Post COVID condition phenotypes-Role in clinical practice?

Introduction/Aim: Post COVID conditions are highly heterogenous and pose significant challenges to healthcare systems. The aim of this study was to identify and characterise symptom clusters at 6-months following COVID illness. Method(s): Symptom burden was assessed in a COVID respiratory clinic 6-months following diagnosis. K-mean cluster analysis was utilised to identify clusters and validated assessment tools for dyspnoea [MMRC], mood [PHQ-4], fatigue [FSS] and pain [WPI]were used to characterise clusters. Result(s): 58 patients (median age 59 years, 31 males) attended 6-month follow up. Cluster 4 represented patients experiencing high symptom burden with high fatigue, pain, depression and anxiety scores. A high proportion of Cluster 2 reported no symptoms but had high dyspnoea scores. Results for PHQ-4, FSS and WPI are presented as means (95%confidence interval) Cluster (n) Symptoms MMRC >1 (n%) PHQ-4 FSS WPI 1(8) anosmia, headache, fatigue, memory, concentration 3(5.1) 1(1,2) 31(17,45) 5(-1,10) 2(42) Isolated Dyspnoea 15(25.9) 1(1,2) 22(18,26) 1(0,1) 3(3) fatigue, nasal congestion, chest pain 3(5.1) 5(-10,21) 36(-26,98) 7(-11,24) 4(4) high symptom burden 4(6.9) 7(0,13) 51(36,66) 12(2,21) Conclusion(s): This exploratory analysis identified 4 possible post COVID condition phenotypes with unique symptom profiles. Larger scale phenotyping may facilitate a streamlined and customised approach to managing this evolving chronic and highly heterogenous clinical condition.

Clinical and respiratory function outcomes 6-months following diagnosis of COVID-19

Introduction/Aim: As health systems emerge through successive waves of COVID-19, focus shifts to the management of Post-COVID-19 conditions. The aim of this prospective observational study was to characterise and evaluate the respiratory sequelae affecting patients 6-months post-diagnosis of COVID-19. SIGNFICANT MODELLING PREDICTORS Outcome Predictors MMRC>= 1 Disease severity Moderate: OR 16.5 +/- 1.02 (SE) p = 0.006 Impaired DLCO (%predicted) Disease severity B=-1.51+/-0.67 (SE) p = 0.010 Impaired TLC (%predicted) D-Dimer B= -0.305 +/- 0.001 (SE), p = 0.05 TLC below LLN Diabetes B=-1.28 +/- 0.32 (SE), p = 0.044 Methods: Patients were evaluated for symptom burden and lung function at 6-months post-diagnosis of COVID-19 in an outpatient setting. Result(s): Fifty-eight (45 inpatients and 13 outpatients;median age 59 years, 28 females) patients attended 6-month clinic appointment. Whilst nearly half (28,48.3%) were asymptomatic at 6-months, 24 (41.3%) patients reported a modified medical research council dyspnoea scale (MMRC) >= 1 and 21 (36.2%) patient-reported fatigue (n= 21, 36.2%). Reduced TLC (n= 11/50, 22.0%) and DLCO (n = 12/51, 23.5%) were common at 6-months. Results of predictive modelling analyses are described in adjacent table. Conclusion(s): Patients presenting with increased disease severity are at risk of persistent dyspnoea and impaired diffusion capacity, 6-months following acute COVID-19 illness. Research guided management of this growing at risk cohort, while paramount, poses a formidable challenge to stretched healthcare systems.

Essential fatty acid and lipoprotein status in pediatric cystic fibrosis: Impact of cystic fibrosis transmembrane conductance regulator modulators

