Assessment of Readmission Risk Factors after Index Hospital Discharge for Covid-19 Patients

INTRODUCTION: During the COVID-19 pandemic, the burden on the healthcare system makes it critical to examine readmission patterns. In this study, we evaluated the readmission rates and risk factors associated with COVID-19 from the large SCCM Discovery VIRUS: COVID-19 Registry. METHOD(S): This was a retrospective, cohort study including hospitalized adult patients from 181 hospitals in 24 countries within the VIRUS: COVID-19 Registry. Demographic, clinical, and outcome data were extracted and divided into two groups: Patients with readmission with COVID-19 in 30 days from discharge and those who were not. A univariate analysis is done using chi-square and t-test as appropriate. Multivariable logistic regression was used to measure risk factor associations with 30-day readmission. RESULT(S): Among 20,283 patients, 1,195 (5.9%) were readmitted within 30 days from discharge. The median (IQR) age of readmitted patients was 66 (55-78) years and 45.2% were female, 60.2% were white, and 78.9% non-Hispanic. Higher odds of readmission were observed in patients aged >60 vs 18-40 years (OR 2.76;95% CI, 2.23-3.41), moderate COVID-19 disease (WHO Ordinal scale 4-5) vs Severe COVID-19 (WHO Ordinal scale 6-9) (OR 1.23;95% CI, 1.10-1.39), no ICU admission at index hospitalization (OR 1.70;95% CI, 1.32-1.80), and Hospital length of stay <=14 vs >14 days (OR 1.53;95% CI, 1.32-1.80) vs those not readmitted (p= < 0.001). Comorbidities including coronary artery disease (OR 2.14;95% CI 1.84-2.48), hypertension (OR 1.58;95% CI 1.40-1.78), congestive Heart Failure (OR 2.54;95% CI 2.16-2.98), chronic pulmonary disease (OR 2.26;95% CI 1.94-2.63), diabetes (OR 1.32;95% CI 1.17-1.49) or chronic kidney disease (CKD) (OR 2.41;95% CI 1.2.09-2.78) were associated with higher odds of readmission. In multivariate logistic regression adjusted for age group, hospital length of stay <=14 days and, highest WHO COVID-19 ordinal scale and index ICU admission coronary artery disease, congestive heart failure, chronic pulmonary disease, chronic kidney disease, hospital length of stay <=14 days and age >60 years remained independent risk factors for readmission within 30 days. CONCLUSION(S): Among hospitalized patients with COVID-19, those readmitted had a higher burden of comorbidities compared to those non-readmitted.

Development of a colorectal cancer screening intervention for Alaska Native people during a pandemic year.

Objectives: Alaska Native (AN) people experience twice the rate of colorectal cancer (CRC) as US Whites. There is a need for increased screening and early detection. We describe the development and implementation of a randomized controlled trial of the multi-target stool DNA test (mt-sDNA; Cologuard® Exact Sciences, Madison WI) to increase CRC screening among AN people. Methods: A total of 32 rural/remote AN communities were randomized to a varied intensity intervention (patient navigation vs mailed health education) compared to 14 communities receiving usual opportunistic care. Outcome measures include screening completion and method used (mt-sDNA vs colonoscopy). Health care provider interviews and AN patient focus groups will be used to assess patient-, provider-, and system-level CRC screening promoters and barriers. Results: The study began in April 2020 during the COVID-19 pandemic, resulting in a number of challenges and study adaptations. These included difficulty finding laboratory space, lack of timely mail service due to flight reductions across the state, and travel restrictions that led to postponement of in-person focus groups. Videoconferencing platforms for Tribal engagement replaced face-to-face interactions. After an extensive search, a laboratory with space available was identified and the preprocessing laboratory established. Study staff will work closely with patients to monitor mail service to get mt-sDNA kits sent on time. We are also exploring the use of videoconferencing platforms as alternatives to in-person focus groups. Conclusions: Despite the challenges encountered during the COVID-19 pandemic, we successfully initiated the intervention and established the first mt-sDNA preprocessing laboratory in Alaska.

