Medical intensivist directed VV ECMO cannulation for the facilitation of tracheostomy in a patient with severe tracheal stenosis: A case report

Objectives: We present a case report of medical intensivist driven ECMO program using ECMO as a pre-procedural tool to maintain oxygenation in a patient with critical tracheal stenosis during tracheostomy placement. Method(s): VV ECMO is primarily used to support patients when mechanical ventilation is unable to provide adequate gas exchange. Alternatively, it has been used pre-procedurally when intubation is required in anticipation of a difficult airway. Described here is the first intensivist preformed awake VV ECMO cannulation to facilitate tracheostomy in a patient with severe tracheal stenosis. Result(s): The patient is a 41-year-old female with the relevant background of COVID19 pneumonia status post tracheostomy and subsequently decannulated after prolonged intubation and ICU stay. As a result, the patient developed symptomatic tracheal stenosis and presented two years after her ICU stay for scheduled bronchoscopy and balloon dilation. However, the patient developed worsening stridor and shortness of breath requiring heliox and BPAP. After multidisciplinary discussion between the critical care team ENT teams, the decision was made to cannulate for VV ECMO as a pre-procedural maneuver to allow for oxygenation during open tracheostomy in the OR. Dexmedetomidine and local anesthesia were used for the procedure with the patient sitting at 30 degrees on non-invasive ventilation and heliox. The patient was cannulated with a 21F right internal jugular return cannula and 25F right common femoral drainage cannula by medical intensivists in the intensive care unit using ultrasound guidance. The patient went for operative tracheostomy the next day and was subsequently decannulated from ECMO the following day without complication. She was discharged home on trach collar. Conclusion(s): Intensivist performed ECMO cannulation has been shown to be safe and effective. We anticipate the indications and use will continue to expand. This case is an example that intensivist driven preprocedural ECMO is a viable extension of that practice.

Abstract: Cultural responses to the first wave of COVID-19 pandemic in different parts of the world

The article reports on different cultural understandings of the first wave of COVID-19 pandemic and various coping mechanisms in India, Bangladesh, Japan, Syria, New Zealand, South Africa, Kenya, Tunisia, El Salvador, the USA, Italy and Belgium. Culture influences how an epidemic affects society, in terms of its origin, mode of spread and treatment, as well as responses to distress and health practices. Cultural responses to the pandemic contribute to control or accelerate its spread, and even unite or divide certain sectors of society. Culture also influences the perception of medical interventions and thus the demand or not for help from health services. The varied cultural responses show the importance of culture in public health, especially in a crisis, and of understanding it to implement health measures. Finally, in the depths of the first pandemic wave, the collaborative experience of gathering expressions of cultural influence in the pandemic created a sense of connection within the human system of a generation of early career psychiatrists across the globe, which helped cope with the traumatic potential of the pandemic as a factor of isolation and withdrawal, through challenges of respective professional contexts. © 2023 Boeck Universite. All rights reserved.

Delivery of Comprehensive Medication Management and Other Clinical Services via Telehealth by Pharmacy Type.

BACKGROUND: The recent coronavirus pandemic accelerated the need to deliver pharmacy-related services remotely. OBJECTIVE: To describe experiences with providing comprehensive medication management (CMM) and other clinical services via telehealth by pharmacy type, before and during the COVID-19 pandemic. METHODS: An online survey of pharmacists, representing 27 pharmacies, was conducted to capture telehealth usage in three pharmacy types: independently owned, integrated into a clinical setting, and retail chain. A sub-analysis was performed to assess if providing CMM services via telehealth helped, resulted in no change, or worsened the care of different patient groups (e.g., those with diabetes, were low-income, aged 65+ years). RESULTS: During the pandemic, telehealth usage among independently owned pharmacies and those integrated into a clinical setting increased, but no change occurred among retail chain pharmacies. This usage increase in the first two pharmacy types occurred despite limited investments in connectivity-related resources to support telehealth services. Pharmacists from both independently owned pharmacies (63%) and those integrated into a clinical setting (89%) reported CMM via telehealth reached patients they would not otherwise have been able to reach during the pandemic. Most pharmacists/pharmacies found telehealth to be a feasible and acceptable method of delivering CMM. CONCLUSION: Pharmacists and pharmacies are now experienced with and have interest in continuing CMM via telehealth, even as the pandemic recedes. However, investments in telecommunications resources, training support, technical assistance, and continued telehealth reimbursement from health plans are needed to sustain this service delivery model.

