SARS CoV-2 testing and vaccination centered on themes of a lack of accurate information, fear, mistrust, safety, and convenience. Resident-endorsed strategies to increase testing include making testing easier to access either through home or onsite testing locations. Education and information sharing by trusted members of the community are important tools to combat misinformation and build trust.

Factors Associated with Long Covid Symptoms in an Online Cohort Study

Importance

Prolonged symptoms following SARS-CoV-2 infection, or Long COVID, is common, but few prospective studies of Long COVID risk factors have been conducted.

Objective

To determine whether sociodemographic factors, lifestyle, or medical history preceding COVID-19 or characteristics of acute SARS-CoV-2 infection are associated with Long COVID.

Design

Cohort study with longitudinal assessment of symptoms before, during, and after SARS-CoV-2 infection, and cross-sectional assessment of Long COVID symptoms using data from the COVID-19 Citizen Science (CCS) study.

Setting

CCS is an online cohort study that began enrolling March 26, 2020. We included data collected between March 26, 2020, and May 18, 2022.

Participants

Adult CCS participants who reported a positive SARS-CoV-2 test result (PCR, Antigen, or Antibody) more than 30 days prior to May 4, 2022, were surveyed.

Exposures

Age, sex, race/ethnicity, education, employment, socioeconomic status/financial insecurity, self-reported medical history, vaccination status, time of infection (variant wave), number of acute symptoms, pre-COVID depression, anxiety, alcohol and drug use, sleep, exercise.

Main Outcome

Presence of at least 1 Long COVID symptom greater than 1 month after acute infection. Sensitivity analyses were performed considering only symptoms beyond 3 months and only severe symptoms.

Results

13,305 participants reported a SARS-CoV-2 positive test more than 30 days prior, 1480 (11.1% of eligible) responded to a survey about Long COVID symptoms, and 476 (32.2% of respondents) reported Long COVID symptoms (median 360 days after infection).Respondents' mean age was 53 and 1017 (69%) were female. Common Long COVID symptoms included fatigue, reported by 230/476 (48.3%), shortness of breath (109, 22.9%), confusion/brain fog (108, 22.7%), headache (103, 21.6%), and altered taste or smell (98, 20.6%). In multivariable models, number of acute COVID-19 symptoms (OR 1.30 per symptom, 95%CI 1.20-1.40), lower socioeconomic status/financial insecurity (OR 1.62, 95%CI 1.02-2.63), pre-infection depression (OR 1.08, 95%CI 1.01-1.16), and earlier variants (OR 0.37 for Omicron compared to ancestral strain, 95%CI 0.15-0.90) were associated with Long COVID symptoms.

Conclusions and Relevance

Variant wave, severity of acute infection, lower socioeconomic status and pre-existing depression are associated with Long COVID symptoms.

Key Points

Question: What are the patterns of symptoms and risk factors for Long COVID among SARS-CoV-2 infected individuals?Findings: Persistent symptoms were highly prevalent, especially fatigue, shortness of breath, headache, brain fog/confusion, and altered taste/smell, which persisted beyond 1 year among 56% of participants with symptoms; a minority of participants reported severe Long COVID symptoms. Number of acute symptoms during acute SARS-CoV-2 infection, financial insecurity, pre-existing depression, and infection with earlier variants are associated with prevalent Long COVID symptoms independent of vaccination, medical history, and other factors.Meaning: Severity of acute infection, SARS-CoV-2 variant, and financial insecurity and depression are associated with Long COVID symptoms.

Effect of a Personalized Diet to Reduce Postprandial Glycemic Response vs a Low-fat Diet on Weight Loss in Adults With Abnormal Glucose Metabolism and Obesity: A Randomized Clinical Trial

IMPORTANCE

Interindividual variability in postprandial glycemic response (PPGR) to the same foods may explain why low glycemic index or load and low-carbohydrate diet interventions have mixed weight loss outcomes. A precision nutrition approach that estimates personalized PPGR to specific foods may be more efficacious for weight loss.

OBJECTIVE

To compare a standardized low-fat vs a personalized diet regarding percentage of weight loss in adults with abnormal glucose metabolism and obesity.

DESIGN, SETTING, AND PARTICIPANTS

The Personal Diet Study was a single-center, population-based, 6-month randomized clinical trial with measurements at baseline (0 months) and 3 and 6 months conducted from February 12, 2018, to October 28, 2021. A total of 269 adults aged 18 to 80 years with a body mass index (calculated as weight in kilograms divided by height in meters squared) ranging from 27 to 50 and a hemoglobin A1c level ranging from 5.7% to 8.0% were recruited. Individuals were excluded if receiving medications other than metformin or with evidence of kidney disease, assessed as an estimated glomerular filtration rate of less than 60 mL/min/1.73 m2 using the Chronic Kidney Disease Epidemiology Collaboration equation, to avoid recruiting patients with advanced type 2 diabetes.

