scholarly journals 896 Fighting the war against COVID-19: administration of bamlanivimab (BAM) or bamlanivimab + etesivimab (BAM + E); a cooperative effort between a community cancer center and an urgent care (UC) facility

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A940-A940
Author(s):  
Patrick Skeffington ◽  
Robert Aisenberg ◽  
Janice Dallacosta ◽  
Ian Donaghy ◽  
Dani Hackner ◽  
...  
Keyword(s):  
High Risk ◽  
Rhode Island ◽  
Severe Disease ◽  
Admission Rate ◽  
Vulnerability Index ◽  
Urgent Care ◽  
Cancer Center ◽  
Social Vulnerability Index ◽  
Cooperative Effort ◽  
Hospital Admission Rate

BackgroundGoal of the Massachusetts DPH is to ensure equitable distribution of BAM to the most vulnerable at risk of poor outcomes from COVID-19 and to communities with the highest incidences of COVID-19. Hospitals should allocate available doses in a manner consistent with this guidance:1. Patients who meet the EUA criteria; a lottery system will be used if supply is exceeded 2. Patients with comorbidities (high risk) tend to have worse outcomes when infected with SARS-CoV-2 3. BAM was approved under an EUA for the treatment of mild to moderate COVID-19 for those at high risk of progressing to severe disease (revoked 4/16/21). 4. BAM + E combo was approved under an EUA for the same patients and criteria, Southcoast Health entered into this relationship with DPH to provide this service to the southeastern MA population.MethodsPatients identified based on algorithm using Social Vulnerability Index (SVI) and EUA criteriaRNs screened cases for positive criteria using lottery priority and SVIPulmonologists consented appropriate patients, ordered infusions, routed cases for final scheduling within window of treatmentExperienced nursing staff from various Southcoast departments treated up to 6 patients per dayOncology pharmacies are uniquely experienced to prepare monoclonal antibodies (MABS) such as BAM and BAM + EDue to proximity of the Oncology pharmacy to the UC Center, pharmacy reviewed, prepared and delivered infusions to UC once patient was assessed by RNsResultsFirst 152 cases: 7.2% inpatient admissions within 14 days13.8% ED/UC visits within 14 days2% inpatient admissions in 28 days5.9% ED/UC visits within 28 daysTwo deaths during initial 152 cases.ConclusionsCooperative effort between the Cancer Center and Urgent Care led to positive outcomes for local COVID-19 patients. Southcoast demonstrated a 6% hospital admission rate for COVID-19 patients in the MAB program versus 26% admission rate overall for COVID-19 patients.AcknowledgementsThanks to our colleagues at the University of Rhode Island College of Pharmacy for their support with the poster

scholarly journals Implementation of the acutely presenting older patient (APOP) screening program in routine emergency department care

2021 ◽  
Author(s):  
Laura C. Blomaard ◽  
Bas de Groot ◽  
Jacinta A. Lucke ◽  
Jelle de Gelder ◽  
Anja M. Booijen ◽  
...  
Keyword(s):  
Emergency Department ◽  
High Risk ◽  
Older Patients ◽  
Screening Program ◽  
Admission Rate ◽  
Older Patient ◽  
Hospital Admission Rate ◽  
High Risk Patients ◽  
Risk Patients

Abstract Objective The aim of this study was to evaluate the effects of implementation of the acutely presenting older patient (APOP) screening program for older patients in routine emergency department (ED) care shortly after implementation. Methods We conducted an implementation study with before-after design, using the plan-do-study-act (PDSA) model for quality improvement, in the ED of a Dutch academic hospital. All consecutive patients ≥ 70 years during 2 months before and after implementation were included. The APOP program comprises screening for risk of functional decline, mortality and cognitive impairment, targeted interventions for high-risk patients and education of professionals. Outcome measures were compliance with interventions and impact on ED process, length of stay (LOS) and hospital admission rate. Results Two comparable groups of patients (median age 77 years) were included before (n = 920) and after (n = 953) implementation. After implementation 560 (59%) patients were screened of which 190 (34%) were high-risk patients. Some of the program interventions for high-risk patients in the ED were adhered to, some were not. More hospitalized patients received comprehensive geriatric assessment (CGA) after implementation (21% before vs. 31% after; p = 0.002). In 89% of high-risk patients who were discharged to home, telephone follow-up was initiated. Implementation did not influence median ED LOS (202 min before vs. 196 min after; p = 0.152) or hospital admission rate (40% before vs. 39% after; p = 0.410). Conclusion Implementation of the APOP screening program in routine ED care did not negatively impact the ED process and resulted in an increase of CGA and telephone follow-up in older patients. Future studies should investigate whether sustainable changes in management and patient outcomes occur after more PDSA cycles.