Transitioning to Telehealth during COVID-19: Experiences and Insights from Diabetes Prevention and Management Program Providers in Los Angeles County

The onset of the COVID-19 pandemic in March 2020 accelerated the efforts of several organizations providing the National Diabetes Prevention Program (National DPP) and the Diabetes Self-Management Education and Support (DSMES) program to rapidly transition from in-person service delivery to program administration via telehealth. Semi-structured interviews were conducted with 35 National DPP and DSMES experts and providers in Los Angeles County to gain a better understanding of the challenges and benefits associated with this transition. Interviews were completed during June to October 2021. Thematic analyses were performed using the Social-Ecological Model as a guiding framework. The analyses revealed several factors that influenced the transition, including at the individual (e.g., technology and health behaviors), interpersonal (e.g., social connections and support), organizational (e.g., provider workload and program enrollment and retention), community (e.g., recruitment), and policy (e.g., government support and reimbursement for telehealth services) levels. Findings suggest that the transition to telehealth was challenging for most National DPP and DSMES providers. However, because of its lower cost, ability to reach long distances virtually, and potential efficiency when employed as part of a hybrid approach, this delivery modality remains viable, offering benefits beyond the traditional program models.

Psychiatry training goes virtual: the experience of the first online edition of the EPA Research Summer School

Introduction: The European Psychiatric Association (EPA) Summer School allows psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19, the 10th edition in 2021 focused for the first time on research and was conducted remotely. Objective(s): To provide an overview and feedback about the first Virtual EPA Research Summer School as a new way to encourage international networking during COVID-19. Method(s): The School was organized by the EPA Secretary for Education, and 4 Faculty members. It started with a breaking the ice session one week before and then a two-days meeting on 23-24 September 2021 using an online video-platform. This was preceded by all the 21 participants (from 18 different countries) recording a short 4-minute video presentation, which was uploaded and shared with other participants and Faculty. Result(s): Participants were divided on a voluntary basis into three working groups: 1) Drug repurposing: overcoming challenges in pharmacoepidemiology 2) Psychopathological research in psychiatry;3) How to conduct a cross-sectional survey?. The Summer School program was composed of plenary sessions with lectures by the Faculty members, discussion sessions, and working groups time. At the end, each group presented a summary of the work done to the rest of the participants. Conclusion(s): Although the remote format limits social interactions during the Summer School, overall participants' high satisfaction and productivity indicate that not only online formats, but also the topic of research might be covered in future editions.

Vaccine hesitancy: the Grenada experience

Objective: Vaccine hesitancy became a global issue of public health importance following vaccine introduction for SARS-CoV-2 in early 2021. Here, we present the everchanging reasons for vaccine hesitancy in a Small Island Developing State which has an enviably high childhood vaccination rate for other vaccinatable infectious diseases. Design and Methods: Longitudinal data on the stated objections to vaccination were recorded from individuals living in all 6 parishes of Grenada from the introductions of vaccines to the country in February 2021 until mid-February 2022. Result(s): The expressed unwillingness to be vaccinated arose initially from a distrust of the speed of the production of vaccines, then the perceived blood clot risks from the AstraZeneca vaccine and numerous other factors including fear of needles, potential sterility, and a mistrust in the short and long term benefits of the vaccine. A second COVID-19 wave occurred in December which recorded approximately an equal number of vaccinated and unvaccinated individuals becoming infected, which increased hesitancy. Increased vaccine uptake was observed when vaccines were expiring, with the introduction of vaccine choices, and vaccine mandates for entering restaurants, employment, and latterly, travel regulations. Conclusion(s): Despite being one of the first countries to receive vaccines, Grenada has recorded one of the lowest vaccine uptake rates in the region. The complex issues and lessons learned from frontline workers have shown that vaccine hesitancy in Grenada is multifactorial and constantly evolving. The key findings in this study can inform and help develop targeted public health measures regarding vaccination.