INTERVENTIONS

Participants were randomized to either a low-fat diet (<25% of energy intake; standardized group) or a personalized diet that estimates PPGR to foods using a machine learning algorithm (personalized group). Participants in both groups received a total of 14 behavioral counseling sessions and self-monitored dietary intake. In addition, the participants in the personalized group received color-coded meal scores on estimated PPGR delivered via a mobile app.

MAIN OUTCOMES AND MEASURES

The primary outcome was the percentage of weight loss from baseline to 6 months. Secondary outcomes included changes in body composition (fat mass, fat-free mass, and percentage of body weight), resting energy expenditure, and adaptive thermogenesis. Data were collected at baseline and 3 and 6 months. Analysis was based on intention to treat using linear mixed modeling.

RESULTS

Of a total of 204 adults randomized, 199 (102 in the personalized group vs 97 in the standardized group) contributed data (mean [SD] age, 58 [11] years; 133 women [66.8%]; mean [SD] body mass index, 33.9 [4.8]). Weight change at 6 months was -4.31% (95% CI, -5.37% to -3.24%) for the standardized group and -3.26% (95% CI, -4.25% to -2.26%) for the personalized group, which was not significantly different (difference between groups, 1.05% [95% CI, -0.40% to 2.50%]; P = .16). There were no between-group differences in body composition and adaptive thermogenesis; however, the change in resting energy expenditure was significantly greater in the standardized group from 0 to 6 months (difference between groups, 92.3 [95% CI, 0.9-183.8] kcal/d; P = .05).

CONCLUSIONS AND RELEVANCE

A personalized diet targeting a reduction in PPGR did not result in greater weight loss compared with a low-fat diet at 6 months. Future studies should assess methods of increasing dietary self-monitoring adherence and intervention exposure.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03336411.

TH3.8 Retrospective study on the use of colonic stents in malignancy; a bridge to surgery or the end of the line?

Aim

Colonic stenting is a management option for obstructed left sided colorectal malignancy in the emergency and elective setting. Stenting can provide a bridge to curative surgery or to adjuvant treatment. The aim of this study was to assess the role of colonic stenting in management of obstructed colorectal cancer.

Methods

This retrospective cohort study analyses prospectively collected data from two centres within one Health Board in Wales. Patients were recorded in a cancer database, who underwent colonic stenting for left sided colonic malignancy between January 2008 and December 2021. Patient demographics, treatment pathways, length of admission, stoma formation rates and morbidity were recorded.

Results

In total, 98 patients, with a mean age of 73.5 years (range 37–97) underwent a colonic stent. The majority were elective 55% (n=54). The sigmoid colon was the commonest site of tumour in 33 patients, with metastatic disease in 82% (n=80). The study found 86% (n=84) of patients were successfully stented. The mean length of admission was 13 days. The complication rate was 23% (n=23), most commonly stent obstruction (n=6). Stenting was a bridge to curative surgery for 3 patients, and 47% (n=46) received adjuvant treatment. Five-year survival was 19.3% (n=19). The overall stoma rate was 10.2% (10 patients).

Conclusion

This study shows colonic stenting is a viable alternative in surgical management for advanced obstructing colorectal malignancy but not as a bridge to surgery. The majority of this cohort returned home following stenting, had a low overall stoma rate and 19% survival at 5 years.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

A Randomized Clinical Trial to Compare a Precision Nutrition Intervention Targeting a Reduction in Postprandial Glycemic Response to Meals With a Low-Fat Diet for Weight Loss

Objectives

The primary aim is to compare the effects of a low-fat diet vs a personalized diet on % weight loss at 6-months. Secondary outcomes include body composition (fat mass [FM] and fat free mass [FFM]), resting energy expenditure (REE) and adaptive thermogenesis (AT).

Methods

The Personal Diet Study was a 6-month, single-center, randomized clinical trial in adults with pre-diabetes and moderately controlled type 2 diabetes who were overweight or obese. Participants were randomized to follow either a hypocaloric low-fat diet, with < 25% energy intake from total fat (Standardized), or a hypocaloric personalized diet determined by a machine learning algorithm which predicts PPGR to meals (Personalized). Participants in both arms received behavioral counseling and logged dietary intake and physical activity into a smartphone app. Participants in the Personalized arm received real-time feedback as color-coded scores based on pre-consumed meals entered into the smartphone app. T-tests were used to assess group differences.

