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Background: B-cell lymphoma-2 (Bcl-2) proteins play an important role in multiple myeloma (MM) cell survival and represent an attractive therapeutic target. In prior trials, a subgroup analysis of patients with t(11;14)-positive relapsed/refractory (R/R) MM showed the combination of a Bcl-2 inhibitor, a proteasome inhibitor, and dexamethasone improved progression-free survival with no increased mortality. BGB-11417, a Bcl-2 inhibitor, is more potent and selective than venetoclax. BGB-11417- 105 (NCT04973605) is a phase 1b/2 study assessing the safety and efficacy of BGB-11417 monotherapy, in combination with dexamethasone, or with dexamethasone+carfilzomib in patients with t(11;14)-positive R/R MM. Preliminary safety results for the combination of BGB-11417 + dexamethasone are presented. Method(s): Eligible patients had t(11;14)-positive R/R MM and had been exposed to a proteasome inhibitor, immunomodulatory agent, and anti-CD38 therapy. Patients received 80-, 160-, 320-, or 640-mg BGB-11417 daily with 40-mg dexamethasone weekly until death, intolerability, or disease progression. Dose escalation was guided by a mTPI-2 design and overall review by a safety monitoring committee. Pharmacokinetics (PK) were also assessed. Result(s): As of 1 July 2022, 10 patients were enrolled in the 80-, 160-, and 320-mg (3 patients each) and 640-mg (1 patient) dose-escalation cohorts of BGB-11417 + dexamethasone. The median age was 69 years (range, 52-81) and median prior lines of therapy was 3 (range, 1-5). The median treatment duration was 3.2 months (range, 0.5-6.5). No patients experienced dose-limiting toxicity at any dose level. Three patients died whilst on study: 1 due to COVID-19 complications 157 days after treatment discontinuation (day 208), 1 due to progressive disease 50 days after treatment discontinuation (day 89), and 1 due to COVID-19 whilst on study treatment (day 78). No deaths were associated with study treatment. Two patients experienced Grade >= 3 treatment-emergent adverse events (TEAEs). One patient in the 160-mg cohort experienced Grade 3 increase in liver enzymes and lymphopenia. One patient in the 320-mg cohort experienced Grade 3 lymphopenia. The most common TEAEs were insomnia (50%), fatigue (30%), arthralgia (20%), back pain (20%), lymphopenia (20%), and nausea (20%). BGB-11417 exposure increased dose-dependently from 80 mg to 320 mg with high interpatient PK variability. BGB-11417 exposures after single and multiple doses appeared similar, indicating limited accumulation. Conclusion(s): BGB-11417 plus dexamethasone was generally well-tolerated in patients with R/R MM harbouring t(11;14) at doses <=640 mg. Efficacy data are forthcoming. Recruitment is ongoing in the US, Australia, and New Zealand;the BGB-11417, dexamethasone, and carfilzomib combination arm will open in the future.
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PURPOSE: This qualitative study aimed to understand the impact of the coronavirus disease 2019 pandemic from March to November 2020 on healthcare delivery and clinical trials for genitourinary (GU) cancers in Australia. METHODS: Annually a pre-conference workshop is hosted by the Australian New Zealand Urogenital and Prostate Cancer Trials Group for supportive care health professionals. In November 2020, those that selected to attend were invited to participate in a focus group. Workshop and focus group discussions were recorded and transcripts were analyzed thematically. RESULTS: Seventy-two individuals involved in GU cancer care and clinical trials took part. Participants described negative changes to GU cancer care and clinical trials from the pandemic due to reduced clinical services and increased wait times. Trial recruitment was paused temporarily during lockdowns, and standard treatment protocols were used to limit hospital visits. Trial process changes included electronic capture of informed consent, home delivery of oral medications, and delegations of assessments. These changes increased administrative activity for clinical trial teams and Human Research Ethics Committees. A transition to telehealth enabled continuity of service delivery and trials but reduced the opportunity for face-to-face patient consultations with increasing concern about the failure to detect supportive care needs. CONCLUSION: The pandemic has prompted a critical review of service delivery and clinical trials for people with GU cancers.