10th EPA Summer School on Research 2021: sharing experience of the first online edition

The European Psychiatric Association (EPA) Summer School is an intensive program which has been organised for 10 years now by the EPA Committee on Education and allows selected psychiatric trainees and early career psychiatrists (ECPs) from all over Europe to meet, network, and learn together. After the 2020 edition being cancelled due to COVID-19 pandemic, the 2021 edition was held online and continued the EPA educational mission in an innovative and up-to-date approach. Twenty one participants from 16 different countries were selected to attend by the EPA Committee on Education. During the two full days of training, participants were engaged in fundamental educational activities by renowned faculty members such as Dr. Cécile Hanon, Dr. Nicolas Hoertel, Dr. Mariana Pinto da Costa, Prof. Andrea Raballo, Prof. Norman Sartorius and Prof. Peter Falkai. This was the first time EPA Summer School centered its topic on Research in Psychiatry, giving a unique opportunity for ECPs and psychiatric trainees to enrich their knowledge and skills and to find inspiration for their future research. In this paper, we intend to share our experience and provide a perspective on what we have learned during the EPA Summer School sessions. Copyright © 2022 John Libbey Eurotext. L’université d’été de l’Association européenne de psychiatrie (EPA) est un programme intensif organisé depuis 10 ans par le Comité de l’éducation de l’EPA et permet à des stagiaires en psychiatrie et à des psychiatres en début de carrière (ECP) sélectionnés dans toute l’Europe de se rencontrer, de créer des réseaux et d’apprendre ensemble. Après l’annulation de l’édition 2020 en raison de la pandémie de Covid-19, l’édition 2021 s’est tenue en ligne et a poursuivi la mission éducative de l’EPA dans une approche innovante et actualisée. Vingt-et-un participants de 16 pays différents ont été sélectionnés par le comité d’éducation de l’EPA. Pendant les deux jours de formation, les participants ont participé à des activités éducatives fondamentales dispensées par des professeurs renommés tels que le Dr Cécile Hanon, le Dr Nicolas Hoertel, le Dr Mariana Pinto da Costa, le Pr Andrea Raballo, le Pr Norman Sartorius et le Pr Peter Falkai. C’était la première fois que l’école d’été de l’EPA centrait son sujet sur la recherche en psychiatrie, donnant ainsi une occasion unique aux ECP et aux stagiaires en psychiatrie d’enrichir leurs connaissances et leurs compétences et de trouver une inspiration pour leurs futures recherches. Dans cet article, nous avons l’intention de partager notre expérience et de fournir une perspective sur ce que nous avons appris pendant les sessions de l’école d’été de l’EPA. © 2022 John Libbey Eurotext. All rights reserved.

Original Mixed Methods Research Experiences, Service Needs, and Impacts of Workplace Safety and Insurance Board (WSIB) processes on injured and ill workers: evidence from the city and district of Thunder Bay (Ontario, Canada)

Introduction: Individuals experience negative physical, social and psychological ramifications when they are hurt or become ill at work. Ontarios Workplace Safety and Insurance Board (WSIB) is intended to mitigate these effects, yet the WSIB process can be difficult. Supports for injured workers can be fragmented and scarce, especially in underserved areas. We describe the experiences and mental health needs of injured and ill Northwestern Ontario workers in the WSIB process, in order to promote system improvements. Methods: Community-recruited injured and ill workers (n=40) from Thunder Bay and District completed an online survey about their mental health, social service and legal system needs while involved with WSIB. Additional Northwestern Ontario injured and ill workers (n=16) and community service providers experienced with WSIB processes (n=8) completed interviews addressing similar themes. Results: Northwestern Ontario workers described the impacts of workplace injury and illness on their professional, family, financial and social functioning, and on their physical and mental health. Many also reported incremental negative impacts of the WSIB processes themselves, including regional issues such as "small town" privacy concerns and the cost burden of travel required by the WSIB, especially during COVID-19. Workers and service providers suggested streamlining and explicating WSIB processes, increasing WSIB continuity of care, and region-specific actions such as improving access to regional support services through arms-length navigators. Conclusion: Northwestern Ontario workers experienced negative effects from workplace injuries and illness and the WSIB process itself. Stakeholders can use these findings to improve processes and outcomes for injured and ill workers, with special considerations for the North.