Optimizing Premedications In the Prevention of Bendamustine Infusion Related Reactions

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4370-4370
Author(s):  
Rebecca Tombleson ◽  
Viet Q. Ho ◽  
Eduardo M. Sotomayor ◽  
Celeste M. Bello ◽  
Jennifer L. Cultrera ◽  
...  
Keyword(s):  
Growth Factor ◽  
Febrile Neutropenia ◽  
Research Funding ◽  
Safety Data ◽  
Admission Rate ◽  
Lymphocytic Leukemia ◽  
Cancer Center ◽  
Line Treatment ◽  
Effective Prevention ◽  
Hospital Admission Rate

Abstract Abstract 4370 Introduction Bendamustine is indicated for the treatment of CLL and rituximab-refractory indolent NHL. Clinical trials have reported 25% incidence of infusion related reactions (IRR) in patients receiving bendamustine. While these reactions are well documented, there is no consensus on the optimal premedication regimen for the prevention of these adverse effects. The Moffitt Cancer Center (MCC) utilizes a regimen of ondansetron 16 mg PO and dexamethasone 10 mg IVP prior to each bendamustine infusion. Herein, we report our experience with our current premedication regimen with regards to the IRR as well as the incidence of febrile neutropenia (FN). Methods We retrospectively analyzed 79 consecutive patients receiving bendamustine infusions at MCC from June 2008 to June 2010 to determine the incidence of IRR and FN. Data collected include baseline laboratory values, diagnosis, dosing, number of bendamustine infusions, concurrent rituximab use, growth factor utilization, as well as safety data including the rate of adverse reactions, interventions, and hospitalization. The primary objective was to determine the incidence of IRR. Secondary objectives include incidence of febrile neutropenia and hospital admission rate. All analyses were performed using SPSS 17.0. Descriptive statistics were used to analyze data. Results 79 consecutive patients received a total of 513 bendamustine infusions at MCC. Median age was 68 years; M:F (52:27). The most common primary malignancies were indolent non-Hodgkin's lymphoma (NHL), 56%; chronic lymphocytic leukemia (CLL), 38%; and multiple myeloma (MM) 6.3%. Patients had received a median of 2 regimens prior to initiation of bendamustine. Bendamustine was utilized as first line treatment in 25% of patients, second line in 17.7%, third line in 25%, and fourth line or greater in 32.3% of patients. Bendamustine infusions were well-tolerated. Infusion-related reactions (IRR) occurred at a rate of 3.35% (17/513) with all reactions attributed to rituximab. Most commonly reported reactions reported were rigors (2%), chills (1%), and fever (<1%). IRR did not occur in patients receiving bendamustine alone. Overall incidence of FN was 11% (9/79). Of 9 patients that developed FN, 7 patients received bendamustine as 3rd line treatment or greater. The incidence of FN in patients that received bendamustine as 1st or 2nd line treatment was 6% (2/36). Patients that received bendamustine as 3rd line or greater had a 16% (7/43) incidence of FN. Conclusion Based on our experience with bendamustine, ondansetron and dexamethasone provide safe and effective prevention of infusion related reactions associated with bendamustine. Notably, all infusion reactions were attributed to rituximab infusions and no patients experienced an infusion related reaction when receiving bendamustine alone. This compares favorably to the initial reported infusion-related reactions with bendamustine alone (25%). In avoiding the use of other premedications, the likelihood of additional complications or adverse affects can be minimized. The overall incidence of FN was comparable to previously published studies. As may be expected, heavily pretreated patients had a higher incidence of FN (6% vs. 16%) than those who had received 1 or no previous treatments and may warrant growth factor support. Disclosures: Tombleson: Cephalon: Research Funding. Off Label Use: Bendamustine used for the treatment of myeloma. Ho:Cephalon: Consultancy, Research Funding. Pinilla-Ibarz:Cephalon: Speakers Bureau. Wetzstein:Cephalon: Membership on an entity's Board of Directors or advisory committees, Research Funding.

scholarly journals Time Trend, Social Vulnerability, and Identification of Risk Areas for Tuberculosis in Brazil: an Ecological Study

2021 ◽  
Author(s):  
João Paulo Silva de Paiva ◽  
Mônica Avelar Figueiredo Mafra Magalhães ◽  
Thiago Cavalcanti Leal ◽  
Leonardo Feitosa da Silva ◽  
Lucas Gomes da Silva ◽  
...  
Keyword(s):  
High Risk ◽  
Incidence Rate ◽  
Social Vulnerability ◽  
Time Trend ◽  
Ecological Study ◽  
Vulnerability Index ◽  
Scan Statistics ◽  
Spatial Clusters ◽  
Social Vulnerability Index ◽  
Risk Areas

