Specifically designed family communication booklet to help staff to communicate effectively with Intensive Care Unit patients' next of kin

Introduction: Families of patients admitted to the Intensive Care Unit (ICU) experience significant emotional distress.1 Visiting restrictions mandated during the COVID-19 pandemic presented new barriers to family communication, including a shift from regular bedside nursing updates and in-person family meetings to scheduled, clinician-led telephone calls and video calls.2 This resulted in loss of non-verbal clues and feedback during family discussions, difficulties establishing rapport with families and risked inconsistent messages and moral injury to staff.3 Objectives: We aimed to design a system where all ICU family discussions were documented in one place in a standardised format, thereby clarifying information given to families to date and helping staff give families a consistent message. In addition, we aimed to provide practical advice for the staff making family update telephone calls and strategies for managing difficult telephone conversations. Method(s): We designed and implemented an ICU family communication booklet: this was colour-coded blue;separate to other ICU documentation within the patient notes;and included communication aids and schematics to help staff optimise and structure a telephone update. Using Quality Improvement methodology, we completed four Plan-Do-Study-Act (PDSA) cycles and gathered qualitative and quantitative feedback: this occurred prior to the project and at one,12,18 and 21 months post introduction. We implemented suggested changes at each stage. We designed staff surveys with questions in a 5-point Likert scale format plus opportunity for free comments. Twenty-one months post implementation, we designed and delivered an MDT awareness campaign using the 'tea-trolley training' method,4 departmental induction sessions for new ICU doctors and nurses and a 'Message of the Week' initiative. An updated version of the booklet was introduced in February 2022 (Figure 1). Result(s): Staff survey results are shown in Table 1. Forty-six staff participated in tea trolley training, feedback form return rate 100%. Following feedback, the family communication booklet was updated to include the following: a prompt to set up a password;a new communication checklist at the front, including documentation of next of kin contact details, a prompt to confirm details for video calls, confirm primary contact and whether the next of kin would like updates during the night;consent (if the patient is awake) for video calls while sedated;information regarding patient property;prompt to give families our designated ICU email address to allow relatives to send in photographs to display next to patients' beds;prompts to encourage MDT documentation and patient diary entry. Conclusion(s): During unprecedented visiting restrictions in the COVID-19 pandemic, we implemented an ICU family communication booklet which has been so successful that we plan to use it indefinitely. We plan to further develop this tool by encouraging MDT involvement, seek further staff feedback in six months' time, incorporate this structure into our electronic patient information system when introduced and collect feedback from patients and their next of kin at our ICU follow up clinic. This communication booklet would potentially be reproducible and transferable to other ICUs and could be used as part of a national ICU family communication initiative.

The COVID-19 Pandemic Experience for Patients with Central Nervous System (CNS) Tumors: Differences in Patient- Reported Outcomes (PROs) and Practice Recommendations

Background/Purpose: The COVID-19 pandemic and associated mitigation procedures have significantly altered daily life in ways that may disproportionately affect patients with CNS tumors. This study aimed to explore differences in symptom burden and interference, mood disturbance, and health-related quality of life in the CNS tumor patient population during the COVID-19 pandemic, compared to a normative sample of pre-pandemic data. Method(s): Data from the Neuro-Oncology Branch (NOB) Natural History Study, including demographic and clinical data, as well as PROs including PROMIS Anxiety and Depression Short-Forms, EQ- 5D-3L, MDASI-Brain Tumor/Spine Tumor, and NeuroQOL-Cognition Function, were collected and compared across groups ('NOB normative sample' and 'COVID year' patients) using one-sample proportion tests. Result(s): 178 COVID year CNS tumor patients (55% male, 82% Caucasian, median age 45 years) were compared with 678 NOB normative sample patients with similar demographic and clinical characteristics. Symptom burden remained comparably high during the COVID year compared to the NOB normative sample with the most common moderate-severe symptoms being fatigue (31% vs. 35%), difficulty remembering (28% vs. 24%), drowsiness (22% vs. 25%), disturbed sleep (20% vs. 22%), and distress (20% for both). However, a significantly greater proportion of COVID year assessments endorsed moderate-severe depression on the PROMIS compared to the NOB normative sample (17% vs. 12%, p = 0.023, Cohen's h = 0.22) and moderate-severe depression/anxiety on the EQ-5D-3L was also more prevalent (53% vs. 43%, p = 0.009, Cohen's h = 0.28). There were no other significant differences in PROs between groups. Conclusions and Implications: These findings demonstrated that while objective symptom burden for CNS tumor patients was unchanged, there was an increase in depression reported during the COVID-19 pandemic. Future work should investigate potential pandemic-era interventions for screening, targeting, and improving both mood disturbance and other disease-specific symptoms to improve symptom burden and quality of life.