Background: Dyslipidemias and essential fatty acid deficiencies (EFADs) are well established complications of cystic fibrosis (CF). In the general population, a diet high in saturated fat is associated with hyperlipidemia and greater risk of cardiovascular disease and type 2 diabetes. Increasing life expectancy in CF brings concern about the risks of the "legacy" high-fat CF diet. The impact of CFTR modulators on CF-related dyslipidemia and EFAD is not known. Previous studies reported dyslipidemia in people with CF (PwCF) using traditional lipid measures. This study aimed to evaluate the lipoprotein and fatty acid profiles in children and adolescents with CF and to correlate biochemical results with clinical and molecular findings. Plasma and red blood cell (RBC) samples were studied to compare the ability of each method to identify EFAD markers. Method(s): Blood samples (n = 171) were obtained from 142 (78 female) children with CF aged 9.8 +/- 4.7 (range 4 months to 18 years) during routine laboratory draws at pediatric CF center clinic visits. Pancreatic insufficiency was present in 92% and glucose intolerance or diabetes in 14%. Body mass index percentile (BMI%ile) for age z-scorewas 0.23 +/- 0.89 (range -2.4-2.6). F508del mutation was homozygous for 56% and heterozygous for 41%. CFTR modulator therapy had been initiated 3 or more months before for 62% of samples. Sample collection began in September 2019, paused during the COVID-19 pandemic, and resumed in July 2021. An accredited, regional laboratory with expertise in fatty acid analysis processed all samples. Serum was separated and refrigerated for lipoprotein analysis, plasmawas separated and frozen, and RBCs were washed and frozen for fatty acid analysis. Nuclear magnetic resonance lipoprotein assayswere conducted to determine particle number and size of lipoprotein classes. Triglyceride, total cholesterol, and high-density lipoprotein cholesterol (HDL-C) were measured directly (Roche). Low-density lipoprotein cholesterol (LDL-C) and very low-density lipoprotein cholesterol (VLDL-C) were calculated. To correlate laboratory results with clinical findings, medical records were reviewed, and a CF clinic dietitian conducted 24-hour dietary recalls concurrent with study labs. Result(s): Of PwCF homozygous F508del/F508del, 43% tested positive for EFAD biomarkers (RBC linoleic acid, RBC mead acid, RBC triene/tetraene ratio), compared with 13% of PwCF heterozygous F508del ( p <=0.01) (Figure 1). There was no significant difference in concentrations of fatty acid and EFAD biomarkers between those who had or had not initiated CFTR modulator therapy. Lipoprotein abnormalities were identified in 69% of samples with low HDL-C and 39% with large HDL-C, 87% with large VLDL-C particle size and 52% with large VLDL-C particle number, and 5% with high LDL-C or small LDL-C particle numbers. High total cholesterol was found in 15% and high triglycerides in 17%. HDL-C was low in 24%, and 3% had high LDL-C. (Figure Presented) Figure 1. Differences in concentrations of red blood cell (RBC) linoleic and mead acids and triene/tetraene (T/T) ratio between F508del homozygous and F508del heterozygous individuals Conclusion(s): Despite clinical advances and use of CFTR modulator therapy, EFAD remains prevalent and underrecognized in the pediatric CF population. Of PwCF, those homozygous for f508del may have a higher risk of EFAD. Limitations of this study (four different CFTR modulator therapies and small sample sizes in each group) may have precluded significant findings for EFAD and lipid profiles, but PwCF receiving modulator therapy appear to have healthier lipid profiles than those not receiving therapy. Lipids and fatty acid are not routinely evaluated in PwCF, but evaluation should be included in the standard of care for timely dietary interventionsCopyright © 2022, European Cystic Fibrosis Society. All rights reserved

A 2-year longitudinal evaluation of the impact of the COVID-19 pandemic on individuals with pre-existing anxiety disorders.

OBJECTIVES: To examine if the COVID-19 pandemic is associated with a differential effect over a 2-year time period in relation to its psychological and social impact on patients with established anxiety disorders. METHODS: Semi-structured interviews were conducted with 21 individuals attending the Galway-Roscommon Mental Health Services in Ireland with an ICD-10 diagnosis of an anxiety disorder. Interviews occurred at three time-points over a 2-year period to determine the impact of the COVID-19 pandemic and associated restrictions on anxiety and depressive symptoms, social and occupational functioning, and quality of life. RESULTS: No statistical difference in symptomatology was noted between the three time-points in relation to anxiety symptoms as measured utilising psychometric rating scales (Beck Anxiety Inventory (BAI), Hamilton Anxiety Rating Scale (HARS) or Likert Scale measures). The greatest impact of COVID-19 at all time-points related to social functioning and quality of life. Significant variability was noted for individual participants. Qualitative analysis noted a tentative optimism for the future in the setting of vaccination and societal re-opening. Fear of re-emerging anxiety symptoms with the removal of societal restrictions was noted. CONCLUSIONS: No significant overall change in symptomatology or functioning over time was noted for individuals with pre-existing anxiety disorders, however variability was demonstrated, with some individuals describing ongoing anxiety, social isolation and concern for their future. A strong theme of hope for the future and less concern regarding the COVID-19 pandemic was evident; however tailored supports including the utilisation of tele-psychiatry is suggested, particularly for those experiencing increased anxiety with the removal of societal restrictions.

