Group-Based Smoking Cessation Program for Older Adults with Serious Mental Illness

Smoking is one of the most important modifiable risk factors for excess morbidity and mortality in older adults with serious mental illness (SMI). Many older smokers with SMI are reportedly motivated to quit, however evidence-based treatment targeting this vulnerable group is limited. To address an urgent need to identify interventions that assist smoking cessation efforts, we are conducting a pilot two-arm randomized controlled trial (RCT) targeting adults with SMI. Our VIdeogame-based Physical activity (“VIP”) smoking cessation intervention includes: a) group videogame-based physical activity intervention (50 minutes, 3X/week for 12 weeks), b) pharmacotherapy (bupropion or nicotine replacement therapy), and c) smoking cessation counseling. Upon completion of the 12 week program, participants in the VIP and control groups completed a semi-structured interview in order to determine how the program impacted their smoking cessation. To date, six participants completed an interview. Participants described how the program helped with smoking cessation because it allowed them to “face their addiction” and learn more about why they smoke and how to quit. The program provided the structure, resources, and encouragement needed to start the process of quitting. Finally, they enjoyed having the game time as a distraction from smoking. Older adults with SMI need support, resources, and group-based exercise as they begin quitting and practice the skills needed to quit.

1314. Descriptive Epidemiology of 30-day Readmissions among Survivors of Hospitalization with Bacterial Nosocomial Pneumonia in the US, 2012-2019

Background Nosocomial pneumonia (NP) remains associated with excess morbidity and mortality. The effect of NP on other measures of outcome and quality, such as re-admission at 30 days, remains unclear. Moreover, differing types of NP may have varying impacts on re-admissions. Methods We conducted a multicenter retrospective cohort study within the Premier Research database, a source containing administrative, pharmacy, and microbiology data. The rate of rehospitalization at 30 days following the index discharge served as our primary endpoint. We compared NP patients readmitted with pneumonia (RaP) as the principal diagnosis to those readmitted for other reasons (RaO). We also compared readmission rates as function of the type of NP: ventilator-associated bacterial pneumonia (VABP), ventilated hospital-acquired bacterial pneumonia (vHABP), and non-ventilated HABP (nvHABP). Results Among 17,819 patients with NP, 14,123 (79.3%) survived to discharge, of whom 2,151 (15.2%) required an acute readmission within 30 days of index discharge. Of these, 106 (4.9%) were RaP, and the remainder were RaO. At index hospitalization, RaP patients were older (mean age (SD) 67.4 (13.9] vs. 63.0 (15.2) years), more likely medical (44.3% vs. 36.7%), and less chronically ill (median [IQR] Charlson scores (3 [2-5] vs. 4 [2-5]) than persons with RaO. Bacteremia (10.4% vs. 17.5%), need for vasopressors (15.1% vs. 20.0%), dialysis (9.4% vs. 16.5%), and/or sepsis (9.4% vs. 16.5%) or septic shock 14.2% vs. 17.1%) occurred less frequently in the RaP group. With respect to NP type, nvHABP was most common in RaP (47.2%) and VABP in RaO (38.1%). Conclusion One in seven survivors of a hospitalization complicated by NP requires an acute rehospitalization within 30 days. However, few of these readmissions had a principal diagnosis of pneumonia, irrespective of NP type. This suggests that short-term readmission does not capture the quality of care initially delivered to patients for their NP. Of the 5% of NP subjects with RaP, the plurality initially suffered from nvHABP. Disclosures Marya Zilberberg, MD, MPH, Cleveland Clinic (Consultant)J&J (Shareholder)Lungpacer (Consultant, Grant/Research Support)Merck (Grant/Research Support)scPharma (Consultant)Sedana (Consultant, Grant/Research Support)Spero (Grant/Research Support) Brian Nathanson, PhD, Lungpacer (Grant/Research Support)Merck (Grant/Research Support)Spero (Grant/Research Support) Laura A. Puzniak, PhD, Merck & Co., Inc. (Employee) Andrew F. Shorr, MD, MPH, MBA, Merck (Consultant)

Integrating DNA-Methylation Measures of Biological Aging into Social Determinants of Health Research

