Abstract 204: Association Between Presence of Advanced Airway and Hyperventilation During Pediatric Cardiopulmonary Resuscitation: A Report from the VIPER Collaborative

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Karen OConnell ◽  
Sage Myers ◽  
Benjamin Kerrey ◽  
Alexis Sandler ◽  
Ryan Keane ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Univariate Analysis ◽  
Heart Association ◽  
Pediatric Emergency ◽  
Supraglottic Airway ◽  
Advanced Airway ◽  
Independent Association ◽  
Random Effects Modeling ◽  
Ventilation Rates ◽  
The Impact

Background: Hyperventilation is common during pediatric CPR and has known deleterious hemodynamic consequences. It is not known whether the presence of an advanced airway (AA) is independently associated with hyperventilation. Objective: To determine the independent association between the presence of an AA and hyperventilation during pediatric CPR in a collaborative of pediatric emergency departments using video review during resuscitations. Methods/Design: We present a report from the Videography in Pediatric Emergency Resuscitation (VIPER) Collaborative, a prospective review database. All events where CPR was performed and manual ventilations could be counted for at least 30 seconds were eligible for inclusion. Ventilation rates were counted and expressed in segments corresponding to individual CPR providers (‘compressor segments') and extrapolated to breaths per minute (bpm) where applicable. Hyperventilation was defined as a rate greater than 12 bpm, in accordance with American Heart Association recommendations. Ventilation rates were compared between CPR segments with a natural airway (bag-valve mask device; NA) versus an advanced airway (endotracheal tube or supraglottic airway; AA). Univariate analysis was done by two sided t-testing. Repeated measures logistic regression with random effects modeling (patient as intercept) was performed to determine the independent association of the presence of an AA with hyperventilation. Results/Discussion: 595 compressor segments in 67 CPR events were analyzed. Twenty-six patients underwent intubation and had segments with both NA and AA analyzed. Across all patients, 402/595 (68%) of segments occurred with an AA. Ventilation rates were significantly higher in patients with an AA compared with NA (14 + 10 bpm vs. 24 + 17 bpm, p < 0.001). By multivariate analysis, the presence of an advanced airway was independently associated with hyperventilation (AOR 12.2, 95% CI 5.0 - 30.3) during pediatric CPR. Future studies should examine methods of limiting manual hyperventilation during pediatric CPR, as well as the impact of ventilation rates on patient outcomes.

Abstract 348: Laryngoscopy With Vallecula Blade Position is Associated With Higher Success in Tracheal Intubation for Critically Ill Children

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Priyanka Kharayat ◽  
Akira Nishisaki ◽  
Elizabeth Laverriere ◽  
Aaron Donoghue
Keyword(s):  
Tracheal Intubation ◽  
Univariate Analysis ◽  
Pediatric Intensive Care ◽  
Pediatric Emergency ◽  
Laryngoscope Blade ◽  
Critically Ill Children ◽  
Provider Characteristics ◽  
Blade Tip ◽  
Independent Association ◽  
Tip Position

Introduction: Classical teaching in pediatric laryngoscopy advocates the use of straight blades to be placed underneath the epiglottis, whereas curved blades are placed in the vallecula. Anesthesia studies suggest that straight blade positioning in the vallecula may be a satisfactory technique for small children. We sought to assess laryngoscope blade tip position during pediatric tracheal intubation (TI) and its association with intubation success. Methods: Observational single center study. Children undergoing TI from November 2017 until December 2018 in a pediatric emergency department (ED) and pediatric intensive care unit (PICU) using a CMAC video laryngoscope with recorded images available for review were eligible for inclusion. Patient and provider characteristics were obtained from quality improvement database. Each video was independently reviewed, and the blade tip position was determined by study personnel as ‘in vallecula’ or ‘under epiglottis’. TI success was defined as observation of the tube entering the trachea on video. Univariate analysis between blade tip position and success, as well as potential confounders, was performed by chi 2 testing. Multivariable logistic regression to determine the independent association between blade tip position and success while controlling for relevant confounders. Results: 95 TI attempts were analysed. 58% of attempts were successful (14/35 in infants, 8/15 in 1-7 yr old, 33/45 in 8+ yr, p=0.01). Blade tip position was in the vallecula for 20/31 (65%) attempts with curved blades and 23/64 (36%) with straight blades. In univariate analysis, TI attempts with blade tip position ‘in vallecula’ were significantly more successful than attempts with ‘under epiglottis’ (37% vs. 84%, p<0.001). Median duration of laryngoscopy was 41 sec (IQR 27-59), not significantly different between two blade tip positions (p=0.06). After controlling for patient age and blade type (potential confounders), TI attempts with blade tip ‘in vallecula’ was independently associated with success (aOR 7.2, 95% CI 2.6 - 20.1). Conclusion: During pediatric TI, laryngoscope blade tip position in the vallecula was independently associated with success when compared with placement under the epiglottis.

