A Multi-Center, Randomized, Placebo-Controlled, Double-Blinded Trial of Efficacy and Safety of Riluzole in Acute Spinal Cord Injury Study (RISCIS)

INTRODUCTION: Riluzole, a sodium-glutamate antagonist which is FDA approved for ALS has shown promising pre-clinical results and is clinically safe in SCI patients. METHOD(S): The RISCIS trial is an international, multi-center, prospective, double-blinded, randomized, placebo-controlled Phase II/ III trial. Patients with ASIA A-C, C4-C8 SCI and <12 hours from injury were randomized between Riluzole, at an oral dose of 100mg BID for the first 24 hours followed by 50mg BID for the following 13 days, and placebo control. RESULT(S): Due to the impact of the global COVID-19 pandemic this trial was terminated prior to completion. 193 patients were randomized with a follow-up rate of 82.7% at 180-days. No statistical difference was noted in the demographics and baseline injury characteristics between the two groups. At 6 months there was a median gain in total motor scores (TOTM) of 30.0 in the Riluzole group compared to 20.0 for the Placebo group. The improved motor outcomes did not reach statistical significance. Given the decreased sample size, additional sensitivity analyses were conducted. In the ASIA-C population, Riluzole was a significant improver of total motor scores (coefficient estimate: 14.10, p = 0.020) and upper motor scores (CE: 7.68, p = 0.040) at 6 months. ASIA B patients had higher reported independence, as measured by the SCIM score (45.3 vs. 27.3;p = 0.071) and change in mental health scores as measured by the SF-36 mental health domain (2.01 vs. -11.58;p: 0.0205) at 180 days. CONCLUSION(S): Despite the premature termination of the RISCIS trial due to the COVID-19 pandemic, 193 subjects were recruited into this trial. Primary analysis showed a 10-motor point gain in riluzoletreated subjects which did not reach significance. However, on secondary analysis, incomplete cervical SCI subjects (AIS B and C) showed significant gains in functional recovery.

Incorporation of a smart sock with the virtual immersive test for postural stability

Purpose of Study: Assessment of an individual's postural stability serves as an indirect measure for both physiological and biomechanical stresses placed on an individual. More recently, some individuals after COVID-19 (SARS-CoV-2) infection have been identified with neurological complaints (Post-Acute Sequelae of Covid - PASC). These individuals can also be predisposed to decreased postural stability and an increased risk for falls. The purpose of the project was to incorporate two different wearable technology (virtual reality (VR) based virtual immersive sensorimotor test - VIST and pressure senor-based smart sock) to assess postural stability among healthy and individuals with PASC to quantify the overall status of the postural control system. Methods Used: All methods were conducted based on the University's Institutional Review Board (IRB# 21-296) with informed consent. A total of 12 males and females (six healthy and six with self-reported complaints of PASC) have completed the study so far. All participants were tested using the VIST, while standing on a force platform and wearing the smart sock simultaneously. The (VIST uses a VR headset and proprietary software to test an individual's integrated sensory, motor, and cognitive processes through eight unique tests (smooth pursuits, saccades, convergence, peripheral vision, object discrimination, gaze stability, head-eye coordination, cervical neuromotor control). Center of pressure (COP) data from force platform and pressure sensor data from the smart socks were used to calculate anterior-posterior and medial-lateral postural sway variables. These postural sway variables were analyzed using an independent samples t-test between the healthy and PASC groups at an alpha set at 0.05. Summary of Results: Significant differences (p < 0.05) between healthy and individuals with PASC with anteriorposterior and medial-lateral postural sway variables derived from COP measures, with individuals with PASC exhibiting significantly greater postural sway compared to healthy individuals in all eight tests of the VIST. The measures from the smart sock, while not statistically significant, exhibited the same findings of increased postural sway in individuals with PASC compared to healthy individuals. Conclusion(s): Findings from the current analysis revealed that individuals with PASC demonstrated significantly worse postural control compared to the healthy, when challenged with various sensorimotor tests in VIST, suggesting that postural control is compromised due to PASC. While not statistically significant due to a lower sample size, the measures from smart sock also indicated the same findings of the COP measures, suggesting a promising use of wearable technology in postural control assessments. In addition to other neurological signs and symptoms of PASC, assessment of postural stability using the VIST can provide more detailed clinical measures for diagnosis, treatment, and prognosis assessments. Copyright © 2023 Southern Society for Clinical Investigation.