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Introduction: SARS-CoV-2 is a highly infectious disease transmitted by aerosol and droplet particles. Respiratory function tests are aerosol generating procedures. Consequently, this increases the risk of exposure to SARS-Cov-2 to healthcare workers and patients visiting respiratory function laboratories. Proposed recommendations on pulmonary function testing during the SARS-CoV-2 pandemic were published by the ERS and the ANZSRS/TSANZ. Aim(s): To identify strategies implemented in respiratory function laboratories to reduce the risk of SARS-CoV-2 transmission. Method(s): An electronic questionnaire of respiratory laboratories on infection control measures implemented during the SARS-CoV-2 pandemic was sent to active ANZSRS members in an explanatory email. All data obtained was de-identified with only one response per laboratory included in the analysis. Result(s): Responses were received from 32 laboratories. 81% were from a hospital setting, 61% were TSANZ accredited. 94% and 78% of laboratories identified that they had read the ANZSRS/TSANZ statement and the ERS statements, respectively. 25% and 22% of laboratories implemented modifications based on these statements while 13% and 9% indicated barriers prevented changes being made. Infrastructure was the main barrier identified following both statements. The main strategies implemented are summarised in the below table. Strategy implemented Laboratories (%) Triage patients on clinical urgency 91 Screening prior to appointment or on arrival 100 Scientist wearing fit-tested masks during tests 78 Scientist wearing eyewear during tests 75 Wait time post close contacts (routine-14 days) 50 Wait time post positive infection (routine-14 days) 43 Wait time post close contacts (urgent-10 days) 31 Wait time post positive infection (urgent-10 days) 22 Investigated air room changes/hour 66 Allow at least a 15-min washout period between patients 34 Investigated best cleaning methods for their equipment 65 Utilise telehealth 21 Conclusion(s): Laboratories in Australia and New Zealand have put in place a variety of changes in accordance with recommendations made in position statements to reduce risk of SARS-CoV-2 transmission. While some laboratories had already implemented strategies, the ERS and ANZSRS/TSANZ publications have given clear guidelines to reduce aerosolised transmission of SARS-CoV-2.
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The proceedings contain 360 papers. The topics discussed include: comparison of three methods assessing spirometry bronchodilator responsiveness in children;the quality of spirometry testing: a systematic review;airflow severity in asthma minimally affects within-session oscillometry variability;corrected normative multiple breath washout data in pre-school aged children;prevalence and predictors of tidal expiratory-flow-limitation in healthy adolescents/young adults;impact of change of significant bronchodilator response definition;volume-dependence of reactance as a measure of ventilation inhomogeneity;mechanisms of impaired gas exchange following hospitalization for severe COVID-19;increased shunt and dead space in recovered COVID-19 pneumonitis patients;airway hyperresponsiveness detection in atopic asthma using exhaled nitric oxide;increased conductive ventilation heterogeneity following exposure to coal-mine fire smoke;accuracy of transcutaneous carbon dioxide monitoring during sleep studies;and effect of hematopoietic stem cell transplant on small airways function.
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INTRODUCTION: Fostering a research culture is a key goal of the Royal Australian and New Zealand College of Radiologists, yet there has never been an organization-wide enquiry into the extent to which this is being realized. The purpose of this work was to address that deficit for the Radiation Oncology (RO) Faculty to serve as a baseline for future comparison. The hypothesis was that such a culture is closer to fact than fantasy. METHODS: With College approval, three de-identified Excel spreadsheets detailing 25 research-related sub-categories of the Faculty's Continuing Professional Development (CPD) database were interrogated for the 2019-21 triennium, accepting that research activity in 2020-21 would be COVID-19 suppressed. The numbers obligated to self-report CPD were 482, 496 and 511, respectively. Primary endpoints were the percentages of ROs claiming at least one research-related activity overall, and in each of the sub-categories individually, by year. Secondary endpoints were the "breadth" (number of sub-categories claimed/individual) and "depth" (percentages solely claiming in one of four lower-level sub-categories), by year. RESULTS: ROs claimed in 23/25 sub-categories. The percentages of ROs claiming at least one research-related activity were 71%, 44%, and 62% in 2019-21, respectively. The median number of sub-categories claimed by these ROs was 2 (range 1-10) in each year. The commonest activity was journal article co-author (25%, 16% and 27%, respectively). For 2019, the most representative year, other common activities were inhouse/local meeting presentation (17%), invited lecture at state level or above (15%), manuscript peer review and research project principal investigator (14% each). The percentages of ROs solely claiming in one lower-level activity ranged between 4.4% and 5.9% per year. CONCLUSION: A culture of research is arguably more fact than fantasy in ANZ. It is likely that Faculty curriculum requirements, research funding and other promotional initiatives have contributed substantively to this.