GAMBARAN PENGETAHUAN SISWA TENTANG PERILAKU SEKS BEBAS DI SMA/SMK KOTA LUBUKLINGGAU TAHUN 2016

2019 ◽  
Vol 6 (1) ◽  
Author(s):  
Rini Mayasari Rini Mayasari
Keyword(s):  
High School ◽  
Univariate Analysis ◽  
Good Knowledge ◽  
Sex Behavior ◽  
School Class ◽  
Sufficient Knowledge ◽  
High School Class ◽  
Study Population ◽  
The Impact ◽  
Disease Free

ABSTRACT   Free sex is a relationship that is done by men and women without matrimony. Various forms of sexual behavior, such as intimate dating, courtship, to have sexual contact. Factors associated with sex behavior among others, is the lack of knowledge about free sex, free sex impact, forms of promiscuity, perversion LGBT, and disease-free sex. This study design is the technique of sampling using quantitative indirectly using a questionnaire tools shaped questionnaires. Be knew overview of students' knowledge about sex in high school / vocational Lubuk Linggau Year 2016. The study population was high school class XII students in schools in the city Lubuklingga 2016. The sample in this study is the high school class XII students in 9 schools there in Lubuklinggau of 167 people. Results of univariate analysis showed respondent knowledge about free sex amounted to 48 people (28,74%), students with sufficient knowledge of 54 people (32,33%), and students with less knowledge of 65 people (38, 93%). Students with a good knowledge about the impact of free sex amounted to 57 (34,13%), students with sufficient knowledge of 69 people (41,31%), and students with less knowledge 41 (24,56%). Students with a good knowledge about the form of free sex amounted to 58 students (34,73%), students with sufficient knowledge totaled 49 peoples (29,34%), and students with less knowledge of 60 people (35,93%). Students with a good knowledge about LGBT amounted to 54 (32,34%), students with sufficient knowledge amounted to 68 peoples (40.71%), and students with less knowledge amounted 45 peoples (26,95%). Students with a good knowledge about the disease free sex amounted to 22 peoples (13,17%), students with sufficient knowledge of 39 peoples (23,35%), and students with less knowledge amounted to 106 peoples (63,48%).     ABSTRAK   Seks bebas merupakan hubungan yang dilakukan oleh laki-laki dan perempuan tanpa adanya ikatan perkawinan. Berbagai bentuk tingkah laku seksual, seperti berkencan intim, bercumbu, sampai melakukan kontak seksual. Faktor-faktor yang berhubungan dengan perilaku seks bebas antara lain adalah kurangnya pengetahuan tentang seks bebas, dampak seks bebas, bentuk-bentuk seks bebas, penyimpangan LGBT, dan penyakit seks bebas. Desain penelitian ini adalah teknik pengambilan sampel menggunakan teknik kuantitatif yaitu secara tidak langsung menggunakan alat bantu angket berbentuk kuisener. Di ketahuinya gambaran pengetahuan siswa tentang seks bebas di SMA/SMK Kota Lubuk Linggau Tahun 2016. Populasi penelitian ini adalah siswa kelas XII SMA di sekolah yang ada di Kota Lubuklingga tahun 2016. Sampel pada penelitian ini adalah siswa kelas XII SMA di 9 sekolah yang ada di Kota Lubuklinggau yang berjumlah 167 orang. Hasil analisis univariat menunjukan respondent pengetahuan tentang seks bebas berjumlah 48 orang (28,74%), siswa dengan pengetahuan cukup 54 orang (32,33%), dan siswa dengan pengetahuan kurang 65 orang (38,93%). Siswa dengan pengetahuan baik tentang dampak perilaku seks bebas berjumlah 57 orang (34,13%), siswa dengan pengetahuan cukup 69 orang (41,31%), dan siswa dengan pengetahuan kurang 41 orang (24, 56%). Siswa dengan pengetahuan baik tentang bentuk perilaku seks bebas  berjumlah 58 siswa (34,73%), siswa dengan pengetahuan cukup  berjumlah 49orang (29,34%), dan siswa dengan pengetahuan kurang berjumlah 60 orang  (35,93%). Siswa dengan  pengetahuan baik tentang LGBT berjumlah 54 orang (32,34%), siswa dengan pengetahuan cukup berjumlah 68 orang (40,71%), dan siswa dengan  pengetahuan kurang berjumlah 45orang (26,95%). Siswa dengan pengetahuan baik tentang penyakit seks bebas berjumlah 22 orang (13,17%), siswa dengan pengetahuan cukup 39 orang (23,35%), dan siswa dengan pengetahuan kurang berjumlah 106 orang (63,48%).  

