Should COVID-19 pandemic mitigations in the myeloma clinic continue? A summary of patient opinions

Introduction: The COVID-19 pandemic necessitated multiple changes to the format of myeloma clinics to minimise the risk of infection among patients and staff. These included changing in-person clinic appointments to telephone appointments when there was no medical need for face-to- face review and instituting a courier service for delivery of oral or self-administered medications. As COVID-19 restrictions relaxed, we sought to investigate the acceptability of these changes to our patients and to determine which, if any, of the new arrangements should continue. Method(s): Patients who attended the Myeloma Clinic at The Royal Marsden Hospital, both in-person and by telephone, on four separate dates in August and September 2022 were asked to complete a questionnaire to provide their opinions using a combination of multiple-choice, Likert scale and free-text questions. These covered the main domains of change outlined above along with questions about blood test location and attendance with family and friends. Result(s): Questionnaires were returned by 59 patients, 11 relating to in-person appointments and 48 to telephone appointments. 86.0% of patients were in favour of continuing the option of telephone appointments, with many highlighting their convenience and the avoidance of long travel and waiting times, with some also mentioning their COVID-19 security. However, a number of patients expressed concerns including communication difficulties, the inability to effectively assess physical health with an examination and a lack of reassurance. Furthermore, those who attended in-person appointments felt they were very COVID-secure, assigning them a mean of score of 4.5, where 1 was very insecure and 5 very secure. Several suggested that the optimum schedule would include regular telephone appointments with occasional in-person meetings. Interestingly, only 25.5% of patients wanted a video calling option. Patients were also very positive about receiving medications by courier, with 94.1% of patients receiving their medications within two working days of their clinic appointment. 81.8% of patients expressed a wish for this option to continue, highlighting the increased convenience and reduction in waiting times. Conclusion(s): These results suggest that changes made to the Myeloma Clinic in response to the COVID-19 pandemic have improved the patient experience. A mixture of telephone and in-person appointments may be preferable for this cohort of patients, many of whom require regular appointments for chemotherapy approval but are medically stable, and whose frailty makes long travel and waiting times challenging. These findings have implications for the planning of myeloma clinics across the UK.

How able did newly qualified teachers in England feel to support pupils' mental health in the late stages of COVID 19? A qualitative study of teacher perceptions

The prevalence of mental health problems in school children has grown, especially during the pandemic, detrimentally impacting the lives of those affected. In the UK, primary school teachers and schools are well-placed to spot and support pupil mental health. This preliminary research completed during the first part of the COVID-19 pandemic, addresses a gap in the literature to understand whether primary school teachers feel they have personal and professional resources to manage and support pupil mental health. Six recently qualified primary school teachers took part in semi-structured interviews. Thematic analysis of these data generated three themes (a) The impact of school on pupil mental health (b) Where does the expertise lie? and (c) School approaches to mental health. The themes show that teachers varied in how prepared they felt to support pupil mental health and this was related to a degree to the way in which their school approached mental health support. Our participants felt well-placed to support pupils' mental health but also concerned about their ability to do so. These findings and the suggestions for change from our participants have clear implications for how teachers can be better enabled to support pupil mental health during and beyond COVID-19.

Uncovering Hidden Media Framings in Generic Communication Competence Assessments: Is the Face-To-Face Context the Default Framing?

Dispositional communication competencies can be assessed in (a) a generic form that does not include any reference to a particular medium of interaction or in (b) a communication medium-specific version. To date, little is known about the specific media that individuals use as a reference and the weights they assign to them when responding to generic communication items - an important research gap because the use of diverse communication media has risen considerably during the COVID-19 pandemic. Based on media theories, two hypotheses were derived: Generic ratings contain a "hidden" face-to-face (FtF) communication framing that is dominant in the cognitive processing (media naturalness perspective) versus media are equally weighted in the mental aggregate of respondents (adaptation perspective). According to a preregistered study plan, generic and medium-specific communication items were assessed to investigate these hypotheses (referencing FtF, videoconferencing, chat, and e-mail interaction contexts). Training (n = 200) and test (n = 389) datasets were analyzed using latent variable modeling. Results indicated that generic ratings have a strong hidden FtF framing. These hidden framings impact the predictive power of the competencies to explain communication criteria (i.e. communication satisfaction). Exploratory analyses indicated that individual differences in media experience may affect the framings.

