The evolution of a charity support services team

Our charity's mission is dedicated to beating blood cancer by funding research and supporting those affected. Since 1960, we have invested over 500 million in blood cancer research, transforming treatments and saving lives. Since 2015 there has been a Support Services team within the charity. This service was established to provide information that the blood cancer community can trust, in a language they can understand. By connecting and listening to our community they deepen our understanding and help shape our work. Research suggests that blood cancer patients are more likely than any other patients to leave their diagnosis appointment feeling they do not fully understand their condition. Our service can often consolidate the information given by clinicians. Patients also need advice and support on how to adapt to day-to- day life after their diagnosis. There are challenges that are unique to blood cancer, such as living with cancer as a chronic condition, being on 'watch and wait' or fluctuating remissions and relapses. In 2023 the Support Services team have a 7 day presence on our phone line, email and social media platform where people can communicate with one of our trained blood cancer support officers, or one of three Registered Nurses, all who can provide information about blood cancer diagnosis and help with emotional and practical support. We also run an online community forum where people affected by blood cancer can connect, share experiences and provide peer support. The highly experienced haematology nurses provide a clinical aspect to the support of the Blood Cancer Community that enhances the established patient centred support given historically by the charity. The nurses advanced knowledge and experience of haematological cancers, treatments, side effects, holistic care and NHS process can further guide the community. This is in addition to the invaluable information from their treatment teams. In 2023 the Support Services team are now reaching thousands of the blood cancer community. We understand that in the past 3 years the COVID-19 pandemic and the work of our charity around this will have influenced the significant increase in contacts but equally the robust and trusted services provided through this charity has contributed too.

Myocarditis and Pericarditis

Myocarditis and pericarditis are defined as inflammation of the myocardium and pericardium, respectively, according to the current WHO classification. These diseases are usually self-limiting but may present with impaired cardiac function, arrhythmias or cardiogenic shock. This review discusses the management of myocarditis and pericarditis based on the current guidelines of the American College of Cardiology and the European Society of Cardiology. Treatment consists of specific therapy aimed at the cause (i.e., viral, fulminant, autoimmune) and nonspecific therapy aimed at the clinical manifestations such as heart failure or arrhythmias. © 2022 Elsevier Inc. All rights reserved

The updated SIOG COVID-19 working group recommendations on COVID-19 vaccination among older adults with cancer

Background: Older patients with cancer remain at high risk for negative outcomes from COVID-19 infection, particularly those who have multimorbidities and on immunosuppressive therapy. These patients have been excluded or underrepresented in pivotal COVID-19 vaccine clinical trials and there are ongoing concerns that they may not acquire the same level of protection from the available vaccines as the immunocompetent adults. Moreover, the level of protection wanes over time making them more susceptible to emerging COVID-19 novel variants of concern. Despite the implementation of global vaccination campaigns which have successfully reduced COVID-related hospitalisations and deaths in many parts of the world, there remains many unresolved issues and challenges to address as the pandemic ensues. With aging, concerns for age-related dysregulation and immune dysfunctions called immunosenescence may lead to potentially lower immunogenicity to vaccines. Despite receiving the primary vaccination, real-world evidence showed that both patients aged > 65 years and those with cancer have a higher risk of developing breakthrough COVID-19 infections and related complications. Subsequent booster doses are found to be effective at improving immune response, particularly against the novel variants, and the vulnerable population should be given the priority in booster campaigns. Method(s): Since the beginning of the pandemic in 2020, The International Society of Geriatric Oncology set up a COVID-19 Working Group comprised of multidisciplinary specialists by developing recommendations, advocacy, and action plans based on expert opinion and evidence related to older adults with cancer. Result(s): The table below summarises the updated recommendations from the SIOG COVID-19 Working Group. Conclusion(s): The SIOG COVID-19 Working Group supports ongoing public health interventions, continued mass immunisations, and booster campaigns targeting the most vulnerable members of the society, including older adults with cancer (Table Presented).

EFFECTS OF COGNITIVE LOAD, MOTIVATIONAL BELIEFS, ACHIEVEMENT EMOTIONS ON IMPOSTOR SYNDROME IN CLINICAL SKILLS TRAINING FOR FIRST-YEAR MEDICAL STUDENTS

