P-OGC30 High volume oesophagogastric resection in a small private hospital during COVID 19, April 2020- April 2021

Background Like other hospitals at the peak of the pandemic, our institution had limited elective critical care capacity. This study summarises the outcomes of patients undergoing oesophagogastric (OG) resection at our institution, treated as the result of the emergency national contract between the NHS and the independent sector hospitals. Methods Patients undergoing OG resection at our institution between April 2020 and April 2021 were included. Patients were managed through the multidisciplinary team and were treated according to standard ERAS pathways, involving critical care input. National OG Cancer Audit (NOGCA) metrics were collected and compared to pre-COVID data. Results 81 patients underwent oesophagogastric resection in the private sector (60 oesophagectomies). Median length of stay was 9 days (9 pre-COVID). This included 21 patients who were repatriated to our main centre for ongoing management. 30-day mortality was 3.7% (1.8% pre-COVID), 90-day mortality 6.7% (4.2% pre-COVID). This included one patient who contracted COVID following discharge. 9 patients suffered an anastomotic leak, equating to a leak rate of 11% (7% pre-COVID). 22 resections were performed at our main centre (110-140 OG resection pre-COVID) Conclusions It is likely the private institution in this study represented one of the busiest oesophagogastric centres in the UK during COVID-19. A large cohort of patients underwent potentially curative surgery as a result of the emergency contract, who would have otherwise been placed on prolonged or palliative chemotherapy. 30 and 90-day mortality and anastomotic leak rates were higher than pre-pandemic levels, reinforcing the value of centralised tertiary OG resection services.

Residential Care in California: Spatial and Temporal Trends in Facility Development and Care Capacity

The U.S. is aging, and the older adult population and number of long-term care services are growing but not at corresponding rates and concentrations depending on location. Insufficient research has analyzed residential care at the neighborhood or city level of analysis, where geographical trends in growth often reveal notable patterns of long-term care unobserved at county and state levels of analyses. We merged the California Department of Social Services Residential Care for the Elderly Dataset with census place and tract data to chart the growth of facilities and beds per older adults in all of California and its three largest cities, including 805 facilities licensed from 1996 to 2015. During the study timeframe, residential care steadily increased in California by the number of facilities and beds relative to older adults. However, due to a consistently increasing older adult population, the Cities of San Diego and San Jose experienced gradual and intermittent decline in capacity per older adults, respectively, even as they added many beds to their inventories from the sporadic development of large assisted living and continuing care retirement communities. Additionally, San Jose and Los Angeles exhibited the most overlap in mapping densities of facility development and oldest old adults, with San Diego showing less intersection in cartographic analysis. Understanding facility development and care capacity trends can help local agencies and jurisdictions in the U.S. and other countries discern whether planning policies and other geographical and development factors appropriately encourage the development of residential care and other long-term care facilities.

The effect of “TB Mataho” health cadres in improving self-care capacity of patients with pulmonary tuberculosis

TB is still a public health problem throughout the world where Indonesia is a country that has the third largest number of TB sufferers after India and China. Self-care by patients and families during the treatment process was the key to healing pulmonary TB. Using a quasi-experimental method, this study aims to improve the ability of self-care for pulmonary TB patients through intervention by “TB Mataho” health cadres. Most of the self-care capacity of pulmonary TB patients with pre-test results were sufficient, in the treatment group (75.2%) and the control group (62.5%). The post-test results for the treatment group were in the good category (53.1%) and the control group was in the sufficient category (59.4%). The results of the Paired Samples Test analysis in the treatment group obtained a value of p = 0.001 (p <0.05), which means that there was a significant difference in self-care capacity of pulmonary TB patients before and after treatment, as well as the results of the Independent Samples Test analysis, the p value was obtained. 0.030 (p <0.05) which means that there was a significant difference in the post-test results in the treatment group and the control group. Researchers recommend that pulmonary TB survivors who have a basic education of secondary and above can be trained to become health cadres and share their successful experiences with pulmonary TB patients who are still undergoing treatment programs.

Modeling COVID-19 care capacity in a major health system

Hospital resources, especially critical care beds and ventilators, have been strained by additional demand throughout the COVID-19 pandemic. Rationing of scarce critical care resources may occur when available resource limits are exceeded. However, the dynamic nature of the COVID-19 pandemic and variability in projections of the future burden of COVID-19 infection pose challenges for optimizing resource allocation to critical care units in hospitals. Connecticut experienced a spike in the number of COVID-19 cases between March and June 2020. Uncertainty about future incidence made it difficult to predict the magnitude and duration of the increased COVID-19 burden on the healthcare system. In this paper, we describe a model of COVID-19 hospital capacity and occupancy that generates estimates of the resources necessary to accommodate COVID-19 patients under infection scenarios of varying severity. We present the model structure and dynamics, procedure for parameter estimation, and publicly available web application where we implemented the tool. We then describe calibration using data from over 3,000 COVID-19 patients seen at the Yale-New Haven Health System between March and July 2020. We conclude with recommendations for modeling tools to inform decision-making using incomplete information during future crises.

