Point of care and intensive care lung ultrasound: A reference guide for practitioners during COVID-19

Objectives

Current events with the recent COVID-19 outbreak are necessitating steep learning curves for the NHS workforce. Ultrasound, although not used in the diagnosis of COVID-19 may be utilised by practitioners at the point of care (POC) or on the intensive care units (ITUs) where rapid assessment of the lung condition may be required. The aim of this article was to review current literature surrounding the use of lung ultrasound in relation to COVID-19 and provide Sonographers with a quick and digestible reference guide for lung pathologies.

Key findings

Ultrasound is being used in Italy and China to help review lung condition during the COVID-19 outbreak however not strictly as a diagnostic tool as Computed Tomography (CT) of the chest and chest radiographs are currently gold standard. Ultrasound is highly sensitive in the detection of multiple lung pathologies which can be demonstrated in conjunction with COVID-19 however to date there are no specific, nor pathognomonic findings which relate to COVID-19 on ultrasound.

Conclusion

Lung ultrasound is highly sensitive and can quickly and accurately review lung condition creating potential to assess for changes or resolution over time, especially in the ITU and POC setting. However it should not be used as a diagnostic tool for COVID-19 due to low specificity in relation to the virus.

Implications for practice

The adoption of lung ultrasound to monitor lung condition during the COVID-19 outbreak may reduce the need for serial exposure to ionising radiation on the wards and in turn reduce the number of radiographers required to attend infected wards and bays, protecting both patients and the workforce.

Heterogeneous node responses to multi-type epidemics on networks

Having knowledge of the contact network over which an infection is spreading opens the possibility of making individualized predictions for the likelihood of different nodes to become infected. When multiple infective strains attempt to spread simultaneously we may further ask which strain, or strains, are most likely to infect a particular node. In this article we investigate the heterogeneity in likely outcomes for different nodes in two models of multi-type epidemic spreading processes. For models allowing co-infection we derive message-passing equations whose solution captures how the likelihood of a given node receiving a particular infection depends on both the position of the node in the network and the interaction between the infection types. For models of competing epidemics in which co-infection is impossible, a more complicated analysis leads to the simpler result that node vulnerability factorizes into a contribution from the network topology and a contribution from the infection parameters.

AB1349-HPR IMPLEMENTATION OF A GROUP EDUCATION SERVICE FOR RHEUMATOLOGY OUTPATIENTS COMMENCING BIOLOGIC THERAPY AT UNIVERSITY COLLEGE LONDON HOSPITAL (UCLH)

Background:

Biologic therapies are commonly prescribed in a range of rheumatic conditions. From 2016 - 2018, a mean of 226 rheumatology outpatients at UCLH commenced biologic therapy per year for inflammatory arthritis alone1. Patient education is required prior to initiation. At UCLH this is delivered via individual appointments with specialist nurses, contributing to waiting times for nurse appointments and thus delays in starting treatment.

Objectives:

1.To evaluate patient satisfaction following group education.

2.To reduce the burden on specialist nurses delivering multiple individual sessions.

Methods:

A once-weekly group education service was set up at UCLH. This comprised: an oral PowerPoint presentation; injection demonstration; question and answer session; and written leaflets. Patients were provided with pre- and post-session questionnaires to evaluate the service.

Results:

Over the first five weeks of the service, 18 patients attended group education (a median of 4 patients per session). Nine patients (50%) had previously researched the medication via internet search engines. Patients’ questions prior to the session were most commonly centred on side effects and long-term risks. All of the patients (100%) felt that “most or all” of their questions were answered during the session. Patients gave their awareness of the reason for therapy a median score of 7/10 pre-education; this rose to a median of 10/10 post-education. The median score given for confidence to self-administer the drug was 5.5/10 pre-education; this rose to a median of 10/10 post-education. The median anxiety score was 3/5 pre-education; this dropped to 2/5 post-education. The presentation was adapted based on questions that arose during the sessions. Multiple patients gave informal, verbal feedback stating that they found the group environment to be beneficial, providing a chance to meet others with similar conditions, share experiences and feel reassured that they are not alone in starting biologic therapy.

