Social connectedness for socially withdrawn and vulnerable young people's well-being: A qualitative study

Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. A key focus investigated young people's attitudes and experiences of social connection, and how they perceived this to be related to their mental health and future recovery needs. Method(s): Semi-structured interviews were completed with 16 young people (aged 20 to 25) with pre-existing and complex mental health and social problems, between January to December 2021. N = 6 completed follow up interviews approximately 6 months after their initial interview. Interviews were analysed using thematic analysis. Results and Conclusion(s): Four themes were identified. These centred around a preference for balancing solitude and quality relationships within small social worlds, the complex role of in-person versus online connection and interaction, how the COVID-19 lockdowns were a facilitator of both social connection and disconnection, and the importance of relationships, talking and being listened to for well-being. The findings suggest that in-person, and to some extent online connection, is a key component of well-being, and is an active recovery goal that socially withdrawn young people with complex pre-existing mental health problems would like to work on.

The mediating role of social connectedness and hope in the relationship between group membership continuity and mental health problems for vulnerable young people

Aims: The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic. Following the 'social cure' theory, this study aimed to investigate the association, and potential mechanisms, of group membership continuity and reducing mental ill-health amongst vulnerable young people. Method(s): Cross-sectional survey data from a sample of 105 young people aged 16-35, collected approximately 1 year after the global COVID-19 outbreak (January-July 2021). Correlational and path analyses were used to test the associations between group membership continuity and mental health problems (depression, anxiety, psychotic-like experiences), and the mediation of these associations by hope and social connectedness (in-person and online). Results and Conclusion(s): Prior multiple group memberships were associated with the preservation of group memberships during the COVID-19 pandemic. In-person social connectedness, online social connectedness and hope mediated the relationship between group membership continuity and mental health problem symptoms. The results suggest that clinical and public health practice should support vulnerable young people to foster and maintain their social group memberships, hopefulness and perceived sense of social connectedness as a means to potentially help prevent exacerbated symptoms and promote recovery of mental health problems, particularly during significant life events.

Hope and social connectedness as intervention targets in youth mental health

The DisCOVery study sought to better understand the experiences of young people with complex emerging mental health problems over the longer-term social restrictions related to the COVID-19 pandemic Quantitative findings (N = 105) will be shared to demonstrated how belonging to multiple social groups can promote better mental health through the provision of hopefulness and social connectedness. Qualitative findings (N = 16) will be shared to elucidate how young people with complex emerging mental health problems experienced social connectedness during the ongoing social restrictions, and how they perceive social connection to be associated with their well-being Results also indicate young people's social preferences and the complex role of in-person versus online connection and interaction. A brief summary will be given regarding a linked trial (TOGETHER), evaluating the feasibility of delivering a social connectedness-focused intervention for young people with emerging complex mental health problems across clinical and community services in the UK.

Young people with complex emerging mental health problems: Packages of care and peri-pandemic experiences

The PRODIGY trial found that for young people with complex emerging mental health problems in the UK (N = 270), Social Recovery Therapy did not confer additional benefits above and beyond treatment as usual. Treatment as usual in the trial was, however, surprisingly comprehensive. A study was conducted to evaluate the provision of 'packages' of standard youth mental health care, and the association of provision with trial outcomes. In a subsequent study individuals who participated in the PRODIGY trial (N = 13) were interviewed about their experiences during the COVID-19 pandemic. The restrictions imposed by the COVID-19 pandemic have had significant and wide-ranging impacts on young people due to social isolation, disruption to education and employment opportunities, and young people with pre-existing mental health difficulties were considered to have been disproportionality affected. The results of this study indicated a reciprocal relationship between participants' mental health and their response to the pandemic. Participants told stories of both how the pandemic exacerbated their difficulties, but equally told stories of how their long-standing experiences of managing adversity supported them to cope during pandemic-related social restrictions.