Analyse des prescriptions d'antibiotiques associées à une infection à SARS-CoV2 en médecine générale dans 4 pays d'europe durant la première et deuxième vague de la pandémie Covid 19 à partir d'un logiciel de prescription

Introduction La pandémie de SARS-CoV 2 a entrainé une augmentation importante des consultations pour symptômes respiratoires, avec une antibiothérapie probabiliste prescripte en ville devant des tableaux de pneumopathies aigues bilatérales. Durant la première vague peu de patients ont bénificié d'un diagnostic virologique par Rt PCR contrairement à la deuxième vague où l'ensemble des cas suspects ont pu être documentés. L'objectif de l'étude est d'identifier les différences dans la pratique de prescription dans une cohorte de médecins généralistes de quatre pays européens et d'établir l'évolution de la prescription d'antibiotiques associée au diagnostic d'infection à SARS-CoV 2 entre la vague 1 (mars-avril 2020) et 2 (novembre-décembre 2020) de Covid 19 dans deux pays Matériels et méthodes Ont été inclus les médecins généralistes de France (FR), Belgique (BE), Roumanie (RO) et Royaume Uni(RU), utilisant le logiciel de prescription cegedim et réalisant au moins 1000 consultations annuelles. Ceux ayant réalisés moins de 100 ou plus de 3000 consultations par vague ont été exclus. Les données ont été recueillies via le logiciel de prescription, et la fréquence et types d'antibiotique prescrits dans le cadre d'un diagnostic d'infection à SARS-CoV2 ont été analysés pour les deux vagues (FR et RU) ou la vague 2 uniquement (RO et BE) Résultats Parmi les 9162 médecins généralistes inclus, 3694 (40 %) ont retenu au moins une fois le diagnostic d'infection à SARS-CoV2 dont 3440 n avait pas de critères d'exclusion.Parmi eux 1902 (55,2 %) ont prescrit au moins une fois des antibiotiques en association avec un diagnostic de Covid 19. Nous notons une légère diminution du taux moyen d'initiation d'antibiotiques entre vague 1 et vague 2 avec (1384/11594 prescriptions)11,9 %vs 10,4 % (3220/30668)(FR) ; mais pas au RU 19,1 % (243/1271) puis 20.04 % (171/853). Trois antibiotiques (azythromycine (AZ), amoxicilline (AMX) et amoxicilline-acide clavulanique (AMC) formaient la majorité des prescriptions avec des différences significatives entre les 4 pays durant la vague 2. Ainsi la proportion d'AZ était de(2309/3220) 71,7 % (FR),0.5 % (1/171)(RU), 77,2,%(642/831)(RO) et 54,7 % (29/53) (BE). Celle d'AMX representait 9,4 % (305/3220) (FR), 76,0 % (130/171)(RU), 0,7 % (6/830)(RO) et5,6 % (3/53)(BE). Finalement la proportion d'AMC representait (201/3220) 6,24 % (FR), 4,1 %(7/171) (RU), 6,8 %(57/830)(RO) et 26,4 %(14/53) (BE). en ce qui concerne l'évolution du type d'antibiothérapie on note une augmentation significative du taux d"AZ entre vagues 1 et 2 pour la France (42 % (585/1384) vs 71,7 % (2309/3220)), avec dimintion du taux d'AMC (27 %(374/1384) vs 6,4 % (201/3220), alors qu'on ne retrouve pas de difference au RU. Conclusion il existe une hétérogénéité significative dans les modalités de prescriptions d'antibiotiques chez les médecins généralistes des 4 pays étudiés, notamment en terme de fréquence globale de prescription et du choix des molécules. On note également une modification du choix des molécules entre la vague 1 et 2 en FR mais pas au RU Aucun lien d'intérêt

Infection nosocomiale et clusters intra hospitalier d'infection à SARS cov 2 dans un centre hospitalier Général : Bilan d'une année de pandémie