Conclusion:

Patient feedback demonstrated that the group education sessions at UCLH were effective in improving their understanding of the rationale for biologic treatment, increasing their confidence in self-administration, and reducing anxiety. Verbal feedback illustrated that many patients enjoyed the group environment, and the opportunity to interact and share experiences with others. At an average rate of 4 patients currently being seen a week, it is estimated that this will save 192 specialist nurse appointments per year (out of an estimated 226 commencing biologic therapy). There is scope for further research into the effects that this has had on waiting times to receive education / start treatment, and on drug compliance.

References:

[1]Greenwood, Mandy. UCLH Rheumatology Database. UCLH, 2020.

Disclosure of Interests:

None declared

AB0326 REAL-WORLD EXPERIENCE ON SWITCHING ADALIMUMAB ORIGINATOR TO BIOSIMILAR IN INFLAMMATORY ARTHRITIS – A RETROSPECTIVE STUDY

Background:

The patent for adalimumab originator expired in 2018 in the United Kingdom. Subsequently, four adalimumab biosimilars were launched. National Health Service England undertook a managed market share tender to ensure plurality of suppliers and price competition over the longer term. Each hospital was subsequently allocated a preferred brand of adalimumab biosimilar. Here we describe our experience of switching patients with inflammatory arthritis from adalimumab originator to the biosimilar, ABP 501 in a single centre.

Objectives:

To evaluate the proportion of patients successfully switched from adalimumab originator to ABP 501 focusing on drug retention, reasons for remaining on originator and reasons for switching back from biosimilar to originator.

Methods:

A retrospective analysis was completed on the cohort of 287 rheumatology patients who were prescribed adalimumab originator prior to the switch to ABP 501. Case notes were analysed to identify whether patients remained on biosimilar 24 weeks after switching from originator.

Results:

99% patients on adalimumab originator (283/287) were switched to ABP 501 within 32 weeks, starting from February 2019. 1% (4/287) remained on originator due to a confirmed latex allergy, as the needle cover of the ABP 501 pre-filled syringe consists of dry natural rubber. 4% (12/283) of patients who switched to biosimilar reverted to originator (1 patient per 2 weeks over 24 weeks). 3% (9/283) of patients who switched to biosimilar were no longer receiving any adalimumab therapy. Reasons for ceasing therapy included recurrent infections (4/9) and progression to the next line of biologics/small molecule therapy (5/9). 93% (262/283) remained stable on ABP 501 (Table). Applications to revert to originator were reviewed by a Biosimilar Steering Group (BSG). The BSG assessment included a review of disease activity, reported symptoms and adverse reactions before and after the switch to biosimilar. Approval to revert to originator occurred in patients who had a clear increase in disease activity or newly reported adverse reactions. If the patient had active disease prior to switch, a change to non-adalimumab therapy would be recommended instead. Of the 12 patients who reverted to originator, 7 (58%) did so due to reduced effectiveness, 3 (25%) due to adverse reactions, and 2 (17%) due to both. Adverse reactions reported within 24 hours of the first injection included nausea, anxiety, insomnia, tinnitus, dizziness, headaches and injection-site reactions. Patients also reported hair loss, fatigue and mouth ulcers. Reported adverse reactions ceased once biosimilar was stopped and/or switching back to originator. All patients who reverted to originator due to reduced effectiveness reported a reduction in disease activity and improvement in symptoms.

Conclusion:

The vast majority of patients in our cohort on adalimumab were successfully switched from originator to ABP 501. The adalimumab biosimilar has been generally well-tolerated. 93% remained on biosimilar 24 weeks after switching, 4% have switched back to originator and 3% have either stopped or changed treatment. Reasons for switching back to originator from biosimilar included adverse reactions, most of which occurred within 24 hours, and also worsening of symptoms.