A Systems Approach to Understanding Barriers and Facilitators to Faculty Retention at Paediatric Epilepsy Training Courses

Objectives: The British Paediatric Neurology Association delivers three Paediatric Epilepsy Training courses (PET) to improve epilepsy care. It uses a global volunteer trained faculty of 400 trainers across 15 countries. The move to online courses, partially driven by COVID-19, has further focussed attention on faculty retention. This study used the Systems Engineering Initiative for Patient Safety (SEIPS) model to identify barriers and facilitators for faculty trainers, comparing face-to-face and online course delivery. Method(s): A questionnaire was distributed to 375 UK and international faculty members (n = 55) and participants were invited to follow-up semi-structured interviews (SSI) (n = 5). Questionnaire responses allowed quantitative analysis and comparison with a 2016 BPNA internal Faculty Motivation Report. Thematic analysis using the six elements of the SEIPS model was utilised for SSIs and questionnaire free text. Result(s): Faculty across countries stated their primary motivation to improve care of children with epilepsy, as in 2016. Most faculty trainers preferred face-to-face courses, with one country faculty the exception. Facilitators to retention at face-to-face courses were 'internal environment', 'tasks', and 'persons'. Faculty appreciated the environment, which facilitated networking and questions, additionally enhancing their own practice. Barriers were 'organisation', and 'tasks', primarily time demands, and the burden of travel. At online courses, barriers of time and travel were lessened, facilitating teaching. However, some found technology challenging, particularly those with less online experience. 'Internal environment' online was a barrier, with less connection to colleagues and learners. Some found that while courses remained valuable, they were less enjoyable. Conclusion(s): While PET courses run online appear to be popular with participants, the same may not be as true for faculty trainers. This may have implication for future faculty retention upon which the BPNA short courses are reliant.

Process evaluation of a university residence-based SARS-CoV-2 testing programme in the UK : Holly Blake

Background Regular testing for SARS-CoV-2 is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel 4-week intervention implemented at two student residences on a UK university campus, aiming to increase asymptomatic testing frequency and normalise university life through relaxed social restrictions onsite. Methods Mixed-methods process evaluation determined whether RB-TPP was implemented as planned and identified implementation barriers and facilitators. Data were collected from meeting records, university students (online survey: n = 152;focus groups: n = 30), and staff (interviews, n = 13). Barriers and facilitators to implementation were mapped to the ‘Capability, Opportunity, Motivation-Behaviour’ (COM-B) behaviour change framework. Results Uptake was high (n = 464 students opted-in;98% of those living onsite). Implementation was broadly as planned, with adjustments due to national escalation of the COVID-19 Delta variant. Majority engaged in testing (88%);46% (52% of testers) were fully compliant with pre-determined testing frequency. Most felt positively towards relaxed social distancing (97.9%). Implementation was facilitated by convenience and efficiency of testing and reduced negative impacts of isolation through opportunities for students to socialise. Barriers to implementation were mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority. Conclusions This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences. Testing participation increased and student mental wellbeing improved. Rapid adaptions to the changing pandemic context generated complexity and challenge. Findings have global relevance for outbreak prevention and management strategies in higher education settings. Key messages • Delivery of asymptomatic SARS-CoV-2 testing and relaxation of social distancing within residences led to high rates of testing participation and benefits for student mental wellbeing. • This is the first process evaluation of the implementation of asymptomatic SARS-CoV-2 testing in university residences with global relevance for outbreak prevention in higher education settings.

Mixed-methods process evaluation of a residence-based SARS-CoV-2 testing participation pilot on a UK university campus during the COVID-19 pandemic.

