Response art: A resource for practice and supervision, in person and online

Response art is images made by art therapists to support their work. It is widely used in practice and supervision to contain challenging material experienced in session, explore and identify deeper meaning including countertransference, to conceptualize treatment and to demonstrate understanding and meaning to clients and others. Response art carries meaning whether it is used in person or in a video session. The challenges of the COVID-19 pandemic brought impediments to in-person verbal exchanges in traditional therapy and supervision and offered opportunities to expand our communication skills in creative ways. In this article the author encourages art therapists to turn to their own images. Examples of response art contribute to the discussion, encouraging effective use while challenging art therapists to expand its applications. Looking closely at our tools supports their effective application and expands their potential utility. © 2023 Intellect Ltd Notes from the Field. English language.

Safety of omalizumab therapy in patients with resistant urticaria during SARS-CoV- 2 pandemic

Background: The 2021 EAACI Biological Guidelines note safety of omalizumab use during rhinovirus infections, but data on initiation of this biologic therapy for patients with resistant chronic spontaneous urticaria (rCSU) during the SARS-CoV- 2 pandemic and uptake of COVID-19 vaccination are scarce. This study evaluated: 1) safety of omalizumab initiation and continuation during the pandemic;2) rate of COVID-19 positivity in patients on omalizumab therapy and 3) COVID-19 vaccine uptake among patients on biologic therapy. Method(s): A department-held database identified patients who started omalizumab for rCSU between 1 March 2020 and 31 December 2021, and those who contracted COVID-19 infection and their vaccination status. Result(s): Forty-one patients (median age 42 years, 85% females) with rCSU (baseline UAS7 > 28) were started on omalizumab therapy (300mg subcutaneous once every 28 days, 6 doses/cycle), and 17 (41%) were transferred to home care. A total of 316 doses were used with no anaphylaxis events. Nineteen patients had excellent response (UAS < 6) and remained on treatment (53% patients on 2nd cycle), including two patients now on 4th cycle having required almost continuous biologic therapy. A total of 22 patients had stopped omalizumab, 14 having responded to therapy (12 patients had complete response in cycle 1 and two patients in cycle 2) while 8 patients were non-responders (20% overall non-responders;7 patients within cycle 1 and one in cycle 2). Seven patients (17%) tested positive for SARS-CoV- 2 (PCR) whilst on omalizumab therapy, but none had severe illness or required hospitalisation. 90% of patients had at least 1 dose of COVID-19 vaccine, while 27 patients (66%) had 3 doses (2 primary and 1 booster). All patients deferred omalizumab for a week after COVID-19 vaccination. Ninety-eight vaccine doses were given including 64 doses of BNT162b2 mRNA (Pfizer-BioNTech) vaccine, followed by AstraZeneca at 33 doses and 1 dose of Moderna vaccine. One patient had worsening of severe urticaria after first dose of AZ vaccine, and refused further vaccines, subsequently contracted SARS-CoV- 2 whilst on omalizumab therapy. Yet another patient who was never vaccinated having stopped omalizumab after complete response (2nd cycle), subsequently tested positive for SARS-CoV- 2 but did not report relapse of urticaria. Conclusion(s): Omalizumab therapy was safe and effective in rCSU and none of the patients who contracted SARS-CoV- 2 on the biological therapy developed severe illness. (Table Presented).

4DCT as first line imaging during Covid pandeminc

Aim: The Covid-19 pandemic encouraged prompt modification to clinical practice to minimise hospital attendances in an aim to minimize exposure and protection of the NHS whilst maintaining the standards of patient care. Current literature advocates that Four-Dimensional Computerised Tomography (4DCT) has equal diagnostic value as ultrasound alone or a combination of ultrasound and Sestamibi scan in the identification of abnormal parathyroid glands in the work up for surgical management of hyperparathyroidism. In response to the evolving pandemic at Addenbrookes we modified our practice and escalated 4DCT as our first line imaging. In light of this we had a unique opportunity to evaluate the diagnostic value of the currently used imaging modalities. Methods: This is a retrospective study of 270 parathyroidectomies who underwent pre-operative 4DCT (n=270), ultrasound (n= 254) and sestamibi scan (n=253). Subsequently, we assessed the accuracy of these three modalities with the of intra-operative findings, histology, postoperative calcium and PTH. Results: The sensitivity of the 4DCT was 77% in comparison to 43% sensitivity of the ultrasound alone. (p.0.05). The combined sensitivity of ultrasound and Sestamibi scan was found to be 69%. Conclusion: The implementation of 4DCT as a single modality diagnostic imaging can be considered equally effective and accurate in the diagnosis of parathyroid abnormality. Implementing this would reduce the number of diagnostic tests improving the likelihood of successful operative planning and reduce financial cost.

Tracheostomy in the coronavirus disease 2019 patient: evaluating feasibility, challenges and early outcomes of the 14-day guidance.

OBJECTIVES: To report feasibility, early outcomes and challenges of implementing a 14-day threshold for undertaking surgical tracheostomy in the critically ill coronavirus disease 2019 patient. METHODS: Twenty-eight coronavirus disease 2019 patients underwent tracheostomy. Demographics, risk factors, ventilatory assistance, organ support and logistics were assessed. RESULTS: The mean time from intubation to tracheostomy formation was 17.0 days (standard deviation = 4.4, range 8-26 days). Mean time to decannulation was 15.8 days (standard deviation = 9.4) and mean time to intensive care unit stepdown to a ward was 19.2 days (standard deviation = 6.8). The time from intubation to tracheostomy was strongly positively correlated with: duration of mechanical ventilation (r(23) = 0.66; p < 0.001), time from intubation to decannulation (r(23) = 0.66; p < 0.001) and time from intubation to intensive care unit discharge (r(23) = 0.71; p < 0.001). CONCLUSION: Performing a tracheostomy in coronavirus disease 2019 positive patients at 8-14 days following intubation is compatible with favourable outcomes. Multidisciplinary team input is crucial to patient selection.