Prognostic Significance of Chest Imaging by LUS and CT in COVID-19 Inpatients: The ECOVID Multicenter Study

<b><i>Background:</i></b> Point-of-care lung ultrasound (LUS) score is a semiquantitative score of lung damage severity. High-resolution computed tomography (HRCT) is the gold standard method to evaluate the severity of lung involvement from the novel coronavirus disease (COVID-19). Few studies have investigated the clinical significance of LUS and HRCT scores in patients with COVID-19. Therefore, the aim of this study was to evaluate the prognostic yield of LUS and of HRCT in COVID-19 patients. <b><i>Methods:</i></b> We carried out a multicenter, retrospective study aimed at evaluating the prognostic yield of LUS and HRCT by exploring the survival curve of COVID-19 inpatients. LUS and chest CT scores were calculated retrospectively by 2 radiologists with &#x3e;10 years of experience in chest imaging, and the decisions were reached in consensus. LUS score was calculated on the basis of the presence or not of pleural line abnormalities, B-lines, and lung consolidations. The total score (range 0–36) was obtained from the sum of the highest scores obtained in each region. CT score was calculated for each of the 5 lobes considering the anatomical extension according to the percentage parenchymal involvement. The resulting overall global semiquantitative CT score was the sum of each single lobar score and ranged from 0 (no involvement) to 25 (maximum involvement). <b><i>Results:</i></b> One hundred fifty-three COVID-19 inpatients (mean age 65 ± 15 years; 65% M), including 23 (15%) in-hospital deaths for any cause over a mean follow-up of 14 days were included. Mean LUS and CT scores were 19 ± 12 and 10 ± 7, respectively. A strong positive linear correlation between LUS and CT scores (Pearson correlation <i>r</i> = 0.754; <i>R</i>² = 0.568; <i>p</i> &#x3c; 0.001) was observed. By ROC curve analysis, the optimal cut-point for mortality prediction was 20 for LUS score and 4.5 for chest CT score. According to Kaplan-Meier survival analysis, in-hospital mortality significantly increased among COVID-19 patients presenting with an LUS score ≥20 (log-rank 0.003; HR 9.87, 95% CI: 2.22–43.83) or a chest CT score ≥4.5 (HR 4.34, 95% CI: 0.97–19.41). At multivariate Cox regression analysis, LUS score was the sole independent predictor of in-hospital mortality yielding an adjusted HR of 7.42 (95% CI: 1.59–34.5). <b><i>Conclusion:</i></b> LUS score is useful to stratify the risk in COVID-19 patients, predicting those that are at high risk of mortality.

Self-rated resilience and mobility limitations as predictors of change in active aging during COVID-19 restrictions in Finland: a longitudinal study

Social distancing during the COVID-19 pandemic decreased older people’s opportunities to lead an active life. The purpose of this study was to investigate whether walking difficulties predict changes in leading an active life during the COVID-19 social distancing recommendation compared to 2 years before, and whether self-rated resilience moderates this association among older people. Data were collected during social distancing recommendation in May and June 2020 and 2 years before (2017–18) among community-living AGNES study participants initially aged 75, 80, or 85 years (n = 809). Leading an active life was assessed with the University of Jyväskylä Active Aging Scale (UJACAS; total score range 0–272) and resilience with the 10-item Connor-Davidson Resilience Scale (0–40). Self-reported walking difficulties over a 2 km distance were categorized into no difficulty, difficulty, and unable to walk. The total UJACAS score declined 24.9 points (SD 23.5) among those without walking difficulty, 27.0 (SD 25.0) among those reporting walking difficulty and 19.5 (SD 31.2) among those unable to walk 2 km. When adjusted for baseline UJACAS score, those unable to walk 2 km demonstrated the greatest decline. Baseline resilience moderated this association: Higher resilience was associated with less declines in UJACAS scores among persons with or without walking difficulty, and with more declines among persons unable to walk 2 km. When opportunities for leading an active life are compromised, those with less physical and psychological resources become particularly vulnerable to further declines in activity.