BACKGROUND: Regular testing for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is an important strategy for controlling virus outbreaks on university campuses during the COVID-19 pandemic but testing participation rates can be low. The Residence-Based Testing Participation Pilot (RB-TPP) was a novel intervention implemented at two student residences on a large UK university campus over 4 weeks. The aim of the pilot was to increase the frequency of asymptomatic SARS-CoV-2 saliva testing onsite. This process evaluation aimed to determine whether RB-TPP was implemented as planned and identify implementation barriers and facilitators. METHODS: A mixed-methods process evaluation was conducted alongside the RB-TPP. Evaluation participants were students (opting in, or out of RB-TPP) and staff with a role in service provision or student support. Monitoring data were collected from the intervention delivery team and meeting records. Data were collected from students via online survey (n = 152) and seven focus groups (n = 30), and from staff via individual interviews (n = 13). Quantitative data were analysed descriptively and qualitative data thematically. Barriers and facilitators to implementation were mapped to the 'Capability, Opportunity, Motivation-Behaviour' (COM-B) behaviour change framework. RESULTS: Four hundred sixty-four students opted to participate in RB-TPP (98% of students living onsite). RB-TPP was implemented broadly as planned but relaxed social distancing was terminated early due to concerns relating to national escalation of the COVID-19 Delta variant, albeit testing continued. Most students (97.9%) perceived the period of relaxed social distancing within residences positively. The majority engaged in asymptomatic testing (88%); 46% (52% of testers) were fully compliant with pre-determined testing frequency. Implementation was facilitated by convenience and efficiency of testing, and reduction in the negative impacts of isolation through opportunities for students to socialise. Main barriers to implementation were perceived mixed-messages about the rules, ambivalent attitudes, and lack of adherence to COVID-19 protective measures in the minority. CONCLUSIONS: This process evaluation identifies factors that help or hinder the success of university residence-based outbreak prevention and management strategies. RB-TPP led to increased rates of SARS-CoV-2 testing participation among students in university residences. Perceived normalisation of university life significantly enhanced student mental wellbeing. The complexity and challenge generated by multiple lines of communication and rapid adaptions to a changing pandemic context was evident. TRIAL REGISTRATION NUMBER: UKAS 307727-02-01; Pre-results. CLINICALTRIALS: gov Identifier: NCT05045989 ; post-results (first posted, 16/09/21). ETHICAL APPROVAL: Faculty of Medicine & Health Sciences Research Ethics Committee, University of Nottingham (Ref: FMHS 96-0920).

EVALUATION OF THE YOUTH BRIEF INTERVENTION SERVICE (yBIS) FOR YOUTH IN CRISIS

Background: Young people are presenting to services in greater numbers and with higher levels of psychological distress and acuity, greater clinical complexity and reduced capacity in their support networks in the context of the COVID-19 pandemic. Despite this there is often a delay in accessing timely youth-oriented care. Through COVID-19 enhancement funding, the youth Brief Intervention Service (yBIS) has been implemented in the Eastern Suburbs Mental Health Service (ESMHS), Sydney, Australia, adapted from the Brief Lifeworks Intervention Program (BLIP) (Project Air Strategy, 2019). Objectives: To report on the yBIS model of care and discuss effectiveness and implementation data for yBIS. Methods: yBIS is offered to young people aged 12-25 years who present to ESMHS in crisis with suicidal ideation and/or self-harm. Participants, together with a parent or guardian, are offered up to four sessions (face-to-face or virtual) with yBIS clinicians, comprising a psychiatrist, psychologists and a nurse specialist, over a 3- to 4-week period. A battery of measures is being collected at baseline, discharge and longer-term follow-up. Primary effectiveness outcomes are level of suicidal ideation and frequency of self-harm. A range of secondary effectiveness outcomes and implementation components will be explored. Findings: yBIS began servicing youth in crisis in June 2021. We anticipate analysing effectiveness-implementation data on 80 participants in March 2022. Conclusion: yBIS may be a feasible and effective service for youth in crisis. There is potential for yBIS to be scaled up pending the results of the service evaluation as one response to the current crisis in youth mental health presentations.