Electronic smart-hub based intervention during COVID-19 in a rural Psychiatry of Old Age service in North-West Ireland

Introduction: The COVID-19 pandemic caused significant disruptions in services and necessitated innovation to continue care provision to the vulnerable population of older adults with psychiatric needs. Objective(s): The objective of this study was to examine the experiences of staff and patients using a hands-free electronic smart-hub (eSMART hub) intervention to keep patients connected with psychiatry of old age following COVID-19 restrictions. Method(s): A risk stratification register was created of all patients known to the Psychiatry of Old Age service in the North-West of Ireland to identify those at highest risk of relapse. These patients were offered a smart-hub with remote communication and personal assistant technology to be installed into their homes. Smarthubs were also installed in the team base to facilitate direct device to device communication. Semi-structured qualitative interviews were conducted with 10 staff members and 15 patients at 6-12 months following the installation of the smart-hubs. Result(s): The smart-hubs were utilized by the POA team to offer remote interventions over video including clinician reviews, regular contact with key workers and day-hospital based therapeutic interventions such as anxiety management groups and OT led physical exercises. Patients also used the personal assistant aspect of the hub to attend to personal hobbies such as accessing music and radio. Positive feedback related to companionship during isolation and connectivity to services. Negative feedback was mainly related to technology, particularly internet access and narrow scope of communication abilities. Conclusion(s): Electronic smart-hub devices may offer an acceptable avenue for remote intervention and communication for isolated high-risk older persons.

Impact of the COVID-19 pandemic on patients with pre-existing anxiety disorders attending secondary care.

OBJECTIVES: To examine the psychological and social impact of the COVID-19 pandemic on patients with established anxiety disorders during a period of stringent mandated social restrictions. METHODS: Semi-structured interviews were conducted with 30 individuals attending the Galway-Roscommon Mental Health Services with an International Classification of Diseases diagnosis of an anxiety disorder to determine the impact of the COVID-19 restrictions on anxiety and mood symptoms, social and occupational functioning and quality of life. RESULTS: Twelve (40.0%) participants described COVID-19 restrictions as having a deleterious impact on their anxiety symptoms. Likert scale measurements noted that the greatest impact of COVID-19 related to social functioning (mean = 4.5, SD = 2.9), with a modest deleterious effect on anxiety symptoms noted (mean = 3.8, SD = 2.9). Clinician rated data noted that 8 (26.7%) participants had disimproved and 14 (46.7%) participants had improved since their previous clinical review, prior to commencement of COVID-19 restrictions. Conditions associated with no 'trigger', such as generalised anxiety disorder, demonstrated a non-significant increase in anxiety symptoms compared to conditions with a 'trigger', such as obsessive compulsive disorder. Psychiatric or physical comorbidity did not substantially impact on symptomatology secondary to COVID-19 mandated restrictions. CONCLUSIONS: The psychological and social impact of COVID-19 restrictions on individuals with pre-existing anxiety disorders has been modest with only minimal increases in symptomatology or social impairment noted.

Web Content Strategy in Academic Libraries: Methods and Maturity

This paper presents a qualitative analysis of nine interviews with academic library practitioners discussing their approaches to Web content strategy work. Findings reveal shared challenges and suggest that, while awareness of content strategy appears to be growing, its practice remains intermittent for many. An updated version of a Content Strategy Maturity Model for Academic Libraries, reflecting participants’ comments regarding planning, creation, delivery, governance, and user experience, provides a means to address these challenges flexibly within an institution’s culture, resources, and circumstances. Participants also discuss the purpose of the library website and impact of the COVID-19 pandemic. © 2022 by Johns Hopkins University Press, Baltimore, MD 21218.

