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1.
mBio ; : e0317622, 2023.
Article in English | MEDLINE | ID: covidwho-2193471

ABSTRACT

The rapid spread and strong immune evasion of the SARS-CoV-2 Omicron subvariants has raised serious concerns for the global COVID-19 pandemic. These new variants exhibit generally reduced fusogenicity and increased endosomal entry pathway utilization compared to the ancestral D614G variant, the underlying mechanisms of which remain elusive. Here, we show that the C-terminal S1 mutations of the BA.1.1 subvariant, H655Y and T547K, critically govern the low fusogenicity of Omicron. Notably, H655Y also dictates the enhanced endosome entry pathway utilization. Mechanistically, T547K and H655Y likely stabilize the spike trimer conformation as suggested by increased molecular interactions in structural modeling and enhanced S1 shedding of their reversion mutants K547T and Y655H in viral producer cells. Importantly, the H655Y mutation also determines the low fusogenicity and enhanced dependence on the endosomal entry pathway of other Omicron subvariants, including BA.2, BA.2.12.1, BA.4/5, and BA.2.75. Together, these results uncover mechanisms governing Omicron subvariant entry and provide insights into altered Omicron tissue tropism and pathogenesis. IMPORTANCE Omicron has been shown to predominantly use the endosomal entry pathway, resulting in reduced lung tropism and reduced disease severity;however, the underlying mechanism is not fully understood. In addition, whether the most recent Omicron subvariants, including BA.5 and BA.2.75, use the same pathway as their ancestor for entry is currently not known. In this study, we show that T547K and H655Y mutations in the C terminus of the S1 subunit critically determine the enhanced dependence on the endosomal entry pathway as well as the reduced cell-cell fusion activity of Omicron BA.1, BA.1.1, and other subvariants. Further experiments and molecular modeling suggest that H655Y and K547T stabilize the spike trimer conformation, likely contributing to the decreased fusogenicity and endosomal entry. Our work uncovers novel mechanisms underlying the distinct entry pathway of Omicron subvariants and advances our understanding of their biological characteristics.

3.
Australian Journal Of General Practice ; 51:28, 2022.
Article in English | MEDLINE | ID: covidwho-2146361

ABSTRACT

The pathways developed in Moree, NSW, illustrate the importance and impact of community ownership and leadership for effective delivery of a public health intervention.

4.
United European Gastroenterology Journal ; 10(Supplement 8):469-470, 2022.
Article in English | EMBASE | ID: covidwho-2114896

ABSTRACT

Introduction: Pandemic restrictions delayed endoscopic Barrett's surveillance programmes with a risk of late or missed dysplasia and cancer diagnoses. We established a new Cytosponge service and surveillance pathway to address this risk and aid triage of patients to timely gastroscopy alongside gastroscopic assessment for higher risk patients. Aims & Methods: East and North Hertfordshire NHS Trust covers a population of 600,000 people. We have 700 patients on our Barrett's surveillance database.All patients due or overdue surveillance from November 2020 to January 2022 were offered Cytosponge instead of gastroscopy unless contraindicated, or previous history of Dysplasia or oesophageal cancer. Contraindications included strictures, varices and fundoplication - as such, patients with these conditions, as well as those declining or failing Cytosponge, were offered gastroscopy.TFF3 was used as a biomarker for intestinal metaplasia (IM). P53 positivity and atypia were biomarkers for potential dysplasia.33 patients were also included in the DELTA study. Result(s): 230 patients were included in the study.152 patients successfully swallowed Cytosponge with adequate cytology. 78 patients had gastroscopy as a primary surveillance method. Of the Cytosponge group, 115/152 (76%) patients had positive biomarkers - 97(64%) were solely TFF3 positive (suggesting non dysplastic Barrett's oesophagus). 18 (12%) had atypia and/or p53 positive (suggesting dysplasia). 37 (24%) were TFF3 negative and are described elsewhere. Confirmed dysplasia at endoscopy was found in 8/18 patients with atypia/p53 positivity on Cytosponge. 2 patients were found to have evidence of high grade dysplasia, 5 has evidence of low grade dysplasia, and one sample was 1indefinite for dysplasia.5% overall confirmed dysplasia. Of the gastroscopy group, 8/78 (10%) were found to have dysplasia, 2 patients had high grade dysplasia, 2 had low grade displasia and 4 were indefinite for dysplasia. In total, 16/230 (7%) had histologically confirmed dysplasia during the pandemic. Conclusion(s): We were able to prevent delayed Barrett's surveillance during the COVID-19 pandemic using Cytosponge in most patients and reduce unnecessary gastroscopy. Using a combination of Cytosponge in low risk and gastroscopy in higher risk patients for Barrett's surveillance during the pandemic allowed identification of dysplasia.Further stratification of risk using Barrett's length, Male sex and age have been identified from the recently reported DELTA study which may further improve dysplasia detection by identifying those in the Cytosponge group who need more frequent surveillance. Comparison with non-pandemic years going forward will also be important to evaluate this strategy.