Better than expected: client and clinician experiences of videoconferencing therapy (VT) during the COVID-19 pandemic

Videoconferencing therapy (VT) has been an emerging medium of psychological therapy, and during the COVID-19 pandemic there has been substantial growth in its usage as a result of home working. However, there is a paucity of research into client and clinician perceptions of VT. This study sought to assess client and staff experiences of VT. This mixed methods study produced both quantitative and qualitative data. Seven clients who had previously received VT and 11 psychotherapists who had previously delivered VT were recruited from two NHS sites. Clients and psychotherapists took part in qualitative interviews which were analysed using thematic analysis. Quantitative surveys were developed based on themes generated from the interviews and were completed by 172 clients and 117 psychotherapists. These were analysed using simple percentages. VT often exceeded client and psychotherapist expectations and overall experiences of VT were generally positive, although there were mixed findings regarding the therapeutic alliance. Several barriers to VT were cited, such as IT issues, and challenges identified in conducting behavioural experiments, and potential exclusion of certain populations were also cited. The medium of VT was received well by both clients and clinicians, with advantages around convenience seemingly outweighing losses in quality of therapeutic relationship. Future research should focus on overcoming barriers to accessing VT in populations prone to digital exclusion. NHS services not currently employing VT may wish to reconsider their stance, expanding choice of therapy delivery and improving accessibility.

The effectiveness of remote therapy in two London IAPT services

The COVID-19 pandemic increased population levels of depression and anxiety, and infection control measures obliged services to provide psychological therapies remotely. Evidence for the routine provision of psychological therapy via telephone and video-conferencing is limited. This study compared therapy outcomes for 5360 clients in two London Improving Access to Psychological Therapy (IAPT) services before and after homeworking produced a compete shift to remotely delivered therapy. Despite the psychological impacts of pandemic restrictions, and the use of a novel therapy modality in video-conferencing, recovery rates and net score change improved in both services, significantly in one. There was no significant worsening of outcomes for any demographic group or presenting disorder. The findings suggest that for those able to access it, therapy provided by telephone and video is a clinically effective option for IAPT services.

The changing vaccine landscape: rates of COVID-19 vaccine acceptance and hesitancy in young adults during vaccine rollout.

AIMS: Development and rollout of vaccines offers the best opportunity for population protection against the SARS-CoV-2 (COVID-19) virus. However, hesitancy towards the vaccines might impede successful uptake in the United Kingdom, particularly in young adults who demonstrate the highest rates of hesitancy. This prospective study explored COVID-19 vaccine hesitancy in young adults and whether the reasons behind these attitudes changed during the initial stages of the United Kingdom's vaccine rollout. METHOD: Data on vaccination intention were collected from a British university student cohort at three time points: October 2020, February 2021, and March 2021. This online survey included items on intention to receive a vaccine and a free-text response for the reasons behind this intention. Cochran's Q tests examined changes in rates of hesitancy and acceptance over time and free-text responses were analysed thematically. RESULTS: At baseline, 893 students provided data, with 476 participants completing all three time points. Hesitancy declined over time, with 29.4% of participants expressing hesitancy at baseline, reducing to 9.1% at wave 2 and 5.9% at wave 3. The most commonly endorsed themes for those willing to accept a vaccine were self-protection against COVID-19 and pro-social reasons, including protecting the population or unspecific others, and ending the pandemic/returning to normal life. The most commonly endorsed hesitancy themes related to 'confidence' in the vaccines and potential personal risk, including insufficient testing/scientific evidence, concern about side effects, and long-term effects. These reasons remained the most commonly endorsed at both waves 2 and 3. CONCLUSIONS: While a decline in hesitancy was observed over time, the key reasons behind both vaccine acceptance and hesitancy remained consistent. Reasons behind hesitancy aligned with those of the general public, providing support for the use of generalist interventions. Pro-social reasons frequently underpinned vaccine acceptance, so cohort-specific interventions targeting those factors may be of benefit.

Mental well-being and future career intentions of new graduate nurses and midwives in their first year of entry into the workforce: a cross sectional survey

