The Design And Development Of an Individualised Training Program For Metastatic Breast Cancer (MBC) Nursing Incorporating Remote And Onsite Learning Experiences During A Pandemic

Problem statement: Those diagnosed with metastatic breast cancer (MBC) have complex supportive care needs and the Australian Government funded 30 new dedicated MBC nurse roles across Australia in 2019 to better meet these needs. A pilot training program was designed to meet the individual learning needs of these nurses to increase their level of expertise in MBC nursing. Initially this program was designed to be delivered in-person, however recurrent COVID-19 restrictions required a change of approach to enable remote participation. Method(s): An expert working group created a curriculum of 20 learning modules addressing key elements of MBC nursing. From these modules a bespoke training program was designed for each participant to address their identified learning needs based on the validated Cancer Nurse Self-Assessment Tool for Metastatic Breast Cancer (CaN-SAT-MBC) and baseline interviews. During the pilot program, four intakes of two nurses (n=8) participated from August 2021 to June 2022. Participants completed a suite of online learning modules, 'attended' a 3-day clinical practicum, and commenced 12 months of bi-monthly clinical supervision for ongoing support. Participants attended the clinical practicum component either in-person or via a telepresence robot. Knowledge, skills and confidence in relation to MBC nursing are being measured by the CaN-SAT-MBC, and learner goals, expectations and experiences are being explored via qualitative interviews at three-time intervals: pre-training;post-practicum;and 12 months post-clinical supervision. Result(s): The final results of the evaluation will be available in 2023. It is hypothesised that nurses will report increased knowledge, skills and confidence in the areas of MBC nursing relevant to their identified learning needs following completion of the training program. Furthermore, it is also hypothesised that remote participation using robot technology will offer an equivalent learning experience to in-person training in this current pandemic environment. Conclusion(s): This study will test an individualised and innovative approach to breast cancer nurse education that may be utilised across Australia to upskill nurses in the provision of supportive care to those with MBC. There is potential for wide-spread adoption of robot technology for cancer education across Australia and beyond. Disclosure of interest: This project is partially funded by Astra ZenecaCopyright © 2022

Effect of Covid-19 Diagnosis on Organ Donation and Transplantation

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has challenged many aspects of healthcare, including organ donation and transplantation. The purpose of this study is to demonstrate that utilization of COVID-positive organs can be carried out safely. Method(s): De-identified data from 569 organ donors processed through an organ procurement organization (OPO) from March 24, 2020, through September 30, 2021, was collected from the OPO's database and retrospectively analyzed. Demographics, clinical measures, transplant numbers, and outcomes were recorded. Result(s): 25 COVID-positive (study) and 544 COVID-negative (control) organ donors were analyzed. There was no significant difference between the mean ages of the study group (43.12+/-11.08, p = 0.665) and the control group (44.15+/-17.94, p = 0.665). The COVID-positive group achieved donor management goals at a significantly lower rate than the COVID-negative group (4.0% vs 48.7%, p = 0.000012). The COVID-positive group required significantly more continuous renal replacement therapy (16.0% vs 1.8%, p < 0.00001), and extracorporeal membrane oxygenation (24.0% vs 0.7%, p < 0.00001). Significantly fewer organs were transplanted from the COVID-positive donors (1.12+/-1.013, p < 0.00001) than from the COVIDnegative donors (2.56+/-1.671, p < 0.00001). The mean observed to expected ratio for the study group (0.5372+/-0.47434, p < 0.00001) was significantly lower than that of the control group (0.9489+/-0.55041, p < 0.00001). The study group donors were significantly more likely to be categorized as donation after circulatory death (DCD) donors (96.0% vs 27.8%, p < 0.00001). There was no significant difference between the groups regarding delayed graft function in the recipient (18.2% vs 26.8%, p = 0.522561) nor regarding the need for dialysis post-transplant (9.1% vs 11.6%, p = 0.795292). Conclusion(s): Fewer organs from COVID-positive donors were utilized for transplantation than organs from COVID-negative donors over the study period. COVID-positive organs have been of no detriment to recipients, as there is no evidence of increased delayed graft function nor the need for dialysis. Though no short-term COVID-19 transmission has been identified, we will continue to monitor for this and to track non-renal transplant outcomes. A larger multi-center study is warranted to further delineate the safety and efficacy of implementing protocols to utilize these organs.

Highly Expandable Human Alveolar Organoids to Study Respiratory Diseases

Organoids are emerging to be an excellent tool for studying human development and disease. The COVID-19 pandemic has highlighted the importance of physiologically relevant alveolar infection models that include both alveolar epithelial type 1 (AT1) and type 2 (AT2) cells. To address the need for an alveolar organoid culture system for respiratory research, we developed the PneumaCult™ Alveolar Organoid Expansion and Differentiation Media for the highly efficient expansion of isolated primary human AT2 cells and subsequent differentiation into AT1 cells. Alveolar organoids were established from a panel of various donors (n=5) by culturing purified human AT2 cells in Corning® Matrigel® domes with serum-free PneumaCult™ Alveolar Organoid Expansion Medium. Typically by day 10-14 the organoids are fully established and display a spherical morphology. Alveolar organoids can then be either expanded long-term by passaging cultures as single cells in Expansion Medium or differentiated into AT1 cells using the PneumaCult™ Alveolar Organoid Differentiation Medium. Organoids in PneumaCult™ Alveolar Organoid Expansion Medium contain self-renewing AT2 cells marked by the expression of HT2-280 in 89.9 +/- 14.5 (mean +/- SD;n=5 donors) of cells and the presence of Pro-SPC, demonstrate a great expansion potential of > 10,000-fold with more than 13 population doublings within 10 passages (n=5 donors). Alveolar organoids differentiated for 10 days in the PneumaCult™ Alveolar Organoid Differentiation Medium downregulate AT2 markers HT2-280 and Pro-SPC and start expressing AT1 markers HT1-56 in 93.8 +/- 7.2 (mean +/- SD;n=5 donors) of cells and are positive for RAGE and GPRC5a. Furthermore, we assessed the expression of SARS-CoV-2 entry receptor ACE2, which is present in both undifferentiated and differentiated alveolar organoids.To investigate the use of these alveolar organoids for infectious disease modeling, AT2-containing alveolar organoids were transduced with a GFP-labelled Respiratory Syncytial Virus (RSV). Alveolar organoids were susceptible to viral infection and replication was confirmed by fluorescence microscopy and quantitative PCR. In summary, the PneumaCult™ Alveolar Organoid Expansion and Differentiation Media are highly efficient and reproducible tools for the feeder-free expansion of AT2 cells and robust differentiation into AT1 cells, which can be used for infectious disease modeling.