Improving access to cancer clinical trials for patients from CALD backgrounds whose preferred language is not English - Results of a National Survey in Australia (Current Resources)

INTRODUCTION AND OBJECTIVES: Despite Australia having an extremely diverse population, research demonstrates that cancer patients from culturally and linguistically diverse ('CALD') communities are underrepresented in clinical trials. To inform future policy and strategy to address this inequity, we completed a national survey of the Australian clinical trials workforce evaluating current resources to address this issue, identified barriers and preferred solutions. This reports current resources in place. METHODS: An online survey was created using Redcap comprising a mix of 15 closed and open-ended items with an estimated completion time of 20 minutes. The survey was emailed to members of two peak bodies for oncology clinicians in Australia, the Clinical Oncology Society of Australia (COSA) and the Medical Oncology Group of Australia (MOGA) and all major cancer cooperative trial groups (12) in Australia. The survey was also promoted by the study team to relevant individuals and online via Twitter. Quantitative analysis was performed using Microsoft Excel and qualitative analysis of free text entries was performed using NVivo. RESULTS: 91 respondents completed the questionnaire, with representatives from each state - the majority of respondents were from NSW (53%) and Victoria (31%). 68% were clinicians and 16% were clinical trial coordinators. 55% of respondents reported that their trial catchment was comprised of over 20% patients from a CALD background - however, 62% reported that less than 20% of their trials had included CALD participants in the previous 12 months. 74% of respondents reported that their units do not routinely collect data on preferred language or ethnic background of trial patients. Qualitative analysis showed that the only resource routinely available to sites are in person interpreters used in standard of care, which additionally, have been difficult to access during the COVID pandemic leading to only phone interpreters. CONCLUSIONS: This representative survey of the Australian cancer clinical trials workforce confirms an ongoing inequity with disproportionately lower numbers of CALD patients on enrolled in cancer clinical trials compared to the catchments served. Most respondents stated that CALD data is not routinely collected, which inhibits ongoing monitoring of this issue. We did not find evidence of existing specific resources in place to support recruitment of CALD populations, apart from standard of care interpreters.

Everychild

It should have been their senior year. Everychild was seventeen going on a hundred, what with everything that lay ahead. They were pale after months chained to their laptop, pale and blond and exceedingly white, though this too galled them, to be no more than an ally as the world went up in flames. Time to think about college applications, their parents began to chirp in October, Covid month seven “What’s the point?” Everychild’s voice was flat. “We’ll all be climate refugees, and you’ll be dead.” Afterward, Mom and Dad cast their minds back. Was there a precise moment, some tipping point they’d missed? Time had become so folded upon itself that year. Perhaps it began right after the Day No One Could Breathe. When the birds, disoriented, failed to lift into the orange-black sky. When they and Everychild and Younger Brother all woke to the same suffocating murk, six months into the pandemic. It coated them inside and out: skin, feathers, alveoli. The entire state of California was aflame, Silicon Valley run aground on the Exxon Valdez. Outside was the world they had made, both visible and invisible: smoke and ash and fire and virus. They couldn’t leave the house, even if they hadn’t been sheltering in place. They couldn’t even step into the yard. The pool water was slick with platinum ash. © 2022, Missouri Review. All rights reserved.

Long-term ecological research and the COVID-19 anthropause: A window to understanding social-ecological disturbance.

The period of disrupted human activity caused by the COVID-19 pandemic, coined the "anthropause," altered the nature of interactions between humans and ecosystems. It is uncertain how the anthropause has changed ecosystem states, functions, and feedback to human systems through shifts in ecosystem services. Here, we used an existing disturbance framework to propose new investigation pathways for coordinated studies of distributed, long-term social-ecological research to capture effects of the anthropause. Although it is still too early to comprehensively evaluate effects due to pandemic-related delays in data availability and ecological response lags, we detail three case studies that show how long-term data can be used to document and interpret changes in air and water quality and wildlife populations and behavior coinciding with the anthropause. These early findings may guide interpretations of effects of the anthropause as it interacts with other ongoing environmental changes in the future, particularly highlighting the importance of long-term data in separating disturbance impacts from natural variation and long-term trends. Effects of this global disturbance have local to global effects on ecosystems with feedback to social systems that may be detectable at spatial scales captured by nationally to globally distributed research networks.

