The true cost of pre-operative investigations

Introduction: Pre-Operative Assessment (PoA) is an integral part of surgery. It is essential for pre-operative investigations including bloods and COVID-19 swabbing. There was concern within The Breast-Unit that patients may be having unnecessary blood-tests as part of their PoA. This was likely due to PoA not having one unified resource to refer to. Guidance suggests PoA uses The patient's American Association of Anaesthesiologist's (ASA) grade, type of Surgery they are undergoing and additional conditions for determining pre-operative investigations. Method(s): This QIp consistedof 2 cycles. During cycle-1 data was audited against national guidance to see which blood tests were performed unnecessarily. After developing a universal-guidance poster and teaching sessions, a second cycle was performed. Cycle-2 assessed whether there was a reduction in unnecessary blood tests being performed. Result(s): During cycle-1, 216 pre-operative blood tests were undertaken. of these only 99 were required. Therefore 54% of The tests were unnecessary. This equates to 690.77 over 2-months and if extrapolated 4144.62 spent, unnecessarily per-year. This represents a significant cost to The Trust and puts needless pressure onto The laboratory. During cycle-2, after our intervention, there were 57 fewer tests and 40 fewer, incorrect blood tests. Our intervention therefore resulted in a 183.46 saving, which over a year equates to 1110.76 saved. Conclusion(s): The potential benefits of improving PoA include financial savings, patient autonomy, increased appointment availability and reduced pressure on The laboratory. In these unprecedented times, trying to tackle The COVID-19 backlog;we advise all departments to ensure that clear guidance exists.

The Artful Craft of Improving Virtual Summer Camps in the Midst of COVID-19 (Work in Progress)

The Artful Craft of Science (TACoS) is a week-long summer camp that the University of Wyoming has provided annually for up to 80 upcoming 5th and 6th graders since 2015. The program includes a variety of activities in science, technology, engineering, and mathematics (STEM), including a five-day introductory computer science (CS) class. In 2020 and 2021, TACoS ran virtually due to COVID-19, revealing a unique opportunity to compare two instances of the CS section of the program. This study focuses on answering two questions: 1) How does video quality impact student participation and engagement;and 2) How does the length of time that content is accessible affect how students engage with course material? Both virtual years (Summers 2020 and 2021), the CS program included five 20-30-minute videos, a corresponding website for students to follow, and physical components that were mailed to each student prior to the course. After the first year (Summer 2020), improvements were made to the CS course presentation including attention to video quality, fresh course content for repeat-attendees, and further streamlined lesson plans. In the second virtual year (Summer 2021), students were given access to course material for a longer amount of time, as content remained available for a month instead of only during the camp week. Over both virtual years, viewership data was collected from each video including the number of views per activity, the average view duration, the audience retention rate across each video, the average views per viewer, and the lifetime watch time for each video. A total of 37 (46%) parent evaluation reviews (including perspectives of their students) of the TACoS program were collected, providing insight on the overall impressions of the camp, the CS program specifically, the students' favorite project/course within TACoS, the course completion rate, the ranked comparison of parents' time spent helping their child with each TACoS program, and general parent feedback. Findings show that there was improvement in the video content which could have invited more participation in the project/course and higher student engagement with the project/course material in the second virtual year. © American Society for Engineering Education, 2022.

Management of breast incidentalomas: A closed loop audit experience at royal surrey foundation trust

Introduction: Breast Incidentalomas occur as an unexpected abnormality demonstrated on imaging performed for unrelated symptoms. Pre-COVID19 pandemic management involved urgent referrals for initial breast team evaluation. Clinical encounters occurred prior to the Multi-Disciplinary Team meeting (MDT). COVID-19 restrictions necessitated streamlining and optimising service provision with clinically appropriate encounters. Our aim was to re-audit (SU-CA-21-22-068) findings and management of breast incidentalomas during the pandemic. Methods: Pre-pandemic analysis of practice (November 2019 - January 2020) led us to the intervention of all referrals straight to MDT without an unnecessary prior clinical encounter, with secondary planned investigations and clinical assessment thereafter. Completion of audit loop and analysis included referral information, MDT outcome, imaging, and clinical correspondence with descriptive analysis. Results: Post-intervention 61 patients were referred to the MDT over an 18-month period (February 2020 - October 2021). 90% of patients were referred following CT scans. Median age 71 (range 32-93), 38% of patients had no additional breast imaging and 74% of patients did not require a tissue biopsy. 15% (n=9) were diagnosed with new breast cancer, 36% were new benign, with 34% already known lesions. 16% of patients required no further intervention. Conclusion: 15% of incidentalomas were diagnosed as malignancies, compared to local 3-4% from one stop clinics. Prompt referral to MDT accelerates triple assessment and tissue diagnosis. Streamlining of patient care optimised appropriate clinical encounters for vulnerable patients. Early senior radiological assessment at the MDT of incidentalomas during COVID-19 provided confirmation of benign features and therefore no further intervention and reassurance for 16% of patients.

Instructional Planning Modifications to Meet Social Distancing Requirements: Secondary and Post-Secondary Options

Secondary and post-secondary science and engineering educators share common class arrangements with both a laboratory and lecture component, coordinating both components so they build upon each other to create meaningful learning experiences. The COVID-19 pandemic forced educators to convert lectures and exams to online delivery. Doing so came with trade-off decisions about sacrificing laboratory experience goals of hands-on practice, problem-solving, and learning concepts at a deeper, tactile level. Due to rapidly changing conditions, educators faced course redesign to accommodate social distancing and virtual learning requirements. In this study, a team of undergraduate college students including one secondary science preservice teacher planned a set of lessons for STEM outreach to a K-12 audience. The team faced challenges in planning meaningful learning experiences in the face of COVID-19 uncertainty. Options for secondary and post-secondary educators to consider are provided in this article.

Nexus between CNS resident microglia and migrating peripheral T cells pave the way for host immunity against neurotropic virus infection

Neurotropic virus induced neuroinflammation initiates with the activation of brain resident immune cells which causes a heightened release of chemokines/cytokines leading to a compromise in the blood brain barrier integrity. This accentuates the upregulation of regulatory molecules like antiviral Interferon stimulating gene induced tetratricopeptide repeats protein, Ifit2, and augments infiltration of peripheral immune cells. Among the early infiltrating immune cells, a large population is composed of neutrophils and monocyte/macrophages which, along with brain resident microglia, orchestrate the full panoply of innate immune responses. Ifit2 has been shown to be beneficial in protecting mice from lethal neurotropic virus infection by restricting viral replication and amplifying antiviral responses. Using a murine neurotropic coronavirus infection in Ifit2-/- mice, we report that in the absence of Ifit2, viral replication is significantly increased and mice develop severe neuropathy. Despite the enormous viral load, Ifit2-deficient mice are impaired in microglial activation and recruitment of peripheral T cells into the CNS. To further confirm the role of migratory T cells in viral-induced neuroinflammation and neurodegeneration, studies were conducted in CD4-/- mice. Results showed no significant change in acute stage pathogenesis, whereas CD4-/- mice showed accelerated loss of axon-myelin coherence during the chronic stage. Together, studies in Ifit2 and CD4 knockout mice reveal that the interplay between brain resident microglia and migratory helper T cells is important for strengthening host immunity against neurotropic virus infection.