Results

A total of 200 adults (Standardized: n = 97 vs. Personalized: n = 103) contributed data (mean [SD]: age, 58 [11] years; 67% female; BMI, 34.0 [4.8] kg/m²; HbA1c, 5.8 [0.6]%; Metformin use, 21.0%). There were no significant group differences in mean % weight loss (Standardized: −4.4 [4.8]% vs Personalized: −3.3 [5.4]%; p = 0.19), mean absolute change in FM (Standardized: −2.7 [3.4] kg vs. Personalized: −1.6 [3.5] kg; p = 0.18), and AT between the two arms (Standardized: −54.7 [177] kcal/d vs. Personalized: 26.2 [199] kcal/d; p = 0.078). However, the Standardized arm lost significantly more FFM (−1.4 [1.6] kg vs. −0.45 [2.0] kg; p = 0.03) and had a greater decrease in REE (−111.0 [195.0] kcal/d vs. 1.93 [215.0] kcal/d; p = 0.02) compared to Personalized.

Conclusions

A personalized diet to minimize PPGR had no greater effect on % weight loss compared to a low-fat diet at 6-months. Future precision nutrition trials may require deeper phenotyping of individuals or the development of body weight-specific algorithms.

Funding Sources

Supported by grants from the American Heart Association 17SFRN33590133.

0791 Perceived racial discrimination predicts poor PAP adherence: a pilot study

Introduction

Although racial and ethnic differences in continuous positive airway pressure (CPAP) adherence for people with obstructive sleep apnea (OSA) are well known, no studies have examined the influence of racial discrimination on CPAP use. The aim of this study was to determine if racial discrimination influenced CPAP use trajectories.

Methods

Participants with OSA initiating CPAP were enrolled from two sleep centers in New York City. Participants completed questionnaires including sociodemographics, perceived discrimination, daytime sleepiness, and depressive symptoms. Racial discrimination was measured via the validated Everyday Discrimination scale (EDS) , Participants endorsed at least one discriminatory experience “at least once a year” and race was the main reason for this treatment. Sociodemographic and questionnaire comparison were performed between participants reporting the presence and absence of racial discrimination. To examine differences in the trajectory of CPAP use based on racial discrimination status (between-subjects factor), we performed a two-factor repeated measures ANOVA with mean hours of daily use at 7, 30 and 90 days serving as the time dependent variable (within-subjects factor). Analyses were adjusted for depressive symptoms.

Results

The sample consisted of 88 participants (40% female; 40% Non-Hispanic Black; mean age of 57 ± 14 yrs). Twenty-two individuals (25% of the cohort) reported racial discrimination. In unadjusted two-factor repeated measures ANOVA, the test statistic for equality of racial discrimination CPAP adherence means over time was highly significant [ F = 9.71 (1, 68); p = 0.003] while the test for interaction between racial discrimination and time was marginally significant [F = 3.19 (1.53, 103.8); p = 0.059). Main effects for time were significant for participants reporting discrimination (p=0.04) but not for those without racial discrimination experiences (p=0.25). Thus, people reporting racial discrimination experienced greater decrement in CPAP use over time while a more stable CPAP use pattern was observed in those not perceiving racial discrimination.

Conclusion

Racial discrimination status may determine future poor CPAP adherence. Larger studies examining mechanisms of how perceived racial discrimination mediates worse CPAP adherence may assist in mitigating CPAP adherence disparities.

Support (If Any)

Natasha Williams was supported by grant from the National Institutes of Health: K23125939

Antimicrobial prescribing and antimicrobial resistance surveillance in equine practice

BACKGROUND

Antimicrobial resistance (AMR) is an increasingly serious threat to human and animal health, therefore responsible use of antimicrobials in equine practice is vital. There is a need to have accurate, up to date data on antimicrobial prescribing in equine practice in the UK.

OBJECTIVES

To characterise current antimicrobial prescribing practices by equine veterinarians and to describe surveillance, audit processes and identification of AMR.

STUDY DESIGN

Online cross-sectional, questionnaire-based survey.

METHODS

An online questionnaire targeting veterinarians who treat horses in the UK and Europe was distributed. The questionnaire collected data on participants' country of origin, practice policies, prescribing practices including use of high priority critical antimicrobials. Four common clinical case-based scenarios were included to further explore prescribing practice. Responses were compared using both descriptive statistics and multivariable logistic regression models.

RESULTS

Questionnaires were completed by 264 veterinarians from Europe (n=33/264) and the UK (n=231/264); 87% respondents worked only with horses and 67% worked at premises with hospitalisation facilities. Approximately half of respondents (54.4%) had a written antimicrobial use or stewardship policy within their practice. Over half of respondents did not perform any environmental surveillance (54.2%), audit of clinical infections (53.1%) or audit of infection control (57.1%). Potentiated sulphonamides were cited as the most used antimicrobial, although 44% reported using enrofloxacin in the last year and 66% used 3^rd or 4^th generation cephalosporins. Prophylactic antimicrobials before clean surgery were frequently/always prescribed by 48% respondents and 24% respondents frequently/always prescribed antimicrobials post-operatively in clean surgery.

