Impact of the covid-19 pandemic on lung cancer referraland treatment

Background: UK restrictions during covid-19 impacted lung cancer care including referrals into secondary care. Aim(s): (1) document pattern of referrals to this semi-rural Trust, (2) evidence any later presentation of disease, and(3) report impact on treatment. Method(s): Data was collected retrospectively and analysed for pre-covid, lockdown/restriction period, and post-relaxation of rules. Non-parametric data were analysed by chi square (X2) analysis for trend. Result(s): Fall in referrals pivoted on the initial UK peak in 2020 with a slow recovery in two week wait referrals post-lockdown (43%, previously 60%). Table 1 shows distribution in disease stage negatively skewed (all >2.46) with themajority at stage 4. Trend showed no statistical difference in stage with X2 (df 6, n=792, = 3.831, p=.6995) andsimilarly when re-analysing earlier stages. Treatment outcome shows non-significant trends to increased palliativecare (28 to 35%) and radiotherapy (10 to 18%), with less chemotherapy (25 to 21%) or surgery (26 to 15%). Conclusion(s): Locally, lung cancer diagnosis numbers have been maintained, with a similar stage at presentation but a change in referral pattern favouring emergency/upgraded presentation may signal reduced access to primary care.

Understanding the Collaborative Learning Implementation Cycle (CLIC) for a Teacher Learning to Promote Computationally Rich Communication in a Remote STEM Classroom

Promoting productive student talk and computational collaboration in small group work is challenging, especially during COVID-19 induced remote learning. This paper describes a case study of one middle school teacher's participation in a professional learning community and implementations of a physical computing unit where students created data displays to collect and analyze environmental data. The focal teacher implemented the unit twice with astonishingly better results in the second iteration. We discuss lessons from how she participated in a professional learning cycle that used reflection, adaptive support and co-designed tools that helped achieve her vision for student collaboration. © 2022 International Society of the Learning Sciences (ISLS). All rights reserved.

Conventional oxygen therapy versus CPAP as a ceiling of care in ward-based patients with COVID-19: a multi-centre cohort evaluation.

BACKGROUND: Continuous positive airway pressure (CPAP) therapy is commonly used for respiratory failure due to severe COVID-19 pneumonitis, including in patients deemed not likely to benefit from invasive mechanical ventilation (nIMV). Little evidence exists demonstrating superiority over conventional oxygen therapy, whilst ward-level delivery of CPAP presents practical challenges. We sought to compare clinical outcomes of oxygen therapy versus CPAP therapy in patients with COVID-19 who were nIMV. METHODS: This retrospective multi-centre cohort evaluation included patients diagnosed with COVID-19 who were nIMV, had a treatment escalation plan of ward-level care and clinical frailty scale ≤ 6. Recruitment occurred during the first two waves of the UK COVID-19 pandemic in 2020; from 1st March to May 31st, and from 1st September to 31st December. Patients given CPAP were compared to patients receiving oxygen therapy that required FiO2 ≥0.4 for more than 12 hours at hospitals not providing ward-level CPAP. Logistic regression modelling was performed to compare 30-day mortality between treatment groups, accounting for important confounders and within-hospital clustering. FINDINGS: Seven hospitals provided data for 479 patients during the UK COVID-19 pandemic in 2020. Overall 30-day mortality was 75.6% in the oxygen group (186/246 patients) and 77.7% in the CPAP group (181/233 patients). A lack of evidence for a treatment effect persisted in the adjusted model (adjusted odds ratio 0.84 95% CI 0.57-1.23, p=0.37). 49.8% of patients receiving CPAP-therapy (118/237) chose to discontinue it. INTERPRETATION: No survival difference was found between using oxygen alone or CPAP to treat patients with severe COVID-19 who were nIMV. A high patient-initiated discontinuation rate for CPAP suggests a significant treatment burden. Further reflection is warranted on the current treatment guidance and widespread application of CPAP in this setting. FUNDING: L Pearmain is supported by the MRC (MR/R00191X/1). TW Felton is supported by the NIHR Manchester Biomedical Research Centre.