ABSTRACT
BACKGROUND: The American Academy of Neurology Institute and Society for Neuro-Oncology recommend multidisciplinary tumor board (MTB) meetings as a quality metric in neuro-oncology. With the COVID-19 pandemic resulting in travel restrictions, we expanded our existing MTB by transitioning to a virtual format that maintained our commitment to providing consultation for primary CNS tumor cases. This transition permitted participation by neuro-oncology teams from over 30 Brain Tumor Trials Collaborative (BTTC)/National Cancer Institute-Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) centers across the United States. Here, we describe results from opening our MTB remotely to these teams. METHODS: We retrospectively reviewed records from remote MTB meetings held between April 2020 and March 2021. To gauge the impact of our MTB on clinical management, we administered a brief survey querying BTTC members. RESULTS: Twenty-eight providers presented 41 cases during 24 virtual MTB meetings (range: 1-4 cases per meeting). Two cases (5%) were presented only for educational value. Approximately half (54%) of the cases discussed dealt with diagnosis/management of an NCI-CONNECT rare CNS tumor. During MTB discussions of the 39 cases seeking diagnosis/management recommendations, 32% received clinical trial recommendations, 10% were suggested to enroll in the NCI Neuro-Oncology Branch (NOB) Natural History Study (NCT02851706), 17% received a recommendation to obtain central neuropathology review, and 100% received recommendations for further disease management. Most BTTC survey respondents (83%) found these recommendations impactful in the management/treatment of their presented case or generally useful/ informative for their clinical practice. CONCLUSION: We describe the feasibility and utility of an innovative virtual multi-institutional MTB. These novel remote meetings allowed for discussion of complex neuro-oncology cases and recommendations from experts, particularly important for those with rare CNS tumors. Our study's findings during the COVID-19 pandemic of the value of providing remote access to MTBs should apply postpandemic.
ABSTRACT
Background In the past we have done face to face group diabetes education, but this was not possible in times of COVID19. Previously we had talked about teaching carbohydrate counting, around cooking, but not having access to a teaching kitchen. This got us thinking. Objectives • Improve carbohydrate counting knowledge, expertise and confidence. • To be fun as well as educational. • Give young people the skills to be able to carbohydrate count independently in school, home and when out with friends-focus on supporting children going from primary to secondary schools.-Young person centred • Reduce isolation of young people during lockdown, with the chance to meet others virtually who also have type 1 diabetes- Peer Support. • To be accessible, using technology young people are familiar with. Methods The team dietician decided to run Zoom sessions, virtual cooking and carbohydrate counting. Targeting the 8-12 years age bracket with parents in the background. The sessions;scones, pizza, mince pies/strawberry stars. Each session to be run virtually by a dietician and a nurse zooming in separately from their own kitchens. A poster was designed advertising the 'Cook and Count' session, with pictures of the delicious cooking they would have chance to produce. These were distributed by e-mail as well as mentioning when being seen in virtual clinics. If a young person showed interest, a follow up telephone call took place from the dietician, to tell them more about the sessions and see if they would like to take part. One week before a list of ingredients and equipment that will be needed on the day was e-mailed to each young person attending. Reminder e-mails and texts were sent the day before and the morning before. Results Each session was attended by 5 to 6 young people. Feedback: 'Jane loved the baking yesterday and enjoys these sessions with everyone. Thank you' 'Dear Kate, Thank you for your time, Louise loved the session' 'Thank you for the pizza workshop today'. As you may have guessed I am not good at all at cooking and hence, Sara was nervous about it not turning out well. But she was very pleased the pizza turned out not as bad as she was thinking. Thank you for all the support.' 'James has a severe peanut allergy so it gives him more confidence to try new foods when he prepares himself, with the added bonus of working out the carbs too!' Conclusions As health care professionals it is a shear pleasure to see children learning through having fun. This has been a successful way to do this during a time where face to face teaching has not been possible. It has been such a huge success that this is something we will continue to do when lockdowns lift. Young people don't need transport for these sessions, however they do need computer and internet access. Lockdown has meant that young people have had time available to access these sessions. Going forward we will run these in the school holidays, the next being Easter.