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COVID-19 , Radiation Oncology , Humans , Radiation Oncology/education , New Zealand , Fantasy , Reactive Oxygen Species , AustraliaABSTRACT
Introduction: Since 2020, the New Zealand and Australian federal, state and territory governments have used quarantine as a strategic infection control measure to contain the SRS-CoV-2 (COVID-19) virus. However, the quarantine programs of both countries were rapidly operationalised without a clear blueprint for infection prevention. This paper identifies gaps in forecasting the need, and planning, for widespread quarantine within New Zealand's and Australia's Pandemic Preparedness Plans and pandemic exercise reports. Method(s): This paper adhered to the Joanna Briggs Institute (JBI) methodology for scoping reviews. Parliamentary websites and databases (Parlinfo, Pandora) were searched for plans and exercise reports, that were publicly available from 2009 to May 2022. Documents were examined using directive content analysis and assessed on their alignment with the core elements of people, resources, governance, systems, and processes, as addressed in the Australian Disaster Preparedness Framework 2018. Result(s): The degree to which the core elements outlined in the Australian Disaster Preparedness Framework were covered in the documents varies significantly across both New Zealand, and the Australian federal, states and territories. Of the 15 identified plans and 8 exercise reports most did not foresee the need for mandatory, large-scale quarantine of people arriving from interstate or overseas and contemplated voluntary quarantine occurring within people's private residences. Conclusion(s): This paper confirms the need to focus on widespread quarantine as an infection control measure to enhance future pandemic operational preparedness. Further development of quarantine capabilities is required in locations aside from private residences, including at Australia's new purpose-built quarantine facilities.Copyright © 2022
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Background: POSNOC is a UK-ANZ multicentre, non-inferiority, randomised trial comparing systemic therapy alone with systemic therapy plus Axillary Treatment (Axillary radiotherapy or ALND) for women with <=2 macrometastases at SNB. The primary outcome is axillary recurrence within 5 years. This paper describes screening, recruitment and compliance data. Method(s): Sites were requested on a monthly basis to upload screening data and provide reasons for nonrecruitment of eligible patients into the trial. Sites entered in the online database whether the patients were compliant with their randomisation allocation. Result(s): The study opened in July 2014 and completed target recruitment of 1900 women (24% of those screened) in July 2021, at 95 sites in the UK and 20 sites in Australia and New Zealand. The reason for non-enrolment was unknown in 1300 women. Of the remaining 4774 women with known reasons, who were screened but not randomised, the most common reasons for non-recruitment were due to either patients (n=2219, 46.5%) or their clinicians (n=782, 16.4%) favouring axillary treatment, or patients (n=490, 10.3%) or their clinicians (n=170, 3.6%) not wishing to have axillary treatment. Over the course of the study, there was an increase in the proportion of patients wanting axillary treatment and declining the trial (Mean % patients declined 2015 - 17.9%, 2021 - 39.1%). Mean number of participants recruited per site per month was 0.24 (SD 0.18) overall, 0.25 (SD 0.19) in the UK, and 0.19(SD 0.15) in ANZ. The mean was < 0.3 in 79 sites and >0.9 in only one site. Recruitment rate remained consistent throughout the study (mean 25.3 per month) except for during the first 6 months of recruitment (5.7) and during the COVID pandemic Apr-Sep 2020 (7.5). Of 89 (4.8%) participants non-compliant with allocation, n=45 (50.6%) received systemic therapy alone and n=44 (49.4%) received systemic therapy plus axillary treatment. There was no fluctuation in the direction of non-compliance during the study duration. There was increasing uptake of axillary radiotherapy to treat the axilla instead of ALND over the course of the study in patients receiving axillary treatment (Number who had ART of all who had axilla treatment2014-2017 - 248/454 (54.6 %);2018-2021 - 315/449 (70.2%)). Conclusion(s): Recruitment and compliance with randomised allocation remained consistent over a seven-year period. POSNOC with in-built radiotherapy QA will provide definitive data on axillary management in patients undergoing mastectomy or BCS with <=2 macrometastases on SNB.
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In 1990s' Russia, a wave of internationalization brought an evidence-based medical paradigm to Russian healthcare. Whilst there has been considerable critical commentary on the consequences of adopting this paradigm for medical decision-making, much of this relates to specific contexts in Europe, north America and Australasia, with little research addressing post-Soviet clinical practice. Drawing on semi-structured qualitative interviews with Russian physicians, this article explores the entanglements between the introduction of evidence-based medicine (EBM) in the country and the transformation of post-socialist medical professionalism. I single out physicians' efforts to reconcile the EBM paradigm with organizational constraints as indicative of professionals' ground-level agency. I define the following components of such agency: (1) selective application of guidelines and use of foreign clinical recommendations;(2) establishing local professional solidarity;(3) developing relationships based on personalized trust with the patients. The study employs two sets of data (gathered in 2018 and in 2020) to trace the EBM-related agency of medical professionals both before and during COVID-19 pandemic. By offering analytical insights from post-socialist healthcare, where doctors' discretion has historically been limited by excessive state control, the article contributes to academic debate on medical professionals' autonomy and agency in the era of EBM-related standardization.Copyright © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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This chapter focusses on the use of immobility policies and practices in the Asia-Pacific nations of East and South East Asia, Australia and New Zealand to respond to COVID-19 across 2020–2021. Concepts from the field of mobilities studies are adopted for analysis. Transport system managers in the region have increasingly played roles either limiting movement, adjusting transport supply, creating proscribed ‘mobilities passageways’ for travellers that present COVID-risk, and encouraging or mandating passenger compliance with other pandemic measures. The series of immobility policies and practices used at the international, intra-national and local scales are analysed. Transport agency responses differed greatly including whether to retain levels of public transport supply or reduce them in line with falling patronage. A summary of known travel behaviour impacts is then discussed, using available data from government travel portals, and, for Shanghai, Brisbane and Hong Kong, a range of road volumes, public transport boardings, micro-mobility, bicycle and pedestrian counts. There are indications that a series of socio-technical transitions have occurred, such as increased work-from-home, new social practices around walking, increased demands for roads to provide place functions (as opposed to movement functions) and the role of cycling and micro-mobility as liberating technologies in a world of increased control and fear of contagion. Transport agencies have harnessed some of these changes in attitudes and societal needs, using radical institutional responses such as pop-up bike lane trials and other ‘tactical urbanism’ approaches, to adapt their cities to life during and after the pandemic. © 2022 by Emerald Publishing Limited.