Real-World Effectiveness of a New Growing Up Milk on Digestive Comfort and Social-Emotional Outcomes Among Healthy Toddlers in China

Objectives Existing clinical evidence indicates infant formulas containing bovine milk-derived oligosaccharides (MOS) promote soft stools and gut health among young infants. This prospective single-arm study aimed to assess effectiveness of a new growing-up milk (GUM) containing MOS and milk fat (naturally contains sn-2 palmitate) on digestive and social-emotional outcomes among healthy toddlers. Methods Toddlers age 12–36 months were enrolled from an urban area in China to receive the GUM for 28 days. Overall digestive comfort (primary outcome) was assessed by the Gut Comfort Composite Score (GCCS; range 10–60 with increasing scores for higher GI burden) from the 10-item Toddler Gut Comfort Questionnaire (Meng 2019). Other parent-reported culturally relevant outcomes included heatiness based on individual symptoms via Child Heatiness Questionnaire (Sheng 2020; total score range 0–10), and social-emotional outcomes via 3-day mood diary and Children's Playfulness Scale (Li 1995; range 0–69). Results A total of 98 toddlers were enrolled and completed the study. While overall GI burden was low at baseline (mean ± SD GCCS: 15.7 ± 4.7; range 10–32), GCCS at post-baseline visits was further reduced (14.7 ± 4.7 at D7, p = 0.02; 13.5 ± 4.0 at D14, p &lt; 0.001; 13.3 ± 3.6 at D28, p &lt; 0.001). Parental report for child heatiness was reduced over study period (0.5 ± 1.2 at D28 vs. 1.0 ± 1.5 [range 0–7] at baseline, p = 0.002). Percentage of toddlers with heatiness (composite score &gt; 0) was 40% at baseline and reduced to 26% by D28 (p = 0.011). Parents reported that their toddlers’ playful behaviors became more important to them by D28 from baseline (median [IQR]: 62 [13] vs. 58 [11.5], p = 0.002). Over 94% of parents reported their toddlers exhibited happy moods at each post-baseline visit, although not statistically different from baseline. Furthermore, lower gut comfort score was associated with more playful behaviors (p &lt; 0.001) and happier mood during daytime (p &lt; 0.001). Over 95% of parents reported their toddlers liked the taste of the GUM and felt happy when drinking it, while 98% of toddlers indicated they liked to drink the GUM. Conclusions Consumption of a new GUM with MOS and milk fat is associated with improved gut comfort, increased importance of playfulness and reduced heatiness. Parents also reported happy toddler moods and high satisfaction. Funding Sources Sponsored by Wyeth Nutrition.

POS0967 DESCRIPTION OF SACROILIAC CT FINDINGS IN PATIENTS WITH ANKYLOSING SPONDYLITIS AGED OVER 50 YEARS: PRELIMINARY RESULTS OF THE CASIAGE STUDY