Introduction La mise à disposition large des tests PCR SARS cov2 et la stratégie de dépistage systématique autour d'un cas a permis de mettre en évidence la survenue de transmissions croisées entrainant des infections nosocomiales au sein des services de soins. Un cluster est défini par la présence d'au moins 3 cas dans un service de soins dans un délai de 14 jours. L'objectif de l'étude est de définir le nombre de cas d'infection nosocomiale et de phénomène de cluster hospitalier aux décours de la 2ème et 3ème vague d'infection à SARS cov 2 dans un centre hospitalier Général. Matériels et méthodes Etude rétrospective des infections nosocomiales et des clusters intra hospitalier entre avril 2020 et avril 2021 L'infection nosocomiale est définie par la négativité d'une PCR d'entrée et la positivité d'une PCR à plus de 7 jours de l'entrée. Un cluster est défini par au moins trois cas d'infection nosocomiale dans une même unité de lieux et de temps (14jours). La deuxième vague comprend les cas identifiés entre les mois d'octobre et décembre 2020 et janvier avril 2021 pour la troisième. Résultats Quatre mille deux cents cinq PCR positives ont été détectées entre avril 2020 et avril 2021. Le nombre covid nosocomiaux était de 123 des 1654 patients hospitalisés (7.4 %) et ayant un diagnostic virologique d'infection à SARScov2. Cent onze (79 %) des cas nosocomiaux étaient liés à des clusters. Durant la deuxième vague, 14 clusters ont été détectés dans 8 services différents (moyenne de 5 patients par épisodes avec au minimum 3 et au maximum 18 patients par cluster). Pendant la troisième vague, 4 clusters ont été identifiés dans 4 services. La durée moyenne de résolution des clusters a été de 14 jours. Les clusters ont été détectés pour 58 cas (47 %)en secteur médecine chirurgie obstétrique et pour 65 (53 %) cas en secteur soins de suite et rééducation. La moyenne d'âge des cas nosocomiaux était de 83 ans, 85,37 % présentaient au moins une comorbidité et la mortalité a été de 22,76 % contre 19 % pour les cas communautaire (Xhi2 = 1.03 NS). Conclusion L'acquisition nosocomiale du virus SARS cov 2 a été est un phénomène bien réel entrainant une surmortalité en milieu hospitalier. Ces données patients permettent de justifier les mesures spécifiques comme la vaccination précoce et obligatoire des personnels soignants et des patients à risque, un renforcement des mesures d'hygiène et un contrôle des visites. Aucun lien d'intérêt

The Associations Between Access to Recreational Facilities and Adherence to the American Heart Association's Physical Activity Guidelines in US Adults.

Physical activity decreases the risk of long-term health consequences including cardiac diseases. According to the American Health Association (AHA), adults should perform at least 75 min of vigorous physical activity (PA) or 150 min of moderate PA per week to impact long-term health. Results of previous studies are varied and have yet to integrate perceived access to facilities with AHA PA guidelines. We investigated whether access to free or low-cost recreational facilities was associated with meeting the AHA PA guidelines. Methodology: This cross-sectional study utilized data extracted from the Family Life, Activity, Sun, Health, and Eating (FLASHE) database collected in 2017 (n = 1,750). The main exposure variable was access to free or low-cost recreational facilities. The main outcome variable was meeting the AHA guidelines of 150 min moderate PA or 75 min vigorous PA per week. Covariates included age, sex, level of education, overall health, BMI, ethnicity, hours of work per week, income, and time living at current address. Unadjusted and adjusted logistic regression analysis were used to calculate measures of odds ratio (OR) and corresponding 95% confidence interval (CI). Results: Of the 1,750 included participants, 61.7% (n = 1,079) reported to have access to recreational facilities. Of those with access to facilities, 69.9% met AHA PA guidelines while 30.4% did not. After adjusting for covariates, participants who reported access to recreational facilities were 42% more likely to meet AHA PA guidelines compared with participants who did not (adjusted OR 1.42; 95% CI 1.14-1.76). Secondary results suggest that healthier individuals were more likely to have met AHA PA guidelines. Conclusions: Having access to free or low-cost recreational facilities such as parks, walking trails, bike paths and courts was associated with meeting the AHA PA guidelines. Increasing prevalence and awareness of neighborhood recreational facilities could assist in access to these facilities and increase the ability of individuals to meet AHA PA guidelines. Future research should determine which types of recreational facilities impact physical activity strongest and discover methods of increasing their awareness.