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SESSION TITLE: Issues After COVID-19 Vaccination Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Thymoma-associated autoimmune encephalitis (TAAE) is an understudied and overlooked diagnosis in patients presenting with abrupt altered mental status. Described as inflammation of brain tissue, autoimmune encephalitis is seen in 5-10 cases per 100,000 across all age groups per year. A rare subtype involves neuronal surface antibodies to alpha-amino-3-hydroxyl-5-methyl-4isoxazolepropionic acid receptors (AMPA-R) encephalitis is seen even less commonly. Given the "unicorn” nature of presenting cases and difficulty of diagnosis, prompt identification and treatment are critical as prolonged courses without treatment are irreversible and deadly. CASE PRESENTATION: A 47-year-old male with no past medical history presented 3 days after a Johnson & Johnson coronavirus-2019 (COVID-19) booster vaccine due to worsening acute altered mental status over the past week. He complained of episodes of fever & chills prior to this. The patient's wife reported abrupt changes in memory and personality. Upon admission, the patient had a Glasgow Coma Scale of 4. The patient was intubated and transferred to the intensive care unit. Intravenous (IV) vancomycin, ceftriaxone and acyclovir was initiated for meningitis. Computed tomography (CT) scan of the head without contrast was unremarkable. Magnetic resonance imaging (MRI) showed enhancements of the right anterior and medial temporal lobe suggesting encephalitis. Cerebrospinal fluid analysis (CSF) revealed lymphocytic pleocytosis. A CT scan of the chest, abdomen and pelvis showed an anterior mediastinal mass measured 1.8 x 2.3 cm (Figure 1). FilmArray Meningitis polymerase chain reaction was negative as well as Herpes Simplex Virus (HSV) 1 and 2. Autoimmune encephalitis antibody was positive for Anti-AMPAR. Pulse dose steroids and intravenous immunoglobulin were initiated but failed. Rituximab was initiated and cardiothoracic surgery completed a thymectomy. DISCUSSION: TAAE is a rare disease, permanently debilitating, and deadly if unrecognized or treatment is delayed. Autoimmune encephalitis is an umbrella disease process seen in 0.00005% of patients per year. AMPA-R positive encephalitis is even less commonly seen with only 22 cases reported between the years 2009 and 2014 [1]. A rapidly progressive cognitive decline or psychiatric disorders are early features of this disease.Our patient had prodromal symptoms of fever and cognitive decline days after receiving his COVID-19 booster vaccine. CONCLUSIONS: Post-vaccine encephalomyelitis has been described in other settings[2]. This patient was free of symptoms prior to the COVID-19 vaccine booster, and demonstrated altered mental status hours after receiving it. This furthers the possibility of an association of the COVID-19 booster vaccine, development of encephalitis, and in this case a thymoma. Despite this, conclusions can not be made on the account of one report, but introduces a new area of focus to study. Reference #1: Höftberger, R., van Sonderen, A., Leypoldt, F., Houghton, D., Geschwind, M., Gelfand, J., Paredes, M., Sabater, L., Saiz, A., Titulaer, M. J., Graus, F., & Dalmau, J. (2015). Encephalitis and AMPA receptor antibodies: Novel findings in a case series of 22 patients. Neurology, 84(24), 2403–2412. https://doi.org/10.1212/WNL.0000000000001682 Reference #2: Huynh, W., Cordato, D. J., Kehdi, E., Masters, L. T., & Dedousis, C. (2008). Post-vaccination encephalomyelitis: literature review and illustrative case. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 15(12), 1315–1322. https://doi.org/10.1016/j.jocn.2008.05.002 DISCLOSURES: No relevant relationships by Matthew Frank No relevant relationships by Justin Ilagan No relevant relationships by Danielle Mahon No relevant relationships by Danielle Mahon No relevant relationships by Harshini Sahani No relevant relationships by Kameron Tavakolian No relevant relationship by Ndausung Udongwo
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Many patients admitted to critical care with COVID-19 were at risk of malnutrition due to pre-existing chronic diseases associated with underlying poor nutritional intake and sarcopenia (1). Combined with increased energy expenditure and catabolism (2), alterations to gastrointestinal function and deficits in nutritional delivery during critical illness all risked declining nutritional status and subsequent poorer functional ability. International nutrition guidelines (3-6) recommend providing early enteral nutrition support using protocols. The UK and Australian versions created during the pandemic (3;4) recommend for individualised nutrition therapy by registered dietitians to anticipate and manage the complications commonly seen in these patients that can impact on the provision and type of nutrition support. The aim of this study is to evaluate the role of the dietitian in the nutrition interventions provided to patients with COVID-19 during critical illness and compare with recommended guidelines (3;4). Data was collected and analysed for adult patients with COVID-19 admitted to the intensive care units (ICU) requiring advanced respiratory support and enteral or parenteral nutrition support for longer than 48 hours during the period March 2020 to April 2021. Patients were followed from ICU admission to ward step down. Data was available for 453 critically ill patients. Demographic data presented as mean (SD);age 60 years old (12), 67% male, weight 84kg (20), BMI 29kg/m2 (6) for 20 ICU days (18), mortality of 55%. 