Table 1.

The dynamics of the disease activity during treatment with TOFA

Baseline characteristics/outcomeTotalN = 283RAN = 90 (32%)SpAN = 108 (38%)PsAN = 77(27%)OtherN = 8(3%)Mean age (SD)49.8 (14.6)58.5 (14.9)43.6 (11.0)48.4 (13.2)46.1 (15.2)Female, n (%)126 (45)67 (74)29 (38)26 (34)4 (50)Reverted to Originatorn (% of patients within subgroup)12 (4)4 (4)6 (6)1 (1)1 (13)Reasons for switching back to OriginatorInefficacy71411Adverse reactions32100Both21100Switched to another biologic agentn (% of patients within subgroup)5 (2)3 (3)2 (2)0 (0)0 (0)Stopped biologicsn (% of patients within subgroup)4 (1)1 (1)1 (1)2 (3)0 (0)

Disclosure of Interests:

None declared

Flash glucose monitoring (FGM): A clinical review on glycaemic outcomes and impact on quality of life

Flash glucose monitoring (FGM) is widely accepted as an alternative means to conventional finger prick test for measuring glucose level in individuals with diabetes mellitus. In this clinical review, we endeavour to draw all available clinical evidence on the usage and efficacy of FGM from research trials and observational studies in real-world settings. We aim to explore its clinical efficacy and impact on quality of life (QoL) in the diabetic population. In terms of clinical outcomes, use of FGM is associated with a significant reduction in glycated haemoglobin A1c (HbA1c) level, notably in patients with suboptimal glycaemic control prior to commencement of FGM and reduction in time spent in hypoglycaemia. FGM demonstrated non-inferiority in device accuracy when compared to other well-established CGMs available in the market. Patients have reported improved QoL and treatment satisfaction measured by validated objective scores after consistent use of FGM. This results in a positive impact on patient psychosocial wellbeing and ultimately enhances patient compliance and optimisation of glycaemic control. Evaluation of QoL and patient reported outcome measures (PROMs) will require a standardised approach to allow comparability of the results and evidence.

0690 An Evaluation Of Genioglossus Strengthening On Obstructive Sleep Apnea Treatment Outcomes

Introduction

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of pharyngeal collapse. The genioglossus is a major upper airway dilator muscle thought to be important in OSA pathogenesis. Upper airway (UA) muscle training has reported benefits in some OSA patients. Our goal was to assess the effect of upper airway muscle training on OSA outcomes.

Methods

Sixty five patients with OSA (AHI>10/h) were divided in three subgroups: 1) Treated with auto-CPAP (n=21), 2) Previously failed or refused CPAP therapy (no treatment), (n=24), 3) Currently treated with an oral appliance who still have residual OSA (AHI>10/h), (n=20). All subjects were given a custom-made tongue strengthening device. Within each group we conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to UA muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with 1:1 ratio over 6 weeks of treatment (twice daily for 20 min/session). In the baseline and the final visit, subjects completed home sleep testing, questionnaires (ESS, PSQI), acoustic pharynogometry, Iowa Oral Performance Instrument (IOPI), and Psychomotor Vigilance Test (PVT).

Results

Results remain blinded; 33 patients received treatment Y and 32 patients received treatment Z. To date, we have not observed a main effect of treatment group on several measures of OSA severity. Some changes in subjective measures over time were observed but difficult to interpret until unblinding occurs.

Conclusion

Treatment of OSA using upper airway muscle training exercises requires further study. Whether muscle training is a viable approach for a definable subset of OSA patients remains unclear.

Support

R01HL085188-05A1 (U.S. NIH Grant/Contract)

Data-Driven Participant Recruitment: Findings from the Alzheimer's Disease Neuroimaging Initiative 3

BACKGROUND

Effective and measurable participant recruitment methods are urgently needed for clinical studies in Alzheimer's disease.

