Retrospective review of vaccination status in patients with newly diagnosed chronic lymphocytic leukaemia

Introduction: Patients with chronic lymphocytic leukaemia (CLL) are at increased risk of infection. CLL is associated with a secondary immunodeficiency and impaired response to vaccination. Recent British Society of Haematology guidelines recommend that patients with CLL should receive vaccination against pneumococcal infection at diagnosis, an annual influenza vaccine and COVID-19 vaccination. Patients aged 70-79 years should also receive the Shingrix vaccine. Patients with CLL should not receive live vaccines. In response to this guideline, a letter detailing vaccination requirements was created for patients to give to their general practitioner (GP). The local process for vaccination referral has since changed. Previously, vaccination requirements were communicated to the GP via letter. There is now a dedicated Vaccination Hub to which clinicians can directly refer patients for appropriate vaccinations. Aim(s): The aim of this project was to assess vaccination referral and vaccination status in patients with newly diagnosed CLL. Method(s): All new diagnoses of CLL from 2021 to 2022 were identified by review of the Haematology Multi-Disciplinary Team meeting electronic registration forms. Electronic patient records were reviewed to determine vaccination referral completion and vaccination status. Result(s): A total of 29 patients were identified as new diagnoses of CLL. Seventeen patients were diagnosed in 2021 and 12 in 2022. Sixty-nine percent of the patients were male and the average age was 70.9 years. Vaccination was discussed with 11 patients (38%) and 10 patients (34%) were referred for vaccination. Eleven patients (38%) had never received a pneumococcal vaccine. Nine patients (31%) had previously received the vaccine but not within the past 5 years. Five patients (17%) patients had received one dose of Pneumovax 23 following referral. No patients had received the initial Prevenar 13 vaccine. Twelve patients (41%) had not received an influenza vaccine. Of those who had received the vaccine, the majority (70%) had received this routinely. Similarly, 71% of patients had received the COVID-19 vaccine routinely as opposed to three patients who received this postreferral. Of those who were eligible, 50% had received the Shingrix vaccine. Conclusion/Discussion: Local rates of vaccination in patients with CLL are low. Numbers were too small to allow for comparison between the methods of referral. Of those referred, not all received the appropriate vaccinations. Further work is therefore required to improve both the number and completion of the referrals. Future steps will include local teaching on vaccinations in CLL and the referral pathway.

The impact of cognitive fitness and gender on sleep quantity and timing and mental health of competitive athletes

Introduction Mental fitness is increasingly considered key to an athlete's competitive arsenal. Its active ingredients include cognitive fitness factors, such as impulse control, and recovery factors, such as sleep, which may differ between male and female athletes. Our study investigated: 1) gender differences in cognitive fitness;and 2) the associations of gender and cognitive fitness with sleep and mental health in competitive athletes during the COVID-19 lockdown. Methods 84 athletes competing at levels from regional/state to international (42F, mean age=23.2) completed a questionnaire battery containing validated measures of: a) depression, anxiety, and stress;b) sleep (Total Sleep Time, Sleep Latency, mid-sleep time on training- and competition-free days);and c) self-control, intolerance of uncertainty, and impulsivity (representing cognitive fitness constructs). Results Female athletes reported significantly higher depression, anxiety, and stress, a later mid-sleep time on free days, lower self-control, higher intolerance of uncertainty, and higher positive urgency impulsivity compared with male athletes. Self-control was negatively associated, and intolerance of uncertainty was positively associated, with depression, anxiety, and mid-sleep time on free days. Discussion Female athletes in our sample reported poorer mental health and cognitive fitness, and later sleeping times on free days. Greater cognitive fitness was associated with better mental health, independent of gender. Overall, these findings are consistent with prior work in community samples. Future work should examine the source(s) of these gender differences. If replicated, our findings would suggest a need to develop interventions aimed at improving athlete well-being, potentially with a particular focus on female athletes.