Purpose of Review: Acceleration of biological processes of aging is hypothesized to drive excess morbidity and mortality in socially disadvantaged populations. DNA methylation measures of biological aging provide tools for testing this hypothesis.Recent Findings: Next-generation DNA-methylation measures of biological aging developed to predict mortality risk and physiological decline are more predictive of morbidity and mortality than the original epigenetic clocks developed to predict chronological age. These new measures show consistent evidence of more advanced and faster biological aging in people exposed to socioeconomic disadvantage and may be able to record the emergence of socially-determined health inequalities as early as childhood. Next-generation DNA-methylation measures of biological aging also indicate race/ethnic disparities in biological aging. More research is needed on these measures in samples of non-Western and non-White populations.Summary: New DNA-methylation measures of biological aging open opportunities for refining inference about the causes of social disparities in health and devising policies to eliminate them. Further refining measures of biological aging by including more diversity in samples used for measurement development is a critical priority for the field.

Dynamic characteristic of SARS-CoV-2 and its antibody detection

To prevent excess morbidity and mortality of Covid-19, a prompt and accurate diagnosis is crucial. Antibody-based rapid diagnostic test (RDT) is a rapid, fairly reliable, and useful diagnostic testing solution for COVID-19. As a point-of-care test with fast turnaround time, the kit permits quick screening in hospitals to avoid the crowding of specimen collection. However, available RDTs kits have different sensitivity, specificity, and accuracy profiles due to antigen and antibody variability because of the sequence mutation of the SARS-CoV-2 gene. Therefore, it is strongly recommended to either re-measure the accuracy of a rapid test before using it in a different country or use tests developed based on local viral characteristics

Evolving Trends and Changing Perspectives in ANCA Associated Vasculitis– A Review

Anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) is a group of conditions characterized by inflammation and destruction affecting small to medium vessels accompanied by excess morbidity and mortality. These diseases present as multisystem diseases with variety of signs and symptoms. Earlier AAV were considered fatal diseases, however recent advances have changed them to chronic illnesses associated with morbidity& relapses. This review analyses recent developments in the pathogenesis, treatment and follow up of ANCA associated vasculitis.

INCIDENCE OF THROMBOTIC EVENTS IN A COMMERCIALLY-INSURED US POPULATION

Objective: To estimate the US incidence of thrombotic events and related rare diagnoses. Design: Claims-based retrospective cohort study of incidence. Setting: US commercial health insurance administrative claims database. Participants: Adults 25-65 years of age between 2015 and 2019 with a minimum of 12 consecutive thrombosis-free months of continuous enrollment beginning 2014 were selected. Main Outcomes: Age (10 year intervals) and sex stratum specific incidence rates per 100,000 person-years were determined for: venous thromboembolism (VTE), cerebral venous thrombosis (CVT), and any major thrombosis. Incidence also was estimated for immune thrombocytopenic purpura (ITP), hemolytic-uremic syndrome (HUS), and heparin-induced thrombocytopenia (HIT). Results: Among approximately 15 million enrollees per year (half female/male), incidence of any thrombotic event (DVT, PE, CVT, or other thrombosis) was 247.89 per 100,000 person-years (95% CI: 245.96, 249.84). Incidence of VTE was 213.79 with ICD codes alone (95% CI: 211.99, 215.59) and 127.18 (95% CI: 125.80, 128.58) when also requiring a filled anticoagulation prescription. Incidence rates were 6.37 for CVT (95% CI: 6.07, 6.69), 26.06 for ITP (95% CI: 25.44, 26.78), 0.94 for HUS (95% CI: 0.82, 1.06), and 4.82 for HIT (95% CI: 4.56, 5.10). The co-occurrence of CVT with either ITP or HIT (diagnoses within 14 days of one another) was 0.090 (95% CI: 0.06, 0.13). Incidence tended to increase with age and was higher for women under 55. Incidence for CVT, HUS, and CVT with ITP or HIT was higher for women in all age groups. Conclusions: These results are the first US estimates for incidence of thrombotic and rare events in a large, commercially-insured US population. Findings provide a critically important reference for determining excess morbidity associated with COVID-19 and more generally for vaccine pharmacovigilance.

