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Introduction: The global pandemic of COVID-19 has been a huge challenge for health care systems with an estimated mortality rate of 1 4% Elderly population, oncology and immunocompromised patients are at high risks with variable severity of the disease As the data regarding COVID-19 in transplant population is emerging and new insight need to directed toward reducing the risks and embracing new health care services and standards Sharing such experience is fundamental for other health care systems to learn, adapt and innovate during this medically demanding period We would like to shed a light on telemedicine service and innovative ways in dealing with renal transplant recipients in a tertiary hospital in United Arab Emirates Method: We descripted our experience in dealing with outpatient services provided for renal transplant recipients during COVID-19 pandemic (Tawam Hospital, AlAin, UAE) The transition from clinic visit to telemedicine clinics, home delivery of medications and reducing risks of COVID-19 infection among such vulnerable patients Results: More than 200 renal transplant recipients are following up regularly in our outpatient nephrology clinics As the number of COVID-19 infected cases is increasing in UAE, rigorous measures at local, society and international levels have been implemented to contain and overcome this pandemic Telemedicine clinics was considered a reasonable choice to reduce the follow of the renal transplant patients to hospital where they can acquire the infection Scheduling of the patients, sending reminders, phone communication with nephrology consultant, laboratory orders and documentation on electronic health record were allocated Medications prescribed was delivered to the patients' home free of charge and some patients might be eligible for refill medications over 3 months Renal transplant patients with abnormal laboratory results and/ or symptoms of respiratory infections that required medical attention will be directed to clinic or emergency visit Pretransplantation workups were not performed With national regulation of 'Stay At Home' Initiative, renal transplant recipients were instructed to limit exposure with other people, avoid unnecessary out home activities and some were provided medical report to perform work at home Hand hygiene, universal mask wearing, avoidance of sick patients along with infection control measures are essential Through humanitarian UAE efforts: personal care supplies are provided for needy patients Patients who came from outside UAE, they required to stay at home if asymptomatic for 2 weeks with repeated COVID- 19 screening per protocol Several hospital polices and clinical pathways were considered Medical personnel were at front line to accommodate and embrace such changes with continues monitoring Conclusion: Medical innovations and telemedicine has positive impact on health care provided for renal transplant recipient during COVID-19 pandemic Adopting high standard health practices along with other infection control measures resulted in less COVID-19 infected renal transplant cases

Introduction: The prevalence of apparent treatment resistant hypertension (RH) varies based on the population studied. We sought to determine the prevalence and characteristics associated with RH among patients enrolling in cardiac rehabilitation (CR). Methods: Between 2012 and 2017, 504 consecutive individuals at initial intake for entry into phase II CR were evaluated for RH. RH was defined as a participant taking 3 antihypertensive medications including a diuretic, with a resting systolic BP >130 mm Hg, or 4+ antihypertensive medications, regardless of BP. Participants with RH were compared to all other participants using student’s t-test or Fisher’s exact test as appropriate. Results: Sixty-three percent (320/504) of all CR participants carry a diagnosis of hypertension. Of those, 11% were classified as having RH (7% of all participants.) RH patients were more likely to be older, African-American, have higher SBP and higher pulse pressure. They also demonstrated an increased prevalence of co-morbid diagnoses, including heart failure with reduced ejection fraction, peripheral arterial disease, and type 2 diabetes mellitus (Table 1.) Only 3% of participants (1/36) with RH were prescribed a mineralocorticoid receptor antagonist, and only 14% (5/36) visited a hypertension specialist for consultation within a year of the initial CR appointment. Conclusions: The prevalence of RH amongst CR participants is 7%. RH participants have more co-morbidities than normotensive or non-resistant hypertensive counterparts. Given that CR participants are a high cardiovascular risk population, greater efforts to identify patients with RH, and refer for appropriate care are needed.

Introduction: Phase 2 cardiac rehabilitation (CR) is a 36-session medically supervised exercise and educational program prescribed for patients with a variety of cardiovascular conditions. The beneficial effect of physical activity on BP is well established. Whether CR participation affects exercise capacity (EC) and outcomes in patients with resistant hypertension (RH) is unknown. Methods: Participants enrolled in Phase 2 CR at a tertiary academic medical center between 2012 and 2017 were evaluated. Of 504 total CR participants, 298 completed both entry and exit stress testing. Participants were defined as having RH if they were taking 3 antihypertensive medications including a diuretic, with a resting SBP > 130 mm Hg, or 4+ antihypertensive medications, regardless of BP. The percentage change in EC from CR entry to exit and cardiovascular outcomes were compared between patients with and without RH. Results: Of CR participants that completed both entry and exit stress testing, 8% (24) had RH, 62% (185) were non-resistant hypertensives, and 30% (89) had normal BP. Compared to other CR participants, those with RH exhibited lower absolute baseline EC (5.4 +/- 2.4 metabolic equivalents (METs) vs. 6.9 +/- 2.6 , p=0.007) and lower EC after completion of CR (6.6 +/- 2.6 METs vs. 8.4 +/- 3.0 , p=0.004); but demonstrated a similar relative increase in EC (31% vs 28%, p=0.74) pre to post CR. Among all participants in CR (n=504), participants with RH (n=36) were more likely to be hospitalized within 2 years of completion of CR (67% (24/36) vs. 39% (184/468), p=0.002) and demonstrated a trend toward increased mortality (8% (3/36) vs. 4% (18/468), p=0.18) over the subsequent 5 years. Conclusion: Although less fit at baseline, CR participants with RH have a similar relative improvement in EC compared to all other CR participants. However, among CR participants with RH, these data demonstrate that a low absolute level of EC is accompanied by a greater likelihood of being hospitalized in the two years following CR.