Sixteen Things We Learned about Programming for Film Festivals under COVID

Five programme advisors from the British Film Institute (BFI) London Film Festival offer reflections on film programming during and post COVID. In addition to a discussion on hybrid festivals, the programme advisors also comment on audiences, Q&As, the engagement with filmmakers, and what it means to programme for both virtual and live festival formats. © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

ATYPICAL VARIANT OF GRANULOMATOSIS WITH POLYANGIITIS WITH EOSINOPHILIA

SESSION TITLE: Critical Systemic Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a necrotizing granulomatous vasculitis affecting small-to-medium sized blood vessels. GPA is highly associated with antineutrophil cytoplasmic antibodies (ANCAs) and often triggered by environmental factors such as medications and infectious agents. Tracheobronchial stenosis and diffuse alveolar hemorrhage are serious complications of GPA. CASE PRESENTATION: A 35-year-old Caucasian male with a history of chronic sinusitis requiring balloon sinuplasty and recent tympanostomy had presented multiple times to the emergency room due to dyspnea and cough with pinkish sputum production. This was associated with sore throat and fever, which were attributed to his COVID-19 infection and treated with supportive care. Due to persistent drainage through his tympanostomy he was prescribed levofloxacin by his ENT specialist. After the second dose of levofloxacin, he developed Raynaud's phenomenon, diffuse purpuric lesions and swelling over his lower extremity, eyelids, and elbows. Four days later he developed worsening hemoptysis and dyspnea for which he was admitted for further evaluation. Laboratory findings were remarkable for peripheral eosinophilia, elevated ESR 19mm/hr, CRP 9.2mg/dl, c-ANCA 1:320 titer, positive proteinase-3 antibodies and normal p-ANCA titers. Urinalysis with microscopic hematuria. Chest CT scan showed ground glass opacity, consolidative infiltrate with subpleural sparing and minimal left bronchial stenosis. Bronchoscopy suggestive of diffuse alveolar hemorrhage. Limited lung biopsy showed ulcer and granulation tissue with abundant eosinophils, but no granulomatous inflammation noted. Pulse dose steroids and Rituximab were initiated, and rapid clinical improvement was noted. Patient was discharged on prednisone taper and Pneumocystis jiroveci prophylaxis. DISCUSSION: We believe that GPA may have been triggered by recent COVID-19 infection and levofloxacin use. Mild peripheral blood and tissue eosinophilia (<12%) has been described in GPA, however it is a rare finding. GPA and eosinophilic granulomatosis with polyangiitis (EGPA) are both ANCA vasculitis that involve lungs and kidneys. GPA presents with sinusitis, alveolar hemorrhage and high titers of PR-3 antibodies. EGPA presents with a history of atopic, asthma and high titers of myeloperoxidase-ANCA along with abundant peripheral eosinophils. Our patient best fits the diagnostic criteria for GPA with eosinophilia variant rather than EGPA. Our patient had no history of asthma or atopic disease and p-ANCA was normal, which also points away from EGPA. CONCLUSIONS: Clinicians should recognize the differential diagnosis for eosinophils in ANCA vasculitis. Early diagnosis of ANCA vasculitis and initiation of appropriate treatment is important to decrease morbidity and mortality. Reference #1: Potter MB, Fincher RK, Finger DR. Eosinophilia in Wegener's Granulomatosis. Chest 116: 1480-1483, 1999 Reference #2: Krupsky, Meir et al. Wegener's Granulomatosis With Peripheral Eosinophilia. CHEST, Volume 104, Issue 4, 1290 - 1292 Reference #3: Kitching AR, Anders HJ, et al. ANCA-associated vasculitis. Nat Rev Dis Primers. 2020 Aug 27;6(1):71. doi: 10.1038/s41572-020-0204-y. PMID: 32855422. DISCLOSURES: No relevant relationships by Afoma King No relevant relationships by Joshuam Ruiz Vega No relevant relationships by Krishna Shah no disclosure on file for Milos Tucakovic;

