Transcutaneous Electrical Spinal Cord Stimulation to Promote Recovery in Chronic Spinal Cord Injury

Objective: To evaluate the impact of using transcutaneous electrical spinal cord stimulation (TSCSTSCS) on upper and lower extremity function in individuals with chronic spinal cord injury (SCI).Design: Prospective case series.Setting: SCI specific rehabilitation hospital.Participants: A convenience sample (N = 7) of individuals with tetraplegia who had previously been discharged from outpatient therapy due to a plateau in progress.Interventions: Individuals participated in 60 min of upper extremity (UE) functional task-specific practice (FTP) in combination with TSCS and 60 min of locomotor training in combination with TSCS 5x/week.Main Outcome Measures: The primary outcome for this analysis was the Capabilities of Upper Extremity Test (CUE-T). Secondary outcomes include UE motor score (UEMS), LE motor score (LEMS), sensation (light touch and pin prick), Nine-Hole Peg Test, 10 meter walk test, 6 min walk test, and 5 min stand test.Results: Seven individuals (four motor complete; three motor incomplete) completed 20–80 sessions UE and LE training augmented with TSCS and without any serious adverse events. Improvements were reported on the CUE-T in all seven individuals. Two individuals improved their ASIA impairment scale (AIS) classification (B to C; C to D) and two individuals improved their neurologic level of injury by one level (C4–C5; C5–C6). Sensation improved in five individuals and all four who started out with motor complete SCIs were able to voluntarily activate their LEs on command in the presence of stimulation.Conclusion: Individuals with chronic SCI who had previously demonstrated a plateau in function after an intensive outpatient therapy program were able to improve in a variety of UE and LE outcomes in response to TSCS without any adverse events. This was a small pilot study and future fully powered studies with comparative interventions need to be completed to assess efficacy.

Simulation approach to interprofessional education

A team practice simulation approach to interprofessional education is presented. Participants (79 trainees over 4 years) were assigned to one of six teams representing clinical services for a client with complex clinical needs (medical care, outpatient therapy, dental, nutrition, speech and hearing, leadership). Each student within the team was assigned a specific role (e.g., primary care, policy maker, family member). A critical component of this activity is that each participant adopted the role and perspective of an individual in a different clinical area than their own. In preparation for a live discussion by all participants, each team met to study their assigned clinical roles and to prepare a one-page slide addressing specific questions given only to their team. At the live session, the overall goal was to develop a coherent clinical plan for the client. This is an effective approach for IPE in care of clients across the lifespan.

590 ACE-I and ARBS do not influence the chest CT presentation and 1-year survival of COVID-19 patients: Italian multicentre registry

Aims A possible interference between ACE-i or ARBs with ACE-2 receptor and SARS-CoV-2 pathway has been raised. Despite data have shown no clinical impact of therapy with ACE-I or ARBs on COVID-19, these drugs are often discontinued upon hospitalization or diagnosis. To evaluate the effects of cardiovascular risk factors (CVRF) and prior outpatient therapy with RAAS inhibitors on the chest CT severity score performed within 24 h of diagnosis of SARS-CoV-2 infection (before stopping medications or starting specific therapy for COVID-19) and on 1-year survival. Methods and results This is a multicentre, prospective, observational study. All admitted patients diagnosed with SARS-CoV-2 infection who performed chest CT within 24 h of arrival were consecutively enrolled from 1 March to 1 June 2020. A severity score was attributed to Chest CT by two radiologists in blind to the patient’s clinical information and a cut-off value of 19.5 was considered to define severe radiological pneumonia. A 1-year telephone follow-up was performed in order to evaluate the determinants of 1-year survival. 590 patients with a mean age of 63 ± 14 years were included. Seventy-three (12.4%) patients were treated with ACE-I, 85 (14.4%) with ARBs and 62 (10.5%) with CCB. Cox regression analysis showed that male gender (OR: 1.4; 95% CI: from 1.02 to 2.07; P = 0.035), diabetes (OR: 1.6; 95% CI: from 1.03 to 2.7; P = 0.037), age (OR: 1.02; 95% CI: from 1.008 to 1.033; P = 0.001), and obesity (OR: 3.04; 95% CI: from 1.3 to 6.7; P < 0.001) were independently associated with a severe CT score. Of note, while prior outpatient therapy with ACE-I and ARBs was not independently associated with severe CT score, therapy with CCB was independently associated with a severe CT score (OR: 1.9, 95% CI: from 1.05 to 3.4, P = 0.033). Severe chest CT severity score (OR: 1.05; 95% CI: from 1.02 to 1.08; P < 0.001), P/F ratio (OR: 0.998; 95% CI: from 0.994 to 0.998; P < 0.001), and older age (OR: 1.06; 95% CI: from 1.03 to 1.1; P < 0.001) were independently associated with mortality at 1-year follow-up. Neither ACE-I, ARBs, and CCB were associated with mortality at 1 year follow-up. Conclusions ACE-I and ARBs do not influence the chest CT presentation of COVID-19 patients at the time of diagnosis. Furthermore, ACE-I and ARBs do not influence 1-year survival of COVID-19 survivors.