167 patients (37%) were classified as high nutritional risk as determined by experienced critical care dietitians for whom nutritional requirements were individually determined by the dietitian within 24 hours of ICU admission. The remaining patients were seen within a mean of 72hrs. 99% (447/453) were enterally fed and the remaining received parenteral nutrition. Patients received on average 5.2 (4.5) dietetic interventions over the ICU stay, irrespective of nutritional risk. Reasons for dietetic interventions were adjustment of feed to account for calorie provision according to metabolic phase (74%);calories derived from sedation (55%);gastrointestinal dysfunction (32%);weaning from enteral nutrition to oral (32%);and renal, fluid and electrolyte adjustments (26%). A range of enteral feeds were used - the majority of patients (93%) received high protein (6.3-7.5grams protein per 100ml), concentrated (18.5%) (200 kcal per 100ml), peptide (9.5%) and protein supplementation (60%). On average those patients who survived lost 8.2kg (6.4) equating to 8.8% (6.9) of total weight over the ICU stay. A dietetic handover was provided for 100% of patients who transferred to the ward. In this study 100% of patients required dietetic input as their nutritional needs could not be met with protocol alone. A significant number were identified as nutritionally at risk, were prioritised as urgent and seen within the guideline timeframes. The dietitian was needed to tailor dietetic interventions to manage complications common in patients with COVID-19. They were also actively involved in adjusting nutrition interventions to facilitate patients’ nutritional recovery and rehabilitation. Patients lost weight over the ICU stay and all patients were handed over to ward dietitians for further dietetic management. References 1. Zhu N, Zhang D et al. A novel coronavirus from patients with pneumonia in China. NEJM 2020:382:727-33 2. Whittle, J., Molinger, J., MacLeod, D., et al. Persistent hypermetabolism and longitudinal energy expenditure in critically ill patients with COVID-19. Critical Care 2020: 24(1) 1-4. 3. Critical Care Specialist Group (CCSG) of the BDA Guidance on management of nutrition and dietetic services during the COVID-19 pandemic. 2020. (accessed 24.6.21) 4. Chapple, L. A. S., Fetterplace, K., Asrani, V., et al. Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID-19) in Australia and New Zealand. Nutrition & Dietetics,2020: 77(4), 426-436. 5. Barazzoni, R., Bischoff, S. C., Breda, J et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clinical Nutrition, 2020: 39 (6), 1631-1638 6. Martindale, R., Patel, J. J., Taylor, B., et al. Nutrition Therapy in Critically Ill Patients with Coronavirus Disease (COVID-19). Journal of Parenteral and Enteral Nutrition. 2020: 44 (7), 1174-1184
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Background: Single institutions specialising in fetal cardiology often have too few cases to develop robust prognostic indicators for specific conditions. The Australia and New Zealand (ANZ) Fetal Cardiology Working Group instigated a multicentre study to examine fetal risk factors for early postnatal intervention in Tetralogy of Fallot (ToF). Centralised data analysis was not possible due to COVID-19 travel restrictions and ethical constraints related to sharing of retrospectively acquired images. A study of inter-observer agreement of standardised in utero cardiac measurements was undertaken to assess the feasibility of combining data from multiple centres. Methods: Ten fetuses with ToF were randomly identified. Deidentified images were distributed securely to ten ANZ fetal cardiologists. The pulmonary valve (PV) annulus, main pulmonary artery (MPA), branch pulmonary arteries (BPA), aortic valve (AV) annulus, ascending aorta (AA), and ductus arteriosus (DA) were measured in triplicate following a defined protocol. Inter-rater reliability was assessed using a two-way random effects model to calculate the intra-class coefficient (ICC). Results: Measurements were available for seven ANZ fetal cardiologists. There was moderate inter-observer agreement for PV (ICC 0.74, 95% CI 0.49–0.91) and AV (0.71, 95% CI 0.48–0.90), and good agreement for MPA (0.81, 95% CI 0.62–0.94) and AA (0.91, 95% CI 0.80–0.97). Inadequate data were available for BPA and DA analysis. Multi-variate analysis found no patient or investigator factors that influenced measurement variability. Conclusion: Fetal cardiac structures can be measured using a defined measurement protocol by multiple investigators with at least moderate agreement. Analysis of large datasets by multiple investigators is a reasonable alternative to centralised data analysis.