MAIN LIMITATIONS

Potential selection bias of respondents, given individuals volunteered to take part in the survey.

CONCLUSIONS

Compared to a previous similar study conducted in 2009, overall antimicrobial usage appeared to be declining in clinical scenarios and a greater proportion of practices now have stewardship policies. However, the use of high priority critical antimicrobials is still relatively common in equine practice in the UK and Europe.

Protocol of mixed-methods assessment of demographic, epidemiological and clinical profile of decentralised patients with cancer at Nelson Mandela Academic Hospital and Rob Ferreira Hospital, South Africa

INTRODUCTION

Cancer is the second leading cause of death globally. However, cancer care services are often concentrated in urban centres. Two of South Africa's hospitals have decentralised cancer care delivery since February 2018 and August 2019, respectively. This study aims to describe the demographic, epidemiological and clinical profile of various cancers at Nelson Mandela Academic Hospital (NMAH) and Rob Ferreira Hospital (RFH), in South Africa's Eastern Cape and Mpumalanga provinces, respectively.

METHODS AND ANALYSIS

This study will be conducted in the Eastern Cape and Mpumalanga provinces. A mixed-methods study design will be undertaken to gain insight on the characteristics of randomly sampled patients who are treated for cancer at NMAH and RFH between 1 March 2018 and 28 February 2022. A validated, researcher-administered survey questionnaire will be used to assess demographic characteristics, and prevalence of different cancers among patients. Concurrently, a document review will be undertaken on patients with cancer using a patient registry to ascertain the duration of diagnosis, type of cancer(s), management plan and patient survival time. STATA V.17 will be used for data analysis. The Shapiro-Wilk test will be used to explore the distribution of numerical variables. The χ² or Fisher's exact tests will be used depending on the value of the expected frequencies to compare categorical variables. Kaplan-Meier survival estimates will be used to determine the survival time. Hazard ratios will be used to determine the predictors of death. The level of statistical significance will be set at p value ≤0.05. The 95% CI will be used for the precision of estimates.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Human Research Ethics Committees of the University of the Witwatersrand (M210211) and Walter Sisulu University, South Africa (Ref: 040/2020). Findings will be reported through peer-reviewed journal(s), presentations at conferences and at partner meetings.

Bring Your Own Story: The Evolution of a Library Program to Celebrate Diverse Voices

The Harriet F. Ginsburg Health Sciences Library at the University of Central Florida College of Medicine collaborated with the college's Office of Diversity, Equity and Inclusion to enhance its existing diversity programming, created to foster a sense of community throughout the college. Through this partnership, a library-driven idea for an occasional diversity-themed lunch and learn session gained valuable institutional support and transformed into a larger event series. A second related project emerged with a goal of creating a diversity corner for the college. These collaborative efforts have helped the library further its mission to be an inclusive entity within the college and have afforded the library greater programming reach.

Model of delivery of cancer care in South Africa's Eastern Cape and Mpumalanga provinces: a situational analysis protocol

INTRODUCTION

Cancer contributes to a significant proportion of morbidity and mortality globally. Low-income and middle-income countries such as South Africa tend to be characterised by poor and inequitable access to cancer services. Cancer resources are more likely to be found in urban areas, tertiary centres and quaternary hospitals. However, little is known about the linkages to care, continuity of care and packages of cancer care in rural South African settings. This study describes cancer service delivery for South Africa's Eastern Cape and Mpumalanga provinces.

METHODS AND ANALYSIS

A mixed-methods qualitative and quantitative research methods of three substudies which include semistructured interviews with patients, focus group discussions with health providers and a quantitative record review that will be carried out at both Rob Ferreira hospital, Witbank hospital and Nelson Mandela Academic hospital in Mpumalanga and Eastern Cape province, respectively. Instruments assess demographic characteristics, explore packages of cancer care, explore challenges experienced by health professionals, and maps out the referral pathway of patients with a cancer diagnosis in the study sites. Numerical, quantitative data will be explored for normality using the Shapiro-Wilk test and reported using either the mean, SD and range or the median and IQR depending on the normality of the distribution. Qualitative data will be analysed using the phenomenological approach.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Human Research Ethics Committee of Walter Sisulu University (040/2020) and the University of the Witwatersrand (M210211), South Africa. To the research team's knowledge, this is the first study presenting the model of cancer delivery in South Africa's Eastern Cape and Mpumalanga province. This will thus provide better understanding of cancer service delivery systems, packages of cancer care from primary care to quaternary care.

Worst Itch Numerical Rating Scale for Prurigo Nodularis: A Psychometric Evaluation

BACKGROUND

Study TR03 evaluated the safety and efficacy of nalbuphine ER for prurigo nodularis (PN) (NCT02174419).