Social work practice for COVID-19 in the acute hospital setting: Recommendations for psychosocial assessment

The global coronavirus SARS-CoV2 (COVID-19) pandemic outbreak caused immediate, far-reaching social schisms and created unprecedented challenges for hospital social work services worldwide. Existing hospital disaster plans were inadequately equipped for pandemics and organisational plans needed to quickly adapt to respond to the increased clinical demands and unique logistical considerations triggered by the virus. Literature reviews provided little in the way of precise guidance for practitioners. Hospital social workers responded not only to a new cohort of patients, but also to all patients affected by the societal repercussions of the pandemic and by governments' attempts to mitigate the impacts of the virus. Psychosocial assessments, the bedrock of social work intervention, needed to adapt and evolve to encompass and address the exacerbation of existing social risks in new ways. This article originated from the authors' interest in identifying practice implications for hospital social work during the COVID-19 pandemic. The authors briefly outline the distinct impact of COVID-19 on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They create a forum of international hospital social work centres to develop a consensus approach for addressing these issues in the context of a social work psychosocial assessment. The global COVID-19 pandemic stretched hospital resources across the globe and presented unique challenges to social work services. Disaster response plans were not adequately applicable given their time-limited nature. The broader social repercussions of the pandemic and governments' approaches to mitigating it meant that the cornerstone of social work intervention in hospitals-psychosocial assessments-needed to consider the aggravation of social risks in entirely new ways. The authors briefly outline the impacts of the pandemic and response on psychosocial issues such as domestic and family violence, elder abuse, child protection, financial stress and social isolation. They consult international hospital social work centres and develop an agreed approach for addressing these issues in the context of a social work psychosocial assessment.