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Background: Digital mental health services (DMHS) such as THIS WAY UP in Sydney, Australia, and Just a Thought in Hamilton, New Zealand, provide evidence-based interventions to support mental health and well-being. During the COVID-19 pandemic, the number of people in the community experiencing negative psychological symptoms and distress has increased. Aims: To examine the utility of THIS WAY UP and Just a Thought in responding to the demands of the COVID-19 pandemic. Methods: A retrospective audit of THIS WAY UP and Just a Thought service data was conducted in the years before and during the pandemic. Service use indices (e.g. number of course registrations, number of clinicians registering);the demographic and clinical characteristic of users;and the clinical effectiveness of interventions were compared before and during the pandemic. Results: Substantial increases in service use were observed. For example, in 2019 prior to the pandemic, 14,354 people registered for a THIS WAY UP intervention course, whereas 93,893 registered in 2020-2021 during the pandemic (a 273% increase in uptake, peaking at an 837% increase during the first 3 months of the pandemic). Across 10 different courses, comparable user characteristics and clinical effectiveness were observed before and during the pandemic, with improved scores of distress, anxiety and depressive symptoms for service users (effect sizes, g = 0.5-1.4). Conclusion: The uptake of DMHS increased significantly during COVID-19, while the effectiveness of interventions remained reasonably stable. These findings illustrate the agility and scalability of DMHS.
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Background: Iwi Maori (Maori people) are the Indigenous people of Aotearoa. Some estimates predict that Maori have been occupying the lands of Aotearoa for more than 1000 years. After claiming sovereignty in 1835 with He Whakaputanga (Declaration of Independence) following annexing international interests, Maori signed the Treaty of Waitangi (Te Tiriti o Waitangi) 5 years later to ensure independence, protection, ongoing prosperity and justice. Maori were prosperous, trading, had a strong economy and thriving in all areas of life. Maori knowledge systems and language were mainstream and many Pakeha who settled embraced all aspects of Maori culture including te reo Maori. Our history tells us that Te Tiriti was not honoured and this had catastrophic effects on Maori existence. By the late 1890s the Maori population had nearly been wiped out by infectious illnesses, loss of lands and the encroaching effects of assimilation, colonial shift in power and the disempowerment of Maori. Access to health care is a human right and was protected under treaty rights but successive governments have failed to address inequities. Moving forward to 2021, the Ministry of Health recently announced a new health structure and the establishment of a Maori Health Authority (MHA) to independently advise, commission health services for iwi Maori. Many see this change as transformative and a true act of Tino Rangatiratanga (self-determination). The act of re-Indigenising our health systems landscape may find the solutions to restoring equity. Objectives: To provide a personal reflection of the proposed new health care system reforms with a particular focus of the historical socio-cultural context of Aotearoa and illustrate why these reforms are important and transformative. I want to demystify the ideas and rationale for de-colonisation. I also want to consider the implications for Maori health and the enormous expectations others may have towards Maori solutions and the anticipated critics of the new system. Methods: I will briefly review the historical context of Maori in Aotearoa, the causes of poor mental health (MH) outcomes, why equity is important and why things need to change. I will discuss the most recent independent health reviews, which provides the basis of the new health reforms. Understanding Indigenous concepts like Tino Rangatiratanga and Mana Motuhake will be articulated. Understanding the concept of health and wellness from a Maori perspective will be discussed. Findings: Maori MH incidence and prevalence rates for most health conditions continue to be disproportionately higher than the dominant culture. Like Indigenous Australians, youth suicide rates for Maori remain the highest in the modern world, and other health crises such as COVID-19 can perpetuate these outcomes. Healthcare systems (in Australia and New Zealand), health structures and those in the positions of influence continue to underperform. The new proposed health reforms put Maori health leaders in the frontline in decision-backing processes and delivery: 'Ma Maori, mo Maori - By Maori, for Maori'. Conclusion: The enduring effects of colonisation continue to create inequitable health outcomes for Maori in Aotearoa. The new health reforms proposed may generate needed ideological, philosophical and culturally mandated shifts which align with the intent of Te Tiriti o Waitangi and the achievement of Tino Rangatiratanga and Mana Motuhake. There is now a process to re-empower Maori to find their own solutions to poor health outcomes, to rediscover lost knowledge and indigenise our healthcare system. The effects of the new system should be given time to make a difference.