BACKGROUND: Teaching methods can impact achievement emotions and cognitive load in learners. Due to COVID19, the University of Central Florida College of Medicine (UCF) adopted some online clinical-skills training for their first-year medical students (M1s) while the University of Florida College of Medicine (UF) was able to continue with limited in-person instruction. We hypothesized online learning could increase cognitive load, negatively impact self efficacy, and lead to increased levels of imposter syndrome associated with learning clinical skills. METHODS: M1s from UCF and UF from the 20-21 academic year were given an online survey during the Summer of 2021measuring Medical Student Wellbeing Index (WBI), Clance Imposter Phenomenon Scale (CIPS). Cognitive load and achievement emotions were measured using previously validated instruments on a 5-point Likert scale. Demographic data was collected, and IRB approval obtained. Descriptive statistics were obtained with SPSS 27 and reported as frequencies and percent response. Spearman correlation analysis was performed on all variables. T-tests were conducted to compare variables between UF and UCF. Overall response rate was 54% (44% and 61% for UCF and UF, respectively). RESULTS: Analyzing combined data from both schools for history and physical exam components, several statistically significant correlations were found (see Table 1). For both history and physical exam components UF learners had higher task value (4.66, 4.26 p<.001;4.70, 4.52 p=.042), enjoyment (4.34, 3.70 p<.001;4.28, 3.86 p=.001) and self-efficacy (4.43, 4.10 p=.004;4.36, 4.02 p=.007) and lower anxiety (2.32, 2.84, p=.003;2.32, 3.03 p<.001) and extrinsic load (1.88, 3.14 p<.001;2.07, 3.35 p=.001) compared to UCF learners, respectively. UF learners had lower WBI scores than UCF learners (250.74, 279.90 p=.024), but no differences in CIPS scores were found. Higher scores on CIPS and WBI scores indicate greater severity of imposter syndrome and reduced well-being, respectively. CONCLUSIONS: Teaching methods appear to have an impact on learners' achievement emotions, cognitive load, and well-being. Increased task value may mitigate a learners' extrinsic load with implications on how educators apply teaching methods. Further studies are needed to identify long-term impacts of online teaching methods.

SIGN OF THE TIMES: COMMUNITY-ENGAGEMENT TO REFINE A CARDIOVASCULAR MHEALTH INTERVENTION THROUGH A VIRTUAL FOCUS GROUP SERIES DURING THE COVID-19 PANDEMIC

BACKGROUND: African-Americans (AA) are underrepresented in mobile health (mHealth) intervention research studies which can perpetuate health inequities and the digital divide. A community based, user-centered approach to designing mHealth interventions may increase their sociocultural relevance and effectiveness, especially with increased smartphone use during the COVID-19 pandemic. We aimed to refine an existing mHealth intervention via a virtual focus group series for use in a randomized controlled trial (RCT) aiming to improve cardiovascular health (CVH) in AAs. METHODS: AA community members (N=15) from churches in Minneapolis and Rochester, Minnesota were enrolled in a virtual, 3-session focus group series over 5 months to refine an existing CVH focused mHealth application (FAITH! App). Participants completed a baseline electronic survey capturing sociodemographics, mobile technology use, and electronic health information sources prior to start of focus groups. Participants accessed the FAITH! App via their smartphones and received a Fitbit synced to the app. Participants engaged with multimedia CVH focused education modules, a sharing board for social networking, and diet/PA self-monitoring. Participant feedback on app features prompted iterative revisions to yield a refined app. Primary outcomes were app usability (assessed via Health Information Technology Usability Evaluation Scale [Health-ITUES], range 0-5) and user satisfaction which were evaluated via electronic survey after the final focus group. A predetermined goal of mean overall Health-ITUES score of ≥4 was set for the app to advance for use in the RCT. RESULTS: Participants (mean age [SD] 56.9 [12.3] years, 13, 86.7% female) attended a mean 2.8 focus groups (80% attended all sessions). Participant feedback resulted in app refinements to increase visual appeal, increase diversity and gender balance in testimonial videos, further improve ease of diet/PA self-monitoring, and add fitness videos as well as a moderated sharing board. The revised FAITH! App achieved a mean overall Health-ITUES score of ≥4 (mean 4.39, range 3.20-4.95). Participants positively rated updated app content, visual appeal, and use of social incentives to maintain engagement. Increasing user control and further refinement of the moderated sharing board were identified as areas for future improvement. CONCLUSIONS: Virtual focus group data can improve usability and increase participant satisfaction in mHealth lifestyle interventions aiming to promote CVH in AAs.

Photonic resonator interferometric scattering microscopy

Interferometric scattering microscopy is a newly emerging alternative to fluorescence microscopy in biomedical research and diagnostic testing due to its ability to detect nano-objects such as individual proteins, extracellular vesicles, and virions individually through their intrinsic elastic light scattering. To improve the signal-to-noise ratio, we developed photonic resonator interferometric scattering microscopy (PRISM) in which a photonic crystal (PC) resonator is used as the sample substrate. The scattered light is amplified by the PC through resonant near-field enhancement, which then interferes with the <1% transmitted light to create intensity contrast. Importantly, the scattered photons assume the wavevectors defined by PC's photonic band structure, resulting in the ability to utilize a non-immersion objective without significant loss at illumination density as low as 25 W/cm2. We demonstrate virus and protein detection, including highly selective capture and counting of intact pseudotype SARS-CoV-2 from saliva with sensitivity equivalent to conventional nucleic acid tests. The results showcase the promise of nanophotonic surfaces in the development of resonance-enhanced interferometric microscopies, and as a single step, room temperature, and rapid viral detection technology. © 2022 SPIE.