Background:Diagnosis of axial spondyloarthritis (SpA) is nowadays commonly made with the help of pelvic radiography or MRI. However, there is an important inter-observer variability for radiographs, and MRI is subject to possible false positives, and is not the best modality for studying structural lesions. Conversely, pelvic CT has an excellent specificity and appears to be more effective than radiography for the diagnosis of SpA [1]. However, CT findings in patients over 50 years of age have not been studied.Objectives:To describe sacroiliac (SI) joint CT characteristics in patients with ankylosing spondylitis (AS), aged 50 years or older.Methods:An observational, cross sectional study was performed using medical records from Besançon University Hospital’s rheumatology department, which were screened to identify patients with AS. A search was then carried out for patients over 50 years old in the hospital’s imaging archiving system to identify those who had benefited from a CT which included the SI joints in their entirety. Non-inclusion criteria were the existence of pelvic bone lesions and a history of pelvic radiotherapy. For each patient, CT was interpreted using a score previously used by Diekhoff et al. [2], dividing each SI joint into 12 regions, for each of which joint space narrowing (JSN), erosions, and sclerosis are assessed. For this study, we also observed the existence of intra-articular gas and diffuse idiopathic skeletal hyperostosis (DISH) lesions for each region. Quantitative variables are expressed as mean ± standard deviation, qualitative variables as numbers and percentages. Wilcoxon rank-sum test was used to determine factors associated with a higher CT score.Results:A total of 66 patients were included. Mean (SD) age was 65.10 ± 10.59 with a mean (SD) duration of disease of 22.87 ± 14.95 years. 60.29% were male, and 87.04 % were HLA-B27 positive. 40.30% had a bamboo spine. CT findings are described in Table 1. The vast majority of patients have a positive JSN score but significant erosions are found in only a minority of cases. This is partly explained by the fact that 55.9% of the patients had at least one complete bilateral ankylosis (and therefore no erosions) on one of the three slices studied. Bilateral anklylosis was associated with a longer duration of disease (p<0.001) and presence of bamboo spine (p<0.001). Also noteworthy is the low proportion of DISH compared to the general population in this age group, which is 15-25%.Factors associated with a higher total CT score were male sex (p=0.017), longer duration of disease (p<0.001), tobacco use (p=0.033), presence of bamboo spine (p=0.004), absence of DISH (p=0.045) and absence of intra-articular gas (p<0.001). The distribution of lesions appeared to be homogenous over all 24 regions studied (Figure 1).Conclusion:CT findings in AS patients over 50 years of age are mostly represented by changes in joint space, with bilateral ankylosis present in half of the patients. AS appears to be a protective factor for DISH.References:[1]Devauchelle-Pensec V, D’Agostino MA, Marion J, et al. Computed tomography scanning facilitates the diagnosis of sacroiliitis in patients with suspected spondylarthritis: Results of a prospective multicenter French cohort study. Arthritis Rheum 2012;64:1412–9. doi:10.1002/art.33466[2]Diekhoff T, Hermann K-GA, Greese J, et al. Comparison of MRI with radiography for detecting structural lesions of the sacroiliac joint using CT as standard of reference: results from the SIMACT study. Ann Rheum Dis 2017;76:1502–8. doi:10.1136/annrheumdis-2016-210640Table 1.Sacro-iliac CT findings using a score modified from Diekhoff et al.Mean total score (range 0-108)70.36±38.90Presence of joint space narrowing58 (85.29 %)Presence of erosion20 (29.41 %)Presence of sclerosis15 (22.06 %)Presence of Intra-articular gas22 (32.35 %)Presence of DISH3 (4.41 %)Figure 1.Mean scores per region in the anterior, central and posterior SI slices (JSN: joint space narrowing (0-4), Ero: erosions (0-3), Scl: sclerosis (0-2)).Disclosure of Interests:None declared.

495 Efficacy of Lower-Sodium Oxybate on Idiopathic Hypersomnia, Measured by the Idiopathic Hypersomnia Severity Scale

Introduction Idiopathic hypersomnia (IH) is a rare central hypersomnolence disorder with no approved treatment, characterized by excessive daytime sleepiness, prolonged sleep time, and sleep inertia. The Idiopathic Hypersomnia Severity Scale (IHSS) is a 14-item, self-reported questionnaire that assesses severity of IH symptoms, including symptoms related to night/inertia (component I) and day/performance (component II). Individual IHSS items measure symptom frequency, intensity, and consequences using 3- or 4-point Likert scales, yielding a total score (range, 0–50), comprising component I (range, 0–16) and component II (range, 0–34). Higher scores indicate worse symptoms. In a recent clinical trial of the efficacy and safety of lower-sodium oxybate (LXB; Xywav™) for the treatment of IH, the IHSS was a key efficacy measure. Methods Eligible participants 18–75 years of age with IH began LXB treatment with an open-label treatment titration and optimization period (OLTTOP; 10–14 weeks), followed by a 2-week stable-dose period (SDP). Participants were randomized to placebo or continued LXB treatment during a 2-week, double-blind, randomized withdrawal period (DBRWP). The IHSS was completed at baseline, during OLTTOP (weeks 1, 4, and 8), and at the end of OLTTOP, SDP, and DBRWP. Change in IHSS total score from SDP to DBRWP was a key secondary endpoint. Results The efficacy population included 115 participants (mean±SD age, 41±14 years; 71% female). At baseline and the end of SDP, respectively, mean±SD IHSS scores were 31.6±8.3 and 15.3±8.5 for total score, 10.3±3.6 and 5.4±2.8 for component I (night/inertia), and 21.2±5.8 and 9.9±6.5 for component II (day/performance). Worsening from SDP to DBRWP was observed in patients randomized to placebo compared with LXB in IHSS total scores (estimated median difference [95% CI], −12.0 [−15.0, −8.0]; significant P&lt;0.0001), component I scores (LS mean difference [95% CI], −3.9 [−4.9, −2.9]; nominal P&lt;0.0001), and component II scores (LS mean difference [95% CI], −7.8 [−9.6, −5.9]; nominal P&lt;0.0001). Results on all individual IHSS items reflected an improvement with LXB treatment over time during OLTTOP, which remained consistent during SDP. Conclusion These results support the efficacy of LXB for the treatment of IH symptoms, as assessed with the IHSS. Support (if any) Jazz Pharmaceuticals

