Five years of adjuvant chemotherapy in a tertiary oncology centre: outcomes and impact of GCSF on completion of treatment

Background: Patients with non-small cell lung cancer (NSCLC) treated with adjuvant vinorelbine-platinum chemotherapy experience neutropenia, which may lead to early termination of treatment. However, evidence suggests that survival is superior in patients who complete four cycles of chemotherapy [1]. Granulocyte colony stimulating factor (GCSF) prophylaxis is used to prevent neutropenia. During the COVID pandemic, the threshold for initiating prophylaxis was lowered to reduce need for hospital attendance with the concomitant risk of hospital-acquired infection [2]. We evaluated whether GCSF prophylaxis supported completion of chemotherapy in patients treated at St Bartholomew's Hospital. Method(s): Data was retrospectively collected on the 112 patients with NSCLC who received adjuvant vinorelbine-platinum chemotherapy (total 349 cycles) in the period Jan 2017- Jul 2022. GCSF prophylaxis was prescribed at physician discretion. chi2 tests were carried out using SPSS 28. Result(s): A significantly higher proportion of patients who received GCSF prophylaxis completed four cycles of chemotherapy (chi2=5.120, p=0.024). These patients also experienced a lower incidence of grade 3 or 4 neutropenia (chi2=6.801, p=0.009). Over 5 years, 2/112 (1.75%) patients died, both from neutropenic sepsis;neither of these patients received prophylactic GCSF. GCSF prophylaxis was not associated with increase in the incidence of thromboembolic events (chi2=1.462, p=0.442). Conclusion(s): GCSF is safe and effective as primary prophylaxis in NSCLC patients receiving adjuvant chemotherapy. Use of GCSF will reduce proportion of post-operative patients considered too high risk for chemotherapy due to concerns about neutropenia. Disclosure: No significant relationships. [Figure presented]Copyright © 2023 Elsevier B.V.

Longitudinal Assessment of Left Ventricular Function in Patients with Myopericarditis After mRNA COVID-19 Vaccination.

BACKGROUND: Multiple reports have described myopericarditis following mRNA COVID-19 vaccination. However, data on the persistence of subclinical myocardial injury assessed by left ventricular (LV) longitudinal strain (LVLS) is limited. OBJECTIVES: Our aim was to assess LV function longitudinally in our cohort of COVID-19 vaccine-related myopericarditis using ejection fraction (EF), fractional shortening (FS), LVLS, and diastolic parameters. METHODS: Retrospective, single-center review of demographic, laboratory, and management data was performed on 20 patients meeting diagnostic criteria for myopericarditis after mRNA COVID-19 vaccination. Echocardiographic images were obtained on initial presentation (time 0), at a median of 12 days (7.5, 18.5; time 1), and at a median of 44 days (29.5, 83.5; time 2). FS was calculated by M-mode, EF by 5/6 area-length methods, LVLS by utilization of TOMTEC software, and diastolic function by tissue Doppler. All parameters were compared across pairs of these time points using Wilcoxon signed-rank test. RESULTS: Our cohort consisted predominantly of adolescent males (85%) with mild presentation of myopericarditis. The median EF was 61.6% (54.6, 68.0), 63.8% (60.7, 68.3), 61.4% (60.1, 64.6) at times 0, 1, and 2, respectively. Upon initial presentation, 47% of our cohort had LVLS < -18%. The median LVLS was -18.6% (-16.9, -21.0) at time 0, -21.2% at time 1 (-19.4, -23.5) (p = 0.004) and -20.8% (-18.7, -21.7) at time 2 (p = 0.004, as compared to time 0). CONCLUSIONS: Though many of our patients had abnormal strain during acute illness, LVLS improved longitudinally, indicating myocardial recovery. LVLS can be used as marker of subclinical myocardial injury and risk stratification in this population.

