Development and Co-Design of a Digital Intervention for People Affected by Dementia who are Fearful of Disclosing the Diagnosis to Their Social Networks

Background: Receiving a diagnosis of dementia can affect all aspects of an individual's life, including their sense of identity. As a consequence, some people with dementia may socially withdraw due to stigma, embarrassment or fear of what might happen if other people were to find out about the diagnosis. The "Who to tell, how and when" intervention, a group-based face-to-face intervention, has been developed for people affected by dementia who are fearful of disclosing the diagnosis to others. This study aims to adapt the existing intervention for online delivery, in light of the ongoing COVID-19 pandemic. Method(s): A co-created, user-centred design in three phases is applied. In phase 1, focus groups conducted with people with dementia and informal caregivers will inform the platform, features and adaptation of pre-existing material. Phase 2 consists of the development of the digital prototype. In phase 3, the feasibility and usability are tested with end users to inform prototype v. 2.0. Result(s): Research has indicated that peer support in the disclosure decision-making process is especially important for participants. Results from phase 1 and 2, including findings from the discussions with the focus groups and options appraisals for the peer support elements of the digital intervention will be discussed. We will discuss general principles of adaptation from paper manual to digital intervention. Conclusion(s): Online access to this intervention may be especially valuable for people who wish to maintain anonymity and privacy, for example people from cultural or ethnic groups where the stigma of dementia is high. Online versions of face-to-face interventions improve overall accessibility by providing choice. Copyright © 2022 the Alzheimer's Association.

ICONIC: Impact of Covid-19 on Outcomes iN muscle Invasive bladder Cancer - preliminary Results from a prospective IBUS (International British Urological Society) led multicentre collaborative study

Introduction: The Covid-19 pandemic in the UK led to much un-certainty about the delivery of cancer services. A shift from established therapy (and its timing) in patients with Muscle invasive Bladder Cancer (MIBC) has potential deleterious consequences. To understand outcomes, we formed a collaborative to measure overall and diseasefree survival at 3-years in patients with non-metastatic MIBC (Figure 1) treated during the UK's first wave of Covid-19. Secondary aims included comparison between treatment modalities and pre-Covid controls. Patients and Methods: The collaborative included clinicians from 13 major centres, representing 3 UK nations. A prospective clinical audit, endorsed by the National Cancer Research Institute, was started to collect comprehensive data. MIBC patients discussed at the multidisciplinary meeting (MDM) between 1/3/2020-30/06/2020 were included. Results: At submission, data were available from 12 centres for 299 patients. The mean age was 69.3 years (27- 90), and there were 72 female and 227 male patients. Mean Charlson Co-morbidity Index was 5 (1-12). Preliminary analysis of available data indicate the following: MDM recommendations for (at least) 1 in 4 patients were deemed as being modified from standard practice. Twenty six patients received neoadjuvant chemotherapy. In total (from available data), 99 received radical radiotherapy and 146 underwent radical cystectomy (65 and 74 specified as open and robotic assisted, respectively). Preliminary analysis suggests that 1 in 3 patients had died within 1 year. Conclusions: Preliminary Results indicate that recommendations for MIBC patients were significantly altered consequent to the pandemic and mortality was high. Analyses towards endpoints are awaited.

Technology as Treatment: Use of Virtual Complementary and Integrative Therapies by Patients in Neurology