scholarly journals POS1234 IMPACT OF THE CHANGE IN ADMINISTRATION ROUTE OF TOCILIZUMAB AND ABATACEPT, DUE TO THE COVID-19 LOCKDOWN ON DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 900.1-900
Author(s):  
L. Diebold ◽  
T. Wirth ◽  
V. Pradel ◽  
N. Balandraud ◽  
E. Fockens ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Physical Activity ◽  
Disease Activity ◽  
Univariate Analysis ◽  
Route Of Administration ◽  
Anxiety And Depression ◽  
Administration Route ◽  
Factors Associated ◽  
The Impact

Background:Among therapeutics used to treat rheumatoid arthritis (RA), Tocilizumab (TCZ) and Abatacept (ABA) are both biologic agents that can be delivered subcutaneously (SC) or intravenously (IV). During the first COVID-19 lockdown in France, all patients treated with IV TCZ or IV ABA were offered the option to switch to SC administration.Objectives:The primary aim was to assess the impact of changing the route of administration on the disease activity. The second aim was to assess whether the return to IV route at the patient’s request was associated with disease activity variation, flares, anxiety, depression and low physical activity during the lockdown.Methods:We conducted a prospective monocentric observational study. Eligibility criteria: Adult ≥ 18 years old, RA treated with IV TCZ or IV ABA with a stable dose ≥3 months, change in administration route (from IV to SC) between March 16, 2020, and April 17, 2020. The following data were collected at baseline and 6 months later (M6): demographics, RA characteristics, treatment, history of previous SC treatment, disease activity (DAS28), self-administered questionnaires on flares, RA life repercussions, physical activity, anxiety and depression (FLARE, RAID, Ricci &Gagnon, HAD).The primary outcome was the proportion of patients with a DAS28 variation>1.2 at M6. Analyses: Chi2-test for quantitative variables and Mann-Whitney test for qualitative variables. Factors associated with return to IV route identification was performed with univariate and multivariate analysis.Results:Among the 84 patients who were offered to switch their treatment route of administration, 13 refused to change their treatment. Among the 71 who switched (48 TCZ, 23 ABA), 58 had a M6 follow-up visit (13 lost of follow-up) and DAS28 was available for 49 patients at M6. Main baseline characteristics: female 81%, mean age 62.7, mean disease duration: 16.0, ACPA positive: 72.4%, mean DAS28: 2.01, previously treated with SC TCZ or ABA: 17%.At M6, the mean DAS28 variation was 0.18 ± 0.15. Ten (12.2%) patients had a DAS28 worsening>1.2 (ABA: 5/17 [29.4%] and TCZ: 5/32 [15.6%], p= 0.152) and 19 patients (32.8%) had a DAS28 worsening>0.6 (ABA: 11/17 [64.7%] and TCZ: 8/32 [25.0%], p= 0.007).At M6, 41 patients (77.4%) were back to IV route (26 TCZ, 15 ABA) at their request. The proportion of patients with a DAS28 worsening>1.2 and>0.6 in the groups return to IV versus SC maintenance were 22.5%, 42.5% versus 11.1% and 22.2% (p=0.4), respectively. The univariate analysis identified the following factors associated with the return to IV route: HAD depression score (12 vs 41, p=0.009), HAS anxiety score (12 vs 41, p=0.047) and corticosteroid use (70% vs 100%, p=0.021), in the SC maintenance vs return to IV, respectively.Conclusion:The change of administration route of TCZ and ABA during the first COVID-19 lockdown was infrequently associated with a worsening of RA disease. However, the great majority of the patients (77.4%) request to return to IV route, even without disease activity worsening. This nocebo effect was associated with higher anxiety and depression scores.Disclosure of Interests:None declared