THE UK FIREBALL ALLIANCE: LESSONS LEARNED FROM TWO METEORITE FIELD SEARCHES IN THE UK

Introduction: The UK currently has six meteor camera networks that are coordinated through the UK Fireball Alliance (UKFAll) [1]. Together, these networks currently image much of the UK's night sky. Since its formal establishment in 2020, the UKFAll has organised field searches following two detected fireball events that dropped meteorites in the UK: one at 21:54 (UTC) 28th February 2021 in Gloucestershire, England, and another at 23:45 (UTC) 14th April 2022 in Shropshire, England. The former fireball detection led to the recovery of the Winchcombe CM chondrite, the first UK meteorite in 30 years [2-4], whilst our search for the Shropshire meteorite have not yet located any stones. Here, we report some lessons learned as a citizen-science and academic collaboration, and from engaging with both local and national communities in searching for meteorites in Gloucestershire and Shropshire, UK. Camera Networks: UKFAll includes the UK Meteor Network (UKMON), Network for Meteor Triangulation and Orbit Determination (NEMETODE), the UK Fireball Network (UKFN), the Fireball Recovery and InterPlanetary Observation Network (FRIPON), the Global Meteor Network (GMN), and the AllSky7 network. Orbital calculations and dark flight modelling are a collaborative effort by researchers from the Global Fireball Observatory based at Curtin University, Australia, as well as the University of Western Ontario, Canada, and FRIPON, France. Winchcombe: Since the Winchcombe meteorite fell during a national lockdown, we issued a press release asking residents in Gloucestershire to report possible meteorite finds following the fireball, as opposed to sending a search party immediately. This approach was successful, with the Wilcock family waking to find a pile of dark rocks and powder on their driveway, and having seen the news, collecting the material and contacting the UKMON. Following verification of the meteorite fall, and additional refinement of the strewn field, a small (~15 scientists) search party assembled in Gloucestershire on 4th March 2021. This led to the recovery of the largest 152 g stone at Rushbury House farm on 6th March 2021. Field Experience: Members of UKFAll with meteorite searching experience led small teams of 4 - 8 people. The search was conducted in a unique situation due to COVID. Care was taken to remain socially distanced at all times, which made coordination of the search efforts challenging. Positive engagement with the local community was prioritised from the outset, with team leaders contacting landowners for permission to search and emphasising our safety precautions and risk assessments. News of the meteorite fall spread quickly, and residents were very hospitable and enthusiastic about our activities. The UK countryside is full of "meteorwrongs", and the rural terrain was difficult to search due to long grass, bushes etc. A game was devised to help boost morale - and to see if a meteorite would be found in that field - where a convincing meteorwrong was thrown into each new area by one team member to be found by the search team. During the field search, we also received many enquiries. These were managed by dedicated UKFAll team members, who replied to emails and visited potential meteorite finds in the area. The press interest in the story following the announcement that the meteorite had been found was significant, with journalists soon arriving in Winchcombe. This press release came after the main UKFAll search had ended, and there were many requests from the the media for interviews. Following several busy days, a key lesson learned was to the need to have a designated media liaison for any future press releases. Shropshire: This meteorite search was carried out over six days by ~20 scientists in an agricultural area south of Shrewsbury that included grazing land for sheep, wheat and rapeseed fields, and woodland. Searching in mid-April proved more challenging due to the increased vegetation cover. In order to train more people in meteorite hunting strategy, search line leaders were alternated each day. An initial small team arrived for the first two days to engage with the community. This "recon" was used to assess the terrain, identify key areas, and obtain permissions, and to avoid inundating small communities with search teams without advance notice. Early on, we engaged with a business owner, who helped to spread the word using local social media groups. Within 24 hours, most residents in the strewn field were aware of the meteorite fall and our presence, with many families conducting their own searches of public land. On 18th April 2022, a press release with an approximate strewn field was issued to local journalists. As with Winchcombe, there was significant national media interest, despite no stone being found to date. This helped us to gain access to search areas, as several landowers were aware of the meteorite before we contacted them. [ FROM AUTHOR] Copyright of Meteoritics & Planetary Science is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Timing of elimination of hepatitis C virus in Canada's provinces

BACKGROUND: Infection with chronic hepatitis C virus is a global public health concern. A recent study concluded that Canada is on track to achieve hepatitis C elimination goals set by the World Health Organization if treatment levels are maintained. However, recently a falling temporal trend in treatments in Canada was observed, with most provinces seeing a decrease before the global coronavirus pandemic. This study assesses the timing of elimination of hepatitis C in the 10 provinces of Canada. METHODS: Previously published disease and economic burden model of hepatitis C infection was populated with the latest epidemiological and cost data for each Canadian province. Five scenarios were modelled: maintaining the status quo, decreasing diagnosis and treatment levels by 10% annually, decreasing diagnosis and treatment levels by 20% annually, increasing them by 10% annually, and assuming a scenario with no post-coronavirus pandemic recovery in treatment levels. Year of achieving hepatitis C elimination, necessary annual treatments for elimination, and associated disease and economic burden were determined for each province. RESULTS: If status quo is maintained, Manitoba, Ontario, and Quebec are off track to achieve hepatitis C elimination by 2030 and would require 540, 7,700, and 2,800 annual treatments, respectively, to get on track. Timely elimination would save 170 lives and CAD$122.6 million in direct medical costs in these three provinces. CONCLUSIONS: Three of Canada's provinces-two of them most populous in the country-are off track to achieve the hepatitis C elimination goal. Building frameworks and innovative approaches to prevention, testing, and treatment will be necessary to achieve this goal.