ABSTRACTINTRODUCTIONTuberculosis is one of the ten leading causes of death and the leading infectious cause worldwide. The disease represents a challenge to health systems around the world. In 2018, it is estimated that 10 million people were affected by tuberculosis, and approximately 1.5 million people died due to the disease worldwide, including 251,000 patients coinfected with HIV. In Brazil, the disease caused 4,490 deaths, with rate of 2.2 deaths per 100,000 inhabitants. The objective of this study was to analyze the time behavior, spatial distribution, and the effects of social vulnerability on the incidence of TB in Brazil during the period from 2001 to 2017.METHODSA spatial-temporal ecological study was conducted, including all new cases of tuberculosis registered in Brazil during the period from 2001 to 2017. The following variables were analyzed: incidence rate of tuberculosis, the Social Vulnerability Index, its subindices, its 16 indicators, and an additional 14 variables available on the Atlas of Social Vulnerability. The statistical treatment of the data consisted of the following three stages: a) time trend analysis with a joinpoint regression model; b) spatial analysis and identification of risk areas based on smoothing of the incidence rate by local empirical Bayesian model, application of global and local Moran statistics, and, finally, spatial-temporal scan statistics; and c) analysis of association between the incidence rate and the indicators of social vulnerability.RESULTSBrazil reduced the incidence of tuberculosis from 42.8 per 100,000 to 35.2 per 100,000 between 2001 and 2017. Only the state of Minas Gerais showed an increasing trend, whereas nine other states showed a stationary trend. A total of 326 Brazilian municipalities were classified as high priority, and 22 high-risk spatial clusters were identified. The overall Social Vulnerability Index and the subindices of Human Capital and Income and Work were associated with the incidence of tuberculosis. It was also observed that the incidence rates were greater in municipalities with greater social vulnerability.CONCLUSIONSThis study identified spatial clusters with high risk of TB in Brazil. A significant association was observed between the incidence rate of TB and the indices of social vulnerability.

scholarly journals 512. Does Time From COVID-19 Symptom Onset to Administration of Anti-spike Protein Monoclonal Antibody Predict Response?

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S358-S358
Author(s):  
Savanna SanFilippo ◽  
Brynna Crovetto ◽  
Marc Milano ◽  
John Bucek ◽  
Ronald G Nahass ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Hospital Admission ◽  
Symptom Onset ◽  
Severe Disease ◽  
Admission Rate ◽  
Patient Characteristics ◽  
Research Support ◽  
Early Administration ◽  
Hospital Admission Rate ◽  
Patient Reported

Abstract Background Casirivimab/imdevimab is a monoclonal antibody (mAb) cocktail with emergency use authorization for mild-to-moderate coronavirus disease 2019 (Covid-19) in patients at high risk for severe disease progression and/or hospitalization. Little is known about the importance of early administration of this product. The objective of this study was to determine if early administration (within 3 days of symptom onset) of casirivimab/imdevimab is associated with better outcomes. Methods Single-center, retrospective cohort study including all consecutive patients who received casirivimab/imdevimab at our institution through May 2021. The primary outcome was 30-day post-infusion hospital admission rate in patients who received mAb ≥ 3 days (later) or &lt; 3 days (early) in relation to patient reported symptom onset. Secondary outcomes included any hospital revisit within 30-days. Adverse events were also captured. Chi-square and independent samples t-test were used to compare categorical and continuous data, respectively. Multivariable logistic regression was used to adjust for confounders. Results 270 patients met the inclusion criteria and were included in the analysis. There were 80 patients with early administration and 190 with later administration. Baseline characteristics for both groups were similar. Mean age was approximately 64 years and BMI 31 mg/m2. Table 1 provides a summary of patient characteristics. Late and early administration of casirivimab/imdevimab were similar in terms of hospital admission for any therapy related failure within 30 days of mAb administration after adjusting for age and Charlson comorbidity index (3.7% vs. 7.5%; adjusted odds ratio 0.69, 95% confidence interval, 0.20 – 2.39; p=0.561). Similarly, there were no significant differences in any hospital revisit. Conclusion We did not find any difference in outcomes between early and late administration of casirivimab/imdevimab. Disclosures Ronald G. Nahass, MD, Abbvie (Grant/Research Support, Speaker’s Bureau)Alkermes (Grant/Research Support)Gilead (Grant/Research Support, Speaker's Bureau)Merck (Grant/Research Support, Speaker's Bureau)

scholarly journals Practice Transformation: Early Impact of the Oncology Care Model on Hospital Admissions