Objective: To identify the factors associated with perceived success of the transition from hospital to home after traumatic brain injury (TBI). Design: Prospective longitudinal cohort design with data collection at discharge and 1, 3, and 6 months postdischarge. Participants: A total of 127 individuals with TBI discharged to the community and 83 significant others. Main Measures: An analog scale (0-100) of perceived success of the transition from hospital to home rated by individuals and significant others; Sentinel Events Questionnaire; EuroQol Group Quality-of-Life measure visual analog scale; Sydney Psychosocial Reintegration Scale; Mayo-Portland Adaptability Inventory-4; short form of the Depression, Anxiety, Stress Scales; Craig Hospital Inventory of Environmental Factors; and Caregiver Strain Index. Results: Greater perceived success of transition for individuals with a TBI was associated with higher levels of health-related quality of life, level of community integration, and more severe injury. Among survivors, sentinel events such as returning to work and independent community access and changing living situation were associated with greater perceived success; financial strain and difficulty accessing therapy services were associated with less success. Among significant others, lower ratings of transition success were associated with higher significant other stress levels as well as lower levels of community integration and changes in the living situation of the individual with TBI. Conclusion: A combination of sentinel events and personal and environmental factors influences the perceptions of individuals and their families regarding the success of the transition from hospital to home.

Hearing impairment constitutes a highly prevalent chronic health condition among older adults worldwide which negatively impacts on communication and health-related quality of life. Irrespective of this, the majority of older adults do not seek professional help for hearing impairment and/or do not obtain hearing aids. Therefore, a new approach for detecting and promoting help-seeking for hearing impairment is needed. The purpose of this study was to investigate the actions taken by those who failed Telscreen, a telephone-based screening tool for hearing loss, and to increase our understanding of factors that influence taking action.A cohort of 193 participants (112 females, 81 males; age range 24-93 yr) who had failed Telscreen participated in a follow-up telephone interview 4 to 5 mo later. Participants were asked why they called Telscreen, about their hearing ability, their Telscreen result, and what action they had taken toward hearing rehabilitation. One outcome measure was identified: decision to seek professional help for hearing impairment (yes/no). Given that the outcome measure was dichotomized, a logistic regression model for binary outcomes was fitted to the data.Of the 193 participants who failed Telscreen, only 36% sought help from a range of sources (e.g., audiologist, hearing service or hearing aid provider, and family doctor). Results of the logistic regression analysis indicated that individuals who had considered hearing aids before calling Telscreen and/or who recalled their Telscreen result were significantly more likely to seek professional help for their hearing impairment. Nineteen participants who sought help for their hearing impairment had hearing aid fitting recommended to them. Eight participants had aid/s fitted, and of these, six reported a successful outcome.For every 100 individuals who fail a hearing screening, only 36 seek help. Of these 36 individuals who take some action, 13 are recommended hearing aids, approximately half of whom follow this advice and obtain hearing aids. Approximately three-quarters of these individuals use and value their hearing aids. Provided that the screening is automated and low cost, hearing screening via telephone has proven to change the lives of 5% of individuals who decided to seek professional help for hearing impairment at little cost to the other 95% of individuals. Suggestions for future research based on the present research findings are discussed.

Family-centered early childhood services for children with physical disability and their families can afford developmental advantage for children and avert unnecessary stress for families. This study aimed to determine how characteristics of children and families and perceptions of family-centered practice (FCP) relate to satisfaction with early childhood services. Participants comprised parents or carers of children up to 9 years with a physical disability who were accessing early childhood services. Participants completed The European Parent Satisfaction Scale about Early Intervention, Functional Independence Measure for Children, Measure of Processes of Care, and a sociodemographic parent survey. Overall, families (n = 112) reported being relatively satisfied with early childhood services. There was a significant positive relationship between parent perceptions of FCP (coordinated and comprehensive care and providing general information) and satisfaction (β = 3.13 and 1.75, respectively). These aspects of FCP accounted for 68% of the variance in satisfaction scores. Children's level of disability and families' sociodemographic characteristics were not related to satisfaction ratings. These findings suggest that not all aspects of FCP contribute equally to overall satisfaction. Service providers need to pay particular attention to the information needs of families and ensuring that services are well-coordinated and appropriate.

The 2-stage Nagata method for auricular reconstruc- tion in patients with microtia is a widely accepted technique. We have modified this technique into a single-stage procedure for the reconstruction of acquired segmental auricular defects. A prospec- tive analysis was made of the senior author's first 20 consecutive cases over a 4-year period (February 2004 to February 2008). The mean age of patients in our series was 34 years (range, 17Y59 years). There were 15 males and 5 females; 13 were right-sided and 7 were left-sided segmental auricular defects. Five patients had had previous auricular reconstruction including local flaps and grafts. Costal cartilage harvest was ipsilateral to the defect in all cases. All 20 patients underwent a single-stage modification of the Nagata tech- nique. Mean duration of surgery was 8.56 hours (range, 5.5Y11.5 hours). Mean hospital stay was 7.6 days (range, 4Y19 days). Mean time from initial surgery to a satisfactory completion of treatment was 21 months. Overall, a low complication rate and high patient satisfaction were observed in this series. We believe the single-stage modified Nagata technique offers consistent high-quality results in the treatment of acquired segmental auricular defects. All patients undergoing autologus ear reconstruction need to be assessed in a multidisciplinary setting and should be offered all other options for treatment.