ASKING TEENAGERS AND YOUNG ADULTS WITH IBD;'WHAT MATTERS TO YOU'?

Introduction Good paediatric to adult transition of IBD care is important to prevent disengagement and poor disease outcomes. 1 The aim of this study was to qualitatively measure what is important to patients before they attended a new transitional service. There may be a dichotomy between the treating healthcare workers' priorities and teenagers' priorities that form a barrier to effective communication. Unprepared services can result in negative consequences for those involved2 and a greater understanding of what matters to teenagers and young adults may improve the clinicians' ability to facilitate the transition process Methods We asked 75 teenagers and young adults, aged between 14 and 21, who attended a new transitional service at a tertiary IBD unit in the North of England, to complete a survey prior to their clinic review. This 'what matters to you' survey included 12 suggestions they could circle, with no limitations on how many they selected, but a suggestion to choose up to 3 topics. The survey was conducted during the COVID- 19 pandemic and UK national lockdown, between September 2020 and September 2021 Conclusion Inflammatory bowel disease is a condition with potentially a high morbidity from physical symptoms, and it is important not to forget this as a focus of a consultation. Medical therapies and their effects on the patient were important to 48% of responders, and the transition process should include further education on treatment options with discussions of compliance. The impact on education and schooling feature as a significant topic and should be discussed during transition. Minimising the impact on education and employment should be considered when developing transitional services. Mental health wellbeing and body image were highly significant to a smaller number of patients and remain an important consideration. Interestingly not a single responder including the COVID-19 outbreak as a concern despite universally being on biological therapy or immunomodulators. It is important to note that whilst no patients reported 'smoking, drugs and alcohol' as important, risk-taking behaviours are increased in this patient population [3], they need to be sensitively discussed to become apparent and may be under-represented with the methodology used.

Assessment of Bedside Teaching in a Tertiary Care Academic Medical Intensive Care Unit

Introduction Reportedly, teaching at the bedside is declining over time. This purported decline has not been quantified. Quantifying bedside teaching is challenging, and we found only one study quantifying bedside teaching on a hospitalist service. We conducted a study to understand the prevalence of bedside teaching in our medical intensive care unit. Methods We conducted a single-center single-unit study in the medical intensive care unit of an academic tertiary care institution. We utilized a survey tool to assess perceived time spent on bedside teaching, quality of teaching, and total rounding time. In parallel, independent observers objectively measured time spent on rounds and on bedside teaching. Residents were asked to complete the survey once a week. Independent observers collected data daily and weekly averages were obtained. Results A total of 43 responses were collected over a 4-month period. Most respondents (73%) reported a total rounding time of either 90-120 min or greater than 120 min. Median reported bedside teaching time was 16-20 min with 16 respondents (37%) reporting less than 15 min and 27 respondents (63%) reporting 16 min or more. The amount of time spent on bedside teaching was reported as adequate or more than adequate by 77% (33) of respondents with 58% (25) reporting that bedside teaching was very or extremely effective in helping them learn. The mean census reported by the independent observers was 12.75 patients per team. Bedside teaching represented an average of 12% of total rounding time, 16.85 minutes per day. There was no correlation between the team census and the amount of bedside teaching. While total rounding time increased with increasing census, there was no decline in bedside teaching time. Discussion/Conclusion Medical education has evolved over time and has gradually incorporated informal teaching sessions, simulations, and mini lectures in addition to traditional bedside teaching. Despite the evolution in medical education, bedside teaching remains an integral component of post graduate medical education. Even though bedside teaching represented only 12% of total rounding time, medical residents perceived the time and quality of bedside teaching to be adequate. Strengths: Bedside teaching time was corroborated by independent observers and not limited to subjective perception of trainees. Limitations: This study was limited to one medical intensive care unit in an academic tertiary care hospital. This study was conducted during the COVID-19 pandemic which may have affected results. A small number of surveys were collected over a 4-month period. (Figure Presented).