Objective: Given the reductions in in-person visits and the increases in teleneurology visits, we sought to determine whether patients increased their use of virtual complementary and integrative therapies. Background: Patients with neurological disorders may seek treatment options in addition to those recommended by their providers. Prior to the COVID-19 pandemic, about half of patients from populations that sought care in neurology tried complementary and integrative therapies (CITs). Design/Methods: By examining two separate datasets that included cohorts of patients with neurological disorders, we assessed patients' use of virtual (and non-virtual) CITs and determined whether there were clinical characteristics that predicted their use. The two studies that comprised this report included one that examined patient and provider experiences with teleneurology visits, and another that assessed patients with a history of COVID-19 infection who presented for neurologic evaluation. Results: Patients who postponed medical treatment for non-COVID-19-related problems during the pandemic were more likely to seek CITs. Virtual exercise, virtual psychotherapy and relaxation/meditation smartphone applications were the most frequent types of virtual CITs chosen by patients. In both studies, age was a key demographic factor associated with mobile/virtual CIT usage. Conclusions: Data from our investigations demonstrated that, in addition to its other roles in teleneurology, CIT-related technologies may be utilized in the treatment of neurologic conditions.

Accessible, Affordable and Low-Risk Lungs Health Monitoring in Covid-19: Deep Cascade Reconstruction from Degraded LR-ULDCT

We present deep cascade reconstruction of degraded low-resolution ultra-low-dose computed tomography (LR-ULDCT) chest images to restored and super-resolved (SR) ULDCT as accessible, affordable, and relatively less hazardous recourse for lungs health monitoring in COVID-19;when compared to relatively less available, costly, and high radiation dose high-resolution CT (HRCT). The degraded LR-ULDCT is first restored with unsupervised dictionary-based deep residual learning network that handles degradations along with Poisson noise found in CT data. The restored version is given to SR network that increases its spatial resolution by minimizing adversarial loss between LR-ULDCT and reconstructed SR-ULDCT within minimax game. It is then fed for segmentation which is achieved by additional block of convolution, Leaky-ReLU, and batch-normalization in U-Net. Thus restored segmented SR-ULDCT estimates presence of ground glass opacity and facilitates monitoring of lungs health at par HRCT. Comparative experiments and ablation study are presented using synthetic and real COVID-19 data. © 2022 IEEE.

A novel nasal mask-face tent provided continuous nasal ventilation/oxygenation and lowered aerosol/droplet spread during GA induction/intubation/extubation in a difficult airway patient with large neck haematoma

Background: A combined paediatric facemask-face tent provided nasal pre/apnoeic oxygenation and reduced aerosol spread in a COVID-19 positive patient during RSI/intubation/extubation.1,2 It avoided severe desaturation and reduced aerosol/droplet spread during difficult intubation/ extubation in a morbidly obese patient.3 We used it in a difficult airway patient with large neck haematoma. Case Report: A 56-year-old obese male with HTN and right parotid tumor s/p uneventful parotidectomy, developed neck haematoma and severe desaturation, presented for urgent neck exploration. He had swollen neck/lower jaw (right) and Class IV airway (Fig.1). While in incline position, a modified infant facemask-face tent was secured over his nose.1 He was pre-treated with lidocaine oral spray. He breathed comfortable with 4-5cmH2O nasal CPAP (4LO2/min). SpO2 improved from 96% to 100% (93% Expired O2). GA was titrated with midazolam/fentanyl/lidocaine/propofol. Pressurecontrolled nasal ventilation (PIP 15cm H2O/PEEP 5cm H2O/RR 20/min) was initiated. Videolaryngoscope (VL) revealed vocal cords and swollen larynx and tissues. He was then given succinylcholine/ propofol. Atraumatic VL intubation under the face tent was accomplished smoothly (Fig.2). SpO2 (100%) was maintained. He tolerated the procedure well. Prior to extubation, he received lidocaine (5cc 2%) spray via endotracheal-tube. The nasal mask-face tent was re-secured. He was extubated smoothly without coughing. The circuit was re-connected to the nasal mask. He maintained spontaneous nasal ventilation and 100% SpO2. Discussion: This simple nasal mask-face tent provided pressure-controlled ventilation/oxygenation in a patient with large neck haematoma during GA induction/intubation. It helped lower aerosol/ droplet spread during intubation/extubation. Amid COVID-19 pandemic, it should be used as a universal precaution to improve patient oxygenation and provide additional provider protection. (Figure Presented).