Risk of COVID-19 infection in long-term survivors of blood or marrow transplantation: a BMTSS report.

There is limited information regarding COVID-19 in long-term blood or marrow transplant (BMT) survivors. We leveraged the BMT Survivor Study (BMTSS) to address this gap. BMTSS included patients who underwent BMT at 1 of 3 sites in the United States between 1974 and 2014 and survived ≥2 years after BMT. A sibling cohort serves as a non-BMT comparison group. Participants (2430 BMT survivors; 780 non-BMT participants) completed the BMTSS survey between October 2020 and November 2021 about COVID-19 testing, risk mitigation behaviors, morbidity, and health care use. Median age at BMT was 46 years (range, 0-78 years) and median follow-up since BMT was 14 years (6-46 years); 76% were non-Hispanic White, 54% had received allogeneic BMT. The risk of COVID-19 infection was comparable for BMT survivors vs non-BMT participants (15-month cumulative incidence, 6.5% vs 8.1%; adjusted odd ratio [aOR] = 0.93; 95% confidence interval [CI], 0.65-1.33; P = .68). Among survivors, being unemployed (aOR 1.90; 95% CI, 1.12-3.23; P = .02; reference: retired) increased the odds of infection; always wearing a mask in public was protective (aOR = 0.49; 95% CI, 0.31-0.77; P = .002; reference: not always masking). When compared with COVID-positive non-BMT participants, COVID-positive BMT survivors had higher odds of hospitalization (aOR = 2.23; 95% CI, 0.99-5.05; P = .05); however, the odds of emergency department visits were comparable (aOR = 1.60; 95% CI = 0.71-3.58; P = .25). COVID-19 infection status did not increase the odds of hospitalization among BMT survivors (aOR = 1.32; 95% CI = 0.89-1.95; P = .17) but did increase the odds of emergency department visits (aOR = 2.63; 95% CI, 1.74-3.98; P <.0001). These findings inform health care providers about the management of care for long-term BMT survivors during the ongoing pandemic.

Introduction of a novel telescopic pathway to streamline 2-week-wait suspected head and neck cancer referrals and improve efficiency: A prospective service evaluation.

OBJECTIVES: This study summarizes the introduction of a novel telescopic pathway, which streamlines 2-week-wait suspected head and neck cancer referrals to our unit, describes the logistics of the pathway, and analyzes referral numbers and outcomes. We also discuss wider issues surrounding remote assessment in head and neck cancer. METHODS: Data were collected prospectively between January and May 2021, capturing all 2-week-wait referrals to our unit following the introduction of a telescopic pathway which utilized a nurse-led clinic for nasendoscopic examination of selected patients and consultant-led remote assessment using store and forward technology. Information on referral numbers, waiting times and outcomes was recorded. RESULTS: Three hundred and forty (185 high risk, 155 low risk) patients entered the telescopic pathway with the remaining 74 patients seen on the conventional standard of care pathway. Cancer conversion rates were 17%, <1%, and 5.4% for the high-risk telescopic, low-risk telescopic and standard of care pathways respectively. No patients discharged from the telescopic pathway were re-referred within 3 months. Review capacity for endoscopic examination was higher per consultant on the telescopic pathway versus the standard of care (p = .01). CONCLUSION: A combination of risk stratification and asynchronous telescopic assessment shows promise for the management of suspected head and neck cancer referrals. Potential benefits include consultant-led care for all patients and enhanced documentation. Digital communication with patients may also assist with adherence to the new NHS 28-day diagnostic standard for cancer referrals. Ongoing data collection is required to assess how the pathway functions over a longer period. LEVEL OF EVIDENCE: 2c.

Piloting a New Curriculum: Guided At-Home Pediatric Regional Anesthesia Education Using a Portable Ultrasound.

Ultrasound-guided regional anesthesia is the standard of care for most regional blocks in pediatric anesthesiology.Training programs must educate physicians to perform regional blocks safely and efficiently. Hands-on learning with simulation and live models is the gold standard. The coronavirus disease 2019 (COVID-19) pandemic has greatly hampered our ability to safely hold in-person workshops. We describe an at-home, guided virtual workshop using portable ultrasound to safely continue experiential trainee education. The primary objective of this pilot virtual workshop was to develop an effective experiential learning program without the need for live child models. The main goal was to give trainees hands-on experience obtaining anatomical ultrasound images necessary for regional anesthesia blocks in a guided-virtual setting and to evaluate the effectiveness of skills acquisition. This workshop included two pediatric anesthesiology fellows and a pediatric anesthesiologist. Trainees were instructed on ultrasound-guided regional block acquisition. For two weeks, trainees acquired images/movies of regional block anatomy at home using their own children. Virtual video assistance was available. Trainees then used acquired images/movies to discuss needle and local anesthetic placement with a pediatric regional anesthesiologist. Trainees completed pre- and post-workshop surveys assessing attitudes, perceived educational efficacy, and procedural skill acquisition. The faculty member also assessed trainees' skills. The virtual workshop was successful. Trainees expressed successful active learning and increased comfort in performing regional blocks on live patients. They correctly identified relevant anatomy of acquired images/movies, as well as needle and local anesthetic placement at the time of debriefing. Faculty were pleased with trainees' initial performance of regional blocks. Adapting an in-person workshop to an at-home guided experience is a safe, feasible, and well-received method for anesthesiology trainees to obtain experiential learning of ultrasound-guided regional anesthesia. This facilitated at-home learning experience allows for hands-on skill practice while preventing exposure of child models to the hospital setting during a pandemic.