EXPLORING PATIENTS AND FAMILIES EXPERIENCES OF SERVICE ADAPTATIONS IN THE CONTEXT OF COVID-19

Background In March 2020, care within hospices had to be dramatically altered to comply with COVID-19 government guidance. Some services at Dorothy House Hospice were rapidly suspended, others adapted due to safety restrictions. Frequently, the human touch, typically enshrined in hospice care, was replaced with virtual/remote connections including video (Zoom) and telephone calls. Aim To identify and understand the impact of communication changes on patients', clients' and families' experiences of Dorothy House Hospice in the context of COVID-19 and explore their future communication preferences. Method In July 2020 a postal survey was sent to all who had used Dorothy House Hospice services since March 2020. Using closed questions plus free text comments, the survey asked about people's experiences of services since March 2020 including levels of satisfaction with communication, difficulties encountered and preferences for future communication types. Data were analysed using frequency counts, with exemplar quotations extracted. Results Responses were received from 218 participants comprising: patients (62%), family/carers/friends (28%) and bereaved people (10%). 189 (87%) of respondents reported receiving the right amount of information despite service changes, and 185 (85%) were happy with the format of contact received. 172 (62%) respondents did not want to receive video calls in future, however, 71% (n=10) of respondents aged 18-44 were happy with this method, compared with 12% (n=18) aged 65+. Respondents reported minor technical difficulties with Zoom and regret at restrictions on face-toface interactions. Concerns surrounding privacy during remote consultations at home, and hearing difficulties, were occasionally raised. Conclusion The majority of responses were overwhelmingly positive;patients, clients and families were reassured and appreciative that they were still able to access Dorothy House Hospice services, albeit sometimes in alternative formats. Steps to improve online access and technical support/education are needed to support older service users to access services with confidence.

Study protocol: investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer.

BACKGROUND: Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC. METHODS: Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants' home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention. DISCUSSION: This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial. TRIAL REGISTRATION: Record not yet public.

Determining the appropriate use of Technology Enabled Care Services (TECS) to manage upper-limb trauma injuries during the COVID-19 pandemic: A multicentre retrospective observational study.

BACKGROUND: The COVID-19 pandemic created a unique opportunity to explore the use of Technology Enabled Care Services (TECS), which remains novel for many service providers. This study assesses the factors that affect adaptation to remote monitoring of patients after upper-limb trauma injury. A standardised risk-stratified screening tool is further developed here to support clinical staff in both the determination of appropriate use of TECS and the optimisation of patient care. OBJECTIVES: 1: To explore the patient and injury factors that determine the appropriate use of TECS for patients with upper-limb injury. 2: To use these findings to refine a standardised screening tool for the appropriate choice of follow-up format. METHODS: A retrospective review of patient management was undertaken across three NHS upper-limb trauma units during the first UK COVID-19 lockdown. Data were collected, and themes were analysed across a number of predetermined categories. This was underpinned by a review of contemporary policy guidance and literature. RESULTS: A total of 85% of patients were offered an appropriate format of follow-up; this was defined by the ability to achieve desired patient-clinician goals and lack of complications. Key factors in determining appropriate follow-up included extent of injury, mental health considerations, and the need for face-to-face (F2F) assessment and treatment. CONCLUSION: Study findings demonstrate consistency between units in the factors determining the appropriate use of TECS. The refined screening tool provides a risk-stratified, standardised approach to the choice of follow-up format, F2F or TECS. It is hoped that this will support future clinical decision-making processes to ensure optimal patient care.