Bleeding Post Constriction Ring Release Surgery Causing Lower Limb Ischemia in an Infant with Undetected Hemophilia B

Bleeding in the immediate postoperative period causing compromised limb circulation is an alarming complication. It is known to occur in coagulation disorders like hemophilia. When such complications happen in a child with no previous history of bleeding problems, one has to have a low threshold for suspecting a coagulation disorder. Repeated diffuse bleeding in the whole of the surgical wound with no specific bleeders must raise the suspicion and appropriate laboratory tests must immediately be ordered. Bleeding in coagulation disorders can stop only with supplementation of the appropriate missing clotting factor. Early diagnosis is important to avoid excess morbidity. We are reporting a 6-month-old child who underwent surgery for constriction ring syndrome in the limbs with Z-plasty please replace with and developed impending limb ischemia due to bleeding in the immediate postoperative period. The article emphasizes the need to think of the possibility while encountering recurrent bleeding in the postoperative period.

Post-COVID Syndrome and Tachycardia: Theoretical Base and Treatment Experience

The coronavirus pandemic showed not only an increase in levels of excess morbidity and mortality in the acute phase, but also persisting symptoms 4 weeks after the onset of the disease. A review of international studies on the prevalence and diversity of the manifestations of postcoid syndrome is presented. The data on such a manifestation of post-COVID syndrome as postural orthostatic tachycardia syndrome (POTS) are accumulating. Pathogenetic mechanisms, modern diagnostic criteria and research data on the prevalence of this syndrome are presented in the article. The Canadian Cardiovascular Society has proposed medications as a treatment for POTS, including the sinus node If channel inhibitor ivabradine. Data from several studies showing the effectiveness of this drug for POTS, including after suffering COVID-19, are presented in the article. Clinical data on the prevalence of tachycardia among patients admitted to the Sechenov University hospital are presented. About 18% of patients with hypertension and 21% of patients with normal blood pressure had a high heart rate. A clinical example of the use of ivabradine in a patient after a coronavirus infection is presented. Drug interactions and individual tolerance of ivabradine in patients after coronavirus infection are being discussed. The authors put forward the hypothesis about the further prospect of using ivabradine in the treatment of clinical manifestations of postcoid syndrome on the basis of literature data and their own experience.

Defining global benchmarks in elective secondary bariatric surgery comprising conversional, revisional and reversal procedures

Objective Management of poor response and of long-term complications after bariatric surgery (BS) is complex and under-investigated. Indications and types of reoperations vary widely and postoperative complication rates are higher compared to primary BS. Benchmarking uses best performance in a given field as reference point for improvement. Our aim was to define ‘‘best possible’’ outcomes for elective secondary BS. Methods The establishment of benchmarks in secondary BS followed a standardized methodology, based on recommendations of a Delphi consensus panel of experts. This multicenter study analyzed patients undergoing elective secondary BS in 18 high-volume centers on 4 continents from 06/2013 to 05/2019. Twenty-one outcome benchmarks were established in low-risk patients, defined as the 75th percentile of the median outcome values of the centers. Benchmark cases had no: previous laparotomy, diabetes, sleep apnea, cardiopathy, renal insufficiency, inflammatory bowel disease, immunosuppression, history of thromboembolic events, BMI>50kg/m2 or age>65 years. Descriptive statistics, multivariate logistic regression and data visualization were performed using the R software. Results Out of 44’884 elective bariatric procedures performed in the participating centers, 5’328 secondary BS cases were identified. The benchmark cohort included 3143 cases, mainly females (85%), aged 43.8±10 years, 8.4±5.3 years after primary BS, with a body mass index 35.2±7kg/m2. Main indications were insufficient weight loss (43%) and gastro-esophageal reflux disease/dysphagia (25%). 90-days postoperatively, 14.57% of benchmark patients presented ≥1 complication, mortality was 0.06% (n = 2). Significantly higher morbidity was observed in non-benchmark cases (OR 1.36) and after conversional or revisional procedures with gastrointestinal suture/stapling (OR 1.7). Benchmark cutoffs at 90-days postoperatively were ≤5.8% re-intervention and ≤8.8% re-operation rate. At 2-years (IQR 1-3) 15.6% of benchmark patients required a reoperation. Conclusion Secondary BS is safe, although postoperative morbidity exceeds the established benchmarks for primary BS. The excess morbidity is due to an increased risk of gastrointestinal leakage and higher need for intensive care. The considerable rate of tertiary BS warrants expertise and future research to optimize the management of non-success after BS.