COVID-19 vaccine uptake and hesitancy amongst Australian patients with breast cancer

Aims: Vaccination uptake is the principal focus of the world-wide response to the COVID-19 pandemic. Vaccine hesitancy remains a critical issue. Our aim was to ascertain rates and reasons for vaccine hesitancy in people with breast cancer (BC) in Australia. Method(s): Between June and October 2021, an anonymous online survey was conducted among people with solid organ cancer treated at nine Australian treatment centres. Data collected included demographics and clinical characteristics. Vaccine hesitancy and related beliefs were assessed using the Oxford COVID-19 Vaccine Hesitancy Scale, the Oxford COVID-19 Vaccine Confidence and Complacency Scale (OCVCCS), and the Disease Influenced Vaccine Acceptance Scale-Six. Descriptive statistics, chi-squared and linear regression were used. Results for the BC subgroup are reported. Result(s): The BC subgroup (N = 986, mean age 58.4 years, 99% female) comprised 36.6% of the responses in the solid cancer population (N = 2691). Most (76%) were treated at metropolitan centres and 64% were receiving ongoing treatment. Early BC was more commonly reported than metastatic BC (77% vs. 23%). Overall, 82% self-reported at least one COVID-19 vaccine dose. Unvaccinated participants were more likely to diagnosed with BC for a shorter time (<2 years (22.1%) vs >=2 years (14.5%), p = 0.003). Participants with metastatic BC were more likely to be unvaccinated and report greater disease-related vaccine concerns and hesitancy, when compared with participants with early BC (all p < 0.05). When compared with participants with all other solid cancers, participants with BC reported more negative attitudes towards COVID-19 vaccine side-effects (OCVCCS Side-Effects subscale mean scores: 5.19 (SD 1.91) vs. 5.46 (SD 1.82), p < 0.001). Conclusion(s):Despite a relatively high rate of self-reported vaccination, people with BC reported lower vaccine confidence when compared with all other solid cancers. A better understanding of these inequalities, and strategies to address vaccine confidence in people with BC, particularly those with metastatic BC, should be developed.

Swallowing and communication assessment in tracheostomy patients: Multi-disciplinary-led quality improvement in a busy tertiary teaching hospital

Introduction: Intensive care patients often have complex swallowing and communication needs. These require coordinated input from the multi-disciplinary team. Increasing evidence highlights the role of speech and language therapy (SLT) within the critical care environment1 and this is represented well in national recommendations specific to patients with tracheostomies. Approximately 10-15% of ICU patients will have a tracheostomy nationally.2 SLT provide expertise in assessment and management of communication and swallowing difficulties, which can vastly improve psychosocial well-being and promote early safe enteral feeding for our patients.3 In 2014 On the right trache?4 found that 52% of patients with a tracheostomy suffered with dysphagia, however only 27% critical care patients had input from SLT. Objectives: To improve the assessment of swallowing and communication in patients undergoing tracheostomy ventilation at the Royal Infirmary of Edinburgh, to comply with Scottish Intensive Care Society Audit Group (SICSAG) quality indicator 2.3. This guidance stipulates all tracheostomy patients should have communication and swallowing needs assessed during ventilator wean.5 Methods: Four distinct areas of intervention were implemented. Pre-populated review text was added to NHS Lothian's clinical notation system (InterSystems TrakCare®), prompting nursing staff to consider swallowing, tracheostomy issues and SLT referral. These were refined between audit cycles. SLT were invited to join safety briefs to identify tracheostomy patients, as well as other patients with complex swallowing needs. This was an opportunity to raise awareness, educate, and prioritise workload. New guidelines for nurse-led swallowing observations were developed and disseminated amongst teams. Finally, staff were offered relevant educational sessions. Baseline data was collected in 2019;serial data collection was then during October - November 2020 and in June - July 2021 following the interventions. Results: All patients who received tracheostomy ventilation were audited (n=31). This showed that very few patients had swallowing and communication assessed adequately. Only 16.1% (n=5) patients had a regular nursing swallowing assessment on the majority of critical care days (>50%). Referral to SLT was often very late when patients were approaching de-cannulation and on many occasions by the time the SLT team were involved patients had already been de-cannulated. Following the intervention period, it became apparent that awareness of swallowing requirements had improved. By mid 2021, 58.9% more patients had swallowing assessed as part of daily care. Additionally, 81.2% of patients had SLT reviews on the unit demonstrating a sustained increase from late 2020. There was a notable increase in the quality of assessments after initial SLT review. Conclusion: Using quality improvement methodology our multidisciplinary team was able to substantially increase the quality of swallowing assessment within our ICU, despite the challenges of the COVID-19 pandemic. Our unit now complies with SICSAG quality indicator 2.3. This is in keeping with national recommendations for a multidisciplinary approach to care of tracheostomy patients. Patients with increased risk of dysphagia are being identified earlier and are more likely to progress and be established on enteral feeding early, which may subsequently reduce the burden of nasogastric feeding, total parenteral nutrition and even related invasive IV access.

Development of a Vascularised Cardiac Organoid Platform Reveals a Regulatory Role for Extracellular Matrix Environment on Muscle Functionality

Multicellular composition of the heart is important for regulating organ development and responses to injury, however the role of cardiac cell types in organ maturation is not well characterised. In this study we characterised a vascularised cardiac organoid model (vhCO) derived from human pluripotent stem cells to better understand cell-cell interactions in human heart tissue. We show that endothelial cells in vhCO increase organoid force of contraction and enhance the expression of mature sarcomeric proteins and extracellular matrix (ECM) components. Through proteomics, we identified LAMA5 as an important component of the ECM network that enhances force of contraction. Subsequent knockdown of LAMA5 specifically in endothelial cells down regulate force of contraction and reverts the ECM protein profile. We also show that endothelial cells are important for modelling cardiac dysfunction induced by cytokine storm following COVID-19 infection. This study identifies matrix regulatory functions of endothelial cells that govern cardiac maturation and also highlights the importance of organoid multicellularity for disease modelling.

Health personnel in the pandemic: working at a permanent risk threshold

This article presents some of the most relevant findings of a qualitative research that included fifteen interviews with health workers (doctors, kinesiologists and nurses) who work in areas of care for patients with Covid-19 in public hospitals and private clinics in seven provinces of Argentina.The objective was to highlight the transformations in their daily routines, with a particular emphasis on the consequences that the emergence of new occupational risks brought. The main hypothesis states that since the emergence of the pandemic, health personnel, especially those working in the Intensive Care Units, began to work at a risk threshold. That is, in a daily relationship with an imminent or effective health catastrophe, which caused physical and psychosocial symptoms and sufferings even in the case of those that had a vast experience. If anything was intensely modified, it was the historical relationship with patients and their families, as well as with their co-workers, as a consequence of the unprecedented contagiousness of this virus and the permanent inclusion of new care protocols.

Characterising anosmia in hospitalised patients with COVID-19

P86 Table 1Anosmia scoring system developedScore for each smell Meaning 0 Able to identify the smell correctly 1 Able to identify the smell but it doesn’t smell right 2 Unable to identify the smell 3 Total anosmia Total scores per patient Definition 0–4 Mild anosmia 5–10 Moderate anosmia 11–15 Severe anosmia ConclusionA significant proportion of patients studied were not aware they had anosmia. This has implications for pandemic management going forward when people are required to self-report this symptom and suggests potential benefit in formal examination of the olfactory nerve.