The impact of COVID-19 on rural treatment-seeking families with children with overweight or obesity.

To examine the early impact of the COVID-19 pandemic on rural parental stress and family behaviors, parents who participated in a 2nd-4th grade pediatric obesity intervention completed a survey in May 2020. Parents (N=77) experienced 7.8±2.7 events on the COVID-19 Exposure and Family Impact Scales (CEFIS) with an average impact of 2.5±0.5, with many parents reporting moderate stress (73%). Parental stress was predictive of personal well-being getting 'worse' while loss of income events were predictive of family routines getting 'better.' Professionals working with rural families may want to assess for these factors when promoting positive changes in family health behaviors.

School considerations for children with heart disease during the COVID-19 pandemic.

This article presents data on Coronavirus disease (COVID-19)-related learning, health, and mental health concerns of 134 families of children with heart disease (HD), the most common birth defect, who are followed by a unique hospital-based Educational Achievement Partnership Program (EAPP) designed to serve as a liaison across the family, the child's medical team, and school. At-school, remote, and hybrid learning alternatives prompted by the COVID-19 pandemic presented families with an especially complex decision to make for children with HD due to competing complications in this population: Increased susceptibility to illness, greater risk of neuropsychological problems, and higher level of individualized education services that are not readily transferable to a home learning platform. Parents of school-aged children with HD completed a survey about COVID-19-related school support needs as part of a quality improvement project. Survey results revealed 51% of children would learn from home during the 2020-2021 school year due to concerns about the child's underlying health condition, indicating a marked change in schooling modality compared to prior years (4% in 2019). Nearly 75% of families requested medical guidance for COVID-19-related school health and education plan addendums. Seventy-three percent of families had mental health concerns about their child; severity of HD was related to families' reports about mental health concerns. Findings suggest follow-up is needed by school psychologists and medical consultative collaborative partners to support the transition back to in-person schooling after the COVID-19 pandemic concludes and to identify long-term educational consequences of disrupted learning during this period. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Weight loss in primary care: A pooled analysis of two pragmatic cluster-randomized trials.

OBJECTIVE: The aim of this study was to report the results of five weight-loss interventions in primary care settings in underserved patients and to compare the level of pragmatism across the interventions using the Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2) tool. METHODS: Data from 54 primary care clinics (2,210 patients) were pooled from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) and Rural Engagement in Primary Care for Optimizing Weight Reduction (REPOWER) cluster-randomized trials. Clinics were randomized to one of five comparators: PROPEL usual care, PROPEL combination of in-clinic and telephone visits, REPOWER in-clinic individual visits, REPOWER in-clinic group visits, or REPOWER telephone group visits. RESULTS: At 24 months, weight loss (kilograms) was -0.50 (95% CI: -1.77 to 0.76), -3.05 (-4.10 to -2.01), -4.30 (-5.35 to -3.26), -4.79 (-5.83 to -3.75), and -4.80 (-5.96 to -3.64) in the PROPEL usual care, REPOWER in-clinic individual visits, REPOWER telephone group visits, REPOWER in-clinic group visits, and PROPEL in-clinic and telephone visits arms, respectively. At 24 months, percentage of weight loss was -0.360 (-1.60 to 0.88), -3.00 (-4.02 to -1.98), -4.23 (-5.25 to -3.20), -4.67 (-5.69 to -3.65), and -4.69 (-5.82 to -3.56), respectively, in the five arms. The REPOWER in-clinic individual visits intervention was the most pragmatic and reflects the current Centers for Medicare and Medicaid Services funding model, although this intervention produced the least weight loss. CONCLUSIONS: Clinically significant weight loss over 6 months in primary care settings is achievable using a variety of lifestyle-based treatment approaches. Longer-term weight-loss maintenance is more difficult to achieve.