EBUS audit: assessing the diagnostic performance of the service at UHL

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an important diagnostic procedure in the lung cancer pathway. False-negative or inadequate sampling can lead to inaccurate staging or delay in diagnosis. This study was conducted to assess the performance of the Cancer EBUS service at a tertiary hospital. Method(s): We conducted a retrospective analysis of patients who underwent EBUS-TBNA for suspected cancer between 1st June 2021 to 31st May 2022. Request forms, CT reports, EBUS reports and pathology reports were reviewed for analysis. Result(s): 205 EBUS-TBNA procedures were performed. All patients had an appropriate staging CT prior to procedure. The mean time to test was 10.5 days (7.4). 77 (38%) had tests within 7 days of request. 293 lymph nodes and 10 mass lesions were sampled. The mean time to pathological results being received was 2.9 days (1.8). Final histology showed 39 (19%) cases of lung adenocarcinomas, 3 (1%) lung non-small cell carcinomas, 25 (12%) lung squamous cell carcinomas, 25 (12%) small cell cancers, 4 (2%) lung NOS, 3 (1%) pulmonary carcinoid, 2 (1%) lymphoma, 12 (6%) other cancers, 12 granulomata and 1 thyroid tissue (6%). 43 (21%) cases showed lymphoid tissue and 28 (14%) were reported as inadequate. No samples were taken in 8 cases (4%). Adequate tissue for predictive marker testing was available in 93% (66) of cases of non-small cell lung cancer (NSCLC). Complications were encountered in 9 cases (4%). Only 3 cases (1.5%) required any form of intervention. [Figure presented] Conclusion(s): Our data provides assurance of safety while also highlighting specific areas for attention regarding performance and time to test that can be addressed and our sensitivity was comparable to national standards. The increased waiting times may be partly related to COVID-19 precautions and will require reauditing at a later date. Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

S6 Timing of pneumothorax post-CT-guided thoracic biopsy in a tertiary referral centre: implications for the ambulatory pneumothorax pathway

S6 Table 1Study population characteristicsn % Total number of procedures 641 - Male 371 57.9% Female 270 42.1% Median age (years) 71.0 - Lesion site RUL 177 27.61% RML 22 3.43% RLL 109 17.00% LUL 151 23.56% LLL 104 16.22% Anterior mediastinal 29 4.52% Pleural 40 6.24% Chest wall 9 1.40% Median lesion size (mm) 41 - Total pneumothorax incidence 223 34.8% Timing of pneumothorax T = 0 hours 186 83.41% T = 0-2 hours 37 16.59% T = 2 hours - 7 days 0 0.00% Pneumothorax management(% of n=223) Conservative 144 64.57% Aspiration 47 21.08% Chest drain 31 13.90% Pleural vent 1 0.45% Total pneumothorax needing intervention (% of n=223) 79 35.43% Immediate pneumothorax management (% of n=186) Conservative 111 59.68% Aspiration 46 24.73% Chest drain 28 15.05% Pleural vent 1 0.54% Immediate pneumothorax needing intervention (% of n=186) 75 33.63% Delayed pneumothorax management (% of n=37) Conservative 33 89.19% Aspiration 1 2.70% Chest drain 3 8.11% Pleural vent 0 0.00% Delayed pneumothorax needing intervention (% of n=37) 4 10.81% ConclusionsThis study demonstrates that the incidence of delayed-onset pneumothorax requiring intervention is low in a tertiary centre setting. The optimal time for patient observation post-CTGB remains unknown. The authors acknowledge a high incidence of pneumothorax in the study cohort, which they postulate may be due to a higher volume of complex procedures in a tertiary setting, higher sensitivity of CT for reporting trivial post-biopsy pneumothorax, and the diversion of more complex lung cancer patients to the CTGB route during the COVID pandemic to avoid aerosol-generating procedures.ReferenceHeerink WJ, de Bock GH, de Jonge GJ, Groen HJ, Vliegenthart R, Oudkerk M. Complication rates of CT-guided transthoracic lung biopsy: meta-analysis. Eur Radiol 2017;Jan;27(1):138–148.

