A psychological needs analysis of individuals with LongCovid

Introduction: Long-Covid is the continuation of broad and debilitating symptoms 4 weeks post-Coronavirus Disease 2019 onset. Our Long-Covid clinic provides holistic care to this population. It includes a variety of professionals but no in-clinic psychological intervention. The clinic requested a psychological needs analysis to inform the development of such intervention. Aim(s): To conduct a psychological needs analysis for the Long-Covid clinic population. Method(s): In addition to routine outcomes: anxiety, depression, and posttraumatic stress disorder (PTSD;GAD-7, PHQ-9, PCL-5), individuals completed the brief Illness Perceptions Questionnaire (b-IPQ). We conducted correlational and regression analyses to identify an interventional target. Result(s): We collected data in August-October 2021 (n=47, mean age=51.3, 32% male). GAD-7 and PCL-5 showed mild anxiety and PTSD (n=37, mean=7.8(6.8);n=37, mean=11.0(19.3)), PHQ-9 showed moderate depression (n=37, mean=11.0(6.9). Individuals reported low treatment control and low illness coherence (Table 1). PHQ-9 significantly correlated with GAD-7, PCL-5, timeline, and emotional representations. 84.5% of the variance of PHQ-9, (F5, 15)=22.8, p<0.001 was explained by our regression model. Three variables were statistically significant, (GAD-7, beta=0.48;PCL-5, beta=0.36;timeline, beta=0.36). Conclusion(s): The relationship between GAD-7, PCL-5, timeline, and PHQ-9 indicate an intervention for depression is warranted. We hypothesise it should also improve individuals' anxiety, PTSD, and illness perceptions.

Humoral and T- cell response to multiple COVID-19 booster vaccinations in people with MS

Introduction: People with multiple sclerosis (PwMS) treated with anti-CD20 therapies and fingolimod are less likely to successfully produce a humoral response to COVID-19 vaccines 1 and 2. Objective(s): To measure the humoral and/or cellular response to COVID-19 booster vaccinations in a cohort of PwMS who were previously seronegative after their initial COVID vaccine course. Aim(s): To determine whether there is a benefit of COVID-19 booster vaccinations for people with MS who are known to have had an attenuated response to initial vaccines. Method(s): We studied a cohort of PwMS all of whom were seronegative for anti-SARS-CoV-2 spike protein IgG after the 1st and 2nd COVID-19 vaccines, including PwMS treated with ocrelizumab (n=53), fingolimod (n=15), other DMTs (n=9) and no DMT (n=2). Dried blood spot +/- whole blood samples were obtained from participants at 2-8 weeks after their 3rd (n=79) and 4th (n=40) COVID-19 vaccines. Samples were used to measure anti-SARS-CoV-2 spike protein IgG (ELISA) and T-cell response (IFN-g release assay measured on whole blood). Result(s): Overall 27/79 (34%) who were seronegative after COVID vaccine 2 seroconverted after vaccine 3. Seroconversion rates were 17% for PwMS treated with ocrelizumab, 47% for fingolimod and 100% for other DMTs. A further 2/30 (7%) of those who remained seronegative after vaccine 3 seroconverted after vaccine 4. Anti-SARS-CoV-2 T-cell responses were measurable in 26/40 (65%) after vaccine 3 and 13/19 (68%) after vaccine 4 but were conspicuously absent in people treated with fingolimod. Overall, 75% of participants showed either humoral or cellular response after receiving 4 COVID vaccinations. PwMS with laboratory evidence of prior COVID-19 infection had higher measurable T-cell responses. Conclusion(s): Booster vaccinations for COVID-19 are associated with incremental benefits in measurable immunity in those with attenuated responses to the initial vaccine course. Overall, three quarters of those who were seronegative after COVID vaccines 1 & 2 had a measurable immune response after COVID vaccine 4. This data supports the use of booster vaccinations in pwMS at risk of attenuated vaccine response.

Multiple sclerosis and COVID-19: Assessing risk perception, patient behaviors and access to disease-modifying therapies.