Improving hepatocellular carcinoma screening in patients with cirrhosis

Introduction: Hepatocellular Carcinoma (HCC) is currently the 4th leading cause of death worldwide and the fastest growing cause of cancer-related deaths in the United States. This increase of incidence in HCC is largely due to the prevalence of Hepatitis B, Hepatitis C, alcoholic liver disease, as well as the surge in obesity-related fatty liver disease. The prognosis of patients diagnosed with HCC remains poor with a 5-year survival rate of 18%, largely due to late detection. Current screening guidelines recommend abdominal ultrasound every 6 months 1/- AFP, and bi-annual screening has been shown to reduce mortality by 37%. Dynamic contrast enhanced CT and MRI are alternatives with higher sensitivity but have never been studied looking at mortality. The goal of this study is to determine how the healthcare system is meeting the needs of these patients and find ways to provide better care for this population. Methods: Using tools within the Electronic Medical Record (EMR), we were able to determine that the number of patients in our community with diagnoses of cirrhosis and being up to date on HCC screening was 189/1123 (16.8%). Working with IT, we developed a Best Practice Advisory (BPA) to ”flag” these patients who have not undergone HCC screening within the past 6 months when seen by outpatient providers. When accepted, the order for abdominal ultrasound was automatically sent and associated with the corresponding diagnosis. Results: The project was initiated in January of 2020 but due to the COVID pandemic, the BPA did not “go live” until October 14th, 2020. At the 6-month mark, the data was analyzed and while the screening rates only increased to 18.2% (221/1213), the incidence of ultrasound usage increased 123% with no change in usage of CT or MRI. Most common causes for the BPA being bypassed were “Not addressed this visit” and “Follows with Gastroenterology.” Conclusion: As the burden of liver disease increases with the obesity epidemic and incidence of NASH, mortality from liver disease is expected to increase. How can we use EMR to continue to improve screening rates in these patients and identify areas of deficiency? We will continue to monitor efficacy of the BPA implemented, with future areas of focus being revamped patient education on hospital discharge, improved follow up, and identification of different socioeconomic barriers to patient care..

Non-invasive Low Cost Fever Detection Systems

with the current covid-19 pandemic ongoing, staying safe is o upmost importance. In being proactive, people everywhere are clothed in facial masks and gloves. Businesses and universities are conducting temperature checks in a multitude of methods such as thermal imaging, forehead, oral, and aural thermometer handguns. From our research, we discovered that the non-contact based devices available in the market today are quite expensive, ranging from $10k-$60k and would still require some close contact with the next individual. Our Artificial Intelligence and Visualizations (AiVi) team at North Carolina A&T State University aimed to create fever detection systems that would promote safer testing in regard to exposure to any viruses or illness one may carry, affordability, as well as equal or greater accuracy. For this research project, we designed, built, and programmed three devices, namely: (i) Aggie Arm, thermometer inspired device that reads temperature values from an individual's forehead when within range;(ii) Aggie Eye, a thermal imaging device that measures body temperature based on values gathered from the tear duct of the eye with higher accuracy;(iii) Aggie Talk, an intercom system coupled with the Aggie Eye to be integrated with existing k-12 school intercom systems.

Striving for balance: women entrepreneurs in Brazil, their multiple gendered roles and Covid-19

Purpose: This paper aims to explore how women entrepreneurs in Brazil are managing their businesses and gendered role expectations at home in the context of Covid-19. Using the lenses of business-family interface theoretical construct, the paper seeks to explain how women are navigating the business and family commitments in the pandemic context. Design/methodology/approach: This paper adopts the interpretivist approach using Gioia methodology and 13 individual semi-structured interviews with women entrepreneurs in Rio De Janeiro, Brazil. Findings: The findings demonstrate that women implement numerous strategies including reliance on social relationships within the family, and externally, to manage the home-business expectations. The findings also reveal entrepreneurial resilience and adaptability in the face of a crisis that marks how women entrepreneurs navigate challenges in their entrepreneurial journeys. Originality/value: This paper contributes to the gender and entrepreneurship literature by giving greater visibility to women entrepreneurs in developing society in the context of the pandemic. This paper also demonstrates how negotiating gender roles can empower women entrepreneurs to challenge gendered norms. © 2021, Emerald Publishing Limited.