OBJECTIVE

We conducted supplementary analyses to assess the psychometric properties of the Worst Itch Numeric Rating Scale (WI-NRS), the TR03 primary endpoint.

METHODS

Study TR03 was a double-blind, placebo-controlled, phase 2 trial in PN patients with documented scores ≥5 on the WI-NRS (0 [no itch]-10 [worst itch imaginable]) on ≥5 of 7 days before baseline. Using TR03 data, the WI-NRS's psychometric properties, including reliability, validity, and ability to detect change, were evaluated. A responder threshold was estimated to facilitate interpretation of WI-NRS score changes.

RESULTS

Among 62 treated patients, improvements in mean [SD] (median) WI-NRS scores were observed between baseline (8.2 [1.21] (8.1)) and Week 10 (5.8 [2.43] (6.0)). The WI-NRS had an intraclass correlation coefficient of 0.96 (95% confidence interval, 0.93-0.98) in 42 patients who had stable Itch verbal rating scale (VRS) scores from Week 9-10, supporting strong test-retest reliability. Construct validity was supported, with strong correlations at Week 10 with Average Itch NRS (r=0.87) and Itch VRS single-day/weekly mean scores (r=0.81/0.89) and moderate correlations with ItchyQoL^TM total/domain scores (r=0.41-0.43). The WI-NRS discriminated between predefined severity subgroups based on the Itch VRS and detected changes in itching severity (effect-size estimate: -2.05; standardized response mean: -1.21). An anchor-based threshold based on a two-category improvement in the single-day Itch VRS suggests a responder threshold of ≥3.8 points (~40% improvement).

CONCLUSIONS

The WI-NRS demonstrates good measurement properties, supporting its use in evaluating treatment change in PN.

Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial

Background

Failure to take medicines for diabetes as prescribed contributes to poor outcomes from the condition. Mobile phones are ubiquitous and short message service (SMS) texts have shown promise as a low-cost intervention. We tested the effectiveness of SMS-text messaging in improving outcomes in adults with type 2 diabetes.

Methods

StAR2D was a 12-month two-arm randomised trial of SMS-text messaging and usual care in Cape Town, South Africa and Lilongwe, Malawi. Messages used behaviour change theory and were developed with patients and staff. The intervention group received four messages each week. The primary outcome was change in HbA1c. Secondary outcomes were the proportion of patients who collected > 80% medication and changes in systolic blood pressure, lipids, cardiovascular risk, and the proportion of the participants reaching treatment goals.

Results

The trial took place between 1 October, 2016 and 1 October 2018, 1186 participants were randomised to intervention (593) and control (593) groups. 91% of participants completed follow-up. There was a reduction in HbA1c (DCCT) in both groups but not in mean change (95% CI) between groups (− 0.08% (− 0.31 to 0.16) (IFCC − 0.82 mmol/mol (− 3.44 to 1.79). There was a small but not significant increase in the proportions of participants likely to have collected 80% or more of medication (Relative risk 1.11 (0.84 to 1.47; P = 0.47). There was a significant difference between groups in change in systolic blood pressure from baseline of 3.46 mmHg (1.48 to 5.44, P = 0.001) in favour of the intervention group. The between group difference in change in 10-year risk of coronary heart disease was − 0.71% (− 1.46 to 0.04, P = 0.064). The proportion of participants meeting treatment goals in the intervention group was 36.0% and in the control group 26.8% (Relative risk 1.36 (1.13 to 1.63, P = 0.001). Participants reported many challenges to adherence despite finding messages acceptable and useful.

Conclusions

Whilst SMS text messages do not lead to improved glycaemia in these low-resource settings there appeared to be an impact on blood pressure and achievement of treatment goals but the mechanisms for this are unclear. Text messages alone, may be unsuccessful unless accompanied by health system strengthening and other forms of self-management support for type 2 diabetes.

Trial registration

Trial registration: ISRCTN, ISRCTN70768808. Registered 1 July 2015, http://www.isrctn.com/I ISRCTN70768808.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11874-7.

Theory and conceptual frameworks: blame and credit/centralization and decentralization

In this presentation we will introduce the politics of blame-avoidance and credit taking. We will also conceptualize centralization between and within governments and lay out the conceptual frameworks which have guided this research. It is almost axiomatic in political science that politicians seek credit and avoid blame. If there is something that will be popular, they try to take credit for it; and if there is something unpopular, they will try to avoid blame and, if possible, cast blame for it onto opponents. If good or bad outcomes cannot be traced to their actions, they will try to change the subject and opt for ‘position-taking' in which they declare their fidelity to what they see as popular positions. This was the strategy adopted by many politicians of the populist radical right around the world during the pandemic, though as the pandemic wore on the ones out of power increasingly focused on blaming incumbent governments for public health measures. Centralization between governments means an increase in the power of the central government vis-a-vis other ‘subnational' governments such as regions, states, provinces, or municipalities. ‘Command and control' is a common recommendation in public health emergencies and central governments do often take powers over or away from subnational governments in crises. This is most politically contentious in federal states such Spain, Canada, or Germany, but can happen even in countries where there is a history of only local government (such as Ireland, Portugal, or the Nordic states).