Objective: To explore mental well-being and future career intentions of new graduate nurses and midwives (NGs) in their first year of work. Background: Mental well-being is important for people to feel good and function well in their daily life. However, little is known about changes in mental well-being and future workforce intentions of nurses and midwives in their first year of professional practice. Study design and methods: A cross-sectional study was conducted at a large Local Health District in New South Wales, Australia. Nurses and midwives (N=170) who commenced a transition program in February 2017 were invited to complete a survey using the Warwick-Edinburgh Mental Well-being Scale after four to six weeks (Group 1) and again at 10-11 months (Group 2). Unpaired t-tests for independent samples were used to compare differences between time-points. Results: Response rates were 47% for Group 1 and 29% for Group 2. The mean (median) mental wellbeing score was 52.1 (52) for Group 1 and 48.7 (50) for Group 2. While the majority of respondents retained a moderate/high sense of well-being, decreases were significant for the items, 'feel relaxed' and 'interested in new things'. Being located in rural areas, being aged between 20-29 years and being female was related to a lower well-being score for Group 2. The main factors contributing to NGs wellbeing were: a supportive environment, resilience, self-efficacy, and sense of achievement. Respondents with higher total well-being scores were significantly more likely to continue working at the current organisations and significantly less likely to seek employment in other organisations. Discussion: This study provides valuable insight into the mental well-being and future career intentions of new graduate nurses and midwives. Most of them retain a moderate to high sense of well-being over their first year of practice which suggests sufficient support is provided, or that they are an inherently resilient population. Building supportive environments that assist resilience, self-efficacy and sense of achievement is critical. Conclusion: With the current COVID pandemic situation, addressing factors impacting on the mental well-being and future career intentions of new graduate nurses and midwives in their first year may be more critical to enhance job satisfaction, leading to improved workforce resilience and capability and therefore the provision of quality healthcare. Implications for research, policy and practice: The findings of the study reinforce the importance of mental well-being to retain new graduate nurses and midwives in the future workforce. What is already known about the topic? Positive mental well-being supports people to feel good and function well. Entering into a new workforce as a novice practitioner is stressful and maintaining positive mental well-being in the workplace enhances the capacity to provide safe quality healthcare. Little is known about changes in mental well-being and future workforce intentions of new graduate nurses and midwives (NGs) in their first year of professional practice. What this paper adds? Findings show that the majority of NGs retained a moderate/high sense of well-being throughout their first year of their professional life. Providing a supportive environment, increasing resilience, self-efficacy and sense of achievement will enhance maintenance of positive mental wellbeing and retention of NGs in the workforce.

Understanding and addressing vaccine hesitancy in the context of COVID-19: development of a digital intervention.

OBJECTIVES: Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) was identified in late 2019, spreading to over 200 countries and resulting in almost two million deaths worldwide. The emergence of safe and effective vaccines provides a route out of the pandemic, with vaccination uptake of 75-90% needed to achieve population protection. Vaccine hesitancy is problematic for vaccine rollout; global reports suggest only 73% of the population may agree to being vaccinated. As a result, there is an urgent need to develop equitable and accessible interventions to address vaccine hesitancy at the population level. STUDY DESIGN: & Method: We report the development of a scalable digital intervention seeking to address COVID-19 vaccine hesitancy and enhance uptake of COVID-19 vaccines in the United Kingdom. Guided by motivational interviewing (MI) principles, the intervention includes a series of therapeutic dialogues addressing 10 key concerns of vaccine-hesitant individuals. Development of the intervention occurred linearly across four stages. During stage 1, we identified common reasons for COVID-19 vaccine hesitancy through analysis of existing survey data, a rapid systematic literature review, and public engagement workshops. Stage 2 comprised qualitative interviews with medical, immunological, and public health experts. Rapid content and thematic analysis of the data provided evidence-based responses to common vaccine concerns. Stage 3 involved the development of therapeutic dialogues through workshops with psychological and digital behaviour change experts. Dialogues were developed to address concerns using MI principles, including embracing resistance and supporting self-efficacy. Finally, stage 4 involved digitisation of the dialogues and pilot testing with members of the public. DISCUSSION: The digital intervention provides an evidence-based approach to addressing vaccine hesitancy through MI principles. The dialogues are user-selected, allowing exploration of relevant issues associated with hesitancy in a non-judgmental context. The text-based content and digital format allow for rapid modification to changing information and scalability for wider dissemination.