Support the frontliners - Good initiatives during the COVID-19 pandemic for healthcare workers across the world: Is this what we really need?

Healthcare workers have faced an unprecedented workload in overstretched health facilities during the COVID-19 pandemic, and we describe various initiatives to support them. Psychological, financial and peer support, accommodation and meal services, proper personal protective equipment, applause and gratitude in the community, spiritual and religious life, child care and volunteering were identified. The potential effects of the COVID-19 pandemic - permanent stress, burnout and other mental health problems among healthcare professionals - can be expected to grow. Continued monitoring is essential to bolster resilience among healthcare workers and prevent the possible consequences for their mental health. Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

Perceived Health Impact and Usage of Public Green Spaces in Brussels' Metropolitan Area During the COVID-19 Epidemic

To fight the COVID-19 epidemic, many countries implemented containment measures that made physical distancing the norm and imposed restrictions on the use of public space. In countries where access to public green spaces (PGSs) was safeguarded, they were expected to partially counterbalance the negative health outcomes of these containment measures, as they offered a unique opportunity to meet others, to avoid isolation, and to move, play and relax at a safe distance. Research on PGS use and its objective association with health during the COVID-19 epidemic is rather limited and is based on quantitative research methodologies. Such methodologies are useful to detect objective associations between PGS use and health or between COVID-19 and PGS use, but fall short in explaining the observed associations. This qualitative research filled this gap by examining how PGS users perceived the health advantages of PGSs and how the use of PGSs changed during the epidemic in the Brussels-Capital Region, Belgium. In total, 23 individual face-to-face in-depth interviews were conducted in various PGSs. We found that while PGSs were initially perceived as a possible threat to health in the first period of the epidemic, they gradually became associated in users' minds with both improved physical and mental health. Although the mechanisms behind this association were also present prior to the epidemic, they became more tangible and more universal. We also found that the use of PGSs changed during the epidemic due to measures and restrictions and due to health risk perceptions. We distinguished five different health risk perception profiles in relation to COVID-19: the denier, the fatalist, the negotiator, the conformer and the worrier. These different health risk perceptions impacted on the use of and behaviour within PGSs. This research confirms the importance of PGSs during an epidemic and may inspire further research, offer pointers to policymakers for developing and implementing strategies related to the use of PGSs during epidemics, and assist them in providing available and accessible PGSs and in designing attractive, more epidemic-proof PGSs.

Neuro-Ophthalmic Literature Review

Greater attenuation of retinal atrophy may occur after 12 months of rituximab treatment, following which time GCIPL atrophy rates are similar to those observed among natalizumab-treated patients with RRMS and HCs. I Xiaojun Zhang i Visuomotor performance as the proxy of training-related function recovery in patients with mu... Lipp I, Foster C, Stickland R, Sgarlata E, Tallantyre EC, Davidson AE, Robertson NP, Jones DK, Wise RG, Tomassini V. Predictors of training-related improvement in visuomotor performance in patients with multiple sclerosis: A behavioural and MRI study. I Michael S. Vaphiades i Modulation of retinal atrophy with rituximab in multiple sclerosis Lambe J, Risher H, Filippatou AG, Murphy OC, Sotirchos ES, Ehrhardt H, Ogbuokiri E, Pellegrini N, Toliver B, Luciano NJ, Davis S, Fioravante N, Kwakyi O, Prince JL, Calabresi PA, Fitzgerald KC, Saidha S. Modulation of Retinal Atrophy With Rituximab in Multiple Sclerosis. This study conducted by a British multidisciplinary group of researchers chose visuo-motor performance as the proxy of functional recovery of multiple sclerosis (MS) patients after undergoing a 4-weeks homebased training session, combing demographic with baseline clinical features and magnetic resonance imaging (MRI) measures to predict function recovery of MS patients. [Extracted from the article] Copyright of Neuro-Ophthalmology is the property of Taylor & Francis Ltd 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 abstract 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 abstract. (Copyright applies to all Abstracts.)