141 New Guidelines to Reduce Unnecessary Blood Tests, Delayed Discharge and Costs Following Robot Assisted Radical Prostatectomy

Objectives

Routine postoperative blood tests (POBT) following robot assisted radical prostatectomy (RARP) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.

Method

The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed to form new guidelines. The new guidelines were prospectively validated in a sample of 300 patients.

Results

Derivation Dataset: 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 day due to delayed or incomplete blood tests. Validation Dataset: No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. Number of POBT requested reduced by 73% (p &lt; 0.001). The new guidelines improved POBT sensitivity for complications from 98% to 100% and specificity from 0% to 74%. Discharge delays reduced from 6% to 0% (p = 0.008). Cost savings were £178 per patient.

Conclusions

Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.

Audit of waist measurement methods during statutory diving medical assessments

BACKGROUND

Measurement of waist circumference is used to assess abdominal fat and risk of heart disease, type 2 diabetes, cancer and stroke. It is performed in several clinical settings for health promotion and medical assessment purposes, including statutory medical assessments where results may influence decisions on fitness to work. Under the Diving at Work Regulations 1997, working divers must have an annual assessment of their fitness to dive performed by an approved medical examiner of divers (AMED), appointed by the Health and Safety Executive (HSE). The assessment includes measurement of height, weight and waist circumference, the latter used as an indicator of central adiposity and associated health risks.

AIMS

To establish the practice of AMEDs in measuring waist circumference of working divers undergoing medical assessment to determine their fitness to dive.

METHODS

Ninety-seven AMEDs were sent a questionnaire and asked to describe their current practice in measuring waist circumference. The response rate was 79%. The audit standard used was the consensus document published by the World Health Organization (WHO).

RESULTS

Of the 77 responses, 76 were completed sufficiently to allow analysis. When the waist was measured, there was consistency in the diver's level of clothing, stage of breathing and posture for the procedure but variability in the site of measurement. Only 7/76 (9%) respondents carried out waist measurement fully in line with WHO guidance.

CONCLUSIONS

The audit has identified that there is a need for guidance for AMEDs on measuring waist circumference in the statutory medical assessment of working divers.

O50 New guidelines to reduce unnecessary blood tests, delayed discharge and costs following robot assisted radical prostatectomy

Introduction

Routine postoperative blood tests (POBT) are used to evaluate the impact of surgery on pre-existing co-morbidities and to detect early complications. This practice dates back to an era of open surgery, when blood loss and complication rates were higher. We propose new guidelines to improve the specificity of POBT.

Method

The cases of 1040 consecutive patients who underwent a primary or salvage RARP at two large tertiary urology centres in the United Kingdom were retrospectively reviewed, and new guidelines were designed. The guidelines were prospectively validated in a cohort of 300 patients.

Result

Derivation Dataset 3% and 5% had intra- and post-operative Clavien-Dindo complications, respectively. 15% had clinical concerns postoperatively. 0.9% required perioperative transfusion. 78% had routine blood tests without clinical concerns, none of whom developed a complication. 98% of complications were suspected by clinical judgement. 6% of patients had a discharge delay of ≥ 1 days due to delayed or incomplete blood tests.

Validation Dataset No significant difference existed in complication, clinical concern or transfusion rates between the derivation and validation datasets. New guidelines improved sensitivity for complications from 98% to 100% and specificity from 0% to 74%. The number of blood tests requested reduced by 73% (P &lt; 0.001). Discharge delays reduced from 6% to 0% (P = 0.008). Cost savings were £178 per patient.

Conclusion

Postoperative complications and transfusion following RARP are rare. Routine POBT without clinical indication are unnecessary and inefficient. A guideline-based approach to POBT can reduce costs and optimise discharge without compromising patient safety or care.

Take-home Message

Routine postoperative blood tests following robot assisted radical prostatectomy are often unnecessary. A guideline-based approach can reduce costs and optimise patient care.