scholarly journals Chemotherapy Delays Are Associated with Inferior Outcome in Acute Lymphoblastic Leukemia: A Retrospective Study from a Tertiary Cancer Center in South India

2021 ◽  
Vol 42 (01) ◽  
pp. 051-060
Author(s):  
Vineet Agrawal ◽  
Smita Kayal ◽  
Prasanth Ganesan ◽  
Biswajit Dubashi
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Lymphoblastic Leukemia ◽  
Univariate Analysis ◽  
Cancer Center ◽  
Survival Outcomes ◽  
Separate Analysis ◽  
Term Survival ◽  
Free Survival ◽  
Intensive Phase ◽  
The Impact

Abstract Background Treatment protocols for acute lymphoblastic leukemia (ALL) have evolved over time to give excellent cure rates in children and moderate outcomes in adults; however, little is known how delays in chemotherapy affect long-term survival. Objectives To find the association of delays during different treatment phases on the survival outcomes. Materials and Methods Data from 149 ALL cases treated between 2009 and 2015 were retrospectively analyzed. Treatment course in commonly used protocols was divided into three phases—induction, consolidation (postremission), maintenance, and also a combined intensive phase (induction plus consolidation) for the purpose of analysis, and delay in each phase was defined based on clinically acceptable breaks. Analysis was done to find the impact of treatment delay in each phase on the survival outcomes. Results The median age was 12 years (range, 1–57). Multi-center Protocol-841 (MCP-841) was used for 72%, German Multicenter Study Group for Adult ALL (GMALL) for 19%, and Berlin, Frankfurt, Muenster, 95 protocol (BFM-95) for 9% of patients. Delay in induction was seen in 52%, consolidation in 66%, and during maintenance in 42% of patients. The median follow-up was 41 months, and 3-year survival outcomes for the entire cohort were event-free survival (EFS)—60%, relapse-free survival (RFS)—72%, and overall survival (OS)—68%. On univariate analysis, delay in induction adversely affected EFS (hazard ratio [HR] = 1.78, p = 0.04), while delay in intensive phase had significantly worse EFS and RFS (HR = 2.41 [p = 0.03] and HR = 2.57 [p = 0.03], respectively). On separate analysis of MCP-841 cohort, delay in intensive phase affected both EFS (HR = 3.85, p = 0.02) and RFS (HR = 3.42, p = 0.04), whereas delay in consolidation significantly affected OS with (HR = 4.74, p = 0.04) independently. Conclusion Treatment delays mostly in intensive phase are associated with worse survival in ALL; attempts should be made to maintain protocol-defined treatment intensity while adequately managing toxicities.

scholarly journals A Positive Dermcidin Expression Is an Unfavorable Prognostic Marker for Extramammary Paget’s Disease