Four cases of acute comitant esotropia associated with diffuse intrinsic pontine glioma in children.

BACKGROUND: Acute acquired concomitant esotropia (AACE) is usually a benign form of strabismus that infrequently is associated with intracranial pathology. Clinicians have noted an increase in its incidence and theorize that it may be related to public health "lockdown" measures taken in response to the COVID-19 pandemic. With an increased incidence of AACE clinicians must firstly differentiate AACE from common accommodative esotropia and secondly recognize AACE as a possible sign of serious neuropathology.Diffuse Intrinsic Pontine Glioma (DIPG) is a devastating diagnosis for affected families. Children typically present at age 6-7 years with cranial nerve palsies, long tract signs, and/or cerebellar signs. Diagnosis is made from characteristic findings on magnetic resonance brain imaging (MRI brain) and treatment includes radiotherapy and palliative care. Two years from diagnosis, 90% of affected children will have died from their disease. CASE SERIES: We present four cases that attended our pediatric ophthalmology clinic with AACE either as a presenting sign of DIPG or as a clinical finding following a DIPG diagnosis. Patient A (age 5 years) presented to the emergency eye clinic with sudden onset diplopia and intermittent esotropia. Suppression later developed, they had 0.00 logMAR visual acuity either eye, and bilateral physiological hypermetropia. MRI brain imaging requested as a result of the unusual presentation led to the DIPG diagnosis. The other 3 cases (ages 11, 5 & 5 years) were assessed post DIPG diagnosis and found to have an esotropia measuring bigger on 1/3-meter fixation than 6-meter fixation, full ocular motility, physiological hypermetropia or emmetropia, and visual acuity normal for age. Other than patient B (age 11 years), who had papilledema and gaze evoked nystagmus when they were assessed 2 weeks prior to death, no patient had any other clinical eye findings. CONCLUSIONS: This small series of 4 patients attending our clinic within a 12-month period supports the notion that children presenting with AACE should routinely be offered brain MRI. Not all children with DIPG-associated AACE have significant ophthalmic findings indicative of intracranial pathology. With the potential for increased incidence of AACE related to lockdowns, clinicians should be reminded of the infrequent possibility their patient has a more serious condition.

P53 CPAP supply challenges to UK Sleep centres in 2022

BackgroundContinuous Positive Airway Pressure (CPAP) therapy is the standard treatment for patients with Obstructive Sleep Apnoea (OSA). Significant recent challenges have affected CPAP supply worldwide: increased CPAP demand, interrupted logistics during the COVID pandemic, worldwide Field Safety Notice (2021), plus CPAP component shortages.MethodsTo understand the issues around CPAP delivery and supply, the OSA Alliance sent an email survey to all UK-based Sleep Centres listed on the Sleep Apnoea Trust database in February and again in June 2022.ResultsWe received replies from 22 (February) and 15 (June) UK centres, with 8 centres represented in both surveys.91% (February) and 67% (June) of respondents confirmed ongoing CPAP machine supply shortages. In February, centres were receiving on average 50% usual delivery versus 73% in June. In June, centres described CPAP supply during the past 6 months as: improved 47%, worsened 47%, same in 6%. In free text comments, humidifier shortage was also mentioned by some.Patients on the waiting list for CPAP varied between UK centres from 0–400 (February) and 0–260 (June). All centres with CPAP shortages were using the BTS Clinical Risk Stratification.1In February, patients with high clinical priority according to the risk stratification requiring urgent CPAP therapy could start this quickly (1–2 weeks) in all centres, but the average wait time to start routine CPAP was 13 weeks (range 2 to 40 weeks). In June, the average wait for routine CPAP was 13.3 weeks (range 2–52 weeks). In both surveys, the majority of centres (86% February and 67% June) said delays were due to CPAP supply, not staff shortages.ConclusionsOngoing CPAP supply issues have led to self-reported sleep centre delays in treatment for patients with OSA. CPAP supply appears highly variable between centres, meaning centres have searched for alternative suppliers;a time consuming task with teams not being trained on the respective CPAP models. A humidifier shortage contributes to difficulties that may impact on CPAP adherence. Specific resource allocation towards CPAP provision for patients with OSA is required to address these issues and improve compliance NICE evidence-based therapeutic guidance in the UK.The authors have produced this abstract on behalf of the OSA Alliance, UK.Referencehttps://www.brit-thoracic.org.uk/news/2021/national-patient-safety-alert/