New Zealand's Climate Change Commission report: the critical need to address the missing health co-benefits of reducing emissions

The Climate Change Commission's draft report and recommendations provide a pathway towards achieving the New Zealand Government's commitment to net zero emissions by 2050. However, the Commission has not adequately considered the health co-benefits of climate change mitigation. In this viewpoint, we assess how the Commission has considered health co-benefits in the key response domains. Extrapolating UK evidence to the New Zealand context suggests climate change mitigation strategies that reduce air pollution, transition the population towards plant-based diets and increase physical activity via active transport could prevent thousands of deaths per year in coming decades. Substantial health co-benefits would also arise from improved housing, cleaner water, noise reductions, afforestation and more compact cities. The Commission's draft report only briefly mentions many of these health co-benefits, and some are completely absent. We recommend the Commission's final report: (i) use health co-benefits as an explicit frame;(ii) ensure the government's Treaty of Waitangi obligations are met in all the domains covered to maximise benefits for Maori health and wellbeing;(iii) build on the successful COVID-19 response that demonstrated rapid, science-informed and vigorous government action can address major global health threats;(iv) include both public health expertise and Maori health expertise among its commissioners;(v) explain how health co-benefits are likely to generate major cost-savings to the health system.

Randomized multicenter trial of 3 weekly cabazitaxel versus weekly paclitaxel chemotherapy in the first-line treatment of HER2 negative metastatic breast cancer (MBC)

Background: Paclitaxel is commonly used as first line chemotherapy for HER2 negative MBC. However, with response rates of 21.5-53.7% and a significant risk of peripheral neuropathy there is a need for more effective and better tolerated chemotherapy (CCT). Methods: This open label randomised (1:1) phase 2 trial compared 6 cycles of cabazitaxel (25 mg/m2 ) every 3 weeks, with weekly paclitaxel (80mg/m2 ) over 18 weeks as first line CCT. HER2 negative and performance status ≤1 patients were eligible. Patients on cabazitaxel received GCSF prophylaxis. Primary endpoint was Progression Free Survival (PFS) with 127 events required to detect a hazard ratio (HR) of 0.65 with 85% power. Secondary endpoints included objective response rate (ORR;RECIST 1.1), time to response (TTR), overall survival (OS), safety and tolerability and quality of life (QoL). Results: 158 patients were recruited from 14 UK hospitals (79 in each arm). Median age (range) was 56(34-81) in the cabazitaxel arm and 61(34-79) in the paclitaxel arm. 61% of patients were performance status 0. Median time on treatment was 15 weeks for both arms, but more patients on paclitaxel had a treatment delay (61% vs 39%) or dose reduction (37% vs 24%). Comparing cabazitaxel to paclitaxel after 146 PFS events, median PFS was 6.7 vs 5.8 months (HR 0.84;95%CI 0.60-1.18, P = 0.3). There was no difference in OS, median 19.3 vs 20.0 months (HR 0.94;95%CI 0.63-1.40, P = 0.7), ORR (42% vs 37%) or TTR (HR 1.09;95%CI 0.68- 1.74, P = 0.7). Grade ≥3 adverse events occurred in 42% of patients on cabazitaxel and 48% on paclitaxel. Diarrhoea, febrile neutropenia and nausea were the most common grade ≥3 events in the cabazitaxel arm with rates of 11%, 11% and 10% respectively compared to 1%, 1% and 0% in the paclitaxel arm. In the paclitaxel arm the top grade ≥3 events were lung infection and peripheral neuropathy, 6% and 5% respectively compared to 2.5% and 0% in the cabazitaxel arm. Peripheral neuropathy of any grade was reported by 55% of patients treated with paclitaxel vs 17% on cabazitaxel. Alopecia occurred in 41% of patients on paclitaxel compared to 27% on cabazitaxel. Adverse events leading to discontinuation were more frequent with paclitaxel (22%) than cabazitaxel (14%). Over the course of treatment, mean EQ5D single index utility score (+0.05;95%CI 0.004-0.09, P = 0.03) and visual analogue scale score (+7.7;95%CI 3.1-12.3, P = 0.001) were higher in the cabazitaxel arm compared to paclitaxel suggestive of better QoL on Cabazitaxel. Conclusions: 3 weekly cabazitaxel as first line chemotherapy in HER2 negative MBC does not significantly improve PFS compared to weekly paclitaxel, though it has a lower risk of peripheral neuropathy with better patient reported overall health outcomes. Cabazitaxel is safe and well tolerated for MBC and requires fewer hospital visits, an important consideration in the COVID pandemic and beyond.