Travel or cheers? Examining the drivers and mechanisms of home court advantage in the 2020/2021 NBA regular season

Introduction Home court advantage (HCA) in the National Basketball Association (NBA) is well-documented, yet the co-occurring drivers responsible for this advantage have proven difficult to examine in isolation. The Coronavirus disease (COVID-19) pandemic resulted in the elimination of crowds in ~50% of games during the 2020/2021 NBA season, whereas travel remained unchanged. Using this ‘natural experiment', we investigated the impact of crowds and travel-related sleep and circadian disruption on NBA HCA. Methods 1080 games from the 2020/2021 NBA regular season were analyzed using mixed models (fixed effects: crowds, travel;random effects: team, opponent). Results In games with crowds, home teams won 58.65% of the time and outrebounded (M=2.28) and outscored (M=2.18) their opponents. In games without crowds, home teams won significantly less (50.60%, p = .01) and were outrebounded (M=-0.41, p < .001) and outscored (M=-0.13, p < .05) by their opponents. Further, the increase in home rebound margin fully mediated the relationship between crowds and home points margin (p < .001). No significant sleep or circadian effects were observed. Discussion Taken together, these results suggest that HCA in the 2020/2021 NBA season was predominately driven by the presence of crowds and their influence on the effort exerted by the home team to rebound the ball. Moreover, we speculate that the strict NBA COVID-19 policies may have mitigated the travel-related sleep and circadian effects on the road team. These findings are of considerable significance to a domain wherein marginal gains can have immense competitive, financial, and even historical consequences.

Outcomes of rapid digital transformation of large-scale communications during the COVID-19 pandemic.

Objective This study examined the content and impact of a new digital communication medium, called a VIDCAST, implemented at a large hospital and health service when the COVID-19 pandemic was announced, and the key concerns held by staff at the time when the health service was preparing for the COVID-19 pandemic to arrive in this health service. Methods A mixed-methods approach was used. Thematic analysis of 20 transcripts of daily VIDCASTS broadcast between 30 March and 24 April 2020 was undertaken, in addition to descriptive analysis of feedback from an anonymous online survey. Results Survey feedback from 322 staff indicated almost universal satisfaction with this new communication method. The VIDCASTS provided a new COVID-safe method for the Executive to connect to staff at a time of uncertainty. Thematic analysis of the content of the VIDCASTS revealed three themes: 'Accurate Information', 'Reassurance and Support' and 'Innovation'. The Executive was able to reassure staff about what the organisation was doing to safeguard the health and wellbeing of all, and enabled an effective response to the pandemic. Conclusions The digital communication channel of VIDCASTS, rapidly operationalised at a major Australian hospital and health service in March 2020, provided important information and support for staff as it prepared for the anticipated COVID-19 surge. What is known about the topic? When the COVID-19 pandemic began, traditional face-to-face staff meetings were disrupted and many hospitals and their staff were left scrambling for information, and for reassurance about their safety, as they prepared to receive increasing numbers of COVID-19 patients. What does this paper add? The implementation of a digital communication tool was able to address many of the concerns raised by hospital staff in other geographic locations dealing with surging COVID-19 cases and underpinned a globally leading COVID-19 response. What are the implications for practitioners? New digitised communication methods provided an effective vehicle to inform and support staff in the early stages of pandemic preparation.

An image-based eyelid lesion management service-evaluation of a pilot.

BACKGROUND/AIMS: Oculoplastics is a predominantly visual specialty and many of the pathologies can be diagnosed based on external appearance. An image-based eyelid lesion management service was piloted to reduce the number of patients who would require outpatient clinic review. The aim of this study was to determine its accuracy and feasibility, both as a hospital-based and community optometrist-based service. If successful, the service was envisaged to significantly reduce the number of patients that require face-to-face (F2F) review, in accordance with current post-COVID-19 principles of social distancing. METHODS: Patients with lid lesions attending an oculoplastics clinic were assessed by consultant oculoplastic surgeons in an F2F consultation (Arm A). The lesions were photographed by a professional clinical photographer (Arm B) and by an optometrist with a handheld digital camera (Arm C). These images were reviewed by independent consultants masked to the outcome of the F2F clinical encounter. Data were collected prospectively including patient demographics, diagnosis, suspicion of malignancy and management. The image-based clinic results were compared to the F2F clinic results. RESULTS: Ninety-five patients were included. Clinical diagnoses were compared for intra-observer variability and substantial agreement was demonstrated between gold-standard F2F clinic visit (Arm A) and Arm B (Ƙ = 0.708) and C (Ƙ = 0.776). There was no statistically significant difference in the rate of discharge and all cases of malignancy were either identified or flagged for F2F review in the image-based arms. CONCLUSION: This pilot demonstrated substantial diagnostic agreement of image-based diagnoses with F2F consultation and image review alone did not miss any cases of malignancy.