OBJECTIVES

To develop methods for measuring recruitment tactics and evaluating effectiveness.

METHODS

Recruitment tactics for the Alzheimer's Disease Neuroimaging Initiative (ADNI3) were measured using web and phone analytics, campaign metrics and survey responses.

RESULTS

A total of 462 new participants were enrolled into ADNI3 through recruitment efforts. We collected metrics on recruitment activities including 82,003 unique visitors to the recruitment website and 3,335 calls to study phone numbers. The recruitment sources that produced the most screening and enrollment included online advertisements, local radio and newspaper coverage and emails and referrals from registries.

CONCLUSIONS

Analysis of recruitment activity obtained through tracking methods provided some insight for effective recruitment. ADNI3 can serve as an example of how a data-driven approach to centralized participant recruitment can be utilized to facilitate clinical research.

IDENTIFY: The investigation and detection of urological neoplasia in patients referred with suspected urinary tract cancer: A multicentre cohort study

•

IDENTIFY study: The largest prospective cohort study of haematuria in secondary care.

•

Contemporary urinary cancer detection rates and diagnostic strategies.

•

The effectiveness of diagnostic tests, e.g. ultrasound, in detecting urinary cancer.

•

Novel patient risk factors associated with bladder and upper tract urinary cancers.

Evaluation of the VIDAS Staph Enterotoxin II (SET 2) Immunoassay Method for the Detection of Staphylococcal Enterotoxins in Selected Foods: Collaborative Study

A multilaboratory study was conducted to determine the limit of detection (LOD) of Staphylococcal enterotoxins (SET) in 5 foods. Cooked chicken, ham, potato salad, pasteurized liquid whole milk, and canned mushrooms were each spiked with a different enterotoxin (A, B, C1, D, or E), and tested at 0.25 and 0.5 ng/g SET levels to determine the LOD of the assay for those foods in a collaborative study. Unspiked controls were also included. A total of 19 laboratories representing government and industry participated. In this study, 1674 test portions were analyzed, of which 1638 were used in the statistical analysis. Of the 1638 test portions used in the statistical analysis, 1104 were spiked test portions, of which 1073 were positive by the VIDAS Staph enterotoxin II (SET 2) method. The detection rates at the 0.25 ng/mL level were cooked chicken, 98.2; ham, 99.0; potato salad, 99.1; liquid whole milk, 85.2; and canned mushrooms, 100. The detection rates at the 0.5 ng/mL level were cooked chicken, 97.4; ham, 98.1; potato salad, 100; liquid whole milk, 99.0; and canned mushrooms, 100. The data indicate that the SET 2 method is capable of detecting SET at 0.25 ng/g in cooked chicken, ham, potato salad, and canned mushrooms and at 0.5 ng/g in pasteurized liquid whole milk.

Magnetic-Field Tuning of Light-Induced Superconductivity in Striped La_{2-x}Ba_{x}CuO_{4}

Optical excitation of stripe-ordered La_{2-x}Ba_{x}CuO_{4} has been shown to transiently enhance superconducting tunneling between the CuO_{2} planes. This effect was revealed by a blueshift, or by the appearance of a Josephson plasma resonance in the terahertz-frequency optical properties. Here, we show that this photoinduced state can be strengthened by the application of high external magnetic fields oriented along the c axis. For a 7 T field, we observe up to a tenfold enhancement in the transient interlayer phase correlation length, accompanied by a twofold increase in the relaxation time of the photoinduced state. These observations are highly surprising, since static magnetic fields suppress interlayer Josephson tunneling and stabilize stripe order at equilibrium. We interpret our data as an indication that optically enhanced interlayer coupling in La_{2-x}Ba_{x}CuO_{4} does not originate from a simple optical melting of stripes, as previously hypothesized. Rather, we speculate that the photoinduced state may emerge from activated tunneling between optically excited stripes in adjacent planes.