CREATION OF A VIRTUAL SPECIALIST OUTPATIENT CARDIOLOGY CLINIC FOR CORRECTIONAL FACILITIES IN AUSTRALIA

Background: The COVID-19 pandemic created unprecedented challenges to health care delivery. There was a need to transition to outpatient telehealth visits that involve distanced real-time interaction between patients and providers using audio and video capabilities without direct physical interaction. We co-designed a virtual cardiology clinic at our centre that services all correctional facilitates across New South Wales, which is Australia’s most populous state with a land mass bigger than Texas. Objective: We describe the creation of a virtual care specialist outpatient cardiology clinic for correctional services in NSW and assess the service delivery compared to the pre-COVID face-to-face clinics. Methods: Patients were triaged to in-person or virtual clinics via an online referral system. A co-ordinated approach between our centre and Justice Health and Forensic Mental Health, enabled streamlined access to referrals, patient clinical records, investigations and appointments, with future plans of a reciprocal EMR arrangement. The virtual clinic comprised of a clinician, Justice HealthCare Coordinator and an in-facility nurse. Consultations are performed via telehealth with audio and video capabilities, and real-time access to 12-lead electrocardiograms, blood results, medication and observation charts via the EMR portal. We retrospectively reviewed changes in clinic waiting lists, clinic utilisation and patient transfers pre and post implementation of the virtual clinic. Results: 30 clinics were performed with 127 appointments completed over a 6-month period, with 113 virtual and 14 face to face appointments, resulting in 113 patient transfers saved. The waiting list reduced from 66 to 0 with a 33% increase in clinic utilisation during the 6-month period. Conclusion: Implementation of a telehealth cardiology clinic for correctional services in NSW resulted in a reduction in our waiting list, reduced patient transfers and increased clinic utilisation.

Youth Perspectives on Life and Healthcare After Lung Transplant

Purpose: Adolescence is an inimitable stage of human development representing rapid musculoskeletal, social-emotional and neurocognitive growth. To grow and develop in optimal health, young people need information of relevance to support their engagement in meaningful healthcare and this is especially fundamental to outcomes associated with lung transplant in adolescence. Despite careful consideration of eligibility criteria prior to lung transplant, adolescent recipients have poorer overall length of survival when compared to other recipients. It is hypothesized, that healthcare systems which fail to incorporate developmental tenets of adolescence into their design and delivery may contribute to poor outcomes. The goal of this study was to explore the lived experiences of young lung transplant recipients aged 15-29 years and identify features of clinical care perceived as supportive and features perceived as lacking. What could the unique perspectives of recipients themselves add to a contemporary treatment paradigm to support targeted healthcare and address current morbidity statistics? Methods: This study is an exploratory qualitative design using photo elicitation of everyday activities and in-depth one-on-one semi structured interviews. Interviews were audio recorded and transcribed for thematic analysis using the qualitative data analysis software NVivo. A purposive sample of 16 lung transplant recipients, transplanted prior to 25 years of age was identified and recruited from a national database. Results: Themes that emerged from interviews included: general satisfaction with daily routines and lifestyle choices: challenges adjusting without support to medication and lifestyle needs;importance of communication and mutual respect throughout all stages of transplant;and the impact of COVID-19 upon daily life. Overall, young persons expressed satisfaction with the life they were living and healthcare processes experienced. Conclusion: Themes generated from this study reflect the voices of young people and their identification of the need for: developmentally targeted education;the importance of individuated and collaborative program delivery;and support to learn how to independently manage their own healthcare. In the delivery of effective healthcare, the voices of those for whom intervention is directed, are fundamental to engagement in their own care pathway.

