Increased sTREM-1 plasma concentrations are associated with poor clinical outcomes in patients with COVID-19

Patients with sepsis display increased concentrations of sTREM-1 (soluble Triggering Receptor Expressed on Myeloid cells 1), and a phase II clinical trial focussing on TREM-1 modulation is ongoing. We investigated whether sTREM-1 circulating concentrations are associated with the outcome of patients with coronavirus disease 2019 (COVID-19) to assess the role of this pathway in COVID-19. This observational study was performed in two independent cohorts of patients with COVID-19. Plasma concentrations of sTREM-1 were assessed after ICU admission (pilot cohort) or after COVID-19 diagnosis (validation cohort). Routine laboratory and clinical parameters were collected from electronic patient files. Results showed sTREM-1 plasma concentrations were significantly elevated in patients with COVID-19 (161 [129-196] pg/mL), compared to healthy controls (104 [75-124] pg/mL; P<0.001). Patients with severe COVID-19 needing ICU admission displayed even higher sTREM-1 concentrations compared to less severely ill COVID-19 patients receiving clinical ward-based care (235 [176-319] pg/mL and 195 [139-283] pg/mL respectively, P=0.017). In addition, higher sTREM-1 plasma concentrations were observed in patients who did not survive the infection (326 [207-445] pg/mL) compared to survivors (199 [142-278] pg/mL, P<0.001). Survival analyses indicated that patients with higher sTREM-1 concentrations are at higher risk for death (hazard ratio=3.3, 95%CI 1.4-7.8). In conclusion, plasma sTREM-1 concentrations are elevated in patients with COVID-19, relate to disease severity, and discriminate between survivors and non-survivors. This suggests that the TREM-1 pathway is involved in the inflammatory reaction and the disease course of COVID-19, and therefore may be considered as a therapeutic target in severely ill patients with COVID-19.

Building capacity and ensuring equity in clinical trials during the COVID-19 pandemic.

e13598 Background: The impact on cancer outcomes from the Covid-19 pandemic has yet to be determined. Concerns persist on screening, delays in diagnosis, treatment interruptions and outcomes of infection in the immunosuppressed. The need for agile working has been exemplified by establishment of Nightingale Hospitals, staff redeployment and sudden integration of virtual consultations into clinical working. With most cancer clinical trials halted, recruitment into COVID-19 research became essential and embedded into the everyday. Here we present how rapid implementation of COVID-19 randomised clinical trials within an NHS organisation during the pandemic was achieved. Methods: A COVID-19 senior facilitation committee was set up to provide oversight, maximise staff capacity and resource and prioritise studies. Specific strategies to maximise access and clinical trials recruitment for patients including children and those with solid tumours were designed. These included presence of a research nurse at clinical ward rounds and team meetings, the promotion of protocol and informed consent training to all including doctors in the acute settings and weekly research meetings to share-best practice. Reflecting on learnings from this time provide an opportunity to consider how we adjust working for our patients in the future. Results: The integration of research into the everyday working of clinical teams looking after patients with COVID-19 has become the norm. The provision of protocol and informed consent training for all levels of staff and the consideration of all patients for trials during clinical ward rounds and multi-disciplinary meetings, have ensured access to trials has become embedded. The integration of research nurses working, upskilling and prompting clinical colleagues has ensured equity of access and provided a research presence and focus during the busy clinical day. The adoption of cross-disciplinary working, sharing best practice and a culture of commitment and support to the trials ensures no patient is denied the opportunity to participate. Three RTCs opened over 7 weeks. At one site 1904 patients were screened for one of the randomised-controlled trials and over 18% of these patients (351) were recruited and 175 patients declined. Conclusions: The pandemic has had a devastating impact across the UK. However, a coordinated and collaborative multi-disciplinary approach has supported high recruitment and equity of access for patients into COVID-19 trials. Learnings from this work may lead to embedding clinical trials and access to translational research for cancer patients in the future as we recover from the full impact of the pandemic. COVID-19 research has demonstrated how increased recruitment accelerates access and implementation of new innovations and novel drug combinations.The full impact of improved access to cancer research in the future during COVID recovery is worthy of more research.

