HARD TIMES: ADAPTING A FATIGUE MANAGEMENT PROGRAMME in A PANDEMIC

Background: Fatigue is a symptom of many Rheumatology Conditions (1). Hewlett et al have shown that a Fatigue Management programme (FMP) is effective in reducing fatigue in Rheumatoid Arthritis patients (2). In 2019, a 7-week group-based FMP was developed using a cognitive behavioural approach for Rheumatology patients in NHS Lothian (Scotland). In 2020, due to COVID-19, the in person FMP was adapted for virtual delivery. Referral criteria included Visual Analogue Scale-Fatigue (VAS-F) of ≥6/10 and an infam-matory rheumatic disease diagnosis. The FMP participants recorded Patient Reported Outcome Measures (PROMs) prior to and on completion of the FMP. In August 2021 demand for the FMP far outweighed the capacity of the delivery team and therefore the original 7-week FMP was further adapted to a 4-week programme. This was achieved by focusing on four core elements (i) sleep, (ii) thoughts, emotions and behaviours, (iii) energy conservation, (iv) setbacks. Objectives: The primary objective was to evaluate whether the 4-week programme produced comparable PROMs results to the 7-week programme. In doing so, the aim was to maintain efficacy of the programme and provide increased capacity by offering more groups in the same timeframe. Methods: Fatigue Severity Scale (FSS) and VAS-F were selected for comparison between pre and post FMP PROMs results, these being the main indicators of improvement in fatigue management. Fisher's exact test was used to determine any difference between the PROMs results reported at the end of both programmes. Participants who reported that their PROMs result were the same, worse or who did not respond, were all placed into the category 'Other'. The FMP team recorded the average waiting time for those attending each group. The length of the waiting list at any one time was calculated by removing those who were not interested, had been referred elsewhere, or who did not respond to the invitation, from the total number of referrals received by the FMP team. Results: There was no signifcant difference in FSS and VAS-F results reported by the participants in both groups at the end of the FMPs as determined by Fisher's exact test (Table 1). Waiting list times reduced from 24 weeks in August 2021 to 6 weeks in December 2021 as a result of the adaptation of the FMP from a 7-week programme to a 4-week programme (Figure 1). Conclusion: A 4-week FMP is as effective at improving the management of fatigue in Rheumatology patients as a 7-week FMP and reduces patient waiting times. More research is required to bolster the evidence base to support this novel approach.

“It’s good to talk” – development of a virtual international physiotherapy discussion forum

Objectives: COVID-19 has limited in-person networking opportunities worldwide. To address this, we formed a collaboration of representatives from Australia’s CFPhysio.com Inc, the UK’s Association of Chartered Physiotherapists in Cystic Fibrosis (CF) and US specialist CF physical therapists (PT) with the objective of creating a virtual international discussion forum. To ensure wider interest, views were gathered from international CF colleagues via a self-designed online survey. Here we present survey results and planned outcomes. Methods: Survey topics included respondent demographics;professional development and research priorities;and future forum interest. The online survey circulated between Oct-Dec 2021 via social media channels, established networks and targeted emails to international physio and PT groups. Results: Eighty-four people responded - 94% physio/PTs;74% hospitalbased;equal split between paediatrics and adults;30% currently researchactive. 100% of respondents were interested in attending virtual discussion forums, with 73% keen to plan sessions. The top 3 professional development and research priorities are described in the table. (Table Presented) Conclusions: Results indicate international CF PT/physio interest in a virtual discussion forum. In response to this interest, we developed our vision "To create a virtual space for clinicians and researchers across the globe, working in CF, to learn and to collaborate and deliver on innovative and robust research into the future." Quarterly virtual discussion forums start in Spring 2022, hosted and promoted by beamfeelgood.com (a global exercise and education platform for people with CF and their clinicians). Sessions address the top professional development priorities identified from survey results and aim to facilitate discussions between colleagues to enhance clinical practice and forge future research collaborations.

Prevalence of anti-sars-cov-2 antibodies in south african blood donors

Background: Given the inevitable, likely substantial, under-ascertainment of SARS-CoV-2 infection at the population level, using routine laboratory testing, the prevalence of SARS-CoV-2 antibodies ('seroprevalence') is an important marker of Covid-19 epidemiology. As nationally representative household surveys are a major undertaking, it will be important to find efficient ways to reliably estimate antibody prevalence from much simpler, less expensive protocols. Methods: Subject to meeting standard blood donor eligibility criteria, and a standing opt-out arrangement for research use of specimens primarily obtained for blood safety screening, unsolicited blood donations, obtained on particular 'collection days' at 219 donation sites in South Africa, during January 2021, were tested for SARS-CoV-2 antibodies using the Roche Cobas e411 platform. Donors are currently requested to defer donation if they were diagnosed with Covid-19, or experienced Covid-19-like symptoms, in the preceding 14 days. Estimates were stratified by age, sex and race. The study will have additional testing days. Phone interviews with both antibody positive and negative donors are being conducted to probe PCR diagnosis and symptoms. Results: Tested donations numbered 4547, from donors aged 16-81. Seroprevalence did not vary significantly between sexes or age groups. Headline results for the main race groups (in South African nomenclature) are: Black 58.3% (95% CI 55.8 - 60.7% ), White 13.8% (95% CI 12.3 -15.4%), Asian 23.4% (95% CI 19.4 - 27.7%) and Coloured 36.2%(95% CI 31.4 - 41.1%). The population group weighted overall national estimate is then 51.4% (95% CI 49.4 - 53.4%). This is almost 25 times as high as the official prevalence, on 10 January, of having been diagnosed with Covid-19, namely 2.1%. See Figure. Conclusion: These are the first relatively widely representative SARSCoV- 2 antibody prevalence estimates from South Africa. Population level representativeness of this methodology warrants further exploration - but it is worth noting that 1) as elsewhere, the obtained antibody prevalence estimates imply SARS-CoV-2 attack rates that are easily an order of magnitude higher than the apparently relatively uninformative official case counts;and 2) the marginal cost of performing this study, over the cost of routine blood bank operations, was almost entirely comprised of the cost of reagents. South African case fatality rate estimates will need significant revision.

International Liaison Committee on Resuscitation: COVID-19 consensus on science, treatment recommendations and task force insights.

Consensus on Science and Treatment recommendations aim to balance the benefits of early resuscitation with the potential for harm to care providers during the COVID-19 pandemic. Chest compressions and cardiopulmonary resuscitation have the potential to generate aerosols. During the current COVID-19 pandemic lay rescuers should consider compressions and public-access defibrillation. Lay rescuers who are willing, trained and able to do so, should consider providing rescue breaths to infants and children in addition to chest compressions. Healthcare professionals should use personal protective equipment for aerosol generating procedures during resuscitation and may consider defibrillation before donning personal protective equipment for aerosol generating procedures.