6.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | Web of Science | ID: covidwho-2092432
7.
Public Health ; 213: 5-11, 2022 Oct 25.
Article in English | MEDLINE | ID: covidwho-2083185

ABSTRACT

OBJECTIVES: The COVID-19 pandemic highlighted the importance of routine syndromic surveillance of respiratory infections, specifically new cases of severe acute respiratory infection (SARI). This surveillance often relies on questionnaires carried out by research nurses or transcriptions of doctor's notes, but existing, routinely collected electronic healthcare data sets are increasingly being used for such surveillance. We investigated how patient diagnosis codes, recorded within such data sets, could be used to capture SARI trends in Scotland. STUDY DESIGN: We conducted a retrospective observational study using electronic healthcare data sets between 2017 and 2022. METHODS: Sensitive, specific and timely case definition (CDs) based on patient diagnosis codes contained within national registers in Scotland were proposed to identify SARI cases. Representativeness and sensitivity analyses were performed to assess how well SARI cases captured by each definition matched trends in historic influenza and SARS-CoV-2 data. RESULTS: All CDs accurately captured the peaks seen in laboratory-confirmed positive influenza and SARS-CoV-2 data, although the completeness of patient diagnosis records was discovered to vary widely. The timely CD provided the earliest detection of changes in SARI activity, whilst the sensitive CD provided insight into the burden and severity of SARI infections. CONCLUSIONS: A universal SARI surveillance system has been developed and demonstrated to accurately capture seasonal SARI trends. It can be used as an indicator of emerging secondary care burden of emerging SARI outbreaks. The system further strengthens Scotland's existing strategies for respiratory surveillance, and the methods described here can be applied within any country with suitable electronic patient records.

8.
International Journal of Stroke ; 17(2 Supplement):35-36, 2022.
Article in English | EMBASE | ID: covidwho-2064673

ABSTRACT

Background: The $21.7 million NSW Telestroke Service was a 2019 NSW Government election commitment. Implementation of the service is a collaboration between South Eastern Sydney Local Health District, the NSW Agency for Clinical Innovation, eHealth NSW and the NSW Ministry of Health. Between March 2020 and June 2022, the telestroke service launched at 23 sites across regional and rural NSW, providing access to specialist stroke physicians for rapid assessment, diagnosis and treatment through virtual care. The service has treated over 2200 patients with a reperfusion rate for acute ischaemic stroke patients of 34%. Aim(s): To understand the factors driving the successful implementation of a major project led by multiple health organisations in a complex environment. Interrogating and documenting the success factors will help NSW Health agencies implement similar large-scale, complex projects. Method(s): The implementation team adopted a reflective approach to draw out key lessons during the implementation at each site. Lessons learnt discussions were held at a local and program-wide level, focusing on areas including resourcing, leadership, education and training, and sustainability. Result(s): Key elements of successful implementation highlighted by the reflective lessons learnt approach include: * Division of responsibility that reflected the strengths of each partner agency * Clear implementation roadmap including comprehensive implementation and training packages * Flexibility to adapt the implementation approach based on contextual factors and intervening events * Strong executive support at each partner agency * Upfront focus on sustainability to identify and mitigate issues early on The telestroke service was implemented by the target schedule, despite the significant impacts caused by the COVID-19 pandemic and natural disasters. The service was a finalist in the 2021 NSW Premier's Awards. Conclusion(s): The implementation of telestroke can offer insights for partner agencies into the key factors driving success of transformative projects to improve access to healthcare.