Sudden Shift to Online Learning: COVID-19's Impact on Engineering Student Experiences

In light of the COVID-19 pandemic, engineering education has faced a shift to a partial if not fully virtual environment that has disrupted students' educational experiences. This qualitative study was designed to explore how mechanical engineering students at California Polytechnic University, San Luis Obispo have navigated the shift to virtual learning, what pedagogical practices have been effective online, and how the change has affected students' motivation, learning, and sense of belonging and community. During an hour-long focus group, participants were asked to maintain anonymity by turning off their cameras and by using pseudonyms. They responded to open-ended questions related to teaching strategies, workload, motivation, lab courses, technology issues, building community, academic integrity, and general improvements they wanted to see in future online classes. Summaries were created and analyzed by the two student researchers and discussed among the research team. Further recommendations to professors were made categorized by which theme they applied to best. For example, faculty were advised that students appreciated the effort they put into moving to a virtual environment with such short notice but commented that the quality of online learning could be improved. Our primary findings indicate that the key shortcomings included difficulty building community as well as decreased motivation levels and increased stress levels. © American Society for Engineering Education, 2021

An experimental approach to analyze aerosol and splatter formations due to a dental procedure.

Throughout 2020 and beyond, the entire world has observed a continuous increase in the infectious spread of the novel coronavirus (SARS-CoV-2) otherwise known as COVID-19. The high transmission of this airborne virus has raised countless concerns regarding safety measures employed in the working conditions for medical professionals. Specifically, those who perform treatment procedures on patients which intrinsically create mists of fine airborne droplets, i.e., perfect vectors for this and other viruses to spread. The present study focuses on understanding the splatter produced due to a common dentistry technique to remove plaque buildup on teeth. This technique uses a high-speed dentistry instrument, e.g., a Cavitron ultrasonic scaler, to scrape along the surface of a patient's teeth. This detailed understanding of the velocity and the trajectory of the droplets generated by the splatter will aid in the development of hygiene mechanisms to guarantee the safety of those performing these procedures and people in clinics or hospitals. Optical flow tracking velocimetry (OFTV) method was employed to obtain droplet velocity and trajectory in a two-dimensional plane. Multiple data collection planes were taken in different orientations around a model of adult mandibular teeth. This technique provided pseudo-three-dimensional velocity information for the droplets within the splatter developed from this high-speed dental instrument. These results indicated that within the three-dimensional splatter produced there were high velocities (1-2 m/s) observed directly below the intersection point between the front teeth and the scaler. The splatter formed a cone-shape structure that propagated 10-15 mm away from the location of the scaler tip. From the droplet trajectories, it was observed that high velocity isolated droplets propagate away from the bulk of the splatter. It is these droplets which are concerning for health safety to those performing the medical procedures. Using a shadowgraphy technique, we further characterize the individual droplets' size and their individual velocity. We then compare these results to previously published distributions. The obtained data can be used as a first step to further examine flow and transport of droplets in clinics/dental offices.

Healthy sleep as an important resource and buffer for intersectional discrimination: Results from COVID 19 study

Introduction: Our previous studies have highlighted sleep disparities for this underserved population, including how Grandparents Raising Grandchildren (GRG) experience troubled and disruptive sleep. Intersectional types of discrimination facing these families during COVID 19, include: race/ethnicity of self and children, income, age, essential workforce status, and impairments (mobility, vision, and hearing). This current study intends to explore how healthy sleep is an important resource (potential buffer) for GRG experiencing intersectional discrimination during COVID 19. Methods: We used community partnerships to recruit 600 GRG from all fifty states in USA and several tribes to complete an online survey on their experiences with caregiving and intersectional discrimination during COVID 19. We developed an index on intersectional discrimination based on GRG lived experiences to inform the survey and used descriptive and bivariate statistics to profile this group. Chi-square Automatic Interaction Detector (CHAID) analysis was used to build a predictive model to help determine how variables in our study best merge to explain intersectional discrimination. Results: Of the GRGs', 37% were between 54-65 years and 33% cared for children 6 to 10 years for at least 5 years. The types of discrimination that were more likely to be included in intersectional discrimination include: Black or African American [83.8% (31)], my child's race [59.5% (22)], my lower economic status [56.8% (21)], and my status as a caregiver [56.8% (21)]. The resource needs that showed the most disparity (higher rate showed higher priority/extreme concern) between those with ID and those without included: Information on how COVID impacts race and ethnicity differently (6.0 vs. 3.61), ability to pay utilities (3.7 vs. 1.99), and information on how to achieve healthy sleep (4.19 vs. 2.64). Conclusion: This study suggests that GRG facing intersectional discrimination identify the importance of attaining information on how to achieve healthy sleep as an important resource to them during COVID 19. These results can be used to help mobilize resources and disseminate information for this underserved group to improve healthy sleep and also model for their extended families and communities.