Factors Associated with Outpatient Therapy Utilization in Extremely Preterm Infants

Objective Factors influencing utilization of outpatient interventional therapies for extremely low gestational age newborns (ELGANs) after discharge remain poorly characterized, despite significant risk of neurodevelopmental impairment. We sought to assess the effects of maternal, infant, and environmental characteristics on outpatient therapy utilization in the first two years after discharge using data from the Preterm Erythropoietin Neuroprotection (PENUT) Trial. Study Design This is a secondary analysis of 818 24-27 weeks’ gestation infants enrolled in the PENUT trial who survived through discharge and completed at least one follow-up call or in-person visit between 4 and 24 months of age. Utilization of a state early intervention program (EI), physical (PT), occupational (OT), and speech (ST) therapies was recorded. Odds ratios and cumulative frequency curves for resource utilization were calculated for patient characteristics adjusting for gestational age, treatment group, and birth weight. Results 37% of infants did not access EI and 18% did not use any service (PT/OT/ST/EI). Infants diagnosed with severe morbidities (IVH, ROP, BPD, NEC), discharged with home oxygen, or with gastrostomy placement experienced increased utilization of PT, OT and ST compared to peers. However, substantial variation in service utilization occurred by state of enrollment and selected maternal characteristics. Conclusions ELGANs with severe medical comorbidities are more likely to utilize services after discharge. Therapy utilization may be impacted by maternal characteristics and state of enrollment. Outpatient therapy services remain significantly underutilized in this high-risk cohort. Further research is required to characterize and optimize utilization of therapy services following NICU discharge of ELGANs.

Distance to Treatment Center Is Associated with Health Outcomes in Older Adults with AML Receiving Azacitidine and Venetoclax Containing Regimens

Introduction: Recent analyses have demonstrated that race and geographic area are important factors for outcomes in acute myeloid leukemia (AML) patients under the age of 60. Older patients with AML often receive outpatient therapy aimed at prolonging survival while maintaining time at home, a critical patient-centered outcome. We aimed to describe whether overall survival and time at home were associated with race, geographic area, and other baseline factors for older AML patients in the modern era of combination outpatient therapy including hypomethylating agents and Venetoclax. Methods: We identified all older adults (≥ 60 years) diagnosed with AML from 2015 - 2020 who received first-line treatment with Azacitidine (AZA), Azacitidine + Venetoclax (AZA+VEN), or other Venetoclax-containing regimens (Other VEN) within the University of North Carolina (UNC) Health System. Clinical and sociodemographic factors were captured. The primary independent variables of interest were race, socioeconomic status (SES), rurality, and distance from UNC Cancer Center, an NCI Comprehensive Cancer Center (NCI-CCC). Race was self-reported. SES and rurality were estimated by ZIP code, as determined by Census tract information from the American Community Survey (2015-2019). Geocoding was used to estimate distance and travel time from patient's home address to the NCI-CCC. The primary outcomes were overall survival (OS) and proportion of days engaged in oncologic services (PDEOS), which was defined as the proportion of person-days admitted, in the ED, at an office visit, or in infusion/transfusion divided by the overall number of person-days survived. Linear and logistic regression analyses were performed to assess associations between independent variables and outcomes. Cox proportional hazards models were used to identify associations with OS. Multivariable analyses were performed using covariates of potential significance (p < 0.20). Results: Of 136 newly diagnosed AML patients aged ≥ 60 years identified in the study period, 113 patients had full capture of service records (83%). These patients were treated with AZA (n = 43), AZA+VEN (n = 58), or other VEN (n = 11). Baseline demographics are shown in the Table. The median distance from the NCI-CCC was 42.3 miles. The median OS for the entire cohort was 0.64 years (CI 0.32 - 0.91). Mean PDEOS was 0.42. 35% of patients achieved remission (AZA = 14%, AZA+VEN = 52%; Other VEN = 27%). Race, SES, and rurality were not significantly associated with survival, remission, PDEOS, or chemotherapy regimen received. Median OS was shorter for Black/AA patients (0.47 years, CI 0.23 - 1.25) than for White patients (0.64 years, CI 0.28 - 0.91), although this difference was not statistically significant (p = 0.80). After adjusting for log years of follow-up time, distance from the NCI-CCC was associated with increased PDEOS. Patients who lived ≥ 50 miles from the NCI-CCC spent 7% more days engaged in oncologic services, which amounts to 2.1 more days per month (p = 0.03). No significant association was observed between distance from the NCI-CCC and OS. There was also no association seen between distance from the NCI-CCC and chemotherapy regimen received. We examined the association between PDEOS and age, ELN risk, and median household income, and none of these variables were significant enough in the model to be considered for multivariable analyses. Conclusion: Overall survival in this population of older AML patients was not significantly associated with race, SES, distance to NCI-CCC or rurality. Distance to treatment center was associated with increased burden of healthcare services. Patients who lived the greatest distances from the NCI-CCC spent a greater proportion of their days engaged in oncologic services. These conclusions are limited by the relative racial and ethnic homogeneity, lack of representation from urbanized and rural areas, and limited geographic location. Given the dismal median overall survival of only 7.7 months, targeted interventions including telehealth visits or consolidation of multidisciplinary care would likely be valuable for decreasing healthcare burden among older AML patients, especially for those with long distances to travel. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.