Assessing the impact of coordinated COVID-19 exit strategies across Europe

As rates of new coronavirus disease 2019 (COVID-19) cases decline across Europe owing to nonpharmaceutical interventions such as social distancing policies and lockdown measures, countries require guidance on how to ease restrictions while minimizing the risk of resurgent outbreaks. We use mobility and case data to quantify how coordinated exit strategies could delay continental resurgence and limit community transmission of COVID-19. We find that a resurgent continental epidemic could occur as many as 5 weeks earlier when well-connected countries with stringent existing interventions end their interventions prematurely. Further, we find that appropriate coordination can greatly improve the likelihood of eliminating community transmission throughout Europe. In particular, synchronizing intermittent lockdowns across Europe means that half as many lockdown periods would be required to end continent-wide community transmission.

Clinical decision making in the provision of audiovisual care for upper limb trauma: a survey of UK experiences

Introduction: For many patients, audio-visual appointments have provided a timely and efficient way of seeking advice, assessment and treatment for their hand injuries during the NHS response to COVID-19. This study aimed to explore the experience of hand units across the UK in determining the safe and judicious use of audio-visual outpatient care for the management of acute upper limb trauma. Methods: An online cross-sectional survey was sent to the therapy leads of hand units across the UK. Questions focused on the experience of using audio-visual technology in the management of upper limb trauma, and the relevant factors in determining its appropriate use. A deductive mixed methods analysis was used to identify both common themes and capture community experience and characteristics. Results: A total of 51 out of 76 hand therapy units completed the survey;a response rate of 67%. Of these, 82% (42/51) reported using audio-visual technology to manage upper limb trauma during the UK COVID-19 lockdown. When determining patient suitability for audio-visual consultations, 73% (37/51) of respondents reported the use of COVID-19 guidelines, but only 35% (18/51) reported the use of a clinical decision-making tool. In agreement with our experience at Salisbury Hospital Foundation Trust, 92% (47/51) had concerns relating to the use of audio-visual care. Conclusion: The choice of safely managed remote care or in-person consultation has, to date, largely relied on the discretion of the clinician. A carefully designed clinical decision-making tool for the management of upper limb trauma is needed for use both in clinical practice and in future service planning.

Defining clinical decision making in the provision of audio-visual outpatient care for acute upper limb trauma services: A review of practice.

The Covid-19 pandemic has accelerated the widespread adoption of technology-enabled care in the NHS.1 Moving into phase two of the response, the continuing use of audio-visual technology is expected, where appropriate, to be integral in the provision of safe, quality patient care.2 A clinical need therefore exists to identify when care can be safely delivered remotely using audio-visual technology and when there is a need for in-person contact.  At Salisbury Foundation Trust (SFT), during phase one of the NHS response to Covid-19, the decision to treat upper limb trauma patients in-person or remotely was made using clinical screening criteria. For many patients, audio-visual appointments offered a practical, time efficient way of accessing their reconstructive team for assessment, advice and post-operative care. However, a subset of patients was identified by the team as requiring at least one in-person consultation to minimize perceived clinical risk and to optimize quality outcomes.  In order to understand more fully the challenges and successes of technology-enabled care to date, a national survey of practice across hand units in the UK was conducted. We present here some of our key findings and propose the need to develop nationally agreed screening criteria to determine how and when technology enabled outpatient care can be used in the management of acute upper limb trauma. The results of this survey forms part of a series of projects currently underway looking at the efficacy of audio-visual care in upper limb trauma, including a multicentre observational study.

Upskilling the surgical workforce for vascular access provision during the COVID-19 pandemic - The Salisbury experience.

A vascular access device is defined as a catheter inserted into veins allowing fluids and medicines to be delivered intravenously1. The need for such devices in acutely unwell patients has remained steady throughout the COVID-19 pandemic. We describe here our experience of up-skilling the resident plastic surgery and maxillofacial surgical registrars to provide a vascular access service to reduce the workload on our intensive care colleagues. We hope that our practice and an 'all hands on deck' approach to the utilisation of baseline skills within the existing workforce will inform other departments to help ease the burden on critical care departments as we progress through the next stages of the COVID-19 pandemic.