9.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e459-e459, 2022.
Article in English | Academic Search Complete | ID: covidwho-2036116

ABSTRACT

Complementary and alternative medicine (CAM) use has been well-documented among cancer patients, with increasing public awareness of non-traditional treatments in the era of COVID-19. However, the temporal trends in usage at the patient level have not been well defined. We sought to characterize trends in what CAM interventions patients used before, during and after cancer treatment. An NCI-designated cancer center and a comprehensive cancer center prospectively enrolled adult cancer patients onto a cross-sectional survey assessing CAM use between 2020 and 2021. The survey evaluated perceptions and use of CAM, including vitamins/minerals, herbal supplements and alternative medicines, diets, and mind/body therapies. Types of CAM utilized were self-reported by use before, during and after primary cancer treatment. Differences in utilization were analyzed with two-proportion z-tests. Among 749 patients enrolled, 578 (77%) reported using CAM. Among CAM users, the most popular interventions used at some point included multivitamins (60%), vitamin D (58%), prayer (48%), vitamin C (35%), massage (33%), meditation (28%), fish oil (24%), probiotics (21%), turmeric (20%), CBD products (19%), chiropractic manipulation (17%), marijuana (16%) and vegetarian diet (12%). Vitamin use nearly universally declined over the before → during → after period, for example multivitamin (52% → 39% → 31%, p<0.01), vitamin D (37% → 42% → 30%, p<0.01), and calcium (21% → 24% → 15%), p<0.01). No vitamin consumption increased after treatment compared to before. Multiple herbal supplements increased during treatment but stayed higher than pre-treatment levels, including CBD (5.4% → 13% → 8.2%, p<0.01), marijuana (6.0% → 12% → 7.9%, p<0.01) and turmeric (9.1% → 13% → 9.3%). Many specialized diets were adopted during treatment but were not continued afterward, including vegetarian (5.4% → 8.3% → 5.5%), vegan (2.2% → 5.2% → 2.2%), ketogenic (3.3% → 4.3% → 2.6%), alkaline (1.2% → 3.6% → 1.9%) and raw food (0.9% → 1.4% → 0.3%). Mind/body intervention use also nearly universally decreased over the before to after period, such as chiropractic manipulation (16% → 7.4% → 5.9%, p<0.01), yoga (12% → 12% → 9.2%) or pilates (34.2% → 2.2% → 1.6%). Some increased during treatment but decreased after, like acupuncture (8.0% → 12% → 5.9%, p<0.01) or meditation (18% → 23% → 15%, p<0.01), with the largest decrease being in prayer (43% → 44% → 32%, p<0.01). Although CAM use is known to be common, the patterns of use before, during and after treatment have not been well-defined. Herbal supplements were the most likely to continue to be used after cancer treatment. General health maintenance, wellness and mind/body interventions largely decreased below pre-treatment levels after treatment, regardless of utilization during treatment. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

10.
International Journal of Radiation Oncology, Biology, Physics ; 114(3):e449-e449, 2022.
Article in English | Academic Search Complete | ID: covidwho-2036114

ABSTRACT

The use of complementary and alternative medicine (CAM) has been associated with detrimental effects on survival outcomes in cancer patients compared to standard of care medical interventions. CAM has received a significant increase in public awareness and interest in recent years. We sought to understand use patterns and perceptions in radiotherapy patients. Data was collected from a cross-sectional survey of prospectively enrolled adult cancer patients, conducted at an NCI-designated cancer center and a comprehensive cancer center between 2020 and 2021. Cancer patients who received or were recommended radiotherapy were selected for analysis and grouped by CAM use. CAM users analyzed were those reporting use of enteral and parental interventions, including alternative medicines, special diets and herbal, vitamin and mineral supplements, and excluding mind/body practices. Differences between CAM users and non-users were analyzed with χ2 and two-sample t-tests. Predictors of CAM use were identified with multivariable logistic regression. Of the 749 respondents, 445 (59%) received or were recommended radiotherapy. Of those 445, 297 (67%) used enteral or parenteral CAM. Among CAM users, 81% were satisfied and 77% felt CAM was effective for intended use. The most common goal of CAM therapy was symptom management (44%), although CAM use as a curative-intent treatment (31%) was common. Compared to non-users, CAM users were more likely to be female (76% vs 62%, p<0.01), have self-reported incurable disease (73% vs 62%, p=0.04), to feel CAM is safe (45% vs 9%, p<0.01), effective at curing cancer (26% vs 11%, p<0.01), effective at managing symptoms (42% vs 20%, p<0.01), more likely to trust naturopaths (33% vs 22%, p=0.02) or chiropractors (26% vs 15%, p=0.01), more likely since COVID-19 to have a more favorable view of CAM (79% vs 42%, p=0.01) or use CAM (61% vs 40%, p=0.04), but less likely to decline recommended surgery (7% vs 19%, p<0.01) or recommended radiotherapy (5% vs 11%, p=0.03). No differences were noted between CAM users and non-users in trust of physicians or any media. Predictors of enteral or parenteral CAM use included female gender (OR 1.4, p=0.04), breast cancer (OR 2.1, p=0.03), colon cancer (OR 3.5, p=0.01), and metastatic cancer (OR 2.2, p<0.01). The use of CAM is common among patients receiving or recommended radiotherapy, with nearly one-third of patients using CAM as a cancer cure. However, radiotherapy patients using CAM were less likely than non-users to decline other recommended therapies, dispelling the notion that CAM-users are more likely to eschew standard-of-care treatments, at least in this cohort. Understanding the patterns and perceptions of CAM use in radiotherapy patients is essential for improving patient-physician communication and treatment decision-making. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