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1086
Author(s):  
Shun Ohmori ◽  
Yu Sawada ◽  
Natsuko Saito-Sasaki ◽  
Sayaka Sato ◽  
Yoko Minokawa ◽  
...  
Keyword(s):  
Overall Survival ◽  
Therapeutic Option ◽  
Univariate Analysis ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Positive Staining ◽  
Extramammary Paget’S Disease ◽  
Potential Biomarker ◽  
The Impact ◽  
Extramammary Paget's Disease

Extramammary Paget’s disease is recognized as an apocrine-origin cutaneous tumor and is localized in the intraepithelial skin lesion. However, its advanced form is intractable, and there is currently no therapeutic option with a satisfactory level of clinical outcome. Therefore, it is of great importance to identify a potential biomarker to estimate tumor advancement in extramammary Paget’s disease. Dermcidin is an antimicrobial peptide derived from the eccrine gland and is identified as a biomarker in various malignancies. To investigate the potential of dermcidin in extramammary Paget’s disease, we investigated dermcidin expression in tumors using the immunostaining technique. Although previous studies have reported that extramammary Paget’s disease has no positive staining against dermcidin, 14 out of 60 patients showed positive staining of dermcidin in our study. To clarify the characteristics of positive dermcidin in extramammary Paget’s disease, we investigated the clinical characteristics of positive dermcidin extramammary Paget’s disease patients. Positive dermcidin patients showed a significantly high frequency of lymph node metastasis. We next investigated the impact of positive dermcidin on overall survival. Univariate analysis identified that positive dermcidin showed a significantly increased hazard ratio in overall survival, suggesting that dermcidin might be a prognostic factor for extramammary Paget’s disease.

scholarly journals A Survey of Marine Coastal Litters around Zhoushan Island, China and Their Impacts

2021 ◽  
Vol 9 (2) ◽  
pp. 183
Author(s):  
Xuehua Ma ◽  
Yi Zhou ◽  
Luyi Yang ◽  
Jianfeng Tong
Keyword(s):  
Rapid Development ◽  
Univariate Analysis ◽  
Local Environment ◽  
Marine Litter ◽  
Social Ecological ◽  
The Social ◽  
Significant Difference ◽  
Valuable Method ◽  
Beach Litter ◽  
The Impact

Rapid development of the economy increased marine litter around Zhoushan Island. Social-ecological scenario studies can help to develop strategies to adapt to such change. To investigate the present situation of marine litter pollution, a stratified random sampling (StRS) method was applied to survey the distribution of marine coastal litters around Zhoushan Island. A univariate analysis of variance was conducted to access the amount of litter in different landforms that include mudflats, artificial and rocky beaches. In addition, two questionnaires were designed for local fishermen and tourists to provide social scenarios. The results showed that the distribution of litter in different landforms was significantly different, while the distribution of litter in different sampling points had no significant difference. The StRS survey showed to be a valuable method for giving a relative overview of beach litter around Zhoushan Island with less effort in a future survey. The questionnaire feedbacks helped to understand the source of marine litter and showed the impact on the local environment and economy. Based on the social-ecological scenarios, governance recommendations were provided in this paper.

scholarly journals 600. Decreased Hospital Readmission After Programmatic Strengthening of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S362-S363
Author(s):  
Gaurav Agnihotri ◽  
Alan E Gross ◽  
Minji Seok ◽  
Cheng Yu Yen ◽  
Farah Khan ◽  
...  
Keyword(s):  
Hospital Readmission ◽  
Multinomial Logistic Regression ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Intervention Group ◽  
Care Hospital ◽  
Full Time ◽  
Post Intervention ◽  
Before And After ◽  
The Impact