Oncology clinical nurse specialist versatility: Ensuring a safer, continued day oncology environment throughout COVID

Background: The COVID pandemic has forced organisations to adapt to restrict spread of the virus while continuing to function. Oncology Clinical Nurse Specialists (CNS) have been forefront in these endeavours, often below the radar, ensuring coordination and administration of complex care. Nursing / Midwifery National Planning & Development Unit funding was awarded for a "task versatile" (tv) CNS in 2019 to focus on non ED direct access to a CNS. The key areas of this analysis were telephone triage and the ability of tvCNS COVID screening pre-chemotherapy visits to maintain a safe environment. Methods: Changes in primary roles of individual oncology CNS posts were recorded for 1/20 to 12/20. Data on the activity of the varied adaptive roles of the CNS were captured from the hospital information systems. All patients attending for chemotherapy were contacted 24 hours prior to their planned visit for chemotherapy to screen for COVID symptoms. Patients on arrival for chemotherapy were screened again prior to being allowed up to the chemotherapy unit. Those with concerning COVID symptoms were referred for COVID testing. Activity numbers were recorded by the tvCNS. Results: Nurse-lead telephone triage (NLTT) was assessed from 1/20 to 12/20. From the outbreak of COVID on 1/3/20 the "tv"CNS moved from the NLTT to that of COVID screening / risk reduction. A new CNS was appointed to continue NLTT. Of the 1837 telephone calls received requesting help from 1/20 to 12/20, 93% were resolved by the triage nurse, with only 121 cases attending the ER. In that time period 1304 individual patients made 11606 attendances to the oncology day unit for treatment. From 3/20 to 12/20 COVID pre-screening was performed for 10,417 patient visits. Screening was performed by phone the day before attendance, and on arrival on the day of planned treatment. 133 patients required COVID swab in view of symptoms. No day unit linked outbreaks of COVID occured. Conclusions: The COVID pandemic has demonstrated that versatility is essential in adjusting to the ever-changing scenarios which arise during peaks and troughs of COVID outbreaks. The broad skill mix within specialist oncology nursing were key to such adaptations, allowing continued availability of essential anti-cancer therapies. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Maintaining intravenous anti-cancer systemic therapy during COVID: Pharmacy and nursing factors

Background: The COVID-19 pandemic has impacted many aspects of the practice of oncology around the world. COVID was first detected in Ireland on 29/2/20. Many oncology units saw dramatic changes in activity in the face of rising infection rates. We aim to assess compare pharmacy activity, day unit systemic therapy adminstration and nursing staffing levels during the pre- and COVID periods. Methods: Hospital information systems were used to retrieve numbers of patients attending, numbers and types of items dispensed by pharmacy, and available nurses to deliver the systemic therapies from March 2019 to Feb. 2021. The data was analysed to identify trends in prescribing and dispensing practices for this period. Supportive medications such as anti-emetics, bisphosphosphonates were not included. Subgroup analysis on numbers of chemotherapy, immunotherapy, monoclonal antibody drugs dispensed per month was performed. A paired t-test was used to compare means. Results: 9410 non-clinical trials and 411 clinical trials items were dispensed from March 2019 until February 2020 (pre-COVID) for 11,606 patient attendances. From March 2020 until February 2021 (COVID period), 8931 non-clinical trials and 826 clinical trials items were dispensed for 10818 patient attendances. The mean number of non-clinical trials items dispensed per month were 784 and 744 respectively, with no statistical difference being found (p=0.11). There was a doubling in the number of clinical trials agents dispensed. The mean number of nurses available to administer therapies per day was 5.7 (SD=0.78) compared to the projected 7.8 WTE (whole time equivalents) ideally required. [Formula presented] Conclusions: Despite COVID restrictions it was possible to administer comparable numbers of cancer treatments throughout the COVID period, when compared to the previous year despite modest nursing staff numbers due to the dedication and selflessness of nursing, oncologists and oncology pharmacy staff. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Just-In-Time Simulation Training for Nasopharyngeal Specimen Collection During the SARS-CoV-2 Pandemic.