An analysis of wait times for bronchoscopy Referrals during the covid-19 pandemic in a Tertiary care centre

The COVID-19 pandemic has reshaped the structure of healthcare provision. Bronchoscopy is an essential diagnostic tool for investigating patients with malignant and non-malignant respiratory diseases, but is an aerosol generating procedure. In our centre, essential endoscopic services continued during the COVID-19 pandemic, with several measures to ensure patient and staff safety. Aim We aimed to identify whether there was a significant delay in access to flexible bronchoscopy (FB) and endobronchial ultrasound (EBUS) for urgent cases during the COVID-19 pandemic. Method We reviewed the numbers of procedures and wait time from referral to endoscopy for three periods: Three months prior to the COVID-19 pandemic (December 2019-February 2020), three months during the 'peak' COVID-19 pandemic (March-May 2020) and during the 'recovery' period (June-mid August 2020). Data was analysed with ANOVA and chi-square tests for statistical significance. Results 532 patients underwent FB or EBUS from December 2019-August 2020 (table 1). There was a significant reduction in total and FB procedures during the peak pandemic which has persisted during the recovery period. When comparing pre-COVID months to COVID peak, there was no significant difference in wait for total endoscopy procedures (p=0.8442) or EBUS (p=0.0624), respectively. There was a significant increase in wait for FB (p£0.001). There was an improved wait time for total endoscopy procedures and EBUS after June 2020 (p£0.001 for both). Discussion The COVID-19 pandemic resulted in a significant reduction in the total numbers of FB and EBUS procedures performed but did not result in a significant increase in waiting time for procedure. The prioritization of cancer services over alternative indications for bronchoscopies is the most likely explanation for this difference in numbers performed. The patient-related consequences of these changed diagnostic pathways is unclear. The introduction of mandatory COVID-19 swabbing on the 29th April did not lead to significant delays. Our review demonstrates that it is possible to maintain rapid-access bronchoscopy services in the height of the COVID-19 pandemic.

Maintenance of bronchoscopy services during the covid-19 pandemic: Experience from a Tertiary care centre

Bronchoscopy is an aerosol-generating procedure (AGP) and the COVID-19 pandemic has necessitated changes in provision of our service. This retrospective analysis reviews our institutional response to maintaining safe and efficient bronchoscopy services throughout the COVID-19 pandemic. Aim To analyse changes in numbers of and indications for flexible bronchoscopy (FB) and endobronchial ultrasound (EBUS) between December 2019-August 2020, and the mitigating measures introduced by our centre to keep the service operating. Method Data was pulled from our procedure database for the three months pre-COVID-19 (December 2019-February 2020), the COVID peak (March to May 2020) and the 'recovery' phase (June-mid August 2020). Patient records were analysed for the indication for procedure and diagnosis. Cancelled procedures and research bronchoscopies were excluded. Results 433 procedures were undertaken during the study period. Figure 1 shows the number of endoscopic procedures by indication and procedure type. There was an overall decrease in procedures during the pandemic, with predominantly EBUS cancer procedures being undertaken. The number of cancer cases performed across all three periods was comparable. Pre-procedure COVID swabs became mandatory in our institution from 29th April 2020. Of 167 cases, two were postponed (1 positive test and 1 febrile patient on procedure day). No patients were cancelled during pre-procedural telephone COVID-19 screening. Discussion Bronchoscopy procedures declined during the COVID-19 pandemic. However, our service maintained 4 lists per week during the peak with reinstatement of six lists during the COVID-endemic period. Bronchoscopy training was maintained with all lists having an assigned trainee. AGPrelated air exchange protocols limited the number of procedures per list and elective procedures were postponed early in the pandemic. Our centre had a proactive approach to running the service, introducing mandatory pre-procedure COVID swabbing early together with telephone screening pre-BTS guidance. Staff safety was prioritised via universal use of powered airpurifying respiratory (PAPR) use which eliminated the need for mask-fit testing and seeking FFP3 mask availability. It is feasible to maintain a safe and efficient bronchoscopy service in the midst of a pandemic with the implementation of appropriate pathways and provision of adequate personal protective equipment.