The influence of assisted ventilation and recumbency on cardiorespiratory physiology in the anesthetized freshwater turtle Trachemys scripta scripta

The use of assisted ventilation is required in anesthetized reptiles as their respiratory drive is lost at surgical depths of anesthesia. The minute volume of the assisted ventilation influences arterial blood gases and acid-base regulation. Meanwhile, the ventilatory pattern may also affect hemodynamics in chelonians, which, given their large capacity for cardiac shunts, may impact the efficacy of the ventilation in terms of gas exchange. Hence, there is a need for primary information on the influence of assisted ventilation on chelonian physiology, and we, therefore, performed a randomized study into the effects of recumbency and maximum airway pressure on pressure-cycled ventilation in nine female Trachemys scripta scripta. Pronounced effects of ventilation pressure on arterial PCO₂ and pH regardless of recumbency were revealed, whilst dorsal recumbency led to a larger Arterial-alveolar (A-a) O₂ difference, suggesting compromised pulmonary gas exchange. Plasma [Na⁺] and [K⁺] balance was also significantly correlated with maximum airway pressure. Computed tomography (CT) scanning at a range of end-inspiratory pressures and ventral and dorsal recumbencies in eight T. scripta scripta showed that lung volumes increase with maximum ventilatory pressure, while recumbency did not influence volume at pressures above 5 cmH₂O. Static compliance of the lungs was influenced by recumbency at neutral pressures. In conclusion, dorsal recumbency reduces pulmonary efficacy during positive pressure ventilation and tends to lower lung volume when ventilation is not provided. However, lung volumes and function - even in dorsal recumbency - can be adequately supported by assisted ventilation, and an end inspiratory pressure of 10 cmH₂O at 4 breaths min^-1 provided the most physiologically appropriate ventilation of anesthetized T. scripta scripta.

POS1097 TREATMENT KNOWLEDGE AND PREFERENCES FOR BLACK PEOPLE WITH HIP AND KNEE OSTEOARTHRITIS: A SYSTEMATIC LITERATURE REVIEW AND META-ANALYSIS

Background:

Black people are less likely to undergo total joint arthroplasties, despite reporting more severe symptoms. (1) While racial disparities exist in treatment utilization for osteoarthritis, comprehensive studies of the treatment preferences of Black people have not been conducted.

Objectives:

The purpose of this manuscript is to systematically review the literature and identify Black osteoarthritis patients’ treatment preferences to understand how they may contribute to racial differences in the utilization of different treatment options.

Methods:

Searches ran on April 8, 2019 and April 7, 2020 in the following databases: Ovid MEDLINE (ALL - 1946 to Present); Ovid EMBASE (1974 to present); and The Cochrane Library (Wiley). Using the Patient/Population-Intervention-Comparison/Comparator-Outcome (PICO) format, our population of interest was Black people with hip and/or knee osteoarthritis, our intervention was preferences and opinions about treatment options for osteoarthritis, our comparator was white people with hip and/or knee osteoarthritis, and our outcome was preferences of osteoarthritis therapies. The protocol was registered under the PROSPERO international register, and the Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results:

Searches across the chosen databases retrieved 10,894 studies after de-duplication, 182 full text, and 31 selected for inclusion in this review. Black people were less likely to use NSAIDs or narcotic analgesics compared to white people. (Figure 1) Black people were more likely than white people to use spirituality and prayer, as well as topical treatments. Utilization of meditation, supplement/vitamin use, and hot/cold treatments was not significantly different between groups. Black people were less willing than white people to consider or undergo joint replacements, even if the procedure was needed and recommended by a physician.

Conclusion:

Racial differences persist in OA care across the spectrum of options. Future interventions should focus on providing accessible information surrounding treatment options and targeting perceptions of the importance of joint health.

References:

[1]Suarez-Almazor ME, Souchek J, Kelly PA, et al. Ethnic Variation in Knee Replacement: Patient Preferences or Uninformed Disparity? Arch Intern Med. 2005;165(10):1117-1124. doi:10.1001/archinte.165.10.1117

Figure 1.

Meta-analysis describing the odds ratios of Black people using NSAIDs and Narcotic Analgesics compared to white people

Disclosure of Interests:

Collin Brantner: None declared, Diyu Pearce-Fisher: None declared, Carine Moezinia: None declared, Haley Tornberg: None declared, John FitzGerald: None declared, Michael Parks Consultant of: Zimmer Biomet, Peter Sculco Consultant of: EOS Imaging, Intellijoint Surgical, DePuy Synthes, Lima Corporate, Cynthia Kahlenberg: None declared, Curtis Mensah: None declared, Ajay Premkuar: None declared, Nicholas Williams: None declared, Michelle Demetres: None declared, Susan Goodman Consultant of: UCB, Grant/research support from: Novartis, Horizon Therapeutics.

Cardiac rehabilitation is associated with lower 1-year all-cause mortality in primary pulmonary hypertension

Funding Acknowledgements

Type of funding sources: None.