11.
Pharmazeutische Zeitung ; 167(1):8-9, 2022.
Article in German | EMBASE | ID: covidwho-2006819
12.
Pharmazeutische Zeitung ; 167(10):40-41, 2022.
Article in German | EMBASE | ID: covidwho-2006818
13.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005722

ABSTRACT

Background: Complementary and alternative medicine (CAM) use has been associated with worse survival outcomes in cancer patients compared to standard of care therapies. CAM has received a significant increase in public awareness and interest in the COVID-19 pandemic era. We sought to understand how the COVID-19 pandemic affected CAM use and perceptions in cancer patients. Methods: Data was collected from adult cancer patients prospectively enrolled on a cross-sectional survey conducted at an NCI-designated cancer center and a comprehensive cancer center between 2020 and 2021. The survey included questions assessing changes in patient attitude towards CAM and likelihood of using CAM, both relative to prior to COVID-19. Analyzed CAM users included those taking vitamin, mineral and herbal supplements, alternative medicines and special diets, and excluded mindbody practices as the focus of this analysis was on enteral and parenteral CAM therapies. Differences in the impact of COVID-19 on CAM use beliefs and practices between CAM users and non-users were analyzed with χ2 and two-sample t-tests. Results: Out of 749 respondents, 578 (77%) used any CAM and 470 (63%) used enteral or parenteral CAM. Results shown in table. Compared to prior to COVID- 19, CAM users were more likely to view CAM more favorably (12% vs 5%, p < 0.01), while non-users were more likely to have an unchanged opinion (90% vs 84%, p = 0.03). Females had higher rates of viewing CAM more favorably than males (80% vs 58%, p = 0.04). Patients who viewed CAM more favorably had higher rates of self-reported incurable cancer (36% vs 11%, p = 0.04), declining recommended hormone therapy (22% vs 0%, p < 0.01), and higher trust of social media (19% vs 0%, p = 0.02) and websites (24% vs 0%, p < 0.01). Since the start of COVID-19, CAM users were more likely to report increased likelihood of using CAM (12% vs 6%, p = 0.01). Patients who were more likely to use CAM had higher rates of declining recommended chemotherapy (12% vs 0%, p = 0.02), and higher trust of social media (15% vs 2%, p = 0.01) and websites (28% vs 7%, p < 0.01). Conclusions: During the COVID-19 pandemic, attitudes on CAM use in oncology patients have become increasingly polarizing. Patients with favorable attitudes toward CAM were likely to decline recommended standard of care therapy and more like to use CAM since COVID-19. This data helps characterize shifting attitudes toward CAM and may help guide shared decision-making between physician and patient.