Ensuring equity in the management of patients, over 70 years of age, on immunotherapy during the COVID-19 pandemic

Background: Immunotherapy (IO) has transformed the landscape for melanoma. Checkpoint inhibitors (CPI) are now routinely given to older patients. The impact of performance status (PS) and age on the immune response remains unclear. During the COVID-19 pandemic, most older patients elected to continue their cancer therapy. Meta-analysis from trial data thus far has not demonstrated any association with cancer immunotherapy survival. This abstract reports on real -world experience of older patients with melanoma treated during the global pandemic. Methods: Real world data of all patients over 70 years of age receiving IO for melanoma, was collated at a tertiary cancer centre from Oct 2019 - Dec 2020. The objective was to see how these older patients tolerated CPI, in both the adjuvant and palliative settings, during a global pandemic. Information on demographics including age at diagnosis, intention, sites of metastases, PS, co-morbidities, toxicity, impact of COVID-19 and the patient outcomes were collected. During the pandemic the majority of patients on CPI treatment were assessed and followed up by telephone call rather than face to face. Results: Fifty-six patients over 70 years,were identified to have received CPI during the time period. There were 36 male and 22 female patients. Median age was 74 (range 70-88 years). Sixteen patients (29%) were treated with adjuvant intent;the remaining 40 patients (71%) were treated with palliative intent. Most patients with metastatic disease had 1-3 sites. All patients were PS0-1, except for one patient who was PS2. There were 19 patients (34%) who developed significant grade toxicities. No patients were treated on a clinical trial during the pandemic. Three patients (5%) elected to stop treatment during the pandemic. Calls to triage were taken as normal and the majority of patients had toxicity managed as an outpatient. No patients received the vaccine by the end of the study period. Conclusions: Real-world data explored the use of CPI in older patients and the impact of the COVID-19 pandemic on their management. Older patients were able to continue on CPI during the pandemic and it was given safely in adjuvant and palliative settings. Comprehensive geriatric assessments are planned to be integrated however the current demands on medical colleagues has delayed the introduction. However clinicians working in partnership with patients ensured the safe delivery and no patients died from toxicity of therapy or COVID-19 during this time. These findings suggest that shared decision-making during a pandemic with older patients is essential to support patients and optimise outcomes. We suggest cancer therapies should not be restricted to patients based on age and IO can be given safely if precautions are taken during a global pandemic. Patients have now received first COVID-19 vaccinations and ongoing assessement of the impact of the vaccination is in progress.

Service evaluation of the nurse-led telephoneadvice line in the wake of COVID-19: A report of auditand staff satisfaction

Background/AimsThe Rheumatology nurse advice line (NAL) at the Royal NationalHospital for Rheumatic Diseases (RNHRD, Bath) provides a vitalservice for direct patient access to specialist advice via a designatedvoicemail system. Increasing numbers and difficulty connecting callreturns have increased staff workload, reduced efficiency andimpacted on staff satisfaction. An audit was therefore undertaken toevaluate service use and efficiency, paired with formal assessment ofstaff satisfaction in order to identify areas for improvement.MethodsThe total number of monthly calls through the NAL during 2020 werecounted. A subset of consecutive calls were audited in detail, documenting temporal parameters in relation to the call beinglogged, returned and concluded. The number of clinicians andattempts required to contact the patient was noted. An anonymisedstaff satisfaction questionnaire was completed by NAL nurses andadministrators. Data was analysed using Excel.ResultsAn average 653 calls per month (range 340-894) came through theNAL between January and September 2020. 97 consecutive patientcontacts were audited from August 2020. Multiple attempts wererequired to successfully return the call in 19.6% of cases (n = 19/97).Of those, 68.4% (n = 13/19) of calls needed 2 nurses to contact thepatient. In general, the first attempt to return the call was prompt(average 7.6 hours, range 0.1-27.7). However, the time to conclude thecall from the patient's first call log ranged from 0.1 - 142.6 hours(average 12.7 hours) with increased time associated with difficultiescontacting the patient or when further advice was required from aRheumatology doctor (18.5%, n = 18/97).Staff surveys revealed 67% of staff felt that the NAL is a good serviceto offer patients. However, 67% of staff did not feel the NAL in itscurrent format was easy to manage. Specific comments included thatthe lack of rota'd responsibility, unpredictable workload and timeinefficiencies were barriers to managing the service.ConclusionFrom this data, we conclude that patient calls are returned promptly, but utilising a system of voicemail and unscheduled call returns isinefficient and contributes to staff dissatisfaction. This data has drivenchange for service improvement. To improve efficiency, calls will beanswered live by an administrator during working hours and patientsgiven a call-back time. A doctor will be named as a single point ofcontact for the nurses to seek additional advice and a nurse rota willdesignate responsibility for NAL calls to reduce work-load uncertainty.Follow up service evaluation will include staff and patient satisfactionquestionnaires, and repeat audit, with consideration of ways tosupport frequent service users.