Effect of H2O2 Antiseptic on Dispersal of Cavitation-Induced Microdroplets.

The persisting outbreak of SARS-CoV-2 has posed an enormous threat to global health. The sustained human-to-human transmission of SARS-CoV-2 via respiratory droplets makes the medical procedures around the perioral area vulnerable to the spread of the disease. Such procedures include the ultrasonic dental cleaning method, which occurs within the oral cavity and involves cavitation-induced sprays, thus increasing the risk of pathogen transmission via advection. To understand the associated health and safety risks for patients and clinicians, it is critical to understand the flow pattern of the spray cloud around the operating region, the size and velocity distribution of the emitted droplets, and the extent of fluid dispersion until ultimate deposit on surfaces or escape through air vents. In this work, the droplet size and velocity distributions of the spray emerging from the tip of a free-standing common ultrasonic dental cleaning device were characterized via high-speed imaging. Deionized water and 1.5% and 3% aqueous hydrogen peroxide (H2O2) solutions were used as working fluids, with the H2O2-an established oxidizing agent-intended to curb the survival of virus released in aerosols generated from dental procedures. The measurements reveal that the presence of H2O2 in the working fluid increases the mean droplet size and ejection velocity. Detailed computational fluid dynamic simulations with multiphase flow models reveal benefits of adding small amounts of H2O2 in the feed stream of the ultrasonic cleaner; this practice causes larger droplets with shorter residence times inside the clinic before settling down or escaping through air vents. The results suggest optimal benefits (in terms of fluid spread) of adding 1.5% H2O2 in the feed stream during dental procedures involving ultrasonic tools. The present findings are not specific to the COVID-19 pandemic but should also apply to future outbreaks caused by airborne droplet transmission.

Safety of emergency, elective and day case operating during the winter period at East Suffolk and North Essex NHS Foundation Trust: lessons from the outcomes of 4,254 surgical patients from the first COVID-19 wave.

BACKGROUND: There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. METHODS: We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. RESULTS: There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. CONCLUSIONS: There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.

Feasibility of administrating a cognitive screening tool by telephone prior to surgery in older adults-preliminary results

Background: Preoperative cognitive assessment has been advocated for adults ≥ 65 years-old due to increased risk for post-operative complications such as postoperative delirium, postoperative cognitive decline, and increased mortality. Most screening tools for cognitive impairment require in-person evaluation. During the COVID-19 pandemic, most medical centers have changed their workflows to telemedicine platforms. In this study we aim to assess the feasibility of a telephone-based cognitive assessment tool, the Mini-Montreal Cognitive Assessment (Mini-MOCA) prior to surgery and 30-day post surgery to evaluate any changes in cognitive function. Methods: Patients age ≥70 year who were candidates for surgery and had a telemedicine visit in the preoperative clinic during December 2020 were included. Exclusion criteria included hearing impairment, day-surgery, inability to speak English and a prior diagnosis of Dementia. Eligible patients were asked to complete an attention test, the Mini-MOCA and function assessment using the Katz score for activities of daily living (ADL) and Lawton-Brody for instrumental activities of daily living (IADL). Anxiety was assessed using the Generalized Anxiety Disorder 2-item (GAD-2). Baseline demographics including medications and education level were collected. Anti-cholinergic effect was assessed using an anti-cholinergic score calculator (ACS). Results: Overall 24 patients completed the preoperative assessment. The cohort was 50% female, white (96%), with a median age of 74 years (range: 71-82). The median number of medications was 8 (range:2-20), 16/24 (67%) taking medications with anti-cholinergic effects and a median ACS of 1 (range 1-13), and 4/24 (17%) on Benzodiazepines. The median Katz score was 6 (range: 4-6) and Lawton-Brody score 8 (range: 5-8). The mean time for completion of the phone assessment was 10 minutes and 4 minutes for the Mini- MOCA. The median Mini-MOCA score was 13.5 (range: 9-15). Conclusions: In our preliminary results we show that a telephone- based cognitive assessment prior to surgery is well accepted and feasible among older adults who are candidates for surgery. Our study is ongoing, and will continue to conduct pre- and post-operative cognitive evaluations (updated results will be presented).