Background. Despite introduction of pharmacological therapies to improve outcomes of pulmonary hypertension (PH), poor long-term survival remains present. Cardiac rehabilitation may be an alternative strategy to improve survival. However, no study directly linked CR to mortality in PH patients. Therefore, adopting a retrospective observational study using a large electronic medical record (EMR) database, the objective of this study was to compare mortality between patients with primary PH with CR versus a propensity-matched control group of PH without CR.

Methods. The retrospective analysis was conducted on December 14, 2020 using anonymized data within TriNetX, a global federated health research network with access to EMRs from participating academic medical centres, specialty physician practices, and community hospitals, predominantly in the United States. All patients were aged ≥18 years with primary PH recorded in EMRs at least 18-months before the search date to allow for 1-year follow-up from CR. Using logistic regression, patients with PH with an EMR of CR were 1:1 propensity score-matched with PH patients without CR for age, sex, race, diseases of the respiratory system, disease of the circulatory system, hypertensive disease, heart failure, diabetes mellitus, chronic kidney disease, cerebrovascular disease, cardiovascular procedures and cardiovascular medications.

Results. In total, 70,875 patients with primary PH met the inclusion criteria for the control group and 637 patients with primary PH met the inclusion criteria for the CR and exercise cohort (Table 1). Using the propensity score-matched cohort, and excluding patients with outcomes outside the measurement window, mortality at 1-year from CR was proportionally lower with mortality of 13.9% (n = 87 of 628 patients) in the CR and exercise cohort compared to 21.0% (n = 133 of 632 patients) in the controls (OR 0.60, 95% CI 0.45-0.81).

Conclusion. In conclusion, the present study of 1,264 patients with primary PH suggests that CR is associated with 40% lower odds of 1-year mortality, when compared to propensity score-matched patients without CR or exercise programmes.

Abstract Figure.

791 Association of Obstructive Sleep Apnea Severity and Novel Plasma Biomarkers of Alzheimer’s Disease Pathology

Introduction

Recent evidence suggests novel plasma Alzheimer’s Disease (AD) pathology biomarkers have high potential for AD risk prediction. We determined whether obstructive sleep apnea (OSA) severity is associated with plasma levels of Aβ40, Aβ42, Aβ42/Aβ40, Tau, tau/Aβ42 and NfL and whether this relationship is dependent of amyloid burden.

Methods

Cross-sectional analysis of baseline data from 120 community-dwelling, cognitively normal older-adults, selected from ongoing NYU prospective longitudinal studies on memory, sleep and aging. Of the 120 participants, 70 had baseline CSF-Aβ42 (measured using ELISA). OSA-severity was defined using AHI4% criteria. Levels of plasma Aβ40, Aβ42, Tau and NfL were determined using single molecule array technology ultra-sensitive assays. Associations of OSA-severity and plasma AD-biomarker levels (n=120) were assessed using Pearson correlation analysis. The association of OSA-severity and AD plasma biomarkers dependent on CSF-Aβ42 levels (n=70) was assessed using generalized linear models. Analyses were adjusted for age, sex, BMI, race, education and APOE4.

Results

Of the 120 participants, 80 (67%) were women. Mean (SD) age was 69.1 (7.2) years. Mean (SD) AHI was 14.3/hr. (16.3) {48 (40%) had AHI &lt;5, 30 (25%) had AHI: 5 to ≤ 15, 18 (15%) had AHI: 15 to ≤30, and 22 (18%) had AHI &gt;30}. Independent of amyloid-burden, OSA-severity was associated with higher levels of plasma Aβ40 (r=.21, p-value=.02), plasma Aβ42 (r=.26, p-value=.01), plasma Aβ42/Aβ40 (r=.20, p-value=.05), but not plasma Tau, plasma tau/Aβ42 or plasma NfL. The association of OSA-severity and plasma levels of Tau, Tau/Aβ42 or NfL dependent on CSF-Aβ42 levels revealed significant interactions between CSF-Aβ42 levels and AHI (p-value &lt;.05 for all), with β-estimates suggesting that with combined increases in AHI and decreases in CSF-Aβ42 levels, there were corresponding increases in plasma levels of Tau, plasma Tau/Aβ42 or plasma NfL. The analysis was not powered for generating dichotomized strata specific (i.e. OSA+/Aβ+, OSA+/Aβ-, OSA-/Aβ+ and OSA-/Aβ-) estimates.

Conclusion

In this sample of cognitively-normal older- adults, OSA-severity was associated with levels of plasma Aβ40, Aβ42, Aβ42/Aβ40 and showed a synergistic effect with CSF Aβ42 on plasma levels of tau and NfL. Larger cohorts are necessary to delineate mechanisms and examine for OSA/Aβ strata-specific estimates.

Support (if any)

NIH/NIA/NHLBI (L30-AG064670, CIRAD-P30AG059303-Pilot, NYU-ADRC-P30AG066512-Developmental-Grant, AASM#231-BS-20)