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Many long-term childhood cancer survivors suffer from treatment-related late effects, which may occur in any organ and include a wide spectrum of conditions. Long-term follow-up (LTFU) is recommended to facilitate early diagnosis and to ensure better health outcomes. Due to the heterogeneity of these sequelae, different specialists work together in the diagnosis and treatment of these conditions. Experts from both pediatric and internal medicine are involved in age-appropriate care by providing a transition process. Hence, LTFU of childhood cancer survivors is a prototypic example of multidisciplinary care for patients with complex needs treated in a specialized setting. International collaborations of healthcare professionals and scientists involved in LTFU of childhood cancer survivors, such as the International Guideline Harmonization Group, compile surveillance recommendations that can be clinically adopted all over the world. These global networks of clinicians and researchers make a joint effort to address gaps in knowledge, increase visibility and awareness of cancer survivorship and provide an excellent example of how progress in clinical care and scientific research may be achieved by international and multidisciplinary collaboration.
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Background: & Aims Visiting restrictions during the COVID-19 pandemic resulted in reduced and inconsistent communication with the next-of-kin of elderly inpatients. This project aimed to improve communication between doctors and patients' relatives in accordance with the GMC Good Medical Practice guidelines which outline that doctors 'must be considerate to those close to the patient and be sensitive and responsive in giving them information and support'. Methods: We created a virtual whiteboard on an elderly care ward in an inner London hospital documenting patient demographics, details of named next-of-kin and when they had been contacted. We aimed to update next-of-kin within 48-hours of ward admission and subsequently twice weekly. The outcome was measured via identical 'pre- and postintervention' questionnaires recording the next-of-kin's satisfaction with communication from the doctors. Questionnaires included 11 questions utilising a 5-point Likert scale for satisfaction. Results: were anonymised and analysed using Microsoft Excel. Results: Satisfaction with communication improved in 10 of the 11 domains of the questionnaire following intervention. Cumulative satisfaction scores post-intervention (N = 13) in comparison to pre-intervention (N= 25) were closer to the total possible satisfaction score per question for these 10 domains. The mean cumulative satisfaction score across all domains was 60% post-intervention compared with 44% pre-intervention. Satisfaction following intervention was particularly improved in the domains of frequency of communication (60% post-intervention. 32.8% pre-intervention) and how adequately questions and concerns were addressed (69.2% post-intervention;45.6% pre-intervention). Conclusion: During the COVID-19 pandemic healthcare professionals have had to adapt in communicating with patients' next-of-kin. Our Introduction: of robust standards and a virtual whiteboard to track communication resulted in improved satisfaction and proved useful in adapting to remote communication. We propose that similar practice and standards are extended across additional wards to encourage widespread optimal and consistent communication between doctors and patients' relatives, an integral part of patient care.
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This article discusses the potential that trauma-informed pedagogy and social-emotional learning practices hold for supporting educators during the COVID-19 pandemic and beyond. The authors bring a critical lens to considering these approaches, noting some limitations and provisos in their use. We advocate for dialogue, mentorship, and professional learning in using them not only to support educators but to authentically include diverse ways of knowing, doing, and being in early childhood environments.