14.
Journal of Clinical Oncology ; 40(16), 2022.
Article in English | EMBASE | ID: covidwho-2005670

ABSTRACT

Background: The defective immune system in plasma cell dyscrasia places patients at a higher risk of developing a severe infection, which is one of the leading causes of death in such patients. In an era of a global pandemic, it is essential to protect them against COVID-19, but fewer effective plasma cells lead to a suboptimal response to vaccines. There is still a lack of evidence whether the seroconversion is truly clinically relevant and if patients with plasma cell disorders would benefit from frequent boosters to maintain antibody levels. Methods: Online databases including PubMed, CINAHL, Ovid, and Cochrane were searched (January 11th, 2022), following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Only articles published in the English language were included. s, case reports, and case series were excluded. Out of 40 studies, 5 articles were selected for a systematic review. Results: In all 5 studies (N=654), seroconversion post-vaccination was used as a positive response to COVID-19 vaccination. Although patients with plasma cell disorders had a lower seroconversion rate compared to controls, the overall percentage was substantial and ranged between 23-95.5%. Amongst patients on active therapy, lower seroconversion rates were seen in patients on a CD-38 inhibitor, ranging from 20.2-92.1% (N=174). Also, a significantly lower percentage was recorded in patients above 65 years and those who have been treated with multiple therapies previously. Better seroconversion rates were seen in mRNA vaccines compared to J&J. Conclusions: Variable seropositive rates are seen in patients with plasma cell dyscrasias, lower rates are reported in patients on active therapy, CD-38 targeting therapy, and elderly patients. Hence, these patients should receive a 4 shot series.

16.
Gut ; 71:A94, 2022.
Article in English | EMBASE | ID: covidwho-2005364

ABSTRACT

Introduction During the COVID-19 pandemic gastroscopy was halted with large burden on recovery and risk of late diagnosis. We established an early diagnosis service using Cytosponge to triage patients to timely gastroscopy and management Methods 2 patient cohorts were used: 1. Barrett's oesophagus (BO) on endoscopic surveillance 2. Patients with symptoms of gastro-oesophageal reflux referred for routine gastroscopy. Exclusions were patients with dysplasia on last gastroscopy, fundoplication, pregnancy and patient preference. Triage of patients on the waiting list was from endoscopy referrals, Barrett's surveillance database and telephone triage. 2 research nurses and 2 clinical nurse specialists were trained in delivering Cytosponge. A patient satisfaction survey was completed. All cytology specimens were analysed by Cyted. Results were relayed to patients within 4 weeks by consultant led nurse-run teleclinic and letter. Clinical triage was according to the table below. TFF3+ was used as a marker for intestinal metaplasia (IM), P53+ve and atypia for potential dysplastic change. Results 470 patients agreed to Cytosponge over 14 months November 2020-January 2022. 22 cancelled-mostly COVID related. 34 failed to swallow (5.5% of Barrett's, 8.9% reflux). of those successfully swallowing the sponge 6% were inadequate samples in Barrett's and 9% reflux. No major adverse events occurred. Conclusion We report on the largest single site series of Cytosponge in non-specialist clinical practice in England and its pragmatic use in patients management and pandemic recovery. Significant benefits in the Barrett's cohort were timely identification of dysplasia and those longer requiring surveillance. Benefits in the reflux group include identification of new BO, avoiding unnecessary gastroscopy and early discharge. Overall reduced endoscopy resulted in reduced cost, lower carbon footprint and improved patient experience. Careful follow up and longer-term outcomes will provide confidence to continue this new technique in routine clinical practice.

17.
Ann R Coll Surg Engl ; 2022 Aug 17.
Article in English | MEDLINE | ID: covidwho-1993424

ABSTRACT

BACKGROUND: Suprascapular nerve blockade (SSNB) through injection (SSNBi) and/or pulsed radiofrequency (PRF) provide options for the management of painful shoulder pathology. Multiple techniques for delivery of SSNB are described but no consensus on optimal symptom control is available. This systematic review and meta-analysis aims to assess patient-focussed outcomes in SSNB and explore the impact of variation in the technical application of this treatment modality. METHODS: MEDLINE, Embase and CINAHL were searched for case series, cohort studies and randomised control trials published from database inception until 28 January 2021. Articles reporting use of SSNBi or PRF for treatment of shoulder pain with a minimum 3 months follow-up were included. Patient-reported outcome measures (PROMs) were extracted and the pooled standardised mean difference (SMD), weighted by study size, was reported. Quality of methodology was assessed using Wylde's nonsummative four-point system. FINDINGS: Of 758 references, 18 studies were included, totalling 704 SSNB. Average pain improvement at 3 months was 52.3%, with meta-analysis demonstrating a SMD of 2.37. Whereas SSNBi combined with PRF shows the greatest SMD of 2.75, this did not differ significantly from SSNBi or PRF when used as monotherapy. Location of treatment and the guidance technique used did not influence outcome. CONCLUSION: SSNBi and PRF provide safe and effective treatment for shoulder pain, as judged by PROMs. This may be of particular value in aging or comorbid patients and with surgical restrictions during the Covid-19 pandemic. Regardless of technique, patients experience a marked improvement in pain that is maintained beyond 3 months.

