Validation of the Cognitive Telephone Screening Instruments COGTEL and COGTEL+ in Identifying Clinically Diagnosed Neurocognitive Disorder Due to Alzheimer’s Disease in a Naturalistic Clinical Setting

Background: Telephone-based neurocognitive instruments embody valuable tools in identifying cognitive impairment in research settings and lately also in clinical contexts due to the pandemic crisis. The accuracy of the Cognitive Telephone Screening Instrument (COGTEL) in detecting mild- (MiND) and major (MaND) neurocognitive disorder has not been studied yet. Objective: Comparison of the utility of COGTEL and COGTEL+, which is enriched with orientation items, with the modified Mini-Mental State Examination (3MS) in detecting MiND and MaND due to Alzheimer’s disease (AD) and assessment of the impact of COGTEL face-to-face-versus telephone administration on individual performance. Methods: The study included 197 cognitively intact individuals (CI), being at least 45 years old, 95 and 65 patients with MiND and MaND due to AD, respectively. In 20 individuals COGTEL was administered both in face-to-face and telephone sessions. Statistical analyses included proportional odds logistic regression models, stratified repeated random subsampling used to recursive partitioning to training and validation set (70/30 ratio), and an appropriate F-test. Results: All studied instruments were significant predictors of diagnostic outcome, but COGTEL+ and 3MS explained more variance relative to the original COGTEL. Except for the validation regression models including COGTEL in which the average misclassification error slightly exceeded 15%, in all other cases the average misclassification errors (%) were lower than 15%. COGTEL administration modality was not related to systematic over- or underestimation of performance on COGTEL. Conclusion: COGTEL+ is a valuable instrument in detecting MiND and MaND and can be administered in face-to-face or telephone sessions.

Delivery of systemic anti-cancer therapy during the COVID-19 pandemic

Background The first confirmed case of COVID-19 in Ireland was on February 29th 2020. From March until late April, the number of cases increased exponentially. The delivery of anti-cancer therapy during the COVID-19 pandemic was extremely challenging. In order to balance the benefits of continuing anti-cancer therapy with the associated increased hospital visits, combined with the risk of COVID-19 infection, we undertook a series of system changes in the delivery of cancer care. Methods Patients who attended our dayward over a 4-month period were included. Data were obtained from patient and chemotherapy prescribing records. Patients were screened for symptoms of COVID-19 at two separate timepoints: prior to their visit via telephone, and using a symptom questionnaire on arrival at the hospital. If patients displayed COVID-19 symptoms, they were isolated and a viral swab arranged. Results A total of 456 patients attended from January 1st to April 30th. The numbers of visits from January to April were 601, 586, 575, and 607, respectively. During this period, there were 2369 patient visits to the dayward and 1953 (82%) intravenous regimens administered. Of the 416 visits that did not lead to treatment, 114 (27%) were scheduled non-treatment review visits, 194 (47%) treatments were held due to disease-related illness, and 108 (26%) treatments were held due to treatment-related complications. Screening measurements were implemented on March 18th due to rising COVID-19 prevalence in the general population. Overall, 53 treatments were held due to the screening process: 19 patients (36%) elicited COVID-19 symptoms via telephone screening; 34 patients (64%) were symptomatic in our pre-assessment area and referred for swabs, of which 4 were positive. Those with a negative swab were rescheduled for chemotherapy the following week. Conclusions With careful systematic changes, safe and continued delivery of systemic anti-cancer therapy during the COVID-19 pandemic is possible.

Reducing medical oncology infusion no-show rate by improving patient and intra-clinic communication.