2018 ◽  
Vol 14 (12) ◽  
pp. e739-e745 ◽  
Author(s):  
Molly A. Mendenhall ◽  
Karyn Dyehouse ◽  
Jad Hayes ◽  
Joanie Manzo ◽  
Teresa Meyer-Smith ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Average Cost ◽  
Hospital Admissions ◽  
Admission Rate ◽  
Urgent Care ◽  
Inpatient Cost ◽  
Care Model ◽  
Hospital Admission Rate ◽  
Oncology Care ◽  
Cost Per Admission

Purpose: The purpose of the Oncology Care Model (OCM) is to improve quality and reduce cost through practice transformation. A foundational tenant is to reduce avoidable emergency room (ER) visits and hospitalizations. In anticipation of being an OCM participant, we instituted a multidimensional campaign designed to meet these objectives. Methods: Prior actions included establishment of phone triage unit, after-hours and weekend calls, and institution of weekend urgent care. Results: On the basis of data from the Chronic Condition Warehouse, as provided by the Centers for Medicare and Medicaid Services, we were successful at reducing the acute care admissions rate by 16%. During the baseline period extending from Jan 2016-Mar 2016, the hospital admission rate was 27 per patient, per quarter, at an average cost per admission event of $11,122, translating to an inpatient cost per patient, per quarter, of $3,003. In the year one reporting period of July 2016-July 2017, the hospital admission rate declined to 22.6 per patient, per quarter, at an average cost per admission event of $11,106, translating to an inpatient cost per patient, per quarter, of $2,505. OCM patient survey scores improved. In addition, at Oncology Hematology Care, we achieved improved results compared with the risk-adjusted national averages for the following measures: readmissions (4.9 v 5.6 per 100 patients, respectively), ER use (17 v 18.6 per 100 patients, respectively), and observation stays (2.7 v 3.6 per 100 patients, respectively). Conclusion: By implementing a cost-efficient, reproducible, and scalable campaign targeting ER avoidance and hospitalizations, we were able to decrease hospital admissions. Reported Medicare savings amounted to nearly $798,000 in inpatient cost per quarter over 1,600 patients.

scholarly journals Spatiotemporal Pattern of COVID-19–Related Mortality during the First Year of the Pandemic in Brazil: A Population-based Study in a Region of High Social Vulnerability

2021 ◽  
Author(s):  
Lucas Almeida Andrade ◽  
Wandklebson Silva da Paz ◽  
Alanna G. C. Fontes Lima ◽  
Damião da Conceição Araújo ◽  
Andrezza M. Duque ◽  
...  
Keyword(s):  
High Risk ◽  
Social Vulnerability ◽  
Temporal Trends ◽  
Case Fatality ◽  
Vulnerability Index ◽  
Bayesian Estimator ◽  
Spatiotemporal Pattern ◽  
First Year ◽  
Social Vulnerability Index ◽  
Risk Of Death

Currently, the world is facing a severe pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although the WHO has recommended preventive measures to limit its spread, Brazil has neglected most of these recommendations, and consequently, our country has the second largest number of deaths from COVID-19 worldwide. In addition, recent studies have shown the relationship between socioeconomic inequalities and the risk of severe COVID-19 infection. Herein, we aimed to assess the spatiotemporal distribution of mortality and lethality rates of COVID-19 in a region of high social vulnerability in Brazil (Northeast region) during the first year of the pandemic. A segmented log-linear regression model was applied to assess temporal trends of mortality and case fatality rate (CFR) and according to the social vulnerability index (SVI). The Local Empirical Bayesian Estimator and Global Moran Index were used for spatial analysis. We conducted a retrospective space–time scan to map clusters at high risk of death from COVID-19. A total of 66,358 COVID-19–related deaths were reported during this period. The mortality rate was 116.2/100,000 inhabitants, and the CFR was 2.3%. Nevertheless, CFR was > 7.5% in 27 municipalities (1.5%). We observed an increasing trend of deaths in this region (AMCP = 18.2; P = 0.001). Also, increasing trends were observed in municipalities with high (N = 859) and very high SVI (N = 587). We identified two significant spatiotemporal clusters of deaths by COVID-19 in this Brazilian region (P = 0.001), and most high-risk municipalities were on the coastal strip of the region. Taken together, our analyses demonstrate that the pandemic has been responsible for several deaths in Northeast Brazil, with clusters at high risk of mortality mainly in municipalities on the coastline and those with high SVI.

scholarly journals 514. Anti-SARS-CoV-2 Monoclonal Antibodies for Early COVID-19: A Real World Experience