Improving compliance with blood and platelet transfusion thresholds on a tertiary haematology ward

Restrictive transfusion thresholds are accepted as optimal blood management for patients receiving transfusions. 1 Unnecessary blood transfusions result in increased blood product shortages (exacerbated by the COVID-19 pandemic), 2 adverse patient outcomes and significant costs to health systems. 3 To improve transfusion practice, we aimed to minimise inappropriate transfusions through exploring and targeting areas of noncompliance with locally agreed red blood cell (RBC) and platelet transfusion thresholds of 80 g/l and 10∗109/l respectively. We conducted a retrospective multicycle audit over 4 months (Aug 2020, Feb 2021, May 2021 and Jun 2021) for all patients on the Haematology-Oncology ward. Standards were set at 100% compliance with local hospital guidelines. We analysed the number of RBC and platelet transfusions, pre-and post-transfusion haemoglobin and platelet counts, and clinical indications for transfusion. Actions implemented following each cycle composed of departmental meetings, teaching for foundation doctors and trainees, trust guideline updates and creation of a RBC transfusion checklist on our electronic 'EPIC' prescribing system. 4 Percentage compliance for RBC transfusions improved from 89% to 95% following actions implemented per audit cycle. Inappropriate RBC transfusions associated with discharge decreased from 10% to 1% and transfusion of two RBC units without appropriate increment decreased from 10% to 3%. Although percentage compliance of platelet transfusions did not improve from Aug 2020 to Jun 2021, they were consistently higher (97%) compared to RBC transfusions. This may be secondary to differing causes for inappropriate platelet transfusions detected each cycle. Despite inappropriate HLA-platelet use detected in the latest cycle, there are improvements in documentation to justify platelet transfusions outside normal threshold (100% in latest cycle), total number of platelets transfused and transfusion associated with discharge. Our audit has been successful in improving overall transfusion practice on the Haematology-Oncology ward. Ongoing education and re-audit will ensure this is maintained. (Table Presented).

The Utility of Community-Academic Partnerships in Promoting the Equitable Delivery of COVID-19 Vaccines in Black Communities

Background. In the U.S., non-Hispanic Black individuals are disproportionately represented amongst COVID-19 mortalities. The COVID-19 vaccines are poised to change this outcome;however, inequitable access and decades of medical mistreatment have resulted in healthcare mistrust and an associated low uptake within this group. Loma Linda University (LLU) houses the largest mass vaccination site in San Bernardino County (SBC) California;nevertheless, there has been a perpetual low representation of Black vaccinees. To increase the number of Black persons vaccinated, a selected team at LLU leveraged a community-academic partnership model to address vaccine hesitancy and increase access to the COVID-19 vaccines. The objective of this study was to evaluate the number of Black persons vaccinated in community settings compared to the mass clinic. Methods. LLU developed a tiered approach to increase COVID-19 vaccinations within Black SBC communities. The first tier engaged faith leaders with the academic community in disseminating COVID-19 health information, the second included culturally representative LLU healthcare professionals in the delivery of COVID-19 educational webinars, and the third was to conduct low barrier, remote-site vaccination clinics, within targeted Black communities. Following these efforts, we compared the number of Black individuals vaccinated in the LLU mass clinic to those vaccinated in the community remote-site clinics. Results. The remote-site COVID-19 vaccination clinics commenced in February 2021. From February 1 until April 30, 2021, 24,808 individuals were vaccinated in the LLU mass clinic with a first dose (Pfizer or Moderna) or single dose (Janssen) of a COVID-19 vaccine, however, only 908 (3.7%) were Black vaccinees. Contrastingly, the LLU remote site clinics vaccinated 1,542 individuals with a first or single dose of a COVID-19 vaccine. Of those vaccinees, 675 (44%) were Black. Conclusion. The multi-tiered community approach (remote-site vaccination clinics) resulted in a necessary overrepresentation of Black vaccinees, previously underrepresented in the LLU traditional mass vaccination clinic effort (44% vs. 3.7%, respectively). Further research is warranted to examine the key elements to increase vaccinations amongst minoritized groups.