Pelican Stairs

Pelican Stairs is a multimedia art project started during the depths of Covid-19 lockdown in 2020. The project's reflections on how one's umwelt (one's unique experience of living in one's environment) changes in response to an all-encompassing crisis can serve as a guide, or a provocation, about how future cities need to be reimagined to encompass flexible life-pattern options for their denizens not only to survive but to thrive through the challenges before us. I took photos of my local neighbourhood, Wapping in London, on my daily walks between March and September. I often visited the Thames shore area by climbing a set of steps known as Pelican Stairs. Using those photos as a training set, I generated new images with a Generative Adversarial Network (GAN), which I paired with excerpts from my diary during the same period. The unsettling, almost-real images contrasted with the mundane reality of the diary entries allow the viewer to viscerally (re)experience the inherent tension between an increasingly uncertain external reality and internal attempts at control or sense-making through normal, everyday habits. The project is hosted at https://pelicanstairs.art, and the project includes an interactive element through a Twitter bot which responds to a specific prompt by sharing a random image of generated art from the project. © 2022 Owner/Author.

Targeting Vulnerability to Seasonal and Acute Weather Changes to Keep Australians With Cardiovascular Disease Out of Hospital - The RESILIENCE Trial

Background: Australia is experiencing ever more frequent weather/environmental challenges, including extreme heatwaves and bushfires. There are no proven interventions to reduce seasonal challenges to the cardiovascular health of vulnerable individuals. The REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE (RESILIENCE) Trial will test the hypothesis that an individually-tailored intervention program will reduce re-hospitalisation risk and mortality in vulnerable individuals. Methods: We will recruit 300 medical patients admitted to the Austin Hospital (Melbourne, Australia), with chronic heart disease and multimorbidity and randomise (1:1) to standard care or the RESILIENCE program (RP). Applying a COVID-19 adapted protocol, the RP group will have their bio-behavioural profile and home environment assessed to determine their vulnerability to seasonal events. An individualised case-management program, including virtual clinic review with a nurse and physician, will be applied to promote seasonal resilience. The primary endpoint is all-cause days alive out of hospital during 12-month follow-up. Trial registered at ClinicalTrials.gov NCT04614428. Results: To date, 27 patients have been recruited and randomised. The mean age was 76±9 years and 11 (40%) were female. The most common comorbidities were hypertension (76 %), coronary artery disease (52 %), heart failure (52 %) and chronic kidney disease (52 %). Ten patients (37 %) have had a post-discharge home visit by the RP nurse and 5 (18 %) have attended the clinic. Conclusion: Recruitment is ongoing, and in the absence of further COVID-19 related lockdowns, all patients will be recruited over the next 12 months. Funding: MRFF-Keeping Australians Out of Hospital Grant

Risk factors for readmission following inpatient management of COVID-19 in a low-prevalence setting

This was a single-centre, observational cohort study of inpatients admitted to Austin Health from March to October 2020, investigating demographic, clinical,laboratory and treatment parameters associated with readmission to hospital within 6 months following initial inpatient management of COVID-19. Of 169 patients admitted with COVID-19 between March and October 2020 who survived to discharge, 24 (14.2%) were readmitted to hospital within 6 months(median, 36 days;interquartile range, 15-67 days). Ten(5.9%) patients re-presented with respiratory or COVID-19-specific symptoms,five (3.0%) patients represented with COVID-19 complications, and nine (5.3%) patients represented with unrelated problems.In whole cohort analysis, increased length of stay during index admission was significantly associated with readmission (5 days vs 7 days,P=0.04).Anon-significant increase in readmission was noted inpatients with pre-existing chronic respiratory disease,patients requiring supplemental oxygen, and patients admitted to the intensive care unit (ICU).