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Background: Research shows that healthcare professionals' personal hopefulness is associated with burnout and life satisfaction, highlighting the value of hope-enhancement interventions. Feldman and Dreher developed a single-session hope intervention, but this has been used rarely with oncology professionals, and only in in-person format (Shah, Ferguson, Corn et al.). Given SWOG Cancer Research Network's commitment to assessing hopeenhancement approaches and the need for online interventions given COVID-19, we report a feasibility study of a virtual hope workshop in SWOG members. Methods: The workshop was a single 2-hour session delivered live via Zoom to 6-8 participants at a time. The workshop comprises 3 components: A brief lecture on hope and two exercises-a "hope mapping" exercise (aided by a smartphone app created for the workshop) and a hope visualization exercise-both designed to build hope for a life goal of each participant's choosing. 29 SWOG members participated. A link to post-workshop measures was sent to participants, which they were given a week to complete. Measures included Thanarajasingamet al's 5-item Was-itWorth-it (WIWI) measure;Kirkpatrick's 4-item Training Evaluation Model (TEM;reaction, learning, behavior, results);and an item assessing the degree to which participants believe concepts from the workshop should be integrated into SWOG studies. Results: In all, 25 participants (86%) completed measures. Participants were physicians (n = 8), nurses (n = 4), patient advocates (n = 3), research staff (n = 3), and others (n = 7);mostly female (n = 17), mostly white (n = 18), with a mean age of 55.5 (SD = 13.95). Results for the WIWI items are as follows: "Was it worthwhile to participate in the Hope Workshop?" (23 Yes, 2 No/Undecided/Missing Answer);"If you had to do over, would you participate in the Hope Workshop again?" (22 Yes, 3 No/Undecided/Missing Answer);"Would you recommend participating in the Hope Workshop to others?" (22 Yes, 3 No/Undecided/Missing Answer). Two additional items on the WIWI asked participants to rate on a 3-point scale the degree to which they believe their quality of life had increased due to the workshop (M = 2.52, SD =.51) and their overall experience in the workshop (M = 2.70, SD =.64). Ratings for Kirkpatrick's TEM items likewise were high, ranging from 6.91 (SD = 1.31) to 7.70 (SD =.70) on an 8-point scale. Finally, participants gave a mean rating of 4.44 (SD =.59) on a 5-point scale to the item "To what degree do you believe it may be useful to integrate concepts from this workshop into SWOG trials/studies?" Conclusions: It is feasible to implement hope-enhancement workshops in an online platform that includes a smartphone app. Data obtained from two validated tools (WIWI instrument and Kirkpatrick's TEM) attest to an array of positive outcomes. Participants also overwhelmingly advocated integrating hope concepts into SWOG's research.
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Background: Adults with rheumatic diseases are a COVID-19 vulnerable population with potential increased risk for severe infection. COVID-19 vaccines are a key strategy to ending the pandemic. Unfortunately, fears about vaccines, some of which are propagated by misinformation, are common and may prevent or inappropriately delay vaccination. Refusal or uncertainty to get a vaccine despite its availability is known as vaccine hesitancy. Objectives: This study aims at defining causes of COVID-19 vaccine hesitancy among rheumatology patients. Methods: Between November and December 2020, a cross-sectional survey was completed by rheumatology patients presenting to a large Canadian tertiary-care center for influenza immunization. COVID-19 risk factors, previous COVID-19 infection, the likelihood of getting a future COVID-19 vaccine (scale 0-10), and contextual, individual, and vaccine-specific potential determinants of vaccine hesitancy were assessed. Patients were classified into 5 groups based on how likely they were to get a future COVID-19 vaccine (0= not likely at all;2.5= unlikely;5= intermediate;7.5= likely;10= highly likely). A machine learning approach (XgBoost) was used to fit univariate models for a multi-class correlation. Results: 157 rheumatology patients completed the survey. Most were females (n=112, 71%) with a mean age of 54.6 (standard deviation 17.9). The majority (73%) had tertiary-education, and 46% were employed at the time of the survey. The most common rheumatology diagnoses were rheumatoid arthritis (n=90, 58%), systemic lupus