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Background: Over the previous 48 months the training landscape has been significantly disrupted as a result of the COVID-19 pandemic. This has compounded pre-existing challenges for trainees relating to training requirements, exams, service demands, and other personal circumstances. As a result, the need for advocacy and representation of trainees within the RANZCP has never been greater. However, opportunities for trainees to directly engage in College dialogue and decision-making remains limited. These limitations are out of keeping with contemporary processes for trainee representation across other specialty Colleges in Australasia. To progress these discussions further, we believe that trainees need to first have a seat at the table. Objectives: •• Deliver a trainee-led discussion with a focus on the RANZCP training pathway and associated trainee experiences;•• Describe the challenges faced by RANZCP trainees during the COVID-19 pandemic;•• Describe the challenges reasonably expected in a post-COVID-19 training landscape;•• Explore the role of trainee representation within the RANZCP. Methods: This session will utilise the representation of a diverse group of trainees, recognising that representation within the RANZCP currently takes many forms. The panel will consist of representatives from state-based Associations of Trainees (APTs), current and resigning members of the RANZCP Trainee Representative Committee (TRC), and individual trainee members. Conclusions: Trainees have been impacted by the COVID-19 pandemic and subsequent disruptions to training and assessment. Although trainees are the future of the RANZCP, opportunities for trainees to engage in College dialogue and decision-making remains limited. Further engagement of trainee representation within the RANZCP is needed. It's time for trainees to have a seat at the table.
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Background: Intermittent lockdowns in Adelaide during 2020 necessitated the switching between online and faceto- face teaching. A pause in teaching midyear allowed for the rationalisation of existing material into a 'flipped learning' online programme. We utilised innovative approaches to assessment using online knowledge-based quizzes, novel online objective structured clinical examinations (OSCEs) (pre-clinical) and the Adelaide Medical School's unique simulation facility. Objectives: To outline the Adelaide Psychiatry curriculum and COVID-19 pandemic-associated change. Focus on novel solutions to assessment using online and videobased methods. Comment on the negative impact of social isolation and reduced clinical exposure on engagement with learning and mental health (MH) outcomes for students. Methods: Contrast the advantages and challenges of new modes of course delivery and assessment. Discuss the impact of digital teaching on the development of clinical and professional skills. Findings: The pandemic has fast-tracked the use of technology, but significantly reduced clinical experience. New methods of delivery and assessment provide promise for improved standardisation of teaching in traditional and clinical environments. Actively engaging students in learning during this transition has been challenging and disconnection has had implications for MH and professional development. Programmatic approaches to assessment that consider evolving performance in knowledge base, clinical skills and professional development may provide a more holistic picture of the development of young doctors. Conclusion: Future development of the MH curriculum will involve a careful balance of technology-driven and traditional clinical teaching. The Mental Health Medical Educator Leads Australia and New Zealand network offers a forum to share experience and promote best practice.
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Background: The mental health (MH) curriculum within undergraduate and postgraduate medical programmes in Australia and New Zealand is fundamental to MH competencies in graduate doctors. Despite a shared professional practice, there is an absence of a community of MH lead educators in medical degrees. Objectives: To develop a community of practice network, to enhance the quality, consistency and delivery of the MH curriculum and to enhance standards, resource development, teaching learning and assessment methodology. Challenges to consider include space in the curriculum, online learning during the COVID-19 pandemic and approaches to curriculum delivery posed by lived experiences of students. Methods: Development of the Mental Health Medical Education Leads Australia and New Zealand (MHMELANZ) Mental Health Educators network will be presented. Findings: MH medical education leads from a range of universities bi-nationally, representing graduate and undergraduate courses, will present an overview of the MH curriculum and current challenges and areas of focus for the MHMELANZ. Conclusion: There will be opportunity for discussion, and further development of a network, and a future special interest group with the Royal Australian and New Zealand College of Psychiatrists.