Fibromyalgia, 'fibromyalgianess', and fatigue are common six months following COVID-19 infection

Purpose: To estimate the prevalence of fibromyalgia (FM), 'fibromyalgianess' and fatigue six months following COVID-19 infection. Method: Consecutive consenting patients were recruited from a post-COVID-19 infection clinic. The following self-reported questionnaires were completed 6 months following COVID-19 infection: widespread pain index (WPI), symptom severity scale (SSS), 10-point visual analogue scale to assess fatigue severity (VAS-F) and 9-item, 7-point fatigue severity scale (FSS). The sum of SSS and WPI scores was used to calculate a polysymptomatic distress (PSD) score. FM was defined as per the 2016 revisions to the 2010/2011 American College of Rheumatology (ACR) criteria, and 'fibromyalgianess' was defined using polysymptomatic distress scale recognising the continuum of FM symptoms. Results: Of 25 study participants, the median age was 59 years (range 21-80), nine were female (36%) and 15 had been admitted to hospital for Covid-related complications (60%). Six months following infection, five met WPI and SSS criteria for fibromyalgia and three others had PSD scores >12 suggestive of severe symptoms;all were under 60 years. Problematic fatigue (mean FSS > 4) occurred in nine patients (36%) and although not statistically significant it was seen more frequently in females compared with males (56% vs 25%;95% CI -9% to 71%) and in those <60 years (46% vs 25%;CI -16% to 58%). Mean (± SD) FSS was 29.7 (± 15.0) and VAS-F was 6.0 (± 2.9). Compared to male patients, female patients demonstrated statistically significant higher mean WPI (8.0 vs 2.0), SSS (7.0 vs 2.1) and PSD (15.0 vs 4.1). Conclusion: Six months following COVID-19 infection, fibromyalgia, 'fibromyalgianess' and fatigue are common, with higher frequency in females and younger patients. This pattern parallels conventional fibromyalgia cohorts and may favour targeted service delivery. Further studies are needed to determine whether symptoms persist long-term.

Purveyors of one health: the ecological imperative driving the future of leisure services. (Special Issue: Leisure in the time of Covid-19.)

The coronavirus pandemic, for all of its damage to human health and well-being, has brought to light the wisdom underlying the idea of One Health, whose advocates reason that health is a reciprocal relationship between our species and the environment that sustains us. What is good for people should also be good for the environment, and what is good for the environment should also be good for people. Their preferred future is one in the same. As the recent days, weeks, and months have also shown, leisure is not necessarily a cure for what ails us. Indeed, leisure pursuits may have contributed to the pandemic's spread. What, then, are we to make of leisure in the time of the coronavirus? We believe it is a fundamental lesson in ecology.

Conducting an rct in the COVID-19 pandemic: Targeting vulnerability to seasonal and acute weather changes to keep australians with cardiovascular disease out of hospital-the res

Objective: Australia is experiencing ever more frequent/provocative weather and environmental challenges, including more extreme heatwaves and catastrophic bushfires. Concurrently, the annual challenge of wintry conditions to a population adapted to warmer conditions persists. Remarkably, however, there are no proven interventions to reduce seasonal challenges to the cardiovascular health of vulnerable individuals. In a world-first, the REsilience to Seasonal ILlness and Increased Emergency admissioNs CarE (RESILIENCE) Trial will test the hypothesis that an individually tailored, intervention program will reduce the risk of re-hospitalisation and mortality in vulnerable individuals. Design and method: 300 adult patients admitted to the Austin Hospital in Melbourne, Australia with heart disease and multimorbidity will be recruited and randomised (1:1) to standard care (SC) or the RESILIENCE program (RP) over 12-months. Applying a COVID-19 adapted protocol, the RP group will have their bio-behavioural profile and home environment assessed post-discharge, to determine their vulnerability to seasonal events. An individualised case-management program, including a virtual clinic review with a dedicated RP cardiac nurse and physician, will be applied to promote seasonal resilience. The primary end-point is all-cause days alive out of hospital (DAOH) during 12-month follow-up. Results: With study recruitment delayed due to COVID-19 restrictions, virtual screening of medical in-patients has confirmed the need and potential for the RP. Of 630 potential participants identified over a 6 week period, 196 patients (31%) met eligibility criteria-85 women and 79 men, mean (±SD) age 79 ± 11 years. Non-eligibility was largely due to non-chronic form of heart disease (34%), no comorbidity (23 %), and inability to give informed consent (15%). Conclusions: Preliminary data suggest that once commenced, we will rapidly recruit the requisite number of trial participants and depending on the results, we will be able to determine the cost-effectiveness of the RP to reduce seasonallyinduced admissions and mortality.