Assessment of Job Stress of Clinical Pharmacists in Ho Chi Minh City, Vietnam: A Cross-Sectional Study

Objectives: The official implementation of clinical pharmacy in Vietnam has arrived relatively late, resulting in various stressors. This study aims to evaluate job stress level and suggest viable solutions.Methods: A cross-sectional study was conducted on clinical pharmacists (CPs) in 128 hospitals in Ho Chi Minh City (HCMC). Job stress questions were derived from the Healthcare Profession Stress Inventory (HPSI).Results: A total of 197 CPs participated, giving a response rate of 82.4%. Participants were found to have moderate job stress with an overall mean stress score of 1.5 (0.4) and stress rate of 52.8%. The sample size was statistically adequate and the HPSI was valid and reliable. Patient care responsibility was the main stressor, especially in public hospitals, followed by job conflicts. Lack of experience, low income, and inability to participate in clinical ward rounds caused significant stress to CPs regarding job recognition and job uncertainty. More practice-oriented training programs in bachelor curricula and clinical practice should be applied to help CPs gain more experience, self-confidence, and diminish job stress.Conclusion: CPs in HCMC have moderate stress. More practice-oriented training programs should be prioritized to lessen stress for CPs.

CT findings of COVID-19 pneumonia in ICU-patients

Background: In December 2019, a cluster of unknown etiology pneumonia cases occurred in Wuhan, China leading to identification of the responsible pathogen as SARS-coV-2. Since then, the coronavirus disease 2019 (COVID-19) has spread to the entire world. Computed Tomography (CT) is frequently used to assess severity and complications of COVID-19 pneumonia. The purpose of this study is to compare the CT patterns and clinical characteristics in intensive care unit (ICU) and non-ICU patients with COVID-19 pneumonia.Design and Methods: This retrospective study included 218 consecutive patients (136 males; 82 females; mean age 63±15 years) with laboratory-confirmed SARS-coV-2. Patients were categorized in two different groups: (a) ICU patients and (b) non-ICU inpatients. We assessed the type and extent of pulmonary opacities on chest CT exams and recorded the information on comorbidities and laboratory values for all patients.Results: Of the 218 patients, 23 (20 males: 3 females; mean age 60 years) required ICU admission, 195 (118 males: 77 females, mean age 64 years) were admitted to a clinical ward. Compared with non-ICU patients, ICU patients were predominantly males (60% versus 83% p=0.03), had more comorbidities, a positive CRP (p=0.04) and higher LDH values (p=0.008). ICU patients’ chest CT demonstrated higher incidence of consolidation (p=0.03), mixed lesions (p=0.01), bilateral opacities (p<0.01) and overall greater lung involvement by consolidation (p=0.02) and GGO (p=0.001).Conclusions: CT imaging features of ICU patients affected by COVID-19 are significantly different compared with non-ICU patients. Identification of CT features could assist in a stratification of the disease severity and supportive treatment.

Reducing inappropriate urinary catheter use by involving patients via an app: the Participatient feasibility study (Preprint)

BACKGROUND The risk of urinary tract infections is increased by the inappropriate placement and the unnecessary prolongation of use of indwelling urinary catheters. Sustained behaviour change in infection prevention could be promoted through patient empowerment trough a smartphone app. OBJECTIVE We aimed to assess the feasibility and efficacy of implementation actions on patients’ use of Participatient on a clinical ward, and to compare three survey methods for urinary catheter use. METHODS Participatient was introduced for all admitted patients at the surgical nursing ward in a university hospital in the Netherlands. In three months, the number of new app users, days of use, and sessions were recorded. In a comparison of before-and-after the app, three methods for point prevalence surveys of catheter use were tested. Surveys were conducted through manual parsing of the text in the electronic medical records, checkbox surveys, and nurse-notes surveys. RESULTS In all, 475 patients were admitted to the ward, 42(8.8%) installed the app, with 1-5 new users per week. The actions with most ensuing app use were the kick-off with clinical lesson and the recruiting of the intake nurse. Between the survey methods, there was considerable variation in catheter prevalence. Therefore, we used the standard method of manual parsing in further analyses. Catheter use prevalence decreased from 38% to 27% after app introduction. CONCLUSIONS Clinical application of Participatient, the infection prevention app for patients, could be feasible when implementation actions are combined. For surveying indwelling urinary catheter use prevalence, manual parsing is best applicable.