Medication Intake, Perceived Barriers, and Their Correlates Among Adults With Type 1 and Type 2 Diabetes: Results From Diabetes MILES – The Netherlands

PurposeThe purpose of this study is to investigate medication intake, perceived barriers and their correlates in adults with type 1 or type 2 diabetes.MethodsIn this cross-sectional study, 3,383 Dutch adults with diabetes (42% type 1; 58% type 2) completed the 12-item ‘Adherence Starts with Knowledge’ questionnaire (ASK-12; total score range: 12-60) and reported socio-demographics, clinical and psychological characteristics and health behaviors. Univariable and multivariable logistic regression analyses were used.ResultsAdults with type 1 diabetes had a slightly lower mean ASK-12 score (i.e. more optimal medication intake and fewer perceived barriers) than adults with non-insulin-treated type 2 diabetes. After adjustment for covariates, correlates with suboptimal intake and barriers were fewer severe hypoglycemic events and more depressive symptoms and diabetes-specific distress. In type 2 diabetes, correlates were longer diabetes duration, more depressive symptoms and diabetes-specific distress.ConclusionsAdults with type 1 diabetes showed slightly more optimal medication intake and fewer perceived barriers than adults with non-insulin treated type 2 diabetes. Correlates differed only slightly between diabetes types. The strong association with depressive symptoms and diabetes-specific distress in both diabetes types warrants attention, as improving these outcomes in some people with diabetes might indirectly improve medication intake.

Analytical validation of the Percepta genomic sequencing classifier; an RNA next generation sequencing assay for the assessment of Lung Cancer risk of suspicious pulmonary nodules

Background Bronchoscopy is a common procedure used for evaluation of suspicious lung nodules, but the low diagnostic sensitivity of bronchoscopy often results in inconclusive results and delays in treatment. Percepta Genomic Sequencing Classifier (GSC) was developed to assist with patient management in cases where bronchoscopy is inconclusive. Studies have shown that exposure to tobacco smoke alters gene expression in airway epithelial cells in a way that indicates an increased risk of developing lung cancer. Percepta GSC leverages this idea of a molecular “field of injury” from smoking and was developed using RNA sequencing data generated from lung bronchial brushings of the upper airway. A Percepta GSC score is calculated from an ensemble of machine learning algorithms utilizing clinical and genomic features and is used to refine a patient’s risk stratification. Methods The objective of the analysis described and reported here is to validate the analytical performance of Percepta GSC. Analytical performance studies characterized the sensitivity of Percepta GSC test results to input RNA quantity, the potentially interfering agents of blood and genomic DNA, and the reproducibility of test results within and between processing runs and between laboratories. Results Varying the amount of input RNA into the assay across a nominal range had no significant impact on Percepta GSC classifier results. Bronchial brushing RNA contaminated with up to 10% genomic DNA by nucleic acid mass also showed no significant difference on classifier results. The addition of blood RNA, a potential contaminant in the bronchial brushing sample, caused no change to classifier results at up to 11% contamination by RNA proportion. Percepta GSC scores were reproducible between runs, within runs, and between laboratories, varying within less than 4% of the total score range (standard deviation of 0.169 for scores on 4.57 scale). Conclusions The analytical sensitivity, analytical specificity, and reproducibility of Percepta GSC laboratory results were successfully demonstrated under conditions of expected day to day variation in testing. Percepta GSC test results are analytically robust and suitable for routine clinical use.