NCI Awardee Skills Development Consortium (NASDC): Applicant profiles

Background: In 2020, the NCI funded a new educational consortium, NASDC (NCI Awardee Skills Development Consortium, RFA-CA-19-010 and -011), through four institutionally granted UE5 awards to deliver a specific course each and a U24 award as a Coordinating Center. The goal is to teach current early-career faculty NCI grantees skills in areas critical for successful independent academic cancer research careers. Courses focus on leadership and socioemotional skills, health disparities, immuno-oncology, and cell and gene therapy. Teaching will initially be virtual, given the COVID pandemic. Methods: A steering committee and four working groups were established to build the consortium infrastructure, including the NASDC (osu.edu) website. Clientele are early-career faculty PD/PI of a current NCI-funded grant (K01, K07, K08, K22, K23, K25, R00, R21, DP1, DP2, DP5, R01, R23, R29, R37, R56, RF1, RL1, U01), of whom 454 were directly contacted. Blast emails and social media were also used. We are reporting the characteristics of 154 applicants, who completed the RedCap application online. Results: 85% of the applicants are within the first 5 years of a faculty appointment, 87% at the assistant professor rank, and 65% on tenure track. 40% hold an M.D. degree and 72% a Ph.D. 81% are US citizens, 52% females, and 45/33/16/2/4%-11% are White/Asian/Black/Native Americans/Other-Hispanics/Latino. 76% work at NCI-designated comprehensive cancer centers. Mean protected research time is 80%. Nonmutually exclusive fields of research interest are therapeutics (46%), basic science (37%), disparities (34%) prevention (32%), public health (28%), and pediatrics (10%). 66% have received a K-award grant, 13% each an R21 or R00, and 3% an R01. Additionally, 35% had a second NCI grant as PI, 10% a third grant, and 60% had non-NCI grants. Reasons for applying included (1) not quite ready to lead a research team (42%), (2) need for stronger career mentoring (37%), and (3) not being fully confident in research skills (21%). Conclusions: Applicants to the new NCI educational consortium (NASDC) have a successful start to their academic career with a third having obtained more than one NCI award. Most applicants work at NCI-designated comprehensive cancer centers. As cancer research continues to evolve and has the potential to address critical health care needs of the nation, NASDC will strive to equip scientists to be leaders, teach advances in technology, and impart confidence in research skills.

Promotion de la vaccination anti SARS Cov 2 dans des secteurs à risque : modalités et impact d’une intervention en milieu sanitaire pénitentiaire

Introduction Le milieu carcéral est à haut risque de transmission du SARScov2. Les équipes sanitaires y travaillant ont un faible taux d’adhésion à la vaccination. L’objectif de l’étude est d’évaluer l’impact d’un programme de promotion de la vaccination anti SARScov2. Matériels et méthodes Évaluation des freins à la vaccination par audit qualitatifs collectifs et individuels par deux médecins infectiologues intervenant dans deux unité de soins pénitentiaire en Ile de France. La première phase de l’intervention évaluait le nombre de vaccinés, de volontaires à la vaccination et de personnels ayant été infectés par le Covid-19. La deuxième phase a comporté quatre axes de communication : Premièrement réunion d’information collectives avec questions réponses en fin de présentation dans les locaux de l’unité sanitaire. Deuxièmement, une consultation personnalisée d’infectiologie, ciblée pour les réfractaires à la vaccination. Troisièmement, la remise d’une procédure formalisée, simplifié, avec un numéro de téléphone de rendez-vous de vaccination. Un mois plus tard, un rapport de retour d’expérience a été réalisé par le chef de service de l’unité sanitaire. Résultats Le 16/02/2021, à la première phase de l’audit, zéro des 88 personnels était vacciné, zéro des 88 n’avait entrepris de démarche pour se faire vacciner, 4(4,5 %) étaient volontaires « au bon moment », aucun ne se définissait comme anti vaccin et 3(3,4 %) avaient contracté le Covid-19. Au moment de l’entretien collectif : 27(30,5 %) membres du personnel étaient prévus et présent. Les principaux freins à la vaccination par ordre décroissant de fréquence étaient : « L’absence de recul chronologique suffisant », « Ne pas servir de cobayes », « la peur d’effets secondaires graves », « L’absence de clarté des informations transmises », « La défiance envers la gestion de la crise par les autorités », et « La complexité parmi le choix des vaccins proposés ». Au bilan de fin d’intervention un mois plus tard, l’ensemble des 27 présents à la réunion étaient vaccinés, et au totale 84(95,4 %) des personnels était vacciné selon le parcours de soins spécifiques proposé. Trois avaient une contre-indication temporaire, et 1 resta réfractaire malgré la consultation individuelle. Conclusion Les actions structurées de promotion de la vaccination prenant en compte les spécificités des personnels sanitaires en milieu carcéral peuvent permettre une couverture vaccinale très satisfaisante. Il est nécessaire de promouvoir des stratégies de « aller vers » pour des cibles vaccinales spécifique.

