ABSTRACT
Introduction: Lung Ultrasound (LUS) can track interstitial changes of COVID-19 pneumonia (CP) in the acute phase. CT has been used to evaluate the development of lung fibrosis post CP but its use is associated with increased ionising radiation. Aims and Objectives: We conducted a prospective single-centre pilot to assess the utility and feasibility of using serial LUS in adult patients recovering from CP. We hypothesize that LUS may provide a safe and acceptable alternative to CT imaging for the outpatient follow-up of these patients. Method(s): 21 subjects provided consent on the day of hospital discharge (D0) and were followed up for 83 days. High-resolution CT was performed on Day 83 and correlated with LUS on Days 0/41/83. Serum Ferritin, LDH, CRP, D-Dimer (Days 0/41/83), Spirometry (Day 41/83) and Quality of Life measures (EQ-5D Day 41/83) were obtained. 3 clinicians reviewed and scored the LUS images independently;CT scoring was performed by 2 thoracic radiologists blinded to the LUS findings. Result(s): 19 subjects completed the study (10 males [52%];mean age: 52 years [range:37-74]). LUS scores were significantly lower at Days 83 and 41 compared to Day 0 (Mean = 1.5 [D83] / 2.8 [D41] / 10.9 [D0] p<0.0001). Ground glass change was the most common finding on CT at Day 83. Correlation between LUS with HRCT at Day 83 was weak (Pearson r2=0.44). However a better correlation was observed in % change of LUS scores and KCO at Day 84 compared to Day 42 (r2=0.64). Conclusion(s): LUS may be a useful point of care tool for the assessment of patients recently recovered from CP. However its role in the evaluation of post CP lung fibrosis requires further study.
ABSTRACT
Aims Effective communication skills are vital for Paediatricians to allow them to establish and develop relationships with children and their families. Whilst there is a significant emphasis on communication skills in the RCPCH curriculum, many trainees receive little dedicated communication skills teaching or feedback during Paediatric training. In addition, COVID undoubtedly had an impact on trainees' experiences and their exposure to difficult conversations. We planned a communication skills workshop involving simulated difficult conversations with actors, aimed at doctors working in General Paediatrics. The workshop aimed to offer the opportunity to practise challenging conversations and manage conflict in a supportive environment. Methods We successfully applied for COVID recovery funding to run a full day workshop for communication skills in Paediatrics. Paediatric and GP trainees working in general paediatrics were surveyed using an anonymous online platform about areas of communication they feared most. We used the areas identified to develop communication scenarios that addressed key capabilities in the RCPCH Progress curriculum. These included raising safeguarding concerns with a family, talking to a family when their child has died, exploring mental health concerns with a young person and dealing with conflict. These are common scenarios that trainees may have missed out on due to redeployment or change in work patterns. The workshop, held in October 2021, involved face-to-face simulated communication scenarios with actors for Paediatric and GP trainees currently working in general paediatrics. Each trainee led a simulated communication scenario with an actor and received a full debrief and feedback with experienced faculty. Scenarios were recorded to create a learning tool to use within the trust as examples of good practice. Trainees completed anonymous feedback online immediately after the session. Results Eight doctors attended, consisting of 2 GP trainees, 4 junior Paediatric trainees (ST2-3), 1 Paediatric ST4 trainee and 1 senior clinical fellow. All attendees rated the session as 5/5 overall on a Likert scale. The average rating for relevance to their work was 4.86/5. All felt the session had improved their communication skills (71% of trainees by 'a lot' and 29% of trainees by 'a little'). 100% would recommend the session to colleagues. Specific comments included * 'The environment felt like a safe space to debrief and discuss situations openly in a non-judgemental manner. Having professional actors involved was invaluable to get the most realistic feel to the scenarios.' * 'The faculty were really supportive, the scenarios were very realistic, the atmosphere was non-judgmental and the actors were amazing.' Conclusion Our workshop allowed trainees to experience difficult conversations relevant to their training. By basing the scenarios on trainees' suggestions, we ensured we targeted their identified learning needs. Using professional actors with experienced faculty allowed trainees to develop vital skills in a safe and realistic environment. Feedback was overwhelmingly positive, and we are planning to run another similar workshop in early 2022. We hope to develop a bank of scenarios that can be used to develop and hone the skills that Paediatricians of the future need to communicate effectively with children, young people and their families.