Anxiety, depression, stress, fear and social support during COVID-19 pandemic among Jordanian healthcare workers

The emergence of Coronavirus disease 2019 (COVID-19) has affected health-care workers’ psychological and mental health. Few studies have been conducted examining the psychological effect of COVID-19 on health-care worker psychological health in Jordan. Therefore, the present study aims to assess the respective levels of fear, anxiety, depression, stress, social support, and the associated factors, experienced by Jordanian health-care workers during the COVID-19 Pandemic. This study adopted a cross-sectional, correlational design to collect data from 365 health-care workers in Amman, Jordan, from August 16th to 23rd, 2020. Along with collecting sociodemographic characteristics, the Fear of COVID-19 Scale, the Depression, Anxiety, Stress Scale, and the Multidimensional Scale of Perceived Social Support electronically administered to participants. The majority of the participants (69.3%) were registered nurses. The mean overall score for the Fear of COVID-19 scale was 23.64 (SD + 6.85) which again exceeded the mid-point for the total score range (21), indicating elevated level fear of the COVID-19 pandemic. Participants had displayed extremely severe depression 40%, extremely severe anxiety 60%, and 35% severely distressed. Scores for depression (21.30 ± 10.86), anxiety (20.37 ± 10.80), stress (23.33 ± 10.87) were also high. Factors determined to be associated with psychological distress were being male, married, aged 40 years and older, and having more clinical experience. Assessment of social support indicated moderate-to-high levels of perceived support for all dimensions (significant other: 5.17 ± 1.28, family: 5.03 ± 1.30, friends: 5.05 ± 1.30). Weak significant correlations were found between social support and the other study variables (r < 0.22), indicating a weak association with fear, depression, anxiety, and stress, respectively. Overall, Jordanian health-care workers sample reported fear, depression, anxiety, and stress. The associated factors were being male, married, aged 40 years and older, and having more clinical experience. Regarding social support, participants primarily relied on support from their families, followed by support from friends.

Development and Analysis of a Weighed Prognostic Model in Newly Diagnosed Multiple Myeloma Patients

Background and Objective: Multiple myeloma (MM) is characterized with significant cytogenetic changes and complex tumor microenvironment, thus patient survival is extremely heterogeneous. Various disease-related or patient-related factors affect the prognosis of patients. This study tried to analyze the prognostic indicators of patients with newly-treated MM, especially explored the prognosis of multiple cytogenetic abnormalities and the ratio of lymphocytes to monocytes (LMR). Additionally, we established a comprehensive prognostic model to help determine the patient prognosis. Methods: After screening, 603 patients of untreated MM from January 2008 to June 2017, with complete baseline indicators were enrolled into the study. By univariate and multivariate Cox analysis, risk factors related to the prognosis of patients were evaluated, and a weighted prognosis model was established to compare the survival differences of patients in each risk stratification. Result: Optimal thresholds of ALC, LWR, NLR and LMR were determined by ROC curve and Youdex index: ALC = 1.415, LWR = 0.325, NLR = 1.935, LMR = 2.95. Survival analysis showed that patients with LMR ≤ 2.95, ALC ≥ 1.415 and LWR ≥ 0.325 had significantly better survival compared with their respective control groups. Cox multivariate analysis showed that among the four indicators, only LMR≤2.95 was an independent adverse prognostic factor for overall survival (OS)(Figure 1A). 17p deletion, 1q21 amplification, t (4; 14) / t (14; 16) were define as high-risk cytogenetic abnormalities (HRA). Of the 603 patients, about 60% were associated with at least one high-risk cytogenetic event. Among them, the occurrence of cumulative 0, 1, 2, and 3 HRA were 39.6% (239/603), 42.5% (256/603), 16.6% (100/603), and 1.3% (8/603), respectively. There was no significant difference in survival among patients with same number of HRAs. The median OS of patients with 0, 1 and ≥ 2 HRA were not reached, 62.1 months (95% CI, 49.3-74.9) and 30.4 months (95% CI, 24.5-36.3), respectively (p &lt;0.001)(Figure 1B).Final Cox regression model showed that age 65 ~ 74 (HR=1.77, 95%CI, 1.24-2.51, p=0.001), age ≥75 (HR=2.46, 95%CI, 1.69-3.58, p &lt; 0.001), LDH≥247 U/L (HR =1.65, 95%CI, 1.07-2.51, p=0.023), ISS stage III (HR=1.76, 95%CI, 1.24-2.50, p=0.002), LMR≤2.95 (HR=1.53, 95%CI, 1.08-2.18, p=0.017), 1 HRA (HR=1.87, 95%CI, 1.27-2.75, p=0.002) and ≥2 HRA (HR=3.48, 95%CI, 2.22-5.45, p&lt;0.001) are independent adverse prognostic factors for OS. Then weighted risk factors were summed to establish a comprehensive prognosis model, with a total score range of 0-6 points. Accordingly, the whole cohort was divided into low risk (0-1 points, 45.4%), intermediate risk (2 points, 27.9%), high risk (3 points, 19.2%) and ultra-high risk (4-6 points, 7.5 %) groups. The median OS of the four risk groups were 85.8 months (67.1-104.5), 49.0 months (44.7-53.3), 35.4 months (31.3-39.5), and 23.2 months (18.8-27.6), respectively (p&lt;0.001). The C-statistics of this prognostic model is 0.68 (95% CI, 0.64-0.71), which is significantly better than the D-S stage (C-statistics = 0.52, 95% CI, 0.50-0.55, p &lt;0.001), ISS (C-statistics = 0.60, 95% CI, 0.57-0.64, p &lt;0.001) and R-ISS stage (C-statistics = 0.60, 95% CI, 0.57-0.63, p &lt;0.001). Bootstrap resampling and calibration curve showed that the model has an accurate predictive effect on both short-term and long-term prognosis of patients(Figure 1C). Conclusion: In our analysis, ALC, LWR, LMR were associated with poor prognosis in NDMM patients, while NLR had no significant prognostic significance. Among the four indicators, LMR≤2.95 was the only independent prognostic factor. In NDMM patients, survival of patients with the same number of high-risk cytogenetic abnormalities were comparable with each other, regardless of whichever combination of HRA. Higher number of high-risk cytogenetic abnormalities were associated with worse prognosis. Cox multivariate analysis showed that, old age (65-74 years old, ≥75 years old), increased LDH (≥247 U/L), decreased LMR (≤2.95), ISS III, 1 HRA and ≥ 2 HRA were independent adverse prognostic factors that affect the OS of MM patients. 4. A comprehensive weighted prognostic model was established with the above factors, which was proved to effectively distinguish different prognosis of patients. Figure 1 Disclosures No relevant conflicts of interest to declare.