erythematosus/vasculitis (n=41, 26%) and spondyloarthropathies (n=39, 25%). Most patients were on immunosuppressors (n=93, 59%). Only half (n=85, 54%) were highly likely to accept a future COVID vaccine, 17% (n=26) likely, 19% (n=30) intermediate, 6% (n=10) unlikely, and 4% (n=6) not likely at all. One hundred thirty-five patients (86%) previously received the flu vaccine, whereas 6% (n=10) previously rejected it. Only three patients were previously diagnosed with COVID-19 (2%) one of whom was hospitalized. Eighty-seven patients (56%) considered that the COVID-19 vaccine should be mandatory, and 101 (65%) that they should receive it. Most respondents were somewhat concerned about receiving a future COVID-19 vaccine (n=116, 76%) despite that 65% believed that vaccines benefits outweighed their risks. Almost all, (n=145, 96%) believed that governmental decisions about vaccines are in the best interest of the population, while less than half (n=70, 45%) were confident that pharmaceutical companies would provide safe and effective vaccines. One hundred participants (65%) denied feeling social pressure to get the vaccine, and 55% (n=81) were willing to pay for the vaccine. Feeling social pressure about getting a COVID-19 vaccine, having severe concerns about receiving a future COVID-19 vaccine, distrust in pharmaceutical companies, lower education, and doubts of whether vaccines benefits outweigh their risks, were negatively associated with COVID vaccine acceptance. Conclusion: Forty six percent of rheumatology patients being immunized against influenza showed at least some hesitancy towards COVID-19 vaccination. Multiple contextual, individual, and vaccine-related factors may contribute. Targeted educational strategies, including producing and communicating data on vaccine safety, may help promote vaccine uptake in this potentially vulnerable population.
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Objectives: During the COVID-19 lockdown, temporal artery biopsy (TAB) procedures were not available at ourinstitution for the diagnosis of giant cell arteritis (GCA). For the evaluation of large vessel vasculitis, 18F-fluorodeoxyglucose PET/CT (FDG PET/CT) has good diagnostic performance (pooled sensitivity of 90% andspecificity of 98%). Recently, limited data has been reported that cranial artery inflammation can be detected onnewer generation non-digital PET/CT scanner. With such advancements, it has been suggested that FDG PET/CTmay be able to replace TAB. We hypothesized that digital FDG PET/CT can be used for the diagnosis of GCAthrough the integrated assessment of cranial and extracranial artery inflammation. Methods: We report data from the use of our GE Discovery MI digital PET/CT for the diagnosis of GCA as analternative to TAB during the COVID-19 lockdown. Subjects were included if they were referred for FDG PET/CT forclinically suspected GCA. Exclusion criteria included corticosteroid therapy > 3 days prior to PET/CT or history of known vasculitis. 185-370 MBq of FDG was injected intravenously and imaging acquired 60-90 minutes later.Images were interpreted by two expert readers and a consensus was obtained for every case. Results: Fifteen (9 women, 5 men) subjects were included in the analysis. The mean age was 72 years, mean CRP67.9 mg/L (normal 0-10 mg/L), and mean ESR 56.9 mm/h (normal 2-39 mm/h). Seven subjects were scanned within3 days of corticosteroid initiation and the other 8 had not received corticosteroids. Four of 15 subjects (27%) werediagnosed with GCA by PET with abnormal cranial or large vessel artery uptake (2 subjects with cranial uptakealone and 2 with both cranial and extracranial uptake), and 3 had evidence of PMR on PET without vasculitis. Inthose diagnosed with GCA by PET, vascular inflammation was visualized in the temporal arteries in all 4, maxillaryand occipital arteries in 3 subjects (Fig.1). Alternate diagnoses explaining the clinical presentation were made in 5 of8 remaining subjects (63%) including subacute thyroiditis, active sinusitis, metastatic malignancy and masticatorspace malignancy. During a follow-up period averaging 58 days (range 22 to 94 days), good response to prednisonewas seen in the patients diagnosed with GCA by PET/CT and no evidence of GCA in the remaining non-GCApatients. Conclusions: In conclusion, digital FDG PET/CT appears promising for the diagnosis of GCA through its enhancedsensitivity and resolution to detect small cranial artery inflammation. Further prospective studies comparing digitalFDG PET/CT with current GCA diagnostic modalities is warranted. (Figure Presented).