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S358-S359
Author(s):  
Katherine Belden ◽  
Bryan Hess ◽  
Caroline Brugger ◽  
Rachel Carr ◽  
Todd Braun ◽  
...  
Keyword(s):  
Monoclonal Antibodies ◽  
High Risk ◽  
Real World ◽  
Social Vulnerability ◽  
Vulnerability Index ◽  
Primary Study ◽  
Drug Preparation ◽  
Social Vulnerability Index ◽  
High Resource ◽  
Positive Direct

Abstract Background Anti-SARS-CoV-2 monoclonal antibodies afford prompt immunity, have demonstrated reduction in severe COVID-19 in high risk ambulatory patients, and are available through Emergency Use Authorization. Challenges exist, however, to widespread utilization. Methods This operations study 11/23/20-4/30/21 identified patients meeting monoclonal AB EUA criteria by test results or referral. Outreach to harder-hit neighborhoods included connecting with primary care teams and testing sites. Infusion centers with staff trained in infection control, rapid response and drug preparation were utilized. The primary study outcome was treatment of qualifying patients. Secondary outcomes included infusion complications, hospitalization/death, and symptom resolution. Investigational review board approval was obtained. Results 367 patients were treated: mean age of 63, 201(55%) male, 276(75%) white, 54(15%) black. All patients had a first positive direct SARS-CoV-2 test within 10 days, 232(63%) had &gt; 1 high-risk qualification, 32(9%) were vaccinated for SARS-CoV-2. Of patients with available zipcodes, 135(38%) had a Community Need Index &gt;3.5 and 157(45%) a Social Vulnerability Index &gt;0.5. 190(52%) received bamlanivimab, 93(25%) casirivimab/imdevimab, 84(23%) bamlanivimab/etesevimab. Four patients experienced infusion reaction, 1 with anaphylaxis. 172(73%) of 236 patients were symptom free at day 5. 20 patients (5%) were hospitalized for COVID-19 within 30 days with a median time from symptom onset to infusion of 7 days, 11(55%) were admitted within 24 hours, 1 died. Patient Characteristics COVID-19 course Community Need Index and Social Vulnerability Index by Zipcode Conclusion Our study demonstrates that treatment with anti-SARS-CoV-2 monoclonal antibodies is feasible in a high resource setting. There were no related SARS-CoV-2 exposures and therapy was well tolerated. Trials of anti-SARS-CoV-2 monoclonal antibodies have reported lower rates of hospitalizations in treated patients than we found. This may reflect the expanded time frame for EUA therapy as compared to clinical trials, differences in real world patients or viral variants. Given potential benefit in unvaccinated patients or those at risk for poor vaccine response, the equitable utilization of anti-SARS-CoV-2 monoclonal antibody therapy in early COVID-19 should remain a focus for researchers and clinicians. Disclosures All Authors: No reported disclosures

Personalized stratification of back to work risk amidst COVID-19: A machine learning approach (Preprint)

2020 ◽  
Author(s):  
Carson Lam ◽  
Jacob Calvert ◽  
Gina Barnes ◽  
Emily Pellegrini ◽  
Anna Lynn-Palevsky ◽  
...  
Keyword(s):  
Machine Learning ◽  
High Risk ◽  
Learning Algorithm ◽  
Severe Disease ◽  
High Specificity ◽  
Population Level ◽  
The United States ◽  
Health Condition ◽  
Available P ◽  
Severe Illness

BACKGROUND In the wake of COVID-19, the United States has developed a three stage plan to outline the parameters to determine when states may reopen businesses and ease travel restrictions. The guidelines also identify subpopulations of Americans that should continue to stay at home due to being at high risk for severe disease should they contract COVID-19. These guidelines were based on population level demographics, rather than individual-level risk factors. As such, they may misidentify individuals at high risk for severe illness and who should therefore not return to work until vaccination or widespread serological testing is available. OBJECTIVE This study evaluated a machine learning algorithm for the prediction of serious illness due to COVID-19 using inpatient data collected from electronic health records. METHODS The algorithm was trained to identify patients for whom a diagnosis of COVID-19 was likely to result in hospitalization, and compared against four U.S policy-based criteria: age over 65, having a serious underlying health condition, age over 65 or having a serious underlying health condition, and age over 65 and having a serious underlying health condition. RESULTS This algorithm identified 80% of patients at risk for hospitalization due to COVID-19, versus at most 62% that are identified by government guidelines. The algorithm also achieved a high specificity of 95%, outperforming government guidelines. CONCLUSIONS This algorithm may help to enable a broad reopening of the American economy while ensuring that patients at high risk for serious disease remain home until vaccination and testing become available.

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