Psychological impact of the SARS-CoV-2 outbreak on the staff of a French hospital.

Background: The outbreak of SARS-CoV-2 has resulted in anxiety, depression and post-traumatic stress disorder (PTSD) among hospital staff. The factors associated with this psychological impact remain to be determined. Methods: A cross-sectional study using an online questionnaire completed by the staff of a French hospital, two months after the SARS-CoV-2 outbreak. Results: Among the 353 participants (of whom 67% were healthcare professionals), 32% had symptoms of anxiety, 16% of depression and 16% of PTSD. Eleven per cent had initiated or increased treatment with sleeping pills, and 6% with anxiolytics. In a multivariate analysis, factors independently associated with anxiety were: change of professional team, having a relative infected by SARS-CoV-2 and a new/increased treatment with sleeping pills or anxiolytics. The only factor associated with depression was the feeling of risk during professional practice. The factors associated with PTSD were: having a relative infected by SARS-CoV-2, the feeling of risk during professional practice, the increase in smoking and treatment with sleeping pills. The observance of transmission preventive measures (TPM) was not associated with the psychological impact of SARS-CoV-2. A personal history of SARS-CoV-2 infection and age < 36 years were associated with insufficient use of protective equipment. Age < 36 years, and being a healthcare professional were associated with the non-observance of social distancing. Conclusion: The hospital staff displayed psychological consequences, resulting in the use of anxiolytics and sleeping pills. Belonging to a group with low-risk of severe disease was associated with lower observance of TPM.

Unintended Consequences of the Pandemic: Rapid Development of an Intensivist led Venovenous-Extracorpeal Membrane Oxygenation Cannulation Program

Objective: Veno-venous extracorporeal membrane oxygenation (ECMO) provides support for patients with severe acute respiratory failure. Previous literature shows safety of an medical intensivist-led cannulation in a structured program. Due to the COVID-19 pandemic, this implementation model required rapid acceleration due to risk of healthcare worker infection and limited resources. The objective of this study is to review the safety of a rapidly deployed intensivist-led cannulation program. Design: A retrospective review of 15 subjects undergoing percutaneous cannulation for veno-venous extracorporeal membrane oxygenation. Setting: Adult ICU at a tertiary academic medical institution. Patients: Critically ill adult subjects with severe respiratory failure undergoing percutaneous cannulation for veno-venous extracorporeal membrane oxygenation. Interventions: Percutaneous extracorporeal membrane oxygenation. Measurements and Results: Subject demographics, support type, cannulation configuration, imaging modalities, and complications were recorded. Thirty attempted cannulations with cannula sizes from 18-31F were performed by seven intensivists in 15 subjects. All were venovenous ECMO including femoral-femoral (6.6%), IJ-femoral (80%), and dual lumen (13.3%) configuration. Pre-insertion and intra-procedural vascular ultrasound was performed in all subjects. Fluoroscopy was not used in any patients. Transesophageal echocardiography was utilized in 4/15 (26.6%) patients. Success rate for cannulation attempts was 93.3% (28/30). No major complications occurred. One of the 30 cannulations required surgical assistance. Fourteen cannulations were done in 9 weeks. 64.2% (9/14) patients survived to hospital discharge with one patient currently on VV ECMO support. Conclusions: Percutaneous cannulation for veno-venous ECMO by medical intensivists can be rapidly implemented and performed with a high rate of success and low rate of complications.