INTRODUCTION: Rapid and accurate detection of the novel coronavirus using a nasopharyngeal specimen requires training for professionals who may have limited experience. To respond to the urgent need, an interprofessional team created a just-in-time (JIT) module to provide only what was needed, precisely when needed, and rapidly deployed training sessions to a large group of health professionals. METHODS: In April and May 2020, health professionals from the hospital, ambulatory clinics, and public health attended training. Procedural comfort/knowledge and perception of the training were assessed with pre-survey and post-survey. RESULTS: Comfort level in collecting a nasopharyngeal specimen among participating health professionals increased from 2.89 (n = 338) on the pre-survey to 4.51 (n = 300) on the postsurvey on a 5-point scale. Results revealed a significant difference (P < .01) between pre-post knowledge questions regarding the correct angle and depth of the swab to obtain an adequate sample from the nasopharynx. DISCUSSION: This study demonstrates that a JIT intervention can improve knowledge and comfort regarding the nasopharyngeal swab procedure. In preparation for the prevention and mitigation of future viral outbreaks (ie, coronavirus and influenza), educators should consider creating JIT skills training for health care professionals who may be deployed to assist in mass testing efforts.

Dietary fibre to reduce colon cancer risk in Alaska Native people: the Alaska FIRST randomised clinical trial protocol.

INTRODUCTION: Diet, shown to impact colorectal cancer (CRC) risk, is a modifiable environmental factor. Fibre foods fermented by gut microbiota produce metabolites that not only provide food for the colonic epithelium but also exert regulatory effects on colonic mucosal inflammation and proliferation. We describe methods used in a double-blinded, randomised, controlled trial with Alaska Native (AN) people to determine if dietary fibre supplementation can substantially reduce CRC risk among people with the highest reported CRC incidence worldwide. METHODS AND ANALYSES: Eligible patients undergoing routine screening colonoscopy consent to baseline assessments and specimen/data collection (blood, urine, stool, saliva, breath and colon mucosal biopsies) at the time of colonoscopy. Following an 8-week stabilisation period to re-establish normal gut microbiota post colonoscopy, study personnel randomise participants to either a high fibre supplement (resistant starch, n=30) or placebo (digestible starch, n=30) condition, repeating stool sample collection. During the 28-day supplement trial, each participant consumes their usual diet plus their supplement under direct observation. On day 29, participants undergo a flexible sigmoidoscopy to obtain mucosal biopsy samples to measure the effect of the supplement on inflammatory and proliferative biomarkers of cancer risk, with follow-up assessments and data/specimen collection similar to baseline. Secondary outcome measures include the impact of a high fibre supplement on the oral and colonic microbiome and biofluid metabolome. ETHICS AND DISSEMINATION: Approvals were obtained from the Alaska Area and University of Pittsburgh Institutional Review Boards and Alaska Native Tribal Health Consortium and Southcentral Foundation research review bodies. A data safety monitoring board, material transfer agreements and weekly study team meetings provide regular oversight throughout the study. Study findings will first be shared with AN tribal leaders, health administrators, providers and community members. Peer-reviewed journal articles and conference presentations will be forthcoming once approved by tribal review bodies. TRIAL REGISTRATION NUMBER: NCT03028831.

A Novel Just-In-Time-Online-Training for Nasopharyngeal Swab Specimen Collection During the COVID-19 Pandemic.