Abstract Background Although it is recommended that an OPAT program should be managed by a formal OPAT team that supports the treating physician, many OPAT programs face challenges in obtaining necessary program staff (i.e nurses or pharmacists) due to limited data examining the impact of a dedicated OPAT team on patient outcomes. Our objective was to compare OPAT-related readmission rates among patients receiving OPAT before and after the implementation of a strengthened OPAT program. Methods This retrospective quasi-experiment compared adult patients discharged on intravenous (IV) antibiotics from the University of Illinois Hospital before and after implementation of programmatic changes to strengthen the OPAT program. Data from our previous study were used as the pre-intervention group (1/1/2012 to 8/1/2013), where only individual infectious disease (ID) physicians coordinated OPAT. Post-intervention (10/1/2017 to 1/1/2019), a dedicated OPAT nurse provided full time support to the treating ID physicians through care coordination, utilization of protocols for lab monitoring and management, and enhanced documentation. Factors associated with readmission for OPAT-related problems at a significance level of p&lt; 0.1 in univariate analysis were eligible for testing in a forward stepwise multinomial logistic regression to identify independent predictors of readmission. Results Demographics, antimicrobial indications, and OPAT administration location of the 428 patients pre- and post-intervention are listed in Table 1. After implementation of the strengthened OPAT program, the readmission rate due to OPAT-related complications decreased from 17.8% (13/73) to 6.5% (23/355) (p=0.001). OPAT-related readmission reasons included: infection recurrence/progression (56%), adverse drug reaction (28%), or line-associated issues (17%). Independent predictors of hospital readmission due to OPAT-related problems are listed in Table 2. Table 1. OPAT Patient Demographics and Factors Pre- and Post-intervention Table 2. Factors independently associated with hospital readmission in OPAT patients Conclusion An OPAT program with dedicated staff at a large academic tertiary care hospital was independently associated with decreased risk for readmission, which provides critical evidence to substantiate additional resources being dedicated to OPAT by health systems in the future. Disclosures All Authors: No reported disclosures

scholarly journals A tale of two parts of Switzerland: regional differences in the impact of the COVID-19 pandemic on parents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michelle Seiler ◽  
Georg Staubli ◽  
Julia Hoeffe ◽  
Gianluca Gualco ◽  
Sergio Manzano ◽  
...  
Keyword(s):  
Public Health ◽  
Regional Differences ◽  
Online Survey ◽  
Pediatric Emergency ◽  
The South ◽  
Public Health Agencies ◽  
The North ◽  
Regional Strategies ◽  
Health Agencies ◽  
The Impact

Abstract Background We aimed to document the impact of the coronavirus disease 2019 (COVID-19) pandemic on regions within a European country. Methods Parents arriving at two pediatric emergency departments (EDs) in North of Switzerland and two in South of Switzerland completed an online survey during the first peak of the pandemic (April–June 2020). They were asked to rate their concern about their children or themselves having COVID-19. Results A total of 662 respondents completed the survey. Parents in the South were significantly more exposed to someone tested positive for COVID-19 than in the North (13.9 and 4.7%, respectively; P <  0.001). Parents in the South were much more concerned than in the North that they (mean 4.61 and 3.32, respectively; P <  0.001) or their child (mean 4.79 and 3.17, respectively; P <  0.001) had COVID-19. Parents reported their children wore facemasks significantly more often in the South than in the North (71.5 and 23.5%, respectively; P <  0.001). Conclusion The COVID-19 pandemic resulted in significant regional differences among families arriving at EDs in Switzerland. Public health agencies should consider regional strategies, rather than country-wide guidelines, in future pandemics and for vaccination against COVID-19 for children.

scholarly journals Imaging Appropriateness in Pediatric Radiology during COVID-19 Pandemic: A Retrospective Comparison with No COVID-19 Period

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 463
Author(s):  
Giampiero Bottari ◽  
Giandomenico Stellacci ◽  
Davide Ferorelli ◽  
Alessandro Dell’Erba ◽  
Maurizio Aricò ◽  
...  
Keyword(s):  
Bone Fractures ◽  
Sharp Decrease ◽  
Pediatric Emergency ◽  
Time Interval ◽  
Imaging Studies ◽  
Retrospective Comparison ◽  
Imaging Appropriateness ◽  
Therapeutic Protocols ◽  
The Impact ◽  
Negative Imaging