A longitudinal evaluation of the impact of the COVID-19 pandemic on patients with pre-existing anxiety disorders.

OBJECTIVES: To examine if the COVID-19 pandemic is associated with a differential effect over time in relation to its psychological and social impact on patients with established anxiety disorders. METHODS: Semi-structured interviews were conducted with 24 individuals attending the Galway-Roscommon Mental Health Services with an International Classification of Diseases (ICD)-10 diagnosis of an anxiety disorder at two time points (six months apart) to determine the impact of the COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life. RESULTS: No statistical difference in symptomatology was noted between the two time points in relation to anxiety symptoms as measured by utilising psychometric rating scales (BAI and HARS) or utilising a Likert scale. The greatest impact of COVID-19 at both time points is related to social functioning and quality of life. Significant variability was noted for individual participants. Qualitative analysis noted social isolation, concern for the participants' future and increased difficulty managing anxiety with ongoing restrictions. CONCLUSIONS: No significant overall change in symptomatology or functioning over time was noted for individuals with pre-existing anxiety disorders. Variability was, however, demonstrated between individuals, with some individuals describing ongoing anxiety, social isolation and concern for their future. Identifying those with ongoing symptoms or distress and providing multidisciplinary support to this cohort is suggested.

The impact of COVID-19 on a cohort of patients treated with clozapine.

OBJECTIVES: To examine the psychological and social impact of the COVID-19 pandemic and its associated restrictions on a cohort of patients with severe and enduring mental illness treated with clozapine. METHODS: Semi-structured interviews were conducted with 63 individuals attending a clozapine clinic within the Galway-Roscommon Mental Health Services to determine the impact of COVID-19 restrictions on anxiety and depressive symptoms, social and occupational functioning and quality of life, by utilising Likert scale data. The Beck Anxiety Inventory (BAI) and Hamilton Anxiety Rating Scale (HAM-A) were additionally utilised to measure anxiety symptoms cross-sectionally. RESULTS: Anxiety symptoms were low with a median BAI score of 4.0 and HAM-A score of 4.0. Likert scale measurements recorded only a modest adverse impact of COVID-19 restrictions on anxiety and depressive symptoms, quality of life and occupational and social functioning. Free-text comments from patients (n = 55), were grouped into five themes: neutral impact (n = 22), negative psychological impact (n = 13), negative social impact (n = 11), positive psychological impact (n = 5) and media coverage inducing anxiety (n = 4). CONCLUSIONS: Three months into the COVID-19 pandemic and its restrictions, the impact on individuals with treatment-resistant psychotic disorders attending a clozapine clinic has been modest, with preliminary evidence demonstrating minimal increases in subjective symptoms of anxiety and reduced social functioning. Reduced social engagements and supports attainable both within the community and from mental health services were noted by some participants.

Community-based medical photography improves skin cancer teledermatology triage during the national COVID-19 pandemic