Students' Views towards Sars-Cov-2 Mass Asymptomatic Testing, Social Distancing and Self-Isolation in a University Setting during the COVID-19 Pandemic: A Qualitative Study

We aimed to explore university students' perceptions and experiences of SARS-CoV-2 mass asymptomatic testing, social distancing and self-isolation, during the COVID-19 pandemic. This qualitative study comprised of four rapid online focus groups conducted at a higher education institution in England, during high alert (tier 2) national COVID-19 restrictions. Participants were purposively sampled university students (n = 25) representing a range of gender, age, living circumstances (on/off campus), and SARS-CoV-2 testing/self-isolation experiences. Data were analysed using an inductive thematic approach. Six themes with 16 sub-themes emerged from the analysis of the qualitative data: 'Term-time Experiences', 'Risk Perception and Worry', 'Engagement in Protective Behaviours', 'Openness to Testing', 'Barriers to Testing' and 'General Wellbeing'. Students described feeling safe on campus, believed most of their peers are adherent to protective behaviours and were positive towards asymptomatic testing in university settings. University communications about COVID-19 testing and social behaviours need to be timely and presented in a more inclusive way to reach groups of students who currently feel marginalised. Barriers to engagement with SARS-CoV-2 testing, social distancing and self-isolation were primarily associated with fear of the mental health impacts of self-isolation, including worry about how they will cope, high anxiety, low mood, guilt relating to impact on others and loneliness. Loneliness in students could be mitigated through increased intra-university communications and a focus on establishment of low COVID-risk social activities to help students build and enhance their social support networks. These findings are particularly pertinent in the context of mass asymptomatic testing programmes being implemented in educational settings and high numbers of students being required to self-isolate. Universities need to determine the support needs of students during self-isolation and prepare for the long-term impacts of the pandemic on student mental health and welfare support services.

Collateral damage: Hidden impact of the COVID-19 pandemic on the out-of-hospital cardiac arrest system-of-care.

AIM: Out-of-hospital cardiac arrest (OHCA) during COVID-19 has been reported by countries with high case numbers and overwhelmed healthcare services. Imposed restrictions and treatment precautions may have also influenced OHCA processes-of-care. We investigated the impact of the COVID-19 pandemic period on incidence, characteristics, and survival from OHCA in Victoria, Australia. METHODS: Using data from the Victorian Ambulance Cardiac Arrest Registry, we compared 380 adult OHCA patients who received resuscitation between 16th March 2020 and 12th May 2020, with 1218 cases occurring during the same dates in 2017-2019. No OHCA patients were COVID-19 positive. Arrest incidence, characteristics and survival rates were compared. Regression analysis was performed to understand the independent effect of the pandemic period on survival. RESULTS: Incidence of OHCA did not differ during the pandemic period. However, initiation of resuscitation by Emergency Medical Services (EMS) significantly decreased (46.9% versus 40.6%, p = 0.001). Arrests in public locations decreased in the pandemic period (20.8% versus 10.0%; p < 0.001), as did initial shocks by public access defibrillation/first-responders (p = 0.037). EMS caseload decreased during the pandemic period, however, delays to key interventions (time-to-first defibrillation, time-to-first epinephrine) significantly increased. Survival-to-discharge decreased by 50% during the pandemic period (11.7% versus 6.1%; p = 0.002). Survivors per million person-years dropped in 2020, resulting in 35 excess deaths per million person-years. On adjusted analysis, the pandemic period remained associated with a 50% reduction in survival-to-discharge. CONCLUSION: The COVID-19 pandemic period did not influence OHCA incidence but appears to have disrupted the system-of-care in Australia. However, this could not completely explain reductions in survival.