'Pleural triage' facilitates effective Management of a pleural service in the covid-19 era

Aims The COVID-19 pandemic has created new challenges for management of pleural diseases. Pleural patients can be highly vulnerable to infection and often have conditions for which treatment cannot be safely delayed. We reviewed our pleural service to implement changes that allowed maintenance of a service whilst maximising patient and staff safety. Method Establishment of a Pleural Triage MDT meeting 48 hrs prior to pleural clinic to review all referrals and stream patients to i) telephone consultation only, ii) remote CXR (24 hrs pre-clinic) plus telephone consultation iii) face-to-face (F2F) review or iv) direct to a procedure. We reviewed case numbers post lockdown for March-August 2020 and compared to 2019. Results During the COVID pandemic outpatient pleural management was implemented where possible, including adaptation of our ambulatory pneumothorax pathway to comply with COVID-19 recommendations. March-August 2019 there were 293 F2F pleural consultations. March-August 2020 there were 408 consultations [103 telephone only, 168 remote CXR + telephone consult (11 declined) and 123 F2F (3 declined)]. The 14 declines had telephone consults only. Previously all these patients would have been F2F. COVID-19 symptom screening occurred if attending for CXR/F2F. F2F consults were held in designated outpatient areas with access to CXR and procedure rooms, with timings to maintain social distancing. Where required, definitive pleural intervention was undertaken on the same visit. Direct-to-procedure pathways for thoracoscopy or IPC were implemented with COVID-testing 48 hrs prior. Patients with malignant effusions were counselled on management options and uptake of day-case IPC increased [March-August 2020 vs 2019 IPC = 44 vs 35] compared to elective admission for drain and talc pleurodesis. During the April 2020 COVID peak there were 12 admissions for chest drain vs 50 in April 2019. The pleural/cancer themed ward was designated a COVID-negative area for inpatients. Conclusion In the ever-changing situation of a global pandemic it is possible to successfully implement changes to maintain and enhance the safety and efficiency of pleural services, with selected changes likely to remain post-pandemic. Further evaluation of these changes over time could help to shape the future of pleural medicine.

P29 Maintenance of bronchoscopy services during the COVID-19 pandemic: Experience from a tertiary care centre

P29 Figure 1DiscussionBronchoscopy procedures declined during the COVID-19 pandemic. However, our service maintained 4 lists per week during the peak with reinstatement of six lists during the COVID-endemic period. Bronchoscopy training was maintained with all lists having an assigned trainee. AGP-related air exchange protocols limited the number of procedures per list and elective procedures were postponed early in the pandemic.Our centre had a proactive approach to running the service, introducing mandatory pre-procedure COVID swabbing early together with telephone screening pre-BTS guidance. Staff safety was prioritised via universal use of powered air-purifying respiratory (PAPR) use which eliminated the need for mask-fit testing and seeking FFP3 mask availability.It is feasible to maintain a safe and efficient bronchoscopy service in the midst of a pandemic with the implementation of appropriate pathways and provision of adequate personal protective equipment.

P30 An analysis of wait times for bronchoscopy referrals during the COVID-19 pandemic in a tertiary care centre

P30 Table 1December 2019-February 2020March – May 2020June – mid August 2020Number of procedures (n) Total257128147 FB1364758 EBUS1218189Mean wait (days) Total8.178.237.40FB6.767.946.83EBUS9.099.428.17DiscussionThe COVID-19 pandemic resulted in a significant reduction in the total numbers of FB and EBUS procedures performed but did not result in a significant increase in waiting time for procedure. The prioritization of cancer services over alternative indications for bronchoscopies is the most likely explanation for this difference in numbers performed. The patient-related consequences of these changed diagnostic pathways is unclear. The introduction of mandatory COVID-19 swabbing on the 29th April did not lead to significant delays.Our review demonstrates that it is possible to maintain rapid-access bronchoscopy services in the height of the COVID-19 pandemic.

P26 ‘Pleural Triage’ facilitates effective management of a pleural service in the COVID-19 era

P26 Figure 1ConclusionIn the ever-changing situation of a global pandemic it is possible to successfully implement changes to maintain and enhance the safety and efficiency of pleural services, with selected changes likely to remain post-pandemic. Further evaluation of these changes over time could help to shape the future of pleural medicine.ReferenceGuidance on pleural services during the COVID-19 pandemic;https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/