The feasibility of patient-reported outcomes, physical function, and mobilization in the care pathway for head and neck cancer surgical patients.

BACKGROUND: Head and neck cancer (HNC) patients are an understudied population whose treatment often includes surgery, causing a wide range of side effects. Exercise prehabilitation is a promising tool to optimize patient outcomes and may confer additional benefits as a prehabilitation tool. The primary objective of this study was to assess the feasibility of measuring patient-reported outcomes (PROs), physical function, and in-hospital mobilization across the HNC surgical timeline in advance of a future prehabilitation trial. The secondary objective was to examine potential changes in these outcomes across the surgical timeline. METHODS: HNC patients scheduled to undergo oncologic resection with free-flap reconstruction completed assessments of PROs and physical function at three timepoints across the surgical timeline (baseline, in-hospital, and postsurgical/outpatient). Mobilization was measured during the in-hospital period. The feasibility of recruitment and measurement completion was tracked, as were changes in both PROs and physical function. RESULTS: Of 48 eligible patients, 16 enrolled (recruitment rate of 33%). The baseline and in-hospital PROs were completed by 88% of participants, while the outpatient assessments were completed by 81% of participants. The baseline and in-hospital assessment of physical function were completed by 56% of participants, and 38% completed the outpatient assessment. Measuring in-hospital mobilization was completed for 63% of participants. CONCLUSION: Measuring PROs and in-hospital mobilization is feasible across the surgical timeline in HNC; however, the in-person assessment of physical function prior to surgery was not feasible. A multidisciplinary collaboration between exercise specialists and clinicians supported the development of new clinical workflows in HNC surgical care that will aid in the implementation of a future prehabilitation trial for this patient population.

Who is most vulnerable to psychological distress following working from home? A national survey in U.S. employees during the COVID-19 Pandemic

Introduction: The COVID-19 pandemic has precipitated broad and extensive changes in the way people live and work, especially regarding working from home rather than commuting to a public workplace. While the general subject of working from home has recently drawn increased attention as a research focus, few studies have assessed which demographic subgroups may be more vulnerable to the potential mental health effects of working from home. Material and Methods: Data were from the Health, Ethnicity, and Pandemic Study (HEAP), a national survey conducted in the U.S. during the COVID-19 pandemic in October 2020. The effects of working from home on psychological distress in 1,577 workers were examined via logistic regression, and stratified analyses were conducted to identify vulnerable subgroups. This analytic research project was reviewed and approved for exemption by the University of California, Los Angeles Institutional Review Board. Results: After adjustment for covariates, compared to workers who were not working from home, those who were working from home had higher odds of psychological distress (OR and 95% CI = 2.74 [1.49, 5.04]). Two subgroups, i.e., younger workers (<45 years) and women were identified to be associated with elevated psychological distress (ORs and 95% CIs were 3.23 [1.82, 5.76] and 3.70 [1.64, 8.34], respectively). Conclusions: Working from home is associated with psychological distress, and these associations are stronger in younger workers and in women. These results have implications for workers’ mental health in the overall transition towards working from home in the COVID-19 pandemic era.

The patient experience and clinical efficacy of a novel virtual c13ubt service at an irish tertiary referral center during the covid 19 pandemic