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Background: During COVID-19 in 2020, medical students at The University of Melbourne were withdrawn from clinical sites, leading to challenges in delivery of curriculum and assessment. Objectives: To describe the development of the Mental Health Medical Education Leads Australia and New Zealand (MHMELANZ) community of practice network. To outline the adaptations to teaching mental health (MH) in the medical doctorate (MD) at The University of Melbourne in 2020 and 2021, and future redesigned learnings and challenges. Methods: To outline the MH curriculum within the MD and MH during 2020 and 2021. Findings: Reduction in MH curriculum space, inequity in opportunity, adaptation of teaching to online (asynchronous to enhance clinical contact) and the need to address learning outcomes over 2 years. Presentation of governmental advocacy for essential worker status, while enhancing near-peer and well-being supports, is included. Conclusion: The capacity to adapt the curriculum and strong liaison between the university, hospitals and state government, has ensured delivery of the MH curriculum during 2020 and 2021. Future redesign of the MD will incorporate learnings through this experience and the MD will have an opportunity to be enhanced with the MHMELANZ network.
ABSTRACT
Purpose/Background: Reported international variability in the index management of acute diverticulitis may contribute to the observed differences in short-term outcomes and drive disparities in guidelines. Hypothesis/Aim: Goal: To compare international practices in initial surgical management for acute diverticulitis Hypothesis: Decision making varies by region in comparable patients, impacting outcomes and guidelines Methods/Interventions: The DAMASCUS study was a 6-month prospective, global observational study on the management and short-term outcomes of patients presenting with acute diverticulitis. For this study, baseline patient and disease covariates were reviewed from the RedCap database for initial surgical decision making by region (North America, Europe, UK, Australasia and Asia/Africa/South America [LMIC's]). The main outcome was the international variation in acute surgical management by region. Results/Outcome(s): Of 5659 patients enrolled internationally, 4472 (79%) were admitted on initial presentation and included in this analysis. The admission rate was significantly lower in North America, where only 39% were admitted (p<0.001). 28% (n=1558) reported a prior diverticular episode;North America had significantly higher rates of prior episodes (47%;p<0.01). Prior episodes were mostly >12 months before current presentation in all regions. 709 patients (15.9%) had emergency surgery for diverticulitis. Rates for surgery at initial presentation varied significantly from 6% (North America) to 24% (LMIC's). Surgery was CT-driven in 98%. 95 patients (13.4%) had a laparoscopic lavage/washout, while 614 (86.6%) had resectional surgery. The most common resection was a Hartmann's procedure (71.6%), performed significantly more than a segmental resection in all regions except Europe (P<0.001). A primary anastomosis was performed in 174 overall (28.3%);rates were similar across regions. An end colostomy- whether described as a Hartmann's, anterior resection, or sigmoid colectomy- was the most common stoma overall at 87.3% (P<0.001). Excluding the Hartmann procedures, 24.1% left a covering stoma. Europe and LMIC were significantly less likely to divert (p=0.002). All other regions were comparable. 67.8% left a surgical drain. Nearly all reported treatment was not affected by Covid 19 (98%). Limitations: Audit design, with differences in definitions of procedures and bias possible from who completed the audit. Conclusions/Discussion: The DAMASCUS study confirmed substantial geographical variation in the index surgical decision making for emergency diverticulitis cases. Despite colorectal expersite, a Hartmann's procedure with end colostomy remains the most common procedure in emergency cases. Lower stoma rates in LMIC may be related to less available resources for subsequent cases. Further analysis will be performed to determine whether such variation is associated with short term clinical outcomes.
ABSTRACT
Purpose/Background: The COVID-19 pandemic has resulted in global disruptions to the delivery of healthcare.(1) The national responses of Australia and New Zealand has resulted in unprecedented changes to the care of colorectal cancer patients, amongst others. This paper aims to determine the impact of COVID-19 on colorectal cancer diagnosis and management in Australia and New Zealand. Methods/Interventions: This is a multicentre retrospective cohort study using the prospectively maintained Binational Colorectal Cancer Audit (BCCA) registry. Data is contributed by over 200 surgeons in Australia and New Zealand. Patients receiving colorectal cancer surgery during the pandemic were compared to averages from the same period over the preceding three years. Results/Outcomes: There were fewer operations in 2020 than the historical average. During April to June patients were younger, more likely to have operations in public hospitals and more likely to have urgent or emergency operations. By October to December proportionally less patients had stage I disease, proportionally more had stage II or III disease and there was no difference in stage IV disease. Patients were less likely to have rectal cancer, were increasingly likely to have urgent or emergency surgery and more likely to have a stoma created. Conclusion/Discussion: This study shows that the response to COVID-19 has had measurably negative effects on the diagnosis and management of colorectal cancer in two countries that have had significantly fewer COVID-19 cases than many other countries. The long-term effects on survival and recurrence are yet to be known, but could be significant. Findings will be updated with 2021 data at the completion of the year. (Figure Presented).