Teaching clinicians shared decision making and risk communication online: an evaluation study

ObjectivesTo describe the development and initial evaluation of a brief e-learning course as a means of teaching shared decision making and risk communication skills to clinicians of all specialties.DesignComparison pre-course and post-course of scores in subjective confidence and objective knowledge about shared decision making and risk communication.SettingOnline and open to all specialties and levels of clinical experience, including students.ParticipantsThe course is freely available online and all who started the course from September 2018 to May 2020 were invited to participate in the evaluation study.InterventionThe self-guided e-learning course is made up of four modules and takes approximately 2 hours to complete. It is hosted on the website of the Winton Centre for Risk Communication and the UK’s National Health Service e-learning platform.Main outcome measuresPre-course and post-course confidence in performing shared decision making (as measured by a 10-item scale adapted from the OPTION tool; total score range 10–50), and objective knowledge about basic principles of shared decision making and risk communication, as measured by performance on four knowledge questions and three calculations. At course commencement, a single item from the Berlin Numeracy Test, and the eight-item Subjective Numeracy Test were also asked.ResultsOf 366 unique participants who consented and commenced the course, 210 completed all modules and the final post-course test. Participants’ mean age was 38.1 years, 69% were in current clinical practice and had a mean of 10.5 years of clinical practice. Numeracy was relatively low, with 50.7% correctly answering the Berlin Numeracy Test item pre-course. Participants who completed the course showed a significant improvement in their confidence by a mean summed score of 3.7 units (95% CI 2.9 to 4.6, p<0.0001) from a mean pre-course of 37.4 (SD 6.1) to post-course of 41.1 (SD 6.9). There was an increase in the proportion of correct answers for most knowledge questions (p<0.0001, p=0.013 for two directly compared), although no improvement in most skill questions that involved numbers (eg, calculating relative risks). Participants with higher numeracy appeared to show higher skill and confidence on most questions.ConclusionsThis online, free e-learning course was successful in increasing participants’ confidence in, and some aspects of knowledge about, shared decision making and risk communication. It also highlighted the need for improvements in clinicians’ numerical skills as a vital part of training. We suggest that the course is used in combination with practical face-to-face experience and more intensive numerical skills training.