BACKGROUND: Following the outbreak of COVID-19, global healthcare systems have had to rapidly adapt. People with multiple sclerosis (pwMS) were required to make decisions about their individual risk and consequent work and social behaviors. This study aimed to evaluate risk perception and patterns of shielding behavior amongst pwMS at the onset of the COVID-19 pandemic and the subsequent impact on patients' employment and access to disease modifying therapies (DMTs). METHODS: Postal surveys were sent to 1690 people within a UK population-based MS cohort during the first wave of the COVID-19 pandemic. Patients were surveyed on: (i) perceived vulnerability to COVID-19; (ii) isolation behavior; (iii) interruption to DMT; (iv) employment status; (v) level of satisfaction with their current working arrangement. RESULTS: Responses were received from 1000 pwMS. Two thirds of patients reported isolating at home during the first wave of the pandemic. This behavior was associated with increased age (p<0.0001), higher disability (p<0.0001) and use of high-efficacy DMTs (p = 0.02). The majority of patients reported feeling vulnerable (82%) with perceived vulnerability associated with higher EDSS (p<0.0001) and receiving a high-efficacy DMT (p = 0.04). Clinician-defined risk was associated with shielding behavior, with those at high-risk more likely to self-isolate/shield (p<0.0001). Patients on high-efficacy DMTs were more likely to have an interruption to their treatment (50%) during the first wave of the pandemic. Most pwMS experienced a change to their working environment, and most were satisfied with the adjustments. CONCLUSION: This study highlights the risk perception, social behavioral practices and changes to treatment experienced by pwMS during the first wave of the COVID-19 pandemic in a large, well-described UK cohort. The results may help inform management of pwMS during future pandemic waves.

Neuroscience emergencies simulation teaching

Objectives: Simulation sessions were designed and introduced into the Cardiff University Clinical Neurosciences placement for 4th-year medical students. We present our approach to delivering these simulation sessions, student feedback and our recent experience in the context of the COVID19 pandemic. Design: Three emergency clinical neuroscience simulation scenarios were designed, aimed at final phase (Year 4-5) medical students. Subjects: Final phase (Year 4-5) medical students. Methods: The sessions are delivered weekly during the academic year by the Clinical Neurosciences teaching fellows at The University Hospital of Wales, (UHW) to groups of sixeight students. Student pairs work through each scenario in a high-fidelity simulation suite under the guidance of the tutor. Observing students remain engaged through participation as patient relatives or medical colleagues. Upon completion, learners are debriefed using the Pendleton Model for feedback/reflection, and anonymised feedback is then collected. Results: One year of collated feedback revealed that 90% (109/122) of respondents strongly stated that the sessions were enjoyable, achieved the desired learning outcomes, and advanced their clinical knowledge. One hundred percent of respondents (122/122) agreed that the sessions improved their confidence at managing medical emergencies. Due to the COVID19 pandemic, session modifications included: a larger simulation suite to facilitate social distancing;procurement of appropriate personal-protective-equipment, and a reduction in session size, (<6 students) offset by higher session frequency. Conclusions: Simulation sessions provide a safe, structured environment in which learners can gain confidence managing emergencies. Feedback confirms that our sessions achieve these goals for most students. The possibility of further restrictions on students' exposure to patients remains high due to rising medical student numbers and potential COVID19 resurgences. There may thus be a need to expand the volume and scope of these simulations to cover more scenarios and broader learning outcomes, to ensure future students gain necessary skills and confidence to manage neurological emergencies.

Promoting workforce planning as a means of embedding a learning culture in the rail sector

Reliable intelligence lies at the heart of learning societies. Robust, accessible evidence of current and future skills needs informs policy and planning, helps target investment, improves the quality of education and training, and encourages dialogue and action among stakeholders. Change is continuous and inevitable, but systematic and comprehensive approaches to gathering and using intelligence are essential tools if sectors, communities, and economies are to learn, adapt, and thrive. This chapter discusses how an innovative skills intelligence model designed by the National Academy for Rail in the United Kingdom has been applied to develop a workforce planning strategy for the rail sector. This has enabled the sector to build a continuous learning and training approach that underpins its safe operation, contributes to improved productivity and profitability, and helps to anticipate the impact of potential disruption, including from new technology, demographic trends, and global pandemics. © The Author(s) 2021.

Patient and caregiver perspectives on telehealth in kidney transplantation

Aim: To describe the patient and caregiver experience of telehealth during the COVID-19 pandemic. Background: From March 2020, because of the COVID-19 pandemic, many nephrology clinics had to adopt telehealth to manage kidney transplantation recipients. However, the potential benefits and risks regarding the quality of care from the patient perspective are uncertain. Methods: Five online focus groups were conducted via Zoom with 35 transplant recipients (51% female) across Australia who had experienced at least one telehealth appointment. Transcripts were thematically analysed. Results: Focus group participants were mainly white (74%), female (51%), on average had their transplant for 5 years and were in the age group of 41-50 years old. We identified 4 themes: minimising burden (convenient and easy, reducing exposure to risk, limiting disruption to work, alleviating financial burden);attuning to individual context (dependant on stability of health, respect patient choice of receiving care, environmental distraction);protecting personal connection and trust (requires established rapport with clinicians, missed incidental interactions with healthcare team, reassurance of adequate follow up, loss of opportunities to meet patients);empowerment and readiness (taking on more responsibility for health, needing reassurance and confirmation of information, mental preparedness for appointments). Conclusion: Patients suggested that the option of telehealth should be available, even after the pandemic, and that it should be provide by a trusted nephrologist whom rapport was already established. This information could be used to inform policy about the implementation of telehealth to be offered as a part of main-stream post-transplant care.