During the COVID-19 pandemic, the number of accesses to the Pediatric Emergency Department (pED) in Italy sharply decreased by 30%. The purpose of this study is to evaluate how this novel setting impacted on management of children with trauma, and the use and appropriateness of imaging studies in such patients at the pED. All imaging studies performed in patients with trauma at the pED of a tertiary children’s Hospital during the first wave of the COVID-19 pandemic (between March and May 2020) were reviewed, in comparison with a control time interval (March to May 2019). In the pre-COVID control era, 669 imaging studies documented bone fractures in 145/568 children (25.5%). In the COVID-era, 79/177 (44.6%) pediatric patients showed bone fractures on 193 imaging studies. Comparative analysis shows a 71% decrease in imaging studies, and the proportion of negative imaging studies (with no evidence of bone fractures) dropped in 2020 by 19% compared to the 2019 control era (p < 0.001). The sharp decrease of negative studies suggests that the rate of appropriateness was higher during COVID-era, suggesting some attitude toward defensive medicine in the previous control year, as a result of some degree of imaging inappropriateness. The impact of a pandemic on emergency medicine may offer a unique opportunity to revisit diagnostic and therapeutic protocols in pediatrics.

scholarly journals 962. Linkage to Care Outcomes among Known HIV-Positive Patients at a High Prevalence Urban Hospital Emergency Department

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S511-S511
Author(s):  
Alexander W Sudyn ◽  
Jeffrey M Paer ◽  
Swetha Kodali ◽  
Samuel Maldonado ◽  
Amesika Nyaku ◽  
...  
Keyword(s):  
Hiv Risk ◽  
Hiv Transmission ◽  
Univariate Analysis ◽  
Linkage To Care ◽  
Retrospective Chart Review ◽  
Retention In Care ◽  
Patient Navigator ◽  
Urban Hospital ◽  
Opt Out ◽  
The Impact

Abstract Background Retention in care of persons with HIV (PWH) is essential for achieving viral suppression and decreasing community transmission. CDC estimates that the 23% of known PWH not retained in care account for 43% of all new transmissions. This study seeks to describe the impact of an opt-out ED screening with navigator-assisted linkage to care (LTC) protocol for out of care PWH. Methods An IRB-approved retrospective chart review was conducted among PWH (prior positive) inadvertently retested in the ED between 2015 and 2018. Univariate and multivariate logistic regression was used to identify factors associated with LTC with patient navigator (PN) support. Factors with p ≤ 0.1 were included in the multivariate analysis as were age and sex at birth. Patients who died were excluded from statistical analyses. Results Among 464 patients who tested positive, 338 (73%) were known positive with 120 (35%) of those out of care at the time of screening. Mean age for this group was 47 (SD 11.9); 57% male, 81% non-Hispanic black, 10% Hispanic, and 6% non-Hispanic white. Fifty-five (46%) patients were successfully LTC, 54 (45%) referred to the state for linkage, and 11 (9%) died. A total of 109 patients were included in the analysis. Univariate analysis was performed for age (F(1, 107) = 0.98, p = 0.324) and female sex at birth (OR = 1.42 [95% CI 0.66, 3.05], p = 0.373) as well as Hispanic race (OR = 3.33 [95% CI 0.84, 13.04], p = 0.085), heterosexual HIV risk (OR = 2.76 [95% CI 1.27, 5.99], p = 0.011), IDU (OR = 0.49 [95% CI 0.21, 1.11], p = 0.088), and other SUD (OR = 0.42 [95% CI 0.19, 0.94], p = 0.035). Only heterosexual HIV risk (OR = 3.01 [95% CI 1.23, 7.32], p = 0.015) maintained significance in the final multivariate model. Conclusion Opt-out ED screening revealed &gt;30% of known positive PWH were out of care at the time of testing; of whom nearly 50% were LTC with PN support. It is possible that persons reporting heterosexual HIV risk may feel less stigmatized and therefore are more likely to LTC. Similarly, the association with SUD, albeit non-significant, may reflect underrepresentation of individuals with SUD in remission among patient navigators. Future opt-out ED screening protocols should build upon diverse care teams to further engage patients with SUD and those at risk for non-heterosexual HIV transmission. Disclosures All Authors: No reported disclosures

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