18.
Pharmazeutische Zeitung ; 167(3):10+12, 2022.
Article in German | EMBASE | ID: covidwho-1980464
19.
Women and Leadership in Higher Education During Global Crises ; : 159-174, 2021.
Article in English | Scopus | ID: covidwho-1975012

ABSTRACT

This chapter introduces the audience to the world of four females working in higher education during COVID-19. The narratives provide a glimpse into the roles women in the workforce and specifically mothers in academia played and continue to play throughout the global pandemic of 2020 and 2021. In each narrative, the authors discuss the mental, emotional, physical, and relational tolls of striving to balance the many roles faced during the global pandemic. After exploring personal experiences, the authors look to the future and provide recommendations for how universities can strive to advocate for their female employees, specifically women of color and women serving in caregiver roles, in the forthcoming policies and initiatives. © 2021 by IGI Global. All rights reserved.

20.
Gastroenterology ; 162(7):S-1061, 2022.
Article in English | EMBASE | ID: covidwho-1967404

ABSTRACT

Background-During the COVID-19 pandemic all routine and surveillance gastroscopy was halted or delayed in the UK with considerable burden on recovery and risk of late diagnosis of significant pathology. We established an early diagnosis service using CytospongeR minimally invasive cell sampling device to help triage patients to timely gastroscopy and identify patients who could be managed without endoscopy. Methods-2 patient cohorts were identified: 1. Known Barrett's oesophagus on endoscopic surveillance 2. Patients with symptoms of gastrooesophageal reflux referred for routine gastroscopy. Exclusions were previous dysplasia of any grade on last gastroscopy, previous fundoplication, pregnancy and patient preference. Triage of patients on the waiting list was done initially from referrals to endoscopy and those on the Barrett's surveillance database, and then telephone clinic. 2 research nurses and 2 clinical nurse specialists were fully trained in delivering CytospongeR . All patients provided informed consent. All Cytology specimens were analysed by Cyted. Results were relayed to patients within 4 weeks of the procedure by consultant led nurse-run teleclinic or by letter for the Barrett's surveillance cohort. Clinical triage was according to the table below. TFF3+ was used as a marker for intestinal metaplasia, P53+ve and atypia for potential dysplastic change. Results-408 patients agreed to CytospongeR over 12 months November 2020-2021. 157 for Barrett's surveillance. 251 for Investigation of reflux. 28 failed to swallow (5% of Barrett's, 7.5% reflux). In the Barrett's Cohort 148 patients successfully swallowed, 139 for analysis 8 inadequate (5.4%) first samples. In the reflux cohort 232 successfully swallowed, 200 for analysis 32 inadequate first samples (13.8%) Discussion-Overall 205 (60.5%) of patients had low risk CytospongeR findings (no Barretts/short segment not requiring surveillance under BSG guidance) were managed symptomatically without initial gastroscopy, 114 (33.6%) had evidence of non dysplastic Barrett's and could be managed on a routine pathway. 20 (5.9%) had high risk findings suggesting dysplasia and had urgent gastroscopy. Conclusion-We report the largest single site series of CytospongeR in clinical practice in England and its pragmatic use in patients management and service recovery during the Pandemic. Notable benefits in the Barrett's cohort were timely identification of high numbers of potential dysplasia and also of those no longer requiring surveillance. Identification of new potential Barrett's for surveillance and the avoidance of unnecessary gastroscopy and early discharge were notable benefits in the Reflux cohort. Careful follow up and long-term outcomes of these patients will provide more data and safety netting for adoption of this new technique into routine clinical practice and help avoid unnecessary gastroscopy. (Table Presented)Table 1. CytospongeR findings and triage pathways in Barrett's oesophagus and gastrooesophageal reflux

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