Introduction: UBT is the most accurate non-invasive test for H.pylori infection. The orally given urea, labelled with C13, is hydrolysed by the enzyme urease of H.pylori and C13O2 is measured expired in breath. UBT was our gold standard diagnostic test for H.pylori. This practice changed abruptly in March 2020, when our first wave of coronavirus -2 (SARS-CoV-2) started. UBT carries the risk of contamination by SARS-CoV-2 in the aerosol droplets generated by exhaled air. The British Society of Gastroenterology guideline at that time graded UBT as Aerosol Generating Procedure and therefore at high risk for transmission. Only emergency gastroenterology high risk procedures were recommended during restrictions which effectively terminated our standard UBT service. To maintain a non-invasive diagnostic option we developed a novel virtual test. C13 UBT At Home, is performed by patients at home with step by step instructions involving live video conference interaction between the patients and technicians. Aims & Methods: To determine the acceptability and the accuracy of the novel C13 UBT At Home service. Patients on a UBT waiting list were contacted and invited to undergo the alternative virtual breath test. Willing participants were pre assessed over phone to explain the process. Technical aspects (internet, smart phone or laptop requirements), navigation through the video call system attendanywhere and routine clinical parameters including PPI and antibiotic use were discussed. Suitable patients collected a Home UBT kit (Patient information sheet, test documentation, pre and post collection tubes, collection straw, urea tablet and feedback questionnaire) from a drop off point up to a week prior to their scheduled appointment. The test was performed as standard by the patient at home with live interaction for all active steps. The 20 minute rest between samples 1 and 2 collection was offline which allowed technicians to do concurrent cases. Patients were requested to fill in a feedback questionnaire after the test and to return it with the samples to the drop off point within 48 hours for analysis. The questionnaire included 6 questions covering pre procedure, procedure and post procedure domains. In addition to patient satisfaction, positivity rate, sample error rate and activity numbers were compared between UBT at home and a standard UBT cohort which was reinstated in 2021. Results: 300 patients were enrolled, mean age 41 years (range 7-85), 177 female (59%). Overall response rate was 96% (288), 96% (285) rated the entire UBT at home process as either excellent or good. All other parameters except connection to the hospital video call system, which was subject to external factors were also rated excellent/good by >90%. Accuracy between UBT tests was similar: positivity rate 23% (69/299) versus 22% (74/326), sample error rate 0.33% (1/300) versus 0.6% (2/326) for the UBT at home and standard tests respectively. Currently 3 of every 4 UBT's is now virtual despite reduced restrictions. Conclusion: UBT at home is possible and acceptable to patients with equivalent accuracy to standard UBT and should be continued to improve patient choice and satisfaction.

RECURRENT HEMOPTYSIS IN UNILATERAL PULMONARY ARTERY AGENESIS

TOPIC: Signs and Symptoms of Chest Diseases TYPE: Fellow Case Reports INTRODUCTION: Unilateral pulmonary artery agenesis (UPAA) is a rare condition that is typically from a defect during birth. It may remain asymptomatic and only be diagnosed in adulthood. Symptoms may include dyspnea on exertion, recurrent pulmonary infections, and pleural effusion. Hemoptysis has been described in 10% of patients. Imaging modalities include pulmonary angiography and aortography to localize and embolize collaterals for a therapeutic approach. This case presents a patient with known UPAA with recurrent hemoptysis with difficulty in localization of bleed. CASE PRESENTATION: A 27-year-old female with history of factor 5 Leiden deficiency, von Willebrand's disease, polycystic ovarian syndrome, morbid obesity, absent right pulmonary artery, atrial septal defect, and patent ductus arteriosus presented to the emergency department after experiencing an episode of hemoptysis. She denied any chest pain, fever, or chills, however, since her recent diagnosis with COVID-19, she has had ongoing shortness of breath. In the emergency room, she had a temperature of 98.6°F, heart rate of 123bpm, respiratory rate of 18 breaths/min, blood pressure of 186/113mmHg and Spo2 of 100% on ambient air. Physical exam was unremarkable. Her labs consisted of a normal PT and INR, unremarkable CMP, Hemoglobin of 13.8 g/dL, platelets of 250,000/uL. A CT angiogram was done showing no pulmonary embolism but confirming absence of the right pulmonary artery and showing a hypoplastic right lung (Figure1). She was subsequently admitted under observation. A 2D echo did not show any evidence of pulmonary hypertension. She had additional small episodes of hemoptysis and therefore underwent a bronchoscopy, however, was completely obscured by blood upon entry and was withdrawn. She underwent a repeat bronchoscopy in the operating room which showed a slow ooze from the posterior segment of the right upper lobe. She did not have any further episodes of hemoptysis and was therefore discharged. She presented again with significant hemoptysis requiring intubation followed by a bronchoscopy where a large thrombus and blood was removed. Due to her complex pathology, she was flown to a tertiary care center where her hemoptysis eventually subsided. DISCUSSION: Unilateral pulmonary artery agenesis has a prevalence of 1 in 200,000 patients caused by failure in connection of the sixth aortic arch and pulmonary trunk. It may be accompanied with other congenital heart abnormalities. Therapeutic options include surgical reconstruction of the pulmonary artery early in childhood. In adulthood, one may consider surgical occlusion of collateral vessels or pneumonectomy to avoid hemoptysis. CONCLUSIONS: Outcomes are not well-described given the rare condition, however, routine surveillance in the development of pulmonary hypertension is important. Given our patient's known diagnosis, she was referred to her congenital cardiologist for close follow up. REFERENCE #1: Steiropoulos P, Archontogeorgis K, Tzouvelekis A, Ntolios P, Chatzistefanou A, Bouros D. Unilateral pulmonary artery agenesis: a case series. Hippokratia. 2013;17(1):73-76. REFERENCE #2: Johnson, T.R.C, Thieme, S.F, Deutsch, M.A, et al. Circulation. 2021. Unilateral Pulmonary Artery Agenesis. [online] Available at: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.108.777698 [Accessed 13 April 2021 DISCLOSURES: No relevant relationships by Tokunbo Matthews, source=Web Response No relevant relationships by Awan Rahman, source=Web Response No relevant relationships by Nitasa Sahu, source=Web Response