Human airway lineages derived from pluripotent stem cells reveal the epithelial responses to SARS-CoV-2 infection.

There is an urgent need to understand how SARS-CoV-2 infects the airway epithelium and in a subset of individuals leads to severe illness or death. Induced pluripotent stem cells (iPSCs) provide a near limitless supply of human cells that can be differentiated into cell types of interest, including airway epithelium, for disease modeling. We present a human iPSC-derived airway epithelial platform, composed of the major airway epithelial cell types, that is permissive to SARS-CoV-2 infection. Subsets of iPSC-airway cells express the SARS-CoV-2 entry factors angiotensin-converting enzyme 2 (ACE2), and transmembrane protease serine 2 (TMPRSS2). Multiciliated cells are the primary initial target of SARS-CoV-2 infection. On infection with SARS-CoV-2, iPSC-airway cells generate robust interferon and inflammatory responses, and treatment with remdesivir or camostat mesylate causes a decrease in viral propagation and entry, respectively. In conclusion, iPSC-derived airway cells provide a physiologically relevant in vitro model system to interrogate the pathogenesis of, and develop treatment strategies for, COVID-19 pneumonia.

Impact of a community of practice among cancer clinical nurse consultants

Aims: This study aimed to investigate the impact of a 'Community of Practice' (CoP) intervention on stress, burnout, resilience, job satisfaction and mindfulness among cancer clinical nurse consultants (CNCs) working in a large metropolitan cancer centre. The experiences of CoP participants were also explored. Methods : A consecutive mixed methods approach incorporating a one-group pre and post-test intervention design with qualitative interviews was employed. The intervention consisted of six CoP meetings incorporating structured professional development, networking and mindfulness training. The first CoP was delivered in-person with the remainder online due to COVID-19 restrictions. Participants completed validated and reliable questionnaires at baseline data (T0), after the 4th CoP (T2) and after the 6th CoP (T2) with data analysed using descriptive and inferential statistics. Qualitative interviews were conducted online and data were analysed thematically. Results : Thirteen CNCs completed the measures at all three time points and five contributed to qualitative interviews. No statistically significant differences in job satisfaction, burnout, stress, resilience, or mindfulness were observed between measures except for a decline in personal satisfaction from baseline to T1 and a decline in satisfaction with pay between T1 and T2. Across the study period, participants reported fair-to-good overall job satisfaction, high resilience, moderate mindfulness, moderately low stress and low levels of burnout. Five main themes were inductively derived from the qualitative data: Challenges of role;Existing and desired support;Introducing a community of practice;Importance of connection and relationship building;Acknowledgement, support and promotion of role. Conclusion: The CoP brought cancer CNCs in siloed but similar roles together to learn and connect. The CoP was conducted during a global pandemic when nurses faced unprecedented challenges in their roles. Despite this, participants in the CoP were able to maintain their good baseline levels of job satisfaction, resilience, mindfulness, stress and burnout.

Human airway lineages derived from pluripotent stem cells reveal the epithelial responses to SARS-CoV-2 infection (preprint)

There is an urgent need to understand how SARS-CoV-2 infects the airway epithelium and in a subset of individuals leads to severe illness or death. Induced pluripotent stem cells (iPSCs) provide a near limitless supply of human cells that can be differentiated into cell types of interest, including airway epithelium, for disease modeling. We present a human iPSC-derived airway epithelial platform, composed of the major airway epithelial cell types, that is permissive to SARS-CoV-2 infection. Subsets of iPSC-airway cells express the SARS-CoV-2 entry factors ACE2 and TMPRSS2. Multiciliated cells are the primary initial target of SARS-CoV-2 infection. Upon infection with SARS-CoV-2, iPSC-airway cells generate robust interferon and inflammatory responses and treatment with remdesivir or camostat methylate causes a decrease in viral propagation and entry, respectively. In conclusion, iPSC-derived airway cells provide a physiologically relevant in vitro model system to interrogate the pathogenesis of, and develop treatment strategies for, COVID-19 pneumonia.

Society for Cardiovascular Magnetic Resonance (SCMR) guidance for re-activation of cardiovascular magnetic resonance practice after peak phase of the COVID-19 pandemic.

During the peak phase of the COVID-19 pandemic, alterations of standard operating procedures were necessary for health systems to protect patients and healthcare workers and ensure access to vital hospital resources. As the peak phase passes, re-activation plans are required to safely manage increasing clinical volumes. In the context of cardiovascular magnetic resonance (CMR), re-activation objectives include continued performance of urgent CMR studies and resumption of CMR in patients with semi-urgent and elective indications in an environment that is safe for both patients and health care workers.