The Importance of Clinical History Taking when Assessing Patient Suspected Positive COVID-19

Introduction: COVID-19 pandemic is an on-going devastating global event. It starts from December 2019 and is yet to resolve. To date, there are more than 25 million people diagnosed and 850 thousand deaths with COVID-19 (CDC, 2020). Healthcare services throughout the world are facing immense challenges. History taking has been inevitably the most emphasized tool in approaching all patients. However, the usefulness of medical history strongly depends on the patient’s story offered. Incorrect or hidden history may not only bring wrong diagnosis but endanger health care personnel.Objectives: This case series is aimed to describe the importance of clinical history-taking in assessing patients associated with COVID-19 symptoms or history.Methods: Assessment through interview method in taking patient history was used. The focus of history taking was related to health and COVID-19 history. The data collected is a type of secondary data from medical reports of patients who come to receive medical services at the Emergency and Trauma Department, General Public Hospital Taiping, Perak. A total of three cases are taken using the purposive sampling technique. Data is analysed and presented in the form of qualitative data.Results: This study found that the clinical history taking through interview method has successfully identified three patients with positive COVID-19 through assessment conducted.Conclusion: Therefore, the study proved that effective history taking implemented by paramedics was able to identify patients with positive COVID-19 and to plan an appropriate management and help them get discharged without complications. All physicians and other health care practitioners in the Emergency Department or in the clinical ward are also advised to be more competent by increasing their level of knowledge and skills related to assessing patients through effective clinical history taking.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S13

Remote Monitoring in Chronic Heart Failure Patients: Is Non-Invasive Remote Monitoring the Way to Go?

Heart failure (HF) is a major health care issue, and the incidence of HF is only expected to grow further. Due to the frequent hospitalizations, HF places a major burden on the available hospital and healthcare resources. In the future, HF care should not only be organized solely at the clinical ward and outpatient clinics, but remote monitoring strategies are urgently needed to guide, monitor, and treat chronic HF patients remotely from their homes as well. The intuitiveness and relatively low costs of non-invasive remote monitoring tools make them an appealing and emerging concept for developing new medical apps and devices. The recent COVID-19 pandemic and the associated transition of patient care outside the hospital will boost the development of remote monitoring tools, and many strategies will be reinvented with modern tools. However, it is important to look carefully at the inconsistencies that have been reported in non-invasive remote monitoring effectiveness. With this review, we provide an up-to-date overview of the available evidence on non-invasive remote monitoring in chronic HF patients and provide future perspectives that may significantly benefit the broader group of HF patients.