Going online: Reflections from a therapeutic parenting group

An exploration of the experience of moving a therapeutic parenting group intervention online, necessitated by the Covid-19 pandemic. Two online formats are described, and reflections by participants are offered, from which the benefits for such an approach became evident. © 2021, British Psychological Society. All rights reserved.

Polyp excision rates post-COVID-19: Personal protective equipment does not impairperformance

Aims The UK JAG on GI Endoscopy's minimum standard for polyp detection rates (PDR) in colonoscopy is 15 %. TheCOVID-19 pandemic precipitated the use of restrictive personal protective equipment (PPE) which might reduce dexterityand decrease PDRs. We audited our polyp excision rates both prior to and post the COVID-19 pandemic in order to assesswhether restrictive PPE led to a diminution therein. Methods Our endoscopy database was queried for all colonoscopies performed between 01/01/2014 and 29/02/2020 (Pre-COVID-19, n = 18,231) and between 01/03/2020 and 02/09/2020 (Post-COVID-19, n = 825) and subsequently irrevocablyanonymised. A polyp excision rate (PER) was calculated for each period as a proxy for PDR. A comparative odds ratio was calculated. An ordinary least squares (OLS) regression, using number of polyps excised as the dependent variable and procedure in thepost-COVID-19 period as a primary explanatory variable, was performed. The regression was controlled for age, malegender and procedure coded as therapeutic (as opposed to diagnostic). Results 4,346 and 209 patients had at least one polyp excised in the pre-COVID-19 (PER 23.8 %) and post-COVID-19 (PER25.3 %) periods respectively. Odds ratio 1.08 (95 %CIs: 0.92, 1.27). OLS regression established positive relationships between number of polyps excised and age (0.004, 95 %CIs: 0.003,0.005), male gender (0.10, 95 %CIs: 0.07, 0.13) and procedure coded as therapeutic (1.75, 95 %CIs: 1.71, 1.78). Itdemonstrated no significant relationship between procedure in the post-COVID-19 period (-0.003, 95 %CIs:-0.07, 0.07)and number of polyps excised. Conclusions Odds ratios comparing PERs and an OLS regression analysing number of polyps excised failed to demonstrateany significant difference between the pre-COVID-19 and post-COVID-19 eras.