INTRODUCTION:  The spread of coronavirus disease 2019 (COVID-19) is controlled by timely detection of infected patients using a nasopharyngeal (NP) swab test, followed by isolation and treatment. One challenge encountered with NP swab collection was to train healthcare providers (HCPs) with different training backgrounds and experience for collecting NP swab specimens across Nebraska, including a sizeable rural area. In-person training for NP swab collection skills was challenging due to social distancing. We developed a Just-In-Time-Online Training (JITOT) and delivered it using Facebook Live (TM) to meet our HCPs' training needs. METHODS:  Online training was held on April 21, 2020, and attended by 453 HCPs. A quasi-experimental study based on a survey and a multiple choice questionnaire (MCQ) was conducted to evaluate its effectiveness in improving the participants' knowledge and attitudes. RESULTS:  Group mean knowledge score increased from a pre-test score of 57%-95% in the post-test showing a large effect size (Hedges' g = 0.976877). On a five-point Likert scale, the majority (86.21%) of the survey respondents agreed/strongly agreed that this training increased their overall comfort for nasal swab specimen collection as compared to their pre-training comfort (37.93%) with this procedure. The majority of respondents (96.55%) in the post-training evaluation agreed/strongly agreed that "the delivery method was appropriate." CONCLUSION:  A JITOT session is helpful to teach, demonstrate, clarify doubts, and improve the knowledge and comfort of the participants. It can be quickly delivered using a free social media platform for broader outreach during public health emergencies.

Transmission Based Precaution Practices among Nurses in Edo State, Nigeria during COVID-19 Pandemic.

The novel covid-19 pandemic is a highly infectious disease without known specific treatment and vaccine. Transmission based precautions are important in the fight against the virus. This study investigated the level of transmission-based precautions practiced, the predictors of correct practices, and the challenges experienced by nurses in public health facilities in Edo State during the outbreak of the Covid-19 pandemic. The study employed a descriptive cross-sectional survey to elicit responses from 367 front line nurses using a Google online questionnaire. Data analysis involved descriptive statistics and logistic regression analysis. The majority 314(85.6%) of the respondents maintained a good level of transmission-based precautions practice. Hand hygiene was performed by 327(89.1%) of the respondents. Academic qualification was a significant predictor of good practice in favour of respondents with a degree in nursing. Challenges identified were lack of financial motivation, fear of infecting family members and fear of contracting the virus (93.5%). It was concluded that nurses in Edo State Nigeria have good transmission- based practices in relation to covid-19 however efforts should be made to ensure 100% compliance and sustain practices.

Delivery of systemic anti-cancer therapy during the COVID-19 pandemic

Background: The delivery of systemic anticancer therapy during the COVID-19 pandemic is extremely challenging. Increased hospital visits and active anticancer therapy have been described as risk factors for developing more severe infection. In order to balance the benefits of continuing anticancer therapy with these risks, we undertook a series of system changes in the delivery of cancer care. We examined the rate of COVID-19 infection in patients attending for systemic anticancer treatments and the impact of COVID-19 on therapy delivered at our oncology dayward. Methods: Patients who attended our dayward over a 4 month period were included. Data were obtained from electronic patient records and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 infection at two separate timepoints: the day prior to their visit via telephone, and using a symptom questionnaire given in a preassessment area on arrival at the hospital. This area was established so that patients didn't have to transit through the main hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab was arranged. Results: A total of 456 patients attended from January 1st to April 30th. During this time there were 2369 patient visits to the oncology dayward and 1953 intravenous therapies administered. 416 (18%) visits did not lead to treatments, 114 (27%) of which were scheduled non-treatment visits. 194 (47%) treatments were held due to disease-related illness and 108 (26%) treatments were held due to treatment-related complications. 19 patients were identified as having COVID-19 symptoms via telephone screening. 34 patients were symptomatic on arrival at our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week. Overall, 53 treatments were held due to the screening process. Conclusions: With the introduction of a new patient screening pathway, there have been few treatment disruptions due to the COVID-19 pandemic. The overall rate of symptomatic COVID-19 infection appears low in those who continue on active treatments with regular hospital visits. With careful systematic changes, it is feasible to continue to safely deliver systemic anticancer therapy during the COVID-19 pandemic. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.