The COVID-19 pandemic limited the ability to do conventional outpatient patient face-to-face consultations. New patient skin cancer referrals could not be postponed while awaiting resolution of the COVID-19 pandemic. Photographs taken by patients and community physicians are of ranging quality, adding to the challenge of teledermatology triaging. A new pilot was designed to aid skin cancer triage with professional medical photography images of lesions to be taken in the community setting to avoid patients attending hospital during the COVID-19 pandemic. All consecutive 2-week-wait skin cancer referrals were included over a 2-week period in May 2020 during the peak of the national COVID-19 pandemic. Patients were automatically allocated an appointment time with the medical photography department, in a specifically set up community location. On arrival, patients were given a screening questionnaire with details requested about the nature of their lesion. Professional images were taken and loaded onto the patient's medical illustrations record. Patients were triaged by dermatology consultants based on their general practice referral details, patient questionnaire and professional image. The triage options included booking straight to surgery, clinic appointment or discharge. Patients were then called by a medical professional and informed of the triage outcome. Over the 14-day period, 122 patients were referred to the dermatology department. Mean age was 57 years (range 16-93). One patient was excluded owing to being a child;two patients did not attend their appointment. On allocation of a medical photography appointment, five patients declined to attend and were subsequently booked into clinic. The triage discharge rate was 35.1% (n = 40), with 20.2% (n = 23) being booked directly to a dermatology surgery list, and 43.8% (n = 50) allocated a clinic appointment. Histopathological correlation of the suspected triage diagnosis was confirmed in 72% of patients. Of those seen in the face-to-face clinic, dermatology surgery was subsequently requested in 38% (n = 19). Community-based medical illustration appointments reduced the requirement for patients to attend hospital during the national COVID-19 pandemic. The high-quality images of referred suspected skin cancer lesions, combined with a patient questionnaire, allowed for patients to be promptly remotely triaged, with a higher than previously documented discharge rate vs. standard face-to-face consultation. Patient satisfaction was high, with rapid surgery allocation dates and quick-response triage. Patients with benign conditions were able to be discharged without the risk of having to attend hospital. Triaging consultants reported that triage time was quicker than standard clinic consultation time, which was a further important factor during a time of staff shortages, with illness and redeployment.

The covid-19 pandemic and the impact on child mental health: A socio-ecological perspective

The COVID-19 pandemic poses an increased threat to the mental and behavioral health of children. There is an increasing prevalence of mental health problems in children, coupled with the variability of access to mental health services and the impact of trauma and adverse childhood experiences (ACEs) on child health. The prolonged duration of the current pandemic put children at increased risk for an even higher rate of mental and behavioral health problems. Prior to the pandemic, the mental health workforce was ill equipped to care for the grow-ing need and demand for child-specific services. As the pandemic continues to invade communities across the nation, it is vital for pediatric nurses to acknowl-edge COVID-19 as a major disruptor to the typical growth and development of children. The full impact of this COVID-19 pandemic on the mental health for children is uncertain. However, its impact on an already limited child-focused mental health workforce will indeed have a long-lasting impact on the health and well-being of children and their families. The socio-ecological impact of COVID-19 and its duration for those children with known mental health problems and those in whom such challenges will arise has implications for future models of care. Nurses are well-poised to both assess and intervene with mental health problems to reduce the long-term, potentially negative effect of COVID-19 on the health and well-being of children. © 2020, Anthony J. Jannetti Inc.. All rights reserved.

Late Breaking Abstract - Telerehabilitation compared to centre-based pulmonary rehabilitation: a randomised controlled equivalence trial

Background: Pulmonary rehabilitation is an effective treatment for people with chronic respiratory disease, but is delivered to <5% of eligible individuals. Due to COVID-19 remote rehabilitation models may be critical for future delivery of services. Aims: To compare the efficacy of home-based telerehabilitation (TR) and centre-based pulmonary rehabilitation (PR) in people with chronic respiratory disease. Methods: Assessor blinded, multi-centre RCT, powered for equivalence. Participants were randomised to centre-based PR or home-based TR. Both programs were 2 sessions/week for 8 weeks. Telerehabilitation used a stationary cycle and group videoconferencing to enable social interaction and real time monitoring. The primary outcome was change in chronic respiratory disease questionnaire dyspnea domain (CRQ-D) at end rehabilitation, with a pre-specified equivalence margin of 2.5 points. Results: We randomised 142 participants to PR (n=72) orTR (n=72). Both groups had clinically important improvements in CRQ-D following rehabilitation (TR mean (95%CI) 4 (2 to 5) vs PR 5 (3 to 7)), however equivalence of TR was not confirmed (mean difference between groups (MD) -1 point (-3 to 1)), with similar findings at 12 month followup (MD -1 point (-4 to 1)). The 6-minute walk distance (6MWD) was equivalent at end rehabilitation (MD -6 metres (-26 to 15) and at 12 months superiority of TR could not be excluded (MD 14 metres (-10 to 38). The proportion of participants who completed >70% of prescribed sessions was high (84% TR vs 79% PR). Conclusions: Home-based TR achieved clinically important gains in health-related quality of life, but equivalence to centre-based PR was not confirmed.