47 Background: Parkland Health and Hospital System (PHHS) is the safety-net health system for Dallas County. In a resource-limited health care system, no-shows create waste and delay care. We sought to decrease the no-show rate (NSR) for patients scheduled for infusions, transfusions, and injections in the PHHS medical oncology infusion center by 33% in a 4-month period. Methods: A multidisciplinary team reviewed the NSR from January 2020 to May 2020. The reasons for missed appointments were investigated via chart review to better develop an intervention for meaningful change. A telephone follow-up protocol by the infusion nurses with standardized documentation and communication with the clinic and scheduling teams (intra-clinic communication) was implemented for each missed infusion appointment starting in February 2020. Results: The infusion center had a 16.4% NSR in January 2020. Of the 306 missed appointments, there was no documented reason for 44% (159). 19% (70) were related to change in plan-of-care; 19% (67) were in patients who had been admitted. Patient-related issues (transportation, illness, work/family obligations, etc.) were 13% of no-shows. Only 40 (11%) of the no-shows had a follow-up call. After implementation of follow-up telephone calls, the NSR was 11.2% by May 2020, a 32% decrease. 57.8% (204/1822) of patients who no-showed received a follow-up call to document reason for the missed appointment. Conclusions: We decreased the NSR in the PHHS medical oncology infusion center by 32% over a 4-month period, nearly reaching our goal, by implementing standardized post-no-show follow-up calls. Through our process, we discovered that communication, with the patient and intra-clinic, accounted for the most missed appointments rather than patient-related or other factors. Perhaps confounding our results were changes brought about by the COVID-19 pandemic, including mandatory telephone screening of patients prior to infusion appointments. Next steps include integrating pre-appointment calls into the workflow, standardizing change-in-plan communication, and cost analysis of interventions in our resource-limited setting.

Facebook Is a Useful Recruitment Strategy for a Randomized Clinical Trial of a Lifestyle Approach to Reverse Metabolic Syndrome

Objectives Design and evaluate a Facebook (FB) campaign to recruit a select sample with metabolic syndrome (MetS) to participate in a telephone screening for inclusion in a randomized controlled trial of the efficacy of a lifestyle medicine intervention to reverse MetS. Methods Inclusion and exclusion criteria for participation in the Enhanced Lifestyles for Metabolic Syndrome (ELM) study informed development of a FB ad, utilizing FB guidelines. After clicking a FB ad, co-morbidity and contact information to schedule a screening call were captured via survey using a Qualtrics platform. Phone screen eligibility was defined as having no listed co-morbidities. Providing contact information in addition was deemed to be complete and phone screen-ready. Phone screen eligibility and readiness frequencies were compared to FB campaign performance data on reach, link clicks, demographics and costing using the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) system. Participation was not incentivized. Results The 14-day FB campaign, driven by 11 phrases pertinent to MetS, had a potential reach of 690,000 with ad impressions on 33,243 unique FB accounts resulting in 1160 ad clicks. Ad impressions appeared mostly in female accounts; 90% of ad clickers were female from 18 to 65y or higher; the majority were >45y. Costs ranged from $.47 to $.83/click (averaged $0.61). Total campaign costs were $708.57. Of the 1160 ad clicks, 422 moved past survey page 1, 114 were eligible for phone screening and 85 were phone screen-ready. Of the 85 that provided contact details, 51 completed the phone screen and 21 were deemed eligible for the ELM baseline assessment. CHERRIES response rates were: View 3.5%; Survey participation 36.4%; Phone screen eligible 27% and Completion 74.6%. Of those who clicked on the ad, 7.3% were Phone screen-ready and 20.1% starting the survey were Phone screen-ready. Costs were $6.216 to recruit a phone screen eligible person; $8.336/phone screen-ready person; $13.894/phone screen completion and $33.741/ELM baseline screen eligible subject. Personnel time was <4 h for the FB campaign. Conclusions FB was a cost-effective strategy, requiring minimal personnel investment, to recruit subjects to a MetS clinical trial with demanding inclusion/exclusion criteria. Funding Sources William G. McGowan Charitable Fund, Wegmans School of Health & Nutrition, RIT.

Ultrasound-guided cooled radiofrequency ablation of the genicular nerves: a technique paper

Aim: Cooled radiofrequency ablation (CRFA) has demonstrated efficacy in the management of knee pain caused by osteoarthritis. A typical procedure involves fluoroscopic placement of internally cooled radiofrequency probes to ensure the probes are located near target genicular nerves. Patients & methods: A new technique was developed to perform CRFA using ultrasound (US) guidance. Patient outcomes were reported using a telephone survey. Results: Ablation procedures were successfully performed using US guidance. A total of 51 patients were retrospectively identified for telephone screening. A total of 22 patients completed the telephone questionnaire. There were no safety concerns identified and the majority of patients reported satisfactory outcomes. Conclusion: Patient outcomes demonstrate that US-guided CRFA procedures provide pain relief and functional improvement. Further studies are needed to compare the efficacy of US-guided CRFA to fluoroscopy-guided CRFA procedures.