INFLAMMATORY RESPONSE IN SOLID ORGAN AND TISSUE RECIPIENT WITH COVID-19

Introduction: The COVID-19 infection is caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infection, which was first reported in Hubei, Wuhan province, China, in December 2019. There is a concern that immunocompromised patients are at greater risk of morbidity and mortality due to COVID-19 infection, although there is limited data on these patients. Here, we present an evolution of a series of cases of patients with COVID-19 in our service. Patients and methods: This is a retrospective cohort study conducted at the Hospital Universitário Walter Cantídio in Fortaleza-CE, Brazil. All patients hospitalized due to COVID-19 were screened for a history of organ or tissue transplantation, with a total number of 77 patients. Only patients confirmed for COVID-19 were included in the study. The inflammatory response and initial laboratory results, as well as the CALL score, were compared to a cohort of patients with COVID-19 not transplanted at the same time in our clinical ward or intensive care unit (ICU). The clinical course and clinical findings recorded during treatment were extracted from the electronic medical record. A bilateral P <0.05 (5%) was considered significant. Results: The total number of hospitalizations until July 24, 2020 for confirmed cases of COVID-19 was 77 patients. Of the total, 33 (42%) patients needed ICU. Most patients were male (61%). The median age was 62 [95% CI: 54-63] years, 31 (37%) had a previous diagnosis of hypertension, 24 (28%) of type 2 diabetes mellitus (DM-2). The total lethality of our service was 22%. The CALL score of patients admitted to the clinical ward and in the ICU was analyzed, with a higher average observed in the patients admitted in ICU, the average was 9.34 in the patients admitted in the clinical ward and 10.9 in the patients who required ICU. (p = 0.003) . The effect of neutrophil/lymphocyte ratio(NLR) at admission on the need of ICU care was analyzed by ROC curve and AUC and was found to be significant (AUC: 0.708, p = 0.002, 95% CI = 0.593 to 0.823). The number of transplant recipients in our service was 17 patients. The mean age was 56 years and the median was 55 years [95% CI: 45-65 years]. Of this subgroup, 6 patients (35%) required ICU, with no statistical difference when compared to non- transplanted patients (p = 0.443), and only 3 evolved to death (17%), also without statistical difference when compared to the subgroup of non-transplanted patients (p = 0.484). When compared to the sample of non-transplanted patients, lower values were found of the White Blood cells count, neutrophils and ferritin. However, despite lower values of fibrinogen, D-dimer, C-reactive protein (CRP) and lactate dehydrogenase (LDH), there was no statistical difference. Conclusion: It is a new disease, with few data, mainly in the studied population. Our sample was a reduced sample, however it was surprising to see a lower inflammatory tendency, although without statistical significance and with mortality similar to the general population. In addition, it is worth emphasizing the importance shown on the neutrophil / lymphocyte ratio of admission demonstrated by the ROC curve in patients who evolve in need of an ICU care.

How to measure hospital antibiotic consumption: comparison of two methods from data surveillance in France

Background Antibiotic use (ABU) surveillance in healthcare facilities (HCFs) is essential to guide stewardship. Two methods are recommended: antibiotic consumption (ABC), expressed as the number of DDD/1000 patient-days; and prevalence of antibiotic prescription (ABP) measured through point prevalence surveys. However, no evidence is provided about whether they lead to similar conclusions. Objectives To compare ABC and ABP regarding HCF ranking and their ability to identify outliers. Methods The comparison was made using 2012 national databases from the antibiotic surveillance network and prevalence study. HCF rankings according to each method were compared with Spearman’s correlation coefficient. Analyses included the ABU from entire HCFs as well as according to type, clinical ward and by antibiotic class and specific molecule. Results A total of 1076 HCFs were included. HCF rankings were strongly correlated in the whole cohort. The correlation was stronger for HCFs with a higher number of beds or with a low or moderate proportion of acute care beds. ABU correlation between ABC or ABP was globally moderate or weak in specific wards. Furthermore, the two methods did not identify the same outliers, whichever HCF characteristics were analysed. Correlation between HCF ranking varied according to the antibiotic class. Conclusions Both methods ranked HCFs similarly overall according to ABC or ABP; however, major differences were observed in ranking of clinical wards, antibiotic classes and detection of outliers. ABC and ABP are two markers of ABU that could be used as two complementary approaches to identify targets for improvement.

Effects of pharmacist intervention on polypharmacy in patients with type 2 diabetes in Japan

Objective Investigation of polypharmacy in patients with type 2 diabetes revealed that the medications being administered according to the patient’s symptoms and complaints strongly contributed to polypharmacy. We explored the effects of clinical ward pharmacy service, which evaluated the need for symptomatic treatment, therefore minimizing polypharmacy by reducing inappropriate medications. Results The number of drugs [hospitalization vs. discharge: 9 (1-17) vs. 7 (1-16), P < 0.001] and rate of PP (hospitalization vs. discharge: 75.4% vs. 61.1%, P < 0.001) were significantly lower at discharge. Since hospital admission, the number of drugs increased (n = 6, 11%), remained unchanged (n = 15,28%), decreased by 1 drug (n = 4,8%), decreased by 2 drugs (n = 3,6%), and decreased by more than 2 drugs (n = 25,5%). Daily drug costs were significantly reduced (hospitalization vs. discharge: ＄8.3 vs. ＄6.1, P < 0.001).