Risk of COVID-19 in children treated for demyelinating disorders in the UK

Objective: Paediatric neurologists are concerned about the risk of COVID-19 in children with demyelinating disorders receiving immunomodulatory treatment. To investigate this, we collected data via the UK Childhood Neuro-Inflammatory Disorders (UK-CNID) network of the British Paediatric Neurology Association (BPNA). Methods: Survey of paediatric neurologists managing unvaccinated UK children (<18 years) with a demyelinating disorder (multiple sclerosis [MS];neuromyelitis optica spectrum disorder [NMOSD] and myelin oligodendrocyte glycoprotein antibody disease [MOGAD]) on immunomodulatory therapy with SARS-CoV-2 infection confirmed by reverse transcriptase-polymerase chain reaction (RT-PCR) of nasopharyngeal swabs between March and December 2020. Results: Of 151 UK children (MS 98, MOGAD 37, NMOSD 16) with a median age of 9 years (range 6-18y), with a demyelinating disorder, nine (6.0%) had a positive PCR for SARS-CoV-2. Five had MS and four MOGAD. Four were from south Asian or south-east Asian, four were White and one was mixed White and south Asian. Seven children had COVID-19 symptoms;two were asymptomatic. Two required a brief hospital admission for typical COVID-19 respiratory symptoms and the remaining five had mild symptoms including fever, rash, cough and headache. One with MOGAD, treated with azathioprine, developed transverse myelitis 12 days after COVID-19 onset. She recovered fully with a course of corticosteroids. MS patients were on following disease modifying therapies;dimethylfumarate (n=2), fingolimod (n=1);natalizumab (n=1) and ocrelizumab (n=1). MOGAD cases were on the following immune therapy: combination of oral prednisolone and intravenous immunoglobulin (n=2), prednisolone steroids (n=1) and azathioprine (n=1). Conclusions: In contrast to adult patients, who often have underlying co-morbidities and advanced neurological disabilities, we have identified that children treated for demyelinating disorders appear to have a milder COVID-19 course. Whilst the number of children treated for demyelinating disorders that developed COVID-19 is low, the overall mild course described may provide reassurance to neurologists, patients and family members.

Promoting older adults' physical activity and social well-being during COVID-19. (Special Issue: Leisure in the time of Covid-19.)

Staying healthy while following social distancing protocols is of great importance to older adults due to increased risk of serious complications from COVID-19. Mild to moderate physical activity improves immune system responses to viral respiratory infections. Additionally, social engagement has cumulative health protective benefits across the lifespan. At present, active and social recreation opportunities have been drastically reduced or disbanded due to group size limitations, stay-at-home orders, and reductions in services and facilities. As a result, community dwelling older adults are homebound and need alternative exercise and social opportunities to maintain their health during this time. Leisure professionals can promote physical activity and social well-being among older adults by increasing home-based opportunities, including offering additional online leisure services, opportunities for volunteerism, and social interactions.

Anti-MOG antibody associated demyelination masquerading as COVID-19 encephalopathy?

Introduction: Acute disseminated encephalomyelitis (ADEM) is a rare autoimmune disease involving inflammation of the brain and spinal cord, usually triggered by a preceding illness or vaccination. We describe a case triggered by SARSCoV-2. Case: A previously healthy 1 year old girl presented with reduced GCS, decorticate posturing, seizures and a 3-day history of fever. She required intubation, was started on intravenous antibiotics, Aciclovir and Levetiracetam and was transferred to PICU. PCR nasal swabs revealed the child was SARSCoV-2 and Adenovirus positive. CSF investigations were normal, including a negative SARSCoV-2 RNA. MRI brain showed bilateral widespread T2 and FLAIR signal changes of subcortical white matter and the splenium. Diffusion restriction with T2/FLAIR signal change was noted in the thalami and pons. This was initially felt to be in keeping with Covid-19 encephalopathy, especially given the presence of the splenial lesion. A spinal MR was normal. She made good progress with steroid therapy and at discharge, was able walk a few steps, recognise voices, clap at nursery rhymes, eat and drink normally, but had cortical visual impairment, which is improving. Her anti-MOG antibodies were later found to be positive, which explains the symmetrical scan changes and brainstem involvement. Discussion: In literature, there is a paucity of information regarding COVID-19 related encephalopathy. Lesions in the splenium of the corpus callosum appear to be a relatively consistent finding in children with PIMS-TS. Our child did not have any feature to suggest PIMS-TS. It is likely that SARSCoV-2 triggered off an inflammatory process in this child mediated by MOG antibodies. Conclusion: In the advent of the COVID-19 pandemic, it is important not to attribute clinical findings to SARSCov-2 without excluding other disorders. MOG antibody associated demyelination may mimic the findings described in COVID-19 encephalopathy.