Evaluating the potential for respiratory metagenomics to improve treatment of secondary infection and detection of nosocomial transmission on expanded COVID-19 intensive care units

Background Clinical metagenomics (CMg) has the potential to be translated from a research tool into routine service to improve antimicrobial treatment and infection control decisions. The SARS-CoV-2 pandemic provides added impetus to realise these benefits, given the increased risk of secondary infection and nosocomial transmission of multi-drug-resistant (MDR) pathogens linked with the expansion of critical care capacity. Methods CMg using nanopore sequencing was evaluated in a proof-of-concept study on 43 respiratory samples from 34 intubated patients across seven intensive care units (ICUs) over a 9-week period during the first COVID-19 pandemic wave. Results An 8-h CMg workflow was 92% sensitive (95% CI, 75–99%) and 82% specific (95% CI, 57–96%) for bacterial identification based on culture-positive and culture-negative samples, respectively. CMg sequencing reported the presence or absence of β-lactam-resistant genes carried by Enterobacterales that would modify the initial guideline-recommended antibiotics in every case. CMg was also 100% concordant with quantitative PCR for detecting Aspergillus fumigatus from 4 positive and 39 negative samples. Molecular typing using 24-h sequencing data identified an MDR-K. pneumoniae ST307 outbreak involving 4 patients and an MDR-C. striatum outbreak involving 14 patients across three ICUs. Conclusion CMg testing provides accurate pathogen detection and antibiotic resistance prediction in a same-day laboratory workflow, with assembled genomes available the next day for genomic surveillance. The provision of this technology in a service setting could fundamentally change the multi-disciplinary team approach to managing ICU infections. The potential to improve the initial targeted treatment and rapidly detect unsuspected outbreaks of MDR-pathogens justifies further expedited clinical assessment of CMg.

Percutaneous Dilational Tracheostomy at the Epicenter of the SARS-CoV-2 Pandemic: Impact on Critical Care Resource Utilization and Early Outcomes

Background The COVID-19 pandemic overwhelmed New York City hospitals early in the pandemic. Shortages of ventilators and sedatives prompted tracheostomy earlier than recommended by professional societies. This study evaluates the impact of percutaneous dilational tracheostomy (PDT) in COVID+ patients on critical care capacity. Methods This is a single-institution prospective case series of mechanically ventilated COVID-19 patients undergoing PDT from April 1 to June 4, 2020 at a public tertiary care center. Results Fifty-five patients met PDT criteria and underwent PDT at a median of 13 days (IQR 10, 18) from intubation. Patient characteristics are found in Table 1 . Intravenous midazolam, fentanyl, and cisatracurium equivalents were significantly reduced 48 hours post-PDT ( Table 2 ). Thirty-five patients were transferred from the ICU and liberated from the ventilator. Median time from PDT to ventilator liberation and ICU discharge was 10 (IQR 4, 14) and 12 (IQR 8, 17) days, respectively. Decannulation occurred in 45.5% and 52.7% were discharged from acute inpatient care ( Figure 1 ). Median follow-up for the study was 62 days. Four patients had bleeding complications postoperatively and 11 died during the study period. Older age was associated with increased odds of complication (OR 1.12, 95% CI 1.04, 1.23) and death (OR=1.15, 95% CI 1.05, 1.30). All operators tested negative for COVID-19 during the study period. Conclusion These findings suggest COVID-19 patients undergoing tracheostomy within the standard time frame can improve critical care capacity in areas strained by the pandemic with low risk to operators. Long-term outcomes after PDT deserve further study.

QOLP-09. AUTONOMY DURATION AS ANALYZED BY KPS ≥ 70 CUMULATIVE TIME IN PATIENTS WITH BIOPSY-ONLY GLIOBLASTOMA (BO-GBM). A SUB-ANALYSIS OF THE TIMONE COHORT

BACKGROUND Maintenance of autonomy is a crucial and understudied issue for glioblastoma patients whose outcome is poor. Biopsy-only glioblastoma (BO-GBM) present with short survival and independence is of particular importance. Our objective was to explore their functional outcome. MATERIAL AND METHODS A regional glioma SIRIC cohort was conducted at CHU Timone in 2014-2017 and we retrospectively reviewed the BO-GBM subgroup. We prospectively collected age, tumoral surface, treatment allocated and completed, and survival outcome. Functional independence was analyzed as a cumulative time of Karnofsky performance status (KPS) ≥ 70 from the date of diagnosis until death. We analyzed potential factors associated to time with KPS ≥ 70. RESULTS Among 535 patients enrolled in the cohort, surgery was restricted to biopsy in 139 patients (BO-GBM). Mean tumoral surface measured on gadolinium-enhanced T1-weighted MRI was 1198 mm2 (min: 65; max: 4515mm2). Forty-seven patients were referred to radiotherapy-temozolomide (RT-TMZ), 75 considered unfitted for RT received chemotherapy upfront (CT-UF), and 17 patients were referred to palliative care. Median OS was 7.5 months (95%CI: 6.0-9.2), 14.0 months (95%CI: 9.7-18.7) and 6.0 months (95%CI: 4.6-7.7) for BO-GBM, RT-TMZ and CT-UF respectively. At diagnosis, 81 (58.3%) patients presented with self-care capacity (KPS ≥ 70%). For these patients, median time of autonomy preservation was 7.6 months (95%CI: 6.1-9.0). Median time of autonomy preservation differed according to treatment modalities: it was 8.6 months (95%CI: 5.9-11.3) versus 6.3 months (95%CI: 2.9-9.7) for RT-TMZ versus CT-UF group respectively (p&lt; 0.001). In multivariate analysis, time with KPS ≥ 70 was correlated with age (p=0.001) and KPS at diagnosis (p&lt; 0.001). CONCLUSION Patients with inoperable GBM referred to radiotherapy-temozolomide present a valuable duration of functional independence, although shorter in patients not referred to RT. Duration of functional independence could be considered in addition to PFS and OS for treatment evaluation in patients with GBM.